Exposure of healthcare providers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant safety concern during the coronavirus disease 2019 (COVID-19) pandemic, requiring ...contact/droplet/airborne precautions. Because of global shortages, limited availability of personal protective equipment (PPE) has motivated the development of barrier-enclosure systems, such as aerosol boxes, plastic drapes, and similar protective systems. We examined the available evidence and scientific publications about barrier-enclosure systems for airway management in suspected/confirmed COVID-19 patients. MEDLINE/Embase/Google Scholar databases (from December 1, 2019 to May 27, 2020) were searched for all articles on barrier enclosures for airway management in COVID-19, including references and websites. All sources were reviewed by a panel of experts using a Delphi method with a modified nominal group technique. Fifty-two articles were reviewed for their results and level of evidence regarding barrier device feasibility, advantages, protection against droplets and aerosols, effectiveness, safety, ergonomics, and cleaning/disposal. The majority of analysed papers were expert opinions, small case series, technical descriptions, small-sample simulation studies, and pre-print proofs. The use of barrier-enclosure devices adds to the complexity of airway procedures with potential adverse consequences, especially during airway emergencies. Concerns include limitations on the ability to perform airway interventions and the aid that can be delivered by an assistant, patient injuries, compromise of PPE integrity, lack of evidence for added protection of healthcare providers (including secondary aerosolisation upon barrier removal), and lack of cleaning standards. Enclosure barriers for airway management are no substitute for adequate PPE, and their use should be avoided until adequate validation studies can be reported.
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of ...Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
Airway management is a crucial skill for many clinicians. Besides mastering the technical skills of establishing a patent airway, human factors including leadership and team collaboration are ...essential. Teaching these human factors is often challenging for instructors who lack dedicated training. Therefore, the European Airway Management Society (EAMS) developed the Teach-the-Airway-Teacher (TAT) course.
This online post-course survey of TAT-course participants 2013-2021 investigated the impact of the TAT-course and the status of airway management teaching in Europe. Twenty-eight questions e-mailed to participants (using SurveyMonkey) assessed the courses' strengths and possible improvements. It covered participants' and workplace details; after TAT-course considerations; and specifics of local airway teaching. Data were assessed using Excel and R.
Fifty-six percent (119/213) of TAT-participants answered the survey. Most were anaesthetists (84%), working in university level hospitals (76%). Seventy-five percent changed their airway teaching in some way, but 20% changed it entirely. The major identified limitation to airway teaching in their departments was "lack of dedicated resources" (63%), and the most important educational topic was "Teaching non-technical skills" (70%). "Lecturing " was considered less important (37%). Most surveyed anaesthesia departments lack a standardized airway teaching rotation. Twenty-one percent of TAT-participants rated their departmental level of airway teaching overall as inadequate.
This survey shows that the TAT-course purpose was successfully fulfilled, as most TAT-course participants changed their airway teaching approach and did obtain the EAMS-certificate. The feedback provided will guide future TAT-course improvements to advance and promote a comprehensive approach to teaching airway management.
Debriefing is essential for effective learning during simulation-based medical education. To assess the quality of debriefings, reliable and validated tools are necessary. One widely used validated ...tool is the Objective Structured Assessment of Debriefing (OSAD), which was originally developed in English. The aim of this study was to translate the OSAD into German, and to evaluate the reliability and validity of this German version (G-OSAD) according the 'Standards of Educational and Psychological Measurement'. In Phase 1, the validity evidence based on content was established by a multistage cross-cultural adaptation translation of the original English OSAD. Additionally, we collected expert input on the adequacy of the content of the G-OSAD to measure debriefing quality. In Phase 2, three trained raters assessed 57 video recorded debriefings to gather validity evidence based on internal structure. Interrater reliability, test-retest reliability, internal consistency, and composite reliability were examined. Finally, we assessed the internal structure by applying confirmatory factorial analysis. The expert input supported the adequacy of the content of the G-OSAD to measure debriefing quality. Interrater reliability (intraclass correlation coefficient) was excellent for the average ratings (three raters: ICC = 0.848; two raters: ICC = 0.790), and good for the single rater (ICC = 0.650). Test-retest reliability was excellent (ICC = 0.976), internal consistency was acceptable (Cronbach's α = 0.865), and composite reliability was excellent (ω = 0.93). Factor analyses supported the unidimensionality of the G-OSAD, which indicates that these G-OSAD ratings measure debriefing quality as intended. The G-OSAD shows good psychometric qualities to assess debriefing quality, which are comparable to the original OSAD. Thus, this G-OSAD is a tool that has the potential to optimise the quality of debriefings in German-speaking countries.
High-flow nasal oxygenation is increasingly used during sedation procedures and general anesthesia in apneic patients. Transcutaneous CO2 (ptcCO2)-monitoring is used to monitor hypercapnia. This ...study investigated ptcCO2-monitoring during apneic oxygenation.
We included 100 patients scheduled for elective surgery under general anesthesia in this secondary analysis of a randomized controlled trial. Before surgery, we collected ptcCO2 measured by TCM4 and TCM5 monitors and arterial blood gas (ABG) measurements every two minutes during 15 minutes of apnea. Bland-Altman plots analyzed agreement between measurement slopes; linear mixed models estimated the different measuring method effect, and outlined differences in slope and offset between transcutaneous and arterial CO2 partial pressures.
Bland-Altman plots showed a bias in slope (95% confidence intervals) between ABG and TCM4-measurements of 0.05mmHg/min (-0.05 to 0.15), and limits of agreement were -0.88mmHg/min (-1.06 to -0.70) and 0.98mmHg/min (0.81 to 1.16). Bias between ABG and TCM5 was -0.14mmHg/min (-0.23 to -0.04), and limits of agreement were -0.98mmHg/min (-1.14 to -0.83) and 0.71mmHg/min (0.55 to 0.87). A linear mixed model (predicting the CO2-values) showed an offset between arterial and transcutaneous measurements of TCM4 (-15.2mmHg, 95%CI: -16.3 to -14.2) and TCM5 (-19.1mmHg, -20.1 to -18.0). Differences between the two transcutaneous measurements were statistically significant.
Substantial differences were found between the two transcutaneous measurement systems, and between them and ABG. Transcutaneous CO2 monitoring cannot replace arterial CO2-monitoring during apneic oxygenation. In clinical settings with rapidly changing CO2-values, arterial blood gas measurements are needed to reliably assess the CO2-partial pressure in blood.
ClinicalTrials.gov (NCT03478774).
Interprofessional Education (IPE) aims to improve students' attitudes towards collaboration, teamwork, and leads to improved patient care upon graduation. However, the best time to introduce IPE into ...the undergraduate curriculum is still under debate.
We used a mixed-methods design based on a sequential explanatory model. Medical students from all six years at the University of Bern, Switzerland (n = 683) completed an online survey about attitudes towards interprofessional learning using a scale validated for German speakers (G-IPAS). Thirty-one medical students participated in nine semi-structured interviews focusing on their experience in interprofessional learning and on the possible impact it might have on their professional development.
Women showed better attitudes in the G-IPAS across all years (p = 0,007). Pre-clinical students showed more positive attitudes towards IPE Year 1 to Year 3 (p = 0.011). Students correctly defined IPE and its core dimensions. They appealed for more organized IPE interventions throughout the curriculum. Students also acknowledged the relevance of IPE for their future professional performance.
These findings support an early introduction of IPE into the medical curriculum. Although students realise that interprofessional learning is fundamental to high-quality patient care, there are still obstacles and stereotypes to overcome.
ISRCTN 41715934.
The COVID-19 pandemic hit healthcare professionals (HCPs) hard, potentially leading to mental health deterioration. This longitudinal study investigated the 1-year evolution of psychological health ...of acute care HCPs during the COVID-19 pandemic and explored possible differences between high and low resilient HCPs. From April 2020 to April 2021, a convenience sample of 520 multinational HCPs completed an online survey every 3 months, up to five times. We used mixed linear models to examine the association between resilience and the variation of COVID-19-related anxiety, depressiveness, perceived vulnerability, and psychological trauma symptomatology. We demonstrated "u-shaped" trajectories for all mental health symptoms. We also explored differences in the abovementioned variables between front-line and second-line acute care HCPs. In contrast to HCP.s with lower levels of resilience (-1SD), those with higher levels of resilience (+1SD) showed increased COVID-19 anxiety and perceived vulnerability over time. Front-line and second-line HCPs differed in their depressiveness and psychological trauma variation during the 1-year analysis. High and average resilient second-line HCPs showed steeper depressiveness increases with time than high and average resilient front-line HCPs. Acute care HCPs reported their most elevated clinical symptoms of depressiveness (5-7%) and psychological trauma symptomatology (26-46%) in April 2020. During the first year of the COVID-19 pandemic, second-line HCPs with more resilience showed a steeper worsening of their depressiveness than more resilient front-line HCPs. HCPs with low resilience may benefit from interventions at the beginning of a pandemic, whereas HCPs with high resilience might benefit from resilience-enhancing interventions at later phases.
The study protocol was pre-registered with the International Standard Randomised Controlled Trial Number (ISRCTN13694948) published (Fuchs et al., 2020).
There is agreement among educators and professional bodies that interprofessional education needs to be implemented at the pre-registration level. We performed a systematic review assessing ...interprofessional learning interventions, measuring attitudes towards interprofessional education and involving pre-registration medical students across all years of medical education.
A systematic literature review was performed using PubMed, PsycINFO, EThOS, EMBASE, PEDro and SCOPUS. Search terms were composed of interprofession*, interprofessional education, inter professional, inter professionally, IPE, and medical student. Inclusion criteria were 1) the use of a validated scale for assessment of attitudes towards IPE, and results for more than 35 medical students; 2) peer-reviewed articles in English and German, including medical students; and 3) results for IPE interventions published after the 2011 Interprofessional Education Collaborative (IPEC) report. We identified and screened 3995 articles. After elimination of duplicates or non-relevant topics, 278 articles remained as potentially relevant for full text assessment. We used a data extraction form including study designs, training methods, participant data, assessment measures, results, and medical year of participants for each study. A planned comprehensive meta-analysis was not possible.
This systematic review included 23 articles with a pre-test-post-test design. Interventions varied in their type and topic. Duration of interventions varied from 25 min to 6 months, and interprofessional groups ranged from 2 to 25 students. Nine studies (39%) reported data from first-year medical students, five (22%) from second-year students, six (26%) from third-year students, two (9%) from fourth-year students and one (4%) from sixth-year students. There were no studies including fifth-year students. The most frequently used assessment method was the Readiness for Interprofessional Learning Scale (RIPLS) (n = 6, 26%). About half of study outcomes showed a significant increase in positive attitudes towards interprofessional education after interventions across all medical years.
This systematic review showed some evidence of a post-intervention change of attitudes towards IPE across different medical years studied. IPE was successfully introduced both in pre-clinical and clinical years of the medical curriculum. With respect to changes in attitudes to IPE, we could not demonstrate a difference between interventions delivered in early and later years of the curriculum.
PROSPERO registration number: CRD42020160964 .
Mini Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) are used as formative assessments worldwide. Since an up-to-date comprehensive synthesis of the ...educational impact of Mini-CEX and DOPS is lacking, we performed a systematic review. Moreover, as the educational impact might be influenced by characteristics of the setting in which Mini-CEX and DOPS take place or their implementation status, we additionally investigated these potential influences.
We searched Scopus, Web of Science, and Ovid, including All Ovid Journals, Embase, ERIC, Ovid MEDLINE(R), and PsycINFO, for original research articles investigating the educational impact of Mini-CEX and DOPS on undergraduate and postgraduate trainees from all health professions, published in English or German from 1995 to 2016. Educational impact was operationalized and classified using Barr's adaptation of Kirkpatrick's four-level model. Where applicable, outcomes were pooled in meta-analyses, separately for Mini-CEX and DOPS. To examine potential influences, we used Fisher's exact test for count data.
We identified 26 articles demonstrating heterogeneous effects of Mini-CEX and DOPS on learners' reactions (Kirkpatrick Level 1) and positive effects of Mini-CEX and DOPS on trainees' performance (Kirkpatrick Level 2b; Mini-CEX: standardized mean difference (SMD) = 0.26, p = 0.014; DOPS: SMD = 3.33, p<0.001). No studies were found on higher Kirkpatrick levels. Regarding potential influences, we found two implementation characteristics, "quality" and "participant responsiveness", to be associated with the educational impact.
Despite the limited evidence, the meta-analyses demonstrated positive effects of Mini-CEX and DOPS on trainee performance. Additionally, we revealed implementation characteristics to be associated with the educational impact. Hence, we assume that considering implementation characteristics could increase the educational impact of Mini-CEX and DOPS.
Previous studies concerning humidified, heated high-flow nasal oxygen delivered in spontaneously breathing patients postulated an increase in functional residual capacity as one of its physiological ...effects. It is unclear wheter this is also true for patients under general anesthesia. The sincle-center noninferiority trial was registered at ClinicalTrials.gov (NCT NCT03478774). This secondary outcome analysis shows estimated differences in lung volume changes using electrical impedance tomography between different flow rates of 100% oxygen in apneic, anesthetized and paralyzed adults prior to intubation. One hundred and twenty five patients were randomized to five groups with different flow rates of 100% oxygen: i) minimal-flow: 0.25 l.min.sup.-1 via endotracheal tube; ii) low-flow: 2 l.min.sup.-1 + continuous jaw thrust; iii) medium-flow: 10 l.min.sup.-1 + continuous jaw thrust; iv) high-flow: 70l.min.sup.-1 + continuous jaw thrust; and v) control: 70 l.min.sup.-1 + continuous video-laryngoscopy. After standardized anesthesia induction with non-depolarizing neuromuscular blockade, the 15-minute apnea period and oxygen delivery was started according to the randomized flow rate. Continuous electrical impedance tomography measurements were performed during the 15-minute apnea period. Total change in lung impedance (an estimate of changes in lung volume) over the 15-minute apnea period and times to 25%, 50% and 75% of total impedance change were calculated. One hundred and twenty five patients completed the original study. Six patients did not complete the 15-minute apnea period. Due to maloperation, malfunction and artefacts additional 54 measurements had to be excluded, resulting in 65 patients included into this secondary outcome analysis. We found no differences between groups with respect to decrease in lung impedance or curve progression over the observation period. Different flow rates of humidified 100% oxygen during apnea result in comparable decreases in lung volumes. The demonstrated increase in functional residual capacity during spontaneous breathing with high-flow nasal oxygenation could not be replicated during apnea under general anesthesia with neuromuscular blockade.
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