IntroductionThe Newborn Life Support (NLS) guideline aims to provide healthcare professionals a consistent approach during neonatal resuscitation. Adherence to this and analogous guidelines has repetitively been proven to be difficult.This study evaluates adherence to guideline using a novel augmented reality (Microsoft HoloLens) electronic decision support tool during standardized simulated neonatal resuscitation compared with subjects working from memory alone.MethodsIn this randomized controlled pilot study, 18 professionals responsible for neonatal resuscitation were randomized to the intervention group and 11 to the control group. Demographic characteristics were similar between both groups. A standardized neonatal resuscitation scenario was performed, which was recorded and later assessed for adherence to the NLS algorithm by 2 independent reviewers. Secondary outcomes were error classification in case of algorithm deviation and time to the execution or completion of critical steps in the algorithm to determine delay.ResultsMedian (interquartile range) scores of a theoretical maximum of 40 in the intervention group were 34 (32.5–35.5) versus 29 (27–33) in the control group (P = 0.004). Errors of commission were committed less frequently with the electronic decision support tool 2 (1–2.5) compared with 4 (2–4) in the control group (P = 0.029). Analysis of time to initiation or completion of key steps in the NLS algorithm showed no significant differences between both groups.ConclusionsHealthcare professionals using an electronic decision support tool showed improved adherence to the NLS guideline during simulated neonatal resuscitation.

Bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest is associated with higher survival rates. Even trained health care staff cannot assess breathing well enough to detect cardiac arrest. Recognition of cardiac arrest by lay rescuers might be overlooked in adult basic life support resuscitation guidelines, which explain what to do, but not how to do it. The 2015 Adult Advanced Life Support Resuscitation Guidelines recommend to "look for chest movement." We hypothesize (1) that instructing lay rescuers to look for chest movement allows detecting breathing (or lack thereof); (2) that showing a person their own recorded gaze overlay during a video debriefing intervention enhances breathing detection at postallocation; and (3) that the more time spent looking at a cardiac arrest victim's chest, the greater the probability of detecting breathing (or lack thereof). Monocentric, blinded, prospective, 2-arm parallel randomized controlled trial with balanced randomization (1:1). The design entailed a preallocation simulation, an intervention (video debriefing with or without gaze overlay), and a postallocation simulation. A follow-up simulation took place after 6 months. The main outcome measured was success in detecting breathing. Participants were all prospective students of a bachelor's degree program in nursing. All participants performed better at postallocation (success rate at preallocation = 59%, postallocation = 79%, χ 2 = 7.22, P < 0.01) regardless of viewing their own gaze overlay during video debriefing. We failed to obtain a sufficient number of participants for the follow-up simulation. Instructing lay rescuers to look for chest movement allows them to detect breathing (or lack thereof). Each second spent looking at the thorax increased the odds of successfully detecting breathing by 38%. Mean thorax gaze duration significantly increased by 5.95 seconds (95% confidence interval = 4.71-7.31) from preallocation (3.46 seconds, SD = 4.16) to postallocation (9.41 seconds, SD = 5.98). Laypersons' median diagnosis time was 15.5 seconds (range = 2-63 seconds), similar to another study (13 seconds, range = 5-40 seconds). This is the second study in which the median time to decision exceeded the maximum 10 seconds recommended. International guidelines should consider increasing the time allowed for the "check breathing" step of bystander cardiopulmonary resuscitation procedures.

Emerging literature continues to demonstrate the use of innovative practices such as simulated-based learning experiences to prepare students for professional placements. This scoping review aimed to provide a broad overview of how simulated-based learning experiences have been implemented within or immediately before the professional practice placements of entry-level allied health programs. Four databases (MEDLINE, EMCARE, CINAHL, and Scopus) were searched up to August 2020. Kirkpatrick's evaluation framework was used to categorize outcomes, and the Simulation-Based Research Extension for the CONSORT statement was used to appraise the quality of simulation reporting. The search revealed 6584 unique abstracts with 321 full-text articles reviewed. Forty-eight studies met the inclusion criteria. This review has shown a clear trend toward using simulation within or immediately before the professional practice placements of allied health programs. Using Kirkpatrick's evaluation framework, most studies reported on student reaction (level 1) and learning (level 2) obtained during the simulation experience. There was limited evidence showing how the benefits gained in simulation translated to the clinical environment (level 3) or impacted the organization (level 4). Further research is required to review the optimal proximity of simulation to allied health professional placements and how gains are obtained from simulation transition to the clinical environment. In addition, more consistent reporting of simulation methodologies and evaluation methods are needed to strengthen the evidence base.

Pediatric inpatients are at high risk of adverse events (AE). Traditionally, root cause analysis was used to analyze AEs and identify recommendations for change. Simulation-based event analysis (SBEA) is a protocol that systematically reviews AEs by recreating them using in situ simulated patients, to understand clinician decision making, improve error discovery, and, through guided sequential debriefing, recommend interventions for error prevention. Studies suggest that these interventions are rarely tested before dissemination. This study investigates the use of simulation to optimize recommendations generated from SBEA before implementation. Recommendations and interventions developed through SBEA of 2 hospital-based AEs (event A: error of commission; event B: error of detection) were tested using in situ simulation. Each scenario was repeated 8 times. Interventions were modified based on participant feedback until the error stopped occurring and data saturation was reached. Data saturation was reached after 6 simulations for both scenarios. For scenario A, a critical error was repeated during the first 2 scenarios using the initial interventions. After modifications, errors were corrected or mitigated in the remaining 6 scenarios. For scenario B, 1 intervention, the nursing checklist, had the highest impact, decreasing average time to error detection to 6 minutes. Based on feedback from participants, changes were made to all but one of the original proposed interventions. Even interventions developed through improved analysis techniques, like SBEA, require testing and modification. Simulation optimizes interventions and provides opportunity to assess efficacy in real-life settings with clinicians before widespread implementation.

While exposure of surgeons and other staff to surgical smoke is an increasing health risk concern, there is a similar risk for users in surgical simulation and training. This study was undertaken to determine the chemical composition of smoke produced from a novel training model, Versatile Training Tissue (VTT), which is used for surgical simulation and training, and to compare this with smoke from a chemosynthetic model and porcine muscle and liver. A variety of models (VTT, polyvinyl alcohol, porcine muscle and liver) were prepared and cauterized. Identification of chemical substances in smoke was performed using gas chromatography-mass spectrometry. Quantitative instrumental analysis was implemented with gas chromatography-mass spectrometry and high-performance liquid chromatography. A convenient analysis was performed with a general smoke tube kit. The main chemical components of smoke produced from VTT models include water and carbon dioxide. A small number of organic compounds were detected. Versatile Training Tissue models produced smoke with fewer compounds than smoke from a chemosynthetic model or porcine muscle. The concentration of organic compounds from VTT models is considered to be below relevant health risk limits and lower than from polyvinyl alcohol and porcine muscle models. Although porcine liver smoke contains less of the main organic compounds of concern than a KM, it contains potentially hazardous nitrile compounds that are absent in KM smoke. Therefore, surgical simulation and training with VTT models should be considered relatively safe for trainees.

IntroductionThe study examined how the spacing of training during initial acquisition of cardiopulmonary resuscitation (CPR) skill affects longer-term retention and sustainment of these skills.MethodsThis was a multiphased, longitudinal study. Nursing students were randomly assigned to 2 initial acquisition conditions in which they completed 4 consecutive CPR training sessions spaced by shorter (1 or 7 days) or longer (30 or 90 days) training intervals. Students were additionally randomized to refresh skills for 1 year every 3 months, 6 months, or at a personalized interval prescribed by the Predictive Performance Optimizer (PPO), a cognitive tool that predicts learning and decay over time.ResultsAt the end of the acquisition period, performance was better if training intervals were shorter. At 3 or 6 months after acquisition, performance was better if initial training intervals were longer. At 1 year after acquisition, compression and ventilation scores did not differ by initial training interval nor by 3-month or PPO-prescribed sustainment interval refreshers. However, 6-month interval refreshers were worse than the PPO for compressions and worse than 3 months for ventilations. At the final test session, participants in the personalized PPO condition had less variability in compression scores than either the 3- or 6-month groups.ConclusionsResults suggest that CPR learning trajectories may be accelerated by first spacing training sessions by days and then expanding to longer intervals. Personalized scheduling may improve performance, minimize performance variability, and reduce overall training time.

Summary StatementThere is little global consensus on how to train, assess, and evaluate skills in obstetric ultrasound. The outcomes of curricula, where present, are often based on the number of clinical cases completed, rather than objective outcomes. The central question in this review is whether simulation enhances training and prepares trainees for clinical practice. A systematic review was conducted of the currently available literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies considering the use of simulators in training or assessment of sonographers were eligible for inclusion. We conclude that simulation is best used for acquisition of technical skills and image optimization. Best outcomes are observed when simulation augments traditional learning, with a strong focus on specific, objective, and measurable skills. Integrating simulation into training curricula could allow trainees to contribute to clinical service while learning. How skills learned in a simulated environment translate to the clinic is poorly addressed by the literature.

IntroductionTrauma leadership skills are increasingly being addressed in trauma courses, but few resources are available to systematically observe and debrief trainees' performances. The authors therefore translated their previously developed, extensive Taxonomy of Trauma Leadership Skills (TTLS) into a practical observation tool that is tailored to the vocabulary of clinician instructors and their workflow and workload during simulation-based training.MethodsIn 2016 to 2018, the TTLS was subjected to practical evaluation in an iterative process of 2 stages. In the first stage, testing panels of trauma specialists observed excerpts from videotaped simulations and indicated from the list of elements which behaviors they felt were being shown. Any ambiguities or redundancy were addressed by rephrasing or combining elements. In the second stage, iterations were used in actual scenario training to observe and debrief trainees' performances. The instructors' recommendations resulted in further improvements of clarity, ease of use, and usefulness, until no new suggestions were raised.ResultsThe resultant “TTLS–Shortened for Observation and Reflection in Training” was given a simpler structure and more concrete and self-explanatory benchmarks. It contains 6 skill categories for evaluation, each with 4 to 6 benchmark behaviors.ConclusionsThe TTLS–Shortened for Observation and Reflection in Training is an important addition to other trauma assessment tools because of its specific focus on leadership skills. It helps set concrete performance expectations, simplify note taking, and target observations and debriefings. One central challenge was striking a balance between its conciseness and specificity. The authors reflected on how the decisions for the resultant structure ease and leverage the conduct of observations and performance debriefing.

There is still a need for competent breast lump detection palpation skills, especially in developing countries. Our goal is to design, develop, and establish a test to determine whether students can, by touch alone, identify and discriminate between a range of different simulated lesions at different adiposity levels. Common lesions, breast cancers, and cysts were physically simulated and hidden in a test object referred to as the "tactile landscape" (TL). Ribs, intercostal muscle, and nodularity-normal anatomical features-increased their realistic complexity. Varying depths of features simulated varying degrees of adiposity. A testing protocol was created to determine the testee's ability to identify and discriminate different commonly occurring breast masses using palpation. Five experts (four breast surgeons and one general practitioner) and 20 inexperienced medical students were recruited and tested. Results were compared. The TL has been based on previously verified breast models and has softness similar to 53% of women's breasts and nodularity similar to 60% as assessed in a breast clinic by breast surgeons. The five experts indicated that the simulated lesions felt like those they might encounter in clinical practice and all of them identified the lesions and nonlesions hidden in the TL 100% correctly, thus indicating the value of the model. In contrast, only one student was able to identify all the lesions. One student identified none of them. The remaining students mean score was 65%. All students but one performed poorly in comparison to the experts. This indicates that the test could be useful to test students' ability to identify and discriminate breast masses. If successful, it will add previously missing capability to the mix of assessment instruments already used, thus potentially improving clinical breast examination training and assessment.

IntroductionWe developed a new smartphone application to deliver an automated external defibrillator (AED) to out-of-hospital cardiac arrest scene. The aim of this study was to evaluate whether an AED could be delivered earlier with or without an application in a simulated randomized controlled trial.MethodsParticipants, who were asked to work as bystanders, were randomly assigned to either an application group or control group and were asked to bring an AED in both groups. The bystanders in the application group sent a signal notification using the application to two responders, who were stationed within 200 meters of the arrest scene, to carry an AED. The primary outcome was the AED delivery time by either the bystander or his/her responder.ResultsIn total, 61 bystanders were eligible and randomized to either the application group (32) or the control group (29). The 52 with time data were available and analyzed. The AED delivery time by either the bystander or his/her responder was significantly shorter in the application group than in the control group [133.6 (44.4) seconds vs. 202.2 (122.2) seconds, P = 0.01].ConclusionsIn this simulation-based trial, AED delivery time was shortened by our newly developed smartphone application for the bystander to ask nearby responders to find and bring an AED to the cardiac arrest scene (UMIN-Clinical Trials Registry 000016506).