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Bray L, Krogh TB, Østergaard D. Simulation-based training for continuing professional development within a primary care context: a systematic review. EDUCATION FOR PRIMARY CARE 2023; 34:64-73. [PMID: 36730551 DOI: 10.1080/14739879.2022.2161424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Given the increasing complexity of tasks transferred to primary care, discipline-specific educational opportunities are required for those working within this context. Simulation-based training (SBT) is widely applied within a hospital setting, underpinned by extensive research. However, little is known about the transfer of simulations' utility to primary care. This systematic review sought to determine which SBT approaches are adopted for continuing professional development within primary care and appraise their impact. METHODS Medline, Embase, CINAHL and Web of Science databases were searched, with additional articles obtained through secondary searching. Eligible studies employed and evaluated a simulation-based educational intervention for fully qualified healthcare professionals, working within primary care. Included studies were quality assessed using the Mixed Methods Appraisal Tool (v18) and their findings narratively synthesised. RESULTS Forty-nine studies were included, sampling 4,601 primary care health professionals. Studies primarily adopted a quantitative design and demonstrated variable quality. Simulation approaches comprised standardised patients (n = 21), role-play (n = 14), virtual (n = 6), manikin (n = 5) and mixed manikin/standardised patients (n = 3). Efficacy was evaluated across Kirkpatrick levels and demonstrated a positive impact for knowledge-, skills- and attitude-based outcomes, though this was limited in select studies. DISCUSSION SBT has been adopted in the education of the spectrum of health professionals working within primary care, with the most common approach being standardised patients. Simulation delivers an acceptable and effective educational method, demonstrating a positive impact across various learning objectives. Further research assessing the impact at an organisational- and patient-level is required.
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Affiliation(s)
- Lucy Bray
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Copenhagen, Denmark
| | - Tobias Browall Krogh
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ferrante G, Licari A, Cilluffo G, Lombardi E, Turchetta A, Pifferi M, Tancredi G, La Grutta S. Impact of a supervised training course on spirometry competency for primary care pediatricians. J Asthma 2020; 58:1292-1297. [PMID: 32529907 DOI: 10.1080/02770903.2020.1781888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Spirometry is the most commonly performed lung function test, and performance, adherence to acceptability and repeatability criteria, and accurate interpretation of results help optimize the test's usefulness. This study aimed to measure the effects of spirometry training courses supported by the Italian Pediatric Respiratory Society (IPRS) on primary care pediatricians' (PCP) knowledge of spirometry test quality, ability to interpret results, and overall degree of satisfaction with the course.Methods: Of the six face-to-face courses, four lasted two days and two lasted one day: mean duration of theoretical lessons was five and four hours respectively; and practical sessions lasted eight and six hours, respectively. At the end of each course, participants took a learning test consisting of evaluating six flow-volume curves. Degree of satisfaction was assessed by asking participants to rank the relevance, quality, and usefulness of the course.Results: 261 PCPs were involved, with most (67.43%) taking two-day courses. Nearly all participants correctly identified normal and restrictive patterns. Intrathoracic large-airway obstruction was the pattern most difficult to identify correctly (70.5% overall), whereas > 80% of the participants correctly classified artifacts, obstructive-restrictive, and obstructive patterns. Participants in longer courses reported significantly higher values on the learning score. The overall degree of satisfaction average ranged between "good" and "excellent".Conclusions: This pilot study showed the greater impact of two-day courses than one-day courses for training PCPs to properly interpret spirometry, confirming that a practical module lasting at least six hours is sufficient to deliver adequate training on spirometry for healthcare professionals.
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Affiliation(s)
- Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanna Cilluffo
- IInstitute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Palermo, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, "Anna Meyer" Pediatric University-Hospital, Florence, Italy
| | | | - Massimo Pifferi
- Section of Pneumology and Allergology, Unit of Pediatrics, Pisa University Hospital, Pisa, Italy
| | | | - Stefania La Grutta
- IInstitute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, Palermo, Italy
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Kellerer C, Schneider A, Klütsch K, Husemann K, Sorichter S, Jörres RA. Correspondence between Capnovolumetric and Conventional Lung Function Parameters in the Diagnosis of Obstructive Airway Diseases. Respiration 2020; 99:389-397. [PMID: 32369822 DOI: 10.1159/000507098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Capnovolumetry is of interest as a method for the diagnosis of obstructive airway diseases, requiring little cooperation from the patient. OBJECTIVE To help in the interpretation of capnovolumetric parameters, we aimed to identify their correspondence to conventional lung function indices. METHODS We studied 978 patients from a diagnostic study with complete functional data and the clinical diagnosis of asthma, chronic obstructive pulmonary disease (COPD), or no respiratory disease. Using path analysis, four capnovolumetric parameters (slope of expiratory phase 3, ratio of slopes of phases 3 and 2, volume of phase 2, and the ratio area/volume of phase 3) previously identified as predictors of airway obstruction in terms of spirometry and body ple-thysmography, were analyzed regarding their relationship to each other and the diagnostic categories of asthma or COPD versus control, or obstruction versus no obstruction. We then identified four lung function parameters showing relationships as much as possible isomorphic to those between capnovolumetric parameters. RESULTS The four capnovolumetric parameters were related to COPD and obstruction via both direct and indirect influences, but only two of them to asthma. Regarding the correspondence to lung function parameters, the slope of expiratory phase 3 corresponded best to the ratio of residual volume to total lung capacity, the ratio of slopes of phases 3 and 2 to forced expiratory volume in 1 s, the volume of phase 2 to forced expired flow at 50% of vital capacity, and the ratio area/volume of phase 3 to forced vital capacity. CONCLUSIONS Our results indicated an intricate relationship of capnovolumetric parameters to each other and to airway obstruction, asthma, or COPD. The correspondence to conventional lung function measures seemed to reflect the entities lung hyperinflation, overall ventilatory impairment, bronchoconstriction, and ventilated lung volume, in that order. These findings might be helpful for clinicians in the interpretation of capnovolumetry.
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Affiliation(s)
- Christina Kellerer
- Institute of General Practice and Health Services Research, Technical University of Munich School of Medicine, Munich, Germany,
| | - Antonius Schneider
- Institute of General Practice and Health Services Research, Technical University of Munich School of Medicine, Munich, Germany
| | - Klaus Klütsch
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Kim Husemann
- Medizinisches Versorgungszentrum MVZ Klinikum Kempten, Kempten, Germany
| | | | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig Maximilian University of Munich, Munich, Germany
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Ramos Hernández C, Núñez Fernández M, Pallares Sanmartín A, Mouronte Roibas C, Cerdeira Domínguez L, Botana Rial MI, Blanco Cid N, Fernández Villar A. Validation of the portable Air-Smart Spirometer. PLoS One 2018; 13:e0192789. [PMID: 29474502 PMCID: PMC5825056 DOI: 10.1371/journal.pone.0192789] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/30/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Air-Smart Spirometer is the first portable device accepted by the European Community (EC) that performs spirometric measurements by a turbine mechanism and displays the results on a smartphone or a tablet. METHODS In this multicenter, descriptive and cross-sectional prospective study carried out in 2 hospital centers, we compare FEV1, FVC, FEV1/FVC ratio measured with the Air Smart-Spirometer device and a conventional spirometer, and analyze the ability of this new portable device to detect obstructions. Patients were included for 2 consecutive months. We calculate sensitivity, specificity, positive and negative predictive value (PPV and NPV) and likelihood ratio (LR +, LR-) as well as the Kappa Index to evaluate the concordance between the two devices for the detection of obstruction. The agreement and relation between the values of FEV1 and FVC in absolute value and the FEV1/FVC ratio measured by both devices were analyzed by calculating the intraclass correlation coefficient (ICC) and the Pearson correlation coefficient (r) respectively. RESULTS 200 patients (100 from each center) were included with a mean age of 57 (± 14) years, 110 were men (55%). Obstruction was detected by conventional spirometry in 73 patients (40.1%). Using a FEV1/FVC ratio smaller than 0.7 to detect obstruction with the Air Smart-Spirometer, the kappa index was 0.88, sensitivity (90.4%), specificity (97.2%), PPV (95.7%), NPV (93.7%), positive likelihood ratio (32.29), and negative likelihood ratio (0.10). The ICC and r between FEV1, FVC, and FEV1 / FVC ratio measured by the Air Smart Spirometer and the conventional spirometer were all higher than 0.94. CONCLUSION The Air-Smart Spirometer is a simple and very precise instrument for detecting obstructive airway diseases. It is easy to use, which could make it especially useful non-specialized care and in other areas.
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Affiliation(s)
- Cristina Ramos Hernández
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I + i. Institute of Health Research South Galicia (IISGS), Vigo, Pontevedra, Spain
| | | | | | - Cecilia Mouronte Roibas
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I + i. Institute of Health Research South Galicia (IISGS), Vigo, Pontevedra, Spain
| | | | - Maria Isabel Botana Rial
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I + i. Institute of Health Research South Galicia (IISGS), Vigo, Pontevedra, Spain
| | - Nagore Blanco Cid
- Department of Pneumonology, Hospital Complex of Pontevedra, Vigo, Pontevedra, Spain
| | - Alberto Fernández Villar
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I + i. Institute of Health Research South Galicia (IISGS), Vigo, Pontevedra, Spain
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Represas-Represas C, Fernández-Villar A, Ruano-Raviña A, Priegue-Carrera A, Botana-Rial M. Screening for Chronic Obstructive Pulmonary Disease: Validity and Reliability of a Portable Device in Non-Specialized Healthcare Settings. PLoS One 2016; 11:e0145571. [PMID: 26726887 PMCID: PMC4699810 DOI: 10.1371/journal.pone.0145571] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 12/04/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction and Objectives The underdiagnosis of chronic obstructive pulmonary disease (COPD) could be improved through screening using portable devices simpler than conventional spirometers in specific healthcare settings to reach a higher percentage of the at-risk population. This study was designed to assess the validity and reliability of the COPD-6 portable device to screen for COPD in non-specialized healthcare settings. Methods Prospective cohort study to validate a diagnostic test. Three cohorts were recruited: primary care (PC), emergency services (ES) and community pharmacies (CPh). Study population: individuals with risk factors for COPD (>40 years, smoking >10 pack-years, with respiratory symptoms). The values measured using the COPD-6 were FEV1, FEV6 and the FEV1/FEV6 ratio. Subsequently, participants underwent conventional spirometry at hospital, using a post-bronchodilator FEV1/FVC value <0.7 as the gold standard criterion for the COPD diagnosis. Results 437 participants were included, 362 were valid for the analysis. COPD was diagnosed in 114 patients (31.5%). The area under the ROC curve for the COPD-6 for COPD screening was 0.8.The best cut-off point for the FEV1/FEV6 ratio was 0.8 (sensitivity, 92.1%) using spirometry with the bronchodilator test as the gold standard. There were practically no differences in the COPD-6 performancein the different settings and also regarding age, gender and smoking status. Conclusions The COPD-6 device is a valid tool for COPD screening in non-specialized healthcare settings. In this context, the best cut-off point for the FEV1/FEV6 ratio is 0.8.
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Affiliation(s)
- Cristina Represas-Represas
- Pulmonology Department, NeumoVigoI+i Research Group, University Hospital Complex of Vigo (CHUVI), Estructura Organizativa de Xestión Integrada de Vigo (EOXI Vigo), BiomedicalResearchInstitute of Vigo (IBIV), Vigo, Spain
- * E-mail:
| | - Alberto Fernández-Villar
- Pulmonology Department, NeumoVigoI+i Research Group, University Hospital Complex of Vigo (CHUVI), Estructura Organizativa de Xestión Integrada de Vigo (EOXI Vigo), BiomedicalResearchInstitute of Vigo (IBIV), Vigo, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and PublicHealth, University of Santiago de Compostela, Santiago de Compostela, Spain, CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Ana Priegue-Carrera
- Pulmonology Department, NeumoVigoI+i Research Group, University Hospital Complex of Vigo (CHUVI), Estructura Organizativa de Xestión Integrada de Vigo (EOXI Vigo), BiomedicalResearchInstitute of Vigo (IBIV), Vigo, Spain
| | - Maribel Botana-Rial
- Pulmonology Department, NeumoVigoI+i Research Group, University Hospital Complex of Vigo (CHUVI), Estructura Organizativa de Xestión Integrada de Vigo (EOXI Vigo), BiomedicalResearchInstitute of Vigo (IBIV), Vigo, Spain
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