A cost-effectiveness analysis of self-debriefing versus instructor debriefing for simulated crises in perioperative medicine in Canada.

PurposeHigh-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other.MethodsThis study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve.ResultsSelf-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can300, instructor debriefing was the preferred alternative.ConclusionWith a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education

Post-war mothers. childbirth letters to Grantly Dick-Read 1946-1956

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Uteri E inversion revisited

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Development of an in vitro microfluidic platform to mimic the blood-brain barrier

Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2022-2023. Directora: Anna Lagunas, Tutor: Manel Puig.There are very few models able to simulate with precision the complex structure of the blood-brain barrier (BBB): our body’s most restrictive barrier which, while protecting our brain from pathogens, toxins, inflammation, injury and disease, is also the main obstacle for the delivery of drugs to the brain. This paper examines all the aspects that have to be taken into account to properly develop, from scratch, an in vitro microfluidic platform to mimic the human BBB. The thesis details every step of the fabrication of the device, provides an economic and technical analysis of its feasibility, and considers the ethical and legal aspects of its implementation to the market. Following a thorough analysis of the different existing models of the BBB and their benefits, this work develops a design incorporating a tri-culture of human astrocytes, pericytes and endothelial cells ensembled in a 3D environment of hydrogel within a structure of PDMS . The resulting BBB-on-a-chip (BBB-oC) is an accurate, reproducible, animal-free and cheaper alternative to in vivo models for mimicking the function and structure of the BBB. Evaluation techniques carried out in this project showed a suitable environment for the cells inside the chip, confirming their correct morphology and viability up to the 7th day. Permeability assays revealed that the barrier is size restrictive, thus allowing smaller molecules to pass through faster than bigger molecules. To provide a clinical application to the model, permeability performance tests were conducted on two different nanotherapeutic systems which target the inhibition of Aβ fibrillation as a possible treatment for Alzheimer’s disease