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Trial registered on ANZCTR
Registration number
ACTRN12611001155987
Ethics application status
Approved
Date submitted
3/11/2011
Date registered
3/11/2011
Date last updated
3/11/2011
Type of registration
Retrospectively registered
Titles & IDs
Public title
Ultrasound imaging of the obstetric epidural space and validation of a training programme: A superiority randomized controlled trial of explicit versus implicit training
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Scientific title
Ultrasound imaging of the obstetric epidural space and validation of a training programme in anaesthesiologists: A superiority randomized controlled trial of explicit versus implicit training
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Secondary ID [1]
273317
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Spinal ultrasound teaching and learning in Anaesthesiologists
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Condition category
Condition code
Anaesthesiology
279280
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0
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Anaesthetics
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Public Health
279284
279284
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0
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Health promotion/education
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Two spinal ultrasound workshops were conducted and supervised 1 week apart by 2 experienced spinal ultrasonographers. They had 3 months of intensive supervised training by the principle investigator (4 years experience in performing and teaching novices spinal ultrasound) prior to commencement of the study. Each workshop comprised of an explicit teaching intervention (20 minutes), practice period (40 minutes) and videorecorded assessment period(20 minutes).
Explicit teaching intervention:Prior to initiating the study we developed and trialed a standardized explicit 10-step training programme called “the 10 easy steps of performing spinal ultrasound” based on the technique described by Carvalho et al. and modifying it to avoid some of the problems commonly encountered while learning the skill, as defined by Margarido et al. Standardized explicit (didactic) spinal ultrasound training method was taught explicitly for 20 minutes via a didactic sequential step-by-step approach.This included a 10 minute narrated PowerPoint presentation and a 10 minute demonstration of the “10 easy steps of performing spinal ultrasound”.
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Intervention code [1]
283668
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Other interventions
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Comparator / control treatment
Two spinal ultrasound workshops were conducted and supervised 1 week apart by 2 experienced spinal ultrasonographers. They had 3 months of intensive supervised training by the principle investigator (4 years experience in performing and teaching novices spinal ultrasound) prior to commencement of the study. Each workshop comprised of an implicit teaching intervention (20 minutes), practice period (40 minutes) and videorecorded assessment period(20 minutes).
Implicit teaching intervention: Prior to study commencement we developed a 20 minute implicit training programme of spinal ultrasound similar to the technique described by Carvalho J et al. and Margarido et al. The teaching method was finalized after consensus by the investigators, and were trailed on two trainees who did not participate in the study.The implicit teaching method taught the technique practically without verbally referring to the 10-steps.
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Control group
Active
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Outcomes
Primary outcome [1]
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Global Rating Scale (GRS) score:GRS consisted of a 5-point scale that used seven-item behavioural descriptors (maximum score 40), and focused on the measuring the overall performance of the trainee rather than the specifics of the manual tasks. The GRS was chosen as it has been previously validated for objectively evaluating different anaesthesia skills.
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Assessment method [1]
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Timepoint [1]
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Timepoint: Immediately after first teaching intervention & practice session and at 1 week immediately after second teaching intervention & practice session
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Secondary outcome [1]
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Task specific checklist(TCL) score: The TCL consisted of 10 prespecified items which were rated on a scale of 0-2 (where 0=task not performed, 1=poorly performed and 2=well performed) (maximum score 20). This secondary outcome objectively measured the specifics of performing the manual spinal ultrasound tasks.
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Assessment method [1]
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Timepoint [1]
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Timepoint: Immediately after first teaching intervention & practice session and at 1 week immediately after second teaching intervention & practice session
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Secondary outcome [2]
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Image quality (IQ) score: The ultrasound images in the transverse median plane were scored on a scale of 1-5, where 1= poor visibility and all structures not identifiable, 2= all structures reasonably identifiable, 3= all structures satisfactorily identifiable, 4= good visibility of all important structures, 5= very good visibility of all important structures. This secondary outcome measured the quality of the ultrasound images obtained by the anaesthetists.
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Assessment method [2]
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Timepoint [2]
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Timepoint: Immediately after first teaching intervention & practice session and at 1 week later immediately after second teaching intervention & practice session
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Secondary outcome [3]
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Intraclass correlation coefficients (ICC) were calculated to assess agreement between 2 reviewers
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Assessment method [3]
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Timepoint [3]
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Timepoint: Immediately after first teaching intervention & practice session and at 1 week later immediately after second teaching intervention & practice session
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Eligibility
Key inclusion criteria
Anaesthetists (including trainees) with no prior spinal ultrasound experience
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Unavailable to attend both workshop sessions
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Study design
Purpose of the study
Educational / counselling / training
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
All anaesthetists in the state (Australian Capital Territory, Australia), who were eligible to participate in the study were approached for participation. Allocation concealment was achieved with opaque sequentially numbered sealed envelopes.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
For each workshop the anaesthesiologists (novices in performing the spinal ultrasound technique) are randomized according to a computer-generated random table, teaching groups to receive standardized training via either an explicit (didactic) 10-step or an implicit (interactive) learning.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
Single centre (Australia) prospective, assessor-blinded (2 reviewers from international centre) randomized controlled trial
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Phase
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
23/11/2009
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
18
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Address [1]
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Country [1]
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Primary sponsor type
Hospital
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Name
Calvary Hospital, Canberra, Australian Capital Territories
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Address
Corner of Belconnen Way and Haydon Drive, Bruce, ACT, 2617
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
269112
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Other collaborator category [1]
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Individual
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Name [1]
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Cristian Arzola
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Address [1]
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600 University Avenue Toronto, ON M5G 1X5, Canada
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Country [1]
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Canada
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Other collaborator category [2]
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Individual
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Name [2]
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Mrinalini Balki
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Address [2]
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600 University Avenue Toronto, ON M5G 1X5
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Country [2]
260333
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Canada
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Human Research and Ethics Committee, Calvary Health Care, Canberra
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Ethics committee address [1]
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Corner of Belconnen Way and Haydon Drive, Bruce, ACT, 2617
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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15/09/2009
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Approval date [1]
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21/10/2009
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Ethics approval number [1]
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22-2009
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Summary
Brief summary
Background Spinal ultrasound has great potential as a teaching tool for epidural insertion; however it is currently underutilized. Purpose The purpose of the study was to test the efficacy of a standardized training programme of spinal ultrasound and to determine the optimal teaching method. Methods The study was conducted as a prospective, assessor-blinded randomized controlled trial as part of 2 standardized workshops 1 week apart at a single centre in Australia during December 2010. For each workshop the anaesthesiologists (novices in performing the spinal ultrasound technique) were randomized according to a computer-generated random table, into 2 teaching groups to receive standardized training via either an explicit (didactic) 10-step or an implicit (interactive) learning method. Allocation concealment achieved with opaque sequentially numbered sealed envelopes. This was followed by a practice session and assessment of specific ultrasound tasks on pregnant volunteers. They were individually videorecorded for assessment, and subsequently rated by two experienced international blinded assessors from a using a global rating scale (GRS) and checklist. Saved lumbar intervertebral images were also rated. Main outcome measure: GRS score. Secondary outcome measures: Task specific checklist and image quality scores. ICC’s were calculated to assess agreement between reviewers.
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Trial website
None
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Trial related presentations / publications
Terblanche, N and Lawson, R and Blackford, D. Ultrasound imaging of the obstetric epidural space: validation of a training programme , Proceedings of the 40th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, May 12-16, San Antonio, Texas (2010) [Conference Extract]
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Nico Terblanche
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Address
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48 Liverpool Street
Hobart
Tasmania
7000
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Country
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Australia
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Phone
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+61 03 6222 7866
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Fax
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+61 03 6222 7533
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Email
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[email protected]
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Contact person for scientific queries
Name
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Nico Terblanche
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Address
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48 Liverpool Street
Hobart
Tasmania
7000
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Country
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Australia
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Phone
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+61 03 6222 7866
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Fax
7431
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+61 03 6222 7533
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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