Novel Neonatal Simulator Provides High-Fidelity Ventilation Training Comparable to Real-Life Newborn Ventilation

Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but positive end-expiratory pressure (PEEP) was lower in manikin ventilation. Correlations between PIP, eVT and leak followed a consistent pattern for manikin and neonatal PPV, with a negative relationship between eVT and leak being the only significant correlation. Airway obstruction occurred with the same frequency in the manikin and newborns. These findings support the fidelity of the manikin in simulating clinical conditions encountered during real newborn ventilation. Two limitations of the simulator provide focus for further improvements.

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Pediatrics Residents' Preparedness for Neonatal Resuscitation Assessed Using High-Fidelity Simulation

Journal of Graduate Medical Education ◽

10.4300/jgme-d-12-00192.1 ◽

2013 ◽

Vol 5 (3) ◽

pp. 399-404 ◽

Cited By ~ 8

Author(s):

Leandro Cordero ◽

Brandon J. Hart ◽

Rene Hardin ◽

John D. Mahan ◽

Peter J. Giannone ◽

...

Keyword(s):

Intensive Care ◽

Neonatal Intensive Care ◽

Neonatal Resuscitation ◽

Delivery Room ◽

Positive Pressure ◽

High Fidelity ◽

Procedural Skill ◽

Actual Performance ◽

Self Confidence ◽

Skill Performance

Abstract Background Pediatrics residents are expected to demonstrate preparedness for neonatal resuscitation, yet research has shown gaps in residents' readiness to perform this skill. Objective To evaluate procedural skills and team performance of pediatrics residents during neonatal resuscitation (NR) using a high-fidelity mannequin, and to assess residents' confidence in their NR skills before and after training. Methods Two teams of residents (all had completed NR program training) participated in 2 separate, 90-minute sessions (2 to 3 weeks apart) in an off-site delivery room during their neonatal intensive care rotation. Residents' confidence in assisting and leading NR was surveyed before each session. Teams participated in a scenario (adapted from the NR program), which required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Video recording was used for debriefing and scoring. Skills were scored for technique and timeliness, and team behaviors were scored for communication, management, and leadership. Results Twenty-six residents (11 teams) completed 2 paired sessions. Self-confidence scores increased between the 2 sessions but were not correlated with performance. Gaps in procedural skill performance were observed, and timeliness for most skills did not meet expectations. Significant improvement in team communication was noted. Conclusions Important gaps in procedural skill performance, particularly timeliness, were detected by NR simulation training; residents' improvements in self-confidence did not reflect gains in actual performance. Their relative unpreparedness for NR (despite prior certification) highlights the need for deliberate practice and specific team training before and during neonatal intensive care delivery room rotations.

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A Randomised Controlled Study of Low-Dose High-Frequency In-Situ Simulation Training to Improve Newborn Resuscitation

Children ◽

10.3390/children8121115 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1115

Author(s):

Joanna Haynes ◽

Siren Rettedal ◽

Jeffrey Perlman ◽

Hege Ersdal

Keyword(s):

High Frequency ◽

Simulation Training ◽

Low Dose ◽

Real Life ◽

Controlled Study ◽

Positive Pressure ◽

High Resource ◽

Resource Setting ◽

Randomised Controlled Study ◽

Randomised Controlled

Positive pressure ventilation of the non-breathing newborn is a critical and time-sensitive intervention, considered to be the cornerstone of resuscitation. Many healthcare providers working in delivery units in high-resource settings have little opportunity to practise this skill in real life, affecting their performance when called upon to resuscitate a newborn. Low-dose, high-frequency simulation training has shown promise in low-resource settings, improving ventilation performance and changing practice in the clinical situation. We performed a randomised controlled study of low-dose, high-frequency simulation training for maintenance of ventilation competence in a multidisciplinary staff in a busy teaching hospital in Norway. We hypothesised that participants training according to a low-dose, high-frequency protocol would perform better than those training as they wished. Our results did not support this, although the majority of protocol participants were unable to achieve training targets. Subgroup analysis comparing no training to at least monthly training did identify a clear benefit to regular simulation practice. Simulated ventilation competence improved significantly for all participants over the course of the study. We conclude that frequent, short, simulation-based training can foster and maintain newborn ventilation skills in a multidisciplinary delivery unit staff in a high-resource setting.

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Cohort study of neonatal resuscitation skill retention in frontline healthcare facilities in Bihar, India, after PRONTO simulation training

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000628 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000628

Author(s):

Brennan V Higgins ◽

Melissa M Medvedev ◽

Hilary Spindler ◽

Rakesh Ghosh ◽

Ojungsangla Longkumer ◽

...

Keyword(s):

Heart Rate ◽

Skill Acquisition ◽

Low Income ◽

Simulation Training ◽

Positive Impact ◽

Neonatal Resuscitation ◽

Health Systems Strengthening ◽

Positive Pressure ◽

Skill Retention ◽

Facility Level

BackgroundUse of simulation in neonatal resuscitation (NR) training programmes has increased throughout low-income and middle-income countries. Many of such programmes have demonstrated a positive impact on NR knowledge and skill acquisition along with reduction of early neonatal mortality and fresh stillbirth rates. However, NR skill retention after simulation programmes remains a challenge.MethodsThis study assessed facility level NR skill retention after PRONTO International’s simulation training in Bihar, India. Training was conducted within CARE India’s statewide in-job, on-site Apatkaleen Matritva evam Navjat Tatparta mentoring programme as part of a larger quality improvement and health systems strengthening initiative. Public sector facilities were initially offered training, facilitated by trained nursing graduates, during 8-month phases between September 2015 and January 2017. Repeat training began in February 2018 and was facilitated by peers. NR skills in simulated resuscitations were assessed at the facility level at the midpoint and endpoint of initial training and prior to and at the midpoint of repeat training.ResultsFacilities administering effective positive pressure ventilation and assessing infant heart rate increased (31.1% and 13.1%, respectively, both p=0.03) from midinitial to postinitial training (n=64 primary health centres (PHCs) and 192 simulations). This was followed by a 26.2% and 20.9% decline in these skills respectively over the training gap (p≤0.01). A significant increase (16.1%, p=0.04) in heart rate assessment was observed by the midpoint of repeat training with peer facilitators (n=45 PHCs and 90 simulations). No significant change was observed in other skills assessed.ConclusionsDespite initial improvement in select NR skills, deterioration was observed at a facility-level post-training. Given the technical nature of NR skills and the departure these skills represent from traditional practices in Bihar, refresher trainings at shorter intervals are likely necessary. Very limited evidence suggests peer simulation facilitators may enable such increased training frequency, but further study is required.

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PyDOSS: An open-source Python-based communicable disease outbreak surveillance system designed and used in a COVID-19 community care facility (Preprint)

10.2196/preprints.21760 ◽

2020 ◽

Author(s):

Andrew Fang ◽

Jonathan Kia-Sheng Phua ◽

Terrence Chiew ◽

Daniel De-Liang Loh ◽

Lincoln Ming Han Liow ◽

...

Keyword(s):

Open Source ◽

Surveillance System ◽

Community Care ◽

Communicable Disease ◽

Low Cost ◽

Real Life ◽

Disease Outbreak ◽

Disease Spread ◽

Healthcare Team ◽

Increased Risk

BACKGROUND During the Coronavirus Disease 2019 (COVID-19) outbreak, community care facilities (CCF) were set up as temporary out-of-hospital isolation facilities to contain the surge of cases in Singapore. Confined living spaces within CCFs posed an increased risk of communicable disease spread among residents. OBJECTIVE This inspired our healthcare team managing a CCF operation to design a low-cost communicable disease outbreak surveillance system (CDOSS). METHODS Our CDOSS was designed with the following considerations: (1) comprehensiveness, (2) efficiency through passive reconnoitering from electronic medical record (EMR) data, (3) ability to provide spatiotemporal insights, (4) low-cost and (5) ease of use. We used Python to develop a lightweight application – Python-based Communicable Disease Outbreak Surveillance System (PyDOSS) – that was able perform syndromic surveillance and fever monitoring. With minimal user actions, its data pipeline would generate daily control charts and geospatial heat maps of cases from raw EMR data and logged vital signs. PyDOSS was successfully implemented as part of our CCF workflow. We also simulated a gastroenteritis (GE) outbreak to test the effectiveness of the system. RESULTS PyDOSS was used throughout the entire duration of operation; the output was reviewed daily by senior management. No disease outbreaks were identified during our medical operation. In the simulated GE outbreak, PyDOSS was able to effectively detect an outbreak within 24 hours and provided information about cluster progression which could aid in contact tracing. The code for a stock version of PyDOSS has been made publicly available. CONCLUSIONS PyDOSS is an effective surveillance system which was successfully implemented in a real-life medical operation. With the system developed using open-source technology and the code made freely available, it significantly reduces the cost of developing and operating CDOSS and may be useful for similar temporary medical operations, or in resource-limited settings.

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The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation

Children ◽

10.3390/children8060526 ◽

2021 ◽

Vol 8 (6) ◽

pp. 526

Author(s):

James Ditai ◽

Aisling Barry ◽

Kathy Burgoine ◽

Anthony K. Mbonye ◽

Julius N. Wandabwa ◽

...

Keyword(s):

Low Cost ◽

Neonatal Resuscitation ◽

Sub Saharan Africa ◽

Skilled Birth Attendants ◽

New Device ◽

Birth Attendants ◽

Premature Babies ◽

Sub Saharan ◽

The Uk ◽

The University

The initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside resuscitation surfaces. These new devices are unaffordable, however, in most of sub-Saharan Africa, where 42% of the world’s 2.4 million annual newborn deaths occur. This paper describes the rationale and design of BabySaver, an innovative low-cost mobile resuscitation unit, which was developed iteratively over five years in a collaboration between the Sanyu Africa Research Institute (SAfRI) in Uganda and the University of Liverpool in the UK. The final BabySaver design comprises two compartments; a tray to provide a firm resuscitation surface, and a base to store resuscitation equipment. The design was formed while considering contextual factors, using the views of individual women from the community served by the local hospitals, medical staff, and skilled birth attendants in both Uganda and the UK.

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Abstract 170: Temperature Maintenance and Oxygen Use in Newborns at Birth: A Surveillance of Clinical Practice and Compliance with Neonatal Resuscitation Guidelines

Circulation ◽

10.1161/circ.130.suppl_2.170 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Georg M Schmölzer ◽

Roxanne Pinson ◽

Marion Molesky ◽

Heather Chinnery ◽

Karen Foss ◽

...

Keyword(s):

Body Temperature ◽

Knowledge Transfer ◽

Oxygen Saturation ◽

Neonatal Resuscitation ◽

Positive Pressure ◽

Respiratory Therapists ◽

Vaginal Deliveries ◽

Resuscitation Guidelines ◽

The Right ◽

Continuous Positive Pressure

Background: Guidelines of neonatal resuscitation are revised regularly. Gaps in knowledge transfer commonly occur when the guidelines are communicated to the clinical practitioners. Maintaining body temperature and supporting oxygenation are main goals that clinical practitioners aim to achieve in assisting newborns during the feto-neonatal transition at birth. Objectives: In this study, we aim to examine the compliance to guidelines in neonatal resuscitation regarding the temperature maintenance and oxygen use in newborns at birth. Methods: From October to November 2013, a prospective questionnaire surveillance was conducted in all attended deliveries at all four hospitals in Edmonton, Alberta, Canada. All clinical practitioners (registered nurses, physicians and respiratory therapists) were requested to complete the questionnaires immediately after the attended delivery regarding temperature maintenance and oxygenation monitoring. Descriptive statistics were used with mean±SD (range) and % presented. Results: During the 14-days study period, data was obtained in 518 of 712 (73%) attended deliveries of newborns with gestational age 38.6±2.0 (23-42) weeks and birth weight 3324±589 (348-6168) g. Of these deliveries, 58% were normal vaginal deliveries and 29% were cesarean sections. There were 8.8% and 8.4% newborns who required positive pressure ventilation and continuous positive pressure, respectively. Radiant warmer heat was used in 81% (419/518) with 63% (266/419) turned to full power. Room temperature was 21.6±1.6 (17-31)°C. Body temperature at 30-60 min after birth was 36.8±0.5 (32.4-38.1)°C with hypothermia (<36.5°C) in 17%. Percutaneous oxygen saturation was measured in 15% newborns and 96% had sensors placed at the right wrist. At the initiation of resuscitation, 21% oxygen was used in 76% and the oxygen concentration was adjusted according to an oxygen saturation chart in 17%. In 70% of the cases, clinical practitioners commented that this chart was not helpful. Conclusions: Gaps in knowledge transfer contribute to non-compliance in the guidelines of neonatal resuscitation for temperature maintenance and oxygen use. Caution is needed to avoid hypothermia and hyperoxia in at-risk populations such as prematurity.

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Extending QGroundControl for Automated Mission Planning of UAVs

Sensors ◽

10.3390/s18072339 ◽

2018 ◽

Vol 18 (7) ◽

pp. 2339 ◽

Cited By ~ 8

Author(s):

Cristian Ramirez-Atencia ◽

David Camacho

Keyword(s):

Flight Control ◽

Low Cost ◽

Real Life ◽

Mission Planning ◽

Human Computer Interface ◽

Simulation Environment ◽

Test Bed ◽

Multiple Vehicles ◽

Operator Workload ◽

Selection Of

Unmanned Aerial Vehicles (UAVs) have become very popular in the last decade due to some advantages such as strong terrain adaptation, low cost, zero casualties, and so on. One of the most interesting advances in this field is the automation of mission planning (task allocation) and real-time replanning, which are highly useful to increase the autonomy of the vehicle and reduce the operator workload. These automated mission planning and replanning systems require a Human Computer Interface (HCI) that facilitates the visualization and selection of plans that will be executed by the vehicles. In addition, most missions should be assessed before their real-life execution. This paper extends QGroundControl, an open-source simulation environment for flight control of multiple vehicles, by adding a mission designer that permits the operator to build complex missions with tasks and other scenario items; an interface for automated mission planning and replanning, which works as a test bed for different algorithms, and a Decision Support System (DSS) that helps the operator in the selection of the plan. In this work, a complete guide of these systems and some practical use cases are provided

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Rapid Antibody Selection Using Surface Plasmon Resonance for High-Speed and Sensitive Hazelnut Lateral Flow Prototypes

Biosensors ◽

10.3390/bios8040130 ◽

2018 ◽

Vol 8 (4) ◽

pp. 130 ◽

Cited By ~ 6

Author(s):

Georgina Ross ◽

Maria Bremer ◽

Jan Wichers ◽

Aart van Amerongen ◽

Michel Nielen

Keyword(s):

Surface Plasmon Resonance ◽

Surface Plasmon ◽

Plasmon Resonance ◽

High Speed ◽

Selection Process ◽

Low Cost ◽

Real Life ◽

Cross Reactivity ◽

Lateral Flow ◽

Label Free

Lateral Flow Immunoassays (LFIAs) allow for rapid, low-cost, screening of many biomolecules such as food allergens. Despite being classified as rapid tests, many LFIAs take 10–20 min to complete. For a really high-speed LFIA, it is necessary to assess antibody association kinetics. By using a label-free optical technique such as Surface Plasmon Resonance (SPR), it is possible to screen crude monoclonal antibody (mAb) preparations for their association rates against a target. Herein, we describe an SPR-based method for screening and selecting crude anti-hazelnut antibodies based on their relative association rates, cross reactivity and sandwich pairing capabilities, for subsequent application in a rapid ligand binding assay. Thanks to the SPR selection process, only the fast mAb (F-50-6B12) and the slow (S-50-5H9) mAb needed purification for labelling with carbon nanoparticles to exploit high-speed LFIA prototypes. The kinetics observed in SPR were reflected in LFIA, with the test line appearing within 30 s, almost two times faster when F-50-6B12 was used, compared with S-50-5H9. Additionally, the LFIAs have demonstrated their future applicability to real life samples by detecting hazelnut in the sub-ppm range in a cookie matrix. Finally, these LFIAs not only provide a qualitative result when read visually, but also generate semi-quantitative data when exploiting freely downloadable smartphone apps.

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Manual ventilation devices in neonatal resuscitation: Tidal volume and positive pressure-provision

Resuscitation ◽

10.1016/j.resuscitation.2009.10.008 ◽

2010 ◽

Vol 81 (2) ◽

pp. 202-205 ◽

Cited By ~ 38

Author(s):

Charles C. Roehr ◽

Marcus Kelm ◽

Hendrik S. Fischer ◽

Christoph Bührer ◽

Gerd Schmalisch ◽

...

Keyword(s):

Tidal Volume ◽

Neonatal Resuscitation ◽

Positive Pressure ◽

Manual Ventilation

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DYSKIMOT: An ultra-low-cost inertial sensor to assess head’s rotational kinematics in adults during the Didren-Laser Test

10.31224/osf.io/6n4ke ◽

2019 ◽

Author(s):

Renaud Hage ◽

Christine Detrembleur ◽

Frédéric Dierick ◽

Laurent Pitance ◽

Laurent Jojczyk ◽

...

Keyword(s):

Time Series ◽

Clinical Practice ◽

Gold Standard ◽

Inertial Sensor ◽

Low Cost ◽

Real Life ◽

Optoelectronic System ◽

Qualitative Level ◽

Cervical Motion ◽

Head Rotations

Various noninvasive measurement devices can be used to assess cervical motion. Size, complexity and cost of gold-standard systems make them not suited in clinical practice, and actually difficult to use outside dedicated laboratory. Nowadays, ultra-low-cost inertial measurement units are available but without any packaging nor user-friendly interface. DYSKIMOT is a home- designed, small-sized, motion sensor based on the latter technology, aiming at being used by clinicians in “real-life situations”. In the present study. DYSKIMOT was compared with a gold- standard optoelectronic system (Elite). Our goal was to evaluate the accuracy of DYSKIMOT in assessing the kinematics in fast head rotations. Kinematics was simultaneously recorded by the DYSKIMOT and Elite systems during the execution of the DidRen Laser test and performed by 15 participants and 9 patients. Kinematic variables were computed from the position, speed and acceleration time series. Two-way ANOVA, Passing-Bablok regressions and Dynamic Time Warping analysis showed good to excellent agreement between Elite and DYSKIMOT, both at the qualitative level of the time series shape and at the quantitative level of peculiar kinematical events’ measured values. In conclusion, DYSKIMOT sensor is as relevant as a gold-standard system to assess kinematical features during fast head rotations in participants and patients, demonstrating its usefulness in clinical practice or research in ecological environment.

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