scholarly journals Assessment of a massive open online course (MOOC) incorporating interactive simulation videos on residents’ knowledge retention regarding mechanical ventilation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tài Pham ◽  
François Beloncle ◽  
Lise Piquilloud ◽  
Stephan Ehrmann ◽  
Damien Roux ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Knowledge Retention ◽  
Respiratory Physiology ◽  
Medical Residents ◽  
Interactive Simulation ◽  
Knowledge And Skills ◽  
Course Assessment ◽  
Simulation Based ◽  
The Impact

Abstract Background Understanding respiratory physiology and mechanical ventilation is a challenge for healthcare workers, particularly, medical residents. A team of French-speaking experts developed an innovative MOOC incorporating interactive simulation-based videos and serious games aiming at improving knowledge and skills in mechanical ventilation. Our objective was to evaluate the long-term knowledge retention regarding key concepts presented in this MOOC. Methods French residents registered for the MOOC 2020’s winter session were invited to participate in a two-step study. The first step consisted in evaluating students’ pre-course knowledge of respiratory physiology and mechanical ventilation fusing a 20 five-item multiple choice questions test with a total score ranging from 0 to 100. For the second step, the same students answered the same test (after shuffling the questions) six months after the completion of the course. We assessed the impact of this MOOC on the students’ knowledge retention by comparing pre-course and post-course scores. Result Of the 102 residents who agreed to participate in the study, 80 completed the course and their mean ± SD pre-course score was 76.0 ± 8.0. Fifty-one respondents also completed the second and their post-course score was significantly higher than the baseline one (83.1 ± 7.3 vs. 77.5 ± 7.6, p < 0.001). Scores of the first and second rounds did not differ upon comparing respondents’ background specialty or number of years of residency. For the vast majority of individual questions (96%), the success rate was higher at the post-course than at the pre-course assessment. Conclusion An innovative MOOC incorporating simulation-based videos was effective in teaching medical residents basic mechanical ventilation knowledge and skills, especially in the field of respiratory physiology and ventilatory modes. We observed effective long-term knowledge retention with a higher score at the post-course assessment six months after the completion of the course compared with the pre-course score.

Educational impact of a pilot paediatric simulation-based training course in Botswana

2019 ◽  
Vol 6 (5) ◽  
pp. 279-283
Author(s):  
Nicolaus W Glomb ◽  
Manish I Shah ◽  
Adeola A Kosoko ◽  
Cara B Doughty ◽  
Cafen Galapi ◽  
...  
Keyword(s):  
Test Scores ◽  
Self Efficacy ◽  
Limited Resource ◽  
Knowledge And Skills ◽  
Training Course ◽  
Resource Setting ◽  
Simulation Based ◽  
And Performance ◽  
Training Programmes ◽  
The Impact

BackgroundAs emergency medical services (EMS) systems develop globally in resource-limited settings, equipping providers with paediatric training is essential. Low-fidelity simulation-based training is an effective modality for training healthcare workers, though limited data exist on the impact of such training programmes. The objective of this study was to evaluate the paediatric portion of a simulation-based curriculum for prehospital providers in Botswana.MethodsThis was a prospective cohort study of EMS providers from more populated regions of Botswana, who attended a 2-day training that included didactic lectures, hands-on skills stations and low-fidelity simulation training. We collected data on participant self-efficacy with paediatric knowledge and skills and performance on both written and simulation-based tests. Self-efficacy and test data were analysed, and qualitative course feedback was summarised.ResultsThirty-one EMS providers participated in the training. Median self-efficacy levels increased for 13/15 (87%) variables queried. The most notable improvements were observed in airway management, newborn resuscitation and weight estimation. Mean written test scores increased by 10.6%, while mean simulation test scores increased by 21.5% (p<0.0001). One hundred per cent of the participants rated the course as extremely useful or very useful.Discussion/ConclusionWe have demonstrated that a low-fidelity simulation-based training course based on a rigorous needs assessment may enhance short-term paediatric knowledge and skills for providers in a developing EMS system in a limited-resource setting. Future studies should focus on studying larger groups of learners in similar settings, especially with respect to the impact of educational programmes like these on real-world patient outcomes.

Long-term Effects of Different Humidification Systems on Endotracheal Tube Patency

2004 ◽  
Vol 100 (4) ◽  
pp. 782-788 ◽  
Author(s):  
Samir Jaber ◽  
Jérôme Pigeot ◽  
Redouane Fodil ◽  
Salvatore Maggiore ◽  
Alain Harf ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Heated Humidifier ◽  
Long Term Effects ◽  
Moisture Exchanger ◽  
Acoustic Reflection ◽  
Heat And Moisture ◽  
The Impact

Background Accumulation of mucous secretions in an endotracheal tube (ETT) increases its resistance, and the amount of deposit may be affected by the quality of humidification and heating of the inspired gas. Methods The authors assessed the impact of two humidification systems, a heated humidifier (HH) and a hygroscopic-hydrophobic heat and moisture exchanger (HME), on the ETT patency in patients selected to require mechanical ventilation for more than 48 h. This comparison was performed over two consecutive periods and used the acoustic reflection method, which characterizes the amount and site of ETT obstruction and allows estimating ETT inner volume and resistance. Measurements were performed three times a week over the period of mechanical ventilation. Comparisons were performed at mid duration and at the end of the mechanical ventilation period. Results The HH was used in 34 patients, and the HME was used in 26 patients. The two groups had similar severity and duration of mechanical ventilation. At mid duration of mechanical ventilation (5.5 +/- 3.3 vs. 4.8 +/- 3.3 days; P = 0.4), no difference was observed in ETT volume and resistance between the two groups. At the end of the study period (10.5 +/- 5.8 vs. 9.6 +/- 6.3 days of mechanical ventilation; P = 0.4), ETT volume was reduced to a greater extent with HME than with HH (-3.3 +/- 2.9 vs. -5.1 +/- 2.5%; P = 0.008), and ETT resistance increased significantly more with the HME than with the HH (8.4 +/- 12.2 vs. 19.4 +/- 17.7%; P = 0.001). Conclusion Prolonged use of humidification systems results in progressive reduction of ETT patency, and to a greater extent with HMEs than with HHs.

scholarly journals Outliers in Mixed Models for Monthly Average Temperatures

2016 ◽  
Vol 39 (3) ◽  
Author(s):  
Mercedes Andrade-Bejarano ◽  
Nicholas T. Longford
Keyword(s):  
Mixed Models ◽  
Data Sets ◽  
Weather Patterns ◽  
Monthly Average ◽  
Recording Process ◽  
Simulation Based ◽  
Site Variation ◽  
Valle Del Cauca ◽  
The Impact

Long-term series of monthly average temperatures taken at 28 sites in Valle del Cauca, Colombia, are studied. Mixed models are applied to cater for the within- and between-site variation. Outliers are inevitable in such studies, due to faulty equipment, slip-ups in the recording process, or unusual weather patterns. We apply a simulation-based approach to the assessment of the outlier status of suspected observations. It is a method based on graphical comparisons of user-defined features, related to large residuals, in the real andsimulated data sets. Robustness in the identification of the outliers is achieved by applying the procedure with several alternative models. The impact of the identified outliers is assessed. Two meteorological stations, Zaragoza and Monteloro, are identified as having many outliers, so that all the data from them should be discarded.

scholarly journals Compu Castel: An Instructional Tool for Teaching Firewall Concepts

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Mahmoud Mostafa
Keyword(s):  
Knowledge Acquisition ◽  
Video Game ◽  
Computer Network ◽  
Educational Games ◽  
Knowledge Retention ◽  
Educational Game ◽  
Short Term ◽  
Educational Video Game ◽  
The Impact

Firewall is an essential device in every computer network. It needs skillful professionals to accurately configure its rules for proper functioning. To help prepare these professionals, university level students need more engaging and attractive interactive tools to develop their skills.  For this regard, this paper presents the design, implementation and evaluation of "Compu Castel" educational video game that teaches firewall concepts. In addition to evaluating the impact of educational game on short-term knowledge acquisition, both, mid-term (after 2 months) and long-term (after 5 months) knowledge retention is analyzed. The results confirm that educational games affect positively short-term knowledge acquisition compared with traditional text based methods. Moreover, educational games enhance knowledge retention for mid-term and long-term periods.

scholarly journals LO65: Frailty and associated outcomes among emergency department patients requiring endotracheal intubation

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S31
Author(s):  
S. Fernando ◽  
D. McIsaac ◽  
B. Rochwerg ◽  
S. Bagshaw ◽  
A. Seely ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Endotracheal Intubation ◽  
Resource Utilization ◽  
Long Term Care ◽  
Clinical State ◽  
Term Care ◽  
The Impact

Introduction: Risk-stratification of patients requiring endotracheal intubation and mechanical ventilation in the Emergency Department (ED) is necessary for informed discussions with patients regarding goals-of-care. Frailty is a clinical state characterized by reduced physiologic reserve, and resulting from accumulation of physiological stresses and comorbid disease. Frailty is increasingly being identified as an important independent predictor of outcome among critically ill patients. Our objective was to identify the impact of clinical frailty (defined by the Clinical Frailty Scale [CFS]) on in-hospital mortality and resource utilization of ED patients requiring endotracheal intubation and mechanical ventilation. Methods: We analyzed a prospectively collected registry (2011-2016) of patients requiring endotracheal intubation in the ED at two academic hospitals and six community hospitals. We included all patients ≥18 years of age, who survived to the point of ICU admission. All patient information, outcomes, and resource utilization were stored in the registry. CFS scores were obtained through chart abstraction by two blinded reviewers. The primary outcome, in-hospital mortality, was analyzed using a multivariable logistic regression model, controlling for confounding variables (including patient sex, comorbidities, and illness severity). We defined “frailty” as a CFS ≥ 5. Results: 4,622 patients were included. Mean age was 61.2 years (SD: 17.5), and 2,614 (56.6%) were male. Frailty was associated with increased risk of in-hospital mortality, as compared to those who were not frail (adjusted odds ratio [OR] 2.21 [1.98-2.51]). Frailty was also associated with higher likelihood of discharge to long-term care (adjusted OR 1.78 [1.56-2.01]) among patients initially from a home setting. Frail patients were more likely to fail extubation during their hospitalization (adjusted OR 1.81 [1.67-1.95]) and were more likely to require tracheostomy (adjusted OR 1.41 [1.34-1.49]). Conclusion: Presence of frailty among ED patients requiring endotracheal intubation and mechanical ventilation was associated with increased in-hospital mortality, discharge to long-term care, extubation failure, and tracheostomy. ED physicians should consider the impact of frailty on patient outcomes, and discuss associated prognosis with patients prior to intubation.

scholarly journals Simulation-Based Assessment of the Impact of Non-Adherence on Endoxifen Target Attainment in Different Tamoxifen Dosing Strategies

2021 ◽  
Vol 14 (2) ◽  
pp. 115
Author(s):  
Anna Mueller-Schoell ◽  
Lena Klopp-Schulze ◽  
Robin Michelet ◽  
Madelé van Dyk ◽  
Thomas E. Mürdter ◽  
...  
Keyword(s):  
Interindividual Variability ◽  
Breast Cancer Treatment ◽  
Tamoxifen Therapy ◽  
Adherence Rate ◽  
Target Attainment ◽  
Disease Outcomes ◽  
Simulation Based ◽  
Dosing Strategies ◽  
The Impact

Tamoxifen is widely used in breast cancer treatment and minimum steady-state concentrations of its active metabolite endoxifen (CSS,min ENDX) above 5.97 ng/mL have been associated with favourable disease outcome. Yet, about 20% of patients do not reach target CSS,min ENDX applying conventional tamoxifen dosing. Moreover, 4–75% of patients are non-adherent, resulting in worse disease outcomes. Assuming complete adherence, we previously showed model-informed precision dosing (MIPD) to be superior to conventional and CYP2D6-guided dosing in minimising the proportion of patients with subtarget CSS,min ENDX. Given the high non-adherence rate in long-term tamoxifen therapy, this study investigated the impact of non-adherence on CSS,min ENDX target attainment in different dosing strategies. We show that MIPD allows to account for the expected level of non-adherence (here: up to 2 missed doses/week): increasing the MIPD target threshold from 5.97 ng/mL to 9 ng/mL (the lowest reported CSS,min ENDX in CYP2D6 normal metabolisers) as a safeguard resulted in the lowest interindividual variability and proportion of patients with subtarget CSS,min ENDX even in non-adherent patients. This is a significant improvement to conventional and CYP2D6-guided dosing. Adding a fixed increment to the originally selected dose is not recommended, since it inflates interindividual variability.

scholarly journals Rational and Design of the SIMULATOR Study: A Multicentre Randomized Study to Assess the Impact of SIMULation-bAsed Training on Transoesophageal echocardiOgraphy leaRning for Cardiology Residents

2021 ◽  
Vol 8 ◽  
Author(s):  
Théo Pezel ◽  
Anne Bernard ◽  
Yoan Lavie Badie ◽  
Julien Dreyfus ◽  
Etienne Audureau ◽  
...  
Keyword(s):  
Randomized Study ◽  
Intervention Group ◽  
Medical Residents ◽  
Control Group ◽  
Traditional Teaching ◽  
Single Center ◽  
Simulation Based ◽  
Simulator Study ◽  
And Performance ◽  
The Impact

Introduction: Simulation-based training in transesophageal echocardiography (TEE) seems promising. However, data are limited to non-randomized or single-center studies. To assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology.Materials and Methods: Nationwide prospective randomized multicenter study involving 43 centers throughout France allowing for the inclusion of &gt;70% of all French cardiology residents. All cardiology residents naive from TEE will be included. Randomization with stratification by center will allocate residents to either a control group receiving theoretical knowledge by e-learning only, or to an intervention group receiving two simulation-based training sessions on a TEE simulator in addition.Results: All residents will undergo both a theoretical test (0–100 points) and a practical test on a TEE simulator (0–100 points) before and 3 months after the training. Satisfaction will be assessed by a 5-points Likert scale. The primary outcomes will be to compare the scores in the final theoretical and practical tests between the two groups, 3 months after the completion of the training.Conclusion: Data regarding simulation-based learning in TEE are limited to non-randomized or single-center studies. The randomized multicenter SIMULATOR study will assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology, and whether such an educational program should be proposed in first line for TEE teaching.

scholarly journals 1209. Impact of Respiratory Staphylococcus aureus Abundance on Risk for Ventilator-Associated Pneumonia During Long-Term Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S626-S626
Author(s):  
James J Harrigan ◽  
Hatem Abdallah ◽  
Erik Clarke ◽  
Ebbing Lautenbach ◽  
Emily Reesey ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Mechanical Ventilation ◽  
Bacterial Community ◽  
Acute Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
16S Sequencing ◽  
Wide Range ◽  
The Impact

Abstract Background Patients admitted to long-term acute care hospital (LTACH) for ventilator weaning are at high risk for ventilator-associated pneumonia, which may contribute to adverse ventilator-associated events (VAE). Staphylococcus aureus (Sa) is a common cause of VAP. We sought to evaluate the impact of respiratory Sa colonization and bacterial community dominance on subsequent Sa VAP and VAE during long-term acute care. Methods We enrolled 83 subjects dependent on mechanical ventilation at LTACH admission, collected endotracheal aspirates, performed 16S rRNA gene sequencing (Illumina HiSeq) and bacterial community profiling (QIIME2). Statistical analysis was performed with R and Stan; mixed effects models were fit to relate the abundance of respiratory Sa on admission to clinically-diagnosed VAP and VAE. Results Of the 83 subjects, 8 were diagnosed with Sa pneumonia during the 14 days prior to LTACH admission (“Known Sa”), and 17 additional subjects received anti- Sa antibiotics within 48 hours of admission (“Suspected Sa”); 58 subjects had no known or suspected Sa (“Unknown Sa”). Among the Known Sa group, all 8 had Sa detectable by 16S sequencing, with elevated admission Sa proportional abundance (median 0.36; range 0.0013 - 1). Among the Suspected Sa group, only 7 had Sa detectable by 16S sequencing, with a wide range of admission Sa proportional abundance (median 0; range 0 - 0.96). 25 of 58 subjects in the Unknown Sa group also had detectable respiratory Sa, and a wide range of Sa proportional abundance at admission (median 0; range 0 - 0.93). Incident Sa VAP was observed within 30 days among 2 (25%) of the Known Sa subjects, 0 (0%) of the Suspected Sa subjects, and 3 (5.17%) of the Unknown Sa subjects. VAE was observed within 30 days among 0 (0%) of the Known Sa subjects, 3 (18%) of the Suspected Sa subjects, and 1 (1.7%) of the Unknown Sa subjects. Admission Sa abundance was positively associated with 30-day VAP risk in the Suspected Sa (type S error &lt; 0.001) and Unknown Sa (type S error &lt; 0.001) groups. Conclusion Among patients admitted to LTACH for weaning for mechanical ventilation, we observed a high prevalence of respiratory Sa colonization. Respiratory Sa abundance was associated with risk of incident Sa VAP, particularly among subjects without recognized Sa colonization. Disclosures All Authors: No reported disclosures

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