7 resultados para J31 - Wage Level and Structure
em University of Washington
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Thesis (Ph.D.)--University of Washington, 2016-08
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Senior thesis written for Oceanography 445
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Examines the limitations of the dynamic theory of classification in accommodating the changes and rapid growth of new topics in the universe of knowledge. Change in an analytico-synthetic scheme for classification is much more a web of connections and mapping these changes is a complex process. Suggests that there is need for exploration of this complexity for both improving systems, and revisiting our theory.
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Background and Objectives: Peripheral nerve blockade requires regional anesthesia skills that trainees learn in several formats. Technical proficiency has shifted from a quota to comprehensive procedural evaluation. Successful nerve blockade is the clinical endpoint validating proficiency but patient, technical and procedural factors influence this result. The purpose of this study was to determine if procedural expertise for sciatic nerve blockade influenced postoperative pain scores and opioid requirements and if patient factors, technique and repetition influenced this outcome. Method: Sciatic nerve blockade by nerve stimulation and ultrasound guidance and training level of the resident performing the procedure were recorded. Patient obesity, trauma, chronic pain, opioid use and preoperative pain scores were compared to post-procedure pain scores and opioid analgesic requirements. Results: 102 patients received sciatic nerve blockade from 47 trainees over a 36 month interval. A significant relation between training level and improved pain scores was not demonstrated but transition from nerve stimulation to ultrasound guidance lowered scores in all groups. Nerve blockade failure was frequent with chronic opioid use and trauma. Conclusion: Analgesic outcomes should be an integral part of assessment of proficiency in regional anesthesia techniques. Evaluating outcomes of procedures throughout training will longitudinally assess technical expertise.
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Thesis (Ph.D.)--University of Washington, 2016-05
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Thesis (Ph.D.)--University of Washington, 2016-04
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Thesis (Ph.D.)--University of Washington, 2016-06