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Biomedical subjects

A J Byrne

Publications and source records attributed to A J Byrne.

At least 19 recordsLinked to original sources
PubMed2005

Dynamic confidence during simulated clinical tasks.

OBJECTIVE: Doctors' confidence in their actions is important for clinical performance. While static confidence has been widely studied, no study has examined how confidence changes dynamically during clinical tasks. METHOD: The confidence of novice (n = 10) and experienced (n = 10) trainee anaesthetists was measured during two simulated anaesthetic crises, bradycardia (easy task) and failure to ventilate (difficult task). RESULTS: As expected, confidence was high in the novice and experienced groups in the easy task. What was surprising, however, was that confidence during the difficult task decreased for both groups, despite appropriate performance. CONCLUSIONS: Given that confidence affects performance, it is alarming that doctors who may be acting unsupervised should lose dynamic confidence so quickly. Training is needed to ensure that confidence does not decrease inappropriately during a correctly performed procedure. Whether time on task interacts with incorrect performance to produce further deficits in confidence should now be investigated.

Anesthesiology↗
PubMed2002

Effect of videotape feedback on anaesthetists' performance while managing simulated anaesthetic crises: a multicentre study.

The aim of this study was to examine the performance of anaesthetists while managing simulated anaesthetic crises and to see whether their performance was improved by reviewing their own performances recorded on videotape. Thirty-two subjects from four hospitals were allocated randomly to one of two groups, with each subject completing five simulations in a single session. Individuals in the first group completed five simulations with only a short discussion between each simulation. Those in the second group were allowed to review their own performance on videotape between each of the simulations. Performance was measured by both 'time to solve the problem' and mental workload, using anaesthetic chart error as a secondary task. Those trainees exposed to videotape feedback had a shorter median 'time to solve' and a smaller decrease in chart error when compared to those not exposed to video feedback. However, the differences were not statistically significant, confirming the difficulties encountered by other groups in designing valid tests of the performance of anaesthetists.

Anesthesiology↗
PubMed2001

Tumour lysis syndrome during anaesthesia.

We describe a child who developed acidosis, hyperkalaemia and cyanosis while emerging from an otherwise uneventful anaesthetic. A diagnosis of tumour lysis syndrome was suspected and confirmed biochemically. Although this syndrome is usually associated with chemotherapy and has been described to occur spontaneously, it has not previously been reported as being associated with anaesthesia.

Abdomen↗
PubMed2001

Assessment instruments used during anaesthetic simulation: review of published studies.

This review was undertaken to discover what assessment instruments have been used as measures of performance during anaesthesia simulation and whether their validity and reliability has been established. The literature describing the assessment of performance during simulated anaesthesia amounted to 13 reports published between 1980 and 2000. Only four of these were designed to investigate the validity or reliability of the assessment systems. We conclude that the efficacy of methodologies for assessment of performance during simulation is largely undetermined. The introduction of simulator-based tests for certification or re-certification of anaesthetists would be premature.

Anesthesiology↗
PubMed2001

Trismus due to bilateral mandibular coronoid hyperplasia.

Bilateral mandibular coronoid hyperplasia is a rare cause of restricted mouth opening. Diagnosis of the condition prior to general anaesthetic is essential, as oral intubation may be impossible. The reported case illustrates the role of computed tomography in assessment of the disorder and effective treatment by coronoidectomy.

Adult↗
PubMed1999

Development of evidence-based guidelines in midwifery and gynaecology nursing.

OBJECTIVE: To develop an effective and efficient method for basing nursing practice on research evidence. SETTING: The Royal Women's Hospital, Brisbane, Australia. METHOD: Nurses and midwives from various clinical areas were invited to participate in an evidence-based practice project. Standard procedures for retrieving relevant articles and evaluating their quality were observed. Where possible, raw data from studies with similar methods were summarised using appropriate statistical tests. FINDINGS: Several guidelines have been developed, staff involved with the project have become 'research literate' and the project is contributing to the hospital-wide quality improvement activities. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It is possible to translate research findings into practice when small groups use systematic reviews to develop practice guidelines.

Australia↗
PubMed1998

Errors on anaesthetic record charts as a measure of anaesthetic performance during simulated critical incidents.

We have measured the performance of 10 trainee anaesthetists during a single simulated anaesthetic during which there was a complex critical incident. Errors in the recording on the anaesthetic charts of the "patient's" oxygen saturation, heart rate, systolic and diastolic arterial pressures and end-tidal carbon dioxide concentrations were used as a measure of mental workload and hence performance. The critical incident was designed to be stressful and contained, in sequence, episodes of hypotension, arrhythmia and bronchospasm. Chart recording errors increased markedly during the critical incident (P < 0.01) and decreased subsequently when the "patient" had stabilized. More than 22% of the values charted during the simulation were in error by more than 25% of the real value, and errors in excess of 100% of the actual value were recorded. There was no evidence of a tendency to consistently underestimate the magnitude of abnormal values. This method is appropriate for assessing the performance of groups of anaesthetists during simulated critical incidents. It also raises questions on the accuracy of anaesthetic record charts when recording critical incidents.

Anesthesiology↗
PubMed1997

Responses to simulated anaesthetic emergencies by anaesthetists with different durations of clinical experience.

We have compared the responses of four groups of anaesthetists, with different durations of clinical experience, to nine different simulated emergencies. Five anaesthetists in each group completed each of the nine simulated emergencies. Anaesthetists with less than 1 yr experience performed less well than the three other groups of anaesthetists (chi-square, P < 0.02). However, all groups made serious errors in both diagnosis and treatment, and accepted treatment guidelines were not followed. We have shown that a simple, inexpensive simulator can be used to evaluate the performance of anaesthetists of different durations of clinical experience.

Anesthesiology↗
PubMed1997

Inaccurate reporting of simulated critical anaesthetic incidents.

Eleven anaesthetists completed a simulated anaesthetic which was deliberately complicated by a slow progressive bradycardia followed by an episode of severe bronchospasm. After the simulation, each anaesthetist was asked to complete an anaesthetic chart and a critical incident report. Considerable discrepancies were found between the anaesthetists' written accounts, a videotape of their performance and actual data from the simulator. During the simulations, all of the anaesthetists reacted appropriately and treated their "patient" successfully but their written accounts showed a tendency to record "typical" rather than actual events and to ignore events not consistent with their final diagnosis. Only four anaesthetists mentioned bradycardia in their written description and none accurately described the changes in arterial pressure during the episode of bronchospasm. The findings are in keeping with other studies which suggest that people record events as "schemata" rather than as collections of discrete facts. These results have significant implications for those involved in the teaching of anaesthesia and in the analysis of critical incidents.

Anesthesiology↗
PubMed1996

A new breakfast cereal containing guar gum reduces postprandial plasma glucose and insulin concentrations in normal-weight human subjects.

A new guar-containing wheatflake product was developed to assess its effect on carbohydrate tolerance in normal-weight, healthy subjects. The extruded wheatflake breakfast cereals containing 0 (control) or approximately 90 g guar gum/kg DM were fed to ten fasting, normal-weight, healthy subjects using a repeated measures design. The meals were similar in energy (approximately 1.8 MJ), available carbohydrate (78 g), protein (15 g) and fat (5.4 g) content. The guar gum content of the test meals was 6.3 g. Venous blood samples were taken fasting and at 15, 30, 45, 60, 90, 120, 150 and 240 min after commencing each breakfast and analysed for plasma glucose, insulin and C-peptide. The guar wheatflake meal produced a significant main effect for glucose and insulin at 0-60 min and 0-240 min time intervals respectively, but not for the C-peptide levels compared with the control meal. Significant reductions in postprandial glucose and insulin responses were seen following the guar wheatflake meal compared with the control meal at 15 and 60 min (glucose) and 15, 60, 90 and 120 min (insulin). The 60 and 120 min areas under the curve for glucose and insulin were significantly reduced by the guar gum meal, as was the 240 min area under the curve for insulin. Thus, it can be concluded that the use of a severe method of heat extrusion to produce guar wheatflakes does not diminish the physiological activity of the guar gum.

Adult↗
PubMed1994

Basic simulations for anaesthetists. A pilot study of the ACCESS system.

This paper describes the design and initial testing of the ACCESS (Anaesthetic Computer Controlled Emergency Situation Simulator) system, which has been designed to simulate anaesthetic emergencies with the aim of providing training for junior doctors. The simulations require little or no capital expenditure with minimal use of time by staff or trainees. They are based on standard anaesthetic equipment, with a microcomputer providing an image of commonly used instruments. Problems are presented as scenarios administered by the teacher, and test the skills of the pupil. During 64 scenarios, five trainees caused two 'deaths' and solved the problems in a median time of 2.5 min, while an experienced group of anaesthetists caused one 'death' and took 1.8 min. The simulation was rated by the pupils as easy to use, realistic and a valuable educational tool.

Anesthesiology↗