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Yun R, Qian D, Wang E, Zuniga M, Forbes T, Li B, Rodriguez ST, Jackson C, Caruso TJ. A prospective, observational validation of HRAD±, a novel pediatric affect and cooperation scale. J Clin Anesth 2024; 94:111410. [PMID: 38340678 DOI: 10.1016/j.jclinane.2024.111410] [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: 11/05/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
STUDY OBJECTIVE HRAD± was developed to quickly assess pediatric perioperative affect and cooperation. HRAD± represents: Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperativity. The primary aim of this study was to investigate the clinical utility of HRAD± as an affect and cooperation assessment tool for inhalational mask induction. Secondary aims examined inter-rater reliability (IRR) of HRAD± and predictive validity of induction HRAD± with emergence delirium. DESIGN This was a prospective observational investigation. SETTING We conducted this investigation at Lucile Packard Children's Hospital Stanford, an academic, quaternary care children's hospital in Northern California. PATIENTS A total of 197 patients were included in this investigation. Children 1-14 years of age, who underwent daytime procedures with inhalational induction of anesthesia and American Society of Anesthesiologists physical status I-III were eligible. INTERVENTIONS During mask induction, two trained research assistants (RAs) independently scored the patient's affect and cooperation. After extubation, the same investigators observed the patient's emergence. MEASUREMENTS RAs scored each mask induction using the following scales: HRAD±, modified Yale Preoperative Anxiety Scale (mYPAS), Observation Scale of Behavioral Distress (OSBD), and Induction Compliance Checklist (ICC). Correlations were calculated to HRAD±. IRR of HRAD± between the RAs as well as predictive validity of HRAD± to Pediatric Anesthesia Emergence Delirium (PAED), Watcha and Cravero scales were calculated. MAIN RESULTS HRAD± scores strongly correlated with mYPAS (r = 0.840, p < 0.0001) with moderate correlation to OSBD (r = 0.685, p < 0.0001) and ICC (-0.663, p < 0.0001). IRR was moderate for the affect and cooperation portion of the HRAD± scale, respectively (κ = 0.595 [p < 0.0001], κ = 0.478 [p < 0.0001]). A weak correlation was observed with PAED (r = 0.134 [p = 0.0597]) vs HRAD±. No correlations were observed between Watcha (r = 0.013 [p = 0.8559]) and Cravero and HRAD± scales (r = 0.002 [p = 0.9767]). CONCLUSIONS HRAD± is a clinically useful and simple scale for evaluating pediatric affect and cooperation during inhalational mask induction. Results demonstrate correlation with commonly utilized research assessment scales.
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Affiliation(s)
- Romy Yun
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, United States of America.
| | - Daniel Qian
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
| | - Ellen Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, United States of America
| | - Michelle Zuniga
- Lucile Packard Children's Hospital Stanford, Stanford Chariot Program, 725 Welch Road, Palo Alto, CA 94304, USA
| | - Ty Forbes
- McGovern Medical School at University of Texas Health, 6341 Fannin St, Houston, TX 77030, United States of America
| | - Brian Li
- Lucile Packard Children's Hospital Stanford, Stanford Chariot Program, 725 Welch Road, Palo Alto, CA 94304, USA
| | - Samuel T Rodriguez
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, United States of America
| | - Christian Jackson
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, United States of America
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, United States of America
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Fonseca A, Qian D, Forbes T, Li BSK, Lee C, Burdsall K, Rodriguez S, Jackson C, Wang EY, Caruso TJ. Reducing Preoperative Caregiver Anxiety With Virtual Reality: A Pragmatic, Randomized Controlled Study. J Patient Exp 2024; 11:23743735231220190. [PMID: 38188533 PMCID: PMC10771051 DOI: 10.1177/23743735231220190] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Pediatric patients and their caregivers often experience perioperative anxiety. Interventions reduce caregiver anxiety improve cooperation and contribute to an improved patient experience. This study seeks to evaluate the efficacy of virtual reality (VR)-assisted mindfulness on perioperative caregiver anxiety. Participants were randomized into a standard of care (SOC) group, which included snacks but no technology-based distractions, or a VR group, which included snacks and a VR-guided meditation. Caregiver anxiety was measured before and after the intervention using the Visual Analogue Scale for Anxiety (VAS-A). Secondary aims explored participants' baseline anxiety with the State-Trait Anxiety Inventory (STAI). VR group participants completed a satisfaction survey. Linear regression models of VAS-A and STAI were used to compare group differences. Satisfaction survey results were reported with descriptive statistics. 26 participants were included, with 12 randomized to the SOC group and 14 to the VR group. VAS-A scores in the VR group were lower than those in the SOC group (p = .002). The STAI found no change in participants' state of anxiety in the SOC group (p = .7108), compared to a significant reduction (p = .014) in the VR group when controlling for anxiety traits. 12 of 14 caregivers in the VR group expressed satisfaction or strong satisfaction. This study supports the implementation of VR mindfulness as a method to reduce caregiver anxiety. VR use in the pediatric healthcare setting is safe and inexpensive, and the intervention had a high degree of participant satisfaction.
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Affiliation(s)
- Ahtziri Fonseca
- Chariot Program, Stanford Children's Health, Palo Alto, CA, USA
| | - Daniel Qian
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ty Forbes
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
- University of Texas McGovern Medical School, Houston, TX, USA
| | - Brian S-K Li
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
- Department of Comparative Literature, Princeton University, Princeton, NJ, USA
| | - Charles Lee
- Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Kylie Burdsall
- Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Samuel Rodriguez
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christian Jackson
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Ellen Y Wang
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Thomas J Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
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Rodriguez ST, Makarewicz N, Wang EY, Zuniga-Hernandez M, Titzler J, Jackson C, Suen MY, Rosales O, Caruso TJ. Virtual reality facilitated exercise improves pain perception: A crossover study. J Clin Anesth 2023; 91:111257. [PMID: 37708601 DOI: 10.1016/j.jclinane.2023.111257] [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: 04/07/2023] [Revised: 07/26/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
STUDY OBJECTIVE Both virtual reality (VR) and exercise are recognized for their analgesic and anxiolytic properties. The purpose of this study is to evaluate the ability of VR-facilitated exercise to modulate pain. DESIGN Within-subject cross-over clinical trial. SETTING The Stanford Chariot Program conducted this study at Lucile Packard Children's Hospital Stanford (LCPHS). PATIENTS Healthy participants meeting inclusion criteria were recruited by volunteer solicitation from LCPHS. INTERVENTIONS Participants were randomized by hand dominance and subjected to a standardized cold pressor test with no VR or exercise. After a 5-min wash-out period, participants repeated the test on their other hand while experiencing a VR-facilitated exercise condition. Pain sensitivity, pain tolerance, and sympathetic activation data were collected during both conditions. MEASUREMENTS Pain sensitivity was scored 0-10 and collected every 30 s. Pain tolerance was recorded as the duration a participant could endure the painful stimuli. Sympathetic activation was measured by skin conductance response density (SCRD) and recorded in 30 s epochs by a biosensor. In all analyses, data were nested by participant. MAIN RESULTS Forty-one participants completed both interventions. Pain sensitivity was reduced in the VR-facilitated exercise condition (p < 0.0001). There was no difference in pain tolerance between conditions. While both conditions resulted in an increase in sympathetic activity, SCRD was higher at all time points in the VR-facilitated exercise condition. CONCLUSIONS The reduction in pain sensitivity indicates VR-facilitated exercise results in improved pain perception. VR-facilitated exercise may be especially useful for patients with chronic pain or other conditions requiring physical therapy, where pain may be exacerbated by exercise.
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Affiliation(s)
- Samuel T Rodriguez
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Nathan Makarewicz
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA; Stanford University School of Medicine, Stanford, CA, USA
| | - Ellen Y Wang
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Michelle Zuniga-Hernandez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Janet Titzler
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Christian Jackson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Man Yee Suen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Oswaldo Rosales
- Stanford University Graduate School of Education, Stanford, CA, USA
| | - Thomas J Caruso
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA.
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Wang EY, Kennedy KM, Zhang L, Qian D, Forbes T, Zuniga-Hernandez M, Li BSK, Domingue B, Caruso TJ. Predicting pediatric healthcare provider use of virtual reality using a technology acceptance model. JAMIA Open 2023; 6:ooad076. [PMID: 37693368 PMCID: PMC10483581 DOI: 10.1093/jamiaopen/ooad076] [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: 06/02/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The primary aim of this study was to apply a novel technology acceptance model (TAM) for virtual reality (VR) in healthcare. The secondary aim was to assess reliability of this model to evaluate factors that predict the intentions of pediatric health providers' use of VR as an anxiolytic for hospitalized pediatric patients. Materials and Methods Healthcare providers that interacted with pediatric patients participated in a VR experience available as anxiolysis for minor procedures and then completed a survey evaluating attitudes, behaviors, and technology factors that influence adoption of new technologies. Results Reliability for all domain measurements were good, and all confirmatory factor analysis models demonstrated good fit. Usefulness, ease of use, curiosity, and enjoyment of the VR experience all strongly predict intention to use and purchase VR technologies. Age of providers, past use, and cost of technology did not influence future purchase or use, suggesting that VR technologies may be broadly adopted in the pediatric healthcare setting. Discussion Previous VR-TAM models in non-healthcare consumers formulated that age, past use, price willing to pay, and curiosity impacted perceived ease of use. This study established that age, past use, and cost may not influence use in healthcare. Future studies should be directed at evaluating the social influences and facilitating conditions within healthcare that play a larger influence on technology adoption. Conclusion The VR-TAM model demonstrated validity and reliability for predicting intent to use VR in a pediatric hospital.
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Affiliation(s)
- Ellen Y Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Lijin Zhang
- Stanford University Graduate School of Education, Stanford, CA, United States
| | - Daniel Qian
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ty Forbes
- McGovern Medical School at University of Texas Health, Houston, TX, United States
| | | | | | - Benjamin Domingue
- Stanford University Graduate School of Education, Stanford, CA, United States
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
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Rama A, Tsai AH, Caruso TJ. Enhancing Telemedicine Perioperative Simulations Using Augmented Reality. J Educ Perioper Med 2023; 25:E711. [PMID: 37720372 PMCID: PMC10502605 DOI: 10.46374/volxxv_issue3_rama] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Asheen Rama
- The authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor and Thomas J. Caruso is a Clinical Professor in the Division of Pediatric Anesthesia. Albert H. Tsai is a Clinical Assistant Professor in the Division of Cardiothoracic Anesthesia
| | - Albert H. Tsai
- The authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor and Thomas J. Caruso is a Clinical Professor in the Division of Pediatric Anesthesia. Albert H. Tsai is a Clinical Assistant Professor in the Division of Cardiothoracic Anesthesia
| | - Thomas J. Caruso
- The authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor and Thomas J. Caruso is a Clinical Professor in the Division of Pediatric Anesthesia. Albert H. Tsai is a Clinical Assistant Professor in the Division of Cardiothoracic Anesthesia
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Tsai A, Bodmer N, Hong T, Frackman A, Hess O, Khoury M, Jackson C, Caruso TJ. Participant Perceptions of Augmented Reality Simulation for Cardiac Anesthesiology Training: A Prospective, Mixed-Methods Study. J Educ Perioper Med 2023; 25:E712. [PMID: 37720369 PMCID: PMC10502607 DOI: 10.46374/volxxv_issue3_tsai] [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] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Simulations are a critical component of anesthesia education, and ways to broaden their delivery and accessibility should be studied. The primary aim was to characterize anesthesiology resident, fellow, and faculty experience with augmented reality (AR) simulations. The secondary aim was to explore the feasibility of quantifying performance using integrated eye-tracking technology. Methods This was a prospective, mixed-methods study using qualitative thematic analysis of user feedback and quantitative analysis of gaze patterns. The study was conducted at a large academic medical center in Northern California. Participants included 7 anesthesiology residents, 6 cardiac anesthesiology fellows, and 5 cardiac anesthesiology attendings. Each subject participated in an AR simulation involving resuscitation of a patient with pericardial tamponade. Postsimulation interviews elicited user feedback, and eye-tracking data were analyzed for gaze duration and latency. Results Thematic analysis revealed 5 domains of user experience: global assessment, spectrum of immersion, comparative assessment, operational potential, and human-technology interface. Participants reported a positive learning experience and cited AR technology's portability, flexibility, and cost-efficiency as qualities that may expand access to simulation training. Exploratory analyses of gaze patterns suggested that trainees had increased gaze duration of vital signs and gaze latency of malignant arrythmias compared with attendings. Limitations of the study include lack of a control group and underpowered statistical analyses of gaze data. Conclusions This study suggests positive user perception of AR as a novel modality for medical simulation training. AR technology may increase exposure to simulation education and offer eye-tracking analyses of learner performance.
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Affiliation(s)
- Albert Tsai
- The following authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, Palo Alto, CA: Albert Tsai, Natalie Bodmer, and Anna Frackman are Clinical Assistant Professors; Tracey Hong is an Anesthesiology Resident; Michael Khoury is a Research Assistant; Thomas J. Caruso is a Clinical Professor. Olivia Hess is a Medical Student at Stanford University School of Medicine, Palo Alto, CA. Christian Jackson is a Data Analyst in the Department of Epidemiology and Population Health at Stanford University, Stanford, CA
| | - Natalie Bodmer
- The following authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, Palo Alto, CA: Albert Tsai, Natalie Bodmer, and Anna Frackman are Clinical Assistant Professors; Tracey Hong is an Anesthesiology Resident; Michael Khoury is a Research Assistant; Thomas J. Caruso is a Clinical Professor. Olivia Hess is a Medical Student at Stanford University School of Medicine, Palo Alto, CA. Christian Jackson is a Data Analyst in the Department of Epidemiology and Population Health at Stanford University, Stanford, CA
| | - Tracey Hong
- The following authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, Palo Alto, CA: Albert Tsai, Natalie Bodmer, and Anna Frackman are Clinical Assistant Professors; Tracey Hong is an Anesthesiology Resident; Michael Khoury is a Research Assistant; Thomas J. Caruso is a Clinical Professor. Olivia Hess is a Medical Student at Stanford University School of Medicine, Palo Alto, CA. Christian Jackson is a Data Analyst in the Department of Epidemiology and Population Health at Stanford University, Stanford, CA
| | - Anna Frackman
- The following authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, Palo Alto, CA: Albert Tsai, Natalie Bodmer, and Anna Frackman are Clinical Assistant Professors; Tracey Hong is an Anesthesiology Resident; Michael Khoury is a Research Assistant; Thomas J. Caruso is a Clinical Professor. Olivia Hess is a Medical Student at Stanford University School of Medicine, Palo Alto, CA. Christian Jackson is a Data Analyst in the Department of Epidemiology and Population Health at Stanford University, Stanford, CA
| | - Olivia Hess
- The following authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, Palo Alto, CA: Albert Tsai, Natalie Bodmer, and Anna Frackman are Clinical Assistant Professors; Tracey Hong is an Anesthesiology Resident; Michael Khoury is a Research Assistant; Thomas J. Caruso is a Clinical Professor. Olivia Hess is a Medical Student at Stanford University School of Medicine, Palo Alto, CA. Christian Jackson is a Data Analyst in the Department of Epidemiology and Population Health at Stanford University, Stanford, CA
| | - Michael Khoury
- The following authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, Palo Alto, CA: Albert Tsai, Natalie Bodmer, and Anna Frackman are Clinical Assistant Professors; Tracey Hong is an Anesthesiology Resident; Michael Khoury is a Research Assistant; Thomas J. Caruso is a Clinical Professor. Olivia Hess is a Medical Student at Stanford University School of Medicine, Palo Alto, CA. Christian Jackson is a Data Analyst in the Department of Epidemiology and Population Health at Stanford University, Stanford, CA
| | - Christian Jackson
- The following authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, Palo Alto, CA: Albert Tsai, Natalie Bodmer, and Anna Frackman are Clinical Assistant Professors; Tracey Hong is an Anesthesiology Resident; Michael Khoury is a Research Assistant; Thomas J. Caruso is a Clinical Professor. Olivia Hess is a Medical Student at Stanford University School of Medicine, Palo Alto, CA. Christian Jackson is a Data Analyst in the Department of Epidemiology and Population Health at Stanford University, Stanford, CA
| | - Thomas J. Caruso
- The following authors are in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, Palo Alto, CA: Albert Tsai, Natalie Bodmer, and Anna Frackman are Clinical Assistant Professors; Tracey Hong is an Anesthesiology Resident; Michael Khoury is a Research Assistant; Thomas J. Caruso is a Clinical Professor. Olivia Hess is a Medical Student at Stanford University School of Medicine, Palo Alto, CA. Christian Jackson is a Data Analyst in the Department of Epidemiology and Population Health at Stanford University, Stanford, CA
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Friedman N, Zuniga-Hernandez M, Titzler J, Suen MY, Wang E, Rosales O, Graham J, D'Souza P, Menendez M, Caruso TJ. Prehospital Pediatric Emergency Training Using Augmented Reality Simulation: A Prospective, Mixed Methods Study. PREHOSP EMERG CARE 2023; 28:271-281. [PMID: 37318845 DOI: 10.1080/10903127.2023.2224876] [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] [Received: 04/10/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Pediatric emergencies are high-stakes yet low-volume clinical encounters for emergency medical services (EMS) clinicians, necessitating innovative approaches to training. We sought to explore the acceptability, usability, and ergonomics of a novel augmented reality (AR) software for EMS crisis management training. METHODS This was a prospective, mixed-methods study employing qualitative and quantitative analyses. We enrolled emergency medical technicians (EMTs) and paramedics at a municipal fire service in Northern California. We ran the Chariot Augmented Reality Medical simulation software (Stanford Chariot Program, Stanford University, Stanford, CA) on the ML1 headset (Magic Leap, Inc., Plantation, FL), which enabled participants to view an AR image of a patient overlaid with real-world training objects. Participants completed a simulation of a pediatric hypoglycemia-induced seizure and cardiac arrest. Participants subsequently engaged in structured focus group interviews assessing acceptability, which we coded and thematically analyzed. We evaluated the usability of the AR system and ergonomics of the ML1 headset using previously validated scales, and we analyzed findings with descriptive statistics. RESULTS Twenty-two EMS clinicians participated. We categorized focus group interview statements into seven domains after an iterative thematic analysis: general appraisal, realism, learning efficacy, mixed reality feasibility, technology acceptance, software optimization, and alternate use cases. Participants valued the realism and the mixed reality functionality of the training simulation. They reported that AR could be effective for practicing pediatric clinical algorithms and task prioritization, building verbal communication skills, and promoting stress indoctrination. However, participants also noted challenges with integrating AR images with real-world objects, the learning curve required to adapt to the technology, and areas for software improvement. Participants favorably evaluated the ease of use of the technology and comfortability of wearing the hardware; however, most participants reported that they would need technical support. CONCLUSION Participants positively evaluated the acceptability, usability, and ergonomics of an AR simulator for pediatric emergency management training, and participants identified current technological limitations and areas for improvement. AR simulation may serve as an effective training adjunct for prehospital clinicians.
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Affiliation(s)
- Nicholas Friedman
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | | | - Janet Titzler
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | - Man Yee Suen
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Oswaldo Rosales
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | - Jenna Graham
- Mountain View Fire Department, City of Mountain View, Mountain View, California
| | - Peter D'Souza
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Maria Menendez
- Stanford Chariot Program, Lucile Packard Children's Hospital, Palo Alto, California
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Yun R, Hess O, Kennedy K, Stricker PA, Blake L, Caruso TJ. Assessing pediatric perioperative affect: A concise review of research and clinically relevant scales. Paediatr Anaesth 2023; 33:243-249. [PMID: 36178764 DOI: 10.1111/pan.14568] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 02/07/2023]
Abstract
Perioperative anxiety and distress are common in pediatric patients undergoing general anesthesia and increase the risk for immediate and long-term postoperative complications. This concise review outlines key research and clinically-relevant scales that measure pediatric perioperative affect. Strengths and weaknesses of each scale are highlighted. A literature review identified 11 articles with the following inclusion criteria: patients less than or equal to 18 years, perioperative anxiety or distress, and original studies with reliability or validity data. Although robust research-based assessment tools to measure anxiety have been developed, such as the Modified Yale Preoperative Anxiety Scale, they are too complex and time-consuming to complete by clinicians also providing anesthesia. Clinically-based anxiety measurement scales tend to be easier to use, however they require further testing before widespread standard utilization. The HRAD ± scale (Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperation) may be a promising observational anxiety scale that is efficient and includes an assessment of compliance. Further studies are needed to refine a clinically-relevant anxiety assessment tool and appraise interventions that reduce perioperative distress.
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Affiliation(s)
- Romy Yun
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, California, USA
| | - Olivia Hess
- Stanford School of Medicine, Stanford, California, USA
| | | | - Paul A Stricker
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lindsay Blake
- University of Arkansas for Medical Sciences Library, Little Rock, Arkansas, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, California, USA
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Nguyen AT, Hemphill S, Donahue B, Menendez M, Rodriguez S, Caruso TJ. Use of virtual reality for targeted physical rehabilitation: Case report on managing functional motor disorder. J Pediatr Rehabil Med 2023; 16:415-423. [PMID: 36120795 DOI: 10.3233/prm-210009] [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] [Indexed: 11/15/2022] Open
Abstract
Virtual reality (VR) technology has seen increasing use in physical rehabilitation and in the management of acute and chronic pain. Functional movement disorders (FMDs) are a source of disability with no known association to neurologic pathology, and patients are generally offered multidisciplinary treatment approaches to improve functional movement. However, patients who are not compliant with rehabilitation may have persistent FMD and long-term disability. Given VR's use in physical rehabilitation, it may serve as a useful adjunct for the management of FMD. Utilizing an application called MovementTM to create a playlist of targeted applications for the restoration of motor function and balance, this case study presents the application of VR as a tool to engage patients in physical therapy for the management of FMD. The VR games were selected to encourage movement while customization of levels within the games facilitated achievement of physical therapy goals. Physical rehabilitation aided by VR, when used in collaboration with a multidisciplinary care team, may be used to facilitate recovery from FMD.
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Affiliation(s)
- Alan T Nguyen
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Sydney Hemphill
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Bridgette Donahue
- Department of Physical Therapy and Rehabilitation, Lucile Packard Children'sHospital Stanford, Stanford University School of Medicine, PaloAlto, CA, USA
| | - Maria Menendez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
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10
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Gupta R, Toppozini C, Caruso TJ, Lobos AT. Integrating leadership into interprofessional non-acute care pediatric provider resuscitation training. J Clin Transl Res 2022; 8:499-505. [PMID: 36452004 PMCID: PMC9706314] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND AIM Due to limited clinical exposure, non-acute care pediatric providers often rely on simulated experiences to maintain resuscitation skills. Few training options designed for the non-acute care setting exist, are often difficult to access, and lack incorporation of non-technical skills. The first five minutes (FFM) is a previously published curriculum designed to train non-acute care providers. The goal of this study was to determine the curriculum's effectiveness during a pilot intervention. METHODS A single cohort of multi-professional, non-acute care pediatric providers participated. The primary outcome skill was "establishing leadership," and secondary outcomes included other technical and non-technical skills. Learning of outcome skills was assessed using changes in retrospective pre-post self-assessment Likert scale scores. Differences were compared using paired t-tests and ANOVA. RESULTS Thirty-seven participants submitted self-assessments. There was improvement in establishing leadership (pre-mean 1.14, post-mean 2.30, P < 0.01), and all other objectives studied. Compared to each other, subgroups of nurses, physicians, and respiratory therapists demonstrated significant differences in learning of technical skills, but similar improvements with non-technical skills. CONCLUSION These findings suggest that the FFM curriculum is an effective tool for training non-acute care pediatric providers interprofessional resuscitation skills. Future research should assess provider behavioral changes, retention of training requirements, and patient outcomes. RELEVANCE FOR PATIENTS Traditional resuscitation education programs focus largely, or entirely, on performance of technical skills and algorithmic actions. However, non-technical skills, such as leadership, are crucial to the overall success of resuscitation efforts. The FFM program was developed to incorporate leadership principles into the resuscitation education of non-acute care pediatric inpatient providers, and this curricular evaluation suggests that improvements in participant leadership skills occurred due to the program.
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Affiliation(s)
- Ronish Gupta
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, McMaster University, ON, Canada
- School of Education, Johns Hopkins University, MD, USA
| | | | - Thomas J. Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, CA, USA
| | - Anna-Theresa Lobos
- Children’s Hospital of Eastern Ontario, ON, Canada
- Division of Critical Care, Department of Pediatrics, University of Ottawa, ON, Canada
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11
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Leung T, Hess CW, Choate ES, Van Orden AR, Tremblay-McGaw AG, Menendez M, Boothroyd DB, Parvathinathan G, Griffin A, Caruso TJ, Stinson J, Weisman A, Liu T, Koeppen K, Koeppen K. Virtual Reality-Augmented Physiotherapy for Chronic Pain in Youth: Protocol for a Randomized Controlled Trial Enhanced With a Single-Case Experimental Design. JMIR Res Protoc 2022; 11:e40705. [PMID: 36508251 PMCID: PMC9793297 DOI: 10.2196/40705] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal (MSK) pain is a prominent health concern, resulting in pain-related disability, loss of functioning, and high health care costs. Physiotherapy rehabilitation is a gold-standard treatment for improving functioning in youth with chronic MSK pain. However, increasing physical activity can feel unattainable for many adolescents because of pain-related fear and movement avoidance. Virtual reality (VR) offers an immersive experience that can interrupt the fear-avoidance cycle and improve engagement in physiotherapy. Despite promising initial findings, data are limited and often lack the rigor required to establish VR as an evidence-based treatment for MSK pain. OBJECTIVE This trial evaluates physiorehabilitation with VR in adolescents with MSK pain. This protocol outlines the rationale, design, and implementation of a randomized controlled trial enhanced with a single-case experimental design. METHODS This study is a 2-group randomized controlled trial assessing the use of physiorehabilitation with VR in adolescents with MSK pain. The authors will collaborate with physical therapists to integrate VR into their standard clinical care. For participants enrolled in standard physiotherapy, there will be no VR integrated into their physical therapy program. Primary outcomes include physical function and engagement in VR. Secondary outcomes include pain-related fear and treatment adherence. Moreover, we will obtain clinician perspectives regarding the feasibility of integrating the intervention into the flow of clinical practice. RESULTS The pilot study implementing physiorehabilitation with VR demonstrated that high engagement and use of physiorehabilitation with VR were associated with improvements in pain, fear, avoidance, and function. Coupled with qualitative feedback from patients, families, and clinicians, the pilot study results provide support for this trial to evaluate physiorehabilitation with VR for youth with chronic MSK pain. Analysis of results from the main clinical trial will begin as recruitment progresses, and results are expected in early 2024. CONCLUSIONS Significant breakthroughs for treating MSK pain require mechanistically informed innovative approaches. Physiorehabilitation with VR provides exposure to progressive challenges, real-time feedback, and reinforcement for movement and can include activities that are difficult to achieve in the real world. It has the added benefit of sustaining patient motivation and adherence while enabling clinicians to use objective benchmarks to influence progression. These findings will inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of physiorehabilitation with VR, serving as the basis for potential large-scale implementation of physiorehabilitation with VR. TRIAL REGISTRATION ClinicalTrials.gov NCT04636177; https://clinicaltrials.gov/ct2/show/NCT04636177. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40705.
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Affiliation(s)
| | - Courtney W Hess
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Ellison S Choate
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Amanda R Van Orden
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexandra G Tremblay-McGaw
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Maria Menendez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Derek B Boothroyd
- Quantitative Statistical Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Gomathy Parvathinathan
- Quantitative Statistical Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Anya Griffin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Jennifer Stinson
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,The Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Amy Weisman
- Department of Rehabilitation, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Timothy Liu
- Department of Rehabilitation, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Kurt Koeppen
- California Rehabilitation & Sports Therapy, Palo Alto, CA, United States
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12
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Rodriguez S, Caruso TJ. What every anesthesiologist should know about virtual reality. Paediatr Anaesth 2022; 32:1276-1277. [PMID: 36352521 DOI: 10.1111/pan.14464] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Samuel Rodriguez
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Thomas J Caruso
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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13
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Hess O, Qian J, Bruce J, Wang E, Rodriguez S, Haber N, Caruso TJ. Communication Skills Training Using Remote Augmented Reality Medical Simulation: a Feasibility and Acceptability Qualitative Study. Med Sci Educ 2022; 32:1005-1014. [PMID: 35966166 PMCID: PMC9362415 DOI: 10.1007/s40670-022-01598-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Augmented reality (AR) has promise as a clinical teaching tool, particularly for remote learning. The Chariot Augmented Reality Medical (CHARM) simulator integrates real-time communication into a portable medical simulator with a holographic patient and monitor. The primary aim was to analyze feedback from medical and physician assistant students regarding acceptability and feasibility of the simulator. METHODS Using the CHARM simulator, we created an advanced cardiovascular life support (ACLS) simulation scenario. After IRB approval, preclinical medical and physician assistant students volunteered to participate from August to September 2020. We delivered augmented reality headsets (Magic Leap One) to students before the study. Prior to the simulation, via video conference, we introduced students to effective communication skills during a cardiac arrest. Participants then, individually and remotely from their homes, synchronously completed an instructor-led ACLS AR simulation in groups of three. After the simulation, students participated in a structured focus group using a qualitative interview guide. Our study team coded their responses and interpreted them using team-based thematic analysis. RESULTS Eighteen medical and physician assistant students participated. We identified four domains that reflected trainee experiences: experiential satisfaction, learning engagement, technology learning curve, and opportunities for improvement. Students reported that the simulator was acceptable and enjoyable for teaching trainees communication skills; however, there were some technical difficulties associated with initial use. CONCLUSION This study suggests that multiplayer AR is a promising and feasible approach for remote medical education of communication skills during medical crises. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01598-7.
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Affiliation(s)
- Olivia Hess
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
| | - Jimmy Qian
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
| | - Janine Bruce
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA
| | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
| | - Nick Haber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
- Stanford University Graduate School of Education, Stanford, CA USA
| | - Thomas J. Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Way, H3580, MC 5640, Stanford, 94304 CA USA
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14
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Esfahanian M, Marcott SC, Hopkins E, Burkart B, Khosla RK, Lorenz HP, Wang E, De Souza E, Algaze-Yojay C, Caruso TJ. Enhanced recovery after cleft palate repair: A quality improvement project. Paediatr Anaesth 2022; 32:1104-1112. [PMID: 35929340 DOI: 10.1111/pan.14541] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children undergoing cleft palate repair present challenges to postoperative management due to several factors that can complicate recovery. Utilization of multimodal analgesic protocols can improve outcomes in this population. We report experience designing and implementing an enhanced recovery after surgery (ERAS) pathway for cleft palate repair to optimize postoperative recovery. AIMS The primary aim was to implement an ERAS pathway with >70% bundle adherence to achieve a 30% reduction in postoperative opioid consumption within 12 months. Our secondary aims assessed intraoperative opioid consumption, length of stay, timeliness of oral intake, and respiratory recovery. METHODS A multidisciplinary team of perioperative providers developed an ERAS pathway for cleft palate patients. Key drivers included patient and provider education, formal pathway creation and implementation, multimodal pain therapy, and target-based care. Interventions included maxillary nerve blockade and enhanced intra- and postoperative medication regimens. Outcomes were displayed as statistical process control charts. RESULTS Pathway compliance was 77.0%. Patients during the intervention period (n = 39) experienced a 49% reduction in postoperative opioid consumption (p < .0001) relative to our historical cohort (n = 63), with a mean difference of -0.33 ± 0.11 mg/kg (95% CI -0.55 to -0.12 mg/kg). Intraoperative opioid consumption was reduced by 36% (p = .002), with a mean difference of -0.27 ± 0.09 mg/kg (95% CI -0.45 to -0.09 mg/kg). Additionally, patients in the intervention group had a 45% reduction in time to first oral intake (p = .02) relative to our historical cohort, with a mean difference of -3.81 ± 1.56 h (95% CI -6.9 to -0.70). There was no difference in PACU or hospital length of stay, but there was a significant reduction in variance of all secondary outcomes. CONCLUSION Opioid reduction and improved timeliness of oral intake is possible with an ERAS protocol for cleft palate repair, but our protocol did not alter PACU or hospital length of stay.
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Affiliation(s)
- Mohammad Esfahanian
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - Stephen Craig Marcott
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - Elena Hopkins
- Lucile Packard Children's Hospital Stanford, Plastic and Reconstructive Surgery, Cleft and Craniofacial Center, Palo Alto, California, USA
| | - Brendan Burkart
- Center for Pediatric & Maternal Value (CPMV), Lucile Packard Children's Hospital Stanford, Analytics & Clinical Effectiveness, Palo Alto, California, USA
| | - Rohit Kumar Khosla
- Lucile Packard Children's Hospital Stanford, Plastic and Reconstructive Surgery, Cleft and Craniofacial Center, Palo Alto, California, USA.,Division of Plastic & Reconstructive Surgery, Department of Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - H Peter Lorenz
- Lucile Packard Children's Hospital Stanford, Plastic and Reconstructive Surgery, Cleft and Craniofacial Center, Palo Alto, California, USA.,Division of Plastic & Reconstructive Surgery, Department of Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ellen Wang
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - Elizabeth De Souza
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - Claudia Algaze-Yojay
- Center for Pediatric & Maternal Value (CPMV), Lucile Packard Children's Hospital Stanford, Analytics & Clinical Effectiveness, Palo Alto, California, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - Thomas J Caruso
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, USA
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15
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Qian J, Rama A, Wang E, Wang T, Hess O, Khoury M, Jackson C, Caruso TJ. Assessing Pediatric Life Support Skills Using Augmented Reality Medical Simulation With Eye Tracking: A Pilot Study. J Educ Perioper Med 2022; 24:E691. [PMID: 36274998 PMCID: PMC9583759 DOI: 10.46374/volxxiv_issue3_qian] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Augmented reality (AR) and eye tracking are promising adjuncts for medical simulation, but they have remained distinct tools. The recently developed Chariot Augmented Reality Medical (CHARM) Simulator combines AR medical simulation with eye tracking. We present a novel approach to applying eye tracking within an AR simulation to assess anesthesiologists during an AR pediatric life support simulation. The primary aim was to explore clinician performance in the simulation. Secondary outcomes explored eye tracking as a measure of shockable rhythm recognition and participant satisfaction. METHODS Anesthesiology residents, pediatric anesthesiology fellows, and attending pediatric anesthesiologists were recruited. Using CHARM, they participated in a pediatric crisis simulation. Performance was scored using the Anesthesia-centric Pediatric Advanced Life Support (A-PALS) scoring instrument, and eye tracking data were analyzed. The Simulation Design Scale measured participant satisfaction. RESULTS Nine each of residents, fellows, and attendings participated for a total of 27. We were able to successfully progress participants through the AR simulation as demonstrated by typical A-PALS performance scores. We observed no differences in performance across training levels. Eye tracking data successfully allowed comparisons of time to rhythm recognition across training levels, revealing no differences. Finally, simulation satisfaction was high across all participants. CONCLUSIONS While the agreement between A-PALS score and gaze patterns is promising, further research is needed to fully demonstrate the use of AR eye tracking for medical training and assessment. Physicians of multiple training levels were satisfied with the technology.
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Affiliation(s)
- Jimmy Qian
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Asheen Rama
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Ellen Wang
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Tammy Wang
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Olivia Hess
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Michael Khoury
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Christian Jackson
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
| | - Thomas J. Caruso
- The following authors are at Stanford School of Medicine, Stanford, CA: Jimmy Qian is a Medical Student; Olivia Hess is a medical student. The following authors are in the Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, at Stanford University School of Medicine, Stanford, CA: Asheen Rama is a Clinical Assistant Professor; Ellen Wang is a Clinical Associate Professor; Tammy Wang is a Clinical Associate Professor; Christian Jackson is a Statistician; Thomas J. Caruso is a Clinical Professor. Michael Khoury is a Research Assistant in the Stanford Chariot Program at Stanford School of Medicine, Stanford, CA and at Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
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Tsai AH, Bodmer NJ, Gupta K, Caruso TJ. It Takes a Village: A Narrative Review of Anesthesiology Mentorship. Anesthesiol Clin 2022; 40:301-313. [PMID: 35659402 DOI: 10.1016/j.anclin.2022.01.005] [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] [Indexed: 06/15/2023]
Abstract
Mentorships play a critical role in the development of physician careers and should be tailored within a structured, evidence-based mentoring program to ensure mutual benefit and avoidance of pitfalls. We offer a narrative review of the current literature and commentary on mentoring at the medical student, GME trainee, and early career faculty levels within anesthesiology, and propose a framework on which an effective mentoring program can be implemented.
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Affiliation(s)
- Albert H Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H3580, MC 5640, Stanford, CA 94305, USA.
| | - Natalie J Bodmer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H3580, MC 5640, Stanford, CA 94305, USA
| | - Kush Gupta
- Class of 2022, Stanford University School of Medicine, 300 Pasteur Drive, Room H3580, MC 5640, Stanford, CA 94305, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room H3580, MC 5640, Stanford, CA 94305, USA
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17
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Pan S, Lee CK, Caruso TJ, Vorhies JS, Tsui BCH. Systemic lidocaine absorption from continuous erector spinae plane catheters after paediatric posterior spine fusion surgery. Reg Anesth Pain Med 2022; 47:251-252. [PMID: 35012993 DOI: 10.1136/rapm-2021-103234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/14/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Stephanie Pan
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, California, USA
| | - Charles K Lee
- Stanford School of Medicine, Stanford, California, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - John S Vorhies
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ban C H Tsui
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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18
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Hemphill S, Rodriguez S, Wang E, Koeppen K, Aitken-Young B, Jackson C, Simons L, Caruso TJ. Virtual Reality Augments Movement During Physical Therapy: A Pragmatic Randomized Trial. Am J Phys Med Rehabil 2022; 101:229-236. [PMID: 33935153 DOI: 10.1097/phm.0000000000001779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
OBJECTIVE Virtual reality facilitates physical therapy via improved engagement. Although shown to benefit specific patient populations, such as stroke patients, it is less established in otherwise healthy adults and children receiving outpatient physical therapy. The primary objective was to compare total physical therapy-guided movement supplemented with virtual reality with physical therapy-guided movement alone without virtual reality. DESIGN This pragmatic, randomized, crossover study compared physical therapy-guided movement supplemented with virtual reality with physical therapy-guided movement alone without virtual reality in outpatients (ages 6-80 yrs). This community sample had variable physical therapy indications (injury, postoperative, chronic pain), and in pre-existing conditions, therefore, participants served as their own controls. Participants received 10 mins of both physical therapy-guided movement supplemented with virtual reality and physical therapy-guided movement alone without virtual reality separated by 5 mins. The primary outcome was differences in aggregate movement of physical therapy-guided exercises. Secondary outcomes explored OMNI rating of perceived exertion and participant and physical therapist satisfaction. Paired t tests, χ2 tests, and regression models were used to analyze differences. RESULTS The 41 participants (17 pediatric and 24 adult) moved significantly more during physical therapy-guided movement supplemented with virtual reality compared with physical therapy-guided movement alone without virtual reality (1120.88 vs. 672.65 m, P < 0.001), regardless of which intervention was completed first. Physical therapy-guided movement supplemented with virtual reality treatment was associated with more movement of the target limbs, lower body (P < 0.001), and upper body (P < 0.05). The OMNI rating of perceived exertion scores did not differ between those who started with physical therapy-guided movement supplemented with virtual reality or physical therapy-guided movement alone without virtual reality, and physical therapist and patient surveys endorsed physical therapy-guided movement supplemented with virtual reality. CONCLUSIONS Patients completed more physical therapy-guided movement during physical therapy-guided movement supplemented with virtual reality than physical therapy-guided movement alone without virtual reality, and therapists and patients supported its use. Future studies will examine finer tracking of movements.
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Affiliation(s)
- Sydney Hemphill
- From the Division of Pediatric Anesthesia; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford School of Medicine, Stanford, California (SH, SR, EW, CJ, LS, TJC); and ATI Physical Therapy, Palo Alto, California (KK, BA-Y)
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Murray A, Reece-Nguyen T, Caruso TJ. Integrated diversity, equity, and inclusion curriculum into pediatric anesthesia fellowship training: Another step forward. Paediatr Anaesth 2022; 32:487-488. [PMID: 34971019 DOI: 10.1111/pan.14385] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Murray
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Travis Reece-Nguyen
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Thomas J Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Caruso TJ, Armstrong-Carter E, Rama A, Neiman N, Taylor K, Madill M, Lawrence K, Hemphill SF, Guo N, Domingue BW. The Physiologic and Emotional Effects of 360-Degree Video Simulation on Head-Mounted Display Versus In-Person Simulation: A Noninferiority, Randomized Controlled Trial. Simul Healthc 2022; 17:e105-e112. [PMID: 34120135 DOI: 10.1097/sih.0000000000000587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/26/2022]
Abstract
INTRODUCTION A key simulation component is its capability to elicit physiological changes, improving recall. The primary aim was to determine whether parasympathetic responses to head-mounted display simulations (HMDs) were noninferior to in-person simulations. The secondary aims explored sympathetic and affective responses and learning effectiveness. METHODS The authors conducted a noninferiority trial. Hospital providers who did not use chronotropic medications, have motion sickness, or have seizures were included. The authors randomized participants to in-person or HMD simulation. Biometric sensors collected respiratory sinus arrhythmia and skin conductance levels to measure parasympathetic and sympathetic states at baseline, during, and after the simulation. Affect was measured using a schedule. The authors measured 3-month recall of learning points and used split-plot analysis of variance and Mann-Whitney U tests to analyze. RESULTS One hundred fifteen participants qualified, and the authors analyzed 56 in each group. Both groups experienced a significant change in mean respiratory sinus arrhythmia from baseline to during and from during to afterward. The difference of change between the groups from baseline to during was 0.134 (95% confidence interval = 0.142 to 0.410, P = 0.339). The difference of change from during the simulation to after was -0.060 (95% confidence interval = -0.337 to 0.217, P = 0.670). Noninferiority was not established for either period. Sympathetic arousal did not occur in either group. Noninferiority was not established for the changes in affect that were demonstrated. The mean scores of teaching effectiveness and achievement scores were not different. CONCLUSIONS Although a parasympathetic and affective response to the video simulation on an HMD did occur, it was not discernibly noninferior to in-person in this study.
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Affiliation(s)
- Thomas J Caruso
- From the Department of Anesthesiology, Perioperative, and Pain Medicine (T.J.C., A.R., N.N., K.T., N.G.), Stanford University School of Medicine; Stanford University Graduate School of Education (E.A.-C., B.D.), Stanford, CA; University of Pittsburgh School of Medicine (M.M.), Pittsburgh, PA; Department of Internal Medicine, Legacy Emanuel Medical Center (K.L.), Portland, OR; and Stanford University School of Medicine (S.F.H.), Stanford, CA
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21
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Alonzi S, Caruso TJ, Sindher SB, Cao S, Varadharajulu S, Collins WJ, Chinthrajah RS. Virtual Reality Reduces Pediatric Anxiety During Food Allergy Clinical Trials: A Pilot Randomized, Pragmatic Study. Front Allergy 2022; 2:779804. [PMID: 35387040 PMCID: PMC8974765 DOI: 10.3389/falgy.2021.779804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
Phlebotomy procedures required in food allergy (FA) diagnosis and clinical trials often induce fear and anxiety for pediatric patients. The primary aim of this study was to determine whether virtual reality (VR) applications were effective in reducing anxiety for pediatric FA patients undergoing phlebotomy during FA clinical trials. Secondary aims assessed fear, pain, procedural compliance, and adverse events. Participants undergoing phlebotomy were enrolled and randomized to a VR group or standard of care (SOC) group for this prospective pilot randomized, pragmatic study. Participants in the VR group played interactive applications on a customized Samsung Gear VR headset and those in the SOC group received the standard of care. Participants' anxiety, fear, and pain were assessed with the Children's Anxiety Meter, Children's Fear Scale, and FACES pain scale pre, during, and post phlebotomy procedure. Compliance was assessed using the modified Induction Compliance Checklist during the procedure and compared between two groups. Forty-nine participants were randomized to VR (n = 26) and SOC (n = 23) groups. Although both the VR and SOC groups experienced a decrease in anxiety and fear from pre- to post-procedure, those in the VR group experienced less anxiety and fear during the procedure than SOC participants. Similarly, both groups experienced an increase in pain from pre- to post-procedure; however, the VR group reported less pain during the procedure than SOC. Fewer symptoms of procedural non-compliance were reported in the VR group. Interactive VR applications may be an effective tool for reducing fear, anxiety, and pain during phlebotomy for FA clinical trials.
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Affiliation(s)
- Sarah Alonzi
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Thomas J. Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Sayantani B. Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Sara Varadharajulu
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - William J. Collins
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
- Department of Medicine, Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - R. Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, United States
- *Correspondence: R. Sharon Chinthrajah
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22
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Richey AE, Khoury M, Segovia NA, Hastings KG, Caruso TJ, Frick S, Rodriguez S. Use of Bedside Entertainment and Relaxation Theater (BERT) to Reduce Fear and Anxiety Associated With Outpatient Procedures in Pediatric Orthopaedics. J Pediatr Orthop 2022; 42:30-34. [PMID: 34739431 DOI: 10.1097/bpo.0000000000002005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the effectiveness of the Bedside Entertainment and Relaxation Theater (BERT) on fear, anxiety, and pain outcomes in pediatric orthopaedic patients associated with cast removal and/or pin removal in the outpatient clinic setting. METHODS A total of 66 pediatric patients between the ages of 2 and 6 undergoing clinic procedures were recruited for this study and randomized into the control group or the intervention (BERT) group. Patients in the control group received standard of care during the cast room procedure; patients in the BERT group were given headphones and watched a movie on a projector during the procedure. Fear, anxiety, and pain were measured before and after the procedure. Procedures included cast removal, pin removal, or a combination of the 2. RESULTS Patients in the BERT group reported less fear and anxiety overall after the procedure than patients in the control group (P=0.009, 0.015). Adjusting for procedure type (ie, pin removal), patients in the BERT group reported a 0.67 point decrease (95% confidence interval: 0.04, 1.30) on the fear scale after the procedure (P=0.039) and a 1.81 point decrease (95% confidence interval: 0.04, 3.59) on the anxiety scale associated with the procedure (P=0.045), compared with the control group. Patients and caregivers reported high satisfaction with BERT. CONCLUSION This randomized, controlled trial demonstrates an evidence-based distraction tool that can be implemented across medical centers for pediatric patients undergoing office based orthopaedic procedures. BERT can be used to reduce fear and anxiety associated with these procedures, and increase patient and parent satisfaction. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | - Michael Khoury
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | | | | | - Thomas J Caruso
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | | | - Samuel Rodriguez
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
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Caruso TJ, Fonseca A, Barreau A, Khoury M, Menendez M, Wang E, Lawrence K, Jackson C, Rodriguez S. Real-time reorientation and cognitive load adjustment allow for broad application of virtual reality in a pediatric hospital. J Clin Transl Res 2021; 7:750-753. [PMID: 34988325 PMCID: PMC8710353] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/11/2021] [Accepted: 09/29/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND With a new generation of affordable portable virtual reality (VR), clinicians are discovering more utility for VR, while also identifying opportunities for improvement, such as the inability to reorient the horizon line during repositioning or transport, or modulate cognitive load in real time. AIM At our institution, this lack of functionality prohibited or decreased VR usage in some clinical scenarios such as dressing changes with dynamic positioning. The purpose of this brief report is to describe the development and use of a VR application that is optimized for the healthcare setting and report historical effects of patients who utilized VR as supplement to Child Life procedures. Eligible affects per chart review included Happy, Relaxed, Anxious, Distressed, Unable to Assess. MATERIALS AND METHODS Given the need for real-time reorientation and cognitive load modulation, we created the Space Pups™ VR application. The experience was launched as part of the Stanford Chariot Program in the summer of 2017, and its usage was tracked through the electronic medical record and a VR application dashboard. Chart review was queried from 3 January 2018 to 9 August 2021 for pediatric patients who used VR with real-time reorientation and cognitive load modulation as a supplement to their Child Life interventions. RESULTS The Space Pups™ experience has been successfully used in a variety of settings, including perioperative care, vascular access, wound care, and ENT clinic, a total of 1696 times. Patients ranged from 6 years to 18-year old, with no reports of side effects. Significant results (P<0.001) were observed pre- and post-VR use for affect improvements in Happy, Relaxed, and Anxious, but not for Distressed. CONCLUSIONS The ability to reorient VR experiences in real time has increased functionality where other applications have failed. RELEVANCE FOR PATIENTS While more studies are needed to quantify the anxiolytic and pain-reducing effect of Space Pups™, our report demonstrates the feasibility of this VR experience as a non-pharmacological modality to safely increase patient cooperation in a wide variety of clinical settings.
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Affiliation(s)
- Thomas J. Caruso
- 1Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA,Corresponding author: Thomas J. Caruso Department of Anesthesiology, Perioperative, and Pain Medicine. Stanford University School of Medicine. Stanford, CA, 94304, USA. E-mail:
| | - Ahtziri Fonseca
- 2Stanford Chariot Program, Lucile Packard Children’s Hospital, Palo Alto, CA, 94305, USA
| | - Ariana Barreau
- 2Stanford Chariot Program, Lucile Packard Children’s Hospital, Palo Alto, CA, 94305, USA
| | - Michael Khoury
- 2Stanford Chariot Program, Lucile Packard Children’s Hospital, Palo Alto, CA, 94305, USA
| | - Maria Menendez
- 2Stanford Chariot Program, Lucile Packard Children’s Hospital, Palo Alto, CA, 94305, USA
| | - Ellen Wang
- 1Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Kiley Lawrence
- 3Department of Anesthesiology, Perioperative, and Pain Medicine. Massachusetts General Hospital. Boston, MA, 02114, USA
| | - Christian Jackson
- 2Stanford Chariot Program, Lucile Packard Children’s Hospital, Palo Alto, CA, 94305, USA
| | - Samuel Rodriguez
- 1Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
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Kennedy K, Wang E, Rodriguez ST, Qian J, Khoury M, Kist MN, Jackson C, Yun R, Caruso TJ. Development and assessment of an efficient pediatric affect and cooperation scale. J Clin Anesth 2021; 76:110569. [PMID: 34739949 DOI: 10.1016/j.jclinane.2021.110569] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/03/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE HRAD± was developed to quickly evaluate pediatric preprocedural affect and cooperativity during mask induction of anesthesia and peripheral intravenous (PIV) placement. HRAD± represents: Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperativity. The primary aim of this study was to compare HRAD± to previously published scales. DESIGN We conducted an observational study. SETTING Videos of pediatric patients were collected in the perioperative environment. PATIENTS Twenty-four children, twenty-one pediatric anesthesiologists and twenty pediatric perioperative providers were included. INTERVENTIONS To assess the reliability of HRAD±, standard patient videos were created. Children underwent mask induction or PIV placement, and these interventions were video recorded. Mask induction and PIV placement videos were rated by pediatric anesthesiologists and perioperative non-physician providers respectively using HRAD±. MEASUREMENTS Two trained researchers provided the modified Yale Preoperative Anxiety Scale (mYPAS), Observation Scale of Behavioral Distress (OSBD), and Induction Compliance Checklist (ICC) scores, and we calculated correlations to HRAD±, inter-rater reliability, and intra-rater reliability. MAIN RESULTS HRAD± scores strongly correlated with mYPAS (r = 0.846, p < 0.0001) and OSBD scores (r = 0.723, p < 0.0001). Cooperativity scores correlated strongly with ICC scores in the mask induction group (r = -0.715, p < 0.0001) and in the PIV group (r = -0.869, p < 0.0001). HRAD± inter-rater reliability for mask induction was 0.414 (p < 0.0001) and for PIV assessment was 0.378 (p < 0.0001). Inter-rater reliability for cooperativity on mask induction was 0.797 (p < 0.0001) and PIV assessment was 0.683 (p < 0.0001). Intra-rater reliability for mask induction was 0.675 and PIV assessments was 0.678. Intra-rater reliability for cooperativity for mask induction was 0.894 and for PIV assessments was 0.765. CONCLUSIONS HRAD± is an efficient and reliable scale that serves as a practical alternative for measuring pediatric affect during mask induction and PIV placement. The results demonstrate strong correlation with commonly utilized yet more complex affect scales.
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Affiliation(s)
- KristinM Kennedy
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, 453 Quarry Road MC5663, Palo Alto, CA 94304, USA
| | - Samuel T Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, 453 Quarry Road MC5663, Palo Alto, CA 94304, USA
| | - Jimmy Qian
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Michael Khoury
- Lucile Packard Children's Hospital Stanford, Stanford Chariot Program, 725 Welch Road, Palo Alto, CA 94304, USA
| | - Madison N Kist
- Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Christian Jackson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, 453 Quarry Road MC5663, Palo Alto, CA 94304, USA
| | - Romy Yun
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, 453 Quarry Road MC5663, Palo Alto, CA 94304, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, 453 Quarry Road MC5663, Palo Alto, CA 94304, USA.
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Mehta A, Patel P, Caruso TJ, Anderson TA. Publication misrepresentation among pediatric anesthesiology fellowship applicants: A retrospective single-center cohort study. Paediatr Anaesth 2021; 31:962-967. [PMID: 34214229 DOI: 10.1111/pan.14251] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Many medical specialties have found publication misrepresentation in residency and fellowship applications, but pediatric anesthesia fellowship application data is lacking. AIMS We sought to determine the prevalence of publication misrepresentation among pediatric anesthesia fellowship applications. METHODS In this retrospective cohort study, fellowship applications to Stanford University's pediatric anesthesiology fellowship program from 2009 to 2019 were reviewed. Only peer-reviewed journal articles listed as accepted or published were included. Nine additional variables were collected: applicant age, gender, citizenship status, American vs. international medical school, public vs. private medical school, allopathic doctor versus osteopathic doctor, number of years between college and medical school, additional degrees, and application year. The primary outcome was the rate of publication misrepresentation, defined as peer-reviewed journal citations listed on the application that could not be verified or on which the applicant was not listed as an author. Secondary outcomes were the associations between publication misrepresentation and the additional collected variables. RESULTS 1280 peer-reviewed journal publications from 877 applicants were reviewed. 3.4% of all citations listed as peer-reviewed journal articles were misrepresented and 9.0% of all applicants with at least 1 publication had ≥1 misrepresented publications. 30.2% of publications labelled "misrepresented" were located in our search of databases but did not have the applicant as an author, and 69.8% could not be located using the search databases. Only one of the 9 collected variables (public vs private medical school) was significantly associated with publication misrepresentation. CONCLUSIONS In this single-center retrospective study, publication misrepresentation was found to occur in one out of 11 pediatric anesthesia fellowship applications with at least one publication. Since residency and fellowship applicant publications may be heavily weighted during the application process, programs may want to include additional inquiries into the accuracy of applicant publications.
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Affiliation(s)
- Ashin Mehta
- Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Palak Patel
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas Anthony Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
PURPOSE OF REVIEW Commercial availability of virtual reality headsets and software has exponentially grown over the last decade as it has become more sophisticated, less expensive, and portable. Although primarily used by the general public for entertainment, virtual reality has been adopted by periprocedural clinicians to improve patient experiences and treatments. The purpose of this review is to explore recently reported evidence for virtual reality effectiveness for pediatric periprocedural care and discuss considerations for clinical implementation. RECENT FINDINGS In the preprocedure setting, practitioners use virtual reality to introduce children to periprocedural environments, distract attention from preprocedural vascular access, and increase cooperation with anesthesia induction. Intraprocedure, virtual reality decreases sedation requirements, and in some instances, eliminates anesthesia for minor procedures. Virtual reality also augments pain reduction therapies in the acute and extended rehabilitation periods, resulting in faster recovery and improved outcomes. Virtual reality seems to be well treated for pediatric use, given close clinical care and carefully curated content. SUMMARY Given the multiple clinical applications of virtual reality to supplement pediatric periprocedural care, practitioners should consider developing clinical programs that reliably provide access to virtual reality. Future research should focus on identification of patient characteristics and types of software that yield optimal patient outcomes.
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Affiliation(s)
- Ellen Wang
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford
| | - James J Thomas
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Samuel T Rodriguez
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford
| | | | - Thomas J Caruso
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford
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Logan DE, Simons LE, Caruso TJ, Gold JI, Greenleaf W, Griffin A, King CD, Menendez M, Olbrecht VA, Rodriguez S, Silvia M, Stinson JN, Wang E, Williams SE, Wilson L. Leveraging Virtual Reality and Augmented Reality to Combat Chronic Pain in Youth: Position Paper From the Interdisciplinary Network on Virtual and Augmented Technologies for Pain Management. J Med Internet Res 2021; 23:e25916. [PMID: 33667177 PMCID: PMC8111507 DOI: 10.2196/25916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/14/2020] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions. However, in this young field, there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. OBJECTIVE The INOVATE-Pain (Interdisciplinary Network on Virtual and Augmented Technologies for Pain management) consortium aims to advance the field of VR for pediatric chronic pain rehabilitation by providing guidance for best practices in the design, evaluation, and dissemination of VR-based interventions targeting this population. METHODS An interdisciplinary meeting of 16 academics, clinicians, industry partners, and philanthropy partners was held in January 2020. RESULTS Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR and AR clinical care, highlighted key opportunities and challenges facing the field, and established a consensus on best methodological practices to adopt in future efforts to advance the research and practice of VR and AR in pediatric pain. The consortium also identified important next steps to undertake to continue to advance the work in this promising new area of digital health pain interventions. CONCLUSIONS To realize the promise of this realm of innovation, key ingredients for success include productive partnerships among industry, academic, and clinical stakeholders; a uniform set of outcome domains and measures for standardized evaluation; and widespread access to the latest opportunities, tools, and resources. The INOVATE-Pain collaborative hopes to promote the creation, rigorous yet efficient evaluation, and dissemination of innovative VR-based interventions to reduce pain and improve quality of life for children.
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Affiliation(s)
- Deirdre E Logan
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Jeffrey I Gold
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Anya Griffin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Maria Menendez
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Vanessa A Olbrecht
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Megan Silvia
- Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, United States
- Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA, United States
| | | | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Sara E Williams
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Luke Wilson
- Mighty Immersion, Inc., New York, NY, United States
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Yuan JC, Rodriguez S, Caruso TJ. Unique considerations of virtual reality utilization for perioperative pediatric patients. Paediatr Anaesth 2021; 31:377-378. [PMID: 33631038 DOI: 10.1111/pan.14108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Justin C Yuan
- Department of Internal Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
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Caruso TJ, Hess O, Roy K, Wang E, Rodriguez S, Palivathukal C, Haber N. Integrated eye tracking on Magic Leap One during augmented reality medical simulation: a technical report. BMJ Simul Technol Enhanc Learn 2021; 7:431-434. [DOI: 10.1136/bmjstel-2020-000782] [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] [Received: 09/09/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Abstract
Augmented reality (AR) has been studied as a clinical teaching tool, however eye-tracking capabilities integrated within an AR medical simulator have limited research. The recently developed Chariot Augmented Reality Medical (CHARM) simulator integrates real-time communication into a portable medical simulator. The purpose of this project was to refine the gaze-tracking capabilities of the CHARM simulator on the Magic Leap One (ML1). Adults aged 18 years and older were recruited using convenience sampling. Participants were provided with an ML1 headset that projected a hologram of a patient, bed and monitor. They were instructed via audio recording to gaze at variables in this scenario. The participant gaze targets from the ML1 output were compared with the specified gaze points from the audio recording. A priori investigators planned to iterative modifications of the eye-tracking software until a capture rate of 80% was achieved. Two consecutive participants with a capture rate less than 80% triggered software modifications and the project concluded after three consecutive participants’ capture rates were greater than 80%. Thirteen participants were included in the study. Eye-tracking concordance was less than 80% reliable in the first 10 participants. The investigators hypothesised that the eye movement detection threshold was too sensitive, thus the algorithm was adjusted to reduce noise. The project concluded after the final three participants’ gaze capture rates were 80%, 80% and 80.1%, respectively. This report suggests that eye-tracking technology can be reliably used with the ML1 enabled with CHARM simulator software.
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Tsui BCH, Brodt J, Pan S, Caruso TJ, Kim R, Horn JL, Boublik J, Tsui JH. Alternating Side Programmed Intermittent Repeated (ASPIRe) Bolus Regimen for Delivering Local Anesthetic via Bilateral Interfascial Plane Catheters. J Cardiothorac Vasc Anesth 2021; 35:3143-3145. [PMID: 33731299 DOI: 10.1053/j.jvca.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Ban C H Tsui
- Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine Stanford, CA.
| | - Jessica Brodt
- Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine Stanford, CA
| | - Stephanie Pan
- Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine Stanford, CA
| | - Thomas J Caruso
- Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine Stanford, CA
| | - Richard Kim
- Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine Stanford, CA
| | - Jean Louis Horn
- Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine Stanford, CA
| | - Jan Boublik
- Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine Stanford, CA
| | - Jeremy H Tsui
- Department of Anesthesiology and Pain Medicine, Stanford University School of Medicine Stanford, CA
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Prionas ND, Kung TH, Dohn A, Piro N, von Eyben R, Katznelson L, Caruso TJ. A pilot, randomized controlled trial of telementorship: A useful tool during social distancing. J Clin Transl Res 2021; 7:66-71. [PMID: 34104809 PMCID: PMC8177021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/01/2020] [Accepted: 11/05/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND During social distancing, resident mentorship may be an unmet need. Telementorship, mentorship through video conferencing software, presents a unique approach to overcome these challenges. AIMS This study evaluated whether telementorship through video conference increased access to mentorship encounters and decreased perceived barriers to access, factors that determine likelihood to maintain mentor relationships, and quality of mentorship. METHODS A year-long randomized, prospective cohort study was conducted in 2016-2017 with pairs of resident mentors from seven different training programs and medical student mentees, randomized to telementorship or in-person mentorship. The number of quarterly encounters was monitored and demographic predictors of meeting were determined. Likert scale survey responses were analyzed with linear regression. RESULTS Forty-three of 46 (93.5%) volunteer mentor-mentee pairs participated. Telementorship did not alter likelihood of meeting or attitudes toward mentorship barriers (time and distance). Mentee satisfaction increased from 42.5% to 65.4% (P<0.05) throughout the year. Operating room-based practice (P<0.05) and higher postgraduate level (P=0.02) decreased the likelihood of meeting. CONCLUSION Telementorship provided an equal number of encounters compared to the pairs who were asked to meet in-person. Telementorship may serve as an adjunct modality for flexible communication. RELEVANCE FOR PATIENTS Medical mentorship is a key component to medical education. Effective mentorship increases academic research productivity, job satisfaction, and advancement of clinical skills, which translate to improved patient care.
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Affiliation(s)
- Nicolas D. Prionas
- 1Department of Radiation Oncology, University of California San Francisco Medical Center 505 Parnassus Ave. San Francisco, CA
| | - Tiffany H. Kung
- 2Department of Anesthesiology, Perioperative, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA
| | - Ann Dohn
- 3Department of Graduate Medical Education, Stanford University Medical Center, 300 Pasteur Drive - Room HC435, Stanford, CA
| | - Nancy Piro
- 3Department of Graduate Medical Education, Stanford University Medical Center, 300 Pasteur Drive - Room HC435, Stanford, CA
| | - Rie von Eyben
- 4Department of Radiation Oncology, Stanford Cancer Center, MC 5847, 875 Blake Wilbur Drive Stanford, CA
| | - Laurence Katznelson
- 3Department of Graduate Medical Education, Stanford University Medical Center, 300 Pasteur Drive - Room HC435, Stanford, CA,5Department of Medicine, Stanford University Medical Center, 300 Pasteur Drive - Room S102, Stanford, CA,6Department of Neurosurgery, Stanford Neuroscience Health Center, 213 Quarry Road, Palo Alto CA
| | - Thomas J. Caruso
- 3Department of Graduate Medical Education, Stanford University Medical Center, 300 Pasteur Drive - Room HC435, Stanford, CA,7Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3584 Stanford, CA,
Corresponding author: Thomas J. Caruso Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3584 Stanford, CA 94305-5640, United States. E-mail:
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Griffin A, Wilson L, Feinstein AB, Bortz A, Heirich MS, Gilkerson R, Wagner JF, Menendez M, Caruso TJ, Rodriguez S, Naidu S, Golianu B, Simons LE. Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study. JMIR Rehabil Assist Technol 2020; 7:e22620. [PMID: 33226346 PMCID: PMC7721555 DOI: 10.2196/22620] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 07/17/2020] [Revised: 09/02/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background In the field of pain, virtual reality (VR) technology has been increasingly common in the context of procedural pain management. As an interactive technology tool, VR has the potential to be extended beyond acute pain management to chronic pain rehabilitation with a focus on increasing engagement with painful or avoided movements. Objective We outline the development and initial implementation of a VR program in pain rehabilitation intervention to enhance function in youth with chronic pain. Methods We present the development, acceptability, feasibility, and utility of an innovative VR program (Fruity Feet) for pediatric pain rehabilitation to facilitate increased upper and lower extremity engagement. The development team was an interdisciplinary group of pediatric experts, including physical therapists, occupational therapists, pain psychologists, anesthesiologists, pain researchers, and a VR software developer. We used a 4-phase iterative development process that engaged clinicians, parents, and patients via interviews and standardized questionnaires. Results This study included 17 pediatric patients (13 female, 4 male) enrolled in an intensive interdisciplinary pain treatment (IIPT) program, with mean age of 13.24 (range 7-17) years, completing a total of 63 VR sessions. Overall reports of presence were high (mean 28.98; max 40; SD 4.02), suggestive of a high level of immersion. Among those with multisession data (n=8), reports of pain (P<.001), fear (P=.003), avoidance (P=.004), and functional limitations (P=.01) significantly decreased. Qualitative analysis revealed (1) a positive experience with VR (eg, enjoyed VR, would like to utilize the VR program again, felt VR was a helpful tool); (2) feeling distracted from pain while engaged in VR; (3) greater perceived mobility; and (4) fewer clinician-observed pain behaviors during VR. Movement data support the targeted impact of the Fruity Feet compared to other available VR programs. Conclusions The iterative development process yielded a highly engaging and feasible VR program based on qualitative feedback, questionnaires, and movement data. We discuss next steps for the refinement, implementation, and assessment of impact of VR on chronic pain rehabilitation. VR holds great promise as a tool to facilitate therapeutic gains in chronic pain rehabilitation in a manner that is highly reinforcing and fun.
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Affiliation(s)
- Anya Griffin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Luke Wilson
- Mighty Immersion, Inc., New York, NY, United States
| | - Amanda B Feinstein
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Adeline Bortz
- PGSP-Stanford University Psy.D. Consortium, Stanford, CA, United States
| | - Marissa S Heirich
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Jenny Fm Wagner
- Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Maria Menendez
- Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Srinivas Naidu
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Brenda Golianu
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
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Caruso TJ, Lin C, O'Connell C, Weiss D, MD GB, Wu M, Kwiatkowski D, Maeda K, Tsui BC. Systemic Absorption of Lidocaine from Continuous Erector Spinae Plane Catheters After Congenital Cardiac Surgery: A Retrospective Study. J Cardiothorac Vasc Anesth 2020; 34:2986-2993. [DOI: 10.1053/j.jvca.2020.05.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/14/2022]
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Caruso TJ, O'Connell C, Qian J, Menendez M, Fonseca A, Lawrence K, Sidell DR, Darling C, Tsui B. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in pediatric bronchoscopy: A prospective pilot study. J Clin Anesth 2020; 68:110086. [PMID: 33075630 DOI: 10.1016/j.jclinane.2020.110086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Thomas J Caruso
- Lucile Packard Children's Hospital Stanford, Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford University, CA, USA.
| | | | - Jimmy Qian
- Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Menendez
- Lucile Packard Children's Hospital Stanford, Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford University, CA, USA
| | - Ahtziri Fonseca
- Lucile Packard Children's Hospital Stanford, Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford University, CA, USA
| | - Kiley Lawrence
- Stanford University School of Medicine, Stanford, CA, USA
| | - Douglas R Sidell
- Lucile Packard Children's Hospital Stanford, Department of Otolaryngology, Head, and Neck Surgery, Stanford University School of Medicine, Stanford University, CA, USA
| | - Curtis Darling
- Lucile Packard Children's Hospital Stanford, Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford University, CA, USA
| | - Ban Tsui
- Lucile Packard Children's Hospital Stanford, Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford University, CA, USA
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Hemphill S, Nguyen A, Rodriguez ST, Menendez M, Wang E, Lawrence K, Caruso TJ. Mobilization and calibration of the HTC VIVE for virtual reality physical therapy. Digit Health 2020; 6:2055207620950929. [PMID: 32963801 PMCID: PMC7488919 DOI: 10.1177/2055207620950929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/19/2019] [Accepted: 07/28/2020] [Indexed: 01/13/2023] Open
Abstract
Aims The HTC VIVE virtual reality (VR) system is a potential tool for collecting kinematic data during inpatient and outpatient physical therapy (PT). When validated against research-grade systems, the VIVE has a reported translational error between 1.7 mm-2.0 cm. Our purpose was to portabilize the VIVE for room to room PT and validate the motion tracking software. Methods The VIVE was configured on a mobile cart. To validate the motion tracking software, the VIVE sensors (motion tracker, controller, headset) were mounted on a rigid linear track and driven through 10, one-meter translations in the X, Y, and Z axes. Results The mean translational error for all three sensors was below 4.9 cm. While error is greater than that reported for research-grade systems, motion tracking software on the portable VIVE unit appears to be a valid means of tracking aggregate movement. Conclusion Some therapy may require more precise measurements, however, the advantages of portability and accessibility to patients may outweigh the limitation of reduced precision.
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Affiliation(s)
- Sydney Hemphill
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Alan Nguyen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Samuel T Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Maria Menendez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Kiley Lawrence
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
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Caruso TJ, Madill M, Sidell D, Meister K, Wang E, Menendez M, Kist MN, Rodriguez S. Using Augmented Reality to Reduce Fear and Promote Cooperation During Pediatric Otolaryngologic Procedures. Laryngoscope 2020; 131:E1342-E1344. [PMID: 32886794 DOI: 10.1002/lary.29098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/07/2020] [Revised: 07/14/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022]
Abstract
This case series examines interactive AR during minor otolaryngologic procedures. Although VR has been successfully used for pediatric vascular access, removing children from comforting people in the real world has resulted in patient anxiety. AR offers a potential advantage, utilizing distracting holographic images when patients maintain eye contact with parents. The primary objective was to determine the effect of AR on fear during pediatric otolaryngologic procedures. Secondary objectives included evaluating pain; procedure compliance; and patient, parent and physician attitudes toward AR, as well as assessing the feasibility of adding AR to a busy outpatient otolaryngologic clinic. Laryngoscope, 131:E1342-E1344, 2021.
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Affiliation(s)
- Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Martine Madill
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Douglas Sidell
- Department of Otolaryngology, Head, and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Kara Meister
- Department of Otolaryngology, Head, and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Maria Menendez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Madison N Kist
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, U.S.A
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Dinh A, Furukawa L, Caruso TJ. The virtual visit: Using immersive technology to visit hospitals during social distancing and beyond. Paediatr Anaesth 2020; 30:954-956. [PMID: 32959974 DOI: 10.1111/pan.13922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
Medical trainees face substantial financial and scheduling burdens during the interview process at various levels of training. With current social distancing and travel restrictions in place, in-person interviews now carry an additional health risk that make it difficult for training programs and applicants to conduct a thorough interview process. Virtual interviews and presentations are some of the technology-driven solutions that have been accelerated in the current social context to mitigate financial burdens and health risks. By utilizing immersive technology to provide virtual tours of training sites, applicants have the opportunity to gain a comprehensive perspective before making the critical decision of where to continue their training. We provide our experiences with creating a 360-degree virtual tour of our children's hospital and the methods for distribution to pediatric anesthesia fellowship applicants. Moving forward, training programs may consider immersive virtual tours as an alternative to face-to-face site visits to not only help alleviate the financial and scheduling burden for applicants but also to protect the well-being of healthcare personnel and patients in the context of a global pandemic.
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Affiliation(s)
- Andrew Dinh
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Louise Furukawa
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
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Marquez JL, Wang E, Rodriguez ST, O'Connell C, Munshey F, Darling C, Tsui B, Caruso J, Caruso TJ. A retrospective cohort study of predictors and interventions that influence cooperation with mask induction in children. Paediatr Anaesth 2020; 30:867-873. [PMID: 32452092 DOI: 10.1111/pan.13930] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uncooperative pediatric mask induction is linked to perioperative anxiety. Although some risk factors for uncooperative inductions have been reported, there are no large cohort studies that identify intrinsic patient characteristics associated with cooperation. AIM The primary aim was to identify patient characteristics associated with cooperative mask inductions. The secondary aim was to determine whether preoperative interventions were associated with increased cooperation. METHODS This retrospective cohort study included patients 2-11 years old and ASA class I-IV who underwent mask induction. Our primary outcome of interest was cooperation with mask induction, which was correlated against the Induction Compliance Checklist. The variables analyzed for association with cooperation were age, sex, ASA class, class of surgery, preferred language, and race. Interventions examined for association with induction cooperation included premedication with midazolam, exposure to distraction technology, parental presence, and the presence of a Child Life Specialist. Multivariate mixed-effects logistic regression was used to assess the relationship between patient characteristics and cooperation. A separate multivariate mixed-effects logistic regression was used to examine the association between preoperative interventions and cooperation. RESULTS 9692 patients underwent 23 474 procedures during the study period. 3372 patients undergoing 5980 procedures met inclusion criteria. The only patient characteristic associated with increased cooperation was age (OR 1.20, p-value 0.03). Involvement of Child Life Specialists was associated with increased cooperation (OR 4.44, p-value = 0.048) while parental/guardian presence was associated with decreased cooperation (OR 0.38, p-value = 0.002). CONCLUSION In this cohort, increasing age was the only patient characteristic found to be associated with increased cooperation with mask induction. Preoperative intervention by a Child Life Specialists was the sole intervention associated with improved cooperation.
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Affiliation(s)
- Juan L Marquez
- Department of Preventive Medicine, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ellen Wang
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Samuel T Rodriguez
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Chloe O'Connell
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Farrukh Munshey
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Curtis Darling
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ban Tsui
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas J Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Caruso TJ, Qian J, Lawrence K, Armstrong-Carter E, Domingue BW. From Socrates to Virtual Reality: A Historical Review of Learning Theories and Their Influence on the Training of Anesthesiologists. J Educ Perioper Med 2020; 22:E638. [PMID: 32939366 PMCID: PMC7485431 DOI: 10.46374/volxxii-issue2-caruso] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Over the past couple of centuries, the training of American physicians, and anesthesiologists in particular, has undergone a radical transformation. The revolution of medical training has been and continues to be fueled by insights from learning theorists. In this historical review, we discuss the origins of American medical education in the 1700s and continue through the centuries illustrating the impact of learning theories on the education and training of anesthesiologists. In particular, we explore the impact of learning theories of the 1800s and the adult-centered teaching strategies of the 1900s. We also discuss the role of learning theories in molding medical education in the modern technological age.
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Munshey F, Caruso TJ, Wang EY, Tsui BCH. Programmed Intermittent Bolus Regimen for Erector Spinae Plane Blocks in Children. Anesth Analg 2020; 130:e63-e66. [DOI: 10.1213/ane.0000000000003817] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rama A, Knight LJ, Berg M, Chen M, Gonzales R, Delhagen T, Copperman L, Caruso TJ. Near Miss in Intraoperative Magnetic Resonance Imaging: A Case for In Situ Simulation. Pediatr Qual Saf 2020; 4:e222. [PMID: 32010849 PMCID: PMC6946230 DOI: 10.1097/pq9.0000000000000222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022] Open
Abstract
Pediatric patients in intraoperative magnetic resonance imaging (iMRI) settings are at high risk for morbidity should an adverse event occur. We describe an experience in the iMRI scanner where no harm occurred, yet revealed an opportunity to improve the safety of patients utilizing the iMRI. The perioperative quality improvement team, resuscitation team, and radiology nurse leadership collaborated to understand the process better through in situ simulation.
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Affiliation(s)
- Asheen Rama
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Lynda J Knight
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | - Marc Berg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Michael Chen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Ralph Gonzales
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | | | | | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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Caruso TJ, George A, Menendez M, De Souza E, Khoury M, Kist MN, Rodriguez ST. Virtual reality during pediatric vascular access: A pragmatic, prospective randomized, controlled trial. Paediatr Anaesth 2020; 30:116-123. [PMID: 31785015 DOI: 10.1111/pan.13778] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Vascular access is a minor procedure that is associated with reported pain and fear in pediatric patients, often resulting in procedural incompliance. Virtual reality has been shown to be effective in adult populations for reducing pain and anxiety in various medical settings, although large studies are lacking in pediatrics. AIMS The primary aim was to determine whether pain would be reduced in pediatric patients using virtual reality undergoing vascular access. The four secondary aims measured patient fear, procedural compliance, satisfaction, and adverse events. METHODS A prospective, randomized, controlled trial was completed at a pediatric hospital, enrolling children 7-18 years old undergoing vascular access in a variety of clinical settings, randomized to virtual reality or standard of care. Pain scores were measured using a numeric pain faces scale. The secondary outcomes of patient fear, procedural compliance, satisfaction, and adverse events were measured with the Child Fear Scale, modified Induction Compliance Checklist, and satisfaction surveys, respectively. Chi-squared, t tests, and regression models were used to analyze the results. RESULTS The analysis included 106 patients in the virtual reality group and 114 in the control. There were no significant differences in postprocedure pain (VR group estimated 0.11 points lower, 95% confidence interval: 0.50 points lower to 0.28 points greater, P = .59), postprocedure fear (VR group estimated 0.05 points lower, 95% confidence interval: 0.23 points lower to 0.13 points greater), or compliance (adjusted odds ratio 2.31, 95% confidence interval: 0.96-5.56). Children in the virtual reality group were satisfied with the intervention. There were no adverse events. CONCLUSION This study demonstrates no reduction in pain while using Virtual reality (VR) across a heterogeneous pediatric inpatient population undergoing vascular access.
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Affiliation(s)
- Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexandria George
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Menendez
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth De Souza
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Khoury
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Madison N Kist
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Samuel T Rodriguez
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
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Kist M, Bekemeyer Z, Ralls L, Carvalho B, Rodriguez ST, Caruso TJ. Virtual reality successfully provides anxiolysis to laboring women undergoing epidural placement. J Clin Anesth 2019; 61:109635. [PMID: 31662229 DOI: 10.1016/j.jclinane.2019.109635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/21/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M Kist
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - Z Bekemeyer
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - L Ralls
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - B Carvalho
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - S T Rodriguez
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America
| | - T J Caruso
- Stanford University, Department of Anesthesiology, Perioperative, and Pain Medicine, United States of America.
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Robinson JD, Caruso TJ, Wu M, Kleiman ZI, Kwiatkowski DM. Intraoperative Methadone Is Associated with Decreased Perioperative Opioid Use Without Adverse Events: A Case-Matched Cohort Study. J Cardiothorac Vasc Anesth 2019; 34:335-341. [PMID: 31699597 DOI: 10.1053/j.jvca.2019.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/21/2019] [Accepted: 09/25/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine if there is an association of intraoperative methadone use and total perioperative opioid exposure in patients undergoing congenital heart surgeries. DESIGN Retrospective, case-match cohort study. SETTING Single center quaternary care teaching hospital. PARTICIPANTS Seventy-four patients with congenital heart disease (CHD) undergoing surgical repair or palliative surgery. INTERVENTION Thirty-seven patients undergoing CHD surgeries receiving intraoperative methadone were matched to 37 patients based upon age and procedure who did not receive intraoperative methadone. The primary study outcome was to evaluate total opioid use in intravenous milligrams of morphine equivalents per kilogram (mg ME/kg) within the first 36-hours postoperatively. Mann-Whitney U test was used to compare total opioid exposure. MEASUREMENTS AND MAIN RESULTS The total opioid use was compared between groups. The methadone cohort required less opioids intraoperatively, in the first 12 hours postoperatively, and during the first 36 hours postoperatively (2.51 v 4.39 mg ME/kg, p < 0.001; 0.43 v 1.28 mg ME/kg, p = 0.001; and 0.83 v 1.91 mg ME/kg, p < 0.001) compared with the matched control cohort. There were no differences in clinical outcomes or adverse events. A dose-dependent reduction in opioid consumption in high- versus low-dose groups also was not observed. CONCLUSION Intraoperative methadone use was associated with a decrease in perioperative opioid exposure in patients undergoing congenital heart surgery and was not associated with adverse events or prolonged durations of mechanical ventilation or ICU stay.
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Affiliation(s)
- Joshua D Robinson
- Pharmacy Department, Lucile Packard Children's Hospital Stanford, Palo Alto, CA; Department of Pharmaceutical Services, University of California San Francisco Medical Center, San Francisco, CA.
| | - Thomas J Caruso
- Division of Pediatric Anesthesia, Department of Anesthesia Perioperative and Postoperative Pain, Stanford University School of Medicine, Palo Alto, CA
| | - May Wu
- Pharmacy Department, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | - Zachary I Kleiman
- Division of Pediatric Anesthesia, Department of Anesthesia Perioperative and Postoperative Pain, Stanford University School of Medicine, Palo Alto, CA
| | - David M Kwiatkowski
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Caruso TJ, Sidell DR, Lennig M, Menendez M, Fonseca A, Rodriguez ST, Tsui B. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) augments oxygenation in children with cyanotic heart disease during microdirect laryngoscopy and bronchoscopy. J Clin Anesth 2019; 56:53-54. [DOI: 10.1016/j.jclinane.2019.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/06/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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Esfahanian M, Caruso TJ, Lin C, Kuan C, Purkey NJ, Maeda K, Tsui BC. Toward Opioid-Free Fast Track for Pediatric Congenital Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:2362-2363. [DOI: 10.1053/j.jvca.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 11/11/2022]
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Colletti AA, Wang E, Marquez JL, Schwenk HT, Yeverino C, Sharek PJ, Caruso TJ. A multifaceted quality improvement project improves intraoperative redosing of surgical antimicrobial prophylaxis during pediatric surgery. Paediatr Anaesth 2019; 29:705-711. [PMID: 31034725 DOI: 10.1111/pan.13651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/12/2019] [Accepted: 04/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate intraoperative antibiotic redosing contributes to prevention of surgical site infections in pediatric patients. Ensuring compliance with evolving national guidelines of weight-based, intraoperative redosing of antibiotics is challenging to pediatric anesthesiologists. AIMS Our primary aim was to increase compliance of antibiotic redoses at the appropriate time and appropriate weight-based dose to 70%. Secondary aims included a subset analysis of time compliance and dose compliance individually, and compliance based on order entry method of the first dose (verbal or electronic). METHODS At a freestanding, academic pediatric hospital, we reviewed surgical cases between May 1, 2014, and October 31, 2017 requiring antibiotic redoses. After an institutional change in cefazolin dosing in May 2015, phased interventions to improve compliance included electronic countermeasures to display previous and next dose timing, an alert 5 minutes prior to next dose, and weight-based dose recommendation (September 2015). Physical countermeasures include badge cards, posting of guidelines, and updates to housestaff manual (September 2015). Statistical process control charts were used to assess overall antibiotic redose compliance, time compliance, and dose compliance. The chi-square test was used to analyze group differences. RESULTS A total of 3015 antibiotic redoses were administered during 2341 operative cases between May 1, 2014, and October 31, 2017. Mean monthly compliance with redosing was 4.3% (May 2014-April 2015) and 73% (November 2015-October 2017) (P < 0.001). Dose-only compliance increased from 76% to 89% (P < 0.001), and time-only compliance increased from 4.9% to 82% (P < 0.001). After implementation of countermeasures, electronic order entry compared with verbal order was associated with higher dose compliance, 90% vs 86% (P = 0.015). CONCLUSION This quality improvement project, utilizing electronic and physical interventions, was effective in improving overall prophylactic antibiotic redosing compliance in accordance with institutional redosing guidelines.
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Affiliation(s)
- Ashley A Colletti
- Division of Pediatric Anesthesia, Department of Anesthesiology and Pain Medicine, Washington and Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Ellen Wang
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Juan L Marquez
- Department of Preventive Medicine, University of Michigan, School of Public Health, Ann Arbor
| | - Hayden T Schwenk
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Calida Yeverino
- Department of Pharmacy Services, Lucile Packard Children's Hospital Stanford, Stanford, California
| | - Paul J Sharek
- Department of Pediatrics, Washington and Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Thomas J Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Rodriguez ST, Jang O, Hernandez JM, George AJ, Caruso TJ, Simons LE. Varying screen size for passive video distraction during induction of anesthesia in low-risk children: A pilot randomized controlled trial. Paediatr Anaesth 2019; 29:648-655. [PMID: 30916447 DOI: 10.1111/pan.13636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preoperative anxiety affects up to 65% of children who undergo anesthesia induction and often results in uncooperative behavior. Electronic devices have been used to distract children to reduce anxiety and create a more enjoyable preoperative experience. Few studies have compared the effects of different video delivery systems on preoperative anxiety. AIMS The primary aim was to determine if a large projection-based video screen mounted to a patient's bed decreased anxiety when compared to a tablet during mask induction of anesthesia in children from 4-10 years of age. METHODS We performed a prospective, randomized trial to determine differences in our primary outcome, preoperative anxiety, between the large Bedside Entertainment and Relaxation Theater (BERT) and a smaller tablet screen. Secondary outcomes included (a) induction compliance; (b) child fear; (c) frequency of emergence delirium; and (d) satisfaction. RESULTS In examining the primary outcome for 52 patients, there was a main effect for time on mYPAS scores, f(2, 51) = 13.18, P < 0.01. mYPAS scores significantly increased across time for both groups. The interaction for time (T0, T1 or T2) × group (BERT vs Tablet) was not significant, f(2, 51) = 1.96, P = 0.15; thus changes in mYPAS scores across time did not differ by group status. There was no significant difference in induction compliance, child fear, emergence delirium, or satisfaction between the two groups. CONCLUSION In a low-risk population, preoperative anxiety was low and induction compliance was high when pairing screen-based distraction interventions, regardless of size, with parental presence at induction of anesthesia.
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Affiliation(s)
- Samuel T Rodriguez
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Olivia Jang
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Jessica Maya Hernandez
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexandria Joseph George
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Thomas J Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Laura E Simons
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Darling CE, Lin C, Caruso TJ, Tsui BC. Lumbar erector spinae plane catheter via a thoracic approach for iliac crest autograft in a pediatric patient. J Clin Anesth 2019; 54:164-165. [DOI: 10.1016/j.jclinane.2018.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/08/2018] [Indexed: 11/15/2022]
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Caruso TJ. A Sustainable and Effective Mentorship Model for Graduate Medical Education Programs. J Grad Med Educ 2019; 11:221-225. [PMID: 31024657 PMCID: PMC6476078 DOI: 10.4300/jgme-d-18-00650.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/09/2018] [Accepted: 02/11/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mentorship models rarely seek generalizability across training programs at the graduate medical education (GME) level. OBJECTIVE We examined the sustainability and effectiveness of an intervention to increase the number and usefulness of trainee mentorship. METHODS A 0.20 full-time equivalent GME faculty adviser position (MD, MEd) implemented mentorship programs in residencies and fellowships. In group 1, 6 GME programs implemented the mentorship strategies prior to 2014, which were used to measure whether the number of mentor relationships were longitudinally sustained. In group 2, 10 different GME programs implemented the mentorship strategies in 2016, which were used to measure whether the intervention immediately increased the number of mentor relationships. To measure mentorship usefulness, trainees rated mentors' ability to promote clinical skills and personal and professional development. The remaining programs were the comparison. Responses from the 2014 and 2016 annual institutional trainee survey were analyzed. RESULTS The incidence of group 1 reporting mentor relationships in 2014 compared to the incidence of group 1 in 2016 were 89% (41 of 46) and 95% (42 of 44), respectively, suggesting that the intervention was sustained for 2 years (P = .26). Group 2 showed a higher proportion of trainees reporting mentors in 2016 (88%, 149 of 170) compared to preintervention (66%, 71 of 108; P = .00001). Groups 1 and 2 reported significant increases in mentorship usefulness. CONCLUSIONS A GME initiative to enhance mentoring across specialties in 16 GME training programs was self-sustaining and effective.
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