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OBJECTIVE: The NASA Task Load Index is a questionnaire widely used in aviation. This index might help for attesting the quality of a scenario in high-fidelity simulation in healthcare. The main purpose of this study was to observe whether NASA Task Load Index for critical care-simulated scenarios, designed for residents, was consistent with the literature. The second purpose was to describe relationships between NASA Task Load Index, performance and generated stress during high-fidelity simulation. METHODS: All residents in anaesthesia and intensive care undergoing high-fidelity simulation were included. The primary endpoint was the task load generated by each scenario assessed by NASA Task Load Index. Based on the literature, the NASA Task Load Index scores between 39 and 61 were considered an acceptable level. Stress level (Visual Analogue Scale) and specific technical and non-technical skills performances (Team Emergency Assessment Measure) were also assessed. RESULTS: Totally 53 residents actively participated in 1 of 10 different scenarios, between June and December 2017. The median NASA Task Load Index score of scenarios was 61 [48-65]. Five scenarios generated acceptable task load levels. There was no association between the NASA Task Load Index score and technical or non-technical skills performance scores, but an association between NASA Task Load Index and the stress level (rho=4.7, P =.001) was observed. CONCLUSION: Simulation scenarios generate different task loads for residents; the task load was deemed acceptable for half of the scenarios. The NASA Task Load Index could be considered as a tool to assess the pedagogic adequacy of scenarios. Scenario and generated stress level, but not task load, can modify residents' performance during simulation. This should be considered when planning normative simulation.
RESUMO
Introduction: Preoperative anxiety before cesarean section is a major issue. Nonpharmacologic anxiety control is believed to be more suitable in pregnant women. Auricular acupuncture (AA) is an inexpensive, easy-to-use, and validated intervention to reduce anxiety in different surgical settings. We evaluated the effect of AA on preoperative cesarean section anxiety. Methods: In a prospective, blind, controlled trial, pregnant women with a scheduled cesarean section under spinal anesthesia were randomized to receive AA with needle, AA without needle (sham), or usual care (no intervention). Anxiety level was assessed by using a visual analogue scale for anxiety (VAS-A; 0-minimal anxiety, 100-maximal anxiety) at three time points: inclusion (pre-induction room-T0), when entering the operating room (T1), and before incision (T2). The primary outcome was the VAS-A variation (percentage changes) between T0 and T1 in the AAe group compared with that in the sham AA group. The secondary outcomes were the VAS-A variation between T0 and T1 in the AA group compared with that in the control group, and the variation between T0 and T2 compared between the three groups, the effect of AA on parasympathetic tone, and the incidence of adverse effects. Results: In women immediately before anesthesia for cesarean section, the AA produced a 19% decrease of anxiety, compared with a 21% anxiety increase in sham AA, which is significantly different. The effect of AA was more present in women with low initial anxiety. The proportion of patients reaching clinically significant anxiety reduction (>33% from the initial level) was 2.5 times higher in the AA group (p = 0.02) compared with the sham group. No differences in anxiety variations were found compared with the no-intervention group. No effect of AA was noted on parasympathetic tone. Conclusion: Compared with sham, AA decreased maternal anxiety level when arriving in the operation room and just before the beginning of the cesarean section, with a trend toward improvement compared with usual care.
