Technical and non-technical skills can be reliably assessed during paramedic simulation training

BACKGROUND

Medical teams depend on technical skills (TS) as well as non-technical skills (NTS) for successful management of critical events. Simulated scenarios are an opportunity for presentation of similar crisis situations. The aim of this study was to test whether TS and NTS are assessable with satisfactory interrater reliability (IRR) during a regular paramedic training.

METHODS

Thirty paramedics were rated by two independent observers using video-recording and previously validated checklists while managing two simulated emergency scenarios as a team of two. The observed items of the team's TS included type, order, and time of adequate medical care. The NTS were restricted to six team-oriented dimensions. The IRR was quantified by calculating the intraclass correlation coefficient (ICC). The z-transformed values of the TS and NTS were correlated by Pearson's correlation. Internal consistency was controlled using Cronbach's alpha.

RESULTS

The average measures ICC for the IRR was between 0.97 [95% confidence interval (CI) 0.91-0.99] and 0.98 (95% CI 0.94-0.99) for the TS sum-score, and was 0.94 (95% CI 0.87-0.97) for the NTS sum-score; the Cronbach's alpha of this NTS sum-score was 0.86. There is a positive correlation between the normalised TS and NTS sum-scores (r=0.53; P<0.05).

CONCLUSION

Assessment of TS and NTS is feasible and reliable during paramedic training in emergency scenarios. TS can be reliably assessed by one trained observer; for NTS, two trained raters provide a suitable condition for excellent observations. There is a significant positive correlation between TS and NTS.

Digestive proteinases of the larger black flour beetle, Cynaeus angustus (Coleoptera: Tenebrionidae)

Digestion in the larger black flour beetle, Cynaeus angustus (LeConte), was studied to identify new control methods for this pest of stored grains and grain products. The physiological pH of the larval gut, as measured with extracts in water, was approximately 6.1, and the pH for optimal hydrolysis of casein by gut extracts was 6.2 when buffers were reducing. However, under non-reducing conditions, hydrolysis of casein and synthetic serine proteinase substrates was optimal in alkaline buffer. Three major proteinase activities were observed in zymograms using casein or gelatin. Caseinolytic activity of C. angustus gut extracts was inhibited by inhibitors that target aspartic and serine proteinase classes, with minor inhibition by a cysteine proteinase inhibitor. In particular, soybean trypsin and trypsin/chymotrypsin inhibitors were most effective in reducing the in vitro caseinolytic activity of gut extracts. Based on these data, further studies are suggested on the effects of dietary soybean inhibitors of serine proteinases, singly and in combination with aspartic and cysteine proteinase inhibitors, on C. angustus larvae. Results from these studies can be used to develop new control strategies to prevent damage to grains and stored products by C. angustus and similar coleopteran pests.

[Interdisciplinary emergency room management of trauma patients from the standpoint of coworkers]

INTRODUCTION

The purpose of this study was to examine whether staff questionnaire evaluation is useful for quality control in the emergency room (ER) setting.

METHODS

Consecutive anonymous questionnaires (Likert scale 1-5) were filled out by the involved medical staff in all ER trauma cases in a university hospital from July 2002 to December 2003 (analysis of variance, P<0.05).

RESULTS

In 171 ER cases, 844 staff members responded. Main criticisms concerned time management or satisfaction with personal ER training (Likert <4). Consultants rated the quality of their training significantly higher than younger doctors, two thirds of consultants vs one third of residents having passed an Advanced Trauma and Life Support course (P<0.001). Depending on responders' professional specialties and whether the situation concerned multiple trauma (Injury Severity Score >15), a significant systematic difference resulted.

CONCLUSION

Our standardized staff questionnaire evaluation was revealed to be a discriminative instrument for quality management of trauma cases in the ER. To confirm these findings, correlation with clinical outcome data and further validation of the method are needed.

Multiple-trauma management

BACKGROUND AND OBJECTIVE

Staff attitude plays a pivotal role in quality management. The objective of the present study was to further define how interdisciplinary emergency hospital staff experience their daily work and the extent to which the professional speciality and training of an individual influences his/her assessment of multiple-trauma team performance.

METHODS

The clinical staff involved in multiple-trauma emergency management of a university hospital was asked to answer a confidential questionnaire. Factorial analysis was used to identify 8 major dimensions from a total of 53 items.

RESULTS

The questionnaire was returned by 128 team members. All professional groups were most dissatisfied with the dimensions 'education and training', 'work sequence between specialities' and 'communication between specialities'. Assessment of the quality of in-hospital emergency-trauma management differed significantly between professional specialities (ANOVA, F=5.2; P=0.028); surgeons gave the highest ratings for all but one dimension. Having taken an Advanced Trauma Life Support (ATLS) course influenced significantly the total rating of multiple-trauma treatments of anaesthetists and surgeons (F=5.5; P=0.024).

CONCLUSIONS

The perceptions of interdisciplinary trauma team members without the completion of an ATLS training course were that they did not communicate enough with each other and that there were differences between their expectations and reality. The differences and the communication deficits were overcome in team members who had passed an ATLS course.

Digestive proteinases in Lasioderma serricorne (Coleoptera: Anobiidae)

The cigarette beetle, Lasioderma serricorne (Fabricius), is a common pest of stored foods. A study of digestive proteinases in L. serricorne was performed to identify potential targets for proteinaceous biopesticides, such as proteinase inhibitors. Optimal casein hydrolysis by luminal proteinases of L. serricorne was in pH 8.5-9.0 buffers, although the pH of luminal contents was slightly acidic. Results from substrate and inhibitor analyses indicated that the primary digestive proteinases were serine proteinases. The most effective inhibitors of caseinolytic hydrolysis were from soybean (both Bowman Birk and Kunitz), with some inhibition by chymostatin, N-tosyl-L-phenylalanine chloromethyl ketone, and leupeptin. Casein zymogram analysis identified at least eight proteolytic activities. Activity blot analyses indicated one major proteinase activity that hydrolysed the trypsin substrate N-alpha-benzoyl-L-arginine rho-nitroanilide, and three major proteinase activities that hydrolysed the chymotrypsin substrate N-succinyl ala-ala-pro-phe rho-nitroanilide. The absence of cysteine, aspartic, and metallo proteinases in L. serricorne digestion was evidenced by the lack of activation by thiol reagents, alkaline pH optima, and the results from class-specific proteinase inhibitors. The data suggest that protein digestion in L. serricorne is primarily dependent on trypsin- and chymotrypsin-like proteinases.

Epithelial implantation cysts of the upper eyelid after lid-lowering procedures

PURPOSE

Epithelial inclusion cysts are benign lesions that have been described after intraocular and intraorbital surgery or trauma. The authors determine the rate of occurrence and characteristics of epithelial implantation cysts after upper eyelid-lowering procedures using a posterior conjunctival incision.

METHOD

The records of 109 upper eyelid-lowering cases over a 9-year period that had an internal incision were reviewed retrospectively. Any cysts removed were sent for histopathologic examination.

RESULTS

The incidence of cyst development was found to be 2.75%. The cysts were small and remained under 4 mm over time. Histopathologic findings of the two epithelial cysts removed suggested a conjunctival origin. The development of cysts did not correlate with length and difficulty of the procedure.

CONCLUSION

Epithelial implantation cysts of the eyelid after posterior approach levator recession procedures are rare (2.75% incidence). However, they often require surgical excision due to their conspicuous location. Their origin is probably the conjunctival epithelium implanted while manipulating the conjunctival incision edge.

Effects of a cholecystokinin receptor antagonist on intestinal phase of pancreatic and biliary responses in man

The present study was designed (a) to characterize the activity of loxiglumide as a peripheral cholecystokinin (CCK) antagonist in healthy human subjects, and (b) to determine whether CCK is a physiologic regulator of the intestinal phase of meal-stimulated exocrine pancreatic and biliary secretions in man. Intravenous loxiglumide (22 mumol/kg per h) was highly potent in antagonizing CCK8-induced pancreatic enzyme and bile acid secretion as well as pancreatic polypeptide release. The potency and selectivity of loxiglumide as an antagonist of CCK provides the tool for evaluating the role of CCK as a physiological mediator of meal-induced pancreatic and biliary responses in humans. Infusion of a liquid test meal into the duodenum evoked an immediate response of pancreatic enzyme and bilirubin outputs, respectively. Intravenous loxiglumide significantly inhibited the meal-induced pancreatic amylase output by 63% (P less than 0.05), lipase output by 43% (P less than 0.05), and bilirubin output by 59% (P less than 0.05). These data suggest that CCK is a physiological mediator of the intestinal phase of meal-stimulated pancreatic and biliary responses.