Airway skills training using a human patient simulator

Background: Airway skills education is important for the safe and effective care of patients. Interns often encounter critical airway situations. Their ability to cope derives from the recall of formal lectures and tutorials, as well as accumulated experience. We tested whether human patient simulators enabled trainees to enhance skills and knowledge in a safe and realistic environment.Method: An airway training programme was developed using a high-fidelity lifelike human patient simulator (METI®) to simulate realistic airway scenarios. An equivalent programme using traditional methods (lectures and tutorials) contained the same information. A written assessment [(multiple-choice questions (MCQ)] and four assessment stations [objective structured clinical examination (OSCE)] were administered before and after instruction. A questionnaire documented previous exposure to the simulator, airway management techniques and devices, and participants’ subjective opinions on the instruction received.Results: Eighty-two participants were enrolled into two groups of 41. Groups were comparable in terms of previous exposure and experience, as well as in pre-training scores. Both groups showed significant improvement in post-training scores. However, subjects receiving simulator training achieved significantly higher test scores in the MCQ (median 43 out of 50, interquartile range (IQR) 42 45, versus 41 out of 50, IQR 39–43); and OSCE assessment station 3 (median 15 out of 15, IQR 13–15, versus 14 and 12–15), and OSCE assessement station 4 (median 13 out of 15, IQR 12–14, versus 12 and 10–13). The simulator group showed greater participant satisfaction (95% vs. 34%).Conclusion: There was improved immediate retention of knowledge and performance of airway management skills using the simulator. Participant satisfaction was much better in the simulator group. The importance of psychomotor reinforcement should be borne in mind when designing simulation courses.Keywords: human patient simulator, simulation, airway management, psychomotor skill

Fitness for purpose in anaesthesiology: a review

The purpose of this review is to explore how fitness for purpose can be defined for anaesthesiology graduates and to delineate the parameters of this concept for anaesthesiology. Newly qualified anaesthesiology graduates experience difficulties with the transition from trainee to specialist, with perceptions of unpreparedness especially in non-technical skills. This may be deleterious to the individual, the patient, colleagues and the workplace. It is possible that graduates may be deemed competent yet are unable to fulfil all their specialist roles. Fitness for purpose and its relationship with competence, expertise and excellence in anaesthesiology have been poorly defined in the literature. These concepts are not synonymous but provide a hierarchical framework for the development of a specialist from a beginner to an expert. The uncertainties surrounding competence are numerous, with generic competency frameworks not addressing all aspects unique to anaesthesiology. The applicability of such frameworks in areas outside which they were originally designed and, in particular, in anaesthesiology, is questionable and requires further investigation. Defining fitness for purpose in anaesthesiology will assist training departments, curriculum designers, assessors and regulators to produce specialists that are experts in their chosen field without any deficiencies and thus able to perform all their required roles.Keywords: anaesthesiology, fitness for purpose, medical educatio

Is Obesity a risk factor for increased Perioperative Blood loss following Laparotomy? A Matched Cohort Study from South Africa.

Background: The prevalence of obesity is growing in the South African (SA) population. Some of these obese individuals might require surgery during their lives. However, there are no specific studies from this setting that have investigated the impact of obesity on perioperative complications, such as blood loss, following high-risk abdominal surgery. This knowledge has potentially important implications for the perioperative management of obese SA abdominal surgery patients. Our objective was to address the identified gap in the published literature. Methods: We conducted a matched cohort study involving data from an existing laparotomy database at a SA tertiary hospital. Non-obese and obese patients were matched on established factors associated with perioperative blood loss. The Gross Equation was used to calculate the estimated perioperative blood loss. Mean estimated perioperative blood loss (with standard deviation - SD) was then statistically compared between obese and non-obese patient groups. Results: 58 patients were matched (29 non-obese and 29 obese). The estimated mean (SD) perioperative blood loss in non-obese patients was 806.96 (536.9) mL. The estimated mean (SD) perioperative blood loss in obese patients was 725.06 (513.9) mL. Overall, there was similar perioperative blood loss between non-obese and obese patients (p=0.438). Conclusion: Obese and non-obese patients undergoing laparotomy experienced similar blood loss. Recommendations: Obese patients in our setting should be managed for perioperative bleeding in the same way as non-obese patients

External patient temperature control in emergency centres, trauma centres, intensive care units and operating theatres: A multi-society literature review

Here we review the available literature supporting the routine and timely use of external patient warming devices of all possible types during emergency department and peri-operative situations, including the role of best ambient temperature, and provides a best-practice statement on the need for such devices. It aims to present a guideline document endorsed by the major South African professional societies in the field of emergency and peri-operative care

Comparison of nutrient intake by sleep status in selected adults in Mysore, India

Insomnia has become a major public health issue in recent times. Although quality of sleep is affected by environmental, psychophysiological, and pharmacological factors, diet and nutrient intake also contribute to sleep problems. This study investigated the association between nutrient intake and co-morbid symptoms associated with sleep status among selected adults. Subjects in this study included 87 men and women aged 21-45 years. Presence of insomnia was assessed using the Insomnia Screening Questionnaire, and dietary intake was measured over three consecutive days by dietary survey. Descriptive analysis, ANOVA, and Chi-Square tests were performed to compute and interpret the data. Approximately 60% of the participants were insomniacs. People with insomnia consumed significantly lesser quantities of nutrients as compared to normal sleepers. Differences in intakes of energy, carbohydrates, folic acid, and B12 were highly significant (P < 0.002). Further, intakes of protein, fat, and thiamine were significantly different (P < 0.021) between insomniacs and normal sleepers. The nutrient intake pattern of the insomniacs with co-morbid symptoms was quite different from that of the normal sleepers. Based on these results, it is probable that there is an association between nutrition deficiency, co-morbid symptoms, and sleep status. More studies are required to confirm these results

Open defecation and childhood stunting in India: an ecological analysis of new data from 112 districts.

Poor sanitation remains a major public health concern linked to several important health outcomes; emerging evidence indicates a link to childhood stunting. In India over half of the population defecates in the open; the prevalence of stunting remains very high. Recently published data on levels of stunting in 112 districts of India provide an opportunity to explore the relationship between levels of open defecation and stunting within this population. We conducted an ecological regression analysis to assess the association between the prevalence of open defecation and stunting after adjustment for potential confounding factors. Data from the 2011 HUNGaMA survey was used for the outcome of interest, stunting; data from the 2011 Indian Census for the same districts was used for the exposure of interest, open defecation. After adjustment for various potential confounding factors--including socio-economic status, maternal education and calorie availability--a 10 percent increase in open defecation was associated with a 0.7 percentage point increase in both stunting and severe stunting. Differences in open defecation can statistically account for 35 to 55 percent of the average difference in stunting between districts identified as low-performing and high-performing in the HUNGaMA data. In addition, using a Monte Carlo simulation, we explored the effect on statistical power of the common practice of dichotomizing continuous height data into binary stunting indicators. Our simulation showed that dichotomization of height sacrifices statistical power, suggesting that our estimate of the association between open defecation and stunting may be a lower bound. Whilst our analysis is ecological and therefore vulnerable to residual confounding, these findings use the most recently collected large-scale data from India to add to a growing body of suggestive evidence for an effect of poor sanitation on human growth. New intervention studies, currently underway, may shed more light on this important issue

Starch safety in resuscitation

This correspondence is in response to the article: Parrish A, Blockman M, Starch safety in resuscitation − when will we ever learn? S Afr Med J 2013;103(6):365-367. [http://dx.doi.org/10.7196/samj.6969] in three parts:1. Starch safety in resuscitation: Withdrawal of hydroxyethyl starch solutions − a plea for evidence. R E Hodgson, G A Richards, A C Lundgren, M G L Spruyt, J P Pretorius, L R Mathiva, R Dickerson, P D Gopalan 2. Starch safety in resuscitation: Plea for evidence. M F M James, I A Joubert, J L Piercy3. Starch safety in resuscitation: Response from A Parrish and M Blockma

Early farmers from across Europe directly descended from Neolithic Aegeans

Farming and sedentism first appeared in southwestern Asia during the early Holocene and later spread to neighboring regions, including Europe, along multiple dispersal routes. Conspicuous uncertainties remain about the relative roles of migration, cultural diffusion, and admixture with local foragers in the early Neolithization of Europe. Here we present paleogenomic data for five Neolithic individuals from northern Greece and northwestern Turkey spanning the time and region of the earliest spread of farming into Europe. We use a novel approach to recalibrate raw reads and call genotypes from ancient DNA and observe striking genetic similarity both among Aegean early farmers and with those from across Europe. Our study demonstrates a direct genetic link between Mediterranean and Central European early farmers and those of Greece and Anatolia, extending the European Neolithic migratory chain all the way back to southwestern Asia