Mastery learning of toxicology life support skills by nurses and doctors, utilizing simulation technology in Nepal

2020 ◽  
Vol 6 (01) ◽  
Author(s):  
Vivekanshu Verma ◽  
Ajay Thapa ◽  
Narendra Nath Jena ◽  
S. Nath Senthilkumaran ◽  
Devendra Richhariya ◽  
...  
Keyword(s):  
Life Support ◽  
Clinical Performance ◽  
Research Training ◽  
Patient Simulation ◽  
Educational Interventions ◽  
Modern Medicine ◽  
Acute Onset ◽  
Adverse Outcomes ◽  
Rapid Progression ◽  
Forensic Professionals

Modern Medicine has been at the forefront in the use of patient simulation for research, training and performance assessment. With simulation, no patients are at risk for exposure to novice caregivers or unproven technologies. It becomes very important in field of toxicological emergencies, due to its acute onset of presentation, rapid progression of symptoms, and early deterioration of vitals and adverse outcomes in morbidity and mortality of patients in extremes of ages. Our observational study suggests that Emergency, Forensic Medicine and Toxicology (FMT) residents and Nurses have limited exposure to critically ill patients of trauma and toxicology and the budding forensic professionals lack the skills to manage them. Simulation has the potential to fill this educational void in managing clinical forensic and toxicological emergencies. The following review will attempt to answer this call by quantifying the effect of simulation-based educational interventions on retention of knowledge and clinical performance, as applied to acute care toxicology.

In situ deteriorating patient simulation in general practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711425
Author(s):  
Joanna Lawrence ◽  
Petronelle Eastwick-Field ◽  
Anne Maloney ◽  
Helen Higham
Keyword(s):  
Life Support ◽  
Early Recognition ◽  
Phase 1 ◽  
Patient Simulation ◽  
Medical Emergency ◽  
Phase 2 ◽  
Action Plans ◽  
Integrated Simulation ◽  
Deteriorating Patient

BackgroundGP practices have limited access to medical emergency training and basic life support is often taught out of context as a skills-based event.AimTo develop and evaluate a whole team integrated simulation-based education, to enhance learning, change behaviours and provide safer care.MethodPhase 1: 10 practices piloted a 3-hour programme delivering 40 minutes BLS and AED skills and 2-hour deteriorating patient simulation. Three scenarios where developed: adult chest pain, child anaphylaxis and baby bronchiolitis. An adult simulation patient and relative were used and a child and baby manikin. Two facilitators trained in coaching and debriefing used the 3D debriefing model. Phase 2: 12 new practices undertook identical training derived from Phase 1, with pre- and post-course questionnaires. Teams were scored on: team working, communication, early recognition and systematic approach. The team developed action plans derived from their learning to inform future response. Ten of the 12 practices from Phase 2 received an emergency drill within 6 months of the original session. Three to four members of the whole team integrated training, attended the drill, but were unaware of the nature of the scenario before. Scoring was repeated and action plans were revisited to determine behaviour changes.ResultsEvery emergency drill demonstrated improved scoring in skills and behaviour.ConclusionA combination of: in situ GP simulation, appropriately qualified facilitators in simulation and debriefing, and action plans developed by the whole team suggests safer care for patients experiencing a medical emergency.

Quick Looks Into the Acute Abdomen- Findings from A 1 Year Audit of Asian Emergency Department Ct Scans

2021 ◽  
Author(s):  
Siang Hiong Goh ◽  
Calvin Yit-Kun Goh ◽  
Hong Choon Oh ◽  
Narayan Venkataraman ◽  
Ling Tiah
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Clinical Performance ◽  
Biliary Tract Disease ◽  
Renal Stones ◽  
Adverse Outcomes ◽  
Ct Scans ◽  
Lower Quadrant ◽  
Lengths Of Stay ◽  
The Common

Abstract BackgroundMuch of the literature regarding Emergency Department CT scan usage for abdominal pain has been in American and European settings, and less so in the rest of the world. We performed an audit for this in our Southeast Asian hospital to see how we compare with international data, also to glean some insights into optimising its use locally.Results – An anonymised de-identified electronic database of all ED patients had been set up since 2020 with the aim of capturing 10 years of ED retrospective data for audit of our clinical performance. From this master database, a subset of all CTAPs done in 2020 was created and then extracted for analysis. Costs, length of stay in the ED and wards, CT reports, disposal from ED, and other data were captured for study. A description was made of the common conditions found, with a subgroup analysis of the elderly, and disposal outcomes from the ED. Specific analysis was done for appendicitis using Mann-Whitney U tests. For 2020, 1860 patients (56% male, and ages 14 to 99 years) had ED CTAPs done. Top indications included right upper and lower quadrant pains, flank pains, persistent abdominal pain despite analgesia, and suspicion for intestinal obstruction. Acute appendicitis, biliary tract disease, renal stones, ovarian disease, and bowel disease were the common diagnoses. 16.2% of CTAPs revealed no abnormality. Malignancies were uncommon diagnoses. For the patients that were discharged from the ED after a negative CTAP, no patient returned within 72 hours nor were there any adverse outcomes. When analysed using Mann-Whitney U tests, patients who had ED CTAPs done for appendicitis had significantly faster time to CT and surgery than those with inpatient imaging, with lower inpatient costs and lengths of stay.Conclusion – CT scans in the ED for appendicitis patients reduces costs, time to surgery, and lengths of stay. Generally, ED CTAPs allows better siting and disposition of patients. Presence of RLQ pain increases the likelihood of a positive scan. Our negative scan rate of 16.2% is comparable to other studies. Protocols and senior inputs can improve accuracy of this important ED resource.

Abstract 14109: Basic Life Support With Reperfusion Injury Protection Improves 24 Hour Survival Outcomes in a Porcine Model of Prolonged Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Guillaume Debaty ◽  
Keith G Lurie ◽  
Anja Metzger ◽  
Michael Lick ◽  
Jason Bartos ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Reperfusion Injury ◽  
Basic Life Support ◽  
Life Support ◽  
Coronary Perfusion Pressure ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Coronary Perfusion ◽  
Ventricular Ejection Fraction

Introduction: Ischemic postconditioning (PC) using 3 intentional short pauses at the start of cardiopulmonary resuscitation (CPR) improves outcomes after cardiac arrest in pigs when epinephrine (epi) is used before defibrillation. Hypothesis: Basic life support (BLS) with PC will protect against reperfusion injury and enhance 24 hour functional recovery in the absence of epi. Methods: Female pigs (n=46; wt ~ 40 kg) were anesthetized (isoflurane). PC was delivered using 3 cycles alternating between automated CPR for 20 sec and no CPR for 20 sec at the start of each protocol. Protocol A: After 12 minutes of ventricular fibrillation (VF), 28 pigs were randomized in 4 groups: A/ Standard CPR (SCPR), B/ active compression-decompression with an impedance threshold device (ACD-ITD), C/ SCPR+PC (SCPR+PC) and D/ ACD-ITD+PC. Protocol B: After 15 min of VF, 18 pigs were randomized to ACD-ITD CPR or ACD-ITD + PC. The BLS duration was 2.75 min in Protocol A and 5 min in Protocol B. Following BLS up to 3 shocks were delivered. Without return of spontaneous circulation (ROSC) CPR was resumed and epi (0.5 mg) and defibrillation delivered. The primary end point was the incidence of major adverse outcomes at 24 h (defined as death or coma, refractory seizures and cardio-respiratory distress leading to euthanasia). Hemodynamic parameters and left ventricular ejection fraction (LVEF) were also measured. Data are presented as mean ± standard error of mean. Results: Protocol A: ACD-ITD CPR + PC (group D) provided the highest coronary perfusion pressure after 3 min of BLS compared with the 3 other groups (28 ± 6, 35 ± 7, 23 ± 5 and 47 ± 7 for groups A, B, C, D respectively, p= 0.05 by ANOVA). ROSC with BLS was achieved in 0, 3, 0, and 3 pigs in groups A, B, C and D, respectively (p=0.22) with no significant differences in 24-hour survival between groups. Protocol B: Four hours post ROSC, LVEF was significantly higher with ACD-ITD+IPC vs ACD-ITD alone (52.5 ± 3% vs. 37.5 ± 6.6%, p = 0.045). There was a significantly lower incidence of major adverse outcomes 24 hr after ROSC with ACD-ITD+PC compared with ACD-ITD alone (Log-rank comparison, p=0.027). Conclusion: BLS using ACD-ITD + PC mitigates post resuscitation cardiac dysfunction and facilitates neurological recovery after prolonged untreated VF in pigs.

Path to Action – Closing the Gap to Make Patient Blood Management the New Norm(al) as Viewed by Implementors in Diverse Countries

2020 ◽  
Author(s):  
Axel Hofmann ◽  
Donat R. Spahn ◽  
Anke-Peggy Holtorf
Keyword(s):  
Blood Loss ◽  
Research Training ◽  
Multidisciplinary Care ◽  
Adverse Outcomes ◽  
National Standard ◽  
Care Process ◽  
Patient Blood Management ◽  
Blood Management ◽  
Structured Interviews ◽  
Implementation Framework

Abstract Background: Patient Blood Management (PBM) is an evidence-based approach in surgery and emergency care which aims to minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process before, during, and after surgery. In combination with blood loss, anemia is the main driver for transfusion and an independent risk factor for adverse outcomes including morbidity and mortality. Hence, identifying and correcting anemia as well as minimizing blood loss are important pillars of PBM. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. The aim of this study is to analyze the collective experiences of a diverse group of PBM implementors across countries reflecting different healthcare contexts and to use these experiences to develop a guidance for initiating and orchestrating PBM implementation for stakeholders from diverse professional backgrounds.Methods: Semi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses reflecting the drivers, barriers, measures, and stakeholders regarding the implementation of PBM were summarized per country, and key observations extracted. By clustering the levels of intervention for PBM implementation, a PBM implementation framework was created and populated.Results: A set of PBM implementation measures were extracted from the interviews with the implementors. Most of these measures relate to one of six levels of implementation including government, healthcare providers, funding, research, training/education, and patients/public. Essential cross-level measures are multi-stakeholder communication and collaboration.Conclusion: This implementation framework helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to independently initiate and develop strategies to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.

Generation of Respiratory Flow Having Fractal Signal Feature

2011 ◽  
Vol 366 ◽  
pp. 211-214
Author(s):  
Zhong Hai He ◽  
Yi Hao Du ◽  
Zhao Xia Wu
Keyword(s):  
Life Support ◽  
Patient Simulation ◽  
Medical Patient ◽  
Heart Beat ◽  
Mechanical Ventilators ◽  
Patient Simulator ◽  
Physiological Signal ◽  
Respiratory Flow ◽  
Fractal Signal ◽  
Heart Beat Rate

In this paper how to generate respiratory flow that has fractal signal feature is introduced. Physiological signal have fractal feature have been verified by many researchers, such as heart beat rate, interbreath interval. Mechanical ventilators are used to provide life support for patients with respiratory failure. But these machines can damage the lung, causing them to collapse. On the other hand, fractal feature can be used as an indication of health situation; as a result in patient simulation the physiological signal should also have fractal features. The fractal feature is generated by fractional Brownian motion simulation. The fractal dimension is decided by Hurst exponent in routine. The algorithm is realized by R language and result is input into LabVIEW which have friendly interface and easy for simulation control usage. The method can be used in design of mechanical ventilator and medical patient simulator.

scholarly journals Clustering Heatmap for Visualizing and Exploring Complex and High-dimensional Data Related to Chronic Kidney Disease

2020 ◽  
Vol 9 (2) ◽  
pp. 403 ◽  
Author(s):  
Cheng-Sheng Yu ◽  
Chang-Hsien Lin ◽  
Yu-Jiun Lin ◽  
Shiyng-Yu Lin ◽  
Sen-Te Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Complex Disease ◽  
Early Recognition ◽  
Adverse Outcomes ◽  
Rapid Decline ◽  
Rapid Progression

Background: Preventive medicine and primary health care are essential for patients with chronic kidney disease (CKD) because the symptoms of CKD may not appear until the renal function is severely compromised. Early identification of the risk factors of CKD is critical for preventing kidney damage and adverse outcomes. Early recognition of rapid progression to advanced CKD in certain high-risk populations is vital. Methods: This is a retrospective cohort study, the population screened and the site where the study has been performed. Multivariate statistical analysis was used to assess the prediction of CKD as many potential risk factors are involved. The clustering heatmap and random forest provides an interactive visualization for the classification of patients with different CKD stages. Results: uric acid, blood urea nitrogen, waist circumference, serum glutamic oxaloacetic transaminase, and hemoglobin A1c (HbA1c) were significantly associated with CKD. CKD was highly associated with obesity, hyperglycemia, and liver function. Hypertension and HbA1c were in the same cluster with a similar pattern, whereas high-density lipoprotein cholesterol had an opposite pattern, which was also verified using heatmap. Early staged CKD patients who are grouped into the same cluster as advanced staged CKD patients could be at high risk for rapid decline of kidney function and should be closely monitored. Conclusions: The clustering heatmap provided a new predictive model of health care management for patients at high risk of rapid CKD progression. This model could help physicians make an accurate diagnosis of this progressive and complex disease.

Advancing evidence-based decisions in the management of EGFR-mutated metastatic NSCLC.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20663-e20663
Author(s):  
Tara Herrmann ◽  
Martin Warters ◽  
Douglas Blevins ◽  
Panos Fidias
Keyword(s):  
Learning Experience ◽  
Patient Simulation ◽  
Treatment Resistance ◽  
Educational Interventions ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Decisions ◽  
First Line ◽  
Metastatic Nsclc ◽  
Egfr Mutated

e20663 Background: In patients diagnosed with metastatic NSCLC it is now essential to identify targetable mutations and markers of treatment resistance in order to determine the appropriate therapy. A study was conducted to determine if simulation-based educational interventions to address clinical practice gaps could improve decisions of oncologists in the management of EGFR-mutated metastatic NSCLC. Methods: A cohort of US-oncologists who participated in a virtual patient simulation (VPS)-based education was evaluated. The VPS consisted of 2 cases that allowed oncologists to assess the patient and choose from a database of diagnostic possibilities matching the scope and depth of practice. Clinical decisions were analyzed using a decision engine, and instantaneous clinical guidance (CG) employing current evidence-based and expert faculty recommendations was provided after each decision. Oncologists were allowed a second chance at each decision point and decisions before and after CG were compared using a 2-tailed paired T-test to determine differences from pre- to post CG. P values are shown as a measure of significance; with P < .05 statistically significant. Results: 197 oncologists made clinical decisions within the simulation. As a result of CG, significant improvements were observed in: Ordering EGFR mutational testing (16%, P= 0.008) and making an accurate diagnosis (36%) Selecting an EGFR TKI in the first-line setting (24%, P< 0.001) Ordering a PET scan to assess disease progression (10%) and in diagnosing patients with EGFR T790M disease that is resistant (29% , P< 0.001) Evidence-based treatment selection for individuals whose disease progressed on first-line therapy (19%, P= .003) Number of oncologists who ordered adverse event education and counseling (23%, P< .001) Conclusions: This study showed improvements in evidence-based practices of oncologists in the diagnosis and management of EGFR-mutated NSCLC; demonstrating that VPS-based instruction that immerses and engages oncologists for an authentic, practical and16. consequence-free learning experience can result in an increase in appropriate clinical decisions. Therefore, VPS may have a role in improving the quality of patient care.

Dementia of acute onset in the Canadian Study of Health and Aging

2005 ◽  
Vol 17 (3) ◽  
pp. 451-459 ◽  
Author(s):  
Paige King ◽  
Pratima Devichand ◽  
Kenneth Rockwood
Keyword(s):  
Risk Factors ◽  
Acute Onset ◽  
Vascular Risk Factors ◽  
Adverse Outcomes ◽  
Vascular Risk ◽  
Canadian Study ◽  
People With Dementia ◽  
Gradual Onset ◽  
Insidious Onset ◽  
Onset Group

Background: Although most people with dementia experience an insidious onset of symptoms, in some cases onset can be acute. The importance of acute onset is unclear. Some reports suggest that it portends a worse course.Methods: We performed a secondary analysis of the clinical examination cohort (n=2914) of the Canadian Study of Health and Aging (CSHA). We defined “acute onset of dementia” from the Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) questionnaire, conducted with an informant. People with dementia of acute onset were compared to those with dementia of insidious onset for development of adverse outcomes of death and institutionalization over 5years.Results: Of the 1132 people who had dementia, 130 (11.5%) met criteria for acute onset. Compared with gradual-onset dementia patients, those with acute-onset dementia were more often men (42% vs. 30%, p<0.05), resided in nursing homes (75% vs. 63%, p<0.05), had vascular risk factors (72% vs. 47%, p<0.05), and a Hachinski Ischemia Scale (HIS) score ≥7 (64% vs. 19%, p<0.05). More patients with dementia of acute onset than gradual onset were diagnosed with vascular dementia (55% vs. 13%; p<0.05). Adjusted hazard ratios (HRs) for survival and institutionalization in the acute-onset group were 0.93 [95% confidence interval (CI) 0.7–1.2] and 0.76 (95% CI 0.4–1.3), respectively, compared with the gradual-onset group.Conclusions: People with acute-onset dementia had more vascular risk factors than those with gradual-onset dementia across all dementia diagnoses, and lower risks of institutionalization but worse survival. Routine inquiry about the onset of dementia might help to better clarify prognoses in patients with dementia.

Reliability and validity of a scoring instrument for clinical performance during Pediatric Advanced Life Support simulation scenarios

Resuscitation ◽  
2010 ◽  
Vol 81 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Aaron Donoghue ◽  
Akira Nishisaki ◽  
Robert Sutton ◽  
Roberta Hales ◽  
John Boulet
Keyword(s):  
Life Support ◽  
Clinical Performance ◽  
Reliability And Validity ◽  
Advanced Life Support

scholarly journals Evaluation of a research methods course for clinical residents

2019 ◽  
Vol 8 (2) ◽  
pp. 124-130
Author(s):  
Maryamalsadat Kazemi Shishavan ◽  
Mahasti Alizadeh
Keyword(s):  
Research Training ◽  
Medical Science ◽  
Data Gathering ◽  
Participation Rate ◽  
Educational Interventions ◽  
Scholarly Activity ◽  
Structured Interviews ◽  
Product Model ◽  
Research Skills ◽  
Executive Staff

Background: Residency programs generally carry out various educational interventions to improve residents’ publication records. Since an intervention may not produce the same effect in different locations, evaluating the effectiveness of individual interventions is essential for examining progress in this field of study. Authorities at the Tabriz University of Medical Science (TUOMS) proposed a research training program targeting a rise in residents’ scholarly activity and publications; this study aimed to evaluate the program and share the findings and experiences. Methods: Questionnaires were sent to 182 residents and the heads of all clinical departments. Evaluators used Kirkpatrick’s four-level model and Stufflebeam’s Context, Input, Process and Product model for data gathering and analyzing. Focus group discussions (FGDs) and in-depth semi-structured interviews were done with faculty members, executive staff, and residents to complement the survey results. Data were summarized and categorized using quantitative and qualitative analysis. Results: The participation rate for residents and heads of departments were 76 (41.7%) and 14(70%), respectively. At the end of the course, residents assessed their knowledge and research skills as weak or medium in most of the subjects. A total of 182 (100 %) residents prepared thesis proposals. Only 82 (49.1%) residents completed their thesis, and 19 (11.3%) published papers.Generally, participants were not satisfied with the course. Barriers noted were: mandatory topics for theses, an intensive course with a one-month duration, a lack of consideration of practical subjects, high cost of the course, and failure to achieve an increase in publications. Conclusion: The Self-assessment results of increased knowledge and research skills did not indicate improvement. Mandatory participation in the course did not result in the expected publication increase.

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