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Collis AC, Raikhel AV, Bell JR, Carlbom D, Roach V, Rosenman ED. A Rapid Response Mobile Application Improves First-Year Resident Clinical Performance During Simulated Care Events: A Randomized Controlled Trial. J Gen Intern Med 2024:10.1007/s11606-024-08949-7. [PMID: 39037518 DOI: 10.1007/s11606-024-08949-7] [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: 02/22/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Rapid response teams (RRTs) are critical to the timely and appropriate management of acutely decompensating patients. In the academic setting, the vital role of RRT leader is often filled by a junior resident physician who may lack the necessary medical knowledge and experience. Cognitive aids help improve guideline adherence and may support resident performance as they transition into leadership roles. OBJECTIVE This study evaluated the impact of a rapid response mobile application on intern performance during simulated rapid response events. DESIGN This randomized controlled trial compared the performance of interns in two simulated rapid response scenarios with and without access to the rapid response mobile application. The scenarios included anaphylaxis and supraventricular tachycardia (SVT). Simulations were video recorded and coded by trained raters. PARTICIPANTS Interns in all specialties at our institution. MAIN MEASURES Outcomes included (1) time to ordering critical medications (epinephrine and adenosine), (2) overall clinical performance using a checklist-based performance measure, and (3) usability of the mobile application. Enrollment and data collection occurred between November 2022 and February 2023. KEY RESULTS Forty-four interns from 12 specialties were randomized to the intervention group (N = 22) and the control group (N = 22). Time to order critical medications was significantly reduced in the intervention group compared to control for anaphylaxis (P < 0.005) and SVT (P < 0.005). The intervention group had significantly higher performance scores compared to the control group for the anaphylaxis portion (P < 0.006). Usability scores for the rapid response toolkit were good. CONCLUSIONS Access to a rapid response mobile application improved the quality of care administered by interns during two simulated rapid response scenarios as determined by a decrease in time to ordering critical medications and improved performance scores. The intervention group found the mobile application to be usable. This work adds to existing literature supporting the use of technology-based cognitive aids to improve patient care.
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Affiliation(s)
- Alexandra C Collis
- University of Washington, Seattle, WA, USA.
- University of Washington Medical Center, Seattle, USA.
| | - A Vincent Raikhel
- University of Washington, Seattle, WA, USA
- Seattle VA Medical Center, Seattle, USA
| | | | - David Carlbom
- University of Washington, Seattle, WA, USA
- Harborview Medical Center Seattle, Seattle, USA
| | | | - Elizabeth D Rosenman
- University of Washington, Seattle, WA, USA
- University of Washington Medical Center, Seattle, USA
- Harborview Medical Center Seattle, Seattle, USA
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Gu H, Perl J, Rhine W, Yamada NK, Sherman J, McMillin A, Halamek LP, Wall JK, Fuerch JH. A Novel Method for Administering Epinephrine during Neonatal Resuscitation. Am J Perinatol 2024; 41:e1850-e1857. [PMID: 37105225 DOI: 10.1055/a-2082-4729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE This study aimed to determine if prefilled epinephrine syringes will reduce time to epinephrine administration compared with conventional epinephrine during standardized simulated neonatal resuscitation. STUDY DESIGN Timely and accurate epinephrine administration during neonatal resuscitation is lifesaving in bradycardic infants. Current epinephrine preparation is inefficient and error-prone. For other emergency use drugs, prefilled medication syringes have decreased error and administration time. Twenty-one neonatal intensive care unit nurses were enrolled. Each subject engaged in four simulated neonatal resuscitation scenarios involving term or preterm manikins using conventional epinephrine or novel prefilled epinephrine syringes specified for patient weight and administration route. All scenarios were video-recorded. Two investigators analyzed video recordings for time to epinephrine preparation and administration. Differences between conventional and novel techniques were evaluated using the Wilcoxon Signed Rank Tests. RESULTS Twenty-one subjects completed 42 scenarios with conventional epinephrine and 42 scenarios with novel prefilled syringes. Epinephrine preparation was faster using novel prefilled epinephrine syringes (median = 17.0 s, interquartile range [IQR] = 13.3-22.8) compared with conventional epinephrine (median = 48.0 s, IQR = 40.5-54.9, n = 42, z = 5.64, p < 0.001). Epinephrine administration was also faster using novel prefilled epinephrine syringes (median = 26.9 s, IQR = 22.1-33.2) compared with conventional epinephrine (median = 57.6 s, IQR = 48.8-66.8, n = 42, z = 5.63, p < 0.001). In a poststudy survey, all subjects supported the clinical adoption of prefilled epinephrine syringes. CONCLUSION During simulated neonatal resuscitation, epinephrine preparation and administration are faster using novel prefilled epinephrine syringes, which may hasten return of spontaneous circulation and be lifesaving for bradycardic neonates in clinical practice. KEY POINTS · Currently, epinephrine administration in neonatal resuscitation is inefficient and error prone.. · Prefilled epinephrine syringes hasten medication administration in simulated neonatal resuscitation.. · Clinical use of prefilled epinephrine syringes may be lifesaving for bradycardic neonates..
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Affiliation(s)
- Hannah Gu
- Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California
| | - Juliana Perl
- Division of Pediatric General Surgery, Stanford University, Palo Alto, California
| | - William Rhine
- Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California
| | - Nicole K Yamada
- Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California
| | - Jules Sherman
- Innovation Ventures, Children's National Research Institute, Washington, District of Columbia
| | - Alexandra McMillin
- Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California
| | - Louis P Halamek
- Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California
| | - James K Wall
- Division of Pediatric General Surgery, Stanford University, Palo Alto, California
| | - Janene H Fuerch
- Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California
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Benguigui L, Le Gouzouguec S, Balanca B, Ristovski M, Putet G, Butin M, Guillois B, Beissel A. A Customizable Digital Cognitive Aid for Neonatal Resuscitation: A Simulation-Based Randomized Controlled Trial. Simul Healthc 2024:01266021-990000000-00119. [PMID: 38587329 DOI: 10.1097/sih.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Adherence to the International Liaison Committee on Resuscitation (ILCOR) algorithm optimizes the initial management of critically ill neonates. In this randomized controlled trial, we assessed the impact of a customizable sequential digital cognitive aid (DCA), adapted from the 2020 ILCOR recommendations, compared with a poster cognitive aid (standard of care [SOC]), on technical and nontechnical performance of junior trainees during a simulated critical neonatal event at birth. METHODS For this prospective, bicentric video-recorded study, students were recruited on a voluntary basis, and randomized into groups of 3 composed of a pediatric resident and two midwife students. They encountered a simulated cardiac arrest at birth either (1) with DCA use and ILCOR algorithm poster displayed on the wall (intervention group) or (2) with sole ILCOR algorithm poster (poster cognitive aid [SOC]). Technical and nontechnical skills (NTS) between the two groups were assessed using a standardized scoring of videotaped performances. A neonate specific NTS score was created from the adult Team score. RESULTS 108 students (36 groups of three) attended the study, 20 groups of 3 in the intervention group and 16 groups of 3 in the poster cognitive aid (SOC) group. The intervention group showed a significant improvement in the technical score (P < 0.001) with an average of 24/27 points (24.0 [23.5-25.0]) versus 20.8/27 (20.8 [19.9-22.5]) in poster cognitive aid (SOC) group. No nontechnical score difference was observed. Feedback on the application was positive. CONCLUSIONS During a simulated critical neonatal event, use of a DCA was associated with higher technical scores in junior trainees, compared with the sole use of ILCOR poster algorithm.
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Affiliation(s)
- Laurie Benguigui
- From the Women, Mother and Children Hospital (L.B., M.B., A.B.), Departement of Neonatology, Claude Bernard University of Lyon, Bron, France; The Center for Teaching by Simulation in Health Care (B.B., A.B.), SAMSEI, Lyon, France; The Normandie Simulation Center in Health Care (NorSimS) (M.R., B.G.), Division of Neonatology, Department of Pediatrics, Caen Normandie University, Caen, France (M.R., B.G.); Fleyriat Hospital, Department of Pediatrics, Division of Pediatric Medecine, Bourg en Bresse, France (S.L.); Pierre Wertheimer Hospital, Department of Anesthesia, Intensive Care Unit, Bron, France (B.B.); and Croix-Rousse University Hospital, Department of Neonatology, Lyon, France (G.P.)
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Kardaş Özdemir F, Kesgin Güngör MC, Cici AM. Comparison of video-assisted education and traditional classroom education in pediatric cardiopulmonary resuscitation education of nursing students. J Pediatr Nurs 2023; 73:e388-e394. [PMID: 37833157 DOI: 10.1016/j.pedn.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
AIM This research aimed to compare the effectiveness of traditional classroom education and video-assisted education methods used in Pediatric (CPR) education and determine students' level of satisfaction with the education methods used. METHOD This research had a randomized, experimental, pretest-posttest design. The research was completed with 98 students (54 in the video-assisted education group and 44 in the traditional classroom education group). The traditional classroom education group received pediatric CPR education through traditional classroom education. On the other hand, the video-assisted education group watched the pediatric CPR education video prepared by the researchers. The level of knowledge of pediatric CPR, the level of pediatric CPR practice skills, and the satisfaction score of each student were evaluated. RESULTS When the skills levels of the groups were compared, it was determined that there was no statistical difference between the test results. In both groups, the students' mean knowledge and skill scores in the first and second posttests were significantly higher than their pretest knowledge scores. The satisfaction scores of the students in both groups were similar. CONCLUSION Both methods effectively improve students' pediatric CPR-related knowledge, skills, and satisfaction. IMPLICATIONS FOR PRACTICE As support for traditional education, using video-assisted visual education materials that nursing students can constantly access when needed is important.
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Wohlgemut JM, Pisirir E, Kyrimi E, Stoner RS, Marsh W, Perkins ZB, Tai NRM. Methods used to evaluate usability of mobile clinical decision support systems for healthcare emergencies: a systematic review and qualitative synthesis. JAMIA Open 2023; 6:ooad051. [PMID: 37449057 PMCID: PMC10336299 DOI: 10.1093/jamiaopen/ooad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
Objective The aim of this study was to determine the methods and metrics used to evaluate the usability of mobile application Clinical Decision Support Systems (CDSSs) used in healthcare emergencies. Secondary aims were to describe the characteristics and usability of evaluated CDSSs. Materials and Methods A systematic literature review was conducted using Pubmed/Medline, Embase, Scopus, and IEEE Xplore databases. Quantitative data were descriptively analyzed, and qualitative data were described and synthesized using inductive thematic analysis. Results Twenty-three studies were included in the analysis. The usability metrics most frequently evaluated were efficiency and usefulness, followed by user errors, satisfaction, learnability, effectiveness, and memorability. Methods used to assess usability included questionnaires in 20 (87%) studies, user trials in 17 (74%), interviews in 6 (26%), and heuristic evaluations in 3 (13%). Most CDSS inputs consisted of manual input (18, 78%) rather than automatic input (2, 9%). Most CDSS outputs comprised a recommendation (18, 78%), with a minority advising a specific treatment (6, 26%), or a score, risk level or likelihood of diagnosis (6, 26%). Interviews and heuristic evaluations identified more usability-related barriers and facilitators to adoption than did questionnaires and user testing studies. Discussion A wide range of metrics and methods are used to evaluate the usability of mobile CDSS in medical emergencies. Input of information into CDSS was predominantly manual, impeding usability. Studies employing both qualitative and quantitative methods to evaluate usability yielded more thorough results. Conclusion When planning CDSS projects, developers should consider multiple methods to comprehensively evaluate usability.
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Affiliation(s)
- Jared M Wohlgemut
- Corresponding Author: Jared M. Wohlgemut, MSc, Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark St, London E1 2AT, UK;
| | - Erhan Pisirir
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Evangelia Kyrimi
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Rebecca S Stoner
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts NHS Health Trust, London, UK
| | - William Marsh
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Zane B Perkins
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts NHS Health Trust, London, UK
| | - Nigel R M Tai
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts NHS Health Trust, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine, Birmingham, UK
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Blattgerste J, Behrends J, Pfeiffer T. TrainAR: An Open-Source Visual Scripting-Based Authoring Tool for Procedural Mobile Augmented Reality Trainings. INFORMATION 2023. [DOI: 10.3390/info14040219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Mobile Augmented Reality (AR) is a promising technology for educational purposes. It allows for interactive, engaging, and spatially independent learning. While the didactic benefits of AR have been well studied in recent years and commodity smartphones already come with AR capabilities, concepts and tools for a scalable deployment of AR are still missing. The proposed solution TrainAR combines an interaction concept, a didactic framework and an authoring tool for procedural AR training applications for smartphones. The contribution of this paper is the open-source visual scripting-based authoring tool of TrainAR in the form of a Unity Editor extension. With this approach, TrainAR allows non-programmer domain experts to create (“author”) their own procedural AR trainings by offering a customized editor, while at any time programmers may decide to utilize Unity’s full capabilities. Furthermore, utility and usability evaluations of several already developed TrainAR trainings (combined n = 317) show that TrainAR trainings provide utility in several contexts and are usable by the target groups. A systematic usability evaluation of the TrainAR Authoring Tool (n = 30) shows that it would be usable by non-programmer domain experts, though the learning curve depends on the media competency of the authors.
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Affiliation(s)
- Jonas Blattgerste
- Faculty of Technology, University of Applied Sciences Emden/Leer, Constantiaplatz 4, 26723 Emden, Germany
| | - Jan Behrends
- Faculty of Technology, University of Applied Sciences Emden/Leer, Constantiaplatz 4, 26723 Emden, Germany
| | - Thies Pfeiffer
- Faculty of Technology, University of Applied Sciences Emden/Leer, Constantiaplatz 4, 26723 Emden, Germany
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Corazza F, Fiorese E, Arpone M, Tardini G, Frigo AC, Cheng A, Da Dalt L, Bressan S. The impact of cognitive aids on resuscitation performance in in-hospital cardiac arrest scenarios: a systematic review and meta-analysis. Intern Emerg Med 2022; 17:2143-2158. [PMID: 36031672 PMCID: PMC9420676 DOI: 10.1007/s11739-022-03041-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
Abstract
Different cognitive aids have been recently developed to support the management of cardiac arrest, however, their effectiveness remains barely investigated. We aimed to assess whether clinicians using any cognitive aids compared to no or alternative cognitive aids for in-hospital cardiac arrest (IHCA) scenarios achieve improved resuscitation performance. PubMed, EMBASE, the Cochrane Library, CINAHL and ClinicalTrials.gov were systematically searched to identify studies comparing the management of adult/paediatric IHCA simulated scenarios by health professionals using different or no cognitive aids. Our primary outcomes were adherence to guideline recommendations (overall team performance) and time to critical resuscitation actions. Random-effects model meta-analyses were performed. Of the 4.830 screened studies, 16 (14 adult, 2 paediatric) met inclusion criteria. Meta-analyses of eight eligible adult studies indicated that the use of electronic/paper-based cognitive aids, in comparison with no aid, was significantly associated with better overall resuscitation performance [standard mean difference (SMD) 1.16; 95% confidence interval (CI) 0.64; 1.69; I2 = 79%]. Meta-analyses of the two paediatric studies, showed non-significant improvement of critical actions for resuscitation (adherence to guideline recommended sequence of actions, time to defibrillation, rate of errors in defibrillation, time to start chest compressions), except for significant shorter time to amiodarone administration (SMD - 0.78; 95% CI - 1.39; - 0.18; I2 = 0). To conclude, the use of cognitive aids appears to have benefits in improving the management of simulated adult IHCA scenarios, with potential positive impact on clinical practice. Further paediatric studies are necessary to better assess the impact of cognitive aids on the management of IHCA scenarios.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy
| | - Elena Fiorese
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marta Arpone
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Giacomo Tardini
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Adam Cheng
- Departments of Paediatrics and Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Canada
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy.
- Department of Women's and Children's Health, University of Padova, Padova, Italy.
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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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Schmucker M, Haag M. Automated Size Recognition in Pediatric Emergencies Using Machine Learning and Augmented Reality: Within-Group Comparative Study. JMIR Form Res 2021; 5:e28345. [PMID: 34542416 PMCID: PMC8491115 DOI: 10.2196/28345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 01/26/2023] Open
Abstract
Background Pediatric emergencies involving children are rare events, and the experience of emergency physicians and the results of such emergencies are accordingly poor. Anatomical peculiarities and individual adjustments make treatment during pediatric emergency susceptible to error. Critical mistakes especially occur in the calculation of weight-based drug doses. Accordingly, the need for a ubiquitous assistance service that can, for example, automate dose calculation is high. However, few approaches exist due to the complexity of the problem. Objective Technically, an assistance service is possible, among other approaches, with an app that uses a depth camera that is integrated in smartphones or head-mounted displays to provide a 3D understanding of the environment. The goal of this study was to automate this technology as much as possible to develop and statistically evaluate an assistance service that does not have significantly worse measurement performance than an emergency ruler (the state of the art). Methods An assistance service was developed that uses machine learning to recognize patients and then automatically determines their size. Based on the size, the weight is automatically derived, and the dosages are calculated and presented to the physician. To evaluate the app, a small within-group design study was conducted with 17 children, who were each measured with the app installed on a smartphone with a built-in depth camera and a state-of-the-art emergency ruler. Results According to the statistical results (one-sample t test; P=.42; α=.05), there is no significant difference between the measurement performance of the app and an emergency ruler under the test conditions (indoor, daylight). The newly developed measurement method is thus not technically inferior to the established one in terms of accuracy. Conclusions An assistance service with an integrated augmented reality emergency ruler is technically possible, although some groundwork is still needed. The results of this study clear the way for further research, for example, usability testing.
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Affiliation(s)
- Michael Schmucker
- GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany
| | - Martin Haag
- GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany
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Corazza F, Arpone M, Snijders D, Cheng A, Stritoni V, Ingrassia PL, De Luca M, Tortorolo L, Frigo AC, Da Dalt L, Bressan S. PediAppRREST: effectiveness of an interactive cognitive support tablet app in reducing deviations from guidelines in the management of paediatric cardiac arrest: protocol for a simulation-based randomised controlled trial. BMJ Open 2021; 11:e047208. [PMID: 34321297 PMCID: PMC8319988 DOI: 10.1136/bmjopen-2020-047208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/01/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Paediatric cardiac arrest (PCA), despite its low incidence, has a high mortality. Its management is complex and deviations from guideline recommendations occur frequently. We developed a new interactive tablet app, named PediAppRREST, to support the management of PCA. The app received a good usability evaluation in a previous pilot trial. The aim of the study is to evaluate the effectiveness of the PediAppRREST app in reducing deviations from guideline recommendations in PCA management. METHODS AND ANALYSIS This is a multicentre, simulation-based, randomised controlled, three-parallel-arm study. Participants are residents in Paediatric, Emergency Medicine, and Anaesthesiology programmes in Italy. All 105 teams (315 participants) manage the same scenario of in-hospital PCA. Teams are randomised by the study statistician into one of three study arms for the management of the PCA scenario: (1) an intervention group using the PediAppRREST app or (2) a control group Paediatric Advanced Life Support (CtrlPALS+) using the PALS pocket reference card; or (3) a control group (CtrlPALS-) not allowed to use any PALS-related cognitive aid. The primary outcome of the study is the number of deviations (delays and errors) in PCA management from PALS guideline recommendations, according to a novel checklist, named c-DEV15plus. The c-DEV15plus scores will be compared between groups with a one-way analysis of variance model, followed by the Tukey-Kramer multiple comparisons adjustment procedure in case of statistical significance. ETHICS AND DISSEMINATION The Ethics Committee of the University Hospital of Padova, coordinating centre of the trial, deemed the project to be a negligible risk study and approved it through an expedited review process. The results of the study will be disseminated in peer-reviewed journals, and at national and international scientific conferences. Based on the study results, the PediAppRREST app will be further refined and will be available for download by institutions/healthcare professionals. TRIAL REGISTRATION NUMBER NCT04619498; Pre-results.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marta Arpone
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Deborah Snijders
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Adam Cheng
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Valentina Stritoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Pier Luigi Ingrassia
- Interdepartmental Centre for Innovative Didactics and Simulation in Medicine and Health Professions, SIMNOVA, University of Eastern Piedmont Amedeo Avogadro School of Medicine, Novara, Italy
| | - Marco De Luca
- Pediatric Emergency Medicine, Meyer University Hospital, University of Florence, Florence, Italy
| | - Luca Tortorolo
- Institute of Intensive Care Medicine and Anesthesiology, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
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