Improving compliance with isolation measures in the operating room: a prospective simulation study comparing the effectiveness and costs of simulation-based training vs video-based training

BACKGROUND

Different isolation measures are required according to the routes of transmission of pathogens. Few studies have compared different forms of hygiene training in terms of efficiency and/or improvement of perception towards hygiene measures. This study aimed to evaluate the benefits of different forms of isolation training in the operating room, and their respective effects on the perception of hygiene measures by comparing simulation training with video-based training.

METHODS

This multi-centre, prospective, randomized, controlled trial compared hygiene knowledge, psychological safety and perception of training among healthcare workers after in-centre simulation training and conventional video-based training.

RESULTS

Neither type of training led to a significant improvement in knowledge or perceived psychological safety (F=0.235, P=0.629, η2=0.003). Participants in the simulation group reported higher levels of willingness to speak up in the depicted scenario compared with participants who received video-based training. Participants perceived the simulation-based training significantly more positively than the video-based training.

CONCLUSION

Clear definition of the goals of training based on the pre-existing level of knowledge of the participants is crucial. For future studies, it would be interesting to investigate the long-term effect and continuing benefits concerning the implementation of hygiene regulations after different types of training.

„Die Puppe hat Luftnot“ – Simulation zum interprofessionellen Lernen im Team: aber sinnvoll!

Ausbildungskonzepte, die eine Simulation von Fällen und Szenarien aller Art nutzen, haben breiten Eingang in Curricula und Praxis gefunden. Ein Vertrauen in technische Simulationsmethoden ohne qualifizierte Ausbildung in der Methode kann schaden. Deswegen sollte nach der Auswahl der korrekten Simulationsmethode großer Wert auf die Durchführung der Simulation gelegt werden. Neben einem strukturierten Design der simulierten Szenarien und der korrekten technischen Durchführung ist für den Lernerfolg vor allem das Debriefing, die Nachbesprechung, entscheidend. Prüfungen mit Simulation als Methode sind nur zu empfehlen, wenn sie von Trainings getrennt durchgeführt werden und die Bewertung nach transparenten, validierten Kriterien erfolgt.

Über Oxocuprate, ΧVIII. Zur Kristallstruktur von Sr2Cu3O4Br2

Sr2Cu3O4Br2 was prepared and examined by single crystal X-ray work. It is isotypic with Sr2Cu3O4Cl2; space group D4h 17- I4/mmm with a = 548.9 and c = 1330.6 pm. A discussion of the result in respect of the octahedral distortion is given.

Concluding results from the first phase of the Zurich Unexpected Difficult Airway course based on exercise of technical skills

We analysed the results of the first phase of the Zurich Unexpected Difficult Airway course. Two hundred and twenty-eight staff members performed a total of 2712 standardised airway rescue procedures with four airway devices: SensaScope™, LMA Fastrach™, Laryngeal Tube and needle cricothyrodotomy. Four consecutive attempts were performed using each device. We analysed the success rate and the time needed for successful completion for each attempt and device. The success rates and mean (SD) completion times for all participants were 96.2% and 30.2 (15.3) s for the SensaScope, 88.1% and 40.4 (17.2) s for the LMA Fastrach, 99.0% and 12.1 (10.6) s for the Laryngeal Tube and 99.0% and 12.3 (6.1) s for needle cricothyroidotomy. The learning curves resulting from the four consecutive attempts with each device showed a clear pattern of improvement. This institutional airway training course represents a promising method to improve the capability of practitioners to cope with unexpected difficult airway situations.

Adaptation in anaesthesia team coordination in response to a simulated critical event and its relationship to clinical performance

BACKGROUND

Recent studies in anaesthesia and intensive care indicate that a team's ability to adapt its coordination activities to changing situational demands is crucial for effective teamwork and thus, safe patient care. This study addresses the relationship between adaptation of team coordination and markers of clinical performance in response to a critical event, particularly regarding which types of coordination activities are used and which team member engages in those coordination activities.

METHODS

Video recordings of 15 two-person anaesthesia teams (anaesthesia trainee plus anaesthesia nurse) performing a simulated induction of general anaesthesia were coded, using a structured observation system for coordination activities. The simulation involved a critical event-asystole during laryngoscopy. Clinical performance was assessed using two separate reaction times related to the critical event.

RESULTS

Analyses of variance revealed a significant effect of the critical event on team coordination: after the occurrence of the asystole, team members adapted their coordination activities by spending more time on information management-a specific type of coordination activity (F(1,28)=15.17, P=0.001). No significant effect was found for task management. The increase in information management was related to faster decisions regarding how to respond to the critical event, but only for trainees and not for nurses.

CONCLUSIONS

Our findings support the claim that adaptation of coordination activities is related to improved team performance in healthcare. Moreover, adaptation and its relationship to team performance were found to vary with regard to type of coordination activities and team member.

[Autosomal dominant polycystic kidney disease in infancy]

We report on a 6 months old infant with suddenly developed severe arterial hypertension caused by polycystic kidneys. Examinations of the relatives revealed similar changes of the kidneys in 4 adults and 5 children. They were all diagnosed to have autosomal dominant polycystic kidney disease. Excretory kidney function of all patients is normal; however, blood pressure was raised in the adults. We would like to stress the importance of family screening in this disease, in particular with regard to possible early diagnosis and treatment of arterial hypertension. The long-term prognosis of the early manifestation of the dominantly inherited cystic kidney disease is uncertain.

Long-term anticoagulant therapy after myocardial infarction in women

A multicentre trial from five medical departments in Oslo has been carried out to determine the value in women patients of one year's long-term anticoagulant therapy. Follow-up long-term laboratory control and anticoagulant dosage were performed at one centre (the Rikshospitalet). One hundred and fifty-nine patients were assigned randomly into two similar well-matched groups (control and treatment). Dosage was controlled by Thrombotest, aiming at 10-20% levels, and 50% of the tests were less than 14%. Compared with the control group, the treatment group showed a significant reduction in mortality and in reinfarction rate. No serious bleeding complications occurred. It is concluded that women benefit as much as men from long-term anticoagulant therapy.