1
|
Michaud V, Morel B, Adamsbaum C, Bruneau B, Lenoir M, Petit P, Leiber LM, Blondiaux E, Brunereau L, Remérand F, Brisse HJ, Laffon M. French survey of sedation practices for pediatric magnetic resonance and computed tomography imaging. Pediatr Radiol 2023; 53:1669-1674. [PMID: 36932258 DOI: 10.1007/s00247-023-05635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Pediatric magnetic resonance imaging (MRI) and computed tompgraphy (CT) require patient immobility and therefore often require sedation or general anesthesia of patients. Consensus on these procedures is lacking in France. OBJECTIVE Thus, the aim of this study was to describe the current sedation practices for pediatric MRI and CT in France. MATERIAL AND METHODS From January 2019 to December 2019, an online questionnaire was delivered by electronic mail to a representative radiologist in 60 pediatric radiology centers registered by the French-speaking pediatric and prenatal imaging society. Questions included protocols, drugs used, monitoring and side effects. RESULTS Representatives of 40 of the 60 (67%) radiology centers responded to the survey. Among them, 31 performed sedation including 17 (55%) centers where radiologists performed sedation without anesthesiologists present during the procedure. The premedication drugs were hydroxyzine (n = 8, 80%) and melatonin (n = 2, 20%), Sedation drugs used for children ages 0 to 6 years old were pentobarbital (n = 9, 60%), midazolam (n = 2, 13%), chloral hydrate (n = 2, 13%), diazepam (n = 1, 6.5%) and chlorpromazine (n = 1, 6.5%). A written sedation protocol was available in 10/17 (59%) centers. In 6/17 (35%) centers, no monitoring was used during the procedures. Blood pressure monitoring and capnography were rarely used (< 10%) and post-sedation monitoring was heterogeneous. No life-threatening adverse effect was reported, but 6 centers reported at least one incident per year. CONCLUSION For half of the responding radiology centers, radiologists performed sedation alone in agreement with the local anesthesiology team. Sedation procedures and monitoring were heterogenous among centers. Adjustment and harmonization of the practices according to the capacity of each center may be useful.
Collapse
Affiliation(s)
- Valentin Michaud
- Anesthesia and Intensive Care Department, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France.
| | - Baptiste Morel
- UMR 1253, iBrain, Inserm, University of Tours, 37000, Tours, France
| | - Catherine Adamsbaum
- Pediatric Radiology Department, University of Paris Saclay, AP-HP, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, France
| | - Bertrand Bruneau
- Radiology Department, University Hospital of Rennes, 35200, Rennes, France
| | - Marion Lenoir
- Radiology Department, University Medical Center, 25000, Besançon, France
| | - Philippe Petit
- Pediatric and prenatal imaging unit, Aix Marseille University, La Timone-Enfants Hospital, 13005, Marseille, France
| | - Louis-Marie Leiber
- Department of Radiology, University Hospital of Angers, 49000, Angers, France
| | - Eléonore Blondiaux
- Department of Radiology, Trousseau Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Laurent Brunereau
- Radiology Department, University Hospital of Tours, 37000, Tours, France
| | - Francis Remérand
- Anesthesia and Intensive Care Department, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France
| | - Hervé J Brisse
- Imaging Department, Institut Curie, 75005, Paris, France
| | - Marc Laffon
- Anesthesia and Intensive Care Department, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France
| |
Collapse
|
2
|
Iyeyasu JN, Cecilio-Fernandes D, de Carvalho KM. Longitudinal evaluation of the Ophthalmology residents in Brazil: an observational prospective study. SAO PAULO MED J 2022; 141:e202292. [PMID: 36197351 PMCID: PMC10065116 DOI: 10.1590/1516-3180.2022.0092.r1.01072022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The longitudinal evaluation of students seems to be a better way to assess their knowledge compared with that of the traditional methods of evaluation, such as modular and final tests. Currently, progress testing is the most consolidated type of longitudinal testing method. However, despite being well consolidated as an assessment tool in medical education, the use of this type of test in residency programs is scarce. OBJECTIVES This study aimed to investigate residents' knowledge growth regarding residency training and to describe the implementation of a longitudinal evaluation test in ophthalmological residency training across several medical schools in Brazil. Finally, the study aimed to check whether performance in the tests can be used as a predictor of the results of the specialist title test. DESIGN AND SETTING This was a prospective observational study. This study was conducted using an online platform. METHODS Online tests were developed following the same pattern as the Brazilian Ophthalmology Council specialist tests. All the residents performed the test simultaneously. The tests were conducted once a year at the end of the school year. RESULTS A progress test was conducted across 13 services with 259 residents. Our results demonstrated that resident scores improved over the years (P < 0.0001) and had a moderate correlation with the Brazilian Opthalmology Council specialist test (P = 0.0156). CONCLUSION The progress test can be considered a valuable tool to assess knowledge, meaning their knowledge increased over residency training. In addition, it can be used as a predictor of the result in the specialist title test.
Collapse
Affiliation(s)
- Josie Naomi Iyeyasu
- MD. Ophthalmologist and Assistant Doctor, Low Vision and
Strabismus Sector, Hospital de Clínicas, Faculdade de Ciências Médicas da
Universidade Estadual de Campinas (HC/FCM/UNICAMP), Campinas (SP), Brazil
| | - Dario Cecilio-Fernandes
- Psy, MSc, PhD. Psycologist and Researcher, Department of
Psychology and Psychiatry, Faculdade de Ciências Médicas da Universidade
Estadual de Campinas (FCM/UNICAMP), Campinas (SP), Brazil
| | - Keila Monteiro de Carvalho
- MD. Ophthalomologist and Full Professor, Faculty of Medical
Sciences, Universidade Estadual de Campinas (UNICAMP); and Chief Department of
Ophthalmo-Otorrynolaringology, Faculdade de Ciências Médicas da Universidade
Estadual de Campinas (FCM/UNICAMP), Campinas (SP), Brazil
| |
Collapse
|
3
|
Lecler A, Hage R, Charbonneau F, Vignal C, Sené T, Picard H, Leturcq T, Zuber K, Belangé G, Affortit A, Sadik JC, Savatovsky J, Clavel G. Validation of a multimodal algorithm for diagnosing giant cell arteritis with imaging. Diagn Interv Imaging 2021; 103:103-110. [PMID: 34663548 DOI: 10.1016/j.diii.2021.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this study was to identify which combination of imaging modalities should be used to obtain the best diagnostic performance for the non-invasive diagnosis of giant cell arteritis (GCA). MATERIALS AND METHODS This IRB-approved prospective single-center study enrolled participants presenting with a suspected diagnosis of GCA from December 2014 to October 2017. Participants underwent high-resolution 3T magnetic resonance imaging (MRI), temporal and extra-cranial arteries ultrasound and retinal angiography (RA), prior to temporal artery biopsy (TAB). Diagnostic accuracy of each imaging modality alone, then a combination of several imaging modalities, was evaluated. Several algorithms were constructed to test optimal combinations using McNemar test. RESULTS Forty-five participants (24 women, 21 men) with mean age of 75.4 ± 16 (SD) years (range: 59-94 years) were enrolled; of these 43/45 (96%) had ophthalmological symptoms. Diagnosis of GCA was confirmed in 25/45 (56%) patients. Sensitivity and specificity of MRI, ultrasound and RA alone were 100% (25/25; 95% CI: 86-100) and 86% (19/22; 95% CI: 65-97), 88% (22/25; 95% CI: 69-97) and 84% (16/19; 95% CI: 60-97), 94% (15/16; 95% CI: 70-100) and 74% (14/19; 95% CI: 49-91), respectively. Sensitivity, specificity, positive predictive and negative predictive values ranged from 95 to 100% (95% CI: 77-100), 67 to 100% (95% CI: 38-100), 81 to 100% (95% CI: 61-100) and 91 to 100% (95% CI: 59-100) when combining several imaging tests, respectively. The diagnostic algorithm with the overall best diagnostic performance was the one starting with MRI, followed either by ultrasound or RA, yielding 100% sensitivity (22/22; 95% CI: 85-100%) 100% (15/15; 95% CI: 78-100) and 100% accuracy (37/37; 95% CI: 91-100). CONCLUSION The use of MRI as the first imaging examination followed by either ultrasound or RA reaches high degrees of performance for the diagnosis of GCA and is recommended in daily practice.
Collapse
Affiliation(s)
- Augustin Lecler
- Department of Radiology, Rothschild Hospital Foundation, 75019 Paris, France.
| | - Rabih Hage
- Department of Ophthalmology, Rothschild Hospital Foundation, 75019 Paris, France
| | | | - Catherine Vignal
- Department of Ophthalmology, Rothschild Hospital Foundation, 75019 Paris, France
| | - Thomas Sené
- Department of Internal Medicine, Rothschild Hospital Foundation, 75019 Paris, France
| | - Hervé Picard
- Clinical Research Unit, Rothschild Hospital Foundation, 75019 Paris, France
| | - Tifenn Leturcq
- Department of Internal Medicine, Rothschild Hospital Foundation, 75019 Paris, France
| | - Kevin Zuber
- Clinical Research Unit, Rothschild Hospital Foundation, 75019 Paris, France
| | - Georges Belangé
- Department of Internal Medicine, Rothschild Hospital Foundation, 75019 Paris, France
| | - Aude Affortit
- Department of Ophthalmology, Rothschild Hospital Foundation, 75019 Paris, France
| | - Jean-Claude Sadik
- Department of Radiology, Rothschild Hospital Foundation, 75019 Paris, France
| | - Julien Savatovsky
- Department of Radiology, Rothschild Hospital Foundation, 75019 Paris, France
| | - Gaëlle Clavel
- Department of Internal Medicine, Rothschild Hospital Foundation, 75019 Paris, France
| |
Collapse
|
4
|
Zhang J, Han X, Yang Z, Wang Z, Zheng J, Yang Z, Zhu J. Radiology residency training in China: results from the first retrospective nationwide survey. Insights Imaging 2021; 12:25. [PMID: 33595737 PMCID: PMC7889775 DOI: 10.1186/s13244-021-00970-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives This was the first study to systematically landscape and examine China’s nationwide standardized residency training in radiology. Methods In this retrospective cross-sectional study, we used data from the 2019 national survey of the first two cohorts of 3679 radiology residents who completed training in 2017 and 2018 across all 31 provinces in China. A total of 1163 (32%) residents participated in the survey. Multivariable logistic regression was used to examine the implementation frequency of 24 identified training tasks (categorized into six competencies) by region, demographics, and other residency information. Results Among the 1163 respondents, 592 (51%) were trained in the more developed eastern region. Of the 24 identified training tasks, 15 were implemented significantly differently across regions, while the frequency of the most frequently conducted tasks (e.g., CT, MR, and radiograph interpretation and reporting) was consistent. The top 10 tasks all fell into the patient care and medical knowledge competency domains, while other competencies tended to be neglected. We found region and marital status were the most influential factors of training task implementation frequencies. Respondents trained in the northeast and the west were more likely to report, for instance, radiological examination recommendation (OR = 1.91, 95%CI = 1.27–2.88), as “very frequent.” Married respondents were more likely to report first-line night shift as “very frequent” (OR = 1.71, 95%CI = 1.29–2.26). Conclusions Despite the fast-win achievements of developing a national radiology residency training program, there is a gap to train quality and homogeneous radiologists across regions. Future improvement should be more tailored to residents’ personal characteristics and emphasize some “soft” competencies (e.g., communication skills).
Collapse
Affiliation(s)
- Jingfeng Zhang
- Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Xinxin Han
- School of Medicine, Tsinghua University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zheng
- Department of Radiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zimo Yang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China.
| |
Collapse
|
5
|
Implementation of the Clinically Oriented Reasoning Evaluation: Impact on the European Diploma in Radiology (EDiR) exam. Insights Imaging 2020; 11:45. [PMID: 32128635 PMCID: PMC7054579 DOI: 10.1186/s13244-020-00844-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022] Open
Abstract
The aim of the study is to perform an analysis of the results that have been compiled in the nine years that the examination has existed.
Collapse
|