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de Oliveira HC, Campos JF, de Souza LC, de Bakker GB, Ferreira LLB, da Silva RN, Dos Santos Pires PR, Brandão MAG. Theoretical, Conceptual, and Operational Aspects in Simulation Training With Rapid Cycle Deliberate Practice: An Integrative Review. Simul Healthc 2024; 19:e91-e98. [PMID: 37747465 DOI: 10.1097/sih.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
SUMMARY STATEMENT An integrative review following Whittemore and Knafl's 5-stage approach (problem identification, literature search, data evaluation, data analysis, and presentation) was conducted to synthesize the evidence on the theoretical, conceptual, and operational aspects of simulation training with rapid cycle deliberate practice (RCDP). After the literature search, 2 reviewers independently read and critically evaluated primary studies using the eligibility criteria. A third more experienced reviewer solved disagreements between the reviewers.This review included 31 articles. Eight themes were identified and grouped into 2 pre-established categories: theoretical/conceptual and operational aspects. The first category had the following 3 themes: definition of RCDP, concepts related to the principles of RCDP, and theories underpinning RCDP. The second category had the following 5 themes: total training time, number of participants in the training, training system, first scenario without intervention, and progressive difficulty. This review showed that knowledge about RCDP is still under construction. As a new simulation strategy, there are some theoretical, conceptual, and operational differences in the studies applying RCDP interventions as simulation training.
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Affiliation(s)
- Hudson Carmo de Oliveira
- Escola de Enfermagem Anna Nery-Universidade Federal do Rio de Janeiro (H.C.O., J.F.C., G.B.B., L.L.B.F., P.R.S.P., M.A.G.B.); Samaritano Hospital (L.C.S.); Municipal Health Department of Rio de Janeiro (R.N.S.), Rio de Janeiro, Brazil
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Montgomery EE, Anderson IA, Scherzer DJ, Arteaga GM, Rozenfeld RA, Wing R, Umoren RA, Wall JJ, McKissic DA, Centers GI, Searly CR, Mandt MJ, Jackson BM, Hulfish EW, Maloney LM, Duman-Bender TM, Kennedy C, Adler M, Naples J, Luk J, Gleich SJ, Lutfi R, Pearson KJ, Reames SE, Auerbach MA, Abulebda K. A National Simulation-Based Study of Pediatric Critical Care Transport Teams Performance. J Pediatr 2024; 276:114303. [PMID: 39278534 DOI: 10.1016/j.jpeds.2024.114303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 08/29/2024] [Accepted: 09/09/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVES To assess pediatric critical care transport (CCT) teams' performance in a simulated environment and to explore the impact of team and center characteristics on performance. STUDY DESIGN This observational, multicenter, simulation-based study enlisted a national cohort of pediatric transport centers. Teams participated in 3 scenarios: nonaccidental abusive head injury, sepsis, and cardiac arrest. The primary outcome was teams' simulation performance score. Secondary outcomes were associations between performance, center and team characteristics. RESULTS We recruited 78 transport teams with 196 members from 12 CCT centers. Scores on performance measures that were developed were 89% (IQR 78-100) for nonaccidental abusive head injury, 63.3% (IQR 45.5-81.8) for sepsis, and 86.6% (IQR 66.6-93.3) for cardiac arrest. In multivariable analysis, overall performance was higher for teams including a respiratory therapist (0.5 points [95% CI: 0.13, 0.86]) or paramedic (0.49 points [95% CI: 0.1, 0.88]) and dedicated pediatric teams (0.37 points [95% 0.06, 0.68]). Each year increase in program age was associated with an increase of 0.04 points (95% CI: 0.02, 0.06). CONCLUSIONS Dedicated pediatric teams, inclusion of respiratory therapists and paramedics, and center age were associated with higher simulation scores for pediatric CCT teams. These insights can guide efforts to enhance the quality of care for children during interfacility transports.
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Affiliation(s)
- Erin E Montgomery
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Ingrid A Anderson
- Pediatric Emergency Medicine, Case Western Reserve University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mark Adler
- Ann and Robert H Lurie Children's Hospital of Chicago
| | | | - Jeffrey Luk
- Pediatric Emergency Medicine, Case Western Reserve University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | | | - Riad Lutfi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Kellie J Pearson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | | | - Marc A Auerbach
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
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Gaskin K, Daniels A. Enhancing discharge preparation for parents after complex cardiac surgery: evaluation of an e-learning resource for nurses. Nurs Child Young People 2024:e1515. [PMID: 38973285 DOI: 10.7748/ncyp.2024.e1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 07/09/2024]
Abstract
Parents need to be appropriately prepared by knowledgeable healthcare professionals before going home with their infant following cardiac surgery for complex congenital heart disease (CHD). A quality improvement project was undertaken between 2018 and 2021 to equip healthcare professionals including children's cardiac nurses with the knowledge required to use the Congenital Heart Assessment Tool (CHAT) to teach parents how to monitor their infant at home. The project involved developing, implementing and evaluating an e-learning resource that included simulated scenarios captured on video. An online survey showed that users perceived the e-learning resource as having a positive effect on their understanding of complex CHD and their practice of preparing parents for discharge and home monitoring.
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Affiliation(s)
- Kerry Gaskin
- School of Nursing and Midwifery, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, England
| | - Amanda Daniels
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, England
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Tawfik M, Schiff E, Mosavian R, Campisi C, Shen A, Lin J, Windsor AM, Weingarten‐Arams J, Soshnick SH, Nishisaki A, Je S, Maa T, Harwayne‐Gidansky I, Fortunov RM, Yang CJ. Validation of a Novel Mobile Application for Assessing Pediatric Tracheostomy Emergency Simulations. OTO Open 2024; 8:e145. [PMID: 38974176 PMCID: PMC11222740 DOI: 10.1002/oto2.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/27/2024] [Indexed: 07/09/2024] Open
Abstract
Objective Pediatric tracheostomy is associated with high morbidity and mortality, yet clinician knowledge and quality of tracheostomy care may vary widely. In situ simulation is effective at detecting and mitigating related latent safety threats, but evaluation via retrospective video review has disadvantages (eg, delayed analysis, and potential data loss). We evaluated whether a novel mobile application is accurate and reliable for assessment of in situ tracheostomy emergency simulations. Methods A novel mobile application was developed for assessment of tracheostomy emergency in situ simulation team performance. After 1.25 hours of training, 6 raters scored 10 tracheostomy emergency simulation videos for the occurrence and timing of 12 critical steps. To assess accuracy, rater scores were compared to a reference standard to determine agreement for occurrence or absence of critical steps and a timestamp within ±5 seconds. Interrater reliability was determined through Cohen's and Fleiss' kappa and intraclass correlation coefficient. Results Raters had 86.0% agreement with the reference standard when considering step occurrence and timing, and 92.8% agreement when considering only occurrence. The average timestamp difference from the reference standard was 1.3 ± 18.5 seconds. Overall interrater reliability was almost perfect for both step occurrence (Fleiss' kappa of 0.81) and timing of step (intraclass correlation coefficient of 0.99). Discussion Using our novel mobile application, raters with minimal training accurately and reliably assessed videos of tracheostomy emergency simulations and identified areas for future refinement. Implications for Practice With refinements, this innovative mobile application is an effective tool for real-time data capture of time-critical steps in in situ tracheostomy emergency simulations.
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Affiliation(s)
| | | | | | | | - Amanda Shen
- Albert Einstein College of MedicineBronxNew YorkUSA
| | - Juan Lin
- Albert Einstein College of MedicineBronxNew YorkUSA
| | - Alanna M. Windsor
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Otorhinolaryngology–Head and Neck SurgeryMontefiore Medical CenterBronxNew YorkUSA
| | - Jacqueline Weingarten‐Arams
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Pediatrics, Division of Pediatric Critical Care MedicineChildren's Hospital at MontefioreBronxNew YorkUSA
| | - Sara H. Soshnick
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Pediatrics, Division of Pediatric Critical Care MedicineChildren's Hospital at MontefioreBronxNew YorkUSA
| | - Akira Nishisaki
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Sangmo Je
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Tensing Maa
- Ohio State University College of MedicineColumbusOhioUSA
- Department of Pediatrics, Division of Pediatric Critical Care MedicineNationwide Children's HospitalColumbusOhioUSA
| | - Ilana Harwayne‐Gidansky
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, The Bernard & Millie Duker Children's HospitalAlbany Medical CenterAlbanyNew YorkUSA
- Albany Medical CollegeAlbanyNew YorkUSA
| | - Regine M. Fortunov
- Department of Pediatrics, Division of NeonatologyBaylor College of MedicineHoustonTexasUSA
- Texas Children's HospitalHoustonTexasUSA
| | - Christina J. Yang
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Otorhinolaryngology–Head and Neck SurgeryMontefiore Medical CenterBronxNew YorkUSA
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Tachejian S, Moussa A. 360-degree virtual reality video to teach neonatal resuscitation: an exploratory development study. Sci Rep 2024; 14:14383. [PMID: 38909130 PMCID: PMC11193781 DOI: 10.1038/s41598-024-65299-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 06/19/2024] [Indexed: 06/24/2024] Open
Abstract
Simulation is an effective training method for neonatal resuscitation (NR). However, the limitations brought about by the COVID-19 pandemic, and other resource constraints, have necessitated exploring alternatives. Virtual reality (VR), particularly 360-degree VR videos, have gained attraction in medical training due to their immersive qualities. The primary objectives of the study were to produce a high quality 360-degree virtual reality (VR) video capturing NR simulation and to determine if it could be an acceptable adjunct to teach NR. The secondary objective was to determine which aspects of NR could benefit from the incorporation of such a video in training. This was an exploratory development study. The first part consisted of producing the video using a GoPro action camera, Adobe Premiere Pro, and Unity Editor. In the second part participants were recruited, based on level of experience, to watch the video and answer questionnaires to determine acceptability (user experience and cognitive load) and aspects of NR which could benefit from the video. The video was successfully developed. Forty-six participants showed a strong general appreciation. User experience revealed high means (> 6) in the positive subscales and low means (< 4) for immersion side effect, with no difference between groups. Cognitive load was higher than anticipated. Participants indicated that this video could be effective for teaching crisis resource management principles, human and environment interactions, and procedural skills. The 360-degree VR video could be a potential new simulation adjunct for NR. Future studies are needed to evaluate learning outcomes of such videos.
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Affiliation(s)
- Sevag Tachejian
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Ahmed Moussa
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada.
- CHU Sainte-Justine Research Center, Montreal, QC, Canada.
- Centre for Applied Health Sciences Education (CPASS), Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
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Skrisovska T, Djakow J, Jabandziev P, Kramplova T, Klucka J, Kosinova M, Stourac P. Ventilation efficacy during paediatric cardiopulmonary resuscitation (PEDIVENT): simulation-based comparative study. Front Med (Lausanne) 2024; 11:1400948. [PMID: 39175823 PMCID: PMC11340506 DOI: 10.3389/fmed.2024.1400948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/22/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction This simulation-based study aimed to evaluate the efficacy of ventilation during paediatric cardiopulmonary resuscitation (CPR) provided by healthcare professionals (HCPs) and lay rescuers (LRs). The objective was to assess the number of effective breaths delivered during the initial sequence of CPR. Effective ventilation plays a critical role during paediatric CPR as most cardiac arrests are secondary to hypoxia in origin. The recommendations on initial resuscitation in unresponsive, non-breathing children differ worldwide. The European Resuscitation Council (ERC) guidelines recommend five breaths before starting the chest compressions. Yet, this recommendation was based on the expert consensus historically and has not changed since 2000 because of the lack of evidence. This research addresses the identified knowledge gap, with potential implications for improving resuscitation practices and ultimately enhancing patient outcomes. Methods HCPs and LRs performed 90 s of CPR involving two mannequins: 5-kg Baby and 20-kg Junior. Both groups (HCPs and LRs) performed the task before and after structured CPR training, and the efficacy of ventilation before and after the training was compared. The HCPs provided bag-mask ventilation; LR performed dispatcher-assisted CPR with mouth-to-mouth ventilation. Results The number of participants that reached the primary outcome before and after the training in Baby was 26 (65%) vs. 40 (100%) in HCPs and 28 (60.9%) vs. 45 (97.8%) in LRs (improvement in both p < 0.001), respectively. The number of participants that reached the primary outcome before and after the training in the Junior mannequin was 31 (77.5%) vs. 32 (82.1%) in HCPs (p = 0.77) and 32 (82.1%) vs. 37 (94.9%) in LRs (p = 0.005), respectively. Discussion This simulation-based study is the first to investigate ventilation efficacy during paediatric CPR provided by HCPs and LRs. Ventilation represents an important aspect of good-quality CPR in children. The concept of initiating paediatric CPR with initial breaths, as stated in ERC guidelines 2021, is justifiable. Trained HCPs and LRs providing dispatcher-assisted CPR could deliver effective ventilation to paediatric mannequins. These findings can contribute to future research in this area and address identified knowledge gaps concerning resuscitation guidelines, given the unique practical application of simulation as a research tool.
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Affiliation(s)
- Tamara Skrisovska
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jana Djakow
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
- Paediatric Intensive Care Unit, NH Hospital Inc., Hořovice, Czechia
| | - Petr Jabandziev
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Paediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tereza Kramplova
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jozef Klucka
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martina Kosinova
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petr Stourac
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
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7
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Woodward M, Dixon-Woods M, Randall W, Walker C, Hughes C, Blackwell S, Dewick L, Bahl R, Draycott T, Winter C, Ansari A, Powell A, Willars J, Brown IAF, Olsson A, Richards N, Leeding J, Hinton L, Burt J, Maistrello G, Davies C, van der Scheer JW. How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study. BMJ Qual Saf 2024; 33:258-270. [PMID: 38124136 PMCID: PMC10982632 DOI: 10.1136/bmjqs-2023-016196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
Clinical tools for use in practice-such as medicine reconciliation charts, diagnosis support tools and track-and-trigger charts-are endemic in healthcare, but relatively little attention is given to how to optimise their design. User-centred design approaches and co-design principles offer potential for improving usability and acceptability of clinical tools, but limited practical guidance is currently available. We propose a framework (FRamework for co-dESign of Clinical practice tOols or 'FRESCO') offering practical guidance based on user-centred methods and co-design principles, organised in five steps: (1) establish a multidisciplinary advisory group; (2) develop initial drafts of the prototype; (3) conduct think-aloud usability evaluations; (4) test in clinical simulations; (5) generate a final prototype informed by workshops. We applied the framework in a case study to support co-design of a prototype track-and-trigger chart for detecting and responding to possible fetal deterioration during labour. This started with establishing an advisory group of 22 members with varied expertise. Two initial draft prototypes were developed-one based on a version produced by national bodies, and the other with similar content but designed using human factors principles. Think-aloud usability evaluations of these prototypes were conducted with 15 professionals, and the findings used to inform co-design of an improved draft prototype. This was tested with 52 maternity professionals from five maternity units through clinical simulations. Analysis of these simulations and six workshops were used to co-design the final prototype to the point of readiness for large-scale testing. By codifying existing methods and principles into a single framework, FRESCO supported mobilisation of the expertise and ingenuity of diverse stakeholders to co-design a prototype track-and-trigger chart in an area of pressing service need. Subject to further evaluation, the framework has potential for application beyond the area of clinical practice in which it was applied.
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Affiliation(s)
- Matthew Woodward
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | | | | | - Louise Dewick
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Rachna Bahl
- Royal College of Obstetricians and Gynaecologists, London, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Tim Draycott
- Royal College of Obstetricians and Gynaecologists, London, UK
- North Bristol NHS Trust, Westbury on Trym, UK
| | | | - Akbar Ansari
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Powell
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Janet Willars
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Imogen A F Brown
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Annabelle Olsson
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Natalie Richards
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Joann Leeding
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lisa Hinton
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jenni Burt
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | - Jan W van der Scheer
- THIS Institute (The Healthcare Improvement Studies Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Cornthwaite KR, Bahl R, Lattey K, Draycott T. Management of impacted fetal head at cesarean delivery. Am J Obstet Gynecol 2024; 230:S980-S987. [PMID: 38462267 PMCID: PMC11000504 DOI: 10.1016/j.ajog.2022.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/05/2022] [Accepted: 10/09/2022] [Indexed: 03/12/2024]
Abstract
Globally, more than 1 in 5 women give birth by cesarean delivery, and at least 5% of these births are at full cervical dilatation. In these circumstances, and when labor has been prolonged in the first stage of labor, the fetal head can become low and wedged deep in the woman's pelvis, making it difficult to deliver the baby. This emergency is known as impacted fetal head. These are technically challenging births associated with serious risks to both the woman and the baby. The difficulty in disimpacting the fetal head increases maternal risks of hemorrhage and injury to adjacent organs and may have long-term consequences for future pregnancies. In addition, there can be associated neonatal consequences, such as skull fractures, brain hemorrhage, hypoxic brain injury, and, rarely, perinatal death. Globally, maternity staff are increasingly encountering this emergency, with studies in the United Kingdom suggesting that impacted fetal head may complicate as many as 1 in 10 emergency cesarean deliveries. Moreover, there has been a sharp increase in reports of perinatal brain injuries associated with impaction of the fetal head at cesarean delivery. When an impacted fetal head occurs, the maternity team can employ a range of approaches to help deliver the fetal head, including an assistant (another obstetrician or midwife) pushing the head up from the vagina, delivering the baby feet first (reverse breech extraction), administering tocolysis to relax the uterus, and using a balloon cephalic elevation device (Fetal Pillow) to elevate the baby's head. However, there is currently no consensus on how best to manage these births, resulting in a lack of confidence among maternity staff, variable practice, and potentially avoidable harm in some circumstances. This article examined the evidence for the prevention and management of this critical obstetrical emergency and outlined recommendations for best practices and training.
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Affiliation(s)
- Katie R Cornthwaite
- University of Bristol and Royal College of Obstetricians and Gynaecologists, Bristol, United Kingdom.
| | - Rachna Bahl
- University Hospitals Bristol NHS Trust and Royal College of Obstetricians and Gynaecologists, Bristol, United Kingdom
| | | | - Tim Draycott
- North Bristol NHS Trust and Royal College of Obstetricians and Gynaecologists, Bristol, United Kingdom
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Sumera K, Ilczak T, Bakkerud M, Lane JD, Pallas J, Martorell SO, Sumera A, Webster CA, Quinn T, Sandars J, Niroshan Siriwardena A. CPR Quality Officer role to improve CPR quality: A multi-centred international simulation randomised control trial. Resusc Plus 2024; 17:100537. [PMID: 38261942 PMCID: PMC10796959 DOI: 10.1016/j.resplu.2023.100537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Background An out-of-hospital cardiac arrest requires early recognition, prompt and quality clinical interventions, and coordination between different clinicians to improve outcomes. Clinical team leaders and clinical teams have high levels of cognitive burden. We aimed to investigate the effect of a dedicated Cardio-Pulmonary Resuscitation (CPR) Quality Officer role on team performance. Methods This multi-centre randomised control trial used simulation in universities from the UK, Poland, and Norway. Student Paramedics participated in out-of-hospital cardiac arrest scenarios before randomisation to either traditional roles or assigning one member as the CPR Quality Officer. The quality of CPR was measured using QCPR® and Advanced Life Support (ALS) elements were evaluated. Results In total, 36 teams (108 individuals) participated. CPR quality from the first attempt (72.45%, 95% confidence interval [CI] 64.94 to 79.97) significantly increased after addition of the CPR Quality role (81.14%, 95% CI 74.20 to 88.07, p = 0.045). Improvement was not seen in the control group. The time to first defibrillation had no significant difference in the intervention group between the first attempt (53.77, 95% CI 36.57-70.98) and the second attempt (48.68, 95% CI 31.31-66.05, p = 0.84). The time to manage an obstructive airway in the intervention group showed significant difference (p = 0.006) in the first attempt (168.95, 95% CI 110.54-227.37) compared with the second attempt (136.95, 95% CI 87.03-186.88, p = 0.1). Conclusion A dedicated CPR Quality Officer in simulated scenarios improved the quality of CPR compressions without a negative impact on time to first defibrillation, managing the airway, or adherence to local ALS protocols.
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Affiliation(s)
- Kacper Sumera
- East Midlands Ambulance Service NHS Trust, Education, Nottingham NG11 8NS, UK
- European Pre-hospital Research Network, United Kingdom
| | - Tomasz Ilczak
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biała, Poland
- European Pre-hospital Research Network, United Kingdom
| | - Morten Bakkerud
- Oslo Metropolitan University, Department of Nursing and Health Promotion, Pilestredet 32, 0166 Oslo, Norway
- European Pre-hospital Research Network, United Kingdom
| | - Jon Dearnley Lane
- Edge Hill University, Allied Health, Social Work & Wellbeing, Ormskirk L39 4QP, UK
| | - Jeremy Pallas
- John Hunter Hospital, Emergency Department, NSW 2305, Australia
| | - Sandra Ortega Martorell
- Liverpool John Moores University, School of Computer Science and Mathematics, Liverpool L3 5UX, UK
| | - Agnieszka Sumera
- University of Chester, Faculty of Health, Medicine & Society, Chester CH1 1SL, UK
- European Pre-hospital Research Network, United Kingdom
| | - Carl A. Webster
- Nottingham Trent University, Institute of Health and Allied Professions, Nottingham NG11 8NS, UK
- European Pre-hospital Research Network, United Kingdom
| | - Tom Quinn
- Kingston University & St George’s, University of London, Centre for Health and Social Care Research, London KT2 7LB, UK
- European Pre-hospital Research Network, United Kingdom
| | - John Sandars
- Edge Hill University, Allied Health, Social Work & Wellbeing, Ormskirk L39 4QP, UK
| | - A. Niroshan Siriwardena
- University of Lincoln, School of Health and Social Care, Lincoln LN6 7TS, UK
- European Pre-hospital Research Network, United Kingdom
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Charnetski MD, Wawersik D, Palaganas JC, Duff JP, Bailey SKT, Ramachandra G, Birido N, Elkin R, Nair B, Thurber P, Gross IT. Understanding the Effects of Health Care Distance Simulation: A Systematic Review. Simul Healthc 2024; 19:S57-S64. [PMID: 38240619 DOI: 10.1097/sih.0000000000000760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT The use of distance simulation has rapidly expanded in recent years with the physical distance requirements of the COVID-19 pandemic. With this development, there has been a concurrent increase in research activities and publications on distance simulation. The authors conducted a systematic review of the peer-reviewed distance health care simulation literature. Data extraction and a risk-of-bias assessment were performed on selected articles. Review of the databases and gray literature reference lists identified 10,588 titles for review. Of those, 570 full-text articles were assessed, with 54 articles included in the final analysis. Most of these were published during the COVID-19 pandemic (2020-2022). None of the included studies examined an outcome higher than a Kirkpatrick level of 2. Most studies only examined low-level outcomes such as satisfaction with the simulation session. There was, however, a distinction in studies that were conducted in a learning environment where all participants were in different locations ("distance only") as compared with where some of the participants shared the same location ("mixed distance"). This review exclusively considered studies that focused solely on distance. More comparative studies exploring higher level outcomes are required to move the field forward.
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Affiliation(s)
- Matthew D Charnetski
- From the Dartmouth Health (M.C.), Lebanon, NH; Nova Southeastern University (D.W.), Fort Lauderdale, FL; MGH Institute of Health Professions (J.P.), Boston, MA; Department of Pediatrics (J.P.D.), University of Alberta, Edmonton, Alberta, Canada; Center for Advanced Medical Learning & Simulation (S.K.T.B.), Morsani College of Medicine, University of South Florida, Tampa, FL; Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad, India; Royal College of Surgeons in Ireland - Medical University of Bahrain (N.B., B.N.), Busaiteen, Bahrain; Columbia University Vagelos College of Physicians and Surgeons (R.E.), New York, NY; The Dartmouth Institute for Health Policy and Clinical Practice (P.T.), Hanover, NH; and Yale University School of Medicine (I.T.G.), New Haven, CT
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Corvetto MA, Altermatt FR, Belmar F, Escudero E. Health Care Simulation as a Training Tool for Epidemic Management: A Systematic Review. Simul Healthc 2023; 18:382-391. [PMID: 36881436 DOI: 10.1097/sih.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
SUMMARY STATEMENT The objective of this research was to identify and review studies that have evaluated the impact of simulation-based training on health care professionals during epidemics.All studies in health care simulation-based training published during the last 5 epidemics with a global impact (SARS-CoV, H1N1, MERS, Ebola, SARS-CoV-2; through July 2021) were selected from a systematic search of PUBMED, EMBASE, and key journals.The search strategy identified 274 studies; 148 met the inclusion criteria and were included. Most of the studies were developed in response to SARS-CoV-2 infection (n = 117, 79.1%), used a descriptive approach (n = 54, 36.5%), and were used to train technical skills (n = 82, 55.4%).This review demonstrates a growing interest in publications related to health care simulation and epidemics. Most of the literature is marked by limited study designs and outcome measurements, although there is a trend toward the use of more refined methodologies in the most recent publications. Further research should seek the best evidence-based instructional strategies to design training programs in preparation for future outbreaks.
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Affiliation(s)
- Marcia A Corvetto
- From the Department of Anesthesiology (M.A.C., F.R.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Experimental Surgery and Simulation Center (M.A.C., F.B.), Department of Digestive Surgery, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; and Comité Académico de Fundación Garrahan (E.E.), Buenos Aires, Argentina
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Orchard L, Van M, Abbas J, Malik R, Stevenson J, Tolley N. Mixed-reality technology for clinical communication: objective assessment of the HoloLens 2 as a clinical communication device in a simulated on-call scenario. J Laryngol Otol 2023; 137:1165-1169. [PMID: 36992658 DOI: 10.1017/s0022215123000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Specialty on-call clinicians cover large areas and complex workloads. This study aimed to assess clinical communication using the mixed-reality HoloLens 2 device within a simulated on-call scenario. METHOD This study was structured as a randomised, within-participant, controlled study. Thirty ENT trainees used either the HoloLens 2 or a traditional telephone to communicate a clinical case to a consultant. The quality of the clinical communication was scored objectively and subjectively. RESULTS Clinical communication using the HoloLens 2 scored statistically higher than telephone (n = 30) (11.9 of 15 vs 10.2 of 15; p = 0.001). Subjectively, consultants judged more communication episodes to be inadequate when using the telephone (7 of 30) versus the HoloLens 2 (0 of 30) (p = 0.01). Qualitative feedback indicates that the HoloLens 2 was easy to use and would add value during an on-call scenario with remote consultant supervision. CONCLUSION This study demonstrated the benefit that mixed-reality devices, such as the HoloLens 2 can bring to clinical communication through increasing the accuracy of communication and confidence of the users.
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Affiliation(s)
- L Orchard
- Department of ENT Surgery, St Mary's Hospital, Praed St, London, UK
| | - M Van
- Department of ENT Surgery, St Mary's Hospital, Praed St, London, UK
| | - J Abbas
- Human Factors Academy, Manchester University NHS Trust, University of Manchester, Manchester, UK
| | - R Malik
- Medical School, Imperial College London, London, UK
| | - J Stevenson
- Infomation Technology, Imperial College Healthcare NHS Trust, London, UK
| | - N Tolley
- Department of ENT Surgery, St Mary's Hospital, Praed St, London, UK
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Martinez FT, Soto JP, Valenzuela D, González N, Corsi J, Sepúlveda P. Virtual Clinical Simulation for Training Amongst Undergraduate Medical Students: A Pilot Randomised Trial (VIRTUE-Pilot). Cureus 2023; 15:e47527. [PMID: 38022294 PMCID: PMC10663973 DOI: 10.7759/cureus.47527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Clinical virtual simulators are promising new technologies that might facilitate teaching clinical skills. OBJECTIVE This study aimed to assess whether a virtual reality simulator might facilitate learning and improve adherence to current clinical guidelines. METHODOLOGY A double-masked randomised trial was undertaken among fourth-year medical students at Universidad Andres Bello, Chile. Participants were randomised to a clinical virtual simulator (Body Interact®, Body Interact Inc., Austin, TX) or a small-group discussion session on the management of myocardial infarction. Main outcomes included performance in an objective structured clinical examination (OSCE) and adherence to clinical recommendations. Analyses were undertaken under the intention to treat principle by an independent statistician. RESULTS Fifty students volunteered to participate. Most were female (30 students, 58.8%) and had a mean age of 23.0±2.7 years. Thirty-two participants (62.8%) had used virtual reality platforms before. Students allocated to the simulator showed better OSCE scores (mean difference: 2.8 points; 95% confidence interval (CI): -3.2 to +8.7 points, p=0.14) and were faster to implement diagnostic and therapeutic interventions, but not in a statistically significant way. DISCUSSION Academic performance was slightly improved by the use the simulator, although the overall effect was smaller than expected. CONCLUSION This study examined the influence of a clinical virtual simulator on the academic performance and guideline adherence of undergraduate medical students, with small group discussions as a point of comparison. The findings revealed that there were no statistically significant distinctions between the two methods, potentially attributed to the selection of the comparator and the relatively brief intervention period.
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Affiliation(s)
- Felipe T Martinez
- Clinical Research, Concentra Educación e Investigación Biomédica, Viña del Mar, CHL
- Internal Medicine, Facultad de Medicina, Universidad Andrés Bello, Viña del Mar, CHL
| | - Juan Pablo Soto
- Clinical Simulation Hospital, Facultad de Medicina, Universidad Andrés Bello, Viña del Mar, CHL
| | - Daniela Valenzuela
- Clinical Simulation Hospital, Facultad de Medicina, Universidad Andrés Bello, Viña del Mar, CHL
| | | | - Jorge Corsi
- Intensive Care Unit, Clínica Ciudad del Mar, Viña del Mar, CHL
| | - Patricio Sepúlveda
- Clinical Simulation Hospital, Faculdad de Medicina, Universidad Andrés Bello, Viña del Mar, CHL
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Ruangsomboon O, Surabenjawongse U, Jantataeme P, Chawaruechai T, Wangtawesap K, Chakorn T. Association between cardiopulmonary resuscitation audit results with in-situ simulation and in-hospital cardiac arrest outcomes and key performance indicators. BMC Cardiovasc Disord 2023; 23:299. [PMID: 37312018 DOI: 10.1186/s12872-023-03320-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION In-situ simulation (ISS) is a method to evaluate the performance of hospital units in performing cardiopulmonary resuscitation (CPR). It is conducted by placing a high-fidelity mannequin at hospital units with simulated scenarios and having each unit's performance evaluated. However, little is known about its impact on actual patient outcomes. Therefore, we aimed to evaluate the association between the ISS results and actual outcomes of patients with in-hospital cardiac arrest (IHCA). METHODS This retrospective study was conducted by reviewing Siriraj Hospital's CPR ISS results in association with the data of IHCA patients between January 2012 and January 2019. Actual outcomes were determined by patients' outcomes (sustained return of spontaneous circulation (ROSC) and survival to hospital discharge) and arrest performance indicators (time-to-first-epinephrine and time-to-defibrillation). These outcomes were investigated for association with the ISS scores in multilevel regression models with hospital units as clusters. RESULTS There were 2146 cardiac arrests included with sustained ROSC rate of 65.3% and survival to hospital discharge rate of 12.9%. Higher ISS scores were significantly associated with improved sustained ROSC rate (adjusted odds ratio 1.32 (95%CI 1.04, 1.67); p = 0.01) and a decrease in time-to-defibrillation (-0.42 (95%CI -0.73, -0.11); p = 0.009). Although higher scores were also associated with better survival to hospital discharge and a decrease in time-to-first-epinephrine, most models for these outcomes failed to reach statistical significance. CONCLUSION CPR ISS results were associated with some important patient outcomes and arrest performance indicators. Therefore, it may be an appropriate performance evaluation method that can guide the direction of improvement.
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Affiliation(s)
- Onlak Ruangsomboon
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Usapan Surabenjawongse
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Pongthorn Jantataeme
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Thanawin Chawaruechai
- Siriraj Medical Simulation for Education and Training (SiMSET), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khemchat Wangtawesap
- Siriraj Medical Simulation for Education and Training (SiMSET), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Tipa Chakorn
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
- Siriraj Medical Simulation for Education and Training (SiMSET), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Cheng A, Davidson J, Wan B, St-Onge-St-Hilaire A, Lin Y. Data-informed debriefing for cardiopulmonary arrest: A randomized controlled trial. Resusc Plus 2023; 14:100401. [PMID: 37260809 PMCID: PMC10227448 DOI: 10.1016/j.resplu.2023.100401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023] Open
Abstract
Aim To determine if data-informed debriefing, compared to a traditional debriefing, improves the process of care provided by healthcare teams during a simulated pediatric cardiac arrest. Methods We conducted a prospective, randomized trial. Participants were randomized to a traditional debriefing or a data-informed debriefing supported by a debriefing tool. Participant teams managed a 10-minute cardiac arrest simulation case, followed by a debriefing (i.e. traditional or data-informed), and then a second cardiac arrest case. The primary outcome was the percentage of overall excellent CPR. The secondary outcomes were compliance with AHA guidelines for depth and rate, chest compression (CC) fraction, peri-shock pause duration, and time to critical interventions. Results A total of 21 teams (84 participants) were enrolled, with data from 20 teams (80 participants) analyzed. The data-informed debriefing group was significantly better in percentage of overall excellent CPR (control vs intervention: 53.8% vs 78.7%; MD 24.9%, 95%CI: 5.4 to 44.4%, p = 0.02), guideline-compliant depth (control vs. intervention: 60.4% vs 85.8%, MD 25.4%, 95%CI: 5.5 to 45.3%, p = 0.02), CC fraction (control vs intervention: 88.6% vs 92.6, MD 4.0%, 95%CI: 0.5 to 7.4%, p = 0.03), and peri-shock pause duration (control vs intervention: 5.8 s vs 3.7 s, MD -2.1 s, 95%CI: -3.5 to -0.8 s, p = 0.004) compared to the control group. There was no significant difference in time to critical interventions between groups. Conclusion When compared with traditional debriefing, data-informed debriefing improves CPR quality and reduces pauses in CPR during simulated cardiac arrest, with no improvement in time to critical interventions.
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Affiliation(s)
- Adam Cheng
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, KidSIM-ASPIRE Research Program, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada
| | - Jennifer Davidson
- KidSIM Simulation Program, Alberta Children’s Hospital, University of Calgary, Canada
| | - Brandi Wan
- KidSIM Simulation Program, Alberta Children’s Hospital, University of Calgary, Canada
| | | | - Yiqun Lin
- KidSIM Simulation Program, Alberta Children’s Hospital, University of Calgary, Canada
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Boyle TP, Dugas JN, Liu J, Stapleton SN, Medzon R, Walsh BM, Corey P, Shubitowski L, Horne JR, O'Connell R, Williams G, Nelson KP, Nadkarni VM, Camargo CA, Feldman JA. Adaptation of a Simulation Model and Checklist to Assess Pediatric Emergency Care Performance by Prehospital Teams. Simul Healthc 2023; 18:82-89. [PMID: 35238848 PMCID: PMC9437138 DOI: 10.1097/sih.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Simulation tools to assess prehospital team performance and identify patient safety events are lacking. We adapted a simulation model and checklist tool of individual paramedic performance to assess prehospital team performance and tested interrater reliability. METHODS We used a modified Delphi process to adapt 3 simulation cases (cardiopulmonary arrest, seizure, asthma) and checklist to add remote physician direction, target infants, and evaluate teams of 2 paramedics and 1 physician. Team performance was assessed with a checklist of steps scored as complete/incomplete by raters using direct observation or video review. The composite performance score was the percentage of completed steps. Interrater percent agreement was compared with the original tool. The tool was modified, and raters trained in iterative rounds until composite performance scoring agreement was 0.80 or greater (scale <0.20 = poor; 0.21-0.39 = fair, 0.40-0.59 = moderate; 0.60-0.79 = good; 0.80-1.00 = very good). RESULTS We achieved very good interrater agreement for scoring composite performance in 2 rounds using 6 prehospital teams and 4 raters. The original 175 step tool was modified to 171 steps. Interrater percent agreement for the final modified tool approximated the original tool for the composite checklist (0.80 vs. 0.85), cardiopulmonary arrest (0.82 vs. 0.86), and asthma cases (0.80 vs. 0.77) but was lower for the seizure case (0.76 vs. 0.91). Most checklist items (137/171, 80%) had good-very good agreement. Among 34 items with fair-moderate agreement, 15 (44%) related to patient assessment, 9 (26%) equipment use, 6 (18%) medication delivery, and 4 (12%) cardiopulmonary resuscitation quality. CONCLUSIONS The modified checklist has very good agreement for assessing composite prehospital team performance and can be used to test effects of patient safety interventions.
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Affiliation(s)
- Tehnaz P Boyle
- From the Department of Pediatrics (T.P.B., B.M.W.), Boston Medical Center, Boston University School of Medicine; Department of Emergency Medicine (J.N.D., J.L., S.N.S., R.M., J.A.F.), Boston Medical Center, Boston University School of Medicine; Solomont Center for Simulation (T.P.B., S.N.S., R.M., B.M.W., P.C.), Boston Medical Center; Boston Emergency Medical Services (L.S., J.R.H., R.O.C., G.W.); Department of Biostatistics (K.P.N.), Boston University, Boston, MA; Center for Simulation, Advanced Education and Innovation (V.M.N.); Department of Anesthesiology and Critical Care Medicine (V.M.N.); The Children's Hospital of Philadelphia (V.M.N.), University of Pennsylvania Perelman School of Medicine (V.M.N.), Philadelphia, PA; and Department of Emergency Medicine (C.A.C.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Vemuri S, O'Neill J, Hynson J, Gillam L. Informing Simulation Design: A Qualitative Phenomenological Study of the Experiences of Bereaved Parents and Actors. Simul Healthc 2023; 18:75-81. [PMID: 35081089 DOI: 10.1097/sih.0000000000000634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulations, which represent reality, are effective in pediatric healthcare communication skills education and training. Parents are increasingly engaged in simulation development, particularly for authentic character development, to help achieve greater psychological fidelity. For simulated encounters related to a child's end-of-life, involvement of bereaved parents would make sense. However, this is challenging because there is limited research to guide their inclusion and significant responsibility for any approach to be thoughtful and psychologically safe for participating parents. This study explores the impact and experiences of bereaved parents and actors who participated in simulation design. METHODS This qualitative phenomenological study involved five bereaved parents and two actors who participated in a full-day workshop to design and develop characters for use in a simulation. Individual semistructured interviews were conducted up to four weeks after the workshop. Data collected from these telephone interviews were analyzed using inductive content analysis. RESULTS Bereaved parents found the workshop emotionally challenging but positive, worthwhile, and beneficial. Similarly, actors found the workshop helpful in character development and, although it was an intense experience for them, it validated the importance of their work. Key elements of our research findings could inform future such activities. CONCLUSIONS Involving bereaved parents in simulation design can be psychologically safe and beneficial for both parents and actors. Ongoing involvement of bereaved parents may lead to higher-quality simulated experiences, allowing clinicians to practice skills to enhance care provided at a child's end-of-life.
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Affiliation(s)
- Sidharth Vemuri
- From the Department of Paediatrics (S.V.), The University of Melbourne, Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Murdoch Children's Research Institute; Department of Nursing Research (J.O.), The Royal Children's Hospital Melbourne; Victorian Paediatric Palliative Care Program (J.H.), The Royal Children's Hospital Melbourne; Department of Paediatrics The University of Melbourne; and Department of Paediatrics (L.G.), The University of Melbourne, Children's Bioethics Centre, The Royal Children's Hospital Melbourne, Parkville, Australia
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Effects of the Interruption Management Strategy "Stay S.A.F.E." During Medication Administration. Rehabil Nurs 2023; 48:65-74. [PMID: 36792960 DOI: 10.1097/rnj.0000000000000404] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE This study measured the impact of the Stay S.A.F.E. intervention on nursing students' management of and response to interruptions during medication administration. Time to return to the primary task, performance (procedural failures and error rate), and perceived task load were evaluated. DESIGN This experimental study used a randomized prospective trial. METHODS Nursing students were randomized into two groups. Group 1 (the experimental group) received two educational PowerPoints: the Stay S.A.F.E. strategy and medication safety practices. Group 2 (the control group) received educational PowerPoint on medication safety practices. Nursing students participated in three simulations where they were interrupted during a simulated medication administration. Eye tracking of students' eye movements determined focus, time to return to the primary task, performance including procedural failures and errors, and fixation time on the interrupter. The perceived task load was measured using the NASA Task Load Index. RESULTS The intervention group, which was the Stay S.A.F.E. group, demonstrated a significant reduction in time away from task. There was a significant difference in perceived task load across the three simulations, including decreased frustration scores for this group as well. The control group members reported a higher mental demand, increased effort, and frustration. CLINICAL RELEVANCE Rehabilitation units often hire new nursing graduates or individuals with little experience. For new graduates they have typically practiced their skills without interruptions. However, interruptions in performing care, particularly in medication management, occur frequently in real-world situations. Improving the education of nursing students related to interruption management has the potential to improve their transition to practice and patient care. CONCLUSION Students who received the Stay S.A.F.E. training, a strategy to manage interruptions in care, had decreasing frustration over time and spent more time on the task of medication administration.
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Joshi P, Tewari V, Kumar S, Singh A. Blockchain technology for sustainable development: a systematic literature review. JOURNAL OF GLOBAL OPERATIONS AND STRATEGIC SOURCING 2023. [DOI: 10.1108/jgoss-06-2022-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Purpose
Blockchain technology (BCT) is one of the latest disruptive innovations, brought along with-it immense scope of diverse applications contributing towards sustainable development (SD). The consistent increase in the publications reveal that the application of BCT for SD has become popular among researchers and practitioners in past few years, in turn, urged for a systematic literature review (SLR) to get an insight into the research journey travelled so far and setting directions for future research in this area. Therefore, this study aims to identify, map and synthesize the available literature on application of BCT for SD.
Design/methodology/approach
The automatic and manual search resulted into 1,277 studies from Scopus and Web of Science database. Further applying inclusion and exclusion criterion resulted in bringing out total of 157 studies, which were termed as primary studies. Based on the results of descriptive analysis, conducted through Bibliometric and VOSviewer software, the characteristics of BCT and its key capabilities, contributing towards shaping the recent SD literature, were critically examined. Identified research themes for clustering primary studies were aligned with United Nations Sustainability Development Goals (UNSDG). A mind-map was also prepared on the basis of thematic classification of primary studies.
Findings
The research themes “business practice and economic sustainability”, “agriculture and food security” and “business practice and environment sustainability” were found to be the focal points of scholarly attention. Synthesis and analysis of primary studies resulted into classification of research gaps under four categories – theoretical foundation, methodological limitation, research themes and technology implementation challenges. The study was concluded by sensitizing and sanitizing the concrete research questions for future research.
Research limitations/implications
The research findings shall be a roadmap for research scholars, academicians and practitioners to comprehend the present state of knowledge in the domain of “BCT application for SD” and decide upon adopting the future course of action to attain the UNSDGs by the year 2030.
Originality/value
To the best of the authors’ knowledge, the current study is the first attempt in its own sense to analyse and synthesize the available literature on “attaining SD through BCT” using SLR approach.
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Krammer T, Kessler L, Aspalter G, Kuster L, Fussenegger B, Aichner H, Simma B. Video-Recorded In Situ Simulation Before Moving to the New Combined Neonatal/Pediatric Intensive Care Facility: An Observational Study. Pediatr Crit Care Med 2023; 24:e1-e8. [PMID: 36226954 DOI: 10.1097/pcc.0000000000003080] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Moving an ICU to a new location is a challenge. The objective of this study was to use in situ simulation to identify potential problems and solutions with the new environment before commencing patient care. DESIGN Planned, observational video-recorded simulation study using four scenarios: delivery room management of term-neonate; delivery room management of extremely low-birth-weight infant; management and transfer of an infant with respiratory syncytial virus bronchiolitis and apnea; and management and transfer of an adolescent with septic shock. SETTING Academic tertiary neonatal and combined neonatal ICU/PICU. PARTICIPANTS Sixteen volunteers (eight physicians, eight nurses). INTERVENTIONS Standardized briefing introduction, with before versus after survey of thoughts about each scenario, and after 8 weeks, debriefing at least 60 minutes and additional video recording. MEASUREMENTS AND MAIN RESULTS A total of 91 potential problem areas were identified and included issues related to technical aspects ( n = 29), infrastructure ( n = 27), administration ( n = 19), and structure ( n = 16). Fifty-three (58%) of these potential issues could be resolved before the move, including: 15 of 29 technical, 15 of 27 infrastructure, nine of 19 administration, and 14 of 16 structural. The video analysis revealed an additional 13 problem areas (six technical, three infrastructure, two administration, and two structural). Participants felt more confident 8 weeks after the simulations (χ 2 = 12.125; p < 0.002). All 16 participants confirmed the usefulness of the in situ simulation, the majority wanted further introductions to the new ward ( n = 13) and noted a positive impact of the changes on the new ward ( n = 12). CONCLUSIONS In situ simulation before moving into a new facility identifies numerousness potential problem areas. Survey shows that providers feel better prepared and are more confident. Video recording reveals additional difficulties not addressed in conventional verbal debriefing.
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Affiliation(s)
- Theresa Krammer
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Lisa Kessler
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Gerhard Aspalter
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Lucas Kuster
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Barbara Fussenegger
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Heidi Aichner
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Burkhard Simma
- Pediatric Simulation Center, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
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Carney L, Hall M, Heller K, Kennedy C. Development, implementation, and evaluation of a simulation-based educational curriculum for pediatric hospitalists. J Hosp Med 2022; 17:967-974. [PMID: 36222435 DOI: 10.1002/jhm.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Minimal published simulation-based educational training exists for practicing pediatric hospitalists. Our aim was to determine specific pediatric hospital medicine (PHM) knowledge, skill, and competency needs aligned with our scope of practice and evaluate the impact of a simulation-based training curriculum. DESIGN AND METHODS Baseline and post-training surveys were administered to 48 physicians providing self-ratings on a 5-point scale from Novice to Expert on published PHM competencies. Results were used to develop a targeted simulation curriculum. Participants were considered competent in a domain if their mean score was 3 or greater. We categorized participant responses to individual questions into nine domain scores on survey self-assessments. Score analysis was performed using the signed-rank test and McNemar's test. Post-training evaluations solicited curriculum acceptance and perceived clinical value. RESULTS The baseline response rate was 98% and the post-training response rate was 85%. Areas with the lowest competency on baseline self-assessment included advanced airway management (38%), vascular access and emergency medications (38%), code cart skills (19%), team communication (51%), and medically complex care (49%). Post-training scores improved significantly for five of nine domains, with the largest gains in the "not competent" at baseline group. Percent competent (% with mean score >3) increased significantly in three domains (advanced airway management, code cart skills, and complex care). Participants rated educational sessions favorably (98%) and most (95%) reported using knowledge/skills learned for patient care. CONCLUSION Baseline self-assessment results were instrumental in curriculum design. Post-training analysis revealed gains in multiple domains and identified opportunities for future interventions. Most hospitalists reported participation positively impacted patient care with high learner satisfaction.
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Affiliation(s)
- Lisa Carney
- Pediatric Hospital Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Kayla Heller
- Pediatric Hospital Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Chris Kennedy
- Pediatric Emergency Medicine, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
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22
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O'Regan SA, Ekelund K, Watterson LM. Emotional Activation in Simulation: Measuring the Influence of Participant Roles and Scenario Design. Simul Healthc 2022; 17:394-402. [PMID: 34652327 DOI: 10.1097/sih.0000000000000615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The degree of emotional activation required for optimal learning in either hands-on or observer roles is unclear, as is the level of stress that impedes learning. Measuring emotional activation is time-consuming, and many scales measure threat or anxiety without considering pleasurable activation. This study examined emotional activation in the observer and hands-on roles in 2 different scenario designs. METHODS This study was a 2-cohort, parallel study of graduate nurses and doctors completing 2 different courses in managing the deteriorating patient. We examined emotional activation by role across 2 scenario designs. We measured emotional activation on 3 anchored measures scales: the State Trait Anxiety Inventory, Cognitive Appraisal Index, and the Affect Grid with data analysis using analysis of variance and repeated measures. RESULTS Hands-on learners experienced higher anxiety, threat, and arousal levels and less pleasure than observers in both scenario designs. There were no differences in pre-emotional and postemotional activation in immersive scenarios for either role and increased arousal and decreased threat and anxiety in the hands-on role in the pause-and-discuss scenario design. CONCLUSIONS Hands-on learners were more emotionally activated than observers in both scenario designs. There was significant perceived anxiety, threat, and pleasurable arousal in both roles and both scenario designs. Pause-and-discuss scenarios demonstrated similar levels of activation as the immersive scenario design. The Affect Grid provided a quick subjective view of arousal and pleasure in simulation participants, potentially providing educators with an indication of whether emotional activation is positive (excitement) or negative (stressful) and may be helpful in educational planning and future research.
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Affiliation(s)
- Stephanie A O'Regan
- From the Sydney Clinical Skills and Simulation Centre (S.A.O., L.M.W.), St Leonards; Monash University (S.A.O.), Melbourne, Australia; and Copenhagen Academy for Medical Education and Simulation (K.E.), Copenhagen, Denmark
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23
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Cornthwaite K, Draycott T, Winter C, Lenguerrand E, Hewitt P, Bahl R. Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study. Acta Obstet Gynecol Scand 2022; 102:43-50. [PMID: 36349412 PMCID: PMC9780722 DOI: 10.1111/aogs.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Impacted fetal head (IFH) is a challenging complication of cesarean section (CS) associated with significant morbidity. Training opportunities for IFH have been reported as inconsistent and inadequate. This study assessed the validity of a novel birth simulator for IFH at cesarean section. MATERIAL AND METHODS Obstetricians and midwives collaborated with model-making company, Limbs & Things (UK), to modify the original PROMPT Flex® simulator and develop a new "Enhanced CS Module" for IFH at cesarean section. Changes included addition of a retractable uterus and restricted pelvic inlet, and the fetal mannequin was modified to allow accurate limb articulation and flexion at the waist. Obstetricians and midwives from three maternity units in Southwest England were individually recorded, each undertaking three simulated scenarios of IFH at cesarean section. Obstetricians were asked to deliver the fetal head and midwives, to perform a vaginal push-up. Participants completed a questionnaire on realism (face validity) and usefulness for training (content validity) with five-point Likert scale responses. Construct validity was assessed by testing an a priori hypothesis that "experts" (consultant obstetricians with >7 years' experience) would be more likely to achieve delivery than "novices" (registrars with <7 years' experience). Performance variables were compared between groups using Chi-square and Mann-Whitney U-tests. RESULTS In all, 105 simulated scenarios were undertaken by 35 obstetricians and midwives. A range of techniques were employed to deliver the IFH including change of hand, vaginal disimpaction and reverse breech extraction. Overall, 86% (30/35) described the model as fairly (4)/very realistic (5) (median = 4, interquartile range [IQR] = 4-5). The model was considered fairly (4)/very useful (5) for training by 97% (34/35; median = 5; IQR = 5-5). Experts delivered the fetal head in all simulations (36/36) and novices delivered the head in 76.9% (30/39) (p = 0.002). Experts delivered the fetal head 58% quicker than novices (median = 66.8 s, IQR = 53-86 vs median = 104 s, IQR = 67.7-137). CONCLUSIONS This novel birth trainer realistically simulates IFH at cesarean section and allows rehearsal of all disimpaction techniques. It was reported to be very useful for training and distinguishes between novice and expert obstetricians. Techniques for IFH are difficult to learn experientially. Simulation is likely to provide an effective and safe form of training.
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Affiliation(s)
- Katie Cornthwaite
- Women's Health DepartmentNorth Bristol NHS TrustBristolUK,Translational Health SciencesUniversity of BristolBristolUK
| | - Tim Draycott
- Women's Health DepartmentNorth Bristol NHS TrustBristolUK
| | - Cathy Winter
- Women's Health DepartmentNorth Bristol NHS TrustBristolUK
| | | | - Pauline Hewitt
- Women's Heatlh DepartmentGloucestershire Royal Hospitals NHS Foundation TrustGloucesterUK
| | - Rachna Bahl
- Women's Health DepartmentUniversity Hospital Bristol Foundation NHS TrustBristolUK
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Kerins J, Keay R, Smith SE, Tallentire VR. Assessing team behaviours and time to defibrillation during simulated cardiac arrest: a pilot study of internal medicine trainees. Simul Healthc 2022. [DOI: 10.54531/cope7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding team behaviours leading to successful outcomes in resuscitation could help guide future training. Guidelines recommend defibrillation for shockable rhythm cardiac arrests within 2 minutes. This observational pilot study aimed to determine whether teamwork behaviours among medical trainees differed when time to defibrillation (TTD) was less than 2 minutes, versus 2 minutes or more.
Following ethical approval, groups of six internal medicine trainee (IMT) doctors in Scotland formed an
Twenty-three videos involving 138 trainees were scored using the TEAM tool. Scores ranged from 19–39.5/44 (mean 28.2). Mean TTD was 86.2 seconds (range 24–224), with 17/23 teams achieving defibrillation in under 2 minutes. Those achieving fast TTD achieved higher TEAM scores, and the result was statistically significant (30.1 ± 5.0 vs 22.9 ± 3.3,
This observational pilot study found that improved team performance, as measured by the TEAM tool, was associated with faster defibrillation by IMT doctors in simulated cardiac arrest. It highlighted the importance of adaptability as a team behaviour associated with successful performance, which is of interest to those involved in training high stakes emergency teams.
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Affiliation(s)
- Joanne Kerins
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Rona Keay
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Samantha E Smith
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Victoria R Tallentire
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
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De Cloedt L, Jeffers J, Alix-Séguin L, Sauthier M, Tremblay-Roy JS, Pettersen G. Pediatric Interfacility Transport Curriculum: Its Impact on the Pediatric Intensive Care and Emergency Medicine Fellows' Performance and Confidence. Air Med J 2022; 41:442-446. [PMID: 36153140 DOI: 10.1016/j.amj.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/24/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Pediatric interfacility transports are frequent. Despite the absence of a formal pediatric transport curriculum in eastern Canada, directly managing patients during transport and medical direction of the referring center and transport team are part of the pediatric critical care medicine (PCCM) and pediatric emergency medicine (PEM) program requirements. The authors developed a pediatric interfacility transport curriculum and measured its impact on fellows' confidence and performance. METHODS This was a pilot interventional prospective study in Montreal, Canada. Postcurriculum surveys were used to measure confidence, and high-fidelity simulations were used to measure performance. A target threshold for confidence was defined before implementation, and pre- and post values were compared. The simulation scenario and assessment checklist were locally developed. RESULTS The participants were 11 PCCM and 3 PEM fellows. The content of the curriculum and educational methods were selected based on the literature and a needs assessment survey. All participants rated themselves as confident at the end of the curriculum. Eighty-three percent of the participants were deemed proficient with a perfect interrater agreement. CONCLUSION The pediatric transport curriculum had a positive impact on PEM and PCCM fellows' confidence and performance in transport. Further studies should look at the impact of such a curriculum on participants' real-life performance and patient care.
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Affiliation(s)
| | - Justin Jeffers
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laurence Alix-Séguin
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada
| | - Michaël Sauthier
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada
| | - Jean-Sébastien Tremblay-Roy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | - Géraldine Pettersen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada.
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Corazza F, Stritoni V, Martinolli F, Daverio M, Binotti M, Genoni G, Ingrassia PL, De Luca M, Palmas G, Maccora I, Frigo AC, Da Dalt L, Bressan S. Adherence to guideline recommendations in the management of pediatric cardiac arrest: a multicentre observational simulation-based study. Eur J Emerg Med 2022; 29:271-278. [PMID: 35404331 PMCID: PMC10878464 DOI: 10.1097/mej.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND IMPORTANCE Pediatric cardiac arrest is a rare emergency with associated high mortality. Its management is challenging and deviations from guidelines can affect clinical outcomes. OBJECTIVES To evaluate the adherence to guideline recommendations in the management of a pediatric cardiac arrest scenario by teams of pediatric residents. Secondarily, the association between the use of the Pediatric Advanced Life Support-2015 (PALS-2015) pocket card, and the teams' adherence to international guidelines, were explored. DESIGN, SETTINGS AND PARTICIPANTS Multicentre observational simulation-based study at three Italian University Hospitals in 2018, including PALS-2015 certified pediatric residents in their 3rd-5th year of residency program, divided in teams of three. INTERVENTION OR EXPOSURE Each team conducted a standard nonshockable pediatric cardiac arrest scenario and independently decided whether to use the PALS-2015 pocket card. OUTCOME MEASURE AND ANALYSIS The primary outcome was the overall number and frequency of individual deviations from the PALS-2015 guidelines, measured by the novel c-DEV15plus score (range 0-15). Secondarily, the performance on the validated Clinical Performance Tool for asystole scenarios, the time to perform resuscitation tasks and cardiopulmonary resuscitation (CPR) quality metrics were compared between the teams that used and did not use the PALS-2015 pocket card. MAIN RESULTS Twenty-seven teams (81 residents) were included. Overall, the median number of deviations per scenario was 7 out of 15 [interquartile range (IQR), 6-8]. The most frequent deviations were delays in positioning of a CPR board (92.6%), calling for adrenaline (92.6%), calling for help (88.9%) and incorrect/delayed administration of adrenaline (88.9%). The median Clinical Performance Tool score was 9 out of 13 (IQR, 7-10). The comparison between teams that used ( n = 13) and did not use ( n = 14) the PALS-2015 pocket card showed only significantly higher Clinical Performance Tool scores in the former group [9 (IQR 9-10) vs. 7 (IQR 6-8); P = 0.002]. CONCLUSIONS Deviations from guidelines, although measured by means of a nonvalidated tool, were frequent in the management of a pediatric cardiac arrest scenario by pediatric residents. The use of the PALS-2015 pocket card was associated with better Clinical Performance Tool scores but was not associated with less deviations or shorter times to resuscitation tasks.
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Affiliation(s)
- Francesco Corazza
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Valentina Stritoni
- Department of Woman’s and Child’s Health, Paediatric Intensive Care Unit, University of Padua, Padua
| | - Francesco Martinolli
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Marco Daverio
- Department of Woman’s and Child’s Health, Paediatric Intensive Care Unit, University of Padua, Padua
| | - Marco Binotti
- Neonatal and Paediatric Intensive Care Unit, Maggiore della Carità University Hospital, University of Piemonte Orientale, Novara, Italy
| | - Giulia Genoni
- Neonatal and Paediatric Intensive Care Unit, Maggiore della Carità University Hospital, University of Piemonte Orientale, Novara, Italy
| | - Pier Luigi Ingrassia
- Centro di Simulazione (CeSi), Centro Professionale Sociosanitario di Lugano, Lugano, Switzerland
| | - Marco De Luca
- Paediatric Simulation Centre, Meyer Children’s University Hospital
| | - Giordano Palmas
- Department of Health Sciences, University of Florence and Meyer Children’s University Hospital, Florence
| | - Ilaria Maccora
- Department of Health Sciences, University of Florence and Meyer Children’s University Hospital, Florence
| | - Anna Chiara Frigo
- Department of Cardiac, Biostatistics, Epidemiology and Public Health Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Silvia Bressan
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
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27
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Kotur PF, Kurdi MS, Theerth K, Chokshi T. Simulation-based airway research: The fast-track recipes? Indian J Anaesth 2022; 66:395-398. [PMID: 35903595 PMCID: PMC9316681 DOI: 10.4103/ija.ija_501_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Premanath F Kotur
- Department of Anaesthesiology, Aarupadai Veedu Medical College, Puducherry, India
| | - Madhuri S. Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India
| | - Kaushik Theerth
- Consultant Neuroanaesthesiologist, Medical Trust Hospital, Ernakulam, Kerala, India
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Wang J, Wei L, Li H, Zhang H, Gu R, Zhang Y, Li Q, Sun T, Wang Y. Effectiveness of a Game-Based Phone Application in Educating Health Care Workers on the Proper Use of Personal Protective Equipment. J Contin Educ Nurs 2022; 53:212-220. [PMID: 35510925 DOI: 10.3928/00220124-20220414-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective This study explored the feasibility and effects of a game-based phone application for training health care workers to use personal protective equipment. Method A single-blind randomized controlled trial was conducted. All participants in the experimental group (n = 123) and the control group (n = 125) received 75 minutes of training and were provided with a video and a paper copy of the procedures. Participants in the experimental group used an additional game-based phone application to simulate the procedures. Results Participants in the experimental group practiced a median of 15 times (range, 14-19 times). The learning curve indicated that they needed at least 12 repetitions to master the skill. Score improvements (Z = -2.257, p = .024) in the experimental group were significantly superior to those in the control group, as were the incidences of procedural errors of hand hygiene (χ2 = 4.085, p = .043) and protective clothing (χ2 = 5.394, p = .02). Conclusion The game-based phone application simulation guided participants to practice enough times to master the skill, enhance their skill performance, and reduce the incidence of procedural errors. [J Contin Educ Nurs. 2022;53(5):212-220.].
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Abstract
BACKGROUND CHD was the most prevalent congenital anomaly (60.9 per 10,000, 95% CI 59.0-62.8) in England in 2018, with 1767 babies born with severe cardiac defects. The 30-day survival rates for complex procedures continue to improve; however despite care advances, the early post-operative period and first year of life remain a critical time for these infants. The Congenital Heart Assessment Tool was developed to support parental decision-making, standardise care provision, improve communication, and the safety and quality of care. AIM To further evaluate the Congenital Heart Assessment Tool. DESIGN A four centre collaborative mixed-methods quality improvement project funded by The Health Foundation, involving eight phases conducted during 2016-2018. Phases six to eight (clinical simulation exercise, parent workshop, and updated tool) are reported in this paper. RESULTS Four themes emerged from the clinical simulation exercise (phase six) including: improving documentation; preparation of parents; preparation of health care professionals; and communication. One main theme emerged from the parent workshop (phase seven): "what parents know versus what professionals know [about CHD]". CONCLUSION These phases further validated the effectiveness of the CHATm in terms of triggering amber and red indicators and demonstrated parents' ability to identify deterioration in their infant's clinical condition. Recommendations arising from the quality improvement project enabled the project team to create an updated version of the Congenital Heart Assessment Tool, CHAT2.
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Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial. J Pers Med 2022; 12:jpm12030428. [PMID: 35330427 PMCID: PMC8948631 DOI: 10.3390/jpm12030428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023] Open
Abstract
For maintaining collaboration and coordination among emergency department (ED) caregivers, it is essential to effectively share patient-centered information. Indirect activities on patients, such as searching for laboratory results and sharing information with scattered colleagues, waste resources to the detriment of patients and staff. Therefore, we conducted a pilot study to evaluate the initial efficacy of a mobile app to facilitate rapid mobile access to central laboratory results and remote interprofessional communication. A total of 10 ED residents and registered nurses were randomized regarding the use of the app versus conventional methods during semi-simulated scenarios in a pediatric ED (PED). The primary outcome was the elapsed time in minutes in each group from the availability of laboratory results to their consideration by participants. The secondary outcome was the elapsed time to find a colleague upon request. Time to consider laboratory results was significantly reduced from 23 min (IQR 10.5–49.0) to 1 min (IQR 0–5.0) with the use of the app compared to conventional methods (92.2% reduction in mean times, p = 0.0079). Time to find a colleague was reduced from 24 min to 1 min (i.e., 93.0% reduction). Dedicated mobile apps have the potential to improve information sharing and remote communication in emergency care.
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Hamm RM, Kelley DM, Medina JA, Syed NS, Harris GA, Papa FJ. Effects of using an abdominal simulator to develop palpatory competencies in 3rd year medical students. BMC MEDICAL EDUCATION 2022; 22:63. [PMID: 35081956 PMCID: PMC8793257 DOI: 10.1186/s12909-022-03126-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical school faculty are hard pressed to provide clerkship students with sufficient opportunity to develop and practice their capacity to perform a competent clinical examination, including the palpatory examination of the abdomen. We evaluated the impact of training with an abdominal simulator, AbSim, designed to monitor the depth, location, and thoroughness of their palpation and to provide concurrent and summative feedback regarding their performance. METHODS All third-year medical students were given the opportunity to develop their palpatory skills with the AbSim simulator during the family medicine rotation. The performance of those who studied with the simulator was measured by its sensors, before and after a training session that included visual feedback regarding the depth and coverage of the student's manual pressure. Additionally, all students reported their confidence in their evolving abdominal palpation skills at the beginning and end of the rotation. RESULTS 119 (86.9%) of 137 students filled out the initial questionnaire, and 73 (61.3%) studied with the abdominal simulator. The training produced a highly significant improvement in their overall performance (4 measures, p's < 0.001). Pre-training performance (depth calibration and thoroughness of coverage) was not related to the number of months of previous clinical rotations nor to previous internal medicine or surgery rotations. There was little relation between students' confidence in their abdominal examination skills and objective measures of their palpatory performance; however, students who chose the training started with less confidence, and became more confident after training. CONCLUSIONS Guided abdominal simulator practice increased medical students' capacity to perform an abdominal examination with more appropriate depth and thoroughness of palpation. Interpretation of changes in confidence are uncertain, because confidence was unrelated to objectively measured performance. However, students with low initial confidence in their abdominal examination seemed to be more likely to choose to study with the abdominal simulator.
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Affiliation(s)
- Robert M Hamm
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St., Oklahoma City, OK, 73104, USA.
| | - David M Kelley
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St., Oklahoma City, OK, 73104, USA
| | - Jose A Medina
- Physician Associate Program, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Noreen S Syed
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St., Oklahoma City, OK, 73104, USA
| | - Geraint A Harris
- Great Plains Family Medicine Residency Program, Oklahoma City, OK, USA
| | - Frank J Papa
- Texas College of Osteopathic Medicine, University of North Texas, Fort Worth, TX, USA
- ACDET, Inc., Fort Worth, TX, USA
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Lutfi R, Berrens ZJ, Ackerman LL, Montgomery EE, Mustafa M, Kirby ML, Pearson KJ, Abu-Sultaneh S, Abulebda K. Quality of Resuscitative Care Provided to an Infant With Abusive Head Trauma in Community Emergency Departments: An In Situ, Prospective, Simulation-Based Study. Pediatr Emerg Care 2022; 38:e337-e342. [PMID: 33148953 DOI: 10.1097/pec.0000000000002277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Abusive head trauma (AHT) is a very common and serious form of physical abuse, and a major cause of mortality and morbidity for young children. Early Recognition and supportive care of children with AHT is a common challenge in community emergency department (CEDs). We hypothesized that standardized, in situ simulation can be used to measure and compare the quality of resuscitative measures provided to children with AHT in a diverse set of CEDs. METHODS This prospective, simulation-based study measured teams' performance across CEDs. The primary outcome was overall adherence to AHT using a 15-item performance assessment checklist based on the number of tasks performed correctly on the checklist. RESULTS Fifty-three multiprofessional teams from 18 CEDs participated in the study. Of 270 participants, 20.7% were physicians, 65.2% registered nurses, and 14.1% were other providers. Out of all tasks, assessment of airway/breathing was the most successfully conducted task by 53/53 teams (100%). Although 43/53 teams (81%) verbalized the suspicion for AHT, only 21 (39.6%) of 53 teams used hyperosmolar agent, 4 (7.5%) of 53 teams applied cervical spine collar stabilization, and 6 (11.3%) of 53 teams raised the head of the bed. No significant difference in adherence to the checklist was found in the CEDs with an inpatient pediatric service or these with designated adult trauma centers compared with CEDs without. Community emergency departments closer to the main academic center outperformed CEDs these that are further away. CONCLUSIONS This study used in situ simulation to describe quality of resuscitative care provided to an infant presenting with AHT across a diverse set of CEDs, revealing variability in the initial recognition and stabilizing efforts and provided and targets for improvement. Future interventions focusing on reducing these gaps could improve the performance of CED providers and lead to improved patient outcomes.
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Affiliation(s)
- Riad Lutfi
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Zachary J Berrens
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Laurie L Ackerman
- Department of Neurosurgery, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Manahil Mustafa
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Michele L Kirby
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Kellie J Pearson
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Samer Abu-Sultaneh
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
| | - Kamal Abulebda
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics
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Bransen D, Govaerts MJB, Panadero E, Sluijsmans DMA, Driessen EW. Putting self-regulated learning in context: Integrating self-, co-, and socially shared regulation of learning. MEDICAL EDUCATION 2022; 56:29-36. [PMID: 33988857 PMCID: PMC9291108 DOI: 10.1111/medu.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 06/01/2023]
Abstract
Processes involved in the regulation of learning have been researched for decades, because of its impact on academic and workplace performance. In fact, self-regulated learning is the focus of countless studies in health professions education and higher education in general. While we will always need competent individuals who are able to regulate their own learning, developments in healthcare require a shift from a focus on the individual to the collective: collaboration within and between healthcare teams is at the heart of high-quality patient care. Concepts of collaborative learning and collective competence challenge commonly held conceptualisations of regulatory learning and call for a focus on the social embeddedness of regulatory learning and processes regulating the learning of the collective. Therefore, this article questions the alignment of current conceptualisations of regulation of learning with demands for collaboration in current healthcare. We explore different conceptualisations of regulation of learning (self-, co-, and socially shared regulation of learning), and elaborate on how the integration of these conceptualisations adds to our understanding of regulatory learning in healthcare settings. Building on these insights, we furthermore suggest ways forward for research and educational practice.
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Affiliation(s)
- Derk Bransen
- School of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
| | - Marjan J. B. Govaerts
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life ScienceMaastricht UniversityMaastrichtThe Netherlands
| | - Ernesto Panadero
- Facultad de Psicología y EducaciónUniversidad de DeustoBilbaoEspaña
- IKERBASQUEBasque Foundation for ScienceBilbaoSpain
| | | | - Erik W. Driessen
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life ScienceMaastricht UniversityMaastrichtThe Netherlands
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Luu C, Chan M, Langga L, Bragg E, Rake A, Young C, Lau J, Guerrero E, Buan J, Chang T. Development of a Mannequin for Simulation-Based Trials Involving Respiratory Viral Spread During Respiratory Arrest and Cardiopulmonary Arrest Scenarios. Cureus 2021; 13:e20304. [PMID: 35028208 PMCID: PMC8744367 DOI: 10.7759/cureus.20304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/12/2022] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, mannequin models have been developed to mimic viral spread using fluorescent particles. These models use contraptions such as a spray gun or an exploding latex balloon to emanate a sudden acceleration of particles, simulating a "cough" reflex. No models have been developed to mimic passive aerosolization of viral particles during a cardiopulmonary arrest simulation. Our novel approach to aerosolization of simulated viral spread allows for a continuous flow of particles, which allows us to maintain components of high-fidelity team-based simulations. Our simulated model emanated GloGerm (Moab, UT) from the respiratory tract using a continuous nebulization chamber. Uniquely, the construction of our apparatus allowed for the ability to perform full, simulated cardiopulmonary resuscitation scenarios (such as chest compressions, bag-mask ventilation, and endotracheal intubation) on a high-fidelity mannequin while visualizing potential contamination spread at the conclusion of the simulation. Positive feedback from users included the ability to visualize particulate contamination after cardiopulmonary resuscitations in the context of personal protective equipment usage and roles in resuscitation (i.e. physician, respiratory therapist, nurse). Negative criticism towards the simulation included the lack of certain high-fidelity feedback markers of the mannequin (auscultating breath sounds and checking pulses) due to the construction of the particle aerosolization mechanism.
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Affiliation(s)
- Cindy Luu
- Department of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Margaux Chan
- Las Madrinas Simulation Center, Children's Hospital Los Angeles, Los Angeles, USA
| | - Leo Langga
- Department of Respiratory Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Elizabeth Bragg
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Alyssa Rake
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Caulette Young
- Las Madrinas Simulation Center, Children's Hospital Los Angeles, Los Angeles, USA
| | - Jennifer Lau
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Edward Guerrero
- Department of Respiratory Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Joshua Buan
- Department of Respiratory Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Todd Chang
- Department of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, USA
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Joseph MN, Chang J, Buck SG, Auerbach MA, Wong AH, Beardsley TD, Reeves PM, Ray JM, Evans LV. A Novel Application of the Modified Angoff Method to Rate Case Difficulty in Simulation-Based Research. Simul Healthc 2021; 16:e142-e150. [PMID: 33273423 DOI: 10.1097/sih.0000000000000530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Simulation use in research is often limited by controlling for scenario difficulty when using repeated measures. Our study assesses the feasibility of the Modified Angoff Method to reach expert consensus regarding difficulty of medical simulations. We compared scores with participant physiologic stress. METHODS Emergency medicine physicians with expertise in simulation education were asked to review 8 scenarios and estimate the percentage of resident physicians who would perform all critical actions using the modified Angoff method. A standard deviation (SD) of less than 10% of estimated percentage correct signified consensus. Twenty-five residents then performed the 6 scenarios that met consensus and heart rate variability (HRV) was measured. RESULTS During round 1, experts rated 4/8 scenarios within a 10% SD for postgraduate year 3 (PGY3) and 3/8 for PGY4 residents. In round 2, 6/8 simulation scenarios were within an SD of 10% points for both years. Intraclass correlation coefficient was 0.84 for PGY3 ratings and 0.89 for PGY4 ratings. A mixed effects analysis of variance showed no significant difference in HRV change from rest to simulation between teams or scenarios. Modified Angoff Score was not a predictor of HRV (multiple R2 = 0.0176). CONCLUSIONS Modified Angoff ratings demonstrated consensus in quantifying the estimated percentage of participants who would complete all critical actions for most scenarios. Although participant HRV did decrease during the scenarios, we were unable to significantly correlate this with ratings. This modified Angoff method is a feasible approach to evaluate simulation difficulty for educational and research purposes and may decrease the time and resources necessary for scenario piloting.
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Affiliation(s)
- Melissa N Joseph
- From the Department of Emergency Medicine (M.N.J., S.G.B., M.A.A., A.H.W., J.M.R., L.V.E.), Yale School of Medicine; Yale School of Medicine (J.C.), New Haven, CT; University of Florida COM-Jacksonville (T.D.B.), Jacksonville, FL; and Johns Hopkins University School of Medicine (P.M.R.), Baltimore, Maryland
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Abulebda K, Whitfill T, Montgomery EE, Kirby ML, Ahmed RA, Cooper DD, Nitu ME, Auerbach MA, Lutfi R, Abu-Sultaneh S. Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based Collaborative Improvement Program. Pediatr Emerg Care 2021; 37:543-549. [PMID: 30870337 DOI: 10.1097/pec.0000000000001751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs. METHODS This prospective interventional study measured adherence of multiprofessional teams caring for pediatric DKA patients preimplementation and postimplementation of an improvement program in simulated setting. The program consisted of (a) a postsimulation debriefing, (b) assessment reports, (c) distribution of educational materials and access to pediatric resources, and (d) ongoing communication with the academic medical center (AMC). All simulations were conducted in situ (in the CED resuscitation bay) and were facilitated by a collaborative team from the AMC. A composite adherence score was calculated using a critical action checklist. A mixed linear regression model was performed to examine the impact of CED and team-level variables on the scores. RESULTS A total of 91 teams from 13 CEDs participated in simulated sessions. There was a 22-point improvement of overall adherence to the DKA checklist from the preintervention to the postintervention simulations. Six of 9 critical checklist actions showed statistically significant improvement. Community emergency departments with medium pediatric volume showed the most overall improvement. Teams from CEDs that are further from the AMC showed the least improvement from baseline. CONCLUSIONS This study demonstrated a significant improvement in adherence to pediatric DKA guidelines in CEDs across the state after execution of an in situ simulation-based collaborative improvement program.
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Affiliation(s)
- Kamal Abulebda
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | | | | | | | - Rami A Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | - Dylan D Cooper
- Department of Emergency Medicine, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | - Mara E Nitu
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | | | - Riad Lutfi
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | - Samer Abu-Sultaneh
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
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Alsaedi H, Berrens ZJ, Lutfi R, Weinstein E, Montgomery EE, Pearson KJ, Kirby ML, Abu-Sultaneh S, Abulebda K, Thammasitboon S. Simulation-based assessment of care for infant cardiogenic shock in the emergency department. Nurs Crit Care 2021; 28:353-361. [PMID: 34699685 DOI: 10.1111/nicc.12716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is the leading cause of infant deaths associated with birth defects. Neonates with undiagnosed CHD often present to general emergency departments (GEDs) for initial resuscitation that are less prepared than paediatric centres, resulting in disparities in the quality of care. Neonates with undiagnosed CHD represent a challenge; thus, it is necessary for GEDs to be prepared for this population. AIM To evaluate the process of resuscitative care provided to a neonate in cardiogenic shock due to CHD in the GEDs in a simulated setting and to describe the impact of teams and GED variables on the process of care. METHODS This is a prospective simulation-based assessment of the process of care provided to a neonate with coarctation of the aorta in cardiogenic shock. Simulation sessions were conducted at participating GEDs utilizing each GED's interdisciplinary team and resources. The primary outcome was adherence to best practice, as measured by a 15-item overall composite adherence score (CAS). In addition, we stratified the overall CAS into CHD-critical items and the general resuscitation items CAS. The secondary outcome was the impact of the team's and GED's characteristics on the scores. FINDINGS This study enrolled 32 teams from 12 GEDs. Among 161 participants, 103 (63.97%) were registered nurses, 33 (20.50%) were physicians, 17 (10.56%) were respiratory therapists, and 8 (4.97%) were other medical professionals. The overall median CAS was 84, with the CHD-critical items having a median CAS of 34.5. The most underperformed tasks are checking pulses on the upper and lower extremities (44%), obtaining blood pressure in the upper and lower extremities (25%), and administering prostaglandin E1 (22%). CONCLUSIONS Using in situ simulation in a set of GEDs, we revealed gaps in the resuscitation care of neonates with CHD in cardiogenic shock. RELEVANCE TO CLINICAL PRACTICE These findings highlight the importance of targeted improvement programs for high-stakes illnesses in GED.
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Affiliation(s)
- Hani Alsaedi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Zachary J Berrens
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Riad Lutfi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Elizabeth Weinstein
- Department of Emergency Medicine, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana, USA
| | - Kellie J Pearson
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana, USA
| | - Michelle L Kirby
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana, USA
| | - Samer Abu-Sultaneh
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Satid Thammasitboon
- Associate Professor of Pediatrics, Critical Care Medicine Section, Director, Center for Research, Innovation and Scholarship in Medical Education (CRIS), Chair, Resident Scholarship Program Executive Committee, Texas Children's Hospital Baylor College of Medicine, Houston, Texas, USA
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Lacour M, Bloudeau L, Combescure C, Haddad K, Hugon F, Suppan L, Rodieux F, Lovis C, Gervaix A, Ehrler F, Manzano S, Siebert JN. Impact of a Mobile App on Paramedics' Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e31748. [PMID: 34617916 PMCID: PMC8532016 DOI: 10.2196/31748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrests (OHCAs) are stressful, high-stake events that are associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services. Children are particularly vulnerable to such errors. To date, no app has been validated to specifically support emergency drug preparation by paramedics through reducing the stress level of this procedure and medication errors. OBJECTIVE This study aims to determine the effectiveness of an evidence-based mobile app compared with that of the conventional preparation methods in reducing acute stress in paramedics at the psychological and physiological levels while safely preparing emergency drugs during simulated pediatric OHCA scenarios. METHODS In a parent, multicenter, randomized controlled trial of 14 emergency medical services, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario in an 18-month-old child. The primary outcome was participants' self-reported psychological stress perceived during sequential preparations of 4 intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate) with the support of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory and Visual Analog Scale questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of the participants' heart rate with optical photoplethysmography. RESULTS From September 3, 2019, to January 21, 2020, 150 advanced paramedics underwent randomization. A total of 74 participants were assigned to the mobile app (intervention group), and 76 did not use the app (control group). A total of 600 drug doses were prepared. Higher State-Trait Anxiety Inventory-perceived stress increase from baseline was observed during the scenario using the conventional methods (mean 35.4, SD 8.2 to mean 49.8, SD 13.2; a 41.3%, 35.0 increase) than when using the app (mean 36.1, SD 8.1 to mean 39.0, SD 8.4; a 12.3%, 29.0 increase). This revealed a 30.1% (95% CI 20.5%-39.8%; P<.001) lower relative change in stress response in participants who used the app. On the Visual Analog Scale questionnaire, participants in the control group reported a higher increase in stress at the peak of the scenario (mean 7.1, SD 1.8 vs mean 6.4, SD 1.9; difference: -0.8, 95% CI -1.3 to -0.2; P=.005). Increase in heart rate during the scenario and over the 4 drugs was not different between the 2 groups. CONCLUSIONS Compared with the conventional method, dedicated mobile apps can reduce acute perceived stress during the preparation of emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. TRIAL REGISTRATION ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-019-3726-4.
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Affiliation(s)
- Matthieu Lacour
- University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | | | - Christophe Combescure
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Hugon
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Suppan
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédérique Rodieux
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Lovis
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Ehrler
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Sergio Manzano
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Johan N Siebert
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
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- See Authors' Contributions,
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Abulebda K, Yuknis ML, Whitfill T, Montgomery EE, Pearson KJ, Rousseau R, Diaz MCG, Brown LL, Wing R, Tay KY, Good GL, Malik RN, Garrow AL, Zaveri PP, Thomas E, Makharashvili A, Burns RA, Lavoie M, Auerbach MA. Preparedness for Pediatric Office Emergencies: A Multicenter, Simulation-Based Study. Pediatrics 2021; 148:peds.2020-038463. [PMID: 34433688 DOI: 10.1542/peds.2020-038463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Pediatric emergencies can occur in pediatric primary care offices. However, few studies have measured emergency preparedness, or the processes of emergency care, provided in the pediatric office setting. In this study, we aimed to measure emergency preparedness and care in a national cohort of pediatric offices. METHODS This was a multicenter study conducted over 15 months. Emergency preparedness scores were calculated as a percentage adherence to 2 checklists on the basis of the American Academy of Pediatrics guidelines (essential equipment and supplies and policies and protocols checklists). To measure the quality of emergency care, we recruited office teams for simulation sessions consisting of 2 patients: a child with respiratory distress and a child with a seizure. An unweighted percentage of adherence to checklists for each case was calculated. RESULTS Forty-eight teams from 42 offices across 9 states participated. The mean emergency preparedness score was 74.7% (SD: 12.9). The mean essential equipment and supplies subscore was 82.2% (SD: 15.1), and the mean policies and protocols subscore was 57.1% (SD: 25.6). Multivariable analyses revealed that independent practices and smaller total staff size were associated with lower preparedness. The median asthma case performance score was 63.6% (interquartile range: 43.2-81.2), whereas the median seizure case score was 69.2% (interquartile range: 46.2-80.8). Offices that had a standardized process of contacting emergency medical services (EMS) had a higher rate of activating EMS during the simulations. CONCLUSIONS Pediatric office preparedness remains suboptimal in a multicenter cohort, especially in smaller, independent practices. Academic and community partnerships using simulation can help address gaps and implement important processes like contacting EMS.
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Affiliation(s)
- Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Indiana University and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Matthew L Yuknis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Indiana University and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Travis Whitfill
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana
| | - Kellie J Pearson
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana
| | - Rosa Rousseau
- Department of Pediatric Emergency, Inova Fairfax Medical Center, Fairfax, Virginia
| | - Maria Carmen G Diaz
- Nemours Institute for Clinical Excellence, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Linda L Brown
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School, Brown University and Hasbro Children's Hospital, Providence, Rhode Island
| | - Robyn Wing
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School, Brown University and Hasbro Children's Hospital, Providence, Rhode Island
| | - Khoon-Yen Tay
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grace L Good
- Center for Simulation, Advanced Education, and Innovation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rabia N Malik
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amanda L Garrow
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, England
| | - Pavan P Zaveri
- Emergency Medicine and Trauma Center, Children's National, Washington, District of Columbia
| | - Eileen Thomas
- College of Health Professions, Pace University, New York, New York
| | - Ana Makharashvili
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rebekah A Burns
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Megan Lavoie
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Simulation-based research in emergency medicine in Canada: Priorities and perspectives. CAN J EMERG MED 2021; 22:103-111. [PMID: 31554535 DOI: 10.1017/cem.2019.416] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Simulation plays an integral role in the Canadian healthcare system with applications in quality improvement, systems development, and medical education. High-quality, simulation-based research will ensure its effective use. This study sought to summarize simulation-based research activity and its facilitators and barriers, as well as establish priorities for simulation-based research in Canadian emergency medicine (EM). METHODS Simulation-leads from Canadian departments or divisions of EM associated with a general FRCP-EM training program surveyed and documented active EM simulation-based research at their institutions and identified the perceived facilitators and barriers. Priorities for simulation-based research were generated by simulation-leads via a second survey; these were grouped into themes and finally endorsed by consensus during an in-person meeting of simulation leads. Priority themes were also reviewed by senior simulation educators. RESULTS Twenty simulation-leads representing all 14 invited institutions participated in the study between February and May, 2018. Sixty-two active, simulation-based research projects were identified (median per institution = 4.5, IQR 4), as well as six common facilitators and five barriers. Forty-nine priorities for simulation-based research were reported and summarized into eight themes: simulation in competency-based medical education, simulation for inter-professional learning, simulation for summative assessment, simulation for continuing professional development, national curricular development, best practices in simulation-based education, simulation-based education outcomes, and simulation as an investigative methodology. CONCLUSION This study summarized simulation-based research activity in EM in Canada, identified its perceived facilitators and barriers, and built national consensus on priority research themes. This represents the first step in the development of a simulation-based research agenda specific to Canadian EM.
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Pettersen G, Gauvin F, Robitaille N, Sansregret A, Lesage S, Levy A. Massive Hemorrhage Protocol Application and Teamwork Skills. AEM EDUCATION AND TRAINING 2021; 5:e10513. [PMID: 34027278 PMCID: PMC8122128 DOI: 10.1002/aet2.10513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Massive hemorrhages (MHs) are rare but serious complications of pediatric trauma and obstetric cases. This study aimed to evaluate the impact of interprofessional simulation to improve adherence to a MH protocol (MHP), teamwork skills and confidence levels during a hemorrhagic crisis situation.Methods: This was a pre-post experimental study conducted at a tertiary care mother-child simulation center. Pediatric emergency and obstetric teams were submitted to simulated trauma and postpartum MH scenarios. Training consisted of two case scenarios followed by debriefing sessions and a lecture on the MHP. The primary outcome was adherence to MHP processes (checklist) measured prior to and 2 weeks following training sessions. Other outcomes were the measure of teamwork skills (Mayo High Performance Teamwork Scale) and confidence of the participants. RESULTS Sixty-two health care professionals were involved in eight interprofessional teams. Mean scores for adherence to the MHP improved from 19.1 in the pretraining phase to 25.8 in the posttraining phase (difference of 6.7; 95% confidence interval [CI] = 4.4 to 8.9). Mean scores pertaining to teamwork skills also improved significantly between pre- and posttraining phases (difference = 3.9; 95% CI = 1.5 to 6.4). Confidence questionnaires showed significant improvements in the posttraining phase (difference = 6.9; 95% CI = 5.3 to 8.3). CONCLUSIONS Targeted training involving simulation and protocol review improved participant adherence to MHP processes and teamwork skills. Confidence levels improved across all disciplines.
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Affiliation(s)
- Géraldine Pettersen
- Critical Care DivisionDepartment of PediatricsUniversity of MontrealMontrealQCCanada
| | - France Gauvin
- Critical Care DivisionDepartment of PediatricsUniversity of MontrealMontrealQCCanada
| | - Nancy Robitaille
- Hematology‐Oncology DivisionUniversity of MontrealMontrealQCCanada
| | - Andrée Sansregret
- Department of Obstetrics‐GynecologyUniversity of MontrealMontrealQCCanada
| | - Sandra Lesage
- Department of AnesthesiologyUniversity of MontrealMontrealQCCanada
| | - Arielle Levy
- Department of Pediatric Emergency MedicineUniversity of MontrealMontrealQCCanada
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Manton JW, Kennedy KS, Lipps JA, Pfeil SA, Cornelius BW. Medical Emergency Management in the Dental Office (MEMDO): A Pilot Study Assessing a Simulation-Based Training Curriculum for Dentists. Anesth Prog 2021; 68:76-84. [PMID: 34185862 PMCID: PMC8258755 DOI: 10.2344/anpr-67-04-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/20/2020] [Indexed: 11/11/2022] Open
Abstract
In the event of a medical emergency in the dental office, the dentist must be able to identify a patient in distress, assess the situation, and institute proper management. This study assessed the impact of a simulation-based medical emergency preparedness curriculum on a resident's ability to manage medical emergencies. This interventional and pre-post educational pilot study included 8 participants who completed a standard curriculum and 8 who completed a modified curriculum (N = 16). The intervention consisted of a comprehensive medical emergency preparedness curriculum that replaced lecture sessions in a standard curriculum. Participants completed performance assessments using scenario-based objective structured clinical examinations (OSCEs) that were recorded and evaluated by calibrated faculty reviewers using a customized scoring grid. The intervention group performed significantly better than the control group on their summative OSCEs, averaging 90.9 versus 61.2 points out of 128 (p = .0009). All participants from the intervention group passed their summative OSCE with scores >60%, while none from the control group received passing scores. Completion of a simulation-based medical emergency preparedness curriculum significantly improved resident performance during simulated medical emergencies.
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Affiliation(s)
- Jesse W Manton
- The Ohio State University, College of Dentistry, Division of Oral and Maxillofacial Surgery and Dental Anesthesiology
- The Ohio State University, College of Medicine, Department of Anesthesiology
| | - Kelly S Kennedy
- The Ohio State University, College of Dentistry, Division of Oral and Maxillofacial Surgery and Dental Anesthesiology
| | - Jonathan A Lipps
- The Ohio State University, College of Medicine, Department of Anesthesiology
| | - Sheryl A Pfeil
- The Ohio State University, College of Medicine, Medical Director-Clinical Skills Education and Assessment Center
- The Ohio State University, College of Medicine, Department of Internal Medicine Division of Gastroenterology, Hepatology and Nutrition, Columbus, Ohio
| | - Bryant W Cornelius
- The Ohio State University, College of Dentistry, Division of Oral and Maxillofacial Surgery and Dental Anesthesiology
- The Ohio State University, College of Medicine, Department of Anesthesiology
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Reed K, Reed B, Bailey J, Beattie K, Lynch E, Thompson J, Vines R, Wong KC, McCrossin T, Wilson R. Interprofessional education in the rural environment to enhance multidisciplinary care in future practice: Breaking down silos in tertiary health education. Aust J Rural Health 2021; 29:127-136. [PMID: 33982852 DOI: 10.1111/ajr.12733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Western Sydney University has implemented a rural interprofessional learning programme to promote collaborative care approaches to enhance cross-discipline communications, improve knowledge and clarity of roles and improve patient care and outcomes. DESIGN Rural interprofessinal learning is an interprofessional educational approach, consisting of simulations of complex health events. Simulation methodology frames the study with a focus on human interaction. A mixed-methods evaluation has been conducted, incorporating pre- and post- event participant surveys along with semi-structured focus groups. SETTING Simulations are conducted in the rural setting, including community settings, working farms and rural hospitals. MAIN OUTCOME MEASURES Reflexive thematic analysis was used to identify themes measuring students' perceptions of interdisciplinary care, knowlede of other health discipline roles and skills and how they believe the exercise will influence their future practice. Facilitator feedback regarding the efficacy of the simulations was also recorded and analysed using reflexive thematic analysis. PARTICIPANTS Care of simulated patient(s)/bystander(s) is primarily provided by paramedicine, nursing and medical students; however, increasing interest has expanded the programme to include students from a range of allied health professions. Simulations are facilitated by a multidisciplinary team of experienced practitioners and specialists. INTERVENTION Four rural interprofessional learning events have been held. RESULTS 120 students have participated in the evaluation. Findings include increased understanding of the contributions of other disciplines in enhancing patient care, team approaches, cross-discipline communication and a need to engage in collaborative care in future practice. CONCLUSION Creating a collaborative learning environment creates a culture of multidisciplinary care, enhancing patient care and improving outcomes. The rural interprofessional learning model is an effective interprofessional educational approach, which can be repeated, refined and improved for continual professional development.
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Affiliation(s)
- Krista Reed
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia.,School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Buck Reed
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Karen Beattie
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Elizabeth Lynch
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Jane Thompson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Robyn Vines
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Kam Cheong Wong
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Tim McCrossin
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Ross Wilson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
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Chmielewski J, Łoś K, Waszkiewicz N, Łuczyński W. Mindfulness Is Related to the Situational Awareness of Medical Students Confronted with Life-Threatening Emergency Situations. J Clin Med 2021; 10:jcm10091955. [PMID: 34063194 PMCID: PMC8124909 DOI: 10.3390/jcm10091955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Emergency medicine can impose a heavy psychological burden on healthcare workers. Stress experienced during life-threatening situations may disrupt situational awareness (SA), i.e., the perception of environmental elements with respect to time and space, the comprehension of their meaning, and the projection of their state into the near future. We aimed to investigate whether mindfulness (a special way of paying attention: conscious, non-judgmental, and oriented to the present moment) can be related to the SA levels among final-year medical students confronted with life-threatening situations during medical simulations. METHODS The simulations were constructed as high-fidelity scenarios in children and adults (ClinicalTrials.gov ID: NCT03761355). The components of mindfulness were assessed using the Five Facet Mindfulness Questionnaire. SA among students was assessed using The Situation Awareness Global Assessment Technique at three levels: (1) data, (2) comprehension, and (3) projection. RESULTS In total, 117 students were included. Level 1 SA positively correlated with the overall mindfulness score and its components, i.e., nonreactivity, conscious presence, and nonjudgment. Moreover, level 3 SA significantly correlated with the description, but not with the overall mindfulness score. A regression model showed that nonreactivity explained 34% of Level 1 of SA variability. The addition of conscious presence and nonjudgment into this model did not change its predictive value. CONCLUSIONS nonreactivity a component of mindfulness of final-year medical students is related to the meticulous data collection of patients in life-threatening situations.
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Affiliation(s)
- Jacek Chmielewski
- Department of Psychiatry, Medical University of Białystok, Plac Brodowicza 1, 16-070 Choroszcz, Poland; (J.C.); (N.W.)
| | - Kacper Łoś
- Department of Medical Simulations, Medical University of Białystok, Szpitalna 30, 15-295 Białystok, Poland;
| | - Napoleon Waszkiewicz
- Department of Psychiatry, Medical University of Białystok, Plac Brodowicza 1, 16-070 Choroszcz, Poland; (J.C.); (N.W.)
| | - Włodzimierz Łuczyński
- Department of Medical Simulations, Medical University of Białystok, Szpitalna 30, 15-295 Białystok, Poland;
- Correspondence: ; Tel.: +48-85-686-5253
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Bae GE, Choi A, Beom JH, Kim MJ, Chung HS, Min IK, Chung SP, Kim JH. Correlation between real-time heart rate and fatigue in chest compression providers during cardiopulmonary resuscitation: A simulation-based interventional study. Medicine (Baltimore) 2021; 100:e25425. [PMID: 33879672 PMCID: PMC8078290 DOI: 10.1097/md.0000000000025425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/26/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The American Heart Association guidelines recommend switching chest compression providers at least every 2 min depending on their fatigue during cardiopulmonary resuscitation (CPR). Although the provider's heart rate is widely used as an objective indicator for detecting fatigue, the accuracy of this measure is debatable. OBJECTIVES This study was designed to determine whether real-time heart rate is a measure of fatigue in compression providers. STUDY DESIGN A simulation-based prospective interventional study including 110 participants. METHODS Participants performed chest compressions in pairs for four cycles using advanced cardiovascular life support simulation. Each participant's heart rate was measured using wearable healthcare devices, and qualitative variables regarding individual compressions were obtained from computerized devices. The primary outcome was correct depth of chest compressions. The main exposure was the change in heart rate, defined as the difference between the participant's heart rate during individual compressions and that before the simulation was initiated. RESULTS With a constant compression duration for one cycle, the overall accuracy of compression depth significantly decreased with increasing heart rate. Female participants displayed significantly decreased accuracy of compression depth with increasing heart rate (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.98; P < .001). Conversely, male participants displayed significantly improved accuracy with increasing heart rate (OR: 1.03; 95% CI: 1.02-1.04; P < .001). CONCLUSION Increasing heart rate could reflect fatigue in providers performing chest compressions with a constant duration for one cycle. Thus, provider rotation should be considered according to objectively measured fatigue during CPR.
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Affiliation(s)
| | | | | | | | | | - In Kyung Min
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea
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Ehrler F, Sahyoun C, Manzano S, Sanchez O, Gervaix A, Lovis C, Courvoisier DS, Lacroix L, Siebert JN. Impact of a shared decision-making mHealth tool on caregivers' team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial. Trials 2021; 22:277. [PMID: 33849611 PMCID: PMC8042906 DOI: 10.1186/s13063-021-05170-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background Effective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR. Methods We will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication. Discussion This clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology. Trial registration ClinicalTrials.gov NCT04464603. Registered on 9 July 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05170-3.
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Affiliation(s)
- Frédéric Ehrler
- Department of Diagnostic, Geneva University Hospitals, Geneva, Switzerland
| | - Cyril Sahyoun
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Oliver Sanchez
- Division of Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Christian Lovis
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | | | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland
| | - Johan N Siebert
- Department of Pediatric Emergency Medicine, Children's Hospital, Geneva University Hospitals, 47 Avenue de la Roseraie, 1211, Geneva 14, Switzerland. .,University of Geneva, Geneva, Switzerland.
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Influence of Cardiopulmonary Resuscitation Coaching on Interruptions in Chest Compressions During Simulated Pediatric Cardiac Arrest. Pediatr Crit Care Med 2021; 22:345-353. [PMID: 33214515 DOI: 10.1097/pcc.0000000000002623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the impact of a cardiopulmonary resuscitation coach on the frequency and duration of pauses during simulated pediatric cardiac arrest. DESIGN This is a secondary analysis of video data collected from a prospective multicenter trial. Forty simulated pediatric cardiac arrest scenarios (20 noncoach and 20 coach teams), each lasting 18 minutes in duration, were reviewed by three clinical experts to document events surrounding each pause in chest compressions. SETTING Four pediatric academic medical centers from Canada and the United States. SUBJECTS Two-hundred healthcare providers in five-member interprofessional resuscitation teams that included either a cardiopulmonary resuscitation coach or a noncoach clinical provider. INTERVENTIONS Teams were randomized to include either a trained cardiopulmonary resuscitation coach or an additional noncoach clinical provider. MEASUREMENTS AND MAIN RESULTS The frequency, duration, and associated factors with each interruption in chest compressions were recorded and compared between the groups with and without a cardiopulmonary resuscitation coach, using t tests, Wilcoxon rank-sum tests, or chi-squared tests, depending on the distribution and types of outcome variables. Mixed-effect linear models were used to explore the effect of cardiopulmonary resuscitation coaching on pause durations, accounting for multiple measures of pause duration within teams. A total of 655 pauses were identified (noncoach n = 304 and coach n = 351). Cardiopulmonary resuscitation-coached teams had decreased total mean pause duration (98.6 vs 120.85 s, p = 0.04), decreased intubation pause duration (median 4.0 vs 15.5 s, p = 0.002), and similar mean frequency of pauses (17.6 vs 15.2, p = 0.33) when compared with noncoach teams. Teams with cardiopulmonary resuscitation coaches are more likely to verbalize the need for pause (86.5% vs 73.7%, p < 0.001) and coordinate change of the compressors, rhythm check, and pulse check (31.7% vs 23.2%, p = 0.05). Teams with cardiopulmonary resuscitation coach have a shorter pause duration than non-coach teams, adjusting for number and types of tasks performed during the pause. CONCLUSIONS When compared with teams without a cardiopulmonary resuscitation coach, the inclusion of a trained cardiopulmonary resuscitation coach leads to improved verbalization before pauses, decreased pause duration, shorter pauses during intubation, and better coordination of key tasks during chest compression pauses.
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Duff JP, Bhanji F, Lin Y, Overly F, Brown LL, Bragg EA, Kessler D, Tofil NM, Bank I, Hunt EA, Nadkarni V, Cheng A. Change in Cardiopulmonary Resuscitation Performance Over Time During Simulated Pediatric Cardiac Arrest and the Effect of Just-in-Time Training and Feedback. Pediatr Emerg Care 2021; 37:133-137. [PMID: 33651758 DOI: 10.1097/pec.0000000000002359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Effective cardiopulmonary resuscitation (CPR) is critical to ensure optimal outcomes from cardiac arrest, yet trained health care providers consistently struggle to provide guideline-compliant CPR. Rescuer fatigue can impact chest compression (CC) quality during a cardiac arrest event, although it is unknown if visual feedback or just-in-time training influences change of CC quality over time. In this study, we attempt to describe the changes in CC quality over a 12-minute simulated resuscitation and examine the influence of just-in-time training and visual feedback on CC quality over time. METHODS We conducted secondary analysis of data collected from the CPRCARES study, a multicenter randomized trial in which CPR-certified health care providers from 10 different pediatric tertiary care centers were randomized to receive visual feedback, just-in-time CPR training, or no intervention. They participated in a simulated cardiac arrest scenario with 2 team members providing CCs. We compared the quality of CCs delivered (depth and rate) at the beginning (0-4 minutes), middle (4-8 minutes), and end (8-12 minutes) of the resuscitation. RESULTS There was no significant change in depth over the 3 time intervals in any of the arms. There was a significant increase in rate (128 to 133 CC/min) in the no intervention arm over the scenario duration (P < 0.05). CONCLUSIONS There was no significant drop in CC depth over a 12-minute cardiac arrest scenario with 2 team members providing compressions.
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Affiliation(s)
| | | | - Yiqun Lin
- University of Calgary, Calgary, Canada
| | | | | | | | - David Kessler
- Columbia University Vagelos College of Physicians and Surgeons New York, NY
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Kong JY, Bharadwaj SS, Chinnadurai A, Ho SKY. Being Prepared During the Evolving COVID-19 Pandemic: A Neonatal Experience in Training and Simulation. Front Pediatr 2021; 9:785524. [PMID: 34926355 PMCID: PMC8674782 DOI: 10.3389/fped.2021.785524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Rapid spread of the COVID-19 pandemic raised an urgent need for preparedness in the healthcare sector, including training of healthcare workers to cope with the burden of infected cases while ensuring proper protection of themselves. Improper infection prevention and control measures were key reasons for infection in healthcare workers during the early phase of the outbreak. Objectives/Methods: This paper describes the combined approach of 3 restructured hospitals in Singapore in preparing and training neonatal healthcare workers' during the COVID-19 pandemic crisis, as well as lessons learnt during this process. Results: Information sharing was conducted in the form of e-learning, emphasizing on topics like disease knowledge and infection prevention and control procedures. Skills and competency training were carried out in the form of simulation, with sessions scaled into 4 levels progressing from individual task training to larger group simulations involving multiple disciplines and departments. Challenges encountered included information fatigue by large amount of constantly changing information and multiple amendments to workflows as more information arose. Difficulties conducting training and simulation sessions included restriction of group size to mitigate infection risk amongst participants and the limited supply of personal protective equipment prioritized for direct patient care. Conclusion: Healthcare institutions should ensure adequate dissemination of conceptual knowledge as well as skills competency training of staff in infection control measures for the protection of healthcare workers and patient safety. Ongoing training for sustainability of knowledge and skills, while adapting to the rapidly evolving situation is important in the preparation for future outbreaks.
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Affiliation(s)
- Juin Yee Kong
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Srabani Samanta Bharadwaj
- Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - Amutha Chinnadurai
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Neonatology, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Selina Kah Ying Ho
- Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore
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Asakura K, Bogo M. Editorial: The Use of Simulation in Advancing Clinical Social Work Education and Practice. CLINICAL SOCIAL WORK JOURNAL 2021; 49:111-116. [PMID: 33994599 PMCID: PMC8106363 DOI: 10.1007/s10615-021-00810-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 05/16/2023]
Affiliation(s)
- Kenta Asakura
- Carleton University School of Social Work, Ottawa, ON Canada
| | - Marion Bogo
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON Canada
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