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Tatikonda CM, Prasad KRK, Rout N, Panda S, Mishra SB, Dash A, Samal S, Roy C. Teaching Bundle Care Approach to Intensive Care Nurses to Prevent Ventilator Associated Pneumonia with a Stratified Validated Module. Dimens Crit Care Nurs 2023; 42:358-365. [PMID: 37756510 DOI: 10.1097/dcc.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Module-based teaching of ventilator-associated pneumonia (VAP) with a systematic, stratified approach is expected to have a promising role in teaching. We hypothesized it to improve the skill and knowledge of intensive care unit nurses. OBJECTIVES The aim of this study was to determine the efficacy of the teaching module with debriefing sessions on the VAP bundle care approach, and the secondary objective was to estimate the improvement in individual components of the VAP bundle. METHODS A total of 200 paramedical staff were exposed to a teaching module consisting of pretest didactic lectures, debriefing sessions, reflection by participants, and feedback. Posttest analysis was done to assess knowledge. Skill assessment was done with directly observed procedural skills (DOPS) assessment, and feedback was taken from participants. Follow-up was done at 6 months to assess decay in knowledge and skills. RESULTS Preworkshop and postworkshop DOPS scores were analyzed using the Mann-Whitney U test. Subgroup analysis was performed using the paired t test. Median pretest and posttest scores were 6 (interquartile range, 4-8) and 13 (interquartile range, 11-15), respectively (P < .001). Comparing DOPS scores before and after exposure to the teaching module, the number of subjects with scores that were below expectations was 24 and 4; meeting expectations was 94 and 24; borderline expectations were 36 and 104; and above expectations was 46 and 58, respectively, between the groups (P < .001). A decay in knowledge and skills was noted in the follow-up. CONCLUSION A validated teaching module with debriefing sessions is useful in training bundle care approaches to intensive care unit nurses.
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Carpallo-Porcar B, Romo-Calvo L, Pérez-Palomares S, Jiménez-Sánchez C, Herrero P, Brandín-de la Cruz N, Calvo S. Efficacy of an asynchronous telerehabilitation program in post-COVID-19 patients: A protocol for a pilot randomized controlled trial. PLoS One 2022; 17:e0270766. [PMID: 35853037 PMCID: PMC9295945 DOI: 10.1371/journal.pone.0270766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background
About 40% of patients who have had COVID-19 still have symptoms three months later whereas a 10% may experience physical and/or psychological consequences two years later. Therefore, it is necessary to perform preventive interventions when patients are discharged from the hospital to decrease the aforementioned sequelae. The purpose of this pilot-controlled trial will be to determine the efficacy of a rehabilitation program on functional status and psychosocial factors for post-COVID-19 patients when it is delivered through a tele-care platform versus a booklet-based rehabilitation.
Methods
The estimated sample size will be of 50 participants who have been discharged after COVID-19 and have a level of fatigue equal or greater than 4 on the Fatigue Severity Scale. The primary outcome will be the severity of fatigue. Participants will be randomly allocated to an “asynchronous telerehabilitation group” or to a “booklet-based rehabilitation group”. Treatment in both groups will be the same and will consist of a combination of therapeutic exercise and an educative program. Treatment outcomes will be evaluated the last day of the intervention and at three- and six-months follow-up.
Discussion
The telerehabilitation intervention appears to be a viable and efficacy option in decreasing severe fatigue and other fitness variables such as strength and aerobic capacity, similar to other traditional rehabilitation formats such as through an explanatory booklet.
Clinical trial registration
This trial has been prospectively registered at clinialtrials.gov identifier: NCT04794036.
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Affiliation(s)
- Beatriz Carpallo-Porcar
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Laura Romo-Calvo
- Hospital Real y Provincial Nuestra Señora de Gracia, Zaragoza, Spain
| | - Sara Pérez-Palomares
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, Zaragoza, Spain
| | - Carolina Jiménez-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
- * E-mail:
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, Zaragoza, Spain
| | - Natalia Brandín-de la Cruz
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Sandra Calvo
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, Zaragoza, Spain
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Virtual Deliberate Practice Module for Tracheostomy Change Training: An Application of Educational Design Research. ATS Sch 2022; 3:135-143. [PMID: 35633996 PMCID: PMC9132089 DOI: 10.34197/ats-scholar.2021-0110oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background The pandemic poses challenges for in-person procedural skills training. We developed a virtual module for teaching hands-on tracheostomy skills. Objective To develop and evaluate a virtual module prototype grounded in deliberate practice using tracheostomy change as an example. Methods After identifying desirable features of a virtual module by surveying stakeholders, we designed a prototype using VoiceThread, a multimedia-based collaborative learning platform. We created an asynchronous module accessible to learners for repeated skill practice and for video upload of individual performance on a tracheostomy task trainer using personal devices. This virtual module provided a four-step coaching (demonstration, deconstruction, formulation, and performance) to practice tracheostomy change. Two instructors reviewed the learners’ performance videos, providing timely feedback for further refinement of skills. Results Sixty-four residents completed the module, System Usability Scale, and self-efficacy survey. All residents rated the module, with a mean System Usability Scale score of 68.6 ± 18.4 (maximum score of 100). Two independent instructors rated performance videos using a 12-item checklist with mean interobserver agreement of 88.1% (standard deviation, 9.7) and mean performance checklist score (n = 40) of 10.1 (standard deviation, 1.2) out of 12. After training, residents reported high confidence in their ability to list and perform procedural steps, with improvement in median (interquartile range) comfort levels from 1 (1–2) to 4 (3–4) out of 5 (P < 0.0001). Conclusion We developed an asynchronous deliberate practice module on a virtual platform using tracheostomy change as an example. Residents evaluated the module favorably using system usability and learner self-efficacy surveys with improvement of skills.
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Bajwa SJS, Mehdiratta L. Cardiopulmonary resuscitation during COVID-19 times…. Time to recover and emerge stronger! Indian J Anaesth 2022; 66:95-99. [PMID: 35359475 PMCID: PMC8963224 DOI: 10.4103/ija.ija_153_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: 02/12/2022] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Lalit Mehdiratta
- Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India
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Díaz-Bohada L, Segura-Salguero JC, Garzón-Beltrán NF, Salazar-Balcázar D, Otálora-Estéban M. Considerations of invasive mechanical ventilation in prone position. A narrative review. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The evidence regarding logistic considerations and safety events associated with prone position ventilation (PPV) is summarized and a flow diagrama for safe provision of mechanical ventilation in the setting of the COVID-19 pandemic is proposed. A review of the literature was conducted in the Medline via Pubmed, Embase, and Lilacs databases, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Randomized Controlled Trials, Cochrane Database of Abstracts of Reviews of Effects, ProQuest Nursing and Allied Health Database, and Google scholar. Overall, 31 articles were selected for the analysis. The incidence of PPV-related safety events varies between 1% and 11.9% and the most frequent complications are pressure ulcers and airway complications. Early initiation of enteral nutrition is recommended, and transfers are possible in patients on PPV. There is controversy regarding contraindications and recommendations for PPV. Recommendations for its safe provision are based on expert opinions and the establishment of protocols for healthcare staff training. Clinical studies are required to determine which are the recommendations that should be considered for safe and reproducible PPV use during this pandemic.
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George LR, George SE, Dhawan I, Babu M, Sahajanandan R, Joselyn AS. Simulation with a colour indicator to help reduce contamination during airway management in COVID-19 times: An experience from a tertiary centre in India. Indian J Anaesth 2021; 65:820-829. [PMID: 35001955 PMCID: PMC8680416 DOI: 10.4103/ija.ija_768_21] [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: 08/17/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND AIMS The coronavirus disease 2019 (COVID-19) pandemic has initiated modified protocols for aerosol-generating procedures. A simulation study using dye was conducted to highlight contamination at intubation and extubation and to encourage adherence to the new COVID-19 protocol among anaesthesia personnel in our institution. METHODS A video demonstrating the new COVID-19 protocols was circulated in the Department of Anaesthesiology a week prior to the study. Thirty teams, each comprising an anaesthesia resident and a staff technician, were enroled. Each team was asked to demonstrate the steps of preparation, intubation and extubation on a mannequin in a COVID-19 scenario. Checklists were used to assess points of contamination and adherence to the protocols. Following debriefing, a repeat simulation was conducted. The use of a dye highlighted the points of contamination. The study subjects provided feedback on the usefulness of the session and practical difficulties encountered in adapting to the new protocols. RESULTS The average contamination scores decreased by 3.4 (95% confidence interval (CI): 2.4-4.4, P < 0.001) in the post-debrief session. Adherence to the steps of the modified protocol improved by a score of 2.7 (CI: 3.6-1.83) among anaesthesiologists and by 4.3 (CI: 5.3-3.3) among technicians. Further, 93% felt that the use of the colour indicator reinforced awareness of the possible points of contamination. CONCLUSION Simulation with a low-fidelity mannequin by using colour indicator for secretions is an effective teaching tool to reduce health hazards during airway management in COVID-19 times.
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Affiliation(s)
- Leah R. George
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Smitha E. George
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Ira Dhawan
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Malavika Babu
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Raj Sahajanandan
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anita S. Joselyn
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Mehdiratta L, Sharma R, Jain S. Anaesthesiology as an oasis amid the crisis of the vital medicine 'Oxygen'- innovations and local modifications. Indian J Anaesth 2021; 65:S145-S148. [PMID: 34908565 PMCID: PMC8613475 DOI: 10.4103/ija.ija_904_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India
| | - Ridhima Sharma
- Department of Paediatric Anaesthesia, Superspeciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, Uttar Pradesh, India
| | - Sarvesh Jain
- Department of Anaesthesiology, Critical Care and Pain Medicine, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
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Mehdiratta L, Bajwa SJS. Technology, engineering and innovations- Power buffers in the COVID driveline..... Indian J Anaesth 2021; 65:351-355. [PMID: 34211191 PMCID: PMC8202795 DOI: 10.4103/ija.ija_423_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 01/30/2023] Open
Affiliation(s)
- Lalit Mehdiratta
- Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
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Mehdiratta L, Bajwa SJS, Kurdi MS, Bhattacharya PK. Research in COVID times-Innovations, revolutions and contentions. Indian J Anaesth 2021; 65:277-281. [PMID: 34103740 PMCID: PMC8174599 DOI: 10.4103/ija.ija_285_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
| | - Madhuri S Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India
| | - Pradip Kumar Bhattacharya
- Department of Critical Care Medicine, New Trauma and Emergency Centre, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
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Santos KBD, Püschel VADA, Luiz FS, Leite ICG, Cavalcante RB, Carbogim FDC. SIMULATION TRAINING FOR HOSPITAL ADMISSION OF PATIENTS WITH COVID-19: ASSESSMENT OF NURSING PROFESSIONALS. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to assess skills, satisfaction, self-confidence and experience with debriefing of nursing professionals in a simulated scenario for hospital admission of patients with COVID-19. Method: this is a quantitative, observational, cross-sectional study, carried out at a university hospital with nursing professionals. Data were collected in June 2020 using the following instruments: sociodemographic questionnaire, checklist for assessing patient admission skills, the Student Satisfaction and Self-Confidence in Learning Scale and the Debriefing Experience Scale. Subsequently, the collected data were analyzed using descriptive and analytical statistics. Results: sixty-two professionals participated, 23 (37.10%) nurses and 39 (62.90%) nursing technicians, with an average age of 36.82 (±6.19). Compliance with patient admission skills ranged from 66.13% to 90.32%. The overall average score on the Student Satisfaction and Self-Confidence in Learning Scale was 4.46 (± 0.36) and, on the Debriefing Experience Scale and factors, 4.63 (±0.33). Professionals who updated themselves with scientific articles and protocols obtained a higher average score on both scales (p<0.05). Conclusion: most professionals demonstrated skills on patient admission, satisfaction with learning, self-confidence in the simulated scenario and adequate experience with debriefing.
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Abd Samat AH, Isa MH, Sabardin DM, Md Jamal S, Jaafar MJ, Hamzah FA, Mahmud A, Sanip A, Syed Ali SM, Mohd Saiboon I. Knowledge and Confidence Level Among Emergency Healthcare Workers in Airway Management and Resuscitation of Suspected COVID-19 Patients: A Cross Sectional Study in Malaysia. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2020335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: This study aims to evaluate the knowledge and confidence of emergency healthcare workers (EHCW) in facing the COVID-19 pandemic. Materials and Methods: A cross-sectional online study using a validated questionnaire was distributed to doctors (MD), assistant medical officers (AMO), and staff nurses (SN) at an urban tertiary Emergency Department. It comprised of 40 knowledge and 10 confidence-level questions related to resuscitation and airway management steps. Results: A total of 135 from 167 eligible EHCW were enrolled. 68.9% (n = 93) had high knowledge while 53.3% (n = 72) possessed high confidence level. Overall knowledge mean score was 32.96/40 (SD = 3.63) between MD (33.88±3.09), AMO (32.28±4.03), and SN (32.00±3.60), P = 0.025. EHCWs with a length of service (LOS) between 4–10 years had the highest knowledge compared to those with LOS <4-year (33.71±3.39 versus 31.21±3.19 P = 0.002). Airway-related knowledge was significantly different between the designations and LOS (P = 0.002 and P = 0.003, respectively). Overall, EHCW confidence level against LOS showed significant difference [F (2, 132) = 5.46, P = 0.005] with longer LOS showing better confidence. MD showed the highest confidence compared to AMO and SN (3.67±0.69, 3.53±0.68, 3.26±0.64) P = 0.049. The majority EHCW were confident in performing highquality chest-compression, and handling of Personal Protective Equipment but less than half were confident in resuscitating, leading the resuscitation, managing the airway or being successful in first intubation attempt. Conclusions: EHCW possessed good knowledge in airway and resuscitation of COVID-19 patients, but differed between designations and LOS. A longer LOS was associated with better confidence, but there were some aspects in airway management and resuscitation that needed improvement. Keywords: Airway; Confidence; COVID-19; Knowledge; Resuscitation (CPR).
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Gupta B, Jain G, Mishra P, Pathak S. Preparedness to combat COVID-19 via structured online training program regarding specific airway management: A prospective observational study. Indian J Anaesth 2020; 64:796-799. [PMID: 33162575 PMCID: PMC7641076 DOI: 10.4103/ija.ija_655_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Bhavna Gupta
- Departments of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - Gaurav Jain
- Departments of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - Priyanka Mishra
- Departments of Anaesthesiology, AIIMS, Rishikesh, Uttarakhand, India
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Bhatnagar S, Mehdiratta L, Karthik AR. Corona pandemic: Bringing Anaesthesiologist's professional role and other skills to the fore. Indian J Anaesth 2020; 64:S87-S90. [PMID: 32773844 PMCID: PMC7293376 DOI: 10.4103/ija.ija_579_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, IRCH, New Delhi, India
| | - Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Center, Bhopal, Madhya Pradesh, India. E-mail:
| | - A R Karthik
- Department of Onco-Anaesthesia and Palliative Medicine, DR. BRAIRCH, AIIMS, New Delhi, India
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