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Bajwa M, Ahmed R, Lababidi H, Morris M, Morton A, Mosher C, Wawersik D, Herx-Weaver A, Gross IT, Palaganas JC. Development of Distance Simulation Educator Guidelines in Healthcare: A Delphi Method Application. Simul Healthc 2024; 19:1-10. [PMID: 36598821 DOI: 10.1097/sih.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The abrupt disruption of in-person instruction in health care during the COVID-19 pandemic resulted in the rapid adoption of distance simulation as an immediate alternative to providing in-person simulation-based education. This massive instructional shift, combined with the lack of educator training in this domain, led to challenges for both learners and educators. This study aimed to disseminate the first set of competencies required of and unique to effective distance simulation educators. METHODS This was a multiphasic and iterative modified Delphi study validating the content of carefully and rigorously synthesized literature. Experts were invited from around the globe to participate in this study with mandatory attendance at an annual health care simulation conference to openly discuss the guidelines presented as competencies in this document. We divided each competency into "Basic" and "Advanced" levels, and agreement was sought for these levels individually. The experts provided their opinion by choosing the options of "Keep, Modify, or Delete." A free-marginal kappa of 0.60 was chosen a priori. RESULTS At the conclusion of the Delphi process, the number of competencies changed from 66 to 59, basic subcompetencies from 216 to 196, and advanced subcompetencies from 179 to 182. CONCLUSIONS This article provides the first set of consensus guidelines to distance simulation educators in health care, and paved the way for further research in distance simulation as a modality.
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Affiliation(s)
- Maria Bajwa
- From the MGH Institute of Health Professions (M.B., R.A., H.L., M.M., A.M., A.H., J.C.P.), Boston, MA; Indiana University School of Medicine (R.A.), Indianapolis, IN; King Fahad Medical City (H.L.), Riyadh, Saudi Arabia; Nova Southeastern University (M.M.), Ft. Lauderdale, FL; Alfaisal University, College of Medicine (C.M.), Riyadh, Saudi Arabia; Henry Ford College (D.W.), Dearborn, MI; Fitchburg State University (A.H.), Fitchburg, MA; UMass Chan Medical School (A.H.), Worcester, MA; Yale University School of Medicine (I.T.G.), New Haven, CT; and Harvard Medical School (J.C.P.), Boston, MA
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Charnetski MD, Wawersik D, Palaganas JC, Duff JP, Bailey SKT, Ramachandra G, Birido N, Elkin R, Nair B, Thurber P, Gross IT. Understanding the Effects of Health Care Distance Simulation: A Systematic Review. Simul Healthc 2024; 19:S57-S64. [PMID: 38240619 DOI: 10.1097/sih.0000000000000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT The use of distance simulation has rapidly expanded in recent years with the physical distance requirements of the COVID-19 pandemic. With this development, there has been a concurrent increase in research activities and publications on distance simulation. The authors conducted a systematic review of the peer-reviewed distance health care simulation literature. Data extraction and a risk-of-bias assessment were performed on selected articles. Review of the databases and gray literature reference lists identified 10,588 titles for review. Of those, 570 full-text articles were assessed, with 54 articles included in the final analysis. Most of these were published during the COVID-19 pandemic (2020-2022). None of the included studies examined an outcome higher than a Kirkpatrick level of 2. Most studies only examined low-level outcomes such as satisfaction with the simulation session. There was, however, a distinction in studies that were conducted in a learning environment where all participants were in different locations ("distance only") as compared with where some of the participants shared the same location ("mixed distance"). This review exclusively considered studies that focused solely on distance. More comparative studies exploring higher level outcomes are required to move the field forward.
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Affiliation(s)
- Matthew D Charnetski
- From the Dartmouth Health (M.C.), Lebanon, NH; Nova Southeastern University (D.W.), Fort Lauderdale, FL; MGH Institute of Health Professions (J.P.), Boston, MA; Department of Pediatrics (J.P.D.), University of Alberta, Edmonton, Alberta, Canada; Center for Advanced Medical Learning & Simulation (S.K.T.B.), Morsani College of Medicine, University of South Florida, Tampa, FL; Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad, India; Royal College of Surgeons in Ireland - Medical University of Bahrain (N.B., B.N.), Busaiteen, Bahrain; Columbia University Vagelos College of Physicians and Surgeons (R.E.), New York, NY; The Dartmouth Institute for Health Policy and Clinical Practice (P.T.), Hanover, NH; and Yale University School of Medicine (I.T.G.), New Haven, CT
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Stefanidis D, Cook D, Kalantar-Motamedi SM, Muret-Wagstaff S, Calhoun AW, Lauridsen KG, Paige JT, Lockey A, Donoghue A, Hall AK, Patocka C, Palaganas J, Gross IT, Kessler D, Vermylen J, Lin Y, Aebersold M, Chang TP, Duff J, Kolbe M, Rutherford-Hemming T, Decker S, Collings A, Toseef Ansari M. Society for Simulation in Healthcare Guidelines for Simulation Training. Simul Healthc 2024; 19:S4-S22. [PMID: 38240614 DOI: 10.1097/sih.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. METHODS Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. OBJECTIVE These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare. RESULTS Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided. CONCLUSIONS The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.
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Affiliation(s)
- Dimitrios Stefanidis
- From the Department of Surgery (D.S., S.-M.K.-M.), Indiana University School of Medicine, Indianapolis, IN; Department of Internal Medicine (D.C.), Mayo Clinic, Rochester, MN; Department of Surgery (S.M.-W.), Emory University, Atlanta, GA; Department of Pediatrics (A.W.C.), University of Louisville School of Medicine and Norton Children's Medical Group, Louisville, KY; Department of Medicine (K.G.L.), Randers Regional Hospital, Randers, Denmark; Research Center for Emergency Medicine (K.G.L.), Aarhus University, Aarhus, Denmark; Department of Surgery (J.T.P.), LSU Health New Orleans School of Medicine, New Orleans, LA; Emergency Department (A.L.), Calderdale and Huddersfield NHS Trust, Halifax; School of Human and Health Sciences (A.L.), University of Huddersfield, Huddersfield, UK; Critical Care Medicine and Pediatrics (A.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Emergency Medicine (A.K.H.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine (C.P.), Cumming School of Medicine University of Calgary, Calgary, AB, Canada; Department of Health Professions Education (J.P.), School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA; Department of Pediatrics (I.T.G.), Section of Emergency Medicine, Yale University, New Haven, CT; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY,; Department of Medicine and Medical Education (J.V.), Feinberg School of Medicine, Northwestern University, Chicago, IL; KidSIM Simulation Research Program (Y.L.), Alberta Children's Hospital, Calgary, Canada; University of Michigan School of Nursing (M.A.), Ann Arbor, MI; Las Madrinas Simulation Center, Children's Hospital (T.C.), University South California, Los Angeles, CA; Department of Pediatrics (J.D.), University of Alberta, Edmonton, Alberta, Canada; Simulation Center (M.K.), University Hospital Zurich, ETH Zurich, Switzerland; Department of Nursing (T.R.-H.), University of North Carolina, Chapel Hill, NC; Department of Nursing (S.D.), Texas Tech University Health Sciences Center, Lubbock, TX; Department of Surgery (A.C.), University of Louisville, Louisville, KY; and Independent Methodologist (M.T.A.), Ottawa, Ontario, Canada
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Birido N, Brown KM, Olmo Ferrer D, Friedland R, Bailey SKT, Wawersik D, Charnetski M, Nair B, Kutzin JM, Gross IT, Palaganas JC. Health Care Simulation in Person and at a Distance: A Systematic Review. Simul Healthc 2024; 19:S65-S74. [PMID: 38240620 DOI: 10.1097/sih.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT Distance simulation is a method of health care training in which the learners and facilitators are in different physical locations. Although methods of distance simulation have existed in health care for decades, this approach to education became much more prevalent during the COVID-19 pandemic. This systematic review studies a subset of distance simulation that includes combined in-person and distance simulation elements, identified here as "mixed- distance simulation." A review of the distance simulation literature identified 10,929 articles. Screened by inclusion and exclusion criteria, 34 articles were ultimately included in this review. The findings of this review present positive and negative aspects of mixed-distance simulation formats, a description of the most frequent configurations related to delivery, terminology challenges, as well as future directions including the need for faculty development, methodological rigor, and reporting details.
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Affiliation(s)
- Nuha Birido
- From the Royal College of Surgeons in Ireland-Medical University of Bahrain (N.B., B.N.), Busaiteen, Bahrain; Johns Hopkins University School of Nursing (K.M.B.), Baltimore, MD; Norfolk and Norwich University (D.O.-F.), Norfolk, UK; University of South Florida (S.K.T.B.), Tampa, FL; Nova Southeastern University (D.W.), Fort Lauderdale, FL; Dartmouth Health (M.C.), Lebanon, NH; The Mount Sinai Hospital (J.M.K.). New York, NY; Yale University School of Medicine (I.T.G.), New Haven, CT; and MGH Institute of Health Professions (J.C.P.), Boston, MA
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Duff JP, Morse KJ, Seelandt J, Gross IT, Lydston M, Sargeant J, Dieckmann P, Allen JA, Rudolph JW, Kolbe M. Debriefing Methods for Simulation in Healthcare: A Systematic Review. Simul Healthc 2024; 19:S112-S121. [PMID: 38240623 DOI: 10.1097/sih.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
ABSTRACT Debriefing is a critical component in most simulation experiences. With the growing number of debriefing concepts, approaches, and tools, we need to understand how to debrief most effectively because there is little empiric evidence to guide us in their use. This systematic review explores the current literature on debriefing in healthcare simulation education to understand the evidence behind practice and clarify gaps in the literature. The PICO question for this review was defined as "In healthcare providers [P], does the use of one debriefing or feedback intervention [I], compared to a different debriefing or feedback intervention [C], improve educational and clinical outcomes [O] in simulation-based education?" We included 70 studies in our final review and found that our current debriefing strategies, frameworks, and techniques are not based on robust empirical evidence. Based on this, we highlight future research needs.
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Affiliation(s)
- Jonathan P Duff
- From the Department of Pediatrics (J.P.D.), University of Alberta. Edmonton, Canada; College of Nursing and Health Professions (K.J.M.), Drexel University, Philadelphia, PA; Simulation Centre (J.S., M.K.), University Hospital, Zurich, Switzerland; Department of Pediatrics, Section of Emergency Medicine (I.T.G.), Yale University School of Medicine, New Haven, CT; Treadwell Virtual Library (M.L.), Massachusetts General Hospital, Boston, MA; Faculty of Medicine (J.S.), Dalhousie University, Halifax, Canada; Copenhagen Academy for Medical Education and Simulation (CAMES) (P.D.), Herlev, Denmark; Department of Quality and Health Technology (P.D.), University of Stavanger, Stavanger, Norway; Department of Public Health (P.D.), University of Copenhagen, Denmark; Department of Family and Preventive Medicine (J.A.A.), University of Utah, Salt Lake City, UT; Center for Medical Simulation (J.W.R.), Boston, MA; and ETH Zurich (M.K.), Zurich, Switzerland
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Elkin R, Duff JP, LaForest ML, Stapleton S, Ramachandra G, Palaganas JC, Gross IT. Distance simulation in the health professions: a scoping review. Adv Simul (Lond) 2023; 8:27. [PMID: 37978416 PMCID: PMC10656877 DOI: 10.1186/s41077-023-00266-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Distance simulation is defined as simulation experiences in which participants and/or facilitators are separated from each other by geographic distance and/or time. The use of distance simulation as an education technique expanded rapidly with the recent COVID-19 pandemic, with a concomitant increase in scholarly work. METHODS A scoping review was performed to review and characterize the distance simulation literature. With the assistance of an informationist, the literature was systematically searched. Each abstract was reviewed by two researchers and disagreements were addressed by consensus. Risk of bias of the included studies was evaluated using the Risk of Bias 2 (RoB 2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tools. RESULTS Six thousand nine hundred sixty-nine abstracts were screened, ultimately leading to 124 papers in the final dataset for extraction. A variety of simulation modalities, contexts, and distance simulation technologies were identified, with activities covering a range of content areas. Only 72 papers presented outcomes and sufficient detail to be analyzed for risk of bias. Most studies had moderate to high risk of bias, most commonly related to confounding factors, intervention classification, or measurement of outcomes. CONCLUSIONS Most of the papers reviewed during the more than 20-year time period captured in this study presented early work or low-level outcomes. More standardization around reporting is needed to facilitate a clear and shared understanding of future distance simulation research. As the broader simulation community gains more experience with distance simulation, more studies are needed to inform when and how it should be used.
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Affiliation(s)
- Rachel Elkin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | - Jonathan P Duff
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Marian L LaForest
- Augustus Long Health Sciences Library, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Geethanjali Ramachandra
- Department of Pediatric Intensive Care, Krishna Institute of Medical Science, Secunderabad, India
| | - Janice C Palaganas
- Department of Health Professions Education, MGH Institute of Health Professions, Boston, MA, USA
| | - Isabel T Gross
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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Auerbach MA, Whitfill T, Montgomery E, Leung J, Kessler D, Gross IT, Walsh BM, Fiedor Hamilton M, Gawel M, Kant S, Janofsky S, Brown LL, Walls TA, Alletag M, Sessa A, Arteaga GM, Keilman A, Van Ittersum W, Rutman MS, Zaveri P, Good G, Schoen JC, Lavoie M, Mannenbach M, Bigham L, Dudas RA, Rutledge C, Okada PJ, Moegling M, Anderson I, Tay KY, Scherzer DJ, Vora S, Gaither S, Fenster D, Jones D, Aebersold M, Chatfield J, Knight L, Berg M, Makharashvili A, Katznelson J, Mathias E, Lutfi R, Abu-Sultaneh S, Burns B, Padlipsky P, Lee J, Butler L, Alander S, Thomas A, Bhatnagar A, Jafri FN, Crellin J, Abulebda K. Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments. Pediatrics 2023:e2022060790. [PMID: 37416979 DOI: 10.1542/peds.2022-060790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality. METHODS Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored. RESULTS A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores. CONCLUSIONS A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores.
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Affiliation(s)
| | | | - Erin Montgomery
- Indiana University School of Medicine, Indianapolis, Indiana
| | - James Leung
- McMaster University, Hamilton, Ontario, Canada
| | - David Kessler
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Isabel T Gross
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Marcie Gawel
- Yale University School of Medicine, New Haven, Connecticut
| | - Shruti Kant
- University of California San Francisco, San Francisco, California
| | - Stephen Janofsky
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Linda L Brown
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Theresa A Walls
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle Alletag
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna Sessa
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Grace M Arteaga
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Ashley Keilman
- University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | - Maia S Rutman
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Pavan Zaveri
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Grace Good
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Meghan Lavoie
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark Mannenbach
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | | | | | - Pamela J Okada
- University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Michelle Moegling
- Case Western Reserve University and UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Ingrid Anderson
- Case Western Reserve University and UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Khoon-Yen Tay
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Stacy Gaither
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel Fenster
- Columbia University Irving Medical Center, New York, New York
| | - Derick Jones
- Mayo Clinic Health System, Albert Lea and Austin, Minnesota
| | | | | | - Lynda Knight
- Stanford Medicine Children's Health, Palo Alto, California
| | - Marc Berg
- Stanford Medicine Children's Health, Palo Alto, California
| | | | | | | | - Riad Lutfi
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Brian Burns
- University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | - Jumie Lee
- The Lundquist Institute, Torrance, California
| | - Lucas Butler
- Virginia Mason Medical Center, Seattle, Washington
| | - Sarah Alander
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania; and
| | - Anita Thomas
- University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | | | - Jason Crellin
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania; and
| | - Kamal Abulebda
- Indiana University School of Medicine, Indianapolis, Indiana
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Gross IT, Clapper TC, Ramachandra G, Thomas A, Ades A, Walsh B, Kreuzer F, Elkin R, Wagner M, Whitfill T, Chang TP, Duff JP, Deutsch ES, Loellgen RM, Palaganas JC, Fayyaz J, Kessler D, Calhoun AW. Setting an Agenda: Results of a Consensus Process on Research Directions in Distance Simulation. Simul Healthc 2023; 18:100-107. [PMID: 36989108 DOI: 10.1097/sih.0000000000000663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic forced rapid implementation and refinement of distance simulation methodologies in which participants and/or facilitators are not physically colocated. A review of the distance simulation literature showed that heterogeneity in many areas (including nomenclature, methodology, and outcomes) limited the ability to identify best practice. In April 2020, the Healthcare Distance Simulation Collaboration was formed with the goal of addressing these issues. The aim of this study was to identify future research priorities in the field of distance simulation using data derived from this summit. METHODS This study analyzed textual data gathered during the consensus process conducted at the inaugural Healthcare Distance Simulation Summit to explore participant perceptions of the most pressing research questions regarding distance simulation. Participants discussed education and patient safety standards, simulation facilitators and barriers, and research priorities. Data were qualitatively analyzed using an explicitly constructivist thematic analysis approach, resulting in the creation of a theoretical framework. RESULTS Our sample included 302 participants who represented 29 countries. We identified 42 codes clustered within 4 themes concerning key areas in which further research into distance simulation is needed: (1) safety and acceptability, (2) educational/foundational considerations, (3) impact, and (4) areas of ongoing exploration. Within each theme, pertinent research questions were identified and categorized. CONCLUSIONS Distance simulation presents several challenges and opportunities. Research around best practices, including educational foundation and psychological safety, are especially important as is the need to determine outcomes and long-term effects of this emerging field.
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Affiliation(s)
- Isabel T Gross
- From the Department of Pediatrics (I.T.G., T.W.), Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT; Weill Cornell Medicine NewYork-Presbyterian Simulation Center (T.C.C.), Weill Cornell Medical College, New York, NY; Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad, India; Division of Pediatric Emergency Medicine (A.T.), Department of Pediatrics, Seattle Children's Hospital, Seattle, WA; Division of Neonatology (A.A.), Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Pediatric Emergency Medicine (B.W.), Department of Pediatrics, Boston University School of Medicine, Boston, MA; Faculty of Medicine (F.K.), Ludwig-Maximilians-University Munich, Munich, Germany; Department of Emergency Medicine (R.E., D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY; Division of Neonatology (M.W.), Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria; Department of Emergency Medicine (T.W.), Yale University School of Medicine, New Haven, CT; Division of Emergency Medicine (T.P.C.), Department of Medical Education, Children's Hospital Los Angeles & Keck School of Medicine at University of Southern California, Los Angeles, CA; Division of Pediatric Critical Care Medicine (J.P.D.), Department of Pediatrics, University of Alberta, Edmonton, Canada; Department of Anesthesiology and Critical Care Medicine (E.S.D.), Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatric Emergency Medicine (R.M.L.), Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Anesthesia, Critical Care, and Pain Medicine (J.C.P.), Harvard Medical School, Boston, MA; Department of Pediatric Emergency Medicine (J.F.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics (A.W.C.), University of Louisville and Norton Children's Hospital, Louisville, KY
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Calhoun AW, Gross IT, Mallory LB, Shepard LN, Adler MD, Maa T, Auerbach MA, Cheng A, Kessler DO, Whitfill TM, Duff JP. From Concept to Publication: Effectiveness of the International Network for Simulation-Based Pediatric Innovation, Research, and Education Project Development Process at Generating Simulation Scholarship. Simul Healthc 2022; 17:385-393. [PMID: 34966128 DOI: 10.1097/sih.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As simulation matures, it is critical to develop pathways for researchers. A recent analysis, however, demonstrates a low conversion rate between abstract and peer-reviewed journal publication in our field. The International Network for Simulation-based Pediatric Innovation, Research, and Education has used the ALERT Presentation process for the past decade as a means of accelerating research. In this study, we analyze the scholarly products attributable to ALERT Presentations. METHODS Surveys were distributed to all International Network for Simulation-based Pediatric Innovation, Research, and Education Advanced Look Exploratory Research Template (ALERT) Presentation first authors from January 2011 through January 2020. Presenters were asked to provide information on abstracts, grants, journal publications, and book chapters related to their ALERT Presentation, as well as basic demographic information. A structured literature search was conducted for those ALERT Presentations whose authors did not return a survey. The resulting database was descriptively analyzed, and statistical correlations between demographic variables and scholarship were examined. RESULTS One hundred sixty-five new ALERT presentations were presented over 10 years. We identified 361 associated scholarly works (170 conference abstracts, 125 peer-reviewed journal publications, 65 grants, and 1 book chapter). Sixty-one percent (101 of 165) of ALERT Presentations produced at least 1 item of scholarship, and 59% (34 of 58) of ALERT Presentations that resulted in at least 1 abstract also led to at least 1 peer-reviewed journal article. Presenter gender was associated with likelihood of journal publication. CONCLUSIONS The ALERT Presentation process is an effective approach for facilitating the development of projects that result in disseminated scholarship. Wider adoption may benefit other simulation and education research networks.
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Affiliation(s)
- Aaron W Calhoun
- From the Division of Pediatric Critical Care (A.W.C.), Department of Pediatrics, University of Louisville School of Medicine, and Norton Children's Hospital, Louisville, KY; Section of Pediatric Emergency Medicine (I.G., M.Au., T.W.), Department of Pediatrics (I.G., M.Au., T.W.), Yale University School of Medicine, New Haven, CT; Department of Medical Education (L.M.), The Hannaford Center for Simulation, Innovation and Education; Section of Hospital Medicine (L.M.), Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Division of Pediatric Critical Care (L.S.), Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Pediatric Emergency Medicine (M.Ad.), Department of Pediatrics, Northwestern University School of Medicine, Chicago, IL; Department of Pediatrics (T.M.), Division of Pediatric Critical Care, Ohio State University, Columbus, OH; Departments of Pediatrics and Emergency Medicine (A.C.), University of Calgary, Calgary, Canada; Section of Emergency Medicine (D.K.), Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY; and Division of Critical Care (J.P.), Department of Pediatrics, University of Alberta, Alberta, Canada
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Chang TP, Elkin R, Boyle TP, Nishisaki A, Walsh B, Benary D, Auerbach M, Camacho C, Calhoun A, Stapleton SN, Whitfill T, Wood T, Fayyaz J, Gross IT, Thomas AA. Characterizing preferred terms for geographically distant simulations: distance, remote and telesimulation. Simul Healthc 2022. [DOI: 10.54531/drkq7209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulationists lack standard terms to describe new practices accommodating pandemic restrictions. A standard language around these new simulation practices allows ease of communication among simulationists in various settings.
We explored consensus terminology for simulation accommodating geographic separation of participants, facilitators or equipment. We used an iterative process with participants of two simulation conferences, with small groups and survey ranking.
Small groups (n = 121) and survey ranking (n = 54) were used with
This research has deepened our understanding of how simulationists interpret this terminology, including the derived themes: (1) physical distance/separation, (2) overarching nature of the term and (3) implications from existing terms. We further deepen the conceptual discussion on healthcare simulation aligned with the search of the terminologies. We propose there are nuances that prevent an early consensus recommendation. A taxonomy of descriptors specifying the conduct of
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Affiliation(s)
- Todd P Chang
- 1Division of Emergency Medicine & Transport, Children’s Hospital Los Angeles/Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rachel Elkin
- 2Division of Pediatric Emergency Medicine, New York-Presbyterian Morgan Stanley Children’s Hospital-Columbia University Irving Medical Center/Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tehnaz P Boyle
- 3Division of Pediatric Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Akira Nishisaki
- 4Division of Pediatric Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Walsh
- 5Division of Emergency Medicine, Boston Children’s Hospital, Harvard University, Boston, MA, USA
| | - Doreen Benary
- 6Division of Pediatric Emergency Medicine, NYU Langone Medical Center, New York University, New York, NY, USA
| | - Marc Auerbach
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cheryl Camacho
- 8Simulation and Outreach Education, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Aaron Calhoun
- 9Division of Critical Care, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Stephanie N Stapleton
- 10Department of Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Travis Whitfill
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Trish Wood
- 11Starship Child Health, Auckland, New Zealand
| | - Jabeen Fayyaz
- 12Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Isabel T Gross
- 13Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Anita A Thomas
- 14Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA
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Chang TP, Elkin R, Boyle TP, Nishisaki A, Walsh B, Benary D, Auerbach M, Camacho C, Calhoun A, Stapleton SN, Whitfill T, Wood T, Fayyaz J, Gross IT, Thomas AA. Characterizing preferred terms for geographically distant simulations: distance, remote and telesimulation. Simul Healthc 2022; 1:55-65. [DOI: 10.54531/dwti2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulationists lack standard terms to describe new practices accommodating pandemic restrictions. A standard language around these new simulation practices allows ease of communication among simulationists in various settings.
We explored consensus terminology for simulation accommodating geographic separation of participants, facilitators or equipment. We used an iterative process with participants of two simulation conferences, with small groups and survey ranking.
Small groups (n = 121) and survey ranking (n = 54) were used with
This research has deepened our understanding of how simulationists interpret this terminology, including the derived themes: (1) physical distance/separation, (2) overarching nature of the term and (3) implications from existing terms. We further deepen the conceptual discussion on healthcare simulation aligned with the search of the terminologies. We propose there are nuances that prevent an early consensus recommendation. A taxonomy of descriptors specifying the conduct of
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Affiliation(s)
- Todd P Chang
- 1Division of Emergency Medicine & Transport, Children’s Hospital Los Angeles/Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rachel Elkin
- 2Division of Pediatric Emergency Medicine, New York-Presbyterian Morgan Stanley Children’s Hospital-Columbia University Irving Medical Center/Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tehnaz P Boyle
- 3Division of Pediatric Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Akira Nishisaki
- 4Division of Pediatric Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Walsh
- 5Division of Emergency Medicine, Boston Children’s Hospital, Harvard University, Boston, MA, USA
| | - Doreen Benary
- 6Division of Pediatric Emergency Medicine, NYU Langone Medical Center, New York University, New York, NY, USA
| | - Marc Auerbach
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cheryl Camacho
- 8Simulation and Outreach Education, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Aaron Calhoun
- 9Division of Critical Care, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Stephanie N Stapleton
- 10Department of Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Travis Whitfill
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Trish Wood
- 11Starship Child Health, Auckland, New Zealand
| | - Jabeen Fayyaz
- 12Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Isabel T Gross
- 13Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Anita A Thomas
- 14Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA
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Goldman MP, Query LA, Wong AH, Gross IT, Emerson BL, Auerbach MA, Tiyyagura GK. Closing the Loop: Program Description and Qualitative Analysis of a Pediatric Posttransfer Follow-up and Feedback Program. Pediatr Emerg Care 2021; 37:e1535-e1543. [PMID: 33009320 PMCID: PMC8012401 DOI: 10.1097/pec.0000000000002108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Follow-up and feedback foster improvement. General emergency medicine providers working in community hospitals desire follow-up and feedback on pediatric patients transferred to children's hospitals. We implemented a novel program to provide these data to our colleagues. The objective of this study was to explore stakeholder perspectives of our program. METHODS We provided secure, electronic reports on transfers from 7 general emergency departments (GEDs). Patient follow-up and feedback data were delivered to the GED's pediatric emergency care coordinator. Seven pediatric emergency care coordinators and 2 children's hospital liaisons participated in semistructured interviews. Five researchers coded and analyzed transcribed data using the constant comparative method of grounded theory. Codes were refined and clustered to develop themes. RESULTS Perceived values of the program included GED appreciation of closing the loop on transferred patients, providing education, and informing quality improvement. Participants valued the concise and timely nature of the reports and their empathetic delivery. Facilitators of program implementation included established professional relationships between the GED and the children's hospital liaisons and a GED's culture of self-inquiry. Barriers to program implementation included potential medicolegal exposure and the time burden for report generation and processing. Suggested programmatic improvements included focusing on generalizable, evidence-based learning points and analyzing care trends. CONCLUSIONS Stakeholders of our pediatric posttransfer follow-up and feedback program reported many benefits and provided key suggestions that may promote successful dissemination of similar programs nationwide. Examining data trends in transferred children may focus efforts to improve the care of children across all emergency care settings.
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Affiliation(s)
- Michael P Goldman
- From the Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Goldman MP, Auerbach MA, Garcia AM, Gross IT, Tiyyagura GK. Pediatric Emergency Medicine ECHO (Extension for Community Health Care Outcomes): Cultivating Connections to Improve Pediatric Emergency Care. AEM Educ Train 2021; 5:e10548. [PMID: 34141996 PMCID: PMC8164662 DOI: 10.1002/aet2.10548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/28/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND An Extension for Community Health Care Outcomes (ECHO) provides the opportunity for specialists at academic medical centers (AMCs) and frontline community generalists to engage in bidirectional learning. Specialists provide generalists with the current best evidence, and generalists share the local challenges applying this evidence to their practice. All ECHO participants strategize how to navigate these challenges together. Pediatric emergency medicine (PEM) may benefit from this knowledge translation strategy because most children seek emergency care from generalists in community emergency departments (CEDs) where variations in care between the AMC and the CED have been reported. METHODS Our objective was to use ECHO to cultivate a PEM community of practice that facilitated knowledge translation and generated future CED pediatric improvement initiatives. As such, we developed, implemented, and evaluated a PEM ECHO. We conducted general and targeted needs assessments to inform our curriculum and formatted the sessions to generate bidirectional learning. A postparticipation evaluation collected self-reported perceptions about knowledge translation, planned provider practice changes, and perceptions of the formation of a community of practice. Additionally, we solicited information on the implementation of any pediatric improvement activities attributed to the PEM ECHO. RESULTS Thirteen 1-hour sessions covered the chosen PEM topics. Participants represented diverse CEDs, with varied experience and roles in caring for children. All respondents (13/13) appreciated the ECHO learning format, reported improved PEM knowledge, and perceived the cultivation of a community of practice. Nine (85%) individuals attributed implementation of new pediatric improvement activities to the PEM ECHO. CONCLUSIONS Our PEM ECHO was associated with improved perceptions of PEM knowledge, cultivated a community of practice, and facilitated the implementation of CED pediatric improvement activities. The PEM ECHO's bidirectional learning format generated new initiatives and partnerships aiming to improve the emergency care of children.
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Affiliation(s)
- Michael P. Goldman
- From theDepartment of PediatricsSection of Pediatric Emergency Medicine and Department of Emergency MedicineYale University School of MedicineNew HavenCTUSA
| | - Marc A. Auerbach
- From theDepartment of PediatricsSection of Pediatric Emergency Medicine and Department of Emergency MedicineYale University School of MedicineNew HavenCTUSA
| | - Angelica M. Garcia
- and theDepartment of Emergency MedicineBoston Children’s HospitalBostonMAUSA
| | - Isabel T. Gross
- From theDepartment of PediatricsSection of Pediatric Emergency Medicine and Department of Emergency MedicineYale University School of MedicineNew HavenCTUSA
| | - Gunjan K. Tiyyagura
- From theDepartment of PediatricsSection of Pediatric Emergency Medicine and Department of Emergency MedicineYale University School of MedicineNew HavenCTUSA
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Wagner M, Jaki C, Löllgen RM, Mileder L, Eibensteiner F, Ritschl V, Steinbauer P, Gottstein M, Abulebda K, Calhoun A, Gross IT. Readiness for and Response to Coronavirus Disease 2019 Among Pediatric Healthcare Providers: The Role of Simulation for Pandemics and Other Disasters. Pediatr Crit Care Med 2021; 22:e333-e338. [PMID: 33350800 PMCID: PMC8162220 DOI: 10.1097/pcc.0000000000002649] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Early preparation for the training and education of healthcare providers, as well as the continuation or modification of routine medical education programs, is of great importance in times of the coronavirus disease 2019 pandemic or other public health emergencies. The goal of this study was to characterize these self-reported efforts by the pediatric simulation community. DESIGN This was a global, multicenter survey developed via a Delphi process. SETTING International survey study. SUBJECTS The survey was sent to 555 individual members of the three largest international pediatric simulation societies (The International Pediatric Simulation Society, International Network for Simulation-based Pediatric Innovation, Research & Education, and Netzwerk Kindersimulation e.V.) between April 27, 2020, and May 18, 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Description of coronavirus disease 2019 pandemic simulation-based preparation activities of pediatric acute and critical care healthcare providers. The Delphi process included 20 content experts and required three rounds to reach consensus. The survey was completed by 234 participants (42.2%) from 19 countries. Preparation differed significantly between the geographic regions, with 79.3% of Anglo-American/Anglo-Saxon, 82.6% of Indian, and 47.1% of European participants initiating specifically coronavirus disease 2019-related simulation activities. Frequent modifications to existing simulation programs included the use of telesimulation and virtual reality training. Forty-nine percent of institutions discontinued noncoronavirus disease 2019-related simulation training. CONCLUSIONS The swift incorporation of disease-specific sessions and the transition of standard education to virtual or hybrid simulation training modes occurred frequently. The approach used, however, depended heavily on local requirements, limitations, and circumstances. In particular, the use of telesimulation allowed education to continue while maintaining social distancing requirements.
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Affiliation(s)
- Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Christina Jaki
- Simulation Center STUPS Klinikum Stuttgart, Stuttgart, Germany
| | - Ruth M Löllgen
- Pediatric Emergency Department, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Mileder
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Kamal Abulebda
- Division of Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Aaron Calhoun
- Division of Critical Care Medicine, Department of Pediatrics, University of Louisville, Louisville, KY
| | - Isabel T Gross
- Department of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
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Duff J, Kardong-Edgren S, Chang TP, Elkin RL, Ramachandra G, Stapleton S, Palaganas JC, Kou M, Gross IT. Closing the gap: a call for a common blueprint for remote distance telesimulation. BMJ Simul Technol Enhanc Learn 2021; 7:185-187. [PMID: 35516822 PMCID: PMC8936613 DOI: 10.1136/bmjstel-2021-000875] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/10/2021] [Indexed: 11/20/2022]
Abstract
The physical requirements mandated by the COVID-19 pandemic have presented a challenge and an opportunity for simulation educators. Although there were already examples of simulation being delivered at a distance, the pandemic forced this technique into the mainstream. With any new discipline, it is important for the community to agree on vocabulary, methods and reporting guidelines. This editorial is a call to action for the simulation community to start this process so that we can best describe and use this technique.
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Affiliation(s)
- Jonathan Duff
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Suzie Kardong-Edgren
- Department of Health Professions Education, MGH Institute of Health Professions, Boston, MA, USA
| | - Todd P Chang
- Division of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Rachel L Elkin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Geethanjali Ramachandra
- Pediatric Intensive Care, Krishna Institute of Medical Science, Secunderabad, Telangana, India
| | - Stephanie Stapleton
- Department of Emergency Medicine, Boston University, Boston, Massachusetts, USA
| | - Janice C Palaganas
- Department of Health Professions Education, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care & Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Maybelle Kou
- Graduate Medical Education, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Isabel T Gross
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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Abulebda K, Ahmed RA, Auerbach MA, Bona AM, Falvo LE, Hughes PG, Gross IT, Sarmiento EJ, Barach PR. National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic. World J Crit Care Med 2020; 9:74-87. [PMID: 33384950 PMCID: PMC7754533 DOI: 10.5492/wjccm.v9.i5.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/04/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine and plan for the optimal allocation of medical resources for the highest priority patients. There is limited data describing pediatric intensive care unit (PICU) preparedness and their health worker protections.
AIM To describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a set of PICUs within a simulation-based network nationwide.
METHODS A cross-sectional multi-center national survey of PICU medical director(s) from children’s hospitals across the United States. The questionnaire was developed and reviewed by physicians with expertise in pediatric critical care, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through a long-established national research network. The questions focused on six themes: (1) PICU and medical director demographics; (2) Pediatric patient flow during the pandemic; (3) Changes to the staffing models related to the pandemic; (4) Use of personal protective equipment (PPE); (5) Changes in clinical practice and innovations; and (6) Current modalities of training including simulation.
RESULTS We report on survey responses from 22 of 35 PICUs (63%). The majority of PICUs were located within children’s hospitals (87%). All PICUs cared for pediatric patients with COVID-19 at the time of the survey. The majority of PICUs (83.4%) witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicated units, and 74.6% pivoted to accept adult COVID-19 patients. All PICUs implemented changes to their staffing models with the most common changes being changes in COVID-19 patient room assignment in 50% of surveyed PICUs and introducing remote patient monitoring in 36% of the PICU units. Ninety-five percent of PICUs conducted training for donning and doffing of enhanced PPE. Even 6 months into the pandemic, one-third of PICUs across the United States reported shortages in PPE. The most common training formats for PPE were hands-on training (73%) and video-based content (82%). The most common concerns related to COVID-19 practice were changes in clinical protocols and guidelines (50%). The majority of PICUs implemented significant changes in their airway management (82%) and cardiac arrest management protocols in COVID-19 patients (68%). Simulation-based training was the most commonly utilized training modality (82%), whereas team training (73%) and team dynamics (77%) were the most common training objectives.
CONCLUSIONS A substantial proportion of surveyed PICUs reported on large changes in their preparedness and training efforts before and during the pandemic. PICUs implemented broad strategies including modifications to staffing, PPE usage, workflow, and clinical practice, while using simulation as the preferred training modality. Further research is needed to advance the level of preparedness, support staff assuredness, and support deep learning about which preparedness actions were effective and what lessons are needed to improve PICU care and staff protection for the next COVID-19 patient waves.
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Affiliation(s)
- Kamal Abulebda
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, United States
| | - Rami A Ahmed
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Marc A Auerbach
- Department of Pediatrics, Division of Pediatrics Emergency Medicine, Yale University School of Medicine, New Haven, CT 06504, United States
| | - Anna M Bona
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Lauren E Falvo
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Patrick G Hughes
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Isabel T Gross
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT 06504, United States
| | - Elisa J Sarmiento
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Paul R Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48202, Jefferson College of Population Health, Philadelphia, PA, 19107, United States
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Whitfill T, Auerbach M, Diaz MCG, Walsh B, Scherzer DJ, Gross IT, Cicero MX. Cost-effectiveness of a video game versus live simulation for disaster training. BMJ STEL 2020; 6:268-273. [DOI: 10.1136/bmjstel-2019-000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 11/04/2022]
Abstract
IntroductionDisaster triage training for emergency medical service (EMS) providers is unstandardised. We hypothesised that disaster triage training with the paediatric disaster triage (PDT) video game ‘60 s to Survival’ would be a cost-effective alternative to live simulation-based PDT training.MethodsWe synthesised data for a cost-effectiveness analysis from two previous studies. The video game data were from the intervention arm of a randomised controlled trial that compared triage accuracy in a live simulation scenario of exposed vs unexposed groups to the video game. The live simulation and feedback data were from a prospective cohort study evaluating live simulation and feedback for improving disaster triage skills. Postintervention scores of triage accuracy were measured for participants via live simulations and compared between both groups. Cost-effectiveness between the live simulation and video game groups was assessed using (1) A net benefit regression model at various willingness-to-pay (WTP) values. (2) A cost-effectiveness acceptability curve (CEAC).ResultsThe total cost for the live simulation and feedback training programme was $81 313.50 and the cost for the video game was $67 822. Incremental net benefit values at various WTP values revealed positive incremental net benefit values, indicating that the video game is more cost-effective compared with live simulation and feedback. Moreover, the CEAC revealed a high probability (>0.6) at various WTP values that the video game is more cost-effective.ConclusionsA video game-based simulation disaster triage training programme was more cost-effective than a live simulation and feedback-based programme. Video game-based training could be a simple, scalable and sustainable solution to training EMS providers.
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Gross IT, Whitfill T, Redmond B, Couturier K, Bhatnagar A, Joseph M, Joseph D, Ray J, Wagner M, Auerbach M. Comparison of Two Telemedicine Delivery Modes for Neonatal Resuscitation Support: A Simulation-Based Randomized Trial. Neonatology 2020; 117:159-166. [PMID: 31905354 DOI: 10.1159/000504853] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous research has described technical aspects of telemedicine and the clinical impact of provider-to-patient telemedicine; however, little is known about provider-to-provider telemedical interventions. OBJECTIVE The primary aim of this study was to compare two telemedicine delivery modes on the quality of a simulated neonatal resuscitation. Our secondary aim was to evaluate the providers' task load. METHODS This was a prospective, single-center, randomized, simulation-based trial comparing a remote neonatal team leader ("teleleader") versus a remote consultant ("teleconsultant"). Participants resuscitated a simulated, apneic, and bradycardic neonate. Performance was assessed by video review and task load was measured by the self-reported NASA task load index (NASA-TLX) tool. In the teleleader group, one remote neonatal specialist assumed the role of team leader in the resuscitation. In the teleconsultant group, the same remote specialist assumed the role of teleconsultant. RESULTS Twenty-two participants were included in the analyses. The teleleader group was associated with a higher overall checklist score compared to teleconsultants (median score 68%, interquartile range [IQR]: 66-69 vs. 58%, IQR: 42-62; p = 0.016). No significant difference was seen in overall subjective workload as measured by the NASA-TLX tool. However, mental demand and frustration were significantly greater with teleconsultants compared to teleleaders (mean mental demand: 14.1 vs. 17.0 out of 21; frustration: 7.9 vs. 14.7 out of 21). CONCLUSIONS Simulated neonates randomized to teams with teleleaders received significantly better resuscitative care compared to those randomized to teams with teleconsultants. Mental demand and frustration were higher for providers in the teleconsultant compared to teleleader teams.
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Affiliation(s)
- Isabel T Gross
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA,
| | - Travis Whitfill
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brooke Redmond
- Department of Neonatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Katherine Couturier
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambika Bhatnagar
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melissa Joseph
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel Joseph
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jessica Ray
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Wagner
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Marc Auerbach
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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Couturier K, Whitfill T, Bhatnagar A, Panchal RA, Parker J, Wong AH, Bruno CJ, Auerbach MA, Gross IT. Impact of telemedicine on neonatal resuscitation in the emergency department: a simulation-based randomised trial. BMJ Simul Technol Enhanc Learn 2019; 6:10-14. [PMID: 35514445 DOI: 10.1136/bmjstel-2018-000398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2018] [Indexed: 11/04/2022]
Abstract
Background The delivery and initial resuscitation of a newborn infant are required but rarely practised skills in emergency medicine. Deliveries in the emergency department are high-risk events and deviations from best practices are associated with poor outcomes. Introduction Telemedicine can provide emergency medicine providers real-time access to a Neonatal Resuscitation Program (NRP)-trained paediatric specialist. We hypothesised that adherence to NRP guidelines would be higher for participants with access to a remotely located NRP-trained paediatric specialist via telemedicine compared with participants without access. Materials and methods Prospective single-centre randomised trial. Emergency Medicine residents were randomised into a telemedicine or standard care group. The participants resuscitated a simulated, apnoeic and bradycardic neonate. In the telemedicine group a remote paediatric specialist participated in the resuscitation. Simulations were video recorded and assessed for adherence to guidelines using four critical actions. The secondary outcome of task load was measured through participants' completion of the NASA Task Load Index (NASA-TLX) and reviewers completed a detailed NRP checklist. Results Twelve participants were included. The use of telemedicine was associated with significantly improved adherence to three of the four critical actions reflecting NRP guidelines as well as a significant improvement in the overall score (p<0.001). On the NASA-TLX, no significant difference was seen in overall subjective workload assessment, but of the subscore components, frustration was statistically significantly greater in the control group (p<0.001). Conclusions In this study, telemedicine improved adherence to NRP guidelines. Future work is needed to replicate these findings in the clinical environment.
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Affiliation(s)
- Katherine Couturier
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Travis Whitfill
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambika Bhatnagar
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rajavee A Panchal
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Parker
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christie J Bruno
- Department of Neonatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marc A Auerbach
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isabel T Gross
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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Gross IT, Abrahan DG, Kumar A, Noether J, Shilkofski NA, Pell P, Bahar-Posey L. Rapid Cycle Deliberate Practice (RCDP) as a Method to Improve Airway Management Skills - A Randomized Controlled Simulation Study. Cureus 2019; 11:e5546. [PMID: 31523589 PMCID: PMC6721918 DOI: 10.7759/cureus.5546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Paediatric intubations are a relatively rare but critical procedure that requires adequate practice to achieve skillful performance. Simulation is a method to teach intubation skills in a safe environment. Rapid Cycle Deliberate Practice (RCDP), as a method of simulation debriefing, has been shown to improve pediatric resident resuscitation skills. It has not been demonstrated if RCDP can be effectively used in procedural skills training. The objective of this study was to determine if RCDP with feedback in real-time, as well as an opportunity to repeat the action, is superior to a simulation where no feedback is provided during the simulation and is instead provided after the simulation. Materials and Methods: This was a randomized controlled single-blinded study. All participants were videotaped during a simulated pre-assessment intubation, then received either the intervention (RCDP) or the control teaching (feedback after the simulation), followed by a post-assessment intubation. These videos were scored by two independent raters on an intubation checklist. The primary outcome was the change in score. The secondary outcome was intubation success. Results: Thirty-five students met the inclusion criteria. The RCDP group achieved a significantly higher score improvement in the preparation and post-procedure care categories. The overall score change in the RCDP group was significantly higher than in the control group, with a mean difference of -11.86 (CI -15.57 to -8.15, p<0.00001), but there was no significant improvement in intubation success. Conclusion: Our study suggests that RCDP is an effective method to teach the procedural skill of intubation with an emphasis on procedural choreography. RCDP could be an appropriate method for debriefing learners in procedural skills training in this population.
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Affiliation(s)
- Isabel T Gross
- Pediatrics, Yale University School of Medicine, New Haven, USA
| | | | - Ambuj Kumar
- Internal Medicine, University of South Florida College of Medicine, Tampa, USA
| | - Julia Noether
- Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | | | - Paula Pell
- Pediatric Emergency Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Laleh Bahar-Posey
- Pediatric Emergency Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
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Abstract
OBJECTIVE The aim of this study was to assess the staff perception of a global positioning system (GPS) as a patient tracking tool at an emergency department (ED) receiving patients from a simulated mass casualty event. METHODS During a regional airport disaster drill a plane crash with 46 pediatric patients was simulated. Personnel from airport fire, municipal fire, law enforcement, emergency medical services, and emergency medicine departments were present. Twenty of the 46 patient actors required transport for medical evaluation, and we affixed GPS devices to 12 of these actors. At the hospital, ED staff including attending physicians, fellows and nurses working in the ED during the time of the drill accessed a map through an application that provided real-time geolocation of these devices. The primary outcome was staff reception of the GPS device as assessed via Likert scale survey after the event. The secondary outcomes were free text feedback from staff and event debriefing observations. RESULTS Queried registered nurses, attending physicians, and pediatric emergency medicine fellows perceived the GPS device as an advantage for patient care during a disaster. The GPS device allowed multiple-screen real-time tracking and improved situational awareness in cases with and without EMS radio communication prior to arrival at the hospital. CONCLUSION ED staff reported that the use of GPS trackers in a disaster improved real-time tracking and could potentially improve patient management during a mass casualty event.
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Affiliation(s)
| | - Ronald Ford
- Joe DiMaggio Children's Hospital, Hollywood, Florida
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Portalupi S, von Elm E, Schmucker C, Lang B, Motschall E, Schwarzer G, Gross IT, Scherer RW, Bassler D, Meerpohl JJ. Protocol for a systematic review on the extent of non-publication of research studies and associated study characteristics. Syst Rev 2013; 2:2. [PMID: 23302739 PMCID: PMC3577647 DOI: 10.1186/2046-4053-2-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methodological research has found that non-published studies often have different results than those that are published, a phenomenon known as publication bias. When results are not published, or are published selectively based on the direction or the strength of the findings, healthcare professionals and consumers of healthcare cannot base their decision-making on the full body of current evidence. METHODS As part of the OPEN project (http://www.open-project.eu) we will conduct a systematic review with the following objectives:1. To determine the proportion and/or rate of non-publication of studies by systematically reviewing methodological research projects that followed up a cohort of studies that a. received research ethics committee (REC) approval,b. were registered in trial registries, orc. were presented as abstracts at conferences.2. To assess the association of study characteristics (for example, direction and/or strength of findings) with likelihood of full publication.To identify reports of relevant methodological research projects we will conduct electronic database searches, check reference lists, and contact experts. Published and unpublished projects will be included. The inclusion criteria are as follows:a. RECs: methodological research projects that examined the subsequent proportion and/or rate of publication of studies that received approval from RECs;b. Trial registries: methodological research projects that examine the subsequent proportion and/or rate of publication of studies registered in trial registries;c. Conference abstracts: methodological research projects that examine the subsequent proportion and/or rate of full publication of studies which were initially presented at conferences as abstracts. PRIMARY OUTCOMES Proportion/rate of published studies; time to full publication (mean/median; cumulative publication rate by time). SECONDARY OUTCOMES Association of study characteristics with full publication.The different questions (a, b, and c) will be investigated separately. Data synthesis will involve a combination of descriptive and statistical summaries of the included methodological research projects. DISCUSSION Results are expected to be publicly available in mid 2013.
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Affiliation(s)
- Susan Portalupi
- German Cochrane Centre, Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany
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