Correction: Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation-based training.
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SUBMITTER: PLOS ONE Staff
PROVIDER: S-EPMC8084179 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The time-critical 'can't intubate, can't oxygenate' [CICO] emergency post-induction of anaesthesia is rare, but one which, should it occur, requires Anaesthetists to perform rapid emergency front of neck access [FONA] to the trachea, restoring oxygenation, and preventing death or brain hypoxia. The UK Difficult Airway Society [DAS] has directed all Anaesthetists to be trained with surgical cricothyroidotomy [SCT] as the primary emergency FONA method, sometimes referred to as 'Cric' as a shorthand. We present a longitudinal analysis using a classical approach to Grounded Theory methodology of ten Specialist Trainee Anaesthetists' data during a 6-month training programme delivered jointly by Anaesthetists and Surgeons. We identified with a critical realist ontology and an objectivist epistemology meaning data interpretation was driven by participants' narratives and accepted as true accounts of their experience. Our theory comprises three themes: 'Identity as an Anaesthetist'; 'The Role of a Temporary Surgeon'; and 'Training to Reconcile Identities', whereby training facilitated the psychological transition from a 'bloodless Doctor' (Anaesthetist) to becoming a 'temporary Surgeon'. The training programme enabled Specialist Trainees to move between the role of control and responsibility (Identity as an Anaesthetist), through self-described 'failure' and into a role of uncertainty about one's own confidence and competence (The Role of a Temporary Surgeon), and then return to the Anaesthetist's role once the airway had been established. Understanding the complexity of an intervention and providing a better insight into the training needs of Anaesthetic trainees, via a Grounded Theory approach, allows us to evaluate training programmes against the recognised technical and non-technical needs of those being trained.
| S-EPMC7987190 | biostudies-literature
Project description:As research teams are increasingly comprised of members from multiple disciplines, ranging from the physical sciences, life sciences, social and behavioral sciences to the arts and humanities, it is important to revisit how research is conducted at several levels. Coupled with the national concern over rigor and reproducibility in research, it is therefore crucial to ensure that all members of such multidisciplinary teams view the need for ethics in the conduct of research in similar ways. Towards this end, Wayne State University developed a course in the Responsible Conduct of Research (RCR) which was mandatory for all its 1500 doctoral students across all disciplines in its 75 PhD programs. We found that student perceptions of the validity, applicability and usefulness of the course varied by discipline. This was in spite of iterative changes made to the course by faculty in those disciplines to make the content palatable to all. The findings show that more work needs to be done to fully incorporate the needs of social sciences and humanities disciplines in a comprehensive university course. This is especially important as these students become members of large multidisciplinary research teams in order to uphold the highest levels of rigor, reproducibility and ethics.
| S-EPMC6881010 | biostudies-literature
Project description:Interventions: Participants will be enrolled in a flexible inter-disciplinary prehabilitation programme if they are referred to surgical services after colonoscopy. The aim of this programme is to prepare participants physically, mentally, and emotionally for possible bowel surgery. The programme includes physical activity, physiotherapy, occupational therapy, dietetics, and health psychology. Each of these services will be made available to participants by experienced registered clinicians working in an inter-disciplinary team at the Auckland District Health Board (ADHB). Each of these services are described below. The prehabilitation programme coordinator will first meet with each potential participant to discuss the study, obtain their written informed consent, and assess their needs and preferences for the components of the prehabilitation programme. This is expected to take approximately one hour. The coordinator will then refer participants to services as indicated.
Physical activity: Participants will be invited to complete an exercise test with an ADHB clinical exercise physiologist, to evaluate their current level of cardiovascular fitness and prescribe a programme of supervised high-intensity interval training (HIIT). The programme involves exercising on a treadmill or stationery bike, depending on participant preference and clinician judgement. This programme is designed to efficiently increase cardiovascular fitness in 3 sessions per week for up to 4 weeks, while participants await their surgical treatment. HIIT will begin as soon as possible after participants join the prehabilitation programme, and will stop at least 72 hours prior to scheduled surgery. The duration of the programme is therefore flexible, depending on the amount of time available prior to schedule
Primary outcome(s): The primary outcome is the effect size of high intensity interval training (HIIT), calculated from the percentage change in VO2Max in L/min between the initial and final CPET assessments. [Effect size of HIIT training will be calculated between the initial CPET assessment prior to the HIIT training intervention, and the final CPET assessment immediately after the HIIT training intervention and prior to surgery. This change was made before recruitment of the first participant.]
Study Design: Purpose: Treatment; Allocation: Non-randomised trial
| 2470101 | ecrin-mdr-crc
Project description:ObjectivesTo investigate the interdisciplinary interobserver reproducibility of Hertel-exophthalmometry-like protrusion measurements on multidetector-row-computed-tomography- (MDCT-) images of the orbit to facilitate structured evaluation of the orbit and mid-face.MethodsRespective reproducibility of base-length along the interfronto-zygomatic line, right and left ocular protrusion, and deriving interocular difference was measured in this retrospective (04/2009-03/2020) single-centre observational study. MDCT-series and slice-positions were selected independently, using picture-archiving-and-communication-system- (PACS-) tools on tilt-corrected axial MDCT-images (slice-thickness 0.6-3.0 mm, window/centre 350/50 HU) in 37 selected adult patients (24 female, age 57 ± 13 years, average±standard-deviation) with clinical indication for Hertel-exophthalmometry, by one radiology-attending, two ophthalmology-attendings, one critical-care-attending, and one ear-nose-throat-surgery resident, respectively. Bland-Altman plots and Wilcoxon-matched-pairs-signed-rank-tests compared interobserver results.ResultsMean and median interobserver and intraobserver (radiology-attending) deviations were within 1 mm of respective averages of base-length (98 ± 4 mm), right and left ocular protrusion (21 ± 4 mm) and interocular difference (2 ± 1 mm). Relative interobserver deviations were within 2.0% of average (all patients) for base-length, and 5.0% (>80% of patients) for ocular protrusion. Pairwise interobserver comparison showed no significant differences between interocular differences of protrusion.ConclusionsRespective measurements of base-length, ocular protrusion, and deriving interocular difference show high interdisciplinary interobserver reproducibility in tilt-corrected axial MDCT-images of the orbit or mid-face.Advances in knowledgeHertel-exophthalmometry-like protrusion measurements did not depend on the years of experience or the medical subspecialty of the observer. Measurements are objective, well reproducible and important for multiple medical disciplines and should thus be included in pertinent radiology reports.
| S-EPMC10392662 | biostudies-literature
Project description:BackgroundHow the application of evidence to planned birth practices, induction of labour (IOL) and prelabour caesarean (CS), differs between Australian maternity units remains poorly understood. Perceptions of readiness for practice change and resources to implement change in individual units are also unclear.AimTo identify inter-hospital and inter-professional variations in relation to current planned birth practices and readiness for change, reported by clinicians in 7 maternity units.MethodCustom-created survey of maternity staff at 7 Sydney hospitals, with questions about women's engagement with decision making, indications for planned birth, timing of birth and readiness for change. Responses from midwives and medical staff, and from each hospital, were compared.FindingsOf 245 completed surveys (27% response rate), 78% were midwives and 22% medical staff. Substantial inter-hospital variation was noted for stated planned birth indication, timing, women's involvement in decision-making practices, as well as in staff perceptions of their unit's readiness for change. Overall, 48% (range 31-64%) and 64% (range 39-89%) agreed on a need to change their unit's caesarean and induction practices respectively. The three units where greatest need for change was perceived also had least readiness for change in terms of leadership, culture, and resources. Regarding inter-disciplinary variation, medical staff were more likely than midwifery staff to believe women were appropriately informed and less likely to believe unit practice change was required.ConclusionPlanned birth practices and change readiness varied between participating hospitals and professional groups. Hospitals with greatest perceived need for change perceived least resources to implement such change.
| S-EPMC8135152 | biostudies-literature
Project description:ObjectiveThe aim was to explore the experiences of a person-centred e-health intervention, in patients diagnosed with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF).DesignGrounded theory was applied to gather and analyse data.SettingThe study is part of a research project evaluating the effects of person-centred care (PCC) using a digital platform and structured telephone support for people with COPD or CHF recruited from nine primary care units in Sweden.ParticipantsTwelve patients from the intervention group were purposefully selected in accordance with the initial sampling criteria.InterventionThe intervention was delivered through a digital platform and telephone support system for 6 months. The intervention relied on person-centred ethics operationalised through three core PCC components: patient narratives, partnership and shared documentation.ResultsA core category was formulated: Being welcomed through the side door when lacking the front door keys. The core category reflects how a PCC intervention delivered remotely provides access to mutual and informal meetings at times when professional contacts were desired to support patient self-management goals. According to patients' wishes, family and friends were seldom invited as care partners in the e-health context.ConclusionsA PCC intervention delivered remotely as a complement to standard care in a primary care setting for patients diagnosed with COPD or CHF is a viable approach to increase patients' access and involvement in preventive care. The e-health intervention seemed to facilitate PCC, strengthen patients' position in the health service system and support their self-management.
| S-EPMC7682879 | biostudies-literature
Project description:AimsCKD-HF patients suffer excess hospitalization and mortality, often under-treated with life-prolonging medications due to fear of worsening renal function and hyperkalaemia. Yet, role of inter-disciplinary working in improving therapy is unknown, which this study aims to investigate.Methods and resultsClinical, biochemical data, and medications at first and last clinic visit were obtained from patient records for 124 patients seen in kidney failure-heart failure clinic (23 March 2017 to 11 April 2019). Medication dose groups (none, low, and high dose), number of RAASi agents, and blood test results were compared between first and last visit in patients with at least two clinic visits (n = 97). Patient characteristics were age 78.5 years (IQR 68.1-84.4 years), male 67.7%, diabetes 51.6%, moderate (45.2%) vs. severe (39.5%) CKD, HF with reduced ejection fraction (HFrEF) (49.2%), follow-up 234 days (IQR 121-441 days). HFrEF was associated with increased risk of death (adjusted OR 4.49, 95% CI 1.43-14.05; P = 0.01). Distributions of patients according to number of RAASi agents they were on differed between first and last visit (P = 0.03). Dosage was increased in 25.9% for beta-blockers, 33.0% for ACEi/ARBs, and 17.5% for MRAs. Distributions of patients across MRA dosage groups was different (P = 0.03), with higher proportions on higher dosages at last visit, without significant changes in serum potassium or creatinine. Serum ferritin improved (131.0 vs. 267.5 μg/L; P < 0.001), and fewer patients had iron deficiency (56.7% vs. 26.8%; P = 0.002) at last visit compared to the first.ConclusionsThis inter-disciplinary clinic improved guideline-recommended medication prescription, MRA dosages in CKD-HF patients without significant biochemical abnormality, and iron status. A prospectively designed study with medication titration protocol and defined patient-centred outcomes is needed to further assess effectiveness of such clinic.
| S-EPMC7524254 | biostudies-literature
Project description:BackgroundThere has been comparatively little consideration of the impact that the changes to undergraduate curricula might have on postgraduate academic performance. This study compares the performance of graduates by UK medical school and gender in the Multiple Choice Question (MCQ) section of the first part of the Fellowship of the Royal College of Anaesthetists (FRCA) examination.MethodsData from each sitting of the MCQ section of the primary FRCA examination from June 1999 to May 2008 were analysed for performance by medical school and gender.ResultsThere were 4983 attempts at the MCQ part of the examination by 3303 graduates from the 19 United Kingdom medical schools. Using the standardised overall mark minus the pass mark graduates from five medical schools performed significantly better than the mean for the group and five schools performed significantly worse than the mean for the group. Males performed significantly better than females in all aspects of the MCQ - physiology, mean difference = 3.0% (95% CI 2.3, 3.7), p < 0.001; pharmacology, mean difference = 1.7% (95% CI 1.0, 2.3), p < 0.001; physics with clinical measurement, mean difference = 3.5% (95% CI 2.8, 4.1), p < 0.001; overall mark, mean difference = 2.7% (95% CI 2.1, 3.3), p < 0.001; and standardised overall mark minus the pass mark, mean difference = 2.5% (95% CI 1.9, 3.1), p < 0.001. Graduates from three medical schools that have undergone the change from Traditional to Problem Based Learning curricula did not show any change in performance in any aspects of the MCQ pre and post curriculum change.ConclusionGraduates from each of the medical schools in the UK do show differences in performance in the MCQ section of the primary FRCA, but significant curriculum change does not lead to deterioration in post graduate examination performance. Whilst females now outnumber males taking the MCQ, they are not performing as well as the males.
| S-EPMC2707380 | biostudies-literature
Project description:ObjectiveTo determine inter-observer and inter-examination variability of manual attenuation measurements of the vertebrae in low-dose unenhanced chest computed tomography (CT).MethodsThree hundred and sixty-seven lung cancer screening trial participants who underwent baseline and repeat unenhanced low-dose CT after 3 months because of an indeterminate lung nodule were included. The CT attenuation value of the first lumbar vertebrae (L1) was measured in all CTs by one observer to obtain inter-examination reliability. Six observers performed measurements in 100 randomly selected CTs to determine agreement with limits of agreement and Bland-Altman plots and reliability with intraclass correlation coefficients (ICCs). Reclassification analyses were performed using a threshold of 110 HU to define osteoporosis.ResultsInter-examination reliability was excellent with an ICC of 0.92 (p < 0.001). Inter-examination limits of agreement ranged from -26 to 28 HU with a mean difference of 1 ± 14 HU. Inter-observer reliability ICCs ranged from 0.70 to 0.91. Inter-examination variability led to 11.2 % reclassification of participants and inter-observer variability led to 22.1 % reclassification.ConclusionsVertebral attenuation values can be manually quantified with good to excellent inter-examination and inter-observer reliability on unenhanced low-dose chest CT. This information is valuable for early detection of osteoporosis on low-dose chest CT.Key points• Vertebral attenuation values can be manually quantified on low-dose unenhanced CT reliably. • Vertebral attenuation measurements may be helpful in detecting subclinical low bone density. • This could become of importance in the detection of osteoporosis.
| S-EPMC4972882 | biostudies-literature
Project description:IntroductionOnce smoking starts, some tobacco cigarette smokers (TCS) can make very rapid transitions into tobacco dependence syndromes (TCD). With adjustment for smoking frequency, we posit female excess risk for this rapid-onset TCD. In a novel application of functional analysis for tobacco research, we estimate four Hill function parameters and plot TCD risk against a gradient of smoking frequency, as observed quite soon after smoking onset.MethodsIn aggregate, the National Surveys of Drug Use and Health, 2004-2013, identified 1546 newly incident TCS in cross-sectional research, each with standardized TCD assessment.ResultsHill function estimates contradict our apparently over-simplistic hypothesis. Among newly incident TCS males with only 1-3 recent smoking days, an estimated 1%-3% had become rapid-onset TCD cases; non-overlapping confidence intervals show lower TCD risk for females. In contrast, among daily smokers, closer to 50% of female TCS showed rapid-onset TCD, versus under 20% of male TCS, but a larger sample will be needed to confirm the apparent female excess risk at the daily smoking frequency level.ConclusionsSmoking frequency and TCD onset become inter-dependent quite soon after TCS onset. Feedback loops are expected, and might explain a potential reversal of male-female differences across smoking frequency gradients. These novel epidemiological estimates prompt new thinking and questions about interventions.ImplicationsIn this large sample epidemiological study, with a nationally representative sample of newly incident TCS assessed cross-sectionally, we see a quite rapid onset of tobacco dependence, with an early male excess that fades out at higher levels of smoking frequency. Next steps include development of outreach and intervention for this very rapid-onset tobacco dependence.
| S-EPMC5103934 | biostudies-literature