Simulation-based training in maxillofacial surgery: are we going to be left behind?

Simulation is an important way both to optimise a trainee’s learning time and reduce morbidity and operating time for patients. We have reviewed the current use of simulation in training for maxillofacial surgery, and provide an overview of areas of practice where it may be useful. A web-based survey of trainees’ opinions of it was made in February 2018, and disseminated using the Junior and Fellows in Training group mailing lists. We also reviewed popular current simulation courses that are available. A total of 45 of the 57 trainees who replied agreed that simulation-based training would be beneficial in maxillofacial surgery, particularly with regard to maxillofacial surgical emergencies. A total of 54 of the 57 also agreed that simulation-based training would be a useful adjunct to their clinical training. However, most of the simulation-based courses available were priced beyond the budgets available to UK-based trainees for study, although funding changed in April 2018. While other surgical disciplines have adopted simulated clinical teaching and its benefits, maxillofacial surgery has limited the use of all types of formal simulation. Surgical simulation training is increasingly being used to complement the traditional surgical apprenticeship in other specialties, and ours needs to consider ways in which we can use it, given that trainees within the specialty think that it would be useful. Other specialties have shown that there is good transfer of skills from simulation to the actual clinical operating environment, and this increases satisfaction, decreases morbidity, and reduces the time required for intraoperative teaching.     

Training simulation for oral and maxillofacial surgeons based on the techniques of arthroscopy in the temporomandibular joint

Arthroscopy is a diagnostic-therapeutic technique used in the treatment of disorders of the temporomandibular joint (TMJ). The difficulties of arthroscopy lie in the manipulation of the tools, which is why training in the technique of triangulation in artificial models is essential. We developed a training system based on the techniques of arthroscopy in the TMJ, using simulators. The first simulator was a metal box containing three holes for insertion of the instruments, and the second was a human artificial model made of polymers. We found that they facilitated training in the techniques of arthroscopy, which subsequently reduced operating time and led to a better execution of skills in reality.     

纤维鼻咽喉镜吞咽功能检查对脑卒中吞咽障碍患者摄食训练的指导价值

目的 分析纤维鼻咽喉镜吞咽功能检查(FEES)对脑卒中吞咽障碍患者摄食训练的指导价值。方法 采用随机信封法将2019年1月-2021年1月北京市大兴区中西医结合医院和北京市丰台区南苑医院收治的120例脑卒中吞咽障碍患者分为观察组(n=60)和对照组(n=60)。对照组采用标准吞咽功能评估(SSA),在阴性后进行摄食训练,观察组采用FEES,在阴性后进行摄食训练,最终观察组纳入55例,对照组纳入54例。比较治疗前1周和治疗后1周两组患者的动脉血气分析、并发症发生情况、误吸程度、吞咽功能评级和安全性指标水平。结果 两组患者治疗后动脉血二氧化碳分压(PaCO₂)水平、误吸和腹胀发生率均较治疗前降低,且观察组较对照组低;观察组肺部感染发生率低于对照组;两组患者治疗后动脉血氧分压(PaO₂)和动脉血氧饱和度(SaO₂)水平均较治疗前升高,且观察组较对照组高;治疗后,两组患者误吸程度均较治疗前减轻,且观察组优于对照组;治疗后,两组患者吞咽功能均较治疗前改善,且观察组优于对照组,差异有统计学意义(P <0.05)。结论 脑卒中吞...     

Differences between late preterm and full-term infants: Comparing effects of a short bout of practice on early reaching behavior

This study compared the effects of a short bout of practice on reaching behavior between late preterm and full-term infants at the onset of goal-directed reaching. Twelve late preterm infants and twelve full-term infants received reaching practice based on a serial schedule. Late preterm and full-term infants were assessed in 3.3 ± 1.4 and 2.6 ± 1.0 days after the onset of goal-directed reaching in two measures in a single day: immediately before practice (pre-test) and immediately after practice (post-test). During the assessments, the infants were placed in a baby chair and a rubber toy was presented at their midline within reaching distance for 2 min. Between assessments, the infants received practice of toy-oriented reaching in 3 activities repeated for approximately 4 min. The activities were elicited in a pre-established serial sequence and were applied by a physical therapist. During the pre-test, late preterm infants presented lower range of proximal adjustments, greater proportion of reaches with semi-open hand, and greater proportion of reaches without grasping than the full-term infants. During the post-test, late preterm infants presented greater motor variability of proximal adjustments, but explored and selected distal control and grasping outcomes less compared to the full-term group. Differences in reaching and gross motor behavior between late preterm and full-term infants can be found at the age of reaching onset. Practice provided new opportunities for late preterm infants to improve perception-action coupling to reach; however, relative to full-terms, they seemed less advanced in benefiting from the experience for more refined manual tasks.     

家属陪同模拟场景呼吸训练对冠状动脉CT血管造影检查的影响

目的 探讨在家属陪同下进行模拟场景呼吸训练对冠状动脉CT血管造影(CCTA)检查时患者呼吸配合及图像质量的影响,旨在提高患者检查配合度、检查效率及图像质量。方法 选取2021年7月至2022年6月收治于西安大兴医院心脏内科拟行CCTA检查的患者作为研究对象。将其随机分为3组,每组各90例。A组：检查前1 d至医院准备室,在家属全程陪同下于模拟场景中进行呼吸训练;B组：检查当天在无家属陪同的情况下,于模拟场景中进行呼吸训练;C组：检查当天接受常规呼吸训练。比较3组患者呼吸训练前及正式检查前焦虑自评量表(SAS)得分情况,以及正式检查时的呼吸配合达标率、心率稳定度和冠状动脉图像质量。结果 A组及B组患者CCTA检查呼吸配合达标率均为100%,C组为91.11%,3组比较差异有统计学意义(χ²=8.326,P=0.004)。正式检查前,A组患者SAS评分低于B组与C组(P<0.05);且A组患者检查过程中心率波动最小[(1.81±6.99)次/min],冠状动脉图像质量优良率最高(97.78%);均优于B、C组(P<0.05)。结论 检查前1 d在家属陪同下...     

In-situ simulation for nursing students' professional competence development in postanesthesia care: A quasi-experimental study

AimTo evaluate the differences in professional competence development between nursing students in routine clinical practice and those who experienced four additional in-situ simulations.BackgroundThe amount of clinical practice time available to nursing students is limited. Occasionally, clinical settings do not provide all of the content that nursing students are expected to acquire. In high-risk clinical scenarios, such as the postanesthesia care unit, clinical practice may not provide sufficient context for students to develop the professional competence.DesignThis was a non-blinded, non-randomized, quasi-experimental study. The study was conducted in the postanesthesia care unit of a tertiary hospital in China between April 2021 and December 2022. Nursing students' self-assessed professional competence development and faculty-assessed clinical judgment were used as indicators.MethodsA total of 30 final year undergraduate nursing students were divided into two groups according to the time they arrived at the unit for their clinical practice. Nursing students in the control group followed the routine teaching protocol of the unit. Students in the simulation group received four additional in-situ simulations during the second and third weeks of their practice in addition to the routine program. Nursing students self-assessed their postanesthesia care unit professional competence at the end of the first and fourth weeks. At the end of the fourth week, the nursing students were evaluated on their clinical judgment.ResultsNursing students in both groups scored higher on the professional competence at the end of the fourth week than at the end of the first week and there was a trend of higher competence improvement in the simulation group than in the control group. For clinical judgment, nursing students in the simulation group scored higher than the control group.ConclusionsIn-situ simulation contributes to the development of professional competence and clinical judgment of nursing students during their clinical practice in the postanesthesia care unit.