Comparison of virtual patient simulation with Mannequin-based simulation for improving clinical performances in assessing and managing clinical deterioration: Randomized controlled trial

10.2196/jmir.3322Journal of Medical Internet Research169e21

Cutaneous tactile allodynia associated with microvascular dysfunction in muscle

<p>Abstract</p> <p>Background</p> <p>Cutaneous tactile allodynia, or painful hypersensitivity to mechanical stimulation of the skin, is typically associated with neuropathic pain, although also present in chronic pain patients who do not have evidence of nerve injury. We examine whether deep tissue microvascular dysfunction, a feature common in chronic non-neuropathic pain, contributes to allodynia.</p> <p>Results</p> <p>Persistent cutaneous allodynia is produced in rats following a hind paw ischemia-reperfusion injury that induces microvascular dysfunction, including arterial vasospasms and capillary slow flow/no-reflow, in muscle. Microvascular dysfunction leads to persistent muscle ischemia, a reduction of intraepidermal nerve fibers, and allodynia correlated with muscle ischemia, but not with skin nerve loss. The affected hind paw muscle shows lipid peroxidation, an upregulation of nuclear factor kappa B, and enhanced pro-inflammatory cytokines, while allodynia is relieved by agents that inhibit these alterations. Allodynia is increased, along with hind paw muscle lactate, when these rats exercise, and is reduced by an acid sensing ion channel antagonist.</p> <p>Conclusion</p> <p>Our results demonstrate how microvascular dysfunction and ischemia in muscle can play a critical role in the development of cutaneous allodynia, and encourage the study of how these mechanisms contribute to chronic pain. We anticipate that focus on the pain mechanisms associated with microvascular dysfunction in muscle will provide new effective treatments for chronic pain patients with cutaneous tactile allodynia.</p

Systems Analysis and Design: Techniques, Methodologies, Approaches, and Architecture

For the last two decades, IS researchers have conducted empirical studies leading to better understanding of the impact of Systems Analysis and Design methods in business, managerial, and cultural contexts. SA & D research has established a balanced focus not only on technical issues, but also on organizational and social issues in the information society.This volume presents the very latest, state-of-the-art research by well-known figures in the field. The chapters are grouped into three categories: techniques, methodologies, and approaches

Interprofessional simulation-based education program: A promising approach for changing stereotypes and improving attitudes toward nurse–physician collaboration

10.1016/j.apnr.2014.03.005Applied Nursing Research274258-26

Research in brief - Interprofessional learning in undergraduate education through simulation crisis team training

Singapore Nursing Journal39336-3

An interprofessional communication training using simulation to enhance safe care for a deteriorating patient

10.1016/j.nedt.2013.02.019Nurse Education Today342259-26

An interprofessional communication training using simulation to enhance safe care for a deteriorating patient

Background: Communication and teamwork between doctors and nurses are critical for optimal patient care. Simulation and interprofessional team learning are emerging as significant learning strategies to promote teamwork and communication between different health professionals.Aim: The aim of the study is to describe the development, implementation and evaluation of a simulation-based interprofessional educational (Sim-IPE) program, using a presage-process-product (3P) model, for improving medical and nursing students' communication skills in caring of a patient with physiological deterioration.Method: The program was conducted using full-scale simulation and communication strategies adapted from Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). 127 medical and nursing students participated in a 3-hour small group interprofessional learning that incorporated simulation scenarios of deteriorating patients. Pre and post-tests were conducted to assess the students' self-confidence in interprofessional communication and perception in interprofessional learning. After the training, the students completed a,satisfaction questionnaire.Results: Both medicine and nursing groups demonstrated a significant improvement on post-test score from pretest score for self-confidence (p < .0001) and perception (p < .0001) with no significant differences detected between the two groups. The participants were highly satisfied with their simulation learning.Conclusion: The Sim-IPE has better prepared the medical and nursing students in communicating with one another in providing safe care for deteriorating patient In addition, it has improved their perception towards interprofessional learning. This pre-registration interprofessional education could prepare them for more comprehensive interprofessional team learning at post-registration level. (C) 2014 Elsevier Ltd. All rights reserved

Comparison of virtual patient simulation with mannequin-based simulation for improving clinical performances in assessing and managing clinical deterioration: randomized controlled trial

Background: Virtual patient simulation has grown substantially in health care education. A virtual patient simulation was developed as a refresher training course to reinforce nursing clinical performance in assessing and managing deteriorating patients. Objective: The objective of this study was to describe the development of the virtual patient simulation and evaluate its efficacy, by comparing with a conventional mannequin-based simulation, for improving the nursing students' performances in assessing and managing patients with clinical deterioration. Mehtods: A randomized controlled study was conducted with 57 third-year nursing students who were recruited through email. After a baseline evaluation of all participants' clinical performance in a simulated environment, the experimental group received a 2-hour fully automated virtual patient simulation while the control group received 2-hour facilitator-led mannequin-based simulation training. All participants were then re-tested one day (first posttest) and 2.5 months (second posttest) after the intervention. The participants from the experimental group completed a survey to evaluate their learning experiences with the newly developed virtual patient simulation. Results: Compared to their baseline scores, both experimental and control groups demonstrated significant improvements (P<.001) in first and second post-test scores. While the experimental group had significantly lower (P<.05) second post-test scores compared with the first post-test scores, no significant difference (P=.94) was found between these two scores for the control group. The scores between groups did not differ significantly over time (P=.17). The virtual patient simulation was rated positively. Conclusions: A virtual patient simulation for a refreshing training course on assessing and managing clinical deterioration was developed. Although the randomized controlled study did not show that the virtual patient simulation was superior to mannequin-based simulation, both simulations have demonstrated to be effective refresher learning strategies for improving nursing students' clinical performance. Given the greater resource requirements of mannequin-based simulation, the virtual patient simulation provides a more promising alternative learning strategy to mitigate the decay of clinical performance over time

Information Systems Analysis and Design: Past Revolutions, Present Challenges, and Future Research Directions

Systems Analysis and Design (SAND) is undoubtedly a pillar in the field of Information Systems (IS). Some researchers have even claimed that SAND is the field that defines the Information Systems discipline and is the core of information systems. The past decades have seen the development of Structured SAND methodologies and Object-Oriented Methodologies. In the early 1990s, key players in the field collaborated to develop the Unified Modeling Language and the Unified Process. Agile approaches followed, as did other dynamic methods. These approaches remain heavily employed in the development of contemporary information systems. At the same time, new approaches such as DevOps and DevSecOps continue to emerge. This paper curates these trends in SAND. It reviews past and present SAND research, discusses current challenges, and provides insights that can assist SAND researchers in identifying future SAND research streams and important future research directions

Information Systems Analysis and Design: Past Revolutions, Present Challenges, and Future Research Directions

Systems Analysis and Design (SAND) is undoubtedly a pillar in the field of Information Systems (IS). Some researchers have even claimed that SAND is the field that defines the Information Systems discipline and is the core of information systems. The past decades have seen the development of Structured SAND methodologies and Object-Oriented Methodologies. In the early 1990s, key players in the field collaborated to develop the Unified Modeling Language and the Unified Process. Agile approaches followed, as did other dynamic methods. These approaches remain heavily employed in the development of contemporary information systems. At the same time, new approaches such as DevOps and DevSecOps continue to emerge. This paper curates these trends in SAND. It reviews past and present SAND research, discusses current challenges, and provides insights that can assist SAND researchers in identifying future SAND research streams and important future research directions