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  • The impact of simulated patient death on medical students’ stress response and learning of ACLS.

    7 septembre 2017, par DeMaria S, Silverman ER, Lapidus KA, Williams CH, Spivack J, Levine A, Goldberg A — Med Teach
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    The impact of simulated patient death on medical students' stress response and learning of ACLS.

    Med Teach. 2016 Jul;38(7):730-7

    Authors: DeMaria S, Silverman ER, Lapidus KA, Williams CH, Spivack J, Levine A, Goldberg A

    Abstract
    INTRODUCTION: There is considerable controversy as to whether the simulator should die during high-fidelity simulation (HFS). We sought to describe the physiologic and biochemical stress response induced by simulated patient death as well as the impact on long-term retention of Advanced Cardiovascular Life Support (ACLS) knowledge and skills.
    METHODS: Twenty-six subjects received an American Heart Association (AHA) ACLS provider course. Following the course, subjects participated in HFS and were randomized to simulated death or survival. Heart rate and salivary cortisol (SC) and dihydroepiandrosterone (DHEA) were collected at this time. Subjects returned six months later for a follow-up simulation in which ACLS knowledge and skills were tested.
    RESULTS: For all participants, there was an increase in heart rate during simulation compared with baseline heart rate (+ 32 beats/minute), p < 0.0001. Similarly, SC and DHEA were higher compared with baseline levels (+ 0.115 μg/dL, p <0.01 and + 97 pg/mL, p < 0.001, respectively). However, the only statistically significant difference between groups was an increase in heart rate response at the end of the simulation compared with baseline in the death group (+ 29.2 beats/minute versus + 18.5 beats/minute), p < 0.05. There was no difference on long-term knowledge or skills.
    CONCLUSIONS: Learners experience stress during high-fidelity simulation; however, there does not appear to be a readily detectable difference or negative response to a simulated patient death compared with simulated survival.

    PMID: 27052665 [PubMed - indexed for MEDLINE]

  • Mannequin-based telesimulation : Increasing access to simulation-based education.

    29 août 2017, par Hayden EM, Khatri A, Kelly HR, Yager PH, Salazar GM — Acad Emerg Med

    Mannequin-based telesimulation: Increasing access to simulation-based education.

    Acad Emerg Med. 2017 Aug 28;:

    Authors: Hayden EM, Khatri A, Kelly HR, Yager PH, Salazar GM

    Abstract
    The 2017 Academic Emergency Medicine Consensus Conference, "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes," highlights how simulation can improve the delivery of health care across larger systems; however, how can systems change when valuable educational interventions reach only limited populations? Studies have demonstrated the benefit of simulation education(1,2) but have questioned the use of simulation in a system with limited financial resources.(3) Most academic medical centers have mannequin-based simulation technology;(4) yet, it is unclear from the literature how many community hospitals, especially in rural areas, have a simulation center or mannequins. This article is protected by copyright. All rights reserved.

    PMID: 28846175 [PubMed - as supplied by publisher]

  • Using high-fidelity simulation for critical event training.

    23 août 2017, par Willie C, Chen F, Joyner BL, Blasius K — Med Educ
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    Using high-fidelity simulation for critical event training.

    Med Educ. 2016 Nov;50(11):1161-1162

    Authors: Willie C, Chen F, Joyner BL, Blasius K

    PMID: 27762015 [PubMed - indexed for MEDLINE]

  • Using High-Technology Simulators to Prepare Anesthesia Providers Before Implementation of a New Electronic Health Record Module : A Technical Report.

    15 août 2017, par Weintraub AY, Deutsch ES, Hales RL, Buchanan NA, Rock WL, Rehman MA — Anesth Analg
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    Using High-Technology Simulators to Prepare Anesthesia Providers Before Implementation of a New Electronic Health Record Module: A Technical Report.

    Anesth Analg. 2017 Jun;124(6):1815-1819

    Authors: Weintraub AY, Deutsch ES, Hales RL, Buchanan NA, Rock WL, Rehman MA

    Abstract
    Learning to use a new electronic anesthesia information management system can be challenging. Documenting anesthetic events, medication administration, and airway management in an unfamiliar system while simultaneously caring for a patient with the vigilance required for safe anesthesia can be distracting and risky. This technical report describes a vendor-agnostic approach to training using a high-technology manikin in a simulated clinical scenario. Training was feasible and valued by participants but required a combination of electronic and manual components. Further exploration may reveal simulated patient care training that provides the greatest benefit to participants as well as feedback to inform electronic health record improvements.

    PMID: 28207594 [PubMed - indexed for MEDLINE]

  • A Taxonomy of Delivery and Documentation Deviations During Delivery of High-Fidelity Simulations.

    11 août 2017, par McIvor WR, Banerjee A, Boulet JR, Bekhuis T, Tseytlin E, Torsher L, DeMaria S, Rask JP, Shotwell MS, Burden A, Cooper JB, Gaba DM, Levine A, Park C, Sinz E, Steadman RH, Weinger MB — Simul Healthc
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    A Taxonomy of Delivery and Documentation Deviations During Delivery of High-Fidelity Simulations.

    Simul Healthc. 2017 Feb;12(1):1-8

    Authors: McIvor WR, Banerjee A, Boulet JR, Bekhuis T, Tseytlin E, Torsher L, DeMaria S, Rask JP, Shotwell MS, Burden A, Cooper JB, Gaba DM, Levine A, Park C, Sinz E, Steadman RH, Weinger MB

    Abstract
    INTRODUCTION: We developed a taxonomy of simulation delivery and documentation deviations noted during a multicenter, high-fidelity simulation trial that was conducted to assess practicing physicians' performance. Eight simulation centers sought to implement standardized scenarios over 2 years. Rules, guidelines, and detailed scenario scripts were established to facilitate reproducible scenario delivery; however, pilot trials revealed deviations from those rubrics. A taxonomy with hierarchically arranged terms that define a lack of standardization of simulation scenario delivery was then created to aid educators and researchers in assessing and describing their ability to reproducibly conduct simulations.
    METHODS: Thirty-six types of delivery or documentation deviations were identified from the scenario scripts and study rules. Using a Delphi technique and open card sorting, simulation experts formulated a taxonomy of high-fidelity simulation execution and documentation deviations. The taxonomy was iteratively refined and then tested by 2 investigators not involved with its development.
    RESULTS: The taxonomy has 2 main classes, simulation center deviation and participant deviation, which are further subdivided into as many as 6 subclasses. Inter-rater classification agreement using the taxonomy was 74% or greater for each of the 7 levels of its hierarchy. Cohen kappa calculations confirmed substantial agreement beyond that expected by chance. All deviations were classified within the taxonomy.
    CONCLUSIONS: This is a useful taxonomy that standardizes terms for simulation delivery and documentation deviations, facilitates quality assurance in scenario delivery, and enables quantification of the impact of deviations upon simulation-based performance assessment.

    PMID: 28146449 [PubMed - indexed for MEDLINE]

  • A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation : A Randomized Controlled Trial.

    10 août 2017, par Siebert JN, Ehrler F, Combescure C, Lacroix L, Haddad K, Sanchez O, Gervaix A, Lovis C, Manzano S — J Med Internet Res
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    A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.

    J Med Internet Res. 2017 Feb 01;19(2):e31

    Authors: Siebert JN, Ehrler F, Combescure C, Lacroix L, Haddad K, Sanchez O, Gervaix A, Lovis C, Manzano S

    Abstract
    BACKGROUND: During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion.
    OBJECTIVE: The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods.
    METHODS: The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection.
    RESULTS: A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods.
    CONCLUSIONS: In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.

    PMID: 28148473 [PubMed - indexed for MEDLINE]

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