RESUMEN
BACKGROUND: In an earlier interview-based study the authors identified that learners experience one or more of eight explicit perceptual responses during the active phase of simulation-based training (SBT) comprising a sense: of belonging to instructor and group, of being under surveillance, of having autonomy and responsibility for patient management, of realism, of an understanding of the scenario in context, of conscious mental effort, of control of attention, and of engagement with task. These were adapted into a ten-item questionnaire: the Simulation Based Training Quality Assurance Tool (SBT-QA10) to allow monitoring of modifiable factors that may impact upon learners' experiences. This study assessed the construct validity evidence of the interpretation of the results when using SBT-QAT10. MATERIALS AND METHODS: Recently graduated doctors and nurses participating in a SBT course on the topic of the deteriorating patient completed the SBT-QAT10 immediately following their participation in the scenarios. The primary outcome measure was internal consistency of the questionnaire items and their correlation to learners' satisfaction scores. A secondary outcome measure compared the impact of allocation to active versus observer role. RESULTS: A total of 349 questionnaires were returned by 96 course learners. The median of the total score for the ten perception items (TPS) was 39 (out of 50), with no significant difference between the scenarios. We identified fair and positive correlations between nine of the 10 items and the SBT-QA10-TPS, the exception being "mental effort". Compared to observers, active learners reported significantly more positive perceptions related to belonging to the team and interaction with the instructor, their sense of acting independently, and being focused. The questionnaire items were poorly correlated with the two measures of global satisfaction. CONCLUSION: Except for the item for mental effort, the QA10-TPS measures learners' experiences during the active phase of simulation scenarios that are associated with a positive learning experience. The tool may have utility to learners, instructors, and course providers by informing subsequent debriefing and reflection upon practice for learners and faculty. The relationship between these perceptions and commonly used measures of satisfaction remains poorly understood raising questions about the value of the latter.
Asunto(s)
Entrenamiento Simulado , Humanos , Aprendizaje , Simulación por Computador , Encuestas y Cuestionarios , Competencia ClínicaRESUMEN
OBJECTIVES: To describe the development of an analyzable database of statutory notifications received from long-term care facilities (LTCFs) and to describe trends in receipt of notifications from 2013 to 2019. DESIGN: Description of database development with descriptive and trend analyses. SETTING AND PARTICIPANTS: LTCFs for older persons and for people with disability in Ireland. METHODS: Data on notifications received and on centers were extracted from a system internal to the health and social services regulator and combined into an analyzable database. Variables were screened for personal information, cleaned, transformed, or redacted and combined into a database suitable for open access publication. Descriptive analyses of the volume of notifications, trends over time and breakdown by service type, notification type, and risk-rating were conducted. RESULTS: The Database of Statutory Notifications from Social Care in Ireland was developed and an open access version published in February 2021. Protection of personal data was an important consideration in publishing the data publicly. Uses of the database include examination of national trends and identification of determinants of adverse events and areas for quality improvement. The number of notifications received increased over time. Quarterly notifications contributed to the largest proportion of notifications (older persons, 36.7%; disability, 39.1%). This was followed by serious injury notifications in LTCFs for older persons (33.3%) and abuse allegation notifications in LTCFs for people with disability (36.0%). Less than 1% of individual notifications were risk-rated red (highest severity level of impact on resident welfare). The types of notifications that were collectively risk-rated highest were staff misconduct, abuse allegations, and outbreaks of infectious disease. CONCLUSIONS AND IMPLICATIONS: The methodology and findings can inform publications of notifications, planning and resourcing for receipt and submission of notifications, target areas for quality improvement initiatives, mandating of timelines for receipt of notifications, and the mandating of notifications in legislation.
Asunto(s)
Personas con Discapacidad , Cuidados a Largo Plazo , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Humanos , Irlanda/epidemiología , Instituciones de Cuidados Especializados de EnfermeríaRESUMEN
INTRODUCTION: The degree of emotional activation required for optimal learning in either hands-on or observer roles is unclear, as is the level of stress that impedes learning. Measuring emotional activation is time-consuming, and many scales measure threat or anxiety without considering pleasurable activation. This study examined emotional activation in the observer and hands-on roles in 2 different scenario designs. METHODS: This study was a 2-cohort, parallel study of graduate nurses and doctors completing 2 different courses in managing the deteriorating patient. We examined emotional activation by role across 2 scenario designs. We measured emotional activation on 3 anchored measures scales: the State Trait Anxiety Inventory, Cognitive Appraisal Index, and the Affect Grid with data analysis using analysis of variance and repeated measures. RESULTS: Hands-on learners experienced higher anxiety, threat, and arousal levels and less pleasure than observers in both scenario designs. There were no differences in pre-emotional and postemotional activation in immersive scenarios for either role and increased arousal and decreased threat and anxiety in the hands-on role in the pause-and-discuss scenario design. CONCLUSIONS: Hands-on learners were more emotionally activated than observers in both scenario designs. There was significant perceived anxiety, threat, and pleasurable arousal in both roles and both scenario designs. Pause-and-discuss scenarios demonstrated similar levels of activation as the immersive scenario design. The Affect Grid provided a quick subjective view of arousal and pleasure in simulation participants, potentially providing educators with an indication of whether emotional activation is positive (excitement) or negative (stressful) and may be helpful in educational planning and future research.
Asunto(s)
Emociones , Aprendizaje , Humanos , Simulación por Computador , AnsiedadRESUMEN
Background: Simulation is reported as an appropriate replacement for a significant number of clinical hours in pregraduate programmes. To increase access for learners, educators have looked to understanding and improving learning in observer roles. Studies report equivalent learning outcomes and less stress in observer roles. However, reports on the prevalence, use and perceived value of observer roles from the educator's perspective are lacking. Methods: An exploratory survey for Australian and New Zealand (ANZ) simulation educators based on literature findings was developed and piloted with a small sample (n=10) of like subjects for language, clarity, skip logic and completion time. The final survey comprised 36 questions. Quantitative data were analysed using Pearson's chi-squared test, Welch's ANOVA and exploratory factor analysis. Select qualitative data were analysed using content analysis and summarised with frequency counts and categorisation. Results: Two hundred and sixty-seven surveys were completed, with 221 meeting criteria for analysis. The observer role is widely used in ANZ and most learners experience both hands-on and observer roles. The location of observers is dependent upon several factors including facility design, learner immersion, scenario design and observer involvement. Verbal briefings and/or other guides are provided to 89% of observers to direct their focus and 98% participate in the debrief. Educators value observer roles but tend to believe the best learning is hands-on. Conclusions: The learning in observer roles is less valued by educators than hands-on roles. Focused observation provides opportunities for noticing and attributing meaning, an essential skill for clinical practice. Learning spaces require consideration of scenario design and learning objectives. Scenario design should include objectives for observer roles and incorporate the observer into all phases of simulation. Attention to these areas will help promote the value of the different type of learning available in observer roles.
RESUMEN
BACKGROUND: Effective communication between patients-clinicians, supervisors-learners and facilitators-participants within a simulation is a key priority in health profession education. There is a plethora of frameworks and recommendations to guide communication in each of these contexts, and they represent separate discourses with separate communities of practice and literature. Finding common ground within these frameworks has the potential to minimise cognitive load and maximise efficiency, which presents an opportunity to consolidate messages, strategies and skills throughout a communication curriculum and the possibility of expanding the research agenda regarding communication, feedback and debriefing in productive ways. METHODS: A meta-synthesis of the feedback, debriefing and clinical communication literature was conducted to achieve these objectives. RESULTS: Our analysis revealed that the concepts underlying the framework can be usefully categorised as stages, goals, strategies, micro-skills and meta-skills. Guidelines for conversations typically shared a common structure, and strategies aligned with a stage. Core transferrable communication skills (i.e., micro-skills) were identified across various types of conversation, and the major differences between frameworks were related to the way that power was distributed in the conversation and the evolution of conversations along the along the path of redistributing power. As part of the synthesis, an overarching framework "prepare-EMPOWER enact" was developed to capture these shared principles across discourses. CONCLUSIONS: Adopting frameworks for work-based communication that promote dialogue and empower individuals to contribute may represent an important step towards learner-centred education and person-centred care for patients.
Asunto(s)
Comunicación , Curriculum , Educación Médica , Humanos , Entrenamiento SimuladoAsunto(s)
Urticaria Crónica/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Tacrolimus/uso terapéutico , Administración Oral , Adulto , Anciano , Femenino , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Tacrolimus/efectos adversos , Resultado del TratamientoRESUMEN
The feeding patterns of species of large sharks on human corpses are well documented in the literature however, that of smaller sharks are less known. This may introduce uncertainty in the medicolegal conclusions. For that reason, accurate identification of patterns of shark predation is very relevant, specifically in areas bordered by the sea. In the case described here, an unidentified lesion was noted on the body of a victim of a scuba diving accident off the island of Kauai, in Hawaii. The aim of this study was to identify the origin of the lesion and investigate its potential to inform on the context of death and/or decomposition. The original outline of the lesion was digitally reconstructed to enable the collection of measurements which were compared with the literature and interpreted with an interdisciplinary approach. This approach permitted to determine that the macroscopic appearance and dimensions of the lesion (major axis = 3.53 cm) were consistent with a bitemark of a cookiecutter shark (Isistius brasiliensis). It was further determined that the bitemark was incomplete and that the specimen involved had a total length of about 24 cm and was likely to be a juvenile. This is the second report in the published literature of cookiecutter bitemarks on humans in the Hawaiian waters. This study brings new evidence-based insights into the interactions between cookiecutter sharks and human remains in marine environments and provides a valuable contribution to the knowledge base on the topic.
Asunto(s)
Mordeduras y Picaduras/patología , Conducta Alimentaria , Tiburones , Animales , Autopsia , Restos Mortales , Buceo , Hawaii , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Simulation is widely used in health professional education. The convention that learners are actively involved may limit access to this educational method. The aim of this paper is to review the evidence for learning methods that employ directed observation as an alternative to hands-on participation in scenario-based simulation training. We sought studies that included either direct comparison of the learning outcomes of observers with those of active participants or identified factors important for the engagement of observers in simulation. We systematically searched health and education databases and reviewed journals and bibliographies for studies investigating or referring to observer roles in simulation using mannequins, simulated patients or role play simulations. A quality framework was used to rate the studies. METHODS: We sought studies that included either direct comparison of the learning outcomes of observers with those of active participants or identified factors important for the engagement of observers in simulation. We systematically searched health and education databases and reviewed journals and bibliographies for studies investigating or referring to observer roles in simulation using mannequins, simulated patients or role play simulations. A quality framework was used to rate the studies. RESULTS: Nine studies met the inclusion criteria. Five studies suggest learning outcomes in observer roles are as good or better than hands-on roles in simulation. Four studies document learner satisfaction in observer roles. Five studies used a tool to guide observers. Eight studies involved observers in the debrief. Learning and satisfaction in observer roles is closely associated with observer tools, learner engagement, role clarity and contribution to the debrief. Learners that valued observer roles described them as affording an overarching view, examination of details from a distance, and meaningful feedback during the debrief. Learners who did not value observer roles described them as passive, or boring when compared to hands-on engagement in the simulation encounter. CONCLUSIONS: Learning outcomes and role satisfaction for observers is improved through learner engagement and the use of observer tools. The value that students attach to observer roles appear contingent on role clarity, use of observer tools, and inclusion of observers' perspectives in the debrief.
RESUMEN
Multipotent and pluripotent stem cells are potential sources for cell and tissue replacement therapies. For example, stem cell-derived red blood cells (RBCs) are a potential alternative to donated blood, but yield and quality remain a challenge. Here, we show that application of insight from human population genetic studies can enhance RBC production from stem cells. The SH2B3 gene encodes a negative regulator of cytokine signaling and naturally occurring loss-of-function variants in this gene increase RBC counts in vivo. Targeted suppression of SH2B3 in primary human hematopoietic stem and progenitor cells enhanced the maturation and overall yield of in-vitro-derived RBCs. Moreover, inactivation of SH2B3 by CRISPR/Cas9 genome editing in human pluripotent stem cells allowed enhanced erythroid cell expansion with preserved differentiation. Our findings therefore highlight the potential for combining human genome variation studies with genome editing approaches to improve cell and tissue production for regenerative medicine.
Asunto(s)
Eritrocitos/citología , Células Madre/citología , Sistemas CRISPR-Cas , Diferenciación Celular , Citocinas/metabolismo , Células Madre Embrionarias/citología , Sangre Fetal/citología , Técnicas Genéticas , Variación Genética , Genoma Humano , Células Madre Hematopoyéticas/citología , Hemoglobinas/análisis , Humanos , Mutación , Células Madre Pluripotentes/citología , Medicina Regenerativa/métodosRESUMEN
RATIONALE: Individuals with naturally occurring loss-of-function proprotein convertase subtilisin/kexin type 9 (PCSK9) mutations experience reduced low-density lipoprotein cholesterol levels and protection against cardiovascular disease. OBJECTIVE: The goal of this study was to assess whether genome editing using a clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated system can efficiently introduce loss-of-function mutations into the endogenous PCSK9 gene in vivo. METHODS AND RESULTS: We used adenovirus to express CRISPR-associated 9 and a CRISPR guide RNA targeting Pcsk9 in mouse liver, where the gene is specifically expressed. We found that <3 to 4 days of administration of the virus, the mutagenesis rate of Pcsk9 in the liver was as high as >50%. This resulted in decreased plasma PCSK9 levels, increased hepatic low-density lipoprotein receptor levels, and decreased plasma cholesterol levels (by 35-40%). No off-target mutagenesis was detected in 10 selected sites. CONCLUSIONS: Genome editing with the CRISPR-CRISPR-associated 9 system disrupts the Pcsk9 gene in vivo with high efficiency and reduces blood cholesterol levels in mice. This approach may have therapeutic potential for the prevention of cardiovascular disease in humans.
Asunto(s)
Repeticiones Palindrómicas Cortas Agrupadas y Regularmente Espaciadas , Hígado/enzimología , Mutación , Proproteína Convertasas/genética , Edición de ARN , ARN Guía de Kinetoplastida/genética , Serina Endopeptidasas/genética , Células 3T3-L1 , Adenoviridae/genética , Animales , Biomarcadores/sangre , Enfermedades Cardiovasculares/enzimología , Enfermedades Cardiovasculares/genética , Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Femenino , Regulación Enzimológica de la Expresión Génica , Vectores Genéticos , Genotipo , Masculino , Ratones , Ratones Endogámicos C57BL , Fenotipo , Proproteína Convertasa 9 , Proproteína Convertasas/sangre , Factores Protectores , ARN Guía de Kinetoplastida/metabolismo , Receptores de LDL/metabolismo , Serina Endopeptidasas/sangre , Factores de Tiempo , TransfecciónRESUMEN
STUDY OBJECTIVES: To prospectively evaluate compliance with current interhospital trauma transfer guidelines in South West Sydney, before and after an implementation programme was instituted. METHODS: A scoring system was developed to assess compliance with the 11 main components of the guideline. Baseline compliance was measured during an initial 3-month period (pre), followed by an implementation programme to alert staff at referring hospitals to the presence of the guidelines. Following this, compliance was again measured over 3 months (post). RESULTS: Twenty-two patients were transferred during the pre-implementation phase and 35 patients during the post-phase. Overall compliance with the guidelines increased from 62 to 67%. Mean pre-hospital compliance rose from 75 to 95%, and referring hospital compliance rose from 59 to 63%. While there was an improvement in compliance with the use of the dedicated trauma hotline (86-97%), the use of a transfer checklist (41-53%), and appropriateness of transfer (95-100%), none of these reached statistical significance. CONCLUSION: Practice guidelines have been developed to optimise the process of interhospital trauma transfers. An implementation programme met with limited success in improving compliance with the guidelines. Further work is needed to ensure awareness of these guidelines, with ongoing monitoring to ensure best practice and optimal patient outcome.