Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the...Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (p<.05). The probability of making an accidental dural puncture was 64% (OR: 0.36) lower for trainees who had the training than for those who did not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.展开更多
Land degradation and early forms of desertification in both advanced economies and emerging countries reflect complex socio-environmental processes driven by multiple interactions between biophysical and socioeconomic...Land degradation and early forms of desertification in both advanced economies and emerging countries reflect complex socio-environmental processes driven by multiple interactions between biophysical and socioeconomic forces across different spatial scales.The present study investigates desertification risk,land degradation,and socio-demographic dynamics through the lens of“resilience,”adopting complex adaptive systems(CAS)thinking.The resilience of socio-environmental systems exposed to land degradation is defined as the capacity of a regional economy to respond to crises and reorganize by making changes to preserve functions,structure,and feedback,and to promote future development options.By reviewing the socioeconomic resilience of local socio-ecological systems exposed to land degradation,this study achieves a better comprehension of the multifaceted processes that lead to a higher risk of desertification and the intimate relationship with underlying population trends and demographic dynamics.A comprehensive approach based on resilience thinking was formulated to review both environmental and socio-demographic issues at the landscape scale,and provide a suitable foundation for sustainability science and regional development policies.展开更多
文摘Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (p<.05). The probability of making an accidental dural puncture was 64% (OR: 0.36) lower for trainees who had the training than for those who did not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.
文摘Land degradation and early forms of desertification in both advanced economies and emerging countries reflect complex socio-environmental processes driven by multiple interactions between biophysical and socioeconomic forces across different spatial scales.The present study investigates desertification risk,land degradation,and socio-demographic dynamics through the lens of“resilience,”adopting complex adaptive systems(CAS)thinking.The resilience of socio-environmental systems exposed to land degradation is defined as the capacity of a regional economy to respond to crises and reorganize by making changes to preserve functions,structure,and feedback,and to promote future development options.By reviewing the socioeconomic resilience of local socio-ecological systems exposed to land degradation,this study achieves a better comprehension of the multifaceted processes that lead to a higher risk of desertification and the intimate relationship with underlying population trends and demographic dynamics.A comprehensive approach based on resilience thinking was formulated to review both environmental and socio-demographic issues at the landscape scale,and provide a suitable foundation for sustainability science and regional development policies.
