A targeted tracheostomy care educational initiative to augment resuscitation training in the pediatric setting.

OBJECTIVE: To implement a surgeon led initiative for tracheostomy education for non-surgical pediatric first responders in the hospital setting and to assess its efficacy. METHODS: A prospective, observational study conducted from September 2018 to March 2019. All pediatric residents at a tertiary care children's hospital were invited to participate. An objective knowledge test and self-assessment comfort questionnaire was completed before and after the intervention and at 6-month follow up. Educational sessions involved a targeted, interactive program with a didactic presentation and case-based simulation. RESULTS: Forty-four pediatric residents participated. Residents had limited experience with tracheostomy intervention with only one reporting personally resolving a tracheostomy issue. However, tracheostomy complications were relatively common with 43% reporting having watched another specialty intervene on a tracheostomy issue during an airway related emergency. The objective knowledge test results significantly increased; from pre-knowledge test percent mean of 61.25 (SD = 13.52) to post-knowledge test percent mean of 81.25 (SD = 10.57) [t(39) = -8.144, p < 0.001]. Comfort levels questionnaire median (IQR) results were also significantly higher than pre-intervention [3.70 (3.20-3.88) vs. 2.65 (2.13-3.00), Z = 780, p < .001]. CONCLUSION: We demonstrated improved knowledge among pediatric residents after a surgeon-led module for tracheostomy care and emergency management. A targeted tracheostomy education program may fill a gap in pediatric resident emergency resuscitation education.

Tracheostomy Care Education for the Nonsurgical First Responder: A Needs-Based Assessment and Quality Improvement Initiative.

OBJECTIVES: To perform a needs-based assessment for tracheostomy care education for nonsurgical first responders in the hospital setting and to implement and assess the efficacy of a targeted tracheostomy educational program. METHODS: A prospective observational study conducted between October 2017 and May 2018 including emergency medicine (EM) residents, internal medicine (IM) residents, and intensive care unit (ICU) advanced practice providers at 2 tertiary hospitals. Needs-based assessments were conducted, leading to specialty specific curricula. One-hour educational sessions included didactics and case-based simulation. A pre- and posttest objective knowledge quiz and self-assessment were administered, and a posttest was repeated at 6 months. RESULTS: There were 85 participants (13 ICU, 40 EM, 32 IM). Significant improvement (P < .05) in mean objective knowledge score was seen across all groups between pre- and postintervention assessments with relative but not significant improvement at 6 months. There were significant increases in comfort level from pre- to postintervention. At 6-month follow-up, comfort level remained significantly increased for the majority of questions for the EM group and for select questions for IM and ICU advanced practice provider groups. DISCUSSION: Nonsurgeons are often first responders to critical airway situations yet receive limited formal education regarding tracheostomy. We demonstrated improvement in knowledge and comfort after a targeted educational module for tracheostomy care and management. IMPLICATIONS FOR PRACTICE: Although tracheostomy care is multidisciplinary, specialty-specific education may provide a more relevant foundation on which to build skills. Prompt and effective management of tracheostomy emergencies by first responders may improve patient safety and reduce mortality.

Super-resolution scanning patch clamp reveals clustering of functional ion channels in adult ventricular myocyte.

RATIONALE: Compartmentation of ion channels on the cardiomyocyte surface is important for electric propagation and electromechanical coupling. The specialized T-tubule and costameric structures facilitate spatial coupling of various ion channels and receptors. Existing methods such as immunofluorescence and patch clamp techniques are limited in their ability to localize functional ion channels. As such, a correlation between channel protein location and channel function remains incomplete. OBJECTIVE: To validate a method that permits routine imaging of the topography of a live cardiomyocyte and study clustering of functional ion channels from a specific microdomain. METHODS AND RESULTS: We used scanning ion conductance microscopy and conventional cell-attached patch clamp with a software modification that allows controlled increase of pipette tip diameter. The sharp nanopipette used for topography scan was modified into a larger patch pipette that could be positioned with nanoscale precision to a specific site of interest (crest, groove, or T-tubules of cardiomyocytes) and sealed to the membrane for cell-attached recording of ion channels. Using this method, we significantly increased the probability of detecting activity of L-type calcium channels in the T-tubules of ventricular cardiomyocytes. We also demonstrated that active sodium channels do not distribute homogenously on the sarcolemma instead, they segregate into clusters of various densities, most crowded in the crest region, that are surrounded by areas virtually free of functional sodium channels. CONCLUSIONS: Our new method substantially increases the throughput of recording location-specific functional ion channels on the cardiomyocyte sarcolemma, thereby allowing characterization of ion channels in relation to the microdomain where they reside.