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Katz D, Hyers B, Patten E, Sarte D, Loo M, Burnett GW. Relationship between demographic and social variables and performance in virtual reality among healthcare personnel: an observational study. BMC Med Educ 2024; 24:227. [PMID: 38439056 PMCID: PMC10981290 DOI: 10.1186/s12909-024-05180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Virtual reality is emerging as an important component of medical education. Although the benefits of virtual reality are apparent, the optimal strategy to orient to or differentiate learners in the virtual space have not been delineated. The purpose of this study was to investigate the relationships between demographic variables, social variables, and self-perceived comfort with technology to performance on a standardized non-medical virtual reality experience. METHODS This observational study was performed at the International Meeting on Simulation in Healthcare in 2022. This conference includes medical and non-medical attendees. Participants provided demographic information and participated in a scored non-medical VR experience due to the heterogeneity of the sample. Participants then completed a System Usability Index and NASA Task Load Index form. Participants were dividedintolow scoring, medium scoring, and high scoring groups according to their final game score for further analysis. RESULTS 95 participants were included in final analysis. 55 (57.9%) of participants had prior virtual reality experience. Higher scores were associated with younger age (11.09, p < 0.001), identifying as male (11.09, p < 0.001), and a higher frequency of playing video games in the past (18.96, p < 0.001). The high score group was more likely to report comfort with virtual reality (6.29, p = 0.003) as well as comfort with new technology (4.61, p = 0.012). NASA Task Load Index scores trended down and System Usability Index scores trended up with increasing score. Being a nurse was a positive predictor of a higher score when compared to physicians in the multivariate analysis. CONCLUSION Performance during an immersive virtual reality experience was most closely related to age, gender, and frequency of playing video games. Self-perceived comfort with virtual reality was more predictive of score than prior virtual reality experience.
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Affiliation(s)
- Daniel Katz
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, 10029, New York, NY, USA
| | - Benjamin Hyers
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, 10029, New York, NY, USA
| | - Eric Patten
- Department of Academic Learning Environment, Ross University School of Medicine, 1600 SW 80th Terrace, Suite106A, 33324, Plantation, FL, USA
| | - Darren Sarte
- Department of Academic Learning Environment, Ross University School of Medicine, 1600 SW 80th Terrace, Suite106A, 33324, Plantation, FL, USA
| | - Mariano Loo
- Department of Academic Learning Environment, Ross University School of Medicine, 1600 SW 80th Terrace, Suite106A, 33324, Plantation, FL, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Pain, & Perioperative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, 10029, New York, NY, USA.
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Maffucci P, Park CH, Shirur M, Hyers B, Levine AI, Katz D, Burnett GW, Laitman JT. Human dissection for anesthesiology resident training augments anatomical knowledge and clinical skills. Anat Sci Educ 2024; 17:413-421. [PMID: 38124364 DOI: 10.1002/ase.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
Anatomy is an essential component of clinical anesthesiology. The use of simulated patients and alternative materials, including embalmed human bodies, have become increasingly common during resident physician training due to the deemphasis on anatomical education during undergraduate medical training. In this report, the need for a more extensive review of relevant anatomy for the practice of anesthesiology was addressed by the design, evaluation, and dissemination of a human dissection course for procedural training of anesthesiology residents. The course utilized "freedom art" embalmed human bodies that allowed trainees to perform ultrasound-based regional and neuraxial techniques followed by detailed dissections of critical anatomy. One hundred and four residents participated in workshops and small group discussions and were evaluated using pre- and post-course assessments. A variety of clinical techniques were performed on the bodies, including regional blocks and neuraxial catheter placement. Insertion of peripheral/neuraxial catheters was successful, with dissections demonstrating the expected placement. Assessment scores improved following the course (pre-course mean 52.7%, standard deviation (σ) 13.1%; post-course mean 72.2%, σ 11.6%; t-test p < 0.0001) and feedback highlighted the usefulness and clinical relevance of course content. The ability to correlate ultrasound imaging with subsequent dissections of the "blocked" area and visualization of dye staining was extremely relevant for spatial understanding of the anatomy relevant for the clinical practice of these techniques. This manuscript demonstrates successful implementation of a comprehensive course for anesthesiology resident physicians to address gaps in undergraduate anatomical education and suggests that broader adoption of dissection courses may be beneficial for training anesthesiologists.
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Affiliation(s)
- Patrick Maffucci
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chang H Park
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mo Shirur
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin Hyers
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam I Levine
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey T Laitman
- Center for Anatomy and Functional Morphology, Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Chang DR, Burnett GW, Chiu S, Ouyang Y, Lin HM, Hyman JB. Single-use versus reusable metallic laryngoscopes for non-emergent intubation: A retrospective review of 72,672 intubations. J Clin Anesth 2023; 89:111187. [PMID: 37339555 DOI: 10.1016/j.jclinane.2023.111187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023]
Abstract
STUDY OBJECTIVE Increased regulatory requirements for sterilization in recent years have prompted a widespread transition from reusable to single-use laryngoscopes. The purpose of this study was to determine if the transition from metallic reusable to metallic single-use laryngoscopes impacted the performance of direct laryngoscopy at an academic medical center. DESIGN Single-site retrospective cohort study. SETTING General anesthetic cases requiring tracheal intubation. PATIENTS Adult patients undergoing non-emergent procedures. INTERVENTIONS Data were collected two years before and two years after a transition from metallic reusable to metallic single-use laryngoscopes. MEASUREMENTS The primary outcome was need for intubation rescue with an alternate device. Secondary outcomes were difficult laryngeal view (modified Cormack-Lehane grade ≥ 2b) and hypoxemia (SpO2 < 90% for >30 s) during direct laryngoscopy intubations. Subgroup analyses for rapid sequence induction, Macintosh blades, Miller blades, and patients with difficult airway risk factors (Obstructive Sleep Apnea, Mallampati ≥3, Body Mass Index >30 kg/m2) were performed. MAIN RESULTS In total, 72,672 patients were included: 35,549 (48.9%) in the reusable laryngoscope cohort and 37,123 (51.1%) in the single-use laryngoscope cohort. Compared with reusable laryngoscopes, single-use laryngoscopes were associated with fewer rescue intubations with an alternate device (covariates-adjusted odds ratio [OR] 0.81 95% CI 0.66-0.99). Single-use laryngoscopes were also associated with lower odds of difficult laryngeal view (OR 0.86; 95% CI 0.80-0.93). Single use laryngoscopes were not associated with hypoxemia during the intubation attempt (OR 1.03; 95% CI 0.88-1.20). Similar results were observed for subgroup analyses including rapid sequence induction, Macintosh blades, Miller blades, and patients with difficult airway risk factors. CONCLUSIONS Metallic single-use laryngoscopes were associated with less need for rescue intubation with alternate devices and lower incidence of poor laryngeal view compared to reusable metallic laryngoscopes.
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Affiliation(s)
- Daniel R Chang
- Department of Anesthesiology, Perioperative and Pain medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY 10029, United States.
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY 10029, United States.
| | - Sophia Chiu
- Department of Anesthesiology and Critical Care, University of Pennsylvania, 3400 Spruce Street, Suite 680 Dulles, Philadelphia, PA 19104, United States.
| | - Yuxia Ouyang
- Department of Anesthesiology, Perioperative and Pain medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY 10029, United States.
| | - Hung-Mo Lin
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, United States.
| | - Jaime B Hyman
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, United States.
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Li CJ, Vaile JR, Gal JS, Park CH, Burnett GW. Analgesic options for anterior approach to scoliosis repair: a scoping review. Spine Deform 2023; 11:1031-1040. [PMID: 37233950 DOI: 10.1007/s43390-023-00699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE The ideal analgesic regimen for the anterior approach to scoliosis repair is not clearly defined. The purpose of the study was to summarize and identify gaps in the current literature specific to the anterior approach to scoliosis repair. METHODS A scoping review was conducted in July 2022 utilizing PubMed, Cochrane, and Scopus databases guided by the PRISMA-ScR framework. RESULTS The database search generated 641 possible articles, 13 of which met all inclusion criteria. All articles focused on the effectiveness and safety of regional anesthetic techniques, while a minority also provided both opioid and non-opioid medication frameworks. CONCLUSION Continuous Epidural Analgesia (CEA) is the most well-studied intervention for pain control in anterior scoliosis repair, but other, more novel regional anesthetic techniques offer safe and effective potential alternatives. More research is indicated to compare the effectiveness of different regional techniques and perioperative medication regimens specific to anterior scoliosis repair.
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Affiliation(s)
- Chris J Li
- Sidney Kimmel Medical College, Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - John R Vaile
- Sidney Kimmel Medical College, Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Jonathan S Gal
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Chang H Park
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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Maffucci P, Smith NK, Zerillo J, Baron E, Katz D, Burnett GW. The use of simulation in liver transplantation anesthesiology fellowship training: A survey of fellowship program directors in the United States. Clin Transplant 2023; 37:e15055. [PMID: 37398991 DOI: 10.1111/ctr.15055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/20/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Liver transplantation surgeries are challenging cases for anesthesiologists. While intra-operative teaching is paramount, simulation has emerged as an educational tool to augment clinical training. A variety of simulation modalities have been described in the literature, but no study has aimed to assess the use of simulation in liver transplantation fellowship training. METHODS A 20-question survey detailing the use of simulation, including simulation modalities used and barriers to simulation use, was developed and distributed to 22 program directors for liver transplantation anesthesiology fellowships. An exploratory analysis was performed on multiple-choice and free-text responses. RESULTS Thirteen program directors completed the survey and were included in our analysis. Most programs (61.5%) did not report the use of simulation for liver transplantation fellow training. Of the programs that did use simulation, four required it as a mandatory component of their curriculum. Task trainers and screen-based simulators were more commonly used by these programs. Faculty availability and interest, as well as a lack of an established curriculum, were cited as major limitations to simulation use. CONCLUSIONS Simulation is an important component of anesthesiology trainee education, as evidenced by the requirement for simulation during residency by the American Council for Graduate Medical Education. Our findings suggest that simulation is an underutilized educational tool that we believe could greatly augment the training of liver transplantation anesthesiology fellows by providing exposure to a wide range of clinical challenges.
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Affiliation(s)
- Patrick Maffucci
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
| | - Natalie K Smith
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
| | - Jeron Zerillo
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elvera Baron
- Department of Anesthesiology, Case Western Reserve University School of Medicine at Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Daniel Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
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Burnett GW, Taree A, Martin L, Bryson EO. In reply: Like patients, practitioners are not cases: (re)humanizing the "case" report. Can J Anaesth 2023; 70:1115. [PMID: 37165132 DOI: 10.1007/s12630-023-02472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Garrett W Burnett
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Amir Taree
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ethan O Bryson
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Burnett GW. Electroconvulsive Therapy. Advanced Anesthesia Review 2023:905-C362.S6. [DOI: 10.1093/med/9780197584521.003.0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Electroconvulsive therapy (ECT) involves the induction of a generalized tonic-clonic seizure to treat various psychiatric disorders, including treatment-resistant depression, catatonia, psychosis, and more. General anesthesia is provided for patient comfort and safety. Medications commonly used in anesthesia affect seizure quality and duration; therefore, it is vital that anesthesiologists prepare a tailored anesthetic for each patient undergoing ECT. ECT is often performed in non–operating room locations, and it is necessary to ensure all monitoring and emergency equipment are available. ECT is associated with an initial parasympathetic surge followed by a longer lasting sympathetic surge, which may lead to prolonged hypertension and tachycardia. Depending on each patient’s comorbidities, prophylaxis or intraoperative treatment of parasympathetic and sympathetic symptoms may be required.
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Burnett GW, Taree A, Martin L, Bryson EO. Propofol misuse in medical professions: a scoping review. Can J Anaesth 2023; 70:395-405. [PMID: 36577890 DOI: 10.1007/s12630-022-02382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE We aimed to describe the current literature concerning propofol misuse in medical professionals, specifically relating to the individual demographics of those misusing propofol and the outcomes of propofol misuse. METHODS We conducted a retrospective scoping review of the literature using a modified PRISMA approach. We used MEDLINE, EMBASE, and PsycINFO databases to identify relevant studies based on search terms. Studies describing individual medical professionals misusing propofol were included. RESULTS Twenty-four articles describing 88 individual cases of propofol misuse were included for data charting and analysis. Anesthesiologists and certified registered nurse anesthetists were most commonly identified. Death was a common method of identification of misuse, while rehabilitation and death were common final outcomes associated with propofol misuse. CONCLUSIONS Despite knowledge of the pharmacokinetic and pharmacodynamic properties of propofol by those misusing this medication, death was a common outcome reported in the literature. Data related to long-term outcomes including re-entry to clinical practice or success of rehabilitation were limited.
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Affiliation(s)
- Garrett W Burnett
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, 1450 Madison Avenue, KCC 8th Floor Box 411, New York, NY, 10029, USA.
| | - Amir Taree
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, 1450 Madison Avenue, KCC 8th Floor Box 411, New York, NY, 10029, USA
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ethan O Bryson
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, 1450 Madison Avenue, KCC 8th Floor Box 411, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Burnett GW. Nerve Injury Monitoring During ENT Surgery. Advanced Anesthesia Review 2023:832-C332.S6. [DOI: 10.1093/med/9780197584521.003.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Intraoperative nerve monitoring during otolaryngologic surgery allows for identification of nerves susceptible to injury during surgery using electromyography. Commonly monitored nerves include the facial nerve (VII), recurrent laryngeal nerve (X), and spinal accessory nerve (XI). Specialized equipment is necessary for electromyographic (EMG) monitoring of these nerves, and collaboration between the otolaryngologist and anesthesiologist is required. Medications such as neuromuscular blockade should be avoided in order not to disrupt EMG signals. Careful electrode placement and vigilant monitoring are important components of intraoperative neuromonitoring. Early recognition of postoperative nerve injury is crucial, particularly in recurrent laryngeal nerve injury, which may result in stridor, airway obstruction, or aspiration.
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Raymond HE, Alasadi H, Zubizarreta N, Hayden BL, Chen D, Burnett GW, Park C, DeMaria S, Poeran J, Moucha CS. Primary spoken language and regional anaesthesia use in total joint arthroplasty. Reg Anesth Pain Med 2023:rapm-2022-103828. [PMID: 36697030 DOI: 10.1136/rapm-2022-103828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/14/2023] [Indexed: 01/26/2023]
Affiliation(s)
- Hayley E Raymond
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Husni Alasadi
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Nicole Zubizarreta
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Brett L Hayden
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Darwin Chen
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, New York, New York, USA
| | - Chang Park
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, New York, New York, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, New York, New York, USA
| | - Jashvant Poeran
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
| | - Calin S Moucha
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, New York, USA
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Zhou G, Burnett GW, Shah RS, Lai CY, Katz D, Fried EA. Development of an Easily Reproducible Cough Simulator With Droplets and Aerosols for Rapidly Testing Novel Personal Protective Equipment. Simul Healthc 2022; 17:336-342. [PMID: 35238849 DOI: 10.1097/sih.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The current COVID-19 pandemic has produced numerous innovations in personal protective equipment, barrier devices, and infection mitigation strategies, which have not been validated. During high-risk procedures such as airway manipulation, coughs are common and discrete events that may expose healthcare workers to large amounts of viral particles. A simulated cough under controlled circumstances can rapidly test novel devices and protocols and thus aid in their evaluation and the development of implementation guidelines. Physiologic cough simulators exist but require significant expertise and specialized equipment not available to most clinicians. METHODS Using components commonly found in healthcare settings, a cough simulator was designed for clinicians to easily assemble and use. Both droplet and aerosol particle generators were incorporated into a bimodal experimental system. High-speed flash photography was used for data collection. RESULTS Using a gas flow analyzer, video recordings, and high-speed digital photography, the cough and particle simulators were quantitatively and qualitatively compared with known physiologic cough parameters and in vivo Schlieren imaging of human coughs. CONCLUSIONS Based on our validation studies, this cough and particle simulator model approximates a physiologic, human cough in the context of testing personal protective equipment, barrier devices, and infection prevention measures.
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Affiliation(s)
- George Zhou
- From the Department of Anesthesiology, Perioperative and Pain Medicine (G.Z.), Stanford University Hospital, Stanford, CA; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.B., C.Y.L., D.K., E.A.F.); and Department of Anesthesiology and Critical Care Medicine (R.S.S.), Memorial Sloan Kettering Cancer Center, New York, NY
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Porter S, Prendiville E, Allen BFS, Booth G, Boublik J, Burnett GW, Elkassabany N, Hausman J, Klesius L, Le-Wendling L, Machi AT, Maniker R, Parra M, Rosenquist R, Spofford CM, Suresh S, Tedore T, Wilson EH, Zhou JY, Woodworth G. Development of entrustable professional activities for regional anesthesia and pain medicine fellowship training. Reg Anesth Pain Med 2022; 47:rapm-2022-103854. [PMID: 35878963 DOI: 10.1136/rapm-2022-103854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Accreditation Council for Graduate Medical Education (ACGME) offers descriptions of competencies and milestones but does not provide standardized assessments to track trainee competency. Entrustable professional activities (EPAs) and special assessments (SAs) are emerging methods to assess the level of competency obtained by regional anesthesiology and acute pain medicine (RAAPM) fellows. METHODS A panel of RAAPM physicians with experience in education and competency assessment and one medical student were recruited to participate in a modified Delphi method with iterative rounds to reach consensus on: a list of EPAs, SAs, and procedural skills; detailed definitions for each EPA and SA; a mapping of the EPAs and SAs to the ACGME milestones; and a target level of entrustment for graduating US RAAPM fellows for each EPA and procedural skill. A gap analysis was performed and a heat map was created to cross-check the EPAs and SAs to the ACGME milestones. RESULTS Participants in EPA and SA development included 19 physicians and 1 medical student from 18 different programs. The Delphi rounds yielded a final list of 23 EPAs, a defined entrustment scale, mapping of the EPAs to ACGME milestones, and graduation targets. A list of 73 procedural skills and 7 SAs were similarly developed. DISCUSSION A list of 23 RAAPM EPAs, 73 procedural skills, and 7 SAs were created using a rigorous methodology to reach consensus. This framework can be utilized to help assess RAAPM fellows in the USA for competency and allow for meaningful performance feedback.
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Affiliation(s)
- Steven Porter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Elaine Prendiville
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Gregory Booth
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth Department of Anesthesiology and Pain Medicine, Portsmouth, Virginia, USA
| | - Jan Boublik
- Anesthesiology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Garrett W Burnett
- Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nabil Elkassabany
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jonathan Hausman
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lisa Klesius
- Department of Anesthesiology, University of Wisconsin System, Madison, Wisconsin, USA
| | | | - Anthony T Machi
- Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Robert Maniker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
- Department of Anesthesiology, Columbia University Medical Center, New York, New York, USA
| | | | | | - Christina M Spofford
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Santhanam Suresh
- Pediatric Anesthesiology, Northwestern Medicine, Chicago, Illinois, USA
| | - Tiffany Tedore
- Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Elizabeth H Wilson
- Department of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jon Yan Zhou
- Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, California, USA
| | - Glenn Woodworth
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Burnett GW, Zhou G, Fried EA, Shah RS, Park C, Katz D. Intraoperative aerosol box use: does an educational visual aid reduce contamination? Korean J Anesthesiol 2020; 74:158-164. [PMID: 33198432 PMCID: PMC8024202 DOI: 10.4097/kja.20511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/04/2020] [Indexed: 01/25/2023] Open
Abstract
Background The aerosol box was rapidly developed and disseminated to minimize viral exposure during aerosolizing procedures during the COVID-19 pandemic, yet users may not understand how to use and clean the device. This could potentially lead to increased viral exposure to subsequent patients and practitioners. We evaluated intraoperative contamination and aerosol box decontamination and the impact of a preoperative educational visual aid. Methods Using a double-blinded randomized design, forty-four anesthesiology trainees and faculty completed a simulated anesthetic case using an aerosol box contaminated with a fluorescent marker; half of the subjects received a visual aid prior to the simulation. Intraoperative contamination was evaluated at 10 standardized locations using an ultraviolet (UV) light. Next, subjects were instructed to clean the aerosol box for use on the next patient. Following cleaning, the box was evaluated for decontamination using an UV light. Results Median total contamination score was significantly reduced in the experimental group (5.0 vs. 10.0, P < 0.001). The aerosol box was completely cleaned by 36.4% of subjects in the experimental group compared to 4.5% in the control group (P = 0.009). Conclusions The use of a visual aid significantly decreased intraoperative contamination and improved box cleaning. Despite these findings, a potentially clinically significant amount of viral exposure may exist. Thorough evaluation of the risks and benefits of the aerosol box should be completed prior to use. If an aerosol box is used, a visual aid should be considered to remind practitioners how to best use and clean the box.
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Affiliation(s)
- Garrett W Burnett
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Zhou
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Eric A Fried
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronak S Shah
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chang Park
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Katz
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Fried EA, Zhou G, Shah R, Shin DW, Shah A, Katz D, Burnett GW. Barrier Devices, Intubation, and Aerosol Mitigation Strategies: Personal Protective Equipment in the Time of Coronavirus Disease 2019. Anesth Analg 2020; 132:38-45. [PMID: 33315602 PMCID: PMC7523478 DOI: 10.1213/ane.0000000000005249] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Numerous barrier devices have recently been developed and rapidly deployed worldwide in an effort to protect health care workers (HCWs) from exposure to coronavirus disease 2019 (COVID-19) during high-risk procedures. However, only a few studies have examined their impact on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19. METHODS Two commonly used barrier devices, an intubation box and a clear plastic intubation sheet, were evaluated using a physiologically accurate cough simulator. Aerosols were modeled using a commercially available fog machine, and droplets were modeled with fluorescein dye. Both particles were propelled by the cough simulator in a simulated intubation environment. Data were captured by high-speed flash photography, and aerosol and droplet dispersion were assessed qualitatively with and without a barrier in place. RESULTS Droplet contamination after a simulated cough was seemingly contained by both barrier devices. Simulated aerosol escaped the barriers and flowed toward the head of the bed. During barrier removal, simulated aerosol trapped underneath was released and propelled toward the HCW at the head of the bed. Usage of the intubation sheet concentrated droplets onto a smaller area. If no barrier was used, positioning the patient in slight reverse Trendelenburg directed aerosols away from the HCW located at the head of the bed. CONCLUSIONS Our observations imply that intubation boxes and sheets may reduce HCW exposure to droplets, but they both may merely redirect aerosolized particles, potentially resulting in increased exposure to aerosols in certain circumstances. Aerosols may remain within the barrier device after a cough, and manipulation of the box may release them. Patients should be positioned to facilitate intubation, but slight reverse Trendelenburg may direct infectious aerosols away from the HCW. Novel barrier devices should be used with caution, and further validation studies are necessary.
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Affiliation(s)
- Eric A Fried
- From the Department of Anesthesiology, Perioperative & Pain Medicine
| | - George Zhou
- From the Department of Anesthesiology, Perioperative & Pain Medicine
| | - Ronak Shah
- From the Department of Anesthesiology, Perioperative & Pain Medicine
| | - Da Wi Shin
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anjan Shah
- From the Department of Anesthesiology, Perioperative & Pain Medicine
| | - Daniel Katz
- From the Department of Anesthesiology, Perioperative & Pain Medicine
| | - Garrett W Burnett
- From the Department of Anesthesiology, Perioperative & Pain Medicine
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Burnett GW, Shah AS, Katz DJ, Jeng CL. Survey of regional anesthesiology fellowship directors in the USA on the use of simulation in regional anesthesiology training. Reg Anesth Pain Med 2019; 44:rapm-2019-100719. [PMID: 31527159 DOI: 10.1136/rapm-2019-100719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite a growing interest in simulated learning, little is known about its use within regional anesthesia training programs. In this study, we aimed to characterise the simulation modalities and limitations of simulation use for US-based resident and fellow training in regional anesthesiology. METHODS An 18-question survey was distributed to regional anesthesiology fellowship program directors in the USA. The survey aimed to describe residency and fellowship program demographics, modalities of simulation used, use of simulation for assessment, and limitations to simulation use. RESULTS Forty-two of 77 (54.5%) fellowship directors responded to the survey. Eighty per cent of respondents with residency training programs utilized simulation for regional anesthesiology education, while simulation was used for 66.7% of fellowship programs. The most common modalities of simulation were gel phantom models (residency: 80.0%, fellowship: 52.4%) and live model scanning (residency: 50.0%, fellowship: 42.9%). Only 12.5% of residency programs and 7.1% of fellowship programs utilized simulation for assessment of skills. The most common greatest limitation to simulation use was simulator availability (28.6%) and funding (21.4%). CONCLUSIONS Simulation use for education is common within regional anesthesiology training programs, but rarely used for assessment. Funding and simulator availability are the most common limitations to simulation use.
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Affiliation(s)
- Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Anjan S Shah
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Daniel J Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Christina L Jeng
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Burnett GW, Meisner J, Hyman JB, Levin EJ. Bacitracin irrigation leading to anaphylaxis and cardiovascular collapse in the ambulatory surgery center setting. J Clin Anesth 2018; 46:35-36. [DOI: 10.1016/j.jclinane.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
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Abstract
/ Protected area management is increasingly important throughout the world, particularly in less developed countries and arid regions. The Middle East, includingJordan, has important and unique resources due to its varied topography and climate. In Jordan, the protected areas are privately, rather than publicly, managed, and this provides for a unique and somewhat challenging management effort. The purpose of this paper is to review the establishment and administration of Jordan's protected areas with particular emphasis on the challenges of multiple administrative and legislative layers, departmental working relationships, and a paucity of funding. Interviews with government and nongovernmental experts in Jordan, coupled with a review of pertinent academic and planning literature, served as the information base for this study. Despite new legislative and administrative initiatives, results reveal important and continuing challenges for Jordan. Recommendations include completion of protected area inventories, government wide institutional strengthening, partnering with organizations and the public, as well as legislative reexamination.
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Affiliation(s)
- IE Schneider
- Department of Recreation Management & Tourism, College of Public Programs, Arizona State University, P.O. Box 874905, Tempe, Arizona 85287-4905, USA
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Burnett GW. Old and new concepts of dental caries. Tex Dent J 1971; 89:16-20. [PMID: 5278031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Burnett GW. The microbiology of dental infections. Dent Clin North Am 1970; 14:681-95. [PMID: 5272454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Burnett GW. Progress is what dentistry needs. J South Calif Dent Assoc 1970; 38:116-8. [PMID: 5309965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Burnett GW. The image of dentistry. J Ga Dent Assoc 1969; 43:32-3. [PMID: 5258442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Burnett GW, Moriera BJ. Rampant dental caries or odontoclasia in Malaysian children. Dent J Malaysia Singapore 1969; 9:45-50. [PMID: 5264315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Burnett GW. Comprehensive dentistry. J Ga Dent Assoc 1969; 42:36-7 passim. [PMID: 5254777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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