Age and its impact on crisis management performance and learning after simulation-based education by acute care physicians: a multicentre prospective cohort study.

BACKGROUND: Physiological changes associated with ageing could negatively impact the crisis resource management skills of acute care physicians. This study was designed to determine whether physician age impacts crisis resource management skills, and crisis resource management skills learning and retention using full-body manikin simulation training in acute care physicians. METHODS: Acute care physicians at two Canadian universities participated in three 8-min simulated crisis (pulseless electrical activity) scenarios. An initial crisis scenario (pre-test) was followed by debriefing with a trained facilitator and a second crisis scenario (immediate post-test). Participants returned for a third crisis scenario 3-6 months later (retention post-test). RESULTS: For the 48 participants included in the final analysis, age negatively correlated with baseline Global Rating Scale (GRS; r=-0.30, P<0.05) and technical checklist scores (r=-0.44, P<0.01). However, only years in practice and prior simulation experience, but not age, were significant in a subsequent stepwise regression analysis. Learning from simulation-based education was shown with a mean difference in scores from pre-test to immediate post-test of 2.28 for GRS score (P<0.001) and 1.69 for technical checklist correct score (P<0.001); learning was retained for 3-6 months. Only prior simulation experience was significantly correlated with a decreased change in learning (r=-0.30, P<0.05). CONCLUSIONS: A reduced amount of prior simulation training and increased years in practice, but not age on its own, were significant predictors of low baseline crisis resource management performance. Simulation-based education leads to crisis resource management learning that is well retained for 3-6 months, regardless of age or years in practice.

Domiciliary dentistry - remote consultation and risk assessment tool.

Collecting information in preparation for a domiciliary visit can identify potential barriers to treatment and allow for appropriate planning and mitigation of treatment risks. The coronavirus (COVID-19) pandemic has changed the way dental professionals can work. Prior identification can eliminate unnecessary visits and so reduce the risk of potential COVID-19 transmission between dental professionals and patients receiving domiciliary dental care. This article will explain two documents: the Domiciliary Patient Information Sheet (DPIS) and Domiciliary Risk Assessment (DRA). Case studies will be used to demonstrate the importance of the DPIS and DRA implementation.

Dual energy CT: a step ahead in brain and spine imaging.

OBJECTIVE: The purpose of this pictorial essay is to illustrate the utility of dual energy CT as an adjunct or alternative to routine single energy CT (SECT) scan of the brain and spine in emergency neuroradiology practice. CONCLUSION: Dual energy CT can be used as a problem-solving tool in brain and spine imaging. It enables one to make a confident and accurate diagnosis for a variety of clinical conditions thereby impacting patient management.

Impact of Critical Event Checklists on Anaesthetist Performance in Simulated Operating Theatre Emergencies.

Introduction Crises in the operating theatre during a paediatric case are rare with the incidence of anesthesia-related cardiac arrest in non-cardiac patients being 1.4/10,000. In order to address this, the Society for Pediatric Anesthesia (SPA) developed cognitive aids (CAs) in the form of Critical Event Checklists (SPA CECs). Several studies have demonstrated the benefit of CAs in improving performance of critical tasks. Despite the presence of CAs, individuals often do not use the aids consistently. The objective of our study was to investigate whether the presence of SPA CECs, and orientation to these tools, improve the performance of trainees during simulated critical events. Methods With local Research Ethics Board (REB) approval we used a randomized, 2 x 2 factorial design. The first randomization was the participant orientation to the SPA CECs (e-module vs. didactic). The second randomization assigned participants to complete the simulations with or without SPA CECs available. The simulations were videoed and rated by two raters using a scenario-specific checklist and global rating scale (GRS). Results We conducted 78 simulations. The SPA CEC was used in 17.9% of scenarios. The SPA CEC was used in 44.8% of diagnosis-based scenarios and only 2.0% of generic problem-based scenarios. Participants' performance was superior with the SPA CEC present (GRS mean 3 [SD 1.27]) than without the SPA CEC available (GRS mean 2.43 [SD 0.89]) (p = 0.048). Conclusion Overall, we showed that uptake of the SPA CECs is poor. We also demonstrated that when the SPA CECs are utilized, they enhance the performance of trainees in simulated operating room (OR) critical events.

Frequency and characteristics of disease flares in ankylosing spondylitis.

OBJECTIVE: To examine the characteristics and frequency of disease flares in a cohort of people with AS. METHODS: A prospective data set from a randomized controlled trial (RCT) of a probiotic treatment/placebo was utilized to examine disease flares in 134 people with AS. Disease flares were defined as either minor/localized flares (pain/swelling localized to one area with fatigue and stiffness) or major/generalized flares (generalized pain, hot burning joints, muscle spasm, fever, sweating, extreme fatigue and stiffness). Results. One hundred and thirty-four people were followed up for 1216 person follow-up weeks and there were 71.4 flares per 100 person-weeks. Of these, 12 were major/generalized flares and 59.4 were minor/localized flares. People who experienced at least one major/generalized flare during the study period had worse disease during flare-free periods in terms of disease activity, impaired function, self-reported night pain and iritis compared with those who did not experience any major/generalized flares during the study. Major/generalized flares lasted for an average of 2.4 weeks (s.d. 2.7), and were preceded by and followed by a minor/localized flare in 92% (55/60) of cases. CONCLUSION: Seventy per cent of people with AS felt they had a flare in any given week. Those who experienced major/generalized flares appear to have more severe and active disease even during periods when not in flare, compared with those who do not experience major/generalized flares. These results have implications for the timing of assessments prior to starting anti-TNF therapy and suggest that the presence of major flares may be helpful in identifying patients with severe disease.

Internet-based randomised controlled trials for the evaluation of complementary and alternative medicines: probiotics in spondyloarthropathy.

BACKGROUND: The clinical effectiveness of complementary and alternative medicines (CAMs) is widely debated because of a lack of clinical trials. The internet may provide an effective and economical approach for undertaking randomised controlled trials (RCTs) of low-risk interventions. We investigated whether the internet could be used to perform an internet-based RCT of a CAM fulfilling the revised CONSORT (Consolidated Standards of Reporting Trials) statement quality checklist for reporting of RCTs. A secondary aim was to examine the effect of probiotics compared to placebo in terms of well-being over 12 weeks. METHODS: People aged > or =18 years with confirmed spondyloarthropathy living in the United Kingdom with internet access were invited to participate in an internet-based RCT of probiotic compared to placebo for improving well-being and bowel symptoms. The intervention was a probiotic containing 4 strains of live bacteria or identical placebo taken by mouth daily for 3 months. The primary outcome measure was the performance of the trial according to the revised CONSORT statement. RESULTS: 147 people were randomised into the trial. The internet-based trial of the CAM fulfilled the revised CONSORT statement such as efficient blinding, allocation concealment, intention to treat analysis and flow of participants through the trial. Recruitment of the required number of participants was completed in 19 months. Sixty-five percent (96/147) completed the entire 3 months of the trial. The trial was low cost and demonstrated that in an intention to treat analysis, probiotics did not improve well-being or bowel symptoms. CONCLUSION: The internet-based RCT proved to be a successful and economical method for examining this CAM intervention. Recruitment, adherence and completion rate were all similar to those reported with conventional RCTs but at a fraction of the cost. Internet-based RCTs can fulfil all the criteria of the revised CONSORT statement and are an appropriate method for studying low-risk interventions. TRIAL REGISTRATION: ISRCTN36133252.