Improve Success Rates Research Articles

Short-term outcomes of intra-aortic balloon pump combined with venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis.

The effectiveness of intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock or cardiac arrest remains controversial. The aim of this systematic review and meta-analysis was to investigate the short-term clinical outcomes of IABP combined with VA-ECMO versus VA-ECMO alone. We searched PubMed, Embase, and the Cochrane Library for English language articles published from inception to August 18, 2018. Observational studies comparing IABP combined with VA-ECMO with VA-ECMO were considered eligible for the current study. Twelve observational studies with 3704 patients were included. In the IABP combined with VA-ECMO group mortality was 59.7%, compared with 65.8% in the VA-ECMO alone group. The risk ratio (RR) for this comparison was 0.90 (95% confidence interval [CI], 0.80-1.02; P=0.107; 59.7% vs. 65.8%). In the one-way sensitivity analysis for estimating the effect of each study on mortality, omission of each study did not make a significant difference. Furthermore, the proportion of patients weaned from VA-ECMO was significantly higher in IABP combined VA-ECMO group than in the VA-ECMO alone group (RR, 1.28; 95% CI, 1.21-1.35; P<0.001; 77.9% vs. 61.2%). IABP combined with VA-ECMO could improve success rate of weaning from VA-ECMO, but did not reduce in-hospital mortality in patients with cardiogenic shock or cardiac arrest.

Pulmonary vein reconnections or substrate in the left atrium: what is the reason for atrial fibrillation recurrences? A dialogue on a pressing clinical situation

Pulmonary vein isolation (PVI) has long been held as the cornerstone for atrial fibrillation (AF) ablation. There are patients who do not have successful AF ablations though, especially among those with persistent AF. At the same time, the evidence suggests that ablating beyond the pulmonary veins does not improve success rates. Two possibilities for the incomplete success rates from the procedure are discussed: that more attention needs to be paid to PVI, optimizing delivery of durable, transmural lesions; or alternatively, shifting the focus away from just PVI and addressing the left atrial substrate itself. These two approaches are likely complementary though, and high-density mapping may offer us the ability to undertake them more effectively. The conclusion from this dialogue is that AF is a heterogenous disease and key is to recognize this heterogeneity and respond to it, rather than have a standardized, dogmatic approach. Durable PVI is clearly an important determinant of success but concurrently, we would suggest we need to go beyond this where appropriate to maximize success rates. Clearly the challenge is defining which patients this is appropriate for and how best to do this. Consequently, rather than being 'the' cornerstone of AF ablation, it is more appropriate to consider PVI as 'a' cornerstone of the procedure going forwards and high-density mapping may be the key to optimizing both aspect of the procedure and in so doing improve long term success rates.

Factors contributing to prosthodontic exam anxiety in undergraduate dental students.

IntroductionProsthodontics is a challenging subject for dental students. This study explores the incidence of exam anxiety among prosthodontics students and the variables that moderate it.MethodsA cross-sectional, self-administered questionnaire was distributed to fourth-year undergraduate students immediately before examinations, with a 77% response rate (55.7% female, 44.3% male).ResultsA lack of time to prepare before exams and an inability to recall before exams were the main factors affected by gender. In addition, 63.5% of male students agreed that social media and mobile phones are distractions, while 81.8% of female students disagreed (P<0.001). Within the removable prosthodontic courses (preclinical or clinical), 61.0% of students agreed that a lack of time to prepare before exams is an issue with the clinical course, while 58.5% of the students moderately agreed it is an issue with the preclinical course (P=0.044). A lack of time to prepare, fear of failure, and the time of the examination were of greater concern with regard to quizzes than with mid-term examinations.ConclusionThis study highlights the presence of exam anxiety among prosthodontics students, as well as how that anxiety is influenced by gender, clinical courses, and the type of exam. This study suggests that students should be taught strategies to improve their study, life and time-management skills in order to overcome exam anxiety. This study additionally suggests that improving success rates in dental school requires placing an increased focus in the curriculum on test competency and examination patterns.

Effect of continuous furosemide infusion on outcome of acute kidney injury.

Objective:To evaluate the clinical effects of continuous intravenous infusion with high-dose furosemide on early acute kidney injury (AKI) complicated with acute lung edema.Methods:Ninety patients who had been treated by furosemide at routine dose for 12 hour but with unsatisfactory outcomes were selected and subjected to continuous intravenous infusion with high-dose furosemide. The dose was adjusted according to hourly urine output. Serum levels of urea nitrogen, creatinine and potassium, pH, oxygenation index and mechanical ventilation time before and 6, 12, 24, 48 and 72 hour after treatment were compared.Results:The urine outputs before and 6, 12, 24, 48 and 72 hour after treatment were (10.71 ± 1.81), (164.52 ± 21.42), (189.71 ± 29.61), (181.33 ± 23.52), (176.82 ± 24.80) and (164.52 ± 18.91) ml/h respectively. Compared with data before treatment, the serum levels of urea nitrogen, creatinine and potassium significantly decreased while pH and oxygenation index significantly increased after six hour of treatment (P<0.05). After treatment, the kidney functions of 80 patients (88.9%) were completely recovered, without obvious adverse reactions.Conclusion:For patients with early AKI complicated with acute pulmonary edema who cannot be cured by diuretic agent at routine dose, high-dose furosemide increases urine output and improves success rate.

Comparative evaluation of implant designs: Influence of diameter, length, and taper on stress and strain in the mandibular segment—A three-dimensional finite element analysis

Introduction:Success or failure of dental implants depends on the amount of stress transferred to the surrounding bone. Increased amount of loading to the bone through implant cause failure, whereas decrease in the amount of loading to the bone causes improved success rate of implants. Biomechanical interaction between implant and bone decides the long-term function or prognosis of dental implant system.Aim and Objectives:The aims of this study were to evaluate the influence of implant length and diameter on stress distribution, to understand the stress distribution around bone–implant interface, and to understand the response of bone under axial and non-axial loading conditions.Materials and Methods:Finite element three-dimensional mandibular model was made using cone beam computed tomography of patient with completely edentulous mandible, and in that model five posterior bone segments were selected. NobelReplace Select Tapered implants with diameters and lengths 3.5 × 10 mm, 4.3 × 10 mm, 3.5 × 11.5 mm, and 4.3 × 11.5 mm, respectively were selected and three dimensionally modeled using Creo 2.0 Parametric Pro/E software. Bone and implant models were assembled as 20 models and finite element analysis was performed using ANSYS Workbench v17.0 under axial and non-axial loads.Result:Under axial and non-axial loads, 3.5 × 10 mm implant showed maximum von Mises stress and strain in both cortical and cancellous bone whereas implant with diameter and length 4.3 × 11.5 mm showed minimum von Mises stress and strain in both cortical and cancellous bone.Conclusion:In axial and non-axial loads, amount of stress distribution around implant–bone interface is influenced by diameter and length of implant in cortical and cancellous bone, respectively. Increased diameter of the implant produces the minimum stress in cortical bone. Increased length of the implant produces the minimum stress in cancellous bone.

Translational science as a key for improving success rate of drug development

Translational science as a key for improving success rate of drug development

Vascular access: How to do it

There is good evidence that using ultrasound to guide peripheral intravenous cannulation improves success rates when cannulating paediatric patients. Preparation of the patient and ultrasound transducer to minimise infective complications is a vital part of all ultrasound guided procedures, including peripheral intravenous cannulation. Recent recommendations have included that transducers be disinfected before and after each procedure. Ergonomic considerations are equally important as the procedural technique itself. The room needs to be set up to ensure the proceduralist is in the optimum position for success. A holding position that, dependent on the patient's age, enhances the patients’ comfort while keeping the arm immobile, needs to be planned and discussed with the child's carers. Lastly, an assistant essential to immobilise the limb while not impeding the proceduralist. Holding the transducer to maximise both the comfort of the proceduralist, and visualisation of the vein and needle tip is required. After the cannula is directly visualised entering the skin, the proceduralist's actions must strictly watch and be guided by the images on the ultrasound monitor. Tiny movements of the transducer and cannula are required to maximise needle tip control accuracy. Once the cannula has entered the vein it is important to continue advancing it a further four to five millimetres before advancing the catheter off the stylet to ensure its seamless entry into the vein. Many tips and tricks will be shared with participants during the conference presentation.

Correlation Between Immunological Laboratory Status of Omega-3-Fatty-Acid-Supplemented Patients of a German Fertility Centre and Outcome of IVF-Treatment

A well-defined group of patients of a German Fertility Centre, all supplemented periconceptually with omega-3-fatty acids, was monitored for specific alterations in the immunological laboratory status in correlation with the outcome of in-vitro-fertilization-(IVF)-treatment. For 36 of 52 IVF-patients IVF-treatment was successful. Patients with IVF-success revealed statistically significant lower soluble interleukin-2-receptor concentrations than unsuccessfully treated patients. Decreased numbers of CD4-positive T-cells could be correlated with increased failure rates of IVF, increased numbers of regulatory T-cells on the other hand with significantly improved success rates. Six of the parameters analyzed (T-lymphocytes, T-helper cells, B-lymphocytes, CD4/CD8 ratio and both classes of regulatory T-cells) significantly more often were below the median of the respective distribution in patients without IVF-success than in successfully treated. These results offer the possibility of developing a simple prognostic measure for the outcome of an IVF-therapy by assessing these parameters in relation to the median of the respective distribution. With increasing numbers of parameters lying below the median, the probability of successful IVF-treatment is decreasing.

Efficacy of a Biliary Splint at the Anastomosis in Living Donor Liver Transplantation−With a Special Reference to Postoperative Endoscopic Treatment for Biliary Stricture

Objective: For successful biliary anastomosis in living donor liver transplantation (LDLT), the efficacy of a biliary splint at the anastomosis remains controversial. In the case of biliary anastomotic stricture (BAS), endoscopic intervention is mostly performed as the initial treatment. In this study, we evaluated the efficacy of endoscopic treatment for BAS in patients with placement of splints. Methods: A retrospective study was conducted with 148 adult patients who underwent LDLT with duct-to-duct biliary anastomosis from 2005 to 2015. A biliary splint was placed in all cases; the splint was removed 3 months after the LDLT. Patients who postoperatively underwent endoscopic treatment for BAS were divided into successful and failed groups. Results: A total of 24 patients (16.2%) underwent endoscopic treatment postoperatively. The successful group included 14 patients (63.6%) and the failed group included 8 (36.4%). Comparison between the 2 groups in terms of demographic, pretransplant, intraoperative, and posttransplant data did not show any significant differences. Two patients developed BAS within 3 months after LDLT. In these 2 patients, the splint was dislocated, and endoscopic intervention was not successful. Twenty patients developed BAS later than 3 months after LDLT. In contrast to the success rate of endoscopic intervention of 73.3% in patients without splint dislocation (n = 15), it was 60% in the patient with dislocation of the splint (n = 5). Conclusion: The prevention of early biliary stricture by placing a splint may lead to an improved success rate of endoscopic intervention, since endoscopic intervention was difficult in the cases of early biliary stricture within 3 months.

Laser technology in the ART laboratory: a narrative review.

To improve success rates, assisted reproductive technology (ART) procedures continually undergo optimization and enhancement such that the best quality gametes and embryos can be identified and manipulated, thus improving clinical outcomes. Laser technology is now being applied across ART to reduce procedure times and increase the consistency and reproducibility of traditional ART techniques such as assisted hatching, embryo biopsy, intracytoplasmic sperm injection cryopreservation and sperm immobilization/selection. This review examines the current status of cutting-edge laser-assisted reproductive technologies, investigates experimental techniques that are increasingly being applied clinically. It highlights the benefits of lasers as a powerful technology at the forefront of both diagnostic and therapeutic treatments for general subfertility and male-factor infertility. However, it is important to note that although lasers are becoming increasingly commonplace in ART units, there is comparatively little information in the existing literature pertaining to the potential negative effects that laser application might have on the developing human embryo, thus creating the need for further investigative research.

Societal preferences for fertility treatment in Australia: a stated preference discrete choice experiment

Objective: To investigate preferences for fertility treatment from the Australian general population with the aims of calculating the willingness to pay in tax contribution for attributes (characteristics) that make up treatment and for an “ideal” fertility treatment program. We also assessed whether willingness-to-pay varies by the relationship status or sexual orientation of the patient.Methods: A stated preference discrete choice experiment was administered to a panel of 801 individuals representative of the Australian general population. Seven attributes of fertility treatment under three broad categories were included: outcome, process, and cost. Attributes were identified through published literature, focus group discussions, expert knowledge, and a pilot study. A Bayesian fractional experimental design was used, and data analysis was performed using a generalized multinomial logit model. Further analyses included interaction terms and latent class modeling.Results: Six of the seven attributes influenced the choice of a treatment program. Under process attributes, individuals preferred: continuity of care of clinic staff, where patients are seen by the same doctor but different nurses at each visit; “alternative” treatments being offered to all patients; and onsite clinic counseling and peer-support groups. Personalization and tailoring of the treatment journey were not important. Among outcome attributes, the improved success rate of having a baby per cycle and significant side-effects were considered important. Cost of treatment also influenced the choice of treatment program. Individual preferences for fertility treatment were not associated with patients’ relationship status or sexual orientation. Latent class modeling revealed sub-groups with distinct fertility treatment preferences.Conclusion: This study provides important insights into the attributes that influence the preferences of fertility treatment in Australia. It also estimates socially-inclusive willingness-to-pay values in tax contributions for an “ideal” package of treatment. The results can inform economic evaluations of fertility treatment programs.

Indigenous students: Barriers and success strategies-A review of existing literature

There are many factors that effect the post-secondary completion rate of Indigenous students. The Indigenous student completion rate is a reflection of the number of students entering post-secondary education but is significantly affected by withdrawal rates (institutional withdrawals and student voluntary withdrawals). In the Saskatchewan Polytechnic School of Nursing, the Indigenous student withdrawal rate was 4.2% higher than the total nursing student population. Lower success rates among Indigenous students is a concerning issue in nursing programs. Continuing to operate programs and teach in the same fashion is not improving success rates. The Truth and Reconciliation Commission of Canada: Calls to Action (2012) highlighted the need to examine strategies and develop policies to enhance Indigenous student success. To this end, recent literature was reviewed to determine trends among Indigenous nursing students, their struggles, and more importantly, the successful strategies currently being implemented. Indigenous peoples are not a homogenous group; rather, they are a mosaic of cultures, languages and nations. The authors examined the literature to determine key factors that enabled or prevented the success of post-secondary Indigenous students. Twenty-one articles on current research regarding Indigenous student success facilitators and barriers were examined. These articles encompassed research from Canada, the United States, Australia and New Zealand. The purpose of this literature review was to identify themes and gaps, drive positive change in education, and guide future research. The research team found four common themes: academic preparedness, cultural safety, intrinsic student factors, and student support.

Ultrasound-Assisted Lumbar Puncture in a Neuromuscular Clinic has a High Success Rate and Less Pain

Lumbar puncture (LP) performed with the assistance of ultrasound (US) may improve success rate, with fewer puncture attempts and less pain. To explore the utility of US-assisted LP in a neuromuscular clinic. We performed a prospective, randomized, open-label study between May 2016 and January 2017. The primary outcome measure was LP success rate, and the secondary outcome measures included procedure time, number of attempts, and the levels of pain, anxiety, and satisfaction. Lumbar puncture was performed in 40 consecutive patients. Ultrasound-assisted LP had a 100% success rate, compared with 85% (95% confidence interval: 58%-96%) without US assistance, although this difference failed to reach statistical significance. Ultrasound-assisted LP was associated with less pain and, also in patients &gt;60 years of age, with fewer needle insertions. Both groups reported high satisfaction rates, regardless of the use of US. Ultrasound-assisted LP has a high success rate and less pain than unassisted LP, and can be accomplished easily in the outpatient neuromuscular clinic setting equipped with US.

PH Professional Network: The Burden of Prior Authorization for Pulmonary Hypertension Medications: A Practical Guide for Managing the Process

Medications for pulmonary hypertension (PH) are expensive and often require prior authorization from insurance payers. The task of submitting prior authorization requests and appealing denials can burden PH practices with a heavy workload and delay or interrupt medical treatment. However, it is possible to reduce this burden, improve success rates, and reduce waiting times by implementing a standard office workflow for managing the prior authorization process. Such a system involves several key components: assessment of existing staff and level of expertise; dedicated office staff to oversee the process from start to finish; streamlined gathering, storage, and transmittal of patient documents; direct communication with pharmacies and Risk Evaluation Mitigation Strategy programs; and careful documentation of PH diagnosis and treatment plans for a given patient, aimed at reducing the necessity for appeals. This article reviews prior authorization strategies and systems used at PH clinics, and case studies in other therapeutic areas that demonstrate how such systems can reduce staff time and waiting time for initiation of medications while improving the rate of success. The article also describes the special challenges of requesting prior authorization for PH medications prescribed to pediatric patients.

Fast personalized electrophysiological models from computed tomography images for ventricular tachycardia ablation planning.

Clinical application of patient-specific cardiac computer models requires fast and robust processing pipelines that can be seamlessly integrated into clinical workflows. We aim at building such a pipeline from computed tomography (CT) images to personalized cardiac electrophysiology (EP) model. The simulation output could be useful in the context of post-infarct ventricular tachycardia (VT) radiofrequency ablation (RFA) planning for pre-operative targets prediction. The support for model personalization is a patient-specific virtual three-dimensional heart obtained from CT images. Here, the scar is identified as thinning of the myocardial wall on automatically computed thickness maps. We then use an Eikonal model of wave front propagation with reduced velocity in the damaged areas. An image-based vessel enhancement algorithm can automatically identify VT isthmuses. The personalized model is used for virtual pacing. We obtained a very fast pipeline that enables simulations in only a few minutes. It is fully automated starting from the semi-automated image segmentation phase. The computational time frame is compatible with the construction of a virtual pacing tool. In this tool, onset points and an optional directional block could be interactively selected. The directional block is a simple way to model tissue refractoriness. Output activation maps are compared with EP data acquired pre-operatively. We show that this framework allows the reproduction of recorded re-entrant VT activation patterns. Our simulation framework has an application in VT RFA intervention planning. It could be used to guide EP explorations and even predict ablation targets pre-operatively. This could reduce intervention duration and improve success rate.

Social Media Advertising Trends in Tourism

Advertising in our days is moving to the social media since consumers are spending more and more time on such platforms that offer very customized information for each user. Facebook, for example, is trying to bring each person the most meaningful content, which means the advertising is ultra-customized based on the user activity and preferences, but this kind of personalisation can easily have an unpleasant side effect. The advertising for touristic destinations can become very complex by using fine-tuned campaigns triggered by user consumption patterns revealed in the digital world. By adding a button like “buy now”, the social media apps can easily integrate important e-commerce features, so the advertising of today is not only about presenting the content but also about instantly buying products and services. This paper highlights the way in which advertising messages emerging social media can quickly have a greatly improved success rate. Research methodology took as its starting point the findings of scientific studies published in the literature, the obtained results being interpreted from the perspective of the authors' personal considerations on the topic of the paper. The conclusions highlight the main trends related to increasing the success rate of advertisements in tourism by using social media and by choosing the most appropriate platforms, advertising methods and buying tools such as augmented and/or virtual reality that allow to experiment in advance a travel package, placing of advertising messages on the platforms with the greatest impact and including the direct purchase options inside the add, so that viewing the message can be immediately followed by the acquisition of the promoted services.

Alternative strategies to improve success rate of mitral isthmus block.

Achieving bidirectional conduction block (BDB) across the mitral isthmus (MI) is technically challenging. We describe our experience using different ablation strategies for achieving successful MI block.We reviewed the records of patients who had undergone MI ablation for peri-mitral (PM) flutter at our institution from January 2010 to May 2015. We investigated ablation strategies for achieving MI block and their long-term outcomes in terms of recurrence of atrial tachyarrhythmia.Single endocardial MI ablation with or without distal coronary sinus (CS) ablation achieved MI block in 129 out of 236 (54.7%) patients. After failure of MI block, a new MI line ablation, ablation targeting the vein of Marshall (VOM), or anterior line ablation was performed in selected patients. The MI block was achieved in 13 (52.0%) out of 25 patients with new MI line ablation and in 13 (68.4%) out of 19 patients with VOM ablation. Anterior line ablation was tried in 23 patients and the line of block was achieved in 12 (52.2%) patients. Finally, overall PM BDB (PMB, MI block or anterior line block) was achieved in 167 (70.8%) of 236 patients. The incidence atrial tachyarrhythmia was similar between the patients with successful PMB and those with failed PMB (32.9% vs 42.0%, P = .18). In multivariable Cox regression analysis, the PMB was not associated with recurrence of atrial tachyarrhythmia (hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.43–1.12).In conclusion, single endocardial MI line with or without distal CS ablation showed limited success for achieving MI block. Additional substrate modifications such as a new MI line ablation, anterior line ablation, or ablation targeting the VOM may improve the success rate of PMB block. However, the benefits of PMB were not clear in this study.

Ultrasound-assisted Lumbar Punctures: A Systematic Review and Meta-Analysis.

Lumbar punctures (LPs) are a common procedure in emergency medicine. However, studies have found that failed procedure rates can be as high as 50%. Ultrasound has been suggested to improve success rates by visually identifying the location and trajectory for the LP procedure. This systematic review and meta-analysis was performed to determine whether the use of ultrasound improved the rate of successful LP performance. PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all randomized controlled trials comparing the success rates of ultrasound-assisted LP with landmark-based LP. Secondary outcomes included the rate of traumatic LPs, time to procedural success, number of needle passes, and patient pain score. Data were dual extracted into a predefined worksheet, and quality analysis was performed using the Cochrane Risk of Bias tool. Data were summarized and a meta-analysis was performed with subgroup analyses by pediatric versus adult patients and by operator training level. Twelve studies (n=957 total patients) were identified. Ultrasound-assisted LP was successful in 90.0% of patients and landmark-based LP was successful in 81.4% of patients. The calculated risk difference (RD) was 8.9% (95% confidence interval [CI]= 1.2% to 16.7%) with an odds ratio (OR) of 2.22 (95% CI= 1.03 to 4.77) in favor of the ultrasound-assisted group. There were fewer traumatic LPs in the ultrasound-assisted group (10.7% vs. 26.5%; RD= -16.4%, 95% CI= -27.6% to -5.2%; OR= 0.28, 95% CI= 0.18 to 0.45). Ultrasound-assisted LP was also associated with a shorter time to successful LP (6.87 minutes vs. 7.97 minutes), fewer mean needle passes (2.07 vs. 2.66), and lower patient pain scores (3.75 vs. 6.31). Ultrasound-assisted LPs were associated with higher success rates, fewer traumatic LPs, shorter time to successful LP, fewer needle passes, and lower patient pain scores. Ultrasound should be considered prior to performing all LPs, especially in patients with difficult anatomy. Further studies are recommended to determine whether this effect is consistent in both adult and pediatric subgroups, as well as the impact of transducer type and body habitus on this technique.

TARGET PRACTICE: SIMULATION-BASED MASTERY LEARNING FOR ULTRASOUND-GUIDED PERIPHERAL IV INSERTION

SESSION TITLE: Education, Research, and Quality Improvement 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: Ultrasound use for peripheral IV (PIV) insertion has been shown to improve success rates and decrease overall time to placement [1,2]. Residents are often relied on to obtain venous access in patients with difficult access or an urgent need for intravenous medications; however, few studies have assessed competency-based training methods for internal medicine residents in ultrasound-guided (USG) PIV placement. We evaluated the effectiveness of simulation-based mastery learning of USG-PIV through a “train-the-trainer” approach. METHODS: Data on residents who participated in a simulation-based training on USG-PIV insertion was evaluated retrospectively. Internal medicine residents underwent a 1-hour simulation-based training with the expectation of performing USG-PIV placement to mastery standards on a task trainer. Pre and post-surveys were completed on the day of training. Survey questions regarding self-confidence and skills were rated on a numerical scale of 1-5, with 5 representing high confidence. Skill performance was assessed by an approved trainer using a detailed checklist upon completion of training. RESULTS: Eleven residents completed the training during a 2-week period. 73% (N= 8) were PGY-2 and 27% (N = 3) were PGY-3. Seventy-three percent (N=8) had received general ultrasound training previously, but none had received formal ultrasound training for PIV insertion. Forty-five percent (N=5) of residents had never placed an USG-PIV, and 55% (N=6) had placed less than 5 USG-PIVs. Self-confidence and self-skills assessment improved significantly after training. Average self-confidence in correctly identifying the vein using USG by transverse and longitudinal technique was significantly higher post-simulation (3.0 vs 4.6, p=0.008 and 2.3 vs 4.5, p=0.002, respectively). There was also a significant increase in self-confidence following the needle tip into the target vein using USG transverse and longitudinal technique (2.3 vs 4.5, p=0.001 and 1.9 vs 4.3, p=0.001, respectively). Residents met the mastery standard for skills with a 100% pass rate on the skills-based checklist. CONCLUSIONS: A simulation-based mastery learning model for USG-PIV insertion improves resident self-confidence, self-skill assessment and technical skills in a simulated environment. Deliberate practice with a mastery learning model ensures that each learner has achieved the necessary skill set to place a PIV using USG. CLINICAL IMPLICATIONS: We developed a feasible and time-efficient method for USG-PIV training that relies on developing a group of resident “super-users.” We look to evaluate the effect of this train-the-trainer approach for USGPIV insertion on internal medicine resident skill, behaviors and patient outcomes. DISCLOSURES: No relevant relationships by Karishma Bhatia, source=Web Response No relevant relationships by Hailey Gupta, source=Web Response No relevant relationships by Krystle Hernandez, source=Web Response No relevant relationships by Paru Patrawalla, source=Web Response No relevant relationships by Adam Rothman, source=Web Response No relevant relationships by Daniel Steinberg, source=Web Response

An original design of remote robot-assisted intubation system

The success rate of pre-hospital endotracheal intubation (ETI) by paramedics is lower than physicians. We aimed to establish a remote robot-assisted intubation system (RRAIS) and expected it to improve success rate of pre-hospital ETI. To test the robot’s feasibility, 20 pigs were intubated by direct laryngoscope or the robot system. Intubation time, success rate, airway complications were recorded during the experiment. The animal experiment showed that participants achieved a higher success rate in absolute numbers by the robot system. In summary, we have successfully developed a remote robot-assisted intubation system. It is promising for RRAIS to improve the success rate of pre-hospital ETI and change the current rescue model.