The impact of video games on ultrasound-guided regional anesthesia skills

Background: There is an association between video game practice and laparoscopic expertise in trainee surgeons. Ultrasound-guided regional anesthesia has many parallels with laparoscopic surgery. The aim of this study was to explore whether video game experience is associated with enhanced performance in a simulated ultrasound-guided task in novice operators.Methods: In this prospective observational study, 60 medical student volunteers were recruited. Following characterization of video game experience, they underwent an assessment of visuospatial abilities. Following standardized teaching, the recruits’ technical performance of an ultrasound-guided needle task was assessed for overall quality by global rating scale [GRS].Results: Out of a total possible GRS score of 35, gamers compared to non-gamers demonstrated 5.2 (95% CI 1.9, 8.4) units of better performance. Gamers also performed better in mental rotation test (MRT) scores (Difference 4.1, 95% CI 1.2, 7.0) .Conclusion: Video game practice is associated with increased mental rotation ability and enhanced technical performance in a simulated ultrasound-guided task

Visuospatial ability as a predictor of novice performance in ultrasound–guided regional anesthesia

Background: Visuospatial ability correlates positively with novice performance of simple laparoscopic tasks. The aims of this study were to identify if visuospatial ability could predict technical performance of an ultrasound–guided needle task by novice operators, and to describe how emotional state, intelligence and fear of failure impact on this. Methods: Sixty medical student volunteers enrolled in this observational study. We used an instructional video to standardize training for ultrasound-guided needle advancement in a turkey breast model and assessed volunteers’ performance independently by two assessors using composite error score (CES) and global rating scale (GRS). We assessed their ‘visuospatial ability’ with mental rotation test (MRT), group embedded figures test (GEFT) and Alice Heim group ability (AH4) test. ‘Emotional state’ was judged with UWIST mood adjective checklist (UMACL) and fear of failure, and ‘general cognitive ability’ with numerical reasoning test (NRT-20). Results: High CES scores (high error rate) were associated with low MRT scores (= −0.54; P<0.001). Better GRS scores were associated with better MRT scores (= 0.47; P<0.001). Regarding emotions, GRS scores were low when anxiety levels were high (= −0.35; P= 0.005) and CES scores (errors) were low when individuals reported feeling vigorous and active (= −0.30; P= 0.01). Conclusions: MRT predicts novice performance of an ultrasound-guided needling task on a turkey model, and as a trait measure could be used as a tool to focus training resources on less able individuals. Anxiety adversely affects performance. Both may therefore prove useful in directing targeted training in USGRA

Validity and reliability of an objective structured assessment tool for performance of ultrasound-guided regional anaesthesia

Background: We aimed to examine the validity and reliability of previously developed criterion-referenced assessment checklist (AC) and global rating scale (GRS) to assess performance in ultrasound-guided regional anaesthesia (UGRA). Methods: Twenty-one anaesthetists’ single, real-time, UGRA procedures (total: 21 blocks) were assessed using 22-item AC and 9-item GRS scored on a 3-point and 5-point Likert scales respectively. We used one-way ANOVA to compare assessment scores between 3 groups (group I: ≤30 blocks in the preceding year; group II: 31–100; group III: >100). Concurrent validity was evaluated using Pearson’s correlation (r). We calculated type-A intra- class correlation coefficient (ICC) using an absolute agreement definition in two-way random effects model, and inter-rater reliability (IRR) using absolute agreement between raters. The inter-item consistency was assessed by Cronbach’s alpha (α). Results: Greater UGRA experience in the preceding year was associated with better AC [F (2,18) 12.01; p <0.001] and GRS [F (2,18) 7.44; p =0.004] scores. There was strong correlation between mean AC and GRS scores [r=0.73 (p <0.001)] and strong inter-item consistency for AC (α = 0.94) and GRS (α = 0.83). The ICC (95% CI) and IRR (95% CI) for AC was 0.96 (0.95 – 0.96) and 0.91 (0.88 – 0.95) respectively and 0.93 (0.90 – 0.94) and 0.80 (0.74 – 0.86) for GRS. Conclusions: Both assessments differentiated between individuals who have performed fewer (≤30) and many (>100) blocks in the preceding year, supporting construct validity. It also established concurrent validity and overall reliability. We recommend both tools may be used in UGRA assessment

Validity and reliability of an objective structured assessment tool for performance of ultrasound-guided regional anaesthesia

Background: We aimed to examine the validity and reliability of previously developed criterion-referenced assessment checklist (AC) and global rating scale (GRS) to assess performance in ultrasound-guided regional anaesthesia (UGRA). Methods: Twenty-one anaesthetists’ single, real-time, UGRA procedures (total: 21 blocks) were assessed using 22-item AC and 9-item GRS scored on a 3-point and 5-point Likert scales respectively. We used one-way ANOVA to compare assessment scores between 3 groups (group I: ≤30 blocks in the preceding year; group II: 31–100; group III: >100). Concurrent validity was evaluated using Pearson’s correlation (r). We calculated type-A intra- class correlation coefficient (ICC) using an absolute agreement definition in two-way random effects model, and inter-rater reliability (IRR) using absolute agreement between raters. The inter-item consistency was assessed by Cronbach’s alpha (α). Results: Greater UGRA experience in the preceding year was associated with better AC [F (2,18) 12.01; p <0.001] and GRS [F (2,18) 7.44; p =0.004] scores. There was strong correlation between mean AC and GRS scores [r=0.73 (p <0.001)] and strong inter-item consistency for AC (α = 0.94) and GRS (α = 0.83). The ICC (95% CI) and IRR (95% CI) for AC was 0.96 (0.95 – 0.96) and 0.91 (0.88 – 0.95) respectively and 0.93 (0.90 – 0.94) and 0.80 (0.74 – 0.86) for GRS. Conclusions: Both assessments differentiated between individuals who have performed fewer (≤30) and many (>100) blocks in the preceding year, supporting construct validity. It also established concurrent validity and overall reliability. We recommend both tools may be used in UGRA assessment

Cost effectiveness of epidural steroid injections to manage chronic lower back pain

Background The efficacy of epidural steroid injections in the management of chronic low back pain is disputed, yet the technique remains popular amongst physicians and patients alike. This study assesses the cost effectiveness of injections administered in a routine outpatient setting in England. Methods Patients attending the Nottingham University Hospitals’ Pain Clinic received two injections of methylprednisolone plus levobupivacaine at different dosages, separated by at least 12 weeks. Prior to each injection, and every week thereafter for 12 weeks, participants completed the EQ-5D health-related quality of life instrument. For each patient for each injection, total health state utility gain relative to baseline was calculated. The cost of the procedure was modelled from observed clinical practice. Cost effectiveness was calculated as procedure cost relative to utility gain. Results 39 patients provided records. Over a 13-week period commencing with injection, mean quality adjusted life year (QALY) gains per patient for the two dosages were 0.028 (SD 0.063) and 0.021 (SD 0.057). The difference in QALYs gained by dosage was insignificant (paired t-test, CIs -0.019 – 0.033). Based on modelled resource use and data from other studies, the mean cost of an injection was estimated at £219 (SD 83). The cost utility ratio of the two injections amounted to £8,975 per QALY gained (CIs 5,480 – 22,915). However, at costs equivalent to the tariff price typically paid to providers by health care purchasers, the ratio increased to £27,459 (CIs 16,779 – 70,091). Conclusions When provided in an outpatient setting, epidural steroid injections are a short term, but nevertheless cost effective, means of managing chronic low back pain. However, designation of the procedure as a day case requires the National Health Service to reimburse providers at a price which pushes the procedure to the margin of cost effectiveness

Des sources du savoir aux médicaments du futur

L'origine des pharmacopées traditionnelles L'élaboration des pharmacopées Les médicaments du XXIe siècle Comment les connaissances des savoirs thérapeutiques se sont-elles transmises au travers des différentes cultures ? Cet ouvrage innovant, qui réunit les travaux présentés au 4e Congrès européen d'ethnopharmacologie, fait remonter à la préhistoire les sources des connaissances thérapeutiques. Si les pharmacopées écrites jalonnent l'histoire des grandes médecines savantes, d'autres modes d'accès à la connaissance semblent exister dans l'univers chamanique des sociétés de tradition orale ainsi que dans la façon dont les animaux malades se soignent par les plantes. L'évaluation des propriétés pharmaco-toxicologiques et chimiques des plantes d'usage traditionnel devrait par ailleurs favoriser le développement futur des médicaments à base de plantes, l'un des thèmes porteurs abordés dans cet ouvrage. Mais l'objectif de ce livre est aussi de susciter, partout dans le monde, de nouvelles thématiques de recherche dans le domaine de la préhistoire du médicament et de la compréhension de l'acquisition et de la transmission du savoir. Le développement du phytomédicament non toxique destiné à l'homme et à l'animal figure également parmi les enjeux majeurs de demain.The origin of traditional pharmacopoeias The development of pharmacopoeias The medicines of the XXIth century How have the traditional Therapeutical knowledges been transmited to the différent cultures? This innovating book containing the proceedings of the 4th European Congress of Ethnopharmacology return to prehistory the sources of fherapeutical knowledge and asks how the animals cure themselves with plants. If the printing pharmacopoeias ponctuate the history of learning medicines other way of accessibility to the knowledge seems exist in the world of shaman in society with oral tradition. Ethnopharmacological evaluation of traditional médicinal plant should favour the development of phytomedicine. The purpose of this publication is also to provide dues to scientists in the whole world and help them identify new avenues for research in the field of the prehistory of drugs, for a better understanding of the way knowledge is acquired and then transmitted, and for the development of non-toxic herbal medicines for administration to human and animal beings