Patterns of skills acquisition in anesthesiologists during simulated interscalene block training on the soft embalmed Thiel cadaver (Preprint)

2021 ◽  
Author(s):  
Graeme McLeod ◽  
Mel McKendrick ◽  
Tedis Tafili ◽  
Mateo Obregon ◽  
Ruth Neary ◽  
...  
Keyword(s):  
Eye Gaze ◽  
Mastery Learning ◽  
Primary Objective ◽  
Learning Curves ◽  
Interscalene Block ◽  
Major Surgery ◽  
Skills Acquisition ◽  
Gaze Tracking ◽  
Self Rating ◽  
Wide Range

BACKGROUND Demand for regional anesthesia for major surgery has increased considerably but only a small number of anesthesiologists can provide such care. Simulation may improve clinical performance, but opportunities to rehearse procedures are limited and not formalised. Clinical educational outcomes prescribed by the Royal College of Anesthesiologists training curriculum 2021 are difficult to attain. Educational paradigms such as mastery learning and dedicated practice are increasingly used to teach technical skills in order to enhance skills acquisition. Moreover, high fidelity resilient cadaver simulators are now available: the soft embalmed Thiel cadaver shows similar physical characteristics and functional alignment to patients. The elasticity of tissues results in resolution of perineural fluid injection and enables hundreds of repeated injections without damage. However, learning curves, and their intra- and inter-individual dynamics, have not hitherto been measured on the Thiel cadaver simulator using the mastery learning and dedicated practice educational paradigm coupled with validated, quantitative metrics, such as checklists, eye tracking metrics and self-rating scores. OBJECTIVE Our primary objective was to measure the times taken to complete the scanning and needling phases of interscalene block conducted repeatedly on the soft embalmed Thiel cadaver over a 3-hour period of training. The primary outcome was the best-fit linear slope of log-log transformed time to complete the scanning and needling phases of repetitive, simulated interscalene block. METHODS Thirty anesthesiologists, with a wide range of experience, conducted up to 60 ultrasound-guided interscalene blocks over 3h on the left side of two soft embalmed Thiel cadavers. The duration of scanning and needling phases was defined as the time taken to perform all steps correctly. Our secondary objectives were to: measure pre-procedural psychometrics; describe deviations from the learning slope; correlate scanning and needling phase data; characterize skills according to clinical grade; re-test a sub-group of participants 2 to 3 months after training; measure learning curves using objective eye gaze tracking and subjective self-rating measures; and use these to discriminate between levels of scanning and needling performance RESULTS The median (IQR (range]) log-log learning slopes were -0.47 (-0.62 - -0.32 [-0.96 - 0.30]) and -0.23 (-0.34 - -0.19 [-0.71 - 0.27]) during the scanning and needling phases respectively. Loess curves showed wide variability in within-participant performance. The learning slopes of the scanning and needling phases correlated; rho 0.55 (0.23 - 0.76), P<.001; and rho -0.72 (-0.46 - -0.87), P<.001 respectively. Eye gaze fixation count and glance count during scanning and needling phases best reflected block duration. Using clustering techniques, fixation count and glance identified four distinct patterns of learning behaviour. CONCLUSIONS We quantified the rate or slope of learning by log-log transformation of learning curves and identified intra- and inter-individual patterns of variability. CLINICALTRIAL N/A

scholarly journals Decision Making from the Experience of Orthognathic Surgery Patients: A Grounded Theory Approach

2021 ◽  
pp. 238008442110144
Author(s):  
N.R. Paul ◽  
S.R. Baker ◽  
B.J. Gibson
Keyword(s):  
Decision Making ◽  
Grounded Theory ◽  
Treatment Options ◽  
Study Data ◽  
Primary Objective ◽  
Major Surgery ◽  
Future Research ◽  
Decision Making Process ◽  
Theory Approach

Introduction: Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision. Objectives: The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment. Methods: This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding. Results: The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face. Conclusion: The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies. Knowledge Transfer Statement: The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.

An adaptive blink detector to initialize and update a view-basedremote eye gaze tracking system in a natural scenario

2009 ◽  
Vol 30 (12) ◽  
pp. 1144-1150 ◽  
Author(s):  
Diego Torricelli ◽  
Michela Goffredo ◽  
Silvia Conforto ◽  
Maurizio Schmid
Keyword(s):  
Tracking System ◽  
Eye Gaze ◽  
Gaze Tracking

Effects of Weld Strength Mismatch on Estimation Procedures for J and CTOD Fracture Parameters Using SE(B) Specimens

2007 ◽  
Author(s):  
Gustavo H. B. Donato ◽  
Claudio Ruggieri
Keyword(s):  
Mouth Opening ◽  
Estimation Procedure ◽  
Primary Objective ◽  
Weld Strength ◽  
Crack Mouth Opening Displacement ◽  
Opening Displacement ◽  
Fracture Parameters ◽  
Wide Range ◽  
Estimation Procedures ◽  
Fracture Specimens

This work presents an exploratory development of J and CTOD estimation procedures for welded fracture specimens under bending based upon plastic eta factors and plastic rotation factors. The techniques considered include: i) estimating J and CTOD from plastic work and ii) estimating CTOD from the plastic rotational factor. The primary objective is to gain additional understanding on the effect of weld strength mismatch on estimation techniques to determine J and CTOD fracture parameters for a wide range of a/W-ratios and mismatch levels. Very detailed non-linear finite element analyses for plane-strain models of SE(B) fracture specimens with center cracked, square groove welds provide the evolution of load with increased load-line displacement and crack mouth opening displacement which are required for the estimation procedure. The results show that levels of weld strength mismatch within the range ±20% mismatch do not affect significantly J and CTOD estimation expressions applicable to homogeneous materials, particularly for deeply cracked fracture specimens. The present analyses, when taken together with previous studies, provide a fairly extensive body of results which serve to determine parameters J and CTOD for different materials using bend specimens with varying geometries and mismatch levels.

Large Eddy Simulations of Staggered Parallel-Plate Flows

2005 ◽  
Author(s):  
M. V. Pham ◽  
F. Plourde ◽  
S. K. Doan
Keyword(s):  
Heat Transfer ◽  
Numerical Simulations ◽  
Heat Transfer Enhancement ◽  
Parallel Plate ◽  
Large Scale ◽  
Primary Objective ◽  
Transfer Enhancement ◽  
Turbulent Structures ◽  
Wide Range ◽  
Large Eddy

Heat transfer enhancement is a subject of major concern in numerous fields of industry and research. Having received undivided attention over the years, it is still studied worldwide. Given the exponential growth of computing power, large-scale numerical simulations are growing steadily more realistic, and it is now possible to obtain accurate time-dependent solutions with far fewer preliminary assumptions about the problems. As a result, an increasingly wide range of physics is now open for exploration. More specifically, it is time to take full advantage of large eddy simulation technique so as to describe heat transfer in staggered parallel-plate flows. In fact, from simple theory through experimental results, it has been demonstrated that surface interruption enhances heat transfer. Staggered parallel-plate geometries are of great potential interest, and yet many numerical works dedicated to them have been tarnished by excessively simple assumptions. That is to say, numerical simulations have generally hypothesized lengthwise periodicity, even though flows are not periodic; moreover, the LES technique has not been employed with sufficient frequency. Actually, our primary objective is to analyze turbulent influence with regard to heat transfers in staggered parallel-plate fin geometries. In order to do so, we have developed a LES code, and numerical results are compared with regard to several grid mesh resolutions. We have focused mainly upon identification of turbulent structures and their role in heat transfer enhancement. Another key point involves the distinct roles of boundary restart and the vortex shedding mechanism on heat transfer and friction factor.

Sign in / Sign up

Export Citation Format

Share Document