1,720,979 research outputs found
Arresto cardiaco: nuove modalità di simulazione come strumenti per ottimizzare l'educazione medica e la cura del paziente
No full textIntroduction. The challenge of Emergency Medicine is to guarantee optimal care in very complex and environmentally dependent situations. Within all acute events, cardiac arrest is the most dramatic event that could occur.
Having tools for training, research and the validation of protocols and procedures is necessary. Simulation encompasses all of these aspects and could meet the challenge of increasingly good patient care.
Aim. My main project was to develop new simulation modalities to improve training and research in cardiac arrest.
Methods. 1) Holo-BLSD is an Augmented Reality self-instruction training system, in which a standard CPR manikin is “augmented” within an interactive virtual environment that reproduces realistic scenarios. During the experience, users were trained to use the device while being guided through an emergency simulation and, at the end, were asked to complete a survey to assess the usability of the Holo-BLSD.
Subsequently we enrolled 58 volunteer first-year nursing students randomly split in two groups: 29 participants underwent a self- training with the Holo-BLSD tool, and 29 students (control group) were trained in a traditional instructor-led course. We analyzed the appropriateness of action learning.
2) This study is a multi-center randomized controlled three-arm trial based on simulation. The intervention arm tested the PediAppRREST app; the two control arms, instead, were allocated to the PALS pocket card and to no cognitive aid, respectively. All participants are residents in Pediatrics, Anesthesia and Intensive Care or Emergency Medicine. The primary outcome of the study is a score calculated according to the c-DEV15plus checklist, which represents the number of deviations from PALS guidelines performed by each team during the management of the simulated cardiac arrest scenario.
Results. 1) Holo-BLSD was rated easy to use (mean 4.00, SD 0.94), and the trainees stated that most people would learn to use it very quickly (mean 4.00, SD 0.89). Voice (mean 4.48, SD 0.87), gaze (mean 4.12, SD 0.97), and gesture interaction (mean 3.84, SD 1.14) were judged positively, although some hand gesture recognition errors reduced the feeling of having the right level of control over the system (mean 3.40, SD 1.04).
The average overall examiner scores of the two groups are rather close (39.48 for the traditional training group, 37.07 for the Augmented Reality training group, on a maximum score of 44) and their difference is not statistically significant.
2) This is an interim analysis of the trial, including a sample size equal to approximately 78% of the final sample; so far, 82 teams. The c-DEV15plus score, expressed as median (IQR), was 3.0 (2.0-4.0) in the intervention arm and 6.0 (4.0-7.0) and 6.0 (5.0-7.0) in the CtrlPALS+ and CtrlPALS- control arms, respectively (p<0.0001). The CPT score, a validated indicator of the resuscitation performance, showed an improvement trend in the intervention group, which is statistically significant (p=0.0059). The team leaders’ workload resulted similar in the three groups. With regards the time of the first compression and to first adrenaline administration, no statistically significant differences were shown between the study groups. RCP quality was suboptimal, with no significant statistical differences between the three groups. The usability of the app was good according to the System Usability Scale (median of 77.5).
Conclusions. The different simulation modalities (AR and High fidelity) were used in both the training and research and showed good resultsIntroduction. The challenge of Emergency Medicine is to guarantee optimal care in very complex and environmentally dependent situations. Within all acute events, cardiac arrest is the most dramatic event that could occur.
Having tools for training, research and the validation of protocols and procedures is necessary. Simulation encompasses all of these aspects and could meet the challenge of increasingly good patient care.
Aim. My main project was to develop new simulation modalities to improve training and research in cardiac arrest.
Methods. 1) Holo-BLSD is an Augmented Reality self-instruction training system, in which a standard CPR manikin is “augmented” within an interactive virtual environment that reproduces realistic scenarios. During the experience, users were trained to use the device while being guided through an emergency simulation and, at the end, were asked to complete a survey to assess the usability of the Holo-BLSD.
Subsequently we enrolled 58 volunteer first-year nursing students randomly split in two groups: 29 participants underwent a self- training with the Holo-BLSD tool, and 29 students (control group) were trained in a traditional instructor-led course. We analyzed the appropriateness of action learning.
2) This study is a multi-center randomized controlled three-arm trial based on simulation. The intervention arm tested the PediAppRREST app; the two control arms, instead, were allocated to the PALS pocket card and to no cognitive aid, respectively. All participants are residents in Pediatrics, Anesthesia and Intensive Care or Emergency Medicine. The primary outcome of the study is a score calculated according to the c-DEV15plus checklist, which represents the number of deviations from PALS guidelines performed by each team during the management of the simulated cardiac arrest scenario.
Results. 1) Holo-BLSD was rated easy to use (mean 4.00, SD 0.94), and the trainees stated that most people would learn to use it very quickly (mean 4.00, SD 0.89). Voice (mean 4.48, SD 0.87), gaze (mean 4.12, SD 0.97), and gesture interaction (mean 3.84, SD 1.14) were judged positively, although some hand gesture recognition errors reduced the feeling of having the right level of control over the system (mean 3.40, SD 1.04).
The average overall examiner scores of the two groups are rather close (39.48 for the traditional training group, 37.07 for the Augmented Reality training group, on a maximum score of 44) and their difference is not statistically significant.
2) This is an interim analysis of the trial, including a sample size equal to approximately 78% of the final sample; so far, 82 teams. The c-DEV15plus score, expressed as median (IQR), was 3.0 (2.0-4.0) in the intervention arm and 6.0 (4.0-7.0) and 6.0 (5.0-7.0) in the CtrlPALS+ and CtrlPALS- control arms, respectively (p<0.0001). The CPT score, a validated indicator of the resuscitation performance, showed an improvement trend in the intervention group, which is statistically significant (p=0.0059). The team leaders’ workload resulted similar in the three groups. With regards the time of the first compression and to first adrenaline administration, no statistically significant differences were shown between the study groups. RCP quality was suboptimal, with no significant statistical differences between the three groups. The usability of the app was good according to the System Usability Scale (median of 77.5).
Conclusions. The different simulation modalities (AR and High fidelity) were used in both the training and research and showed good result
Epinephrine, absorption, and local anaesthetic systemic toxicity: insights from continuous fascial block pharmacokinetic models
No full textFascial plane blocks have become increasingly popular owing to their technical ease and inclusion in postoperative analgesia guidelines, although uncertainties about their mechanisms and safety remain. A recent study of the impact of epinephrine on levobupivacaine pharmacokinetics in continuous fascial plane blocks proposes a potential safe dosing threshold and highlights the role of epinephrine in reducing systemic absorption. The study presents promising findings that advance our understanding of local anaesthetic pharmacokinetics in fascial blocks while raising important questions about drug absorption, patient-specific risk factors for local anaesthetic systemic toxicity, and the incompletely understood microanatomy of fascial tissues
Role of health simulation centres in the COVID-19 pandemic response in Italy: a national study
Full text linkINTRODUCTION: The COVID-19 pandemic has dramatically affected the Italian health systems and drastically impacted healthcare workers’ daily routine and training. Simulation is an efficient tool to provide medical education, especially in the case of incoming public health emergencies. This study investigated the role and activities of Italian simulation centres (SCs) during the acute phase of the COVID-19 pandemic. METHODS: The population was identified through a web search. The directors of Italian SCs were contacted via email and then enrolled. A structured interview was created, internally validated and administrated by phone to participants. RESULTS: Following the government’s ordinance, 37 (88.37%) SCs had to be closed to the public. Twenty (46.51%) SCs organised in situ simulation while 7 (16.28%) of them organised simulation inside the centre. Twenty-three (53.49%) SCs resorted to telematic modalities to provide training about COVID-19 and 21 (48.84%) of them for other training. Up to date, 13 SCs are still closed to the public. CONCLUSIONS: Italy has been severely hit by COVID-19, with differences between the regions. Almost all the SCs were closed, with only a few delivering training. The SCs took advantage of emergent technologies to create new ways to train people safely. Unfortunately, nearly one-fourth of Italian SCs have not reopened yet. The evolution of the COVID-19 epidemic calls for reconsideration about training activities including adequate safety measures implemented for all individuals involved
Use of backboards in cardiopulmonary resuscitation: a systematic review and meta-analysis
No full textTo achieve optimal chest compression depth, victims of cardiac arrest should be placed on a firm surface. Backboards are usually placed between the mattress and the back of a patient in the attempt to increase cardiopulmonary resuscitation (CPR) quality, but their effectiveness remains controversial. A systematic search was performed to include studies on humans and simulation manikins assessing CPR quality with or without backboards. The primary outcome of the meta-analysis was the difference in chest compression depth between these two conditions. Out of 557 records, 16 studies were included in the review and all were performed on manikins. The meta-analysis, performed on 15 articles, showed that the use of backboards during CPR increases chest compression depth by 1.46 mm in manikins. Despite statistically significant, this increase could have a limited clinical impact on CPR, due to the substantial heterogeneity of experimental conditions and the scarcity of other CPR quality indicators
Augmented Reality learning environment for basic life support and defibrillation Training: a feasibility and acceptability study.
Full text linkBackground: Basic life support (BLS) is crucial in the emergency response system, as sudden cardiac arrest is still a major cause of death worldwide. Unfortunately, only a minority of victims receive cardiopulmonary resuscitation (CPR) from bystanders. In this context, training could be helpful to save more lives, and technology-enhanced BLS simulation is one possible solution.
Objective: The aim of this study is to assess the feasibility and acceptability of our augmented reality (AR) prototype as a tool for BLS training.
Methods: Holo-BLSD is an AR self-instruction training system, in which a standard CPR manikin is “augmented” with an interactive virtual environment that reproduces realistic scenarios. Learners can use natural gestures, body movements, and spoken commands to perform their tasks, with virtual 3D objects anchored to the manikin and the environment. During the experience, users were trained to use the device while being guided through an emergency simulation and, at the end, were asked to complete a survey to assess the feasibility and acceptability of the proposed tool (5-point Likert scale; 1=Strongly Disagree, 5=Strongly Agree).
Results: The system was rated easy to use (mean 4.00, SD 0.94), and the trainees stated that most people would learn to use it very quickly (mean 4.00, SD 0.89). Voice (mean 4.48, SD 0.87), gaze (mean 4.12, SD 0.97), and gesture interaction (mean 3.84, SD 1.14) were judged positively, although some hand gesture recognition errors reduced the feeling of having the right level of control over the system (mean 3.40, SD 1.04).
Conclusions: We found the Holo-BLSD system to be a feasible and acceptable tool for AR BLS training
Pandemic COVID-19: the residents' resilience
Full text linkHealthcare workers are often exposed to secondary traumatic stress. The SARS-CoV-2 outbreak caused intense psychological pressure in various healthcare professionals, with increased risk of post-traumatic stress disorder. Objective of our study was to evaluate the incidence of post-traumatic stress disorder in italian residents in Intensive Care and Emergency Departments facing COVID-19 emergency
SIMPEDVR: using VR in teaching pediatric emergencies to undergraduate students—a pilot study
Full text linkThe objective of this work was to provide pilot data on feasibility of using virtual reality (VR) to train undergraduate students in pediatric emergency scenarios. We staged VR sessions for a total of 45 medical and nursing students; in every session, each student managed two pediatric emergency virtual scenarios. At the end of the sessions, students completed a Technology Assessment Questionnaire to evaluate the perceived usefulness and perceived ease-of-use of their VR training experience and rated their perceived level of competence in managing the two clinical scenarios. The median perceived usefulness was 91.7/100 (interquartile range (IQR) 80.6-100), while the median perceived ease-of-use was 77.8/100 (IQR 63.9-88.9). The perceived level of competence increased from 2 (IQR 1-3) to 4 (IQR 3-4) on a 5-point Likert scale, for both scenarios (p < 0.001, Wilcoxon test for paired samples).Conclusions: The staged VR sessions had a good perceived usefulness and resulted in an increase in the perceived level of competence. The results on the ease-of-use, however, show that an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made; further work is required to ease the integration of VR into curricula
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