Predicting the Difficulty Score of Spinal Anaesthesia

Background: Spinal anaesthesia is the commonest regional anaesthesia conducted for several surgical procedures. Objectives: This study aims to predict the difficulty score of spinal anaesthesia to scale back the complications and ultimately improve anaesthesia quality. Materials and Methods: Patients undergoing various surgeries involving spinal anaesthesia were taken in this study and several parameters like demographic details, body mass index, spinous process condition were recorded pre operatively to see how they influenced the difficulty of performing spinal anesthesia on them. Results: Out of the 101 patients enrolled in this study, 53 underwent an easy SA by the first attempt in the first space. It was moderate in 36 and difficult in 12 patients. Conclusion: Considering the examination of patients with respect to BMI, lumbar spinous process status and deformities, radiological signs of lumbar vertebrae can be helpful in predicting how difficult the SA procedure is going to be.

Annotation Difficulties in Natural Language Inference

State-of-the-art models have obtained high accuracy on mainstream Natural Language Inference (NLI) datasets. However, recent research has suggested that the task is far from solved. Current models struggle to generalize and fail to consider the inherent human disagreements in tasks such as NLI. In this work, we conduct an experiment based on a small subset of the NLI corpora such as SNLI and SICK. It reveals that some inference cases are inherently harder to annotate than others, although good-quality guidelines can reduce this difficulty to some extent. We propose adding a Difficulty Score to NLI datasets, to capture the human difficulty level of agreement.

Comparison of the statistics and item analysis of multiple-choice questions between free and tuition-paying admission

Background: The purpose of this pilot was to compare the multiple-choice test statistics of medical and dental students' exams between free and tuition-paying.Methods: This descriptive-analytical study was conducted at Golestan University of Medical Sciences in Iran in 2020. The study population included students of medicine and dentistry. A total of 56 exams were selected in two student groups of free and tuition-paying admission in the physiology course. The results of quantitative evaluation of tests were used as the data of this study. The variables included difficulty index, discrimination index, the degree of difficulty, score variance, and Kuder-Richardson correlation coefficient. Results: There were 32 medical and 24 dentistry exams. The cumulative total number of questions in these exams was 437 and 330 multiple choice questions, respectively. The number of medical students participating in the free-tuition and paying-tuition admissions was 1336 and 1076, and for dental students, these numbers were 395 and 235, respectively. There were no significant differences in normalized adjusted exams scores between two admission groups in both medical and dentistry tests. The mean of discrimination index in the free-tuition group was higher than in the paying-tuition group. The interaction between the type of admission and the field of study was significant for the discrimination index. This difference was more in tuition-free dental students than tuition-free medical students and tuition-paying dental students. Conclusion: The type of student admission has no significant effect on student assessments in multiple-choice exams in matched educational conditions.

Using Patch ECG Device During Lower Third Molar Surgery

This study aimed to evaluate cardiac activity changes during lower third molar surgery concerning gender and anxiety levels. Thirty healthy subjects who required lower third molar surgery filled out Norman Corah dental anxiety scale (DAS) before surgery. A patch ECG device (Savvy, Institute ''Jožef Stefan'', Ljubljana, Slovenia) was applied to the patient to evaluate heart rate (HR) and heart rhythm. These parameters were assessed in 8 different intervals. Periods of the highest mean HR values—incision and flap elevation compared to the period with minimal mean HR values—during suturing showed statistical significance difference (p<0.05). The most common outstanding ECG finding was sinus tachycardia, especially in anxious compared to non-anxious patients. Extraction difficulty score was correlated with the procedure duration time and with the abnormal ECG findings in the period of tooth extraction. Significant cardiac activity changes are detected during surgery. Physiological manifestations of anxiety may be evaluated successfully using a patch ECG device.

Online educational module for paramedics on prehospital 15-lead ECG recording – results of the educational part of the “Finding LCX AMI With posterior ECG leads” (FLAWLESS) trial

Background The diagnosis of ST elevation myocardial infarction (STEMI) is challenging when the culprit is in the left circumflex coronary artery (CX) territory because ST elevations are often not captured by the standard 12-lead electrocardiogram (ECG). Although, guidelines recommend the acquisition of the additional posterior leads V7-V9 (pECG) when the suspicion of acute coronary syndrome (ACS) is high and the ECG non-diagnostic, this is not routinely done. Purpose The purpose of the FLAWLESS trial, was to improve the prehospital CX STEMI diagnostic. The study consisted of 2 parts: a) a training and implementation study, and b) an outcomes study after implementation. In the implementation study we evaluated the FLAWLESS process from the paramedic's point of view on experiences, implementation of pECG lead recordings and its barriers. Methods Before initiating the trial, all active paramedics in 2 health care regions were educated via a specifically designed and mandatory online 30 min course and all 250 ambulances equipped with a SMART-CARD (instructing how to record pECG leads) and FAQ-sheet. All paramedics were invited by email to anonymously answer an online questionnaire (OQ) designed in REDCap® and interviewed. Utility-score and difficulty-score, ranging from 0 (not useful at all/very easy) to 100 (very useful/very difficult), were introduced for quantitative assessments. Results A total of 1268 paramedics were invited to answer the OQ. The response rate was intermediate at 35%. Among responders, 89% had completed the OEP. On duty 80% had used FAQ-sheet and 74% SMART-CARD in the field. The median utility scores were 80 (25th and 75th quartiles 67–90) for OEP, 79 (61–90) for FAQ-sheet and 85 (75–97) for SMART-CARD, respectively. The implementation of pECG leads recordings was fairly high – 54% reported always recording V7-V9 in ACS patients and 36% reported doing it frequently. Difficulty-score for recording V7-V9 leads in the prehospital setting was 50 (19–70). Finally, 43% reported difficulties that were related to technicalities i.e. defibrillators not having dedicated V7, V8 and V9 cables, hence ambulance staff is forced to record and transmit a second ECG after moving the V4, V5 and V6 cables to the V7-V9 positioned electrodes. Conclusion We demonstrated that large-scale online training of paramedics in the recording of prehospital 15-lead ECG is feasible. The evaluation was positive regarding training and support tools in the ambulances but almost 50% of paramedics found the recording very difficult in the field. Future ECG machines used in emergency settings should be constructed with 13 instead of 10 cables to allow simultaneously recording of 15 leads (standard, precordial and the V7-V9 posterior). This would ease acquisition, facilitate implementation of guideline recommendation. FUNDunding Acknowledgement Type of funding sources: None.

Comparison of Suicide Attempts and Suicide Deaths by Jumping from a High Place in Korean Children and Adolescents

Jumping from a high place is the most common method of suicide among Korean children and adolescents. The aim of this study was to examine the personal, family, and school life of Korean children and adolescents who chose jumping from a high place, among suicide attempts and suicide deaths, based on teachers’ reports. Data on suicide attempts and suicide deaths by jumping from a high place in children and adolescents were collected through the Ministry of Education in South Korea from 2016 to 2018. We compared sociodemographic variables, suicide-related variables, emotional and behavioral status, school life related variables, and variables related to family problems among suicide deaths (n = 262), actual suicide attempts (n = 50), and interrupted or aborted suicide attempts (n = 210). There were differences in educational stage (p < 0.001), place of suicide (p < 0.001), presence of suicide note (p < 0.05) and previous suicide attempt (p < 0.001) among the three groups. The total difficulty score on the Strength Difficulty Questionnaire of interrupted or aborted suicide attempts was higher than that of the other two groups. Our study suggests that the suicide death group tend to present fewer personal and family pathologies and better school adjustment than the suicide attempt group.

The learning curve of laparoscopic liver resection utilising a difficulty score

Background This study aimed to quantitatively evaluate the learning curve of laparoscopic liver resection (LLR) of a single surgeon. Patients and methods A retrospective review of a prospectively maintained database of liver resections was conducted. 171 patients undergoing pure LLRs between April 2008 and April 2021 were analysed. The Halls difficulty score (HDS) for theoretical predictions of intraoperative complications (IOC) during LLR was applied. IOC was defined as blood loss over 775 mL, unintentional damage to the surrounding structures, and conversion to an open approach. Theoretical association between HDS and the predicted probability of IOC was utilised to objectify the shape of the learning curve. Results The obtained learning curve has resulted from thirteen years of surgical effort of a single surgeon. It consists of an absolute and a relative part in the mathematical description of the additive function described by the logarithmic function (absolute complexity) and fifth-degree regression curve (relative complexity). The obtained learning curve determines the functional dependency of the learning outcome versus time and indicates several local extreme values (peaks and valleys) in the learning process until proficiency is achieved. Conclusions This learning curve indicates an ongoing learning process for LLR. The proposed mathematical model can be applied for any surgical procedure with an existing difficulty score and a known theoretically predicted association between the difficulty score and given outcome (for example, IOC).

Development and validation of a preoperative “difficulty score” for laparoscopic transabdominal adrenalectomy: a multicenter retrospective study

Background A difficulty score for laparoscopic adrenalectomy (LA) is lacking in the literature. A retrospective cohort study was designed to develop a preoperative “difficulty score” for LA. Methods A multicenter study was conducted involving four Italian tertiary centers for adrenal disease. The population was randomly divided into two subsets: training group and validation one. A multicenter study was undertaken, including 964 patients. Patient, adrenal lesion, surgeon’s characteristics, and the type of procedure were studied as potential predictors of target events. The operative time (pOT), conversion rate (cLA), or both were used as indicators of the difficulty in three multivariate models. All models were developed in a training cohort (70% of the sample) and validated using 30% of patients. For all models, the ability to predict complicated postoperative course was reported describing the area under the curve (AUCs). Logistic regression, reporting odds ratio (OR) with p-value, was used. Results In model A, gender (OR 2.04, p = 0.001), BMI (OR 1.07, p = 0.002), previous surgery (OR 1.29, p = 0.048), site (OR 21.8, p < 0.001) and size of the lesion (OR 1.16, p = 0.002), cumulative sum of procedures (OR 0.99, p < 0.001), extended (OR 26.72, p < 0.001) or associated procedures (OR 4.32, p = 0.015) increased the pOT. In model B, ASA (OR 2.86, p = 0.001), lesion size (OR 1.20, p = 0.005), and extended resection (OR 8.85, p = 0.007) increased the cLA risk. Model C had similar results to model A. All scores obtained predicted the target events in validation cohort (OR 1.99, p < 0.001; OR 1.37, p = 0.007; OR 1.70, p < 0.001, score A, B, and C, respectively). The AUCs in predicting complications were 0.740, 0.686, and 0.763 for model A, B, and C, respectively. Conclusion A difficulty score based on both pOT and cLA (Model C) was developed using 70% of the sample. The score was validated using a second cohort. Finally, the score was tested, and its results are able to predict a complicated postoperative course.

Psychological Well-Being of Parents of Very Young Children With Type 1 Diabetes – Baseline Assessment

BackgroundType 1 diabetes in young children is a heavy parental burden. As part of pilot phase of the KIDSAP01 study, we conducted a baseline assessment in parents to study the association between hypoglycemia fear, parental well-being and child behavior.MethodsAll parents were invited to fill in baseline questionnaires: hypoglycemia fear survey (HFS), WHO-5, Epworth Sleepiness Scale and Strength and Difficulties Questionnaire (SDQ).Results24 children (median age: 5-year, range 1-7 years, 63% male, mean diabetes duration: 3 ± 1.7 years) participated. 23/24 parents filled out the questionnaires. We found a higher score for the hypoglycemia fear behavior 33.9 ± 5.6 compared to hypoglycemia worry 34.6 ± 12.2. Median WHO-5 score was 16 (8 - 22) with poor well-being in two parents. Median daytime sleepiness score was high in five parents (&gt;10). For six children a high total behavioral difficulty score (&gt;16) was reported. Pro social behavior score was lower than normal in six children (&lt;6). Parental well-being was negatively associated with HFS total (r = - 0.50, p &lt;.05) and subscale scores (r = - 0.44, p &lt;.05 for HFS-Worry and HFS-Behavior), child behavior (r = - 0.45, p = .05) and positively with child age and diabetes duration (r = 0.58, p &lt;.01, r = 0.6, p &lt;.01). HFS, parental well-being nor daytime sleepiness are associated with the HbA1c.ConclusionRegular screening of parental well-being, hypoglycemia fear and child behavior should be part of routine care to target early intervention.