Neonatal videolaryngoscopy as a teaching aid: the trainees’ perspective

2020 ◽  
pp. fetalneonatal-2020-319619
Author(s):  
Joyce E O'Shea ◽  
Sandy Kirolos ◽  
Marta Thio ◽  
C Omar Farouk Kamlin ◽  
Peter G Davis
Keyword(s):  
Learning Experience ◽  
Controlled Trial ◽  
Descriptive Statistics ◽  
Intubation Attempt ◽  
Controlled Environment ◽  
Success Rates ◽  
Parental Presence ◽  
Confidence Levels ◽  
Teaching Package ◽  
Randomised Controlled

IntroductionNeonatal intubation is a challenging skill to acquire. A randomised controlled trial (RCT) found junior trainees had higher intubation success rates if their supervisor shared their airway view on a videolaryngoscope screen compared with intubations where the supervisor could not see the videolaryngoscope screen. The intubations in the trial were supervised by a group of experienced neonatologists who developed an intubation teaching package that aimed to be informative, consistent and supportive. We surveyed the trainees to assess their experiences of the intubation attempts.MethodsTrainees participating in the RCT completed questionnaires anonymously after each intubation attempt. Questionnaires used 5-point Likert scales and free comment sections. Quantitative analysis was performed using descriptive statistics. In a qualitative analysis, free comments were coded to identify central recurring themes.ResultsTwo hundred and six questionnaires were completed by 36 trainees. The majority reported that the guidance received during intubation was helpful, the postprocedure feedback was educational and their confidence levels were increased. Trainees appreciated a controlled environment and calm, consistent guidance. They found intubations in the delivery room, those involving unstable infants, large audiences and parental presence more stressful. Responses were positive whether the videolaryngoscope screen was visible or covered, emphasising the importance of consistent guidance. Overall, 16% of intubations were reported as intimidating.ConclusionThe shared airway view offered by videolaryngoscopy was well received. In addition, taking measures to control the setting, with standardised guidance and feedback, improved confidence and created a more positive learning experience.

The impact of acupuncture on IVF success rates: A randomised controlled trial

2018 ◽  
Vol 5 (2) ◽  
pp. 48
Author(s):  
Roy Homburg ◽  
K. Gillerman ◽  
A. Kulkarni ◽  
A. Shah ◽  
A. Gudi
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Success Rates ◽  
Randomised Controlled ◽  
The Impact

P56 Virtual reality simulation in neurosurgical training: a single blinded randomised controlled trial & review of all available training models

2019 ◽  
Vol 90 (3) ◽  
pp. e38.2-e38
Author(s):  
A Ansaripour ◽  
AR Haddad ◽  
E Maratos ◽  
B Zebian
Keyword(s):  
Virtual Reality ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Intervention Group ◽  
Training Models ◽  
Confidence Levels ◽  
Performance Time ◽  
Vr Training ◽  
Randomised Controlled

ObjectivesVirtual reality (VR) simulators are one of the training models allowing the practice of surgical skills for trainees. We aim to assess the benefit of VR training in neurosurgery.DesignA single-blinded randomised controlled trial and a literature review.SubjectsTrainees (n=12), Fellows and Consultant Neurosurgeons (n=4) and Medical Students (n=6) with no experience of VR.MethodsParticipants were randomised according to their grades. Both groups completed microsurgical tasks and duration and quality of each task was recorded at the start and the endpoint of the study. Questionnaires were used to assess the participants’ confidence in microsurgical skills. The intervention group underwent structured training using a VR simulator (NeuroVR). The primary outcome measure was microsurgical performance assessed by three independent assessors blinded to trainee status. The secondary outcome measure was performance time and confidence levels.ResultsObserved improvements in the primary outcome were not significant. The performance time in the intervention group improved significantly with a mean difference of 79.8 s (8–178 s) (p<0.05). The intervention group reported significantly improved confidence levels in all microsurgical skills (8.8%, p<0.001). Less experienced trainees had the greatest reductions in time and improved confidence levels.ConclusionsVR training in neurosurgery, particularly in less experienced trainees, can prove useful. Future studies should assess the effect of VR training on clinical procedures.

scholarly journals Analysis of unsuccessful intubations in neonates using videolaryngoscopy recordings

2017 ◽  
Vol 103 (5) ◽  
pp. F408-F412 ◽  
Author(s):  
Joyce E O’Shea ◽  
Prakash Loganathan ◽  
Marta Thio ◽  
C Omar Farouk Kamlin ◽  
Peter G Davis
Keyword(s):  
Controlled Trial ◽  
Objective Assessment ◽  
Blade Design ◽  
Success Rates ◽  
Vocal Cords ◽  
Unsuccessful Attempt ◽  
Anatomical Structures ◽  
Intubation Success ◽  
Randomised Controlled ◽  
Oesophageal Intubation

ObjectivesNeonatal intubation is a difficult skill to learn and teach. If an attempt is unsuccessful, the intubator and instructor often cannot explain why. This study aims to review videolaryngoscopy recordings of unsuccessful intubations and explain the reasons why attempts were not successful.Study designThis is a descriptive study examining videolaryngoscopy recordings obtained from a randomised controlled trial that evaluated if neonatal intubation success rates of inexperienced trainees were superior if they used a videolaryngoscope compared with a laryngoscope. All recorded unsuccessful intubations were included and reviewed independently by two reviewers blinded to study group. Their assessment was correlated with the intubator’s perception as reported in a postintubation questionnaire. The Cormack-Lehane classification system was used for objective assessment of laryngeal view.ResultsRecordings and questionnaires from 45 unsuccessful intubations were included (15 intervention and 30 control). The most common reasons for an unsuccessful attempt were oesophageal intubation and failure to recognise the anatomy. In 36 (80%) of intubations, an intubatable view was achieved but was then either lost, not recognised or there was an apparent inability to correctly direct the endotracheal tube. Suctioning was commonly performed but rarely improved the view.ConclusionsLack of intubation success was most commonly due to failure to recognise midline anatomical structures. Trainees need to be taught to recognise the uvula and epiglottis and use these landmarks to guide intubation. Excessive secretions are rarely a factor in elective and premedicated intubations, and routine suctioning should be discouraged. Better blade design may make it easier to direct the tube through the vocal cords.

scholarly journals TILT: Time-Lapse Imaging Trial: A pragmatic, Multi-Centre, Three-Arm Randomised Controlled Trial to Assess the Clinical Effectiveness and Safety of Time-Lapse Imaging in in-Vitro Fertilisation Treatment.

2020 ◽  
Author(s):  
Priya Bhide ◽  
Arasaratnam Srikanthara ◽  
Doris Lanz ◽  
Julie Dodds ◽  
Bonnie Collins ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Live Birth ◽  
Controlled Trial ◽  
Time Lapse ◽  
Economic Benefits ◽  
In Vitro Fertilisation ◽  
Success Rates ◽  
Randomised Controlled ◽  
Time Lapse Imaging

Abstract • Background: Subfertility is a common problem for which in-vitro fertilisation (IVF) treatment is commonly recommended. Success rates following IVF are suboptimal and have remained static over the last few years. This imposes a considerable financial burden on overstretched healthcare resources. Time-lapse imaging (TLI) of developing embryos in IVF treatment is hypothesised to improve the success rates of treatment. This may be either by providing undisturbed culture conditions and/or improving the predictive accuracy for optimal embryo selection from a cohort of available embryos. However, current best evidence for its effectiveness is inconclusive. • Methods: The time-lapse imaging trial is a pragmatic, multi-centre, three-arm parallel group randomised controlled trial using re-randomisation. The primary objective of the trial is to determine if the use of TLI or undisturbed culture in IVF treatment results in a higher live birth rate when compared to current standard methods of embryo incubation and assessment. Secondary outcomes include measures of clinical efficacy and safety. The trial will randomise 1575 participants to detect an increase in live birth from 26.5% to 35.25%.• Discussion: In the absence of high quality evidence, there is no current national guidance, recommendation or policy for the use of TLI. The use of TLI is not consistently incorporated into standard IVF care. A large, pragmatic, multicentre, trial will provide much needed definitive evidence regarding the effectiveness of TLI. If proven to be effective, its incorporation into standard care would translate into significant clinical and economic benefits. If not, it would allow allocation of resources to more effective interventions.• Trial registration: ISRCTN registry, ISRCTN17792989, 18/04/2018, prospectively registered.

scholarly journals Transnasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergent intubation (Kids THRIVE): a protocol for a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e025997 ◽  
Author(s):  
Shane George ◽  
Susan Humphreys ◽  
Tara Williams ◽  
Ben Gelbart ◽  
Arjun Chavan ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Cost Effective ◽  
Intubation Attempt ◽  
Emergency Intubation ◽  
Intention To Treat ◽  
High Incidence ◽  
Registration Number ◽  
Randomised Controlled ◽  
Paediatric Intensive Care Units

IntroductionEmergency intubation of children with abnormal respiratory or cardiac physiology is a high-risk procedure and associated with a high incidence of adverse events including hypoxemia. Successful emergency intubation is dependent on inter-related patient and operator factors. Preoxygenation has been used to maximise oxygen reserves in the patient and to prolong the safe apnoeic time during the intubation phase. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) prolongs the safe apnoeic window for a safe intubation during elective intubation. We designed a clinical trial to test the hypothesis that THRIVE reduces the frequency of adverse and hypoxemic events during emergency intubation in children and to test the hypothesis that this treatment is cost-effective compared with standard care.Methods and analysisThe Kids THRIVE trial is a multicentre randomised controlled trial performed in participating emergency departments and paediatric intensive care units. 960 infants and children aged 0–16 years requiring emergency intubation for all reasons will be enrolled and allocated to THRIVE or control in a 1:1 allocation with stratification by site, age (<1, 1–7 and >7 years) and operator (junior and senior). Children allocated to THRIVE will receive weight appropriate transnasal flow rates with 100% oxygen, whereas children in the control arm will not receive any transnasal oxygen insufflation. The primary outcomes are defined as follows: (1) hypoxemic event during the intubation phase defined as SpO2<90% (patient-dependent variable) and (2) first intubation attempt success without hypoxemia (operator-dependent variable). Analyses will be conducted on an intention-to-treat basis.Ethics and disseminationEthics approval for the protocol and consent process has been obtained (HREC/16/QRCH/81). The trial has been actively recruiting since May 2017. The study findings will be submitted for publication in a peer-reviewed journal.Trial registration numberACTRN12617000147381.

PP23  Soiled airway tracheal intubation and the effectiveness of decontamination by north east paramedics: a randomised controlled manikin study. The satiated2 study

2020 ◽  
Vol 37 (10) ◽  
pp. e11.1-e11
Author(s):  
Graham McClelland ◽  
Richard Pilbery ◽  
Sarah Hepburn
Keyword(s):  
Controlled Trial ◽  
Research Question ◽  
Ambulance Service ◽  
Success Rates ◽  
North East ◽  
Significant Difference ◽  
Intubation Success ◽  
First Pass ◽  
Intubation Success Rate ◽  
Randomised Controlled

BackgroundVomiting and regurgitation are commonly encountered in out-of-hospital cardiac arrest, but traditional paramedic suctioning techniques may be insufficient to manage severely soiled airways.A technique called Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) has been developed to help clinicians manage these difficult airways. The only UK SALAD study (SATIATED) reported improved paramedic first-pass intubation success rate. This study has now been replicated in a different ambulance service.The primary research question was: Does paramedic first-pass intubation rate in North East Ambulance Service improve following training in SALAD? The secondary research question was: Does training in SALAD affect the time taken to intubate by paramedics?MethodsA randomised controlled trial of SALAD was conducted using a modified airway manikin capable of vomiting to simulate a soiled airway. The intervention comprised SALAD training and the introduction of the DuCanto catheter for post-training attempts. Participants were randomised into two groups: A01A02B01 who made two pre-training intubation attempts and one post-training attempt, and A11B11B12, who made one pre-training and two post-training attempts. Data were collected on length of service, success rates, timings and techniques used.ResultsParamedics (n=102 participants, n=99 completed the study) were recruited between August and December 2019. First-pass intubation success rates on the second attempts (A02versus B11) were 86% and 96% respectively; a non-significant improvement of 10% (95% CI 1–21%, p=0.09). Both groups intubated faster on third attempts compared to first attempts. A01 to B01 mean improvement 5 (SD 14) seconds, A11 to B12 mean improvement 9 (SD 15) seconds. There was no significant difference in improvement between groups (mean difference -4 seconds, 95% CI -11–3 seconds, p=0.22).ConclusionsNorth East Ambulance Service paramedics demonstrated improved first-pass intubation success rates in a simulated soiled airway following SALAD training and improved time to intubation. This study supports the findings of the SATIATED study.

scholarly journals Patient Perceptions of the Challenges to Recruitment Into a Renal Rct Registry : A Pilot Questionnaire Based Study

2021 ◽  
Author(s):  
Ellen Murphy ◽  
Niamh O Shea ◽  
Eva Long ◽  
Joseph A Eustace ◽  
Frances Shiely
Keyword(s):  
Quantitative Data ◽  
Observational Studies ◽  
Controlled Trial ◽  
Renal Dialysis ◽  
Current Treatment ◽  
Descriptive Statistics ◽  
Cross Sectional ◽  
Randomised Controlled ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Randomised controlled trials (RCTs) are the gold standard for demonstrating the efficacy of new therapies. Despite this, nephrology trials, especially of patients with end-stage renal disease (ESRD) are much fewer in number than other medical subspecialties. Recruitment difficulties are cited as a particular challenge. Using registries to conduct RCTs is a reasonably new practice but is appealing as it combines the benefits of both observational studies and clinical trials. There is limited literature on patient motivators, barriers, and consent to these registries. The purpose of our study was to establish the factors that motivate and/or inhibit patients from joining a registry for randomised controlled trial, and to determine what information matters to patients when making an enrolment decision to participate in such a registry. MethodsWe conducted a cross-sectional questionnaire-based study at a dialysis centre in Southwest Ireland representing a catchment patient population of approximately 430,000. Quantitative data were coded and analysed in SPSS (v16). Descriptive statistics were produced, and open-ended questions were analysed by thematic analysis. Results 87 patients completed the questionnaire. Reasons for participation in the registry included personal and altruistic benefits. Barriers were time and travel requirements associated with registry participation, data safety concerns, risks, and side effects, along with concerns that registry participation would impact their current treatment. Although 29.8% of patients expressed, that they would have concerns regarding their data being stored in a registry, 79.3% of patients were still willing to consent to have their data uploaded and stored in a registry for conducting RCTs. It was important to patients to have their GP (general practitioner) involved in the decision to participate, despite little day-to-day contact with their GP for renal dialysis management. ConclusionChallenges to recruitment to registries for RCTs exist but addressing the identified concerns of potential participants may improve recruitment to registries, and by extension, to RCTs conducted using the registry.

scholarly journals What Drives Responses to Willingness-to-pay Questions? A Methodological Inquiry in the Context of Hypertension Self-management

10.36469/9818 ◽  
2016 ◽  
Vol 4 (2) ◽  
pp. 158-171
Author(s):  
Billingsley Kaambwa ◽  
Stirling Bryan ◽  
Emma Frew ◽  
Emma Bray ◽  
Sheila Greenfield ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Contingent Valuation ◽  
Multivariate Regression ◽  
Statistical Tests ◽  
Controlled Trial ◽  
A Priori ◽  
Descriptive Statistics ◽  
Self Management ◽  
Self Monitoring ◽  
Randomised Controlled

Background: The use of economic evaluation to determine the cost-effectiveness of health interventions is recommended by decision-making bodies internationally. Understanding factors that explain variations in costs and benefits is important for policy makers. Objective: This work aimed to test a priori hypotheses defining the relationship between benefits of using self-management equipment (measured using the willingness-to-pay (WTP) approach) and a number of demographic and other patient factors. Methods: Data for this study were collected as part of the first major randomised controlled trial of self-monitoring combined with self-titration in hypertension (TASMINH2). A contingent valuation framework was used with patients asked to indicate how much they were willing to pay for equipment used for self-managing hypertension. Descriptive statistics, simple statistical tests of differences and multivariate regression were used to test six a priori hypotheses. Results: Data for this study were collected as part of the first major randomised controlled trial of self-monitoring combined with self-titration in hypertension (TASMINH2). A contingent valuation framework was used with patients asked to indicate how much they were willing to pay for equipment used for self-managing hypertension. Descriptive statistics, simple statistical tests of differences and multivariate regression were used to test six a priori hypotheses. Conclusion: The majority of hypertensive patients who had taken part in a self-management study were prepared to purchase the self-monitoring equipment using their own funds, more so for men, those with higher incomes and those with greater satisfaction. Further research based on bigger and more diverse populations is recommended.

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