No abstract

BackgroundThe American Society of Anesthesiologists physical status (ASA-PS) is a grading system adopted worldwide by anesthesiologists to classify the overall health status of patients. Its importance is demonstrated not only by its routine use in clinical practice, but also by its deployment in other healthcare-related environments. However, a weak/moderate inter-rater reliability for ASA-PS has been previously shown, and although definitions and clinical examples of each class are provided by ASA, doubts remain on the individual factors influencing assignment to an ASA-PS class. The aim of this study was to investigate whether and how an anesthesiologist’s experience affects classification into a specific ASA-PS class.MethodsAn online survey presenting eight fictitious patients was administered to a group of Italian anesthesiologists and residents. Respondents were asked to assign each of the eight patients to a specific ASA-PS class. Anesthesiologists were subdivided into five classes according to years of experience as an anesthesiologist.ResultsSix hundred one surveys were correctly completed. The highest mean number of correct answers was obtained by residents (3.95 ± 1.13), with the number decreasing progressively with increasing work experience. The lowest value was recorded in the most experienced group (3.13 ± 1.25). Inter-rater reliability was weak/moderate in all experience level groups (k = 0.38).ConclusionsLow inter-reliability of the ASA-PS and the experience-dependence of the anesthesiologist in assigning classifications must be taken into account when evaluating a patient, particularly in settings where wide differences in experience are present.

Introduction The Erector Spinae Plane (ESP) block is a novel inter-fascial block developed in 2016, which has several clinical indications. YouTube ( www.youtube.com ; YT) is a popular American video-sharing platform. YT permits every user to view, share, and comment the videos uploaded by other users. The aim of the study was to evaluate the educational value and the technical video quality of didactic videos for the ESP block on a popular video-sharing platform, to evaluate the difference in quality between academic and nonacademic videos, and to evaluate the correlation between the views and quality of the videos, the length, and the time since upload. Methods We performed a search on YT trying to detect all relevant educational videos for the ESP block. Both the educational value and the technical video quality were assessed independently by three assessors. Assessors were asked to watch the videos and to fill in two questionnaires, the first one regarding the technical and educational aspects of ESP block, the second one regarding the video-editing quality. The video length, academic origin, views, and time from upload were also registered. Results We identified 62 videos and 21 videos entered the final analysis. The educational material for the ESP block had an overall low quality. Academic videos have a higher quality than non-academic ones. The video views are correlated with time since upload but not with the video quality. Conclusions The educational material for the ESP block on YT has a limited technical and video quality. For this reason, we recommend physicians to be very cautious in using video-sharing platforms as a unique source of medical knowledge.

Context. Underweight, overweight and obesity are important global public health issues and risk factors for adverse perinatal outcomes. Objective. To assess the distribution of the body mass index (BMI) in the Romanian obstetric population in the first trimester of pregnancy and its correlation with pregnancy outcomes. We also report the distribution of blood pressure (BP) parameters and their correlation with BMI. Design. This retrospective study includes 9,064 women attending routine first trimester visit and ultrasound scan at 12.8(±0.6) gestational weeks. Characteristics, parity, method of conception, blood pressure (from 3,650 women), maternal weight and height, BMI and foetal ultrasound were recorded. Pregnancy outcomes were available for 1,607 deliveries. The Pearson correlation coefficient was assessed for each BMI group vs. blood pressure parameters, gestational age and birth weight. ANOVA analysis and post hoc tests were used to determine group differences. Linear regression was applied to estimate the contribution of BMI and gestational age to birth weight variance. Results. In our population, 66.37% pregnant women had a normal BMI, 19.29% were overweight, and 7.56% were obese. There was a weak-to-medium positive correlation between BMI and blood pressure parameters, for all weight categories. The correlation between maternal BMI and birth weight was positive for normal and overweight. Conclusions. Our findings highlight the need for more effective health strategies targeting reduction of weight-related problems in women of childbearing age.

IntroductionErrors are frequent in health care and Emergency Departments are one of the riskiest areas due to frequent changes of team composition, complexity and variety of the cases and difficulties encountered in managing multiple patients. As the majority of clinical errors are the results of human factors and not technical in nature or due to the lack of knowledge, a training focused on these factors appears to be necessary. Crisis resource management (CRM), a tool that was developed initially by the aviation industry and then adopted by different medical specialties as anesthesia and emergency medicine, has been associated with decreased error rates.The aim of the studyTo assess whether a single day CRM training, combining didactic and simulation sessions, improves the clinical performance of an interprofessional emergency medical team.Material and MethodsSeventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. Twenty individual interprofessional teams were created. Each team was assessed before and after the training, through two in situ simulated exercises. The exercises were videotaped and were evaluated by two assessors who were blinded as to whether it was the initial or the final exercise. Objective measurement of clinical team performance was performed using a checklist that was designed for each scenario and included essential assessment items for the diagnosis and treatment of a critical patient, with the focus on key actions and decisions. The intervention consisted of a one-day training, combining didactic and simulation sessions, followed by instructor facilitated debriefing. All participants went through this training after the initial assessment exercises.ResultsAn improvement was seen in most of the measured clinical parameters.ConclusionOur study supports the use of combined CRM training for improving the clinical performance of an interprofessional emergency team. Empirically this may improve the patient outcome.