The impact of central line simulation before the ICU experience

Background

This study was designed to evaluate whether resident performance of placing central lines improved after simulation training on newly available partial-task simulators.

Methods

This study was designed as a prospective, randomized controlled trial of standard training versus simulated training using CentralLine Man (SimuLab, Seattle, WA, USA). After receiving a lecture on central line placement, all junior residents on the trauma rotation were randomized on a monthly alternating schedule. Equivalency of groups was determined with a self-reported survey. All lines placed by the participants were monitored, and data were collected on performance and complications.

Results

The 2 groups (n = 34; 21 standard and 13 simulated) were equivalent at baseline. The simulated training group had a significantly higher level of comfort and ability than the standard training group. The simulated group outperformed the standard group on 12 of the 15 specific variables monitored, although this did not reach statistical significance. There were significantly more complications in the standard group.

Conclusions

Simulation for central line placement using a partial-task simulator does positively impact resident performance.     

The current role of medical simulation in american urological residency training programs: an assessment by program directors

PURPOSE: Although medical simulation opportunities are increasingly available, resident training to date has involved primarily hands-on, subjective assessments. The role of simulation and computer based training for urology residents remains unknown. We evaluated the current status of medical simulation among urological training programs in the United States. MATERIALS AND METHODS: An anonymous questionnaire was developed and mailed to the program director at the 119 Accreditation Council for Graduate Medical Education accredited United States urology training programs, and consisted of 17 questions documenting the prior experience of the responder to medical simulation as well as the current status of simulation at their institution. An additional 14 questions sought the responders' opinion of medical simulation in urology training programs. RESULTS: The questionnaire was returned by 41 program directors (35%). Among respondents, access to a laparoscopy simulator was 76%. In comparison, reported access to cystoscopy, ureteroscopy, transurethral resection and percutaneous access simulators was 16%, 21%, 8% and 12%, respectively. Respondents indicated that these simulators were good educational tools, realistic and easy to use. Unanimous agreement was reported for simulation training in residency and that simulators allow practice in a controlled environment. Disagreement was reported about the cost effectiveness, validity and ability of simulators to replace hands-on instruction in the operating room. CONCLUSIONS: Among responders a high level of access to laparoscopic simulators for urology residents is coupled with low levels of access to other endoscopic trainers. Urology residency program directors unanimously recognize a role for simulation training in residency, although the extent to which they may be incorporated remains to be resolved.     

The use of haptics in medical applications

Explains the need for haptics (feeling of touch) in medical simulation systems. Describes a variety of laparoscopic training systems and other surgical simulators. Highlights the Reachin Technologies AB Application Programming Interface (API) which is a software tool that significantly speeds up the development of surgical simulators.     

Patient safety: an overview

The subject of patient safety has been studied extensively in recent years. It is widely accepted that most healthcare systems are not as safe as they could be. As healthcare has become more complex the interactions of human judgements coupled with technology and medical advances can lead to significant adverse events and patient harm. The core of the issue is not just the necessity for safer systems, but the absolute requirement for a change in attitude by doctors, acknowledging that it is common to err and that we are all fallible. Surgical errors account for up to half of all avoidable adverse events in developed countries. This article will review the history of patient safety and illustrate the common issues and strategies to reduce harm to patients in the delivery of healthcare.     

Development and decay of procedural skills in surgery: A systematic review of the effectiveness of simulation-based medical education interventions

ContextChanges to surgical training programmes in the UK has led to a reduction in theatre time for trainees, and an increasing reliance on simulation to provide procedural experience. Whilst simulation offers opportunity for repetitive practice, the effectiveness of simulation as an educational intervention for developing procedural surgical skills is unclear.MethodsA systematic literature review was undertaken to retrieve all studies describing simulation-based medical education (SBME) interventions for the development of procedural surgical skills using the MEDLINE, PsycINFO, CINAHL, EMBASE and PUBMED databases. Studies measuring skill retention or demonstrating transferability of skills for improving patient outcomes were included in the review.ResultsSBME is superior to no training and can lead to improvement in procedural surgical skills, such that skills transfer from simulated environments into theatre. SBME results in minimal skill degradation after 2 weeks, although more significant decay results after >90 days. Many studies recruited <10 participants, used a variety of methods and were restricted to endoscopic surgical techniques. All studies did not compare interventions with non-SBME teaching methods for developing procedural surgical skills. No studies compared the curriculum design of different surgical training programmes.ConclusionsSBME interventions are effective for developing procedural skills in surgery. SBME interventions are also effective for preventing the decay of procedural surgical skills. Although no studies demonstrate non-inferiority of SBME interventions compared to time in theatre developing skills, SBME interventions do enable the transfer of skills into theatre, and the potential for improving patient outcomes.     

Training trauma teams in the Nordic countries: an overview and present status

Background:  During the last decade there has been an increased interest in the organisation and quality of trauma care in the Nordic countries. Still, most patients are initially cared for at hospitals with low caseloads of severe trauma. More than 200 hospitals offer initial care to trauma patients. Training of trauma teams using simulators or simulated patients has evolved in the same period, as one important factor to overcome lack of practical training. This overview describes the present state of trauma team training in the Nordic countries.
Methods:  Members of a Nordic working group on the use of simulation in medicine reviewed present literature on training with simulation and described the present use of team training in their own countries during winter 2004.
Results:  There is an increasing amount of evidence indicating that training of teams with simulation reduces treatment errors and improves performance. The training activities do not need to be complex, but skilled debriefing seems necessary. Few Nordic hospitals train their trauma teams. The training activities vary considerably between and within countries.
Conclusion:  There is considerable evidence supporting an increased use of experience gained in other high-risk domains where training in communication, leadership and decision-making is the focus for safety and improvement efforts. There is a need for more widespread training of trauma teams. The different training activities actually undertaken should be scientifically evaluated.     

High fidelity simulation as a research tool

Medical simulation has grown explosively over the last decade. Simulation is becoming commonplace in clinical education but can also be used as an investigative clinical tool in its own right. There are thus two arms of simulation in clinical research. The first is investigation of the clinical impact of simulation as an educational tool and the second as an instrument to assess the function of clinical practitioners and systems. This article reviews the terminology, current practice and current research in simulation. The use of simulation in assessment of the clinical performance of devices, people and systems will then be discussed and some current work in these areas presented. Finally, medical simulation will be discussed within the paradigm of translational research. Early examples of this 'tool-bench to bedside' model will be presented as possible prototypes for future work directed towards patient safety.     

Training opportunities and the role of virtual reality simulation in acquisition of basic laparoscopic skills

BACKGROUND: Within the past decade, there has been increasing interest in simulation-based devices for training and assessment of technical skills, especially for minimally invasive techniques such as laparoscopy. The aim of this study was to investigate the perceptions of senior and junior surgeons to virtual reality simulation within the context of current training opportunities for basic laparoscopic procedures. METHODS: A postal questionnaire was sent to 245 consultants and their corresponding specialist registrar (SpR), detailing laparoscopic surgical practice and their knowledge and use of virtual reality (VR) surgical simulators. RESULTS: One hundred ninety-one (78%) consultants and 103(42%) SpRs returned questionnaires; 16%(10/61) of junior SpRs (year 1-4) had performed more than 50 laparoscopic cholecystectomies to date compared with 76% (32/42) of senior SpRs (year 5-6) (P < 0.001); 90% (55/61) of junior SpRs and 67% (28/42) of senior SpRs were keen to augment their training with VR (P = 0.007); 81% (238/294) of all surgeons agreed that VR has a useful role in the laparoscopic surgical training curriculum. CONCLUSIONS: There is a lack of experience in index laparoscopic cases of junior SpRs, and laparoscopic VR simulation is recognized as a useful mode of practice to acquire technical skills. This should encourage surgical program directors to drive the integration of simulation-based training into the surgical curriculum.     

Medical negligence and informed consent: an overview

The process of informed consent is central to all clinical practice, and particularly to operative surgery. If complications occur, and surgery has been undertaken without adequate information being provided, patients may potentially bring a claim of negligence. Three separate factors must all be present for negligence to have occurred; it must be shown that a duty of care existed, that this duty has been breached, and that the breach caused harm to come to the patient. For consent to be valid, the patient must have capacity to understand, retain and process the information given; this must include the nature of the procedure, alternative treatment options, and serious or frequently occurring risks. Whilst the use of consent forms is not a legal requirement, trusts invariably insist on it. Consent may be obtained by any suitably trained individual, but it remains the surgeon’s responsibility to ensure this has been done before commencing the procedure.     

Regulatory pathways to the market: an overview

This paper presents an overview of the U.S. Food and Drug Administration's regulatory requirements for introducing medical device and diagnostic products into commercial distribution in the United States. For any specific product, the requirements vary depending upon the product's associated risks, classification, and when it or a similar product was first introduced into commercial distribution. Regulatory pathways available and/or required for a manufacturer to introduce a medical product into the U.S. marketplace are outlined.     

医护团队情景教学法在急诊临床教学中的应用

目的探讨医护团队情景教学法在急诊临床教学中的应用及效果。方法将急诊科实习的67名本科医学生、89名护生随机分为观察组和对照组,每组78名。对照组采用传统教学法教学,观察组采用医护团队情景教学法教学。培训4周后,比较两组综合考核评分。采用中文版评判性思维能力量表(CTDI-CV)对学生培训前、后进行评定并对两组的教学满意度进行评价。结果培训后,观察组综合考核评分、评判性思维总分及5个因子分显著高于对照组(均P<0.05)。观察组对教学模式满意度的评分显著高于对照组(P<0.01)。结论医护团队情景教学法能够有效提升学生的临床操作和思维能力,提高临床教学质量。     

The role of antioxidant therapy in the treatment of male infertility: an overview

In recent years, many studies have focused on the effect of oxidative stress, reactive oxygen species (ROS) and antioxidants on the male eproductive system. Under physiological conditions, sperm produces small amounts of ROS, which are needed for fertilisation, acrosome reaction and capacitation. However, if an increased production of ROS is not associated with a similar increase in scavenging systems, peroxidative damage of the sperm plasma membrane and loss of DNA integrity typically occur, which leads to cell death and reduced fertility. Furthermore, since there is no linear correlation between sperm quality and pregnancy rates, an improvement in semen parameters should not be the sole outcome considered in studies of antioxidant therapies. A definitive conclusion regarding the benefit of these therapies is difficult to obtain, as most of the previous studies lacked control groups, considered different antioxidants in different combinations and doses, or did not evaluate pregnancy rates in previously infertile couples. Even if beneficial effects were reported in a few cases of male infertility, more multicentre, double-blind studies performed with the same criteria are necessary for an increased understanding of the effects of various antioxidants on fertility.     

角色模拟培训对儿科低年资护士人文素养的影响

目的 探索角色模拟培训提升儿科低年资护士人文素养的效果。 方法 将儿科工作时间≤3年的低年资护士59人随机分为对照组（n=29）和观察组（n=30）。对照组按年度常规培训计划进行人文关怀及沟通培训,观察组在对照组基础上,进行为期2个月共8次的角色模拟培训。培训前后采用人文关怀能力量表、临床护士沟通能力量表测评培训效果。 结果 培训后观察组人文关怀能力、沟通能力总分显著高于对照组（均P＜0.05）。 结论 对儿科低年资护士进行角色模拟培训,可以有效提升护士的人文关怀能力及临床沟通能力。