Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 11 appraisals
BMJ open
Difficult intravenous access (DIVA) in the adult population: an umbrella review.
OBJECTIVES: To synthesise evidence from systematic reviews on difficult intravenous access (DIVA) in adults, focusing on definitions, diagnostic criteria, risk factors and clinical interventions to guide clinical practice and health policy. DESIGN: Umbrella review of systematic reviews and meta-analyses. SETTING: Any clinical setting involving adult patients requiring peripheral venous access (including hospital, emergency and outpatient care). DATA SOURCES: A systematic search was performed in PubMed, CINAHL, Cochrane, Scopus and Web of Science in July 2025. ELIGIBILITY CRITERIA: Systematic reviews and meta-analyses published from 2014 to 2025 that addressed DIVA in the adult population were included. Primary studies and protocols were excluded. DATA EXTRACTION AND SYNTHESIS: Methodological quality was assessed using the Risk Of Bias In Systematic Reviews tool. Data extraction followed the Joanna Briggs Institute methodology for overviews and the Preferred Reporting Items for Overviews of Reviews reporting guideline. RESULTS: Seven reviews (six systematic reviews and one meta-analysis) were included. Three analytical dimensions emerged: (1) the conceptual and operational definition of DIVA, identifying common elements such as ≥2 failed attempts, lack of visible or palpable veins and a documented history of difficult access; (2) risk factors and clinical assessment, highlighting obesity, chronic diseases, prior chemotherapy, venous invisibility or non-palpability and the limited validation of diagnostic tools and (3) interventions, including organisational strategies (escalation protocols, specialised teams), technological resources (ultrasound guidance) and clinical measures (pain management and technique optimisation). CONCLUSIONS: DIVA is a multifactorial challenge that requires a standardised definition to improve clinical identification. Effective management relies on a combination of specialised training, the use of ultrasound technology and the implementation of escalation protocols to ensure patient safety and efficiency. PROSPERO REGISTRATION NUMBER: CRD420251084947.
14 June 2026
Read appraisal →BMJ paediatrics open
The efficacy of oral sucrose for relieving lumbar puncture pain in neonates: a randomised clinical trial
OBJECTIVE: To evaluate the analgesic efficacy and physiological effects of oral sucrose during lumbar puncture (LP) in term neonates. STUDY DESIGN: This double-blind, randomised trial enrolled 60 full-term neonates undergoing LP. Participants were randomly given 2 mL of 25% oral sucrose or sterile water 2 min before the procedure. The primary outcome was pain score change from baseline via the Neonatal Infant Pain Scale (NIPS). Secondary outcomes included changes in heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO₂). Measurements were taken at baseline, 1 min, and 3 min post-LP. RESULTS: The sucrose group showed significantly smaller changes in NIPS scores at 1 min (1.0 vs 5.0, p<0.001) and 3 min (0.0 vs 4.0, p<0.001), along with smaller HR increases (p=0.012) and SpO₂ decreases (p=0.023) at 1 min post-procedure. Clinically significant tachycardia (HR >160 bpm) occurred in 40% of controls vs 13.3% of sucrose-treated infants (p=0.045), and desaturation (SpO₂ <90%) in 26.7% of controls vs 6.7% of the sucrose group (p=0.038). CONCLUSION: A 2 mL dose of 25% oral sucrose administered 2 min prior to LP is a safe and effective intervention that significantly reduces behavioural and physiological markers of pain in term neonates during the immediate post-procedural period.
1 June 2026
Read appraisal →The Cochrane database of systematic reviews
Botulinum toxin type A for subacute/chronic neck pain
RATIONALE: Botulinum toxin type A (BoNT-A) intramuscular injections are commonly administered for neck pain unresponsive to other therapies, but the benefit-harm profile remains uncertain. OBJECTIVES: To assess the benefits and harms of intramuscular BoNT-A injection for people with subacute to chronic neck pain. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registers, together with reference checking, citation searching and contact with study authors up to 4 March 2026. ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs), including cross-over, pragmatic, or cluster designs, were included for adults with subacute to chronic neck disorder without radicular findings, with or without cervicogenic headache, and compared BoNT-A to placebo or no-treatment. OUTCOMES: Our outcomes were pain, function-disability, health-related quality of life, participant-reported treatment success, adverse events and costs at both short-term (< 24 weeks) and long-term (≥ 24 weeks) follow-up. RISK OF BIAS: We assessed the risk of bias (RoB) using the ROB 2 tool. SYNTHESIS METHODS: We synthesised results using meta-analyses with random-effects models to calculate mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CIs), or using SWiM (Synthesis Without Meta-analysis) methods. We assessed certainty with GRADE. INCLUDED STUDIES: This update included 16 trials (855 participants) compared to six (252 participants) in the previous review: 13 parallel RCTs and three cross-over RCTs. One other trial is awaiting classification. Short-term follow-up ranged from 3 to 12 weeks post-treatment, and long-term follow-up was six months. Participants (mean age 45 years; 64% female; pain severity 56 on the Visual Analogue Scale (VAS 0 to 100)) were from ambulatory care settings in North America (five trials), Central America (one trial), Europe (six trials), the Middle East (one trial), Central Asia (one trial), and the East Asia & Pacific region (two trials), from upper (12 trials) or upper-middle (four trials) income economies. Disorder classifications included non-specific neck pain - myofascial (eight trials), whiplash-associated disorder (four trials), and cervicogenic headache (four trials). Overall, 88% of participants had chronic pain. The dose varied from 10 to 400 units over 1 to 10 trigger points. The RoB was high or raised some concern across all outcomes. SYNTHESIS OF RESULTS: Since 2011, evidence has shifted from no benefit to a potentially slight-to-small short-term benefit for BoNT-A compared with placebo. No trials compared BoNT-A with no treatment, and evidence was limited by bias (no studies with an overall low RoB), imprecision, and potential publication bias. For pain intensity measured on the VAS (scale 0 to 100), BoNT-A may result in a slight-to-small improvement in the short term (MD 5.95 points lower, 95% CI 10.89 lower to 1.02 lower; I2 = 0%; 12 studies, 393 participants; low-certainty evidence; downgraded two levels due to high overall RoB and indirectness), but not in the long term (MD 11.74 points lower, 95% CI 35.63 lower to 12.16 higher; I² = 50%; 2 studies, 43 participants; low-certainty evidence; downgraded two levels due to high RoB and imprecision). Mean pain in the placebo group was 46.66 points compared to 40.71 in the BoNT-A group, representing an absolute improvement of 6% (95% CI 11% better to 1% better). Additionally, there may be a moderate risk reduction in pain events in the short term (RR 0.68, 95% CI 0.56 to 0.83; I² = 0%; 2 studies, 292 participants; low-certainty evidence; downgraded two levels due to high overall RoB and dissemination bias, including potential conflict of interest from funding sources that may overestimate effects). Assuming a 70% risk with placebo, the corresponding risk with BoNT-A is 47%, representing a 23% absolute risk reduction. Five people (95% CI 3 to 9) would need BoNT-A treatment for one person to benefit. For physical function measured on the Neck Disability Index (scale 0 to 100), BoNT-A may have little to no effect in the short term, but the evidence is very uncertain (MD 2.49 points higher, 95% CI 9.72 lower to 14.70 higher; I² = 0%; 3 studies, 76 participants; very low-certainty evidence; downgraded three levels due to high overall RoB, indirectness, and wide confidence intervals). For health-related quality of life (change score), BoNT-A may make little to no difference in the short term (MD 2.30 points higher, 95% CI 12.57 lower to 17.17 higher; 1 study, 28 participants; low-certainty evidence; downgraded two levels due to imprecision). For participant-reported treatment success, BoNT-A may provide a small improvement in the global rating of change. Short-term results: MD 1.16 points lower on a 1 to 5 Verbal Rating Scale (95% CI 1.86 lower to 0.46 lower; 1 study, 31 participants; low-certainty evidence), corresponding to an absolute improvement of 20% (95% CI 10% to 36%). Long-term results were similar: MD 2.00 points lower on a 0 to 10 Patient Global Assessment (95% CI 3.80 lower to 0.20 lower; 1 study, 19 participants; 20% absolute risk reduction, low-certainty evidence). Evidence was downgraded by two levels for RoB and imprecision. No studies evaluated participant satisfaction or serious adverse events. For non-serious adverse events, participants treated with BoNT-A may have a small, negligible increased risk (RR 1.51, 95% CI 1.04 to 2.20; I² = 28%; number-needed-to-treat for an additional harmful outcome (NNTH) 6, 95% CI 4 to 12; 7 studies, 489 participants; low-certainty evidence; downgraded two levels due to RoB and indirectness). Participants treated with BoNT-A have a 16% increased absolute risk of experiencing non-serious adverse events lasting up to three weeks, such as injection soreness, muscle fatigue, and headache. AUTHORS' CONCLUSIONS: BoNT-A may provide slight-to-small short-term pain relief (6%) and perceived treatment success (20%) for subacute and chronic neck pain, but may offer no long-term physical function or health-related quality of life benefits. The moderate (23%) risk reduction in pain events may be overestimated due to publication bias. Non-serious adverse events are 16% more frequent. Uncertainty remains due to wide confidence intervals, short-term single-dose trials, and dose variation, highlighting the need for larger, high-quality studies with comprehensive adverse event reporting. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol and previous versions available via doi.org/10.1002/14651858.CD008626, doi.org/10.1002/14651858.CD008626.pub2 and doi.org/10.1002/14651858.CD008626.pub3 (withdrawn).
30 May 2026
Read appraisal →JMIR formative research
An In-Hospital Mortality Risk Model for Patients Undergoing Coronary Artery Bypass Grafting Based on Machine Learning: Cohort Study
BACKGROUND: Ischemic heart disease remains the leading cause of death worldwide. Coronary artery bypass grafting (CABG) remains the primary surgical treatment for ischemic heart disease. There is currently a lack of highly accurate and widely applicable models for assessing the risk of postoperative mortality following CABG. OBJECTIVE: This study aimed to develop and validate an in-hospital mortality risk prediction system for patients undergoing coronary artery bypass grafting (CABG) by using machine learning algorithms and to compare its performance with the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and Sino System for Coronary Operative Risk Evaluation (SinoSCORE). METHODS: Between January 2017 and December 2020, 21,443 patients undergoing CABG in the Chinese Cardiac Surgery Registry were included. Patients were randomly divided into training (n=17,753) and test (n=3690) cohorts. We addressed class imbalance using the synthetic minority oversampling technique (SMOTE) and optimized hyperparameters via grid search. Fifteen machine learning algorithms were developed to predict in-hospital mortality. Performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration metrics (Brier score), and decision curve analysis, and was compared against EuroSCORE II and SinoSCORE. RESULTS: A total of 21,443 patients were included. Overall, in-hospital mortality was 2.1% (n=450). The Extreme Gradient Boosting (XGBoost) model achieved the best performance with an AUC of 0.850 in the training cohort and 0.782 in the independent test cohort (this cohort was independent and not involved in model construction). While EuroSCORE II showed an AUC of 0.722 and SinoSCORE showed an AUC of 0.726 in the test cohort, the XGBoost model demonstrated superior discrimination and calibration (P<.05). CONCLUSIONS: Our study developed and validated a machine learning-based risk prediction model for in-hospital mortality after CABG by using a large-scale Chinese multicenter registry. Among the algorithms tested, the XGBoost model demonstrated superior discrimination and calibration compared with the traditional EuroSCORE II and SinoSCORE, suggesting that locally calibrated models may better capture the risk profile of Chinese patients. The derived 7-variable web calculator may serve as an exploratory auxiliary tool to provide a preliminary reference for bedside risk stratification, though its direct impact on surgical decision-making requires further prospective validation. Future research should focus on independent test cohorts across diverse hospital tiers to ensure broad generalizability.
26 May 2026
Read appraisal →Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Cephalosporins Versus Non-cephalosporin Antibiotics for Perioperative Prophylaxis in Primary Arthroplasty: A Systematic Review and Meta-Analysis
BACKGROUND: The number of arthroplasty procedures and infection-related complications, including prosthetic joint infections (PJIs) and surgical site infections (SSIs), continues to rise. Although current guidelines recommend cefazolin or cefuroxime as the first-line perioperative prophylactic antibiotic, substitutions with non-cephalosporins remain common, especially among patients with reported β-lactam allergies. These substitutions may increase infection risk and healthcare costs. Evidence comparing outcomes across antibiotic classes remains variable. METHODS: We conducted a systematic review and meta-analysis of studies comparing single-agent cephalosporin versus single-agent non-cephalosporin prophylaxis in adults undergoing primary arthroplasty. Cochrane, Embase, Medline, Scopus, and Web of Science were searched from database inception through January 2025. Random-effect or fixed-effect models were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses stratified results by cephalosporin type, study era, and risk of bias. RESULTS: Twenty-three studies (7 randomized controlled trials and 16 observational studies) were included, encompassing 191 527 arthroplasties in the cephalosporin arm and 20 058 in the non-cephalosporin arm. The odds of PJI were lower with cephalosporins (OR 0.59; 95% CI, .46-.75). No overall difference was observed for SSI (OR 0.70; 95% CI, .36-1.36), though post-2013 studies and the cefazolin subgroup demonstrated a significant protective effect. Randomized trial estimates were limited and heterogeneous and did not reach statistical significance. Certainty of evidence was graded as moderate. CONCLUSIONS: Cephalosporins, particularly cefazolin or cefuroxime, remain the preferred prophylactic agents for primary arthroplasty. This quantitative synthesis reinforces their protective association against prosthetic joint infection and supports adherence to guideline-endorsed prophylaxis.
22 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Chronic pain after Shouldice versus Lichtenstein inguinal hernia repair: a systematic review and meta-analysis
PURPOSE: The Lichtenstein (mesh) and Shouldice (non-mesh) techniques are the main options for open inguinal hernia repair. This systematic review and meta-analysis compared the prevalence of chronic postoperative pain between them. METHODS: A systematic search was conducted in Medline, Embase and Cochrane databases for studies comparing the prevalence of chronic pain after Shouldice and Lichtenstein techniques in adult patients undergoing inguinal hernia repair. Meta-analysis was performed using RevMan and the effect model was determined based on heterogeneity, assessed by the I² statistic. Subgroup analyses were conducted by mean follow-up duration and study design. RESULTS: Ten studies with 4,122 patients (59.8% Lichtenstein) were included. Shouldice repair was associated with a 34% relative risk reduction in chronic postoperative pain compared to Lichtenstein (RR 0.66; 95%CI 0.56-0.78; p < 0.00001; I² = 5%). Conversely, the Shouldice technique demonstrated a higher risk of long-term hernia recurrence (RR 2.54; 95%CI 1.15-5.63; p = 0.02). There were no statistically significant differences between the two techniques regarding early postoperative complications (RR 1.01; 95%CI 0.85-1.19; p = 0.95) or mean operative time (MD 5.96 min; 95%CI -0.79 to 12.71; p = 0.08). CONCLUSION: Although the Lichtenstein repair is more widely practiced, the Shouldice technique yields significantly lower rates of chronic postoperative pain, albeit with a higher risk of long-term recurrence. This trade-off highlights Shouldice as a potential alternative in selected patients.
14 May 2026
Read appraisal →BMJ open
Indocyanine green fluorescence for intraoperative detection of liver tumours in minimally invasive surgery: protocol for the LIVERGREEN phase IV multicentre clinical trial
INTRODUCTION: Liver tumours are a leading cause of global morbidity and mortality. Current diagnostic tools, including computed tomography (CT), magnetic resonance imaging (MRI) and intraoperative ultrasound (IOUS), have limitations in detecting liver neoplasms. Indocyanine green (ICG) has emerged as a promising tool for improving liver tumour detection. This study aims to assess the impact of preoperative ICG on intraoperative tumour detection in minimally invasive surgery and develop a machine-learning algorithm to enhance tumour detection using ICG fluorescence. METHODS AND ANALYSIS: This prospective, multicentre, phase IV clinical trial adheres to Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Patients with liver tumours eligible for minimally invasive surgery and a preoperative imaging test will be included. ICG will be administered intravenously 24 hours before surgery. Intraoperative procedures will include IOUS, ICG mapping and photographic documentation. Patients will be followed for 90 days to assess tumour progression, morbidity and mortality. The photographic analysis will enable the development of an artificial intelligence algorithm using machine learning and neural networks to identify lesions based on ICG fluorescence. The estimated sample size is 173 patients and the trial is predicted to accrue in 3 years. ETHICS AND DISSEMINATION: The trial will be conducted in accordance with the Declaration of Helsinki and the Spanish Agency of Medicines and Medical Devices (AEMPS) guidelines. Approved by the local institutional Ethics Committee and the AEMPS, the results will be shared with the scientific community through publications and conferences. EUDRACT NUMBER: 2023-5 08 316-27-00. TRIAL REGISTRATION NUMBER: NCT06398028. PROTOCOL VERSION: V.12, 18 March 2025.
18 Apr 2026
Read appraisal →Medicine
Effectiveness of Chinese herbal medicine mouthwash in preventing ventilator-associated pneumonia in patients with endotracheal intubation: A systematic review and meta-analysis
BACKGROUND: To systematically evaluate the effectiveness and safety of Chinese herbal medicine mouthwash (CHMM) in preventing ventilator-associated pneumonia (VAP) in patients with endotracheal intubation (ETT). METHODS: Computer searches were conducted for relevant randomized controlled trials (RCTs) in the China National Knowledge Infrastructure (CNKI), WANFANG DATA, Chinese Scientific and Technical Journal Database (VIP), Chinese Biomedical Literature Database (SinoMed), PubMed, Embase, Cochrane Library, and CINAHL Database from the establishment to April 5, 2023. The data were analyzed by RevMan 5.3 software. The methodological quality of papers was evaluated by the Cochrane version 5.1.0 and the certainty of evidence was evaluated by the GRADE system. RESULTS: We included 27 RCTs with 2426 patients. Most of the included studies were of poor methodological quality. Meta-analysis showed that CHMM (RR = 0.41, 95% CI: 0.34-0.50, P < .00001, low-certainty evidence) or CHMM + routine oral care (RR = 0.31, 95% CI: 0.18-0.56, P < .0001) could reduce the incidence of VAP compared to non-CHMM. CHMM may be superior to saline (low-certainty evidence) and chlorhexidine (moderate-certainty evidence) in preventing VAP (P < .05). CONCLUSION: Low-certainty evidence shows that CHMM may be more advantageous in reducing the incidence of VAP compared to non-CHMM. However, due to some limitations and the low certainty of evidence, we cannot recommend CHMM for routine clinical use at this time. Large-scale and high-quality RCTs are also needed to definitively evaluate the safety and clinical benefits of CHMM in the future.
12 Apr 2026
Read appraisal →JMIR formative research
A Gamified Pain Management Intervention for Adults With Chronic Pain in Mainland China: Single-Arm Pre-Post Pilot Study With Machine Learning Predictive Modeling
BACKGROUND: The widespread prevalence of chronic pain (CP) significantly impacts daily functioning worldwide. In mainland China, maintaining engagement in biopsychosocial interventions remains challenging. Gamification, designed based on self-determination theory, can enhance motivation, while machine learning (ML) algorithms can assist clinicians in dynamically optimizing pain management. OBJECTIVE: This study aimed to (1) evaluate the preliminary effectiveness of a gamified pain management (GPM) program on CP and psychological outcomes and (2) identify key factors of significant pain improvements through the application of ML to guide intervention adjustments. METHODS: A single-arm, pre-post study was conducted with 16 participants with CP in mainland China, recruited via social media using convenience sampling. Participants engaged in a 10-week web-based GPM intervention consisting of education, physical activities, and gamified elements, including points, avatars, and feedback. Primary outcomes were pain intensity and interference measured by the Brief Pain Inventory. Secondary outcomes included anxiety, depression, and quality of life. Analysis included paired t tests, and ML models were trained to predict clinically meaningful pain reductions. Shapley additive explanations, least absolute shrinkage and selection operator regression, association rule mining, and Kaplan-Meier survival analysis were used to identify key predictors and optimal sessions and intervention durations across subgroups. RESULTS: A total of 16 participants were engaged, with a mean age of 27.63 (SD 9.584) years. Results from paired t tests reported significant improvements in pain intensity (decreased by 27.3%, 95% CI 1.061 to 3.064; P=.001), pain interference (decreased by 27.3%, 95% CI 8.159-17.216; P<.001), and psychological distress, including anxiety (t15=3.538, 95% CI 0.969 to 3.906; P=.003) and depression (t15=4.559, 95% CI 2.230 to 6.145; P<.001). The gradient boosting model demonstrated the highest predictive accuracy (area under the curve=0.89 and accuracy=0.82). Least absolute shrinkage and selection operator regression identified session 3 (β=-0.45, 95% CI -0.68 to -0.22; P<.001) and session 5 (β=-0.32, 95% CI -0.59 to -0.05; P=.02) as most predictive of clinical success, while association rule mining revealed effective session combinations for different patient subgroups. Time-to-event analyses indicated that individuals with low back pain and higher baseline severity required longer intervention durations for improvement (5 wk; P=.03). CONCLUSIONS: This pilot study presents an innovative method that combines ML with dynamic engagement data from a GPM program during interventions, rather than relying on static baseline data in prior studies. The results show preliminary efficacy and identify specific optimal session combinations and personalized treatment durations for different pain subgroups. These exploratory findings contribute to the field by providing a data-driven method for adaptive, personalized digital health interventions that move beyond one-size-fits-all strategies, potentially enabling clinicians to modify content and dosage to improve engagement and outcomes if validated in larger sample trials.
10 Apr 2026
Read appraisal →Biomedical physics & engineering express
Bluetooth low energy thermohygrometric sensor for continuous respiratory rate monitoring: 48 h breathing simulator and human proof-of-concept
Continuous respiratory rate monitoring is essential for early detection of clinical deterioration, but conventional methods like capnography are often impractical outside high-acuity settings. We developed a low-cost, Bluetooth Low Energy (BLE) respiratory rate monitor incorporating a MEMS temperature-humidity sensor (AHT21) and Nordic nRF52840 microcontroller, designed to attach externally to a standard oxygen mask. The device detects breaths using rapid, cyclic changes in exhaled temperature and humidity via a slope-based time-domain algorithm. Bench validation over 48 h using a breathing simulator (5-60 breaths min-1, tidal volume 300 ml, 34 °C, 95%-100% RH) demonstrated 96.4% overall breath detection accuracy and strong correlation with programmed rates (r = 0.996, P < 0.0001). Sensor saturation occurred at high respiratory rates (60 breaths min-1), and high ambient humidity levels (90% RH) both of which reduced measurement accuracy. Human testing in three healthy adults showed strong agreement with capnography (mean bias 0.44 breaths min-1; 95% limits of agreement -1.86 to 2.75), with minor under-detection at the highest rate (50 breaths min-1). The device operated reliably across oxygen flow rates of 4-15 l min-1, with reduced performance at 0-2 l min-1due to saturation of the sensor. These results demonstrate that BLE-enabled MEMS thermohygrometric sensors can accurately monitor respiratory rate under controlled conditions while highlighting operational limits due to sensor saturation. This study extends prior work on humidity-based respiratory monitoring and illustrates the potential for low-cost, portable respiratory rate devices suitable for low-acuity or resource-limited clinical settings.
9 Apr 2026
Read appraisal →Annals of medicine
Immersive virtual reality-assisted anatomy training improves endotracheal intubation performance in simulation: a randomized controlled trial among Chinese non-anesthesiology residents
INTRODUCTION: This study aimed to compare immersive virtual reality (IVR)-assisted versus conventional anatomy training for teaching endotracheal intubation (ETI) to novice non-anesthesiology residents enrolled in China's Standardized Residency Training program. METHODS: A total of 90 non-anesthesiology residents without prior ETI experience were randomly assigned to either an IVR group receiving IVR-assisted anatomy training (n = 45) or a control group receiving conventional anatomy training (n = 45). All participants underwent a standardized teaching protocol. The primary endpoint was residents' ETI performance on a simulator, assessed using both the Global Rating Scale (GRS) and a task-specific checklist. The secondary endpoints included changes in written multiple-choice question (MCQ) scores and residents' evaluations of the course. RESULTS: In practical ETI assessments on a manikin, the IVR group achieved significantly higher scores on the task-specific checklist than the control group (90.34 ± 2.89 vs. 87.20 ± 3.29; p < 0.001), whereas GRS scores were comparable between groups. Both groups showed significant post-training improvement in knowledge scores (p < 0.001), with the IVR group showing a greater gain in theoretical knowledge (54.0% vs. 36.3%; p < 0.001). Participants in the IVR group also expressed a stronger preference for their training method (80.8%) and reported higher levels of motivation, confidence, and enjoyment (all p < 0.05). CONCLUSION: IVR-assisted anatomy training enhances the effectiveness of ETI training for novice non-anesthesiology residents, offering an interactive, engaging, and reproducible approach within China's Standardized Residency Training framework.
5 Apr 2026
Read appraisal →