Biomedical subjects

John D McAllister

Publications and source records attributed to John D McAllister.

4 recordsLinked to original sources

PubMed2005

A simulation-based acute skills performance assessment for anesthesia training.

UNLABELLED: In an earlier study, trained raters provided reliable scores for a simulation-based anesthesia acute care skill assessment. In this study, we used this acute care skill evaluation to measure the performance of student nurse anesthetists and resident physician trainees. The performance of these trainees was analyzed to provide data about acute care skill acquisition during training. Group comparisons provided information about the validity of the simulated exercises. A set of six simulation-based acute care exercises was used to evaluate 43 anesthesia trainees (28 residents [12 junior and 16 senior] and 15 student nurse anesthetists). Six raters scored the participants on each exercise using either a detailed checklist, key-action items, or a global rating. Trainees with the most education and clinical experience (i.e., senior residents) received higher scores on the simulation scenarios, providing some evidence to support the validity of the multi-scenario assessment. Trainees varied markedly in ability depending on the content of the exercise. In general, anesthesia providers demonstrated similar aptitude in managing each of the six simulated events. Most participants effectively managed ventricular tachycardia, but postoperative events such as anaphylaxis and stroke were more difficult for all trainees to promptly recognize and treat. Training programs could use a simulation-based multiple encounter evaluation to measure provider skill in acute care. IMPLICATIONS: A trainee's skill in managing critical events can be assessed using a multiple scenario simulation-based performance evaluation.

Anesthesiology↗

PubMed2004

Acute care skills in anesthesia practice: a simulation-based resident performance assessment.

BACKGROUND: A recurring initiative in graduate education is to find more effective methods to assess specialists' skills. Life-sized simulators could be used to assess the more complex skills expected in specialty practice if a curriculum of relevant exercises were developed that could be simply and reliably scored. The purpose of this study was to develop simulation exercises and associated scoring methods and determine whether these scenarios could be used to evaluate acute anesthesia care skills. METHODS: Twenty-eight residents (12 junior and 16 senior) managed three intraoperative and three postoperative simulation exercises. Trainees were required to make a diagnosis and intervention in a simulation encounter designed to recreate an acute perioperative complication. The videotaped performances were scored by six raters. Three raters used a checklist scoring system. Three faculty raters measured when trainees performed three key diagnostic or therapeutic actions during each 5-min scenario. These faculty also provided a global score using a 10-cm line with scores from 0 (unsatisfactory) to 10 (outstanding). The scenarios included (1) intraoperative myocardial ischemia, (2) postoperative anaphylaxis, (3) intraoperative pneumothorax, (4) postoperative cerebral hemorrhage with intracranial hypertension, (5) intraoperative ventricular tachycardia, and (6) postoperative respiratory failure. RESULTS: The high correlation among all of the scoring systems and small variance among raters' scores indicated that all of the scoring systems measured similar performance domains. Scenarios varied in their overall difficulty. Even though trainees who performed well on one exercise were likely to perform well in subsequent scenarios, the authors found that there were considerable differences in case difficulty. CONCLUSION: This study suggests that simulation can be used to measure more complex skills expected in specialty training. Similar to other studies that assess a broad content domain, multiple encounters are needed to estimate skill effectively and accurately.

Acute Disease↗

PubMed2002

Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia.

BACKGROUND: Children display a variety of behaviour during anaesthetic recovery. The purpose of this study was to study the frequency and duration of emergence behaviour in children following anaesthesia and the factors that alter the incidence of various emergence behaviour following anaesthesia. METHODS: A prospective study of children who required outpatient lower abdominal surgery was designed to determine an incidence and duration of emergence agitation. We developed a 5-point scoring scale to study the postanaesthetic behaviour in these children. The scale included behaviour from asleep (score=1) to disorientation and severe restlessness (score=5). Children were scored by a blinded observer every 10 min during the first hour of recovery or until discharge from same day surgery. RESULTS: We found 27 of 260 children experienced a period of severe restlessness and disorientation (score 5) during anaesthesia emergence. Thirty percent of the children (79/260) experienced a period of inconsolable crying or severe restlessness (score 4 or 5) following anaesthesia. The frequency of this behaviour was greatest on arrival in the recovery room, but many children who arrived asleep in the recovery room later experienced a period of agitation or inconsolable crying. CONCLUSIONS: Repeated assessments of behaviour following anaesthetic recovery are required to define an incidence and duration of emergence agitation. Emergence agitation occurs most frequently in the initial 10 min of recovery, but many children who arrive asleep experience agitation later during recovery.

Abdomen↗

PubMed2002

Sedation for peritonsillar abscess drainage in the pediatric emergency department.

OBJECTIVE: To evaluate the use of intravenous (IV) sedation in children during peritonsillar abscess (PTA) incision and drainage in the emergency department (ED). DESIGN: Retrospective review of medical records of children with a diagnosis of PTA. SETTING: The ED of a large, urban, academic children's hospital. PATIENTS: Consecutive patients 18 years or younger presenting from April 1995 to November 1998. METHODS: Information was retrieved from a time-based sedation record that included age, sex, ASA classification, time since last liquid or solid, agent and dose, level of sedation (A=alert, V=response to voice, P=purposeful response to pain, U=unresponsive), vital signs, complications, recovery time, and disposition. RESULTS: Forty-two patients had incision and drainage performed with IV sedation in the ED. Mean age was 11.3 +/- 4.3 years (range 4-18 years); 57% were African-American, and 64% were female. Agents used included ketamine plus midazolam (K/M) (n = 36, 86%), morphine plus midazolam (n = 3, 7%), meperidine plus midazolam (n = 2, 5%), and nitrous oxide plus midazolam (n = 1, 2%). No cardiorespiratory complications, including laryngospasm, occurred. Vomiting occurred in 1 patient who received meperidine and midazolam. The deepest level of sedation reached included: 12% A, 64% V, and 24% P. No patient who had an abscess drained in the ED with IV sedation was admitted, and mean recovery time was 81.0 +/- 30.1 minutes. CONCLUSIONS: IV sedation in children for incision and drainage of PTA by skilled personnel in the ED may eliminate the need for admission and surgical drainage in the operating room. K/M was used most frequently, without adverse effect, and all patients were discharged from the ED. Because K/M may result in deep sedation, appropriate personnel and equipment must be present.

Adolescent↗