Simulation in healthcare : journal of the Society for Simulation in Healthcare
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Traditionally, pausing chest compressions during airway management in a cardiac arrest has been the accepted norm. However, updated American Heart Association and the European Resuscitation Council guidelines for Advanced Cardiac Life Support emphasize reducing pauses in chest compressions, often referred to as "no-flow time," to improve return of spontaneous circulation. We used simulation to evaluate whether placing a laryngeal mask airway versus endotracheal intubation via direct laryngoscopy would reduce no-flow times during a simulated cardiac arrest. ⋯ We conclude that although neither device was superior to the other with respect to the primary outcome of reducing no-flow time, effective ventilation was established more rapidly with the laryngeal mask airway in the hands of the RTs who participated in this study. These results may be affected by the differences between simulated and human airways.
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Specialty milestones and the next accreditation system: an opportunity for the simulation community.
The Accreditation for Graduate Medical Education has developed a new process of accreditation, the Next Accreditation System (NAS), which focuses on outcomes. A key component of the NAS is specialty milestones-specific behavior, attributes, or outcomes within the general competency domains. Milestones will mark a level of proficiency of a resident within a competency domain. ⋯ The simulation community has focused many graduate medical education efforts at training and formative assessment. Milestone assessment represents an opportunity for simulation modalities to offer summative assessment of milestone proficiencies, adding to the potential methods that residency programs will likely use or adapt. This article discusses the NAS, milestone assessment, and the opportunity to the simulation community to become involved in this next stage of graduate medical education assessment.
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Relocating obstetric (OB) services to a children's hospital imposes demands on facility operations, which must be met to ensure quality care and a satisfactory patient experience. We used in situ simulations to prospectively and iteratively evaluate operational readiness of a children's hospital-based OB unit before it opened for patient care. ⋯ In situ simulations identified multiple operational deficiencies on the OB unit, allowing us to take corrective action before its opening. This project may guide other children's hospitals regarding care processes likely to require significant focus and possible modification to accommodate an OB service.
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Randomized Controlled Trial
Training induces cognitive bias: the case of a simulation-based emergency airway curriculum.
Training-induced cognitive bias may affect performance. Using a simulation-based emergency airway curriculum, we tested the hypothesis that curriculum design would induce bias and affect decision making. ⋯ Practical training in only 1 technique caused bias in both groups despite a preceding didactic lecture. The chief finding was an asymmetrical effect of training sequence even after training in both techniques. Initial training in cricothyroidotomy caused bias that did not correct despite subsequent supraglottic airway training. Educators must be alert to the risk of inducing cognitive bias when designing curricula.
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Comparative Study Clinical Trial
A simulator-based study of in-flight auscultation.
The use of a stethoscope is essential to the delivery of continuous, supportive en route care during aeromedical evacuations. We compared the capability of 2 stethoscopes (electronic, Litmann 3000; conventional, Litmann Cardiology III) at detecting pathologic heart and lung sounds, aboard a C135, a medical transport aircraft. ⋯ Flight practitioners involved in aeromedical evacuation on C135 plane are more able to practice lung auscultation on a mannequin with this amplified stethoscope than with the traditional one. No benefit was found for heart sounds.