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Gheihman G, Harrold GK, Howard D, Albin CSW, Kaplan TB. Using Neurology Trainees as Standardized Patients in a Neurological Emergency Simulation Curriculum for Medical Students. MEDICAL SCIENCE EDUCATOR 2024; 34:589-599. [PMID: 38887414 PMCID: PMC11180045 DOI: 10.1007/s40670-024-02016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 06/20/2024]
Abstract
Purpose Simulation manikins have limited ability to mimic neurological exam findings, which has historically constrained their use in neurology education. We developed a cased-based simulation curriculum in which neurology trainees acted as standardized patients (SPs) and portrayed the neurologic exam for medical students. Materials/Methods We ran monthly simulations of two cases (acute stroke and seizure) with resident/fellow SPs. Pre-/post-session surveys assessed students' self-rated confidence in neurological clinical skills (gathering a history, performing an exam, presenting a case) and knowledge domains. Questions about students' attitudes about neurology were adapted from a validated assessment tool. Paired t-tests were performed for quantitative items. Qualitative thematic analysis identified key themes. Results Sixty-one students participated. Post-session, students reported significantly higher self-confidence in all neurological clinical skills and knowledge domains (p < 0.002). Greater than ninety-five percent agreed the session met the learning objectives; 95% recommended it to others. Resident/fellow SPs were cited as the most effective educational component. Students appreciated evaluating acute emergencies and reported an increased interest in neurology careers. Conclusions A case-based simulation curriculum with neurology trainees portraying the SP increased students' self-reported knowledge, skills, and confidence in managing neurological emergencies. Our intervention may improve medical student neurology education and increase interest in the field. Future research should evaluate clinical skills objectively. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-024-02016-w.
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Affiliation(s)
- Galina Gheihman
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - G. Kyle Harrold
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Danielle Howard
- Department of Neurology, Tufts Medical Center, Boston, MA USA
| | | | - Tamara B. Kaplan
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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2
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Aljuwaiser S, Abdel-Fattah AR, Brown C, Kane L, Cooper J, Mostafa A. Evaluating the effects of simulation training on stroke thrombolysis: a systematic review and meta-analysis. Adv Simul (Lond) 2024; 9:11. [PMID: 38424568 PMCID: PMC10905914 DOI: 10.1186/s41077-024-00283-6] [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: 11/01/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Ischaemic strokes are medical emergencies, and reperfusion treatment, most commonly intravenous thrombolysis, is time-critical. Thrombolysis administration relies on well-organised pathways of care with highly skilled and efficient clinicians. Simulation training is a widespread teaching modality, but results from studies on the impact of this intervention have yet to be synthesised. This systematic review and meta-analysis aimed to synthesise the evidence and provide a recommendation regarding the effects of simulation training for healthcare professionals on door-to-needle time in the emergency thrombolysis of patients with ischaemic stroke. METHODS Seven electronic databases were systematically searched (last updated 12th July 2023) for eligible full-text articles and conference abstracts. Results were screened for relevance by two independent reviewers. The primary outcome was door-to-needle time for recombinant tissue plasminogen activator administration in emergency patients with ischaemic stroke. The secondary outcomes were learner-centred, improvements in knowledge and communication, self-perceived usefulness of training, and feeling 'safe' in thrombolysis-related decision-making. Data were extracted, risk of study bias assessed, and analysis was performed using RevMan™ software (Web version 5.6.0, The Cochrane Collaboration). The quality of the evidence was assessed using the Medical Education Research Study Quality Instrument. RESULTS Eleven studies were included in the meta-analysis and nineteen in the qualitative synthesis (n = 20,189 total patients). There were statistically significant effects of simulation training in reducing door-to-needle time; mean difference of 15 min [95% confidence intervals (CI) 8 to 21 min]; in improving healthcare professionals' acute stroke care knowledge; risk ratio (RR) 0.42 (95% CI 0.30 to 0.60); and in feeling 'safe' in thrombolysis-related decision-making; RR 0.46 (95% CI 0.36 to 0.59). Furthermore, simulation training improved healthcare professionals' communication and was self-perceived as useful training. CONCLUSION This meta-analysis showed that simulation training improves door-to-needle times for the delivery of thrombolysis in ischaemic stroke. However, results should be interpreted with caution due to the heterogeneity of the included studies.
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Affiliation(s)
- Sameera Aljuwaiser
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | | | - Craig Brown
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Leia Kane
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jamie Cooper
- Emergency Medicine, NHS Grampian, Aberdeen, Scotland
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Alyaa Mostafa
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
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3
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Lim RBT, Hoe KWB, Tan CGL, Zheng H. A Systematic Review on the Effectiveness of Systems-Based Practice Curricula in Health Professions Education. Eval Health Prof 2023; 46:242-254. [PMID: 37439658 DOI: 10.1177/01632787231188182] [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: 07/14/2023]
Abstract
This systematic review aims to evaluate the effectiveness of systems-based practice (SBP) curricula from the perspective of health professions students and workers. A total of 8468 citations were sourced from six electronic databases and manual searches conducted independently by two researchers, of which 44 studies were eventually included. A meta-analysis using a random effects model and a meta-synthesis using the thematic synthesis approach were conducted. Most studies targeted medical students, residents, and resident physicians from various clinical specialties. Almost half of all studies focused on didactic or knowledge-based interventions to teach SBP. About a third of all studies measured non-self-evaluated knowledge change, clinical abilities, and clinical outcomes. Both meta-analysis and meta-synthesis results revealed positive outcomes of increased knowledge of SBP, increased recognition of SBP as a core competency in one's profession, and increased application of SBP knowledge in one's profession. Meta-synthesis results also revealed negative outcomes at the institutional and teacher/health professions level. This review highlights the importance of SBP education and supports the effectiveness of SBP curricula. There is a need to address the negative outcomes at the institutional and teacher/health professions level. Moreover, future studies could investigate the integration of self-assessment outcomes with comparison to some external standard.
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Affiliation(s)
- Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kenneth Wee Beng Hoe
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Claire Gek Ling Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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4
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Svobodová V, Maršálková H, Volevach E, Mikulík R. Simulation-based team training improves door-to-needle time for intravenous thrombolysis. BMJ Open Qual 2023; 12:bmjoq-2022-002107. [PMID: 36810293 PMCID: PMC9944663 DOI: 10.1136/bmjoq-2022-002107] [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: 08/31/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE There is a clinical need for shortened door-to-needle time (DNT) for intravenous thrombolysis, but effective training methods are missing. Simulation training improves teamwork and logistics in numerous fields. Still, it is not clear if simulation improves logistics in stroke. METHODS To evaluate the efficiency of a simulation training programme, the DNT of participating centres was compared with the rest of stroke centres in the Czech Republic. Patients' data were prospectively collected from the nationally used Safe Implementation of Treatments in Stroke Registry. The outcome was an improvement in DNT in 2018 as compared with 2015 (after and before the simulation training). Scenarios were based on real clinical cases, and simulation courses were conducted in a standardly equipped simulation centre. FINDINGS Between 2016 and 2017, 10 courses were conducted for stroke teams from 9 of all 45 stroke centres. DNT data were available both in 2015 and 2018 from 41 (91%) stroke centres. The simulation training improved the DNT in 2018 as compared with 2015 by 30 min (95% CI 25.7 to 34.7) and as compared with 20 min (95% CI 15.8 to 24.3) in stroke centres without the simulation training (p=0.01). Any parenchymal haemorrhage occurred in 5.4% and 3.5% of patients treated in centres without and with simulation training (p=0.054), respectively. CONCLUSIONS DNT was considerably shortened nationally. It was feasible to implement simulation as a nationwide training programme. The simulation was associated with improved DNT; however, other studies should confirm that such an association is causal.
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Affiliation(s)
- Veronika Svobodová
- International Clinical Research Center, St Anne's University Hospital in Brno, Brno, Czech Republic
| | - Hana Maršálková
- International Clinical Research Center, St Anne's University Hospital in Brno, Brno, Czech Republic
| | - Ekaterina Volevach
- International Clinical Research Center, St Anne's University Hospital in Brno, Brno, Czech Republic
| | - Robert Mikulík
- International Clinical Research Center, St Anne's University Hospital in Brno, Brno, Czech Republic .,Department of Neurology, Masaryk University Faculty of Medicine, Brno, Czech Republic
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5
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Benameur K, Gandrakota N, Ali MK. Nutritional Counseling of Stroke Patients by Neurology Residents, a Call to Action. Front Neurol 2022; 13:940931. [PMID: 35899264 PMCID: PMC9309345 DOI: 10.3389/fneur.2022.940931] [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: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Poor diet quality has been found to be an independent risk factor for mortality in stroke. However, it is unknown to what extent Neurologists are trained and are comfortable enough to provide dietary counseling to stroke patients. Objective To assess the knowledge, attitudes, and practices of neurology residents relating to dietary counseling of stroke patients. Methods An online anonymous survey was administered to neurology residents throughout the country between August and November 2019 among a total of 109 (68%) US neurology programs. Self-reported practices and knowledge regarding stroke prevention through nutritional counseling were queried using validated questionnaires. Results 453 responses out of a potential 672 were received. A minority of residents (12.3%) consistently offered nutritional counseling to stroke patients. 47.7% considered that it was not the neurologist's role to provide nutritional counseling to stroke patients. 83.4% of residents felt that it was the responsibility of the dietician to provide nutritional counseling, yet only 21.4% of residents consistently referred stroke patients to a dietician. 77.9% of respondents felt nutritional counseling is important for stroke patients, yet 65.6% felt they were not adequately trained to provide nutritional counseling. Conclusion Neurologists in training believe diet to be an important part of stroke prevention, but practical knowledge and training in nutrition are suboptimal. This study suggests the need to include nutrition as an integral part of neurology training, to ensure neurologists feel empowered to be an important part of the team providing nutritional counseling to stroke patients.
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Affiliation(s)
- Karima Benameur
- Department of Neurology, Emory University, Atlanta, GA, United States
- *Correspondence: Karima Benameur
| | - Nikhila Gandrakota
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Mohammed K. Ali
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
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6
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Bohmann FO, Gruber K, Kurka N, Willems LM, Herrmann E, du Mesnil de Rochemont R, Scholz P, Rai H, Zickler P, Ertl M, Berlis A, Poli S, Mengel A, Ringleb P, Nagel S, Pfaff J, Wollenweber FA, Kellert L, Herzberg M, Koehler L, Haeusler KG, Alegiani A, Schubert C, Brekenfeld C, Doppler CEJ, Onur ÖA, Kabbasch C, Manser T, Steinmetz H, Pfeilschifter W. Simulation-based training improves process times in acute stroke care (STREAM). Eur J Neurol 2021; 29:138-148. [PMID: 34478596 DOI: 10.1111/ene.15093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The objective of the STREAM Trial was to evaluate the effect of simulation training on process times in acute stroke care. METHODS The multicenter prospective interventional STREAM Trial was conducted between 10/2017 and 04/2019 at seven tertiary care neurocenters in Germany with a pre- and post-interventional observation phase. We recorded patient characteristics, acute stroke care process times, stroke team composition and simulation experience for consecutive direct-to-center patients receiving intravenous thrombolysis (IVT) and/or endovascular therapy (EVT). The intervention consisted of a composite intervention centered around stroke-specific in situ simulation training. Primary outcome measure was the 'door-to-needle' time (DTN) for IVT. Secondary outcome measures included process times of EVT and measures taken to streamline the pre-existing treatment algorithm. RESULTS The effect of the STREAM intervention on the process times of all acute stroke operations was neutral. However, secondary analyses showed a DTN reduction of 5 min from 38 min pre-intervention (interquartile range [IQR] 25-43 min) to 33 min (IQR 23-39 min, p = 0.03) post-intervention achieved by simulation-experienced stroke teams. Concerning EVT, we found significantly shorter door-to-groin times in patients who were treated by teams with simulation experience as compared to simulation-naive teams in the post-interventional phase (-21 min, simulation-naive: 95 min, IQR 69-111 vs. simulation-experienced: 74 min, IQR 51-92, p = 0.04). CONCLUSION An intervention combining workflow refinement and simulation-based stroke team training has the potential to improve process times in acute stroke care.
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Affiliation(s)
- Ferdinand O Bohmann
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Katharina Gruber
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Natalia Kurka
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Laurent M Willems
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Eva Herrmann
- Faculty of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University, Frankfurt am Main, Germany
| | | | - Peter Scholz
- NICU Nursing Staff, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Heike Rai
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Philipp Zickler
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Ansgar Berlis
- Department for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Sven Poli
- Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany.,Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany.,Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Peter Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Simon Nagel
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Pfaff
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Frank A Wollenweber
- Department of Neurology, Ludwig Maximilians-University Munich, Munich, Germany.,Department of Neurology, Helios-HSK Wiesbaden, Wiesbaden, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilians-University Munich, Munich, Germany
| | - Moriz Herzberg
- Department for Diagnostic and Interventional Neuroradiology, Ludwig Maximilians-University Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Luzie Koehler
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | | | - Anna Alegiani
- Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Charlotte Schubert
- Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christopher E J Doppler
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Özgür A Onur
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany
| | - Tanja Manser
- School of Applied Psychology, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Helmuth Steinmetz
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
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7
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Casolla B. Simulation for Neurology training: Acute setting and beyond. Rev Neurol (Paris) 2021; 177:1207-1213. [PMID: 34229869 DOI: 10.1016/j.neurol.2021.03.008] [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: 11/23/2020] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 10/20/2022]
Abstract
Simulation-based training is adapted for teaching neurology, and it can offer multiple programs for general and specialized neurologists. Indeed, simulation training is "learner-centered", assuring sessions tailored to each learner level, and provides a realistic, safe, controlled and reproducible environment to improve knowledge, technical and non-technical skills, including situational awareness, communication, teamwork and leadership. Indeed, simulation tools allow multidisciplinary sessions with different team members (nurses, physician associates, specialist trainees, technicians) participating with their experiences. Multidisciplinary scenarios maximize awareness on the "human factors" and contribute to the safety of future patients. Simulation sessions require clear learning objectives and debriefing points tailored to the learning groups, but instructors may vary the scenarios in real time according to learners' actions. Different simulation techniques are applied according to learning objectives. The simulation session always includes a briefing, a simulation scenario and a structured debriefing, driven by the instructor, which is crucial for learning consolidation. In neurology training, simulation methods are applicable for: i) training on emergency situations, where the neurologist team has to manage in frontline a specific medical emergency (stroke, status epilepticus, coma, neuromuscular respiratory failure); ii) improving technical skills (lumbar puncture, electroencephalography (EEG), cervical ultrasound and transcranial Doppler, endovascular thrombectomy procedures, neuroradiological investigations); iii) improving procedures and patient pathways (stroke pathway, telemedicine); and iv) training non-technical skills (communication, teamwork, leadership). This manuscript provides a brief overview on the general principles of simulation techniques and their potential application in neurology training, in the acute setting and beyond.
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Affiliation(s)
- B Casolla
- University Côte d'Azur (UCA), Department of Neurology, Stroke unit, CHU Nice, 06000 Nice, France.
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Mass-Ramírez S, Vergara-Burgos H, Sierra-Ochoa C, Lozada-Martinez ID, Moscote-Salazar LR, Janjua T, Rahman MM, Rahman S, Picón-Jaimes YA. Utility of medical simulation in neurovascular critical care education. JOURNAL OF NEUROCRITICAL CARE 2021. [DOI: 10.18700/jnc.210010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Stainman RS, Lewis A, Nelson A, Zabar S, Kurzweil AM. Training in Neurology: Identifying and addressing struggling colleagues in the era of physician burnout. Neurology 2020; 95:796-799. [DOI: 10.1212/wnl.0000000000010601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Zhang X, Liu Y, Cao X, Xu X, Zhu Y, Wang C. Effect of multi-level stroke education on treatment and prognosis of acute ischemic stroke. Exp Ther Med 2020; 20:2888-2894. [PMID: 32765786 PMCID: PMC7401734 DOI: 10.3892/etm.2020.9028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/27/2020] [Indexed: 12/26/2022] Open
Abstract
This observational study aimed at the significance of multi-level education in the treatment and prognosis of acute ischemic stroke. Multi-level stroke education was carried out among residents and medical staff for one year in Guancheng district. After 1 year, 519 patients with acute ischemic stroke admitted to The First People's Hospital of Zhengzhou were invited to the study, 272 patients from the Guancheng district were divided into the experimental group, and 247 patients who were not from the Guancheng district but in the neighborhood of The First People's Hospital of Zhengzhou were divided into the control group. Statistical methods were applied to analyze the degree of awareness of stroke, the time from onset to hospital, the route to hospital, the number of patients coming to the hospital within 4.5 h, the number of intravenous thrombolysis, door-to-needle time (DNT), modified Rankin scale (MRS) score, and the number of hemorrhagic transformation cases. After one year of multi-level systematic stroke education, there were significant differences in stroke awareness between the experimental group and the control group in terms of limb weakness (87.87 vs. 62.75%), speech inarticulation (78.3 vs. 55.06%), facial paralysis (69.12 vs. 38.06%), limb numbness (57.35 vs. 29.15%), consciousness disorder (62.50 vs. 42.11%), walking instability with severe dizziness (39.97 vs. 15.79%) (P<0.05). There was no statistical significant difference in unclear vision or blind eyes or severe headache (P>0.05). There were statistical differences between the two groups in the time from the onset to the hospital (14.82±17.67 vs. 25.92±25.23), emergency medical services (EMS) (36.02 vs. 16.19%), number of patients coming to the hospital within 4.5 h (67 vs. 32), venous thrombolysis cases (55 vs. 17), DNT time (42.43±17.30 vs. 63.35±26.53), hemorrhagic transformation cases (11 vs. 21), and MRS score grade ≥2 (230 vs. 169) (P<0.05). Multi-level education can effectively improve the patient's awareness of stroke, encourage more patients to use EMS system to the hospital. More patients were aware that they should reach the hospital within 4.5 h. It helps shorten DNT time and give more patients the opportunity to receive intravenous thrombolysis or intravascular thrombectomy, which may improve the prognosis and reduce hemorrhagic transformation without reducing mortality.
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Affiliation(s)
- Xiaoman Zhang
- Department of Neurology, The First People's Hospital of Zhengzhou, Zhengzhou, Henan 450004, P.R. China
| | - Yinfang Liu
- Department of Neurology, The First People's Hospital of Zhengzhou, Zhengzhou, Henan 450004, P.R. China
| | - Xinhui Cao
- Department of Neurology, The First People's Hospital of Zhengzhou, Zhengzhou, Henan 450004, P.R. China
| | - Xiaoyu Xu
- Department of Neurology, The First People's Hospital of Zhengzhou, Zhengzhou, Henan 450004, P.R. China
| | - Yatao Zhu
- Department of Neurology, The First People's Hospital of Zhengzhou, Zhengzhou, Henan 450004, P.R. China
| | - Chaogang Wang
- Department of Neurology, The First People's Hospital of Zhengzhou, Zhengzhou, Henan 450004, P.R. China
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Demaerschalk BM, Scharf EL, Cloft H, Barrett KM, Sands KA, Miller DA, Meschia JF. Contemporary Management of Acute Ischemic Stroke Across the Continuum: From TeleStroke to Intra-Arterial Management. Mayo Clin Proc 2020; 95:1512-1529. [PMID: 32622453 DOI: 10.1016/j.mayocp.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022]
Abstract
In this comprehensive contemporary review of acute ischemic stroke management, what is new and different will be highlighted beginning with prehospital stroke systems of care, emergency medical systems, and mobile stroke units, followed by hospital stroke teams, emergency evaluation, telemedicine, and brain and vascular imaging, and finishing with emergency treatments including thrombolysis and mechanical thrombectomy.
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Affiliation(s)
| | - Eugene L Scharf
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Mayo Clinic, Rochester, MN
| | - Harry Cloft
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, MN
| | - Kevin M Barrett
- Departments of Neurology and Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| | - Kara A Sands
- Department of Neurology Mayo Clinic, Phoenix/Scottsdale, AZ
| | - David A Miller
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - James F Meschia
- Departments of Neurology and Neurologic Surgery, Mayo Clinic, Jacksonville, FL
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Kurzweil AM, Lewis A, Pleninger P, Rostanski SK, Nelson A, Zhang C, Zabar S, Ishida K, Balcer LJ, Galetta SL. Education Research: Teaching and assessing communication and professionalism in neurology residency with simulation. Neurology 2020; 94:229-232. [DOI: 10.1212/wnl.0000000000008895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
How to cite this article: Kulkarni AP. Simulation: Is it the Future of Training in Critical Care Medicine? IJCCM 2019;23(11):495-496.
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Affiliation(s)
- Atul P Kulkarni
- Department of Anaesthesiology, Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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14
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Bohmann FO, Kurka N, du Mesnil de Rochemont R, Gruber K, Guenther J, Rostek P, Rai H, Zickler P, Ertl M, Berlis A, Poli S, Mengel A, Ringleb P, Nagel S, Pfaff J, Wollenweber FA, Kellert L, Herzberg M, Koehler L, Haeusler KG, Alegiani A, Schubert C, Brekenfeld C, Doppler CEJ, Onur OA, Kabbasch C, Manser T, Pfeilschifter W. Simulation-Based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM)-A Prospective Single-Arm Multicenter Trial. Front Neurol 2019; 10:969. [PMID: 31572288 PMCID: PMC6749045 DOI: 10.3389/fneur.2019.00969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/23/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Acute stroke care delivered by interdisciplinary teams is time-sensitive. Simulation-based team training is a promising tool to improve team performance in medical operations. It has the potential to improve process times, team communication, patient safety, and staff satisfaction. We aim to assess whether a multi-level approach consisting of a stringent workflow revision based on peer-to-peer review and 2–3 one-day in situ simulation trainings can improve acute stroke care processing times in high volume neurocenters within a 6 months period. Methods and Analysis: The trial is being carried out in a pre-test-post-test design at 7 tertiary care university hospital neurocenters in Germany. The intervention is directed at the interdisciplinary multiprofessional stroke teams. Before and after the intervention, process times of all direct-to-center stroke patients receiving IV thrombolysis (IVT) and/or endovascular therapy (EVT) will be recorded. The primary outcome measure will be the “door-to-needle” time of all consecutive stroke patients directly admitted to the neurocenters who receive IVT. Secondary outcome measures will be intervention-related process times of the fraction of patients undergoing EVT and effects on team communication, perceived patient safety, and staff satisfaction via a staff questionnaire. Interventions: We are applying a multi-level intervention in cooperation with three “STREAM multipliers” from each center. First step is a central meeting of the multipliers at the sponsor's institution with the purposes of algorithm review in a peer-to-peer process that is recorded in a protocol and an introduction to the principles of simulation training and debriefing as well as crew resource management and team communication. Thereafter, the multipliers cooperate with the stroke team trainers from the sponsor's institution to plan and execute 2–3 one-day simulation courses in situ in the emergency department and CT room of the trial centers whereupon they receive teaching materials to perpetuate the trainings. Clinical Trial Registration: STREAM is a registered trial at https://clinicaltrials.gov/ct2/show/NCT03228251.
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Affiliation(s)
| | - Natalia Kurka
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Katharina Gruber
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Peter Rostek
- NICU Nursing Staff, University Hospital Frankfurt, Frankfurt, Germany
| | - Heike Rai
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Zickler
- Department of Neurology and Clinical Neurophysiology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Ansgar Berlis
- Department for Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Sven Poli
- Department of Neurology With Focus on Neurovascular Diseases and Neurooncology, University Hospital Tübingen, Tübingen, Germany.,Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Annerose Mengel
- Department of Neurology With Focus on Neurovascular Diseases and Neurooncology, University Hospital Tübingen, Tübingen, Germany.,Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Peter Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Simon Nagel
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Pfaff
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Lars Kellert
- Department of Neurology, Ludwig Maximilians-University, Munich, Germany
| | - Moriz Herzberg
- Department for Diagnostic and Interventional Neuroradiology, Ludwig Maximilians-University, Munich, Germany
| | - Luzie Koehler
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Karl Georg Haeusler
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Anna Alegiani
- Department of Neurology, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | - Charlotte Schubert
- Department of Neurology, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | | | - Oezguer A Onur
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, University Hospital Cologne, Cologne, Germany
| | - Tanja Manser
- School of Applied Psychology, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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15
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Rostanski SK, Kurzweil AM, Zabar S, Balcer LJ, Ishida K, Galetta SL, Lewis A. Education Research: Simulation training for neurology residents on acquiring tPA consent. Neurology 2018; 91:e2276-e2279. [DOI: 10.1212/wnl.0000000000006651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Elkind MS, Mohl S. American Stroke Month: The Role of the Professional Stroke Community. Stroke 2018; 49:1053-1054. [DOI: 10.1161/strokeaha.118.021346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Mitchell S.V. Elkind
- From the Department of Neurology, Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.)
| | - Stephanie Mohl
- American Heart Association/American Stroke Association, Dallas, TX (S.M.)
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