在高级诊断支气管镜检查过程中,肺部和重症监护病人的参与的影响
Ara A Chrissian1, Sevwandi De Silva1, Erin Wiltchik2
1Division of Pulmonary, Critical Care, Hyperbaric, and Sleep Medicine.
ATS scholar
|February 5, 2025
概括
肺部和重症监护医学 (PCCM) 实习生参与高级诊断支气管镜检查 (ADB) 增加了手术时间和轻微并发症风险. 培训优化对于那些处于最的学习曲线上的学员来说是必要的.
科学领域:
- 肺部医学 肺部医学
- 关键护理医学 关键护理医学
- 医学教育 医学教育
- 干预性肺病学 干预性肺病学
背景情况:
- 肺部和重症监护医学 (PCCM) 实习生经常参加高级诊断支气管镜检查 (ADB) 程序.
- 同事参与对ADB结果的影响需要在现实世界的临床环境中进行调查.
研究的目的:
- 评估PCCM在ADB中的同学参与对程序持续时间,安全性,范围和诊断产量的影响.
- 为了比较在干预性肺病学家 (IP) 监督下由研究员进行的ADB的结果与仅由IP教师进行的结果.
主要方法:
- 使用从2018年2月到2021年12月前性收集的注册表数据进行的回顾性观察队列研究.
- 与PCCM同事参与和不参与的ADB程序进行比较,分析持续时间,并发症和诊断性能.
- 使用多变量分析来调整潜在的混因素.
主要成果:
- 同伴参与 (628个ADB中的60.3%) 与程序持续时间的延长有关,特别是在凸探头内支气管超声支气管和外周支气管检查中.
- 调整后的分析显示,参与研究人员的程序总体上长了7.2分钟,这意味着研究生5年研究员的效率下降了16%.
- 与同学进行的手术有较高的轻微并发症率 (38.7%vs.25.8%) 和过早终止,但与仅与教师进行的手术相比,诊断性能和重大并发症率相似.
结论:
- 在PCCM同学参与ADB延长了手术时间,增加了轻微并发症的风险.
- 当学员处于ADB.的最密集的学习阶段时,效率显著下降.
- 奖学金主管和教师应该考虑这些影响,以优化支气管镜训练和实践.
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