SDLRS score may not be an important predictor of academic performance when students are given learning objectives and open access to learning resources. A number of limitations of the current study should be noted.
Firstly, the neuroanatomy module comprised the first three weeks of the teaching semester which reduced the number of laboratory sessions where students had access to apps. Lastly, this study drew participants enrolled in one unit at a single institution who were mostly from one major which may limit the generalizability of our findings. The practical implications for integrating the use of anatomy apps in the laboratory are five-fold: 1 anatomy instructors should be able to demonstrate how to use apps in a seamless, readily comprehensible, manner; 2 an adequate amount of time should be provided to students to familiarize themselves with the apps prior to use in the laboratory; 3 students can readily utilize apps for revision of basic anatomy; 4 3D apps are particularly useful for identifying and understanding the form of c-shaped structures, such as the caudate nucleus and fornix and 5 there is a need for higher-order knowledge quizzes and inclusion of spinal cord pathways in apps featuring neuroanatomy.
Our findings indicated that short-term use of anatomy apps did not influence student learning outcomes. In particular, such studies should examine whether time spent using educational apps, extent of instruction in using educational apps, and matching app content to learning outcomes, significantly influences anatomy learning outcomes.
Data will not be shared as ethical approval was not granted for the public release of the data. All authors contributed to the conceptualization of the study, analysis, and drafting of the manuscript. Skip to main content Skip to sections.
Advertisement Hide. Download PDF. Stomski C. Open Access. First Online: 01 December Methods Second-year anatomy students, enrolled in a Bachelor of Science with Chiropractic Major program, were randomly allocated to experimental and control groups in July Conclusions App use did not enhance learning outcomes in a second-year anatomy unit. Background Teaching in anatomy is evolving, with a reduction in contact hours, increased student numbers, increased costs associated with cadavers and advances in technology, all driving change in the anatomy learning environment [ 1 , 2 ].
Focus group A focus group was conducted immediately after the summative assessment by a staff member who was not involved in the teaching of anatomy to the students. Participants Completed questionnaires were obtained from 50 out of 57 student enrolled in the study. Two students did not consent to have their data included and five students had incomplete data. Participant characteristics are reported below in Tables 1 and 2. Table 1 Neuroanatomy apps used in the gross anatomy laboratory.
Table 2 Characteristics of the study participants. SD standard deviation. The mean neuroanatomy assessments scores were not different between the groups control: Neither self-directed laboratory-based anatomy app use, gender, nor SDLRS affected neuroanatomy assessment scores. Table 3 Results of the multivariate linear regression analysis. Funding Not applicable. Availability of data and materials Data will not be shared as ethical approval was not granted for the public release of the data.
Competing interests The authors declare that they have no competing interests. Consent for publication Not applicable. Shaffer K. Teaching anatomy in the digital world. N Engl J Med. Medical education in the anatomical sciences: the winds of change continue to blow. Anat Sci Educ. Complementing anatomy education using three-dimensional anatomy mobile software applications on tablet computers. Clin Anat. Google Scholar. Development and assessment of a new 3D neuroanatomy teaching tool for MRI training. VARK learning preferences and mobile anatomy software application use in pre-clinical chiropractic students.
Development of a self-directed learning readiness scale for nursing education. Nurse Educ Today. Educ Health. CrossRef Google Scholar. Adv Physiol Educ. Williams B, Brown T. Nurs Health Sci. Readiness for self-directed learning and academic performance in an abilities laboratory course. Am J Pharm Educ. Hendry GD, Ginns P. Readiness for self-directed learning: validation of a new scale with medical students. Med Teach. Brain and Nervous System Pro.
In: iPad edn. San Diego: 3D4Medical. Essential Anatomy 5. In: iPhone, iPad, iPod touch edn. Inc AP. In: 6.
Unexpected vascular punctures, symptomatic hemidiaphragmatic paresis, Horner syndrome, pneumothorax or neurological deficits were recorded. Pain intensity related to the procedure was assessed at the end of blockade using an point verbal numerical rating scale NRS from 0 no pain to 10 worst imaginable pain by an observer blinded to the study protocol. SPSS v.
A pilot study was conducted on 20 patients to estimate the prevalence of a satisfactory sensory block. A calculated sample size of patients per group was required for a statistical power of 0. Categorical variables, including the proportion of patients with successful sensory and motor blocks at 5, 10, 15, 20, 25 and 30 min, were expressed as percentages. Successful sensory and motor blocks at different times were compared using a Friedman's repeated-measures analysis of variance on ranks for within-group comparisons, and a Kruskal-Wallis one-way analysis of variance on ranks for intergroup comparisons.
The P-value was calibrated using the Benjamini and Hochberg method. Kaplan-Meier life-table analysis was used to analyze the duration of sensory and motor blocks. A total of patients were enrolled, and patients completed the study Fig. The success rates for sensory and motor blocks in the ulnar, radial, median and axillary nerves differed between the SI and TI groups Figs.
Percentage of complete sensory blocks of the A ulnar, B radial, C median and D axillary nerves assessed at 5 min intervals until 30 min post-injection. SI group. SI, single injection; TI, triple injection. Percentages of complete motor blocks of the A ulnar, B radial, C median and D axillary nerves assessed at 5 min intervals until 30 min post-injection.
Sensation or strength did not differ significantly between the two groups at baseline testing. Patients in the TI group described a greater sensory block to pain, beginning at 30 min following the interscalene blockade, which persisted throughout the 17 h assessment period Fig. Survival analyses for regression of sensory and motor blocks. This was measured as the longevity of the block from the time of placement and analyzed using survival analyses Cox model.
The figure exhibits the proportion of patients reporting a block over time. Patients in the TI group reported significantly longer durations of A sensory and B motor blocks compared to patients in the SI group. SI and TI methods resulted in a similar rate of success at 30 min. There were no significant differences in the prevalence of unexpected vascular punctures or Horner syndrome, and symptomatic hemidiaphragmatic paresis, pneumothorax or neurological deficits were not observed. NRS is presented as the median range.
The TI method exhibited a faster onset post-injection compared to the SI method, and patients in the TI group experienced longer sensory and motor blocks compared with the SI group. However, there was no significant difference in the success rate of surgical anesthesia at 30 min post-injection. There have been conflicting reports regarding the quality of nerve blockade with TI compared with SI.
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A recent systematic review of randomized controlled trials comparing ultrasound-guided TI and SI for supraclavicular brachial plexus blockade suggested that TI may provide a modest improvement in the onset and quality of blockade 7. In the present study, no significant differences were observed in the success rate of the two methods. However, to the best of our knowledge, this is the first study to focus on the onset of sensory and motor blocks of four nerves, as well as the duration of blockade as a primary outcome.
The TI group surpassed the SI group in achieving sensory and motor blocks at 5 min intervals for the first 10 min. A paraneural sheath surrounds the brachial plexus as a thin membrane 10 , 12 , and it is possible that the paraneural sheath precludes the need for direct circumferential injection. As the space between nerve roots is limited, the area becomes saturated with LA, and multiple injections force incoming LA molecules to find alternate paths of less resistance.
This mechanism may explain why, initially, the TI method provided a shorter time of onset and more successful blocks in the first 10 min. In the present study, sensory and motor blocks of the ulnar nerve were significantly more effective with TI compared with SI at all time points. The first injection of the TI was deep and potentially close to the lower trunk. Accordingly, the subsequent difference in the success of the ulnar nerve blockade may have eliminated the need for further injections, as the initial deep injection typically targets the lower region of the brachial plexus that gives origin to the ulnar nerve 13 , Another notable observation in the present study was that the duration of blockade was prolonged in the TI group compared with the SI group.
This may have been due to reduced systemic uptake of LA in the TI group, due to more LA being contained within the brachial plexus sheath, thus increasing the reservoir volume of LA solution Franco et al 12 described the interior of the sheath surrounding the neuronal tissue as a combination of loose connective tissue and fat, with few veins running along the sheath interior.
These observations potentially explain the results of the present study, as there may have been decreased systemic absorption of LA in the TI group due to reduced vascularity on the interior of the sheath.
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In conclusion, and in accordance with previous work 7 , 15 , 16 , no significant difference was observed in the success rates of the SI and multiple injection methods. Furthermore, the TI method deposited LA in the interscalene brachial plexus more caudally than in the SI method, which may have resulted in greater distal distribution of anesthesia and a higher blockade success in the ulnar nerve.
Exp Ther Med. Published online Jan PMID: China Find articles by Cun-Jin Wang. China Find articles by Ya-Li Ge. China Find articles by Ju Gao. China Find articles by Feng-Yun Long. China Find articles by Zhi-Hua Mi. China Find articles by Tian-Feng Huang. China Find articles by Xiang-Zhi Fang.
China Find articles by Xiao-Ping Chen. China Find articles by Yu-Si Hua. China Find articles by Yang Zhang. Correspondence to : Mr. China, E-mail: moc. Received Apr 15; Accepted Mar Abstract Ultrasound-guided interscalene brachial plexus blockade IBPB has a relatively high success rate in shoulder surgery; however, whether multiple injections are superior to a single injection SI is currently unknown. Keywords: ultrasound, brachial plexus, single-injection, triple-injection, shoulder surgery.
Introduction Blockade of the brachial plexus through an interscalene approach has a relatively high success rate in shoulder surgery 1 — 3. Subjects and methods Study subjects A total of patients undergoing arthroscopic shoulder surgery between September and December at Subei People's Hospital of Jiangsu Province Yangzhou, China were included in the present study.
Table I. Patient characteristics of the study groups. Open in a separate window. Figure 1. Assessment of blockade Evaluation of nerve blockades was performed by a separate anesthesiologist to those who administered the blocks. Table II. Rating scale for muscle force. Rating Description 6 Normal muscle force 5 Slightly reduced muscle force 4 Greatly reduced muscle force 3 Slightly impaired mobility 2 Greatly impaired mobility 1 Near complete paralysis 0 Complete paralysis.