Management of Acute Contrast Reactions—Understanding Radiologists' Preparedness and the Efficacy of Simulation-Based Training in Canada

2018 ◽  
Vol 69 (4) ◽  
pp. 349-355 ◽  
Author(s):  
Tyler M. Coupal ◽  
Anne R. Buckley ◽  
Sanjiv Bhalla ◽  
Jessica L. Li ◽  
Stephen G.F. Ho ◽  
...  
Keyword(s):  
National Level ◽  
Daily Practice ◽  
Training Model ◽  
Initial Management ◽  
Mandated Training ◽  
Comfort Levels ◽  
Correct Dose ◽  
Simulation Based ◽  
Before And After ◽  
Life Threatening

Purpose Acute radiologic emergencies, primarily severe contrast reactions, are rare but life-threatening events. Given a generalized paucity of formalized or mandated training, studies have shown that radiologists and trainees perform poorly when acutely managing such events. Moreover, skill base, knowledge, and comfort levels precipitously decline over time given the infrequent occurrence of these events during one's daily practice. The primary aim of this study was to assess radiologists' preparedness for managing acute radiologic emergencies and to determine the efficacy of a high-fidelity simulation based training model in an effort to provide a rationale for similar programs to be implemented on a provincial or national level. Methods This was a prospective, observational study of radiology residents and attending radiologists throughout the province who were recruited to attend a full-day simulation-based course presenting various cases of acute radiologic emergencies. Participant demographics were collected at the time of commencement of the workshop. Course materials were disseminated 4 weeks prior to the workshop, and a 17-question knowledge quiz was administered before and after the workshop. Likert-type questionnaires were also distributed to survey comfort levels and equipment familiarity. The knowledge quiz and questionnaire were redistributed at 3- and 6-month intervals for acquisition of follow-up data. Results A total of 14 attending radiologists and 7 residents attended the workshop, with all participants completing the preworkshop questionnaire and 90.5% (19 of 21) completing the post-workshop questionnaire. Participants' principle locations of practice were as follows: academic institutions (50%), community hospitals (36.9%), and private clinics (13.1%). A significant increase in knowledge was demonstrated, with average scores of 10 out of 17 (59%) and 14.5 out of 17 (85%) ( P < .001) before and after the workshop, respectively. A significant increase in participants' comfort levels in recognizing acute anaphylactic reactions (3.5; 4.7, P < .001), commencing initial management for acute radiologic emergencies (3.3; 5.0, P < .001), and administering the correct dose for anaphylactic reactions (2.5; 4.8, P < .001) was also demonstrated. Moreover, participants became increasingly familiar with the contents and equipment found within contrast reaction kits (2.8; 3.8, P < .01). Repeat evaluations at 3 and 6 months found an average knowledge test score of 13.8 out of 17 (81%) and 10.8 out of 17 (64%), respectively. Comfort levels were also reassessed in recognizing acute anaphylactic reactions (4.5; 4.1), commencing initial management (4.0; 3.9) and administering the correct dose of medication (4.0; 3.7) at 3- and 6-month intervals. Conclusions Acute radiologic emergencies are rare but life-threatening events that require rapid diagnosis and treatment to mitigate associated morbidity and mortality. Simulation-based workshops are a highly efficacious training model to increase knowledge, comfort levels, and equipment familiarity for radiologists and trainees alike; however, retraining at regular intervals is required.

A longitudinal method of teaching pediatric palliative care to interns: Preliminary findings regarding changes in interns' comfort level

2010 ◽  
Vol 8 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Shahram Yazdani ◽  
Elana Evan ◽  
Danielle Roubinov ◽  
Paul J. Chung ◽  
Lonnie Zeltzer
Keyword(s):  
Palliative Care ◽  
Los Angeles ◽  
Assessment Tool ◽  
Death And Dying ◽  
Comfort Level ◽  
Pediatric Palliative Care ◽  
First Year ◽  
Comfort Levels ◽  
Before And After ◽  
Life Threatening

AbstractObjective:A longitudinal pediatric palliative care curriculum was introduced into the pediatric residency program at the University of California, Los Angeles. The present study explores the possible effects of this curriculum on the interns' self-assessed comfort levels regarding caring for children with life-threatening conditions.Methods:A newly created assessment tool was administered to interns in order to rate their comfort regarding pediatric palliative care at the beginning and conclusion of their intern year.Results:Twenty-two of the 29 interns completed this survey. Baseline data indicated 55% of the interns had some experience with taking care of a dying pediatric patient during their medical school training, and 79% indicated that they had taken care of a dying adult. Only 7% of the interns felt adequately prepared to deal with death and dying, but all interns indicated interest in further learning about pediatric palliative care. Comparison of the overall comfort levels of the 22 responding residents before and after the first year of training in 20 different related tasks demonstrated a significant self-assessed improvement of comfort in seven areas. There was no increase in self-reported comfort in communication related to palliative care.Significance of results:Residents indicated increased comfort in some areas of pediatric palliative care after the first year of their training. The underlying cause of this increased comfort is unclear at this time. The overall effect of longitudinal palliative care curriculums on residents' level of comfort in caring for this population deserves further assessment.

Seeking the best training model for difficult conversations in neonatology

2016 ◽  
Vol 44 (4) ◽  
Author(s):  
Beatrice E. Lechner ◽  
Robin Shields ◽  
Richard Tucker ◽  
G. Jesse Bender
Keyword(s):  
Clinical Practice ◽  
Communication Skills ◽  
Training Model ◽  
High Stakes ◽  
Web Based ◽  
Comfort Levels ◽  
Difficult Conversations ◽  
Simulation Based ◽  
Simulation Group ◽  
Better Than

AbstractWe hypothesize that a formal simulation curriculum prepares neonatology fellows for difficult conversations better than traditional didactics.Single-center neonatology fellowship graduates from 1999 to 2013 were sent a retrospective web-based survey. Some had been exposed to a Difficult Conversations curriculum (simulation group), others had not (no simulation group). The simulation group participated in one workshop annually, consisting of lecture, simulation, and debriefing. Scenarios were customized to year of training. Epoch comparisons were made between the simulation and no simulation groups.Self-rated baseline effectiveness at discussing difficult topics was not different. The simulation group reported more supervised family meetings and feedback after fellow-led meetings. Simulations were rated very positively. The simulation group reported increased comfort levels. Strategic pause and body positioning were specific communication skills more frequently acquired in the simulation group. In both groups, the highest ranked contributors to learning were mentor observation and clinical practice. In the simulation group, simulation and debriefing outranked didactics or other experiences.Simulation-based workshops improve communication skills in high stakes conversations. However, they do not substitute for mentor observation and experience. Establishing a structured simulation-based difficult conversations curriculum refines vital communication skills necessary for the high stakes conversations neonatologists direct in clinical practice.

scholarly journals Simulation-based Training for Pelvic and Breast Physical Examination: Effect on the Anxiety and Self-confidence of Medical Students

2020 ◽  
Vol 42 (11) ◽  
pp. 739-745
Author(s):  
Talles Dias Orsi ◽  
Ana Lucia Ribeiro Valadares ◽  
Paula Miranda Esteves Orsi ◽  
Isabella Miranda Esteves Orsi ◽  
Alexandre Sampaio Moura
Keyword(s):  
Medical Students ◽  
Self Report ◽  
Student Anxiety ◽  
Factors Associated ◽  
Confidence Levels ◽  
Learning Satisfaction ◽  
Self Confidence ◽  
Breast Examination ◽  
Simulation Based ◽  
Before And After

Abstract Objective To evaluate factors associated with anxiety and the effect of simulation-based training (SBT) on student anxiety, self-confidence and learning satisfaction in relation to pelvic and breast examination. Methods A longitudinal study was conducted with 4th year medical students at the Universidade José do Rosário Vellano. A 12-item, self-report questionnaire on student anxiety at performing gynecological examinations was applied before and after SBT, with answers being given on a Likert-type scale. After training, the self-confidence levels and satisfaction of the students related to the learning process were also evaluated. Results Eighty students with a mean age of 24.1 ± 4.2 years were included in the study. Of these, 62.5% were women. Pre-SBT evaluation showed that students were more anxious at performing a pelvic examination than a breast examination (2.4 ± 1.0 versus 1.7 ± 0.8, respectively; p < 0.001). The primary reason for anxiety regarding both pelvic and breast examination was fear of hurting the patient. SBT significantly reduced student anxiety (2.0 ± 0.8 versus 1.5 ± 0.5, respectively; p < 0.001). The satisfaction and self-confidence of the students were found to be high (6.8 ± 0.3 and 6.0 ± 0.9, respectively), with no difference between genders. Conclusion The use of SBT in teaching students to perform pelvic and breast examinations resulted in reduced anxiety and increased self-confidence in a group of medical students of both genders, with high levels of satisfaction in relation to the training.

scholarly journals Effect of COVID-19 outbreak on emergency department attendances in an Italian academic hospital

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Poletto ◽  
G Perri ◽  
F Malacarne ◽  
B Bianchet ◽  
A Doimo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Initial Phase ◽  
Mainland China ◽  
Hospital Setting ◽  
Academic Hospital ◽  
Significant Difference ◽  
Before And After ◽  
Life Threatening ◽  
The Mean ◽  
Critical Patients

Abstract Background Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was discovered during the 2019 outbreak in Mainland China and the first cases were reported in Italy on February 21, 2020. This study evaluates the emergency department (ED) attendances of an academic hospital in northern Italy before and after media reported the news of the first infected patients in Italy. Methods Adult attendances in ED in February 2020 were analysed dividing the period into 4 weeks (days 1-7, 8-14, 15-21, 22-28) compared with the same periods in 2019. The visits were analysed separately according to the Italian colour code of triage: white (non-critical), green (low-critical), yellow (medium critical), red (life-threatening). The mean weekly number of attendances was compared with t-test. Results February 2020 total ED attendances compared with February 2019 were 4865 vs 5029 (-3.3%), of which white codes were 834 vs 762 (+9.4%), green 2450 vs 2580 (-5.0%), yellow 1427 vs 1536 (-7.1%), red 154 vs 151 (+2.0%). February 2020 weekly mean ED attendances compared with February 2019 had statistically significant difference only in the fourth week (days 22-28) for green codes (75 vs 92, p = 0.007) and yellow codes (41 vs 52, p = 0.047), not for white (27 vs 26, p = 0.760) and red codes (5 vs 5, p = 0.817). The first three weeks of February 2020 compared with 2019 showed no statistically significant difference in weekly mean ED attendances. Conclusions There was a significant reduction of green and yellow codes attendances at ED in the fourth week of February 2020, corresponding to the initial phase of Italian COVID-19 outbreak. The fear of contracting SARS-CoV-2 by attending the ED probably acted as a significant deterrent in visits, especially for low and medium critical patients. Additional data are required to better understand the phenomenon, including the behaviour of non-critical attendances. Key messages A reduction of green and yellow codes attendances was reported during initial phase of COVID-19 outbreak in an Italian academic hospital. Fear of contracting COVID-19 infection in a hospital setting could impact on emergency department attendances.

Serious game, lectures or simulation-based mastery learning course which is the best method for training students about cardiac arrest management?

2019 ◽  
Author(s):  
Giuliana Scarpati ◽  
Paolo Remondelli ◽  
Ornella Piazza
Keyword(s):  
Cardiac Arrest ◽  
Medical Students ◽  
Primary Outcome ◽  
Serious Game ◽  
Training Time ◽  
Simulation Based ◽  
Before And After ◽  
Second Year ◽  
Cpr Training ◽  
Passing Score

"Background and aim: This study aimed to compare a serious game and lectures for the pretraining of medical students before learning about simulation-based management of cardiac arrest. Methods: Participants were 150 volunteer second-year medical students between April and June 2018 randomly assigned to CPR training using either lectures (n = 75) or a serious game (n = 75). Each participant was evaluated on a scenario of cardiac arrest before and after exposure to the learning methods. The primary outcome measures were the median total training time needed for the student to reach the minimum passing score. This same outcome was also assessed three months later. Results: The median training time necessary for students to reach the minimum passing score was similar between the two groups (p=0,45). Achieving an appropriate degree of chest compression was the most difficult requirement to fulfill for students in both groups. Singing the refrain of the song ""staying alive"" significantly increased the number of compressions with the correct rate. Three months later, the median training time decreased significantly in both groups. However, students have remained interested in the serious game for a longer time showing a preference for using this method. Conclusions: The serious game was not superior to lectures to pretraining medical students in the management of a cardiac arrest."

WEB-BASED SOFTWARE FOR REAL-TIME SIMULATION-ASSISTED TRIAL DESIGN IN ALZHEIMER’S DISEASE

2015 ◽  
pp. 1-4
Author(s):  
D. Polhamus ◽  
J. Kang ◽  
J. Rogers ◽  
M. Gastonguay
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Statistical Power ◽  
Operating Characteristics ◽  
Longitudinal Models ◽  
Exclusion Criteria ◽  
Web Based ◽  
Correct Dose ◽  
Time Simulation ◽  
Simulation Based

Clinical trials for Alzheimer’s Disease (AD) are necessarily designed in the presence of substantial quantitative uncertainty. Certain important aspects of this uncertainty can be mitigated by developing longitudinal models for AD progression and by using these models to simulate virtual trials and estimate operating characteristics (such as statistical power, the probability of stopping at an interim analysis, the probability of identifying the correct dose, etc.) as a function of candidate design features, such as inclusion / exclusion criteria. In this brief report we describe the development and deployment of a customized software solution that allows such simulation-based results to be generated “on the fly” in the context of a drug development team meeting. This solution leverages a number of recent practical advances in statistical and scientific computing that could be much more broadly leveraged to assure more quantitatively grounded trial designs in Alzheimer’s Disease.

scholarly journals Analysis on the Effect of Protective Equipment Training on Hospital Infection Managers

CONVERTER ◽  
2021 ◽  
pp. 211-219
Author(s):  
Yongli Zou Et al.
Keyword(s):  
Personal Protective Equipment ◽  
Protective Clothing ◽  
Training Model ◽  
Hospital Infection ◽  
Protective Equipment ◽  
Practical Training ◽  
Training Methods ◽  
Before And After ◽  
Improper Use ◽  
Expert Theory

Objectives: To analyze the effect of personal protective equipment training on new hospital infection managers. Methods: Personnel are divided into two batches by region. Adopt a diversified training model to train all personnel, finally conduct practical assessments and issue certificates. Collect information through information technology, analyze questionnaires, and understand trainees’ circumstances before and after the training. Each training batch has uniform teachers and the same training methods. Results: After the training, the trainees' proficiency in putting on and taking off protective equipment increased by 22.85%, and ability to choose protective equipment according to different working environments increased by 22.04%; 78.23% trainees believed that practical exercises should be emphasized. Taking off protective clothing was considered as the most difficult link in practical training (91.13%), followed by putting on protective clothing (70.43%). 96.24% trainees believed that this training is helpful for future work. Conclusions: It is quite necessary to implement personal protective equipment training among new hospital infection managers; where, practical training, assessment, information-based questionnaire survey, expert theory teaching have achieved good results; the training helps reduce occupational exposure-induced hospital infection, and at the same time, avoids improper use of protective materials and waste.

scholarly journals Organophosphorus Poisoning

2008 ◽  
Vol 47 (172) ◽  
Author(s):  
Buddhi Prasad Paudyal
Keyword(s):  
Signs And Symptoms ◽  
Clinical Problem ◽  
Acute Poisoning ◽  
The Body ◽  
Organophosphorus Insecticides ◽  
Basic Principles ◽  
Initial Management ◽  
Organophosphorus Poisoning ◽  
Life Threatening ◽  
History Of

Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, withthousands of deaths occurring every year. Most of these pesticide poisoning and subsequentdeaths occur in developing countries following a deliberate self ingestion of the poison. Metacid(Methyl parathion) and Nuvan (Dichlorovos) are commonly ingested OP pesticides; Dimethoate,Profenofos, and Chlorpyrifos are other less frequently ingested compounds in Nepal. The toxicityof these OP pesticides is due to the irreversible inhibition of acetylcholinesterase (AChE) enzymeleading to accumulation of acetylcholine and subsequent over-activation of cholinergic receptorsin various parts of the body. Acutely, these patients present with cholinergic crisis; intermediatesyndrome and delayed polyneuropathy are other sequel of this form of poisoning. The diagnosisdepends on the history of exposure to these pesticides, characteristic manifestations of toxicityand improvements of the signs and symptoms after administration of atropine. The supportivetreatment of OP poisoning includes the same basic principles of management of any acutelypoisoned patient i.e., rapid initial management of airways, breathing, and circulation. Gastriclavage and activated charcoal are routinely used decontamination procedures, but their valuehas not been conclusively proven in this poisoning. Atropine is the mainstay of therapy, andcan reverse the life threatening features of this acute poisoning. However, there are no clearcut guidelines on the dose and duration of atropine therapy in OP poisoning. Cholinesterasereactivators, by regenerating AChE, can reverse both the nicotinic and muscarinic effects;however, this benefit has not been translated well in clinical trials. All these facts highlight thatthere are many unanswered questions and controversies in the management of OP poisoningand there is an urgent need for research on this aspect of this common and deadly poisoning.Key Words: poisoning, organophosphorus insecticides, decontamination, antidotes

Combination of rituximab with chemotherapy in diffuse large B-cell lymphoma. Evaluation in daily practice before and after approval of rituximab in this indication

2008 ◽  
Vol 26 (3) ◽  
pp. 139-147 ◽  
Author(s):  
Hervé Ghesquières ◽  
Céline Ferlay ◽  
Catherine Sebban ◽  
Catherine Chassagne ◽  
Liana Carausu ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Daily Practice ◽  
Large B Cell Lymphoma ◽  
Before And After ◽  
Large B Cell

scholarly journals Feasibility of Using Global Positioning Systems (GPS) With Diverse Urban Adults: Before and After Data on Perceived Acceptability, Barriers, and Ease of Use

2012 ◽  
Vol 9 (7) ◽  
pp. 924-934 ◽  
Author(s):  
Shannon N. Zenk ◽  
Amy J. Schulz ◽  
Angela M. Odoms-Young ◽  
JoEllen Wilbur ◽  
Stephen Matthews ◽  
...  
Keyword(s):  
Ethnically Diverse ◽  
Ease Of Use ◽  
Global Positioning Systems ◽  
Pilot Studies ◽  
Positioning Systems ◽  
Comfort Levels ◽  
Lower Socioeconomic ◽  
Global Positioning ◽  
Before And After ◽  
Urban Adults

Background:Global positioning systems (GPS) have emerged as a research tool to better understand environmental influences on physical activity. This study examined the feasibility of using GPS in terms of perceived acceptability, barriers, and ease of use in a racially/ethnically diverse sample of lower socioeconomic position (SEP).Methods:Data were from 2 pilot studies involving a total of 170 African American, Hispanic, and White urban adults with a mean (standard deviation) age of 47.8 (±13.1) years. Participants wore a GPS for up to 7 days. They answered questions about GPS acceptability, barriers (wear-related concerns), and ease of use before and after wearing the GPS.Results:We found high ratings of GPS acceptability and ease of use and low levels of wear-related concerns, which were maintained after data collection. While most were comfortable with their movements being tracked, older participants (P < .05) and African Americans (P < .05) reported lower comfort levels. Participants who were younger, with higher education, and low incomes were more likely to indicate that the GPS made the study more interesting (P < .05). Participants described technical and wear-related problems, but few concerns related to safety, loss, or appearance.Conclusions:Use of GPS was feasible in this racially/ethnically diverse, lower SEP sample.

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