High-fidelity Simulation Study Research Articles

Measuring Stereotypes in Interprofessional Education: A Pilot High-Fidelity Simulation Study Among Postgraduate Nursing and Physician Students in a Spanish University.

Nursing professionals are often subject to social stereotypes that can hinder effective teamwork with other healthcare professionals and limit their professional growth. Interprofessional education (IPE) enhances teamwork skills and promotes a better understanding of other professional groups. This study aimed to identify the presence of stereotypes associated with nursing among postgraduate nursing and student physicians specializing in emergency medicine and to assess the applicability of simulation as an IPE strategy. A pilot study using high-fidelity simulation activity focusing on interdisciplinary collaboration was designed for students in the master's programs in emergency nursing and emergency medicine at the Catholic University of Murcia. The activity took place in May 2024 and involved 52 participants (24 postgraduate nursing students and 28 postgraduate student physicians). A mixed-method descriptive study was conducted using a 16-item self-administered questionnaire. Data were analyzed using the Shapiro-Wilk test for normality, Fisher's F test, and the Mann-Whitney U test to evaluate the relationship between variables (p < 0.05). A total of 22 questionnaires were collected (16 from nurses postgraduate student and 6 from postgraduate physicians). Positive attitudes toward nursing stereotypes were found in 9 of the 13 items. No statistically significant differences were observed between the groups regarding most stereotypes, except for one. Negative stereotypes about nursing leadership, professional autonomy, and patient relations were more prominent among nursing students. Stereotypical perceptions exist among both postgraduate nursing and postgraduate student physicians, particularly in nursing leadership and autonomy. Most participants expressed satisfaction with the simulation-based IPE activity, indicating its value in improving the understanding of other professionals' roles. IPE should be incorporated into health sciences education.

Compression after impact (CAI) failure mechanisms and damage evolution in large composite laminates: High-fidelity simulation and experimental study

This study focuses on developing and validating a high-fidelity finite element model for predicting damage evolution and residual strength in fiber-reinforced composite panels. Impact and compression after impact (CAI) tests were conducted at both barely visible impact damage (BVID) and clearly visible impact damage (CVID) levels. The ASTM D7137 standard 100 mm × 150 mm CAI coupons were inadequate to cover the range of experimental studies required for model validation. Therefore, larger 254 mm × 304.8 mm laminates were investigated under two CAI testing conditions: one a scaled-up version of ASTM standard coupon, and the other with additional anti-buckling support plates to reduce unsupported areas to 127 mm × 177.8 mm. The model captured inter- and intra-laminar failure modes, including fiber breakage, splitting, kinking, pull-out, and crushing as well as matrix cracking, delamination, and their interactions. This was achieved by cohesive zone modeling technique and enhancement of the LaRC05 failure criteria through modeling the fiber damage evolution and utilizing an efficient search algorithm to determine the matrix fracture plane and fiber kink band angle. This study underscores the efficacy of the high-fidelity modeling approach in accurately predicting both impact damage and CAI strength in typical aircraft impact damage scenarios. Additionally, it provides insights into complex CAI failure mechanisms and energy release associated with various damage modes and highlights the effect of global buckling on the failure behavior and compressive strength of composite laminates. Furthermore, it shows that the proposed fixture with support plates is suitable for testing a broader range of impact scenarios without experiencing global buckling.

User Perceptions of Visual Clot in a High-Fidelity Simulation Study: Mixed Qualitative-Quantitative Study.

Viscoelastic hemostatic assays, such as rotational thromboelastometry (ROTEM) or thromboelastography, enable prompt diagnosis and accelerate targeted treatment. However, the complex interpretation of the results remains challenging. Visual Clot-a situation awareness-based visualization technology-was developed to assist clinicians in interpreting viscoelastic tests. Following a previous high-fidelity simulation study, we analyzed users' perceptions of the technology, to identify its strengths and limitations from clinicians' perspectives. This is a mixed qualitative-quantitative study consisting of interviews and a survey. After solving coagulation scenarios using Visual Clot in high-fidelity simulations, we interviewed anesthesia personnel about the perceived advantages and disadvantages of the new tool. We used a template approach to identify dominant themes in interview responses. From these themes, we defined 5 statements, which were then rated on Likert scales in a questionnaire. We interviewed 77 participants and 23 completed the survey. We identified 9 frequently mentioned topics by analyzing the interview responses. The most common themes were "positive design features," "intuitive and easy to learn," and "lack of a quantitative component." In the survey, 21 respondents agreed that Visual Clot is easy to learn and 16 respondents stated that a combination of Visual Clot and ROTEM would help them manage complex hemostatic situations. A group of anesthesia care providers found Visual Clot well-designed, intuitive, and easy to learn. Participants highlighted its usefulness in emergencies, especially for clinicians inexperienced in coagulation management. However, the lack of quantitative information is an area for improvement.

Effectiveness of RANS in predicting indoor airborne viral transmission: A critical evaluation against LES

We investigate the dispersal of droplet nuclei inside a canonical room of size 10×10×3.2m3 with a four-way cassette air-conditioning unit placed at the center of the ceiling. We use Reynolds averaged Navier–Stokes (RANS) simulations with three flow rates corresponding to air changes per hour (ACH) values of 2.5, 5, and 10. The room setup as well as the operating conditions are chosen to match those of a recent high-fidelity large eddy simulation (LES) study. We use statistical overloading with a total of one million droplet nuclei being initially distributed randomly with uniform probability within the room. Six nuclei sizes are considered ranging in radius from 0.1 to 10μm (166,667 nuclei per size). The simulations are one-way coupled and employ the Langevin equations to model sub-grid motion. The flow and particle statistics are compared against the reference LES simulations, and we find that the RANS k−ɛ realizable model may be used as a computationally cheaper alternative to LES for predicting pathogen concentration in confined spaces albeit, with potentially increased statistical discrepancy.

High-Fidelity Simulation Study of the Unsteady Flow Effects on High-Pressure Turbine Blade Performance

Abstract Unsteadiness, in the form of both broadband background disturbances and discrete coherent wakes, can have a strong effect on the performance of turbomachinery blades. The influence of the incoming flow has received much interest as it inevitably affects the blade boundary layers and develops as it passes through the machine. In the present work, we investigate the effect of unsteady flow on high-pressure turbines (HPTs), using high-fidelity datasets produced by wall resolved large-eddy simulation of an HPT stage. The effects of incident wakes from an upstream stator, compounded by the presence of freestream turbulence, on the downstream rotor are investigated. Based on analyzing cases with different turbulence intensities and length scales prescribed at the inlet, we show that changing the freestream turbulence characteristics has a direct effect on the unsteady behavior of the stator wakes. As a result, the performance of the rotor is also significantly affected. By detailing the influence of the wake–turbulence interaction, we aim to distinguish driving forces on rotor performance, be it changes in the incident wakes or direct influence from the freestream turbulence. Furthermore, the aerothermal behaviors of the rotor blades have been extensively investigated, showing that the blade boundary layers on the suction and pressure sides respond differently to external disturbances. The insights gained can provide designers with guidelines in understanding the unsteady flow effects of a given flow state, and how the unsteadiness present, either broadband or deterministic, will affect the performance of downstream blades.

Not only for caregivers: intranasal glucagon for severe hypoglycaemia in a simulation study.

To evaluate: (i) the propensity of paediatrics and emergency medicine residents to select different therapeutic options and (ii) the speed and administration success in a high-fidelity simulation of severe hypoglycaemia in a child with type 1 diabetes (T1DM). In this single-centre high-fidelity simulation study, 51 paediatrics or emergency medicine residents were exposed to a scenario of severe hypoglycaemia in a T1DM child attending an ambulatory setting, before and after a training on the preparation and administration of both injectable and IN glucagon. Time for drug delivery and its effectiveness were collected. Before training, 45.1% of participants chose to administer injectable glucagon, 43.1% intravenous glucose solution, 5.9% intranasal (IN) glucagon, and 5.9% took no action. Administration was successful in 74% of injectable glucagon, 33.3% intravenous glucose solution, and 22.7% IN glucagon. After training, 58.8% of participants chose IN and 41.2% injectable glucagon, with 100% of successful administrations for IN glucagon and 90.5% for injectable glucagon. Time to successful administration was shorter for IN than injectable glucagon (23 ± 10 vs. 38 ± 7s, p < 0.0001). IN glucagon is an easy and effective option for severe hypoglycaemia treatment, with an almost zero possibility of failure provided that adequate training is imparted.

Simulation-based randomized trial of medical emergency cognitive aids

BackgroundMedical emergencies are complex and stressful, especially for the young and inexperienced. Cognitive aids (CA) have been shown to facilitate management of simulated medical emergencies by experienced teams. In this randomized trial we evaluated guideline adherence and treatment efficacy in simulated medical emergencies managed by residents with and without CA.MethodsPhysicians attending educational courses executed simulated medical emergencies. Teams were randomly assigned to manage emergencies with or without CA. Primary outcome was risk reduction of essential working steps. Secondary outcomes included prior experience in emergency medicine and CA, perceptions of usefulness, clinical relevance, acceptability, and accuracy in CA selection. Participants were grouped as “medical” (internal medicine and neurology) and “perioperative” (anesthesia and surgery) regarding their specialty. The study was designed as a prospective randomized single-blind study that was approved by the ethical committee of the University Duisburg-Essen (19-8966-BO). Trial registration: DRKS, DRKS00024781. Registered 16 March 2021—Retrospectively registered, http://www.drks.de/DRKS00024781.ResultsEighty teams participated in 240 simulated medical emergencies. Cognitive aid usage led to 9% absolute and 15% relative risk reduction. Per protocol analysis showed 17% absolute and 28% relative risk reduction. Wrong CA were used in 4%. Cognitive aids were judged as helpful by 94% of the participants. Teams performed significantly better when emergency CA were available (p < 0.05 for successful completion of critical work steps). Stress reduction using CA was more likely in “medical” than in “perioperative” subspecialties (3.7 ± 1.2 vs. 2.9 ± 1.2, p < 0.05).ConclusionsIn a high-fidelity simulation study, CA usage was associated with significant reduction of incorrect working steps in medical emergencies management and was characterized by high acceptance. These findings suggest that CA for medical emergencies may have the potential to improve emergency care.

Anesthesia personnel’s visual attention regarding patient monitoring in simulated non-critical and critical situations, an eye-tracking study

BackgroundCognitive ergonomics design of patient monitoring may reduce human factor errors in high-stress environments. Eye-tracking is a suitable tool to gain insight into the distribution of visual attention of healthcare professionals with patient monitors, which may facilitate their further development.MethodsThis prospective, exploratory, high-fidelity simulation study compared anesthesia personnel’s visual attention (fixation count and dwell-time) to 15 areas of interest on the patient monitor during non-critical and critical anesthesia situations. Furthermore, we examined the extent to which participants’ experience influenced visual attention and which vital signs displayed on the patient monitor received the most visual attention. We used mixed zero-inflated Poisson regression and mixed linear models to analyze the data.ResultsAnalyzing 23 ten-minute scenarios, we found significantly more fixations to the areas of interest on the patient monitor during critical than non-critical situations (rate ratio of 1.45; 95% CI 1.33 to 1.59; p < 0.001). However, the dwell-time on the areas of interest did not significantly differ between the non-critical and critical situations (coefficient of − 1.667; 95% CI − 4.549 to 1.229; p = 0.27). The professional experience did not significantly influence the visual attention (fixation: rate ratio of 0.88; 95% CI 0.54 to 1.43; p = 0.61 and dwell-time: coefficient of 0.889; 95% CI − 1.465 to 3.229; p = 0.27).Over all situations, anesthesia personnel paid the most attention to the vital signs blood pressure (fixation: mean [SD] of 108 [74.83]; dwell-time: mean [SD] of 27 [15.90] seconds), end-expiratory carbon dioxide (fixation: mean [SD] of 59 [47.39]; dwell-time: mean [SD] of 30 [21.51] seconds), and the electrocardiogram (fixation: mean [SD] of 58 [64.70]; dwell-time: mean [SD] of 15 [14.95] seconds).ConclusionsCritical anesthesia situations increased anesthesia personnel’s visual interaction with the patient monitor. Furthermore, we found that their visual attention focused mainly on a few vital signs. To assist clinicians in critical situations, manufacturers should optimize monitors to convey necessary information as easily and quickly as possible and optimize the visibility of less frequently observed but equally critical vital signs, especially when they are in an abnormal range.

User Perceptions of Different Vital Signs Monitor Modalities During High-Fidelity Simulation: Semiquantitative Analysis.

BackgroundPatient safety during anesthesia is crucially dependent on the monitoring of vital signs. However, the values obtained must also be perceived and correctly classified by the attending care providers. To facilitate these processes, we developed Visual-Patient-avatar, an animated virtual model of the monitored patient, which innovatively presents numerical and waveform data following user-centered design principles. After a high-fidelity simulation study, we analyzed the participants’ perceptions of 3 different monitor modalities, including this newly introduced technique.ObjectiveThe aim of this study was to collect and evaluate participants’ opinions and experiences regarding 3 different monitor modalities, which are Visual-Patient-avatar, Split Screen (avatar and Conventional monitor alongside each other), and Conventional monitor after using them during simulated critical anesthetic events.MethodsThis study was a researcher-initiated, single-center, semiquantitative study. We asked 92 care providers right after finishing 3 simulated emergency scenarios about their positive and negative opinions concerning the different monitor modalities. We processed the field notes obtained and derived the main categories and corresponding subthemes following qualitative research methods.ResultsWe gained a total of 307 statements. Through a context-based analysis, we identified the 3 main categories of “Visual-Patient-avatar,” “Split Screen,” and “Conventional monitor” and divided them into 11 positive and negative subthemes. We achieved substantial interrater reliability in assigning the statements to 1 of the topics. Most of the statements concerned the design and usability features of the avatar or the Split Screen mode.ConclusionsThis study semiquantitatively reviewed the clinical applicability of the Visual-Patient-avatar technique in a high-fidelity simulation study and revealed the strengths and limitations of the avatar only and Split Screen modality. In addition to valuable suggestions for improving the design, the requirement for training prior to clinical implementation was emphasized. The responses to the Split Screen suggest that this symbiotic modality generates better situation awareness in combination with numerical data and accurate curves. As a subsequent development step, a real-life introduction study is planned, where we will test the avatar in Split Screen mode under actual clinical conditions.

High performance solar receiver–reactor for hydrogen generation

This paper reports on the numerical analysis of a volumetric solar receiver-reactor for hydrogen production, using the 2-step reduction–oxidation cycle. A detailed parametric sweep covering hundreds of various parameter combinations is performed for a large solar reactor, using a transient physical model. We generate performance maps which are currently cost prohibitive via experimental or high–fidelity simulation studies. The following performance metrics are evaluated: solar to fuel efficiency, hydrogen yield, conversion extent and specific hydrogen yield. We show that the relations between the different performance metrics are complex, leading to different optimal points depending on the metric pursued. The daily hydrogen yield for a single reactor varied between 0.89 kg for an absorber thickness of 30 mm, and up to 1.04 kg for a 60 mm thick receiver, with solar to fuel efficiency values of 3.84% and 3.81% respectively. For a case with 45 mm thick receiver, an intermediate hydrogen yield of 0.94 kg is calculated, while exhibiting the highest efficiency (4.05%). The efficiency can be further increased to 5.86% by using a simple heat recovery system, and reach an upper limit of 21.16% with a more sophisticated heat recovery method.

Three learning modalities' impact on clinical judgment and perceptions in newly graduated registered nurses: A quasi-experimental study.

Newly graduated registered nurses face numerous challenges stemming from high patient workload, complicated interpersonal relationships, and a lack of nursing competence, which can lead to transitional shocks. Clinical judgment and confidence are well-known keys to successful role transitions for these nurses. Simulation training is proposed as a new modality for enhancing comprehensive clinical competence of nurses, but current evidence on the impact of different simulations on nurses' clinical judgment and confidence are still limited or inconsistent. This study compared the impact of three types of learning modalities on newly graduated registered nurses' clinical judgment, perceptions of self-confidence, and evaluations of the design features of the learning modalities. A quasi-experimental design was used. Fifty-nine participants were randomly assigned to three groups: (1) high-fidelity simulation, (2) virtual simulation, and (3) case study. Scales were used after the simulation. The virtual simulation group showed a higher level of clinical judgment. The high-fidelity simulation group felt more confident than the virtual simulation and case study groups. Both the high-fidelity simulation group and virtual simulation group reported higher scores in the domain of fidelity.

Impact of Postshock Transcutaneous Pacing on Chest Compression Quality during Resuscitation: A Simulation-Based Pilot Study

Background Successful defibrillation is commonly followed by a transient nonperfusing state. To provide perfusion in this stagnant phase, chest compressions are recommended irrespective of arrhythmia termination. Implantable cardioverters-defibrillators (ICD) used immediately after delivery of the shock are capable of pacing the heart, and this feature is commonly activated in these devices. Potential utility of external, transcutaneous postshock pacing in patients with SCA in shockable rhythms has not been determined. This study aimed at presenting an impact of a short-term external postshock pacing (ePSP) on a quality of chest compressions (CC) without compromising them. Methods The study was designed as a high-fidelity simulation study. Twenty triple-paramedic teams were invited. Participants were asked to take part in a 10-minute adult cardiac arrest scenario with ventricular fibrillation. In the first simulation, paramedics had to resume compressions after each shock (control group). In the second, simultaneous with compressions, one of the rescuers started transcutaneous pacing (TCP) with a current output of 200 mA and a pacer rate of 80 ppm. TCP was finished after 30 seconds (experimental group). The primary outcomes were chest compression fraction (CCF), mean depth and rate of compressions, percent of fully recoiled compressions, and percent of compressions of correct depth and their rate. Results In both experimental and control group, CCF, mean depth, and rate were similar (84.65 ± 3.67 vs. 85.45 ± 4.95, p=0.54; 55.75 ± 3.40 vs. 55.25 ± 2.73, p=0.63; 122.70 ± 4.92 vs. 120.80 ± 6.00, p=0.25, respectively). In turn, percent of CC performed in correct depth, rate, and recoil was unsatisfactory in both groups (51.00 ± 17.40 vs. 52.60 ± 18.72, p=0.76; 122.70 ± 4.92 vs. 120.80 ± 6.00, p=0.25, respectively). Small differences were not statistically significant. Moreover, appropriate hand-positioning was observed more frequently in the control group, and this was the only significant difference (95.60 ± 5.32 vs. 99.30 ± 1.59, p=0.006). Conclusion This difference was statistically significant (p < 0.01). Introducing an ePSP does not influence relevantly the quality of CC.

Avatar-based patient monitoring in critical anaesthesia events: a randomised high-fidelity simulation study

BackgroundFailures in situation awareness cause two-thirds of anaesthesia complications. Avatar-based patient monitoring may promote situation awareness in critical situations. MethodsWe conducted a prospective, randomised, high-fidelity simulation study powered for non-inferiority. We used video analysis to grade anaesthesia teams managing three 10 min emergency scenarios using three randomly assigned monitoring modalities: only conventional, only avatar, and split-screen showing both modalities side by side. The primary outcome was time to performance of critical tasks. Secondary outcomes were time to verbalisation of vital sign deviations and the correct cause of the emergency, perceived workload, and usability. We used mixed Cox and linear regression models adjusted for various potential confounders. The non-inferiority margin was 10%, or hazard ratio (HR) 0.9. ResultsWe analysed 52 teams performing 154 simulations. For performance of critical tasks during a scenario, split-screen was non-inferior to conventional (HR=1.13; 95% confidence interval [CI], 0.96–1.33; not significant in test for superiority); the result for avatar was inconclusive (HR=0.98; 95% CI, 0.83–1.15). Avatar was associated with a higher probability for verbalisation of the cause of the emergency (HR=1.78; 95% CI, 1.13–2.81; P=0.012). We found no evidence for a monitor effect on perceived workload. Perceived usability was lower for avatar (coefficient=–23.0; 95% CI, –27.2 to –18.8; P<0.0001) and split-screen (–6.7; 95% CI, –10.9 to –2.4; P=0.002) compared with conventional. ConclusionsThis study showed non-inferiority of split-screen compared with conventional monitoring for performance of critical tasks during anaesthesia crisis situations. The patient avatar improved verbalisation of the correct cause of the emergency. These results should be interpreted considering participants' minimal avatar but extensive conventional monitoring experience.

Placing Grid-Forming Converters to Enhance Small Signal Stability of PLL-Integrated Power Systems

The modern power grid features the high penetration of power converters, which widely employ a phase-locked loop (PLL) for grid synchronization. However, it has been pointed out that PLL can give rise to small-signal instabilities under weak grid conditions. This problem can be potentially resolved by operating the converters in grid-forming mode, namely, without using a PLL. Nonetheless, it has not been theoretically revealed how the placement of grid-forming converters enhances the small-signal stability of power systems integrated with large-scale PLL-based converters. This paper aims at filling this gap. Based on matrix perturbation theory, we explicitly demonstrate that the placement of grid-forming converters is equivalent to increasing the power grid strength and thus improving the small-signal stability of PLL-based converters. Furthermore, we investigate the optimal locations to place grid-forming converters by increasing the smallest eigenvalue of the weighted and Kron-reduced Laplacian matrix of the power network. The analysis in this paper is validated through high-fidelity simulation studies on a modified two-area test system and a modified 39-bus test system. This paper potentially lays the foundation for understanding the interaction between PLL-based (i.e., grid-following) converters and grid-forming converters, and coordinating their placements in future converter-dominated power systems.

High-Fidelity Simulation Versus Case Study: Which Is Best for Practical Nursing Students?

There is a gap in the literature regarding how simulation affects critical thinking skills for practical nursing students. A quasi-experimental two-group pretest-posttest study was conducted to determine the effects of high-fidelity simulation and interactive case studies on critical thinking scores of 29 practical nursing students. Both interventions had significant results (p = .001) between pretest and posttest; however, significance was not found regarding posttest scores between the high-fidelity simulation and interactive case study groups. Identifying pedagogical strategies that increase critical thinking skills for certificate-seeking practical nursing students is necessary to provide excellent nursing care and promote better patient outcomes.

Short-term immediate post-shock pacing in adult advanced life support – a feasibility study of modified ALS algorithm

Abstract Introduction It is well known that the majority of patients remains transiently pulseless after successfull defibrillation shock during routine advanced cardiovascular life support (ACLS). The post-shock asystole is longer than 120 seconds in as many as 25% of patients. Not only asystole, but also profound postshock bradycardia and high degree AV blocks are described as common. The need for post-shock pacing (PSP) in adult ACLS is unknown, but there is extensive use of that feature in implantable cardioverters – defibrillators (ICD). PSP feature is widely used in these devices. The wide utilisation of PSP in ICD patients warrants the research towards any possible benefit of it during ACLS measures. Material and methods We performed high-fidelity simulation study including 60 paramedic at 20 scenarios. The participants were asked to perform routine resuscitation scenarios according to the AHA ACLS algorithm. In the control group paramedics had to resume compressions after each shock. In experimental group simultaneously with the compressions, transcutaneous pacing with 200 mA output and rate of 80 ppm was delivered. Several parameters were monitored: chest compression fraction, compressions depth and rate, percent of recoiled compression, compressions on correct depth, and other. Results There were no statistically significant differences between both groups in respect of compressions depth and rate, time needed to achieve advanced airway, initiate and achieve intravenous line, administer medications (Table 1). The detailed results are presented in Table 1. Discussion According to the best of the authors knowledge, this is the first study describing the feasibility of PSP in resuscitation. The quality of resuscitation depends on adherence to the protocol. Any additional element in the protocol can negatively affect the outcome. In the presented study we present that major ACLS steps are delivered without significant delay when PSP is utilised. Conclusions The implementation of PSP had no negative impact on adherence to ACLS protocol. The authors see the need for further intensive research in this area. Figure 1. Design of the study. Funding Acknowledgement Type of funding source: None

Local atmospheric factors that enhance air-borne dispersion of coronavirus - High-fidelity numerical simulation of COVID19 case study in real-time

The spatial patterns of the spreading of the COVID19 indicate the possibility of airborne transmission of the coronavirus. As the cough-jet of an infected person is ejected as a plume of infected viral aerosols into the atmosphere, the conditions in the local atmospheric boundary layer together dictate the fate of the infected plume. For the first time - a high-fidelity numerical simulation study - using Weather-Research-Forecast model coupled with the Lagrangian Hybrid Single-Particle Lagrangian Integrated Trajectory model (WRF-HYSPLIT) model has been conducted to track the infected aerosol plume in real-time during March 9-April 6, 2020, in New York City, the epicenter of the coronavirus in the USA for comparing the morning, afternoon and evening release. Atmospheric stability regimes that result in low wind speeds, low level turbulence and cool moist ground conditions favor the transmission of the disease through turbulence energy-containing large-scale horizontal “rolls” and vertical thermal “updrafts” and “downdrafts”. Further, the wind direction is an important factor that dictates the direction of the transport. From the initial time of release, the virus can spread up to 30 min in the air, covering a 200-m radius at a time, moving 1–2 km from the original source.

From bartending interruptions to medication delivery interruptions: Managing the risks of a high-fidelity simulation study with pilot research.

In this paper we describe the risks of complex applied research, especially in work domains where professional practitioners are scarce. For such research, careful preparation and piloting is needed, especially when estimating sample size is required for a full study. However, such pilot work may reduce the potential sample size for the full study. We describe how the these issues have been addressed in applied psychology contexts. We then present a case study illustrating how we determined sample size for a study investigating the impact of workplace interruptions on errors that intensive care unit nurses might make during medication preparation and administration. The pilot work was performed in a functionally related domain to nursing-bartending-and bartender participants filled cocktail orders. Pilot 1 investigated performance with 0 interruptions and applied a model from a field observation to estimate probable effect sizes and sample sizes with 1 or 4 interruptions per medication scenario. Pilot 2 collected empirical data on the effect of 1 or 4 interruptions per cocktail scenario on cocktail errors and estimated sample size for the medication study, which was subsequently successfully run. The applied community could benefit from further discussions about these issues and the means for addressing them. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Situation Awareness-Oriented Patient Monitoring with Visual Patient Technology: A Qualitative Review of the Primary Research.

Visual Patient technology is a situation awareness-oriented visualization technology that translates numerical and waveform patient monitoring data into a new user-centered visual language. Vital sign values are converted into colors, shapes, and rhythmic movements—a language humans can easily perceive and interpret—on a patient avatar model in real time. In this review, we summarize the current state of the research on the Visual Patient, including the technology, its history, and its scientific context. We also provide a summary of our primary research and a brief overview of research work on similar user-centered visualizations in medicine. In several computer-based studies under various experimental conditions, Visual Patient transferred more information per unit time, increased perceived diagnostic certainty, and lowered perceived workload. Eye tracking showed the technology worked because of the way it synthesizes and transforms vital sign information into new and logical forms corresponding to the real phenomena. The technology could be particularly useful for improving situation awareness in settings with high cognitive demand or when users must make quick decisions. This comprehensive review of Visual Patient research is the foundation for an evaluation of the technology in clinical applications, starting with a high-fidelity simulation study in early 2020.

Analysis of the quality of chest compressions during resuscitation in an understaffed team — randomised crossover manikin study

INTRODUCTION: According to the chain of survival, chest compressions (CCs) are crucial in every cardiac arrest patient. It is very challenging to provide high-quality resuscitation in a two-paramedic team. The task of an automatic chest compression device (ACCD) is to relieve the rescuer and improve the quality of CCs. Its influence on the quality of the whole resuscitation as well as the survival of patients is still subject to discussion worldwide. This study aimed to assess the quality of CCs during resuscitation in a two-paramedic team using ACCD. MATERIAL AND METHODS: This research was designed as a prospective, randomised, cross-over, high-fidelity simulation study. Fifty-two double paramedic teams took part in the research. The role of the participants was to conduct full advanced resuscitation in a human patient’s simulator. Each team provided resuscitation twice. Once with an ACCD and once using manual compressions. Chest compression quality parameters, as well as chest compression fraction (CCF), were measured. RESULTS : Statistically significant differences were found between manual and automated compressions in: mean depth (48 ± 4 mm vs. 56 ± 3 mm, p < 0.0001), mean rate (117 ± 9 mm vs. 103 ± 1 mm, p < 0.0001), percentage of CC with correct depth (46 ± 25 vs. 87 ± 13, p < 0.0001), rate (72 ± 22 vs. 96 ± 4, p < 0.0001), and recoil (55 ± 23 vs. 89 ± 13, p < 0.0001). CCF was also higher when the ACCD was used (74 ± 7% vs. 83 ± 2%, p < 0.0001). CONCLUSIONS: The use of an ACCD increases the quality of compressions by improving CCF, chest recoil, and the percentage of compressions performed with adherence to guidelines.