Characterization of anesthetists’ behavior during simulation training: performance versus stress achieving medical tasks with or without physical effort

Decades of research about stress have shown that it could be source of performance but also of cognitive deficit. The studies have led to highlight occupational stress variables that researchers have characterized by physiological measurements, data treatments and protocols becoming more and more complex with time. If these devices are gaining in precision, they are now too complex to allow non-specialist users to produce a quick interpretation of results. Yet for vocational training, specifically on simulators, trainers need to know in real time whether or not what they implement allows the trainees to learn in good conditions, i.e. by favoring the behavior produced by the positive effect of stress on performance. The present paper addresses the performance versus occupational stress during training sessions of anesthetists on simulator. We studied the performance and stress with or without physical effort using a simple protocol based on the use of basic heart parameters in order to obtain a quasi-instantaneous interpretation of the data. We identified cognitive deficit zone during training according to the Yerkes & Dodson (1908) relationship between performance and stress. We showed that performance versus stress during simulation training with or without physical efforts could be successfully analyzed for immediate assessment of stress influencing performance. Suggestions have been made for improving training sessions and avoid trainees’ behavior induced by cognitive deficit. Limits of the protocol are exposed

Gastroparesis and functional dyspepsia: excerpts from the AGA/ANMS meeting

Despite the relatively high prevelance of gastroparesis and functional dyspepsia, the aetiology and pathophysiology of these disorders remain incompletely understood. Similarly, the diagnostic and treatment options for these two disorders are relatively limited despite recent advances in our understanding of both disorders.This manuscript reviews the advances in the understanding of the epidemiology, pathophysiology, diagnosis, and treatment of gastroparesis and functional dyspepsia as discussed at a recent conference sponsored by the American Gastroenterological Association (AGA) and the American Neurogastroenterology and Motility Society (ANMS). Particular focus is placed on discussing unmet needs and areas for future research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78690/1/j.1365-2982.2009.01434.x.pd

Intraoperative non invasive intracranial pressure monitoring during pneumoperitoneum: a case report and a review of the published cases and case report series.

Non-invasive measurement of ICP (nICP) can be warranted in patients at risk for developing increased ICP during pneumoperitoneum (PP). Our aim was to assess available data on the application of nICP monitoring during these procedures and to present a patient assessed with an innovative combination of noninvasive tools. Literature review of nICP assessment during PP did not find any studies comparing different methods intraprocedurally and only few studies of any nICP monitoring were available: transcranial Doppler (TCD) studies used the pulsatility index (PI) as an estimator of ICP and failed to detect a significant ICP increase during PP, whereas two out of three optic nerve sheath diameter (ONSD) studies detected a statistically significant ICP increase. In the case study, we describe a 52 year old man with a high grade thalamic glioma who underwent urgent laparoscopic cholecystectomy. Considering the high intraoperative risk of developing intracranial hypertension, he was monitored through parallel ONSD ultrasound measurement and TCD derived formulae (flow velocity diastolic formula, FVdnICP, and PI). ONSD and FVdnICP methods indicated a significant ICP increase during PP, whereas PI was not significantly increased. Our experience, combined with the literature review, seems to suggest that PI might not detect ICP changes in this context, however we indicate a possible interest of nICP monitoring during PP by means of ONSD and of TCD derived FVdNICP, especially for patients at risk for increased ICP.D.C. and M.C. are partially supported by NIHR Brain Injury Healthcare Technology Co-operative, Cambridge, UK

Impact of ownership on the international involvement of SMEs

This paper analyses the relationship between the internationalisation strategies of SMEs and types of ownership. Different types of ownership affect firms, and this in turn will influence the internationalisation strategy adopted. Using a sample of Spanish SMEs, our results show that internationalisation is negatively related to family ownership and positively related to corporate ownership. We have also observed that the presence of a corporate blockholder in family firms encourages internationalisation. These results support the idea that ownership type influences the decision to internationalise. Journal of International Business Studies (2006) 37, 340–351. doi:10.1057/palgrave.jibs.8400196