Learning to deal with crisis in the home: Part 2 - preparing preregistration students.

PubMed

Gibson, Caroline E; Dickson, Caroline; Lawson, Bill; McMillan, Ailsa; Kelly, Helena

2015-12-01

The global shift of health care is from acute services to community and primary care. Therefore, registrants must be prepared to work effectively within diverse settings. This article is the second in a series discussing the preparation of nurses for contemporary health-care challenges in the community. In it, we outline the design, implementation, and evaluation of simulated emergency scenarios within an honours degree-level, pre-registration nursing curriculum in Scotland. Over 3 years, 99 final-year students participated in interactive sessions focusing on recognition and management of the deteriorating patient and emergency care. Clinical scenarios were designed and delivered collaboratively with community practitioners. Debriefing challenged the students to reflect on learning and transferability of skills of clinical reasoning and care management to the community context. Students considered the scenarios to be realistic and perceived that their confidence had increased. Development of such simulation exercises is worthy of further debate in education and practice.

Evidence-Centered Design for Simulation-Based Assessment. CRESST Report 800

ERIC Educational Resources Information Center

Mislevy, Robert J.

2011-01-01

Simulations provide opportunities for individuals to learn and develop skills for situations that may be expensive, time-consuming, or dangerous. Careful design can support a person's learning by tailoring the features of situations to his or her skill level(s), allowing repeated attempts, and by providing timely feedback. Furthermore, simulations…

Designing and Evaluating an Interactive Multimedia Web-Based Simulation for Developing Nurses’ Competencies in Acute Nursing Care: Randomized Controlled Trial

PubMed Central

Wong, Lai Fun; Chan, Sally Wai-Chi; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Sophia Bee Leng; Goh, Poh Sun; Ang, Emily Neo Kim

2015-01-01

Background Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice. Objective This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses’ competencies in acute nursing care. Methods Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants’ clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool. Results The clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving. Conclusions Engaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses’ competencies in acute care. Web-based simulations provide a promising educational tool in institutions where large groups of nurses need to be trained in acute nursing care and accessibility to repetitive training is essential for achieving long-term retention of clinical competency. PMID:25583029

Designing and evaluating an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care: randomized controlled trial.

PubMed

Liaw, Sok Ying; Wong, Lai Fun; Chan, Sally Wai-Chi; Ho, Jasmine Tze Yin; Mordiffi, Siti Zubaidah; Ang, Sophia Bee Leng; Goh, Poh Sun; Ang, Emily Neo Kim

2015-01-12

Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice. This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care. Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants' clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool. The clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving. Engaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses' competencies in acute care. Web-based simulations provide a promising educational tool in institutions where large groups of nurses need to be trained in acute nursing care and accessibility to repetitive training is essential for achieving long-term retention of clinical competency.

Implementation of Hydrodynamic Simulation Code in Shock Experiment Design for Alkali Metals

NASA Astrophysics Data System (ADS)

Coleman, A. L.; Briggs, R.; Gorman, M. G.; Ali, S.; Lazicki, A.; Swift, D. C.; Stubley, P. G.; McBride, E. E.; Collins, G.; Wark, J. S.; McMahon, M. I.

2017-10-01

Shock compression techniques enable the investigation of extreme P-T states. In order to probe off-Hugoniot regions of P-T space, target makeup and laser pulse parameters must be carefully designed. HYADES is a hydrodynamic simulation code which has been successfully utilised to simulate shock compression events and refine the experimental parameters required in order to explore new P-T states in alkali metals. Here we describe simulations and experiments on potassium, along with the techniques required to access off-Hugoniot states.

Simulation for the training of human performance and technical skills: the intersection of how we will train health care professionals in the future.

PubMed

Hamman, William R; Beaubien, Jeffrey M; Beaudin-Seiler, Beth M

2009-12-01

The aims of this research are to begin to understand health care teams in their operational environment, establish metrics of performance for these teams, and validate a series of scenarios in simulation that elicit team and technical skills. The focus is on defining the team model that will function in the operational environment in which health care professionals work. Simulations were performed across the United States in 70- to 1000-bed hospitals. Multidisciplinary health care teams analyzed more than 300 hours of videos of health care professionals performing simulations of team-based medical care in several different disciplines. Raters were trained to enhance inter-rater reliability. The study validated event sets that trigger team dynamics and established metrics for team-based care. Team skills were identified and modified using simulation scenarios that employed the event-set-design process. Specific skills (technical and team) were identified by criticality measurement and task analysis methodology. In situ simulation, which includes a purposeful and Socratic Method of debriefing, is a powerful intervention that can overcome inertia found in clinician behavior and latent environmental systems that present a challenge to quality and patient safety. In situ simulation can increase awareness of risks, personalize the risks, and encourage the reflection, effort, and attention needed to make changes to both behaviors and to systems.

Representing the work of medical protocols for organizational simulation.

PubMed Central

Fridsma, D. B.

1998-01-01

Developing and implementing patient care protocols within a specific organizational setting requires knowledge of the protocol, the organization, and the way in which the organization does its work. Computer-based simulation tools have been used in many industries to provide managers with prospective insight into problems of work process and organization design mismatch. Many of these simulation tools are designed for well-understood routine work processes in which there are few contingent tasks. In this paper, we describe theoretic that make it possible to simulate medical protocols using an information-processing theory framework. These simulations will allow medical administrators to test different protocol and organizational designs before actually using them within a particular clinical setting. PMID:9929231

What We Call What We Do Affects How We Do It: A New Nomenclature for Simulation Research in Medical Education

ERIC Educational Resources Information Center

Haji, Faizal A.; Hoppe, Daniel J.; Morin, Marie-Paule; Giannoulakis, Konstantine; Koh, Jansen; Rojas, David; Cheung, Jeffrey J. H.

2014-01-01

Rapid technological advances and concern for patient safety have increased the focus on simulation as a pedagogical tool for educating health care providers. To date, simulation research scholarship has focused on two areas; evaluating instructional designs of simulation programs, and the integration of simulation into a broader educational…

Conceptual modeling for Prospective Health Technology Assessment.

PubMed

Gantner-Bär, Marion; Djanatliev, Anatoli; Prokosch, Hans-Ulrich; Sedlmayr, Martin

2012-01-01

Prospective Health Technology Assessment (ProHTA) is a new and innovative approach to analyze and assess new technologies, methods and procedures in health care. Simulation processes are used to model innovations before the cost-intensive design and development phase. Thus effects on patient care, the health care system as well as health economics aspects can be estimated. To generate simulation models a valid information base is necessary and therefore conceptual modeling is most suitable. Project-specifically improved methods and characteristics of simulation modeling are combined in the ProHTA Conceptual Modeling Process and initially implemented for acute ischemic stroke treatment in Germany. Additionally the project aims at simulation of other diseases and health care systems as well. ProHTA is an interdisciplinary research project within the Cluster of Excellence for Medical Technology - Medical Valley European Metropolitan Region Nuremberg (EMN), which is funded by the German Federal Ministry of Education and Research (BMBF), project grant No. 01EX1013B.

Using discrete event simulation to compare the performance of family health unit and primary health care centre organizational models in Portugal.

PubMed

Fialho, André S; Oliveira, Mónica D; Sá, Armando B

2011-10-15

Recent reforms in Portugal aimed at strengthening the role of the primary care system, in order to improve the quality of the health care system. Since 2006 new policies aiming to change the organization, incentive structures and funding of the primary health care sector were designed, promoting the evolution of traditional primary health care centres (PHCCs) into a new type of organizational unit--family health units (FHUs). This study aimed to compare performances of PHCC and FHU organizational models and to assess the potential gains from converting PHCCs into FHUs. Stochastic discrete event simulation models for the two types of organizational models were designed and implemented using Simul8 software. These models were applied to data from nineteen primary care units in three municipalities of the Greater Lisbon area. The conversion of PHCCs into FHUs seems to have the potential to generate substantial improvements in productivity and accessibility, while not having a significant impact on costs. This conversion might entail a 45% reduction in the average number of days required to obtain a medical appointment and a 7% and 9% increase in the average number of medical and nursing consultations, respectively. Reorganization of PHCC into FHUs might increase accessibility of patients to services and efficiency in the provision of primary care services.

An agent-based simulation model to study accountable care organizations.

PubMed

Liu, Pai; Wu, Shinyi

2016-03-01

Creating accountable care organizations (ACOs) has been widely discussed as a strategy to control rapidly rising healthcare costs and improve quality of care; however, building an effective ACO is a complex process involving multiple stakeholders (payers, providers, patients) with their own interests. Also, implementation of an ACO is costly in terms of time and money. Immature design could cause safety hazards. Therefore, there is a need for analytical model-based decision-support tools that can predict the outcomes of different strategies to facilitate ACO design and implementation. In this study, an agent-based simulation model was developed to study ACOs that considers payers, healthcare providers, and patients as agents under the shared saving payment model of care for congestive heart failure (CHF), one of the most expensive causes of sometimes preventable hospitalizations. The agent-based simulation model has identified the critical determinants for the payment model design that can motivate provider behavior changes to achieve maximum financial and quality outcomes of an ACO. The results show nonlinear provider behavior change patterns corresponding to changes in payment model designs. The outcomes vary by providers with different quality or financial priorities, and are most sensitive to the cost-effectiveness of CHF interventions that an ACO implements. This study demonstrates an increasingly important method to construct a healthcare system analytics model that can help inform health policy and healthcare management decisions. The study also points out that the likely success of an ACO is interdependent with payment model design, provider characteristics, and cost and effectiveness of healthcare interventions.

Application of a nonrandomized stepped wedge design to evaluate an evidence-based quality improvement intervention: a proof of concept using simulated data on patient-centered medical homes.

PubMed

Huynh, Alexis K; Lee, Martin L; Farmer, Melissa M; Rubenstein, Lisa V

2016-10-21

Stepped wedge designs have gained recognition as a method for rigorously assessing implementation of evidence-based quality improvement interventions (QIIs) across multiple healthcare sites. In theory, this design uses random assignment of sites to successive QII implementation start dates based on a timeline determined by evaluators. However, in practice, QII timing is often controlled more by site readiness. We propose an alternate version of the stepped wedge design that does not assume the randomized timing of implementation while retaining the method's analytic advantages and applying to a broader set of evaluations. To test the feasibility of a nonrandomized stepped wedge design, we developed simulated data on patient care experiences and on QII implementation that had the structures and features of the expected data from a planned QII. We then applied the design in anticipation of performing an actual QII evaluation. We used simulated data on 108,000 patients to model nonrandomized stepped wedge results from QII implementation across nine primary care sites over 12 quarters. The outcome we simulated was change in a single self-administered question on access to care used by Veterans Health Administration (VA), based in the United States, as part of its quarterly patient ratings of quality of care. Our main predictors were QII exposure and time. Based on study hypotheses, we assigned values of 4 to 11 % for improvement in access when sites were first exposed to implementation and 1 to 3 % improvement in each ensuing time period thereafter when sites continued with implementation. We included site-level (practice size) and respondent-level (gender, race/ethnicity) characteristics that might account for nonrandomized timing in site implementation of the QII. We analyzed the resulting data as a repeated cross-sectional model using HLM 7 with a three-level hierarchical data structure and an ordinal outcome. Levels in the data structure included patient ratings, timing of adoption of the QII, and primary care site. We were able to demonstrate a statistically significant improvement in adoption of the QII, as postulated in our simulation. The linear time trend while sites were in the control state was not significant, also as expected in the real life scenario of the example QII. We concluded that the nonrandomized stepped wedge design was feasible within the parameters of our planned QII with its data structure and content. Our statistical approach may be applicable to similar evaluations.

Contingency contracting with delinquents: effects of a brief training manual on staff contract negotiation and writing skills.

PubMed

Welch, S J; Holborn, S W

1988-01-01

A brief training manual was developed for the purpose of teaching child-care workers to contingency contract with delinquent youths living in residential care facilities. The manual was designed to require minimal supplementary training by a professional. In Experiment 1 a multiple baseline design was used to assess the effect of the manual on 4 child-care workers' contract negotiation and writing behaviors. Experiment 2 consisted of four A-B systematic replications. Behaviors were assessed within the context of analogue training simulations and generalization tests with delinquent youths. Results from the analogue simulations indicated that the manual was successful in increasing both types of behaviors to a level of proficiency that equaled or surpassed that of behaviorally trained graduate students, and results from the generalization tests indicated that the child-care workers were able to apply their newly acquired contracting skills with delinquent youths. Procedural reliability varied across child-care workers, but was usually high.

Contingency contracting with delinquents: effects of a brief training manual on staff contract negotiation and writing skills.

PubMed Central

Welch, S J; Holborn, S W

1988-01-01

A brief training manual was developed for the purpose of teaching child-care workers to contingency contract with delinquent youths living in residential care facilities. The manual was designed to require minimal supplementary training by a professional. In Experiment 1 a multiple baseline design was used to assess the effect of the manual on 4 child-care workers' contract negotiation and writing behaviors. Experiment 2 consisted of four A-B systematic replications. Behaviors were assessed within the context of analogue training simulations and generalization tests with delinquent youths. Results from the analogue simulations indicated that the manual was successful in increasing both types of behaviors to a level of proficiency that equaled or surpassed that of behaviorally trained graduate students, and results from the generalization tests indicated that the child-care workers were able to apply their newly acquired contracting skills with delinquent youths. Procedural reliability varied across child-care workers, but was usually high. PMID:3225253

Using the ECD Framework to Support Evidentiary Reasoning in the Context of a Simulation Study for Detecting Learner Differences in Epistemic Games

ERIC Educational Resources Information Center

Sweet, Shauna J.; Rupp, Andre A.

2012-01-01

The "evidence-centered design" (ECD) framework is a powerful tool that supports careful and critical thinking about the identification and accumulation of evidence in assessment contexts. In this paper, we demonstrate how the ECD framework provides critical support for designing simulation studies to investigate statistical methods…

PubMed

Aléx, Jonas; Gyllencreutz, Lina

2018-02-05

Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts. Our pilot study shows that insufficiencies in systematic care lead to an ineffective treatment for trauma patients which in turn may increase the risk of complications and mortality.

Modeling and Compensation Design for a Power Hardware-in-the-Loop Simulation of an AC Distribution System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ainsworth, Nathan; Hariri, Ali; Prabakar, Kumaraguru

Power hardware-in-the-loop (PHIL) simulation, where actual hardware under text is coupled with a real-time digital model in closed loop, is a powerful tool for analyzing new methods of control for emerging distributed power systems. However, without careful design and compensation of the interface between the simulated and actual systems, PHIL simulations may exhibit instability and modeling inaccuracies. This paper addresses issues that arise in the PHIL simulation of a hardware battery inverter interfaced with a simulated distribution feeder. Both the stability and accuracy issues are modeled and characterized, and a methodology for design of PHIL interface compensation to ensure stabilitymore » and accuracy is presented. The stability and accuracy of the resulting compensated PHIL simulation is then shown by experiment.« less

Modeling and Compensation Design for a Power Hardware-in-the-Loop Simulation of an AC Distribution System: Preprint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Prabakar, Kumaraguru; Ainsworth, Nathan; Pratt, Annabelle

Power hardware-in-the-loop (PHIL) simulation, where actual hardware under text is coupled with a real-time digital model in closed loop, is a powerful tool for analyzing new methods of control for emerging distributed power systems. However, without careful design and compensation of the interface between the simulated and actual systems, PHIL simulations may exhibit instability and modeling inaccuracies. This paper addresses issues that arise in the PHIL simulation of a hardware battery inverter interfaced with a simulated distribution feeder. Both the stability and accuracy issues are modeled and characterized, and a methodology for design of PHIL interface compensation to ensure stabilitymore » and accuracy is presented. The stability and accuracy of the resulting compensated PHIL simulation is then shown by experiment.« less

Using in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving operational changes in a labor and delivery ward.

PubMed

Hamman, William R; Beaudin-Seiler, Beth M; Beaubien, Jeffrey M; Gullickson, Amy M; Orizondo-Korotko, Krystyna; Gross, Amy C; Fuqua, Wayne; Lammers, Richard

2010-01-01

Since the publication of "To Err Is Human" in 1999, health care professionals have looked to high-reliability industries such as aviation for guidance on improving system safety. One of the most widely adopted aviation-derived approaches is simulation-based team training, also known as crew resource management training. In the health care domain, crew resource management training often takes place in custom-built simulation laboratories that are designed to replicate operating rooms or labor and delivery rooms. Unlike these traditional crew resource management training programs, "in situ simulation" occurs on actual patient care units, involves actual health care team members, and uses actual organization processes to train and assess team performance. During the past 24 months, our research team has conducted nearly 40 in situ simulations. In this article, we present the results from 1 such simulation: a patient who experienced a difficult labor that resulted in an emergency caesarian section and hysterectomy. During the simulation, a number of latent environmental threats to safety were identified. This article presents the latent threats and the steps that the hospital has taken to remedy them.

Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment.

PubMed

Ohtake, Patricia J; Lazarus, Marcilene; Schillo, Rebecca; Rosen, Michael

2013-02-01

Rehabilitation of patients in critical care environments improves functional outcomes. This finding has led to increased implementation of intensive care unit (ICU) rehabilitation programs, including early mobility, and an associated increased demand for physical therapists practicing in ICUs. Unfortunately, many physical therapists report being inadequately prepared to work in this high-risk environment. Simulation provides focused, deliberate practice in safe, controlled learning environments and may be a method to initiate academic preparation of physical therapists for ICU practice. The purpose of this study was to examine the effect of participation in simulation-based management of a patient with critical illness in an ICU setting on levels of confidence and satisfaction in physical therapist students. A one-group, pretest-posttest, quasi-experimental design was used. Physical therapist students (N=43) participated in a critical care simulation experience requiring technical (assessing bed mobility and pulmonary status), behavioral (patient and interprofessional communication), and cognitive (recognizing a patient status change and initiating appropriate responses) skill performance. Student confidence and satisfaction were surveyed before and after the simulation experience. Students' confidence in their technical, behavioral, and cognitive skill performance increased from "somewhat confident" to "confident" following the critical care simulation experience. Student satisfaction was highly positive, with strong agreement the simulation experience was valuable, reinforced course content, and was a useful educational tool. Limitations of the study were the small sample from one university and a control group was not included. Incorporating a simulated, interprofessional critical care experience into a required clinical course improved physical therapist student confidence in technical, behavioral, and cognitive performance measures and was associated with high student satisfaction. Using simulation, students were introduced to the critical care environment, which may increase interest in working in this practice area.

Linking Six Sigma to simulation: a new roadmap to improve the quality of patient care.

PubMed

Celano, Giovanni; Costa, Antonio; Fichera, Sergio; Tringali, Giuseppe

2012-01-01

Improving the quality of patient care is a challenge that calls for a multidisciplinary approach, embedding a broad spectrum of knowledge and involving healthcare professionals from diverse backgrounds. The purpose of this paper is to present an innovative approach that implements discrete-event simulation (DES) as a decision-supporting tool in the management of Six Sigma quality improvement projects. A roadmap is designed to assist quality practitioners and health care professionals in the design and successful implementation of simulation models within the define-measure-analyse-design-verify (DMADV) or define-measure-analyse-improve-control (DMAIC) Six Sigma procedures. A case regarding the reorganisation of the flow of emergency patients affected by vertigo symptoms was developed in a large town hospital as a preliminary test of the roadmap. The positive feedback from professionals carrying out the project looks promising and encourages further roadmap testing in other clinical settings. The roadmap is a structured procedure that people involved in quality improvement can implement to manage projects based on the analysis and comparison of alternative scenarios. The role of Six Sigma philosophy in improvement of the quality of healthcare services is recognised both by researchers and by quality practitioners; discrete-event simulation models are commonly used to improve the key performance measures of patient care delivery. The two approaches are seldom referenced and implemented together; however, they could be successfully integrated to carry out quality improvement programs. This paper proposes an innovative approach to bridge the gap and enrich the Six Sigma toolbox of quality improvement procedures with DES.

The impact of transmural multiprofessional simulation-based obstetric team training on perinatal outcome and quality of care in the Netherlands

PubMed Central

2014-01-01

Background Perinatal mortality and morbidity in the Netherlands is relatively high compared to other European countries. Our country has a unique system with an independent primary care providing care to low-risk pregnancies and a secondary/tertiary care responsible for high-risk pregnancies. About 65% of pregnant women in the Netherlands will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire obstetric collaborative network process parameters could be improved. Studies have shown that obstetric team training improves perinatal outcome and that simulation-based obstetric team training implementing crew resource management (CRM) improves team performance. In addition, deliberate practice (DP) improves medical skills. The aim of this study is to analyse whether transmural multiprofessional simulation-based obstetric team training improves perinatal outcome. Methods/Design The study will be implemented in the south-eastern part of the Netherlands with an annual delivery rate of over 9,000. In this area secondary care is provided by four hospitals. Each hospital with referring primary care practices will form a cluster (study group). Within each cluster, teams will be formed of different care providers representing the obstetric collaborative network. CRM and elements of DP will be implemented in the training. To analyse the quality of care as perceived by patients, the Pregnancy and Childbirth Questionnaire (PCQ) will be used. Furthermore, self-reported collaboration between care providers will be assessed. Team performance will be measured by the Clinical Teamwork Scale (CTS). We employ a stepped-wedge trial design with a sequential roll-out of the trainings for the different study groups. Primary outcome will be perinatal mortality and/or admission to a NICU. Secondary outcome will be team performance, quality of care as perceived by patients, and collaboration among care providers. Conclusion The effect of transmural multiprofessional simulation-based obstetric team training on perinatal outcome has never been studied. We hypothesise that this training will improve perinatal outcome, team performance, and quality of care as perceived by patients and care providers. Trial registration The Netherlands National Trial Register, http://www.trialregister.nl/NTR4576, registered June 1, 2014 PMID:25145317

Standardised simulation-based emergency and intensive care nursing curriculum to improve nursing students' performance during simulated resuscitation: A quasi-experimental study.

PubMed

Chen, Jie; Yang, Jian; Hu, Fen; Yu, Si-Hong; Yang, Bing-Xiang; Liu, Qian; Zhu, Xiao-Ping

2018-06-01

Simulation-based curriculum has been demonstrated as crucial to nursing education in the development of students' critical thinking and complex clinical skills during a resuscitation simulation. Few studies have comprehensively examined the effectiveness of a standardised simulation-based emergency and intensive care nursing curriculum on the performance of students in a resuscitation simulation. To evaluate the impact of a standardised simulation-based emergency and intensive care nursing curriculum on nursing students' response time in a resuscitation simulation. Two-group, non-randomised quasi-experimental design. A simulation centre in a Chinese University School of Nursing. Third-year nursing students (N = 39) in the Emergency and Intensive Care course were divided into a control group (CG, n = 20) and an experimental group (EG, n = 19). The experimental group participated in a standardised high-technology, simulation-based emergency and intensive care nursing curriculum. The standardised simulation-based curriculum for third-year nursing students consists of three modules: disaster response, emergency care, and intensive care, which include clinical priorities (e.g. triage), basic resuscitation skills, airway/breathing management, circulation management and team work with eighteen lecture hours, six skill-practice hours and twelve simulation hours. The control group took part in the traditional curriculum. This course included the same three modules with thirty-four lecture hours and two skill-practice hours (trauma). Perceived benefits included decreased median (interquartile ranges, IQR) seconds to start compressions [CG 32 (25-75) vs. EG 20 (18-38); p < 0.001] and defibrillation [CG 204 (174-240) vs. EG 167 (162-174); p < 0.001] at the end of the course, compared with compressions [CG 41 (32-49) vs. EG 42 (33-46); p > 0.05] and defibrillation [CG 222 (194-254) vs. EG 221 (214-248); p > 0.05] at the beginning of the course. A simulation-based emergency and intensive care nursing curriculum was created and well received by third-year nursing students and associated with decreased response time in a resuscitation simulation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effects of Simulation With Problem-Based Learning Program on Metacognition, Team Efficacy, and Learning Attitude in Nursing Students: Nursing Care With Increased Intracranial Pressure Patient.

PubMed

Lee, Myung-Nam; Nam, Kyung-Dong; Kim, Hyeon-Young

2017-03-01

Nursing care for patients with central nervous system problems requires advanced professional knowledge and care skills. Nursing students are more likely to have difficulty in dealing with adult patients who have severe neurological problems in clinical practice. This study investigated the effect on the metacognition, team efficacy, and learning attitude of nursing students after an integrated simulation and problem-based learning program. A real scenario of a patient with increased intracranial pressure was simulated for the students. The results showed that this method was effective in improving the metacognitive ability of the students. Furthermore, we used this comprehensive model of simulation with problem-based learning in order to assess the consequences of student satisfaction with the nursing major, interpersonal relationships, and importance of simulation-based education in relation to the effectiveness of the integrated simulation with problem-based learning. The results can be used to improve the design of clinical practicum and nursing education.

What we call what we do affects how we do it: a new nomenclature for simulation research in medical education.

PubMed

Haji, Faizal A; Hoppe, Daniel J; Morin, Marie-Paule; Giannoulakis, Konstantine; Koh, Jansen; Rojas, David; Cheung, Jeffrey J H

2014-05-01

Rapid technological advances and concern for patient safety have increased the focus on simulation as a pedagogical tool for educating health care providers. To date, simulation research scholarship has focused on two areas; evaluating instructional designs of simulation programs, and the integration of simulation into a broader educational context. However, these two categories of research currently exist under a single label-Simulation-Based Medical Education. In this paper we argue that introducing a more refined nomenclature within which to frame simulation research is necessary for researchers, to appropriately design research studies and describe their findings, and for end-point users (such as program directors and educators), to more appropriately understand and utilize this evidence.

A high-compression electron gun for C6+ production: concept, simulations and mechanical design

NASA Astrophysics Data System (ADS)

Mertzig, Robert; Breitenfeldt, M.; Mathot, S.; Pitters, J.; Shornikov, A.; Wenander, F.

2017-07-01

In this paper we report on simulations and the mechanical design of a high-compression electron gun for an Electron Beam Ion Source (EBIS) dedicated for production of high intensity and high repetition rate pulses of bare carbon ions for injection into linac-based hadron therapy facilities. The gun is presently under construction at CERN to be retrofitted into the TwinEBIS test bench for experimental studies. We describe the design constraints, show results of numeric simulations and report on the mechanical design featuring several novel ideas. The reported design makes use of combined-function units with reduced number of mechanical joints that were carefully controlled and tuned during the manufacturing phase. The simulations addressed a wide range of topics including the influence of thermal effects, focusing optics, symmetry-breaking misalignments and injection into a full 5 T field.

Applying dynamic simulation modeling methods in health care delivery research-the SIMULATE checklist: report of the ISPOR simulation modeling emerging good practices task force.

PubMed

Marshall, Deborah A; Burgos-Liz, Lina; IJzerman, Maarten J; Osgood, Nathaniel D; Padula, William V; Higashi, Mitchell K; Wong, Peter K; Pasupathy, Kalyan S; Crown, William

2015-01-01

Health care delivery systems are inherently complex, consisting of multiple tiers of interdependent subsystems and processes that are adaptive to changes in the environment and behave in a nonlinear fashion. Traditional health technology assessment and modeling methods often neglect the wider health system impacts that can be critical for achieving desired health system goals and are often of limited usefulness when applied to complex health systems. Researchers and health care decision makers can either underestimate or fail to consider the interactions among the people, processes, technology, and facility designs. Health care delivery system interventions need to incorporate the dynamics and complexities of the health care system context in which the intervention is delivered. This report provides an overview of common dynamic simulation modeling methods and examples of health care system interventions in which such methods could be useful. Three dynamic simulation modeling methods are presented to evaluate system interventions for health care delivery: system dynamics, discrete event simulation, and agent-based modeling. In contrast to conventional evaluations, a dynamic systems approach incorporates the complexity of the system and anticipates the upstream and downstream consequences of changes in complex health care delivery systems. This report assists researchers and decision makers in deciding whether these simulation methods are appropriate to address specific health system problems through an eight-point checklist referred to as the SIMULATE (System, Interactions, Multilevel, Understanding, Loops, Agents, Time, Emergence) tool. It is a primer for researchers and decision makers working in health care delivery and implementation sciences who face complex challenges in delivering effective and efficient care that can be addressed with system interventions. On reviewing this report, the readers should be able to identify whether these simulation modeling methods are appropriate to answer the problem they are addressing and to recognize the differences of these methods from other modeling approaches used typically in health technology assessment applications. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The effect of centralization of health care services on travel time and its equality.

PubMed

Kobayashi, Daisuke; Otsubo, Tetsuya; Imanaka, Yuichi

2015-03-01

To analyze the regional variations in travel time between patient residences and medical facilities for the treatment of ischemic heart disease and breast cancer, and to simulate the effects of health care services centralization on travel time and equality of access. We used medical insurance claims data for inpatients and outpatients for the two target diseases that had been filed between September 2008 and May 2009 in Kyoto Prefecture, Japan. Using a geographical information system, patient travel times were calculated based on the driving distance between patient residences and hospitals via highways and toll roads. Locations of residences and hospital locations were identified using postal codes. We then conducted a simulation analysis of centralization of health care services to designated regional core hospitals. The simulated changes in potential spatial access to care were examined. Inequalities in access to care were examined using Gini coefficients, which ranged from 0.4109 to 0.4574. Simulations of health care services centralization showed reduced travel time for most patients and overall improvements in equality of access, except in breast cancer outpatients. Our findings may contribute to the decision-making process in policies aimed at improving the potential spatial access to health care services. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Simulations of Interdigitated Electrode Interactions with Gold Nanoparticles for Impedance-Based Biosensing Applications

PubMed Central

MacKay, Scott; Hermansen, Peter; Wishart, David; Chen, Jie

2015-01-01

In this paper, we describe a point-of-care biosensor design. The uniqueness of our design is in its capability for detecting a wide variety of target biomolecules and the simplicity of nanoparticle enhanced electrical detection. The electrical properties of interdigitated electrodes (IDEs) and the mechanism for gold nanoparticle-enhanced impedance-based biosensor systems based on these electrodes are simulated using COMSOL Multiphysics software. Understanding these properties and how they can be affected is vital in designing effective biosensor devices. Simulations were used to show electrical screening develop over time for IDEs in a salt solution, as well as the electric field between individual digits of electrodes. Using these simulations, it was observed that gold nanoparticles bound closely to IDEs can lower the electric field magnitude between the digits of the electrode. The simulations are also shown to be a useful design tool in optimizing sensor function. Various different conditions, such as electrode dimensions and background ion concentrations, are shown to have a significant impact on the simulations. PMID:26364638

Simulation of eye disease in virtual reality.

PubMed

Jin, Bei; Ai, Zhuming; Rasmussen, Mary

2005-01-01

It is difficult to understand verbal descriptions of visual phenomenon if one has no such experience. Virtual Reality offers a unique opportunity to "experience" diminished vision and the problems it causes in daily life. We have developed an application to simulate age-related macular degeneration, glaucoma, protanopia, and diabetic retinopathy in a familiar setting. The application also includes the introduction of eye anatomy representing both normal and pathologic states. It is designed for patient education, health care practitioner training, and eye care specialist education.

Using simulation pedagogy to enhance teamwork and communication in the care of older adults: the ELDER project.

PubMed

Mager, Diana R; Lange, Jean W; Greiner, Philip A; Saracino, Katherine H

2012-08-01

The Expanded Learning and Dedication to Elders in the Region (ELDER) project addressed the needs of under-served older adults by educating health care providers in home health and long-term care facilities. Four agencies in a health professional shortage/medically underserved area participated. Focus groups were held to determine agency-specific educational needs. Curricula from the John A. Hartford Foundation were adapted to design unique curricula for each agency and level of personnel during the first 2 years. The focus of this report is the case-based simulation learning approach used in year 3 to validate application of knowledge and facilitate teamwork and interprofessional communication. Three simulation sessions on varying topics were conducted at each site. Postsimulation surveys and qualitative interviews with hired evaluators showed that participants found simulations helpful to their practice. Tailored on-site education incorporating mid-fidelity simulation was an effective model for translating gerontological knowledge into practice and encouraging communication and teamwork in these settings. Copyright 2012, SLACK Incorporated.

Modification of Obstetric Emergency Simulation Scenarios for Realism in a Home-Birth Setting.

PubMed

Komorowski, Janelle; Andrighetti, Tia; Benton, Melissa

2017-01-01

Clinical competency and clear communication are essential for intrapartum care providers who encounter high-stakes, low-frequency emergencies. The challenge for these providers is to maintain infrequently used skills. The challenge is even more significant for midwives who manage births at home and who, due to low practice volume and low-risk clientele, may rarely encounter an emergency. In addition, access to team simulation may be limited for home-birth midwives. This project modified existing validated obstetric simulation scenarios for a home-birth setting. Twelve certified professional midwives (CPMs) in active home-birth practice participated in shoulder dystocia and postpartum hemorrhage simulations. The simulations were staged to resemble home-birth settings, supplies, and personnel. Fidelity (realism) of the simulations was assessed with the Simulation Design Scale, and satisfaction and self-confidence were assessed with the Student Satisfaction and Self-Confidence in Learning Scale. Both utilized a 5-point Likert scale, with higher scores suggesting greater levels of fidelity, participant satisfaction, and self-confidence. Simulation Design Scale scores indicated participants agreed fidelity was achieved for the home-birth setting, while scores on the Student Satisfaction and Self-Confidence in Learning indicated high levels of participant satisfaction and self-confidence. If offered without modification, simulation scenarios designed for use in hospitals may lose fidelity for home-birth midwives, particularly in the environmental and psychological components. Simulation is standard of care in most settings, an excellent vehicle for maintaining skills, and some evidence suggests it results in improved perinatal outcomes. Additional study is needed in this area to support home-birth providers in maintaining skills. This pilot study suggests that simulation scenarios intended for hospital use can be successfully adapted to the home-birth setting. © 2016 by the American College of Nurse-Midwives.

Competency-based learning in an ambulatory care setting: Implementation of simulation training in the Ambulatory Care Rotation during the final year of the MaReCuM model curriculum.

PubMed

Dusch, Martin; Narciß, Elisabeth; Strohmer, Renate; Schüttpelz-Brauns, Katrin

2018-01-01

Aim: As part of the MaReCuM model curriculum at Medical Faculty Mannheim Heidelberg University, a final year rotation in ambulatory care was implemented and augmented to include ambulatory care simulation. In this paper we describe this ambulatory care simulation, the designated competency-based learning objectives, and evaluate the educational effect of the ambulatory care simulation training. Method: Seventy-five final year medical students participated in the survey (response rate: 83%). The control group completed the ambulatory rotation prior to the implementation of the ambulatory care simulation. The experimental group was required to participate in the simulation at the beginning of the final year rotation in ambulatory care. A survey of both groups was conducted at the beginning and at the end of the rotation. The learning objectives were taken from the National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM). Results: The ambulatory care simulation had no measurable influence on students' subjectively perceived learning progress, the evaluation of the ambulatory care rotation, or working in an ambulatory care setting. At the end of the rotation participants in both groups reported having gained better insight into treating outpatients. At the beginning of the rotation members of both groups assessed their competencies to be at the same level. The simulated ambulatory scenarios were evaluated by the participating students as being well structured and easy to understand. The scenarios successfully created a sense of time pressure for those confronted with them. The ability to correctly fill out a narcotic prescription form as required was rated significantly higher by those who participated in the simulation. Participation in the ambulatory care simulation had no effect on the other competencies covered by the survey. Discussion: The effect of the four instructional units comprising the ambulatory care simulation was not measurable due to the current form or the measurement point at the end of the 12-week rotation. The reasons for this could be the many and statistically elusive factors relevant to the individual and the wide variety among final year rotation placements, the late point in time of the final survey, and the selection of simulated scenarios. The course is slated to undergo specific further development and should be supplemented with additional learning opportunities to ensure that the main learning objectives are covered. The description of the teaching format is meant to contribute to the ongoing development of medical education with an emphasis on competency in the areas of ambulatory care, communication, prevention and health promotion.

Enhancing student communication during end-of-life care: A pilot study.

PubMed

Bloomfield, Jacqueline G; O'Neill, Bernadette; Gillett, Karen

2015-12-01

Quality end-of-life care requires effective communication skills, yet medical and nursing students report limited opportunities to develop these skills, and that they lack confidence and the related competence. Our purpose was to design, implement, and evaluate an educational intervention employing simulated patient actors to enhance students' abilities to communicate with dying patients and their families. A study employing a mixed-methods design was conducted with prequalification nursing and medical students recruited from a London university. The first phase involved focus groups with students, which informed the development of an educational intervention involving simulated patient actors. Questionnaires measuring students' perceptions of confidence and competence levels when communicating with dying patients and their families were administered before and after the intervention. The themes from focus groups related to responding to grief and anger, difficulties dealing with emotions, knowing the "right thing" to say, and a lack of experience. A significant increase (p < 0.5) in competence and confidence from baseline levels followed participation in the simulated scenarios. Simulation was found to be an effective means of preparing students to communicate with dying patients and their families. The opportunity to develop communication skills was valued. Integration of educational interventions employing simulated patient actors into nursing and medical curricula may assist in improving the care provided to patients at the end of life.

Simulation-based crisis resource management training for pediatric critical care medicine: a review for instructors.

PubMed

Cheng, Adam; Donoghue, Aaron; Gilfoyle, Elaine; Eppich, Walter

2012-03-01

To review the essential elements of crisis resource management and provide a resource for instructors by describing how to use simulation-based training to teach crisis resource management principles in pediatric acute care contexts. A MEDLINE-based literature source. OUTLINE OF REVIEW: This review is divided into three main sections: Background, Principles of Crisis Resource Management, and Tools and Resources. The background section provides the brief history and definition of crisis resource management. The next section describes all the essential elements of crisis resource management, including leadership and followership, communication, teamwork, resource use, and situational awareness. This is followed by a review of evidence supporting the use of simulation-based crisis resource management training in health care. The last section provides the resources necessary to develop crisis resource management training using a simulation-based approach. This includes a description of how to design pediatric simulation scenarios, how to effectively debrief, and a list of potential assessment tools that instructors can use to evaluate crisis resource management performance during simulation-based training. Crisis resource management principles form the foundation for efficient team functioning and subsequent error reduction in high-stakes environments such as acute care pediatrics. Effective instructor training is required for those programs wishing to teach these principles using simulation-based learning. Dissemination and integration of these principles into pediatric critical care practice has the potential for a tremendous impact on patient safety and outcomes.

Why simulation can be efficient: on the preconditions of efficient learning in complex technology based practices.

PubMed

Hofmann, Bjørn

2009-07-23

It is important to demonstrate learning outcomes of simulation in technology based practices, such as in advanced health care. Although many studies show skills improvement and self-reported change to practice, there are few studies demonstrating patient outcome and societal efficiency. The objective of the study is to investigate if and why simulation can be effective and efficient in a hi-tech health care setting. This is important in order to decide whether and how to design simulation scenarios and outcome studies. Core theoretical insights in Science and Technology Studies (STS) are applied to analyze the field of simulation in hi-tech health care education. In particular, a process-oriented framework where technology is characterized by its devices, methods and its organizational setting is applied. The analysis shows how advanced simulation can address core characteristics of technology beyond the knowledge of technology's functions. Simulation's ability to address skilful device handling as well as purposive aspects of technology provides a potential for effective and efficient learning. However, as technology is also constituted by organizational aspects, such as technology status, disease status, and resource constraints, the success of simulation depends on whether these aspects can be integrated in the simulation setting as well. This represents a challenge for future development of simulation and for demonstrating its effectiveness and efficiency. Assessing the outcome of simulation in education in hi-tech health care settings is worthwhile if core characteristics of medical technology are addressed. This challenges the traditional technical versus non-technical divide in simulation, as organizational aspects appear to be part of technology's core characteristics.

Does simulation enhance nurses' ability to assess deteriorating patients?

PubMed

Bliss, Maria; Aitken, Leanne M

2018-01-01

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Role-playing simulation as an educational tool for health care personnel: developing an embedded assessment framework.

PubMed

Libin, Alexander; Lauderdale, Manon; Millo, Yuri; Shamloo, Christine; Spencer, Rachel; Green, Brad; Donnellan, Joyce; Wellesley, Christine; Groah, Suzanne

2010-04-01

Simulation- and video game-based role-playing techniques have been proven effective in changing behavior and enhancing positive decision making in a variety of professional settings, including education, the military, and health care. Although the need for developing assessment frameworks for learning outcomes has been clearly defined, there is a significant gap between the variety of existing multimedia-based instruction and technology-mediated learning systems and the number of reliable assessment algorithms. This study, based on a mixed methodology research design, aims to develop an embedded assessment algorithm, a Knowledge Assessment Module (NOTE), to capture both user interaction with the educational tool and knowledge gained from the training. The study is regarded as the first step in developing an assessment framework for a multimedia educational tool for health care professionals, Anatomy of Care (AOC), that utilizes Virtual Experience Immersive Learning Simulation (VEILS) technology. Ninety health care personnel of various backgrounds took part in online AOC training, choosing from five possible scenarios presenting difficult situations of everyday care. The results suggest that although the simulation-based training tool demonstrated partial effectiveness in improving learners' decision-making capacity, a differential learner-oriented approach might be more effective and capable of synchronizing educational efforts with identifiable relevant individual factors such as sociobehavioral profile and professional background.

Evaluating a Clinical Decision Support Interface for End-of-Life Nurse Care.

PubMed

Febretti, Alessandro; Stifter, Janet; Keenan, Gail M; Lopez, Karen D; Johnson, Andrew; Wilkie, Diana J

2014-01-01

Clinical Decision Support Systems (CDSS) are tools that assist healthcare personnel in the decision-making process for patient care. Although CDSSs have been successfully deployed in the clinical setting to assist physicians, few CDSS have been targeted at professional nurses, the largest group of health providers. We present our experience in designing and testing a CDSS interface embedded within a nurse care planning and documentation tool. We developed four prototypes based on different CDSS feature designs, and tested them in simulated end-of-life patient handoff sessions with a group of 40 nurse clinicians. We show how our prototypes directed nurses towards an optimal care decision that was rarely performed in unassisted practice. We also discuss the effect of CDSS layout and interface navigation in a nurse's acceptance of suggested actions. These findings provide insights into effective nursing CDSS design that are generalizable to care scenarios different than end-of-life.

Mobile health IT: the effect of user interface and form factor on doctor-patient communication.

PubMed

Alsos, Ole Andreas; Das, Anita; Svanæs, Dag

2012-01-01

Introducing computers into primary care can have negative effects on the doctor-patient dialogue. Little is known about such effects of mobile health IT in point-of-care situations. To assess how different mobile information devices used by physicians in point-of-care situations support or hinder aspects of doctor-patient communication, such as face-to-face dialogue, nonverbal communication, and action transparency. The study draws on two different experimental simulation studies where 22 doctors, in 80 simulated ward rounds, accessed patient-related information from a paper chart, a PDA, and a laptop mounted on a trolley. Video recordings from the simulations were analyzed qualitatively. Interviews with clinicians and patients were used to triangulate the findings and to verify the realism and results of the simulations. The paper chart afforded smooth re-establishment of eye contact, better verbal and non-verbal contact, more gesturing, good visibility of actions, and quick information retrieval. The digital information devices lacked many of these affordances; physicians' actions were not visible for the patients, the user interfaces required much attention, gesturing was harder, and re-establishment of eye contact took more time. Physicians used the devices to display their actions to the patients. The analysis revealed that the findings were related to the user interface and form factor of the information devices, as well as the personal characteristics of the physician. When information is needed and has to be located at the point-of-care, the user interface and the physical form factor of the mobile information device are influential elements for successful collaboration between doctors and patients. Both elements need to be carefully designed so that physicians can use the devices to support face-to-face dialogue, nonverbal communication, and action visibility. The ability to facilitate and support the doctor-patient collaboration is a noteworthy usability factor in the design of mobile EPR systems. The paper also presents possible design guidelines for mobile point-of-care systems for improved doctor-patient communication. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Simulation Research in Gastrointestinal and Urologic Care-Challenges and Opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Biomedical Imaging and Bioengineering Workshop.

PubMed

Aggarwal, Rajesh; Brown, Kimberly M; de Groen, Piet C; Gallagher, Anthony G; Henriksen, Kerm; Kavoussi, Louis R; Peng, Grace C Y; Ritter, E Matthew; Silverman, Elliott; Wang, Kenneth K; Andersen, Dana K

2018-01-01

: A workshop on "Simulation Research in Gastrointestinal and Urologic Care: Challenges and Opportunities" was held at the National Institutes of Health in June 2016. The purpose of the workshop was to examine the extent to which simulation approaches have been used by skilled proceduralists (not trainees) caring for patients with gastrointestinal and urologic diseases. The current status of research findings in the use and effectiveness of simulation applications was reviewed, and numerous knowledge gaps and research needs were identified by the faculty and the attendees. The paradigm of "deliberate practice," rather than mere repetition, and the value of coaching by experts was stressed by those who have adopted simulation in music and sports. Models that are most useful for the adoption of simulation by expert clinicians have yet to be fully validated. Initial studies on the impact of simulation on safety and error reduction have demonstrated its value in the training domain, but the role of simulation as a strategy for increased procedural safety remains uncertain in the world of the expert practitioner. Although the basic requirements for experienced physicians to acquire new skills have been explored, the widespread availability of such resources is an unrealized goal, and there is a need for well-designed outcome studies to establish the role of simulation in improving the quality of health care.

BeeSign: Designing to Support Mediated Group Inquiry of Complex Science by Early Elementary Students

ERIC Educational Resources Information Center

Danish, Joshua A.; Peppler, Kylie; Phelps, David

2010-01-01

All too often, designers assume that complex science and cycles of inquiry are beyond the capabilities of young children (5-8 years old). However, with carefully designed mediators, we argue that such concepts are well within their grasp. In this paper we describe two design iterations of the BeeSign simulation software that was designed to help…

An Academic-Business Partnership for Advancing Clinical Informatics.

ERIC Educational Resources Information Center

Connors, Helen R.; Weaver, Charlotte; Warren, Judith; Miller, Karen L.

2002-01-01

A partnership between a university school of nursing and a health care information technology supplier resulted in the Simulated E-hEalth Delivery System (SEEDS). This program enables nursing students to learn clinical skills in a state-of-the-art environment using a live-production, clinical information system designed for care delivery. (JOW)

Design of a smart hemodynamic monitoring simulator.

PubMed

Kilty, Brennan G; Wright, Cameron H G; Barrett, Steven F; Calkins, Jerry M; Drzewiecki, Tadeusz M

2007-01-01

We describe the design of a medical patient status simulator developed as a proof of concept for the United States Air Force. The simulator is the precursor to a system that analyzes hemodynamic information in order to act as an intelligent assistant to a Critical Care Air Transport Team (CCATT) monitoring a critically injured casualty. The simulator displays hemodynamic information, alerts to abnormal values, offers likely diagnoses, and allows the team to review recommended therapies. The focus has been to develop a user interface and modular system architecture that allows individual modules to easily be evaluated and altered as needed. While initiated by the military, this work could also be used to aid civilian first responders.

Designing High Fidelity Simulation to Maximize Student Registered Nursing Decision-Making Ability

ERIC Educational Resources Information Center

Deckers, Cathleen

2011-01-01

The current healthcare environment is a complex system of patients, procedures, and equipment that strives to deliver safe and effective medical care. High fidelity simulation provides healthcare educators with a tool to create safety conscious practitioners utilizing an environment that replicates practice without risk to patients. Using HFS…

Comparing methods for estimation of heterogeneous treatment effects using observational data from health care databases.

PubMed

Wendling, T; Jung, K; Callahan, A; Schuler, A; Shah, N H; Gallego, B

2018-06-03

There is growing interest in using routinely collected data from health care databases to study the safety and effectiveness of therapies in "real-world" conditions, as it can provide complementary evidence to that of randomized controlled trials. Causal inference from health care databases is challenging because the data are typically noisy, high dimensional, and most importantly, observational. It requires methods that can estimate heterogeneous treatment effects while controlling for confounding in high dimensions. Bayesian additive regression trees, causal forests, causal boosting, and causal multivariate adaptive regression splines are off-the-shelf methods that have shown good performance for estimation of heterogeneous treatment effects in observational studies of continuous outcomes. However, it is not clear how these methods would perform in health care database studies where outcomes are often binary and rare and data structures are complex. In this study, we evaluate these methods in simulation studies that recapitulate key characteristics of comparative effectiveness studies. We focus on the conditional average effect of a binary treatment on a binary outcome using the conditional risk difference as an estimand. To emulate health care database studies, we propose a simulation design where real covariate and treatment assignment data are used and only outcomes are simulated based on nonparametric models of the real outcomes. We apply this design to 4 published observational studies that used records from 2 major health care databases in the United States. Our results suggest that Bayesian additive regression trees and causal boosting consistently provide low bias in conditional risk difference estimates in the context of health care database studies. Copyright © 2018 John Wiley & Sons, Ltd.

Effects of nursing process-based simulation for maternal child emergency nursing care on knowledge, attitude, and skills in clinical nurses.

PubMed

Kim, Sunghee; Shin, Gisoo

2016-02-01

Since previous studies on simulation-based education have been focused on fundamental nursing skills for nursing students in South Korea, there is little research available that focuses on clinical nurses in simulation-based training. Further, there is a paucity of research literature related to the integration of the nursing process into simulation training particularly in the emergency nursing care of high-risk maternal and neonatal patients. The purpose of this study was to identify the effects of nursing process-based simulation on knowledge, attitudes, and skills for maternal and child emergency nursing care in clinical nurses in South Korea. Data were collected from 49 nurses, 25 in the experimental group and 24 in the control group, from August 13 to 14, 2013. This study was an equivalent control group pre- and post-test experimental design to compare the differences in knowledge, attitudes, and skills for maternal and child emergency nursing care between the experimental group and the control group. The experimental group was trained by the nursing process-based simulation training program, while the control group received traditional methods of training for maternal and child emergency nursing care. The experimental group was more likely to improve knowledge, attitudes, and skills required for clinical judgment about maternal and child emergency nursing care than the control group. Among five stages of nursing process in simulation, the experimental group was more likely to improve clinical skills required for nursing diagnosis and nursing evaluation than the control group. These results will provide valuable information on developing nursing process-based simulation training to improve clinical competency in nurses. Further research should be conducted to verify the effectiveness of nursing process-based simulation with more diverse nurse groups on more diverse subjects in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.

Design of an Integrated Division-Level Battle Simulation for Research, Development, and Training. Volume 2. Detailed Design Notes

DTIC Science & Technology

1979-08-01

frag orders for tactical considerations. Frag orders issued by simulated modules will be " edited " by the same procedure as that used with populated...record and distributed as required. Queries transmitted from any staff module will be reviewed and edited at event time for technical accuracy. If an...of this kind will have to be carefully edited and interpreted by the control- ler(s) and/or computer before the chanqe is instituted in the real world

Studying distributed cognition of simulation-based team training with DiCoT.

PubMed

Rybing, Jonas; Nilsson, Heléne; Jonson, Carl-Oscar; Bang, Magnus

2016-03-01

Health care organizations employ simulation-based team training (SBTT) to improve skill, communication and coordination in a broad range of critical care contexts. Quantitative approaches, such as team performance measurements, are predominantly used to measure SBTTs effectiveness. However, a practical evaluation method that examines how this approach supports cognition and teamwork is missing. We have applied Distributed Cognition for Teamwork (DiCoT), a method for analysing cognition and collaboration aspects of work settings, with the purpose of assessing the methodology's usefulness for evaluating SBTTs. In a case study, we observed and analysed four Emergo Train System® simulation exercises where medical professionals trained emergency response routines. The study suggests that DiCoT is an applicable and learnable tool for determining key distributed cognition attributes of SBTTs that are of importance for the simulation validity of training environments. Moreover, we discuss and exemplify how DiCoT supports design of SBTTs with a focus on transfer and validity characteristics. Practitioner Summary: In this study, we have evaluated a method to assess simulation-based team training environments from a cognitive ergonomics perspective. Using a case study, we analysed Distributed Cognition for Teamwork (DiCoT) by applying it to the Emergo Train System®. We conclude that DiCoT is useful for SBTT evaluation and simulator (re)design.

Methodology for balancing design and process tradeoffs for deep-subwavelength technologies

NASA Astrophysics Data System (ADS)

Graur, Ioana; Wagner, Tina; Ryan, Deborah; Chidambarrao, Dureseti; Kumaraswamy, Anand; Bickford, Jeanne; Styduhar, Mark; Wang, Lee

2011-04-01

For process development of deep-subwavelength technologies, it has become accepted practice to use model-based simulation to predict systematic and parametric failures. Increasingly, these techniques are being used by designers to ensure layout manufacturability, as an alternative to, or complement to, restrictive design rules. The benefit of model-based simulation tools in the design environment is that manufacturability problems are addressed in a design-aware way by making appropriate trade-offs, e.g., between overall chip density and manufacturing cost and yield. The paper shows how library elements and the full ASIC design flow benefit from eliminating hot spots and improving design robustness early in the design cycle. It demonstrates a path to yield optimization and first time right designs implemented in leading edge technologies. The approach described herein identifies those areas in the design that could benefit from being fixed early, leading to design updates and avoiding later design churn by careful selection of design sensitivities. This paper shows how to achieve this goal by using simulation tools incorporating various models from sparse to rigorously physical, pattern detection and pattern matching, checking and validating failure thresholds.

Evaluating Isolation Behaviors by Nurses Using Mobile Computer Workstations at the Bedside.

PubMed

Beam, Elizabeth L; Gibbs, Shawn G; Hewlett, Angela L; Iwen, Peter C; Nuss, Suzanne L; Smith, Philip W

2016-09-01

This secondary analysis from a larger mixed methods study with a sequential explanatory design investigates the clinical challenges for nurses providing patient care, in an airborne and contact isolation room, while using a computer on wheels for medication administration in a simulated setting. Registered nurses, who regularly work in clinical care at the patient bedside, were recruited as study participants in the simulation and debriefing experience. A live volunteer acted as the standardized patient who needed assessment and intravenous pain medication. The simulation was video recorded in a typical hospital room to observe participating nurses conducting patient care in an airborne and contact isolation situation. Participants then reviewed their performance with study personnel in a formal, audio-recorded debriefing. Isolation behaviors were scored by an expert panel, and the debriefing sessions were analyzed. Considerable variation was found in behaviors related to using a computer on wheels while caring for a patient in isolation. Currently, no nursing care guidelines exist on the use of computers on wheels in an airborne and contact isolation room. Specific education is needed on nursing care processes for the proper disinfection of computers on wheels and the reduction of the potential for disease transmission from environmental contamination.

Interprofessional, simulation-based training in end of life care communication: a pilot study.

PubMed

Efstathiou, Nikolaos; Walker, Wendy Marina

2014-01-01

This paper reports on the process and outcomes of a study, designed to pilot the use of interprofessional, simulation-based training in end of life care communication. Participants comprised 50 final year medicine, nursing, physiotherapy and pharmacy students. Learning methods included observation of role play and facilitated, interactive group discussion. A Likert scale rating questionnaire was used to evaluate the impact of the learning experience. Evaluation data revealed that students were supportive of interprofessional learning and could recognise its benefits. The results indicated self-perceived improvements in knowledge, skills, confidence and competence when dealing with challenging end of life care communication situations. Comparison of pre- and post-intervention scores revealed a statistically significant positive change in the students' perceptions about their level of knowledge (Z = -5.887, p = 0.000). The reported benefits need to be balanced against design and delivery issues that proved labour and resource intensive. Economic evaluation is worthy of further consideration.

Winter Simulation Conference, Miami Beach, Fla., December 4-6, 1978, Proceedings. Volumes 1 & 2

NASA Technical Reports Server (NTRS)

Highland, H. J. (Editor); Nielsen, N. R.; Hull, L. G.

1978-01-01

The papers report on the various aspects of simulation such as random variate generation, simulation optimization, ranking and selection of alternatives, model management, documentation, data bases, and instructional methods. Simulation studies in a wide variety of fields are described, including system design and scheduling, government and social systems, agriculture, computer systems, the military, transportation, corporate planning, ecosystems, health care, manufacturing and industrial systems, computer networks, education, energy, production planning and control, financial models, behavioral models, information systems, and inventory control.

Design of a breathing mattress based on the respiratory movement of kangaroo mother care for the development of neonates.

PubMed

Schets, M W M; Chen, W; Bambang Oetomo, S

2015-01-01

Kangaroo mother care (KMC) benefits the development of neonates. This paper focuses on the design and implementing the extension of KMC for infants at Neonatal Intensive Care Units (NICU). A breathing mattress is proposed to comfort infants and stimulate them to breathe regularly by mimicking the movement of the parent's chest during KMC. The incubator mattress simulates the breathing of the parent's chest with embedded electronics and pneumatic technology for mattress motion actuating systems. The stakeholders, including the child, parents and NICU staff, were directly involved during the concept development, prototyping and evaluation.

Incorporating quality and safety education for nurses competencies in simulation scenario design.

PubMed

Jarzemsky, Paula; McCarthy, Jane; Ellis, Nadege

2010-01-01

When planning a simulation scenario, even if adopting prepackaged simulation scenarios, faculty should first conduct a task analysis to guide development of learning objectives and cue critical events. The authors describe a strategy for systematic planning of simulation-based training that incorporates knowledge, skills, and attitudes as defined by the Quality and Safety Education for Nurses (QSEN) initiative. The strategy cues faculty to incorporate activities that target QSEN competencies (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics, and safety) before, during, and after simulation scenarios.

Identifying Facilitators and Barriers for Patient Safety in a Medicine Label Design System Using Patient Simulation and Interviews.

PubMed

Dieckmann, Peter; Clemmensen, Marianne Hald; Sørensen, Trine Kart; Kunstek, Pina; Hellebek, Annemarie

2016-12-01

Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. The study design is qualitative and exploratory, with a convenience sample of 10 nurses and 10 physicians from different acute care specialties working in hospitals in the Capital Region of Denmark. In 2 patient simulation scenarios and a sorting task, the participants selected the medicines from a range of ampules, vials, and infusion bags. After each scenario and in the end of the study, the participants were interviewed. Notes were validated with the participants, and content was analyzed. The label design benefited from the standardized construction of the labels, the clear layout and font, and some warning signs. The complexity of the system and some inconsistencies (different meaning of colors) posed challenges, when considered with the actual application context, in which there is little time to get familiar with the design features. For optimizing medicine labels and obtaining the full benefit of label design features on patient safety, it is necessary to consider the context in which they are used.

Effects of a simulated emergency airway management education program on the self-efficacy and clinical performance of intensive care unit nurses.

PubMed

Han, Myong-Ja; Lee, Ju-Ry; Shin, Yu-Jung; Son, Jeong-Suk; Choi, Eun-Joo; Oh, Yun-Hee; Lee, Soon-Haeng; Choi, Hye-Ran

2017-12-21

To examine the effects of a simulated emergency airway management education program on the self-efficacy and clinical performance among nurses in intensive care units. A one-group, pre- and post-test design was used. Thirty-five nurses who were working in adult intensive care units participated in this study. The simulation education program included lectures, skill demonstration, skill training, team-based practice, and debriefing. Self-efficacy and clinical performance questionnaires were completed before the program and 1 week after its completion. The data were analyzed by using descriptive statistics and the paired t-test to compare the mean differences between the pre-test and post-test. The scores before and after education were compared. After education, there was a significant improvement in the nurses' self-efficacy and clinical performance in emergency airway management situations. Simulation education effectively improved the self-efficacy and clinical performance of the nurses who were working in intensive care units. Based on the program for clinical nurses within a hospital, it will provide information that might advance clinical nursing education. © 2017 Japan Academy of Nursing Science.

A protocol for evaluating progressive levels of simulation fidelity in the development of technical skills, integrated performance and woman centred clinical assessment skills in undergraduate midwifery students

PubMed Central

2013-01-01

Background Simulation as a pedagogical approach has been used in health professional education to address the need to safely develop effective clinical skills prior to undertaking clinical practice. However, evidence for the use of simulation in midwifery is largely anecdotal, and research evaluating the effectiveness of different levels of simulation fidelity are lacking. Woman centred care is a core premise of the midwifery profession and describes the behaviours of an individual midwife who demonstrates safe and effective care of the individual woman. Woman centred care occurs when the midwife modifies the care to ensure the needs of each individual woman are respected and addressed. However, a review of the literature demonstrates an absence of a valid and reliable tool to measure the development of woman centred care behaviours. This study aims to determine which level of fidelity in simulated learning experiences provides the most effective learning outcomes in the development of woman centred clinical assessment behaviors and skills in student midwives. Methods/Design Three-arm, randomised, intervention trial. In this research we plan to: a) trial three levels of simulation fidelity - low, medium and progressive, on student midwives performing the procedure of vaginal examination; b) measure clinical assessment skills using the Global Rating Scale (GRS) and Integrated Procedural Performance Instrument (IPPI); and c) pilot the newly developed Woman Centred Care Scale (WCCS) to measure clinical behaviors related to Woman-Centredness. Discussion This project aims to enhance knowledge in relation to the appropriate levels of fidelity in simulation that yield the best educational outcomes for the development of woman centred clinical assessment in student midwives. The outcomes of this project may contribute to improved woman centred clinical assessment for student midwives, and more broadly influence decision making regarding education resource allocation for maternity simulation. PMID:23706037

Can broader diffusion of value-based insurance design increase benefits from US health care without increasing costs? Evidence from a computer simulation model.

PubMed

Braithwaite, R Scott; Omokaro, Cynthia; Justice, Amy C; Nucifora, Kimberly; Roberts, Mark S

2010-02-16

Evidence suggests that cost sharing (i.e.,copayments and deductibles) decreases health expenditures but also reduces essential care. Value-based insurance design (VBID) has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs. We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1) applying VBID solely to pharmacy benefits and (2) applying VBID to both pharmacy benefits and other health care services (e.g., devices). We assumed that cost sharing would be eliminated for high-value services (<$100,000 per life-year), would remain unchanged for intermediate- or unknown-value services ($100,000-$300,000 per life-year or unknown), and would be increased for low-value services (>$300,000 per life-year). All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80%) of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase. Broader diffusion of VBID may amplify benefits from US health care without increasing health expenditures.

Human Simulators and Standardized Patients to Teach Difficult Conversations to Interprofessional Health Care Teams

PubMed Central

Zimmerman, Christine; Kennedy, Christopher; Schremmer, Robert; Smith, Katharine V.

2010-01-01

Objective To design and implement a demonstration project to teach interprofessional teams how to recognize and engage in difficult conversations with patients. Design Interdisciplinary teams consisting of pharmacy students and residents, student nurses, and medical residents responded to preliminary questions regarding difficult conversations, listened to a brief discussion on difficult conversations; formed ad hoc teams and interacted with a standardized patient (mother) and a human simulator (child), discussing the infant's health issues, intimate partner violence, and suicidal thinking; and underwent debriefing. Assessment Participants evaluated the learning methods positively and a majority demonstrated knowledge gains. The project team also learned lessons that will help better design future programs, including an emphasis on simulations over lecture and the importance of debriefing on student learning. Drawbacks included the major time commitment for design and implementation, sustainability, and the lack of resources to replicate the program for all students. Conclusion Simulation is an effective technique to teach interprofessional teams how to engage in difficult conversations with patients. PMID:21088725

Effects of pre-education combined with a simulation for caring for children with croup on senior nursing students.

PubMed

Lee, Myung-Nam; Kang, Kyung-Ah; Park, Sun-Jung; Kim, Shin-Jeong

2017-06-01

Educational outcomes, such as knowledge, confidence in performance, ability in nursing practice, and satisfaction with learning methods in caring for children with croup, were compared between groups of students that received education through simulation combined with pre-education, simulation only, and pre-education only. In this quasi-experimental design, the educational intervention for the experimental group was the pre-education modality. Data from a convenience sample of 127 senior nursing students were drawn from three nursing schools in South Korea. There were significant differences in the mean scores of knowledge, confidence in performance, satisfaction with the learning method, and ability in nursing practice between the three groups. Pre-education with simulation significantly enhanced students' knowledge, confidence in performance, ability in nursing practice, and satisfaction with learning methods compared with pre-education or simulation alone. Simulation strategies should focus more on enhancing nursing students' learning outcomes. © 2017 John Wiley & Sons Australia, Ltd.

Expert knowledge elicitation using computer simulation: the organization of frail elderly case management as an illustration.

PubMed

Chiêm, Jean-Christophe; Van Durme, Thérèse; Vandendorpe, Florence; Schmitz, Olivier; Speybroeck, Niko; Cès, Sophie; Macq, Jean

2014-08-01

Various elderly case management projects have been implemented in Belgium. This type of long-term health care intervention involves contextual factors and human interactions. These underlying complex mechanisms can be usefully informed with field experts' knowledge, which are hard to make explicit. However, computer simulation has been suggested as one possible method of overcoming the difficulty of articulating such elicited qualitative views. A simulation model of case management was designed using an agent-based methodology, based on the initial qualitative research material. Variables and rules of interaction were formulated into a simple conceptual framework. This model has been implemented and was used as a support for a structured discussion with experts in case management. The rigorous formulation provided by the agent-based methodology clarified the descriptions of the interventions and the problems encountered regarding: the diverse network topologies of health care actors in the project; the adaptation time required by the intervention; the communication between the health care actors; the institutional context; the organization of the care; and the role of the case manager and his or hers personal ability to interpret the informal demands of the frail older person. The simulation model should be seen primarily as a tool for thinking and learning. A number of insights were gained as part of a valuable cognitive process. Computer simulation supporting field experts' elicitation can lead to better-informed decisions in the organization of complex health care interventions. © 2013 John Wiley & Sons, Ltd.

The Role of Transfer in Designing Games and Simulations for Health: Systematic Review

PubMed Central

Terlouw, Gijs; Wartena, Bard O; van 't Veer, Job TB; Prins, Jelle T; Pierie, Jean Pierre EN

2017-01-01

Background The usefulness and importance of serious games and simulations in learning and behavior change for health and health-related issues are widely recognized. Studies have addressed games and simulations as interventions, mostly in comparison with their analog counterparts. Numerous complex design choices have to be made with serious games and simulations for health, including choices that directly contribute to the effects of the intervention. One of these decisions is the way an intervention is expected to lead to desirable transfer effects. Most designs adopt a first-class transfer rationale, whereas the second class of transfer types seems a rarity in serious games and simulations for health. Objective This study sought to review the literature specifically on the second class of transfer types in the design of serious games and simulations. Focusing on game-like interventions for health and health care, this study aimed to (1) determine whether the second class of transfer is recognized as a road for transfer in game-like interventions, (2) review the application of the second class of transfer type in designing game-like interventions, and (3) assess studies that include second-class transfer types reporting transfer outcomes. Methods A total of 6 Web-based databases were systematically searched by titles, abstracts, and keywords using the search strategy (video games OR game OR games OR gaming OR computer simulation*) AND (software design OR design) AND (fidelity OR fidelities OR transfer* OR behaviour OR behavior). The databases searched were identified as relevant to health, education, and social science. Results A total of 15 relevant studies were included, covering a range of game-like interventions, all more or less mentioning design parameters aimed at transfer. We found 9 studies where first-class transfer was part of the design of the intervention. In total, 8 studies dealt with transfer concepts and fidelity types in game-like intervention design in general; 3 studies dealt with the concept of second-class transfer types and reported effects, and 2 of those recognized transfer as a design parameter. Conclusions In studies on game-like interventions for health and health care, transfer is regarded as a desirable effect but not as a basic principle for design. None of the studies determined the second class of transfer or instances thereof, although in 3 cases a nonliteral transfer type was present. We also found that studies on game-like interventions for health do not elucidate design choices made and rarely provide design principles for future work. Games and simulations for health abundantly build upon the principles of first-class transfer, but the adoption of second-class transfer types proves scarce. It is likely to be worthwhile to explore the possibilities of second-class transfer types, as they may considerably influence educational objectives in terms of future serious game design for health. PMID:29175812

Unifying interdisciplinary education: designing and implementing an intern simulation educational curriculum to increase confidence in critical care from PGY1 to PGY2.

PubMed

Bullard, Mark J; Leuck, Jo Anna; Howley, Lisa D

2017-11-06

A longitudinal, multidisciplinary critical care simulation curriculum was developed and implemented within a teaching hospital to address the need for consistent, safe, efficient, and unified critical care training within graduate medical education. Primary goals were to increase learner confidence in critical care topics and procedural skills across all specialties. Secondary goals included improving communication skills and obtaining a high level of learner satisfaction. All interns caring for adult patients within our hospital participated in three 4-h simulation-based sessions scheduled over the second half of their intern year. Pre- and postcurricular surveys evaluated self-confidence in critical care topics, procedures, and communication skills. The Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV) Short Form was used to evaluate facilitator debriefing. Data were compared with Wilcoxon rank sum and signed rank test. Pre- and postcurricular surveys were collected from 51 of 52 interns (98% response rate) in curricular year 1 and 59 of 59 interns (100% response rate) in curricular year 2 in six programs within the hospital. Resident confidence significantly improved in all areas (p < .05). DASH-SV demonstrated overall effective facilitator debriefing and > 75% of interns in both curricular years 1 and 2 expressed a desire for future educational sessions. The implemented curriculum increased learner confidence in select critical care topics, procedures, and communication skills and demonstrated a high level of learner satisfaction. The curriculum has expanded to learners from three other teaching hospitals within our system to unify critical care education for all interns caring for adult patients.

Specifications of a Simulation Model for a Local Area Network Design in Support of a Stock Point Logistics Integrated Communication Environment (SPLICE).

DTIC Science & Technology

1983-06-01

constrained at each step. Use of dis- crete simulation can be a powerful tool in this process if its role is carefully planned. The gross behavior of the...by projecting: - the arrival of units of work at SPLICE processing facilities (workload analysis) . - the amount of processing resources comsumed in

Addressing Dual Patient and Staff Safety Through A Team-Based Standardized Patient Simulation for Agitation Management in the Emergency Department.

PubMed

Wong, Ambrose H; Auerbach, Marc A; Ruppel, Halley; Crispino, Lauren J; Rosenberg, Alana; Iennaco, Joanne D; Vaca, Federico E

2018-06-01

Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management. We used a mixed-methods approach with emergency medicine resident and attending physicians, Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), ED nurses, technicians, and security officers at two hospital sites. After a simulated agitated patient encounter, we conducted uniprofessional and interprofessional focus groups. We undertook structured thematic analysis using a grounded theory approach. Quantitative data consisted of responses to the KidSIM Questionnaire addressing teamwork and simulation-based learning attitudes before and after each session. We reached data saturation with 57 participants. KidSIM scores revealed significant improvements in attitudes toward relevance of simulation, opportunities for interprofessional education, and situation awareness, as well as four of six questions for roles/responsibilities. Two broad themes emerged from the focus groups: (1) a team-based agitated patient simulation addressed dual safety of staff and patients simultaneously and (2) the experience fostered interprofessional discovery and cooperation in agitation management. A team-based simulated agitated patient encounter highlighted the need to consider the dual safety of staff and patients while facilitating interprofessional dialog and learning. Our findings suggest that simulation may be effective to enhance teamwork in behavioral emergency care.

Simulation and curriculum design: a global survey in dental education.

PubMed

Perry, S; Burrow, M F; Leung, W K; Bridges, S M

2017-12-01

Curriculum reforms are being driven by globalization and international standardization. Although new information technologies such as dental haptic virtual reality (VR) simulation systems have provided potential new possibilities for clinical learning in dental curricula, infusion into curricula requires careful planning. This study aimed to identify current patterns in the role and integration of simulation in dental degree curricula internationally. An original internet survey was distributed by invitation to clinical curriculum leaders in dental schools in Asia, Europe, North America, and Oceania (Australia and New Zealand). The results (N = 62) showed Asia, Europe and Oceania tended towards integrated curriculum designs with North America having a higher proportion of traditional curricula. North America had limited implementation of haptic VR simulation technology but reported the highest number of scheduled simulation hours. Australia and New Zealand were the most likely regions to incorporate haptic VR simulation technology. This survey indicated considerable variation in curriculum structure with regionally-specific preferences being evident in terms of curriculum structure, teaching philosophies and motivation for incorporation of VR haptic simulation into curricula. This study illustrates the need for an improved evidence base on dental simulations to inform curriculum designs and psychomotor skill learning in dentistry. © 2017 Australian Dental Association.

Discrete event simulation: the preferred technique for health economic evaluations?

PubMed

Caro, Jaime J; Möller, Jörgen; Getsios, Denis

2010-12-01

To argue that discrete event simulation should be preferred to cohort Markov models for economic evaluations in health care. The basis for the modeling techniques is reviewed. For many health-care decisions, existing data are insufficient to fully inform them, necessitating the use of modeling to estimate the consequences that are relevant to decision-makers. These models must reflect what is known about the problem at a level of detail sufficient to inform the questions. Oversimplification will result in estimates that are not only inaccurate, but potentially misleading. Markov cohort models, though currently popular, have so many limitations and inherent assumptions that they are inadequate to inform most health-care decisions. An event-based individual simulation offers an alternative much better suited to the problem. A properly designed discrete event simulation provides more accurate, relevant estimates without being computationally prohibitive. It does require more data and may be a challenge to convey transparently, but these are necessary trade-offs to provide meaningful and valid results. In our opinion, discrete event simulation should be the preferred technique for health economic evaluations today. © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Modeling, simulation, and analysis at Sandia National Laboratories for health care systems

NASA Astrophysics Data System (ADS)

Polito, Joseph

1994-12-01

Modeling, Simulation, and Analysis are special competencies of the Department of Energy (DOE) National Laboratories which have been developed and refined through years of national defense work. Today, many of these skills are being applied to the problem of understanding the performance of medical devices and treatments. At Sandia National Laboratories we are developing models at all three levels of health care delivery: (1) phenomenology models for Observation and Test, (2) model-based outcomes simulations for Diagnosis and Prescription, and (3) model-based design and control simulations for the Administration of Treatment. A sampling of specific applications include non-invasive sensors for blood glucose, ultrasonic scanning for development of prosthetics, automated breast cancer diagnosis, laser burn debridement, surgical staple deformation, minimally invasive control for administration of a photodynamic drug, and human-friendly decision support aids for computer-aided diagnosis. These and other projects are being performed at Sandia with support from the DOE and in cooperation with medical research centers and private companies. Our objective is to leverage government engineering, modeling, and simulation skills with the biotechnical expertise of the health care community to create a more knowledge-rich environment for decision making and treatment.

Mock ECHO: A Simulation-Based Medical Education Method.

PubMed

Fowler, Rebecca C; Katzman, Joanna G; Comerci, George D; Shelley, Brian M; Duhigg, Daniel; Olivas, Cynthia; Arnold, Thomas; Kalishman, Summers; Monnette, Rebecca; Arora, Sanjeev

2018-04-16

This study was designed to develop a deeper understanding of the learning and social processes that take place during the simulation-based medical education for practicing providers as part of the Project ECHO® model, known as Mock ECHO training. The ECHO model is utilized to expand access to care of common and complex diseases by supporting the education of primary care providers with an interprofessional team of specialists via videoconferencing networks. Mock ECHO trainings are conducted through a train the trainer model targeted at leaders replicating the ECHO model at their organizations. Trainers conduct simulated teleECHO clinics while participants gain skills to improve communication and self-efficacy. Three focus groups, conducted between May 2015 and January 2016 with a total of 26 participants, were deductively analyzed to identify common themes related to simulation-based medical education and interdisciplinary education. Principal themes generated from the analysis included (a) the role of empathy in community development, (b) the value of training tools as guides for learning, (c) Mock ECHO design components to optimize learning, (d) the role of interdisciplinary education to build community and improve care delivery, (e) improving care integration through collaboration, and (f) development of soft skills to facilitate learning. Mock ECHO trainings offer clinicians the freedom to learn in a noncritical environment while emphasizing real-time multidirectional feedback and encouraging knowledge and skill transfer. The success of the ECHO model depends on training interprofessional healthcare providers in behaviors needed to lead a teleECHO clinic and to collaborate in the educational process. While building a community of practice, Mock ECHO provides a safe opportunity for a diverse group of clinician experts to practice learned skills and receive feedback from coparticipants and facilitators.

Toward a new paradigm in hospital-based pediatric education: the development of an onsite simulator program.

PubMed

Weinstock, Peter H; Kappus, Liana J; Kleinman, Monica E; Grenier, Barry; Hickey, Patricia; Burns, Jeffrey P

2005-11-01

The low incidence of crises in pediatrics, coupled with logistic issues and restricted work hours for trainees, hinders opportunities for frequent practice of crisis management and teamwork skills. We hypothesized that a dedicated simulator suite contiguous to the intensive care unit (ICU) would enhance the frequency and breadth of critical-incident training for a range of clinicians. Descriptive study. A tertiary-care pediatric teaching hospital. A realistic pediatric simulator suite was constructed 100 feet from the ICU, at a total base cost of $290,000. The simulation room is an exact replica of an ICU bed space, incorporating high-fidelity mannequin simulators. To capture an even wider audience, a portable unit was also created. Leaders from seven departments-critical care, cardiac intensive care, emergency medicine, transport medicine, anesthesia, respiratory care, and general pediatrics-completed instructor training to ensure effective debriefing techniques. Pediatric staff, including 100% of critical care fellows, 86% of nurses, 90% of respiratory therapists, and 74% of pediatric house staff, participated in >1500 learning encounters per year. All individuals were trained during their normal workday in the hospital. Courses in crisis resource management, skills acquisition, annual review, orientation, and trauma management (1,116, 98, 90, 60, and 60 encounters per year, respectively) were all designed by a multidisciplinary committee to ensure goal-directed education to a range of audiences. Annual costs were on par with those at other centers (approximately 44 dollars per trainee encounter). An onsite and comprehensive simulation program can significantly increase the opportunities for clinicians from multiple disciplines, in the course of their daily routines, to repetitively practice responses to pediatric medical crises. After an initial capital investment, the training appears to be cost-effective. Hospital-based simulator suites may point the way forward as a new paradigm for the effective education of today's busy clinicians.

Simulation in the Executive Suite: Lessons Learned for Building Patient Safety Leadership.

PubMed

Rosen, Michael A; Goeschel, Christine A; Che, Xin-Xuan; Fawole, Joseph Oluyinka; Rees, Dianne; Curran, Rosemary; Gelinas, Lillee; Martin, Jessica N; Kosel, Keith C; Pronovost, Peter J; Weaver, Sallie J

2015-12-01

Simulation is a powerful learning tool for building individual and team competencies of frontline health care providers with demonstrable impact on performance. This article examines the impact of simulation in building strategic leadership competencies for patient safety and quality among executive leaders in health care organizations. We designed, implemented, and evaluated a simulation as part of a larger safety leadership network meeting for executive leaders. This simulation targeted knowledge competencies of governance priority, culture of continuous improvement, and internal transparency and feedback. Eight teams of leaders in health care organizations-a total of 55 participants-participated in a 4-hour session. Each team performed collectively as a new chief executive officer (CEO) tasked with a goal of rescuing a hospital with a failing safety record. Teams worked on a modifiable simulation board reflecting the current dysfunctional organizational structure of the simulated hospital. They assessed and redesigned accountability structures based on information acquired in encounter sessions with confederates playing the role of internal staff and external consultants. Data were analyzed, and results are presented as qualitative themes arising from the simulation exercise, participant reaction data, and performance during the simulation. Key findings include high degrees of variability in solutions developed for the dysfunctional hospital system and generally positive learner reactions to the simulation experience. This study illustrates the potential value of simulation as a mechanism for learning and strategy development for executive leaders grappling with patient safety issues. Future research should explore the cognitive or functional fidelity of organizational simulations and the use of custom scenarios for strategic planning.

Piloting Augmented Reality Technology to Enhance Realism in Clinical Simulation.

PubMed

Vaughn, Jacqueline; Lister, Michael; Shaw, Ryan J

2016-09-01

We describe a pilot study that incorporated an innovative hybrid simulation designed to increase the perception of realism in a high-fidelity simulation. Prelicensure students (N = 12) cared for a manikin in a simulation lab scenario wearing Google Glass, a wearable head device that projected video into the students' field of vision. Students reported that the simulation gave them confidence that they were developing skills and knowledge to perform necessary tasks in a clinical setting and that they met the learning objectives of the simulation. The video combined visual images and cues seen in a real patient and created a sense of realism the manikin alone could not provide.

Objective measures of situation awareness in a simulated medical environment

PubMed Central

Wright, M; Taekman, J; Endsley, M

2004-01-01

One major limitation in the use of human patient simulators is a lack of objective, validated measures of human performance. Objective measures are necessary if simulators are to be used to evaluate the skills and training of medical practitioners and teams or to evaluate the impact of new processes or equipment design on overall system performance. Situation awareness (SA) refers to a person's perception and understanding of their dynamic environment. This awareness and comprehension is critical in making correct decisions that ultimately lead to correct actions in medical care settings. An objective measure of SA may be more sensitive and diagnostic than traditional performance measures. This paper reviews a theory of SA and discusses the methods required for developing an objective measure of SA within the context of a simulated medical environment. Analysis and interpretation of SA data for both individual and team performance in health care are also presented. PMID:15465958

Use of discrete event simulation to improve a mental health clinic.

PubMed

Kim, Bo; Elstein, Yisraela; Shiner, Brian; Konrad, Renata; Pomerantz, Andrew S; Watts, Bradley V

2013-01-01

To improve clinic design, trial-and-error is commonly used to discover strategies that lead to improvement. Our goal was to predict the effects of various changes before undertaking them. Systems engineers collaborated with staff at an integrated primary care-mental health care clinic to create a computer simulation that mirrored how the clinic currently operates. We then simulated hypothetical changes to the staffing to understand their effects on percentage of patients seen outside scheduled clinic hours and service completion time. We found that, out of the change options being considered by the clinic, extending daily clinic hours by two and including an additional psychiatrist are likely to result in the greatest incremental decreases in patients seen outside clinic hours and in service time. Simulation in partnership with engineers can be an attractive tool for improving mental health clinics, particularly when changes are costly and thus trial-and-error is not desirable. © 2013.

Selecting a dynamic simulation modeling method for health care delivery research-part 2: report of the ISPOR Dynamic Simulation Modeling Emerging Good Practices Task Force.

PubMed

Marshall, Deborah A; Burgos-Liz, Lina; IJzerman, Maarten J; Crown, William; Padula, William V; Wong, Peter K; Pasupathy, Kalyan S; Higashi, Mitchell K; Osgood, Nathaniel D

2015-03-01

In a previous report, the ISPOR Task Force on Dynamic Simulation Modeling Applications in Health Care Delivery Research Emerging Good Practices introduced the fundamentals of dynamic simulation modeling and identified the types of health care delivery problems for which dynamic simulation modeling can be used more effectively than other modeling methods. The hierarchical relationship between the health care delivery system, providers, patients, and other stakeholders exhibits a level of complexity that ought to be captured using dynamic simulation modeling methods. As a tool to help researchers decide whether dynamic simulation modeling is an appropriate method for modeling the effects of an intervention on a health care system, we presented the System, Interactions, Multilevel, Understanding, Loops, Agents, Time, Emergence (SIMULATE) checklist consisting of eight elements. This report builds on the previous work, systematically comparing each of the three most commonly used dynamic simulation modeling methods-system dynamics, discrete-event simulation, and agent-based modeling. We review criteria for selecting the most suitable method depending on 1) the purpose-type of problem and research questions being investigated, 2) the object-scope of the model, and 3) the method to model the object to achieve the purpose. Finally, we provide guidance for emerging good practices for dynamic simulation modeling in the health sector, covering all aspects, from the engagement of decision makers in the model design through model maintenance and upkeep. We conclude by providing some recommendations about the application of these methods to add value to informed decision making, with an emphasis on stakeholder engagement, starting with the problem definition. Finally, we identify areas in which further methodological development will likely occur given the growing "volume, velocity and variety" and availability of "big data" to provide empirical evidence and techniques such as machine learning for parameter estimation in dynamic simulation models. Upon reviewing this report in addition to using the SIMULATE checklist, the readers should be able to identify whether dynamic simulation modeling methods are appropriate to address the problem at hand and to recognize the differences of these methods from those of other, more traditional modeling approaches such as Markov models and decision trees. This report provides an overview of these modeling methods and examples of health care system problems in which such methods have been useful. The primary aim of the report was to aid decisions as to whether these simulation methods are appropriate to address specific health systems problems. The report directs readers to other resources for further education on these individual modeling methods for system interventions in the emerging field of health care delivery science and implementation. Copyright © 2015. Published by Elsevier Inc.

Nonspecialty Nurse Education: Evaluation of the Oncology Intensives Initiative, an Oncology Curriculum to Improve Patient Care

PubMed

Bagley, Kimberly A; Dunn, Sarah E; Chuang, Eliseu Y; Dorr, Victoria J; Thompson, Julie A; Smith, Sophia K

2018-04-01

A community hospital combined its medical and surgical patients with cancer on one unit, which resulted in nurses not trained in oncology caring for this patient population. The Oncology Intensives Initiative (ONCii) involved the (a) design and implementation of a daylong didactic boot camp class and a four-hour simulation session and (b) the examination of nurses' worries, attitudes, self-efficacy, and perception of interdisciplinary teamwork. A two-group, pre-/post-test design was implemented. Group 1 consisted of nurses who attended the didactic boot camp classes alone, whereas group 2 was comprised of nurses who attended the didactic boot camp classes and the simulation sessions. Results of data analysis showed a decrease in worries and an increase in positive attitudes toward chemotherapy administration in both groups, as well as an increase in self-efficacy among members of group 2.

Effects of High Fidelity Simulation on Knowledge Acquisition, Self-Confidence, and Satisfaction with Baccalaureate Nursing Students Using the Solomon-Four Research Design

ERIC Educational Resources Information Center

Hall, Rachel Mattson

2013-01-01

High Fidelity Simulation is a teaching strategy that is becoming well-entrenched in the world of nursing education and is rapidly expanding due to the challenges and demands of the health care environment. The problem addressed in this study is the conflicting research results regarding the effectiveness of HFS for students' knowledge acquisition…

Using Patient Case Video Vignettes to Improve Students' Understanding of Cross-cultural Communication.

PubMed

Arif, Sally; Cryder, Brian; Mazan, Jennifer; Quiñones-Boex, Ana; Cyganska, Angelika

2017-04-01

Objective. To develop, implement, and assess whether simulated patient case videos improve students' understanding of and attitudes toward cross-cultural communication in health care. Design. Third-year pharmacy students (N=159) in a health care communications course participated in a one-hour lecture and two-hour workshop on the topic of cross-cultural communication. Three simulated pharmacist-patient case vignettes highlighting cross-cultural communication barriers, the role of active listening, appropriate use of medical interpreters, and useful models to overcome communication barriers were viewed and discussed in groups of 20 students during the workshop. Assessment. A pre-lecture and post-workshop assessed the effect on students' understanding of and attitudes toward cross-cultural communication. Understanding of cross-cultural communication concepts increased significantly, as did comfort level with providing cross-cultural care. Conclusion. Use of simulated patient case videos in conjunction with an interactive workshop improved pharmacy students' understanding of and comfort level with cross-cultural communication skills and can be useful tools for cultural competency training in the curriculum.

The role of simulation in continuing medical education for acute care physicians: a systematic review.

PubMed

Khanduja, P Kristina; Bould, M Dylan; Naik, Viren N; Hladkowicz, Emily; Boet, Sylvain

2015-01-01

We systematically reviewed the effectiveness of simulation-based education, targeting independently practicing qualified physicians in acute care specialties. We also describe how simulation is used for performance assessment in this population. Data source included: DataMEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL Database of Controlled Trials, and National Health Service Economic Evaluation Database. The last date of search was January 31, 2013. All original research describing simulation-based education for independently practicing physicians in anesthesiology, critical care, and emergency medicine was reviewed. Data analysis was performed in duplicate with further review by a third author in cases of disagreement until consensus was reached. Data extraction was focused on effectiveness according to Kirkpatrick's model. For simulation-based performance assessment, tool characteristics and sources of validity evidence were also collated. Of 39 studies identified, 30 studies focused on the effectiveness of simulation-based education and nine studies evaluated the validity of simulation-based assessment. Thirteen studies (30%) targeted the lower levels of Kirkpatrick's hierarchy with reliance on self-reporting. Simulation was unanimously described as a positive learning experience with perceived impact on clinical practice. Of the 17 remaining studies, 10 used a single group or "no intervention comparison group" design. The majority (n = 17; 44%) were able to demonstrate both immediate and sustained improvements in educational outcomes. Nine studies reported the psychometric properties of simulation-based performance assessment as their sole objective. These predominantly recruited independent practitioners as a convenience sample to establish whether the tool could discriminate between experienced and inexperienced operators and concentrated on a single aspect of validity evidence. Simulation is perceived as a positive learning experience with limited evidence to support improved learning. Future research should focus on the optimal modality and frequency of exposure, quality of assessment tools and on the impact of simulation-based education beyond the individuals toward improved patient care.

Facilitating Tough Conversations: Using an Innovative Simulation-Primed Qualitative Inquiry in Pediatric Research.

PubMed

Wong, Ambrose H; Tiyyagura, Gunjan K; Dodington, James M; Hawkins, Bonnie; Hersey, Denise; Auerbach, Marc A

Deep exploration of a complex health care issue in pediatrics might be hindered by the sensitive or infrequent nature of a particular topic in pediatrics. Health care simulation builds on constructivist theories to guide individuals through an experiential cycle of action, self-reflection, and open discussion, but has traditionally been applied to the educational domain in health sciences. Leveraging the emotional activation of a simulated experience, investigators can prime participants to engage in open dialogue for the purposes of qualitative research. The framework of simulation-primed qualitative inquiry consists of 3 main iterative steps. First, researchers determine applicability by consideration of the need for an exploratory approach and potential to enrich data through simulation priming of participants. Next, careful attention is needed to design the simulation, with consideration of medium, technology, theoretical frameworks, and quality to create simulated reality relevant to the research question. Finally, data collection planning consists of a qualitative approach and method selection, with particular attention paid to psychological safety of subjects participating in the simulation. A literature review revealed 37 articles that used this newly described method across a variety of clinical and educational research topics and used a spectrum of simulation modalities and qualitative methods. Although some potential limitations and pitfalls might exist with regard to resources, fidelity, and psychological safety under the auspices of educational research, simulation-primed qualitative inquiry can be a powerful technique to explore difficult topics when subjects might experience vulnerability or hesitation. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Instructional design affects the efficacy of simulation-based training in central venous catheterization.

PubMed

Craft, Christopher; Feldon, David F; Brown, Eric A

2014-05-01

Simulation-based learning is a common educational tool in health care training and frequently involves instructional designs based on Experiential Learning Theory (ELT). However, little research explores the effectiveness and efficiency of different instructional design methodologies appropriate for simulations. The aim of this study was to compare 2 instructional design models, ELT and Guided Experiential Learning (GEL), to determine which is more effective for training the central venous catheterization procedure. Using a quasi-experimental randomized block design, nurse anesthetists completed training under 1 of the 2 instructional design models. Performance was assessed using a checklist of central venous catheterization performance, pass rates, and critical action errors. Participants in the GEL condition performed significantly better than those in the ELT condition on the overall checklist score after controlling for individual practice time (F[1, 29] = 4.021, P = .027, Cohen's d = .71), had higher pass rates (P = .006, Cohen's d = 1.15), and had lower rates of failure due to critical action errors (P = .038, Cohen's d = .81). The GEL model of instructional design is significantly more effective than ELT for simulation-based learning of the central venous catheterization procedure, yielding large differences in effect size. Copyright © 2014 Elsevier Inc. All rights reserved.

MACHETE: Environment for Space Networking Evaluation

NASA Technical Reports Server (NTRS)

Jennings, Esther H.; Segui, John S.; Woo, Simon

2010-01-01

Space Exploration missions requires the design and implementation of space networking that differs from terrestrial networks. In a space networking architecture, interplanetary communication protocols need to be designed, validated and evaluated carefully to support different mission requirements. As actual systems are expensive to build, it is essential to have a low cost method to validate and verify mission/system designs and operations. This can be accomplished through simulation. Simulation can aid design decisions where alternative solutions are being considered, support trade-studies and enable fast study of what-if scenarios. It can be used to identify risks, verify system performance against requirements, and as an initial test environment as one moves towards emulation and actual hardware implementation of the systems. We describe the development of Multi-mission Advanced Communications Hybrid Environment for Test and Evaluation (MACHETE) and its use cases in supporting architecture trade studies, protocol performance and its role in hybrid simulation/emulation. The MACHETE environment contains various tools and interfaces such that users may select the set of tools tailored for the specific simulation end goal. The use cases illustrate tool combinations for simulating space networking in different mission scenarios. This simulation environment is useful in supporting space networking design for planned and future missions as well as evaluating performance of existing networks where non-determinism exist in data traffic and/or link conditions.

The Role of Transfer in Designing Games and Simulations for Health: Systematic Review.

PubMed

Kuipers, Derek A; Terlouw, Gijs; Wartena, Bard O; van 't Veer, Job Tb; Prins, Jelle T; Pierie, Jean Pierre En

2017-11-24

The usefulness and importance of serious games and simulations in learning and behavior change for health and health-related issues are widely recognized. Studies have addressed games and simulations as interventions, mostly in comparison with their analog counterparts. Numerous complex design choices have to be made with serious games and simulations for health, including choices that directly contribute to the effects of the intervention. One of these decisions is the way an intervention is expected to lead to desirable transfer effects. Most designs adopt a first-class transfer rationale, whereas the second class of transfer types seems a rarity in serious games and simulations for health. This study sought to review the literature specifically on the second class of transfer types in the design of serious games and simulations. Focusing on game-like interventions for health and health care, this study aimed to (1) determine whether the second class of transfer is recognized as a road for transfer in game-like interventions, (2) review the application of the second class of transfer type in designing game-like interventions, and (3) assess studies that include second-class transfer types reporting transfer outcomes. A total of 6 Web-based databases were systematically searched by titles, abstracts, and keywords using the search strategy (video games OR game OR games OR gaming OR computer simulation*) AND (software design OR design) AND (fidelity OR fidelities OR transfer* OR behaviour OR behavior). The databases searched were identified as relevant to health, education, and social science. A total of 15 relevant studies were included, covering a range of game-like interventions, all more or less mentioning design parameters aimed at transfer. We found 9 studies where first-class transfer was part of the design of the intervention. In total, 8 studies dealt with transfer concepts and fidelity types in game-like intervention design in general; 3 studies dealt with the concept of second-class transfer types and reported effects, and 2 of those recognized transfer as a design parameter. In studies on game-like interventions for health and health care, transfer is regarded as a desirable effect but not as a basic principle for design. None of the studies determined the second class of transfer or instances thereof, although in 3 cases a nonliteral transfer type was present. We also found that studies on game-like interventions for health do not elucidate design choices made and rarely provide design principles for future work. Games and simulations for health abundantly build upon the principles of first-class transfer, but the adoption of second-class transfer types proves scarce. It is likely to be worthwhile to explore the possibilities of second-class transfer types, as they may considerably influence educational objectives in terms of future serious game design for health. ©Derek A Kuipers, Gijs Terlouw, Bard O Wartena, Job TB van 't Veer, Jelle T Prins, Jean Pierre EN Pierie. Originally published in JMIR Serious Games (http://games.jmir.org), 24.11.2017.

Assessment of Delirium in Intensive Care Unit Patients: Educational Strategies.

PubMed

Smith, Judith M; Van Aman, M Nancy; Schneiderhahn, Mary Elizabeth; Edelman, Robin; Ercole, Patrick M

2017-05-01

Delirium is an acute brain dysfunction associated with poor outcomes in intensive care unit (ICU) patients. Critical care nurses play an important role in the prevention, detection, and management of delirium, but they must be able to accurately assess for it. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument is a reliable and valid method to assess for delirium, but research reveals most nurses need practice to use it proficiently. A pretest-posttest design was used to evaluate the success of a multimodal educational strategy (i.e., online learning module coupled with standardized patient simulation experience) on critical care nurses' knowledge and confidence to assess and manage delirium using the CAM-ICU. Participants (N = 34) showed a significant increase (p < .001) in confidence in their ability to assess and manage delirium following the multimodal education. No statistical change in knowledge of delirium existed following the education. A multimodal educational strategy, which included simulation, significantly added confidence in critical care nurses' performance using the CAM-ICU. J Contin Nurs Educ. 2017;48(5):239-244. Copyright 2017, SLACK Incorporated.

Can Broader Diffusion of Value-Based Insurance Design Increase Benefits from US Health Care without Increasing Costs? Evidence from a Computer Simulation Model

PubMed Central

Scott Braithwaite, R.; Omokaro, Cynthia; Justice, Amy C.; Nucifora, Kimberly; Roberts, Mark S.

2010-01-01

Background Evidence suggests that cost sharing (i.e.,copayments and deductibles) decreases health expenditures but also reduces essential care. Value-based insurance design (VBID) has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs. Methods and Findings We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1) applying VBID solely to pharmacy benefits and (2) applying VBID to both pharmacy benefits and other health care services (e.g., devices). We assumed that cost sharing would be eliminated for high-value services (<$100,000 per life-year), would remain unchanged for intermediate- or unknown-value services ($100,000–$300,000 per life-year or unknown), and would be increased for low-value services (>$300,000 per life-year). All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80%) of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase. Conclusion Broader diffusion of VBID may amplify benefits from US health care without increasing health expenditures. Please see later in the article for the Editors' Summary PMID:20169114

Strengthening Cultural Competence in Prenatal Care With a Virtual Community: Building Capacity Through Collaboration.

PubMed

Weideman, Yvonne L; Young, Lisa; Lockhart, Joan Such; Grund, Faye J; Fridline, Mark M; Panas, Marie

2016-01-01

The purpose of this project was to design, implement, and evaluate a virtual simulation experience (VSE) facilitating student access to diverse cultures and strengthening their ability to provide culturally congruent care. Faculty from two universities collaborated in designing a pre/postnatal VSE with African American and Amish patients. Students viewed patient assessments, interacted with patients, worked in teams to develop culturally appropriate care plans, and engaged in debriefing. Outcomes measurements included Jeffreys' Transcultural Self-Efficacy Test (TSET), researcher developed care plans, and program evaluation. Over 80% (N=141) of the invited students consented. Significant increases occurred in overall and subscale post-TSET scores (P<.001). Care plan mean scores were ≥8.82 out of 10 points per category. Students recognized the need to be nonjudgmental in patient care. This study suggests that VSEs are effective in transcending geographic barriers, gaining access to diverse cultures, and strengthening students' cultural competence. Copyright © 2016 Elsevier Inc. All rights reserved.

Development of an Antimicrobial Stewardship-based Infectious Diseases Elective that Incorporates Human Patient Simulation Technology

PubMed Central

Meyer, Susan M.

2014-01-01

Objective. To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. Design. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Assessment. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. Conclusion. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs. PMID:25386016

Use of the Inverse Approach for the Manufacture and Decoration of Food Cans

NASA Astrophysics Data System (ADS)

Duffett, G. A.; Forgas, A.; Neamtu, L.; Naceur, H.; Batoz, J. L.; Guo, Y. Q.

2005-08-01

Innovation is a key objective in the metal packaging industry in order to produce new concepts, designs, shapes and printing. Simulation technology now allows both the can design as well as the manufacturing process to be carefully analysed before any physical prototypes or dies have been manufactured. These simulations are traditionally carried out using incremental simulation methodologies. However, much information may also be attained by using the inverse approach: the initial blank format for the can body as well as its lid may be optimised much faster, the actual decoration of the can may be evaluated and even calculated when deformation printing techniques are utilised. This paper presents some of the technical details relating to the inverse approach employed in Stampack to carry out simulations important for the manufacture of food cans that are shown via industrial.

Current concepts in simulation-based trauma education.

PubMed

Cherry, Robert A; Ali, Jameel

2008-11-01

The use of simulation-based technology in trauma education has focused on providing a safe and effective alternative to the more traditional methods that are used to teach technical skills and critical concepts in trauma resuscitation. Trauma team training using simulation-based technology is also being used to develop skills in leadership, team-information sharing, communication, and decision-making. The integration of simulators into medical student curriculum, residency training, and continuing medical education has been strongly recommended by the American College of Surgeons as an innovative means of enhancing patient safety, reducing medical errors, and performing a systematic evaluation of various competencies. Advanced human patient simulators are increasingly being used in trauma as an evaluation tool to assess clinical performance and to teach and reinforce essential knowledge, skills, and abilities. A number of specialty simulators in trauma and critical care have also been designed to meet these educational objectives. Ongoing educational research is still needed to validate long-term retention of knowledge and skills, provide reliable methods to evaluate teaching effectiveness and performance, and to demonstrate improvement in patient safety and overall quality of care.

Simulation of transient effects in the heavy ion fusion injectors

NASA Astrophysics Data System (ADS)

Chen, Yu-Jiuan; Hewett, D. W.

1993-05-01

We have used the 2-D PIC code, GYMNOS, to study the transient behaviors in the Heavy Ion Fusion (HIF) injectors. GYMNOS simulations accurately provide the steady state Child-Langmuir current and the beam transient behavior within a planar diode. The simulations of the LBL HIF ESAC injector experiments agree well with the experimental data and EGUN steady state results. Simulations of the nominal HIF injectors have revealed the need to design the accelerating electrodes carefully to control the ion beam current, particularly the ion loss at the end of the bunch as the extraction voltage is reduced.

Evaluation of cognitive load and emotional states during multidisciplinary critical care simulation sessions.

PubMed

Pawar, Swapnil; Jacques, Theresa; Deshpande, Kush; Pusapati, Raju; Meguerdichian, Michael J

2018-04-01

The simulation in critical care setting involves a heterogeneous group of participants with varied background and experience. Measuring the impacts of simulation on emotional state and cognitive load in this setting is not often performed. The feasibility of such measurement in the critical care setting needs further exploration. Medical and nursing staff with varying levels of experience from a tertiary intensive care unit participated in a standardised clinical simulation scenario. The emotional state of each participant was assessed before and after completion of the scenario using a validated eight-item scale containing bipolar oppositional descriptors of emotion. The cognitive load of each participant was assessed after the completion of the scenario using a validated subjective rating tool. A total of 103 medical and nursing staff participated in the study. The participants felt more relaxed (-0.28±1.15 vs 0.14±1, P<0.005; d=0.39), excited (0.25±0.89 vs 0.55±0.92, P<0.005, d=0.35) and alert (0.85±0.87 vs 1.28±0.73, P<0.00001, d=0.54) following simulation. There was no difference in the mean scores for the remaining five items. The mean cognitive load for all participants was 6.67±1.41. There was no significant difference in the cognitive loads among medical staff versus nursing staff (6.61±2.3 vs 6.62±1.7; P>0.05). A well-designed complex high fidelity critical care simulation scenario can be evaluated to identify the relative cognitive load of the participants' experience and their emotional state. The movement of learners emotionally from a more negative state to a positive state suggests that simulation can be an effective tool for improved knowledge transfer and offers more opportunity for dynamic thinking.

Developing a Simulation to Study Conflict in Intensive Care Units

PubMed Central

Chiarchiaro, Jared; Schuster, Rachel A.; Ernecoff, Natalie C.; Barnato, Amber E.; Arnold, Robert M.

2015-01-01

Rationale: Although medical simulation is increasingly being used in healthcare education, there are few examples of how to rigorously design a simulation to evaluate and study important communication skills of intensive care unit (ICU) clinicians. Objectives: To use existing best practice recommendations to develop a medical simulation to study conflict management in ICUs, then assess the feasibility, acceptability, and realism of the simulation among ICU clinicians. Methods: The setting was a medical ICU of a tertiary care, university hospital. Participants were 36 physicians who treat critically ill patients: intensivists, palliative medicine specialists, and trainees. Using best-practice guidelines and an iterative, multidisciplinary approach, we developed and refined a simulation involving a critically ill patient, in which the patient had a clear advance directive specifying no use of life support, and a surrogate who was unwilling to follow the patient’s preferences. ICU clinicians participated in the simulation and completed surveys and semistructured interviews to assess the feasibility, acceptability, and realism of the simulation. Measurements and Main Results: All participants successfully completed the simulation, and all perceived conflict with the surrogate (mean conflict score, 4.2 on a 0–10 scale [SD, 2.5; range, 1–10]). Participants reported high realism of the simulation across a range of criteria, with mean ratings of greater than 8 on a 0 to 10 scale for all domains assessed. During semistructured interviews, participants confirmed a high degree of realism and offered several suggestions for improvements. Conclusions: We used existing best practice recommendations to develop a simulation model to study physician–family conflict in ICUs that is feasible, acceptable, and realistic. PMID:25643166

Nurse students learning acute care by simulation - Focus on observation and debriefing.

PubMed

Abelsson, Anna; Bisholt, Birgitta

2017-05-01

Simulation creates the possibility to experience acute situations during nursing education which cannot easily be achieved in clinical settings. To describe how nursing students learn acute care of patients through simulation exercises, based on observation and debriefing. The study was designed as an observational study inspired by an ethnographic approach. Data was collected through observations and interviews. Data was analyzed using an interpretive qualitative content analysis. Nursing students created space for reflection when needed. There was a positive learning situation when suitable patient scenarios were presented. Observations and discussions with peers gave the students opportunities to identify their own need for knowledge, while also identifying existing knowledge. Reflections could confirm or reject their preparedness for clinical practice. The importance of working in a structured manner in acute care situations became apparent. However, negative feedback to peers was avoided, which led to a loss of learning opportunity. High fidelity simulation training as a method plays an important part in the nursing students' learning. The teacher also plays a key role by asking difficult questions and guiding students towards accurate knowledge. This makes it possible for the students to close knowledge gaps, leading to improved patient safety. Copyright © 2017 Elsevier Ltd. All rights reserved.

Design of a 100 MW X-band klystron

NASA Astrophysics Data System (ADS)

Eppley, Kenneth

1989-02-01

Future linear colliders will require klystrons with higher peak power at higher frequency than are currently in use. SLAC is currently designing a 100 MW klystron at 11.4 GHz as a prototype for such a tube. The gun has been designed for 440 kV and 510 amps. Transporting this beam through a 5 mm radius X-band drift tube presents the major design problem. The area convergence ratio of 190 to one is over ten times higher than is found in conventional klystrons. Even with high magnetic fields of 6 to 7 kilogauss careful matching is required to prevent excessive scalloping. Extensive EGUN and CONDOR simulations have been made to optimize the transmission and RF efficiency. The EGUN simulations indicate that better matching is possible by using resonant magnetic focusing. CONDOR calculations indicate efficiencies of 45 percent are possible with a double output cavity. We will discuss the results of the simulations and the status of the experimental program.

Conflict Management Strategies in the ICU Differ Between Palliative Care Specialists and Intensivists

PubMed Central

Chiarchiaro, Jared; White, Douglas B.; Ernecoff, Natalie C.; Buddadhumaruk, Praewpannarai; Schuster, Rachel A.; Arnold, Robert M.

2016-01-01

OBJECTIVE Conflict is common between physicians and surrogate decision makers around end-of-life care in intensive care units (ICU). Involving experts in conflict management improve outcomes, but little is known about what differences in conflict management styles may explain the benefit. We used simulation to examine potential differences in how palliative care specialists manage conflict with surrogates about end-of-life treatment decisions in ICUs compared with intensivists. DESIGN Subjects participated in a high-fidelity simulation of conflict with a surrogate in an ICU. In this simulation, a medical actor portrayed a surrogate decision maker during an ICU family meeting who refuses to follow an advance directive that clearly declines advanced life-sustaining therapies. We audio-recorded the simulation encounters and applied a coding framework to quantify conflict management behaviors, which was organized into two categories: task-focused communication and relationship-building. We used negative binomial modeling to determine whether there were differences between palliative care specialists’ and intensivists’ use of task-focused communication and relationship building. SETTING Single academic medical center ICU PARTICIPANTS Palliative care specialists and intensivists INTERVENTIONS none MEASUREMENTS and MAIN RESULTS We enrolled 11 palliative care specialists and 25 intensivists. The palliative care specialists were all attending physicians. The intensivist group consisted of 11 attending physicians, 9 pulmonary and critical care fellows, and 5 internal medicine residents rotating in the intensive care unit. We excluded the 5 residents from the primary analysis in order to reduce confounding due to training level. Physicians’ mean age was 37 years with a mean of 8 years in practice. Palliative care specialists used 55% fewer task-focused communication statements (Incidence Rate Ratio 0.55, 95% CI 0.36–0.83, p= 0.005) and 48% more relationship building statements (Incidence Rate Ratio 1.48, 95% CI 0.89–2.46, p=0.13) compared with intensivists. CONCLUSIONS We found that palliative care specialists engage in less task-focused communication when managing conflict with surrogates compared to intensivists. These differences may help explain the benefit of palliative care involvement in conflict and could be the focus of interventions to improve clinicians’ conflict resolution skills. PMID:26765500

Design and evaluation of a wireless electronic health records system for field care in mass casualty settings.

PubMed

Lenert, L A; Kirsh, D; Griswold, W G; Buono, C; Lyon, J; Rao, R; Chan, T C

2011-01-01

There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD). WIISARD combined advanced networking technology with electronic triage tags that reported victims' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds. WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:53-1:05:32 vs 18:55-57:22). Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters.

Design and evaluation of a wireless electronic health records system for field care in mass casualty settings

PubMed Central

Kirsh, D; Griswold, W G; Buono, C; Lyon, J; Rao, R; Chan, T C

2011-01-01

Background There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD). Materials and methods WIISARD combined advanced networking technology with electronic triage tags that reported victims' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds. Results WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:53–1:05:32 vs 18:55–57:22). Conclusion Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters. PMID:21709162

Successes and Challenges of Interprofessional Physiologic Birth and Obstetric Emergency Simulations in a Nurse-Midwifery Education Program.

PubMed

Shaw-Battista, Jenna; Belew, Cynthia; Anderson, Deborah; van Schaik, Sandrijn

2015-01-01

This article describes childbirth simulation design and implementation within the nurse-midwifery education program at the University of California, San Francisco. Nurse-midwife and obstetrician faculty coordinators were supported by faculty from multiple professions and specialties in curriculum review and simulation development and implementation. The primary goal of the resulting technology-enhanced simulations of normal physiologic birth and obstetric emergencies was to assist learners' development of interprofessional competencies related to communication, teamwork, and patient-centered care. Trainees included nurse-midwifery students; residents in obstetrics, pediatrics, and family medicine; medical students; and advanced practice nursing students in pediatrics. The diversity of participant types and learning levels provided benefits and presented challenges to effective scenario-based simulation design among numerous other theoretical and logistical considerations. This project revealed practical solutions informed by emerging health sciences and education research literature, faculty experience, and formal course evaluations by learners. Best practices in simulation development and implementation were incorporated, including curriculum revision grounded in needs assessment, case- and event-based clinical scenarios, optimization of fidelity, and ample time for participant debriefing. Adequate preparation and attention to detail increased the immersive experience and benefits of simulation. Suggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings. Pre- and postsimulation measurements of knowledge, skills, and attitudes are ongoing and not reported. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. © 2015 by the American College of Nurse-Midwives.

Simulation as a Tool to Facilitate Practice Changes in Teams Taking Care of Patients Under Investigation for Ebola Virus Disease in Spain.

PubMed

Rojo, Elena; Oruña, Clara; Sierra, Dolores; García, Gema; Del Moral, Ignacio; Maestre, Jose M

2016-04-01

We analyzed the impact of simulation-based training on clinical practice and work processes on teams caring for patients with possible Ebola virus disease (EVD) in Cantabria, Spain. The Government of Spain set up a special committee for the management of EVD, and the Spanish Ministry of Health and foreign health services created an action protocol. Each region is responsible for selecting a reference hospital and an in-house care team to care for patients under investigation. Laboratory-confirmed cases of EVD have to be transferred to the Carlos III Health Institute in Madrid. Predeployment training and follow-up support are required to help personnel work safely and effectively. Simulation-based scenarios were designed to give staff the opportunity to practice before encountering a real-life situation. Lessons learned by each team during debriefings were listed, and a survey administered 3 months later assessed the implementation of practice and system changes. Implemented changes were related to clinical practice (eg, teamwork principles application), protocol implementation (eg, addition of new processes and rewriting of confusing parts), and system and workflow (eg, change of shift schedule and rearrangement of room equipment). Simulation can be used to detect needed changes in protocol or guidelines or can be adapted to meet the needs of a specific team.

Design and implementation of a simulation exercise for teaching confidentiality of patient information.

PubMed

Snyder, J R

1982-05-01

Allied health students, making the transition from a purely academic to a professional school setting, are suddenly faced with judgment decisions about disclosure of medical information. Obscure guidelines and new interpersonal relationships with other members of the health care team complicate this transition and pose a threat to confidentiality of patient information. This article describes the design and implementation of a simulation exercise to reinforce lecture guidelines specifying disclosure of medical information without risk to the patient or student. The simulation is comprised of 10 critical incidents calling for responses ranging from logical to judgmental. Although written primarily for medical technologists, with emphasis on limitations governing release of patient laboratory data, the simulation approach is presented here as a model for other allied health professions. The use of a latent image format provides learners with positive or negative reinforcement as they learn the consequences of their decisions. The simulation activity described is easily adapted to small group discussion or computer-assisted instruction. While the simulation appears to be an accurate representation of reality, peer and real-life pressures could not be totally simulated.

The impact of peer-led simulations on student nurses.

PubMed

Valler-Jones, Tracey

Simulation within nurse education has been widely accepted as an educational approach. However, this is mainly led by the facilitator with the student maintaining a passive role in the learning. This paper describes a study that was undertaken to analyse the effectiveness of peer-led simulations in the undergraduate nursing programme. A mixed-method approach was used for this study design. This study took place in a simulation suite within a university in the Midlands. Twenty four second-year child branch students were purposively selected to take part. Students designed and facilitated a simulation based on the care of a critically ill child. Formal assessment of the learning was collected via the use of a structured clinical examination. Students completed an evaluation of their perceived confidence and competence levels. There was 100% pass rate in the assessment of students' clinical competence following the simulation. Thematic analysis of the evaluation highlighted the learning achieved by the students, not only of their clinical skills but also their personal development. The use of peer-led simulation promotes new learning and is a valuable educational approach.

Development of an antimicrobial stewardship-based infectious diseases elective that incorporates human patient simulation technology.

PubMed

Falcione, Bonnie A; Meyer, Susan M

2014-10-15

To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs.

A System Dynamics Approach to Modeling the Sensitivity of Inappropriate Emergency Department Utilization

NASA Astrophysics Data System (ADS)

Behr, Joshua G.; Diaz, Rafael

Non-urgent Emergency Department utilization has been attributed with increasing congestion in the flow and treatment of patients and, by extension, conditions the quality of care and profitability of the Emergency Department. Interventions designed to divert populations to more appropriate care may be cautiously received by operations managers due to uncertainty about the impact an adopted intervention may have on the two values of congestion and profitability. System Dynamics (SD) modeling and simulation may be used to measure the sensitivity of these two, often-competing, values of congestion and profitability and, thus, provide an additional layer of information designed to inform strategic decision making.

Using Patient Case Video Vignettes to Improve Students’ Understanding of Cross-cultural Communication

PubMed Central

Cryder, Brian; Mazan, Jennifer; Quiñones-Boex, Ana; Cyganska, Angelika

2017-01-01

Objective. To develop, implement, and assess whether simulated patient case videos improve students’ understanding of and attitudes toward cross-cultural communication in health care. Design. Third-year pharmacy students (N=159) in a health care communications course participated in a one-hour lecture and two-hour workshop on the topic of cross-cultural communication. Three simulated pharmacist-patient case vignettes highlighting cross-cultural communication barriers, the role of active listening, appropriate use of medical interpreters, and useful models to overcome communication barriers were viewed and discussed in groups of 20 students during the workshop. Assessment. A pre-lecture and post-workshop assessed the effect on students’ understanding of and attitudes toward cross-cultural communication. Understanding of cross-cultural communication concepts increased significantly, as did comfort level with providing cross-cultural care. Conclusion. Use of simulated patient case videos in conjunction with an interactive workshop improved pharmacy students' understanding of and comfort level with cross-cultural communication skills and can be useful tools for cultural competency training in the curriculum. PMID:28496276

Specialty Payment Model Opportunities and Assessment: Oncology Simulation Report.

PubMed

White, Chapin; Chan, Chris; Huckfeldt, Peter J; Kofner, Aaron; Mulcahy, Andrew W; Pollak, Julia; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

2015-07-15

This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis-$960 total per six-month episode-represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices' Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced.

Therapeutic touch and agitation in individuals with Alzheimer's disease.

PubMed

Hawranik, Pamela; Johnston, Pat; Deatrich, Judith

2008-06-01

Limited effective strategies exist to alleviate or treat disruptive behaviors in people with Alzheimer's disease. Fifty-one residents of a long-term care facility with Alzheimer's disease were randomly assigned to one of three intervention groups. A multiple time series, blinded, experimental design was used to compare the effectiveness of therapeutic touch, simulated therapeutic touch, and usual care on disruptive behavior. Three forms of disruptive behavior comprised the dependent variables: physical aggression, physical nonaggression, and verbal agitation. Physical nonaggressive behaviors decreased significantly in those residents who received therapeutic touch compared with those who received the simulated version and the usual care. No significant differences in physically aggressive and verbally agitated behaviors were observed across the three study groups. The study provided preliminary evidence for the potential for therapeutic touch in dealing with agitated behaviors by people with dementia. Researchers and practitioners must consider a broad array of strategies to deal with these behaviors.

Reliability and maintainability assessment factors for reliable fault-tolerant systems

NASA Technical Reports Server (NTRS)

Bavuso, S. J.

1984-01-01

A long term goal of the NASA Langley Research Center is the development of a reliability assessment methodology of sufficient power to enable the credible comparison of the stochastic attributes of one ultrareliable system design against others. This methodology, developed over a 10 year period, is a combined analytic and simulative technique. An analytic component is the Computer Aided Reliability Estimation capability, third generation, or simply CARE III. A simulative component is the Gate Logic Software Simulator capability, or GLOSS. The numerous factors that potentially have a degrading effect on system reliability and the ways in which these factors that are peculiar to highly reliable fault tolerant systems are accounted for in credible reliability assessments. Also presented are the modeling difficulties that result from their inclusion and the ways in which CARE III and GLOSS mitigate the intractability of the heretofore unworkable mathematics.

Assessment of immigrant certified nursing assistants' communication when responding to standardized care challenges.

PubMed

Massey, Meredith; Roter, Debra L

2016-01-01

Certified nursing assistants (CNAs) provide 80% of the hands-on care in US nursing homes; a significant portion of this work is performed by immigrants with limited English fluency. This study is designed to assess immigrant CNA's communication behavior in response to a series of virtual simulated care challenges. A convenience sample of 31 immigrant CNAs verbally responded to 9 care challenges embedded in an interactive computer platform. The responses were coded with the Roter Interaction Analysis System (RIAS), CNA instructors rated response quality and spoken English was rated. CNA communication behaviors varied across care challenges and a broad repertoire of communication was used; 69% of response content was characterized as psychosocial. Communication elements (both instrumental and psychosocial) were significant predictors of response quality for 5 of 9 scenarios. Overall these variables explained between 13% and 36% of the adjusted variance in quality ratings. Immigrant CNAs responded to common care challenges using a variety of communication strategies despite fluency deficits. Virtual simulation-based observation is a feasible, acceptable and low cost method of communication assessment with implications for supervision, training and evaluation of a para-professional workforce. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Design and implementation of a hospital-based usability laboratory: insights from a Department of Veterans Affairs laboratory for health information technology.

PubMed

Russ, Alissa L; Weiner, Michael; Russell, Scott A; Baker, Darrell A; Fahner, W Jeffrey; Saleem, Jason J

2012-12-01

Although the potential benefits of more usable health information technologies (HIT) are substantial-reduced HIT support costs, increased work efficiency, and improved patient safety--human factors methods to improve usability are rarely employed. The US Department of Veterans Affairs (VA) has emerged as an early leader in establishing usability laboratories to inform the design of HIT, including its electronic health record. Experience with a usability laboratory at a VA Medical Center provides insights on how to design, implement, and leverage usability laboratories in the health care setting. The VA Health Services Research and Development Service Human-Computer Interaction & Simulation Laboratory emerged as one of the first VA usability laboratories and was intended to provide research-based findings about HIT designs. This laboratory supports rapid prototyping, formal usability testing, and analysis tools to assess existing technologies, alternative designs, and potential future technologies. RESULTS OF IMPLEMENTATION: Although the laboratory has maintained a research focus, it has become increasingly integrated with VA operations, both within the medical center and on a national VA level. With this resource, data-driven recommendations have been provided for the design of HIT applications before and after implementation. The demand for usability testing of HIT is increasing, and information on how to develop usability laboratories for the health care setting is often needed. This article may assist other health care organizations that want to invest in usability resources to improve HIT. The establishment and utilization of usability laboratories in the health care setting may improve HIT designs and promote safe, high-quality care for patients.

Interdisciplinary Development of an Improved Emergency Department Procedural Work Surface Through Iterative Design and Use Testing in Simulated and Clinical Environments.

PubMed

Zhang, Xiao C; Bermudez, Ana M; Reddy, Pranav M; Sarpatwari, Ravi R; Chheng, Darin B; Mezoian, Taylor J; Schwartz, Victoria R; Simmons, Quinneil J; Jay, Gregory D; Kobayashi, Leo

2017-03-01

A stable and readily accessible work surface for bedside medical procedures represents a valuable tool for acute care providers. In emergency department (ED) settings, the design and implementation of traditional Mayo stands and related surface devices often limit their availability, portability, and usability, which can lead to suboptimal clinical practice conditions that may affect the safe and effective performance of medical procedures and delivery of patient care. We designed and built a novel, open-source, portable, bedside procedural surface through an iterative development process with use testing in simulated and live clinical environments. The procedural surface development project was conducted between October 2014 and June 2016 at an academic referral hospital and its affiliated simulation facility. An interdisciplinary team of emergency physicians, mechanical engineers, medical students, and design students sought to construct a prototype bedside procedural surface out of off-the-shelf hardware during a collaborative university course on health care design. After determination of end-user needs and core design requirements, multiple prototypes were fabricated and iteratively modified, with early variants featuring undermattress stabilizing supports or ratcheting clamp mechanisms. Versions 1 through 4 underwent 2 hands-on usability-testing simulation sessions; version 5 was presented at a design critique held jointly by a panel of clinical and industrial design faculty for expert feedback. Responding to select feedback elements over several surface versions, investigators arrived at a near-final prototype design for fabrication and use testing in a live clinical setting. This experimental procedural surface (version 8) was constructed and then deployed for controlled usability testing against the standard Mayo stands in use at the study site ED. Clinical providers working in the ED who opted to participate in the study were provided with the prototype surface and just-in-time training on its use when performing bedside procedures. Subjects completed the validated 10-point System Usability Scale postshift for the surface that they had used. The study protocol was approved by the institutional review board. Multiple prototypes and recursive design revisions resulted in a fully functional, portable, and durable bedside procedural surface that featured a stainless steel tray and intuitive hook-and-lock mechanisms for attachment to ED stretcher bed rails. Forty-two control and 40 experimental group subjects participated and completed questionnaires. The median System Usability Scale score (out of 100; higher scores associated with better usability) was 72.5 (interquartile range [IQR] 51.3 to 86.3) for the Mayo stand; the experimental surface was scored at 93.8 (IQR 84.4 to 97.5 for a difference in medians of 17.5 (95% confidence interval 10 to 27.5). Subjects reported several usability challenges with the Mayo stand; the experimental surface was reviewed as easy to use, simple, and functional. In accordance with experimental live environment deployment, questionnaire responses, and end-user suggestions, the project team finalized the design specification for the experimental procedural surface for open dissemination. An iterative, interdisciplinary approach was used to generate, evaluate, revise, and finalize the design specification for a new procedural surface that met all core end-user requirements. The final surface design was evaluated favorably on a validated usability tool against Mayo stands when use tested in simulated and live clinical settings. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

A Handy Preterm Infant Incubator for Providing Intensive Care: Simulation, 3D Printed Prototype, and Evaluation.

PubMed

Zaylaa, Amira J; Rashid, Mohamad; Shaib, Mounir; El Majzoub, Imad

2018-01-01

Preterm infants encounter an abrupt delivery before their complete maturity during the third trimester of pregnancy. Polls anticipate an increase in the rates of preterm infants for 2025, especially in middle- and low-income countries. Despite the abundance of intensive care methods for preterm infants, such as, but not limited to, commercial, transport, embrace warmer, radiant warmer, and Kangaroo Mother Care methods, they are either expensive, lack the most essential requirements or specifications, or lack the maternal-preterm bond. This drove us to carry this original research and innovative idea of developing a new 3D printed prototype of a Handy preterm infant incubator. We aim to provide the most indispensable intensive care with the lowest cost, to bestow low-income countries with the Handy incubator's care, preserve the maternal -preterm's bond, and diminish the rate of mortality. Biomedical features, electronics, and biocompatible materials were utilized. The design was simulated, the prototype was 3D printed, and the outcomes were tested and evaluated. Simulation results showed the best fit for the Handy incubator's components. Experimental results showed the 3D-printed prototype and the time elapsed to obtain it. Evaluation results revealed that the overall performance of Kangaroo Mother Care and the embrace warmer was 75 ± 1.4% and 66.7 ± 1.5%, respectively, while the overall performance of our Handy incubator was 91.7 ± 1.6%, thereby our cost-effective Handy incubator surpassed existing intensive care methods. The future step is associating the Handy incubator with more specifications and advancements.

Using Simulated Patients to Teach Clinical Nutrition.

ERIC Educational Resources Information Center

Carroll, J. Gregory; And Others

1983-01-01

"Clinical Nutrition in an Interdisciplinary Setting" is a course designed to introduce basic nutrition knowledge and concepts of nutritional assessment, counseling, and intervention in the clinical care of patients. Provides a brief course overview and descriptions of its development, use, and preliminary evaluation of the patient simulation…

Design of a multi-arm randomized clinical trial with no control arm.

PubMed

Magaret, Amalia; Angus, Derek C; Adhikari, Neill K J; Banura, Patrick; Kissoon, Niranjan; Lawler, James V; Jacob, Shevin T

2016-01-01

Clinical trial designs that include multiple treatments are currently limited to those that perform pairwise comparisons of each investigational treatment to a single control. However, there are settings, such as the recent Ebola outbreak, in which no treatment has been demonstrated to be effective; and therefore, no standard of care exists which would serve as an appropriate control. For illustrative purposes, we focused on the care of patients presenting in austere settings with critically ill 'sepsis-like' syndromes. Our approach involves a novel algorithm for comparing mortality among arms without requiring a single fixed control. The algorithm allows poorly-performing arms to be dropped during interim analyses. Consequently, the study may be completed earlier than planned. We used simulation to determine operating characteristics for the trial and to estimate the required sample size. We present a potential study design targeting a minimal effect size of a 23% relative reduction in mortality between any pair of arms. Using estimated power and spurious significance rates from the simulated scenarios, we show that such a trial would require 2550 participants. Over a range of scenarios, our study has 80 to 99% power to select the optimal treatment. Using a fixed control design, if the control arm is least efficacious, 640 subjects would be enrolled into the least efficacious arm, while our algorithm would enroll between 170 and 430. This simulation method can be easily extended to other settings or other binary outcomes. Early dropping of arms is efficient and ethical when conducting clinical trials with multiple arms. Copyright © 2015 Elsevier Inc. All rights reserved.

Partially coherent wavefront propagation simulations: Mirror and monochromator crystal quality assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wiegart, L., E-mail: lwiegart@bnl.gov; Fluerasu, A.; Chubar, O.

2016-07-27

We have applied fully-and partially-coherent synchrotron radiation wavefront propagation simulations, implemented in the “Synchrotron Radiation Workshop” (SRW) computer code, to analyse the effects of imperfect mirrors and monochromator at the Coherent Hard X-ray beamline. This beamline is designed for X-ray Photon Correlation Spectroscopy, a technique that heavily relies on the partial coherence of the X-ray beam and benefits from a careful preservation of the X-ray wavefront. We present simulations and a comparison with the measured beam profile at the sample position, which show the impact of imperfect optics on the wavefront.

Veterans’ Preferences for Exchanging Information Using Veterans Affairs Health Information Technologies: Focus Group Results and Modeling Simulations

PubMed Central

Chavez, Margeaux; Nazi, Kim; Antinori, Nicole; Melillo, Christine; Cotner, Bridget A; Hathaway, Wendy; Cook, Ashley; Wilck, Nancy; Noonan, Abigail

2017-01-01

Background The Department of Veterans Affairs (VA) has multiple health information technology (HIT) resources for veterans to support their health care management. These include a patient portal, VetLink Kiosks, mobile apps, and telehealth services. The veteran patient population has a variety of needs and preferences that can inform current VA HIT redesign efforts to meet consumer needs. Objective This study aimed to describe veterans’ experiences using the current VA HIT and identify their vision for the future of an integrated VA HIT system. Methods Two rounds of focus group interviews were conducted with a single cohort of 47 veterans and one female caregiver recruited from Bedford, Massachusetts, and Tampa, Florida. Focus group interviews included simulation modeling activities and a self-administered survey. This study also used an expert panel group to provide data and input throughout the study process. High-fidelity, interactive simulations were created and used to facilitate collection of qualitative data. The simulations were developed based on system requirements, data collected through operational efforts, and participants' reported preferences for using VA HIT. Pairwise comparison activities of HIT resources were conducted with both focus groups and the expert panel. Rapid iterative content analysis was used to analyze qualitative data. Descriptive statistics summarized quantitative data. Results Data themes included (1) current use of VA HIT, (2) non-VA HIT use, and (3) preferences for future use of VA HIT. Data indicated that, although the Secure Messaging feature was often preferred, a full range of HIT options are needed. These data were then used to develop veteran-driven simulations that illustrate user needs and expectations when using a HIT system and services to access VA health care services. Conclusions Patient participant redesign processes present critical opportunities for creating a human-centered design. Veterans value virtual health care options and prefer standardized, integrated, and synchronized user-friendly interface designs. PMID:29061553

Clinical simulation practise framework.

PubMed

Khalili, Hossein

2015-02-01

Historically, simulation has mainly been used to teach students hands-on skills in a relatively safe environment. With changes in the patient population, professional regulations and clinical environments, clinical simulation practise (CSP) must assist students to integrate and apply their theoretical knowledge and skills with their critical thinking, clinical judgement, prioritisation, problem solving, decision making, and teamwork skills to provide holistic care and treatment to their patients. CSP holds great potential to derive a positive transformation in students' transition into the workplace, by associating and consolidating learning from classrooms to clinical settings, and creating bridges between theory and practice. For CSP to be successful in filling the gap, the design and management of the simulation is crucial. In this article a new framework called 'Clinical simulation practise framework: A knowledge to action strategy in health professional education' is being introduced that aims to assist educators and curriculum developers in designing and managing their simulations. This CSP framework theorises that simulation as an experiential educational tool could improve students' competence, confidence and collaboration in performing professional practice in real settings if the CSP provides the following three dimensions: (1) a safe, positive, reflective and fun simulated learning environment; (2) challenging, but realistic, and integrated simulated scenarios; and (3) interactive, inclusive, interprofessional patient-centred simulated practise. © 2015 John Wiley & Sons Ltd.

Hybrid power systems for autonomous MEMS

NASA Astrophysics Data System (ADS)

Bennett, Daniel M.; Selfridge, Richard H.; Humble, Paul; Harb, John N.

2001-08-01

This paper describes the design of a hybrid power system for use with autonomous MEMS and other microdevices. This hybrid power system includes energy conversion and storage along with an electronic system for managing the collection and distribution of power. It offers flexibility and longevity in a compact package. The hybrid power system couples a silicon solar cell with a microbattery specially designed for MEMS applications. We have designed a control/interface charging circuit to be compatible with a MEMS duty cycle. The design permits short pulses of 'high' power while taking care to avoid excessive charging or discharging of the battery. Charging is carefully controlled to provide a balance between acceptably small charging times and a charging profile that extends battery life. Our report describes the charging of our Ni/Zn microbatteries using solar cells. To date we have demonstrated thousands of charge/discharge cycles of a simulated MEMS duty cycle.

A Novel IEEE 802.15.4e DSME MAC for Wireless Sensor Networks

PubMed Central

Sahoo, Prasan Kumar; Pattanaik, Sudhir Ranjan; Wu, Shih-Lin

2017-01-01

IEEE 802.15.4e standard proposes Deterministic and Synchronous Multichannel Extension (DSME) mode for wireless sensor networks (WSNs) to support industrial, commercial and health care applications. In this paper, a new channel access scheme and beacon scheduling schemes are designed for the IEEE 802.15.4e enabled WSNs in star topology to reduce the network discovery time and energy consumption. In addition, a new dynamic guaranteed retransmission slot allocation scheme is designed for devices with the failure Guaranteed Time Slot (GTS) transmission to reduce the retransmission delay. To evaluate our schemes, analytical models are designed to analyze the performance of WSNs in terms of reliability, delay, throughput and energy consumption. Our schemes are validated with simulation and analytical results and are observed that simulation results well match with the analytical one. The evaluated results of our designed schemes can improve the reliability, throughput, delay, and energy consumptions significantly. PMID:28275216

A Novel IEEE 802.15.4e DSME MAC for Wireless Sensor Networks.

PubMed

Sahoo, Prasan Kumar; Pattanaik, Sudhir Ranjan; Wu, Shih-Lin

2017-01-16

IEEE 802.15.4e standard proposes Deterministic and Synchronous Multichannel Extension (DSME) mode for wireless sensor networks (WSNs) to support industrial, commercial and health care applications. In this paper, a new channel access scheme and beacon scheduling schemes are designed for the IEEE 802.15.4e enabled WSNs in star topology to reduce the network discovery time and energy consumption. In addition, a new dynamic guaranteed retransmission slot allocation scheme is designed for devices with the failure Guaranteed Time Slot (GTS) transmission to reduce the retransmission delay. To evaluate our schemes, analytical models are designed to analyze the performance of WSNs in terms of reliability, delay, throughput and energy consumption. Our schemes are validated with simulation and analytical results and are observed that simulation results well match with the analytical one. The evaluated results of our designed schemes can improve the reliability, throughput, delay, and energy consumptions significantly.

Cognitive Tools for Assessment and Learning in a High Information Flow Environment.

ERIC Educational Resources Information Center

Lajoie, Susanne P.; Azevedo, Roger; Fleiszer, David M.

1998-01-01

Describes the development of a simulation-based intelligent tutoring system for nurses working in a surgical intensive care unit. Highlights include situative learning theories and models of instruction, modeling expertise, complex decision making, linking theories of learning to the design of computer-based learning environments, cognitive task…

Assessment of the Ability of the Health Care Provider to Detect Manifestations Indicative of TBI Management of care for TBI Through the Utilization of High Fidelity Simulation

DTIC Science & Technology

2015-09-01

position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting...to be tested in the research study were: Hypothesis 1. The study participants will be able to identify the manifestations for patients with traumatic...brain injuries in pre and post evaluation measures. Hypothesis 2. The study participants will have an increased rate of the identification of

Opportunities and pitfalls in clinical proof-of-concept: principles and examples.

PubMed

Chen, Chao

2018-04-01

Clinical proof-of-concept trials crucially inform major resource deployment decisions. This paper discusses several mechanisms for enhancing their rigour and efficiency. The importance of careful consideration when using a surrogate endpoint is illustrated; situational effectiveness of run-in patient enrichment is explored; a versatile tool is introduced to ensure a strong pharmacological underpinning; the benefits of dose-titration are revealed by simulation; and the importance of adequately scheduled observations is shown. The general process of model-based trial design and analysis is described and several examples demonstrate the value in historical data, simulation-guided design, model-based analysis and trial adaptation informed by interim analysis. Copyright © 2018 Elsevier Ltd. All rights reserved.

Let's get honest about sampling.

PubMed

Mobley, David L

2012-01-01

Molecular simulations see widespread and increasing use in computation and molecular design, especially within the area of molecular simulations applied to biomolecular binding and interactions, our focus here. However, force field accuracy remains a concern for many practitioners, and it is often not clear what level of accuracy is really needed for payoffs in a discovery setting. Here, I argue that despite limitations of today's force fields, current simulation tools and force fields now provide the potential for real benefits in a variety of applications. However, these same tools also provide irreproducible results which are often poorly interpreted. Continued progress in the field requires more honesty in assessment and care in evaluation of simulation results, especially with respect to convergence.

An agent based simulation tool for scheduling emergency department physicians.

PubMed

Jones, Spencer S; Evans, R Scott

2008-11-06

Emergency department overcrowding is a problem that threatens the public health of communities and compromises the quality of care given to individual patients. The Institute of Medicine recommends that hospitals employ information technology and operations research methods to reduce overcrowding. This paper describes the development of an agent based simulation tool that has been designed to evaluate the impact of various physician staffing configurations on patient waiting times in the emergency department. We evaluate the feasibility of this tool at a single hospital emergency department.

Simulation-Based Communication Skills Training for Experienced Clinicians to Improve Family Conversations About Organ and Tissue Donation.

PubMed

Potter, Julie Elizabeth; Gatward, Jonathan J; Kelly, Michelle A; McKay, Leigh; McCann, Ellie; Elliott, Rosalind M; Perry, Lin

2017-12-01

The approach, communication skills, and confidence of clinicians responsible for raising deceased organ donation may influence families' donation decisions. The aim of this study was to increase the preparedness and confidence of intensive care clinicians allocated to work in a "designated requester" role. We conducted a posttest evaluation of an innovative simulation-based training program. Simulation-based training enabled clinicians to rehearse the "balanced approach" to family donation conversations (FDCs) in the designated requester role. Professional actors played family members in simulated clinical settings using authentic scenarios, with video-assisted reflective debriefing. Participants completed an evaluation after the workshop. Simple descriptive statistical analysis and content analysis were performed. Between January 2013 and July 2015, 25 workshops were undertaken with 86 participants; 82 (95.3%) returned evaluations. Respondents were registered practicing clinicians; over half (44/82; 53.7%) were intensivists. Most attended a single workshop. Evaluations were overwhelmingly positive with the majority rating workshops as outstanding (64/80; 80%). Scenario fidelity, competence of the actors, opportunity to practice and receive feedback on performance, and feedback from actors, both in and out of character, were particularly valued. Most (76/78; 97.4%) reported feeling more confident about their designated requester role. Simulation-based communication training for the designated requester role in FDCs increased the knowledge and confidence of clinicians to raise the topic of donation.

Bridging burn care education with modern technology, an integration with high fidelity human patient simulation.

PubMed

Reeves, Patrick T; Borgman, Matthew A; Caldwell, Nicole W; Patel, Leela; Aden, James; Duggan, John P; Serio-Melvin, Maria L; Mann-Salinas, Elizabeth A

2018-08-01

The Advanced Burn Life Support (ABLS) program is a burn-education curriculum nearly 30 years in the making, focusing on the unique challenges of the first 24h of care after burn injury. Our team applied high fidelity human patient simulation (HFHPS) to the established ABLS curriculum. Our hypothesis was that HFHPS would be a feasible, easily replicable, and valuable adjunct to the current curriculum that would enhance learner experience. This prospective, evidenced-based practice project was conducted in a single simulation center employing the American Burn Association's ABLS curriculum using HFHPS. Participants managed 7 separate simulated polytrauma and burn scenarios with resultant clinical complications. After training, participants completed written and practical examinations as well as satisfaction surveys. From 2012 to 2013, 71 students participated in this training. Simulation (ABLS-Sim) participants demonstrated a 2.5% increase in written post-test scores compared to traditional ABLS Provider Course (ABLS Live) (p=0.0016). There was no difference in the practical examination when comparing ABLS-Sim versus ABLS Live. Subjectively, 60 (85%) participants completed surveys. The Educational Practice Questionnaire showed best practices rating of 4.5±0.7; with importance of learning rated at 4.4±0.8. The Simulation Design Scale rating for design was 4.6±0.6 with an importance rating of 4.4±0.8. Overall Satisfaction and Self-Confidence with Learning were 4.4±0.7 and 4.5±0.7, respectfully. Integrating HFHPS with the current ABLS curriculum led to higher written exam scores, high levels of confidence, satisfaction, and active learning, and presented an evidenced-based model for education that is easily employable for other facilities nationwide. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

EM Talk: communication skills training for emergency medicine patients with serious illness.

PubMed

Grudzen, Corita R; Emlet, Lillian L; Kuntz, Joanne; Shreves, Ashley; Zimny, Erin; Gang, Maureen; Schaulis, Monique; Schmidt, Scott; Isaacs, Eric; Arnold, Robert

2016-06-01

The emergency department visit for a patient with serious illness represents a sentinel event, signalling a change in the illness trajectory. By better understanding patient and family wishes, emergency physicians can reinforce advance care plans and ensure the hospital care provided matches the patient's values. Despite their importance in care at the end of life, emergency physicians have received little training on how to talk to seriously ill patients and their families about goals of care. To expand communication skills training to emergency medicine, we developed a programme to give emergency medicine physicians the ability to empathically deliver serious news and to talk about goals of care. We have built on lessons from prior studies to design an intervention employing the most effective pedagogical techniques, including the use of simulated patients/families, role-playing and small group learning with constructive feedback from master clinicians. Here, we describe our evidence-based communication skills training course EM Talk using simulation, reflective feedback and deliberate practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Nursing students' experiences of being video-recorded during examination in a fictive emergency care situation.

PubMed

Nyström, Anita; Pålsson, Ylva; Hofsten, Anna; Häggström, Elisabeth

2014-10-01

Promoting undergraduate nursing students' learning in simulated care can be achieved through dynamic scenario-based training sessions that are documented using simple video equipment. One valuable aspect of this kind of training is the subsequent reflective dialogue that takes place between the teacher and the students during the examination. The aim of the present paper is to describe bachelor nursing students' experiences of being video-recorded during an examination with a simulated patient in emergency care. The study was descriptive in design and used a qualitative approach with written answers to open-ended questions; 44 undergraduate nursing students participated. A latent content analysis resulted in three themes: (i) visualization might cause nervousness at first; (ii) visualization promotes dialogue and acknowledgement; and (iii) visualization promotes increased self-knowledge and professional growth. The conclusion is that video-recording is a good way for undergraduate nursing students to develop skills in emergency care situations and to understand their own actions; it might also help them increase their self-knowledge. © 2013 Wiley Publishing Asia Pty Ltd.

Improving mixing efficiency of a polymer micromixer by use of a plastic shim divider

NASA Astrophysics Data System (ADS)

Li, Lei; Lee, L. James; Castro, Jose M.; Yi, Allen Y.

2010-03-01

In this paper, a critical modification to a polymer based affordable split-and-recombination static micromixer is described. To evaluate the improvement, both the original and the modified design were carefully investigated using an experimental setup and numerical modeling approach. The structure of the micromixer was designed to take advantage of the process capabilities of both ultraprecision micromachining and microinjection molding process. Specifically, the original and the modified design were numerically simulated using commercial finite element method software ANSYS CFX to assist the re-designing of the micromixers. The simulation results have shown that both designs are capable of performing mixing while the modified design has a much improved performance. Mixing experiments with two different fluids were carried out using the original and the modified mixers again showed a significantly improved mixing uniformity by the latter. The measured mixing coefficient for the original design was 0.11, and for the improved design it was 0.065. The developed manufacturing process based on ultraprecision machining and microinjection molding processes for device fabrication has the advantage of high-dimensional precision, low cost and manufacturing flexibility.

Specialty Payment Model Opportunities and Assessment

PubMed Central

White, Chapin; Chan, Chris; Huckfeldt, Peter J.; Kofner, Aaron; Mulcahy, Andrew W.; Pollak, Julia; Popescu, Ioana; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis—$960 total per six-month episode—represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices’ Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced. PMID:28083365

Design of a Kaplan turbine for a wide range of operating head -Curved draft tube design and model test verification-

NASA Astrophysics Data System (ADS)

KO, Pohan; MATSUMOTO, Kiyoshi; OHTAKE, Norio; DING, Hua

2016-11-01

As for turbomachine off-design performance improvement is challenging but critical for maximising the performing area. In this paper, a curved draft tube for a medium head Kaplan type hydro turbine is introduced and discussed for its significant effect on expanding operating head range. Without adding any extra structure and working fluid for swirl destruction and damping, a carefully designed outline shape of draft tube with the selected placement of center-piers successfully supresses the growth of turbulence eddy and the transport of the swirl to the outlet. Also, more kinetic energy is recovered and the head lost is improved. Finally, the model test results are also presented. The obvious performance improvement was found in the lower net head area, where the maximum efficiency improvement was measured up to 20% without compromising the best efficiency point. Additionally, this design results in a new draft tube more compact in size and so leads to better construction and manufacturing cost performance for prototype. The draft tube geometry parameter designing process was concerning the best efficiency point together with the off-design points covering various water net heads and discharges. The hydraulic performance and flow behavior was numerically previewed and visualized by solving Reynolds-Averaged Navier-Stokes equations with Shear Stress Transport turbulence model. The simulation was under the assumption of steady-state incompressible turbulence flow inside the flow passage, and the inlet boundary condition was the carefully simulated flow pattern from the runner outlet. For confirmation, the corresponding turbine efficiency performance of the entire operating area was verified by model test.

Potential health benefits of simulated laughter: a narrative review of the literature and recommendations for future research.

PubMed

Mora-Ripoll, Ramon

2011-06-01

Scientific research has shown that laughter may have both preventive and therapeutic values. Health-related benefits of laughter are mainly reported from spontaneous laughter interventional studies. While the human mind can make a distinction between simulated and spontaneous laughter, the human body cannot. Either way health-related outcomes are deemed to be produced. Simulated laughter is thus a relatively under-researched treatment modality with potential health benefits. The aim of this review was firstly to identify, critically evaluate and summarize the laughter literature; secondly to assess to which extent simulated laughter health-related benefits are currently sustained by empirical evidence; and lastly to provide recommendations and future directions for further research. A comprehensive laughter literature search was performed. A list of inclusion and exclusion criteria was identified. Thematic analysis was applied to summarize laughter health-related outcomes, relationships, and general robustness. Laughter has shown different physiological and psychological benefits. Adverse effects are very limited and laughter is practically lacking in counter-indications. Despite the limited number of publications, there is some evidence to suggest that simulated laughter has also some effects on certain aspects of health, though further well-designed research is warranted. Simulated laughter techniques can be easily implemented in traditional clinical settings for health and patient care. Their effective use for therapeutic purposes needs to be learned, practiced, and developed as any other medical strategy. Practical guidelines and further research are needed to help health care professionals (and others) implement laughter techniques in their health care portfolio. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Innovation in healthcare processes and patient safety using clinical simulation].

PubMed

Rojo, E; Maestre, J M; Díaz-Mendi, A R; Ansorena, L; Del Moral, I

2016-01-01

Many excellent ideas are never implemented or generalised by healthcare organisations. There are two related paradigms: thinking that individuals primarily change through accumulating knowledge, and believing that the dissemination of that knowledge within the organisation is the key element to facilitate change. As an alternative, a description and evaluation of a simulation-based inter-professional team training program conducted in a Regional Health Service to promote and facilitate change is presented. The Department of Continuing Education completed the needs assessment using the proposals presented by clinical units and management. Skills and behaviors that could be learned using simulation were selected, and all personnel from the units participating were included. Experiential learning principles based on clinical simulation and debriefing, were used for the instructional design. The Kirkpatrick model was used to evaluate the program. Objectives included: a) decision-making and teamwork skills training in high prevalence diseases with a high rate of preventable complications; b) care processes reorganisation to improve efficiency, while maintaining patient safety; and, c) implementation of new complex techniques with a long learning curve, and high preventable complications rate. Thirty clinical units organised 39 training programs in the 3 public hospitals, and primary care of the Regional Health Service during 2013-2014. Over 1,559 healthcare professionals participated, including nursing assistants, nurses and physicians. Simulation in healthcare to train inter-professional teams can promote and facilitate change in patient care, and organisational re-engineering. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Simulating clinical trial visits yields patient insights into study design and recruitment.

PubMed

Lim, S Sam; Kivitz, Alan J; McKinnell, Doug; Pierson, M Edward; O'Brien, Faye S

2017-01-01

We elicited patient experiences from clinical trial simulations to aid in future trial development and to improve patient recruitment and retention. Two simulations of draft Phase II and Phase III anifrolumab studies for systemic lupus erythematosus (SLE)/lupus nephritis (LN) were performed involving African-American patients from Grady Hospital, an indigent care hospital in Atlanta, GA, USA, and white patients from Altoona Arthritis and Osteoporosis Center in Altoona, PA, USA. The clinical trial simulation included an informed consent procedure, a mock screening visit, a mock dosing visit, and a debriefing period for patients and staff. Patients and staff were interviewed to obtain sentiments and perceptions related to the simulated visits. The Atlanta study involved 6 African-American patients (5 female) aged 27-60 years with moderate to severe SLE/LN. The Altoona study involved 12 white females aged 32-75 years with mild to moderate SLE/LN. Patient experiences had an impact on four patient-centric care domains: 1) information, communication, and education; 2) responsiveness to needs; 3) access to care; and 4) coordination of care; and continuity and transition. Patients in both studies desired background material, knowledgeable staff, family and friend support, personal results, comfortable settings, shorter wait times, and greater scheduling flexibility. Compared with the Altoona study patients, Atlanta study patients reported greater preferences for information from the Internet, need for strong community and online support, difficulties in discussing SLE, emphasis on transportation and child care help during the visits, and concerns related to financial matters; and they placed greater importance on time commitment, understanding of potential personal benefit, trust, and confidentiality of patient data as factors for participation. Using these results, we present recommendations to improve study procedures to increase retention, recruitment, and compliance for clinical trials. Insights from these two studies can be applied to the development and implementation of future clinical trials to improve patient recruitment, retention, compliance, and advocacy.

Using cognitive task analysis to develop simulation-based training for medical tasks.

PubMed

Cannon-Bowers, Jan; Bowers, Clint; Stout, Renee; Ricci, Katrina; Hildabrand, Annette

2013-10-01

Pressures to increase the efficacy and effectiveness of medical training are causing the Department of Defense to investigate the use of simulation technologies. This article describes a comprehensive cognitive task analysis technique that can be used to simultaneously generate training requirements, performance metrics, scenario requirements, and simulator/simulation requirements for medical tasks. On the basis of a variety of existing techniques, we developed a scenario-based approach that asks experts to perform the targeted task multiple times, with each pass probing a different dimension of the training development process. In contrast to many cognitive task analysis approaches, we argue that our technique can be highly cost effective because it is designed to accomplish multiple goals. The technique was pilot tested with expert instructors from a large military medical training command. These instructors were employed to generate requirements for two selected combat casualty care tasks-cricothyroidotomy and hemorrhage control. Results indicated that the technique is feasible to use and generates usable data to inform simulation-based training system design. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

Training Pediatric Fellows in Palliative Care: A Pilot Comparison of Simulation Training and Didactic Education.

PubMed

Brock, Katharine E; Cohen, Harvey J; Sourkes, Barbara M; Good, Julie J; Halamek, Louis P

2017-10-01

Pediatric fellows receive little palliative care (PC) education and have few opportunities to practice communication skills. In this pilot study, we assessed (1) the relative effectiveness of simulation-based versus didactic education, (2) communication skill retention, and (3) effect on PC consultation rates. Thirty-five pediatric fellows in cardiology, critical care, hematology/oncology, and neonatology at two institutions enrolled: 17 in the intervention (simulation-based) group (single institution) and 18 in the control (didactic education) group (second institution). Intervention group participants participated in a two-day program over three months (three simulations and videotaped PC panel). Control group participants received written education designed to be similar in content and time. (1) Self-assessment questionnaires were completed at baseline, post-intervention and three months; mean between-group differences for each outcome measure were assessed. (2) External reviewers rated simulation-group encounters on nine communication domains. Within-group changes over time were assessed. (3) The simulation-based site's PC consultations were compared in the six months pre- and post-intervention. Compared to the control group, participants in the intervention group improved in self-efficacy (p = 0.003) and perceived adequacy of medical education (p < 0.001), but not knowledge (p = 0.20). Reviewers noted nonsustained improvement in four domains: relationship building (p = 0.01), opening discussion (p = 0.03), gathering information (p = 0.01), and communicating accurate information (p = 0.04). PC consultation rate increased 64%, an improvement when normalized to average daily census (p = 0.04). This simulation-based curriculum is an effective method for improving PC comfort, education, and consults. More frequent practice is likely needed to lead to sustained improvements in communication competence.

Risk adjustment alternatives in paying for behavioral health care under Medicaid.

PubMed Central

Ettner, S L; Frank, R G; McGuire, T G; Hermann, R C

2001-01-01

OBJECTIVE: To compare the performance of various risk adjustment models in behavioral health applications such as setting mental health and substance abuse (MH/SA) capitation payments or overall capitation payments for populations including MH/SA users. DATA SOURCES/STUDY DESIGN: The 1991-93 administrative data from the Michigan Medicaid program were used. We compared mean absolute prediction error for several risk adjustment models and simulated the profits and losses that behavioral health care carve outs and integrated health plans would experience under risk adjustment if they enrolled beneficiaries with a history of MH/SA problems. Models included basic demographic adjustment, Adjusted Diagnostic Groups, Hierarchical Condition Categories, and specifications designed for behavioral health. PRINCIPAL FINDINGS: Differences in predictive ability among risk adjustment models were small and generally insignificant. Specifications based on relatively few MH/SA diagnostic categories did as well as or better than models controlling for additional variables such as medical diagnoses at predicting MH/SA expenditures among adults. Simulation analyses revealed that among both adults and minors considerable scope remained for behavioral health care carve outs to make profits or losses after risk adjustment based on differential enrollment of severely ill patients. Similarly, integrated health plans have strong financial incentives to avoid MH/SA users even after adjustment. CONCLUSIONS: Current risk adjustment methodologies do not eliminate the financial incentives for integrated health plans and behavioral health care carve-out plans to avoid high-utilizing patients with psychiatric disorders. PMID:11508640

Design and implementation of a combined influenza immunization and tuberculosis screening campaign with simulation modelling.

PubMed

Heim, Joseph A; Huang, Hao; Zabinsky, Zelda B; Dickerson, Jane; Wellner, Monica; Astion, Michael; Cruz, Doris; Vincent, Jeanne; Jack, Rhona

2015-08-01

Design and implement a concurrent campaign of influenza immunization and tuberculosis (TB) screening for health care workers (HCWs) that can reduce the number of clinic visits for each HCW. A discrete-event simulation model was developed to support issues of resource allocation decisions in planning and operations phases. The campaign was compressed to100 days in 2010 and further compressed to 75 days in 2012 and 2013. With more than 5000 HCW arrivals in 2011, 2012 and 2013, the 14-day goal of TB results was achieved for each year and reduced to about 4 days in 2012 and 2013. Implementing a concurrent campaign allows less number of visiting clinics and the compressing of campaign length allows earlier immunization. The support of simulation modelling can provide useful evaluations of different configurations. © 2015 John Wiley & Sons, Ltd.

Timber management simulated field trip

Treesearch

Ronald M. Walters; Warren R. Bacon; Asa D. Twombly

1979-01-01

Timber Management techniques are changing the appearance of our nation's wildlands. Standard harvest practices often result in harsh visual impacts and public outcry. In some cases, subtle harvesting has been done, but without adequate thought as to what the visual result will be over time. Better visual results can be obtained by careful harvest design which...

Understanding the complexity of redesigning care around the clinical microsystem.

PubMed

Barach, P; Johnson, J K

2006-12-01

The microsystem is an organizing design construct in which social systems cut across traditional discipline boundaries. Because of its interdisciplinary focus, the clinical microsystem provides a conceptual and practical framework for simplifying complex organizations that deliver care. It also provides an important opportunity for organizational learning. Process mapping and microworld simulation may be especially useful for redesigning care around the microsystem concept. Process mapping, in which the core processes of the microsystem are delineated and assessed from the perspective of how the individual interacts with the system, is an important element of the continuous learning cycle of the microsystem and the healthcare organization. Microworld simulations are interactive computer based models that can be used as an experimental platform to test basic questions about decision making misperceptions, cause-effect inferences, and learning within the clinical microsystem. Together these tools offer the user and organization the ability to understand the complexity of healthcare systems and to facilitate the redesign of optimal outcomes.

Field Research and Parametric Analysis in a Medical-Surgical Unit.

PubMed

Nanda, Upali; Pati, Sipra; Nejati, Adeleh

2015-01-01

To study the workplace in a medical-surgical (med-surg) unit and to identify suboptimal environmental conditions that can be improved in the current unit and avoided in future design, through rapidly deployed field research and timely simulation. Literature emphasizes the importance of the healthcare workplace and the effect on patient outcomes. What is lacking are studies conducted on-site and used for immediate application in design to assess and improve workplace conditions. A rapidly deployed field research and simulation study was conducted in a 40-bed med-surg unit of a large healthcare system as part of the process of designing a new medical tower. Online surveys, systematic behavioral observations, semi-structured interviews, sound studies, and advanced spatial analysis through parametric modeling were conducted. The following created challenges for patient monitoring, care coordination, and management: (1) waste and variability in walking, (2) limited point-of-use access to supplies, (3) large distances traveled for minor tasks, and (4) low visibility and connectivity. The corridor is used as a workspace/communication hub. There is a distinct difference in beginning of day and night shift patterns and between walking "distance" and walking "sequence." There is a tendency for nurses to multitask, but a simulation exercise shows that for key tasks like medication delivery, multitasking may not always reduce walking distances. Co-location of medications, supplies, and nourishment; accommodation for work on wheels; and spatial and technological connectivity between care team and patients should be considered while designing a med-surg unit. Understanding the key activity sequences helps determine the proximity of spaces in relationship to patient rooms and each other. © The Author(s) 2015.

The future vision of simulation in health care

PubMed Central

Gaba, D

2004-01-01

Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. The diverse applications of simulation in health care can be categorised by 11 dimensions: aims and purposes of the simulation activity; unit of participation; experience level of participants; health care domain; professional discipline of participants; type of knowledge, skill, attitudes, or behaviours addressed; the simulated patient's age; technology applicable or required; site of simulation; extent of direct participation; and method of feedback used. Using simulation to improve safety will require full integration of its applications into the routine structures and practices of health care. The costs and benefits of simulation are difficult to determine, especially for the most challenging applications, where long term use may be required. Various driving forces and implementation mechanisms can be expected to propel simulation forward, including professional societies, liability insurers, health care payers, and ultimately the public. The future of simulation in health care depends on the commitment and ingenuity of the health care simulation community to see that improved patient safety using this tool becomes a reality. PMID:15465951

Using a medical simulation center as an electronic health record usability laboratory

PubMed Central

Landman, Adam B; Redden, Lisa; Neri, Pamela; Poole, Stephen; Horsky, Jan; Raja, Ali S; Pozner, Charles N; Schiff, Gordon; Poon, Eric G

2014-01-01

Usability testing is increasingly being recognized as a way to increase the usability and safety of health information technology (HIT). Medical simulation centers can serve as testing environments for HIT usability studies. We integrated the quality assurance version of our emergency department (ED) electronic health record (EHR) into our medical simulation center and piloted a clinical care scenario in which emergency medicine resident physicians evaluated a simulated ED patient and documented electronically using the ED EHR. Meticulous planning and close collaboration with expert simulation staff was important for designing test scenarios, pilot testing, and running the sessions. Similarly, working with information systems teams was important for integration of the EHR. Electronic tools are needed to facilitate entry of fictitious clinical results while the simulation scenario is unfolding. EHRs can be successfully integrated into existing simulation centers, which may provide realistic environments for usability testing, training, and evaluation of human–computer interactions. PMID:24249778

Integrating Sonography Training Into Undergraduate Medical Education: A Study of the Previous Exposure of One Institution's Incoming Residents.

PubMed

Day, James; Davis, Joshua; Riesenberg, Lee Ann; Heil, Daniel; Berg, Katherine; Davis, Robyn; Berg, Dale

2015-07-01

Sonography is a crucial and versatile tool within the field of medicine. Recent advancements in technology have led to increased use of point-of-care sonography. We designed a survey to assess prior point-of-care sonography training among incoming interns at an academic teaching hospital. In 2012 and 2013, we surveyed incoming interns (n = 154 and 145, respectively) regarding point-of-care sonography training received during medical school. The survey questions included formal didactic sessions, bedside instruction, and the use of simulation technology. One-fourth (26.3% in 2012 and 23.4% in 2013) of responding interns reported having never done an ultrasound scan at the bedside. In 2012 and 2013, 55.0% and 55.6% of respondents reported never having done an ultrasound scan in a simulation center, respectively. Interns agreed that sonography education should be provided during medical school. On average, interns disagreed with the statement that sonography should be taught in residency only. There was no significant difference in the sex or general previous experience with sonography across both intern classes. Point-of-care sonography is inconsistently taught in medical school. The interns in our study also thought that sonography education should begin in medical school, and sonography should be taught by using simulation and at the bedside. © 2015 by the American Institute of Ultrasound in Medicine.

Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting

PubMed Central

Harrison, Andrew M.; Thongprayoon, Charat; Aakre, Christopher A.; Jeng, Jack Y.; Dziadzko, Mikhail A.; Gajic, Ognjen; Pickering, Brian W.

2017-01-01

Background Electronic Health Record (EHR)-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored. Objective To test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system. Study Design In one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview. Results The alert acknowledgement rate from the severe sepsis alert system was 3% (N = 148) and 51% (N = 156) from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min (N = 5) and median 2 min (N = 80) from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers. Conclusion Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting. PMID:28316887

Implementation and Evaluation of a Team Simulation Training Program.

PubMed

Rice, Yvonne; DeLetter, Mary; Fryman, Lisa; Parrish, Evelyn; Velotta, Cathie; Talley, Cynthia

2016-01-01

Care of the trauma patient requires a well-coordinated intensive effort during the golden hour to optimize survival. We hypothesized that this program would improve knowledge, satisfaction, self-confidence, and simulated team performance. A pre-, post-test design with N = 7 BSN nurses, 21 years of age, less than 2 years of intensive care unit and nursing experience. Trauma intensive care unit, single-center academic Level 1 trauma center. Improvement was shown in perception of team structure (paired t test 13.71-12.57; p = .0001) and communication (paired t test 14.85-12.14; p = .009). Improvement was shown in observed situation monitoring (paired t test 17.42-25.28; p = .000), mutual support (paired t test 12.57-18.57; p = .000), and communication (paired t test 15.42-25.00; p = .001). A decrease was shown in attitudes of mutual support (paired t test 25.85-19.71; p = .04) and communication (paired t test 26.14-23.00; p = .001). Mean satisfaction scores were 21.5 of a possible 25 points. Mean self-confidence scores were 38.83 out of a possible 40 points. Simulation-based team training improved teamwork attitudes, perceptions, and performance. Team communication demonstrated significant improvement in 2 of the 3 instruments. Most participants agreed or strongly agreed that they were satisfied with simulation and had gained self-confidence.

Propagation of uncertainty in nasal spray in vitro performance models using Monte Carlo simulation: Part II. Error propagation during product performance modeling.

PubMed

Guo, Changning; Doub, William H; Kauffman, John F

2010-08-01

Monte Carlo simulations were applied to investigate the propagation of uncertainty in both input variables and response measurements on model prediction for nasal spray product performance design of experiment (DOE) models in the first part of this study, with an initial assumption that the models perfectly represent the relationship between input variables and the measured responses. In this article, we discard the initial assumption, and extended the Monte Carlo simulation study to examine the influence of both input variable variation and product performance measurement variation on the uncertainty in DOE model coefficients. The Monte Carlo simulations presented in this article illustrate the importance of careful error propagation during product performance modeling. Our results show that the error estimates based on Monte Carlo simulation result in smaller model coefficient standard deviations than those from regression methods. This suggests that the estimated standard deviations from regression may overestimate the uncertainties in the model coefficients. Monte Carlo simulations provide a simple software solution to understand the propagation of uncertainty in complex DOE models so that design space can be specified with statistically meaningful confidence levels. (c) 2010 Wiley-Liss, Inc. and the American Pharmacists Association

The usefulness of design of experimentation in defining the effect difficult airway factors and training have on simulator oral-tracheal intubation success rates in novice intubators.

PubMed

Thomas, Frank; Carpenter, Judi; Rhoades, Carol; Holleran, Renee; Snow, Gregory

2010-04-01

This exploratory study examined novice intubators and the effect difficult airway factors have on pre- and posttraining oral-tracheal simulation intubation success rates. Using a two-level, full-factorial design of experimentation (DOE) involving a combination of six airway factors (curved vs. straight laryngoscope blade, trismus, tongue edema, laryngeal spasm, pharyngeal obstruction, or cervical immobilization), 64 airway scenarios were prospectively randomized to 12 critical care nurses to evaluate pre- and posttraining first-pass intubation success rates on a simulator. Scenario variables and intubation outcomes were analyzed using a generalized linear mixed-effects model to determine two-way main and interactive effects. Interactive effects between the six study factors were nonsignificant (p = 0.69). For both pre- and posttraining, main effects showed the straight blade (p = 0.006), tongue edema (p = 0.0001), and laryngeal spasm (p = 0.004) significantly reduced success rates, while trismus (p = 0.358), pharyngeal obstruction (p = 0.078), and cervical immobilization did not significantly change the success rate. First-pass intubation success rate on the simulator significantly improved (p = 0.005) from pre- (19%) to posttraining (36%). Design of experimentation is useful in analyzing the effect difficult airway factors and training have on simulator intubation success rates. Future quality improvement DOE simulator research studies should be performed to help clarify the relationship between simulator factors and patient intubation rates.

Insurance Benefit Preferences of the Low-income Uninsured

PubMed Central

Danis, Marion; Biddle, Andrea K; Goold, Susan Dorr

2002-01-01

OBJECTIVE A frequently cited obstacle to universal insurance is the lack of consensus about what benefits to offer in an affordable insurance package. This study was conducted to assess the feasibility of providing uninsured patients the opportunity to define their own benefit package within cost constraints. DESIGN Structured group exercises SETTING Community setting PARTICIPANTS Uninsured individuals recruited from clinical and community settings in central North Carolina. MEASUREMENTS Insurance choices were measured using a simulation exercise, CHAT (Choosing Healthplans All Together). Participants designed managed care plans, individually and as groups, by selecting from 15 service categories having varied levels of restriction (e.g., formulary, copayments) within the constraints of a fixed monthly premium comparable to the typical per member/per month managed care premium paid by U.S. employers. MAIN RESULTS Two hundred thirty-four individuals who were predominantly male (70%), African American (55%), and socioeconomically disadvantaged (53% earned <$15,000 annually) participated in 22 groups and were able to design health benefit packages individually and in groups. All 22 groups chose to cover hospitalization, pharmacy, dental, and specialty care, and 21 groups chose primary care and mental health. Although individuals' choices differed from their groups' selections, 86% of participants were willing to abide by group choices. CONCLUSIONS Groups of low-income uninsured individuals are able to identify acceptable benefit packages that are comparable in cost but differ in benefit design from managed care contracts offered to many U.S. employees today. PMID:11841528

Nitinol Embolic Protection Filters: Design Investigation by Finite Element Analysis

NASA Astrophysics Data System (ADS)

Conti, Michele; de Beule, Matthieu; Mortier, Peter; van Loo, Denis; Verdonck, Pascal; Vermassen, Frank; Segers, Patrick; Auricchio, Ferdinando; Verhegghe, Benedict

2009-08-01

The widespread acceptance of carotid artery stenting (CAS) to treat carotid artery stenosis and its effectiveness compared with surgical counterpart, carotid endarterectomy (CEA), is still a matter of debate. Transient or permanent neurological deficits may develop in patients undergoing CAS due to distal embolization or hemodynamic changes. Design, development, and usage of embolic protection devices (EPDs), such as embolic protection filters, appear to have a significant impact on the success of CAS. Unfortunately, some drawbacks, such as filtering failure, inability to cross tortuous high-grade stenoses, malpositioning and vessel injury, still remain and require design improvement. Currently, many different designs of such devices are available on the rapidly growing dedicated market. In spite of such a growing commercial interest, there is a significant need for design tools as well as for careful engineering investigations and design analyses of such nitinol devices. The present study aims to investigate the embolic protection filter design by finite element analysis. We first developed a parametrical computer-aided design model of an embolic filter based on micro-CT scans of the Angioguard™ XP (Cordis Endovascular, FL) EPD by means of the open source pyFormex software. Subsequently, we used the finite element method to simulate the deployment of the nitinol filter as it exits the delivery sheath. Comparison of the simulations with micro-CT images of the real device exiting the catheter showed excellent correspondence with our simulations. Finally, we evaluated circumferential basket-vessel wall apposition of a 4 mm size filter in a straight vessel of different sizes and shape. We conclude that the proposed methodology offers a useful tool to evaluate and to compare current or new designs of EPDs. Further simulations will investigate vessel wall apposition in a realistic tortuous anatomy.

Using clinical simulation centers to test design interventions: a pilot study of lighting and color modifications.

PubMed

Gray, Whitney Austin; Kesten, Karen S; Hurst, Stephen; Day, Tama Duffy; Anderko, Laura

2012-01-01

The aim of this pilot study was to test design interventions such as lighting, color, and spatial color patterning on nurses' stress, alertness, and satisfaction, and to provide an example of how clinical simulation centers can be used to conduct research. The application of evidence-based design research in healthcare settings requires a transdisciplinary approach. Integrating approaches from multiple fields in real-life settings often proves time consuming and experimentally difficult. However, forums for collaboration such as clinical simulation centers may offer a solution. In these settings, identical operating and patient rooms are used to deliver simulated patient care scenarios using automated mannequins. Two identical rooms were modified in the clinical simulation center. Nurses spent 30 minutes in each room performing simulated cardiac resuscitation. Subjective measures of nurses' stress, alertness, and satisfaction were collected and compared between settings and across time using matched-pair t-test analysis. Nurses reported feeling less stressed after exposure to the experimental room than nurses who were exposed to the control room (2.22, p = .03). Scores post-session indicated a significant reduction in stress and an increase in alertness after exposure to the experimental room as compared to the control room, with significance levels below .10. (Change in stress scores: 3.44, p = .069); (change in alertness scores: 3.6, p = .071). This study reinforces the use of validated survey tools to measure stress, alertness, and satisfaction. Results support human-centered design approaches by evaluating the effect on nurses in an experimental setting.

Integrating the fundamentals of care framework in baccalaureate nursing education: An example from a nursing school in Denmark.

PubMed

Voldbjerg, Siri Lygum; Laugesen, Britt; Bahnsen, Iben Bøgh; Jørgensen, Lone; Sørensen, Ingrid Maria; Grønkjaer, Mette; Sørensen, Erik Elgaard

2018-06-01

To describe and discuss the process of integrating the Fundamentals of Care framework in a baccalaureate nursing education at a School of Nursing in Denmark. Nursing education plays an essential role in educating nurses to work within healthcare systems in which a demanding workload on nurses results in fundamental nursing care being left undone. Newly graduated nurses often lack knowledge and skills to meet the challenges of delivering fundamental care in clinical practice. To develop nursing students' understanding of fundamental nursing, the conceptual Fundamentals of Care framework has been integrated in nursing education at a School of Nursing in Denmark. Discursive paper using an adjusted descriptive case study design for describing and discussing the process of integrating the conceptual Fundamentals of Care Framework in nursing education. The process of integrating the Fundamentals of Care framework is illuminated through a description of the context, in which the process occurs including the faculty members, lectures, case-based work and simulation laboratory in nursing education. Based on this description, opportunities such as supporting a holistic approach to an evidence-based integrative patient care and challenges such as scepticism among the faculty are discussed. It is suggested how integration of Fundamentals of Care Framework in lectures, case-based work and simulation laboratory can make fundamental nursing care more explicit in nursing education, support critical thinking and underline the relevance of evidence-based practice. The process relies on a supportive context, a well-informed and engaged faculty, and continuous reflections on how the conceptual framework can be integrated. Integrating the Fundamentals of Care framework can support nursing students' critical thinking and reflection on what fundamental nursing care is and requires and eventually educate nurses in providing evidence-based fundamental nursing care. © 2018 John Wiley & Sons Ltd.

Effects of a Simulation Exercise on Nursing Students' End-of-Life Care Attitudes.

PubMed

Dame, Linda; Hoebeke, Roberta

2016-12-01

Students consider end-of-life care content in their nursing curricula to be inadequate and deficient in promoting the development of the necessary attitudes to care for dying patients. Research identifies simulation as an effective teaching strategy to examine nursing students' attitudes toward end-of-life care. An end-of-life care simulation was developed, implemented, and evaluated. Attitudes toward caring for dying patients were measured pre- and postsimulation on a convenience sample of 57 sophomore nursing students using the Frommelt Attitudes Toward Care of the Dying Scale-Form B. Repeated measures of ANOVA on outcome variables evaluated student attitudes toward end-of-life care. Participation in an end-of-life care simulation resulted in more positive student attitudes toward caring for dying patients (p < .001). Simulation is an active learning strategy to incorporate end-of-life care in nursing curricula and improve student attitudes toward caring for dying patients. [J Nurs Educ. 2016;55(12):701-705.]. Copyright 2016, SLACK Incorporated.

Strategies for Optimal Implementation of Simulated Clients for Measuring Quality of Care in Low- and Middle-Income Countries.

PubMed

Fitzpatrick, Anne; Tumlinson, Katherine

2017-03-24

The use of simulated clients or "mystery clients" is a data collection approach in which a study team member presents at a health care facility or outlet pretending to be a real customer, patient, or client. Following the visit, the shopper records her observations. The use of mystery clients can overcome challenges of obtaining accurate measures of health care quality and improve the validity of quality assessments, particularly in low- and middle-income countries. However, mystery client studies should be carefully designed and monitored to avoid problems inherent to this data collection approach. In this article, we discuss our experiences with the mystery client methodology in studies conducted in public- and private-sector health facilities in Kenya and in private-sector facilities in Uganda. We identify both the benefits and the challenges in using this methodology to guide other researchers interested in using this technique. Recruitment of appropriate mystery clients who accurately represent the facility's clientele, have strong recall of recent events, and are comfortable in their role as undercover data collectors are key to successful implementation of this methodology. Additionally, developing detailed training protocols can help ensure mystery clients behave identically and mimic real patrons accurately while short checklists can help ensure mystery client responses are standardized. Strict confidentiality and protocols to avoid unnecessary exams or procedures should also be stressed during training and monitored carefully throughout the study. Despite these challenges, researchers should consider mystery client designs to measure actual provider behavior and to supplement self-reported provider behavior. Data from mystery client studies can provide critical insight into the quality of service provision unavailable from other data collection methods. The unique information available from the mystery client approach far outweighs the cost. © Fitzpatrick and Tumlinson.

Strategies for Optimal Implementation of Simulated Clients for Measuring Quality of Care in Low- and Middle-Income Countries

PubMed Central

Fitzpatrick, Anne; Tumlinson, Katherine

2017-01-01

ABSTRACT The use of simulated clients or “mystery clients” is a data collection approach in which a study team member presents at a health care facility or outlet pretending to be a real customer, patient, or client. Following the visit, the shopper records her observations. The use of mystery clients can overcome challenges of obtaining accurate measures of health care quality and improve the validity of quality assessments, particularly in low- and middle-income countries. However, mystery client studies should be carefully designed and monitored to avoid problems inherent to this data collection approach. In this article, we discuss our experiences with the mystery client methodology in studies conducted in public- and private-sector health facilities in Kenya and in private-sector facilities in Uganda. We identify both the benefits and the challenges in using this methodology to guide other researchers interested in using this technique. Recruitment of appropriate mystery clients who accurately represent the facility's clientele, have strong recall of recent events, and are comfortable in their role as undercover data collectors are key to successful implementation of this methodology. Additionally, developing detailed training protocols can help ensure mystery clients behave identically and mimic real patrons accurately while short checklists can help ensure mystery client responses are standardized. Strict confidentiality and protocols to avoid unnecessary exams or procedures should also be stressed during training and monitored carefully throughout the study. Despite these challenges, researchers should consider mystery client designs to measure actual provider behavior and to supplement self-reported provider behavior. Data from mystery client studies can provide critical insight into the quality of service provision unavailable from other data collection methods. The unique information available from the mystery client approach far outweighs the cost. PMID:28126970

Performance evaluation in full-mission simulation - Methodological advances and research challenges. [in air transport operations

NASA Technical Reports Server (NTRS)

Chidester, Thomas R.; Kanki, Barbara G.; Helmreich, Robert L.

1989-01-01

The crew-factors research program at NASA Ames has developed a methodology for studying the impact of a variety of variables on the effectiveness of crews flying realistic but high workload simulated trips. The validity of investigations using the methodology is enhanced by careful design of full-mission scenarios, performance assessment using converging sources of data, and recruitment of representative subjects. Recently, portions of this methodology have been adapted for use in assessing the effectiveness of crew coordination among participants in line-oriented flight training.

Practical Strategies for Integrating Interprofessional Education and Collaboration into the Curriculum.

PubMed

Prast, Jean; Herlache-Pretzer, Ellen; Frederick, Andrea; Gafni-Lachter, Liat

2016-01-01

Interprofessional collaboration is vital for the provision of quality patient care. Thoughtfully designed educational programs can help students of health professions develop interprofessional competencies and capacities, including values and ethics, roles and responsibilities, interprofessional communication, and teamwork (Interprofessional Education Collaborative Expert Panel, 2011). The authors were involved in developing Interprofessional Education (IPE) activities and simulations to be infused into the curriculums of the various health professions programs in their College. A review of the IPE experiences revealed students greatly benefited from involvement in a diverse set of IPE activities and simulations.

Procedural training and assessment of competency utilizing simulation.

PubMed

Sawyer, Taylor; Gray, Megan M

2016-11-01

This review examines the current environment of neonatal procedural learning, describes an updated model of skills training, defines the role of simulation in assessing competency, and discusses potential future directions for simulation-based competency assessment. In order to maximize impact, simulation-based procedural training programs should follow a standardized and evidence-based approach to designing and evaluating educational activities. Simulation can be used to facilitate the evaluation of competency, but must incorporate validated assessment tools to ensure quality and consistency. True competency evaluation cannot be accomplished with simulation alone: competency assessment must also include evaluations of procedural skill during actual clinical care. Future work in this area is needed to measure and track clinically meaningful patient outcomes resulting from simulation-based training, examine the use of simulation to assist physicians undergoing re-entry to practice, and to examine the use of procedural skills simulation as part of a maintenance of competency and life-long learning. Copyright © 2016 Elsevier Inc. All rights reserved.

Virtual reality for health care: a survey.

PubMed

Moline, J

1997-01-01

This report surveys the state of the art in applications of virtual environments and related technologies for health care. Applications of these technologies are being developed for health care in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; and architectural design for health-care facilities. To date, such applications have improved the quality of health care, and in the future they will result in substantial cost savings. Tools that respond to the needs of present virtual environment systems are being refined or developed. However, additional large-scale research is necessary in the following areas: user studies, use of robots for telepresence procedures, enhanced system reality, and improved system functionality.

Active-Learning Laboratory Session to Teach the Four M's of Diabetes Care

PubMed Central

Plake, Kimberly S.; Nash, Christiane L.; Shepler, Brian M.

2009-01-01

Objective To implement an active-learning methodology for teaching diabetes care to pharmacy students and evaluate its effectiveness. Design Laboratory instruction was divided into 4 primary areas of diabetes care, referred to by the mnemonic, the 4 M's: meal planning, motion, medication, and monitoring. Students participated in skill-based learning laboratory stations and in simulated patient experiences. A pretest, retrospective pretest, and posttest were administered to measure improvements in students' knowledge about diabetes and confidence in providing care to diabetes patients. Assessment Students knowledge of and confidence in each area assessed improved. Students enjoyed the laboratory session and felt it contributed to their learning. Conclusion An active-learning approach to teaching diabetes care allowed students to experience aspects of the disease from the patient's perspective. This approach will be incorporated in other content areas. PMID:19513160

Simultaneous sequential monitoring of efficacy and safety led to masking of effects.

PubMed

van Eekelen, Rik; de Hoop, Esther; van der Tweel, Ingeborg

2016-08-01

Usually, sequential designs for clinical trials are applied on the primary (=efficacy) outcome. In practice, other outcomes (e.g., safety) will also be monitored and influence the decision whether to stop a trial early. Implications of simultaneous monitoring on trial decision making are yet unclear. This study examines what happens to the type I error, power, and required sample sizes when one efficacy outcome and one correlated safety outcome are monitored simultaneously using sequential designs. We conducted a simulation study in the framework of a two-arm parallel clinical trial. Interim analyses on two outcomes were performed independently and simultaneously on the same data sets using four sequential monitoring designs, including O'Brien-Fleming and Triangular Test boundaries. Simulations differed in values for correlations and true effect sizes. When an effect was present in both outcomes, competition was introduced, which decreased power (e.g., from 80% to 60%). Futility boundaries for the efficacy outcome reduced overall type I errors as well as power for the safety outcome. Monitoring two correlated outcomes, given that both are essential for early trial termination, leads to masking of true effects. Careful consideration of scenarios must be taken into account when designing sequential trials. Simulation results can help guide trial design. Copyright © 2016 Elsevier Inc. All rights reserved.

Secure environment for real-time tele-collaboration on virtual simulation of radiation treatment planning.

PubMed

Ntasis, Efthymios; Maniatis, Theofanis A; Nikita, Konstantina S

2003-01-01

A secure framework is described for real-time tele-collaboration on Virtual Simulation procedure of Radiation Treatment Planning. An integrated approach is followed clustering the security issues faced by the system into organizational issues, security issues over the LAN and security issues over the LAN-to-LAN connection. The design and the implementation of the security services are performed according to the identified security requirements, along with the need for real time communication between the collaborating health care professionals. A detailed description of the implementation is given, presenting a solution, which can directly be tailored to other tele-collaboration services in the field of health care. The pilot study of the proposed security components proves the feasibility of the secure environment, and the consistency with the high performance demands of the application.

Programming and machining of complex parts based on CATIA solid modeling

NASA Astrophysics Data System (ADS)

Zhu, Xiurong

2017-09-01

The complex parts of the use of CATIA solid modeling programming and simulation processing design, elaborated in the field of CNC machining, programming and the importance of processing technology. In parts of the design process, first make a deep analysis on the principle, and then the size of the design, the size of each chain, connected to each other. After the use of backstepping and a variety of methods to calculate the final size of the parts. In the selection of parts materials, careful study, repeated testing, the final choice of 6061 aluminum alloy. According to the actual situation of the processing site, it is necessary to make a comprehensive consideration of various factors in the machining process. The simulation process should be based on the actual processing, not only pay attention to shape. It can be used as reference for machining.

A large-scale mass casualty simulation to develop the non-technical skills medical students require for collaborative teamwork.

PubMed

Jorm, Christine; Roberts, Chris; Lim, Renee; Roper, Josephine; Skinner, Clare; Robertson, Jeremy; Gentilcore, Stacey; Osomanski, Adam

2016-03-08

There is little research on large-scale complex health care simulations designed to facilitate student learning of non-technical skills in a team-working environment. We evaluated the acceptability and effectiveness of a novel natural disaster simulation that enabled medical students to demonstrate their achievement of the non-technical skills of collaboration, negotiation and communication. In a mixed methods approach, survey data were available from 117 students and a thematic analysis undertaken of both student qualitative comments and tutor observer participation data. Ninety three per cent of students found the activity engaging for their learning. Three themes emerged from the qualitative data: the impact of fidelity on student learning, reflexivity on the importance of non-technical skills in clinical care, and opportunities for collaborative teamwork. Physical fidelity was sufficient for good levels of student engagement, as was sociological fidelity. We demonstrated the effectiveness of the simulation in allowing students to reflect upon and evidence their acquisition of skills in collaboration, negotiation and communication, as well as situational awareness and attending to their emotions. Students readily identified emerging learning opportunities though critical reflection. The scenarios challenged students to work together collaboratively to solve clinical problems, using a range of resources including interacting with clinical experts. A large class teaching activity, framed as a simulation of a natural disaster is an acceptable and effective activity for medical students to develop the non-technical skills of collaboration, negotiation and communication, which are essential to team working. The design could be of value in medical schools in disaster prone areas, including within low resource countries, and as a feasible intervention for learning the non-technical skills that are needed for patient safety.

Thermal design of the IUE hydrazine auxiliary propulsion system. [International Ultraviolet Explorer

NASA Technical Reports Server (NTRS)

Skladany, J. T.; Kelly, W. H.

1977-01-01

The International Ultraviolet Explorer is a large astronomical observatory scheduled to be placed in a three-axis stabilized synchronous orbit in the fourth quarter of 1977. The Hydrazine Auxiliary Propulsion System (HAPS) must perform a number of spacecraft maneuvers to achieve a successful mission. This paper describes the thermal design which accomplishes temperature control between 5 and 65 C for all orbital conditions by utilizing multilayer insulation and commandable component heaters. A primary design criteria was the minimization of spacecraft power by the selective use of the solar environment. The thermal design was carefully assessed and verified in both spacecraft thermal balance and subsystem solar simulation testing.

Simulated Patient Studies: An Ethical Analysis

PubMed Central

Rhodes, Karin V; Miller, Franklin G

2012-01-01

Context In connection with health care reform, the U.S. Department of Health and Human Services commissioned a “mystery shopper,” or simulated patient study, to measure access to primary care. But the study was shelved because of public controversy over “government spying” on doctors. Opponents of the study also raised ethical concerns about the use of deception with human subjects without soliciting their informed consent. Methods We undertook an ethical analysis of the use of simulated patient techniques in health services research, with a particular focus on research measuring access to care. Using a case study, we explored relevant methodological considerations and ethical principles relating to deceptive research without informed consent, as well as U.S. federal regulations permitting exceptions to consent. Findings Several relevant considerations both favor and oppose soliciting consent for simulated patient studies. Making research participation conditional on informed consent protects the autonomy of research subjects and shields them from unreasonable exposure to research risks. However, scientific validity is also an important ethical principle of human subjects research, as the net risks to subjects must be justified by the value to society of the knowledge to be gained. The use of simulated patients to monitor access is a naturalistic and scientifically sound experimental design that can answer important policy-relevant questions, with minimal risks to human subjects. As interaction between researchers and subjects increases, however, so does the need for consent. Conclusions As long as adequate protections of confidentiality of research data are in place, minimally intrusive simulated patient research that gathers policy-relevant data on the health system without the consent of individuals working in that system can be ethically justified when the risks and burdens to research subjects are minimal and the research has the potential to generate socially valuable knowledge. PMID:23216428

Using simulation to study difficult clinical issues: prenatal counseling at the threshold of viability across American and Dutch cultures.

PubMed

Geurtzen, Rosa; Hogeveen, Marije; Rajani, Anand K; Chitkara, Ritu; Antonius, Timothy; van Heijst, Arno; Draaisma, Jos; Halamek, Louis P

2014-06-01

Prenatal counseling at the threshold of viability is a challenging yet critically important activity, and care guidelines differ across cultures. Studying how this task is performed in the actual clinical environment is extremely difficult. In this pilot study, we used simulation as a methodology with 2 aims as follows: first, to explore the use of simulation incorporating a standardized pregnant patient as an investigative methodology and, second, to determine similarities and differences in content and style of prenatal counseling between American and Dutch neonatologists. We compared counseling practice between 11 American and 11 Dutch neonatologists, using a simulation-based investigative methodology. All subjects performed prenatal counseling with a simulated pregnant patient carrying a fetus at the limits of viability. The following elements of scenario design were standardized across all scenarios: layout of the physical environment, details of the maternal and fetal histories, questions and responses of the standardized pregnant patient, and the time allowed for consultation. American subjects typically presented several treatment options without bias, whereas Dutch subjects were more likely to explicitly advise a specific course of treatment (emphasis on partial life support). American subjects offered comfort care more frequently than the Dutch subjects and also discussed options for maximal life support more often than their Dutch colleagues. Simulation is a useful research methodology for studying activities difficult to assess in the actual clinical environment such as prenatal counseling at the limits of viability. Dutch subjects were more directive in their approach than their American counterparts, offering fewer options for care and advocating for less invasive interventions. American subjects were more likely to offer a wider range of therapeutic options without providing a recommendation for any specific option.

Action research on the development of a caring curriculum in Taiwan: Part II.

PubMed

Lee-Hsieh, Jane; Kuo, Chien-Lin; Turton, Michael A; Hsu, Chin-Lung; Chu, Hsiu-Chi

2007-12-01

This article presents the development, design, implementation, and evaluation of the third-year course of a caring curriculum being developed for a 5-year associate degree nursing program in Taiwan. The course, titled Application of Caring Concepts, was taught to more than 800 students by 16 instructors recruited from various departments. The instructors attended workshops and seminars on caring and then developed the course materials and teaching strategies. Instructional strategies included role modeling, dialogue, discussions, journaling, simulations, readings, and projects that involved students' applying caring skills outside of the classroom. Students were evaluated by patients in clinical practice using the Caring Behavior Measurement, developed in a previous study, and the course was evaluated by qualitative analysis of student feedback. Student responses to course content and instructional strategies were positive. Patients generally indicated that students always or normally performed caring behaviors. The study showed that with an appropriate curriculum and learning strategies, students can learn caring skills.

Modeling and simulation for space medicine operations: preliminary requirements considered

NASA Technical Reports Server (NTRS)

Dawson, D. L.; Billica, R. D.; McDonald, P. V.

2001-01-01

The NASA Space Medicine program is now developing plans for more extensive use of high-fidelity medical simulation systems. The use of simulation is seen as means to more effectively use the limited time available for astronaut medical training. Training systems should be adaptable for use in a variety of training environments, including classrooms or laboratories, space vehicle mockups, analog environments, and in microgravity. Modeling and simulation can also provide the space medicine development program a mechanism for evaluation of other medical technologies under operationally realistic conditions. Systems and procedures need preflight verification with ground-based testing. Traditionally, component testing has been accomplished, but practical means for "human in the loop" verification of patient care systems have been lacking. Medical modeling and simulation technology offer potential means to accomplish such validation work. Initial considerations in the development of functional requirements and design standards for simulation systems for space medicine are discussed.

Requirements for Modeling and Simulation for Space Medicine Operations: Preliminary Considerations

NASA Technical Reports Server (NTRS)

Dawson, David L.; Billica, Roger D.; Logan, James; McDonald, P. Vernon

2001-01-01

The NASA Space Medicine program is now developing plans for more extensive use of high-fidelity medical Simulation systems. The use of simulation is seen as means to more effectively use the limited time available for astronaut medical training. Training systems should be adaptable for use in a variety of training environments, including classrooms or laboratories, space vehicle mockups, analog environments, and in microgravity. Modeling and simulation can also provide the space medicine development program a mechanism for evaluation of other medical technologies under operationally realistic conditions. Systems and procedures need preflight verification with ground-based testing. Traditionally, component testing has been accomplished, but practical means for "human in the loop" verification of patient care systems have been lacking. Medical modeling and simulation technology offer potential means to accomplish such validation work. Initial considerations in the development of functional requirements and design standards for simulation systems for space medicine are discussed.

When the Simulator Dies: Experiential Education about Death Designed for Undergraduate Nursing Students

ERIC Educational Resources Information Center

Foltz-Ramos, Kelly

2017-01-01

Background and Objectives: Graduates from undergraduate nursing programs report inadequate death education. Most death education is focused on end-of-life care and taught by lecture. Students are not provided opportunities to reflect on their own feelings about death. Due to lack of clinical nursing faculty and shortage of clinical sites, students…

Status of simulation in health care education: an international survey.

PubMed

Qayumi, Karim; Pachev, George; Zheng, Bin; Ziv, Amitai; Koval, Valentyna; Badiei, Sadia; Cheng, Adam

2014-01-01

Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current findings to support simulation in the next developmental stages.

The effects of a human patient simulator vs. a CD-ROM on performance.

PubMed

Johnson, Don; Corrigan, Theresa; Gulickson, Gary; Holshouser, Elizabeth; Johnson, Sabine

2012-10-01

Military health care personnel need to have skills relative to caring for patients on the battlefield. No studies have compared the two teaching strategies of using the human patient simulator (HPS) and a CD-ROM in caring for combat injuries. The objective of this study was to determine if there were statistically significant differences in HPS and CD-ROM educational strategies relative to caring for patients who have trauma. A pretest/post-test prospective experimental design was used. Anesthesia students were randomly assigned to one of three groups: HPS, CD-ROM, or a control group. A valid and reliable instrument, Combat Performance, was used to evaluate the participant's ability to give care to trauma patients. A repeated analysis of variance and a least significant difference post hoc test were used to analyze the data. The HPS group performed better than the CD-ROM and control groups relative to performance (p = 0.001). There was no difference between the CD-ROM and control group (p = 0.171). We speculate that the HPS group performed better than the CD-ROM group because of the realism. In this study, the HPS method of instruction was a more effective method of teaching than the CD-ROM approach.

A web-based simulation of a longitudinal clinic used in a 4-week ambulatory rotation: a cohort study

PubMed Central

Wong, Rene WG; Lochnan, Heather A

2009-01-01

Background Residency training takes place primarily on inpatient wards. In the absence of a resident continuity clinic, internal medicine residents rely on block rotations to learn about continuity of care. Alternate methods to introduce continuity of care are needed. Methods A web-based tool, Continuity of Care Online Simulations (COCOS), was designed for use in a one-month, postgraduate clinical rotation in endocrinology. It is an interactive tool that simulates the continuing care of any patient with a chronic endocrine disease. Twenty-three residents in internal medicine participated in a study to investigate the effects of using COCOS during a clinical rotation in endocrinology on pre-post knowledge test scores and self-assessment of confidence. Results Compared to residents who did the rotation alone, residents who used COCOS during the rotation had significantly higher improvements in test scores (% increase in pre-post test scores +21.6 [standard deviation, SD, 8.0] vs. +5.9 [SD 6.8]; p < .001). Test score improvements were most pronounced for less commonly seen conditions. There were no significant differences in changes in confidence. Residents rated COCOS very highly, recommending its use as a standard part of the rotation and throughout residency. Conclusion A stand-alone web-based tool can be incorporated into an existing clinical rotation to help residents learn about continuity of care. It has the most potential to teach residents about topics that are less commonly seen during a clinical rotation. The adaptable, web-based format allows the creation of cases for most chronic medical conditions. PMID:19187554

A study of design approach of spreading schemes for viral marketing based on human dynamics

NASA Astrophysics Data System (ADS)

Yang, Jianmei; Zhuang, Dong; Xie, Weicong; Chen, Guangrong

2013-12-01

Before launching a real viral marketing campaign, it is needed to design a spreading scheme by simulations. Based on a categorization of spreading patterns in real world and models, we point out that the existing research (especially Yang et al. (2010) Ref. [16]) implicitly assume that if a user decides to post a received message (is activated), he/she will take the reposting action promptly (Prompt Action After Activation, or PAAA). After a careful analysis on a real dataset however, it is found that the observed time differences between action and activation exhibit a heavy-tailed distribution. A simulation model for heavy-tailed pattern is then proposed and performed. Similarities and differences of spreading processes between the heavy-tailed and PAAA patterns are analyzed. Consequently, a more practical design approach of spreading scheme for viral marketing on QQ platform is proposed. The design approach can be extended and applied to the contexts of non-heavy-tailed pattern, and viral marketing on other instant messaging platforms.

Simulation technology for resuscitation training: a systematic review and meta-analysis.

PubMed

Mundell, William C; Kennedy, Cassie C; Szostek, Jason H; Cook, David A

2013-09-01

To summarize current available data on simulation-based training in resuscitation for health care professionals. MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus and reference lists of published reviews. Published studies of any language or date that enrolled health professions' learners to investigate the use of technology-enhanced simulation to teach resuscitation in comparison with no intervention or alternative training. Data were abstracted in duplicate. We identified themes examining different approaches to curriculum design. We pooled results using random effects meta-analysis. 182 studies were identified involving 16,636 participants. Overall, simulation-based training of resuscitation skills, in comparison to no intervention, appears effective regardless of assessed outcome, level of learner, study design, or specific task trained. In comparison to no intervention, simulation training improved outcomes of knowledge (Hedges' g) 1.05 (95% confidence interval, 0.81-1.29), process skill 1.13 (0.99-1.27), product skill 1.92 (1.26-2.60), time skill 1.77 (1.13-2.42) and patient outcomes 0.26 (0.047-0.48). In comparison with non-simulation intervention, learner satisfaction 0.79 (0.27-1.31) and process skill 0.35 (0.12-0.59) outcomes favored simulation. Studies investigating how to optimize simulation training found higher process skill outcomes in courses employing "booster" practice 0.13 (0.03-0.22), team/group dynamics 0.51 (0.06-0.97), distraction 1.76 (1.02-2.50) and integrated feedback 0.49 (0.17-0.80) compared to courses without these features. Most analyses reflected high between-study inconsistency (I(2) values >50%). Simulation-based training for resuscitation is highly effective. Design features of "booster" practice, team/group dynamics, distraction and integrated feedback improve effectiveness. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Veterans' Preferences for Exchanging Information Using Veterans Affairs Health Information Technologies: Focus Group Results and Modeling Simulations.

PubMed

Haun, Jolie N; Chavez, Margeaux; Nazi, Kim; Antinori, Nicole; Melillo, Christine; Cotner, Bridget A; Hathaway, Wendy; Cook, Ashley; Wilck, Nancy; Noonan, Abigail

2017-10-23

The Department of Veterans Affairs (VA) has multiple health information technology (HIT) resources for veterans to support their health care management. These include a patient portal, VetLink Kiosks, mobile apps, and telehealth services. The veteran patient population has a variety of needs and preferences that can inform current VA HIT redesign efforts to meet consumer needs. This study aimed to describe veterans' experiences using the current VA HIT and identify their vision for the future of an integrated VA HIT system. Two rounds of focus group interviews were conducted with a single cohort of 47 veterans and one female caregiver recruited from Bedford, Massachusetts, and Tampa, Florida. Focus group interviews included simulation modeling activities and a self-administered survey. This study also used an expert panel group to provide data and input throughout the study process. High-fidelity, interactive simulations were created and used to facilitate collection of qualitative data. The simulations were developed based on system requirements, data collected through operational efforts, and participants' reported preferences for using VA HIT. Pairwise comparison activities of HIT resources were conducted with both focus groups and the expert panel. Rapid iterative content analysis was used to analyze qualitative data. Descriptive statistics summarized quantitative data. Data themes included (1) current use of VA HIT, (2) non-VA HIT use, and (3) preferences for future use of VA HIT. Data indicated that, although the Secure Messaging feature was often preferred, a full range of HIT options are needed. These data were then used to develop veteran-driven simulations that illustrate user needs and expectations when using a HIT system and services to access VA health care services. Patient participant redesign processes present critical opportunities for creating a human-centered design. Veterans value virtual health care options and prefer standardized, integrated, and synchronized user-friendly interface designs. ©Jolie N. Haun, Margeaux Chavez, Kim Nazi, Nicole Antinori, Christine Melillo, Bridget A Cotner, Wendy Hathaway, Ashley Cook, Nancy Wilck, Abigail Noonan. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.10.2017.

Simulation modeling for the health care manager.

PubMed

Kennedy, Michael H

2009-01-01

This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

'In situ simulation' versus 'off site simulation' in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Unexpected obstetric emergencies threaten the safety of pregnant women. As emergencies are rare, they are difficult to learn. Therefore, simulation-based medical education (SBME) seems relevant. In non-systematic reviews on SBME, medical simulation has been suggested to be associated with improved learner outcomes. However, many questions on how SBME can be optimized remain unanswered. One unresolved issue is how 'in situ simulation' (ISS) versus 'off site simulation' (OSS) impact learning. ISS means simulation-based training in the actual patient care unit (in other words, the labor room and operating room). OSS means training in facilities away from the actual patient care unit, either at a simulation centre or in hospital rooms that have been set up for this purpose. Methods and design The objective of this randomized trial is to study the effect of ISS versus OSS on individual learning outcome, safety attitude, motivation, stress, and team performance amongst multi-professional obstetric-anesthesia teams. The trial is a single-centre randomized superiority trial including 100 participants. The inclusion criteria were health-care professionals employed at the department of obstetrics or anesthesia at Rigshospitalet, Copenhagen, who were working on shifts and gave written informed consent. Exclusion criteria were managers with staff responsibilities, and staff who were actively taking part in preparation of the trial. The same obstetric multi-professional training was conducted in the two simulation settings. The experimental group was exposed to training in the ISS setting, and the control group in the OSS setting. The primary outcome is the individual score on a knowledge test. Exploratory outcomes are individual scores on a safety attitudes questionnaire, a stress inventory, salivary cortisol levels, an intrinsic motivation inventory, results from a questionnaire evaluating perceptions of the simulation and suggested changes needed in the organization, a team-based score on video-assessed team performance and on selected clinical performance. Discussion The perspective is to provide new knowledge on contextual effects of different simulation settings. Trial registration ClincialTrials.gov NCT01792674. PMID:23870501

Task management skills and their deficiencies during care delivery in simulated medical emergency situation: A classification.

PubMed

Morineau, Thierry; Chapelain, Pascal; Quinio, Philippe

2016-06-01

Our objective was to develop the analysis of task management skills by proposing a framework classifying task management stages and deficiencies. Few studies of non-technical skills have detailed the components of task management skills through behavioural markers, despite their central role in care delivery. A post hoc qualitative behavioural analysis was performed of recordings made of professional training sessions based upon simulated scenarios. Four recorded sessions in a high-fidelity simulation setting were observed and recorded. Two scenarios were used (cardiac arrest and respiratory failure), and there were two training sessions per scenario. Four types of task management deficiencies were identified with regards to task constraints: constraint relaxation, unsatisfied constraints, additional constraints and constraint transgression. Both equipment and space constraints were also identified. The lack of prerequisite actions when preparing the environment, corequisite actions for equipment and protocol monitoring, or postrequisite actions to restore the environment were associated with task management deficiencies. Deficiencies in task management behaviours can be identified in simulated as well as actual medical emergency settings. This framework opens perspectives for both training caregivers and designing ergonomic work situations. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Serious Game for Massive Training and Assessment of French Soldiers Involved in Forward Combat Casualty Care (3D-SC1): Development and Deployment.

PubMed

Pasquier, Pierre; Mérat, Stéphane; Malgras, Brice; Petit, Ludovic; Queran, Xavier; Bay, Christian; Boutonnet, Mathieu; Jault, Patrick; Ausset, Sylvain; Auroy, Yves; Perez, Jean Paul; Tesnière, Antoine; Pons, François; Mignon, Alexandre

2016-05-18

The French Military Health Service has standardized its military prehospital care policy in a ''Sauvetage au Combat'' (SC) program (Forward Combat Casualty Care). A major part of the SC training program relies on simulations, which are challenging and costly when dealing with more than 80,000 soldiers. In 2014, the French Military Health Service decided to develop and deploy 3D-SC1, a serious game (SG) intended to train and assess soldiers managing the early steps of SC. The purpose of this paper is to describe the creation and production of 3D-SC1 and to present its deployment. A group of 10 experts and the Paris Descartes University Medical Simulation Department spin-off, Medusims, coproduced 3D-SC1. Medusims are virtual medical experiences using 3D real-time videogame technology (creation of an environment and avatars in different scenarios) designed for educational purposes (training and assessment) to simulate medical situations. These virtual situations have been created based on real cases and tested on mannequins by experts. Trainees are asked to manage specific situations according to best practices recommended by SC, and receive a score and a personalized feedback regarding their performance. The scenario simulated in the SG is an attack on a patrol of 3 soldiers with an improvised explosive device explosion as a result of which one soldier dies, one soldier is slightly stunned, and the third soldier experiences a leg amputation and other injuries. This scenario was first tested with mannequins in military simulation centers, before being transformed into a virtual 3D real-time scenario using a multi-support, multi-operating system platform, Unity. Processes of gamification and scoring were applied, with 2 levels of difficulty. A personalized debriefing was integrated at the end of the simulations. The design and production of the SG took 9 months. The deployment, performed in 3 months, has reached 84 of 96 (88%) French Army units, with a total of 818 hours of connection in the first 3 months. The development of 3D-SC1 involved a collaborative platform with interdisciplinary actors from the French Health Service, a university, and videogame industry. Training each French soldier with simulation exercises and mannequins is challenging and costly. Implementation of SGs into the training program could offer a unique opportunity at a lower cost to improve training and subsequently the real-time performance of soldiers when managing combat casualties; ideally, these should be combined with physical simulations.

The ELDER Project: educational model and three-year outcomes of a community-based geriatric education initiative.

PubMed

Lange, Jean W; Mager, Diana; Greiner, Philip A; Saracino, Katherine

2011-01-01

The purpose of the ELDER (Expanded Learning and Dedication to Elders in the Region) Project was to address the needs of underserved older adults by providing worksite education to individuals who provide nursing care to older adults in community health centers, home health agencies, and long-term care facilities. Four agencies located in a Health Professional Shortage and Medically Underserved Area participated. Project staff conducted separate focus groups with administrators and staff at each agency to determine educational needs and preferences. Curricula from the Hartford Institute, End-of-Life Nursing Education Consortium, and Geriatric Education Centers were adapted to design unique curricula for each agency and level of personnel (licensed nurse or unlicensed caregiver). Activities included focus group meetings to tailor content to the needs of each agency, on-site educational sessions, and identification of an agency champion to sustain the program after the funding ended. A case-based simulation-learning approach was used in the final year to validate application of knowledge and to facilitate teamwork and interprofessional communication. Over 100 nurses and nursing assistants and eight administrators and allied health professionals participated over the three-year period of the project. Retention over this period, independent evaluations, and simulations demonstrated participants' ability to integrate best practices into typical clinical scenarios and revealed improved communication among care providers. Tailored on-site education incorporating simulation was an effective model for translating gerontological knowledge into practice and improving the care of older adults in these multiple settings.

Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach.

PubMed

Zimmermann, Katja; Holzinger, Iris Bachmann; Ganassi, Lorena; Esslinger, Peter; Pilgrim, Sina; Allen, Meredith; Burmester, Margarita; Stocker, Martin

2015-10-29

Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. We designed and implemented a team and resuscitation training program according to Kern's six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleuten's conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Children's Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. The programmatic approach of Kern's six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program.

Computationally efficient optimization of radiation drives

NASA Astrophysics Data System (ADS)

Zimmerman, George; Swift, Damian

2017-06-01

For many applications of pulsed radiation, the temporal pulse shape is designed to induce a desired time-history of conditions. This optimization is normally performed using multi-physics simulations of the system, adjusting the shape until the desired response is induced. These simulations may be computationally intensive, and iterative forward optimization is then expensive and slow. In principle, a simulation program could be modified to adjust the radiation drive automatically until the desired instantaneous response is achieved, but this may be impracticable in a complicated multi-physics program. However, the computational time increment is typically much shorter than the time scale of changes in the desired response, so the radiation intensity can be adjusted so that the response tends toward the desired value. This relaxed in-situ optimization method can give an adequate design for a pulse shape in a single forward simulation, giving a typical gain in computational efficiency of tens to thousands. This approach was demonstrated for the design of laser pulse shapes to induce ramp loading to high pressure in target assemblies where different components had significantly different mechanical impedance, requiring careful pulse shaping. This work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

Status of simulation in health care education: an international survey

PubMed Central

Qayumi, Karim; Pachev, George; Zheng, Bin; Ziv, Amitai; Koval, Valentyna; Badiei, Sadia; Cheng, Adam

2014-01-01

Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current findings to support simulation in the next developmental stages. PMID:25489254

Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes

PubMed Central

Sam, Jonathan; Pierse, Michael; Al-Qahtani, Abdullah; Cheng, Adam

2012-01-01

OBJECTIVE: To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach. DESIGN: Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes. SETTING: Paediatric residency program at BC Children’s Hospital, Vancouver, British Columbia. INTERVENTIONS: The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale. RESULTS: A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration. CONCLUSIONS: A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes. PMID:23372405

Home care and technology: a case study.

PubMed

Stroulia, Eleni; Nikolaidisa, Ioanis; Liua, Lili; King, Sharla; Lessard, Lysanne

2012-01-01

Health care aides (HCAs) are the backbone of the home care system and provide a range of services to people who, for various reasons related to chronic conditions and aging, are not able to take care of themselves independently. The demand for HCA services will increase and the current HCA supply will likely not keep up with this increasing demand without fundamental changes in the current environment. Information and communication technology (ICT) can address some of the workflow challenges HCAs face. In this project, we conducted an ethnographic study to document and analyse HCAs' workflows and team interactions. Based on our findings, we designed an ICT tool suite, integrating easily available existing and newly developed (by our team) technologies to address these issues. Finally, we simulated the deployment of our technologies, to assess the potential impact of these technological solutions on the workflow and productivity of HCAs, their healthcare teams and client care.

Continuing Professional Development: Pedagogical Practices of Interprofessional Simulation in Health Care

ERIC Educational Resources Information Center

Nyström, Sofia; Dahlberg, Johanna; Edelbring, Samuel; Hult, Håkan; Abrandt Dahlgren, Madeleine

2017-01-01

The increasing complexity of health care practice makes continuing professional development (CPD) essential for health care professionals. Simulation-based training is a CPD activity that is often applied to improve interprofessional collaboration and the quality of care. The aim of this study is to explore simulation as a pedagogical practice for…

Careful with Those Priors: A Note on Bayesian Estimation in Two-Parameter Logistic Item Response Theory Models

ERIC Educational Resources Information Center

Marcoulides, Katerina M.

2018-01-01

This study examined the use of Bayesian analysis methods for the estimation of item parameters in a two-parameter logistic item response theory model. Using simulated data under various design conditions with both informative and non-informative priors, the parameter recovery of Bayesian analysis methods were examined. Overall results showed that…

Nursing Student Perceptions Regarding Simulation Experience Sequencing.

PubMed

Woda, Aimee A; Gruenke, Theresa; Alt-Gehrman, Penny; Hansen, Jamie

2016-09-01

The use of simulated learning experiences (SLEs) have increased within nursing curricula with positive learning outcomes for nursing students. The purpose of this study is to explore nursing students' perceptions of their clinical decision making (CDM) related to the block sequencing of different patient care experiences, SLEs versus hospital-based learning experiences (HLEs). A qualitative descriptive design used open-ended survey questions to generate information about the block sequencing of SLEs and its impact on nursing students' perceived CDM. Three themes emerged from the data: Preexperience Anxiety, Real-Time Decision Making, and Increased Patient Care Experiences. Nursing students identified that having SLEs prior to HLEs provided several benefits. Even when students preferred SLEs prior to HLEs, the sequence did not impact their CDM. This suggests that alternating block sequencing can be used without impacting the students' perceptions of their ability to make decisions. [J Nurs Educ. 2016;55(9):528-532.]. Copyright 2016, SLACK Incorporated.

Intensive care nursing students' perceptions of simulation for learning confirming communication skills: A descriptive qualitative study.

PubMed

Karlsen, Marte-Marie Wallander; Gabrielsen, Anita Kristin; Falch, Anne Lise; Stubberud, Dag-Gunnar

2017-10-01

The aim of this study was to explore intensive care nursing students experiences with confirming communication skills training in a simulation-based environment. The study has a qualitative, exploratory and descriptive design. The participants were students in a post-graduate program in intensive care nursing, that had attended a one day confirming communication course. Three focus group interviews lasting between 60 and 80min were conducted with 14 participants. The interviews were transcribed verbatim. Thematic analysis was performed, using Braun & Clark's seven steps. The analysis resulted in three main themes: "awareness", "ice-breaker" and "challenging learning environment". The participants felt that it was a challenge to see themselves on the video-recordings afterwards, however receiving feedback resulted in better self-confidence in mastering complex communication. The main finding of the study is that the students reported improved communication skills after the confirming communication course. However; it is uncertain how these skills can be transferred to clinical practice improving patient outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

3D printed microfluidic mixer for point-of-care diagnosis of anemia.

PubMed

Plevniak, Kimberly; Campbell, Matthew; Mei He

2016-08-01

3D printing has been an emerging fabrication tool in prototyping and manufacturing. We demonstrated a 3D microfluidic simulation guided computer design and 3D printer prototyping for quick turnaround development of microfluidic 3D mixers, which allows fast self-mixing of reagents with blood through capillary force. Combined with smartphone, the point-of-care diagnosis of anemia from finger-prick blood has been successfully implemented and showed consistent results with clinical measurements. Capable of 3D fabrication flexibility and smartphone compatibility, this work presents a novel diagnostic strategy for advancing personalized medicine and mobile healthcare.

Modeling the Information Age Combat Model: An Agent-Based Simulation of Network Centric Operations

NASA Technical Reports Server (NTRS)

Deller, Sean; Rabadi, Ghaith A.; Bell, Michael I.; Bowling, Shannon R.; Tolk, Andreas

2010-01-01

The Information Age Combat Model (IACM) was introduced by Cares in 2005 to contribute to the development of an understanding of the influence of connectivity on force effectiveness that can eventually lead to quantitative prediction and guidelines for design and employment. The structure of the IACM makes it clear that the Perron-Frobenius Eigenvalue is a quantifiable metric with which to measure the organization of a networked force. The results of recent experiments presented in Deller, et aI., (2009) indicate that the value of the Perron-Frobenius Eigenvalue is a significant measurement of the performance of an Information Age combat force. This was accomplished through the innovative use of an agent-based simulation to model the IACM and represents an initial contribution towards a new generation of combat models that are net-centric instead of using the current platform-centric approach. This paper describes the intent, challenges, design, and initial results of this agent-based simulation model.

Data Synchronization Discrepancies in a Formation Flight Control System

NASA Technical Reports Server (NTRS)

Ryan, Jack; Hanson, Curtis E.; Norlin, Ken A.; Allen, Michael J.; Schkolnik, Gerard (Technical Monitor)

2001-01-01

Aircraft hardware-in-the-loop simulation is an invaluable tool to flight test engineers; it reveals design and implementation flaws while operating in a controlled environment. Engineers, however, must always be skeptical of the results and analyze them within their proper context. Engineers must carefully ascertain whether an anomaly that occurs in the simulation will also occur in flight. This report presents a chronology illustrating how misleading simulation timing problems led to the implementation of an overly complex position data synchronization guidance algorithm in place of a simpler one. The report illustrates problems caused by the complex algorithm and how the simpler algorithm was chosen in the end. Brief descriptions of the project objectives, approach, and simulation are presented. The misleading simulation results and the conclusions then drawn are presented. The complex and simple guidance algorithms are presented with flight data illustrating their relative success.

Systems modeling and simulation applications for critical care medicine

PubMed Central

2012-01-01

Critical care delivery is a complex, expensive, error prone, medical specialty and remains the focal point of major improvement efforts in healthcare delivery. Various modeling and simulation techniques offer unique opportunities to better understand the interactions between clinical physiology and care delivery. The novel insights gained from the systems perspective can then be used to develop and test new treatment strategies and make critical care delivery more efficient and effective. However, modeling and simulation applications in critical care remain underutilized. This article provides an overview of major computer-based simulation techniques as applied to critical care medicine. We provide three application examples of different simulation techniques, including a) pathophysiological model of acute lung injury, b) process modeling of critical care delivery, and c) an agent-based model to study interaction between pathophysiology and healthcare delivery. Finally, we identify certain challenges to, and opportunities for, future research in the area. PMID:22703718

Sequential Multiple Assignment Randomized Trial (SMART) with Adaptive Randomization for Quality Improvement in Depression Treatment Program

PubMed Central

Chakraborty, Bibhas; Davidson, Karina W.

2015-01-01

Summary Implementation study is an important tool for deploying state-of-the-art treatments from clinical efficacy studies into a treatment program, with the dual goals of learning about effectiveness of the treatments and improving the quality of care for patients enrolled into the program. In this article, we deal with the design of a treatment program of dynamic treatment regimens (DTRs) for patients with depression post acute coronary syndrome. We introduce a novel adaptive randomization scheme for a sequential multiple assignment randomized trial of DTRs. Our approach adapts the randomization probabilities to favor treatment sequences having comparatively superior Q-functions used in Q-learning. The proposed approach addresses three main concerns of an implementation study: it allows incorporation of historical data or opinions, it includes randomization for learning purposes, and it aims to improve care via adaptation throughout the program. We demonstrate how to apply our method to design a depression treatment program using data from a previous study. By simulation, we illustrate that the inputs from historical data are important for the program performance measured by the expected outcomes of the enrollees, but also show that the adaptive randomization scheme is able to compensate poorly specified historical inputs by improving patient outcomes within a reasonable horizon. The simulation results also confirm that the proposed design allows efficient learning of the treatments by alleviating the curse of dimensionality. PMID:25354029

Measuring the impact of a 3D simulation experience on nursing students' cultural empathy using a modified version of the Kiersma-Chen Empathy Scale.

PubMed

Everson, Naleya; Levett-Jones, Tracy; Lapkin, Samuel; Pitt, Victoria; van der Riet, Pamela; Rossiter, Rachel; Jones, Donovan; Gilligan, Conor; Courtney-Pratt, Helen

2015-10-01

To determine the effect of immersive 3D cultural simulation on nursing students' empathy towards culturally and linguistically diverse patients. Accelerated globalisation has seen a significant increase in cultural diversity in most regions of the world over the past forty years. Clinical encounters that do not acknowledge cultural factors contribute to adverse patient outcomes and health care inequities for culturally and linguistically diverse people. Cultural empathy is an antecedent to cultural competence. Thus, appropriate educational strategies are needed to enhance nursing students' cultural empathy and the capacity to deliver culturally competent care. A one-group pretest, post-test design was used for this study. The simulation exposed students to an unfolding scene in a hospital ward of a developing county. A convenience sample of second-year undergraduate nursing students (n = 460) from a semi-metropolitan university in Australia were recruited for the study. Characteristics of the sample were summarised using descriptive statistics. T-tests were performed to analyse the differences between pre- and post simulation empathy scores using an eight item modified version of the Kiersma-Chen Empathy Scale. Students' empathy towards culturally and linguistically diverse patients significantly improved after exposure to the 3D simulation experience. The mean scores for the Perspective Taking and Valuing Affective Empathy subscales also increased significantly postsimulation. The immersive 3D simulation had a positive impact on nursing students' empathy levels in regards to culturally and linguistically diverse groups. Research with other cohorts and in other contexts is required to further explore the impact of this educational approach. Immersive cultural simulation experiences offer opportunities to enhance the cultural empathy of nursing students. This may in turn have a positive impact on their cultural competence and consequently the quality of care they provide to culturally and linguistically diverse patients. © 2015 John Wiley & Sons Ltd.

Do Bayesian adaptive trials offer advantages for comparative effectiveness research? Protocol for the RE-ADAPT study

PubMed Central

Luce, Bryan R; Broglio, Kristine R; Ishak, K Jack; Mullins, C Daniel; Vanness, David J; Fleurence, Rachael; Saunders, Elijah; Davis, Barry R

2013-01-01

Background Randomized clinical trials, particularly for comparative effectiveness research (CER), are frequently criticized for being overly restrictive or untimely for health-care decision making. Purpose Our prospectively designed REsearch in ADAptive methods for Pragmatic Trials (RE-ADAPT) study is a ‘proof of concept’ to stimulate investment in Bayesian adaptive designs for future CER trials. Methods We will assess whether Bayesian adaptive designs offer potential efficiencies in CER by simulating a re-execution of the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study using actual data from ALLHAT. Results We prospectively define seven alternate designs consisting of various combinations of arm dropping, adaptive randomization, and early stopping and describe how these designs will be compared to the original ALLHAT design. We identify the one particular design that would have been executed, which incorporates early stopping and information-based adaptive randomization. Limitations While the simulation realistically emulates patient enrollment, interim analyses, and adaptive changes to design, it cannot incorporate key features like the involvement of data monitoring committee in making decisions about adaptive changes. Conclusion This article describes our analytic approach for RE-ADAPT. The next stage of the project is to conduct the re-execution analyses using the seven prespecified designs and the original ALLHAT data. PMID:23983160

Optimization of prosthetic foot stiffness to reduce metabolic cost and intact knee loading during below-knee amputee walking: a theoretical study.

PubMed

Fey, Nicholas P; Klute, Glenn K; Neptune, Richard R

2012-11-01

Unilateral below-knee amputees develop abnormal gait characteristics that include bilateral asymmetries and an elevated metabolic cost relative to non-amputees. In addition, long-term prosthesis use has been linked to an increased prevalence of joint pain and osteoarthritis in the intact leg knee. To improve amputee mobility, prosthetic feet that utilize elastic energy storage and return (ESAR) have been designed, which perform important biomechanical functions such as providing body support and forward propulsion. However, the prescription of appropriate design characteristics (e.g., stiffness) is not well-defined since its influence on foot function and important in vivo biomechanical quantities such as metabolic cost and joint loading remain unclear. The design of feet that improve these quantities could provide considerable advancements in amputee care. Therefore, the purpose of this study was to couple design optimization with dynamic simulations of amputee walking to identify the optimal foot stiffness that minimizes metabolic cost and intact knee joint loading. A musculoskeletal model and distributed stiffness ESAR prosthetic foot model were developed to generate muscle-actuated forward dynamics simulations of amputee walking. Dynamic optimization was used to solve for the optimal muscle excitation patterns and foot stiffness profile that produced simulations that tracked experimental amputee walking data while minimizing metabolic cost and intact leg internal knee contact forces. Muscle and foot function were evaluated by calculating their contributions to the important walking subtasks of body support, forward propulsion and leg swing. The analyses showed that altering a nominal prosthetic foot stiffness distribution by stiffening the toe and mid-foot while making the ankle and heel less stiff improved ESAR foot performance by offloading the intact knee during early to mid-stance of the intact leg and reducing metabolic cost. The optimal design also provided moderate braking and body support during the first half of residual leg stance, while increasing the prosthesis contributions to forward propulsion and body support during the second half of residual leg stance. Future work will be directed at experimentally validating these results, which have important implications for future designs of prosthetic feet that could significantly improve amputee care.

Assessing self-care and social function using a computer adaptive testing version of the Pediatric Evaluation of Disability Inventory Accepted for Publication, Archives of Physical Medicine and Rehabilitation

PubMed Central

Coster, Wendy J.; Haley, Stephen M.; Ni, Pengsheng; Dumas, Helene M.; Fragala-Pinkham, Maria A.

2009-01-01

Objective To examine score agreement, validity, precision, and response burden of a prototype computer adaptive testing (CAT) version of the Self-Care and Social Function scales of the Pediatric Evaluation of Disability Inventory (PEDI) compared to the full-length version of these scales. Design Computer simulation analysis of cross-sectional and longitudinal retrospective data; cross-sectional prospective study. Settings Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics; community-based day care, preschool, and children’s homes. Participants Four hundred sixty-nine children with disabilities and 412 children with no disabilities (analytic sample); 38 children with disabilities and 35 children without disabilities (cross-validation sample). Interventions Not applicable. Main Outcome Measures Summary scores from prototype CAT applications of each scale using 15-, 10-, and 5-item stopping rules; scores from the full-length Self-Care and Social Function scales; time (in seconds) to complete assessments and respondent ratings of burden. Results Scores from both computer simulations and field administration of the prototype CATs were highly consistent with scores from full-length administration (all r’s between .94 and .99). Using computer simulation of retrospective data, discriminant validity and sensitivity to change of the CATs closely approximated that of the full-length scales, especially when the 15- and 10-item stopping rules were applied. In the cross-validation study the time to administer both CATs was 4 minutes, compared to over 16 minutes to complete the full-length scales. Conclusions Self-care and Social Function score estimates from CAT administration are highly comparable to those obtained from full-length scale administration, with small losses in validity and precision and substantial decreases in administration time. PMID:18373991

Frequency-domain trade-offs for dielectric elastomer generators

NASA Astrophysics Data System (ADS)

Zanini, Plinio; Rossiter, Jonathan M.; Homer, Martin

2017-04-01

Dielectric Elastomer Generators (DEGs) are an emerging energy harvesting technology based on a the cyclic stretching of a rubber-like membrane. However, most design processes do not take into account different excitation frequencies; thus limits the applicability studies since in real-world situations forcing frequency is not often constant. Through the use of a practical design scenario we use modeling and simulation to determine the material frequency response and, hence, carefully investigate the excitation frequencies that maximize the performance (power output, efficiency) of DEGs and the factors that influence it.

Tailored Prevention of Inpatient Falls

PubMed Central

ZUYEV, LYUBOV; BENOIT, ANGELA N.; CHANG, FRANK Y.; DYKES, PATRICIA C.

2011-01-01

Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model. Three output tools available to be generated from the toolkit are bed poster, plan of care, and patient education handout. A preliminary design of the application was based on initial requirements defined by project leaders and informed by focus groups with end users. Preliminary design partially simulated the paper version of the Morse Fall Scale currently used in hospitals involved in the research study. Strengths and weaknesses of the first prototype were identified by heuristic evaluation. Usability testing was performed at sites where research study is implemented. Suggestions mentioned by end users participating in usability studies were either directly incorporated into the toolkit and output tools, were slightly modified, or will be addressed during training. The next step is implementation of the fall prevention toolkit on the pilot testing units. PMID:20975543

Use of an Auditory Hallucination Simulation to Increase Student Pharmacist Empathy for Patients with Mental Illness

PubMed Central

Eukel, Heidi N.; Frenzel, Jeanne E.; Werremeyer, Amy; McDaniel, Becky

2016-01-01

Objective. To increase student pharmacist empathy through the use of an auditory hallucination simulation. Design. Third-year professional pharmacy students independently completed seven stations requiring skills such as communication, following directions, reading comprehension, and cognition while listening to an audio recording simulating what one experiencing auditory hallucinations may hear. Following the simulation, students participated in a faculty-led debriefing and completed a written reflection. Assessment. The Kiersma-Chen Empathy Scale was completed by each student before and after the simulation to measure changes in empathy. The written reflections were read and qualitatively analyzed. Empathy scores increased significantly after the simulation. Qualitative analysis showed students most frequently reported feeling distracted and frustrated. All student participants recommended the simulation be offered to other student pharmacists, and 99% felt the simulation would impact their future careers. Conclusions. With approximately 10 million adult Americans suffering from serious mental illness, it is important for pharmacy educators to prepare students to provide adequate patient care to this population. This auditory hallucination simulation increased student pharmacist empathy for patients with mental illness. PMID:27899838

Testing and evaluation for astronaut extravehicular activity (EVA) operability.

PubMed

Shields, N; King, L C

1998-09-01

Because it is the human component that defines space mission success, careful planning is required to ensure that hardware can be operated and maintained by crews on-orbit. Several methods exist to allow researchers and designers to better predict how hardware designs will behave under the harsh environment of low Earth orbit, and whether designs incorporate the necessary features for Extra Vehicular Activity (EVA) operability. Testing under conditions of simulated microgravity can occur during the design concept phase when verifying design operability, during mission training, or concurrently with on-orbit mission operations. The bulk of testing is focused on normal operations, but also includes evaluation of credible mission contingencies or "what would happen if" planning. The astronauts and cosmonauts who fly these space missions are well prepared and trained to survive and be productive in Earth's orbit. The engineers, designers, and training crews involved in space missions subject themselves to Earth based simulation techniques that also expose them to extreme environments. Aircraft falling ten thousand feet, alternating g-loads, underwater testing at 45 foot depth, enclosure in a vacuum chamber and subject to thermal extremes, each carries with it inherent risks to the humans preparing for space missions.

Preparing palliative home care nurses to act as facilitators for physicians' learning: Evaluation of a training programme.

PubMed

Pype, Peter; Mertens, Fien; Wens, Johan; Stes, Ann; Van den Eynden, Bart; Deveugele, Myriam

2015-05-01

Palliative care requires a multidisciplinary care team. General practitioners often ask specialised palliative home care teams for support. Working with specialised nurses offers learning opportunities, also called workplace learning. This can be enhanced by the presence of a learning facilitator. To describe the development and evaluation of a training programme for nurses in primary care. The programme aimed to prepare palliative home care team nurses to act as facilitators for general practitioners' workplace learning. A one-group post-test only design (quantitative) and semi-structured interviews (qualitative) were used. A multifaceted train-the-trainer programme was designed. Evaluation was done through assignments with individual feedback, summative assessment through videotaped encounters with simulation-physicians and individual interviews after a period of practice implementation. A total of 35 nurses followed the programme. The overall satisfaction was high. Homework assignments interfered with the practice workload but showed to be fundamental in translating theory into practice. Median score on the summative assessment was 7 out of 14 with range 1-13. Interviews revealed some aspects of the training (e.g. incident analysis) to be too difficult for implementation or to be in conflict with personal preferences (focus on patient care instead of facilitating general practitioners' learning). Training palliative home care team nurses as facilitator of general practitioners' workplace learning is a feasible but complex intervention. Personal characteristics, interpersonal relationships and contextual variables have to be taken into account. Training expert palliative care nurses to facilitate general practitioners' workplace learning requires careful and individualised mentoring. © The Author(s) 2014.

Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review.

PubMed

Neo, Jun Rong Jeffrey; Sagha-Zadeh, Rana; Vielemeyer, Ole; Franklin, Ella

2016-06-01

Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission and nosocomial infections. However, most HH interventions (HHI) have not been sustainable. This review aims to provide a comprehensive summary of recently published evidence-based HHI designed to improve HH compliance (HHC) that will enable health care providers to make informed choices when allocating limited resources to improve HHC and patient safety. The Medline electronic database (using PubMed) was used to identify relevant studies. English language articles that included hand hygiene interventions and related terms combined with health care environments or related terms were included. Seventy-three studies that met the inclusion criteria were summarized. Interventions were categorized as improving awareness with education, facility design, and planning, unit-level protocols and procedures, hospital-wide programs, and multimodal interventions. Past successful HHIs may not be as effective when applied to other health care environments. HH education should be interactive and engaging. Electronic monitoring and reminders should be implemented in phases to ensure cost-effectiveness. To create hospitalwide programs that engage end users, policy makers should draw expertise from interdisciplinary fields. Before implementing the various components of multimodal interventions, health care practitioners should identify and examine HH difficulties unique to their organizations. Future research should seek to achieve the following: replicate successful HHI in other health care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions, examine ways (eg, hospital leadership, financial support, and strategies from public health and infection prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of graphic cardiovascular display in a high-fidelity simulator.

PubMed

Agutter, James; Drews, Frank; Syroid, Noah; Westneskow, Dwayne; Albert, Rob; Strayer, David; Bermudez, Julio; Weinger, Matthew B

2003-11-01

"Human error" in anesthesia can be attributed to misleading information from patient monitors or to the physician's failure to recognize a pattern. A graphic representation of monitored data may provide better support for detection, diagnosis, and treatment. We designed a graphic display to show hemodynamic variables. Twenty anesthesiologists were asked to assume care of a simulated patient. Half the participants used the graphic cardiovascular display; the other half used a Datex As/3 monitor. One scenario was a total hip replacement with a transfusion reaction to mismatched blood. The second scenario was a radical prostatectomy with 1.5 L of blood loss and myocardial ischemia. Subjects who used the graphic display detected myocardial ischemia 2 min sooner than those who did not use the display. Treatment was initiated sooner (2.5 versus 4.9 min). There were no significant differences between groups in the hip replacement scenario. Systolic blood pressure deviated less from baseline, central venous pressure was closer to its baseline, and arterial oxygen saturation was higher at the end of the case when the graphic display was used. The study lends some support for the hypothesis that providing clinical information graphically in a display designed with emergent features and functional relationships can improve clinicians' ability to detect, diagnose, manage, and treat critical cardiovascular events in a simulated environment. A graphic representation of monitored data may provide better support for detection, diagnosis, and treatment. A user-centered design process led to a novel object-oriented graphic display of hemodynamic variables containing emergent features and functional relationships. In a simulated environment, this display appeared to support clinicians' ability to diagnose, manage, and treat a critical cardiovascular event in a simulated environment. We designed a graphic display to show hemodynamic variables. The study provides some support for the hypothesis that providing clinical information graphically in a display designed with emergent features and functional relationships can improve clinicians' ability to detect, diagnosis, mange, and treat critical cardiovascular events in a simulated environment.

Adaptation of the Camera Link Interface for Flight-Instrument Applications

NASA Technical Reports Server (NTRS)

Randall, David P.; Mahoney, John C.

2010-01-01

COTS (commercial-off-the-shelf) hard ware using an industry-standard Camera Link interface is proposed to accomplish the task of designing, building, assembling, and testing electronics for an airborne spectrometer that would be low-cost, but sustain the required data speed and volume. The focal plane electronics were designed to support that hardware standard. Analysis was done to determine how these COTS electronics could be interfaced with space-qualified camera electronics. Interfaces available for spaceflight application do not support the industry standard Camera Link interface, but with careful design, COTS EGSE (electronics ground support equipment), including camera interfaces and camera simulators, can still be used.

Evaluating a Modular Decision Support Application for Colorectal Cancer Screening

PubMed Central

Diiulio, Julie B.; Borders, Morgan R.; Sushereba, Christen E.; Saleem, Jason J.; Haverkamp, Donald; Imperiale, Thomas F.

2017-01-01

Summary Background There is a need for health information technology evaluation that goes beyond randomized controlled trials to include consideration of usability, cognition, feedback from representative users, and impact on efficiency, data quality, and clinical workflow. This article presents an evaluation illustrating one approach to this need using the Decision-Centered Design framework. Objective To evaluate, through a Decision-Centered Design framework, the ability of the Screening and Surveillance App to support primary care clinicians in tracking and managing colorectal cancer testing. Methods We leveraged two evaluation formats, online and in-person, to obtain feedback from a range primary care clinicians and obtain comparative data. Both the online and in-person evaluations used mock patient data to simulate challenging patient scenarios. Primary care clinicians responded to a series of colorectal cancer-related questions about each patient and made recommendations for screening. We collected data on performance, perceived workload, and usability. Key elements of Decision-Centered Design include evaluation in the context of realistic, challenging scenarios and measures designed to explore impact on cognitive performance. Results Comparison of means revealed increases in accuracy, efficiency, and usability and decreases in perceived mental effort and workload when using the Screening and Surveillance App. Conclusion The results speak to the benefits of using the Decision-Centered Design approach in the analysis, design, and evaluation of Health Information Technology. Furthermore, the Screening and Surveillance App shows promise for filling decision support gaps in current electronic health records. PMID:28197619

Mapping the Limitations of Breakthrough Analysis in Fixed-Bed Adsorption

NASA Technical Reports Server (NTRS)

Knox, James Clinton

2017-01-01

The separation of gases through adsorption plays an important role in the chemical processing industry, where the separation step is often the costliest part of a chemical process and thus worthy of careful study and optimization. This work developed a number of new, archival aspects on the computer simulations used for the refinement and design of these gas adsorption processes: 1. Presented a new approach to fit the undetermined heat and mass transfer coefficients in the axially dispersed plug flow equation and associated balance equations 2. Examined and described the conditions where non-physical simulation results can arise 3. Presented an approach to determine the limits of the axial dispersion and LDF mass transfer terms above which non-physical simulation results occur.

Signal detection of adverse events with imperfect confirmation rates in vaccine safety studies using self-controlled case series design.

PubMed

Xu, Stanley; Newcomer, Sophia; Nelson, Jennifer; Qian, Lei; McClure, David; Pan, Yi; Zeng, Chan; Glanz, Jason

2014-05-01

The Vaccine Safety Datalink project captures electronic health record data including vaccinations and medically attended adverse events on 8.8 million enrollees annually from participating managed care organizations in the United States. While the automated vaccination data are generally of high quality, a presumptive adverse event based on diagnosis codes in automated health care data may not be true (misclassification). Consequently, analyses using automated health care data can generate false positive results, where an association between the vaccine and outcome is incorrectly identified, as well as false negative findings, where a true association or signal is missed. We developed novel conditional Poisson regression models and fixed effects models that accommodate misclassification of adverse event outcome for self-controlled case series design. We conducted simulation studies to evaluate their performance in signal detection in vaccine safety hypotheses generating (screening) studies. We also reanalyzed four previously identified signals in a recent vaccine safety study using the newly proposed models. Our simulation studies demonstrated that (i) outcome misclassification resulted in both false positive and false negative signals in screening studies; (ii) the newly proposed models reduced both the rates of false positive and false negative signals. In reanalyses of four previously identified signals using the novel statistical models, the incidence rate ratio estimates and statistical significances were similar to those using conventional models and including only medical record review confirmed cases. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

PubMed Central

de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

2017-01-01

Objective To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Design Cross-sectional observational health facility assessment. Setting Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Participants Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Main outcome measures Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Results Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. Conclusions The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives. PMID:28348194

Near-peer medical student simulation training.

PubMed

Cash, Thomas; Brand, Eleanor; Wong, Emma; Richardson, Jay; Athorn, Sam; Chowdhury, Faiza

2017-06-01

There is growing concern that medical students are inadequately prepared for life as a junior doctor. A lack of confidence managing acutely unwell patients is often cited as a barrier to good clinical care. With medical schools investing heavily in simulation equipment, we set out to explore if near-peer simulation training is an effective teaching format. Medical students in their third year of study and above were invited to attend a 90-minute simulation teaching session. The sessions were designed and delivered by final-year medical students using clinical scenarios mapped to the Sheffield MBChB curriculum. Candidates were required to assess, investigate and manage an acutely unwell simulated patient. Pre- and post-simulation training Likert scale questionnaires were completed relating to self-reported confidence levels. There is growing concern that medical students are inadequately prepared for life as a junior doctor RESULTS: Questionnaires were completed by 25 students (100% response rate); 52 per cent of students had no prior simulation experience. There were statistically significant improvements in self-reported confidence levels in each of the six areas assessed (p < 0.005). Thematic analysis of free-text comments indicated that candidates enjoyed the practical format of the sessions and found the experience useful. Our results suggest that near-peer medical student simulation training benefits both teacher and learner and that this simplistic model could easily be replicated at other medical schools. As the most junior members of the team, medical students are often confined to observer status. Simulation empowers students to practise independently in a safe and protected environment. Furthermore, it may help to alleviate anxiety about starting work as a junior doctor and improve future patient care. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Traffic signal design and simulation for vulnerable road users safety and bus preemption

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lo, Shih-Ching; Huang, Hsieh-Chu

Mostly, pedestrian car accidents occurred at a signalized interaction is because pedestrians cannot across the intersection safely within the green light. From the viewpoint of pedestrian, there might have two reasons. The first one is pedestrians cannot speed up to across the intersection, such as the elders. The other reason is pedestrians do not sense that the signal phase is going to change and their right-of-way is going to be lost. Developing signal logic to protect pedestrian, who is crossing an intersection is the first purpose of this study. In addition, to improve the reliability and reduce delay of publicmore » transportation service is the second purpose. Therefore, bus preemption is also considered in the designed signal logic. In this study, the traffic data of the intersection of Chong-Qing North Road and Min-Zu West Road, Taipei, Taiwan, is employed to calibrate and validate the signal logic by simulation. VISSIM 5.20, which is a microscopic traffic simulation software, is employed to simulate the signal logic. From the simulated results, the signal logic presented in this study can protect pedestrians crossing the intersection successfully. The design of bus preemption can reduce the average delay. However, the pedestrian safety and bus preemption signal will influence the average delay of cars largely. Thus, whether applying the pedestrian safety and bus preemption signal logic to an intersection or not should be evaluated carefully.« less

Hospital influenza pandemic stockpiling needs: A computer simulation.

PubMed

Abramovich, Mark N; Hershey, John C; Callies, Byron; Adalja, Amesh A; Tosh, Pritish K; Toner, Eric S

2017-03-01

A severe influenza pandemic could overwhelm hospitals but planning guidance that accounts for the dynamic interrelationships between planning elements is lacking. We developed a methodology to calculate pandemic supply needs based on operational considerations in hospitals and then tested the methodology at Mayo Clinic in Rochester, MN. We upgraded a previously designed computer modeling tool and input carefully researched resource data from the hospital to run 10,000 Monte Carlo simulations using various combinations of variables to determine resource needs across a spectrum of scenarios. Of 10,000 iterations, 1,315 fell within the parameters defined by our simulation design and logical constraints. From these valid iterations, we projected supply requirements by percentile for key supplies, pharmaceuticals, and personal protective equipment requirements needed in a severe pandemic. We projected supplies needs for a range of scenarios that use up to 100% of Mayo Clinic-Rochester's surge capacity of beds and ventilators. The results indicate that there are diminishing patient care benefits for stockpiling on the high side of the range, but that having some stockpile of critical resources, even if it is relatively modest, is most important. We were able to display the probabilities of needing various supply levels across a spectrum of scenarios. The tool could be used to model many other hospital preparedness issues, but validation in other settings is needed. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases

PubMed Central

Reimers, Mallory; Ernst, Neysa; Bova, Gregory; Nowakowski, Elaine; Bukowski, James; Ellis, Brandon C.; Smith, Chris; Sauer, Lauren; Dionne, Kim; Carroll, Karen C.; Maragakis, Lisa L.; Parrish, Nicole M.

2016-01-01

ABSTRACT In response to the Ebola outbreak in 2014, many hospitals designated specific areas to care for patients with Ebola and other highly infectious diseases. The safe handling of category A infectious substances is a unique challenge in this environment. One solution is on-site waste treatment with a steam sterilizer or autoclave. The Johns Hopkins Hospital (JHH) installed two pass-through autoclaves in its biocontainment unit (BCU). The JHH BCU and The Johns Hopkins biosafety level 3 (BSL-3) clinical microbiology laboratory designed and validated waste-handling protocols with simulated patient trash to ensure adequate sterilization. The results of the validation process revealed that autoclave factory default settings are potentially ineffective for certain types of medical waste and highlighted the critical role of waste packaging in successful sterilization. The lessons learned from the JHH validation process can inform the design of waste management protocols to ensure effective treatment of highly infectious medical waste. PMID:27927920

Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases.

PubMed

Garibaldi, Brian T; Reimers, Mallory; Ernst, Neysa; Bova, Gregory; Nowakowski, Elaine; Bukowski, James; Ellis, Brandon C; Smith, Chris; Sauer, Lauren; Dionne, Kim; Carroll, Karen C; Maragakis, Lisa L; Parrish, Nicole M

2017-02-01

In response to the Ebola outbreak in 2014, many hospitals designated specific areas to care for patients with Ebola and other highly infectious diseases. The safe handling of category A infectious substances is a unique challenge in this environment. One solution is on-site waste treatment with a steam sterilizer or autoclave. The Johns Hopkins Hospital (JHH) installed two pass-through autoclaves in its biocontainment unit (BCU). The JHH BCU and The Johns Hopkins biosafety level 3 (BSL-3) clinical microbiology laboratory designed and validated waste-handling protocols with simulated patient trash to ensure adequate sterilization. The results of the validation process revealed that autoclave factory default settings are potentially ineffective for certain types of medical waste and highlighted the critical role of waste packaging in successful sterilization. The lessons learned from the JHH validation process can inform the design of waste management protocols to ensure effective treatment of highly infectious medical waste. Copyright © 2017 American Society for Microbiology.

Effect of simulation training on the development of nurses and nursing students' critical thinking: A systematic literature review.

PubMed

Adib-Hajbaghery, Mohsen; Sharifi, Najmeh

2017-03-01

To gain insight into the existing scientific evidence on the effect of simulation on critical thinking in nursing education. A systematic literature review of original research publications. In this systematic review, the papers published in English and Farsi databases of PubMed, Science Direct, ProQuest, ERIC, Google Scholar and Ovid, MagIran and SID, from 1975 to 2015 were reviewed by two independent researchers. Original research publications were eligible for review when they described simulation program directed on nursing student and nurses; used a control group or a pretest post-test design; and gave information about the effects of simulation on critical thinking. Two reviewers independently assessed the studies for inclusion. Methodological quality of the included studies was also independently assessed by the reviewers, using a checklist developed by Greenhalgh et al. and the checklist of Cochrane Center. Data related to the original publications were extracted by one reviewer and checked by a second reviewer. No statistical pooling of outcomes was performed, due to the large heterogeneity of outcomes. After screening the titles and abstracts of 787 papers, 16 ones were included in the review according to the inclusion criteria. These used experimental or quasi-experimental designs. The studies used a variety of instruments and a wide range of simulation methods with differences in duration and numbers of exposures to simulation. Eight of the studies reported that simulation training positively affected the critical thinking skills. However, eight studies reported ineffectiveness of simulation on critical thinking. Studies are conflicting about the effect of simulation on nurses and nursing students' critical thinking. Also, a large heterogeneity exists between the studies in terms of the instruments and the methods used. Thus, more studies with careful designs are needed to produce more credible evidence on the effectiveness of simulation on critical thinking. Copyright © 2016 Elsevier Ltd. All rights reserved.

Human cadavers Vs. multimedia simulation: A study of student learning in anatomy.

PubMed

Saltarelli, Andrew J; Roseth, Cary J; Saltarelli, William A

2014-01-01

Multimedia and simulation programs are increasingly being used for anatomy instruction, yet it remains unclear how learning with these technologies compares with learning with actual human cadavers. Using a multilevel, quasi-experimental-control design, this study compared the effects of "Anatomy and Physiology Revealed" (APR) multimedia learning system with a traditional undergraduate human cadaver laboratory. APR is a model-based multimedia simulation tool that uses high-resolution pictures to construct a prosected cadaver. APR also provides animations showing the function of specific anatomical structures. Results showed that the human cadaver laboratory offered a significant advantage over the multimedia simulation program on cadaver-based measures of identification and explanatory knowledge. These findings reinforce concerns that incorporating multimedia simulation into anatomy instruction requires careful alignment between learning tasks and performance measures. Findings also imply that additional pedagogical strategies are needed to support transfer from simulated to real-world application of anatomical knowledge. © 2014 American Association of Anatomists.

The effects of using a human patient simulator compared to a CD-ROM in teaching critical thinking and performance.

PubMed

Johnson, Don; Johnson, Sabine

2014-01-01

Military healthcare personnel, including nurse anesthetists, must have the knowledge and skills to care for the extensive, severe injuries incurred on the battlefield. No studies have compared the 2 teaching strategies of using the human patient simulator (HPS) and a CD-ROM in caring for combat injuries relative to critical thinking and performance using nurse anesthesia participants. A prospective, pretest-posttest experimental, mixed design (within and between) was used to determine if there were statistically significant differences in HPS and CD-ROM educational strategies relative to caring for patients who have trauma. Two instruments were used: critical thinking, which consisted of multiple-choice questions; and a combat performance instrument that measured ability to care for patients. A repeated analysis of variance and a least significant difference post-hoc test were used to analyze the data. The HPS group performed better than the CD-ROM and control groups relative to performance (P=.000) but not on critical thinking (P=.239). There was no difference between the CD-ROM and control group (P=.171) on the combat performance instrument. In this study, the HPS method of instruction was a more effective method of teaching than the CD-ROM approach.

An exploratory examination of medical gas booms versus traditional headwalls in intensive care unit design.

PubMed

Pati, Debajyoti; Evans, Jennie; Waggener, Laurie; Harvey, Tom

2008-01-01

Should power, medical gases, and monitoring and communications systems be located in a headwall or a ceiling-mounted boom in intensive care unit (ICU) rooms? Often, only the financial costs could be determined for the options, whereas data regarding its potential influence on teamwork, safety, and efficiency are lacking. Hence, purchase decisions are more arbitrary than evidence based. This study simulated care delivery in settings with a traditional headwall and a ceiling boom. Observed were the way the following elements were managed and the extent either system affected flexibility, ergonomics, and teamwork: tubing for intravenous fluids, medical gases, and suction drainage; monitoring leads and equipment power cords; and the medical equipment itself. Simulation runs involving 6 scenarios were conducted with the voluntary participation of 2 physicians, 2 nurse practitioners, 2 respiratory therapists, and 4 registered nurses at a children's tertiary care center in December 2007. Analysis suggests that booms have an advantage over headwalls in case of high-acuity ICU patients and when procedures are performed inside patient rooms. However, in case of lower-acuity ICU patients, as well as when procedures are not typically conducted in the patient room, booms may not provide a proportionate level of advantage when compared with the additional cost involved in its procurement.

Xyce parallel electronic simulator : users' guide.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mei, Ting; Rankin, Eric Lamont; Thornquist, Heidi K.

2011-05-01

This manual describes the use of the Xyce Parallel Electronic Simulator. Xyce has been designed as a SPICE-compatible, high-performance analog circuit simulator, and has been written to support the simulation needs of the Sandia National Laboratories electrical designers. This development has focused on improving capability over the current state-of-the-art in the following areas: (1) Capability to solve extremely large circuit problems by supporting large-scale parallel computing platforms (up to thousands of processors). Note that this includes support for most popular parallel and serial computers; (2) Improved performance for all numerical kernels (e.g., time integrator, nonlinear and linear solvers) through state-of-the-artmore » algorithms and novel techniques. (3) Device models which are specifically tailored to meet Sandia's needs, including some radiation-aware devices (for Sandia users only); and (4) Object-oriented code design and implementation using modern coding practices that ensure that the Xyce Parallel Electronic Simulator will be maintainable and extensible far into the future. Xyce is a parallel code in the most general sense of the phrase - a message passing parallel implementation - which allows it to run efficiently on the widest possible number of computing platforms. These include serial, shared-memory and distributed-memory parallel as well as heterogeneous platforms. Careful attention has been paid to the specific nature of circuit-simulation problems to ensure that optimal parallel efficiency is achieved as the number of processors grows. The development of Xyce provides a platform for computational research and development aimed specifically at the needs of the Laboratory. With Xyce, Sandia has an 'in-house' capability with which both new electrical (e.g., device model development) and algorithmic (e.g., faster time-integration methods, parallel solver algorithms) research and development can be performed. As a result, Xyce is a unique electrical simulation capability, designed to meet the unique needs of the laboratory.« less

Improving the governance of patient safety in emergency care: a systematic review of interventions

PubMed Central

Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

2016-01-01

Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design A systematic review of the literature. Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base. PMID:26826151

A Simulation Study on a Single-Unit Wireless EEG Sensor

PubMed Central

Luan, Bo; Sun, Mingui

2015-01-01

Traditional EEG systems are limited when utilized in point-of-care applications due to its immobility and tedious preparation procedures. We are designing a novel device named single-unit wireless EEG sensor to solve these problems. The sensor has a size similar to a U.S. penny. Four electrodes are installed within a 20mm diameter cylinder. It can be applied to scalp in seconds to amplify, digitize and wirelessly transmit EEG. Before the design and construction of an actual sensor, in this paper, we perform a set of simulations to quantitatively study: 1) can the sensor acquire EEG reliably? 2) will the selection of sensor orientation be an important factor to influence signal strength? Our results demonstrate positive answers to these questions. Moreover, the signal sensor acquired appears to be comparable to the signal from the standard 10-20 system. These results warrant the further design and construction of a single-unit wireless EEG sensor. PMID:26207084

Designs and numerical calculations for echo-enabled harmonic generation at very high harmonics

NASA Astrophysics Data System (ADS)

Penn, G.; Reinsch, M.

2011-09-01

The echo-enabled harmonic generation (EEHG) scheme for driving an FEL using two seeded energy modulations at much longer wavelengths than the output wavelength is a promising concept for future seeded FELs. There are many competing requirements in the design of an EEHG beamline which need careful optimization. Furthermore, revised simulation tools and methods are necessary because of both the high harmonic numbers simulated and the complicated nature of the phase space manipulations which are intrinsic to the scheme. This paper explores the constraints on performance and the required tolerances for reaching wavelengths well below 1/100th of that of the seed lasers, and describes some of the methodology for designing such a beamline. Numerical tools, developed both for the GENESIS and GINGER FEL codes, are presented and used here for more accurate study of the scheme beyond a time-averaged model. In particular, the impact of the local structure in peak current and bunching, which is an inherent part of the EEHG scheme, is evaluated.

Opportunities and Challenges in Supply-Side Simulation: Physician-Based Models

PubMed Central

Gresenz, Carole Roan; Auerbach, David I; Duarte, Fabian

2013-01-01

Objective To provide a conceptual framework and to assess the availability of empirical data for supply-side microsimulation modeling in the context of health care. Data Sources Multiple secondary data sources, including the American Community Survey, Health Tracking Physician Survey, and SK&A physician database. Study Design We apply our conceptual framework to one entity in the health care market—physicians—and identify, assess, and compare data available for physician-based simulation models. Principal Findings Our conceptual framework describes three broad types of data required for supply-side microsimulation modeling. Our assessment of available data for modeling physician behavior suggests broad comparability across various sources on several dimensions and highlights the need for significant integration of data across multiple sources to provide a platform adequate for modeling. A growing literature provides potential estimates for use as behavioral parameters that could serve as the models' engines. Sources of data for simulation modeling that account for the complex organizational and financial relationships among physicians and other supply-side entities are limited. Conclusions A key challenge for supply-side microsimulation modeling is optimally combining available data to harness their collective power. Several possibilities also exist for novel data collection. These have the potential to serve as catalysts for the next generation of supply-side-focused simulation models to inform health policy. PMID:23347041

A novel process for introducing a new intraoperative program: a multidisciplinary paradigm for mitigating hazards and improving patient safety.

PubMed

Rodriguez-Paz, Jose M; Mark, Lynette J; Herzer, Kurt R; Michelson, James D; Grogan, Kelly L; Herman, Joseph; Hunt, David; Wardlow, Linda; Armour, Elwood P; Pronovost, Peter J

2009-01-01

Since the Institute of Medicine's report, To Err is Human, was published, numerous interventions have been designed and implemented to correct the defects that lead to medical errors and adverse events; however, most efforts were largely reactive. Safety, communication, team performance, and efficiency are areas of care that attract a great deal of attention, especially regarding the introduction of new technologies, techniques, and procedures. We describe a multidisciplinary process that was implemented at our hospital to identify and mitigate hazards before the introduction of a new technique: high-dose-rate intraoperative radiation therapy, (HDR-IORT). A multidisciplinary team of surgeons, anesthesiologists, radiation oncologists, physicists, nurses, hospital risk managers, and equipment specialists used a structured process that included in situ clinical simulation to uncover concerns among care providers and to prospectively identify and mitigate defects for patients who would undergo surgery using the HDR-IORT technique. We identified and corrected 20 defects in the simulated patient care process before application to actual patients. Subsequently, eight patients underwent surgery using the HDR-IORT technique with no recurrence of simulation-identified or unanticipated defects. Multiple benefits were derived from the use of this systematic process to introduce the HDR-IORT technique; namely, the safety and efficiency of care for this select patient population was optimized, and this process mitigated harmful or adverse events before the inclusion of actual patients. Further work is needed, but the process outlined in this paper can be universally applied to the introduction of any new technologies, treatments, or procedures.

Virtual Simulated Care Coordination Rounds for Nursing Students.

PubMed

Badowski, Donna M

Implementation of the Affordable Care Act has nursing education reflecting on paradigm shifts in order to prepare nursing students for the evolving health care environment. The traditional focus of nursing education on nursing care in acute care settings does not provide learning experiences in care coordination and transitional care management skills. Virtual simulated care coordination rounds, using the National League for Nursing Advancing Care Excellence resources, offer nursing students an innovative experience in care coordination and transition care management.

"Hand-it-on": an innovative simulation on the relation of non-technical skills to healthcare.

PubMed

Dieckmann, Peter; Zeltner, Louise Graae; Helsø, Anne-Mette

2016-01-01

Non-technical skills (NTS) are an integral part of the abilities healthcare professionals need to optimally care for patients. Integrating NTS into the already complex tasks of healthcare can be a challenge for clinicians. Integrating NTS into simulation-based training increases the demands for simulation instructors with regard to scenario design, conduct, and debriefing. We introduce a simulation game, Hand-it-on , that can trigger discussions on how NTS can influence work processes. Hand-it-on aims to help clinicians and simulation instructors alike to improve their understanding of NTS concepts and where they can apply them in their work. It complements existing approaches to teaching NTS by limiting the complexity of the game and by removing medical content, allowing learners to concentrate on NTS. Hand-it-on is relevant for groups and teams working across the range of different healthcare contexts. During Hand-it-on, participants stand in a circle and hand on everyday objects to each other according to simple rules, resulting in many events that can be debriefed in relation to safe patient care. We describe both the conduct of Hand-it-on and ideas on how to debrief participants. We provide variations that can be used in different contexts, focusing the exercise on different learning goals. We also offer the theoretical rationale for using an out-of-context simulation in combination with other forms of teaching. Although we did not evaluate Hand-it-on formally, oral feedback from participants and the replication of Hand-it-on by many simulation teams support its value.

Creation of an active learning healthcare communications course using simulations relevant to pharmacy practice.

PubMed

Collier, Izabela A; Baker, David M

2017-07-01

The purpose of this project was to design and develop a health care communications course built around practice-like simulations and active learning in the first year of a professional pharmacy program. A three-credit health care communications course was divided into one didactic (two hours per week) and three simulation components (one hour per week). The simulation components consisted of one written patient education pamphlet, three group presentations, and three one-on-one patient counseling sessions. This was accomplished by breaking the class of approximately 75 students into eight separate sections, each consisting of 8-10 students and one instructor. Each week four sections were devoted to counseling role-plays: half in the role of pharmacists and half as patients. The other four sections were devoted to hour-long professional group presentations-half in the presenting group and half as audience. The students' performance in the simulated counseling sessions and group presentations has been tracked and analyzed to determine if the simulated exercises had a positive impact on the students' active communications skills. Consistently, over the first four years of the implementation of the course, students' communications skills, as measured by faculty assessments, in both professional group presentations and one-on-one counseling sessions significantly improved. Incorporation of active-learning simulation exercises into a healthcare communications course has a positive impact on the development of students' communications skills. This creates a foundation upon which students can build over the remainder of the professional program and into their future careers. Copyright © 2017 Elsevier Inc. All rights reserved.

A Multidisciplinary Approach to a Pediatric Difficult Airway Simulation Course.

PubMed

Lind, Meredith Merz; Corridore, Marco; Sheehan, Cameron; Moore-Clingenpeel, Melissa; Maa, Tensing

2018-02-01

Objective To design and assess an advanced pediatric airway management course, through simulation-based team training and with multiple disciplines, to emphasize communication and cooperation across subspecialties and to provide a common skill set and knowledge base. Methods Trainees from anesthesiology, emergency medicine, critical care, pediatric surgery, and otolaryngology at a tertiary children's hospital participated in a 1-day workshop emphasizing airway skills and complex airway simulations. Small groups were multidisciplinary to promote teamwork. Participants completed pre- and postworkshop questionnaires. Results Thirty-nine trainees participated over the 3-year study period. Compared with their precourse responses, participants' postcourse responses indicated either agreement or strong agreement that the multidisciplinary format (1) helped in the development of team communication skills and (2) was preferred over single-discipline training. Improvement in confidence in managing critical airway situations and in advanced airway management skills was significant ( P < .05). Eighty-one percent of participants had improved confidence in following the hospital's critical airway protocol, and 64% were better able to locate advanced airway management equipment. Discussion Multiple subspecialists manage pediatric respiratory failure, where successful care requires complex handoffs and teamwork. Multidisciplinary education to teach advanced airway management, teamwork, and communication skills is practical and preferred by learners and is possible to achieve despite differences in experience. Future study is required to better understand the impact of this course on patient care outcomes. Implications for Practice Implementation of a pediatric difficult airway course through simulation-based team training is feasible and preferred by learners among multiple disciplines. A multidisciplinary approach exposes previously unrecognized knowledge gaps and allows for better communication and collaboration among the fields.

Conceptualizing Interprofessional Teams as Multi-Team Systems-Implications for Assessment and Training.

PubMed

West, Courtney; Landry, Karen; Graham, Anna; Graham, Lori; Cianciolo, Anna T; Kalet, Adina; Rosen, Michael; Sherman, Deborah Witt

2015-01-01

SGEA 2015 CONFERENCE ABSTRACT (EDITED). Evaluating Interprofessional Teamwork During a Large-Scale Simulation. Courtney West, Karen Landry, Anna Graham, and Lori Graham. CONSTRUCT: This study investigated the multidimensional measurement of interprofessional (IPE) teamwork as part of large-scale simulation training. Healthcare team function has a direct impact on patient safety and quality of care. However, IPE team training has not been the norm. Recognizing the importance of developing team-based collaborative care, our College of Nursing implemented an IPE simulation activity called Disaster Day and invited other professions to participate. The exercise consists of two sessions: one in the morning and another in the afternoon. The disaster scenario is announced just prior to each session, which consists of team building, a 90-minute simulation, and debriefing. Approximately 300 Nursing, Medicine, Pharmacy, Emergency Medical Technicians, and Radiology students and over 500 standardized and volunteer patients participated in the Disaster Day event. To improve student learning outcomes, we created 3 competency-based instruments to evaluate collaborative practice in multidimensional fashion during this exercise. A 20-item IPE Team Observation Instrument designed to assess interprofessional team's attainment of Interprofessional Education Collaborative (IPEC) competencies was completed by 20 faculty and staff observing the Disaster Day simulation. One hundred sixty-six standardized patients completed a 10-item Standardized Patient IPE Team Evaluation Instrument developed from the IPEC competencies and adapted items from the 2014 Henry et al. PIVOT Questionnaire. This instrument assessed the standardized or volunteer patient's perception of the team's collaborative performance. A 29-item IPE Team's Perception of Collaborative Care Questionnaire, also created from the IPEC competencies and divided into 5 categories of Values/Ethics, Roles and Responsibilities, Communication, Teamwork, and Self-Evaluation, was completed by 188 students including 99 from Nursing, 43 from Medicine, 6 from Pharmacy, and 40 participants who belonged to more than one component, were students at another institution, or did not indicate their institution. The team instrument was designed to assess each team member's perception of how well the team and him- or herself met the competencies. Five of the items on the team perceptions questionnaire mirrored items on the standardized patient evaluation: demonstrated leadership practices that led to effective teamwork, discussed care and decisions about that care with patient, described roles and responsibilities clearly, worked well together to coordinate care, and good/effective communication. Internal consistency reliability of the IPE Team Observation Instrument was 0.80. In 18 of the 20 items, more than 50% of observers indicated the item was demonstrated. Of those, 6 of the items were observed by 50% to 75% of the observers, and the remaining 12 were observed by more than 80% of the observers. Internal consistency reliability of the IPE Team's Perception of Collaborative Care Instrument was 0.95. The mean response score-1 (strongly disagree) to 4 (strongly agree)-was calculated for each section of the instrument. The overall mean score was 3.57 (SD = .11). Internal consistency reliability of the Standardized Patient IPE Team Evaluation Instrument was 0.87. The overall mean score was 3.28 (SD = .17). The ratings for the 5 items shared by the standardized patient and team perception instruments were compared using independent sample t tests. Statistically significant differences (p < .05) were present in each case, with the students rating themselves higher on average than the standardized patients did (mean differences between 0.2 and 0.6 on a scale of 1-4). Multidimensional, competency-based instruments appear to provide a robust view of IPE teamwork; however, challenges remain. Due to the large scale of the simulation exercise, observation-based assessment did not function as well as self- and standardized patient-based assessment. To promote greater variation in observer assessments during future Disaster Day simulations, we plan to adjust the rating scale from "not observed," "observed," and "not applicable" to a 4-point scale and reexamine interrater reliability.

A comparative assessment of nursing students' cognitive knowledge of blood transfusion using lecture and simulation.

PubMed

Flood, Lisa S; Higbie, Julie

2016-01-01

Professional nurses must have the knowledge and skills to safely administer blood products and monitor for life-threatening complications. Nurse educators should ensure that student nurses also learn how to safely administer blood products; however students rarely have the opportunity to witness and manage adverse transfusion reactions. Despite the low incidence of rare adverse transfusion reactions, nursing students must be able to immediately recognize transfusion reactions, implement appropriate interventions, and communicate effectively with health care providers. To reinforce blood transfusion knowledge, practice technical skills, and promote management of adverse reactions, a human patient simulation experience was created for baccalaureate nursing students to provide application of related classroom content. Using a quasi-experimental design, students who received a related didactic lecture preceding the simulation were compared with students who did not receive the lecture. The lecture group's pre/posttest mean scores (n = 42) were significantly higher than the no lecture group's mean scores (n = 44). This simulation design included proper blood administration procedures, patient monitoring, management of transfusion reactions, and practice with interdisciplinary communication. Participation in a human patient simulation following a related didactic lecture may be useful to strengthen cognitive learning and help bridge the didactic-clinic gap. Copyright © 2015 Elsevier Ltd. All rights reserved.

Understanding interdisciplinary health care teams: using simulation design processes from the Air Carrier Advanced Qualification Program to identify and train critical teamwork skills.

PubMed

Hamman, William R; Beaudin-Seiler, Beth M; Beaubien, Jeffrey M

2010-09-01

In the report "Five Years After 'To Err is Human' ", it was noted that "the combination of complexity, professional fragmentation, and a tradition of individualism, enhanced by a well-entrenched hierarchical authority structure and diffuse accountability, forms a daunting barrier to creating the habits and beliefs of common purpose, teamwork, and individual accountability for successful interdependence that a safe culture requires". Training physicians, nurses, and other professionals to work in teams is a concept that has been promoted by many patient safety experts. However the model of teamwork in healthcare is diffusely defined, no clear performance metrics have been established, and the use of simulation to train teams has been suboptimal. This paper reports on the first three years of work performed in the Michigan Economic Development Corporation (MEDC) Tri-Corridor life science grant to apply concepts and processes of simulation design that were developed in the air carrier industry to understand and train healthcare teams. This work has been monitored by the American Academy for the Advancement of Science (AAA) and is based on concepts designed in the Advanced Qualification Program (AQP) from the air carrier industry, which trains and assesses teamwork skills in the same manner as technical skills. This grant has formed the foundation for the Center of Excellence for Simulation Education and Research (CESR).

Design and Simulation of a MEMS Structure for Electrophoretic and Dielectrophoretic Separation of Particles by Contactless Electrodes

NASA Technical Reports Server (NTRS)

Shaw, Harry C.

2007-01-01

Rapid identification of pathogenic bacterial species is an important factor in combating public health problems such as E. coli contamination. Food and waterborne pathogens account for sickness in 76 million people annually (CDC). Diarrheagenic E. coli is a major source of gastrointestinal illness. Severe sepsis and Septicemia within the hospital environment are also major problems. 75 1,000 cases annually with a 30-50% mortality rate (Crit Care Med, July '01, Vol. 29, 1303-10). Patient risks run the continuum from fever to organ failure and death. Misdiagnosis or inappropriate treatment increases mortality. There exists a need for rapid screening of samples for identification of pathogenic species (Certain E. coli strains are essential for health). Critical to the identification process is the ability to isolate analytes of interest rapidly. This poster discusses novel devices for the separation of particles on the basis of the dielectric properties, mass and surface charge characteristics is presented. Existing designs involve contact between electrode surfaces and analyte medium resulting in contamination of the electrode bearing elements Two different device designs using different bulk micromachining MEMS processes (PolyMUMPS and a PyrexBIGold electrode design) are presented. These designs cover a range of particle sizes from small molecules through eucaryotic cells. The application of separation of bacteria is discussed in detail. Simulation data for electrostatic and microfluidic characteristics are provided. Detailed design characteristics and physical features of the as fabricated PolyMUMPS design are provided. Analysis of the simulation data relative to the expected performance of the devices will be provided and subsequent conclusions discussed.

Impact of Hypobarism During Simulated Transport on Critical Care Air Transport Team Performance

DTIC Science & Technology

2017-04-26

AFRL-SA-WP-SR-2017-0008 Impact of Hypobarism During Simulated Transport on Critical Care Air Transport Team Performance Dina...July 2014 – November 2016 4. TITLE AND SUBTITLE Impact of Hypobarism During Simulated Transport on Critical Care Air Transport Team Performance 5a...During Critical Care Air Transport Team Advanced Course validation, three-member teams consisting of a physician, nurse, and respiratory therapist

Computer modeling with randomized-controlled trial data informs the development of person-centered aged care homes.

PubMed

Chenoweth, Lynn; Vickland, Victor; Stein-Parbury, Jane; Jeon, Yun-Hee; Kenny, Patricia; Brodaty, Henry

2015-10-01

To answer questions on the essential components (services, operations and resources) of a person-centered aged care home (iHome) using computer simulation. iHome was developed with AnyLogic software using extant study data obtained from 60 Australian aged care homes, 900+ clients and 700+ aged care staff. Bayesian analysis of simulated trial data will determine the influence of different iHome characteristics on care service quality and client outcomes. Interim results: A person-centered aged care home (socio-cultural context) and care/lifestyle services (interactional environment) can produce positive outcomes for aged care clients (subjective experiences) in the simulated environment. Further testing will define essential characteristics of a person-centered care home.

An Event-Based Approach to Design a Teamwork Training Scenario and Assessment Tool in Surgery.

PubMed

Nguyen, Ngan; Watson, William D; Dominguez, Edward

2016-01-01

Simulation is a technique recommended for teaching and measuring teamwork, but few published methodologies are available on how best to design simulation for teamwork training in surgery and health care in general. The purpose of this article is to describe a general methodology, called event-based approach to training (EBAT), to guide the design of simulation for teamwork training and discuss its application to surgery. The EBAT methodology draws on the science of training by systematically introducing training exercise events that are linked to training requirements (i.e., competencies being trained and learning objectives) and performance assessment. The EBAT process involves: Of the 4 teamwork competencies endorsed by the Agency for Healthcare Research Quality and Department of Defense, "communication" was chosen to be the focus of our training efforts. A total of 5 learning objectives were defined based on 5 validated teamwork and communication techniques. Diagnostic laparoscopy was chosen as the clinical context to frame the training scenario, and 29 KSAs were defined based on review of published literature on patient safety and input from subject matter experts. Critical events included those that correspond to a specific phase in the normal flow of a surgical procedure as well as clinical events that may occur when performing the operation. Similar to the targeted KSAs, targeted responses to the critical events were developed based on existing literature and gathering input from content experts. Finally, a 29-item EBAT-derived checklist was created to assess communication performance. Like any instructional tool, simulation is only effective if it is designed and implemented appropriately. It is recognized that the effectiveness of simulation depends on whether (1) it is built upon a theoretical framework, (2) it uses preplanned structured exercises or events to allow learners the opportunity to exhibit the targeted KSAs, (3) it assesses performance, and (4) it provides formative and constructive feedback to bridge the gap between the learners' KSAs and the targeted KSAs. The EBAT methodology guides the design of simulation that incorporates these 4 features and, thus, enhances training effectiveness with simulation. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Elective course in acute care using online learning and patient simulation.

PubMed

Seybert, Amy L; Kane-Gill, Sandra L

2011-04-11

To enhance students' knowledge of and critical-thinking skills in the management of acutely ill patients using online independent learning partnered with high-fidelity patient simulation sessions. Students enrolled in the Acute Care Simulation watched 10 weekly Web-based video presentations on various critical care and advanced cardiovascular pharmacotherapy topics. After completing each online module, all students participated in groups in patient-care simulation exercises in which they prepared a pharmacotherapeutic plan for the patient, recommended this plan to the patient's physician, and completed a debriefing session with the facilitator. Students completed a pretest and posttest before and after each simulation exercise, as well as midterm and final evaluations and a satisfaction survey. Pharmacy students significantly improved their scores on 9 of the 10 tests (p ≤ 0.05). Students' performance on the final evaluation improved compared with performance on the midterm evaluation. Overall, students were satisfied with the unique dual approach to learning and enjoyed the realistic patient-care environment that the simulation laboratory provided. Participation in an elective course that combined self-directed Web-based learning and hands-on patient simulation exercises increased pharmacy students' knowledge and critical-thinking skills in acute care.

An Interprofessional Learning Workshop for Mammography and Sonography Students Focusing on Breast Cancer Care and Management Via Simulation: A Pilot Study.

PubMed

Giles, Eileen M; Parange, Nayana; Knight, Bronwyn

2017-08-01

The literature surrounding interprofessional education claims that students who learn with, from, and about one another in well-designed interprofessional programs will practice together collaboratively upon graduation, given the skills to do so. The objective of this study was to examine attitudes to interprofessional practice before and after an interprofessional learning (IPL) activity. A total of 35 postgraduate medical imaging students attended a week-long mammography workshop. The sessions provided a range of didactic sessions related to diagnosis and management of breast cancer. An IPL session was incorporated on completion of the workshop to consolidate learning. Props and authentic resources were used to increase the fidelity of the simulation. Participants completed pre- and post-workshop questionnaires comprising an interprofessional education and collaboration scale and a quiz to gauge knowledge of specific content related to professional roles. Responses to each statement in the scale and quiz score, pre or post workshop, were compared, whereas responses to open-ended questions in post-workshop survey were thematically analyzed. Seventeen paired surveys were received. There was a significant total improvement of 10.66% (P = .036). After simulation, there was a statistically significant improvement in participants' understanding (P < .05) that IPL offers holistic care to the patient and that teamwork is useful for reducing errors in patient care. Simulation helped participants develop more awareness of their role within the profession, improve their understanding of other professionals, and gain more realistic expectations of team members. This pilot study confirmed learning within an IPL simulation improved attitudes toward shared learning, teamwork, and communication. Simulation provides opportunities for learning in a safe environment, and technology can be used in diverse ways to provide authentic learning. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

A communication training perspective on AND versus DNR directives.

PubMed

Levin, Tomer T; Coyle, Nessa

2015-04-01

From a communication perspective, the term "do not resuscitate" (DNR) is challenging to use in end-of-life discussions because it omits the goals of care. An alternative, "Allow Natural Death" (AND), has been proposed as a better way of framing this palliative care discussion. We present a case where a nurse unsuccessfully discusses end-of-life goals of care using the term DNR. Subsequently, with the aid of a communication trainer, he is coached to successfully use the term "AND" to facilitate this discussion and advance his goal of palliative care communication and planning. We contrast the advantages and disadvantages of the term AND from the communication training perspective and suggest that AND-framing language replace DNR as a better way to facilitate meaningful end-of-life communication. One well-designed, randomized, controlled simulation study supports this practice. We also consider the communication implications of "natural" versus "unnatural" death.

Beam optical design of in-flight fragment separator for high-power heavy ion beam

NASA Astrophysics Data System (ADS)

Yun, C. C.; Kim, Mi-Jung; Kim, D. G.; Song, J. S.; Kim, Myeong-Jin; Kim, J. W.; Kim, J. R.; Wan, W.

2013-12-01

An in-flight fragment separator has been designed for the rare isotope science project (RISP) in Korea. A beam used for the design is 238U in the energy of 200 MeV/u with the maximum beam power of 400 kW. The use of high-power beam requires careful removal of the primary beam by pre-separator, for which its configuration was revised to employ four dipole magnets instead of two. Different configurations of the separator have been tested in search of optimal design in non-linear optics, which was complicated by the space needed for the target, beam dump and radiation shielding. Non-linear optical calculations have been carried out using GICOSY and COSY Infinity including the fringe fields of large-aperture quadrupole magnets. Correction of non-linear terms is made with multipole coils located inside the superconducting quadrupole magnets and by external multipole magnets. Beam simulations using LISE++ and MOCADI have been performed to consider the effects of multiple charge states of the primary and isotope beams produced at the target. Layout of the separator is being finalized, and detailed optics simulation will continue to refine its design.

Culture, communication and safety: lessons from the airline industry.

PubMed

d'Agincourt-Canning, Lori G; Kissoon, Niranjan; Singal, Mona; Pitfield, Alexander F

2011-06-01

Communication is a critical component of effective teamwork and both are essential elements in providing high quality of care to patients. Yet, communication is not an innate skill but a process influenced by internal (personal/cultural values) as well as external (professional roles and hierarchies) factors. To provide illustrative cases, themes and tools for improving communication. Literature review and consensus opinion based on extensive experience. Professional autonomy should be de-emphasized. Tools such as SBAR and simulation are important in communication and teamwork. Tools designed to improve communication and safety in the aviation industry may have applicability to the pediatric intensive care unit.

A Novel Multiplayer Screen-Based Simulation Experience for African Learners Improved Confidence in Management of Postpartum Hemorrhage.

PubMed

Taekman, Jeffrey M; Foureman, Megan F; Bulamba, Fred; Steele, Michael; Comstock, Emily; Kintu, Andrew; Mauritz, Amy; Olufolabi, Adeyemi

2017-01-01

Postpartum hemorrhage (PPH) remains a global challenge, affecting thirteen million women each year. In addition, PPH is a leading cause of maternal mortality in Asia and Africa. In the U.S.A., care of critically ill patients is often practiced using mannequin-based simulation. Mannequin-based simulation presents challenges in global health, particularly in low- or middle-income countries. We developed a novel multiplayer screen-based simulation in a virtual world enabling the practice of team coordination with PPH. We used this simulation with learners in Mulago, Uganda. We hypothesized that a multiplayer screen-based simulation experience would increase learner confidence in their ability to manage PPH. The study design was a simple pre- and a post-intervention survey. Forty-eight interprofessional subjects participated in one of nine 1-h simulation sessions using the PPH software. A fifteen-question self-assessment administered before and after the intervention was designed to probe the areas of learning as defined by Bloom and Krathwohl: affective, cognitive, and psychomotor. Combined confidence scores increased significantly overall following the simulation experience and individually in each of the three categories of Bloom's Taxonomy: affective, cognitive, and psychomotor. We provide preliminary evidence that multiplayer screen-based simulation represents a scalable, distributable form of learning that may be used effectively in global health education and training. Interestingly, despite our intervention being screen-based, our subjects showed improved confidence in their ability to perform psychomotor tasks. Although there is precedent for mental rehearsal improving performance, further research is needed to understand this finding.

Reference field specification and preliminary beam selection strategy for accelerator-based GCR simulation

NASA Astrophysics Data System (ADS)

Slaba, Tony C.; Blattnig, Steve R.; Norbury, John W.; Rusek, Adam; La Tessa, Chiara

2016-02-01

The galactic cosmic ray (GCR) simulator at the NASA Space Radiation Laboratory (NSRL) is intended to deliver the broad spectrum of particles and energies encountered in deep space to biological targets in a controlled laboratory setting. In this work, certain aspects of simulating the GCR environment in the laboratory are discussed. Reference field specification and beam selection strategies at NSRL are the main focus, but the analysis presented herein may be modified for other facilities and possible biological considerations. First, comparisons are made between direct simulation of the external, free space GCR field and simulation of the induced tissue field behind shielding. It is found that upper energy constraints at NSRL limit the ability to simulate the external, free space field directly (i.e. shielding placed in the beam line in front of a biological target and exposed to a free space spectrum). Second, variation in the induced tissue field associated with shielding configuration and solar activity is addressed. It is found that the observed variation is likely within the uncertainty associated with representing any GCR reference field with discrete ion beams in the laboratory, given current facility constraints. A single reference field for deep space missions is subsequently identified. Third, a preliminary approach for selecting beams at NSRL to simulate the designated reference field is presented. This approach is not a final design for the GCR simulator, but rather a single step within a broader design strategy. It is shown that the beam selection methodology is tied directly to the reference environment, allows facility constraints to be incorporated, and may be adjusted to account for additional constraints imposed by biological or animal care considerations. The major biology questions are not addressed herein but are discussed in a companion paper published in the present issue of this journal. Drawbacks of the proposed methodology are discussed and weighed against alternative simulation strategies.

Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum

PubMed Central

Wong, Ambrose H.; Wing, Lisa; Weiss, Brenda; Gang, Maureen

2015-01-01

Introduction While treating potentially violent patients in the emergency department (ED), both patients and staff may be subject to unintentional injury. Emergency healthcare providers are at the greatest risk of experiencing physical and verbal assault from patients. Preliminary studies have shown that a team-based approach with targeted staff training has significant positive outcomes in mitigating violence in healthcare settings. Staff attitudes toward patient aggression have also been linked to workplace safety, but current literature suggests that providers experience fear and anxiety while caring for potentially violent patients. The objectives of the study were (1) to develop an interprofessional curriculum focusing on improving teamwork and staff attitudes toward patient violence using simulation-enhanced education for ED staff, and (2) to assess attitudes towards patient aggression both at pre- and post-curriculum implementation stages using a survey-based study design. Methods Formal roles and responsibilities for each member of the care team, including positioning during restraint placement, were predefined in conjunction with ED leadership. Emergency medicine residents, nurses and hospital police officers were assigned to interprofessional teams. The curriculum started with an introductory lecture discussing de-escalation techniques and restraint placement as well as core tenets of interprofessional collaboration. Next, we conducted two simulation scenarios using standardized participants (SPs) and structured debriefing. The study consisted of a survey-based design comparing pre- and post-intervention responses via a paired Student t-test to assess changes in staff attitudes. We used the validated Management of Aggression and Violence Attitude Scale (MAVAS) consisting of 30 Likert-scale questions grouped into four themed constructs. Results One hundred sixty-two ED staff members completed the course with >95% staff participation, generating a total of 106 paired surveys. Constructs for internal/biomedical factors, external/staff factors and situational/interactional perspectives on patient aggression significantly improved (p<0.0001, p<0.002, p<0.0001 respectively). Staff attitudes toward management of patient aggression did not significantly change (p=0.542). Multiple quality improvement initiatives were successfully implemented, including the creation of an interprofessional crisis management alert and response protocol. Staff members described appreciation for our simulation-based curriculum and welcomed the interaction with SPs during their training. Conclusion A structured simulation-enhanced interprofessional intervention was successful in improving multiple facets of ED staff attitudes toward behavioral emergency care. PMID:26594279

Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum.

PubMed

Wong, Ambrose H; Wing, Lisa; Weiss, Brenda; Gang, Maureen

2015-11-01

While treating potentially violent patients in the emergency department (ED), both patients and staff may be subject to unintentional injury. Emergency healthcare providers are at the greatest risk of experiencing physical and verbal assault from patients. Preliminary studies have shown that a team-based approach with targeted staff training has significant positive outcomes in mitigating violence in healthcare settings. Staff attitudes toward patient aggression have also been linked to workplace safety, but current literature suggests that providers experience fear and anxiety while caring for potentially violent patients. The objectives of the study were (1) to develop an interprofessional curriculum focusing on improving teamwork and staff attitudes toward patient violence using simulation-enhanced education for ED staff, and (2) to assess attitudes towards patient aggression both at pre- and post-curriculum implementation stages using a survey-based study design. Formal roles and responsibilities for each member of the care team, including positioning during restraint placement, were predefined in conjunction with ED leadership. Emergency medicine residents, nurses and hospital police officers were assigned to interprofessional teams. The curriculum started with an introductory lecture discussing de-escalation techniques and restraint placement as well as core tenets of interprofessional collaboration. Next, we conducted two simulation scenarios using standardized participants (SPs) and structured debriefing. The study consisted of a survey-based design comparing pre- and post-intervention responses via a paired Student t-test to assess changes in staff attitudes. We used the validated Management of Aggression and Violence Attitude Scale (MAVAS) consisting of 30 Likert-scale questions grouped into four themed constructs. One hundred sixty-two ED staff members completed the course with >95% staff participation, generating a total of 106 paired surveys. Constructs for internal/biomedical factors, external/staff factors and situational/interactional perspectives on patient aggression significantly improved (p<0.0001, p<0.002, p<0.0001 respectively). Staff attitudes toward management of patient aggression did not significantly change (p=0.542). Multiple quality improvement initiatives were successfully implemented, including the creation of an interprofessional crisis management alert and response protocol. Staff members described appreciation for our simulation-based curriculum and welcomed the interaction with SPs during their training. A structured simulation-enhanced interprofessional intervention was successful in improving multiple facets of ED staff attitudes toward behavioral emergency care.

Shuttle/TDRSS modelling and link simulation study

NASA Technical Reports Server (NTRS)

Braun, W. R.; Mckenzie, T. M.; Biederman, L.; Lindsey, W. C.

1979-01-01

A Shuttle/TDRSS S-band and Ku-band link simulation package called LinCsim was developed for the evaluation of link performance for specific Shuttle signal designs. The link models were described in detail and the transmitter distortion parameters or user constraints were carefully defined. The overall link degradation (excluding hardware degradations) relative to an ideal BPSK channel were given for various sets of user constraint values. The performance sensitivity to each individual user constraint was then illustrated. The effect of excessive Spacelab clock jitter on the return link BER performance was also investigated as was the problem of subcarrier recovery for the K-band Shuttle return link signal.

Detection of single nano-defects in photonic crystals between crossed polarizers.

PubMed

Grepstad, Jon Olav; Kaspar, Peter; Johansen, Ib-Rune; Solgaard, Olav; Sudbø, Aasmund

2013-12-16

We investigate, by simulations and experiments, the light scattering of small particles trapped in photonic crystal membranes supporting guided resonance modes. Our results show that, due to amplified Rayleigh small particle scattering, such membranes can be utilized to make a sensor that can detect single nano-particles. We have designed a biomolecule sensor that uses cross-polarized excitation and detection for increased sensitivity. Estimated using Rayleigh scattering theory and simulation results, the current fabricated sensor has a detection limit of 26 nm, corresponding to the size of a single virus. The sensor can potentially be made both cheap and compact, to facilitate use at point-of-care.

A Simulated Hospital Pharmacy Module Using an Electronic Medical Record in a Pharmaceutical Care Skills Laboratory Course

PubMed Central

DiVall, Margarita V.; Guerra, Christina; Brown, Todd

2013-01-01

Objectives. To implement and evaluate the effects of a simulated hospital pharmacy module using an electronic medical record on student confidence and abilities to perform hospital pharmacist duties. Design. A module was developed that simulated typical hospital pharmacist tasks. Learning activities were modified based upon student feedback and instructor assessment. Assessments. Ninety-seven percent of respondents reported full-time hospital internship experience and 72% had electronic medical record experience prior to completing the module. Mean scores on confidence with performing typical hospital pharmacist tasks significantly increased from the pre-module survey to the post-module survey from 1.5-2.9 (low comfort/confidence) to 2.0-3.4 (moderate comfort/confidence). Course assessments confirmed student achievement of covered competencies. Conclusions. A simulated hospital pharmacy module improved pharmacy students’ hospital practice skills and their perceived comfort and confidence in completing the typical duties of a hospital pharmacist. PMID:23610480

Students' experiences of learning manual clinical skills through simulation.

PubMed

Johannesson, Eva; Silén, Charlotte; Kvist, Joanna; Hult, Håkan

2013-03-01

Learning manual skills is a fundamental part of health care education, and motor, sensory and cognitive learning processes are essential aspects of professional development. Simulator training has been shown to enhance factors that facilitate motor and cognitive learning. The present study aimed to investigate the students' experiences and thoughts about their learning through simulation skills training. The study was designed for an educational setting at a clinical skills centre. Ten third-year undergraduate nursing students performed urethral catheterisation, using the virtual reality simulator UrecathVision™, which has haptic properties. The students practised in pairs. Each session was videotaped and the video was used to stimulate recall in subsequent interviews. The interviews were analysed using qualitative content analysis. The analysis from interviews resulted in three themes: what the students learn, how the students learn, and the simulator's contribution to the students' learning. Students learned manual skills, how to perform the procedure, and professional behaviour. They learned by preparing, watching, practising and reflecting. The simulator contributed by providing opportunities for students to prepare for the skills training, to see anatomical structures, to feel resistance, and to become aware of their own performance ability. The findings show that the students related the task to previous experiences, used sensory information, tested themselves and practised techniques in a hands-on fashion, and reflected in and on action. The simulator was seen as a facilitator to learning the manual skills. The study design, with students working in pairs combined with video recording, was found to enhance opportunities for reflection.

[Simulation technologies in anesthesiology, resuscitation and intensive care: state of the problem].

PubMed

Pasechnik, I N; Skobelev, E I; Volkova, N N; Sal'nikov, P S

2014-01-01

The foundation of simulation technologies application in educational process is presented in the article. It is described difficulties during anesthesiologists-resuscitators training and education of physicians of not intensive care specialty in intensive care methods. It was emphasized that new innovative educational stage is formed at present time. It is simulation stage between preclinical and clinical stages. Theoretical foundation and practical evidence of efficiency of simulation training are expressed in detail.

A Population-Level Data Analytics Portal for Self-Administered Lifestyle and Mental Health Screening.

PubMed

Zhang, Xindi; Warren, Jim; Corter, Arden; Goodyear-Smith, Felicity

2016-01-01

This paper describes development of a prototype data analytics portal for analysis of accumulated screening results from eCHAT (electronic Case-finding and Help Assessment Tool). eCHAT allows individuals to conduct a self-administered lifestyle and mental health screening assessment, with usage to date chiefly in the context of primary care waiting rooms. The intention is for wide roll-out to primary care clinics, including secondary school based clinics, resulting in the accumulation of population-level data. Data from a field trial of eCHAT with sexual health questions tailored to youth were used to support design of a data analytics portal for population-level data. The design process included user personas and scenarios, screen prototyping and a simulator for generating large-scale data sets. The prototype demonstrates the promise of wide-scale self-administered screening data to support a range of users including practice managers, clinical directors and health policy analysts.

A two-dimensional biased coin design for dual-agent dose-finding trials.

PubMed

Sun, Zhichao; Braun, Thomas M

2015-12-01

Given the limited efficacy observed with single agents, there is growing interest in Phase I clinical trial designs that allow for identification of the maximum tolerated combination of two agents. Existing parametric designs may suffer from over- or under-parameterization. Thus, we have designed a nonparametric approach that can be easily understood and implemented for combination trials. We propose a two-stage adaptive biased coin design that extends existing methods for single-agent trials to dual-agent dose-finding trials. The basic idea of our design is to divide the entire trial into two stages and apply the biased coin design, with modification, in each stage. We compare the operating characteristics of our design to four competing parametric approaches via simulation in several numerical examples. Under all simulation scenarios we have examined, our method performs well in terms of identification of the maximum tolerated combination and allocation of patients relative to the performance of its competitors. In our design, stopping rule criteria and the distribution of the total sample size among the two stages are context-dependent, and both need careful consideration before adopting our design in practice. Efficacy is not a part of the dose-assignment algorithm, nor used to define the maximum tolerated combination. Our design inherits the favorable statistical properties of the biased coin design, is competitive with existing designs, and promotes patient safety by limiting patient exposure to toxic combinations whenever possible. © The Author(s) 2015.

Video-based training of respite care providers: an interactional analysis of presentation format.

PubMed Central

Neef, N A; Trachtenberg, S; Loeb, J; Sterner, K

1991-01-01

We conducted two studies to evaluate a video-based instructional package for training respite care providers and the role of presentation format (viewing the videotapes alone, with a partner, and with structured group training) as a contextual variable. In Study 1, the results of a within-subjects Latin square design nested within a multiple baseline showed that performance during simulated (role-played) respite care situations improved in five of the six skill areas for the 12 trainees following presentation of the videotape, with no differences between presentation formats. Correct responding generalized to respite care situations involving a developmentally disabled child, and in most cases, acquired skills were maintained for up to 6 months. In Study 2, we conducted a clinical replication of Study 1 under conditions more closely approximating those in which the training program would be implemented by respite care agencies. Results of the between-groups analysis were consistent with the findings of Study 1. PMID:1836458

Nurse training with simulation: an innovative approach to teach complex microsurgery patient care.

PubMed

Flurry, Mitchell; Brooke, Sebastian; Micholetti, Brett; Natoli, Noel; Moyer, Kurtis; Mnich, Stephanie; Potochny, John

2012-10-01

Simulation has become an integral part of education at all levels within the medical field. The ability to allow personnel to practice and learn in a safe and controlled environment makes it a valuable tool for initial training and continued competence verification. An area of specific interest to the reconstructive microsurgeon is assurance that the nursing staff has adequate training and experience to provide optimum care for microsurgery patients. Plastic surgeons in institutions where few microsurgeries are performed face challenges teaching nurses how to care for these complex patients. Because no standard exists to educate microsurgery nurses, learning often happens by chance on-the-job encounters. Outcomes, therefore, may be affected by poor handoffs between inexperienced personnel. Our objective is to create a course that augments such random clinical experience and teaches the knowledge and skills necessary for successful microsurgery through simulated patient scenarios. Quality care reviews at our institution served as the foundation to develop an accredited nursing course providing clinical training for the care of microsurgery patients. The course combined lectures on microsurgery, pharmacology, and flap monitoring as well as simulated operating room, surgical intensive care unit, postanesthesia care unit, Trauma Bay, and Floor scenarios. Evaluation of participants included precourse examination, postcourse examination, and a 6-month follow-up. Average test scores were 72% precourse and 92% postcourse. Educational value, effectiveness of lectures and simulation, and overall course quality was rated very high or high by 86% of respondents; 0% respondents rated it as low. Six-month follow-up test score average was 88%. Learning to care for microsurgery patients should not be left to chance patient encounters on the job. Simulation provides a safe, reproducible, and controlled clinical experience. Our results show that simulation is a highly rated and effective way to teach nurses microsurgery patient care. Simulated patient care training should be considered to augment the clinical experience in hospitals where microsurgery is performed.

Multi Modal Anticipation in Fuzzy Space

NASA Astrophysics Data System (ADS)

Asproth, Viveca; Holmberg, Stig C.; Hâkansson, Anita

2006-06-01

We are all stakeholders in the geographical space, which makes up our common living and activity space. This means that a careful, creative, and anticipatory planning, design, and management of that space will be of paramount importance for our sustained life on earth. Here it is shown that the quality of such planning could be significantly increased with help of a computer based modelling and simulation tool. Further, the design and implementation of such a tool ought to be guided by the conceptual integration of some core concepts like anticipation and retardation, multi modal system modelling, fuzzy space modelling, and multi actor interaction.

Flexible alpha allocation strategies for confirmatory adaptive enrichment clinical trials with a prespecified subgroup.

PubMed

Sugitani, Toshifumi; Posch, Martin; Bretz, Frank; Koenig, Franz

2018-06-26

Adaptive enrichment designs have recently received considerable attention as they have the potential to make drug development process for personalized medicine more efficient. Several statistical approaches have been proposed so far in the literature and the operating characteristics of these approaches are extensively investigated using simulation studies. In this paper, we improve on existing adaptive enrichment designs by assigning unequal weights to the significance levels associated with the hypotheses of the overall population and a prespecified subgroup. More specifically, we focus on the standard combination test, a modified combination test, the marginal combination test, and the partial conditional error rate approach and explore the operating characteristics of these approaches by a simulation study. We show that these approaches can lead to power gains, compared to existing approaches, if the weights are chosen carefully. © 2018 John Wiley & Sons, Ltd.

Sample design effects in landscape genetics

USGS Publications Warehouse

Oyler-McCance, Sara J.; Fedy, Bradley C.; Landguth, Erin L.

2012-01-01

An important research gap in landscape genetics is the impact of different field sampling designs on the ability to detect the effects of landscape pattern on gene flow. We evaluated how five different sampling regimes (random, linear, systematic, cluster, and single study site) affected the probability of correctly identifying the generating landscape process of population structure. Sampling regimes were chosen to represent a suite of designs common in field studies. We used genetic data generated from a spatially-explicit, individual-based program and simulated gene flow in a continuous population across a landscape with gradual spatial changes in resistance to movement. Additionally, we evaluated the sampling regimes using realistic and obtainable number of loci (10 and 20), number of alleles per locus (5 and 10), number of individuals sampled (10-300), and generational time after the landscape was introduced (20 and 400). For a simulated continuously distributed species, we found that random, linear, and systematic sampling regimes performed well with high sample sizes (>200), levels of polymorphism (10 alleles per locus), and number of molecular markers (20). The cluster and single study site sampling regimes were not able to correctly identify the generating process under any conditions and thus, are not advisable strategies for scenarios similar to our simulations. Our research emphasizes the importance of sampling data at ecologically appropriate spatial and temporal scales and suggests careful consideration for sampling near landscape components that are likely to most influence the genetic structure of the species. In addition, simulating sampling designs a priori could help guide filed data collection efforts.

Simulation for System Change: Holland Bloorview's Experience Using Simulation to Enhance the Use of Technology at the Point-Of-Care.

PubMed

Hubley, Darlene; Peacocke, Sean; Maxwell, Joanne; Parker, Kathryn

2015-01-01

Simulation has the potential to invigorate teaching practices, facilitate professional development and impact client care. However, there is little literature on using simulation at the level of organizational change in healthcare. In this paper, the authors explore Holland Bloorview Kids Rehabilitation Hospital's experience using simulation to enhance the use of technology at the point-of-care. The simulation event demonstrated documentation using technology in two typical practice environments and allowed learners to discuss the challenges and opportunities. Participant feedback was positive overall, and this article reveals important lessons to support the future use of simulation as an educational tool for organizational change.

What has finite element analysis taught us about diabetic foot disease and its management? A systematic review.

PubMed

Telfer, Scott; Erdemir, Ahmet; Woodburn, James; Cavanagh, Peter R

2014-01-01

Over the past two decades finite element (FE) analysis has become a popular tool for researchers seeking to simulate the biomechanics of the healthy and diabetic foot. The primary aims of these simulations have been to improve our understanding of the foot's complicated mechanical loading in health and disease and to inform interventions designed to prevent plantar ulceration, a major complication of diabetes. This article provides a systematic review and summary of the findings from FE analysis-based computational simulations of the diabetic foot. A systematic literature search was carried out and 31 relevant articles were identified covering three primary themes: methodological aspects relevant to modelling the diabetic foot; investigations of the pathomechanics of the diabetic foot; and simulation-based design of interventions to reduce ulceration risk. Methodological studies illustrated appropriate use of FE analysis for simulation of foot mechanics, incorporating nonlinear tissue mechanics, contact and rigid body movements. FE studies of pathomechanics have provided estimates of internal soft tissue stresses, and suggest that such stresses may often be considerably larger than those measured at the plantar surface and are proportionally greater in the diabetic foot compared to controls. FE analysis allowed evaluation of insole performance and development of new insole designs, footwear and corrective surgery to effectively provide intervention strategies. The technique also presents the opportunity to simulate the effect of changes associated with the diabetic foot on non-mechanical factors such as blood supply to local tissues. While significant advancement in diabetic foot research has been made possible by the use of FE analysis, translational utility of this powerful tool for routine clinical care at the patient level requires adoption of cost-effective (both in terms of labour and computation) and reliable approaches with clear clinical validity for decision making.

Simulating multiprimary LCDs on standard tri-stimulus LC displays

NASA Astrophysics Data System (ADS)

Lebowsky, Fritz; Vonneilich, Katrin; Bonse, Thomas

2008-01-01

Large-scale, direct view TV screens, in particular those based on liquid crystal technology, are beginning to use subpixel structures with more than three subpixels to implement a multi-primary display with up to six primaries. Since their input color space is likely to remain tri-stimulus RGB we first focus on some fundamental constraints. Among them, we elaborate simplified gamut mapping architectures as well as color filter geometry, transparency, and chromaticity coordinates in color space. Based on a 'display centric' RGB color space tetrahedrization combined with linear interpolation we describe a simulation framework which enables optimization for up to 7 primaries. We evaluated the performance through mapping the multi-primary design back onto a RGB LC display gamut without building a prototype multi-primary display. As long as we kept the RGB equivalent output signal within the display gamut we could analyze all desirable multi-primary configurations with regard to colorimetric variance and visually perceived quality. Not only does our simulation tool enable us to verify a novel concept it also demonstrates how carefully one needs to design a multiprimary display for LCD TV applications.

Design of high-fidelity haptic display for one-dimensional force reflection applications

NASA Astrophysics Data System (ADS)

Gillespie, Brent; Rosenberg, Louis B.

1995-12-01

This paper discusses the development of a virtual reality platform for the simulation of medical procedures which involve needle insertion into human tissue. The paper's focus is the hardware and software requirements for haptic display of a particular medical procedure known as epidural analgesia. To perform this delicate manual procedure, an anesthesiologist must carefully guide a needle through various layers of tissue using only haptic cues for guidance. As a simplifying aspect for the simulator design, all motions and forces involved in the task occur along a fixed line once insertion begins. To create a haptic representation of this procedure, we have explored both physical modeling and perceptual modeling techniques. A preliminary physical model was built based on CT-scan data of the operative site. A preliminary perceptual model was built based on current training techniques for the procedure provided by a skilled instructor. We compare and contrast these two modeling methods and discuss the implications of each. We select and defend the perceptual model as a superior approach for the epidural analgesia simulator.

Modeling, numerical simulation, and nonlinear dynamic behavior analysis of PV microgrid-connected inverter with capacitance catastrophe

NASA Astrophysics Data System (ADS)

Li, Sichen; Liao, Zhixian; Luo, Xiaoshu; Wei, Duqu; Jiang, Pinqun; Jiang, Qinghong

2018-02-01

The value of the output capacitance (C) should be carefully considered when designing a photovoltaic (PV) inverter since it can cause distortion in the working state of the circuit, and the circuit produces nonlinear dynamic behavior. According to Kirchhoff’s laws and the characteristics of an ideal operational amplifier for a strict piecewise linear state equation, a circuit simulation model is constructed to study the system parameters (time, C) for the current passing through an inductor with an inductance of L and the voltage across the capacitor with a capacitance of C. The developed simulation model uses Runge-Kutta methods to solve the state equations. This study focuses on predicting the fault of the circuit from the two aspects of the harmonic distortion and simulation results. Moreover, the presented model is also used to research the working state of the system in the case of a load capacitance catastrophe. The nonlinear dynamic behaviors in the inverter are simulated and verified.

Tailored prevention of inpatient falls: development and usability testing of the fall TIPS toolkit.

PubMed

Zuyev, Lyubov; Benoit, Angela N; Chang, Frank Y; Dykes, Patricia C

2011-02-01

Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model. Three output tools available to be generated from the toolkit are bed poster, plan of care, and patient education handout. A preliminary design of the application was based on initial requirements defined by project leaders and informed by focus groups with end users. Preliminary design partially simulated the paper version of the Morse Fall Scale currently used in hospitals involved in the research study. Strengths and weaknesses of the first prototype were identified by heuristic evaluation. Usability testing was performed at sites where research study is implemented. Suggestions mentioned by end users participating in usability studies were either directly incorporated into the toolkit and output tools, were slightly modified, or will be addressed during training. The next step is implementation of the fall prevention toolkit on the pilot testing units.

Electron beam transport analysis of W-band sheet beam klystron

NASA Astrophysics Data System (ADS)

Wang, Jian-Xun; Barnett, Larry R.; Luhmann, Neville C.; Shin, Young-Min; Humphries, Stanley

2010-04-01

The formation and transport of high-current density electron beams are of critical importance for the success of a number of millimeter wave and terahertz vacuum devices. To elucidate design issues and constraints, the electron gun and periodically cusped magnet stack of the original Stanford Linear Accelerator Center designed W-band sheet beam klystron circuit, which exhibited poor beam transmission (≤55%), have been carefully investigated through theoretical and numerical analyses taking advantage of three-dimensional particle tracking solvers. The re-designed transport system is predicted to exhibit 99.76% (cold) and 97.38% (thermal) beam transmission, respectively, under space-charge-limited emission simulations. The optimized design produces the required high aspect ratio (10:1) sheet beam with 3.2 A emission current with highly stable propagation. In the completely redesigned model containing all the circuit elements, more than 99% beam transmission is experimentally observed at the collector located about 160 mm distant from the cathode surface. Results are in agreement of the predictions of two ray-tracing simulators, CST PARTICLE STUDIO and OMNITRAK which also predict the observed poor transmission in the original design. The quantitative analysis presents practical factors in the modeling process to design a magnetic lens structure to stably transport the elliptical beam along the long drift tube.

Development of an Assessment for Entrustable Professional Activity (EPA) 10: Emergent Patient Management.

PubMed

Thompson, Laura R; Leung, Cynthia G; Green, Brad; Lipps, Jonathan; Schaffernocker, Troy; Ledford, Cynthia; Davis, John; Way, David P; Kman, Nicholas E

2017-01-01

Medical schools in the United States are encouraged to prepare and certify the entrustment of medical students to perform 13 core entrustable professional activities (EPAs) prior to graduation. Entrustment is defined as the informed belief that the learner is qualified to autonomously perform specific patient-care activities. Core EPA-10 is the entrustment of a graduate to care for the emergent patient. The purpose of this project was to design a realistic performance assessment method for evaluating fourth-year medical students on EPA-10. First, we wrote five emergent patient case-scenarios that a medical trainee would likely confront in an acute care setting. Furthermore, we developed high-fidelity simulations to realistically portray these patient case scenarios. Finally, we designed a performance assessment instrument to evaluate the medical student's performance on executing critical actions related to EPA-10 competencies. Critical actions included the following: triage skills, mustering the medical team, identifying causes of patient decompensation, and initiating care. Up to four students were involved with each case scenario; however, only the team leader was evaluated using the assessment instruments developed for each case. A total of 114 students participated in the EPA-10 assessment during their final year of medical school. Most students demonstrated competence in recognizing unstable vital signs (97%), engaging the team (93%), and making appropriate dispositions (92%). Almost 87% of the students were rated as having reached entrustment to manage the care of an emergent patient (99 of 114). Inter-rater reliability varied by case scenario, ranging from moderate to near-perfect agreement. Three of five case-scenario assessment instruments contained items that were internally consistent at measuring student performance. Additionally, the individual item scores for these case scenarios were highly correlated with the global entrustment decision. High-fidelity simulation showed good potential for effective assessment of medical student entrustment of caring for the emergent patient. Preliminary evidence from this pilot project suggests content validity of most cases and associated checklist items. The assessments also demonstrated moderately strong faculty inter-rater reliability.

Cluster randomised crossover trials with binary data and unbalanced cluster sizes: application to studies of near-universal interventions in intensive care.

PubMed

Forbes, Andrew B; Akram, Muhammad; Pilcher, David; Cooper, Jamie; Bellomo, Rinaldo

2015-02-01

Cluster randomised crossover trials have been utilised in recent years in the health and social sciences. Methods for analysis have been proposed; however, for binary outcomes, these have received little assessment of their appropriateness. In addition, methods for determination of sample size are currently limited to balanced cluster sizes both between clusters and between periods within clusters. This article aims to extend this work to unbalanced situations and to evaluate the properties of a variety of methods for analysis of binary data, with a particular focus on the setting of potential trials of near-universal interventions in intensive care to reduce in-hospital mortality. We derive a formula for sample size estimation for unbalanced cluster sizes, and apply it to the intensive care setting to demonstrate the utility of the cluster crossover design. We conduct a numerical simulation of the design in the intensive care setting and for more general configurations, and we assess the performance of three cluster summary estimators and an individual-data estimator based on binomial-identity-link regression. For settings similar to the intensive care scenario involving large cluster sizes and small intra-cluster correlations, the sample size formulae developed and analysis methods investigated are found to be appropriate, with the unweighted cluster summary method performing well relative to the more optimal but more complex inverse-variance weighted method. More generally, we find that the unweighted and cluster-size-weighted summary methods perform well, with the relative efficiency of each largely determined systematically from the study design parameters. Performance of individual-data regression is adequate with small cluster sizes but becomes inefficient for large, unbalanced cluster sizes. When outcome prevalences are 6% or less and the within-cluster-within-period correlation is 0.05 or larger, all methods display sub-nominal confidence interval coverage, with the less prevalent the outcome the worse the coverage. As with all simulation studies, conclusions are limited to the configurations studied. We confined attention to detecting intervention effects on an absolute risk scale using marginal models and did not explore properties of binary random effects models. Cluster crossover designs with binary outcomes can be analysed using simple cluster summary methods, and sample size in unbalanced cluster size settings can be determined using relatively straightforward formulae. However, caution needs to be applied in situations with low prevalence outcomes and moderate to high intra-cluster correlations. © The Author(s) 2014.

The 2030 Problem: Caring for Aging Baby Boomers

PubMed Central

Knickman, James R; Snell, Emily K

2002-01-01

Objective To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages. Study Setting A review of economic and demographic data as well as simulations of projected socioeconomic and demographic patterns in the year 2030 form the basis of a review of the challenges related to caring for seniors that need to be faced by society. Study Design A series of analyses are used to consider the challenges related to caring for elders in the year 2030: (1) measures of macroeconomic burden are developed and analyzed, (2) the literatures on trends in disability, payment approaches for long-term care, healthy aging, and cultural views of aging are analyzed and synthesized, and(3)simulations of future income and assets patterns of the Baby Boom generation are developed. Principal Findings The economic burden of aging in 2030 should be no greater than the economic burden associated with raising large numbers of baby boom children in the 1960s. The real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes community services so that care is more accessible, and (4) altering the cultural view of aging to make sure all ages are integrated into the fabric of community life. Conclusions To meet the long-term care needs of Baby Boomers, social and public policy changes must begin soon. Meeting the financial and social service burdens of growing numbers of elders will not be a daunting task if necessary changes are made now rather than when Baby Boomers actually need long-term care. PMID:12236388

Measuring cognitive load: performance, mental effort and simulation task complexity.

PubMed

Haji, Faizal A; Rojas, David; Childs, Ruth; de Ribaupierre, Sandrine; Dubrowski, Adam

2015-08-01

Interest in applying cognitive load theory in health care simulation is growing. This line of inquiry requires measures that are sensitive to changes in cognitive load arising from different instructional designs. Recently, mental effort ratings and secondary task performance have shown promise as measures of cognitive load in health care simulation. We investigate the sensitivity of these measures to predicted differences in intrinsic load arising from variations in task complexity and learner expertise during simulation-based surgical skills training. We randomly assigned 28 novice medical students to simulation training on a simple or complex surgical knot-tying task. Participants completed 13 practice trials, interspersed with computer-based video instruction. On trials 1, 5, 9 and 13, knot-tying performance was assessed using time and movement efficiency measures, and cognitive load was assessed using subjective rating of mental effort (SRME) and simple reaction time (SRT) on a vibrotactile stimulus-monitoring secondary task. Significant improvements in knot-tying performance (F(1.04,24.95)  = 41.1, p < 0.001 for movements; F(1.04,25.90)  = 49.9, p < 0.001 for time) and reduced cognitive load (F(2.3,58.5)  = 57.7, p < 0.001 for SRME; F(1.8,47.3)  = 10.5, p < 0.001 for SRT) were observed in both groups during training. The simple-task group demonstrated superior knot tying (F(1,24)  = 5.2, p = 0.031 for movements; F(1,24)  = 6.5, p = 0.017 for time) and a faster decline in SRME over the first five trials (F(1,26)  = 6.45, p = 0.017) compared with their peers. Although SRT followed a similar pattern, group differences were not statistically significant. Both secondary task performance and mental effort ratings are sensitive to changes in intrinsic load among novices engaged in simulation-based learning. These measures can be used to track cognitive load during skills training. Mental effort ratings are also sensitive to small differences in intrinsic load arising from variations in the physical complexity of a simulation task. The complementary nature of these subjective and objective measures suggests their combined use is advantageous in simulation instructional design research. © 2015 John Wiley & Sons Ltd.

Teaching childbirth with high-fidelity simulation. Is it better observing the scenario during the briefing session?

PubMed

Cuerva, Marcos J; Piñel, Carlos S; Martin, Lourdes; Espinosa, Jose A; Corral, Octavio J; Mendoza, Nicolás

2018-02-12

The design of optimal courses for obstetric undergraduate teaching is a relevant question. This study evaluates two different designs of simulator-based learning activity on childbirth with regard to respect to the patient, obstetric manoeuvres, interpretation of cardiotocography tracings (CTG) and infection prevention. This randomised experimental study which differs in the content of their briefing sessions consisted of two groups of undergraduate students, who performed two simulator-based learning activities on childbirth. The first briefing session included the observations of a properly performed scenario according to Spanish clinical practice guidelines on care in normal childbirth by the teachers whereas the second group did not include the observations of a properly performed scenario, and the students observed it only after the simulation process. The group that observed a properly performed scenario after the simulation obtained worse grades during the simulation, but better grades during the debriefing and evaluation. Simulator use in childbirth may be more fruitful when the medical students observe correct performance at the completion of the scenario compared to that at the start of the scenario. Impact statement What is already known on this subject? There is a scarcity of literature about the design of optimal high-fidelity simulation training in childbirth. It is known that preparing simulator-based learning activities is a complex process. Simulator-based learning includes the following steps: briefing, simulation, debriefing and evaluation. The most important part of high-fidelity simulations is the debriefing. A good briefing and simulation are of high relevance in order to have a fruitful debriefing session. What do the results of this study add? Our study describes a full simulator-based learning activity on childbirth that can be reproduced in similar facilities. The findings of this study add that high-fidelity simulation training in childbirth is favoured by a short briefing session and an abrupt start to the scenario, rather than a long briefing session that includes direct instruction in the scenario. What are the implications of these findings for clinical practice and/or further research? The findings of this study reveal what to include in the briefing of simulator-based learning activities on childbirth. These findings have implications in medical teaching and in medical practice.

Health Worker Focused Distributed Simulation for Improving Capability of Health Systems in Liberia.

PubMed

Gale, Thomas C E; Chatterjee, Arunangsu; Mellor, Nicholas E; Allan, Richard J

2016-04-01

The main goal of this study was to produce an adaptable learning platform using virtual learning and distributed simulation, which can be used to train health care workers, across a wide geographical area, key safety messages regarding infection prevention control (IPC). A situationally responsive agile methodology, Scrum, was used to develop a distributed simulation module using short 1-week iterations and continuous synchronous plus asynchronous communication including end users and IPC experts. The module contained content related to standard IPC precautions (including handwashing techniques) and was structured into 3 distinct sections related to donning, doffing, and hazard perception training. Using Scrum methodology, we were able to link concepts applied to best practices in simulation-based medical education (deliberate practice, continuous feedback, self-assessment, and exposure to uncommon events), pedagogic principles related to adult learning (clear goals, contextual awareness, motivational features), and key learning outcomes regarding IPC, as a rapid response initiative to the Ebola outbreak in West Africa. Gamification approach has been used to map learning mechanics to enhance user engagement. The developed IPC module demonstrates how high-frequency, low-fidelity simulations can be rapidly designed using scrum-based agile methodology. Analytics incorporated into the tool can help demonstrate improved confidence and competence of health care workers who are treating patients within an Ebola virus disease outbreak region. These concepts could be used in a range of evolving disasters where rapid development and communication of key learning messages are required.

Discrete-event simulation of a wide-area health care network.

PubMed Central

McDaniel, J G

1995-01-01

OBJECTIVE: Predict the behavior and estimate the telecommunication cost of a wide-area message store-and-forward network for health care providers that uses the telephone system. DESIGN: A tool with which to perform large-scale discrete-event simulations was developed. Network models for star and mesh topologies were constructed to analyze the differences in performances and telecommunication costs. The distribution of nodes in the network models approximates the distribution of physicians, hospitals, medical labs, and insurers in the Province of Saskatchewan, Canada. Modeling parameters were based on measurements taken from a prototype telephone network and a survey conducted at two medical clinics. Simulation studies were conducted for both topologies. RESULTS: For either topology, the telecommunication cost of a network in Saskatchewan is projected to be less than $100 (Canadian) per month per node. The estimated telecommunication cost of the star topology is approximately half that of the mesh. Simulations predict that a mean end-to-end message delivery time of two hours or less is achievable at this cost. A doubling of the data volume results in an increase of less than 50% in the mean end-to-end message transfer time. CONCLUSION: The simulation models provided an estimate of network performance and telecommunication cost in a specific Canadian province. At the expected operating point, network performance appeared to be relatively insensitive to increases in data volume. Similar results might be anticipated in other rural states and provinces in North America where a telephone-based network is desired. PMID:7583646

The EarthCARE Simulator (Invited)

NASA Astrophysics Data System (ADS)

Donovan, D. P.; van Zadellhoff, G.; Lajas, D.; Eisinger, M.; Franco, R.

2009-12-01

In recent years, the value of multisensor remote sensing techniques applied to cloud, aerosol, radiation and precipitation studies has become clear. For example, combinations of instruments including lidars and/or radars have proved very useful for profile retrievals of cloud macrophysical and microphysical properties. This is amply illustrated by various results from the ARM (and similar) sites as well as from results derived using the Cloudsat/CALIPSO/A-train combination of instruments. The Earth Clouds Aerosol and Radiation Explorer (EarthCARE) mission is a combined ESA/JAXA mission scheduled for launch in 2013 and has been designed with sensor-synergy playing a driving role in its scientific applications. The EarthCARE mission consists of a cloud profiling Doppler radar, a high-spectral-resolution lidar, a cloud/aerosol imager and a three-view broadband radiometer. As part of the mission development process, a detailed end-to-end multisensor simulation system has been developed. The EarthCARE Simulator (ECSIM) consists of a modular general framework populated by various models. The models within ECSIM are grouped according to the following scheme: 1) Scene creation models (3D atmospheric scene definition) 2) Orbit models (orbit and orientation of the platform as it overflies the scene) 3) Forward models (calculate the signal impinging on the telescope/antenna of the instrument(s) in question) 4) Instrument models (calculate the instrument response to the signals calculated by the Forward models) 5) Retrieval models (invert the instrument signals to recover relevant geophysical information) Within the default ECSIM models crude instrument specific parameterizations (i.e. empirically based Z vs IWC relationships) are avoided. Instead, the radiative transfer forward models are kept as separate as possible from the instrument models. In order to accomplish this, the atmospheric scenes are specified in high detail (i.e. bin resolved cloud size distribution are stored) and the relevant wavelength dependent optical properties are stored in a separate database. This helps insure that all the instruments involved in the simulation are treated in a consistent fashion and that the physical relationships between the various measurements are realistically captured (something that using instrument specific parameterizations relationships can not guarantee). As a consequence, ECSIM's modular structure makes it straightforward to add new instruments (thus expanding ECSIM beyond the EarthCARE instrument suite) and also makes ECSIM well-suited for physically based retrieval algorithm development. In this talk, we will introduce ECSIM and emphasize the philosophy behind its design. We will also give a brief overview on the various default models. Finally, we will present several examples of how ECSIM can and is being used for purposes ranging from general radiative transfer calculations to instrument performance estimation and synergistic algorithm development and characterization.

Using Simulation to Improve Systems-Based Practices.

PubMed

Gardner, Aimee K; Johnston, Maximilian; Korndorffer, James R; Haque, Imad; Paige, John T

2017-09-01

Ensuring the safe, effective management of patients requires efficient processes of care within a smoothly operating system in which highly reliable teams of talented, skilled health care providers are able to use the vast array of high-technology resources and intensive care techniques available. Simulation can play a unique role in exploring and improving the complex perioperative system by proactively identifying latent safety threats and mitigating their damage to ensure that all those who work in this critical health care environment can provide optimal levels of patient care. A panel of five experts from a wide range of institutions was brought together to discuss the added value of simulation-based training for improving systems-based aspects of the perioperative service line. Panelists shared the way in which simulation was demonstrated at their institutions. The themes discussed by each panel member were delineated into four avenues through which simulation-based techniques have been used. Simulation-based techniques are being used in (1) testing new clinical workspaces and facilities before they open to identify potential latent conditions; (2) practicing how to identify the deteriorating patient and escalate care in an effective manner; (3) performing prospective root cause analyses to address system weaknesses leading to sentinel events; and (4) evaluating the efficiency and effectiveness of the electronic health record in the perioperative setting. This focused review of simulation-based interventions to test and improve components of the perioperative microsystem, which includes literature that has emerged since the panel's presentation, highlights the broad-based utility of simulation-based technologies in health care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Time delay compensation for closed-loop insulin delivery systems: a simulation study.

PubMed

Reboldi, G P; Home, P D; Calabrese, G; Fabietti, P G; Brunetti, P; Massi Benedetti, M

1991-06-01

Closed loop insulin therapy certainly represents the best possible approach to insulin replacement. However, present limitations preclude wider application of the so-called artificial pancreas. Therefore, a thorough understanding of these limitations is needed to design better systems for future long-term use. The present simulation study was design: to obtain better information on the impact of the measurement delay of currently available closed-loop devices both during closed-loop insulin delivery and blood glucose clamp studies, and to design and test a time delay compensator based on the method originally described by O.J. Smith. Simulations were performed on a Compaq Deskpro 486/25 personal computer under MS-DOS operating system using Simnon rel. 3.00 software. There was a direct relationship between measurement delay and amount of insulin delivered, i.e., the longer the delay the higher the insulin dose needed to control a rise in blood glucose; the closed-loop response in presence of a time delay was qualitatively impaired both during insulin delivery and blood glucose clamp studies; time delay compensation was effective in reducing the insulin dose and improving controller stability during the early phase of clamp studies. However, the robustness of a Smith's predictor-based controller should be carefully evaluated before implementation in closed-loop systems can be considered.

Evaluation of TEAM dynamics before and after remote simulation training utilizing CERTAIN platform.

PubMed

Pennington, Kelly M; Dong, Yue; Coville, Hongchuan H; Wang, Bo; Gajic, Ognjen; Kelm, Diana J

2018-12-01

The current study examines the feasibility and potential effects of long distance, remote simulation training on team dynamics. The study design was a prospective study evaluating team dynamics before and after remote simulation. Study subjects consisted of interdisciplinary teams (attending physicians, physicians in training, advanced care practitioners, and/or nurses). The study was conducted at nine training sites in eight countries. Study subjects completed 2-3 simulation scenarios of acute crises before and after training with the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN). Pre- and post-CERTAIN training simulations were evaluated by two independent reviewers utilizing the Team Emergency Assessment Measure (TEAM), which is a 11-item questionnaire that has been validated for assessing teamwork in the intensive care unit. Any discrepancies of greater than 1 point between the two reviewers on any question on the TEAM assessment were sent to a third reviewer to judge. The score that was deemed discordant by the third judge was eliminated. Pre- and post-CERTAIN training TEAM scores were averaged and compared. Of the nine teams evaluated, six teams demonstrated an overall improvement in global team performance following CERTAIN virtual training. For each of the 11 TEAM assessments, a trend toward improvement following CERTAIN training was noted; however, no assessment had universal improvement. 'Team composure and control' had the least absolute score improvement following CERTAIN training. The greatest improvement in the TEAM assessment scores was in the 'team's ability to complete tasks in a timely manner' and in the 'team leader's communication to the team'. The assessment of team dynamics using long distance, virtual simulation training appears to be feasible and may result in improved team performance during simulated patient crises; however, language and video quality were the two largest barriers noted during the review process.

A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation.

PubMed

Munroe, Belinda; Curtis, Kate; Murphy, Margaret; Strachan, Luke; Considine, Julie; Hardy, Jennifer; Wilson, Mark; Ruperto, Kate; Fethney, Judith; Buckley, Thomas

2016-08-01

The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. A pre-post design was used. The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care. © 2016 John Wiley & Sons Ltd.

Care-givers' reflections on an ethics education immersive simulation care experience: A series of epiphanous events.

PubMed

Gallagher, Ann; Peacock, Matthew; Zasada, Magdalena; Coucke, Trees; Cox, Anna; Janssens, Nele

2017-07-01

There has been little previous scholarship regarding the aims, options and impact of ethics education on residential care-givers. This manuscript details findings from a pragmatic cluster trial evaluating the impact of three different approaches to ethics education. The focus of the article is on one of the interventions, an immersive simulation experience. The simulation experience required residential care-givers to assume the profile of elderly care-recipients for a 24-hr period. The care-givers were student nurses. The project was reviewed favourably by a university ethics committee, and participants provided informed consent. Data from six postsimulation experience focus groups were analysed thematically and three themes were identified: the experience of vulnerability, dignity in care and the organisation of care. Findings suggest that the immersive simulation experience had a powerful immediate impact as participants described epiphanous insights relating to their care experiences. It is suggested that reflecting on and recording epiphanous events has the potential to sustain ethical care practices. Further research is required to evaluate the impact of different ethics education interventions in different cultural contexts. Exploration is also required regarding the meaning and significance of care epiphanies, those "most delicate and evanescent of moments," for the sustainability of ethical care. © 2016 John Wiley & Sons Ltd.

A simulation and video-based training program to address adverse childhood experiences.

PubMed

Wen, Frances K; Miller-Cribbs, Julie E; Coon, Kim A; Jelley, Martina J; Foulks-Rodriguez, Kristin A

2017-05-01

Adverse childhood experiences (ACEs) are 10 categories of childhood abuse and maltreatment, which have a dose-response relationship with common adult health concerns seen in primary care including health risk behaviors, chronic disease, and mental illness. Many of the ACEs-associated biopsychosocial risk factors are modifiable. However, physicians may not address these issues for fear of opening "Pandora's Box", that is, a source of extensive problems for which they are not sufficiently prepared with training, resources, or time. Residents need training in how to conduct trauma-focused conversations within the limited scope of an office visit. To address this need, a 4-hour simulation and video-based training program was developed for primary care residents about how to conduct brief interventions connecting their patients' current health concerns with their experiences of ACEs. Resident participants have evaluated this program as preparatory for real-life encounters and as being designed to allow for educational mastery. This article describes a workshop presenting this training program which was given at the 37th Annual Behavioral Science Forum in Family Medicine. Five skills targeted in the program were presented and a demonstration was made of the components, that is, didactics, provider and patient videos, simulated patient encounters, trainee feedback, and facilitated discussion that encompasses targeted skills, clinical implementation, and self-care. Companion tools were shared, including the syllabus, evaluation rubric, and provider and patient resources. Participants practiced trainee feedback and discussed the challenges in implementation.

Online Simulation of Health Care Reform: Helping Health Educators Learn and Participate

ERIC Educational Resources Information Center

Jecklin, Robert

2010-01-01

Young and healthy undergraduates in health education were not predisposed to learn the complex sprawl of topics in a required course on U.S. Health Care. An online simulation of health care reform was used to encourage student learning about health care and participating in health care reform. Students applied their understanding of high costs,…

Quantifying learning in medical students during a critical care medicine elective: a comparison of three evaluation instruments.

PubMed

Rogers, P L; Jacob, H; Rashwan, A S; Pinsky, M R

2001-06-01

To compare three different evaluative instruments and determine which is able to measure different aspects of medical student learning. Student learning was evaluated by using written examinations, objective structured clinical examination, and patient simulator that used two clinical scenarios before and after a structured critical care elective, by using a crossover design. Twenty-four 4th-yr students enrolled in the critical care medicine elective. All students took a multiple-choice written examination; evaluated a live simulated critically ill patient, requested data from a nurse, and intervened as appropriate at different stations (objective structured clinical examination); and evaluated the computer-controlled patient simulator and intervened as appropriate. Students' knowledge was assessed by using a multiple-choice examination containing the same data incorporated into the other examinations. Student performance on the objective structured clinical examination was evaluated at five stations. Both objective structured clinical examination and simulator tests were videotaped for subsequent scores of responses, quality of responses, and response time. The videotapes were reviewed for specific behaviors by faculty masked to time of examination. Students were expected to perform the following: a) assess airway, breathing, and circulation; b) prepare a mannequin for intubation; c) provide appropriate ventilator settings; d) manage hypotension; and e) request, interpret, and provide appropriate intervention for pulmonary artery catheter data. Students were expected to perform identical behaviors during the simulator examination; however, the entire examination was performed on the whole-body computer-controlled mannequin. The primary outcome measure was the difference in examination scores before and after the rotation. The mean preelective scores were 77 +/- 16%, 47 +/- 15%, and 41 +/- 14% for the written examination, objective structured clinical examination, and simulator, respectively, compared with 89 +/- 11%, 76 +/- 12%, and 62 +/- 15% after the elective (p <.0001). Prerotation scores for the written examination were significantly higher than the objective structured clinical examination or the simulator; postrotation scores were highest for the written examination and lowest for the simulator. Written examinations measure acquisition of knowledge but fail to predict if students can apply knowledge to problem solving, whereas both the objective structured clinical examination and the computer-controlled patient simulator can be used as effective performance evaluation tools.

Teaching End-of-Life Care Using Interprofessional Simulation.

PubMed

Gannon, Jane; Motycka, Carol; Egelund, Eric; Kraemer, Dale F; Smith, W Thomas; Solomon, Kathleen

2017-04-01

Competency in end-of-life (EOL) care is a growing expectation for health professions students. This study assessed the impact of four EOL care scenarios, using high-fidelity simulation, on the perceived learning needs and attitudes of pharmacy and nursing students. On three campuses, pharmacy students (N = 158) were exposed to standard paper EOL case scenarios, while a fourth campus exposed eight graduate nursing and 37 graduate pharmacy students to simulated versions of the same cases. The paper-based groups produced similar pre-post changes on the End of Life Professional Caregiver Survey. Results were pooled and compared with the simulation-only group, revealing significantly higher changes in pre-post scores for the simulation group. Students participating in the simulation group showed some significant differences in attitudes toward EOL care, compared with students in the classroom setting. [J Nurs Educ. 2017;56(4):205-210.]. Copyright 2017, SLACK Incorporated.

Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial.

PubMed

Cheng, Adam; Brown, Linda L; Duff, Jonathan P; Davidson, Jennifer; Overly, Frank; Tofil, Nancy M; Peterson, Dawn T; White, Marjorie L; Bhanji, Farhan; Bank, Ilana; Gottesman, Ronald; Adler, Mark; Zhong, John; Grant, Vincent; Grant, David J; Sudikoff, Stephanie N; Marohn, Kimberly; Charnovich, Alex; Hunt, Elizabeth A; Kessler, David O; Wong, Hubert; Robertson, Nicola; Lin, Yiqun; Doan, Quynh; Duval-Arnould, Jordan M; Nadkarni, Vinay M

2015-02-01

The quality of cardiopulmonary resuscitation (CPR) affects hemodynamics, survival, and neurological outcomes following pediatric cardiopulmonary arrest (CPA). Most health care professionals fail to perform CPR within established American Heart Association guidelines. To determine whether "just-in-time" (JIT) CPR training with visual feedback (VisF) before CPA or real-time VisF during CPA improves the quality of chest compressions (CCs) during simulated CPA. Prospective, randomized, 2 × 2 factorial-design trial with explicit methods (July 1, 2012, to April 15, 2014) at 10 International Network for Simulation-Based Pediatric Innovation, Research, & Education (INSPIRE) institutions running a standardized simulated CPA scenario, including 324 CPR-certified health care professionals assigned to 3-person resuscitation teams (108 teams). Each team was randomized to 1 of 4 permutations, including JIT training vs no JIT training before CPA and real-time VisF vs no real-time VisF during simulated CPA. The proportion of CCs with depth exceeding 50 mm, the proportion of CPR time with a CC rate of 100 to 120 per minute, and CC fraction (percentage CPR time) during simulated CPA. The quality of CPR was poor in the control group, with 12.7% (95% CI, 5.2%-20.1%) mean depth compliance and 27.1% (95% CI, 14.2%-40.1%) mean rate compliance. JIT training compared with no JIT training improved depth compliance by 19.9% (95% CI, 11.1%-28.7%; P < .001) and rate compliance by 12.0% (95% CI, 0.8%-23.2%; P = .037). Visual feedback compared with no VisF improved depth compliance by 15.4% (95% CI, 6.6%-24.2%; P = .001) and rate compliance by 40.1% (95% CI, 28.8%-51.3%; P < .001). Neither intervention had a statistically significant effect on CC fraction, which was excellent (>89.0%) in all groups. Combining both interventions showed the highest compliance with American Heart Association guidelines but was not significantly better than either intervention in isolation. The quality of CPR provided by health care professionals is poor. Using novel and practical technology, JIT training before CPA or real-time VisF during CPA, alone or in combination, improves compliance with American Heart Association guidelines for CPR that are associated with better outcomes. clinicaltrials.gov Identifier: NCT02075450.

Advancing cognitive engineering methods to support user interface design for electronic health records.

PubMed

Thyvalikakath, Thankam P; Dziabiak, Michael P; Johnson, Raymond; Torres-Urquidy, Miguel Humberto; Acharya, Amit; Yabes, Jonathan; Schleyer, Titus K

2014-04-01

Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. Dentists first reviewed the patient's demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient's intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists' patterns of navigation through patient's information and additional information needs during a typical clinician-patient encounter. This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants' knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists' patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Accounting for Uncertainties in Strengths of SiC MEMS Parts

NASA Technical Reports Server (NTRS)

Nemeth, Noel; Evans, Laura; Beheim, Glen; Trapp, Mark; Jadaan, Osama; Sharpe, William N., Jr.

2007-01-01

A methodology has been devised for accounting for uncertainties in the strengths of silicon carbide structural components of microelectromechanical systems (MEMS). The methodology enables prediction of the probabilistic strengths of complexly shaped MEMS parts using data from tests of simple specimens. This methodology is intended to serve as a part of a rational basis for designing SiC MEMS, supplementing methodologies that have been borrowed from the art of designing macroscopic brittle material structures. The need for this or a similar methodology arises as a consequence of the fundamental nature of MEMS and the brittle silicon-based materials of which they are typically fabricated. When tested to fracture, MEMS and structural components thereof show wide part-to-part scatter in strength. The methodology involves the use of the Ceramics Analysis and Reliability Evaluation of Structures Life (CARES/Life) software in conjunction with the ANSYS Probabilistic Design System (PDS) software to simulate or predict the strength responses of brittle material components while simultaneously accounting for the effects of variability of geometrical features on the strength responses. As such, the methodology involves the use of an extended version of the ANSYS/CARES/PDS software system described in Probabilistic Prediction of Lifetimes of Ceramic Parts (LEW-17682-1/4-1), Software Tech Briefs supplement to NASA Tech Briefs, Vol. 30, No. 9 (September 2006), page 10. The ANSYS PDS software enables the ANSYS finite-element-analysis program to account for uncertainty in the design-and analysis process. The ANSYS PDS software accounts for uncertainty in material properties, dimensions, and loading by assigning probabilistic distributions to user-specified model parameters and performing simulations using various sampling techniques.

Simulating care: technology-mediated learning in twenty-first century nursing education.

PubMed

Diener, Elizabeth; Hobbs, Nelda

2012-01-01

The increased reliance on simulation classrooms has proven successful in learning skills. Questions persist concerning the ability of technology-driven robotic devices to form and cultivate caring behaviors, or sufficiently develop interactive nurse-client communication necessary in the context of nursing. This article examines the disconnects created by use of simulation technology in nursing education, raising the question: "Can learning of caring-as-being, be facilitated in simulation classrooms?" We propose that unless time is spent with human beings in the earliest stages of nursing education, transpersonal caring relationships do not have space to develop. Learning, crafting, and maturation of caring behaviors threatens to become a serendipitous event or is no longer perceived as an essential characteristic of nursing. Technology does not negate caring-the isolation it fosters makes transpersonal caring all the more important. We are called to create a new paradigm for nursing education that merges Nightingale's vision with technology's promise. © 2012 Wiley Periodicals, Inc.

Evaluating the introduction of extracorporeal life support technology to a tertiary-care pediatric institution: Smoothing the learning curve through interprofessional simulation training.

PubMed

Sanchez-Glanville, Carlos; Brindle, Mary E; Spence, Tanya; Blackwood, Jaime; Drews, Tanya; Menzies, Steve; Lopushinsky, Steven R

2015-05-01

Extracorporeal life support (ECLS) is a life-saving technology for the critically ill child. Our objective was to evaluate the outcomes of an educational curriculum designed to introduce an ECLS program to a noncardiac pediatric surgical center. An interdisciplinary curriculum was developed consisting of didactic courses, animal labs, simulations, and debrief sessions. We reviewed all patients requiring ECLS between October 2011 and December 2013. All health care practitioners involved in the ECLS training curriculum were surveyed to evaluate their perception of the educational program. Primary outcomes include successful cannulation and 30-day survival. The knowledge and confidence improved with statistical significance (p<0.0001-0.0003) for all of the components of the training curriculum. The highest score was given to the simulations. Twenty-one patients underwent cannulation. All patients were successfully cannulated to bypass, including six (28.6%) ECPR. Median time from activation to cutting was 52min (IQR 40-72), and from cutting to bypass 40min (IQR 30-45). Sixteen patients (76.2%) were decannulated to a sustainable cardiac rhythm and survived 30-days. An ECLS curriculum incorporating simulation and dedicated practice seems to have eliminated the potential learning curve associated with the introduction of a complex technology to a novice environment. Copyright © 2015 Elsevier Inc. All rights reserved.

What do surgical oncology staff nurses know about colorectal cancer ostomy care?

PubMed

Gemmill, Robin; Kravits, Kathy; Ortiz, Mildred; Anderson, Casandra; Lai, Lily; Grant, Marcia

2011-02-01

For most patients diagnosed with colorectal cancer, dealing with the adjustment and rehabilitation after treatment can be overwhelming. There is a significant need for expert educational and counseling support, especially for the patient with a new ostomy. This pilot study describes acute care oncology staff nurses' knowledge about and attitudes toward providing direct ostomy care support and education. This study is part of a larger project assessing gaps in education and services in support of patients with colorectal cancer. The Survey on Ostomy Care questionnaire designed to assess nurses' knowledge about and attitudes toward ostomy care was administered to oncology staff nurses at a comprehensive cancer center. Only 30% of staff nurses surveyed strongly agreed or agreed with the statement, "I care for ostomy patients often enough to keep up my skills in ostomy care." Maintaining staff nurses' ability to teach and demonstrate to patients complex care such as ostomy care depends on the ability to practice both education and hands-on skills. Staff nurses identify that lack of opportunity to care for the new ostomy patient influences their ability to maintain skill expertise. The results show the need to explore the provision of ongoing staff education for low-volume patient populations using creative teaching strategies, such as clinical simulation and short videos. Copyright 2011, SLACK Incorporated.

NETIMIS: Dynamic Simulation of Health Economics Outcomes Using Big Data.

PubMed

Johnson, Owen A; Hall, Peter S; Hulme, Claire

2016-02-01

Many healthcare organizations are now making good use of electronic health record (EHR) systems to record clinical information about their patients and the details of their healthcare. Electronic data in EHRs is generated by people engaged in complex processes within complex environments, and their human input, albeit shaped by computer systems, is compromised by many human factors. These data are potentially valuable to health economists and outcomes researchers but are sufficiently large and complex enough to be considered part of the new frontier of 'big data'. This paper describes emerging methods that draw together data mining, process modelling, activity-based costing and dynamic simulation models. Our research infrastructure includes safe links to Leeds hospital's EHRs with 3 million secondary and tertiary care patients. We created a multidisciplinary team of health economists, clinical specialists, and data and computer scientists, and developed a dynamic simulation tool called NETIMIS (Network Tools for Intervention Modelling with Intelligent Simulation; http://www.netimis.com ) suitable for visualization of both human-designed and data-mined processes which can then be used for 'what-if' analysis by stakeholders interested in costing, designing and evaluating healthcare interventions. We present two examples of model development to illustrate how dynamic simulation can be informed by big data from an EHR. We found the tool provided a focal point for multidisciplinary team work to help them iteratively and collaboratively 'deep dive' into big data.

Simulation and Performance Analysis of Lithium Battery Bank Mounted on the Hybrid Power System for Mobile Public Health Center

NASA Astrophysics Data System (ADS)

Busono, Pratondo; Kartini, Evvy

2013-07-01

Mobile medical clinic has been proposed to serve homeless people, people in the disaster area or in the remote area where no health service exist. At that site, a number of essential services such as primary health care, general health screening, medical treatment and emergency/rescue operations are required. Such services usually requires on board electrical equipments such as refrigerators, komputer, power tools and medical equipments. To supply such electrical equipments, it needs extra auxiliary power sources, in addition of standard automotive power supply. The auxiliary power source specifically design to supply non automotive load which may have similar configuration, but usually uses high power alternator rated and larger deep cycle on board battery bank. This study covers the modeling and dynamic simulation of auxiliary power source/battery to supply the medical equipment and other electrical equipments on board. It consists a variable speed diesel generator set, photovoltaic (PV) generator mounted on the roof of the car, a rechargable battery bank. As an initial step in the system design, a simulation study was performed. The simulation is conducted in the system level. Simulation results shows that dynamical behaviour by means of current density, voltage and power plot over a chosen time range, and functional behaviour such as charging and discharging characteristic of the battery bank can be obtained.

Xyce Parallel Electronic Simulator : users' guide, version 2.0.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoekstra, Robert John; Waters, Lon J.; Rankin, Eric Lamont

2004-06-01

This manual describes the use of the Xyce Parallel Electronic Simulator. Xyce has been designed as a SPICE-compatible, high-performance analog circuit simulator capable of simulating electrical circuits at a variety of abstraction levels. Primarily, Xyce has been written to support the simulation needs of the Sandia National Laboratories electrical designers. This development has focused on improving capability the current state-of-the-art in the following areas: {sm_bullet} Capability to solve extremely large circuit problems by supporting large-scale parallel computing platforms (up to thousands of processors). Note that this includes support for most popular parallel and serial computers. {sm_bullet} Improved performance for allmore » numerical kernels (e.g., time integrator, nonlinear and linear solvers) through state-of-the-art algorithms and novel techniques. {sm_bullet} Device models which are specifically tailored to meet Sandia's needs, including many radiation-aware devices. {sm_bullet} A client-server or multi-tiered operating model wherein the numerical kernel can operate independently of the graphical user interface (GUI). {sm_bullet} Object-oriented code design and implementation using modern coding practices that ensure that the Xyce Parallel Electronic Simulator will be maintainable and extensible far into the future. Xyce is a parallel code in the most general sense of the phrase - a message passing of computing platforms. These include serial, shared-memory and distributed-memory parallel implementation - which allows it to run efficiently on the widest possible number parallel as well as heterogeneous platforms. Careful attention has been paid to the specific nature of circuit-simulation problems to ensure that optimal parallel efficiency is achieved as the number of processors grows. One feature required by designers is the ability to add device models, many specific to the needs of Sandia, to the code. To this end, the device package in the Xyce These input formats include standard analytical models, behavioral models look-up Parallel Electronic Simulator is designed to support a variety of device model inputs. tables, and mesh-level PDE device models. Combined with this flexible interface is an architectural design that greatly simplifies the addition of circuit models. One of the most important feature of Xyce is in providing a platform for computational research and development aimed specifically at the needs of the Laboratory. With Xyce, Sandia now has an 'in-house' capability with which both new electrical (e.g., device model development) and algorithmic (e.g., faster time-integration methods) research and development can be performed. Ultimately, these capabilities are migrated to end users.« less

Numerical Simulation of the Francis Turbine and CAD used to Optimized the Runner Design (2nd).

NASA Astrophysics Data System (ADS)

Sutikno, Priyono

2010-06-01

Hydro Power is the most important renewable energy source on earth. The water is free of charge and with the generation of electric energy in a Hydroelectric Power station the production of green house gases (mainly CO2) is negligible. Hydro Power Generation Stations are long term installations and can be used for 50 years and more, care must be taken to guarantee a smooth and safe operation over the years. Maintenance is necessary and critical parts of the machines have to be replaced if necessary. Within modern engineering the numerical flow simulation plays an important role in order to optimize the hydraulic turbine in conjunction with connected components of the plant. Especially for rehabilitation and upgrading existing Power Plants important point of concern are to predict the power output of turbine, to achieve maximum hydraulic efficiency, to avoid or to minimize cavitations, to avoid or to minimized vibrations in whole range operation. Flow simulation can help to solve operational problems and to optimize the turbo machinery for hydro electric generating stations or their component through, intuitive optimization, mathematical optimization, parametric design, the reduction of cavitations through design, prediction of draft tube vortex, trouble shooting by using the simulation. The classic design through graphic-analytical method is cumbersome and can't give in evidence the positive or negative aspects of the designing options. So it was obvious to have imposed as necessity the classical design methods to an adequate design method using the CAD software. There are many option chose during design calculus in a specific step of designing may be verified in ensemble and detail form a point of view. The final graphic post processing would be realized only for the optimal solution, through a 3 D representation of the runner as a whole for the final approval geometric shape. In this article it was investigated the redesign of the hydraulic turbine's runner, medium head Francis type, with following value for the most important parameter, the rated specific speed ns.

Teaching Communication Skills to Radiology Residents.

PubMed

Itri, Jason N; Yacob, Sammy; Mithqal, Ayman

The transition of health care in the United States from volume to value requires a systems-based approach aligning clinical services across the continuum of care. The ability to communicate effectively and resolve conflict is a critical skill within the systems-based model. Recognizing the essential role of communication in medicine, the Accreditation Council of Graduate Medical Education has designated interpersonal and communication skills a core competency for all residents regardless of specialty. Yet, communication skills are often developed through on-the-job training or not at all. Traditional educational curricula use a predominantly didactic approach without opportunities for trainees to observe, actively experiment, or reflect on what is learned as a part of the learning process. In this article, we describe a 1-day experiential communication skills workshop customized for radiology residents that consists of Myers-Briggs Type Indicator and conflict management sessions designed to develop interpersonal, communication, and conflict management skills through group discussion, role-play, and simulation. The purpose of this educational initiative was to determine the perceived value of an experiential communication skills workshop designed for radiology trainees. Copyright © 2017 Elsevier Inc. All rights reserved.

Considerations for the Use of Remote Gaze Tracking to Assess Behavior in Flight Simulators

NASA Technical Reports Server (NTRS)

Kalar, Donald J.; Liston, Dorion; Mulligan, Jeffrey B.; Beutter, Brent; Feary, Michael

2016-01-01

Complex user interfaces (such as those found in an aircraft cockpit) may be designed from first principles, but inevitably must be evaluated with real users. User gaze data can provide valuable information that can help to interpret other actions that change the state of the system. However, care must be taken to ensure that any conclusions drawn from gaze data are well supported. Through a combination of empirical and simulated data, we identify several considerations and potential pitfalls when measuring gaze behavior in high-fidelity simulators. We show that physical layout, behavioral differences, and noise levels can all substantially alter the quality of fit for algorithms that segment gaze measurements into individual fixations. We provide guidelines to help investigators ensure that conclusions drawn from gaze tracking data are not artifactual consequences of data quality or analysis techniques.

Interprofessional Education Among Student Health Professionals Using Human Patient Simulation

PubMed Central

Chmil, Joyce V.

2014-01-01

Objective. To describe the planning, implementation, and outcomes of an interprofessional education clinical laboratory facilitated through human patient simulation. Design. An interprofessional education clinical laboratory was developed with a patient-care scenario of acute exacerbation of heart failure that incorporated the use of a high-fidelity patient simulator. Pharmacy and nursing students assumed clinical roles in this realistic scenario and collaborated to diagnose and treat the patient. Assessment. Student attitudes toward and readiness to participate in interprofessional education improved following participation in the laboratory. Students reported that the greatest benefit of the experience was in their communication skills. Conclusion. Students’ ability to participate in interprofessional education experiences and their attitudes toward them improved following participation in this curricular initiative. Further evaluation of the impact of interprofessional education on student learning outcomes and changes in practice is warranted. PMID:24954934

Mathematical simulations for bioanalytical assay development: the (un-)necessity and (im-)possibility of free drug quantification.

PubMed

Staack, Roland F; Jordan, Gregor; Heinrich, Julia

2012-02-01

For every drug development program it needs to be discussed whether discrimination between free and total drug concentrations is required to accurately describe its pharmacokinetic behavior. This perspective describes the application of mathematical simulation approaches to guide this initial decision based on available knowledge about target biology, binding kinetics and expected drug concentrations. We provide generic calculations that can be used to estimate the necessity of free drug quantification for different drug molecules. In addition, mathematical approaches are used to simulate various assay conditions in bioanalytical ligand-binding assays: it is demonstrated that due to the noncovalent interaction between the binding partners and typical assay-related interferences in the equilibrium, a correct quantification of the free drug concentration is highly challenging and requires careful design of different assay procedure steps.

One size does not fit all: investigating doctors' stated preference heterogeneity for job incentives to inform policy in Thailand.

PubMed

Lagarde, Mylene; Pagaiya, Nonglak; Tangcharoensathian, Viroj; Blaauw, Duane

2013-12-01

This study investigates heterogeneity in Thai doctors' job preferences at the beginning of their career, with a view to inform the design of effective policies to retain them in rural areas. A discrete choice experiment was designed and administered to 198 young doctors. We analysed the data using several specifications of a random parameter model to account for various sources of preference heterogeneity. By modelling preference heterogeneity, we showed how sensitivity to different incentives varied in different sections of the population. In particular, doctors from rural backgrounds were more sensitive than others to a 45% salary increase and having a post near their home province, but they were less sensitive to a reduction in the number of on-call nights. On the basis of the model results, the effects of two types of interventions were simulated: introducing various incentives and modifying the population structure. The results of the simulations provide multiple elements for consideration for policy-makers interested in designing effective interventions. They also underline the interest of modelling preference heterogeneity carefully. Copyright © 2013 John Wiley & Sons, Ltd.

Tailoring the response of Autonomous Reactivity Control (ARC) systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qvist, Staffan A.; Hellesen, Carl; Gradecka, Malwina

The Autonomous Reactivity Control (ARC) system was developed to ensure inherent safety of Generation IV reactors while having a minimal impact on reactor performance and economic viability. In this study we present the transient response of fast reactor cores to postulated accident scenarios with and without ARC systems installed. Using a combination of analytical methods and numerical simulation, the principles of ARC system design that assure stability and avoids oscillatory behavior have been identified. A comprehensive transient analysis study for ARC-equipped cores, including a series of Unprotected Loss of Flow (ULOF) and Unprotected Loss of Heat Sink (ULOHS) simulations, weremore » performed for Argonne National Laboratory (ANL) Advanced Burner Reactor (ABR) designs. With carefully designed ARC-systems installed in the fuel assemblies, the cores exhibit a smooth non-oscillatory transition to stabilization at acceptable temperatures following all postulated transients. To avoid oscillations in power and temperature, the reactivity introduced per degree of temperature change in the ARC system needs to be kept below a certain threshold the value of which is system dependent, the temperature span of actuation needs to be as large as possible.« less

Simulated human patients and patient-centredness: The uncanny hybridity of nursing education, technology, and learning to care.

PubMed

Ireland, Aileen V

2017-01-01

Positioned within a hybrid of the human and technology, professional nursing practice has always occupied a space that is more than human. In nursing education, technology is central in providing tools with which practice knowledge is mobilized so that students can safely engage with simulated human patients without causing harm to real people. However, while there is an increased emphasis on deploying these simulated humans as emissaries from person-centred care to demonstrate what it is like to care for real humans, the nature of what is really going on in simulation-what is real and what is simulated-is very rarely discussed and poorly understood. This paper explores how elements of postcolonial critical thought can aid in understanding the challenges of educating nurses to provide person-centred care within a healthcare culture that is increasingly reliant on technology. Because nursing education is itself a hybrid of real and simulated practice, it provides an appropriate case study to explore the philosophical question of technology in healthcare discourse, particularly as it relates to the relationship between the human patient and its uncanny simulated double. Drawing on postcolonial elements such as the uncanny, diaspora, hybridity, and créolité, the hybrid conditions of nursing education are examined in order to open up new possibilities of thinking about how learning to care is entangled with this technological space to assist in shaping professional knowledge of person-centred care. Considering these issues through a postcolonial lens opens up questions about the nature of the difficulty in using simulated human technologies in clinical education, particularly with the paradoxical aim of providing person-centred care within a climate that increasingly characterized as posthuman. © 2016 John Wiley & Sons Ltd.

Physician communication coaching effects on patient experience

PubMed Central

Seiler, Adrianne; Knee, Alexander; Shaaban, Reham; Bryson, Christine; Paadam, Jasmine; Harvey, Rohini; Igarashi, Satoko; LaChance, Christopher; Benjamin, Evan; Lagu, Tara

2017-01-01

Background Excellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients’ perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication. Study design We designed a comprehensive physician-training module focused on improving specific “etiquette-based” physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent “always” scores for questions related to patients’ perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists. Results A total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent “always” responses, for the HCAHPS questions of doctors “treating patients with courtesy” “explaining things in a way patients could understand,” and “overall teamwork” showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors “keeping patient informed” (adjusted intercept shift 9.9% P = 0.019), “overall teamwork” (adjusted intercept shift 11%, P = 0.037), and “using words the patient could understand” (adjusted intercept shift 14.8%, p = 0.001). Conclusion A simulation based physician communication coaching method focused on specific “etiquette-based” communication behaviors through a deliberate practice framework was not associated with significantly improved HCAHPS physician communication patient experience scores. Further research could reveal ways that this model affects patients’ perceptions of physician communication relating to specific physicians or behaviors. PMID:28678872

Safer@home—Simulation and training: the study protocol of a qualitative action research design

PubMed Central

Wiig, Siri; Guise, Veslemøy; Anderson, Janet; Storm, Marianne; Lunde Husebø, Anne Marie; Testad, Ingelin; Søyland, Elsa; Moltu, Kirsti L

2014-01-01

Introduction While it is predicted that telecare and other information and communication technology (ICT)-assisted services will have an increasingly important role in future healthcare services, their implementation in practice is complex. For implementation of telecare to be successful and ensure quality of care, sufficient training for staff (healthcare professionals) and service users (patients) is fundamental. Telecare training has been found to have positive effects on attitudes to, sustained use of, and outcomes associated with telecare. However, the potential contribution of training in the adoption, quality and safety of telecare services is an under-investigated research field. The overall aim of this study is to develop and evaluate simulation-based telecare training programmes to aid the use of videophone technology in elderly home care. Research-based training programmes will be designed for healthcare professionals, service users and next of kin, and the study will explore the impact of training on adoption, quality and safety of new telecare services. Methods and analysis The study has a qualitative action research design. The research will be undertaken in close collaboration with a multidisciplinary team consisting of researchers and managers and clinical representatives from healthcare services in two Norwegian municipalities, alongside experts in clinical education and simulation, as well as service user (patient) representatives. The qualitative methods used involve focus group interviews, semistructured interviews, observation and document analysis. To ensure trustworthiness in the data analysis, we will apply member checks and analyst triangulation; in addition to providing contextual and sample description to allow for evaluation of transferability of our results to other contexts and groups. Ethics and dissemination The study is approved by the Norwegian Social Science Data Services. The study is based on voluntary participation and informed written consent. Informants can withdraw at any point in time. The results will be disseminated at research conferences, peer review journals, one PhD thesis and through public presentations to people outside the scientific community. PMID:25079924

Advancing renal education: hybrid simulation, using simulated patients to enhance realism in haemodialysis education.

PubMed

Dunbar-Reid, Kylie; Sinclair, Peter M; Hudson, Denis

2015-06-01

Simulation is a well-established and proven teaching method, yet its use in renal education is not widely reported. Criticisms of simulation-based teaching include limited realism and a lack of authentic patient interaction. This paper discusses the benefits and challenges of high-fidelity simulation and suggests hybrid simulation as a complementary model to existing simulation programmes. Through the use of a simulated patient, hybrid simulation can improve the authenticity of renal simulation-based education while simultaneously teaching and assessing technologically enframed caring. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Flying Lessons for Clinicians: Developing System 2 Practice.

PubMed

Gregoire, Jerome N; Alfes, Celeste M; Reimer, Andrew P; Terhaar, Mary F

There is a long history of adopting lessons learned from aviation to improve health care practice. Two of the major practices that have successfully transferred include using a checklist and simulation. Training and simulation technology is currently underdeveloped for nurses and health care providers entering critical care transport. This article describes a pedagogical approach adopted from aviation to develop a new simulation platform and program of research to develop the science of critical care transport nursing education. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Interprofessional Flight Camp.

PubMed

Alfes, Celeste M; Rowe, Amanda S

2016-01-01

The Dorothy Ebersbach Academic Center for Flight Nursing in Cleveland, OH, holds an annual flight camp designed for master's degree nursing students in the acute care nurse practitioner program, subspecializing in flight nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University. The weeklong interprofessional training is also open to any health care provider working in an acute care setting and focuses on critical care updates, trauma, and emergency care within the critical care transport environment. This year, 29 graduate nursing students enrolled in a master's degree program from Puerto Rico attended. Although the emergency department in Puerto Rico sees and cares for trauma patients, there is no formal trauma training program. Furthermore, the country only has 1 rotor wing air medical transport service located at the Puerto Rico Medical Center in San Juan. Flight faculty and graduate teaching assistants spent approximately 9 months planning for their participation in our 13th annual flight camp. Students from Puerto Rico were extremely pleased with the learning experiences at camp and expressed particular interest in having more training time within the helicopter flight simulator. Copyright © 2016 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Robust blood-glucose control using Mathematica.

PubMed

Kovács, Levente; Paláncz, Béla; Benyó, Balázs; Török, László; Benyó, Zoltán

2006-01-01

A robust control design on frequency domain using Mathematica is presented for regularization of glucose level in type I diabetes persons under intensive care. The method originally proposed under Mathematica by Helton and Merino, --now with an improved disturbance rejection constraint inequality--is employed, using a three-state minimal patient model. The robustness of the resulted high-order linear controller is demonstrated by nonlinear closed loop simulation in state-space, in case of standard meal disturbances and is compared with H infinity design implemented with the mu-toolbox of Matlab. The controller designed with model parameters represented the most favorable plant dynamics from the point of view of control purposes, can operate properly even in case of parameter values of the worst-case scenario.

Little shop of errors: an innovative simulation patient safety workshop for community health care professionals.

PubMed

Tupper, Judith B; Pearson, Karen B; Meinersmann, Krista M; Dvorak, Jean

2013-06-01

Continuing education for health care workers is an important mechanism for maintaining patient safety and high-quality health care. Interdisciplinary continuing education that incorporates simulation can be an effective teaching strategy for improving patient safety. Health care professionals who attended a recent Patient Safety Academy had the opportunity to experience firsthand a simulated situation that included many potential patient safety errors. This high-fidelity activity combined the best practice components of a simulation and a collaborative experience that promoted interdisciplinary communication and learning. Participants were challenged to see, learn, and experience "ah-ha" moments of insight as a basis for error reduction and quality improvement. This innovative interdisciplinary educational training method can be offered in place of traditional lecture or online instruction in any facility, hospital, nursing home, or community care setting. Copyright 2013, SLACK Incorporated.

Pulse contour analysis of arterial waveform in a high fidelity human patient simulator.

PubMed

Persona, Paolo; Saraceni, Elisabetta; Facchin, Francesca; Petranzan, Enrico; Parotto, Matteo; Baratto, Fabio; Ori, Carlo; Rossi, Sandra

2017-10-03

The measurement of cardiac output (CO) may be useful to improve the assessment of hemodynamics during simulated scenarios. The purpose of this study was to evaluate the feasibility of introducing an uncalibrated pulse contour device (MostCare, Vytech, Vygon, Padova, Italy) into the simulation environment. MostCare device was plugged to a clinical monitor and connected to the METI human patient simulator (HPS) to obtain a continuous arterial waveform analysis and CO calculation. In six different simulated clinical scenarios (baseline, ventricular failure, vasoplegic shock, hypertensive crisis, hypovolemic shock and aortic stenosis), the HPS-CO and the MostCare-CO were simultaneously recorded. The level of concordance between the two methods was assessed by the Bland and Altman analysis. 150-paired CO values were obtained. The HPS-CO values ranged from 2.3 to 6.6 L min -1 and the MostCare-CO values from 2.8 to 6.4 L min -1 . The mean difference between HPS-CO and MostCare-CO was - 0.3 L min -1 and the limits of agreement were - 1.5 and 0.9 L min -1 . The percentage of error was 23%. A good correlation between HPS-CO and MostCare-CO was observed in each scenario of the study (r = 0.88). Although MostCare-CO tended to underestimate the CO over the study period, good agreements were found between the two methods. Therefore, a pulse contour device can be integrated into the simulation environment, offering the opportunity to create new simulated clinical settings.

The PMIP4 contribution to CMIP6 - Part 2: Two interglacials, scientific objective and experimental design for Holocene and Last Interglacial simulations

NASA Astrophysics Data System (ADS)

Otto-Bliesner, Bette L.; Braconnot, Pascale; Harrison, Sandy P.; Lunt, Daniel J.; Abe-Ouchi, Ayako; Albani, Samuel; Bartlein, Patrick J.; Capron, Emilie; Carlson, Anders E.; Dutton, Andrea; Fischer, Hubertus; Goelzer, Heiko; Govin, Aline; Haywood, Alan; Joos, Fortunat; LeGrande, Allegra N.; Lipscomb, William H.; Lohmann, Gerrit; Mahowald, Natalie; Nehrbass-Ahles, Christoph; Pausata, Francesco S. R.; Peterschmitt, Jean-Yves; Phipps, Steven J.; Renssen, Hans; Zhang, Qiong

2017-11-01

Two interglacial epochs are included in the suite of Paleoclimate Modeling Intercomparison Project (PMIP4) simulations in the Coupled Model Intercomparison Project (CMIP6). The experimental protocols for simulations of the mid-Holocene (midHolocene, 6000 years before present) and the Last Interglacial (lig127k, 127 000 years before present) are described here. These equilibrium simulations are designed to examine the impact of changes in orbital forcing at times when atmospheric greenhouse gas levels were similar to those of the preindustrial period and the continental configurations were almost identical to modern ones. These simulations test our understanding of the interplay between radiative forcing and atmospheric circulation, and the connections among large-scale and regional climate changes giving rise to phenomena such as land-sea contrast and high-latitude amplification in temperature changes, and responses of the monsoons, as compared to today. They also provide an opportunity, through carefully designed additional sensitivity experiments, to quantify the strength of atmosphere, ocean, cryosphere, and land-surface feedbacks. Sensitivity experiments are proposed to investigate the role of freshwater forcing in triggering abrupt climate changes within interglacial epochs. These feedback experiments naturally lead to a focus on climate evolution during interglacial periods, which will be examined through transient experiments. Analyses of the sensitivity simulations will also focus on interactions between extratropical and tropical circulation, and the relationship between changes in mean climate state and climate variability on annual to multi-decadal timescales. The comparative abundance of paleoenvironmental data and of quantitative climate reconstructions for the Holocene and Last Interglacial make these two epochs ideal candidates for systematic evaluation of model performance, and such comparisons will shed new light on the importance of external feedbacks (e.g., vegetation, dust) and the ability of state-of-the-art models to simulate climate changes realistically.

Heartbeat-based error diagnosis framework for distributed embedded systems

NASA Astrophysics Data System (ADS)

Mishra, Swagat; Khilar, Pabitra Mohan

2012-01-01

Distributed Embedded Systems have significant applications in automobile industry as steer-by-wire, fly-by-wire and brake-by-wire systems. In this paper, we provide a general framework for fault detection in a distributed embedded real time system. We use heartbeat monitoring, check pointing and model based redundancy to design a scalable framework that takes care of task scheduling, temperature control and diagnosis of faulty nodes in a distributed embedded system. This helps in diagnosis and shutting down of faulty actuators before the system becomes unsafe. The framework is designed and tested using a new simulation model consisting of virtual nodes working on a message passing system.

Heartbeat-based error diagnosis framework for distributed embedded systems

NASA Astrophysics Data System (ADS)

Mishra, Swagat; Khilar, Pabitra Mohan

2011-12-01

Distributed Embedded Systems have significant applications in automobile industry as steer-by-wire, fly-by-wire and brake-by-wire systems. In this paper, we provide a general framework for fault detection in a distributed embedded real time system. We use heartbeat monitoring, check pointing and model based redundancy to design a scalable framework that takes care of task scheduling, temperature control and diagnosis of faulty nodes in a distributed embedded system. This helps in diagnosis and shutting down of faulty actuators before the system becomes unsafe. The framework is designed and tested using a new simulation model consisting of virtual nodes working on a message passing system.

Broadband impedance calculations and single bunch instabilities estimations of of the HLS-II storage ring

NASA Astrophysics Data System (ADS)

Zhang, Qing-Kun; Wang, Lin; Li, Wei-Min; Gao, Wei-Wei

2015-12-01

The upgrade project of the Hefei Light Source storage ring is under way. In this paper, the broadband impedances of resistive wall and coated ceramic vacuum chamber are calculated using the analytic formula, and the wake fields and impedances of other designed vacuum chambers are simulated by CST code, and then a broadband impedance model is obtained. Using the theoretical formula, longitudinal and transverse single bunch instabilities are discussed. With the carefully-designed vacuum chamber, we find that the thresholds of the beam instabilities are higher than the beam current goal. Supported by Natural Science Foundation of China (11175182, 11175180)

Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation.

PubMed

Sørensen, Jette Led; Østergaard, Doris; LeBlanc, Vicki; Ottesen, Bent; Konge, Lars; Dieckmann, Peter; Van der Vleuten, Cees

2017-01-21

Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities are called in-house training. In-house training facilities can be part of hospital departments and resemble to some extent simulation centres but often have less technical equipment. In situ simulation, introduced over the past decade, mainly comprises of team-based activities and occurs in patient care units with healthcare professionals in their own working environment. Thus, this intentional blend of simulation and real working environments means that in situ simulation brings simulation to the real working environment and provides training where people work. In situ simulation can be either announced or unannounced, the latter also known as a drill. This article presents and discusses the design of SBME and the advantage and disadvantage of the different simulation settings, such as training in simulation-centres, in-house simulations in hospital departments, announced or unannounced in situ simulations. Non-randomised studies argue that in situ simulation is more effective for educational purposes than other types of simulation settings. Conversely, the few comparison studies that exist, either randomised or retrospective, show that choice of setting does not seem to influence individual or team learning. However, hospital department-based simulations, such as in-house simulation and in situ simulation, lead to a gain in organisational learning. To our knowledge no studies have compared announced and unannounced in situ simulation. The literature suggests some improved organisational learning from unannounced in situ simulation; however, unannounced in situ simulation was also found to be challenging to plan and conduct, and more stressful among participants. The importance of setting, context and fidelity are discussed. Based on the current limited research we suggest that choice of setting for simulations does not seem to influence individual and team learning. Department-based local simulation, such as simulation in-house and especially in situ simulation, leads to gains in organisational learning. The overall objectives of simulation-based education and factors such as feasibility can help determine choice of simulation setting.

Interprofessional simulated learning: short-term associations between simulation and interprofessional collaboration

PubMed Central

2011-01-01

Background Health professions education programs use simulation for teaching and maintaining clinical procedural skills. Simulated learning activities are also becoming useful methods of instruction for interprofessional education. The simulation environment for interprofessional training allows participants to explore collaborative ways of improving communicative aspects of clinical care. Simulation has shown communication improvement within and between health care professions, but the impacts of teamwork simulation on perceptions of others' interprofessional practices and one's own attitudes toward teamwork are largely unknown. Methods A single-arm intervention study tested the association between simulated team practice and measures of interprofessional collaboration, nurse-physician relationships, and attitudes toward health care teams. Participants were 154 post-licensure nurses, allied health professionals, and physicians. Self- and proxy-report survey measurements were taken before simulation training and two and six weeks after. Results Multilevel modeling revealed little change over the study period. Variation in interprofessional collaboration and attitudes was largely attributable to between-person characteristics. A constructed categorical variable indexing 'leadership capacity' found that participants with highest and lowest values were more likely to endorse shared team leadership over physician centrality. Conclusion Results from this study indicate that focusing interprofessional simulation education on shared leadership may provide the most leverage to improve interprofessional care. PMID:21443779

Using simulation to improve the capability of undergraduate nursing students in mental health care.

PubMed

Kunst, Elicia L; Mitchell, Marion; Johnston, Amy N B

2017-03-01

Mental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment. Undergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges. Using a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting. Students who participated in the simulation activity identified and reported significantly increased confidence, knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning. There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting. This study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Simulation in mental health nurse education: The development, implementation and evaluation of an educational innovation.

PubMed

Felton, Anne; Wright, Nicola

2017-09-01

Simulation is an important learning approach for the development of skills for healthcare practice. However, it remains under used in the education of mental health practitioners. This article examines the development, implementation and evaluation of a simulated learning experience for final year undergraduate BSc mental health nursing students in the UK. Scenarios involving managing care in an acute in patient ward and community older persons' team were designed to enable students to develop their complex decision making skills. An evaluation of the simulation experience was undertaken. This was informed by the principles of improvement science methodology and data was collected from the student participants using questionnaires. The findings indicated that simulation provided a realistic environment in which students were able to develop skills and manage clinical situations autonomously without fear of being assessed or making mistakes. Reflecting Dieckmann et al.'s (2007) position that simulation is a social situation in itself, the learning approach enabled mental health students to both experience the safety of the Higher Education setting and also the reality of clinical practice. Simulation may therefore provide an important tool to prepare students for the responsibilities of a qualified nurse. Copyright © 2017. Published by Elsevier Ltd.

Improving surgeon utilization in an orthopedic department using simulation modeling

PubMed Central

Simwita, Yusta W; Helgheim, Berit I

2016-01-01

Purpose Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time. Methods The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization. Results The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services. Conclusion This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. PMID:29355193

[The Learning Effectiveness of Nurses Participating in a Simulated Radiation Therapy Skin Care Workshop].

PubMed

Lee, Yu-San; Kao, Yu-Hsiu

2016-08-01

The skin reaction rate is 60-95% in cancer patients that receive radiation therapy. This therapy is likely to cause physical and mental discomfort and prolong treatment for patients. The current emphasis on lectures rather than practice to help nurses learn proper skin care practices likely imposes difficulties for nurses to handle various clinical situations. To investigate the learning effectiveness of a simulated radiation therapy skin care workshop for nurses. A total of 34 nurses at a hospital in one health system in northern Taiwan who had never used radiation therapy to provide care to patients were enrolled in this quasi-experimental study. A single group pretest, posttest and post-posttest (6 weeks after intervention) approach was used. At the simulated radiation therapy skin care workshop, we used teaching strategies including Ausubel's direct instruction teaching method and practice on simulated wounds on pig skins. Outcomes were evaluated using "the questionnaire of radiation therapy skin care" and "direct observation of procedural skills checklist". The results from the simulated radiation therapy skin care workshop were analyzed using GEE (generalized estimating equation). The post-posttest and posttest scores increased significantly; knowledge mean score 3.14 (< .001) vs 2.64 (< .001), attitude mean score 2.06 (p < .05) vs 2.24 (p < .001), and skill mean score 2.79 (p < .001) vs 1.68 (p < .001). The simulated radiation therapy skin care workshop demonstrated significant and positive effects on learning outcomes. Therefore, we recommend incorporating this workshop into clinical nursing education and training strategies in the future.

The Many Faces of Patient-Centered Simulation: Implications for Researchers.

PubMed

Arnold, Jennifer L; McKenzie, Frederic Rick D; Miller, Jane Lindsay; Mancini, Mary E

2018-06-01

Patient-centered simulation for nonhealthcare providers is an emerging and innovative application for healthcare simulation. Currently, no consensus exists on what patient-centered simulation encompasses and outcomes research in this area is limited. Conceptually, patient-centered simulation aligns with the principles of patient- and family-centered care bringing this educational tool directly to patients and caregivers with the potential to improve patient care and outcomes. This descriptive article is a summary of findings presented at the 2nd International Meeting for Simulation in Healthcare Research Summit. Experts in the field delineated a categorization for better describing patient-centered simulation and reviewed the literature to identify a research agenda. Three types of patient-centered simulation patient-directed, patient-driven, and patient-specific are presented with research priorities identified for each. Patient-centered simulation has been shown to be an effective educational tool and has the potential to directly improve patient care outcomes. Presenting a typology for patient-centered simulation provides direction for future research.

Ventilator caregiver education through the use of high-fidelity pediatric simulators: a pilot study.

PubMed

Tofil, Nancy M; Rutledge, Chrystal; Zinkan, J Lynn; Youngblood, Amber Q; Stone, Julie; Peterson, Dawn Taylor; Slayton, Donna; Makris, Chris; Magruder, Terri; White, Marjorie Lee

2013-11-01

Introduction. Home ventilator programs (HVP) have been developed to train parents of critically ill children. Simulators are used in health care, but not often for parents. We added simulation to our HVP and assessed parents' response. Methods. In July 2008, the HVP at Children's of Alabama added simulation to parent training. Debriefing was provided after the training session to reinforce correct skills and critical thinking. Follow-up surveys were completed after training. Results. Fifteen families participated. All parents were confident in changing tracheostomies, knowing signs of breathing difficulties, and responding to alarms. 71% strongly agree that simulation resulted in feeling better prepared to care for their child. 86% felt simulation improved their confidence in taking care of their child. Conclusion. Simulators provide a crucial transition between learned skills and application. This novel use of simulation-based education improves parents' confidence in emergencies and may lead to shortened training resulting in cost savings.

Use of Simulation to Gauge Preparedness for Ebola at a Free-Standing Children's Hospital.

PubMed

Biddell, Elizabeth A; Vandersall, Brian L; Bailes, Stephanie A; Estephan, Stephanie A; Ferrara, Lori A; Nagy, Kristine M; O'Connell, Joyce L; Patterson, Mary D

2016-04-01

On October 10, 2014, a health care worker exposed to Ebola traveled to Akron, OH, where she became symptomatic. The resulting local public health agencies and health care organization response was unequalled in our region. The day this information was announced, the emergency disaster response was activated at our hospital. The simulation center had 12 hours to prepare simulations to evaluate hospital preparedness should a patient screen positive for Ebola exposure. The team developed hybrid simulation scenarios using standardized patients, mannequin simulators, and task trainers to assess hospital preparedness in the emergency department, transport team, pediatric intensive care unit, and for interdepartmental transfers. These simulations were multidisciplinary and demonstrated gaps in the system that could expose staff to Ebola. The results of these simulations were provided rapidly to the administration. Further simulation cycles were used during the next 2 weeks to identify additional gaps and to evaluate possible solutions.

[Simulation in health to improve the delivery of care].

PubMed

Tesnière, Antoine; Fleury, Cynthia

2017-11-01

Simulation in health care is a very effective training tool. Using mannequins, 'standardised patients' or virtual care environments, it encourages participants to reflect on nursing practices while practising in a safe and controlled space. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Developing integrated patient pathways using hybrid simulation

NASA Astrophysics Data System (ADS)

Zulkepli, Jafri; Eldabi, Tillal

2016-10-01

Integrated patient pathways includes several departments, i.e. healthcare which includes emergency care and inpatient ward; intermediate care which patient(s) will stay for a maximum of two weeks and at the same time be assessed by assessment team to find the most suitable care; and social care. The reason behind introducing the intermediate care in western countries was to reduce the rate of patients that stays in the hospital especially for elderly patients. This type of care setting has been considered to be set up in some other countries including Malaysia. Therefore, to assess the advantages of introducing this type of integrated healthcare setting, we suggest develop the model using simulation technique. We argue that single simulation technique is not viable enough to represent this type of patient pathways. Therefore, we suggest develop this model using hybrid techniques, i.e. System Dynamics (SD) and Discrete Event Simulation (DES). Based on hybrid model result, we argued that the result is viable to be as references for decision making process.

In situ pediatric trauma simulation: assessing the impact and feasibility of an interdisciplinary pediatric in situ trauma care quality improvement simulation program.

PubMed

Auerbach, Marc; Roney, Linda; Aysseh, April; Gawel, Marcie; Koziel, Jeannette; Barre, Kimberly; Caty, Michael G; Santucci, Karen

2014-12-01

This study aimed to evaluate the feasibility and measure the impact of an in situ interdisciplinary pediatric trauma quality improvement simulation program. Twenty-two monthly simulations were conducted in a tertiary care pediatric emergency department with the aim of improving the quality of pediatric trauma (February 2010 to November 2012). Each session included 20 minutes of simulated patient care, followed by 30 minutes of debriefing that focused on teamwork, communication, and the identification of gaps in care. A single rater scored the performance of the team in real time using a validated assessment instrument for 6 subcomponents of care (teamwork, airway, intubation, breathing, circulation, and disability). Participants completed a survey and written feedback forms. A trend analysis of the 22 simulations found statistically significant positive trends for overall performance, teamwork, and intubation subcomponents; the strength of the upward trend was the strongest for the teamwork (τ = 0.512), followed by overall performance (τ = 0.488) and intubation (τ = 0.433). Two hundred fifty-one of 398 participants completed the participant feedback form (response rate, 63%), reporting that debriefing was the most valuable aspect of the simulation. An in situ interdisciplinary pediatric trauma simulation quality improvement program resulted in improved validated trauma simulation assessment scores for overall performance, teamwork, and intubation. Participants reported high levels of satisfaction with the program, and debriefing was reported as the most valuable component of the program.

Improving the Analysis Capabilities of the Synthetic Theater Operations Research Model (STORM)

DTIC Science & Technology

2014-09-01

course of action CSG carrier strike group DMSO defense modeling and simulation DOD Department of Defense DOE design of experiments ESG...development of an overall objective or end-state; a ways ( courses of action); and a means (available resources). STORM is a campaign analysis tool that...refers to the courses of action (COA) that are carefully planned out in advance by individuals relevant to a specific campaign (such as N81). For

An overview of recent applications of computational modelling in neonatology

PubMed Central

Wrobel, Luiz C.; Ginalski, Maciej K.; Nowak, Andrzej J.; Ingham, Derek B.; Fic, Anna M.

2010-01-01

This paper reviews some of our recent applications of computational fluid dynamics (CFD) to model heat and mass transfer problems in neonatology and investigates the major heat and mass-transfer mechanisms taking place in medical devices, such as incubators, radiant warmers and oxygen hoods. It is shown that CFD simulations are very flexible tools that can take into account all modes of heat transfer in assisting neonatal care and improving the design of medical devices. PMID:20439275

The impact of leadership and team behavior on standard of care delivered during human patient simulation: a pilot study for undergraduate medical students.

PubMed

Carlson, Jim; Min, Elana; Bridges, Diane

2009-01-01

Methodology to train team behavior during simulation has received increased attention, but standard performance measures are lacking, especially at the undergraduate level. Our purposes were to develop a reliable team behavior measurement tool and explore the relationship between team behavior and the delivery of an appropriate standard of care specific to the simulated case. Authors developed a unique team measurement tool based on previous work. Trainees participated in a simulated event involving the presentation of acute dyspnea. Performance was rated by separate raters using the team behavior measurement tool. Interrater reliability was assessed. The relationship between team behavior and the standard of care delivered was explored. The instrument proved to be reliable for this case and group of raters. Team behaviors had a positive relationship with the standard of medical care delivered specific to the simulated case. The methods used provide a possible method for training and assessing team performance during simulation.

Using simulation to isolate physician variation in intensive care unit admission decision making for critically ill elders with end-stage cancer: a pilot feasibility study.

PubMed

Barnato, Amber E; Hsu, Heather E; Bryce, Cindy L; Lave, Judith R; Emlet, Lillian L; Angus, Derek C; Arnold, Robert M

2008-12-01

To determine the feasibility of high-fidelity simulation for studying variation in intensive care unit admission decision making for critically ill elders with end-stage cancer. Mixed qualitative and quantitative analysis of physician subjects participating in a simulation scenario using hospital set, actors, medical chart, and vital signs tracings. The simulation depicted a 78-yr-old man with metastatic gastric cancer, life-threatening hypoxia most likely attributable to cancer progression, and stable preferences to avoid intensive care unit admission and intubation. Two independent raters assessed the simulations and subjects completed a postsimulation web-based survey and debriefing interview. Peter M. Winter Institute for Simulation Education and Research at the University of Pittsburgh. Twenty-seven hospital-based attending physicians, including 6 emergency physicians, 13 hospitalists, and 8 intensivists. Outcomes included qualitative report of clinical verisimilitude during the debriefing interview, survey-reported diagnosis and prognosis, and observed treatment decisions. Independent variables included physician demographics, risk attitude, and reactions to uncertainty. All (100%) reported that the case and simulation were highly realistic, and their diagnostic and prognostic assessments were consistent with our intent. Eight physicians (29.6%) admitted the patient to the intensive care unit. Among the eight physicians who admitted the patient to the intensive care unit, three (37%) initiated palliation, two (25%) documented the patient's code status (do not intubate/do not resuscitate), and one intubated the patient. Among the 19 physicians who did not admit the patient to the intensive care unit, 13 (68%) initiated palliation and 5 (42%) documented code status. Intensivists and emergency physicians (p = 0.048) were more likely to admit the patient to the intensive care unit. Years since medical school graduation were inversely associated with the initiation of palliative care (p = 0.043). Simulation can reproduce the decision context of intensive care unit triage for a critically ill patient with terminal illness. When faced with an identical patient, hospital-based physicians from the same institution vary significantly in their treatment decisions.

Can training in empathetic validation improve medical students' communication with patients suffering pain? A test of concept.

PubMed

Linton, Steven J; Flink, Ida K; Nilsson, Emma; Edlund, Sara

2017-05-01

Patient-centered, empathetic communication has been recommended as a means for improving the health care of patients suffering pain. However, a problem has been training health care providers since programs may be time-consuming and difficult to learn. Validation, a form of empathetic response that communicates that what a patient experiences is accepted as true, has been suggested as an appropriate method for improving communication with patients suffering pain. We study the immediate effects of providing medical students with a 2-session (45-minute duration each) program in validation skills on communication. A one group, pretest vs posttest design was employed with 22 volunteer medical students. To control patient variables, actors simulated 1 of 2 patient scenarios (randomly provided at pretest and posttest). Video recordings were blindly evaluated. Self-ratings of validation and satisfaction were also employed. Observed validation responses increased significantly after training and corresponded to significant reductions in invalidating responses. Both the patient simulators and the medical students were significantly more satisfied after the training. We demonstrated that training empathetic validation results in improved communication thus extending previous findings to a medical setting with patients suffering pain. Our results suggest that it would be feasible to provide validation training for health care providers and this warrants further investigation in controlled studies.

A virtual reality intervention to improve the understanding and empathy for people with dementia in informal caregivers: results of a pilot study.

PubMed

Wijma, Eva M; Veerbeek, Marjolein A; Prins, Marleen; Pot, Anne Margriet; Willemse, Bernadette M

2017-07-10

Informal caregivers often experience psychological distress due to the changing functioning of the person with dementia they care for. Improved understanding of the person with dementia reduces psychological distress. To enhance understanding and empathy in caregivers, an innovative technology virtual reality intervention Through the D'mentia Lens (TDL) was developed to experience dementia, consisting of a virtual reality simulation movie and e-course. A pilot study of TDL was conducted. A pre-test-post-test design was used. Informal caregivers filled out questionnaires assessing person-centeredness, empathy, perceived pressure from informal care, perceived competence and quality of the relationship. At post-test, additional questions about TDL's feasibility were asked. Thirty-five caregivers completed the pre-test and post-test. Most participants were satisfied with TDL and stated that TDL gave more insight in the perception of the person with dementia. The simulation movie was graded 8.03 out of 10 and the e-course 7.66. Participants significantly improved in empathy, confidence in caring for the person with dementia, and positive interactions with the person with dementia. TDL is feasible for informal caregivers and seems to lead to understanding of and insight in the experience of people with dementia. Therefore, TDL could support informal caregivers in their caregiving role.

The effect of simulation-based crew resource management training on measurable teamwork and communication among interprofessional teams caring for postoperative patients.

PubMed

Paull, Douglas E; Deleeuw, Lori D; Wolk, Seth; Paige, John T; Neily, Julia; Mills, Peter D

2013-11-01

Many adverse events in health care are caused by teamwork and communication breakdown. This study was conducted to investigate the effect of a point-of-care simulation-based team training curriculum on measurable teamwork and communication skills in staff caring for postoperative patients. Twelve facilities involving 334 perioperative surgical staff underwent simulation-based training. Pretest and posttest self-report data included the Self-Efficacy of Teamwork Competencies Scale. Observational data were captured with the Clinical Teamwork Scale. Teamwork scores (measured on a five-point Likert scale) improved for all eight survey questions by an average of 18% (3.7 to 4.4, p < .05). The observed communication rating (scale of 1 to 10) increased by 16% (5.6 to 6.4, p < .05). Simulation-based team training for staff caring for perioperative patients is associated with measurable improvements in teamwork and communication. Copyright 2013, SLACK Incorporated.

Implementing economic evaluation in simulation-based medical education: challenges and opportunities.

PubMed

Lin, Yiqun; Cheng, Adam; Hecker, Kent; Grant, Vincent; Currie, Gillian R

2018-02-01

Simulation-based medical education (SBME) is now ubiquitous at all levels of medical training. Given the substantial resources needed for SBME, economic evaluation of simulation-based programmes or curricula is required to demonstrate whether improvement in trainee performance (knowledge, skills and attitudes) and health outcomes justifies the cost of investment. Current literature evaluating SBME fails to provide consistent and interpretable information on the relative costs and benefits of alternatives. Economic evaluation is widely applied in health care, but is relatively scarce in medical education. Therefore, in this paper, using a focus on SBME, we define economic evaluation, describe the key components, and discuss the challenges associated with conducting an economic evaluation of medical education interventions. As a way forward to the rigorous and state of the art application of economic evaluation in medical education, we outline the steps to gather the necessary information to conduct an economic evaluation of simulation-based education programmes and curricula, and describe the main approaches to conducting an economic evaluation. A properly conducted economic evaluation can help stakeholders (i.e., programme directors, policy makers and curriculum designers) to determine the optimal use of resources in selecting the modality or method of assessment in simulation. It also helps inform broader decision making about allocation of scarce resources within an educational programme, as well as between education and clinical care. Economic evaluation in medical education research is still in its infancy, and there is significant potential for state-of-the-art application of these methods in this area. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Simulation based training in a publicly funded home birth programme in Australia: A qualitative study.

PubMed

Kumar, Arunaz; Nestel, Debra; Stoyles, Sally; East, Christine; Wallace, Euan M; White, Colleen

2016-02-01

Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. However there is a small risk of emergencies requiring immediate, skilled management to optimise maternal and neonatal outcomes. We developed and implemented a simulation workshop designed to run in a home based setting to assist with emergency training for midwives and paramedical staff. The workshop was evaluated by assessing participants' satisfaction and response to key learning issues. Midwifery and emergency paramedical staff attending home births participated in a simulation workshop where they were required to manage birth emergencies in real time with limited availability of resources to suit the setting. They completed a pre-test and post-test evaluation form exploring the content and utility of the workshops. Content analysis was performed on qualitative data regarding the most important learning from the simulation activity. A total of 73 participants attended the workshop (midwifery=46, and paramedical=27). There were 110 comments, made by 49 participants. The most frequently identified key learning elements were related to communication (among midwives, paramedical and hospital staff and with the woman's partner), followed by recognising the role of other health care professionals, developing an understanding of the process and the importance of planning ahead. Home birth simulation workshop was found to be a useful tool by staff that provide care to women who are having a planned home birth. Developing clear communication and teamwork were found to be the key learning principles guiding their practice. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Development and initial evaluation of the SCI-FI/AT

PubMed Central

Jette, Alan M.; Slavin, Mary D.; Ni, Pengsheng; Kisala, Pamela A.; Tulsky, David S.; Heinemann, Allen W.; Charlifue, Susie; Tate, Denise G.; Fyffe, Denise; Morse, Leslie; Marino, Ralph; Smith, Ian; Williams, Steve

2015-01-01

Objectives To describe the domain structure and calibration of the Spinal Cord Injury Functional Index for samples using Assistive Technology (SCI-FI/AT) and report the initial psychometric properties of each domain. Design Cross sectional survey followed by computerized adaptive test (CAT) simulations. Setting Inpatient and community settings. Participants A sample of 460 adults with traumatic spinal cord injury (SCI) stratified by level of injury, completeness of injury, and time since injury. Interventions None Main outcome measure SCI-FI/AT Results Confirmatory factor analysis (CFA) and Item response theory (IRT) analyses identified 4 unidimensional SCI-FI/AT domains: Basic Mobility (41 items) Self-care (71 items), Fine Motor Function (35 items), and Ambulation (29 items). High correlations of full item banks with 10-item simulated CATs indicated high accuracy of each CAT in estimating a person's function, and there was high measurement reliability for the simulated CAT scales compared with the full item bank. SCI-FI/AT item difficulties in the domains of Self-care, Fine Motor Function, and Ambulation were less difficult than the same items in the original SCI-FI item banks. Conclusion With the development of the SCI-FI/AT, clinicians and investigators have available multidimensional assessment scales that evaluate function for users of AT to complement the scales available in the original SCI-FI. PMID:26010975

Application of a photochemical grid model to milan metropolitan area

NASA Astrophysics Data System (ADS)

Silibello, C.; Calori, G.; Brusasca, G.; Catenacci, G.; Finzi, G.

High ozone levels are regularly reached during summer period in South-European urban areas, calling for careful design of primary pollutants emission reduction strategies. In this perspective the CALGRID modelling system has been applied to Milan metropolitan area, located in the Po Valley, the most industrialised and populated area in Italy. For the first modelling exercise, a simulation domain of 100×100 km 2 has been considered and a summer period, characterised by high photochemical activity, has been selected. Hourly emissions have been derived by spatially and temporally disaggregating national inventories data, while standard upper-air and ground-based meteorological data have been used as input to the CALMET pre-processor. A careful analysis of simulation results versus local network monitoring data has revealed some critical points, related to both modelling assumptions and practical data availability. A satisfactory reproduction of daytime ozone behaviour has been, in fact, accomplished, both in urban and suburban sites, while nighttime primary pollutants accumulations and consequent ozone consumption simulated by the model have not found correspondence in the measurements. Nitrogen dioxide has been also successfully modelled, mostly in city surroundings, whereas higher discrepancies have been found in some urban stations. Possible explanations of these facts are discussed in the paper, giving an insight for further work.

Observational study of treatment space in individual neonatal cot spaces.

PubMed

Hignett, Sue; Lu, Jun; Fray, Mike

2010-01-01

Technology developments in neonatal intensive care units have increased the spatial requirements for clinical activities. Because the effectiveness of healthcare delivery is determined in part by the design of the physical environment and the spatial organization of work, it is appropriate to apply an evidence-based approach to architectural design. This study aimed to provide empirical evidence of the spatial requirements for an individual cot or incubator space. Observational data from 2 simulation exercises were combined with an expert review to produce a final recommendation. A validated 5-step protocol was used to collect data. Step 1 defined the clinical specialty and space. In step 2, data were collected with 28 staff members and 15 neonates to produce a simulation scenario representing the frequent and safety-critical activities. In step 3, 21 staff members participated in functional space experiments to determine the average spatial requirements. Step 4 incorporated additional data (eg, storage and circulation) to produce a spatial recommendation. Finally, the recommendation was reviewed in step 5 by a national expert clinical panel to consider alternative layouts and technology. The average space requirement for an individual neonatal intensive care unit cot (incubator) space was 13.5 m2 (or 145.3 ft2). The circulation and storage space requirements added in step 4 increased this to 18.46 m2 (or 198.7 ft2). The expert panel reviewed the recommendation and agreed that the average individual cot space (13.5 m2/[or 145.3 ft2]) would accommodate variance in working practices. Care needs to be taken when extrapolating this recommendation to multiple cot areas to maintain the minimum spatial requirement.

An investigation of networking techniques for the ASRM facility

NASA Technical Reports Server (NTRS)

Moorhead, Robert J., II; Smith, Wayne D.; Thompson, Dale R.

1992-01-01

This report is based on the early design concepts for a communications network for the Advanced Solid Rocket Motor (ASRM) facility being built at Yellow Creek near Iuka, MS. The investigators have participated in the early design concepts and in the evaluation of the initial concepts. The continuing system design effort and any modification of the plan will require a careful evaluation of the required bandwidth of the network, the capabilities of the protocol, and the requirements of the controllers and computers on the network. The overall network, which is heterogeneous in protocol and bandwidth, is being modeled, analyzed, simulated, and tested to obtain some degree of confidence in its performance capabilities and in its performance under nominal and heavy loads. The results of the proposed work should have an impact on the design and operation of the ASRM facility.

Patient-Centered Appointment Scheduling Using Agent-Based Simulation

PubMed Central

Turkcan, Ayten; Toscos, Tammy; Doebbeling, Brad N.

2014-01-01

Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling. PMID:25954423

EEAP boiler and chiller study II at Fort Sam Houston, San Antonio, Texas. Volume II

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The following assumptions and estimates were used in the modeling of the existing buildings which are served by the boilers and chillers included in this study. (1) The Trace 600 weather data for San Antonio, Texas was used in all of the computer simulations. (2) The Trace 600 computer simulations were performed for the months of January through December to determine annual HVAC equipment energy consumptions. (3) A special holiday schedule was created to incorporate the additional holidays that military personnel living in the area 1300 barracks buildings receive. This schedule includes the seven standard holidays plus the period frommore » December 17 through 31. The standard seven day holiday schedule was used for all other areas. (4) All building dimensions and construction data were determined from as-built drawings when available, or from field measurements taken during the site visit. (5) Design room temperatures for comfort conditions (thermostat setpoints) were obtained from CEMP-E (9 December 1991) Chapter 13, Section 3. These temperatures were 78 deg F, 50% relative humidity for cooling and 70 deg F for heating. No cooling or heating temperature setback control was included in the simulations. The design room conditions for the hospital were determined as follows: Surgery / Critical Care 68 deg F, 55%; Ancillary 72 deg F, 50%; Nursing / Patient Care 76 deg F, 50%; and Computer Room 72 deg F, 50%. (6) The shading coefficient for all windows with interior shading devices was estimated at 0.67 per ASHRAE data. (7) The number of people in each building or room was estimated from interviews with post personnel or field notes taken during the site visit. The sensible and latent heat gain rates used for the people in each room were taken from ASHRAE data.« less

A numerical method for simulations of rigid fiber suspensions

NASA Astrophysics Data System (ADS)

Tornberg, Anna-Karin; Gustavsson, Katarina

2006-06-01

In this paper, we present a numerical method designed to simulate the challenging problem of the dynamics of slender fibers immersed in an incompressible fluid. Specifically, we consider microscopic, rigid fibers, that sediment due to gravity. Such fibers make up the micro-structure of many suspensions for which the macroscopic dynamics are not well understood. Our numerical algorithm is based on a non-local slender body approximation that yields a system of coupled integral equations, relating the forces exerted on the fibers to their velocities, which takes into account the hydrodynamic interactions of the fluid and the fibers. The system is closed by imposing the constraints of rigid body motions. The fact that the fibers are straight have been further exploited in the design of the numerical method, expanding the force on Legendre polynomials to take advantage of the specific mathematical structure of a finite-part integral operator, as well as introducing analytical quadrature in a manner possible only for straight fibers. We have carefully treated issues of accuracy, and present convergence results for all numerical parameters before we finally discuss the results from simulations including a larger number of fibers.

Multilevel Intervention Research: Lessons Learned and Pathways Forward

PubMed Central

Taplin, Stephen H.; Foster, Mary K.; Fagan, Pebbles; Kaluzny, Arnold D.

2012-01-01

This summary reflects on this monograph regarding multilevel intervention (MLI) research to 1) assess its added value; 2) discuss what has been learned to date about its challenges in cancer care delivery; and 3) identify specific ways to improve its scientific soundness, feasibility, policy relevance, and research agenda. The 12 submitted chapters, and discussion of them at the March 2011 multilevel meeting, were reviewed and discussed among the authors to elicit key findings and results addressing the questions raised at the outset of this effort. MLI research is underrepresented as an explicit focus in the cancer literature but may improve implementation of studies of cancer care delivery if they assess contextual, organizational, and environmental factors important to understanding behavioral and/or system-level interventions. The field lacks a single unifying theory, although several psychological or biological theories are useful, and an ecological model helps conceptualize and communicate interventions. MLI research designs are often complex, involving nonlinear and nonhierarchical relationships that may not be optimally studied in randomized designs. Simulation modeling and pilot studies may be necessary to evaluate MLI interventions. Measurement and evaluation of team and organizational interventions are especially needed in cancer care, as are attention to the context of health-care reform, eHealth technology, and genomics-based medicine. Future progress in MLI research requires greater attention to developing and supporting relevant metrics of level effects and interactions and evaluating MLI interventions. MLI research holds an unrealized promise for understanding how to improve cancer care delivery. PMID:22623606

[Innovative education: simulation-based training at the Institute of Health Sciences, Semmelweis University, Hungary].

PubMed

Csóka, Mária; Deutsch, Tibor

2011-01-02

In Hungary, the Institute of Health Sciences at Semmelweis University was the first institution to introduce patient simulation-based practical training of non-physician professionals. Before introducing this novel educational methodology, students could only practice particular examinations and interventions on demonstration tools. Using the simulator they can also follow and analyze the effects of the interventions that have been made. The high fidelity, adult Human Patients Emergency Care Simulator (HPS-ECS, Medical Education Technologies Incorporation, Sarasota, Florida, USA) is particularly suitable for acquiring skills related to the management of various emergency situations. The 180 cm and 34 kg mannequin which can operate in lying and sitting positions has both respiration and circulation which can be examined the same way as in a living person. It is capable to produce several physical and clinical signs such as respiration with chest movement, electric cardiac activity, palpable pulse, and measurable blood pressure. In addition, it can also exhibit blinking, swelling of the tongue and whole-body trembling while intestinal, cardiac and pulmonary sounds can equally be examined. The high fidelity simulator allows various interventions including monitoring, oxygen therapy, bladder catheterization, gastric tube insertion, injection, infusion and transfusion therapy to be practiced as part of complex patient management. Diagnostic instruments such as ECG recorder, sphygmomanometer, pulse-oxymeter can be attached to the simulator which can also respond to different medical interventions such as intubation, defibrillation, pacing, liquid supplementing, and blood transfusion. The mannequin's physiological response can be followed up and monitored over time to assess whether the selected intervention has been proven adequate to achieve the desired outcome. Authors provide a short overview of the possible applications of clinical simulation for education and training in health sciences, and present how patient simulator has been embedded in various practical courses as part of different curriculum designed for different health care specialties.

Numerical Study of Particle Damping Mechanism in Piston Vibration System via Particle Dynamics Simulation

NASA Astrophysics Data System (ADS)

Bai, Xian-Ming; Shah, Binoy; Keer, Leon; Wang, Jane; Snurr, Randall

2008-03-01

Mechanical damping systems with granular particles as the damping media have promising applications in extreme temperature conditions. In particle-based damping systems, the mechanical energy is dissipated through the inelastic collision and friction of particles. In the past, many experiments have been performed to investigate the particle damping problems. However, the detailed energy dissipation mechanism is still unclear due to the complex collision and flow behavior of dense particles. In this work, we use 3-D particle dynamics simulation to investigate the damping mechanism of an oscillating cylinder piston immerged in millimeter-size steel particles. The time evolution of the energy dissipation through the friction and inelastic collision is accurately monitored during the damping process. The contribution from the particle-particle interaction and particle-wall interaction is also separated for investigation. The effects of moisture, surface roughness, and density of particles are carefully investigated in the simulation. The comparison between the numerical simulation and experiment is also performed. The simulation results can help us understand the particle damping mechanism and design the new generation of particle damping devices.

Caregiver involvement in a large clinical systems project.

PubMed Central

Sales, S.; Mathews, P.; Gamblin, D.; Gee, S.

1994-01-01

The Kaiser Permanente Northern California Region (KPNCR) CareGiver Workstation (CGW) Project's mission is to develop and implement a clinical workstation system that will enhance each caregiver-member interaction and aid in the decision-making processes of direct patient care in the inpatient and outpatient settings. The requirements analysis approach for CareGiver Workstation (CGW) is based on the belief that extensive caregiver involvement will provide a better understanding of the diverse needs of Kaiser Permanente Northern California Region (KPNCR). In order to involve as many caregivers as reasonably possible, CGW included a 16 member caregiver core team and 6 different Medical Centers in the requirements definition process. The Medical Centers are referred to as "focus facilities". A "focus group" (caregiver team) at each selected focus facility consisted of a site coordinator and a 24-30 person multidisciplinary team involving physicians, nurses, therapists and other caregivers. The Medical Center selection process identified facilities that provided the best cross-sectional representation of KPNCR. The Lead Focus Facility participated in the initial round of requirements definition activities. These sessions assisted in the design of a simulation that was used at five additional Medical Centers to validate requirements. The five additional Focus Facilities participated in simulation review sessions. Feedback from these sessions was used to revise the simulation and update the requirements document. Caregivers from all six focus facilities and other identified groups participated in a requirements survey to assist CGW with identification of high priority features. Caregiver commitment and continuing involvement are essential for the success of CGW.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7949953

Accessing primary care: a simulated patient study

PubMed Central

Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

2013-01-01

Background Simulated patient, or so-called ‘mystery-shopper’, studies are a controversial, but potentially useful, approach to take when conducting health services research. Aim To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Design and setting Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Method Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Results Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients’ reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders’ possible confusion in answering this question. Conclusion Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients’ satisfaction with their practice is not related to practice call handling, but is related to appointment availability. PMID:23561783

Development of simulated and ovine models of extracorporeal life support to improve understanding of circuit-host interactions.

PubMed

Shekar, Kiran; Fung, Yoke L; Diab, Sara; Mullany, Daniel V; McDonald, Charles I; Dunster, Kimble R; Fisquet, Stephanie; Platts, David G; Stewart, David; Wallis, Steven C; Smith, Maree T; Roberts, Jason A; Fraser, John F

2012-06-01

Extracorporeal life support (ECLS) is a lifesaving technology that is being increasingly used in patients with severe cardiorespiratory failure. However, ECLS is not without risks. The biosynthetic interface between the patient and the circuit can significantly alter inflammation, coagulation, pharmacokinetics and disposition of trace elements. The relative contributions of the pump, disease and patient in propagating these alterations are difficult to quantify in critically ill patients with multiple organ failure. To design a model where the relevance of individual components could be assessed, in isolation and in combination. Four ECLS models were developed and tested - an in-vitro simulated ECLS circuit; and ECLS in healthy sheep, sheep with acute lung injury (ALI), and sheep with ALI together with transfusion of old or new blood. Successful design of in-vitro and in-vivo models. We successfully conducted multiple experiments in the simulated circuits and ECLS runs in healthy and ALI sheep. We obtained preliminary data on inflammation, coagulation, histology, pharmacokinetics and trace element disposition during ECLS. The establishment of in-vitro and in-vivo models provides a powerful means for enhancing knowledge of the pathophysiology associated with ECLS and identification of key factors likely to influence patient outcomes. A clearer description of the contribution of disease and therapeutic interventions may allow improved design of equipment, membranes, medicines and physiological goals for improved patient care.

What can we learn from simulation-based training to improve skills for end-of-life care? Insights from a national project in Israel.

PubMed

Brezis, Mayer; Lahat, Yael; Frankel, Meir; Rubinov, Alan; Bohm, Davina; Cohen, Matan J; Koslowsky, Meni; Shalomson, Orit; Sprung, Charles L; Perry-Mezare, Henia; Yahalom, Rina; Ziv, Amitai

2017-11-06

Simulation-based training improves residents' skills for end-of-life (EOL) care. In the field, staff providers play a significant role in handling those situations and in shaping practice by role modeling. We initiated an educational intervention to train healthcare providers for improved communication skills at EOL using simulation of sensitive encounters with patients and families. Hospital physicians and nurses (n = 1324) attended simulation-based workshops (n = 100) in a national project to improve EOL care. We analyzed perceptions emerging from group discussions following simulations, from questionnaires before and after each workshop, and from video-recorded simulations using a validated coding system. We used the simulation setting as a novel tool for action research. We used a participatory inquiry paradigm, with repetitive cycles of exploring barriers and challenges with participants in an iterative pattern of observation, discussion and reflection - including a description of our own responses and evolution of thought as well as system effects. The themes transpiring included lack of training, knowledge and time, technology overuse, uncertainty in decision-making, poor skills for communication and teamwork. Specific scenarios demonstrated lack of experience at eliciting preferences for EOL care and at handling conflicts or dilemmas. Content analysis of simulations showed predominance of cognitive utterances - by an order of magnitude more prevalent than emotional expressions. Providers talked more than actors did and episodes of silence were rare. Workshop participants acknowledged needs to improve listening skills, attention to affect and teamwork. They felt that the simulation-based workshop is likely to ameliorate future handling of EOL situations. We observed unanticipated consequences from our project manifested as a field study of preparedness to EOL in nursing homes, followed by a national survey on quality of care, leading to expansion of palliative care services and demand for EOL care education in various frameworks and professional areas. Reflective simulation exercises show barriers and paths to improvement among staff providers. When facing EOL situations, physicians and nurses use cognitive language far more often than emotions related expressions, active listening, or presence in silence. Training a critical mass of staff providers may be valuable to induce a cultural shift in EOL care.

Issues related to line-oriented flight training

NASA Technical Reports Server (NTRS)

Lauber, J. K.

1981-01-01

The use of a training simulator along with carefully structured, detailed, line trip scenarios was envisioned by NASA as a means of providing a controllable, repeatable way to observe line crews in a highly realistic simulation of their working environment and obtain better understanding operationally significant human factors problems and issues. Relevant research done by the agency and the results of full-mission simulation scenarios revealed potential implications for flight training. Aspects to be considered in creating training programs closely related to the actual line environment with a total crew application in real world incident experiences include: (1) operational, environmental, equipment, and crew problems in scenario design; (2) real time line oriented flight training operation; (3) performance assessment and debriefing; (4) instructor qualification and training; and (5) other issues such as ub un initial, transition, and upgrade training; procedures developent and evaluation, and equipment evaluation.

Effect of Simulation on Undergraduate Nursing Students' Knowledge of Nursing Ethics Principles.

PubMed

Donnelly, Mary Broderick; Horsley, Trisha Leann; Adams, William H; Gallagher, Peggy; Zibricky, C Dawn

2017-12-01

Background Undergraduate nursing education standards include acquisition of knowledge of ethics principles and the prevalence of health-care ethical dilemmas mandates that nursing students study ethics. However, little research has been published to support best practices for teaching/learning ethics principles. Purpose This study sought to determine if participation in an ethics consultation simulation increased nursing students' knowledge of nursing ethics principles compared to students who were taught ethics principles in the traditional didactic format. Methods This quasi-experimental study utilized a pre-test/post-test design with randomized assignment of students at three universities into both control and experimental groups. Results Nursing students' knowledge of nursing ethics principles significantly improved from pre-test to post-test ( p = .002); however, there was no significant difference between the experimental and control groups knowledge scores ( p = .13). Conclusion Further research into use of simulation to teach ethics principles is indicated.

Endotracheal intubation: application of virtual reality to emergency medical services education.

PubMed

Mayrose, James; Myers, Jeffrey W

2007-01-01

Virtual reality simulation has been identified as an emerging educational tool with significant potential to enhance teaching of residents and students in emergency clinical encounters and procedures. Endotracheal intubation represents a critical procedure for emergency care providers. Current methods of training include working with cadavers and mannequins, which have limitations in their representation of reality, ethical concerns, and overall availability with access, cost, and location of models. This paper will present a human airway simulation model designed for tracheal intubation and discuss the aspects that lend itself to use as an educational tool. This realistic and dynamic model is used to teach routine intubations, while future models will include more difficult airway management scenarios. This work provides a solid foundation for future versions of the intubation simulator, which will incorporate two haptic devices to allow for simultaneous control of the laryngoscope blade and endotracheal tube.

Toward a definition of teamwork in emergency medicine.

PubMed

Fernandez, Rosemarie; Kozlowski, Steve W J; Shapiro, Marc J; Salas, Eduardo

2008-11-01

The patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well-defined, well-researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," a subset of the group expertise and group assessment breakout sections identified evidence-based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well-defined, well-described taxonomy that will help guide design, implementation, and assessment of simulation-based team training programs.

An exploration of the relationship between knowledge and performance-related variables in high-fidelity simulation: designing instruction that promotes expertise in practice.

PubMed

Hauber, Roxanne P; Cormier, Eileen; Whyte, James

2010-01-01

Increasingly, high-fidelity patient simulation (HFPS) is becoming essential to nursing education. Much remains unknown about how classroom learning is connected to student decision-making in simulation scenarios and the degree to which transference takes place between the classroom setting and actual practice. The present study was part of a larger pilot study aimed at determining the relationship between nursing students' clinical ability to prioritize their actions and the associated cognitions and physiologic outcomes of care using HFPS. In an effort to better explain the knowledge base being used by nursing students in HFPS, the investigators explored the relationship between common measures of knowledge and performance-related variables. Findings are discussed within the context of the expert performance approach and concepts from cognitive psychology, such as cognitive architecture, cognitive load, memory, and transference.

Evaluating sampling designs by computer simulation: A case study with the Missouri bladderpod

USGS Publications Warehouse

Morrison, L.W.; Smith, D.R.; Young, C.; Nichols, D.W.

2008-01-01

To effectively manage rare populations, accurate monitoring data are critical. Yet many monitoring programs are initiated without careful consideration of whether chosen sampling designs will provide accurate estimates of population parameters. Obtaining accurate estimates is especially difficult when natural variability is high, or limited budgets determine that only a small fraction of the population can be sampled. The Missouri bladderpod, Lesquerella filiformis Rollins, is a federally threatened winter annual that has an aggregated distribution pattern and exhibits dramatic interannual population fluctuations. Using the simulation program SAMPLE, we evaluated five candidate sampling designs appropriate for rare populations, based on 4 years of field data: (1) simple random sampling, (2) adaptive simple random sampling, (3) grid-based systematic sampling, (4) adaptive grid-based systematic sampling, and (5) GIS-based adaptive sampling. We compared the designs based on the precision of density estimates for fixed sample size, cost, and distance traveled. Sampling fraction and cost were the most important factors determining precision of density estimates, and relative design performance changed across the range of sampling fractions. Adaptive designs did not provide uniformly more precise estimates than conventional designs, in part because the spatial distribution of L. filiformis was relatively widespread within the study site. Adaptive designs tended to perform better as sampling fraction increased and when sampling costs, particularly distance traveled, were taken into account. The rate that units occupied by L. filiformis were encountered was higher for adaptive than for conventional designs. Overall, grid-based systematic designs were more efficient and practically implemented than the others. ?? 2008 The Society of Population Ecology and Springer.

Pneumatic Valve Operated by Multiplex Pneumatic Transmission

NASA Astrophysics Data System (ADS)

Nishioka, Yasutaka; Suzumori, Koichi; Kanda, Takefumi; Wakimoto, Shuichi

A pneumatic system has several advantages, which are cheapness, lightweight, and reliability to human and environment. These advantages are adapted to some research areas, such as industrial lines, medical and nursing cares, and rehabilitation tools. However, the pneumatic system needs several devices; compressor, air tube, and control valve. This research aim to downsize pneumatic system. In this paper, a new method of multiplex pneumatic transmission for multi-pneumatic servo system is proposed. The valve for this system consists of two vibrators supported by springs, which was designed with simple and cheap structure. The working principle of the valve is vibrators resonance from multiplex pneumatic transmission and it is possible to work as ON/OFF valves without electric wire. Dynamic simulation was used to confirm the working principle of the resonance driving system. A prototype device confirming the principle was designed and developed based on the simulation. The experiments show that this new control system works very well to control two separated valves through single pneumatic tube.

Temperature Effects in Varactors and Multipliers

NASA Technical Reports Server (NTRS)

East, J.; Mehdi, Imran

2001-01-01

Varactor diode multipliers are a critical part of many THz measurement systems. The power and efficiencies of these devices limit the available power for THz sources. Varactor operation is determined by the physics of the varactor device and a careful doping profile design is needed to optimize the performance. Higher doped devices are limited by junction breakdown and lower doped structures are limited by current saturation. Higher doped structures typically have higher efficiencies and lower doped structures typically have higher powers at the same operating frequency and impedance level. However, the device material properties are also a function of the operating temperature. Recent experimental evidence has shown that the power output of a multiplier can be improved by cooling the device. We have used a particle Monte Carlo simulation to investigate the temperature dependent velocity vs. electric field in GaAs. This information was then included in a nonlinear device circuit simulator to predict multiplier performance for various temperatures and device designs. This paper will describe the results of this analysis of temperature dependent multiplier operation.

Research on ion implantation in MEMS device fabrication by theory, simulation and experiments

NASA Astrophysics Data System (ADS)

Bai, Minyu; Zhao, Yulong; Jiao, Binbin; Zhu, Lingjian; Zhang, Guodong; Wang, Lei

2018-06-01

Ion implantation is widely utilized in microelectromechanical systems (MEMS), applied for embedded lead, resistors, conductivity modifications and so forth. In order to achieve an expected device, the principle of ion implantation must be carefully examined. The elementary theory of ion implantation including implantation mechanism, projectile range and implantation-caused damage in the target were studied, which can be regarded as the guidance of ion implantation in MEMS device design and fabrication. Critical factors including implantations dose, energy and annealing conditions are examined by simulations and experiments. The implantation dose mainly determines the dopant concentration in the target substrate. The implantation energy is the key factor of the depth of the dopant elements. The annealing time mainly affects the repair degree of lattice damage and thus the activated elements’ ratio. These factors all together contribute to ions’ behavior in the substrates and characters of the devices. The results can be referred to in the MEMS design, especially piezoresistive devices.

Operator procedure verification with a rapidly reconfigurable simulator

NASA Technical Reports Server (NTRS)

Iwasaki, Yumi; Engelmore, Robert; Fehr, Gary; Fikes, Richard

1994-01-01

Generating and testing procedures for controlling spacecraft subsystems composed of electro-mechanical and computationally realized elements has become a very difficult task. Before a spacecraft can be flown, mission controllers must envision a great variety of situations the flight crew may encounter during a mission and carefully construct procedures for operating the spacecraft in each possible situation. If, despite extensive pre-compilation of control procedures, an unforeseen situation arises during a mission, the mission controller must generate a new procedure for the flight crew in a limited amount of time. In such situations, the mission controller cannot systematically consider and test alternative procedures against models of the system being controlled, because the available simulator is too large and complex to reconfigure, run, and analyze quickly. A rapidly reconfigurable simulation environment that can execute a control procedure and show its effects on system behavior would greatly facilitate generation and testing of control procedures both before and during a mission. The How Things Work project at Stanford University has developed a system called DME (Device Modeling Environment) for modeling and simulating the behavior of electromechanical devices. DME was designed to facilitate model formulation and behavior simulation of device behavior including both continuous and discrete phenomena. We are currently extending DME for use in testing operator procedures, and we have built a knowledge base for modeling the Reaction Control System (RCS) of the space shuttle as a testbed. We believe that DME can facilitate design of operator procedures by providing mission controllers with a simulation environment that meets all these requirements.

A presentation system for just-in-time learning in radiology.

PubMed

Kahn, Charles E; Santos, Amadeu; Thao, Cheng; Rock, Jayson J; Nagy, Paul G; Ehlers, Kevin C

2007-03-01

There is growing interest in bringing medical educational materials to the point of care. We sought to develop a system for just-in-time learning in radiology. A database of 34 learning modules was derived from previously published journal articles. Learning objectives were specified for each module, and multiple-choice test items were created. A web-based system-called TEMPO-was developed to allow radiologists to select and view the learning modules. Web services were used to exchange clinical context information between TEMPO and the simulated radiology work station. Preliminary evaluation was conducted using the System Usability Scale (SUS) questionnaire. TEMPO identified learning modules that were relevant to the age, sex, imaging modality, and body part or organ system of the patient being viewed by the radiologist on the simulated clinical work station. Users expressed a high degree of satisfaction with the system's design and user interface. TEMPO enables just-in-time learning in radiology, and can be extended to create a fully functional learning management system for point-of-care learning in radiology.

Simulation-based learning: Just like the real thing

PubMed Central

Lateef, Fatimah

2010-01-01

Simulation is a technique for practice and learning that can be applied to many different disciplines and trainees. It is a technique (not a technology) to replace and amplify real experiences with guided ones, often “immersive” in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Simulation-based learning can be the way to develop health professionals’ knowledge, skills, and attitudes, whilst protecting patients from unnecessary risks. Simulation-based medical education can be a platform which provides a valuable tool in learning to mitigate ethical tensions and resolve practical dilemmas. Simulation-based training techniques, tools, and strategies can be applied in designing structured learning experiences, as well as be used as a measurement tool linked to targeted teamwork competencies and learning objectives. It has been widely applied in fields such aviation and the military. In medicine, simulation offers good scope for training of interdisciplinary medical teams. The realistic scenarios and equipment allows for retraining and practice till one can master the procedure or skill. An increasing number of health care institutions and medical schools are now turning to simulation-based learning. Teamwork training conducted in the simulated environment may offer an additive benefit to the traditional didactic instruction, enhance performance, and possibly also help reduce errors. PMID:21063557

Simulation-based learning: Just like the real thing.

PubMed

Lateef, Fatimah

2010-10-01

Simulation is a technique for practice and learning that can be applied to many different disciplines and trainees. It is a technique (not a technology) to replace and amplify real experiences with guided ones, often "immersive" in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Simulation-based learning can be the way to develop health professionals' knowledge, skills, and attitudes, whilst protecting patients from unnecessary risks. Simulation-based medical education can be a platform which provides a valuable tool in learning to mitigate ethical tensions and resolve practical dilemmas. Simulation-based training techniques, tools, and strategies can be applied in designing structured learning experiences, as well as be used as a measurement tool linked to targeted teamwork competencies and learning objectives. It has been widely applied in fields such aviation and the military. In medicine, simulation offers good scope for training of interdisciplinary medical teams. The realistic scenarios and equipment allows for retraining and practice till one can master the procedure or skill. An increasing number of health care institutions and medical schools are now turning to simulation-based learning. Teamwork training conducted in the simulated environment may offer an additive benefit to the traditional didactic instruction, enhance performance, and possibly also help reduce errors.

One doll fits all: validation of the Leiden Infant Simulator Sensitivity Assessment (LISSA).

PubMed

Voorthuis, Alexandra; Out, Dorothée; van der Veen, Rixt; Bhandari, Ritu; van IJzendoorn, Marinus H; Bakermans-Kranenburg, Marian J

2013-01-01

Children vary hugely in how demanding of their caregivers they are. This creates differences in demands on parents during observation, making the comparison of sensitivity between parents difficult. It would therefore be of interest to create standard situations in which all caregivers are faced with the same level of demand. This study developed an ecologically valid but standardized setting using an infant simulator with interactive features, the Leiden Infant Simulator Sensitivity Assessment (LISSA). The infant simulator resembles a real infant in appearance and it produces crying sounds that are life-like. The simulator begins with fussing and progresses to more intense crying in case of no care or inappropriate care. It responds by being calm again if appropriate care is given. One hundred and eighty-one female participants took care of the infant simulator for two evenings and in a 30 min lab session with increasing competing demands. Sensitive parenting behavior during the lab session was coded with the Ainsworth Sensitivity Scale. Sensitivity ratings covered the whole range of the scale (1-9), and were stable across settings (free play, competing demands). Sensitivity was related to an increase of positive affect during caretaking, and insensitivity was related to intended harsh caregiving response during a computerized cry paradigm. Sensitivity was unrelated to social desirability and self-reported quality of care given to the infant simulator. We discuss the potentials of the infant simulator for research on sensitive parenting, for preventive interventions, and for clinical practices.

On the dielectric conductivity of molecular ionic liquids.

PubMed

Schröder, Christian; Steinhauser, Othmar

2009-09-21

The contribution of the conductivity to the spectrum of the generalized dielectric constant or susceptibility of molecular ionic liquids is analyzed, both in theoretical terms and computationally by means of molecular dynamics simulation of the concrete system 1-ethyl-3-methyl-imidazolium dicyanoamide at 300 K. As a central quantity the simulated current autocorrelation function is modeled by a carefully designed fit function. This not only gives a satisfactory numerical representation but yields the correct conductivity upon integration. In addition the fit function can be Fourier-Laplace transformed analytically. Both, the real and imaginary parts of the transform show expected behavior, in particular, the right limits for zero frequency. This altogether demonstrates that the components of the fit function are of physical relevance.

The effect of Cardiac Arrhythmias Simulation Software on the nurses' learning and professional development.

PubMed

Bazrafkan, Leila; Hemmati, Mehdi

2018-04-01

One of the important tasks of nurses in intensive care unit is interpretation of ECG. The use of training simulator is a new paradigm in the age of computers. This study was performed to evaluate the impact of cardiac arrhythmias simulator software on nurses' learning in the subspecialty Vali-Asr Hospital in 2016. This study was conducted by quasi-experimental randomized Salomon four group design with the participation of 120 nurses in subspecialty Vali-Asr Hospital in Tehran, Iran in 2016 that were selected purposefully and allocated in 4 groups. By this design other confounding factors such as the prior information, maturation and the role of sex and age were controlled by Solomon 4 design. The valid and reliable multiple choice test tools were used to gather information; the validity of the test was approved by experts and its reliability was obtained by Cronbach's alpha coefficient 0.89. At first, the knowledge and skills of the participants were assessed by a pre-test; following the educational intervention with cardiac arrhythmias simulator software during 14 days in ICUs, the mentioned factors were measured for the two groups again by a post-test in the four groups. Data were analyzed using the two way ANOVA. The significance level was considered as p<0.05. Based on randomized four-group Solomon designs and our test results, using cardiac arrhythmias simulator software as an intervention was effective in the nurses' learning since a significant difference was found between pre-test and post-test in the first group (p<0.05). Also, other comparisons by ANOVA test showed that there was no interaction between pre-test and intervention in all of the three knowledge areas of cardiac arrhythmias, their treatments and their diagnosis (P>0.05). The use of software-based simulator for cardiac arrhythmias was effective in nurses' learning in light of its attractive components and interactive method. This intervention increased the knowledge of the nurses in cognitive domain of cardiac arrhythmias in addition to their diagnosis and treatment. Also, the package can be used for training in other areas such as continuing medical education.

Evaluating the influence of goal setting on intravenous catheterization skill acquisition and transfer in a hybrid simulation training context.

PubMed

Brydges, Ryan; Mallette, Claire; Pollex, Heather; Carnahan, Heather; Dubrowski, Adam

2012-08-01

Educators often simplify complex tasks by setting learning objectives that focus trainees on isolated skills rather than the holistic task. We designed 2 sets of learning objectives for intravenous catheterization using goal setting theory. We hypothesized that setting holistic goals related to technical, cognitive, and communication skills would result in superior holistic performance, whereas setting isolated goals related to technical skills would result in superior technical performance. We randomly assigned practicing health care professionals to set holistic (n = 14) or isolated (n = 15) goals. All watched an instructional video and studied a list of 9 goals specific to their group. Participants practiced independently in a hybrid simulation (standardized patient combined with an arm simulator). The first and the last practice trials were videotaped for analysis. One-week later, participants completed a transfer test in another hybrid simulation scenario. Blinded experts evaluated performance on all 3 trials using the Direct Observation of Procedural Skills tool. The holistic group scored higher than the isolated group on the holistic Direct Observation of Procedural Skills score for all 3 trials [mean (SD), 45.0 (9.16) vs. 38.4 (9.17); P = 0.01]. The isolated group did not perform better than the holistic group on the technical skills score [10.3 (2.73) vs. 11.6 (3.01); P = 0.11]. Our results suggest that asking learners to set holistic goals did not interfere with their attaining competent holistic and technical skills during hybrid simulation training. This exploratory trial provides preliminary evidence for how to consider integrating hybrid simulation into medical curricula and for the design of learning goals in simulation-based education.

Virtual Simulation in Enhancing Procedural Training for Fluoroscopy-guided Lumbar Puncture: A Pilot Study.

PubMed

Ali, Saad; Qandeel, Monther; Ramakrishna, Rishi; Yang, Carina W

2018-02-01

Fluoroscopy-guided lumbar puncture (FGLP) is a basic procedural component of radiology residency and neuroradiology fellowship training. Performance of the procedure with limited experience is associated with increased patient discomfort as well as increased radiation dose, puncture attempts, and complication rate. Simulation in health care is a developing field that has potential for enhancing procedural training. We demonstrate the design and utility of a virtual reality simulator for performing FGLP. An FGLP module was developed on an ImmersiveTouch platform, which digitally reproduces the procedural environment with a hologram-like projection. From computed tomography datasets of healthy adult spines, we constructed a 3-D model of the lumbar spine and overlying soft tissues. We assigned different physical characteristics to each tissue type, which the user can experience through haptic feedback while advancing a virtual spinal needle. Virtual fluoroscopy as well as 3-D images can be obtained for procedural planning and guidance. The number of puncture attempts, the distance to the target, the number of fluoroscopic shots, and the approximate radiation dose can be calculated. Preliminary data from users who participated in the simulation were obtained in a postsimulation survey. All users found the simulation to be a realistic replication of the anatomy and procedure and would recommend to a colleague. On a scale of 1-5 (lowest to highest) rating the virtual simulator training overall, the mean score was 4.3 (range 3-5). We describe the design of a virtual reality simulator for performing FGLP and present the initial experience with this new technique. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

[Relations between health information systems and patient safety].

PubMed

Nøhr, Christian

2012-11-05

Health information systems have the potential to reduce medical errors, and indeed many studies have shown a significant reduction. However, if the systems are not designed and implemented properly, there is evidence that suggest that new types of errors will arise--i.e., technology-induced errors. Health information systems will need to undergo a more rigorous evaluation. Usability evaluation and simulation test with humans in the loop can help to detect and prevent technology-induced errors before they are deployed in real health-care settings.

Discretization chaos - Feedback control and transition to chaos

NASA Technical Reports Server (NTRS)

Grantham, Walter J.; Athalye, Amit M.

1990-01-01

Problems in the design of feedback controllers for chaotic dynamical systems are considered theoretically, focusing on two cases where chaos arises only when a nonchaotic continuous-time system is discretized into a simpler discrete-time systems (exponential discretization and pseudo-Euler integration applied to Lotka-Volterra competition and prey-predator systems). Numerical simulation results are presented in extensive graphs and discussed in detail. It is concluded that care must be taken in applying standard dynamical-systems methods to control systems that may be discontinuous or nondifferentiable.

Response of nickel to zinc cells to electric vehicle chopper discharge waveforms

NASA Technical Reports Server (NTRS)

Cataldo, R. L.

1981-01-01

The preliminary results of simulated electric vehicle chopper controlled discharge of a Nickel/Zinc battery shows delivered energy increases of 5 to 25 percent compared to constant current discharges of the same average current. The percentage increase was a function of chopper frequency, the ratio of peak to average current, and the magnitude of the discharge current. Because the chopper effects are of a complex nature, electric vehicle battery/speed controller interaction must be carefully considered in vehicle design to optimize battery performance.

Abstracting data warehousing issues in scientific research.

PubMed

Tews, Cody; Bracio, Boris R

2002-01-01

This paper presents the design and implementation of the Idaho Biomedical Data Management System (IBDMS). This system preprocesses biomedical data from the IMPROVE (Improving Control of Patient Status in Critical Care) library via an Open Database Connectivity (ODBC) connection. The ODBC connection allows for local and remote simulations to access filtered, joined, and sorted data using the Structured Query Language (SQL). The tool is capable of providing an overview of available data in addition to user defined data subset for verification of models of the human respiratory system.

Simulation as a vehicle for enhancing collaborative practice models.

PubMed

Jeffries, Pamela R; McNelis, Angela M; Wheeler, Corinne A

2008-12-01

Clinical simulation used in a collaborative practice approach is a powerful tool to prepare health care providers for shared responsibility for patient care. Clinical simulations are being used increasingly in professional curricula to prepare providers for quality practice. Little is known, however, about how these simulations can be used to foster collaborative practice across disciplines. This article provides an overview of what simulation is, what collaborative practice models are, and how to set up a model using simulations. An example of a collaborative practice model is presented, and nursing implications of using a collaborative practice model in simulations are discussed.

Design and Validation of a 150 MHz HFFQCM Sensor for Bio-Sensing Applications

PubMed Central

Fernández, Román; García, Pablo; García, María; Jiménez, Yolanda; Arnau, Antonio

2017-01-01

Acoustic wave resonators have become suitable devices for a broad range of sensing applications due to their sensitivity, low cost, and integration capability, which are all factors that meet the requirements for the resonators to be used as sensing elements for portable point of care (PoC) platforms. In this work, the design, characterization, and validation of a 150 MHz high fundamental frequency quartz crystal microbalance (HFF-QCM) sensor for bio-sensing applications are introduced. Finite element method (FEM) simulations of the proposed design are in good agreement with the electrical characterization of the manufactured resonators. The sensor is also validated for bio-sensing applications. For this purpose, a specific sensor cell was designed and manufactured that addresses the critical requirements associated with this type of sensor and application. Due to the small sensing area and the sensor’s fragility, these requirements include a low-volume flow chamber in the nanoliter range, and a system approach that provides the appropriate pressure control for assuring liquid confinement while maintaining the integrity of the sensor with a good base line stability and easy sensor replacement. The sensor characteristics make it suitable for consideration as the elemental part of a sensor matrix in a multichannel platform for point of care applications. PMID:28885551

Simulator technology as a tool for education in cardiac care.

PubMed

Hravnak, Marilyn; Beach, Michael; Tuite, Patricia

2007-01-01

Assisting nurses in gaining the cognitive and psychomotor skills necessary to safely and effectively care for patients with cardiovascular disease can be challenging for educators. Ideally, nurses would have the opportunity to synthesize and practice these skills in a protected training environment before application in the dynamic clinical setting. Recently, a technology known as high fidelity human simulation was introduced, which permits learners to interact with a simulated patient. The dynamic physiologic parameters and physical assessment capabilities of the simulated patient provide for a realistic learning environment. This article describes the High Fidelity Human Simulation Laboratory at the University of Pittsburgh School of Nursing and presents strategies for using this technology as a tool in teaching complex cardiac nursing care at the basic and advanced practice nursing levels. The advantages and disadvantages of high fidelity human simulation in learning are discussed.

What Has Finite Element Analysis Taught Us about Diabetic Foot Disease and Its Management? A Systematic Review

PubMed Central

Telfer, Scott; Erdemir, Ahmet; Woodburn, James; Cavanagh, Peter R.

2014-01-01

Background Over the past two decades finite element (FE) analysis has become a popular tool for researchers seeking to simulate the biomechanics of the healthy and diabetic foot. The primary aims of these simulations have been to improve our understanding of the foot’s complicated mechanical loading in health and disease and to inform interventions designed to prevent plantar ulceration, a major complication of diabetes. This article provides a systematic review and summary of the findings from FE analysis-based computational simulations of the diabetic foot. Methods A systematic literature search was carried out and 31 relevant articles were identified covering three primary themes: methodological aspects relevant to modelling the diabetic foot; investigations of the pathomechanics of the diabetic foot; and simulation-based design of interventions to reduce ulceration risk. Results Methodological studies illustrated appropriate use of FE analysis for simulation of foot mechanics, incorporating nonlinear tissue mechanics, contact and rigid body movements. FE studies of pathomechanics have provided estimates of internal soft tissue stresses, and suggest that such stresses may often be considerably larger than those measured at the plantar surface and are proportionally greater in the diabetic foot compared to controls. FE analysis allowed evaluation of insole performance and development of new insole designs, footwear and corrective surgery to effectively provide intervention strategies. The technique also presents the opportunity to simulate the effect of changes associated with the diabetic foot on non-mechanical factors such as blood supply to local tissues. Discussion While significant advancement in diabetic foot research has been made possible by the use of FE analysis, translational utility of this powerful tool for routine clinical care at the patient level requires adoption of cost-effective (both in terms of labour and computation) and reliable approaches with clear clinical validity for decision making. PMID:25290098

Confident but not theoretically grounded - experienced simulation educators' perceptions of their own professional development.

PubMed

Allvin, Renée; Berndtzon, Magnus; Carlzon, Liisa; Edelbring, Samuel; Hult, Håkan; Hultin, Magnus; Karlgren, Klas; Masiello, Italo; Södersved Källestedt, Marie-Louise; Tamás, Éva

2017-01-01

Medical simulation enables the design of learning activities for competency areas (eg, communication and leadership) identified as crucial for future health care professionals. Simulation educators and medical teachers follow different career paths, and their education backgrounds and teaching contexts may be very different in a simulation setting. Although they have a key role in facilitating learning, information on the continuing professional development (pedagogical development) of simulation educators is not available in the literature. To explore changes in experienced simulation educators' perceptions of their own teaching skills, practices, and understanding of teaching over time. A qualitative exploratory study. Fourteen experienced simulation educators participated in individual open-ended interviews focusing on their development as simulation educators. Data were analyzed using an inductive thematic analysis. Marked educator development was discerned over time, expressed mainly in an altered way of thinking and acting. Five themes were identified: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession. Being confident in the role as an instructor seemed to constitute a foundation for the instructor's pedagogical development. Experienced simulation educators' pedagogical development was based on self-confidence in the educator role, and not on a deeper theoretical understanding of teaching and learning. This is the first clue to gain increased understanding regarding educational level and possible education needs among simulation educators, and it might generate several lines of research for further studies.

Promoting Collaboration in Health Care Teams through Interprofessional Education: A Simulation Case Study

ERIC Educational Resources Information Center

Ekmekci, Ozgur

2013-01-01

This simulation study explores how the integration of interprofessional components into health care curriculum may impact professional stereotyping and collaborative behavior in care delivery teams comprised of a physician, a registered nurse, a physician's assistant, a physical therapist, and a radiation therapist. As part of the agent-based…

Design and multiphysics analysis of a 176Â MHz continuous-wave radio-frequency quadrupole

NASA Astrophysics Data System (ADS)

Kutsaev, S. V.; Mustapha, B.; Ostroumov, P. N.; Barcikowski, A.; Schrage, D.; Rodnizki, J.; Berkovits, D.

2014-07-01

We have developed a new design for a 176 MHz cw radio-frequency quadrupole (RFQ) for the SARAF upgrade project. At this frequency, the proposed design is a conventional four-vane structure. The main design goals are to provide the highest possible shunt impedance while limiting the required rf power to about 120 kW for reliable cw operation, and the length to about 4 meters. If built as designed, the proposed RFQ will be the first four-vane cw RFQ built as a single cavity (no resonant coupling required) that does not require π-mode stabilizing loops or dipole rods. For this, we rely on very detailed 3D simulations of all aspects of the structure and the level of machining precision achieved on the recently developed ATLAS upgrade RFQ. A full 3D model of the structure including vane modulation was developed. The design was optimized using electromagnetic and multiphysics simulations. Following the choice of the vane type and geometry, the vane undercuts were optimized to produce a flat field along the structure. The final design has good mode separation and should not need dipole rods if built as designed, but their effect was studied in the case of manufacturing errors. The tuners were also designed and optimized to tune the main mode without affecting the field flatness. Following the electromagnetic (EM) design optimization, a multiphysics engineering analysis of the structure was performed. The multiphysics analysis is a coupled electromagnetic, thermal and mechanical analysis. The cooling channels, including their paths and sizes, were optimized based on the limiting temperature and deformation requirements. The frequency sensitivity to the RFQ body and vane cooling water temperatures was carefully studied in order to use it for frequency fine-tuning. Finally, an inductive rf power coupler design based on the ATLAS RFQ coupler was developed and simulated. The EM design optimization was performed using cst Microwave Studio and the results were verified using both hfss and ansys. The engineering analysis was performed using hfss and ansys and most of the results were verified using the newly developed cst Multiphysics package.

Nursing Students' Nonverbal Reactions to Malodor in Wound Care Simulation

ERIC Educational Resources Information Center

Baker, Gloria Waters

2012-01-01

Background: Wound care is an essential competency which nursing students are expected to acquire. To foster students' competency, nurse educators use high fidelity simulation to expose nursing students to various wound characteristics. Problem: Little is known about how nursing students react to simulated wound characteristics. Malodor is a…

Incorporating Interprofessional Evidenced-Based Sepsis Simulation Education for Certified Nursing Assistants (CNAs) and Licensed Care Providers Within Long-term Care Settings for Process and Quality Improvement.

PubMed

Mihaljevic, Susan E; Howard, Valerie M

2016-01-01

Improving resident safety and quality of care by maximizing interdisciplinary communication among long-term care providers is essential in meeting the goals of the United States' Federal Health care reform. The new Triple Aim goals focus on improved patient outcomes, increasing patient satisfaction, and decreased health care costs, thus providing consumers with quality, efficient patient-focused care. Within the United States, sepsis is the 10th leading cause of death with a 28.6% mortality rate in the elderly, increasing to 40% to 60% in septic shock. As a result of the Affordable Care Act, the Centers for Medicare & Medicaid services supported the Interventions to Reduce Acute Care Transfers 3.0 program to improve health care quality and prevent avoidable rehospitalization by improving assessment, documentation, and communication among health care providers. The Interventions to Reduce Acute Care Transfers 3.0 tools were incorporated in interprofessional sepsis simulations throughout 19 long-term care facilities to encourage the early recognition of sepsis symptoms and prompt communication of sepsis symptoms among interdisciplinary teams. As a result of this simulation training, many long-term care organizations have adopted the STOP and WATCH and SBAR tools as a venue to communicate resident condition changes.

A study to assess the influence of interprofessional point of care simulation training on safety culture in the operating theatre environment of a university teaching hospital.

PubMed

Hinde, Theresa; Gale, Thomas; Anderson, Ian; Roberts, Martin; Sice, Paul

2016-01-01

Interprofessional point of care or in situ simulation is used as a training tool in our operating theatre directorate with the aim of improving crisis behaviours. This study aimed to assess the impact of interprofessional point of care simulation on the safety culture of operating theatres. A validated Safety Attitude Questionnaire was administered to staff members before each simulation scenario and then re-administered to the same staff members after 6-12 months. Pre- and post-training Safety Attitude Questionnaire-Operating Room (SAQ-OR) scores were compared using paired sample t-tests. Analysis revealed a statistically significant perceived improvement in both safety (p < 0.001) and teamwork (p = 0.013) climate scores (components of safety culture) 6-12 months after interprofessional simulation training. A growing body of literature suggests that a positive safety culture is associated with improved patient outcomes. Our study supports the implementation of point of care simulation as a useful intervention to improve safety culture in theatres.

Usability Evaluation of a Clinical Decision Support System for Geriatric ED Pain Treatment.

PubMed

Genes, Nicholas; Kim, Min Soon; Thum, Frederick L; Rivera, Laura; Beato, Rosemary; Song, Carolyn; Soriano, Jared; Kannry, Joseph; Baumlin, Kevin; Hwang, Ula

2016-01-01

Older adults are at risk for inadequate emergency department (ED) pain care. Unrelieved acute pain is associated with poor outcomes. Clinical decision support systems (CDSS) hold promise to improve patient care, but CDSS quality varies widely, particularly when usability evaluation is not employed. To conduct an iterative usability and redesign process of a novel geriatric abdominal pain care CDSS. We hypothesized this process would result in the creation of more usable and favorable pain care interventions. Thirteen emergency physicians familiar with the Electronic Health Record (EHR) in use at the study site were recruited. Over a 10-week period, 17 1-hour usability test sessions were conducted across 3 rounds of testing. Participants were given 3 patient scenarios and provided simulated clinical care using the EHR, while interacting with the CDSS interventions. Quantitative System Usability Scores (SUS), favorability scores and qualitative narrative feedback were collected for each session. Using a multi-step review process by an interdisciplinary team, positive and negative usability issues in effectiveness, efficiency, and satisfaction were considered, prioritized and incorporated in the iterative redesign process of the CDSS. Video analysis was used to determine the appropriateness of the CDS appearances during simulated clinical care. Over the 3 rounds of usability evaluations and subsequent redesign processes, mean SUS progressively improved from 74.8 to 81.2 to 88.9; mean favorability scores improved from 3.23 to 4.29 (1 worst, 5 best). Video analysis revealed that, in the course of the iterative redesign processes, rates of physicians' acknowledgment of CDS interventions increased, however most rates of desired actions by physicians (such as more frequent pain score updates) decreased. The iterative usability redesign process was instrumental in improving the usability of the CDSS; if implemented in practice, it could improve geriatric pain care. The usability evaluation process led to improved acknowledgement and favorability. Incorporating usability testing when designing CDSS interventions for studies may be effective to enhance clinician use.

Creation and Delphi-method refinement of pediatric disaster triage simulations.

PubMed

Cicero, Mark X; Brown, Linda; Overly, Frank; Yarzebski, Jorge; Meckler, Garth; Fuchs, Susan; Tomassoni, Anthony; Aghababian, Richard; Chung, Sarita; Garrett, Andrew; Fagbuyi, Daniel; Adelgais, Kathleen; Goldman, Ran; Parker, James; Auerbach, Marc; Riera, Antonio; Cone, David; Baum, Carl R

2014-01-01

There is a need for rigorously designed pediatric disaster triage (PDT) training simulations for paramedics. First, we sought to design three multiple patient incidents for EMS provider training simulations. Our second objective was to determine the appropriate interventions and triage level for each victim in each of the simulations and develop evaluation instruments for each simulation. The final objective was to ensure that each simulation and evaluation tool was free of bias toward any specific PDT strategy. We created mixed-methods disaster simulation scenarios with pediatric victims: a school shooting, a school bus crash, and a multiple-victim house fire. Standardized patients, high-fidelity manikins, and low-fidelity manikins were used to portray the victims. Each simulation had similar acuity of injuries and 10 victims. Examples include children with special health-care needs, gunshot wounds, and smoke inhalation. Checklist-based evaluation tools and behaviorally anchored global assessments of function were created for each simulation. Eight physicians and paramedics from areas with differing PDT strategies were recruited as Subject Matter Experts (SMEs) for a modified Delphi iterative critique of the simulations and evaluation tools. The modified Delphi was managed with an online survey tool. The SMEs provided an expected triage category for each patient. The target for modified Delphi consensus was ≥85%. Using Likert scales and free text, the SMEs assessed the validity of the simulations, including instances of bias toward a specific PDT strategy, clarity of learning objectives, and the correlation of the evaluation tools to the learning objectives and scenarios. After two rounds of the modified Delphi, consensus for expected triage level was >85% for 28 of 30 victims, with the remaining two achieving >85% consensus after three Delphi iterations. To achieve consensus, we amended 11 instances of bias toward a specific PDT strategy and corrected 10 instances of noncorrelation between evaluations and simulation. The modified Delphi process, used to derive novel PDT simulation and evaluation tools, yielded a high degree of consensus among the SMEs, and eliminated biases toward specific PDT strategies in the evaluations. The simulations and evaluation tools may now be tested for reliability and validity as part of a prehospital PDT curriculum.

Let's Talk Critical. Development and Evaluation of a Communication Skills Training Program for Critical Care Fellows.

PubMed

Hope, Aluko A; Hsieh, S Jean; Howes, Jennifer M; Keene, Adam B; Fausto, James A; Pinto, Priya A; Gong, Michelle Ng

2015-04-01

Although expert communication between intensive care unit clinicians with patients or surrogates improves patient- and family-centered outcomes, fellows in critical care medicine do not feel adequately trained to conduct family meetings. We aimed to develop, implement, and evaluate a communication skills program that could be easily integrated into a U.S. critical care fellowship. We developed four simulation cases that provided communication challenges that critical care fellows commonly face. For each case, we developed a list of directly observable tasks that could be used by faculty to evaluate fellows during each simulation. We developed a didactic curriculum of lectures/case discussions on topics related to palliative care, end-of-life care, communication skills, and bioethics; this month-long curriculum began and ended with the fellows leading family meetings in up to two simulated cases with direct observation by faculty who were not blinded to the timing of the simulation. Our primary measures of effectiveness were the fellows' self-reported change in comfort with leading family meetings after the program was completed and the quality of the communication as measured by the faculty evaluators during the family meeting simulations at the end of the month. Over 3 years, 31 critical care fellows participated in the program, 28 of whom participated in 101 family meeting simulations with direct feedback by faculty facilitators. Our trainees showed high rates of information disclosure during the simulated family meetings. During the simulations done at the end of the month compared with those done at the beginning, our fellows showed significantly improved rates in: (1) verbalizing an agenda for the meeting (64 vs. 41%; Chi-square, 5.27; P = 0.02), (2) summarizing what will be done for the patient (64 vs. 39%; Chi-square, 6.21; P = 0.01), and (3) providing a follow-up plan (60 vs. 37%; Chi-square, 5.2; P = 0.02). More than 95% of our participants (n = 27) reported feeling "slightly" or "much" more comfortable with discussing foregoing life-sustaining treatment and leading family discussions after the month-long curriculum. A communication skills program can be feasibly integrated into a critical care training program and is associated with improvements in fellows' skills and comfort with leading family meetings.

Let’s Talk Critical. Development and Evaluation of a Communication Skills Training Program for Critical Care Fellows

PubMed Central

Hsieh, S. Jean; Howes, Jennifer M.; Keene, Adam B.; Fausto, James A.; Pinto, Priya A.; Gong, Michelle Ng

2015-01-01

Rationale: Although expert communication between intensive care unit clinicians with patients or surrogates improves patient- and family-centered outcomes, fellows in critical care medicine do not feel adequately trained to conduct family meetings. Objectives: We aimed to develop, implement, and evaluate a communication skills program that could be easily integrated into a U.S. critical care fellowship. Methods: We developed four simulation cases that provided communication challenges that critical care fellows commonly face. For each case, we developed a list of directly observable tasks that could be used by faculty to evaluate fellows during each simulation. We developed a didactic curriculum of lectures/case discussions on topics related to palliative care, end-of-life care, communication skills, and bioethics; this month-long curriculum began and ended with the fellows leading family meetings in up to two simulated cases with direct observation by faculty who were not blinded to the timing of the simulation. Our primary measures of effectiveness were the fellows’ self-reported change in comfort with leading family meetings after the program was completed and the quality of the communication as measured by the faculty evaluators during the family meeting simulations at the end of the month. Measurements and Main Results: Over 3 years, 31 critical care fellows participated in the program, 28 of whom participated in 101 family meeting simulations with direct feedback by faculty facilitators. Our trainees showed high rates of information disclosure during the simulated family meetings. During the simulations done at the end of the month compared with those done at the beginning, our fellows showed significantly improved rates in: (1) verbalizing an agenda for the meeting (64 vs. 41%; Chi-square, 5.27; P = 0.02), (2) summarizing what will be done for the patient (64 vs. 39%; Chi-square, 6.21; P = 0.01), and (3) providing a follow-up plan (60 vs. 37%; Chi-square, 5.2; P = 0.02). More than 95% of our participants (n = 27) reported feeling “slightly” or “much” more comfortable with discussing foregoing life-sustaining treatment and leading family discussions after the month-long curriculum. Conclusions: A communication skills program can be feasibly integrated into a critical care training program and is associated with improvements in fellows’ skills and comfort with leading family meetings. PMID:25741996

Sound transmission through an acoustic porous metasurface with periodic structures

NASA Astrophysics Data System (ADS)

Fang, Yi; Zhang, Xin; Zhou, Jie

2017-04-01

We report an analytical, numerical, and experimental study of sound transmission through a metasurface fabricated by porous materials, detailing systematically the factors that influence acoustic properties. The design of the metasurface is composed of four elements with varying properties, which are aligned in a periodic manner. The structures are carefully designed to form a uniform phase shift profile in one period. It is able to refract an incidence wave in an anomalous yet controllable way. A good agreement of refraction behavior between simulated and experimental results is achieved by the study. Furthermore, we systemically summarize the relationships between the refraction and the incidence angles for structures with various ratios of wavelengths and period lengths. Remarkably, the study proves that the propagation directions and the number of refracted waves are only affected by period lengths at a specified frequency. The phase shift profile only has an influence on energy distribution in the refraction region. The study suggests that a careful design of phase shift profile plays an important role in controlling sound energy distribution of the periodic structure, which is vital for applying this kind of porous metasurface in sound absorption and isolation in the future.

Design of a nanoscale time-of-flight sensor and an integrated multiscale module for the point-of-care diagnosis of stroke

NASA Astrophysics Data System (ADS)

Andrus, Matthew

Stroke is a leading cause of death and disability in the United States, however, there remains no rapid diagnostic test for differentiating between ischemic and hemorrhagic stroke within the three-hour treatment window. Here we describe the design of a multiscale microfluidic module with an embedded time-of-flight nanosensor for the clinical diagnosis of stroke. The nanosensor described utilizes two synthetic pores in series, relying on resistive pulse sensing (RPS) to measure the passage of molecules through the time-of-flight tube. Once the nanosensor design was completed, a multiscale module to process patient samples and house the sensors was designed in a similar iterative process. This design utilized pillar arrays, called "pixels" to immobilize oligonucleotides from patient samples for ligase detection reactions (LDR) to be carried out. COMSOL simulations were performed to understand the operation and behavior of both the nanosensor and the modular chip once the designs were completed.

A Multirate Control Strategy to the Slow Sensors Problem: An Interactive Simulation Tool for Controller Assisted Design

PubMed Central

Salt, Julián; Cuenca, Ángel; Palau, Francisco; Dormido, Sebastián

2014-01-01

In many control applications, the sensor technology used for the measurement of the variable to be controlled is not able to maintain a restricted sampling period. In this context, the assumption of regular and uniform sampling pattern is questionable. Moreover, if the control action updating can be faster than the output measurement frequency in order to fulfill the proposed closed loop behavior, the solution is usually a multirate controller. There are some known aspects to be careful of when a multirate system (MR) is going to be designed. The proper multiplicity between input-output sampling periods, the proper controller structure, the existence of ripples and others issues need to be considered. A useful way to save time and achieve good results is to have an assisted computer design tool. An interactive simulation tool to deal with MR seems to be the right solution. In this paper this kind of simulation application is presented. It allows an easy understanding of the performance degrading or improvement when changing the multirate sampling pattern parameters. The tool was developed using Sysquake, a Matlab-like language with fast execution and powerful graphic facilities. It can be delivered as an executable. In the paper a detailed explanation of MR treatment is also included and the design of four different MR controllers with flexible structure to be adapted to different schemes will also be presented. The Smith's predictor in these MR schemes is also explained, justified and used when time delays appear. Finally some interesting observations achieved using this interactive tool are included. PMID:24583971

TEAM-HF Cost-Effectiveness Model: A Web-Based Program Designed to Evaluate the Cost-Effectiveness of Disease Management Programs in Heart Failure

PubMed Central

Reed, Shelby D.; Neilson, Matthew P.; Gardner, Matthew; Li, Yanhong; Briggs, Andrew H.; Polsky, Daniel E.; Graham, Felicia L.; Bowers, Margaret T.; Paul, Sara C.; Granger, Bradi B.; Schulman, Kevin A.; Whellan, David J.; Riegel, Barbara; Levy, Wayne C.

2015-01-01

Background Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable. Methods We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics, use of evidence-based medications, and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model (SHFM). Projections of resource use and quality of life are modeled using relationships with time-varying SHFM scores. The model can be used to evaluate parallel-group and single-cohort designs and hypothetical programs. Simulations consist of 10,000 pairs of virtual cohorts used to generate estimates of resource use, costs, survival, and incremental cost-effectiveness ratios from user inputs. Results The model demonstrated acceptable internal and external validity in replicating resource use, costs, and survival estimates from 3 clinical trials. Simulations to evaluate the cost-effectiveness of heart failure disease management programs across 3 scenarios demonstrate how the model can be used to design a program in which short-term improvements in functioning and use of evidence-based treatments are sufficient to demonstrate good long-term value to the health care system. Conclusion The TEAM-HF Cost-Effectiveness Model provides researchers and providers with a tool for conducting long-term cost-effectiveness analyses of disease management programs in heart failure. PMID:26542504

A reflective-type, quasi-optical metasurface filter

NASA Astrophysics Data System (ADS)

Sima, Boyu; Momeni Hasan Abadi, Seyed Mohamad Amin; Behdad, Nader

2017-08-01

We introduce a new technique for designing quasi-optical, reflective-type spatial filters. The proposed filter is a reflective metasurface with a one dimensional, frequency-dependent phase gradient along the aperture. By careful design of each unit cell of the metasurface, the phase shift gradient provided by the adjacent unit cells can be engineered to steer the beam towards a desired, anomalous reflection direction over the passband region of the filter. Outside of that range, the phase shift gradient required to produce the anomalous reflection is not present and hence, the wave is reflected towards the specular reflection direction. This way, the metasurface acts as a reflective filter in a quasi-optical system where the detector is placed along the direction of anomalous reflection. The spectral selectivity of this filter is determined by the frequency dispersion of the metasurface's phase response. Based on this principle, a prototype of the proposed metasurface filter, which operates at 10 GHz and has a bandwidth of 3%, is designed. The device is modeled using a combination of theoretical analysis using the phased-array theory and full-wave electromagnetic simulations. A prototype of this device is also fabricated and characterized using a free-space measurement system. Experimental results agree well with the simulations.

Sensitivity models and design protocol for partitioning tracer tests in alluvial aquifers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jin, M.; Butler, G.W.; Jackson, R.E.

1997-11-01

Zones of dense, nonaqueous phase liquids (DNAPLs) are difficult to characterize as to their volume, composition, and spatial distribution using conventional ground-water extraction and soil-sampling methods. Such incompletely characterized sites have negative consequences for those responsible for their remedial design, e.g., the uncertainties in the optimal placement of ground-water extraction wells and in the duration of remediation. However, the recent use of the partitioning interwell tracer test (PITT) to characterize DNAPL zones at sites in New Mexico [unsaturated alluvium] and in Ohio, Texas, and Utah [saturated alluvium] demonstrates that the volume and spatial distribution of residual DNAPL can be determinedmore » with accuracy. The PITT involves injection of a suite of tracers which reversibly partition to different degrees between the DNAPL and the ground water or soil air resulting in the chromatographic separation of the tracer signals observed at the extraction well(s). The design of a PITT requires careful consideration of the hydrostratigraphic, hydraulic, and certain geochemical properties of the alluvium being tested. A three-dimensional, numerical model of a heterogeneous alluvial aquifer containing DNAPL has been developed for use with the UTCHEM simulator to demonstrate partitioning tracer testing and to address questions that are frequently raised in its application. The simulations include (1) the estimation of DNAPL volume for the simple case where only residual DNAPL is present in heterogeneous alluvium, (2) sensitivity studies to demonstrate the effect of increasingly low residual DNAPL saturation on the tracer signal, and (3) the effect of free-phase DNAPL on the estimation of the volume of DNAPL present. Furthermore, the potential interference of sedimentary organic carbon as a DNAPL surrogate on the tracer signal is considered and shown to be readily resolved by the careful choice of tracers.« less

Simulation Training in Health Care

DTIC Science & Technology

2015-06-01

Harvey simulates cardiac and lung disease , including blood pressure, breathing, pulses, heart sounds, and murmurs. A significant step toward the...fluoroscopy, cardiovascu- lar and pulmonary disease diagnosis and treatment, anesthesia, patient -centered programs, basic vital signs emergency care, infant...effectiveness. However, in health care, ethical considerations and the quantification of the expenses of clinician “learning” on patients is a challenge to

Collaborative Learning with Screen-Based Simulation in Health Care Education: An Empirical Study of Collaborative Patterns and Proficiency Development

ERIC Educational Resources Information Center

Hall, L. O.; Soderstrom, T.; Ahlqvist, J.; Nilsson, T.

2011-01-01

This article is about collaborative learning with educational computer-assisted simulation (ECAS) in health care education. Previous research on training with a radiological virtual reality simulator has indicated positive effects on learning when compared to a more conventional alternative. Drawing upon the field of Computer-Supported…

Simulation for Operational Readiness in a New Freestanding Emergency Department

PubMed Central

Kerner, Robert L.; Gallo, Kathleen; Cassara, Michael; D'Angelo, John; Egan, Anthony; Simmons, John Galbraith

2016-01-01

Summary Statement Simulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together. Methods throughout the preoperational term included predominantly hands-on skills review, high-fidelity simulation, and simulation with standardized patients. We also used simulation during instruction in disaster preparedness, sexual assault forensics, and community outreach. Our program culminated with 2 days of in-situ simulation deployed in simultaneous and overlapping timeframes to challenge system response capabilities, resilience, and flexibility; this work revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies. PMID:27607095

Medical image archive node simulation and architecture

NASA Astrophysics Data System (ADS)

Chiang, Ted T.; Tang, Yau-Kuo

1996-05-01

It is a well known fact that managed care and new treatment technologies are revolutionizing the health care provider world. Community Health Information Network and Computer-based Patient Record projects are underway throughout the United States. More and more hospitals are installing digital, `filmless' radiology (and other imagery) systems. They generate a staggering amount of information around the clock. For example, a typical 500-bed hospital might accumulate more than 5 terabytes of image data in a period of 30 years for conventional x-ray images and digital images such as Magnetic Resonance Imaging and Computer Tomography images. With several hospitals contributing to the archive, the storage required will be in the hundreds of terabytes. Systems for reliable, secure, and inexpensive storage and retrieval of digital medical information do not exist today. In this paper, we present a Medical Image Archive and Distribution Service (MIADS) concept. MIADS is a system shared by individual and community hospitals, laboratories, and doctors' offices that need to store and retrieve medical images. Due to the large volume and complexity of the data, as well as the diversified user access requirement, implementation of the MIADS will be a complex procedure. One of the key challenges to implementing a MIADS is to select a cost-effective, scalable system architecture to meet the ingest/retrieval performance requirements. We have performed an in-depth system engineering study, and developed a sophisticated simulation model to address this key challenge. This paper describes the overall system architecture based on our system engineering study and simulation results. In particular, we will emphasize system scalability and upgradability issues. Furthermore, we will discuss our simulation results in detail. The simulations study the ingest/retrieval performance requirements based on different system configurations and architectures for variables such as workload, tape access time, number of drives, number of exams per patient, number of Central Processing Units, patient grouping, and priority impacts. The MIADS, which could be a key component of a broader data repository system, will be able to communicate with and obtain data from existing hospital information systems. We will discuss the external interfaces enabling MIADS to communicate with and obtain data from existing Radiology Information Systems such as the Picture Archiving and Communication System (PACS). Our system design encompasses the broader aspects of the archive node, which could include multimedia data such as image, audio, video, and free text data. This system is designed to be integrated with current hospital PACS through a Digital Imaging and Communications in Medicine interface. However, the system can also be accessed through the Internet using Hypertext Transport Protocol or Simple File Transport Protocol. Our design and simulation work will be key to implementing a successful, scalable medical image archive and distribution system.

Comparative Simulation Study of Glucose Control Methods Designed for Use in the Intensive Care Unit Setting via a Novel Controller Scoring Metric.

PubMed

DeJournett, Jeremy; DeJournett, Leon

2017-11-01

Effective glucose control in the intensive care unit (ICU) setting has the potential to decrease morbidity and mortality rates and thereby decrease health care expenditures. To evaluate what constitutes effective glucose control, typically several metrics are reported, including time in range, time in mild and severe hypoglycemia, coefficient of variation, and others. To date, there is no one metric that combines all of these individual metrics to give a number indicative of overall performance. We proposed a composite metric that combines 5 commonly reported metrics, and we used this composite metric to compare 6 glucose controllers. We evaluated the following controllers: Ideal Medical Technologies (IMT) artificial-intelligence-based controller, Yale protocol, Glucommander, Wintergerst et al PID controller, GRIP, and NICE-SUGAR. We evaluated each controller across 80 simulated patients, 4 clinically relevant exogenous dextrose infusions, and one nonclinical infusion as a test of the controller's ability to handle difficult situations. This gave a total of 2400 5-day simulations, and 585 604 individual glucose values for analysis. We used a random walk sensor error model that gave a 10% MARD. For each controller, we calculated severe hypoglycemia (<40 mg/dL), mild hypoglycemia (40-69 mg/dL), normoglycemia (70-140 mg/dL), hyperglycemia (>140 mg/dL), and coefficient of variation (CV), as well as our novel controller metric. For the controllers tested, we achieved the following median values for our novel controller scoring metric: IMT: 88.1, YALE: 46.7, GLUC: 47.2, PID: 50, GRIP: 48.2, NICE: 46.4. The novel scoring metric employed in this study shows promise as a means for evaluating new and existing ICU-based glucose controllers, and it could be used in the future to compare results of glucose control studies in critical care. The IMT AI-based glucose controller demonstrated the most consistent performance results based on this new metric.

Understanding negative feedback from South Asian patients: an experimental vignette study

PubMed Central

Abel, Gary; Elmore, Natasha; Lloyd, Cathy; Benson, John; Sarson, Lara; Carluccio, Anna; Campbell, John; Elliott, Marc N; Roland, Martin

2016-01-01

Objectives In many countries, minority ethnic groups report poorer care in patient surveys. This could be because they get worse care or because they respond differently to such surveys. We conducted an experiment to determine whether South Asian people in England rate simulated GP consultations the same or differently from White British people. If these groups rate consultations similarly when viewing identical simulated consultations, it would be more likely that the lower scores reported by minority ethnic groups in real surveys reflect real differences in quality of care. Design Experimental vignette study. Trained fieldworkers completed computer-assisted personal interviews during which participants rated 3 video recordings of simulated GP–patient consultations, using 5 communication items from the English GP Patient Survey. Consultations were shown in a random order, selected from a pool of 16. Setting Geographically confined areas of ∼130 households (output areas) in England, selected using proportional systematic sampling. Participants 564 White British and 564 Pakistani adults recruited using an in-home face-to-face approach. Main outcome measure Mean differences in communication score (on a scale of 0–100) between White British and Pakistani participants, estimated from linear regression. Results Pakistani participants, on average, scored consultations 9.8 points higher than White British participants (95% CI 8.0 to 11.7, p<0.001) when viewing the same consultations. When adjusted for age, gender, deprivation, self-rated health and video, the difference increased to 11.0 points (95% CI 8.5 to 13.6, p<0.001). The largest differences were seen when participants were older (>55) and where communication was scripted to be poor. Conclusions Substantial differences in ratings were found between groups, with Pakistani respondents giving higher scores than White British respondents to videos showing the same care. Our findings suggest that the lower scores reported by Pakistani patients in national surveys represent genuinely worse experiences of communication compared to the White British majority. PMID:27609844

Technology-enhanced simulation and pediatric education: a meta-analysis.

PubMed

Cheng, Adam; Lang, Tara R; Starr, Stephanie R; Pusic, Martin; Cook, David A

2014-05-01

Pediatrics has embraced technology-enhanced simulation (TES) as an educational modality, but its effectiveness for pediatric education remains unclear. The objective of this study was to describe the characteristics and evaluate the effectiveness of TES for pediatric education. This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. A systematic search of Medline, Embase, CINAHL, ERIC, Web of Science, Scopus, key journals, and previous review bibliographies through May 2011 and an updated Medline search through October 2013 were conducted. Original research articles in any language evaluating the use of TES for educating health care providers at any stage, where the content solely focuses on patients 18 years or younger, were selected. Reviewers working in duplicate abstracted information on learners, clinical topic, instructional design, study quality, and outcomes. We coded skills (simulated setting) separately for time and nontime measures and similarly classified patient care behaviors and patient effects. We identified 57 studies (3666 learners) using TES to teach pediatrics. Effect sizes (ESs) were pooled by using a random-effects model. Among studies comparing TES with no intervention, pooled ESs were large for outcomes of knowledge, nontime skills (eg, performance in simulated setting), behaviors with patients, and time to task completion (ES = 0.80-1.91). Studies comparing the use of high versus low physical realism simulators showed small to moderate effects favoring high physical realism (ES = 0.31-0.70). TES for pediatric education is associated with large ESs in comparison with no intervention. Future research should include comparative studies that identify optimal instructional methods and incorporate pediatric-specific issues into educational interventions. Copyright © 2014 by the American Academy of Pediatrics.

Simulation: A Complementary Method for Teaching Health Services Strategic Management

PubMed Central

Reddick, W. T.

1990-01-01

Rapid change in the health care environment mandates a more comprehensive approach to the education of future health administrators. The area of consideration in this study is that of health care strategic management. A comprehensive literature review suggests microcomputer-based simulation as an appropriate vehicle for addressing the needs of both educators and students. Seven strategic management software packages are reviewed and rated with an instrument adapted from the Infoworld review format. The author concludes that a primary concern is the paucity of health care specific strategic management simulations.

Employer-Sponsored Insurance, Health Care Cost Growth, and the Economic Performance of U.S. Industries

PubMed Central

Sood, Neeraj; Ghosh, Arkadipta; Escarce, José J

2009-01-01

Objective To estimate the effect of growth in health care costs that outpaces gross domestic product (GDP) growth (“excess” growth in health care costs) on employment, gross output, and value added to GDP of U.S. industries. Study Setting We analyzed data from 38 U.S. industries for the period 1987–2005. All data are publicly available from various government agencies. Study Design We estimated bivariate and multivariate regressions. To develop the regression models, we assumed that rapid growth in health care costs has a larger effect on economic performance for industries where large percentages of workers receive employer-sponsored health insurance (ESI). We used the estimated regression coefficients to simulate economic outcomes under alternative scenarios of health care cost inflation. Results Faster growth in health care costs had greater adverse effects on economic outcomes for industries with larger percentages of workers who had ESI. We found that a 10 percent increase in excess growth in health care costs would have resulted in 120,803 fewer jobs, US$28,022 million in lost gross output, and US$14,082 million in lost value added in 2005. These declines represent 0.17 to 0.18 percent of employment, gross output, and value added in 2005. Conclusion Excess growth in health care costs is adversely affecting the economic performance of U.S. industries. PMID:19500165

Commercial application of rainfall simulation

NASA Astrophysics Data System (ADS)

Loch, Rob J.

2010-05-01

Landloch Pty Ltd is a commercial consulting firm, providing advice on a range of land management issues to the mining and construction industries in Australia. As part of the company's day-to-day operations, rainfall simulation is used to assess material erodibility and to investigate a range of site attributes. (Landloch does carry out research projects, though such are not its core business.) When treated as an everyday working tool, several aspects of rainfall simulation practice are distinctively modified. Firstly, the equipment used is regularly maintained, and regularly upgraded with a primary focus on ease, safety, and efficiency of use and on reliability of function. As well, trained and experienced technical support is considered essential. Landloch's chief technician has over 10 years experience in running rainfall simulators at locations across Australia and in Africa and the Pacific. Secondly, the specific experimental conditions established for each set of rainfall simulator runs are carefully considered to ensure that they accurately represent the field conditions to which the data will be subsequently applied. Considerations here include: • wetting and drying cycles to ensure material consolidation and/or cementation if appropriate; • careful attention to water quality if dealing with clay soils or with amendments such as gypsum; • strong focus on ensuring that the erosion processes considered are those of greatest importance to the field situation of concern; and • detailed description of both material and plot properties, to increase the potential for data to be applicable to a wider range of projects and investigations. Other important company procedures include: • For each project, the scientist or engineer responsible for analysing and reporting rainfall simulator data is present during the running of all field plots, as it is essential that they be aware of any specific conditions that may have developed when the plots were subjected to rain; and • Regular calibration of all equipment. In general, typical errors when rainfall simulation is carried out by inexperienced researchers include: • Failure to accurately measure rainfall rates (the most common error); • Inappropriate initial conditions, including wetting treatments; • Use of inappropriately small plots - relating to our concern at the erosion processes considered be those of genuine field relevance; • Inappropriate rainfall kinetic energies; and • Failure to observe critical processes operating on the study plots, such as saturation excess or the presence of impeding layers at shallow depths. Landloch regularly uses erodibility data to design stable batter profiles for minesite waste dumps. Subsequent monitoring of designed dumps has confirmed that modelled erosion rates are consistent with those subsequently measured under field conditions.

Simulation in Occupational Therapy Curricula: A literature review.

PubMed

Bennett, Sally; Rodger, Sylvia; Fitzgerald, Cate; Gibson, Libby

2017-08-01

Simulated learning experiences are increasingly being used in health-care education to enhance student engagement and provide experiences that reflect clinical practice; however, simulation has not been widely investigated in occupational therapy curricula. The aim of this paper was to: (i) describe the existing research about the use and evaluation of simulation over the last three decades in occupational therapy curricula and (ii) consider how simulation has been used to develop competence in students. A literature review was undertaken with searches of MEDLINE, CINAHL and ERIC to locate articles that described or evaluated the use of simulation in occupational therapy curricula. Fifty-seven papers were identified. Occupational therapy educators have used the full scope of simulation modalities, including written case studies (22), standardised patients (13), video case studies (15), computer-based and virtual reality cases (7), role-play (8) and mannequins and part-task trainers (4). Ten studies used combinations of these modalities and two papers compared modalities. Most papers described the use of simulation for foundational courses, as for preparation for fieldwork, and to address competencies necessary for newly graduating therapists. The majority of studies were descriptive, used pre-post design, or were student's perceptions of the value of simulation. Simulation-based education has been used for a wide range of purposes in occupational therapy curricula and appears to be well received. Randomised controlled trials are needed to more accurately understand the effects of simulation not just for occupational therapy students but for longer term outcomes in clinical practice. © 2017 Occupational Therapy Australia.

Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries

PubMed Central

BERNHARDT, ANTONIA K.; BERGER, GREGORY; LEE, JAMES A.; REUTER, KEVIN; DAVANZO, JOAN; MONTGOMERY, ANNE; DOBSON, ALLEN

2016-01-01

Policy Points: At age 65, the average man and woman can respectively expect 1.5 years and 2.5 years of requiring daily help with “activities of daily living.” Available services fail to match frail elders’ needs, thereby routinely generating errors, unreliability, unwanted services, unmet needs, and high costs.The number of elderly Medicare beneficiaries likely to be frail will triple between 2000 and 2050. Low retirement savings, rising medical and long‐term care costs, and declining family caregiver availability portend gaps in badly needed services.The financial simulation reported here for 4 diverse MediCaring Communities shows lower per capita costs. Program savings are substantial and can improve coverage and function of local supportive services within current overall Medicare spending levels. Context The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better‐coordinated and more desirable medical and social services, and local monitoring and management of a community's quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation. Methods The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model. Findings The simulation projected third‐year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%. Conclusions The MediCaring Communities financial simulation demonstrates that better care at lower cost for frail elderly Medicare beneficiaries is possible within current financing levels. Long‐term success of the initiative will require reinvestment of Medicare savings to bolster nonmedical supportive services in the community. Successful implementation will necessitate waiving certain regulations and developing new infrastructure in pilot communities. This financial simulation methodology will help leadership in other communities to project fiscal performance. Since the MediCaring Communities model also achieves the Centers for Medicare and Medicaid Services' vision for care for frail elders (better care, healthier people, smarter spending) and since these reforms can proceed with limited waivers from Medicare, willing communities should explore implementation and share best practices about how to achieve fundamental service delivery changes that can meet the challenges of a much older population in the 21st century. PMID:27378581

Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries.

PubMed

Bernhardt, Antonia K; Lynn, Joanne; Berger, Gregory; Lee, James A; Reuter, Kevin; Davanzo, Joan; Montgomery, Anne; Dobson, Allen

2016-09-01

At age 65, the average man and woman can respectively expect 1.5 years and 2.5 years of requiring daily help with "activities of daily living." Available services fail to match frail elders' needs, thereby routinely generating errors, unreliability, unwanted services, unmet needs, and high costs. The number of elderly Medicare beneficiaries likely to be frail will triple between 2000 and 2050. Low retirement savings, rising medical and long-term care costs, and declining family caregiver availability portend gaps in badly needed services. The financial simulation reported here for 4 diverse MediCaring Communities shows lower per capita costs. Program savings are substantial and can improve coverage and function of local supportive services within current overall Medicare spending levels. The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better-coordinated and more desirable medical and social services, and local monitoring and management of a community's quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation. The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model. The simulation projected third-year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%. The MediCaring Communities financial simulation demonstrates that better care at lower cost for frail elderly Medicare beneficiaries is possible within current financing levels. Long-term success of the initiative will require reinvestment of Medicare savings to bolster nonmedical supportive services in the community. Successful implementation will necessitate waiving certain regulations and developing new infrastructure in pilot communities. This financial simulation methodology will help leadership in other communities to project fiscal performance. Since the MediCaring Communities model also achieves the Centers for Medicare and Medicaid Services' vision for care for frail elders (better care, healthier people, smarter spending) and since these reforms can proceed with limited waivers from Medicare, willing communities should explore implementation and share best practices about how to achieve fundamental service delivery changes that can meet the challenges of a much older population in the 21st century. © 2016 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Advancing cognitive engineering methods to support user interface design for electronic health records

PubMed Central

Thyvalikakath, Thankam P.; Dziabiak, Michael P.; Johnson, Raymond; Torres-Urquidy, Miguel Humberto; Acharya, Amit; Yabes, Jonathan; Schleyer, Titus K.

2014-01-01

Background Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. Objective In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. Methods We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. Results Dentists first reviewed the patient’s demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient’s intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists’ patterns of navigation through patient’s information and additional information needs during a typical clinician-patient encounter. Conclusion This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants’ knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists’ patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records. PMID:24503391

Action research, simulation, team communication, and bringing the tacit into voice society for simulation in healthcare.

PubMed

Forsythe, Lydia

2009-01-01

In healthcare, professionals usually function in a time-constrained paradigm because of the nature of care delivery functions and the acute patient populations usually in need of emergent and urgent care. This leaves little, if no time for team reflection, or team processing as a collaborative action. Simulation can be used to create a safe space as a structure for recognition and innovation to continue to develop a culture of safety for healthcare delivery and patient care. To create and develop a safe space, three qualitative modified action research institutional review board-approved studies were developed using simulation to explore team communication as an unfolding in the acute care environment of the operating room. An action heuristic was used for data collection by capturing the participants' narratives in the form of collaborative recall and reflection to standardize task, process, and language. During the qualitative simulations, the team participants identified and changed multiple tasks, process, and language items. The simulations contributed to positive changes for task and efficiencies, team interactions, and overall functionality of the team. The studies demonstrated that simulation can be used in healthcare to define safe spaces to practice, reflect, and develop collaborative relationships, which contribute to the realization of a culture of safety.

Quality of Care as an Emergent Phenomenon out of a Small-World Network of Relational Actors.

PubMed

Fiorini, Rodolfo; De Giacomo, Piero; Marconi, Pier Luigi; L'Abate, Luciano

2014-01-01

In Healthcare Decision Support System, the development and evaluation of effective "Quality of Care" (QOC) indicators, in simulation-based training, are key feature to develop resilient and antifragile organization scenarios. Is it possible to conceive of QOC not only as a result of a voluntary and rational decision, imposed or even not, but also as an overall system "emergent phenomenon" out of a small-world network of relational synthetic actors, endowed with their own personality profiles to simulate human behaviour (for short, called "subjects")? In order to answer this question and to observe the phenomena of real emergence we should use computational models of high complexity, with heavy computational load and extensive computational time. Nevertheless, De Giacomo's Elementary Pragmatic Model (EPM) intrinsic self-reflexive functional logical closure enables to run simulation examples to classify the outcomes grown out of a small-world network of relational subjects fast and effectively. Therefore, it is possible to take note and to learn of how much strategic systemic interventions can induce context conditions of QOC facilitation, which can improve the effectiveness of specific actions, which otherwise might be paradoxically counterproductive also. Early results are so encouraging to use EPM as basic block to start designing more powerful Evolutive Elementary Pragmatic Model (E2PM) for real emergence computational model, to cope with ontological uncertainty at system level.

[Evaluation of a teaching ambulatory module of respiratory diseases in the undergraduate medical curriculum].

PubMed

Leiva R, Isabel; Bitran C, Marcela; Saldías P, Fernando

2012-05-01

As the focus of healthcare provision shifts towards ambulatory care, increasing attention must now be given to develop opportunities for clinical teaching in this setting. To assess teacher and students' views about the strengths and weaknesses of real and simulated patient interactions for teaching undergraduate students clinical skills in the ambulatory setting. Fourth-year medical students were exposed in a systematic way, during two weeks, to real and simulated patients in an outpatient clinic, who presented common respiratory problems, such as asthma, chronic obstructive pulmonary disease, smoking and sleep apnea syndrome. After the clinical interview, students received feedback from the tutor and their peers. The module was assessed interviewing the teachers and evaluating the results qualitatively. Students evaluated the contents and quality of teaching at the end of the rotation. Tutors identified the factors that facilitate ambulatory teaching. These depended on the module design, resources and patient care, of characteristics of students and their participation, leadership and interaction with professors. They also identified factors that hamper teaching activities such as availability of resources, student motivation and academic recognition. Most students evaluated favorably the interaction with real and simulated patients in the ambulatory setting. Teaching in the ambulatory setting was well evaluated by students and teachers. The use of qualitative methodology allowed contrasting the opinions of teachers and students.

The Cost-effectiveness of Welcome to Medicare Visual Acuity Screening and a Possible Alternative Welcome to Medicare Eye Evaluation Among Persons Without Diagnosed Diabetes Mellitus

PubMed Central

Rein, David B.; Wittenborn, John S.; Zhang, Xinzhi; Hoerger, Thomas J.; Zhang, Ping; Klein, Barbara Eden Kobrin; Lee, Kris E.; Klein, Ronald; Saaddine, Jinan B.

2013-01-01

Objective To estimate the cost-effectiveness of visual acuity screening performed in primary care settings and of dilated eye evaluations performed by an eye care professional among new Medicare enrollees with no diagnosed eye disorders. Medicare currently reimburses visual acuity screening for new enrollees during their initial preventive primary care health check, but dilated eye evaluations may be a more cost-effective policy. Design Monte Carlo cost-effectiveness simulation model with a total of 50 000 simulated patients with demographic characteristics matched to persons 65 years of age in the US population. Results Compared with no screening policy, dilated eye evaluations increased quality-adjusted life-years (QALYs) by 0.008 (95% credible interval [CrI], 0.005–0.011) and increased costs by $94 (95% CrI, −$35 to $222). A visual acuity screening increased QALYs in less than 95% of the simulations (0.001 [95% CrI, −0.002 to 0.004) and increased total costs by $32 (95% CrI, −$97 to $159) per person. The incremental cost-effectiveness ratio of a visual acuity screening and an eye examination compared with no screening were $29 000 and $12 000 per QALY gained, respectively. At a willingness-to-pay value of $15 000 or more per QALY gained, a dilated eye evaluation was the policy option most likely to be cost-effective. Conclusions The currently recommended visual acuity screening showed limited efficacy and cost-effectiveness compared with no screening. In contrast, a new policy of reimbursement for Welcome to Medicare dilated eye evaluations was highly cost-effective. PMID:22232367

Teaching Wound Care Management: A Model for the Budget Conscious Educator

ERIC Educational Resources Information Center

Berry, David C.

2012-01-01

For the author, the concept of wound care has always been a challenging topic to demonstrate. How to teach the concept without having a student in need of wound care or without having to spend money to buy another simulation manikin/model? The author has recently created a simulation to demonstrate and practice the cleaning, closing, and dressing…

Multi-Agent-Based Simulation of a Complex Ecosystem of Mental Health Care.

PubMed

Kalton, Alan; Falconer, Erin; Docherty, John; Alevras, Dimitris; Brann, David; Johnson, Kyle

2016-02-01

This paper discusses the creation of an Agent-Based Simulation that modeled the introduction of care coordination capabilities into a complex system of care for patients with Serious and Persistent Mental Illness. The model describes the engagement between patients and the medical, social and criminal justice services they interact with in a complex ecosystem of care. We outline the challenges involved in developing the model, including process mapping and the collection and synthesis of data to support parametric estimates, and describe the controls built into the model to support analysis of potential changes to the system. We also describe the approach taken to calibrate the model to an observable level of system performance. Preliminary results from application of the simulation are provided to demonstrate how it can provide insights into potential improvements deriving from introduction of care coordination technology.

As accessible as a book on a library shelf: the imperative of routine simulation in modern health care.

PubMed

Gordon, James A

2012-01-01

Technology-enhanced patient simulation has emerged as an important new modality for teaching and learning in medicine. In particular, immersive simulation platforms that replicate the clinical environment promise to revolutionize medical education by enabling an enhanced level of safety, standardization, and efficiency across health-care training. Such an experiential approach seems unique in reliably catalyzing a level of emotional engagement that fosters immediate and indelible learning and allows for increasingly reliable levels of performance evaluation-all in a completely risk-free environment. As such, medical simulation is poised to emerge as a critical component of training and certification throughout health care, promising to fundamentally enhance quality and safety across disciplines. To encourage routine simulation-based practice as part of its core quality and safety mission, Massachusetts General Hospital now incorporates simulation resources within its historic medical library (est. 1847), located at the center of the campus. In this new model, learners go to the library not only to read about a patient's illness, but also to take care of their "patient." Such an approach redefines and advances the central role of the library on the campus and ensures that simulation-based practice is centrally available as part of everyday hospital operations. This article describes the reasons for identifying simulation as an institutional priority leading up to the Massachusetts General Hospital Bicentennial Celebration (1811-2011) and for creating a simulation-based learning laboratory within a hospital library.

The influence of simulator input conditions on the wear of total knee replacements: An experimental and computational study

PubMed Central

Brockett, Claire L; Abdelgaied, Abdellatif; Haythornthwaite, Tony; Hardaker, Catherine; Fisher, John; Jennings, Louise M

2016-01-01

Advancements in knee replacement design, material and sterilisation processes have provided improved clinical results. However, surface wear of the polyethylene leading to osteolysis is still considered the longer-term risk factor. Experimental wear simulation is an established method for evaluating the wear performance of total joint replacements. The aim of this study was to investigate the influence of simulation input conditions, specifically input kinematic magnitudes, waveforms and directions of motion and position of the femoral centre of rotation, on the wear performance of a fixed-bearing total knee replacement through a combined experimental and computational approach. Studies were completed using conventional and moderately cross-linked polyethylene to determine whether the influence of these simulation input conditions varied with material. The position of the femoral centre of rotation and the input kinematics were shown to have a significant influence on the wear rates. Similar trends were shown for both the conventional and moderately cross-linked polyethylene materials, although lower wear rates were found for the moderately cross-linked polyethylene due to the higher level of cross-linking. The most important factor influencing the wear was the position of the relative contact point at the femoral component and tibial insert interface. This was dependent on the combination of input displacement magnitudes, waveforms, direction of motion and femoral centre of rotation. This study provides further evidence that in order to study variables such as design and material in total knee replacement, it is important to carefully control knee simulation conditions. This can be more effectively achieved through the use of displacement control simulation. PMID:27160561

A virtual reality system for the training of volunteers involved in health emergency situations.

PubMed

De Leo, Gianluca; Ponder, Michal; Molet, Tom; Fato, Marco; Thalmann, Daniel; Magnenat-Thalmann, Nadia; Bermano, Francesco; Beltrame, Francesco

2003-06-01

In order to guarantee an effective and punctual medical intervention to injured people involved in health emergency situations, where usually both professional and non-professional health operators are involved, a fast and accurate treatment has to be carried out. In case of catastrophic or very critical situations, non-professional operators who did not receive proper training (volunteers are among them) could be affected by psychological inhibitions. Their performances could slow down in such way that would affect the quality of the treatment and increase both direct and indirect costs. Our virtual reality system that is currently in use at the health care emergency center of San Martino Hospital in Genoa, Italy, has been designed and developed to check health emergency operators' capabilities to adopt correct decision-making procedures, to make optimal use of new technological equipment and to overcome psychological barriers. Our system is composed of (1) a high-end simulation PC, whose main functions are execution of the main software module, rendering of 3D scenes in stereo mode, rendering of sound, and control of data transmission from/to VR devices; (2) a low-end control PC, which controls the VR simulation running on the simulation PC, manages medical emergency simulation scenarios, introduces unexpected events to the simulation and controls the simulation difficulty level; (3) a magnetic-based motion tracking device used for head and hand tracking; (4) a wireless pair of shutter glasses together with a cathode ray tube wall projector; and (5) a high-end surround sound system. The expected benefits have been verified through the design and implementation of controlled clinical trials.

The effect of electronically steering a phased array ultrasound transducer on near-field tissue heating.

PubMed

Payne, Allison; Vyas, Urvi; Todd, Nick; de Bever, Joshua; Christensen, Douglas A; Parker, Dennis L

2011-09-01

This study presents the results obtained from both simulation and experimental techniques that show the effect of mechanically or electronically steering a phased array transducer on proximal tissue heating. The thermal response of a nine-position raster and a 16-mm diameter circle scanning trajectory executed through both electronic and mechanical scanning was evaluated in computer simulations and experimentally in a homogeneous tissue-mimicking phantom. Simulations were performed using power deposition maps obtained from the hybrid angular spectrum (HAS) method and applying a finite-difference approximation of the Pennes' bioheat transfer equation for the experimentally used transducer and also for a fully sampled transducer to demonstrate the effect of acoustic window, ultrasound beam overlap and grating lobe clutter on near-field heating. Both simulation and experimental results show that electronically steering the ultrasound beam for the two trajectories using the 256-element phased array significantly increases the thermal dose deposited in the near-field tissues when compared with the same treatment executed through mechanical steering only. In addition, the individual contributions of both beam overlap and grating lobe clutter to the near-field thermal effects were determined through comparing the simulated ultrasound beam patterns and resulting temperature fields from mechanically and electronically steered trajectories using the 256-randomized element phased array transducer to an electronically steered trajectory using a fully sampled transducer with 40 401 phase-adjusted sample points. Three distinctly different three distinctly different transducers were simulated to analyze the tradeoffs of selected transducer design parameters on near-field heating. Careful consideration of design tradeoffs and accurate patient treatment planning combined with thorough monitoring of the near-field tissue temperature will help to ensure patient safety during an MRgHIFU treatment.

Bridging the gap: enhancing interprofessional education using simulation.

PubMed

Robertson, James; Bandali, Karim

2008-10-01

Simulated learning and interprofessional education (IPE) are increasingly becoming more prevalent in health care curriculum. As the focus shifts to patient-centred care, health professionals will need to learn with, from and about one another in real-life settings in order to facilitate teamwork and collaboration. The provision of simulated learning in an interprofessional environment helps replicate these settings thereby providing the traditional medical education model with opportunities for growth and innovation. Learning in context is an essential psychological and cognitive aspect of education.This paper offers a conceptual analysis of the salient issues related to IPE and medical simulation. In addition, the paper argues for the integration of simulation into IPE in order to develop innovative approaches for the delivery of education and improved clinical practice that may benefit students and all members of the health care team.

A break-even analysis of optimum faculty assignment for ambulatory primary care training.

PubMed

Xakellis, G C; Gjerde, C L; Xakellis, M G; Klitgaard, D

1996-12-01

The increased demand that faculty teach residents in ambulatory clinics necessitates the development of ambulatory care teaching models that are both educationally effective and financially viable. This study was designed to identify the resident-to-faculty ratios needed to provide financially viable faculty supervision of residents while maintaining acceptable resident waiting times for teaching. A computer simulation was developed to estimate the number of residents one or two faculty teachers could supervise in a university-based primary care teaching clinic. The number of residents was calculated for three waiting-time constraints and three scenarios of faculty tasks. A financial analysis of each model was performed. With no non-teaching tasks, two teachers were able to supervise 11 residents and keep waiting times under two minutes, while one teacher was able to supervise only three residents with this waiting-time constraint. The financial break-even point was achieved by all of the two-teacher models, but by none of the one-teacher models. In all three scenarios, using two teachers resulted in more than double the number of residents supervised and in higher utilization of faculty time (higher productivity) than did using one teacher. The two-teacher models of ambulatory supervision allowed for sufficient numbers of residents to be supervised so that teaching costs could be covered from patient care revenues; the one-teacher models did not break even financially. These simulations offer a viable option for academic institutions that are struggling to maintain teaching quality in the face of financial constraints.

A Toolkit to Study Sensitivity of the Geant4 Predictions to the Variations of the Physics Model Parameters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fields, Laura; Genser, Krzysztof; Hatcher, Robert

Geant4 is the leading detector simulation toolkit used in high energy physics to design detectors and to optimize calibration and reconstruction software. It employs a set of carefully validated physics models to simulate interactions of particles with matter across a wide range of interaction energies. These models, especially the hadronic ones, rely largely on directly measured cross-sections and phenomenological predictions with physically motivated parameters estimated by theoretical calculation or measurement. Because these models are tuned to cover a very wide range of possible simulation tasks, they may not always be optimized for a given process or a given material. Thismore » raises several critical questions, e.g. how sensitive Geant4 predictions are to the variations of the model parameters, or what uncertainties are associated with a particular tune of a Geant4 physics model, or a group of models, or how to consistently derive guidance for Geant4 model development and improvement from a wide range of available experimental data. We have designed and implemented a comprehensive, modular, user-friendly software toolkit to study and address such questions. It allows one to easily modify parameters of one or several Geant4 physics models involved in the simulation, and to perform collective analysis of multiple variants of the resulting physics observables of interest and comparison against a variety of corresponding experimental data. Based on modern event-processing infrastructure software, the toolkit offers a variety of attractive features, e.g. flexible run-time configurable workflow, comprehensive bookkeeping, easy to expand collection of analytical components. Design, implementation technology, and key functionalities of the toolkit are presented and illustrated with results obtained with Geant4 key hadronic models.« less

Forecasting the use of elderly care: a static micro-simulation model.

PubMed

Eggink, Evelien; Woittiez, Isolde; Ras, Michiel

2016-07-01

This paper describes a model suitable for forecasting the use of publicly funded long-term elderly care, taking into account both ageing and changes in the health status of the population. In addition, the impact of socioeconomic factors on care use is included in the forecasts. The model is also suitable for the simulation of possible implications of some specific policy measures. The model is a static micro-simulation model, consisting of an explanatory model and a population model. The explanatory model statistically relates care use to individual characteristics. The population model mimics the composition of the population at future points in time. The forecasts of care use are driven by changes in the composition of the population in terms of relevant characteristics instead of dynamics at the individual level. The results show that a further 37 % increase in the use of elderly care (from 7 to 9 % of the Dutch 30-plus population) between 2008 and 2030 can be expected due to a further ageing of the population. However, the use of care is expected to increase less than if it were based on the increasing number of elderly only (+70 %), due to decreasing disability levels and increasing levels of education. As an application of the model, we simulated the effects of restricting access to residential care to elderly people with severe physical disabilities. The result was a lower growth of residential care use (32 % instead of 57 %), but a somewhat faster growth in the use of home care (35 % instead of 32 %).

[Experiencing dementia: evaluation of Into D'mentia].

PubMed

Hattink, Bart J J; Meiland, Franka J M; Campman, Carlijn A M; Rietsema, Jan; Sitskoorn, Margriet; Dröes, Rose-Marie

2015-10-01

Most persons with dementia in the Netherlands live at home, where they are cared for by informal carers such as family members or friends, who offer this care unpaid. Their care-task poses a high burden on these informal carers, increasing the risk of health problems and social isolation. Many informal carers indicate they want more information on the behaviour of those they care for. To develop and evaluate Into D'mentia, a simulation set in a living kitchen in which visitors experience a day in the life of someone with dementia. During this 'day', modern techniques such as sensors and projections, simulate the limitations of having dementia. This intervention is evaluated on usefulness and user friendliness, and on its effect on empathy, attitudes towards dementia, coping, carer burden, person-centered care capabilities and care satisfaction. Nine informal carers and 23 care professionals took part in the research into the Into D'mentia simulation. Before and after their visit, they filled in several questionnaires, with, among others, their opinion on the usefulness and user friendliness of this experience. Participants found Into D'mentia a highly useful and user friendly development. They indicated that the simulation offered good insight in the life of someone with dementia, and that they could offer better care thanks to this experience. Participants also indicated that they often thought back on their experiences in the simulation, in order to better understand the behaviour of people with dementia. Into D'mentia offers a unique, accessible way to experience the limitations dementia has on daily life. Users indicate that it is a useful and user friendly innovation. Into D'mentia appears to be a suitable method to support informal and professional caregivers.

Safer@home-Simulation and training: the study protocol of a qualitative action research design.

PubMed

Wiig, Siri; Guise, Veslemøy; Anderson, Janet; Storm, Marianne; Lunde Husebø, Anne Marie; Testad, Ingelin; Søyland, Elsa; Moltu, Kirsti L

2014-07-29

While it is predicted that telecare and other information and communication technology (ICT)-assisted services will have an increasingly important role in future healthcare services, their implementation in practice is complex. For implementation of telecare to be successful and ensure quality of care, sufficient training for staff (healthcare professionals) and service users (patients) is fundamental. Telecare training has been found to have positive effects on attitudes to, sustained use of, and outcomes associated with telecare. However, the potential contribution of training in the adoption, quality and safety of telecare services is an under-investigated research field. The overall aim of this study is to develop and evaluate simulation-based telecare training programmes to aid the use of videophone technology in elderly home care. Research-based training programmes will be designed for healthcare professionals, service users and next of kin, and the study will explore the impact of training on adoption, quality and safety of new telecare services. The study has a qualitative action research design. The research will be undertaken in close collaboration with a multidisciplinary team consisting of researchers and managers and clinical representatives from healthcare services in two Norwegian municipalities, alongside experts in clinical education and simulation, as well as service user (patient) representatives. The qualitative methods used involve focus group interviews, semistructured interviews, observation and document analysis. To ensure trustworthiness in the data analysis, we will apply member checks and analyst triangulation; in addition to providing contextual and sample description to allow for evaluation of transferability of our results to other contexts and groups. The study is approved by the Norwegian Social Science Data Services. The study is based on voluntary participation and informed written consent. Informants can withdraw at any point in time. The results will be disseminated at research conferences, peer review journals, one PhD thesis and through public presentations to people outside the scientific community. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Design and development of a virtual reality simulator for advanced cardiac life support training.

PubMed

Vankipuram, Akshay; Khanal, Prabal; Ashby, Aaron; Vankipuram, Mithra; Gupta, Ashish; DrummGurnee, Denise; Josey, Karen; Smith, Marshall

2014-07-01

The use of virtual reality (VR) training tools for medical education could lead to improvements in the skills of clinicians while providing economic incentives for healthcare institutions. The use of VR tools can also mitigate some of the drawbacks currently associated with providing medical training in a traditional clinical environment such as scheduling conflicts and the need for specialized equipment (e.g., high-fidelity manikins). This paper presents the details of the framework and the development methodology associated with a VR-based training simulator for advanced cardiac life support, a time critical, team-based medical scenario. In addition, we also report the key findings of a usability study conducted to assess the efficacy of various features of this VR simulator through a postuse questionnaire administered to various care providers. The usability questionnaires were completed by two groups that used two different versions of the VR simulator. One version consisted of the VR trainer with it all its features and a minified version with certain immersive features disabled. We found an increase in usability scores from the minified group to the full VR group.

RF Simulation of the 187 MHz CW Photo-RF Gun Cavity at LBNL

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, Tong-Ming

2008-12-01

A 187 MHz normal conducting Photo-RF gun cavity is designed for the next generation light sources. The cavity is capable of operating in CW mode. As high as 750 kV gap voltage can be achieved with a 20 MV/m acceleration gradient. The original cavity optimization is conducted using Superfish code (2D) by Staples. 104 vacuum pumping slots are added and evenly spaced over the cavity equator in order to achieve better than 10 -10-Tor of vacuum. Two loop couplers will be used to feed RF power into the cavity. 3D simulations are necessary to study effects from the vacuum pumpingmore » slots, couplers and possible multipactoring. The cavity geometry is optimized to minimize the power density and avoid multipactoring at operating field level. The vacuum slot dimensions are carefully chosen in consideration of both the vacuum conduction, local power density enhancement and the power attenuation at the getter pumps. This technical note gives a summary of 3D RF simulation results, multipactoring simulations (2D) and preliminary electromagnetic-thermal analysis using ANSYS code.« less

The History of Simulation and Its Impact on the Future.

PubMed

Aebersold, Michelle

2016-02-01

Simulation has had a long and varied history in many different fields, including aviation and the military. A look into the past to briefly touch on some of the major historical aspects of simulation in aviation, military, and health care will give readers a broader understanding of simulation's historical roots and the relationship to patient safety. This review may also help predict what the future may hold for simulation in nursing. Health care, like aviation, is driven by safety, more specifically patient safety. As the link between simulation and patient safety becomes increasingly apparent, simulation will be adopted as the education and training method of choice for such critical behaviors as communication and teamwork skills.

An interactive learning environment for health care professionals.

PubMed Central

Cobbs, E.; Pincetl, P.; Silverman, B.; Liao, R. L.; Motta, C.

1994-01-01

This article summarizes experiences to date with building and deploying a clinical simulator that medical students use as part of a 3rd year primary care rotation. The simulated microworld helps students and health care professionals gain experience with and learn meta-cognitive skills for the care of complex patient populations that require treatment in the biopsychosocial-value dimensions. We explain lessons learned and next steps resulting from use of the program by over 300 users to date. PMID:7949975

Simulation Suggests That Medical Group Mergers Won’t Undermine The Potential Utility Of Health Information Exchanges

PubMed Central

Schneider, Eric C.; Volk, Lynn A.; Szolovits, Peter; Salzberg, Claudia A.; Simon, Steven R.; Bates, David W.

2013-01-01

Substantial resources are being invested in health information exchanges (HIE), community-based consortia that enable independent health-care organizations to exchange clinical data. However, under pressure to form accountable care organizations, medical groups may merge and support private HIE, reducing the potential utility of community HIEs. Simulations of “care transitions” based on data from 10 Massachusetts communities suggest that mergers would have to be considerable to substantially reduce the potential utility of an HIE. Nonetheless, simulations also suggest that HIEs will need to recruit a large proportion of the medical groups in a community, as hospitals and the largest groups account for only 10 to 20% of care transitions in communities. PMID:22392665

Improving Collaboration Among Social Work and Nursing Students Through Interprofessional Simulation.

PubMed

Kuehn, Mary Beth; Huehn, Susan; Smalling, Susan

2017-08-01

This project implemented first-time simulation with nursing and social work students. Students participated in a contextual learning experience through a patient simulation of interprofessional practice as a health care team member and reflection through debriefing and open response comments. Simulation offers a means to practice interprofessional collaboration prior to entering practice. Participants reported an increased understanding of the scope of practice of other team members through their reflections following simulation. In addition, participants reported increased comprehension of team dynamics and their relationship to improved patient care. Overall, the simulation encouraged development of the skills necessary to function as part of a collaborative, interprofessional team.

The use of computers for perioperative simulation in anesthesia, critical care, and pain medicine.

PubMed

Lambden, Simon; Martin, Bruce

2011-09-01

Simulation in perioperative anesthesia training is a field of considerable interest, with an urgent need for tools that reliably train and facilitate objective assessment of performance. This article reviews the available simulation technologies, their evolution, and the current evidence base for their use. The future directions for research in the field and potential applications of simulation technology in anesthesia, critical care, and pain medicine are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

Confident but not theoretically grounded – experienced simulation educators’ perceptions of their own professional development

PubMed Central

Allvin, Renée; Berndtzon, Magnus; Carlzon, Liisa; Edelbring, Samuel; Hult, Håkan; Hultin, Magnus; Karlgren, Klas; Masiello, Italo; Södersved Källestedt, Marie-Louise; Tamás, Éva

2017-01-01

Background Medical simulation enables the design of learning activities for competency areas (eg, communication and leadership) identified as crucial for future health care professionals. Simulation educators and medical teachers follow different career paths, and their education backgrounds and teaching contexts may be very different in a simulation setting. Although they have a key role in facilitating learning, information on the continuing professional development (pedagogical development) of simulation educators is not available in the literature. Objectives To explore changes in experienced simulation educators’ perceptions of their own teaching skills, practices, and understanding of teaching over time. Methods A qualitative exploratory study. Fourteen experienced simulation educators participated in individual open-ended interviews focusing on their development as simulation educators. Data were analyzed using an inductive thematic analysis. Results Marked educator development was discerned over time, expressed mainly in an altered way of thinking and acting. Five themes were identified: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession. Being confident in the role as an instructor seemed to constitute a foundation for the instructor’s pedagogical development. Conclusion Experienced simulation educators’ pedagogical development was based on self-confidence in the educator role, and not on a deeper theoretical understanding of teaching and learning. This is the first clue to gain increased understanding regarding educational level and possible education needs among simulation educators, and it might generate several lines of research for further studies. PMID:28176931

The economics of treatment for infants with respiratory distress syndrome.

PubMed

Neil, N; Sullivan, S D; Lessler, D S

1998-01-01

To define clinical outcomes and prevailing patterns of care for the initial hospitalization of infants at greatest risk for respiratory distress syndrome (RDS); to estimate direct medical care costs associated with the initial hospitalization; and to introduce and demonstrate a simulation technique for the economic evaluation of health care technologies. Clinical outcomes and usual-care algorithms were determined for infants with RDS in three birthweight categories (500-1,000g; >1,000-1,500g; and >1,500g) using literature- and expert-panel-based data. The experts were practitioners from major U.S. hospitals who were directly involved in the clinical care of such infants. Using the framework derived from the usual care patterns and outcomes, the authors developed an itemized "micro-costing" economic model to simulate the costs associated with the initial hospitalization of a hypothetical RDS patient. The model is computerized and dynamic; unit costs, frequencies, number of days, probabilities and population multipliers are all variable and can be modified on the basis of new information or local conditions. Aggregated unit costs are used to estimate the expected medical costs of treatment per patient. Expected costs of initial hospitalization per uncomplicated surviving infant with RDS were estimated to be $101,867 for 500-1,000g infants; $64,524 for >1,000-1,500g infants; and $27,224 for >1,500g infants. Incremental costs of complications among survivors were estimated to be $22,155 (500-1,000g); $11,041 (>1,000-1,500g); and $2,448 (>1,500 g). Expected costs of initial hospitalization per case (including non-survivors) were $100,603; $72,353; and $28,756, respectively. An itemized model such as the one developed here serves as a benchmark for the economic assessment of treatment costs and utilization. Moreover, it offers a powerful tool for the prospective evaluation of new technologies or procedures designed to reduce the incidence of, severity of, and/or total hospital resource use ascribed to RDS.

The Development of Patient Scheduling Groups for an Effective Appointment System

PubMed Central

2016-01-01

Summary Background Patient access to care and long wait times has been identified as major problems in outpatient delivery systems. These aspects impact medical staff productivity, service quality, clinic efficiency, and health-care cost. Objectives This study proposed to redesign existing patient types into scheduling groups so that the total cost of clinic flow and scheduling flexibility was minimized. The optimal scheduling group aimed to improve clinic efficiency and accessibility. Methods The proposed approach used the simulation optimization technique and was demonstrated in a Primary Care physician clinic. Patient type included, emergency/urgent care (ER/UC), follow-up (FU), new patient (NP), office visit (OV), physical exam (PE), and well child care (WCC). One scheduling group was designed for this physician. The approach steps were to collect physician treatment time data for each patient type, form the possible scheduling groups, simulate daily clinic flow and patient appointment requests, calculate costs of clinic flow as well as appointment flexibility, and find the scheduling group that minimized the total cost. Results The cost of clinic flow was minimized at the scheduling group of four, an 8.3% reduction from the group of one. The four groups were: 1. WCC, 2. OV, 3. FU and ER/UC, and 4. PE and NP. The cost of flexibility was always minimized at the group of one. The total cost was minimized at the group of two. WCC was considered separate and the others were grouped together. The total cost reduction was 1.3% from the group of one. Conclusions This study provided an alternative method of redesigning patient scheduling groups to address the impact on both clinic flow and appointment accessibility. Balance between them ensured the feasibility to the recognized issues of patient service and access to care. The robustness of the proposed method on the changes of clinic conditions was also discussed. PMID:27081406

Educational potential of a virtual patient system for caring for traumatized patients in primary care

PubMed Central

2013-01-01

Background Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC). Methods A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system’s usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data. Results Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results. Conclusions Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on improving clinical diagnosis and treatment of the traumatized refugee patient. PMID:23957962

Impact of a novel training experience on the development of a customer service culture in a large hospital trust.

PubMed

Eales-Reynolds, Lesley-Jane; Clarke, Colin

2012-01-01

This study was designed with the intention of exploring the effectiveness of a novel approach to training health services workers to meet the aims of raising awareness of their customer care framework and encouraging a culture of customer service throughout their organisation. The impact of the educational intervention was examined using a mixed methods approach involving pre- and post-workshop questionnaires and one-to-one, semi-structured interviews. The paper finds that the approach adopted was effective in raising awareness of the customer care framework and in enhancing participant's self-efficacy in relation to the principles of customer care. Transference to the workplace was dependent on personality and departments having sufficient numbers of staff participating. Time and resources for the project limited the follow-up interviews designed to explore if, and to what extent, the learning had had a lasting impact on participants and if it had enabled transference to the workplace. In addition, complications in releasing people from work in order to take part meant that a number of volunteers had to withdraw. This limits the range of data obtained. This paper describes a novel research-informed approach to training, involving participants in high fidelity, error-based simulations and in a research process which facilitated their repeated reflection on the learning. As a result the paper demonstrates large-scale training of customer care can effectively impact on practice.

Haemophilia at various stages of life: design of new therapeutic strategies through an interactive course - the Kogeniale project

PubMed Central

Santagostino, Elena; Messina, Maria; Tagliaferri, Annarita; Iorio, Alfonso; Morfini, Massimo

2013-01-01

Background High-quality evidence is lacking in several areas of haemophilia treatment, in part because little time is allocated to the treatment and care of haemophilia in university education in Italy. Physicians caring for patients with haemophilia must, therefore, rely on their information on background pathophysiology and more experienced colleagues. This makes diagnostic and therapeutic choices difficult, especially when the patient has concomitant disorders or psychological issues. Material and methods This article describes a course to educate young physicians who were already engaged in the management of haemophilia on the emerging and unmet issues of haemophilia care and to implement existing guidelines. Physicians (n=53) already caring for patients with haemophilia in their haematology, internal medicine, or paediatric practices in Italy attended the course. Problem-solving group activity and open discussion were the methods chosen to formulate consensus statements. During the specifically designed interactive course, three clinical cases were simulated: a young child with congenital dislocation of the hip, an adolescent refusing prophylactic treatment, and an elderly man with cardiovascular disorders. The physicians were asked questions during the course and, through a Wi-Fi console, were able to answer and discuss each case interactively. Results Following discussion of each case, agreement was reached regarding general statements on the management of patients with severe haemophilia A in the three different age ranges considered. Discussion This project helped to outline useful decision-making tools for handling diagnostic and treatment issues in the field of haemophilia. PMID:23399360

Collaborative virtual reality based advanced cardiac life support training simulator using virtual reality principles.

PubMed

Khanal, Prabal; Vankipuram, Akshay; Ashby, Aaron; Vankipuram, Mithra; Gupta, Ashish; Drumm-Gurnee, Denise; Josey, Karen; Tinker, Linda; Smith, Marshall

2014-10-01

Advanced Cardiac Life Support (ACLS) is a series of team-based, sequential and time constrained interventions, requiring effective communication and coordination of activities that are performed by the care provider team on a patient undergoing cardiac arrest or respiratory failure. The state-of-the-art ACLS training is conducted in a face-to-face environment under expert supervision and suffers from several drawbacks including conflicting care provider schedules and high cost of training equipment. The major objective of the study is to describe, including the design, implementation, and evaluation of a novel approach of delivering ACLS training to care providers using the proposed virtual reality simulator that can overcome the challenges and drawbacks imposed by the traditional face-to-face training method. We compare the efficacy and performance outcomes associated with traditional ACLS training with the proposed novel approach of using a virtual reality (VR) based ACLS training simulator. One hundred and forty-eight (148) ACLS certified clinicians, translating into 26 care provider teams, were enrolled for this study. Each team was randomly assigned to one of the three treatment groups: control (traditional ACLS training), persuasive (VR ACLS training with comprehensive feedback components), or minimally persuasive (VR ACLS training with limited feedback components). The teams were tested across two different ACLS procedures that vary in the degree of task complexity: ventricular fibrillation or tachycardia (VFib/VTach) and pulseless electric activity (PEA). The difference in performance between control and persuasive groups was not statistically significant (P=.37 for PEA and P=.1 for VFib/VTach). However, the difference in performance between control and minimally persuasive groups was significant (P=.05 for PEA and P=.02 for VFib/VTach). The pre-post comparison of performances of the groups showed that control (P=.017 for PEA, P=.01 for VFib/VTach) and persuasive (P=.02 for PEA, P=.048 for VFib/VTach) groups improved their performances significantly, whereas minimally persuasive group did not (P=.45 for PEA, P=.46 for VFib/VTach). Results also suggest that the benefit of persuasiveness is constrained by the potentially interruptive nature of these features. Our results indicate that the VR-based ACLS training with proper feedback components can provide a learning experience similar to face-to-face training, and therefore could serve as a more easily accessed supplementary training tool to the traditional ACLS training. Our findings also suggest that the degree of persuasive features in VR environments have to be designed considering the interruptive nature of the feedback elements. Copyright © 2014 Elsevier Inc. All rights reserved.

Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial.

PubMed

Cheng, Adam; Hunt, Elizabeth A; Donoghue, Aaron; Nelson-McMillan, Kristen; Nishisaki, Akira; Leflore, Judy; Eppich, Walter; Moyer, Mike; Brett-Fleegler, Marisa; Kleinman, Monica; Anderson, Jodee; Adler, Mark; Braga, Matthew; Kost, Susanne; Stryjewski, Glenn; Min, Steve; Podraza, John; Lopreiato, Joseph; Hamilton, Melinda Fiedor; Stone, Kimberly; Reid, Jennifer; Hopkins, Jeffrey; Manos, Jennifer; Duff, Jonathan; Richard, Matthew; Nadkarni, Vinay M

2013-06-01

Resuscitation training programs use simulation and debriefing as an educational modality with limited standardization of debriefing format and content. Our study attempted to address this issue by using a debriefing script to standardize debriefings. To determine whether use of a scripted debriefing by novice instructors and/or simulator physical realism affects knowledge and performance in simulated cardiopulmonary arrests. DESIGN Prospective, randomized, factorial study design. The study was conducted from 2008 to 2011 at 14 Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing (EXPRESS) network simulation programs. Interprofessional health care teams participated in 2 simulated cardiopulmonary arrests, before and after debriefing. We randomized 97 participants (23 teams) to nonscripted low-realism; 93 participants (22 teams) to scripted low-realism; 103 participants (23 teams) to nonscripted high-realism; and 94 participants (22 teams) to scripted high-realism groups. INTERVENTION Participants were randomized to 1 of 4 arms: permutations of scripted vs nonscripted debriefing and high-realism vs low-realism simulators. Percentage difference (0%-100%) in multiple choice question (MCQ) test (individual scores), Behavioral Assessment Tool (BAT) (team leader performance), and the Clinical Performance Tool (CPT) (team performance) scores postintervention vs preintervention comparison (PPC). There was no significant difference at baseline in nonscripted vs scripted groups for MCQ (P = .87), BAT (P = .99), and CPT (P = .95) scores. Scripted debriefing showed greater improvement in knowledge (mean [95% CI] MCQ-PPC, 5.3% [4.1%-6.5%] vs 3.6% [2.3%-4.7%]; P = .04) and team leader behavioral performance (median [interquartile range (IQR)] BAT-PPC, 16% [7.4%-28.5%] vs 8% [0.2%-31.6%]; P = .03). Their improvement in clinical performance during simulated cardiopulmonary arrests was not significantly different (median [IQR] CPT-PPC, 7.9% [4.8%-15.1%] vs 6.7% [2.8%-12.7%], P = .18). Level of physical realism of the simulator had no independent effect on these outcomes. The use of a standardized script by novice instructors to facilitate team debriefings improves acquisition of knowledge and team leader behavioral performance during subsequent simulated cardiopulmonary arrests. Implementation of debriefing scripts in resuscitation courses may help to improve learning outcomes and standardize delivery of debriefing, particularly for novice instructors.

A utility-based design for randomized comparative trials with ordinal outcomes and prognostic subgroups.

PubMed

Murray, Thomas A; Yuan, Ying; Thall, Peter F; Elizondo, Joan H; Hofstetter, Wayne L

2018-01-22

A design is proposed for randomized comparative trials with ordinal outcomes and prognostic subgroups. The design accounts for patient heterogeneity by allowing possibly different comparative conclusions within subgroups. The comparative testing criterion is based on utilities for the levels of the ordinal outcome and a Bayesian probability model. Designs based on two alternative models that include treatment-subgroup interactions are considered, the proportional odds model and a non-proportional odds model with a hierarchical prior that shrinks toward the proportional odds model. A third design that assumes homogeneity and ignores possible treatment-subgroup interactions also is considered. The three approaches are applied to construct group sequential designs for a trial of nutritional prehabilitation versus standard of care for esophageal cancer patients undergoing chemoradiation and surgery, including both untreated patients and salvage patients whose disease has recurred following previous therapy. A simulation study is presented that compares the three designs, including evaluation of within-subgroup type I and II error probabilities under a variety of scenarios including different combinations of treatment-subgroup interactions. © 2018, The International Biometric Society.

Assessing older adults' perceptions of sensor data and designing visual displays for ambient environments. An exploratory study.

PubMed

Reeder, B; Chung, J; Le, T; Thompson, H; Demiris, G

2014-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records". Our objectives were to: 1) characterize older adult participants' perceived usefulness of in-home sensor data and 2) develop novel visual displays for sensor data from Ambient Assisted Living environments that can become part of electronic health records. Semi-structured interviews were conducted with community-dwelling older adult participants during three and six-month visits. We engaged participants in two design iterations by soliciting feedback about display types and visual displays of simulated data related to a fall scenario. Interview transcripts were analyzed to identify themes related to perceived usefulness of sensor data. Thematic analysis identified three themes: perceived usefulness of sensor data for managing health; factors that affect perceived usefulness of sensor data and; perceived usefulness of visual displays. Visual displays were cited as potentially useful for family members and health care providers. Three novel visual displays were created based on interview results, design guidelines derived from prior AAL research, and principles of graphic design theory. Participants identified potential uses of personal activity data for monitoring health status and capturing early signs of illness. One area for future research is to determine how visual displays of AAL data might be utilized to connect family members and health care providers through shared understanding of activity levels versus a more simplified view of self-management. Connecting informal and formal caregiving networks may facilitate better communication between older adults, family members and health care providers for shared decision-making.

Optimization of solenoid based low energy beam transport line for high current H+ beams

NASA Astrophysics Data System (ADS)

Pande, R.; Singh, P.; Rao, S. V. L. S.; Roy, S.; Krishnagopal, S.

2015-02-01

A 20 MeV, 30 mA CW proton linac is being developed at BARC, Mumbai. This linac will consist of an ECR ion source followed by a Radio Frequency Quadrupole (RFQ) and Drift tube Linac (DTL). The low energy beam transport (LEBT) line is used to match the beam from the ion source to the RFQ with minimum beam loss and increase in emittance. The LEBT is also used to eliminate the unwanted ions like H2+ and H3+ from entering the RFQ. In addition, space charge compensation is required for transportation of such high beam currents. All this requires careful design and optimization. Detailed beam dynamics simulations have been done to optimize the design of the LEBT using the Particle-in-cell code TRACEWIN. We find that with careful optimization it is possible to transport a 30 mA CW proton beam through the LEBT with 100% transmission and minimal emittance blow up, while at the same time suppressing unwanted species H2+ and H3+ to less than 3.3% of the total beam current.

Advanced reliability modeling of fault-tolerant computer-based systems

NASA Technical Reports Server (NTRS)

Bavuso, S. J.

1982-01-01

Two methodologies for the reliability assessment of fault tolerant digital computer based systems are discussed. The computer-aided reliability estimation 3 (CARE 3) and gate logic software simulation (GLOSS) are assessment technologies that were developed to mitigate a serious weakness in the design and evaluation process of ultrareliable digital systems. The weak link is based on the unavailability of a sufficiently powerful modeling technique for comparing the stochastic attributes of one system against others. Some of the more interesting attributes are reliability, system survival, safety, and mission success.

Response of lead-acid batteries to chopper-controlled discharge: Preliminary results

NASA Technical Reports Server (NTRS)

Cataldo, R. L.

1978-01-01

The preliminary results of simulated electric vehicle, chopper, speed controller discharge of a battery show energy output losses up to 25 percent compared to constant current discharges at the same average discharge current of 100 amperes. These energy losses are manifested as temperature rises during discharge, amounting to a two-fold increase for a 400-ampere pulse compared to the constant current case. Because of the potentially large energy inefficiency, the results suggest that electric vehicle battery/speed controller interaction must be carefully considered in vehicle design.

Response of lead-acid batteries to chopper-controlled discharge

NASA Technical Reports Server (NTRS)

Cataldo, R. L.

1978-01-01

The preliminary results of simulated electric vehicle, chopper, speed controller discharge of a battery show energy output losses at up to 25 percent compared to constant current discharges at the same average discharge current of 100 A. These energy losses are manifested as temperature rises during discharge, amounting to a two-fold increase for a 400-A pulse compared to the constant current case. Because of the potentially large energy inefficiency, the results suggest that electric vehicle battery/speed controller interaction must be carefully considered in vehicle design.

Breaking Bad News in obstetrics: a randomized trial of simulation followed by debriefing or lecture.

PubMed

Karkowsky, Chavi Eve; Landsberger, Ellen J; Bernstein, Peter S; Dayal, Ashlesha; Goffman, Dena; Madden, Robert C; Chazotte, Cynthia

2016-11-01

Although communication skills represent an increasingly important aspect of medical care, little has been done to assess the best method of teaching these skills. Our study was designed to assess simulation-debriefing compared to lecture in teaching skills for Breaking Bad News (BBN) in obstetrics. This is a randomized prospective trial of house staff from a large academic medical center. Subjects initially underwent baseline simulation, followed by evaluation on BBN skills by themselves, a faculty observer, and the standardized patient (SP). The subjects were then immediately randomized to a debriefing session by faculty or to a lecture about BBN. Subsequently, both groups underwent a second simulation with the same three assessments, yielding post-intervention data. 35 subjects completed both simulations. Both debriefing and lecture curricula showed improvement in scores by self (p = 0.010) and faculty (p < 0.001). The debriefing group improved significantly more than the lecture group for self-evaluation; additionally, improvements were greater for the debrief group in verbal and nonverbal skills. Long-term follow-up three months after both interventions demonstrated continued improvement in BBN. Simulation training with debriefing is effective for teaching communication skills, and superior to lecture for self-perceived improvement. Long-term follow-up suggested retention of confidence in BBN skills.

Exploring student nurses' attitudes towards those who are obese and whether these attitudes change following a simulated activity.

PubMed

Hunter, Janet; Rawlings-Anderson, Karen; Lindsay, Tracy; Bowden, Tracey; Aitken, Leanne M

2018-06-01

As the prevalence of obesity increases worldwide the field of bariatric medicine has emerged, focussing on the causes, prevention and treatment of obesity. People who are obese regularly face bias from healthcare professionals, which can negativity impact on care delivery and patient outcomes. The introduction of bariatric empathy suits into simulated practice may enable student nurses to appreciate the needs of, and influence their attitudes towards, obese people. The aim of this study was to explore student nurses' attitudes towards those who are obese and whether these attitudes change following a simulated activity. A mixed methods study incorporating a pre-post design. A UK university which provides pre-registration nursing education. Nursing students in part 1 (n = 39) and part 2 (n = 29) in adult and mental health fields. Part 1 and 2 nursing students completed the "Nurses' attitudes towards obesity and obese patients scale" (NATOOPS) questionnaire. Part 2 students also took part in a simulation activity while wearing a bariatric empathy suit and completed the NATOOPS questionnaire again immediately after the simulation activity. Students who wore the empathy suits were invited to a focus group. Part 1 students reported poorer attitudes on the NATOOPS scale than Part 2 students. After wearing the bariatric empathy suits students reported changed attitudes on the NATOOPS in three areas: response to obese patients, characteristics of obese patients and supportive roles in caring for obese patients. Five themes emerged from the focus groups related to physical and psychological impact of the suits; thinking differently; simulation as a learning experience and challenges and recommendations. Following a structured educational experience student nurses' attitudes were more positive towards obese patients. The characteristics of the educational activity that appeared to influence student nurses' attitudes was related to the "lived experience" of wearing bariatric empathy suits. Copyright © 2018 Elsevier Ltd. All rights reserved.

Decompression scenarios in a new underground transportation system.

PubMed

Vernez, D

2000-10-01

The risks of a public exposure to a sudden decompression, until now, have been related to civil aviation and, at a lesser extent, to diving activities. However, engineers are currently planning the use of low pressure environments for underground transportation. This method has been proposed for the future Swissmetro, a high-speed underground train designed for inter-urban linking in Switzerland. The use of a low pressure environment in an underground public transportation system must be considered carefully regarding the decompression risks. Indeed, due to the enclosed environment, both decompression kinetics and safety measures may differ from aviation decompression cases. A theoretical study of decompression risks has been conducted at an early stage of the Swissmetro project. A three-compartment theoretical model, based on the physics of fluids, has been implemented with flow processing software (Ithink 5.0). Simulations have been conducted in order to analyze "decompression scenarios" for a wide range of parameters, relevant in the context of the Swissmetro main study. Simulation results cover a wide range from slow to explosive decompression, depending on the simulation parameters. Not surprisingly, the leaking orifice area has a tremendous impact on barotraumatic effects, while the tunnel pressure may significantly affect both hypoxic and barotraumatic effects. Calculations have also shown that reducing the free space around the vehicle may mitigate significantly an accidental decompression. Numeric simulations are relevant to assess decompression risks in the future Swissmetro system. The decompression model has proven to be useful in assisting both design choices and safety management.

Generalizing Observational Study Results: Applying Propensity Score Methods to Complex Surveys

PubMed Central

DuGoff, Eva H; Schuler, Megan; Stuart, Elizabeth A

2014-01-01

ObjectiveTo provide a tutorial for using propensity score methods with complex survey data. Data SourcesSimulated data and the 2008 Medical Expenditure Panel Survey. Study DesignUsing simulation, we compared the following methods for estimating the treatment effect: a naïve estimate (ignoring both survey weights and propensity scores), survey weighting, propensity score methods (nearest neighbor matching, weighting, and subclassification), and propensity score methods in combination with survey weighting. Methods are compared in terms of bias and 95 percent confidence interval coverage. In Example 2, we used these methods to estimate the effect on health care spending of having a generalist versus a specialist as a usual source of care. Principal FindingsIn general, combining a propensity score method and survey weighting is necessary to achieve unbiased treatment effect estimates that are generalizable to the original survey target population. ConclusionsPropensity score methods are an essential tool for addressing confounding in observational studies. Ignoring survey weights may lead to results that are not generalizable to the survey target population. This paper clarifies the appropriate inferences for different propensity score methods and suggests guidelines for selecting an appropriate propensity score method based on a researcher’s goal. PMID:23855598

Transient modeling in simulation of hospital operations for emergency response.

PubMed

Paul, Jomon Aliyas; George, Santhosh K; Yi, Pengfei; Lin, Li

2006-01-01

Rapid estimates of hospital capacity after an event that may cause a disaster can assist disaster-relief efforts. Due to the dynamics of hospitals, following such an event, it is necessary to accurately model the behavior of the system. A transient modeling approach using simulation and exponential functions is presented, along with its applications in an earthquake situation. The parameters of the exponential model are regressed using outputs from designed simulation experiments. The developed model is capable of representing transient, patient waiting times during a disaster. Most importantly, the modeling approach allows real-time capacity estimation of hospitals of various sizes and capabilities. Further, this research is an analysis of the effects of priority-based routing of patients within the hospital and the effects on patient waiting times determined using various patient mixes. The model guides the patients based on the severity of injuries and queues the patients requiring critical care depending on their remaining survivability time. The model also accounts the impact of prehospital transport time on patient waiting time.

Simscape Modeling Verification in the Simulink Development Environment

NASA Technical Reports Server (NTRS)

Volle, Christopher E. E.

2014-01-01

The purpose of the Simulation Product Group of the Control and Data Systems division of the NASA Engineering branch at Kennedy Space Center is to provide a realtime model and simulation of the Ground Subsystems participating in vehicle launching activities. The simulation software is part of the Spaceport Command and Control System (SCCS) and is designed to support integrated launch operation software verification, and console operator training. Using Mathworks Simulink tools, modeling engineers currently build models from the custom-built blocks to accurately represent ground hardware. This is time consuming and costly due to required rigorous testing and peer reviews to be conducted for each custom-built block. Using Mathworks Simscape tools, modeling time can be reduced since there would be no custom-code developed. After careful research, the group came to the conclusion it is feasible to use Simscape's blocks in MatLab's Simulink. My project this fall was to verify the accuracy of the Crew Access Arm model developed using Simscape tools running in the Simulink development environment.

Kinetic barriers in the isomerization of substituted ureas: implications for computer-aided drug design.

PubMed

Loeffler, Johannes R; Ehmki, Emanuel S R; Fuchs, Julian E; Liedl, Klaus R

2016-05-01

Urea derivatives are ubiquitously found in many chemical disciplines. N,N'-substituted ureas may show different conformational preferences depending on their substitution pattern. The high energetic barrier for isomerization of the cis and trans state poses additional challenges on computational simulation techniques aiming at a reproduction of the biological properties of urea derivatives. Herein, we investigate energetics of urea conformations and their interconversion using a broad spectrum of methodologies ranging from data mining, via quantum chemistry to molecular dynamics simulation and free energy calculations. We find that the inversion of urea conformations is inherently slow and beyond the time scale of typical simulation protocols. Therefore, extra care needs to be taken by computational chemists to work with appropriate model systems. We find that both knowledge-driven approaches as well as physics-based methods may guide molecular modelers towards accurate starting structures for expensive calculations to ensure that conformations of urea derivatives are modeled as adequately as possible.

Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model: A Web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure.

PubMed

Reed, Shelby D; Neilson, Matthew P; Gardner, Matthew; Li, Yanhong; Briggs, Andrew H; Polsky, Daniel E; Graham, Felicia L; Bowers, Margaret T; Paul, Sara C; Granger, Bradi B; Schulman, Kevin A; Whellan, David J; Riegel, Barbara; Levy, Wayne C

2015-11-01

Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable. We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics; use of evidence-based medications; and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model. Projections of resource use and quality of life are modeled using relationships with time-varying Seattle Heart Failure Model scores. The model can be used to evaluate parallel-group and single-cohort study designs and hypothetical programs. Simulations consist of 10,000 pairs of virtual cohorts used to generate estimates of resource use, costs, survival, and incremental cost-effectiveness ratios from user inputs. The model demonstrated acceptable internal and external validity in replicating resource use, costs, and survival estimates from 3 clinical trials. Simulations to evaluate the cost-effectiveness of heart failure disease management programs across 3 scenarios demonstrate how the model can be used to design a program in which short-term improvements in functioning and use of evidence-based treatments are sufficient to demonstrate good long-term value to the health care system. The Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model provides researchers and providers with a tool for conducting long-term cost-effectiveness analyses of disease management programs in heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

Design of a -1 MV dc UHV power supply for ITER NBI

NASA Astrophysics Data System (ADS)

Watanabe, K.; Yamamoto, M.; Takemoto, J.; Yamashita, Y.; Dairaku, M.; Kashiwagi, M.; Taniguchi, M.; Tobari, H.; Umeda, N.; Sakamoto, K.; Inoue, T.

2009-05-01

Procurement of a dc -1 MV power supply system for the ITER neutral beam injector (NBI) is shared by Japan and the EU. The Japan Atomic Energy Agency as the Japan Domestic Agency (JADA) for ITER contributes to the procurement of dc -1 MV ultra-high voltage (UHV) components such as a dc -1 MV generator, a transmission line and a -1 MV insulating transformer for the ITER NBI power supply. The inverter frequency of 150 Hz in the -1 MV power supply and major circuit parameters have been proposed and adopted in the ITER NBI. The dc UHV insulation has been carefully designed since dc long pulse insulation is quite different from conventional ac insulation or dc short pulse systems. A multi-layer insulation structure of the transformer for a long pulse up to 3600 s has been designed with electric field simulation. Based on the simulation the overall dimensions of the dc UHV components have been finalized. A surge energy suppression system is also essential to protect the accelerator from electric breakdowns. The JADA contributes to provide an effective surge suppression system composed of core snubbers and resistors. Input energy into the accelerator from the power supply can be reduced to about 20 J, which satisfies the design criteria of 50 J in total in the case of breakdown at -1 MV.

Design of a CW high charge state heavy ion RFQ for SSC-LINAC

NASA Astrophysics Data System (ADS)

Liu, G.; Lu, Y. R.; He, Y.; Wang, Z.; Xiao, C.; Gao, S. L.; Yang, Y. Q.; Zhu, K.; Yan, X. Q.; Chen, J. E.; Yuan, Y. J.; Zhao, H. W.

2013-02-01

The new linac injector SSC-LINAC has been proposed to replace the existing Separator Sector Cyclotron (SSC). This effort is to improve the beam efficiency of the Heavy Ion Research Facility of Lanzhou (HIRFL). As a key component of the linac, a continuous-wave (CW) mode high charge state heavy ion radio-frequency quadrupole (RFQ) accelerator has been designed. It accelerates ions with the ratio of mass to charge up to 7 from 3.728 keV/u to 143 keV/u. The requirements of CW mode operation and the transportation of intense beam have been considered as the greatest challenges. The design is based on 238U34+ beams, whose current is 0.5 pmA (0.5 particle mili-ampere, which is the measured 17 emA electric current divided by charge state of heavy ions). It achieves the transmission efficiency of 94% with 2508.46 mm long vanes in simulation. To improve the transmission efficiency and quality of the beams, the phase advance has been taken into account to analyze the reasons of beam loss and emittance growth. Parametric resonance and beam mismatch have been carefully avoided by adjusting the structure parameters. The parameter-sensitivity of the design is checked by transportation simulations of various input beams. To verify the applicability of machining, the effects of different vane manufacturing methods on beam dynamics are presented in this paper.

Factors influencing nurses' attitudes toward simulation-based education.

PubMed

Decarlo, Deborah; Collingridge, Dave S; Grant, Carrie; Ventre, Kathleen M

2008-01-01

To identify barriers to nurses' participation in simulation, and to determine whether prior simulation exposure, professional experience, and practice location influence their tendency to perceive specific issues as barriers. We also sought to identify nurses' educational priorities, and to determine whether these were influenced by years of experience or practice location. We surveyed full-time and part-time nurses in a university-affiliated children's hospital to gather data on professional demographics, simulation exposure, perceived barriers to participation in simulation, and training priorities. A total of 523 of 936 (56%) eligible nurses completed the survey. Binary logistic regression analysis revealed that "simulation is 'not the real thing'" was selected as a barrier more often by nurses with prior simulation experience (P = 0.02), fewer years in practice (P = 0.02), and employment in non-acute care areas of the hospital (P = 0.03). "Unfamiliarity with equipment" was reported more often by nurses with less experience (P = 0.01). "Stressful or intimidating environment" was selected more often by those who work in non-acute care areas (P < 0.01). "Providing opportunities to manage rare events" was suggested as a training priority by nurses with less experience (P = 0.08) and by those practicing in acute care areas (P = 0.03). We identified several barriers to nurses' participation in simulation training. Nurses' tendency to name specific issues as barriers is related to prior simulation exposure, years of experience, and area of hospital practice. Rehearsing rare event management is a priority for less-experienced nurses and those in acute care areas.

Radiative Effects of Carbonaceous and Inorganic Aerosols over California during CalNex and CARES: Observations versus Model Predictions

NASA Astrophysics Data System (ADS)

Vinoj, V.; Fast, J. D.; Liu, Y.

2012-12-01

Aerosols have been identified to be a major contributor to the uncertainty in understanding the present climate. Most of this uncertainty arises due to the lack of knowledge of their micro-physical and chemical properties as well as how to adequately represent their spatial and temporal distributions. Increased process level understanding can be achieved through carefully designed field campaigns and experiments. These measurements can be used to elucidate the aerosol properties, mixing, transport and transformation within the atmosphere and also to validate and improve models that include meteorology-aerosol-chemistry interactions. In the present study, the WRF-Chem model is used to simulate the evolution of carbonaceous and inorganic aerosols and their impact on radiation during May and June of 2010 over California when two field campaigns took place: the California Nexus Experiment (CalNex) and Carbonaceous Aerosol and Radiative Effects Study (CARES). We merged CalNex and CARES data along with data from operational networks such as, California Air Resources Board (CARB's) air quality monitoring network, the Interagency Monitoring of Protected Visual Environments (IMPROVE) network, the AErosol RObotic NETwork (AERONET), and satellites into a common dataset for the Aerosol Modeling Test bed. The resulting combined dataset is used to rigorously evaluate the model simulation of aerosol mass, size distribution, composition, and optical properties needed to understand uncertainties that could affect regional variations in aerosol radiative forcing. The model reproduced many of the diurnal, multi-day, and spatial variations of aerosols as seen in the measurements. However, regionally the performance varied with reasonably good agreement with observations around Los Angeles and Sacramento and poor agreement with observations in the vicinity of Bakersfield (although predictions aloft were much better). Some aerosol species (sulfate and nitrate) were better represented than others (organic matter, black carbon) at many locations. The model also reproduced the observed transport of sea-salt by intrusions of marine air from the Bay Area to Sacramento. The vertical distribution of aerosols was simulated reasonably as evidenced from comparison with observed profiles from the High Spectral Resolution Lidar (HSRL) on the NASA B-200 aircraft, although the values in the boundary layer were too high at times. Consistent with the bias in aerosol mass, the simulated column aerosol optical depths at the AERONET and field campaign sites were often too high. Comparisons between observed and predicted aerosol optical depth and single scattering albedo will be presented. Using aerosol observations as a constraint, we will present the radiative effect of simulated aerosols and its sensitivity to the uncertainties in predicted aerosol properties.

The Postoperative Pain Assessment Skills pilot trial.

PubMed

McGillion, Michael; Dubrowski, Adam; Stremler, Robyn; Watt-Watson, Judy; Campbell, Fiona; McCartney, Colin; Victor, Charles; Wiseman, Jeffrey; Snell, Linda; Costello, Judy; Robb, Anja; Nelson, Sioban; Stinson, Jennifer; Hunter, Judith; Dao, Thuan; Promislow, Sara; McNaughton, Nancy; White, Scott; Shobbrook, Cindy; Jeffs, Lianne; Mauch, Kianda; Leegaard, Marit; Beattie, W Scott; Schreiber, Martin; Silver, Ivan

2011-01-01

BACKGROUND⁄ Pain-related misbeliefs among health care professionals (HCPs) are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs) have been effectively used to improve HCPs' assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method - deteriorating patient-based simulation (DPS) - versus SPs for improving HCPs' pain knowledge and assessment skills. Seventy-two HCPs were randomly assigned to a 3 h SP or DPS simulation intervention. Measures were recorded at baseline, immediate postintervention and two months postintervention. The primary outcome was HCPs' pain assessment performance as measured by the postoperative Pain Assessment Skills Tool (PAST). Secondary outcomes included HCPs knowledge of pain-related misbeliefs, and perceived satisfaction and quality of the simulation. These outcomes were measured by the Pain Beliefs Scale (PBS), the Satisfaction with Simulated Learning Scale (SSLS) and the Simulation Design Scale (SDS), respectively. Student's t tests were used to test for overall group differences in postintervention PAST, SSLS and SDS scores. One-way analysis of covariance tested for overall group differences in PBS scores. DPS and SP groups did not differ on post-test PAST, SSLS or SDS scores. Knowledge of pain-related misbeliefs was also similar between groups. These pilot data suggest that DPS is an effective simulation alternative for HCPs' education on postoperative pain assessment, with improvements in performance and knowledge comparable with SP-based simulation. An equivalence trial to examine the effectiveness of deteriorating patient-based simulation versus standardized patients is warranted.

[High fidelity simulation : a new tool for learning and research in pediatrics].

PubMed

Bragard, I; Farhat, N; Seghaye, M-C; Schumacher, K

2016-10-01

Caring for a sick child represents a high risk activity that requires technical and non-technical skills related to several factors such as the rarity of certain events or the stress of caring for a child. As regard these conditions, medi¬cal simulation provides a learning environment without risk, the control of variables, the reproducibility of situations, and the confrontation with rare events. In this article, we des¬cribe the steps of a simulation session and outline the current knowledge of the use of simulation in paediatrics. A session of simulation includes seven phases following the model of Peter Dieckmann, particularly the scenario and the debriefing that form the heart of the learning experience. Several studies have shown the advantages of simulation for paediatric trai¬ning in terms of changes in attitudes, skills and knowledge. Some studies have demonstrated a beneficial transfer to prac¬tice. In conclusion, simulation provides great potential for training and research in paediatrics. The establishment of a collaborative research program by the whole simulation com¬munity would help ensure that this type of training improves the quality of care.

Enhancing nursing informatics competencies and critical thinking skills using wireless clinical simulation laboratories.

PubMed

Cholewka, Patricia A; Mohr, Bernard

2009-01-01

Nursing students at New York City College of Technology are assigned client care experiences that focus on common alterations in health status. However, due to the unpredictability of client census within any healthcare facility, it is not possible for all students to have the same opportunity to care for clients with specific medical conditions. But with the use of patient simulators in a dedicated Clinical Simulation Laboratory setting, students can be universally, consistently, and repeatedly exposed to programmed scenarios that connect theory with the clinical environment. Outcomes from using patient simulators include improved nursing knowledge base, enhanced critical thinking, reflective learning, and increased understanding of information technology for using a Personal Digital Assistant and documenting care by means of an electronic Patient Record System. An innovative nursing education model using a wireless, inter-connective data network was developed by this college in response to the need for increasing nursing informatics competencies and critical thinking skills by students in preparation for client care.

Zeitgeists and development trends in long-term care facility design.

PubMed

Wang, Chia-Hui; Kuo, Nai-Wen

2006-06-01

Through literature analysis, in-depth interviews, and the application of the Delphi survey, this study explored long-term care resident priorities with regard to long-term care facility design in terms of both physical and psychological needs. This study further clarified changing trends in long-term care concepts; illustrated the impact that such changes are having on long-term care facility design; and summarized zeitgeists related to the architectural design of long-term care facilities. Results of our Delphi survey indicated the following top five priorities in long-term care facility design: (1) creating a home-like feeling; (2) adhering to Universal Design concepts; (3) providing well-defined private sleeping areas; (4) providing adequate social space; and (5) decentralizing residents' rooms into clusters. The three major zeitgeists related to long-term care facility design include: (1) modern long-term care facilities should abandon their traditional "hospital" image and gradually reposition facilities into homelike settings; (2) institution-based care for the elderly should be de-institutionalized under the concept of aging-in-place; and (3) living clusters, rather than traditional hospital-like wards, should be designed into long-term care facilities.

Using multimedia virtual patients to enhance the clinical curriculum for medical students.

PubMed

McGee, J B; Neill, J; Goldman, L; Casey, E

1998-01-01

Changes in the environment in which clinical medical education takes place in the United States has profoundly affected the quality of the learning experience. A shift to out-patient based care, minimization of hospitalization time, and shrinking clinical revenues has changed the teaching hospital or "classroom" to a degree that we must develop innovative approaches to medical education. One solution is the Virtual Patient Project. Utilizing state-of-the-art computer-based multimedia technology, we are building a library of simulated patient encounters that will serve to fill some of the educational gaps that the current health care system has created. This project is part of a newly formed and unique organization, the Harvard Medical School-Beth Israel Deaconess Mount Auburn Institute for Education and Research (the Institute), which supports in-house educational design, production, and faculty time to create Virtual Patients. These problem-based clinical cases allow the medical student to evaluate a patient at initial presentation, order diagnostic tests, observe the outcome and obtain context-sensitive feedback through a computer program designed at the Institute. Multimedia technology and authoring programs have reached a level of sophistication to allow content experts (the teaching faculty) to design and create the majority of the program themselves and to allow students to adapt the program to their individual learning needs.

A prototype Crew Medical Restraint System (CMRS) for Space Station Freedom

NASA Technical Reports Server (NTRS)

Johnston, S. L.; Eichstadt, F. T.; Billica, R. D.

1992-01-01

The Crew Medical Restrain System (CMRS) is a prototype system designed and developed for use as a universally deployable medical restraint/workstation on Space Station Freedom (SSF), the Shuttle Transportation System (STS), and the Assured Crew Rescue Vehicle (ACRV) for support of an ill or injured crewmember requiring stabilization and transportation to Earth. The CMRS will support all medical capabilities of the Health Maintenance Facility (HMF) by providing a restraint/interface system for all equipment (advance life support packs, defibrillator, ventilator, portable oxygen supply, IV pump, transport monitor, transport aspirator, and intervenous fluids delivery system) and personnel (patient and crew medical officers). It must be functional within the STS, ACRV, and all SSF habitable volumes. The CMRS will allow for medical capabilities within CPR, ACLS and ATLS standards of care. This must all be accomplished for a worst case transport time scenario of 24 hours from SSF to a definitive medical care facility on Earth. A presentation of the above design prototype with its subsequent one year SSF/HMF and STS/ACRV high fidelity mock-up ground based simulation testing will be given. Also, parabolic flight and underwater Weightless Test Facility evaluations will be demonstrated for various medical contingencies. The final design configuration to date will be discussed with future space program impact considerations.

Electron hole tracking PIC simulation

NASA Astrophysics Data System (ADS)

Zhou, Chuteng; Hutchinson, Ian

2016-10-01

An electron hole is a coherent BGK mode solitary wave. Electron holes are observed to travel at high velocities relative to bulk plasmas. The kinematics of a 1-D electron hole is studied using a novel Particle-In-Cell simulation code with fully kinetic ions. A hole tracking technique enables us to follow the trajectory of a fast-moving solitary hole and study quantitatively hole acceleration and coupling to ions. The electron hole signal is detected and the simulation domain moves by a carefully designed feedback control law to follow its propagation. This approach has the advantage that the length of the simulation domain can be significantly reduced to several times the hole width, which makes high resolution simulations tractable. We observe a transient at the initial stage of hole formation when the hole accelerates to several times the cold-ion sound speed. Artificially imposing slow ion speed changes on a fully formed hole causes its velocity to change even when the ion stream speed in the hole frame greatly exceeds the ion thermal speed, so there are no reflected ions. The behavior that we observe in numerical simulations agrees very well with our analytic theory of hole momentum conservation and energization effects we call ``jetting''. The work was partially supported by the NSF/DOE Basic Plasma Science Partnership under Grant DE-SC0010491. Computer simulations were carried out on the MIT PSFC parallel AMD Opteron/Infiniband cluster Loki.

Medical simulation: Overview, and application to wound modelling and management

PubMed Central

Pai, Dinker R.; Singh, Simerjit

2012-01-01

Simulation in medical education is progressing in leaps and bounds. The need for simulation in medical education and training is increasing because of a) overall increase in the number of medical students vis-à-vis the availability of patients; b) increasing awareness among patients of their rights and consequent increase in litigations and c) tremendous improvement in simulation technology which makes simulation more and more realistic. Simulation in wound care can be divided into use of simulation in wound modelling (to test the effect of projectiles on the body) and simulation for training in wound management. Though this science is still in its infancy, more and more researchers are now devising both low-technology and high-technology (virtual reality) simulators in this field. It is believed that simulator training will eventually translate into better wound care in real patients, though this will be the subject of further research. PMID:23162218

Medical simulation: Overview, and application to wound modelling and management.

PubMed

Pai, Dinker R; Singh, Simerjit

2012-05-01

Simulation in medical education is progressing in leaps and bounds. The need for simulation in medical education and training is increasing because of a) overall increase in the number of medical students vis-à-vis the availability of patients; b) increasing awareness among patients of their rights and consequent increase in litigations and c) tremendous improvement in simulation technology which makes simulation more and more realistic. Simulation in wound care can be divided into use of simulation in wound modelling (to test the effect of projectiles on the body) and simulation for training in wound management. Though this science is still in its infancy, more and more researchers are now devising both low-technology and high-technology (virtual reality) simulators in this field. It is believed that simulator training will eventually translate into better wound care in real patients, though this will be the subject of further research.

Introduction of virtual patients onto a final year anesthesia course: Hong Kong experience

PubMed Central

Leung, Joseph YC; Critchley, Lester AH; Yung, Alex LK; Kumta, Shekhar M

2011-01-01

e-Learning has revolutionized the way in which undergraduate medical education is delivered. One e-learning tool of note is the virtual patient (VP), a type of computer software that simulates real-life clinical scenarios, in which the learner emulates the role of health care provider to obtain the history, conduct examination, and make diagnoses and management decisions. VPs have been in use since 1993. Early designs were based on serial screen-cards of patient history, examination, investigations, diagnoses, treatment, and outcome, which the learner explored. With the development of web technology, VPs can now be accessed via the Internet and are more versatile, supporting different structural designs to suit a variety of learning objectives, and they can branch via different routes through a case. Using VPs has a number of advantages: 1) VPs improve access to learning material, 2) VPs help learners to acquire higher order cognitive skills like strategic thinking and decision making, 3) VPs provide a safe environment to practice, 4) VPs help to teach interdisciplinary care, and 5) VPs can be used instead of patients for examination. A number of well-known VP player systems are in use today: CASUS, CAMPUS, web-based Simulation of Patients, OpenLabyrinth, and vpSim. At the Chinese University of Hong Kong, we have also developed a web-based VP authoring and player system called Formative Assessment Case Studies (FACS), which is run by our Teaching and Learning Resources Centre. FACS has been integrated into Year-5 Anesthesia teaching since 2006. Three VP products have been developed: Anaesthesia FACS (six cases) that teaches preoperative assessment, Acute Pain Management FACS, and an eight-part longitudinal VP which tells the story of a patient’s stay, and anesthesia care, for routine gynecological surgery. Students spend about 3 hours on each during a 2-week clinical attachment. Our VPs have been well received and have overcome problems of providing adequate clinical exposure. PMID:23745078

Introduction of virtual patients onto a final year anesthesia course: Hong Kong experience.

PubMed

Leung, Joseph Yc; Critchley, Lester Ah; Yung, Alex Lk; Kumta, Shekhar M

2011-01-01

e-Learning has revolutionized the way in which undergraduate medical education is delivered. One e-learning tool of note is the virtual patient (VP), a type of computer software that simulates real-life clinical scenarios, in which the learner emulates the role of health care provider to obtain the history, conduct examination, and make diagnoses and management decisions. VPs have been in use since 1993. Early designs were based on serial screen-cards of patient history, examination, investigations, diagnoses, treatment, and outcome, which the learner explored. With the development of web technology, VPs can now be accessed via the Internet and are more versatile, supporting different structural designs to suit a variety of learning objectives, and they can branch via different routes through a case. Using VPs has a number of advantages: 1) VPs improve access to learning material, 2) VPs help learners to acquire higher order cognitive skills like strategic thinking and decision making, 3) VPs provide a safe environment to practice, 4) VPs help to teach interdisciplinary care, and 5) VPs can be used instead of patients for examination. A number of well-known VP player systems are in use today: CASUS, CAMPUS, web-based Simulation of Patients, OpenLabyrinth, and vpSim. At the Chinese University of Hong Kong, we have also developed a web-based VP authoring and player system called Formative Assessment Case Studies (FACS), which is run by our Teaching and Learning Resources Centre. FACS has been integrated into Year-5 Anesthesia teaching since 2006. Three VP products have been developed: Anaesthesia FACS (six cases) that teaches preoperative assessment, Acute Pain Management FACS, and an eight-part longitudinal VP which tells the story of a patient's stay, and anesthesia care, for routine gynecological surgery. Students spend about 3 hours on each during a 2-week clinical attachment. Our VPs have been well received and have overcome problems of providing adequate clinical exposure.

Point-of-care ultrasound education: the increasing role of simulation and multimedia resources.

PubMed

Lewiss, Resa E; Hoffmann, Beatrice; Beaulieu, Yanick; Phelan, Mary Beth

2014-01-01

This article reviews the current technology, literature, teaching models, and methods associated with simulation-based point-of-care ultrasound training. Patient simulation appears particularly well suited for learning point-of-care ultrasound, which is a required core competency for emergency medicine and other specialties. Work hour limitations have reduced the opportunities for clinical practice, and simulation enables practicing a skill multiple times before it may be used on patients. Ultrasound simulators can be categorized into 2 groups: low and high fidelity. Low-fidelity simulators are usually static simulators, meaning that they have nonchanging anatomic examples for sonographic practice. Advantages are that the model may be reused over time, and some simulators can be homemade. High-fidelity simulators are usually high-tech and frequently consist of many computer-generated cases of virtual sonographic anatomy that can be scanned with a mock probe. This type of equipment is produced commercially and is more expensive. High-fidelity simulators provide students with an active and safe learning environment and make a reproducible standardized assessment of many different ultrasound cases possible. The advantages and disadvantages of using low- versus high-fidelity simulators are reviewed. An additional concept used in simulation-based ultrasound training is blended learning. Blended learning may include face-to-face or online learning often in combination with a learning management system. Increasingly, with simulation and Web-based learning technologies, tools are now available to medical educators for the standardization of both ultrasound skills training and competency assessment.

Visual-spatial ability is more important than motivation for novices in surgical simulator training: a preliminary study.

PubMed

Schlickum, Marcus; Hedman, Leif; Felländer-Tsai, Li

2016-02-21

To investigate whether surgical simulation performance and previous video gaming experience would correlate with higher motivation to further train a specific simulator task and whether visual-spatial ability would rank higher in importance to surgical performance than the above. It was also examined whether or not motivation would correlate with a preference to choose a surgical specialty in the future and if simulator training would increase the interest in choosing that same work field. Motivation and general interest in surgery was measured pre- and post-training in 30 medical students at Karolinska Institutet who were tested in a laparoscopic surgical simulator in parallel with measurement of visual-spatial ability and self-estimated video gaming experience. Correlations between simulator performance metrics, visual-spatial ability and motivation were statistically analyzed using regression analysis. A good result in the first simulator trial correlated with higher self-determination index (r =-0.46, p=0.05) in male students. Visual-spatial ability was the most important underlying factor followed by intrinsic motivation score and finally video gaming experience (p=0.02, p=0.05, p=0.11) regarding simulator performance in male students. Simulator training increased interest in surgery when studying all subjects (p=0.01), male subjects (p=0.02) as well as subjects with low video gaming experience (p=0.02). This preliminary study highlights individual differences regarding the effect of simulator training on motivation that can be taken into account when designing simulator training curricula, although the sample size is quite small and findings should be interpreted carefully.

Use of gaming simulation by health care professionals.

PubMed

Smoyak, S A

1977-01-01

Gaming-simulation is being developed foruse in a variety of aspects of health care. A mental health diagnostic and therapeutic application is described for problems in parent-teenager relations; it features gaming, videotaping of interactions, and extensive discussion. Two applications which elucidate the nature of discord between couples and two applications for work-group problems are also described. Gaming-simulation is used in basic and continuing education of health professionals for such issues as problems of dying patients and the aged, and prevention of coronary heart disease. Patients rights issues provide a potential focus for opening dialogues between patients and professionals about all facets of health and illness care.

Training of trainers for community primary health care workers.

PubMed

Cernada, G P

1983-01-01

Training community-based health care workers in "developing" countries is essential to improving the quality of life in both rural and urban areas. Two major obstacles to such training are the tremendous social distance gap between these community workers and their more highly-educated and upper-class trainers (often medical officers) and the didactic, formal educational system. Bridging this gap demands a participant-centered, field-oriented approach which actively involves the trainee in the design, implementation and evaluation of the training program. A description of a philosophic learning approach based on self-initiated change, educational objectives related to planning, organizing, conducting and evaluating training, and specific learning methodologies utilizing participatory learning, non-formal educational techniques, field experience, continuing feedback and learner participation are reviewed. Included are: role playing, story telling, case studies, self-learning and simulation exercises, visuals, and Portapak videotape.

FEAMAC/CARES Stochastic-Strength-Based Damage Simulation Tool for Ceramic Matrix Composites

NASA Technical Reports Server (NTRS)

Nemeth, Noel; Bednarcyk, Brett; Pineda, Evan; Arnold, Steven; Mital, Subodh; Murthy, Pappu; Bhatt, Ramakrishna

2016-01-01

Reported here is a coupling of two NASA developed codes: CARES (Ceramics Analysis and Reliability Evaluation of Structures) with the MAC/GMC (Micromechanics Analysis Code/ Generalized Method of Cells) composite material analysis code. The resulting code is called FEAMAC/CARES and is constructed as an Abaqus finite element analysis UMAT (user defined material). Here we describe the FEAMAC/CARES code and an example problem (taken from the open literature) of a laminated CMC in off-axis loading is shown. FEAMAC/CARES performs stochastic-strength-based damage simulation response of a CMC under multiaxial loading using elastic stiffness reduction of the failed elements.

Physician communication coaching effects on patient experience.

PubMed

Seiler, Adrianne; Knee, Alexander; Shaaban, Reham; Bryson, Christine; Paadam, Jasmine; Harvey, Rohini; Igarashi, Satoko; LaChance, Christopher; Benjamin, Evan; Lagu, Tara

2017-01-01

Excellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients' perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication. We designed a comprehensive physician-training module focused on improving specific "etiquette-based" physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent "always" scores for questions related to patients' perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists. A total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent "always" responses, for the HCAHPS questions of doctors "treating patients with courtesy" "explaining things in a way patients could understand," and "overall teamwork" showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors "keeping patient informed" (adjusted intercept shift 9.9% P = 0.019), "overall teamwork" (adjusted intercept shift 11%, P = 0.037), and "using words the patient could understand" (adjusted intercept shift 14.8%, p = 0.001). A simulation based physician communication coaching method focused on specific "etiquette-based" communication behaviors through a deliberate practice framework was not associated with significantly improved HCAHPS physician communication patient experience scores. Further research could reveal ways that this model affects patients' perceptions of physician communication relating to specific physicians or behaviors.

An integrative cross-design synthesis approach to estimate the cost of illness: an applied case to the cost of depression in Catalonia.

PubMed

Bendeck, Murielle; Serrano-Blanco, Antoni; García-Alonso, Carlos; Bonet, Pere; Jordà, Esther; Sabes-Figuera, Ramon; Salvador-Carulla, Luis

2013-04-01

Cost of illness (COI) studies are carried out under conditions of uncertainty and with incomplete information. There are concerns regarding their generalisability, accuracy and usability in evidence-informed care. A hybrid methodology is used to estimate the regional costs of depression in Catalonia (Spain) following an integrative approach. The cross-design synthesis included nominal groups and quantitative analysis of both top-down and bottom-up studies, and incorporated primary and secondary data from different sources of information in Catalonia. Sensitivity analysis used probabilistic Monte Carlo simulation modelling. A dissemination strategy was planned, including a standard form adapted from cost-effectiveness studies to summarise methods and results. The method used allows for a comprehensive estimate of the cost of depression in Catalonia. Health officers and decision-makers concluded that this methodology provided useful information and knowledge for evidence-informed planning in mental health. The mix of methods, combined with a simulation model, contributed to a reduction in data gaps and, in conditions of uncertainty, supplied more complete information on the costs of depression in Catalonia. This approach to COI should be differentiated from other COI designs to allow like-with-like comparisons. A consensus on COI typology, procedures and dissemination is needed.

PI controller design for indirect vector controlled induction motor: A decoupling approach.

PubMed

Jain, Jitendra Kr; Ghosh, Sandip; Maity, Somnath; Dworak, Pawel

2017-09-01

Decoupling of the stator currents is important for smoother torque response of indirect vector controlled induction motors. Typically, feedforward decoupling is used to take care of current coupling that requires exact knowledge of motor parameters, additional circuitry and signal processing. In this paper, a method is proposed to design the regulating proportional-integral gains that minimize coupling without any requirement of the additional decoupler. The variation of the coupling terms for change in load torque is considered as the performance measure. An iterative linear matrix inequality based H ∞ control design approach is used to obtain the controller gains. A comparison between the feedforward and the proposed decoupling schemes is presented through simulation and experimental results. The results show that the proposed scheme is simple yet effective even without additional block or burden on signal processing. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

Invited article: Dielectric material characterization techniques and designs of high-Q resonators for applications from micro to millimeter-waves frequencies applicable at room and cryogenic temperatures.

PubMed

Le Floch, Jean-Michel; Fan, Y; Humbert, Georges; Shan, Qingxiao; Férachou, Denis; Bara-Maillet, Romain; Aubourg, Michel; Hartnett, John G; Madrangeas, Valerie; Cros, Dominique; Blondy, Jean-Marc; Krupka, Jerzy; Tobar, Michael E

2014-03-01

Dielectric resonators are key elements in many applications in micro to millimeter wave circuits, including ultra-narrow band filters and frequency-determining components for precision frequency synthesis. Distributed-layered and bulk low-loss crystalline and polycrystalline dielectric structures have become very important for building these devices. Proper design requires careful electromagnetic characterization of low-loss material properties. This includes exact simulation with precision numerical software and precise measurements of resonant modes. For example, we have developed the Whispering Gallery mode technique for microwave applications, which has now become the standard for characterizing low-loss structures. This paper will give some of the most common characterization techniques used in the micro to millimeter wave regime at room and cryogenic temperatures for designing high-Q dielectric loaded cavities.

Applications of artificial intelligence 1993: Knowledge-based systems in aerospace and industry; Proceedings of the Meeting, Orlando, FL, Apr. 13-15, 1993

NASA Technical Reports Server (NTRS)

Fayyad, Usama M. (Editor); Uthurusamy, Ramasamy (Editor)

1993-01-01

The present volume on applications of artificial intelligence with regard to knowledge-based systems in aerospace and industry discusses machine learning and clustering, expert systems and optimization techniques, monitoring and diagnosis, and automated design and expert systems. Attention is given to the integration of AI reasoning systems and hardware description languages, care-based reasoning, knowledge, retrieval, and training systems, and scheduling and planning. Topics addressed include the preprocessing of remotely sensed data for efficient analysis and classification, autonomous agents as air combat simulation adversaries, intelligent data presentation for real-time spacecraft monitoring, and an integrated reasoner for diagnosis in satellite control. Also discussed are a knowledge-based system for the design of heat exchangers, reuse of design information for model-based diagnosis, automatic compilation of expert systems, and a case-based approach to handling aircraft malfunctions.

OPC care-area feedforwarding to MPC

NASA Astrophysics Data System (ADS)

Dillon, Brian; Peng, Yi-Hsing; Hamaji, Masakazu; Tsunoda, Dai; Muramatsu, Tomoyuki; Ohara, Shuichiro; Zou, Yi; Arnoux, Vincent; Baron, Stanislas; Zhang, Xiaolong

2016-10-01

Demand for mask process correction (MPC) is growing for leading-edge process nodes. MPC was originally intended to correct CD linearity for narrow assist features difficult to resolve on a photomask without any correction, but it has been extended to main features as process nodes have been shrinking. As past papers have observed, MPC shows improvements in photomask fidelity. Using advanced shape and dose corrections could give more improvements, especially at line-ends and corners. However, there is a dilemma on using such advanced corrections on full mask level because it increases data volume and run time. In addition, write time on variable shaped beam (VSB) writers also increases as the number of shots increases. Optical proximity correction (OPC) care-area defines circuit design locations that require high mask fidelity under mask writing process variations such as energy fluctuation. It is useful for MPC to switch its correction strategy and permit the use of advanced mask correction techniques in those local care-areas where they provide maximum wafer benefits. The use of mask correction techniques tailored to localized post-OPC design can result in similar desired level of data volume, run time, and write time. ASML Brion and NCS have jointly developed a method to feedforward the care-area information from Tachyon LMC to NDE-MPC to provide real benefit for improving both mask writing and wafer printing quality. This paper explains the detail of OPC care-area feedforwarding to MPC between ASML Brion and NCS, and shows the results. In addition, improvements on mask and wafer simulations are also shown. The results indicate that the worst process variation (PV) bands are reduced up to 37% for a 10nm tech node metal case.

Use of a Virtual Learning Platform for Distance-Based Simulation in an Acute Care Nurse Practitioner Curriculum.

PubMed

Carman, Margaret; Xu, Shu; Rushton, Sharron; Smallheer, Benjamin A; Williams, Denise; Amarasekara, Sathya; Oermann, Marilyn H

Acute care nurse practitioner (ACNP) programs that use high-fidelity simulation as a teaching tool need to consider innovative strategies to provide distance-based students with learning experiences that are comparable to those in a simulation laboratory. The purpose of this article is to describe the use of virtual simulations in a distance-based ACNP program and student performance in the simulations. Virtual simulations using iSimulate were integrated into the ACNP course to promote the translation of content into a clinical context and enable students to develop their knowledge and decision-making skills. With these simulations, students worked as a team, even though they were at different sites from each other and from the faculty, to manage care of an acutely ill patient. The students were assigned to simulation groups of 4 students each. One week before the simulation, they reviewed past medical records. The virtual simulation sessions were recorded and then evaluated. The evaluation tools assessed 8 areas of performance and included key behaviors in each of these areas to be performed by students in the simulation. More than 80% of the student groups performed the key behaviors. Virtual simulations provide a learning platform that allows live interaction between students and faculty, at a distance, and application of content to clinical situations. With simulation, learners have an opportunity to practice assessment and decision-making in emergency and high-risk situations. Simulations not only are valuable for student learning but also provide a nonthreatening environment for staff to practice, receive feedback on their skills, and improve their confidence.

Expected outcomes from topical haemoglobin spray in non-healing and worsening venous leg ulcers.

PubMed

Arenberger, P; Elg, F; Petyt, J; Cutting, K

2015-05-01

To evaluate the effect of topical haemoglobin spray on treatment response and wound-closure rates in patients with chronic venous leg ulcers. A linear regression model was used to forecast healing outcomes over a 12-month period. Simulated data were taken from normal distributions based on post-hoc analysis of a 72-patient study in non-healing and worsening wounds (36 patients receiving standard care and 36 receiving standard care plus topical haemoglobin spray). Using a simulated 25,000 'patients' from each group, the proportion of wound closure over time was projected. Simulation results predicted a 55% wound closure rate at six months in the haemoglobin group, compared with 4% in the standard care group. Over a 12-month simulation period, a 43% overall reduction in wound burden was predicted. With the haemoglobin spray, 85% of wounds were expected to heal in 12 months, compared with 13% in the standard care group. Topical haemoglobin spray promises a more effective treatment for chronic venous leg ulcers than standard care alone in wounds that are non-healing or worsening. Further research is required to validate these predictions and to identify achievable outcomes in other chronic wound types.

An Intensive, Simulation-Based Communication Course for Pediatric Critical Care Medicine Fellows.

PubMed

Johnson, Erin M; Hamilton, Melinda F; Watson, R Scott; Claxton, Rene; Barnett, Michael; Thompson, Ann E; Arnold, Robert

2017-08-01

Effective communication among providers, families, and patients is essential in critical care but is often inadequate in the PICU. To address the lack of communication education pediatric critical care medicine fellows receive, the Children's Hospital of Pittsburgh PICU developed a simulation-based communication course, Pediatric Critical Care Communication course. Pediatric critical care medicine trainees have limited prior training in communication and will have increased confidence in their communication skills after participating in the Pediatric Critical Care Communication course. Pediatric Critical Care Communication is a 3-day course taken once during fellowship featuring simulation with actors portraying family members. Off-site conference space as part of a pediatric critical care medicine educational curriculum. Pediatric Critical Care Medicine Fellows. Didactic sessions and interactive simulation scenarios. Prior to and after the course, fellows complete an anonymous survey asking about 1) prior instruction in communication, 2) preparedness for difficult conversations, 3) attitudes about end-of-life care, and 4) course satisfaction. We compared pre- and postcourse surveys using paired Student t test. Most of the 38 fellows who participated over 4 years had no prior communication training in conducting a care conference (70%), providing bad news (57%), or discussing end-of-life options (75%). Across all four iterations of the course, fellows after the course reported increased confidence across many topics of communication, including giving bad news, conducting a family conference, eliciting both a family's emotional reaction to their child's illness and their concerns at the end of a child's life, discussing a child's code status, and discussing religious issues. Specifically, fellows in 2014 reported significant increases in self-perceived preparedness to provide empathic communication to families regarding many aspects of discussing critical care, end-of-life care, and religious issues with patients' families (p < 0.05). The majority of fellows (90%) recommended that the course be required in pediatric critical care medicine fellowship. The Pediatric Critical Care Communication course increased fellow confidence in having difficult discussions common in the PICU. Fellows highly recommend it as part of PICU education. Further work should focus on the course's impact on family satisfaction with fellow communication.

Modeling of light absorption in tissue during infrared neural stimulation.

PubMed

Thompson, Alexander C; Wade, Scott A; Brown, William G A; Stoddart, Paul R

2012-07-01

A Monte Carlo model has been developed to simulate light transport and absorption in neural tissue during infrared neural stimulation (INS). A range of fiber core sizes and numerical apertures are compared illustrating the advantages of using simulations when designing a light delivery system. A range of wavelengths, commonly used for INS, are also compared for stimulation of nerves in the cochlea, in terms of both the energy absorbed and the change in temperature due to a laser pulse. Modeling suggests that a fiber with core diameter of 200 μm and NA=0.22 is optimal for optical stimulation in the geometry used and that temperature rises in the spiral ganglion neurons are as low as 0.1°C. The results show a need for more careful experimentation to allow different proposed mechanisms of INS to be distinguished.

Modeling of light absorption in tissue during infrared neural stimulation

NASA Astrophysics Data System (ADS)

Thompson, Alexander C.; Wade, Scott A.; Brown, William G. A.; Stoddart, Paul R.

2012-07-01

A Monte Carlo model has been developed to simulate light transport and absorption in neural tissue during infrared neural stimulation (INS). A range of fiber core sizes and numerical apertures are compared illustrating the advantages of using simulations when designing a light delivery system. A range of wavelengths, commonly used for INS, are also compared for stimulation of nerves in the cochlea, in terms of both the energy absorbed and the change in temperature due to a laser pulse. Modeling suggests that a fiber with core diameter of 200 μm and NA=0.22 is optimal for optical stimulation in the geometry used and that temperature rises in the spiral ganglion neurons are as low as 0.1°C. The results show a need for more careful experimentation to allow different proposed mechanisms of INS to be distinguished.