Successful Pass Research Articles

The Effect of 8-Week Soccer Training on Group Dynamics and Group Consciousness of Individuals with Intellectual Disabilities

This study examines the effect of 8-week soccer training on group dynamics and group consciousness of individuals with educable intellectual disabilities. In this study, a one-group pretest-posttest model was used. The study included 8 male individuals aged 13-17 in a special education institution in Mersin province. Before and after the 8-week soccer training, 3 physical education teachers made independent observations and evaluated them with an observation form. According to the observation form pre-test and post-test mean scores, the % difference was calculated from descriptive statistics. When the pre-test and post-test percentage differences were examined; improvements were made in the areas of correct defense (40%), correct offense (40%), successful pass (40%), correct intervention (50%), goal to the opponent's goal (50%), ball control (60%), ball winning (50%), defensive error (20%), intervention to teammate (50%), goal to the wrong goal (20%), ball loss (40%) and team integrity (70%). As a result of the study, it was seen that long-term soccer training was beneficial in branch-specific skills, physical and mental development in individuals with intellectual disabilities. In addition, group consciousness was observed in individuals and behavioral changes occurred in this direction. Since there is a limited number of studies on group consciousness and group awareness in individuals with intellectual disabilities; it is thought that this study will contribute to the literature and guide future studies.

Athletic Trainer Emergency Management Skill Assessment via Low Fidelity Simulation Authors

Introduction: Athletic training education requires the inclusion of emergency management (EM) best practices, however the Board of Certification (BOC) does not mandate any continuing education (CE) past Emergency Cardiac Care (ECC). With EM best practices continuing to change there is potential for a large knowledge gap to develop in practicing athletic trainers (ATs) who do not chose to engage in EM CE. The purpose of this study was to identify knowledge gaps in practicing ATs’ EM skills via low fidelity simulation. Methods: A cross-sectional study was conducted in an educational laboratory setting involving twenty-two ATs (age 36.7±10.8 years; 13 males, 9 females, years of experience 13 + 11) attending a simulation-based CE event. A convenience sample of participants who attended the CE event voluntarily participated in data collection. Upon the completion of an educational review session, participants completed four low fidelity simulations (elbow dislocation, femur fracture, heat stroke and external hemorrhage) based on the 2020 Commission on Accreditation of Athletic Training Education (CAATE) standards. Checklists (completed/not completed) were utilized to grade participants simulation specific skill application. Mean overall, critical action, SAMPLE and vital scores were analyzed. Scores were calculated as percentages in order to compare the low fidelity simulation outcomes. A benchmark of 80% skill application was utilized for a successful pass rate. Results: The only benchmark achieved was the critical action score within the femur fracture simulation (82.89% ±14.56). A success rate of 9.6% (8/83) was calculated across all simulations. The mean total percent scores were as follows; elbow dislocation 65.0 ± 11.0, femur fracture 55.3 ±10.0, heatstroke 67.7 ±17.5 and external hemorrhage 64.0 ±13.0. All means beyond the critical action femur, were below the benchmark of 80%. Conclusions: A knowledge gap exists between practicing clinicians and the 2020 CAATE EM standards. Considering the importance of ATs lifesaving skills, ATs should aim to choose CE to improve their EM skills. While this study only investigates EM, ATs may demonstrate knowledge gaps in other domains and therefore ATs should aim to diversify their CE to stay current with best practices.

A WAY TO COMPENSATE PHD STUDENTS' INSUFFICIENT EFL PROFICIENCY: FLIPPED CLASSROOM APPROACH

Background. The shift in standards in Russian education has led to certain changes on the tertiary level of higher education. Most notably the consequences have concerned the aspect of teaching a foreign language to postgraduate students. In particular Samara State University of Economics now does not have language entrance exams anymore and foreign language class time has been rather limited. Nonetheless the level of final exam requirements is yet quite high. The article is relevant due to the need to find a possible remedy to overcome a problem of a fairly low level of previous language training among a certain category of postgraduate students. Purpose. The research purpose was to determine the effectiveness of a flipped classroom strategy as a way to compensate insufficient level of English mastering among the students of postgraduate courses. Materials and methods. Flipped classroom acts as a well-proven approach that could solve the problem. The results of summative assessment are presented in this paper. The methodology adopted in this study is based on the needs analysis, mathematical statistics and content inspection of students' interviews. The range of students, whose needs to improve their language level were determined at the first stage of the experiment then took part took part in a flipped classroom project. At the final stage of the experiment the students were examined for their language performance. Results. The results of the experiment prove the effectiveness of the proposed format for teaching a foreign language for postgraduate students in a non-linguistic university as it increases the efficiency of mastering the skills for the successful exam pass. This study suggests that flipped classroom approach could be an effective remedy to overcome the challenges that teachers and students at postgraduate level are facing today.

Fast and Stable Responses during Decision Making Require Strong Inhibitory Processes in Soccer Players.

Quick decision making is a vital factor for a successful pass in soccer games. Many previous studies of decision making in soccer focused on motor execution, but inhibitory processing has remained unclear. This study aimed to clarify the differences in motor execution and inhibitory among Japanese collegiate soccer players with different skill levels. We evaluated the behavioral data and event-related potentials in the high-skilled, low-skilled, and novice groups during the Go/No-go and pass choice reaction tasks. The reaction time (RT) was significantly shorter in the high group than in the novice group, and RT variability was small in the high group. The amplitude of the N2 component was significantly larger in the high group than in the low and novice groups, and the latency of the P3 component was significantly shorter in the high and low groups than in the novice group during the pass choice reaction task. The subtracted No-go N2 amplitude was also significantly larger in the high and low groups than in the novice group, and correlations existed between the RT, RT variability, and the subtracted No-go N2 amplitude during these tasks. These data indicate that soccer players' behavioral responses and inhibition processing decision-making activities are associated with skill levels.

Abstract WP133: Phase MRI Clot Characteristic and Radiologic Thrombectomy Outcomes in Acute Ischemic Stroke

Background: Magnetic Resonance (MR) susceptibility weighted imaging (SWI) sequences produce filtered Phase images where blood products demonstrate signal intensities opposite to calcifications. Though susceptibility Vessel Sign (SVS) on pre-interventional MRI has been reported as an indicator of outcome following thrombectomy, the association of Phase MR imaging with thrombectomy outcomes is not previously studied. Methods: In this retrospective cohort study of consecutive acute large vessel occlusion strokes with Phase MR imaging prior to thrombectomy, we evaluated the correlation between clot features on pre-interventional MR imaging with radiographic outcomes following thrombectomy. The clot characteristics included the presence of SVS and its geometrical features on both Phase and GRE sequenced MRIs and thrombus extension. Results: A total of 57 patients were included in this analysis (mean age: 65.04 ± 15.8, 33% Female, mean NIHSS: 13.0 (7.5, 19.5), 33% M1 occlusion), among which 52 (91%) patients had positive SVS on phase-sequence MRI. Successful recanalization was achieved in 91% and successful first pass recanalization was observed in 46%. In univariate analysis, baseline demographics and clinical characteristics including age, sex, and comorbidities were not associated with successful recanalization. Homogeneity of Phase-SVS was significantly associated with the first pass successful recanalization (Odds ratio (OR) 1.81; Confidence interval (CI) [1.14-2.88], p: 0.006). Conclusion: Our study suggests MRI Phase-SVS clot homogeneity as a novel predictor of first pass successful recanalization following mechanical thrombectomy in acute stroke.

A Review of the Effectiveness of Educational Digital Game-Based Learning on Students in Tertiary Institutions

The higher institution’s evolution to a more digital era is increasingly making the long-standing learning approaches redundant and ineffective in maintaining student engagement. The digitalization of the educational system sometimes results in a misalignment of the learning approaches with contemporary students’ skill sets and experiences. Many studies have attributed the increase in students’ dropout and poor academic performance to this misalignment in the teaching approaches. Hence, introducing improved teaching methods is essential in uplifting students' learning experiences and academic engagement, contributing to successful student pass rates. Adopting the desktop literary review, the study utilizes relevant literature and theoretical frameworks including The Connectivism Learning Theory by George Siemens and Stephan Downes, The Cognitive Load Theory by John Sweller as well as, a range of theories surrounding the cognitive function in its interrogation of digital game-based learning, and to better understand their effectiveness among our students. This research study aims at advancing traditional conversations in the field of teaching and learning to the role of technology in modern day education, and will benefit educators as, valuable insights on digital game-based learning can be used to promote positive changes in the learning environment, transitioning from conventional approaches such as lengthy lectures in which, according to research studies, was said to be less effective in holding student engagement. The study concludes with a deep engagement and discussion on the positive influence of digital game-based learning on students’ ability to focus and pay attention in learning environments in addition to, processing, comprehending and retaining valuable information, maintaining engagement and increasing memory capacity as well as, improving strategic and critical thinking and problem solving abilities within and beyond the academic institution.

Comparison of Mixed Reality-Assisted Spinal Puncture with Landmark-Guided Spinal Puncture by Novice Practitioners: A Pilot Study.

Performing spinal anaesthesia in elderly patients with ligament calcification or hyperostosis is challenging for novice practitioners. This pilot study aimed to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) by novice practitioners in elderly patients. In this pilot study, 36 patients (aged ≥65 years) scheduled for elective surgery under spinal anaesthesia by anaesthesiology residents were included. Patients were randomly assigned to the MRasp group (n = 18) or the LGsp group (n = 18). The outcomes included the number of needle insertion attempts, redirection attempts, passes, the rate of successful first-attempt needle insertion, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications. The median number of needle insertion attempts was significantly fewer in the MRasp group than in the LGsp group (1.0 vs 2.0, P = 0.023). The proportion of patients with successful first-attempt needle insertion was 72.2% in the MRasp group and 44.4% in the LGsp group (P = 0.176). The incidence of perioperative complications did not significantly differ between the two groups. This pilot study found that novice practitioners made significantly fewer needle insertion attempts in the MRasp group compared to the LGsp group when performing spinal anaesthesia on elderly patients. A future randomized controlled trial (RCT) is warranted to validate its effectiveness. This trial was registered at https://www.chictr.org.cn/showproj.html?proj=178960 (ChiCTR-IPR-2300068520). Public title: Mixed reality-assisted versus landmark-guided spinal puncture in elderly patients: a randomized controlled pilot study. Principal investigator: Lei Gao. The registration date was February 22, 2023. The date of the first participant enrolment was February 27, 2023.

An Examination of Bilateral Skill Proficiency and Frequency of Pass in Selected and Nonselected Youth Academy Gaelic Footballers

This study examined differences in bilateral skill proficiency and frequency of use between selected and nonselected under-17 male intercounty academy Gaelic footballers. Participants (N = 82, mean age = 15.54 years, SD = 0.27) were retrospectively grouped as selected (n = 19) and nonselected (n = 63) for the final squad. A discrete skills test evaluated bilateral hand pass and kick pass proficiency. Within-academy matches (N = 8) were recorded to analyze in-game bilateral passing proficiency and frequency (N = 3,109). Selected players were more proficient in both nondominant kick pass (p = .001) and nondominant hand pass (p = .007) in the discrete skills test and nondominant hand pass (p = .002) in match play. Nonselected players used the dominant hand pass (p = .037) significantly more than selected players in match play. The strongest predictors of selection were the nondominant kick pass and nondominant hand pass in the skills test, and successful dominant kick pass and successful nondominant hand pass in match play (p < .05), with 89% of players correctly classified. The findings suggest that higher bilateral proficiency scores provide greater opportunities to be selected.

562 Investigation of Cerebral Vessel Geometric Morphometrics for Prediction of Mechanical Thrombectomy First Pass Outcome

INTRODUCTION: Vessel tortuosity is a major factor in successful first pass outcomes for mechanical thrombectomy (MT), but previous methods to quantify tortuosity are not accurate enough to predict outcome. We investigated a new method for vessel characterization and outcome prediction based on geometric morphometrics (GMM). METHODS: Vessels and clots were manually segmented and reconstructed from pre-treatment CTA and nCCT images (n=5 cases). The vasculature corresponding to the ICA and MCA from the affected hemisphere was isolated, and centerlines were engineered as curved landmarks. MorphoJ, a GMM software, was used to complete generalized Procrustes and principal component (PC) Analysis that included registration of patient geometries, calculation of average morphology and landmark variation, and identification of anatomical landmarks differentiating MT outcomes. Morphometrics were compared against local and overall tortuosity by measuring the separability of and cohesion within outcome classes. RESULTS: GMM produced two PCs, which described local variation in M1 (PC1) and the ICA (PC2). When compared against vessel tortuosity features, GMM PCs increased the distance between outcome classes (first pass effect vs. no first pass effect), improving separability by 23.6%. Further, GMM PCs increased the compactness/cohesion of outcome classes, reducing cumulative distance between failures by 50% and successes by 9.4%. CONCLUSIONS: GMM analysis of pre-treatment vessel characteristic highlights regional variation in M1 as a strong indicator of MT failure, and suggests that GMM has the potential to better predict MT outcome than ICA tortuosity alone. Investigation of more complex vessel morphometry through feature engineering is needed.

Abstract Number ‐ 151: Impact of Stent‐Retriever Tip Design on Distal Embolization during Mechanical Thrombectomy

Introduction Mechanical thrombectomy (MT) is a widely performed procedure for acute ischemic stroke (AIS) due to large vessel occlusion. Repeated number of passes, clot fragmentation, and distal embolization during MT lead to worse clinical outcomes. We aim to evaluate the impact of different stent‐retriever (SR) distal tip designs on distal emboli generation during MT. Methods Fragment‐prone clot analogs (diameter = 3.53±0.14mm; length = 6.74±0.61mm) were used to create proximal middle cerebral artery (MCA‐M1) occlusions in an in vitro neurovascular model featuring a complete circle of Willis. The anatomical replica was connected to a flow loop with circulating saline at physiological flow rate and temperature; 100‐µm filters were placed at the neurovascular outflow points of the model to collect generated distal emboli. After initial embolization, experiments were randomized into one of the three treatment arms based on SR tip design: open‐end (Open‐SR: Solitaire 6.0×40mm), closed‐end (Closed‐SR: Embotrap II 5.0×33mm), and filter‐end (Filter‐SR: NeVa NET 5.5×37mm). A balloon guide catheter was inflated at the internal carotid artery C1 level immediately after SR deployment, and the SR was pulled out under continuous proximal pump aspiration. A total of 90 cases were performed (30 cases/treatment arm). A single attempt was performed per case and after each pass, distal emboli collected in the outflow filters were analyzed by an image processing algorithm. Successful first pass recanalization (FPR) was confirmed if no residual clot was observed at the initial location or in a distal branch of the model. Primary study endpoints were: FPR rate (%FPR), the size of the largest embolus (largest‐E), the total emboli count (total‐E), the total count of emboli larger than 1mm (total>1mm‐E), and the total area of the filter covered by emboli (area‐E). Results FPR was achieved in 57.8% of cases (52/90): Filter‐SR achieved a non‐significantly higher %FPR (70%) than closed‐SR (50%) and open‐SR (53.3%) (p = 0.244). In comparison to open‐ and closed‐SR, filter‐SR significantly reduced the largest‐E (open‐SR = 1.66±0.68mm vs. closed‐SR = 1.77±0.90mm vs. filter‐SR = 1.22±0.77mm; p = 0.013) as well as the total>1mm‐E (open‐SR = 2.27±2.33 vs. closed‐SR = 3.97±5.68 vs. filter‐SR = 0.93±1.28; p = 0.002), and the area‐E (open‐SR = 18.22±14.47mm2 vs. closed‐SR = 23.98±22.39mm2 vs. filter‐SR = 10.14±8.81mm2; p = 0.013). The differences between distal tip designs were not clearly evidenced in the total‐E (open‐SR = 22.7±10.75 vs. closed‐SR = 23.13±13.16 vs. filter‐SR = 20.63±12.77; p = 0.464). No significant differences were found between open‐ and closed‐SR (p>0.05 in all metrics). Conclusions When facing fragment‐prone clots with low SR engagement, the filter‐SR significantly reduces the number of large clot fragments (>1mm), the size of the largest embolus, and the overall surface area of clot fragments that embolize distally during an MT procedure.

Prospective study of zero-fluoroscopy laser balloon pulmonary vein isolation for the management of atrial fibrillation.

In recent years, there has been increased focus on the development of safe and effective strategies to minimize and ultimately eliminate fluoroscopy use in the electrophysiology lab due to the inherent risks to patients and staff associated with this imaging source. However, studies examining these innovative fluoroless strategies for pulmonary vein isolation (PVI) using catheters without direct 3D mapping system integration are lacking. We sought to develop a method to perform zero-fluoroscopy laser balloon PVI for patients with atrial fibrillation (AF), and to test the safety and efficacy of this approach. We developed a standardized method for performing PVI using the X3 laser balloon (LB) system, 3-dimensional electroanatomic mapping (3D-EAM) and intracardiac echocardiography (ICE) in a cohort of patients with symptomatic AF. The primary endpoint of the study was the ability to perform PVI without the use of fluoroscopy. Secondary outcomes were rate of successful transseptal puncture on first attempt, first pass isolation of target PVs, mean procedural time, active laser time to achieve PVI, need for use of supplemental energy sources, and procedural complication rates. Two hundred consecutive patients undergoing PVI were recruited in the study. In the zero-fluoroscopy group, LB PVI was successfully performed in 100% of participants (n = 100) without the need for fluoroscopy. Transseptal access was achieved in 100% of cases on the first attempt. Successful first pass PVI was achieved in 360 of the 387 pulmonary veins attempted (93%). Mean procedural time was 68.2 ± 16.2min in the zero-fluoroscopy group versus 67.5 ± 17.0min in the conventional fluoroscopy group. PVI was able to be achieved in 100% of cases in both groups without need for use of supplemental energy sources. In the zero-fluoroscopy group there were minimal complications, with 3% of all cases having groin complications and 1 patient with a pericardial effusion noted post-procedure which was managed conservatively. We demonstrated that successful zero-fluoroscopy LB PVI could be performed at a single high-volume center by experienced operators in an effective manner, without significant complications.

Abstract 48: Outcomes And Risk Of Hemorrhagic Transformation Following Mechanical Thrombectomy In Primary Distal Posterior Cerebral Artery Occlusions-subgroup Analysis From STAR

Background: While mechanical thrombectomy (MT) has become the standard of care for acute stroke patients presenting with large vessel occlusion (LVO) and salvageable brain tissue, limited data is currently available regarding the benefits of MT in patents with medium vessel occlusions (MeVO) especially in the posterior circulation (P2 occlusions). Methods: We used the Stroke Thrombectomy and Aneurysm registry (STAR) which included data from 35 stroke centers in North America, Europe, Asia, and South America. We included patients who presented with MeVO in the M2, M3 or P2 segments and underwent MT. We used a Generalized Linear Model to assess the relationship between location of occlusion and outcomes. Results: 9812 patients were included in STAR at the time of this analysis; 43 underwent MT for P2 occlusion, 130 underwent MT for M3 occlusion; and 1273 underwent MT for M2 occlusion. There was no difference in age, sex, race, rate of IV-tPA and stroke severity between patients in all 3 groups (Table 1). There was a trend toward lower rate of atrial fibrillation in patients with P2 and M3 occlusions. Patients with P2 occlusions were less likely to achieve successful recanalization (modified treatment in cerebral infarction score≥2b); intraarterial thrombolysis was used less in P2 occlusions (4.7% compared to 16.2% in M3 occlusions and 10.1% in M2 occlusions). However, there was no difference in the rate of successful first pass. On multivariable analysis, P2 occlusions were not associated with hemorrhagic transformation (OR 2.0, 95% CI 0.7-5.7, P 0.186), 90-day mortality (OR 0.5, 95% CI 0.2-1.4, P 0.183), or 90-day favorable outcome (OR 2.0, 95% CI 0.9-4.4, P 0.084). Conclusions: In this multicenter study, there was no significant difference in safety and efficacy of MT in patients with MeVOs in posterior circulation (P2 occlusions) compared to M2 and M3 occlusions. Improved techniques for successful recanalization are needed for posterior circulation MeVOs.

"Train the Trainers" Program to Improve Knowledge, Attitudes and Perceptions About Organ Donation in the European Union and Neighbouring Countries: Pre- and Post- Data Analysis of the EUDONORGAN Project.

EUDONORGAN, a European Union-funded project to improve organ and tissue donation, included a blended-based "Train the Trainers" program, which was implemented with the support of an international consortium from Croatia, Italy, Slovenia, and Spain. The web-based training included seven modules for which medical aspects, educational tips, and practical activities were scored using a 5-point Likert scale. The overall mean scores of satisfaction were higher than 4 for each module, without significant differences between HCPs and OKPs. In the face-to-face training survey similar scores above 4 were obtained for most items. Knowledge acquisition improved significantly in both HCPs and OKPs, as well as in transplant/donor coordinators, medical doctors, registered nurses, anesthesiologists/intensivists, and intensive care nurses. Improvements in attitudes and perceptions regarding organ donation were also observed, particularly among HCPs. In the accomplishment of the learning process, a successful pass mark of 95% was obtained. The "Train the Trainers" program was associated with an improvement in learning and attitudes of healthcare and non-healthcare professionals for the benefit of organ and tissue donation.

Mechanical thrombectomy of large vessel occlusion using adjustable vs. self-expanding stent-retriever-Comparison of Tigertriever device with stent-like stent-retrievers: A propensity score analysis.

Stent-retrievers used for mechanical thrombectomy are self-expanding tubular stent-like devices with modified mesh structures for clot removal. Tigertriever is designed to provide manual control of its diameter and curvature. A retrospective single-center study was performed to compare Tigertriever with SolitaireX and pRESET (stent-like stent-retrievers group) using propensity score analysis. Patients treated in a comprehensive stroke center due to large vessel occlusion between January 2016 and August 2021 were evaluated. Baseline characteristics and treatment results were compared between these groups before and after pair matching. There were 140 patients (60 in Tigertriever and 80 in the stent-like stent-retriever group). In propensity score analysis, 52 matched pairs were selected in Tigertriever and stent-like stent-retriever groups. The Tigertriever group had a better successful first pass revascularization rate [46 vs. 23%, OR (95% CI): 1.7 (1.1-2.9), p = 0.013] and 14-min shorter groin-to-revascularization time (51 vs. 65 min. p = 0.017). There were no significant differences between Tigertriever and stent-like stent-retriever groups in the following: favorable mRS 3 months, favorable recanalization rate, and symptomatic intracerebral hemorrhages. There were no observed periprocedural adverse events related to Tigertriever, SolitaireX, or pRESET. Tigertriever had a significantly better successful first pass revascularization rate and shorter groin-to-revascularization time in the analysis done before and after propensity score matching with stent-like stent-retrievers. Tigertriever is comparable to stent-like stent-retrievers regarding mortality at 3 months, favorable mRS at 3 months, favorable recanalization rate, or symptomatic cerebral hemorrhagic events.

Abstract 15733: Investigation of Cerebral Vessel Geometric Morphometrics for Prediction of Mechanical Thrombectomy First Pass Outcome

Introduction: Vessel tortuosity is a major factor in successful first pass outcomes for mechanical thrombectomy (MT), but prior methods to quantify tortuosity are not accurate enough to predict outcome. We investigated a new method for vessel characterization and outcome prediction based on geometric morphometrics (GMM). Hypothesis: Our hypothesis was that morphometric analysis of engineered centerline landmarks would identify vessel characteristics that can better predict first pass MT outcome. Methods: Vessels and clots were manually segmented and reconstructed from pre-treatment CTA and nCCT images ( n =5 cases) (Fig. 1A). The vasculature corresponding to the ICA and MCA from the affected hemisphere was isolated, and centerlines were engineered as curved landmarks. MorphoJ, a GMM software, was used to complete generalized Procrustes and principal component (PC) Analysis that included registration of patient geometries, calculation of average morphology and landmark variation, and identification of anatomical landmarks differentiating MT outcomes (Fig. 1B). Morphometrics were compared against local and overall tortuosity by measuring the separability of and cohesion within outcome classes. Results: GMM produced two PCs, which described local variation in M1 (PC1) and the ICA (PC2) (Fig. 1B). When compared against vessel tortuosity features, GMM PCs increased the distance between outcome classes (first pass effect vs. no first pass effect), improving separability by 23.6%. Further, GMM PCs increased the compactness/cohesion of outcome classes, reducing cumulative distance between failures by 50% and successes by 9.4% (Fig. 1C). Conclusions: GMM analysis of pre-treatment vessel characteristic highlights regional variation in M1 as a strong indicator of MT failure and suggests that GMM has the potential to better predict MT outcome than ICA tortuosity alone. Investigation of more complex vessel morphometry through feature engineering is needed.

Development and Validation of a 3-Dimensional Flexible Laryngoscopy Training Simulator

The objective of this study was to validate the use of a 3-Dimensional Flexible Laryngoscopy Training Simulator. This is a simulation device development and validation study. Anonymized CT scan data from a head/neck CT of a patient with normal anatomy was imported and a head/neck digital model was created. A 3D simulation model was printed using a stiff (Stratasys Vero) and flexible (Stratasys Agilus) material combination with a ShoreA hardness value of 60. Novices and experts were instructed and provided 5 trials to pass the laryngoscope. The videos of the first and the last trial were recorded and evaluated by three different evaluators. Performances were measured by the amount of time spent and precision of the task. Repeated measures of ANOVA and generalized linear model with binomial proportion was used were utilized to analyze the data. The post training scores were statistically significantly higher than pre training scores (Mean: 15.57 vs. 13.01, p <0.0001) controlling for trainee experience. The time taken to complete a successful pass post training was statistically significantly lesser than pre training (Mean: 62.55 secs vs. 36.36 secs, p-value = 0.0007) controlling for individual’s experience. The odds of becoming skilled at the task was 4 times higher post training in comparison to pre training, controlling for individual’s experience (OR: 4.05, p-value: 0.0026). The 3-Dimensional Flexible Laryngoscopy Training Simulator is a valid trainer for both novice and experienced individuals. The simulator can improve technical skill performance and is critical for medical training.

Predictors of first pass effect and effect on outcomes in mechanical thrombectomy for basilar artery occlusion

IntroductionFor patients undergoing endovascular thrombectomy (EVT), those who are recanalized with a successful single pass (first pass effect, FPE) have better functional outcomes than those who do not. There is a scarcity of data regarding predictors of FPE in basilar artery occlusion (BAO). We aim to determine what characteristics may predict FPE for posterior circulation thrombectomies in a cohort of patients undergoing EVT for BAO. MethodsWe reviewed prospectively-collected data for patients presenting to a comprehensive stroke center with BAO between December 2015 and April 2019. Patients were included in this study if they underwent manual aspiration thrombectomy for BAO. Patients were excluded if they had occlusions of the posterior cerebral or vertebral arteries or if they had tandem lesions. Patients were stratified by whether FPE or modified FPE (mFPE) was achieved, and multivariate logistic regression analyses were performed to identify predictors of FPE and the effect of FPE on clinical outcome. Results100 patients with BAO underwent thrombectomy. Mean age was 64.7 ± 16.7, 42% were female, and median NIHSS was 20 (IQR 11–27). 33% met criteria for FPE and 60% for mFPE. Univariate analysis identified female gender, lack of IV-tPA use, pcASPECTS, atrial fibrillation, and hyperlipidemia as possible predictors of FPE. On multivariate analysis, age, pcASPECTs, atrial fibrillation, hyperlipidemia and IV-tPA use were not independent predictors of FPE or mFPE. Female gender was an independent predictor of mFPE (p = 0.02), but not FPE (p = 0.18). FPE was a predictor of mRS 0–2 at 90 days (p = 0.04). Predictors of mortality were age (p < 0.01), baseline NIHSS (p < 0.01) and mFPE (p = 0.01). ConclusionIn this cohort analysis of 100 patients with basilar artery occlusion undergoing manual aspiration thrombectomy, female gender was associated with mFPE but not FPE. Previously-reported anterior circulation FPE predictors including age, ASPECTS and atrial fibrillation were not predictors of FPE in this cohort of patients with BAO.

Combined technique as first approach in mechanical thrombectomy: Efficacy and safety of REACT catheter combined with stent retriever.

Mechanical thrombectomy (MT) with combined treatment including both a stent retriever and distal aspiration catheter may improve recanalization rates in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Here, we evaluated the effectiveness and safety of the REACT aspiration catheter used with a stent retriever. This prospective study included consecutive adult patients who underwent MT with a combined technique using REACT 68 and/or 71 between June 2020 and July 2021. The primary endpoints were final and first pass mTICI 2b-3 and mTICI 2c-3 recanalization. Analysis was performed after first pass and after each attempt. Secondary safety outcomes included procedural complications, symptomatic intracranial hemorrhage (sICH) at 24 h, in-hospital mortality, and 90-day functional independence (modified Rankin Scale [mRS] 0-2). A total of 102 patients were included (median age 78; IQR: 73-87; 50.0% female). At baseline, median NIHSS score was 19 (IQR: 11-21), and ASPECTS was 9 (IQR: 8-10). Final mTICI 2b-3 recanalization was achieved in 91 (89.2%) patients and mTICI 2c-3 was achieved in 66 (64.7%). At first pass, mTICI 2b-3 was achieved in 55 (53.9%) patients, and mTICI 2c-3 in 37 (36.3%). The rate of procedural complications was 3.9% (4/102), sICH was 6.8% (7/102), in-hospital mortality was 12.7% (13/102), and 90-day functional independence was 35.6% (36/102). A combined MT technique using a stent retriever and REACT catheter resulted in a high rate of successful recanalization and first pass recanalization in a sample of consecutive patients with AIS due to LVO in clinical use.

Abstract No.: ABS1180: A randomised comparative evaluation of ultrasound guided classical vs parasacral parallel shift (PSPS) technique of sciatic nerve block combined with femoral nerve block as a sole anaesthetic modality for orthopaedic lower limb surgeries

Background and Aims:Sciatic nerve can be blocked in the gluteal region via anterior, posterior and a newly developed lateral/parasacral approach. Primary objective of the study was to compare success of sciatic nerve block using classical versus parasacral parallel shift approach (PSPS).Methods:This study was conducted in a tertiary medical college hospital from October 2020 to October 2021 after approval of Institutional Ethics Committee and written informed patient consent. Total 160 patients (80 in each group) aged 18-80 years with American Society of Anesthesiologists physical status I-III ,undergoing traumatic lower limb orthopaedic surgery were assessed for eligibility based on the inclusion and exclusion criteria. Ultrasonography was used for the blocks.Results:Successful block was administered in 98.61%(n=71) subjects via PSPS approach, compared to 90.27%(n=57) via classical approach(table1). Time between ultrasound localisation of nerve to drug administration was significantly higher with classical as compared to PSPS approach. Successful first needle pass was seen in 90.27%(n=65) of PSPS group compared to 45.54%(n=27) of classical group. Time to motor blockade was found to be 17.33+/-3.6 minutes with PSPS approach, significantly lower than classical (22+/-3.53 minutes) approach.Conclusion:Parasacral sciatic nerve block via PSPS approach is superior to classical approach in terms of time to administration of block, success of block, requirements of sedation intraoperatively, time to motor blockade and time to sensory blockadeTable 1Block performance characteristicsClassical groupPSPS groupPSuccessful blockn=65 (90.27%)n=71 (98.61%)0.029Successful first needle passn=32 (44%)n=65 (90.27%)0.000Time from ultrasound localisation to drug administration (min)9.51±2.163.28±1.190.000Time to motor blockade (min)21.94±3.1917.32±2.490.000Time to sensory blockade (min)20.00±2.7716.21±3.080.000

The effect of left atrial wall thickness and pulmonary vein sizes on the acute procedural success of atrial fibrillation ablation

Nowadays, a novel contact-force guided ablation technique is used for enclosing pulmonary veins in patients with atrial fibrillation (AF). We sought to determine whether left atrial (LA) wall thickness (LAWT) and pulmonary vein (PV) dimensions, as assessed by cardiac CT, could influence the success rate of first-pass pulmonary vein isolation (PVI). In a single-center, prospective study, we enrolled consecutive patients with symptomatic, drug-refractory AF who underwent initial radiofrequency catheter ablation using a modified CLOSE protocol. Pre-procedural CT was performed in all cases. Additionally, the diameter and area of the PV orifices were obtained. A total of 1034 LAWT measurements and 376 PV area measurements were performed in 94 patients (mean CHA2DS2-VASc score 2.1 ± 1.5, mean age 62.4 ± 12.6 years, 39.5% female, 38.3% persistent AF). Mean procedure time was 81.2 ± 19.3 min. Complete isolation of all PVs was achieved in 100% of patients. First-pass isolation rate was 76% and 71% for the right-sided PVs and the left-sided PVs, respectively. No difference was found regarding comorbidities and imaging parameters between those with and without first-pass isolation. LAWT (mean of 11 regions or separately) had no effect on the acute procedural outcome on logistic regression analysis (all p ≥ 0.05). Out of all assessed parameters, only RSPV diameter was associated with a higher rate of successful right-sided first pass isolation (OR 1.01, p = 0.04). Left atrial wall thickness does not have an influence on the acute procedural success of PVI using ablation index and a standardized ablation protocol. RSPV diameter could influence the probability of right sided first-pass isolation.