scholarly journals Difficult Delivery and Neonatal Resuscitation: A Novel Simulation for Emergency Medicine Residents

2019 ◽  
Vol 21 (1) ◽  
pp. 102-107
Author(s):  
Jillian Nickerson ◽  
Taryn Webb ◽  
Lorraine Boehm ◽  
Hayley Neher ◽  
Lillian Wong ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Clinical Performance ◽  
Clinical Skills ◽  
Neonatal Resuscitation ◽  
Shoulder Dystocia ◽  
Choice Test ◽  
Post Intervention ◽  
Convenience Sample ◽  
One Year

Introduction: Newborn delivery and resuscitation are rare, but essential, emergency medicine (EM) skills. We evaluated the effect of simulation on EM residents’ knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation. Methods: We developed a novel simulation that integrates a shoulder dystocia with neonatal resuscitation and studied a convenience sample of EM residents. Each 15-minute simulation was run with one learner, a simulated nurse, and a standardized patient in situ in the emergency department. The learner was required to reduce a shoulder dystocia and then perform neonatal resuscitation. We debriefed with plus/delta format, standardized teaching points, and individualized feedback. We assessed knowledge with a nine-question multiple choice test, confidence with five-point Likert scales, and clinical performance using a checklist of critical actions. Residents repeated all measures one year after the simulation. Results: A total of 23 residents completed all measures. At one-year post-intervention, residents scored 15% higher on the knowledge test. All residents increased confidence in managing shoulder dystocia on a five-point Likert scale (1.4 vs 2.8) and 80% increased confidence in performing neonatal resuscitation (1.8 vs 3.0). Mean scores on the checklist of critical actions improved by 19% for shoulder dystocia and by 27% for neonatal resuscitation. Conclusion: Implementing simulation may improve EM residents’ knowledge, confidence, and clinical skills in managing shoulder dystocia and neonatal resuscitation.

Neonatal resuscitation experience curves: simulation based mastery learning booster sessions and skill decay patterns among pediatric residents

2018 ◽  
Vol 46 (8) ◽  
pp. 934-941 ◽  
Author(s):  
Heideh H. Matterson ◽  
Demian Szyld ◽  
Brad R. Green ◽  
Heather B. Howell ◽  
Martin V. Pusic ◽  
...  
Keyword(s):  
Clinical Skills ◽  
Mastery Learning ◽  
Neonatal Resuscitation ◽  
Skill Retention ◽  
Pediatric Residents ◽  
Simulation Based ◽  
Booster Sessions ◽  
Variable Extent ◽  
One Year ◽  
To Receive

Abstract Background Following neonatal resuscitation program (NRP) training, decay in clinical skills can occur. Simulation-based deliberate practice (SBDP) has been shown to maintain NRP skills to a variable extent. Our study objectives were (a) to determine whether a single 30 min simulation-based intervention that incorporates SBDP and mastery learning (ML) can effectively restore skills and prevent skill decay and (b) to compare different timing options. Methods Following NRP certification, pediatric residents were randomly assigned to receive a video-recorded baseline assessment plus SBDP-ML refresher education at between 6 and 9 months (early) or between 9 and 12 months (late). One year following initial certification, participants had repeat skill retention videotaped evaluations. Participants were scored by blinded NRP instructors using validated criteria scoring tools and assigned a global performance rating score (GRS). Results Twenty-seven participants were included. Residents in both early and late groups showed significant skill decay 7 and 10 months after initial NRP. SBDP-ML booster sessions significantly improved participants’ immediate NRP performance scores (p<0.001), which persisted for 2 months, but were again lower 4 months later. Conclusions NRP skills may be boosted to mastery levels after a short SBDP-ML intervention and do not appear to significantly decline after 2 months. Brief booster training could potentially serve as a useful supplement to traditional NRP training for pediatric residents.

scholarly journals Postdebriefing Supervised Practice Improves Clinical Performance During Simulation-Based Cardiopulmonary Resuscitation Encounter

2020 ◽  
Vol 15 (2) ◽  
pp. 85-92
Author(s):  
Kristin Ann Paloncy
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Athletic Training ◽  
Repeated Measures ◽  
Clinical Performance ◽  
Clinical Skills ◽  
The United States ◽  
Clinical Competency ◽  
Athletic Training Students ◽  
Convenience Sample ◽  
Simulation Based

Context Simulation is commonly incorporated into medical and health programs as a method of skill practice and evaluation and can be effective at improving athletic training student learning outcomes when purposefully designed. Objective The purpose of this study was to determine what level of impact participation in supervised practice after debriefing within a simulation-based cardiovascular emergency scenario using the Laerdal SimMan in a university simulation center in the United States had on athletic training students' clinical performance. Design Quantitative quasi-experimental cohort design with repeated measures study. Patients or Other Participants Convenience sample of undergraduate athletic training students (n = 46) enrolled in a professional program at a university in the Midwest. Intervention(s) Participation in supervised practice of cardiopulmonary resuscitation skills after debriefing in a simulation. Main Outcome Measure(s) Clinical competency with associated cardiopulmonary resuscitation skills using the Laerdal Learning Application software program that interfaces with the simulation hardware. Results There was a statistically significant interaction between groups (F1,10 = 18.70, P &lt; .05, η = 652) indicating participants in the supervised practice after debriefing group were significantly higher (mean = 0.72, SD = 0.05) than those that did not have supervised practice after the debriefing (mean = 0.17, SD = 0.05). Conclusions The design and development of a simulation experience is optimized when there is deliberate consideration of what components and exposure to these learning components will lead to certain outcomes. Even though supervised practice after debriefing has been identified as optional for skill-based simulations, the current study demonstrates that the supervised practice of clinical skills component is vital within emergency cardiovascular simulation encounters for participants to increase clinical competency.

scholarly journals What are the measures that can be used to assess performance during in situ Paediatric Emergency Medicine Simulation?

2017 ◽  
Vol 3 (3) ◽  
pp. 83-87 ◽  
Author(s):  
Jennifer Amanda Mann ◽  
Damian Roland
Keyword(s):  
Emergency Medicine ◽  
Performance Evaluation ◽  
Clinical Skills ◽  
Evaluation Methods ◽  
In Situ Simulation ◽  
Paediatric Emergency ◽  
Paediatric Emergency Medicine ◽  
Study Selection ◽  
Key Terms

BackgroundPaediatric in situ simulation within emergency departments is growing in popularity as an approach for improving multidisciplinary team working, enabling clinical skills development and exploring the importance of human factors in the clinical setting. However, measuring the success of such programmes is often through participant feedback of satisfaction and not measures of performance, which makes it difficult to assess whether such programmes lead to improvements in clinical behaviour.ObjectiveTo identify the measures that can be used to assess performance during in situ paediatric emergency medicine simulations.Study selectionA literature search of EMBASE, ERIC and MEDLINE was performed using the key terms (Paediatrics and Emergency and Simulation.) MeSH and subheadings were used to ensure all possible variations of the key terms were included within the search.FindingsThe search revealed 607 articles, with 16 articles meeting inclusion criteria. Three themes of evaluation strategy were identified—the use of feedback forms (56% n=9/16), performance evaluation methods (63% n=10/16) or other strategies (25% n=4/16), which included provider comfort scores, latent safety threat identification and episodes of suboptimal care and their causation.ConclusionsThe most frequently used method of assessment in paediatric emergency department simulation are performance evaluation methods. None of the studies in this area have looked at patient level outcomes and this is therefore an area which should be explored in the future.

scholarly journals Combining in-situ simulation and live HEMS mission facilitator observation: a flexible learning concept

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Per P. Bredmose ◽  
Jostein Hagemo ◽  
Doris Østergaard ◽  
Stephen Sollid
Keyword(s):  
Simulation Training ◽  
Clinical Skills ◽  
Training Session ◽  
Numerical Data ◽  
Continuous Medical Education ◽  
Structured Interviews ◽  
Immediate Feedback ◽  
In Situ Simulation ◽  
One Year

Abstract Background Continuous medical education is essential in Helicopter Emergency Medical Services (HEMS). In-situ simulation training makes it possible to train in a familiar environment. The use of a dedicated facilitator is essential; however, when an in-situ simulation training session is interrupted by a live mission, the efforts invested in the training are left unfulfilled. This study aims to evaluate if HEMS mission observation and debriefing by the simulation facilitator is a feasible alternative to mission-interrupted simulation training, and how this alternative to simulation training is perceived by both facilitators and HEMS crew members. Methods Facilitator observation during live missions and post-mission debriefing was offered as an alternative to mission-interrupted simulation training over a one-year period at three HEMS bases. Immediate feedback was requested from crews and facilitators after each observed live mission on a predefined questionnaire. At the end of the study period, semi-structured interviews were performed with a sample of HEMS crew members and facilitators to further explore the experience with the concept. Numerical data about the sessions were recorded continuously. Results A total of 78 training sessions were attempted, with 46 (59%) of the simulations conducted as planned. Of the remaining, 23 (29%) were not started because the crew had other duties (fatigued crew or crew called for a mission where observation was inappropriate/impossible), and 9 (12%) training sessions were converted to observed live missions. In total, 43 (55%), 16 (21%) and 19 (24%) attempts to facilitate simulation training were undertaken on the three bases, respectively. The facilitators considered mission observation more challenging than simulation. The interviews identified local know-how, clinical skills, and excellent communication skills as important prerequisites for the facilitators to conduct live mission observation successfully. Participating crews and facilitators found simulation both valuable and needed. Being observed was initially perceived as unpleasant but later regarded as a helpful way of learning. Conclusion Live mission observation and debriefing seems a feasible and well-received alternative to an in-situ simulation program in HEMS to maximise invested resources and maintain the learning outcome. Furthermore, additional training of simulation facilitators to handle the context of live mission observation may further improve the learning output.

Nurse Educators Teaching Medical Interns: Impact of Interprofessional Collaboration

2021 ◽  
Vol 27 (2) ◽  
pp. 125-130
Author(s):  
Maryanne Barra ◽  
Samantha Singh Hernandez ◽  
Janet Czermak
Keyword(s):  
Nurse Educators ◽  
Positive Impact ◽  
Clinical Performance ◽  
Interprofessional Collaboration ◽  
Clinical Skills ◽  
Chief Resident ◽  
Medical Knowledge ◽  
Convenience Sample ◽  
Knowledge And Skills ◽  
Medical Interns

BackgroundThis quantitative educational intervention was conducted to determine the effectiveness of a 1-day internal medicine orientation for new interns, led by nurse educators instead of medical doctors.MethodsScheduled within the orientation week curriculum, this project had a purposeful convenience sample of 14 students comprising the entire intern class. An afternoon of 1:1 clinical skills with nursing guidance followed a morning of didactic lecture on medical knowledge and skills transfer. Students completed a pre/postmedical education test (MET) to evaluate knowledge and skills acquired.ResultsInterns reported increased confidence with clinical competencies to both nurse educators and the chief resident. Outcome questionnaires revealed statistically significant increases in knowledge about clinical skills after the intervention. Interns witnessed interprofessional teamwork.ConclusionNurse educators teaching medical interns facilitates interprofessional team collaboration, communication, and mutual respect. This simulation pedagogy focusing on principles of deliberate practice can have a positive impact on academic and clinical performance.

scholarly journals Evaluation of retention of knowledge, skill and competency of health workers one year after completion of the Helping Babies Breathe training program in South Sudan

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 167 ◽  
Author(s):  
Christopher Vunni Draiko ◽  
Khemika Yamarat ◽  
Alessio Panza ◽  
Judith Draleru
Keyword(s):  
Health Workers ◽  
Neonatal Resuscitation ◽  
Post Intervention ◽  
Chi Square ◽  
Helping Babies Breathe ◽  
Chi Squared ◽  
Chi Square Test ◽  
Mean Differences ◽  
One Year ◽  
Retention Of Knowledge

Introduction: The aim of the study is to evaluate the long-term retention of knowledge, skill and competency of health workers who completed Helping Babies Breathe (HBB) training and effect on newborn mortality. Methods: The study employed pre-post-interventions study and participants were selected based on their previous training on HBB protocols. Health workers were assessed for knowledge, skill and competency pre, post training in March, and 3 months in June 2017 and 1-year post implementation in September 2018.  Health workers were scored on knowledge, skill and competency. The mean score was obtained and repeated ANOVA, chi-squared test and Pearson’s test was used to compare pre- and post-intervention and one-year implementation. Retention of health worker’s knowledge, skill and competency was assessed using the HBB questionnaires, checklist, practical skill and drills, and were scored on knowledge, skill and competency. The scores were computed into percentages, mean scores and mean differences, and compared against scores at 3 months and 1 year. Impact on management of newborn asphyxia was conducted using a review of delivery registry at maternity and children ward scores were group into percentages, averages means, computed using the Chi-square test. Results: Helping Babies Breathe has shown a significant increase in knowledge, skill and competency post-test and three months. Despite the improvement in knowledge, skills and competency of the health within the three months of training, there was marked decline over 1-year period. Conclusions: Immediate evaluation of the health workers after Helping Babies Breathe training resulted into significant increase in knowledge, skills and competency in neonatal resuscitation although this declined over period of one year. The training also resulted into decrease in neonatal mortality.

A Prospective, Non-randomized Feasibility and Preliminary Efficacy Study of a Telemedicine-Enabled Co-management Intervention for Adults With Type 2 Diabetes and Moderate Anxiety and/or Depression

2021 ◽  
Vol 47 (2) ◽  
pp. 144-152
Author(s):  
Michelle F. Magee ◽  
Stacey I. Kaltman ◽  
Mihriye Mete ◽  
Carine M. Nassar
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Management Program ◽  
Post Intervention ◽  
Convenience Sample ◽  
Intervention Delivery ◽  
Management Intervention ◽  
Moderate Depression ◽  
Patient Health

Purpose The primary aim of this pilot study was to examine the feasibility of codelivering a mental health intervention with an evidence-based type 2 diabetes (T2DM) boot camp care management program. The preliminary impact of participation on symptom scores for depression and anxiety and A1C was also examined. Methods This was a 12-week, non-randomized pilot intervention conducted with a convenience sample of adults with uncontrolled T2DM and moderate depression and/or anxiety at an urban teaching hospital. Co-management intervention delivery was via in-person and telehealth visits. Participants were assessed at baseline and 90 days. Results Participants (n = 18) were African American, majority female (83%), and age 50.7 ± 13.4 years. Significant improvements in mental health outcomes were demonstrated, as measured by a reduction in Patient Health Questionnaire − 9 scores of 2.4 ± 2.9 ( P = .01) and in Generalized Anxiety Disorder − 7 scores of 2.3 ± 1.9 ( P = .001). The pre-post intervention mean A1C improved by 3.4 ± 2.1 units from 12% ± 1.4% to 8.5% ± 1.7% ( P < .001). Conclusion The data generated in this pilot support the feasibility of delivering a diabetes and mental health co-management intervention using a combination of in-person and telemedicine visits to engage adults with T2DM and coexisting moderate depression and/or anxiety. Further research is warranted.

scholarly journals A short-term evaluation of a prototype disposable Oscillating Positive Expiratory Pressure (OPEP) device in a cohort of children with cystic fibrosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kevin J. O’Sullivan ◽  
Valerie Power ◽  
Barry Linnane ◽  
Deirdre McGrath ◽  
Magdalena Mulligan ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Clinical Investigation ◽  
Mean Difference ◽  
Short Term ◽  
Intervention Participant ◽  
Post Intervention ◽  
Convenience Sample ◽  
Disposable Device ◽  
Positive Expiratory Pressure

Abstract Background Oscillating Positive Expiratory Pressure (OPEP) devices are important adjuncts to airway clearance therapy in patients with cystic fibrosis (CF). Current devices are typically reusable and require daily, or often more frequent, cleaning to prevent risk of infection by acting as reservoirs of potentially pathogenic organisms. In response, a daily disposable OPEP device, the UL-OPEP, was developed to mitigate the risk of contamination and eliminate the burdensome need for cleaning devices. Methods A convenience sample of 36 participants, all current OPEP device users, was recruited from a paediatric CF service. For one month, participants replaced their current OPEP device with a novel daily disposable device. Assessment included pre- and post-intervention lung function by spirometry, as well as Lung Clearance Index. Quality of life was assessed using the Cystic Fibrosis Questionnaire – Revised, while user experience was evaluated with a post-study survey. Results 31 participants completed the study: 18 males; median age 10 years, range 4–16 years. Lung function (mean difference ± SD, %FEV1 = 1.69 ± 11.93; %FVC = 0.58 ± 10.04; FEV1: FVC = 0.01 ± 0.09), LCI (mean difference ± SD, 0.08 ± 1.13), six-minute walk test, and CFQ-R were unchanged post-intervention. Participant-reported experiences of the device were predominantly positive. Conclusions The disposable OPEP device maintained patients’ lung function during short term use (≤ 1 month), and was the subject of positive feedback regarding functionality while reducing the risk of airway contamination associated with ineffective cleaning. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).

scholarly journals One-Year Clinical Evaluation of the Bonding Effectiveness of a One-Step, Self-Etch Adhesive in Noncarious Cervical Lesion Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Babacar Faye ◽  
Mouhamed Sarr ◽  
Khaly Bane ◽  
Adjaratou Wakha Aidara ◽  
Seydina Ousmane Niang ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Retention Rate ◽  
Recall Rate ◽  
Acid Etching ◽  
Significant Difference ◽  
Usphs Criteria ◽  
One Step ◽  
One Year ◽  
The One ◽  
Self Etch

This study evaluated the one-year clinical performance of a one-step, self-etch adhesive (Optibond All-in-One, Kerr, CA, USA) combined with a composite (Herculite XRV Ultra, Kerr Hawe, CA, USA) to restore NCCLs with or without prior acid etching. Restorations performed by the same practitioner were evaluated at baseline and after 3, 6, and 12 months using modified USPHS criteria. At 6 months, the recall rate was 100%. The retention rate was 84.2% for restorations with prior acid etching, but statistically significant differences were observed between baseline and 6 months. Without acid etching, the retention rate was 77%, and no statistically significant difference was noted between 3 and 6 months. Marginal integrity (93.7% with and 87.7% without acid etching) and discoloration (95.3% with and 92.9% without acid etching) were scored as Alpha or Bravo, with better results after acid etching. After one year, the recall rate was 58.06%. Loss of pulp vitality, postoperative sensitivity, or secondary caries were not observed. After one year retention rate was of 90.6% and 76.9% with and without acid conditioning. Optibond All-in-One performs at a satisfactory clinical performance level for restoration of NCCLs after 12 months especially after acid etching.

scholarly journals Time Waits for No One: Longitudinal Study on the Effects of an Anti-Stigma Seminar on the Psychology Student Population

2021 ◽  
Vol 18 (10) ◽  
pp. 5441
Author(s):  
Luca Pingani ◽  
Sara Evans-Lacko ◽  
Sandra Coriani ◽  
Silvia Ferrari ◽  
Maria Filosa ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Online Survey ◽  
Student Population ◽  
Post Intervention ◽  
People With Mental Illness ◽  
T1 And T2 ◽  
One Year ◽  
Intended Behaviour

The primary aim is to describe the changes in the knowledge of mental health conditions, the attitudes toward the mentally ill, and the intended behaviour towards people with mental illness among the entire student population of the third year of a degree course in Psychology. A total of 570 students attended a seminar on stigma towards mental illness and were invited to complete an online survey which collected data on sociodemographic characteristics and three validated questionnaires evaluating different aspects of stigma at three different time points (pre-intervention, post-intervention, and at one year follow up). A total of 253 students (44.39%) completed the questionnaires at t0, t1, and t2. The mean age of the sample was 23.7 (SD = ±5.89), and 86.96% (n = 220) were females. Between t0 and t1, a statistically significant improvement was observed for all three outcomes, while the intended behaviour outcome was no longer significant between t1 and t2 (Z = −0.70; p = 0.48). Females and who participated live at the seminar maintained a significant knowledge of mental illness and a better attitude toward community mental health care. The effects of the seminar focused on reducing stigma tended to diminish over time at one year follow-up, particular in relation to intended behaviour.

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