Addressing the challenges of ECMO simulation

This document is the Accepted Manuscript. The final, definitive version of this paper has been published in Perfusion, May 2018, published by SAGE Publishing, All rights reserved.Introduction/Aim: The patient’s condition and high-risk nature of extracorporeal membrane oxygenation (ECMO) therapy force clinical services to ensure clinicians are properly trained and always ready to deal effectively with critical situations. Simulation-based education (SBE), from the simplest approaches to the most immersive modalities, helps promote optimum individual and team performance. The risks of SBE are negative learning, inauthenticity in learning and over-reliance on the participants’ suspension of disbelief. This is especially relevant to ECMO SBE as circuit/patient interactions are difficult to fully simulate without confusing circuit alterations. Methods: Our efforts concentrate on making ECMO simulation easier and more realistic in order to reduce the current gap there is between SBE and real ECMO patient care. Issues to be overcome include controlling the circuit pressures, system failures, patient issues, blood colour and cost factors. Key to our developments are the hospital-university collaboration and research funding. Results: A prototype ECMO simulator has been developed that allows for realistic ECMO SBE. The system emulates the ECMO machine interface with remotely controllable pressure parameters, haemorrhaging, line chattering, air bubble noise and simulated blood colour change. Conclusion: The prototype simulator allows the simulation of common ECMO emergencies through innovative solutions that enhance the fidelity of ECMO SBE and reduce the requirement for suspension of disbelief from participants. Future developments will encompass the patient cannulation aspect.Peer reviewe

Parental evaluation of a telemonitoring service for children with Type 1 Diabetes

Introduction In the past years, we developed a telemonitoring service for young patients affected by Type 1 Diabetes. That service provides data to the clinical staff and offers an important tool to the parents, that are able to oversee in real time their children. The aim of this work was to analyze the parents' perceived usefulness of the service. Methods The service was tested by the parents of 31 children enrolled in a seven-day clinical trial during a summer camp. To study the parents' perception we proposed and analyzed two questionnaires. A baseline questionnaire focused on the daily management and implications of their children's diabetes, while a post-study one measured the perceived benefits of telemonitoring. Questionnaires also included free text comment spaces. Results Analysis of the baseline questionnaires underlined the parents' suffering and fatigue: 51% of total responses showed a negative tendency and the mean value of the perceived quality of life was 64.13 in a 0-100 scale. In the post-study questionnaires about half of the parents believed in a possible improvement adopting telemonitoring. Moreover, the foreseen improvement in quality of life was significant, increasing from 64.13 to 78.39 ( p-value\u2009=\u20090.0001). The analysis of free text comments highlighted an improvement in mood, and parents' commitment was also proved by their willingness to pay for the service (median\u2009=\u2009200\u2009euro/year). Discussion A high number of parents appreciated the telemonitoring service and were confident that it could improve communication with physicians as well as the family's own peace of mind

Focal Spot, Winter 2006/2007

https://digitalcommons.wustl.edu/focal_spot_archives/1104/thumbnail.jp

In-situ simulation: A different approach to patient safety through immersive training

Simulation is becoming more and more popular in the field of healthcare education. The main concern for some faculty is knowing how to organise simulation training sessions when there is no simulation centre as they are not yet widely available and their cost is often prohibitive. In medical education, the pedagogic objectives are mainly aimed at improving the quality of care as well as patient safety. To that effect, a mobile training approach whereby simulation-based education is done at the point of care, outside simulation centres, is particularly appropriate. It is usually called “in-situ simulation”. This is an approach that allows training of care providers as a team in their normal working environment. It is particularly useful to observe human factors and train team members in a context that is their real working environment. This immersive training approach can be relatively low cost and enables to identify strengths and weaknesses of a healthcare system. This article reminds readers of the principle of « context specific learning » that is needed for the good implementation of simulation-based education in healthcare while highlighting the advantages, obstacles, and challenges to the development of in-situ simulation in hospitals. The objective is to make clinical simulation accessible to all clinicians for the best interests of the patient.Peer reviewe

L&D in the ED: A Game-Based Approach to Learning High-Risk Obstetric Emergencies.

IntroductionTeaching emergency medicine residents the principles of obstetric emergencies is a challenging task, as these emergencies are uncommon in general practice and include specific maneuvers for difficult and precipitous deliveries. These requirements are not easy to satisfy in a standard lecture and are labor intensive for small groups. This resource is a board game that leverages near-peer teaching, engages student collaboration, and supports friendly competition.MethodsThe game was designed to be used by emergency medicine residents and emphasized the evaluation and management of acute issues related to labor and delivery (L&D). To play the game, three to four learners took turns answering questions. Each correct answer was awarded points for forward movement on the game board. The first person to reach the end of the game won. A faculty moderator circulated among the players to clarify questions or answers as needed.ResultsOur residents loved this resource. They were able to teach each other throughout the game while using reference materials. Participants rated the educational value of the L&D board game as 4.81 (out of 5), as compared to 4.37 for prior lectures covering the same topics. The game was rated similarly to delivery procedural skills workshops implemented in prior years (4.62-4.82).DiscussionGame-based exercises are low-tech, highly interactive teaching tools enabling students to learn from each other in a fun and engaging way. Although we did not assess knowledge retention, this activity's educational value was rated similarly to delivery procedural skills sessions

Providing Language Services in Small Health Care Provider Settings: Examples From the Field

Assesses recent innovations in language service programs and activities at healthcare provider settings with ten or fewer clinicians. Includes an eight-step plan to help providers develop a strategy to meet the needs of their patients

Extracorporeal membrane oxygenation simulation-based training: methods, drawbacks and a novel solution

Introduction: Patients under the error-prone and complication-burdened extracorporeal membrane oxygenation (ECMO) are looked after by a highly trained, multidisciplinary team. Simulation-based training (SBT) affords ECMO centers the opportunity to equip practitioners with the technical dexterity required to manage emergencies. The aim of this article is to review ECMO SBT activities and technology followed by a novel solution to current challenges. ECMO simulation: The commonly-used simulation approach is easy-to-build as it requires a functioning ECMO machine and an altered circuit. Complications are simulated through manual circuit manipulations. However, scenario diversity is limited and often lacks physiological and/or mechanical authenticity. It is also expensive to continuously operate due to the consumption of highly specialized equipment. Technological aid: Commercial extensions can be added to enable remote control and to automate circuit manipulation, but do not improve on the realism or cost-effectiveness. A modular ECMO simulator: To address those drawbacks, we are developing a standalone modular ECMO simulator that employs affordable technology for high-fidelity simulation.Peer reviewe