Anesthesia Equipment Research Articles

Molecular epidemiology, microbiological features and infection control strategies for carbapenem-resistant Acinetobacter baumannii in a German burn and plastic surgery center (2020–2022)

BackgroundCarbapenem-resistant Acinetobacter baumannii (CRAB) frequently causes both healthcare-associated infections and nosocomial outbreaks in burn medicine/plastic surgery and beyond. Owing to the high antibiotic resistance, infections are difficult to treat, and patient outcomes are often compromised. The environmental persistence capability of CRAB favors its transmission in hospitals. A comprehensive analysis and understanding of CRAB epidemiology and microbiology are essential for guiding management.MethodsA three-year retrospective cohort study (2020–2022) was conducted in a German tertiary burn and plastic surgery center. In addition to epidemiological analyses, microbiological and molecular techniques, including whole-genome sequencing, were applied for the comprehensive examination of isolates from CRAB-positive patients.ResultsDuring the study period, eight CRAB cases were found, corresponding to an overall incidence of 0.2 CRAB cases per 100 cases and an incidence density of 0.35 CRAB cases per 1000 patient-days. Six cases (75%) were treated in the burn intensive care unit, and four cases (50%) acquired CRAB in the hospital. Molecular analyses comprising 74 isolates supported the epidemiologic assumption that hospital acquisitions occurred within two separate clusters. In one of these clusters, environmental CRAB contamination of anesthesia equipment may have enabled transmission. Furthermore, molecular diversity of CRAB isolates within patients was observed.ConclusionsCRAB can pose a challenge in terms of infection prevention and control, especially if cases are clustered in time and space on a ward. Our study demonstrates that high-resolution phylogenetic analysis of several bacterial isolates from single patients can greatly aid in understanding transmission chains and helps to take precision control measures.

Efficacy of computer-controlled local anesthesia delivery system on pain in dental anesthesia: a systematic review of randomized clinical trials.

Computer-controlled local anesthesia delivery (CCLAD) is an innovative electronic injection device that represents a cutting-edge approach to dental anesthesia. This system is promising for painless anesthesia using controlled anesthetic injections. This review aimed to compare the discomfort experienced by patients during local anesthesia using a traditional syringe and the CCLAD system and evaluate the potential of the CCLAD system as a painless dental anesthesia solution. The inclusion criteria for this study were based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The study population, including children and adults, underwent dental anesthesia using the CCLAD system, ensuring a comprehensive and representative sample that instills confidence in the validity of the results. Fourteen clinical trials were included in the analysis after they fulfilled the eligibility criteria. We found that using computer-assisted anesthetic equipment not only led to a significantly lower pain perception score, but also had a profound positive impact on patient behavior. Patients using the CCLAD device exhibited more cooperative and helpful conduct, indicating the system's effectiveness in improving patient comfort and experience and reassuring the audience about its positive impact. In conclusion, using a computer-assisted anesthetic device such as the CCLAD system significantly reduced pain perception scores and improved patient behavior, making them more cooperative and helpful. These findings offer hope for pediatric dentistry and apprehensive adult patients, suggesting a more comfortable and less daunting dental experience with the CCLAD system.

Anesthetics drug wastage and preventive strategies: Systematic review.

Surgical Patients and hospitals are now facing financial strain due to direct anesthetic demand as a result of the development of new anesthetic drugs, equipment, and techniques. Up to 15% of a hospital's pharmacy budget is currently allocated to anesthetic drug expenses. Drug wastage during anesthesia practice is a widespread hidden source of healthcare waste that leads to anesthetic drug shortages as well as poor operating room efficiency. On the other hand, despite the fact that it is preventable in the vast majority of cases, it is well described that drug wastage is routinely observed, including in developing countries where the consequences significantly affect both hospitals and patients. This review aims to review the prevalence of anesthetic drug waste across the world and systematically formulate and describe preventive strategies. Relevant publications were identified using systematic searches on databases including Google Scholar, Medline (PubMed), the Cochrane Library, and Embase. In addition, papers were detected and then selected through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria guidelines and the inclusion and exclusion criteria. Using the predetermined terms and dates from the searching databases, a total of 504 articles were identified. Based on the screening criteria, 16 papers were considered eligible and included in the final review. In addition, the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis was used for evaluating the quality of selected articles. This study is registered on PROSPERO, number CRD42024497044. Of the sixteen publications from eleven different nations that were considered suitable for inclusion, only two of them addressed the waste of inhalational anesthetics. In more than half of eligible articles, propofol was the frequently wasted drug that contributed to increased financial loss through drug waste. The first most significant factor contributing to the waste of intravenous and inhalational anesthetics was the disposal of multidrug vials following their use for a single patient and high fresh gas flow, respectively. Anesthetic medication waste is a common occurrence worldwide, despite the fact that it is expensive and has a significant negative impact on operating room efficiency. Because the majority of drug waste is avoidable, preventive measures may lower drug waste and improve patient and hospital efficiency.

Total intravenous anesthesia with Ketofol in rabbits: a comparison of the effects of constant rate infusion of midazolam, fentanyl or dexmedetomidine

BackgroundWhen inhalant anesthetic equipment is not available or during upper airway surgery, intravenous infusion of one or more drugs are commonly used to induce and/or maintain general anesthesia. Total intravenous anesthesia (TIVA) does not require endotracheal intubation, which may be more difficult to achieve in rabbits. A range of different injectable drug combinations have been used as continuous infusion rate in animals. Recently, a combination of ketamine and propofol (ketofol) has been used for TIVA in both human patients and animals. The purpose of this prospective, blinded, randomized, crossover study was to evaluate anesthetic and cardiopulmonary effects of ketofol total intravenous anesthesia (TIVA) in combination with constant rate infusion (CRI) of midazolam, fentanyl or dexmedetomidine in eight New Zealand White rabbits. Following IV induction with ketofol and endotracheal intubation, anesthesia was maintained with ketofol infusion in combination with CRIs of midazolam (loading dose [LD]: 0.3 mg/kg; CRI: 0.3 mg/kg/hr; KPM), fentanyl (LD: 6 µg/kg; CRI: 6 µg/kg/hr; KPF) or dexmedetomidine (LD: 3 µg/kg; CRI: 3 µg/kg/hr; KPD). Rabbits in the control treatment (KPS) were administered the same volume of saline for LD and CRI. Ketofol infusion rate (initially 0.6 mg kg− 1 minute− 1 [0.3 mg kg− 1 minute− 1 of each drug]) was adjusted to suppress the pedal withdrawal reflex. Ketofol dose and physiologic variables were recorded every 5 min.ResultsKetofol induction doses were 14.9 ± 1.8 (KPM), 15.0 ± 1.9 (KPF), 15.5 ± 2.4 (KPD) and 14.7 ± 3.4 (KPS) mg kg− 1 and did not differ among treatments (p > 0.05). Ketofol infusion rate decreased significantly in rabbits in treatments KPM and KPD as compared with saline. Ketofol maintenance dose in rabbits in treatments KPM (1.0 ± 0.1 mg/kg/min) and KPD (1.0 ± 0.1 mg/kg/min) was significantly lower as compared to KPS (1.3 ± 0.1 mg/kg/min) treatment (p < 0.05). Ketofol maintenance dose did not differ significantly between treatments KPF (1.1 ± 0.3 mg/kg/min) and KPS (1.3 ± 0.1 mg/kg/min). Cardiovascular variables remained at clinically acceptable values but ketofol infusion in combination with fentanyl CRI was associated with severe respiratory depression.ConclusionsAt the studied doses, CRIs of midazolam and dexmedetomidine, but not fentanyl, produced ketofol-sparing effect in rabbits. Mechanical ventilation should be considered during ketofol anesthesia, particularly when fentanyl CRI is used.

Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa.

To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.

Anaesthesia delivery systems in low and lower-middle-income Asian countries: A scoping review of capacity and effectiveness.

Literature on anaesthesia systems in low and lower middle-income countries is limited, focused on the Africa region, and provides minimal data on anaesthesia or associated disciplines within intensive care, pain management and emergency medicine. We thus conducted a scoping review of primary and secondary research literature on capacity and effectiveness of anaesthesia delivery in low and lower middle-income countries in the Asia region from 2000-2021, to clarify existing knowledge, important gaps, and possible subsequent steps. We applied Arksey and O'Malley's scoping literature review method to search five databases (i.e. EMBASE, CINAHL, Medline, Scopus, Web of Science), screen, extract, and synthesise data under three themes: (i) availability and type of anaesthesia workforce; (ii) anaesthesia system infrastructure, equipment, and supplies; and (iii) effectiveness of anaesthesia provision. We included 25 eligible sources of 603 identified. Only ten (40%) were published in the last 5 years and Asian lower-income countries were primarily represented in 15 multi-country sources. Fifteen (60%) sources used quantitative methods and provided limited information on data collection, e.g. sampling criteria or geographic areas included. No sources included countrywide data, despite anaesthesia delivery and resources differing significantly sub-nationally (e.g. central versus rural/remote, or insecure areas). Data on anaesthesiology delivery were limited, with findings including insufficiencies in workforce, supplies, training, and skills-building of anaesthesia personnel, along with the lack of consistent strategies for overcoming maldistribution of resources and improving anaesthesia delivery systems in the region. This review, a first attempt to synthesise existing data on anaesthesia delivery systems in low and lower-middle-income Asian countries, shows the anaesthesia literature is still limited. Findings highlight the urgent need for additional research and collaboration nationally and regionally to strengthen anaesthesia delivery and surgical facilities in resource-constrained settings.

A threshold of 100 or more colony-forming units on the anesthesia machine predicts bacterial pathogen detection: a retrospective laboratory-based analysis.

Preventing the spread of pathogens in the anesthesia work area reduces surgical site infections. Improved cleaning reduces the percentage of anesthesia machine samples with ≥ 100 colony-forming units (CFU) per surface area sampled. Targeting a threshold of < 100CFU when cleaning anesthesia machines may be associated with a lower prevalence of bacterial pathogens. We hypothesized that anesthesia work area reservoir samples returning < 100CFU would have a low (< 5%) prevalence ofpathogens. In this retrospective cohort study of bacterial count data from nine hospitals, obtained between 2017 and 2022, anesthesia attending and assistants' hands, patient skin sites (nares, axilla, and groin), and anesthesia machine (adjustable pressure-limiting valve and agent dials) reservoirs were sampled at case start and at case end. The patient intravenous stopcock set was sampled at case end. The isolation of ≥ 1CFU of Staphylococcus aureus, methicillin-resistant Staphylococcusaureus, Enterococcus, vancomycin-resistant Enterococcus, gram-negative (i.e., Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp.) or coagulase-negative Staphylococcus was compared for reservoir samples returning ≥ 100CFU vs those returning < 100CFU. Bacterial pathogens were isolated from 24% (7,601/31,783) of reservoir samples, 93% (98/105) of operating rooms, and 83% (2,170/2,616) of cases. The ratio of total pathogen isolates to total CFU was < 0.0003%. Anesthesia machine reservoirs returned ≥ 100CFU for 44% (2,262/5,150) of cases. Twenty-three percent of samples returning ≥ 100CFU were positive for ≥ 1 bacterial pathogen (521/2,262; 99% lower confidence limit, 22%) vs 3% of samples returning < 100CFU (96/2,888; 99% upper limit, 4%). Anesthesia machine reservoir samples returning < 100CFU were associated with negligible pathogen detection. This threshold can be used for assessment of terminal, routine, and between-case cleaning of the anesthesia machine and equipment. Such feedback may be useful because the 44% prevalence of ≥ 100CFU was comparable to the 46% (25/54) reported earlier from an unrelated hospital.

Regional anaesthesia practice in public hospitals in Botswana: A cross-sectional study.

Little is known about the regional anesthesia practice in low resources settings (LRS). The aim of this study was to describe the regional anesthesia capacity, characteristics of regional anesthesia practice, and challenges and solutions of practicing safe regional anesthesia in public hospitals in Botswana. This was a cross-sectional survey of anesthesia providers working in public hospitals in Botswana. A purposive sampling method of public hospitals was used to achieve representation of different hospital levels across Botswana. Paper-based questionnaires were sent to anesthesia providers from selected hospitals. Descriptive statistics were used for analysis. Questionnaires were distributed to 47 selected anesthesia providers from selected hospitals; 38 (80.9%) were returned. Most participants were nurse anesthetists and medical officers (57.8%). All hospitals perform spinal anesthesia; however, other regional techniques were performed by a small number of participants in one referral hospital. Most hospitals had adequate regional anesthesia drugs and sedation medications, however, most hospitals (except one referral hospital) lacked ultrasound machine and the regional anesthesia kit. The common challenges reported were lack of knowledge and skills, lack of equipment and supplies, and lack of hospital engagement and support. Some solutions were proposed such as regional anesthesia training and engaging the hospital management to get resources. The results of this study suggest that spinal anesthesia is the most common regional anesthesia technique performed by anesthesia providers working in public hospitals in Botswana followed by few upper limb blocks. However, most public hospitals lack enough training capacity, equipment, and supplies for regional anesthesia. More engagement of the hospital management, investment in regional anesthesia resources, and training are needed in order to improve the regional anesthesia capacity and provide safe surgery and anesthesia in Botswana.

Subclavian Vein Blood Sampling in Conscious Rats.

There are several established methods for obtaining repeated blood samples from rats, with the most commonly employed methods being lateral tail vein sampling without anesthesia and jugular vein sampling with anesthesia. However, most of these methods require assistance and anesthetic equipment and sometimes pose difficulties in terms of blood collection or the poor quality of blood samples. In addition, these methods of blood collection consume significant time and human resources when repeated blood sampling is required for a large number of rats. This study presents a technique for repetitive blood sampling in non-anesthetized rats by a single proficient individual. Highly satisfactory blood samples can be obtained by puncturing the subclavian vein. The method demonstrated an impressive overall success rate of 95%, with a median time of merely 2 min from rat restraint to the completion of blood collection. Furthermore, performing consecutive blood collections within the designated range does not inflict any harm on the rats. This method is worth promoting for blood collection, especially in large-scale pharmacokinetic studies.

Assessment of MRI Safety Awareness and Practice Standards in Bangladesh

Objectives: The objective of this study was to evaluate the current MRI safety knowledge, awareness and practice standards among MRI technologist in Bangladesh and to perceive if the identified safety principles related to MRI management are in line with international standards. Materials and Methods: The study was carried out with consent option among MRI technologist in Bangladesh. A self-structured questionnaire was used to collect data through email, the questionnaire contained ten parts and 47 questions in all. MRI technologist voluntarily consented and filled out the questionnaire. The questions were to explore knowledge about MRI safety policy and accessories, patient screening, adverse reaction, Infection control, Device labeling, Equipment safety, signage and barriers, access and communication, and MRI safety during pregnancy generally. The collected data were analyzed with the help of Microsoft Excel. Results: Regarding knowledge of MRI equipment, 34% of respondents were unaware of the symbols or signs used to denote the various zones in your MRI suit, and 27% were unaware of the negative effects of quenching magnets. About 45% of respondents, who were asked about emergency/safety accessories’ availability, answered that crash carts and MRI-compatible anesthetic equipment aren’t present in the department. In case of awareness of different zones of the MRI suite, which is crucial for an MRI unit, 46.08% of respondents were unaware in this issue. 50% of respondents do not believe that MRI has any harmful effect to people who are pregnant. This study revealed that many MRI facilities generally are not aware of departmental/equipment safety notices &amp; obstacles. Conclusion: The study showed that awareness about MRI safely and practice standards were not encouraging with many of the MRI technologists due to their insufficient knowledge. They need training along with other supporting staff connected to patient to enhance their knowledge in implementation of safety policy, patient screening tools and exposure of MRI during pregnancy.

Accurate protamine:heparin matching (not just smaller protamine doses) decreases postoperative bleeding in cardiac surgery; results from a high-volume academic medical center.

A multidisciplinary Quality Assurance/Performance Improvement study to identify the incidence of "heparin rebound" in our adult cardiac surgical population instead detected a thromboelastometry pattern suggestive of initial protamine overdose in 34% despite Hepcon-guided anticoagulation management. Analysis of our practice led to an intervention that made an additional lower-range Hepcon cartridge available to the perfusionists. One year later, an IRB-approved retrospective study was conducted in >500 patients to analyze the effects of the intervention, specifically focusing on the impact of the initial protamine dose accuracy and 18-h mediastinal chest tube drainage (MCTd). No differences were observed between group demographics, surgical procedures, duration of CPB or perioperative blood product transfusion. Both groups were managed using the same perfusion and anesthesia equipment, strategies, and protocols. The median initial protamine dose decreased by 19% (p < .001) in the intervention group (170 [IQR 140-220] mg; n = 295) versus the control group (210 [180-250] mg; n = 257). Mean 18-h MCTd decreased by 13% (p < .001) in the intervention group (405.15 ± 231.54mL; n = 295) versus the control group (466.13 ± 286.73mL; n = 257). Covariate-adjusted mixed effects model showed a significant reduction of MCTd in the intervention group, starting from hour 11 after surgery (group by time interaction p = .002). Though previous investigators have associated lower protamine doses with less MCTd, this study demonstrates that more accurately matching the initial protamine dose to the remaining circulating heparin concentration reduces postoperative bleeding.

Trajtimi atraumatik restaurues në stomatologjinë e fëmijëve

Dental caries is one of the most prevalent multifactorial diseases in the world. In the field of dental caries manage- ment, Atraumatic Restorative Treatment is known as a minimal intervention and minimally invasive procedure and has shown to be successful in both, developed and devel- oping countries. The Atraumatic Restorative Treatment is the technique that involves removing carious tooth tissues using hand instruments only, without the use of anesthesia and electrically-driven equipment and restoring the cavity with adhesive restorative material usually a high-viscosity glass-ionomer cement. The Atraumatic Restorative Treat- ment in the single-surface restorations presented high sur- vival percentages in both primary and permanent posterior teeth, while in the multiple-surface restorations presented lower survival percentages. Researchers should focus on im- proving the materials of atraumatic restorative treatment restoration, extending the knowledge of the technique in association with pain and anxiety and encouraging the use of this approach in national oral health care systems.

The preparedness of preoperative anesthesia equipment's and monitors for pediatric patients.

This study aimed to determine the practice of preoperative anaesthesia equipment and monitor preparation for paediatric patients. A cross-sectional study was employed among 150 consecutively selected paediatrics from April to June 2020. Data were collected by semi-structured questionnaire. Data entry and analysis were done using Epi Data and Stata version 14.0. Descriptive statistics were employed. A total of 150 patients who undergo surgery under anaesthesia were observed in surgical and ophthalmic operation rooms. From those procedures, only stethoscope and small-sized syringes achieved 100% of the standards. But paediatric stylet, paediatric defibrillator and paediatric folly catheter had achieved 0%. The remaining were between 10 and 97% according to standards. Even though some paediatric anaesthesia equipments and monitoring preparation have fulfilled the standards, this study showed practice gaps in majority of cases in the preparation of appropriately sized paediatric equipments and monitors.

ORGANIZATIONAL TECHNOLOGIES TO DEACREASE A RISK OF CRITICAL INCIDENTS DURING ANESTHESIA

Resume. The introduction of checklists during anesthesia could affects the critical incidents incidence during anesthesia.&#x0D; The purpose of the study. Studying the impact of organizational technologies the checklist «Safe Surgery» and the checklist of anesthesia equipment on the frequency of critical incidents in Ukrainian hospitals during anesthesiology.&#x0D; Materials and methods. The audit was conducted at the Department of Surgery, Anesthesiology and Intensive Care of Postgraduate Education of Bogomolets NMU.&#x0D; Results. Critical incidents occurred in 150 (12,73%) cases in the control group and 63 (5,95%)) in the intervention group (OR 0.43 [0.32-0.59], p&lt;0.0001).&#x0D; Conclusions. Being a method with a consistently proven positive effect in almost any surgical environment, a checklist is a reliable way to implement modern safety standards. The checklists used by most anesthesiologists during anesthesiology helped reduce the number of errors and shortcomings during manipulations.

Симуляційні технології у навчанні інтернів та безперервній професійній освіті дипломованих лікарів-анестезіологів

відповідальність за роботу життєво важливих функцій, яка лягає на анестезіолога під час виконання маніпуляцій, вимагає високого рівня навичок, особливо у критичних ситуаціях, тому впровадження та розширення сучасних інноваційних методів навчання – запорука постійного зростання якості підготовки лікарів-спеціалістів. У галузі анестезіології симуляційні тренінги, як інструмент навчання та оцінки набутих знань і вмінь, використовується як для лікарів, абітурієнтів післядипломної освіти, так і для студентів медичних університетів. Включення новітніх методик навчання, розширення бази технічних можливостей для курсантів забезпечує якісну та ефективну підготовки медичного персоналу перед початком його клінічної практики, що є запорукою безпеки для пацієнтів й зменшення навантаження на систему охорони здоров’я через зниження відсотка ускладнень, які виникають внаслідок людського фактора. Зменшення кількості ускладнень, які можуть виникати внаслідок недостатнього рівня підготовки фахівців, сприятливо впливає на систему охорони здоров’я в цілому. Покращення форми контролю придбаних навичок та компетенції дозволяють якісно й швидко виявляти помилки та виправляти їх. На кафедрі хірургії, анестезіології та інтенсивної терапії університету ім. О.О. Богомольця широко використовуються різноманітні освітні програми, що містять семінари, моделювання ситуацій та відпрацювання технічних навичок за допомогою манекенів та анестезіологічного обладнання, телесимуляційних тренінгів за допомогою відеообладнання (телевізорів, камер, проєкторів, планшетів). Вивчення й покращення методик проведення моделювання, збільшення матеріально-технічної бази для навчання, розширює можливості для впровадження новітніх методик лікування у клінічну практику. Успішність розвитку спеціалістів-анестезіологів потребує постійного удосконалення методів, що існують і опрацювання новітніх технологій і методів навчання за перспективними опрацьованими алгоритмами. Впровадження симуляційних технологій та технологій віртуальної реальності, а також їх адаптація до вимог сучасності та доопрацювання вже наявних тренажерів має великий перспективний потенціал для розвитку технологій навчання лікарів-анестезіологів у всьому світі. Розширення мережі навчальних центрів сприятиме збільшенню кількості спеціалістів анестезіологів в цілому. У майбутньому оптимізація симуляційних програм буде залежати від чіткого розуміння того, що можна і чого не можливо досягти за допомогою різних симуляційних моделей і обладнання.

Virtual induction for new doctors in a district general hospital

Background: Staff induction is an opportunity and an obligation for organisations to welcome their new trainees and familiarise them with their new workplace. It is well known that UK trainees rotate regularly between hospitals during their career; we, therefore, believed that an online platform for virtual induction of trainees would aid traditional face-to-face induction. This novel virtual tour induction allows trainees to complete part of their induction at a time convenient for them, and familiarise themselves with their new workplace. Swerdlow and colleagues1 highlighted the advantages of screen-based simulation as ‘cost, availability, simplicity, repeatability and scorability’. Methods: For our virtual induction programme, we took 360 degree pictures and videos of our theatre complex. These videos included a complete tour of the theatre complex, the locations of key equipment such as the difficult airway trolley and familiarisation with anaesthetic equipment and the electronic medical record system used in our trust. We then created a website https://wsheducation.co.uk and uploaded these photos and videos on to our website. This link would be shared with all new trainees as part of their induction pack. Results: We sent out a survey of our virtual induction programme to 10 new trainees, seven of whom responded. All seven of them felt that the online virtual induction platform was user friendly, easy to access, and aided induction and familiarisation with the department. In addition, all seven trainees felt more confident with the use of equipment available in our hospital after watching these videos. Conclusion: We received very positive feedback for this novel method of induction and have shown that this high-fidelity induction programme could be used to help with familiarisation of the working environment for new trainees. The platform provides an easy and convenient form of induction and aids continuous reinforced learning through video-based material which could be used alongside face-to-face induction. 1)Swerdlow B, Soelberg J, Osborne-Smith L. Adv Med Educ Pract 2020; 11: 563–7

Validação de brinquedo terapêutico sobre cateterismo cardíaco

The scope of this work was to validate a toy and a narrative as an instructional tool to present to children who are to be submitted to cardiac catheterization. Content validation was performed by 23 specialist judges (storytellers, child educators, nurses, medics, educational psychologists, occupational therapists, and a psychologist), by using a form considering the following topics: goals, structure and presentation, as well as relevance. Quantitative data was analyzed through the Content Validation Index (CVI) and a cutoff of 0.80 was adopted. Qualitative data was then submitted to thematic content analysis. The toy is composed of: figurines representing the child, the healthcare team, and the person responsible for the child, prototypes of the angiography equipment and the anesthesia equipment, and objects used in hospital for anesthetic induction and vein puncture. The narrative addresses the physical structure of the Hemodynamics room and all steps comprising pre-, trans- and post-cardiac catheterization in a playful way. The technology was validated by the judges with a total CVI of 0.95. The validated toy and narrative constitute a dialog between health, education and art that may contribute to integral and humanized care to the child.

Atraumatic restorative treatment in management of dental caries - A review article

Dental caries is a long-term, sugar-dependent condition. It deteriorates the quality of life and has negative effects on the oral cavity, including pain induction, tooth structural damage, cavity development and tooth decay. The traditional technique of treating dental caries often entails rotary burs, local anesthesia, electrical supply and skilled workers. The development of atraumatic restorative therapy (ART) was prompted by the need to treat dental caries in children and the impoverished in less developed nations with limited access to dental facilities and qualified practitioners. Atraumatic restorative treatment treats decaying teeth with manual excavation rather than local anesthesia, rotary burs or advanced dental equipment. A variety of adhesive materials, including glass ionomer cement are used in ART to reconstruct teeth.

ABOUT VARIABLES THAT AFFECT THE PROPER OPERATION OF ANESTHETIC MACHINE

The number of patients having surgery grew by 13.93% between 2017 and 2018, from 4,867 to 6,444, according to the hospitals polled. Therefore, there is an increased risk of equipment damage occurring during operation as a result of adjustments and management. Consequently, the purpose of this study was to examine the safety of anesthetic equipment, the contributing variables to that safety, and accident prevention strategies. The research indicates that there are 51 devices spread throughout 8 locations, including 12 devices at the First Central Hospital of Mongolia, 3 devices at Intermed, and 3 devices at Gurvan Gal and the Second State Central Hospital, respectively. At the hospitals surveyed, 40–50% of the most frequent breakdowns were caused by sensor malfunctions. At these institutions, 15–35% of the operational equipment was out-of-date, and only 45% of spare parts were replaced on a regular basis within the allotted time. Therefore, it is essential to ensure the availability of spare parts for frequently damaged parts, prompt replacement of spare parts, increase the number of engineers and technicians, uninstall any equipment that is outdated or that has been in use for more than eight years, or check it daily with an analyzer for safety and specialists must adhere attentively to the safety recommendations.

Assessment of Magnetic Resonance Imaging Artefacts Caused by Equine Anaesthesia Equipment: A Cadaver Study

Acquisition of magnetic resonance images of the equine limb is still sometimes conducted under general anaesthesia. Despite low-field systems allow the use of standard anaesthetic equipment, possible interferences of the extensive electronic componentry of advanced anaesthetic machines on image quality is unknown. This prospective, blinded, cadaver study investigated the effects of seven standardised conditions (Tafonius positioned as in clinical cases, Tafonius on the boundaries of the controlled area, anaesthetic monitoring only, Mallard anaesthetic machine, Bird ventilator, complete electronic silence in the room (negative control), source of electronic interference [positive control]) on image quality through the acquisition of 78 sequences using a 0.31T equine MRI scanner. Images were graded with a 4-point scoring system, where 1 denoted absence of artefacts and 4 major artefacts requiring repetition in a clinical setting. A lack of STIR fat suppression was commonly reported (16/26). Ordinal logistic regression showed no statistically significant differences in image quality between the negative control and either the non-Tafonius or the Tafonius groups (P = 0.535 and P = 0.881, respectively), and with the use of Tafonius compared to the other anaesthetic machines (P = 0.578). The only statistically significant differences in scores were observed between the positive control and the non-Tafonius (P = 0.006) and the Tafonius groups (P = 0.017). Our findings suggest that anaesthetic machines and monitoring do not appear to affect MRI scan quality and support the use of Tafonius during acquisition of images with a 0.31T MRI system in a clinical context.