Simulation-Based Ultrasound Training in Obstetrics and Gynecology: A Systematic Review and Meta-Analysis

Objective The purpose of this systematic review and meta-analysis was to examine the effects of simulation-based ultrasound training (SIM-UT) in obstetrics and gynecology compared to non-SIM-UT on trainee learning, clinical performance, patient-relevant outcomes, and cost of training. Methods A systematic search was performed in June 2019 in PubMed, Embase, and Scopus using search terms for the topic and the intervention as well as certain MESH terms. Inclusion criteria were defined in accordance with the PICO question. Studies published in any language involving SIM-UT in obstetrics and gynecology compared to non-SIM-UT or no training were included. The outcomes included effects on health care provider learning and clinical performance, patient-relevant outcomes, and cost of training. Two authors evaluated the study quality with the MERSQI instrument and the Oxford Quality Scoring System. A meta-analysis was planned for the included randomized controlled trials. Results 15 studies were included, and 11 studies were eligible for meta-analysis. SIM-UT was significantly superior to clinical training only and theoretical teaching with standard mean differences (SMD) of 0.84 (0.08–1.61) and 1.20 (0.37–2.04), respectively. However, SIM-UT was not superior to live model training; SMD of 0.65 (–3.25–4.55). Of all studies included in the meta-analysis, 91 % favored SIM-UT over clinical training alone, theoretical teaching, or in some cases live model training. Conclusion In the field of obstetrics and gynecology, SIM-UT in addition to clinical training markedly improves trainee learning, clinical performance, as well as patient-perceived quality of care.

Artwork

“The Surgery” is the product of a live model study and an intuitive collage that evolved into the representation of my memories observing a surgical procedure. My most prominent memory is the anesthesiologist comforting and holding the patient’s hand, asking her to count downwards from ten as her time and sensations slowly vanished. The elements in “The Surgery” are inspired on visions and sensations described by people that have been under the effects of anesthesia. Salma Kazmi moved to Canada from Mexico in 2018 to pursue an undergraduate degree. She is now in her third year of B.Sc. Double Honors Biology and Studio Art. Kazmi describes her work as dynamic and often inspired by the anatomical and ecological aesthetics. Furthermore, Kazmi is interested in studying movement, narrative illustration and perceptions of sexuality.

Intranasal oxytocin enhances approach-related EEG frontal alpha asymmetry during engagement of direct eye contact

The neuropeptide oxytocin is suggested to exert a pivotal role in a variety of complex human behaviors, including interpersonal bonding, trust, and attachment. Recent theories have suggested that the role oxytocin plays in these complex social behaviors involves a modulation of motivational tendencies of approach/avoidance-related behaviors. However, to date, direct neurophysiological evidence supporting this notion is limited. In this double-blind, randomized, placebo-controlled study with parallel design, we assessed the effects of administered intranasal oxytocin in 40 adult men on gaze behavior and a neural marker of approach/avoidance motivational tendencies. Specifically, electroencephalography recordings were performed during the engagement of eye contact with a live model in a naturalistic two-person social context and electroencephalographic frontal alpha asymmetry, an established neurophysiological index of motivational tendencies for approach/avoidance-related behaviors, was assessed. Compared to placebo, a single dose of oxytocin (24 international units) was shown to increase relative left-sided frontal asymmetry upon direct eye contact with a live model, which is indicative of an increase in approach-related motivational tendencies toward the presented eye contact stimulus. Notably, the treatment effect was most prominently observed in participants with lower self-reported social motivation (higher Motivation subscale scores on the Social Responsiveness Scale), indicating that participants with lower social motivation benefitted the most from the administered oxytocin. No treatment-specific changes were identified in terms of gaze behavior toward the eye region of the live model. Together, these observations add neurophysiological evidence to the hypothesized role of oxytocin in modulating approach/avoidance related tendencies and suggest that inter-individual variance in person-dependent factors need to be considered in order to evaluate the potential benefit of intranasal oxytocin as a treatment. This notion is of particular relevance to the variety of neuropsychiatric populations such as autism spectrum disorder, social anxiety disorder and depression, for which intranasal oxytocin is increasingly considered a potential treatment.

Intranasal oxytocin enhances approach-related EEG frontal alpha asymmetry during engagement of direct eye contact

The neuropeptide oxytocin is suggested to play a major role in a variety of complex human behaviours, including interpersonal bonding, trust and attachment. Recent theories have suggested that the role oxytocin plays in these complex social behaviours involves a modulation of motivational tendencies of approach-/avoidance-related behaviours. However, to date, direct neurophysiological evidence supporting this notion is limited. In this double-blind, randomized, placebo-controlled study with parallel design, we assessed the effects of administered intranasal oxytocin in 40 adult men on gaze behaviour and a neural marker of approach/avoidance motivational tendencies. Specifically, electroencephalography recordings were performed during the engagement of eye contact with a live model in a naturalistic two-person social context and electroencephalographic frontal alpha asymmetry, an established neurophysiological index of motivational tendencies for approach-/avoidance-related behaviours, was assessed. Compared to placebo, a single dose of oxytocin (24 international units) was shown to increase relative left-sided frontal asymmetry upon direct eye contact with a live model, which is indicative of an increase in approach-related motivational tendencies towards the presented eye contact stimulus. Notably, the treatment effect was most prominently observed in participants with lower self-reported social motivation (higher Motivation subscale scores on the Social Responsiveness Scale), indicating that participants with lower social motivation benefitted the most from the administered oxytocin. No treatment-specific changes were identified in terms of gaze behaviour towards the eye region of the live model. Together, these observations add neurophysiological evidence to the hypothesized role of oxytocin in modulating approach-/avoidance-related tendencies and suggest that inter-subject variability in person-dependent factors need to be considered to evaluate the potential benefit of intranasal oxytocin as a treatment. This notion is of particular relevance to the variety of neuropsychiatric populations such as autism spectrum disorder, social anxiety disorder and depression, for which intranasal oxytocin is increasingly considered a potential treatment.

An investigation into the structural suitability of standard grade Expanded Polystyrene (EPS) as an innovative building material

Rapid urbanization has brought numerous economic, cultural and political development in South Africa; however, it has also led to some parts of the country turning into slums. The spread of slums is mainly driven by the lack of adequate housing provision by the Government. Although it has been twenty-five years since South Africa had its first democratic elections, millions of citizens still continue to live under squalid conditions as a result of lack of housing. The South African government cites numerous reasons for not being able to eradicate the housing backlog, including insufficient housing budget allocation as well as the worsening global economic climate. It is evident from the current housing backlogs that more building solutions that can reduce cost and construction time are needed. Further, new building materials should be explored in order to alleviate the environmental pressures that conventional building materials cause on the environment. This research investigates the properties of standard grade Expanded Polystyrene (EPS) as a potential contributor in low-cost housing provision. Currently the construction of EPS dome houses using modified EPS is only occurring outside of South Africa and it requires the possession of intricate moulding equipment. Existing suppliers require a minimum order, for instance, Japan Dome House Company supplies dome houses at a minimum order of three-hundred units. This research examines the potential of carving standard grade EPS into a form of dwelling using a hot-wire tool to re-create a model similar to a commercially produced EPS dome house. EPS components were assembled and left exposed to the elements since the main method of analyses of the live model was through exposure, particularly against rain and wind experienced within the jurisdiction of Pietermaritzburg, South Africa. Analyses of the live model was supplemented by testing of compression, flexural and thermal qualities of EPS under laboratory conditions. With wind speeds of thirty-nine km/hr and a rainfall intensity of twenty-eight mm, the model was found to still be in its original state of composure after six-months even without having been permanently anchored to the ground. Existing industry models such as Moladi, Khaya ReadyKit and Fischer Housing were examined to provide a standard of comparison for this investigation. This was done in order to distinguish how EPS dome houses differ to current existing alternative building technologies within the sector of low-cost housing. Observation of the model revealed that it is possible to successfully re-create an EPS dome house without complex moulding equipment. Some of the main findings from the laboratory analysis were that, contrary to expectations, thermo-gravimetric analyses of three different densities (fifteen kg/m3, twenty kg/m3 and thirty kg/m3) revealed that as the density of EPS increases, the maximum degradation value decreases. A study of the interaction of the polystyrene beads through microscopic analysis revealed that in higher EPS densities beads can rupture, leading to a compromise in both structural integrity and form. A water absorption test on EPS revealed that the percentage of water absorbed by EPS is similar to that absorbed by clay bricks over a 24-hour period, which makes the materials comparable in this regard. In terms of the outcomes of the study, the researcher has already published articles in three journals and two conference proceedings. This research will be of value to design professionals in alleviating the environmental impacts of commonly used conventional materials through the inclusion of EPS where low compressive loads are permissible.

Survey of regional anesthesiology fellowship directors in the USA on the use of simulation in regional anesthesiology training

BackgroundDespite a growing interest in simulated learning, little is known about its use within regional anesthesia training programs. In this study, we aimed to characterise the simulation modalities and limitations of simulation use for US-based resident and fellow training in regional anesthesiology.MethodsAn 18-question survey was distributed to regional anesthesiology fellowship program directors in the USA. The survey aimed to describe residency and fellowship program demographics, modalities of simulation used, use of simulation for assessment, and limitations to simulation use.ResultsForty-two of 77 (54.5%) fellowship directors responded to the survey. Eighty per cent of respondents with residency training programs utilized simulation for regional anesthesiology education, while simulation was used for 66.7% of fellowship programs. The most common modalities of simulation were gel phantom models (residency: 80.0%, fellowship: 52.4%) and live model scanning (residency: 50.0%, fellowship: 42.9%). Only 12.5% of residency programs and 7.1% of fellowship programs utilized simulation for assessment of skills. The most common greatest limitation to simulation use was simulator availability (28.6%) and funding (21.4%).ConclusionsSimulation use for education is common within regional anesthesiology training programs, but rarely used for assessment. Funding and simulator availability are the most common limitations to simulation use.

Rembrandt’s nature

In seventeenth-century Holland, the role of the live model in the making of art and, importantly, as a vehicle for artistic training had become a topic of contention. No other aspect of artists’ education had received more criticism than the use of real-life models. Artists ran the risk of drawing too much attention to the live model, leaving the model’s features visible in their works. These works would look too much like life itself. This essay argues that seventeenth-century theorists devised an intricate concept of style in order to keep life in an artwork at bay. To train artists was to discipline them in style.