La simulazione medica nel futuro: un tentativo di visioning The health simulation in the future: an attempt of visioning

La pratica clinica è un componente indispensabile dell’apprendimento e del mantenimento delle competenze in molte delle discipline sanitarie e la simulazione offre l’opportunità di praticare in maniera sicura ed efficace senza rischi per il paziente. La simulazione nella didattica medica si è già ampiamente evoluta rispetto alle sue fasi iniziali. L’introduzione dei simulatori di pazienti umani, intorno alla fine del XX secolo, rappresenta una tappa fondamentale nella scienza dell’educazione in sanità. Fino ad oggi l’attenzione degli sviluppatori si è concentrata da un lato sulla capacità dei simulatori di dare feedback verosimili e coerenti con il comportamento del paziente e con la fisiologia umana e dall’altro sull’interazione fra simulatore e utilizzatore. Le emergenti tecnologie nel campo della percezione sensoriale apporteranno miglioramenti significativi sia nella formazione in simulazione che nella gestione della simulazione stessa. Basandosi sull’analisi delle tecnologie attualmente disponibili e in via di sviluppo, questo scritto vuole essere uno sforzo di visioning sul futuro delle tecniche di simulazione. Nano-sensori e nano-attuatori, usati nella realtà aumentata/virtuale/ mista, permetteranno sia la concettualizzazione di sistemi capaci di aumentare il livello di realismo e di immersione sensoriale ma anche di mappare i movimenti e le azioni al fine di generare protocolli univoci di intervento. Proiettandoci in un ipotetico 2025, la simulazione medica sarà un’esperienza democratica, largamente accessibile, dinamica e immersiva a 360°, grazie alle tecniche di implementazione neuro-percettive.Practice is a key component of skills learning and maintenance in many health disciplines and simulation offers the opportunity to practice in a safe and effective manner improving patient safety. Simulation for healthcare training has already evolved through its initial historical phases. The introduction of human patient simulator toward the end of the 20th century was a milestone in health sciences education. To date the attention of developers has been paid to the capability of the simulator to give feedback, consistent with patient behavior and physiologic response, and the interaction between simulator and users. The emerging technologies in the field of sensorial perception will bring improvements both in education and in management of the simulation. Grounding on the analysis of current and under-development technology, the manuscript is an attempt of visioning simulation-based training in health education in a coming future. Nano-sensors and nano-actuators, used in augmented/virtual/mixed reality, will allow the conceptualization of systems increasing the level of realism and the sensorial immersion, and the mapping of movements and action in order to generate univocal protocols of intervention. Projecting ourselves in 2025, medical simulation will be a democratic, largely accessible, dynamic and 360° sensorial experience, thanks to techniques of neuro-perceptive implementation

Holo-BLSD – A holographic tool for self-training and self-evaluation of emergency response skills

In case of cardiac arrest, prompt intervention of bystanders can be vital in saving lives. Basic Life Support and Defibrillation (BLSD) is a procedure designed to deliver a proficient emergency first response. Developing skills in BLSD in a large part of the population is a primary educational goal of resuscitation medicine. In this context, novel computer science technologies like Augmented Reality (AR) and Virtual Reality (VR) can alleviate some of the drawbacks of traditional instructor-led courses, especially concerning time and cost constraints. This paper presents Holo-BLSD, an AR system that allows users to learn and train the different operations involved in BLSD and receive an automatic assessment. The system uses a standard manikin which is quotes{augmented} by an interactive virtual environment that reproduces realistic emergency scenarios. The proposed approach has been validated through a user study. Subjective results confirmed the usability of the devised tool and its capability to stimulate learners' attention. Objective results indicated no statistical significance in the differences between the examiners' evaluation of users who underwent traditional and AR training; they also showed a close agreement between expert and automatic assessments, suggesting that Holo-BLSD can be regarded as an effective self-learning method and a reliable self-evaluation tool

COVID-19 crisis, safe reopening of simulation centres and the new normal: food for thought

The world is facing a massive burden from the coronavirus disease 2019 (COVID-19) pandemic. Governments took the extraordinary step of locking down their own countries to curb the spread of the coronavirus. After weeks of severe restrictions, countries have begun to relax their strict lockdown measures. However, reopening will not be back to normal. Simulation facilities (SF) are training spaces that enable health professionals and students to learn skills and procedures in a safe and protected environment. Today's clinicians and students have an expectation that simulation laboratories are part of lifelong healthcare education. There is great uncertainty about how COVID-19 will impact future training in SF. In particular, the delivery of training activities will benefit of adequate safety measures implemented for all individuals involved. This paper discusses how to safely reopen SF in the post-lockdown phase

Clinical course and management of acute and chronic viral hepatitis during pregnancy.

Pregnancy is a para-physiologic condition, which usually evolves without any complications in the majority of women, even if in some circumstances moderate or severe clinical problems can also occur. Among complications occurring during the second and the third trimester very important are those considered as concurrent to pregnancy such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, HELLP syndrome and acute fatty liver of pregnancy. The liver diseases concurrent to pregnancy typically occur at specific times during the gestation and they may lead to significant maternal and foetal morbidity and mortality. Commonly, delivery of the foetus, even preterm, usually terminates the progression of these disorders. All chronic liver diseases, such as chronic viral hepatitis, autoimmune hepatitis, Wilson's disease, and cirrhosis of different aetiologies may cause liver damage, independently from pregnancy. In this review we will also comment the clinical implications of pregnancies occurring in women who received a orthotopic liver transplantation (OLT) Therefore, the management of immunosuppressive therapy before and after the delivery in women who received liver transplant is becoming a relevant clinical issue. Finally, we will focus on acute and chronic viral hepatitis occurring during pregnancy, on management of advanced liver disease and we will review the literature on the challenging issue regarding pregnancy and OLT

Wearable proximity sensors for monitoring a mass casualty incident exercise: a feasibility study

Over the past several decades, naturally occurring and man-made mass casualty incidents (MCI) have increased in frequency and number, worldwide. To test the impact of such event on medical resources, simulations can provide a safe, controlled setting while replicating the chaotic environment typical of an actual disaster. A standardised method to collect and analyse data from mass casualty exercises is needed, in order to assess preparedness and performance of the healthcare staff involved. We report on the use of wearable proximity sensors to measure proximity events during a MCI simulation. We investigated the interactions between medical staff and patients, to evaluate the time dedicated by the medical staff with respect to the severity of the injury of the victims depending on the roles. We estimated the presence of the patients in the different spaces of the field hospital, in order to study the patients' flow. Data were obtained and collected through the deployment of wearable proximity sensors during a mass casualty incident functional exercise. The scenario included two areas: the accident site and the Advanced Medical Post (AMP), and the exercise lasted 3 hours. A total of 238 participants simulating medical staff and victims were involved. Each participant wore a proximity sensor and 30 fixed devices were placed in the field hospital. The contact networks show a heterogeneous distribution of the cumulative time spent in proximity by participants. We obtained contact matrices based on cumulative time spent in proximity between victims and the rescuers. Our results showed that the time spent in proximity by the healthcare teams with the victims is related to the severity of the patient's injury. The analysis of patients' flow showed that the presence of patients in the rooms of the hospital is consistent with triage code and diagnosis, and no obvious bottlenecks were found

Cognitive appraisals and team performance under stress: a simulation study

Objectives The present study explored how challenge and threat responses to stress relate to performance, anxiety, confidence, team identity and team characteristics (time spent in training and postgraduate experience) in a medical simulation‐based team competition. Methods The study was conducted during a national simulation‐based training event for residents, the SIMCUP Italia 2018. The SIMCUP is a simulation competition in which teams of four compete in simulated medical emergency scenarios. Cross‐sectional data were collected prior to the 3 days of the competition. Subjects included 95 participants on 24 teams. Before the competition on each day, participants completed brief self‐report measures that assessed demands and resources (which underpin challenge and threat responses to stress), cognitive and somatic anxiety, self‐confidence and team identification. Participants also reported time (hours) spent practising as a team and years of postgraduate experience. A team of referees judged each scenario for performance and assigned a score. A linear mixed model using demands and resources was built to model performance. Results The data showed that both demands and resources have positive effects on performance (31 [11‐50.3] [P < .01] and 54 [25‐83.3] [P < .01] percentage points increase for unitary increases in demands and resources, respectively); however, this is balanced by a negative interaction between the two (demands * resources interaction coefficient = −10 [−16 to −4.2]). A high level of resources is associated with better performance until demands become very high. Cognitive and somatic anxieties were found to be correlated with demands (Pearson's r = .51 [P < .01] and Pearson's r = .48 [P < .01], respectively). Time spent training was associated with greater perceptions of resources (Pearson's r = .36 [P < .01]). Conclusions We describe a model of challenge and threat that allows for the estimation of performance according to perceived demands and resources, and the interaction between the two. Higher levels of resources and lower demands were associated with better performance

Evaluation of a new community-based curriculum in disaster medicine for undergraduates

BACKGROUND: Nowadays, many medical schools include training in disaster medicine in undergraduate studies. This study evaluated the efficacy of a disaster medicine curriculum recently designed for Saudi Arabian medical students. METHODS: Participants were 15 male and 14 female students in their fourth, fifth or sixth year at Jazan University Medical School, Saudi Arabia. The course was held at the Research Center in Emergency and Disaster Medicine and Computer Sciences Applied to the Medical Practice in Novara, Italy. RESULTS: The overall mean score on a test given before the course was 41.0 % and it increased to 67.7 % on the post-test (Wilcoxon test for paired samples: z = 4.71, p < 0.0001). There were no significant differences between the mean scores of males and females, or between students in their fourth, fifth or sixth year of medical school. CONCLUSIONS: These results show that this curriculum is effective for teaching disaster medicine to undergraduate medical students. Adoption of this course would help to increase the human resources available for dealing with disaster situations