Leila Niemi-Murola

Comparison of airway management with the intubating laryngeal mask, laryngeal tube and CobraPLA® by paramedical students in anaesthetized patients

Background:  Because of the importance of airway management in emergency care, alternative methods with shorter learning curves for inexperienced personnel have been looked for as a substitute for endotracheal intubation (ETI).

Medical undergraduate students’ beliefs and attitudes toward pain – How do they mature?

At the University of Helsinki, pain‐related topics are taught throughout medical studies but without a formal pain curriculum. The purpose of this study was to assess medical students’ attitudes towards pain.

Teaching anaesthesia induction to medical students : comparison between full-scale simulation and supervised teaching in the operating theatre

Background and objective The aim of the study was to compare the effectiveness of teaching of general anaesthesia induction to medical students using either full-scale simulation or traditional supervised teaching with patients in the operating theatre. Methods Forty-six fourth year students attending their course in anaesthesiology were enrolled. The students were randomly assigned to two groups. The simulation group received training in the simulator. The traditional training group was supervised by a senior consultant anaesthetist. After the training sessions all students were tested in the simulator setting. The test was assessed using a 40-item evaluation list. Results Thirty-three per cent of students in the traditional group and 87% of the students in the simulation group passed the test. Statistically significant differences were: request of glycopyrrolate (P < 0.001), SpO2 monitoring (P < 0.001), used gloves when placing an intravenous cannula (P = 0.012), intubation attempt within 30 s (P < 0.04), anaesthesia gas set at MAC at least 1 (P < 0.04), instructed anaesthetic nurse to keep SpO2 at least 95% (P < 0.05), keep MAP at least 60 mmHg (P < 0.05), keep heart rate more than 50 beats per minute (P < 0.002), keep end-tidal pCO2 4–5.5 kPa (P < 0.002). Conclusion The simulation group performed better in 25% of the tasks and similarly in the others compared with the traditional teaching group. With the same time and amount of teaching personnel we trained five or six students in the simulator compared with one student in the operating theatre. Further research will reveal whether these promising results with simulation may be applied more generally in anaesthesiology teaching to medical students.

Interprofessional education of medical students and paramedics in emergency medicine.

Background:  Emergency medicine is team work from the field to the hospital and therefore it is also important for physicians to understand the work of paramedics, and vice versa. Interprofessional emergency medicine education for medical and paramedic students in Helsinki was started in 2001. It consisted of a 15 European credit transfer system (ECTS) credits programme combining 22 students in 2001. In 2005, the number of students had increased to 25. The programme consisted of three parts: acute illness in childhood and adults (AI), advanced life support (ALS) and trauma life support (TLS). In this paper, we describe the concept of interprofessional education of medical students and paramedics in emergency medicine.

Postgraduate training in anaesthesiology, pain and intensive care: the new European competence-based guidelines

Over the last few decades, the role of the anaesthesiologist has extended from the operating room as the main area of competence to developing responsibilities in other areas of medicine. The initial tasks, which included assessment and evaluation, maintenance of organ function and analgesia and amnesia for all patients undergoing diagnostic, therapeutic or surgical procedures, have changed. Anaesthesiology has gone towards larger, deeper and more holistic competencies in the perioperative period, in multidisciplinary intensive care medicine, emergency medicine and pain medicine, which in many countries are now an integral part of the clinical specialty. As a result of this evolution, shared border zones have changed or developed with several other medical specialties (e.g. internal medicine) and this development emphasises the importance of a well defined core curriculum in anaesthesiology.

Teaching basic life support to nurses

Background and objective: Every member of healthcare personnel should be able to perform basic life support including defibrillation (CPR‐D). The biggest cost of implementation is training and these costs need to be reduced. The purpose of this randomized study was to evaluate the applicability of distance learning as a method to teach CPR‐D. Methods: Nurses (n = 56) working in a geriatric hospital were randomized into three groups. The first group was given the Internet‐based CPR‐D course and the second was given a traditional, small‐group CPR‐D course. A third group without specific training in CPR‐D served as a control group. An objective structured clinical examination (OSCE) was performed 2 weeks after the courses with a manikin patient having a cardiac arrest. Results: The median score of all participants was 31/49 (range 21–38). The reliability of the checklist was adequate (Cronbach alpha 0.77). Nurses receiving traditional CPR‐D performed better than those receiving the Internet‐based course (median score 34 vs. 28, P < 0.05) and the control group (median score 34 vs. 26, P < 0.0001). Nurses receiving Internet‐based course performed similarly as the control group (median score 28 vs. 26, ns). Conclusions: Distance learning cannot substitute for traditional small‐group learning.

Comparison of articaine and lidocaine for infiltration anaesthesia in patients undergoing bone marrow aspiration and biopsy.

Infiltration anaesthesia with articaine, a local anaesthetic able to penetrate bone, may relieve procedural pain better than lidocaine in bone marrow aspiration and biopsy. This randomised, double‐blind study comprised 150 patients with suspected or known haematologic disease. Either articaine 20 mg/ml (50 patients), articaine 40 mg/ml (49 patients) or lidocaine 20 mg/ml (51 patients), all with adrenaline 5 μg/ml, was infiltrated in volume of 6 ml (sternal manubrium), 8 ml (sternal body) or 10 ml (iliac crest) 2 min before puncture. Numeral rating scale score (median, range) at injection of local anaesthetic was 3.0 (0–10), at bone puncture 2.0 (0–8), at aspiration 3.5 (0–10) and at biopsy (48 patients) 3.0 (0–10). Pre‐procedural anxiety, rated on a verbal scale, correlated significantly with experienced pain (P < 0.01). Very anxious patients had fewer previous bone marrow examinations (P < 0.01) and they experienced more pain during aspiration (P < 0.05). In the post‐interview 42 patients reported appearance of pain (median 2.0, range 1–7) after 6.2 h, on average, and 15 patients needed oral analgesics. No parameter differed significantly between the groups.

Assessment of CPR-D skills of nursing students in two institutions: reality versus recommendations in the guidelines

Significant differences in basic life support skills including cardiopulmonary resuscitation and defibrillation (CPR-D) were detected when nurses working in one Finnish and one Swedish hospital were tested using an Objective Structured Clinical Examination (OSCE). The purpose of this study was to use OSCE test in assessing guideline based CPR-D skills of newly qualified nurses. The CPR-D skills of newly qualified registered nurses studying in Halmstad University (n = 30), Sweden, Helsinki Metropolia University of Applied Sciences (n = 30), and Finland were assessed using an OSCE which was built up with a case of cardiac arrest with ventricular fibrillation as the initial rhythm. The Angoff average, 32.47, was calculated as cutoff point to pass the test. Forty-seven percent of the students in the Swedish group (mean score 32.47/49, range 26–39, SD 3.76) and 13% of the students in the Finnish group (mean score 23.80/49, range 13–35, SD 4.32) passed the OSCE (P<0.0001), the cutoff point being 32.47. Performance grade for the Swedish group was 2.9/5.0 and for the Finnish group 2.1/5.0 (P<0.0001). Good nontechnical skills correlated with high grading of the clinical skills. In conclusion, CPR-D skills of the newly qualified nurses in both the institutes were clearly under par and were not adequate according to the resuscitation guidelines. Current style of teaching is unlikely to result in students being able to perform adequate CPR-D. Standardized testing would help in controlling the quality of learning.

Harmonisation of anaesthesiology training in Europe.

The last 20 years has seen many changes in medical education, with reforms taking place in undergraduate health-care studies with the application of the Bologna principles and also transfer of the same educational principles to postgraduate medical specialty training. It is the aim of this article to grossly sketch and contextualise these reforms in the rapidly evolving European Union, before defining harmonisation of the medical postgraduate training and the bodies involved in this process; thereafter, the authors try to present the potential consensus points that can make the process of harmonisation in anaesthesiology postgraduate training in Europe become a reality. Finally, a brief outline of the potential challenges concludes the paper.

Mandatory documentation of pain in the emergency department increases analgesic administration but does not improve patients’ satisfaction of pain management

Abstract Background Pain is one of the most common symptoms treated in emergency department (ED). Pain may cause suffering and disability for the patient. Inadequate pain management may be associated with increased risk of complications such as sleep disturbance, delirium and depression. Previous studies conclude that pain management in ED is insufficient and inadequate. Yet, little is known about patients’ own experience regarding pain management in ED. Objective The aim of this study was to explore the satisfaction of pain management in patients having acute musculoskeletal injuries before and after implementation of mandatory documentation regarding pain assessment in the ED. Method An observational pre-post intervention study design was used. The study was conducted on patients having acute musculoskeletal injuries such as soft tissue injury, back pain or wrist/arm/leg/foot fractures in a 24-h adult (>15 years) ED at a public urban teaching hospital in Stockholm, Sweden. Data was collected by an interview based on a questionnaire. Results A total of 160 patients answered the questionnaire. In the pre- (n = 80) and post-intervention (n = 80) groups, 91/95% experienced pain in the ED. A significant difference (p < 0.003) was found during the post-intervention period, with more patients receiving analgesics compared to the pre-intervention group. A significant decline (p < 0.03) in patients’ own reported pain intensity at discharge was found between the groups. Patients’ reported satisfaction on pain management in the ED increased in the post-intervention group, but the difference was not statistically significantly. Conclusion Patients’ satisfaction with pain management increased, but not statistically significantly. However, both percentages of patients receiving analgesic drugs increased and pain intensity decrease at discharge were statistically significant after the intervention that made nurses obliged to register pain. Implication According to the findings of this study, mandatory pain documentation facilitates pain management in the ED, but there is still room for improvement. Additional actions are needed to improve patients’ satisfaction on pain management in the ED. Mandatory pain documentation in combination with person-centred care could be a way of improving patients’ satisfaction on pain management. Effective pain management is an important quality measure, and should be focused on in acute care in the ED. By routinely asking patients to report the pain intensity at discharge, the ED personnel can have direct feedback about the factual pain management. RNs may also be encouraged to use intravenous analgesics in higher extent when the patients have very severe pain.