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Gungor I, Gunaydin B, Buyukgebiz Yeşil BM, Bagcaz S, Ozdemir MG, Inan G, Oktar SO. Evaluation of the effectiveness of artificial intelligence for ultrasound guided peripheral nerve and plane blocks in recognizing anatomical structures. Ann Anat 2023; 250:152143. [PMID: 37572764 DOI: 10.1016/j.aanat.2023.152143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND We aimed to assess the accuracy of artificial intelligence (AI) based real-time anatomy identification for ultrasound-guided peripheral nerve and plane block in eight regions in this prospective observational study. METHODS After obtaining ethics committee approval and written informed consent from 40 healthy volunteers (20 men and 20 women, between 18 and 72 years old), an ultrasound device installed with AI software (Nerveblox, SmartAlfa, Turkey) were used to scan regions of the cervical plexus, brachial plexus, pectoralis (PECS), rectus sheet, femoralis, canalis adductorius, popliteal, and ESP by three anesthesiology trainees. During scanning by a trainee, once software indicates 100 % scan success of associated anatomic landmarks, both raw and labeled ultrasound images were saved, assessed, and validated using a 6-point scale between 0 and 5 by two expert validators. Evaluation scores of the validators for each block were compared according to demographics (gender, age, and BMI) and block type exists. RESULTS The scores were not different except ESP, femoralis, and cervical plexus regions between the experts. The mean scores of the experts for the PECS, popliteal and rectus sheath were significant between males and females (p < 0.05). In terms of BMI, significant differences in the scores were observed only in the canalis adductorius, brachial plexus, and ESP regions (p < 0.05). CONCLUSIONS Ultrasound guided AI-based anatomy identification was performed in commonly used eight block regions by the trainees where AI technology can successfully interpret the anatomical structures in real-time sonography which would be valuable in assisting anesthesiologists.
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Affiliation(s)
- Irfan Gungor
- Gazi University Faculty of Medicine, Department of Anesthesiology & Reanimation, Ankara, Besevler 06500, Turkey
| | - Berrin Gunaydin
- Gazi University Faculty of Medicine, Department of Anesthesiology & Reanimation, Ankara, Besevler 06500, Turkey.
| | - Beyza M Buyukgebiz Yeşil
- Gazi University Faculty of Medicine, Department of Anesthesiology & Reanimation, Ankara, Besevler 06500, Turkey
| | - Selin Bagcaz
- Gazi University Faculty of Medicine, Department of Anesthesiology & Reanimation, Ankara, Besevler 06500, Turkey
| | - Miray Gozde Ozdemir
- Gazi University Faculty of Medicine, Department of Anesthesiology & Reanimation, Ankara, Besevler 06500, Turkey
| | - Gozde Inan
- Gazi University Faculty of Medicine, Department of Anesthesiology & Reanimation, Ankara, Besevler 06500, Turkey
| | - Suna O Oktar
- Gazi University Faculty of Medicine, Department of Radiology, Ankara, Besevler 06500, Turkey
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Akavipat P, Suraseranivongse S, Yimrattanabowon P, Sriraj W, Ratanachai P, Summart U. Anesthesia workforce capacity in Thailand: A multicenter study. WHO South East Asia J Public Health 2022; 10:5-11. [PMID: 35046151 DOI: 10.4103/who-seajph.who-seajph_305_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Workforce management in anesthesia services is crucial for service quality. However, the data associated with this are lacking. Therefore, this study was done to analyze workforce and workload and to compare differences among hospital clusters in Thailand. Materials and Methods We conducted a cross-sectional study in multilevel hospitals that were classified by location, the population cared for, and the categorization of physicians. Stratified randomization from all health service regions across Thailand was done. The profile of hospitals, number of anesthesia staffs, their capabilities, and ratio of anesthesia personnel to the service provided during the 5 workdays and 1 weekend period were analyzed. Results A total of 18 hospitals, ranging from secondary to super-tertiary referral centers, were included in the study. The mean number of personnel ranged from 2.0 ± 1.2 to 12.0 ± 0 for anesthesiologists and 7.5 ± 2.9 to 42.3 ± 19.3 for nurse anesthetists from each hospital cluster, which vary in terms of capabilities and the number of staff. The average number of anesthesia service units was 9.1 ± 4.2 to 31.9 ± 16.4, while the number of operating theaters was 6.9 ± 2.2 to 22.7 ± 8.3. However, the ratio of anesthesia personnel to one anesthesia service unit and the ratio of these personnel to an operating theater were not significantly different among the participating hospitals, with a mean of 0.94 ± 0.45 and 1.34 ± 0.38, respectively. Conclusion The overall number of anesthesia service units was above the designated operating theater capacity, while the ratio of anesthesiologists was 0.8-1.3 and nurse anesthetists was 2.4-6.5 per 100,000 people on an average, with a disproportionate responsibility ratio of anesthesia personnel to anesthesia service units during that time.
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Affiliation(s)
- Phuping Akavipat
- Anesthesiology Department, Neurological Institute of Thailand, Bangkok, Thailand
| | | | | | - Wimonrat Sriraj
- Department of Anesthesiology and Clinical Epidemiology Unit, Khon Kaen University, Khon Kaen, Thailand
| | - Prapa Ratanachai
- Department of Anesthesiology, Hatyai Hospital, Songkla, Thailand
| | - Ueamporn Summart
- Anesthesiology Department, Neurological Institute of Thailand, Bangkok, Thailand
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Greenberg MR, Lawrence MB, Chen F, Ross EM. Piloting a New Curriculum: Guided At-Home Pediatric Regional Anesthesia Education Using a Portable Ultrasound. Cureus 2021; 13:e17933. [PMID: 34660123 PMCID: PMC8513732 DOI: 10.7759/cureus.17933] [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] [Accepted: 09/13/2021] [Indexed: 11/09/2022] Open
Abstract
Ultrasound-guided regional anesthesia is the standard of care for most regional blocks in pediatric anesthesiology.Training programs must educate physicians to perform regional blocks safely and efficiently. Hands-on learning with simulation and live models is the gold standard. The coronavirus disease 2019 (COVID-19) pandemic has greatly hampered our ability to safely hold in-person workshops. We describe an at-home, guided virtual workshop using portable ultrasound to safely continue experiential trainee education. The primary objective of this pilot virtual workshop was to develop an effective experiential learning program without the need for live child models. The main goal was to give trainees hands-on experience obtaining anatomical ultrasound images necessary for regional anesthesia blocks in a guided-virtual setting and to evaluate the effectiveness of skills acquisition. This workshop included two pediatric anesthesiology fellows and a pediatric anesthesiologist. Trainees were instructed on ultrasound-guided regional block acquisition. For two weeks, trainees acquired images/movies of regional block anatomy at home using their own children. Virtual video assistance was available. Trainees then used acquired images/movies to discuss needle and local anesthetic placement with a pediatric regional anesthesiologist. Trainees completed pre- and post-workshop surveys assessing attitudes, perceived educational efficacy, and procedural skill acquisition. The faculty member also assessed trainees’ skills. The virtual workshop was successful. Trainees expressed successful active learning and increased comfort in performing regional blocks on live patients. They correctly identified relevant anatomy of acquired images/movies, as well as needle and local anesthetic placement at the time of debriefing. Faculty were pleased with trainees’ initial performance of regional blocks. Adapting an in-person workshop to an at-home guided experience is a safe, feasible, and well-received method for anesthesiology trainees to obtain experiential learning of ultrasound-guided regional anesthesia. This facilitated at-home learning experience allows for hands-on skill practice while preventing exposure of child models to the hospital setting during a pandemic.
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Affiliation(s)
- Michael R Greenberg
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Marley B Lawrence
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Fei Chen
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Elizabeth M Ross
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
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Scallan EM, Voges AK, Chaney KP, Coursey CD, Simon BT. The Effects of Content Delivery Methods on Ultrasound Knobology and Image Quality Recognition Training in First-Year Veterinary Students. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:65-70. [PMID: 31738682 DOI: 10.3138/jvme.2019-0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As new technologies are incorporated into the practice of veterinary medicine, it is imperative we utilize the most effective and impactful content delivery methods. Ultrasound technology has become more affordable and compact for veterinary hospitals, leading to easier incorporation into practice. This study compares three methods of delivering ultrasound knobology content to first-year veterinary students at Texas A&M University College of Veterinary Medicine and Biomedical Sciences. In a prospective study, first-year veterinary students were randomly selected to receive one of three content delivery methods: self-directed active learning (SDL), in-person instructor demonstration, or online module instruction. Knowledge acquisition was assessed using a 10-question quiz for short-term understanding followed by a 10-question quiz after a 6-week period to assess long-term knowledge retention. Student demographics were analyzed using the Chi-square test. Quiz scores were analyzed between groups using Kruskal-Wallis tests followed by Dunn's post-tests for multiple comparisons. Values of p ≤ .05 were considered significant. On the short-term and retention quiz questions, students participating in SDL scored significantly higher (10 [5-10]) than those receiving in-person instructor demonstration (9 [3-10] p = .01 and 8 [2-10] p = .0004, respectively) or the online module instruction training (Group C) (6 [1-10] p < 0.0001 and 8 [4-10] p < .001, respectively). Based on quiz scores, veterinary students exhibited better ultrasound knobology and image quality recognition proficiency immediately and at 6-weeks following SDL when compared with other content delivery methods. Self-directed learning methods are recommended when teaching ultrasonography to veterinary students.
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Sidhu NS, Chuan A, Mitchell CH. Recommendations and resources for regional anaesthesia Fellowships in Australia and New Zealand. Anaesth Intensive Care 2019; 47:452-460. [PMID: 31438720 DOI: 10.1177/0310057x19861113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Regional anaesthesia is a fundamental aspect of anaesthesia practice. Structured Fellowships in regional anaesthesia facilitate the development of expert clinicians, scholars and future leaders. The Australian and New Zealand College of Anaesthetists accredits training sites for the final year of Fellowship training but does not outline specific guidance for subspecialty training. Based on evidence from a systematic literature review and best-practice medical education principles, the ideal structure for a regional anaesthesia Fellowship programme in Australia and New Zealand is outlined in four categories: (a) structure and duration of training; (b) educational aspects; (c) institutional organization; (d) evaluation and improvement. Departments may use this resource to help design, implement and improve their Fellowship programmes while trainees may employ it as a reference to achieve their learning goals at any training stage. Continuing professional education plays a central role in achieving and maintaining mastery of regional anaesthesia competencies.
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Affiliation(s)
- Navdeep S Sidhu
- Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Alwin Chuan
- South West Sydney Clinical School, University of New South Wales, Sydney, Australia
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Bessmann EL, Østergaard HT, Nielsen BU, Russell L, Paltved C, Østergaard D, Konge L, Nayahangan LJ. Consensus on technical procedures for simulation-based training in anaesthesiology: A Delphi-based general needs assessment. Acta Anaesthesiol Scand 2019; 63:720-729. [PMID: 30874309 DOI: 10.1111/aas.13344] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/21/2018] [Accepted: 01/30/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anaesthesiologists are expected to master an increasing number of technical procedures. Simulation-based procedural training can supplement and, in some areas, replace the classical apprenticeship approach during patient care. However, simulation-based training is very resource-intensive and must be prioritised and optimised. Developing a curriculum for simulation-based procedural training should follow a systematic approach, eg the Six-Step Approach developed by Kern. The aim of this study was to conduct a national general needs assessment to identify and prioritise technical procedures for simulation-based training in anaesthesiology. METHODS A three-round Delphi process was completed with anaesthesiology key opinion leaders. In the first round, the participants suggested technical procedures relevant to simulation-based training. In the second round, a needs assessment formula was used to explore the procedures and produce a preliminary prioritised list. In the third round, participants evaluated the preliminary list by eliminating and re-prioritising the procedures. RESULTS All teaching departments in Denmark were represented with high response rates in all three rounds: 79%, 77%, and 75%, respectively. The Delphi process produced a prioritised list of 30 procedure groups suitable for simulation-based training from the initial 138 suggestions. Top-5 on the final list was cardiopulmonary resuscitation, direct- and video laryngoscopy, defibrillation, emergency cricothyrotomy, and fibreoptic intubation. The needs assessment formula predicted the final prioritisation to a great extent. CONCLUSION The Delphi process produced a prioritised list of 30 procedure groups that could serve as a guide in future curriculum development for the simulation-based training of technical procedures in anaesthesiology.
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Affiliation(s)
- Ebbe L. Bessmann
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Helle T. Østergaard
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Anaesthesia Herlev Hospital Herlev Denmark
| | - Bjørn U. Nielsen
- TechSim ‐ The Technical Simulation Centre of Southern Denmark Odense University Hospital Odense Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Department of Anaesthesia Zealand University Hospital Roskilde Denmark
- Department of Intensive Care 4131 Copenhagen University Hospital / Rigshospitalet Copenhagen Denmark
| | - Charlotte Paltved
- MidtSim ‐ Centre for Human Resources, Central Region of Denmark Aarhus University Aarhus Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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Abstract
OBJECTIVES Education in regional anaesthesia covers several complex and diverse areas, from theoretical aspects to procedural skills, professional behaviours, simulation, curriculum design and assessment. The objectives of this study were to summarise these topics and to prioritise these topics in order of research importance. DESIGN Electronic structured Delphi questionnaire over three rounds. SETTING International. PARTICIPANTS 38 experts in regional anaesthesia education and training, identified through the American Society of Regional Anesthesia Education Special Interest Group research collaboration. RESULTS 82 topics were identified and ranked in order of prioritisation. Topics were categorised into themes of simulation, curriculum, knowledge translation, assessment of skills, research methodology, equipment and motor skills. Thirteen topics were ranked as essential research priority, with four topics each on simulation and curriculum, three topics on knowledge translation, and one topic each on methodology and assessment. CONCLUSIONS Researchers and educators can use these identified topics to assist in planning and structuring their research and training in regional anaesthesia education.
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Affiliation(s)
- Alwin Chuan
- Faculty of Medicine, University of New South Wales, Liverpool, New South Wales, Australia
- Department of Anaesthesia, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Reva Ramlogan
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Kim TE, Tsui BCH. Simulation-based ultrasound-guided regional anesthesia curriculum for anesthesiology residents. Korean J Anesthesiol 2018; 72:13-23. [PMID: 30481945 PMCID: PMC6369343 DOI: 10.4097/kja.d.18.00317] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 01/22/2023] Open
Abstract
Proficiency in ultrasound-guided regional anesthesia (UGRA) requires the practitioner to acquire cognitive and technical skills. For anesthesiology residents, an assortment of challenges has been identified in learning UGRA skills. Currently, a validated UGRA curriculum for residents does not exist, and the level of UGRA proficiency achieved during residency training can vary considerably. Simulated practice has been shown to enhance proficiency in UGRA, and a competency-based education with simulation training has been endorsed for anesthesiology residents. The objective of this review is to outline simulation-based training that can be implemented in a UGRA curriculum and to explore educational tools like gamification to facilitate competency in regional anesthesiology.
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Affiliation(s)
- T Edward Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ban C H Tsui
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Anaesthesia in austere environments: literature review and considerations for future space exploration missions. NPJ Microgravity 2018; 4:5. [PMID: 29507873 PMCID: PMC5824960 DOI: 10.1038/s41526-018-0039-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 01/28/2023] Open
Abstract
Future space exploration missions will take humans far beyond low Earth orbit and require complete crew autonomy. The ability to provide anaesthesia will be important given the expected risk of severe medical events requiring surgery. Knowledge and experience of such procedures during space missions is currently extremely limited. Austere and isolated environments (such as polar bases or submarines) have been used extensively as test beds for spaceflight to probe hazards, train crews, develop clinical protocols and countermeasures for prospective space missions. We have conducted a literature review on anaesthesia in austere environments relevant to distant space missions. In each setting, we assessed how the problems related to the provision of anaesthesia (e.g., medical kit and skills) are dealt with or prepared for. We analysed how these factors could be applied to the unique environment of a space exploration mission. The delivery of anaesthesia will be complicated by many factors including space-induced physiological changes and limitations in skills and equipment. The basic principles of a safe anaesthesia in an austere environment (appropriate training, presence of minimal safety and monitoring equipment, etc.) can be extended to the context of a space exploration mission. Skills redundancy is an important safety factor, and basic competency in anaesthesia should be part of the skillset of several crewmembers. The literature suggests that safe and effective anaesthesia could be achieved by a physician during future space exploration missions. In a life-or-limb situation, non-physicians may be able to conduct anaesthetic procedures, including simplified general anaesthesia.
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