Impact of repeated simulation on learning curve characteristics of residents exposed to rare life threatening situations

BackgroundLittle is known about the learning curve characteristics of residents undertaking simulation-based education. It is important to understand the time for acquisition and decay of knowledge and skills needed to manage rare and difficult clinical situations.MethodTen anaesthesiology residents underwent simulation-based education to manage a cannot intubate cannot ventilate scenario during general anaesthesia for caesarean section. Their performance was measured using an assessment tool and debriefed by two experienced anaesthesiologists. The parameters against which the performance was judged were grouped into preoperative assessment, preoperative patient care, equipment availability, induction sequence, communication and adherence to airway algorithm protocol. The scenario was repeated at 6 and 12 months thereafter. The residents’ acquisition of knowledge, technical and non-technical skills were assessed and compared at baseline, 6 months and end of 12 months.ResultThe skills of preoperative assessment, preoperative care and communication quickly improved but the specific skill of managing a difficult airway as measured by adherence to an airway algorithm required more than 6 months (CI at 6 vs 12 months: −3.4 to –0.81, p=0.016). The skills of preoperative assessment and preoperative care improved to a higher level quickly and were retained at this improved level. Communication (CI at 0 vs 6 months: −3.78 to −0.22, p=0.045 and at 6 vs 12 months : −3.39 to −1.49, p=0.007) and difficult airway management skill were slower to improve but continued to do so over the 12 months. The compliance to machine check was more gradual and showed an improvement at 12 months.ConclusionOur study is unique in analysing the learning curve characteristics of different components of a failed obstetric airway management skill. Repeated simulations over a longer period of time help in better reinforcement, retention of knowledge, recapitulation and implementation of technical and non-technical skills.

SVT induction

This case considers an unusual supraventricular tachycardia induction sequence

Capturing and Unmasking the Mask in the Auditory Attentional Blink

Key to our understanding of the temporal limits of attention as reflected in the attentional blink (AB) – the failure to report the second of two targets (T1 and T2) presented in close succession – is the detrimental impact of posttarget distractors, accounted for typically by the construct of masking. Within the context of the auditory AB, we tested the notion of masking by seeking to perceptually “capture” the T2 + 1 distractor away from the target-containing sequence to examine whether perceptual organizational factors could, instead, explain the action of T2 + 1. Using monaural sequences of tones, the presentation of T2 + 1 contralaterally to the rest of the sounds produced the AB. However, the AB was abolished when that contralateral T2 + 1 was perceptually grouped with an induction sequence of irrelevant tones presented to the contralateral ear. Such findings are consistent with a selection-based approach to the AB that emphasizes failure of inhibition and misselection while suggesting a diminished role for masking.

Hypnosis of preschool age children for anxiety reduction in dentistry

- Hypnosis of preschool age children for anxiety reduction in dentistry. A non-verbal hypnotic induction technique for three year old children at their first dental visit rapidly reduces anxiety. The mind set is done via pre-mailed printed materials. The induction sequence is as follows: Adjust shoes and socks, examine fingers, measure height, assist arm levitation, and praise. The key is to allow the child to feel in control, while the dentist acts as a guide. Proceeding against a child's will, destroys hard earned trust forever. Technical procedures require detailed progressive desensitization. Operator patience and painless techniques are most important.Key words: hypnosis, children, non-verbal, dentist, progressive, desensitization.Parole chiave: ipnosi, bambini, non-verbale, dentista, desensibilizzazione progressiva.

Identification of developmental regulatory genes in Aspergillus nidulans by overexpression.

Overexpression of several Aspergillus nidulans developmental regulatory genes has been shown to cause growth inhibition and development at inappropriate times. We set out to identify previously unknown developmental regulators by constructing a nutritionally inducible A. nidulans expression library containing small, random genomic DNA fragments inserted next to the alcA promoter [alcA(p)] in an A. nidulans transformation vector. Among 20,000 transformants containing random alcA(p) genomic DNA fusion constructs, we identified 66 distinct mutant strains in which alcA(p) induction resulted in growth inhibition as well as causing other detectable phenotypic changes. These growth inhibited mutants were divided into 52 FIG (Forced expression Inhibition of Growth) and 14 FAB (Forced expression Activation of brlA) mutants based on whether or not alcA(p) induction resulted in accumulation of mRNA for the developmental regulatory gene brlA. In four FAB mutants, alcA(p) induction not only activated brlA expression but also caused hyphae to differentiate into reduced conidiophores that produced viable spores from the tips as is observed after alcA(p)::brlA induction. Sequence analyses of the DNA fragments under alcA(p) control in three of these four sporulating strains showed that in two cases developmental activation resulted from overexpression of previously uncharacterized genes, whereas in the third strain, the alcA(p) was fused to brlA. The potential uses for this strategy in identifying genes whose overexpression results in specific phenotypic changes like developmental induction are discussed.

Structure of an interferon-α2 gene expressed in the bovine conceptus early in gestation

ABSTRACT Genomic and cDNA clones for bovine trophoblast interferon (IFN) have been isolated by probing a bovine genomic library and a bovine embryonic (day-18 post coitus) cDNA library respectively with the ovine trophoblast IFN cDNA. The two DNA sequences were identical; sequence analysis demonstrated 80% identity between the amino acid sequence of bovine trophoblast IFN and ovine trophoblast IFN, and 70% identity with a previously identified bovine IFN-α2. Southern blotting of bovine genomic DNA indicated the presence of a minimum of three trophoblast IFN genes. Primer extension analysis identified the transcription start site in the 5′ flanking region of the bovine IFN gene. Computer-aided analysis of the 5′ flanking sequence demonstrated a similarity with that of bovine IFN-α2 and the existence of a possible viral induction sequence.