Conservative versus liberal oxygenation targets in critically ill children: the randomised multiple-centre pilot Oxy-PICU trial

BACKGROUND: Oxygen saturation monitoring for children receiving respiratory support is standard worldwide. No randomised clinical trials have compared peripheral oxygen saturation (SpO_{2}) targets for critically ill children. The harm of interventions to raise SpO_{2} to > 94% may exceed their benefits. METHODS: We undertook an open, parallel-group randomised trial of children > 38 weeks completed gestation and  94%) or a conservative oxygenation group (SpO_{2} = 88–92% inclusive). Outcomes were measures of feasibility: recruitment rate, protocol adherence and acceptability, between-group separation of SpO_{2} and safety. The Oxy-PICU trial was registered before recruitment: ClinicalTrials.gov identifier NCT03040570. RESULTS: A total of 159 children met the inclusion criteria, of whom 119 (75%) were randomised between April and July 2017, representing a rate of 10 patients per month per site. The mean time to randomisation from first contact with an intensive care team was 1.9 (SD 2.2) h. Consent to continue in the study was obtained in 107 cases (90%); the children’s parents/legal representatives were supportive of the consent process. The median (interquartile range, IQR) of time-weighted individual mean SpO_{2} was 94.9% (92.6–97.1) in the conservative oxygenation group and 97.5% (96.2–98.4) in the liberal group [difference 2.7%, 95% confidence interval (95% CI) 1.3–4.0%, p < 0.001]. Median (IQR) time-weighted individual mean FiO_{2} was 0.28 (0.24–0.37) in the conservative group and 0.37 (0.30–0.42) in the liberal group (difference 0.08, 95% CI 0.03–0.13, p < 0.001). There were no significant between-group differences in length of stay, duration of organ support or mortality. Two prespecified serious adverse events (cardiac arrests) occurred, both in the liberal oxygenation group. CONCLUSION: A definitive clinical trial of peripheral oxygen saturation targets is feasible in critically ill children

The use of ultrasound in educational settings: what should we consider when implementing this technique for visualisation of anatomical structures?

Ultrasound is a well-established medical imaging technique with pioneering work conducted by Professor Ian Donald and his colleagues at the University of Glasgow, from the mid-1950s onwards, in terms of introducing it as a diagnostic tool in the field of obstetrics and gynaecology. Since then, ultrasound has been extensively used in clinical and research settings. There are few imaging techniques that have undergone such a fast and thriving evolution since their development. Nowadays, diagnostic ultrasound benefits from two-dimensional (2D), three-dimensional (3D), four-dimensional (4D), and a variety of Doppler modes with technologically advanced transducers (probes) producing images of high anatomical fidelity. In the future, there may even be a place for ultrasound in molecular imaging allowing for visualisation at the microscale. Ultrasound is characterised by real-time non-invasive scanning, relative ease of administration, and lack of ionising radiation. All of these features, make ultrasound an appealing option in educational settings for learning topographic anatomy and potentially enhancing future clinical practice for vocational learners. Sophisticated, but relatively inexpensive, portable handheld devices have also contributed to point-of-care ultrasound (POCUS) becoming the norm for bedside and pre-hospital scanning. It has been argued that ultrasound will become the next stethoscope for healthcare professionals. For this to become a reality, however, training is required on increasing familiarity with knobology, correct use of the machine and transducers, and accurate interpretation of anatomy followed by identification of pathologies. The above require incorporation of ultrasound teaching in undergraduate curricula, outwith the realm of opportunistic bedside learning, accompanied by consideration of ethical topics such as the management of incidental findings and careful evaluation of its pedagogical impact cross-sectionally and longitudinally

Pedagogical Perspectives on the Use of Technology within Medical Curricula : Moving Away from Norm Driven Implementation

There is often an expectation that any educational institution worth its salt will be at the forefront of technological advances. An often unchallenged and somewhat romanticised viewpoint persists that, in all cases, technology is best. What is not always openly discussed is the evidence base and pedagogy behind the use of technology, visualisation and traditional approaches of teaching within the fields of medical and anatomy education curricula. There are many advantages to using technology within the learning environment but, often, it is possible to achieve the same outcomes through the use of many other non-technological instructional modalities. The frequent shortcoming when institutions use technology is that there is a lack of integration across the curriculum, a failure to map to the blueprint, little attempt to include technology in the feedback cycle and assessment, and insufficient time and resource allocation for educators developing resources. Without careful implementation and integration, it can appear that institutions are throwing the latest developments at students without due care and consideration to the evidence-base and without the necessary institutional support for staff and resource development. This is not the fault of educators; the competing demands on staff time and institutional drive to climb the ranking tables means that technology is often perceived as the quick fix