A comprehensive description of the competencies required for the performance of an ultrasound-guided axillary brachial plexus blockade

We addressed four research questions, each relating to the training and assessment of the competencies associated with the performance of ultrasound-guided axillary brachial plexus blockade (USgABPB). These were: (i) What are the most important determinants of learning of USgABPB? (ii) What is USgABPB? What are the errors most likely to occur when trainees learn to perform this procedure? (iii) How should end-user input be applied to the development of a novel USgABPB simulator? (iv) Does structured simulation based training influence novice learning of the procedure positively? We demonstrated that the most important determinants of learning USgABPB are: (a) Access to a formal structured training programme. (b) Frequent exposure to clinical learning opportunity in an appropriate setting (c) A clinical learning opporunity requires an appropriate patient, trainee and teacher being present at the same time, in an appropriate environment. We carried out a comprehensive description of the procedure. We performed a formal task analysis of USgABPB, identifying (i) 256 specific tasks associated with the safe and effective performance of the procedure, and (ii) the 20 most critical errors likely to occur in this setting. We described a methodology for this and collected data based on detailed, sequential evaluation of prototypes by trainees in anaesthesia. We carried out a pilot randomised control trial assessing the effectiveness of a USgABPB simulator during its development. Our data did not enable us to draw a reliable conclusion to this question; the trail did provide important new learning (as a pilot) to inform future investigation of this question. We believe that the ultimate goal of designing effective simulation-based training and assessment of ultrasound-guided regional anaesthesia is closer to realisation as a result of this work. It remains to be proven if this approach will have a positive impact on procedural performance, and more importantly improve patient outcomes.

The contribution of Victor Hugo to the liberation, emancipation, and changing perceptions of women in 19th century French society

The over-riding perceptions of Victor Hugo’s attitudes towards women are intensely coloured by his deep-seated Romanticism and his well-testified, stifling and over-bearing treatment of women in his personal life. As such, Hugo’s contribution to the feminist struggle of his time has been woefully overlooked in the larger scheme of his social and political activism. Through a close examination of his largely unstudied public discourse on women’s rights, this thesis situates Hugo’s feminist views firmly in the context of Enlightenment feminism and 19th century feminism, while also drawing heavily on the illuminating principles of Enlightenment feminism. In particular, this thesis examines Hugo’s support for several of the most determining issues of 19th century French feminism, including women’s right to education, equal citizenship, universal suffrage rights, and the issue of regulated prostitution. Further, by examining the way in which Hugo’s views on women’s maternal role extended far beyond the limited vision of domesticity bolstered by the ideology of ‘republican motherhood’, this thesis engages in a re-appraisal of Hugo’s literary representation of maternity which identifies the maternal as a universal quality of devotion and self-sacrifice to which all humankind must aspire for the creation of a just, egalitarian, and democratic society. Though at times inevitably constrained by his Romanticism, this thesis demonstrates the extent to which Hugo’s feminism is grounded in his wider vision of social emancipation and is underpinned by a profound empathy, compassion, and moral conscience – qualities which are just as fundamental today, as they were for Hugo when participating in the fitful, though decisive, feminist struggle in 19th century France.