The COVID-19 drive-through point — screening and testing — first in Poland complex centre experience

Introduction: Rapid widespread of the SARS-CoV-2 virus in early 2020 caused global chaos. In the initial period, a lack of knowledge of epidemiology and viral contamination, as well as no availability of either causal treatment or preventive vaccination, resulted in mass testing of symptomatic individuals as the priority for protection. This study aimed to evaluate the effectiveness and safety of the first COVID-19 (coronavirus disease) drive-through testing model in the Greater Poland Region. Material and methods: The authors demonstrate step-by-step the creation and development of the Centre of Medical Simulation Poznan University of Medical Sciences (PUMS) COVID-19 drive-through testing point for 3.5 million inhabitants in the Greater Poland Region during the 1st through 4th coronavirus pandemic waves. For staff education, low and high-fidelity simulation techniques were used. Additionally, the number of tests performed at the swab point and the efficiency of the developed testing model were evaluated and assessed in all pandemic waves. Results: PUMS POST (point of screening and testing) activity lasted 24 months. Improvement of staff skills developed through simulation training increased the median number of 91 patients tested each day (with a median of 25 tests per hour) during the 1st wave to a maximum of 260 patients tested each day (135 tests per hour) during the 4th wave when the new drive-through POST system was employed (p < 0.001). Conclusion: The present study supported the previous preliminary reports that drive-through systems developed during the COVID-19 pandemic proved to be efficient and safe for mass population testing. Moreover, the Medical Simulation Centre confirmed the effectiveness of staff skills improvement

Paramedic students need more training in left ventricular assist device — a pilot simulation study

INTRODUCTION: Mechanical Circulation Systems are a promising therapy for patients with end-stage of heart failure. Left ventricular assist device (LVAD) enforces using of concomitant anticoagulant therapy. This may lead to severe complications. LVAD patients are more and more frequent users of the emergency department. There are several differences in cardiovascular function in these patients, as well as on examination. Its interpretation may be challenging and result in potentially fatal conclusions. The aim of this research was to assess the skills of paramedic students in assessing patients with LVAD MATERIAL AND METHODS: The study was designed as a simulation study. The aim of this scenario was to provide a full primary survey of an unconscious, spontaneously breathing person with an LVAD pump implanted. Ten groups of paramedic students from Polish medical universities took part in this study. RESULTS: Four teams started chest compressions unnecessarily. Of them, only one had contacted LVAD local coordinator and discontinued after short instructions. Four teams completed the driveline and device check and six checked only the line without moving the controller. No major errors were noted in the field of airway assessment and management as well as assessment of consciousness, breathing, and circulation. CONCLUSIONS: More attention should be paid to educating paramedic students in LVAD therapy. Educators should focus mainly on differences in cardiovascular function and pay attention to complete perfusion assessment. Medical simulation seems to be a good tool for assessing difficult clinical cases rarely encountered in practice

Managing patients on extracorporeal membrane oxygenation support during the COVID-19 pandemic – a proposal for a nursing standard operating procedure

Background Extracorporeal membrane oxygenation (ECMO) is effective in a selected critically ill patient population with promising results in refractory hypoxemia related to the novel coronavirus disease (COVID-19). However, it requires specialized clinicians and resources in advanced technology. Moreover, the COVID-19 remains an ongoing global emergency, and there is no evidence-based practice in preparedness. This article proposes an innovative and optimized nursing care protocol, the Standard Operating Procedure (SOP), that regulates safety and efficiency in using personal protective equipment (PPE) during ECMO-relevant procedures while providing ECMO therapy for patients with COVID-19. Methods After performing a narrative literature search, we developed a high-fidelity translational simulation scenario. It included practicing appropriate donning and doffing PPE during work organization, ECMO-related procedures, and routine daily nursing care and management of ECMO over nine hours. In addition, we held supplementary constructive debrief meetings to consult international expert in the field. Results A proposal for nursing standardized operating procedures was created, divided into categories. They included work organization, workload references, competences, infrastructural conditions, cannulation equipment, daily routine nursing care, and procedures during ECMO. Conclusions High-fidelity medical simulation can play an important role in staff training, improvement in previously gained proficiency, and development of optimal SOP for nursing care and management during ECMO in patients with COVID-19. Optimal SOPs may further guide multidisciplinary teams, including intensive care units and interventional departments

The concept of a sustainable business model: Opportunities and challenges

The concept of sustainable development is considered one of the most important and urgent challenges facing humanity today. Therefore, solutions that promote sustainable business are of particular importance. The purpose of this article was to explore the concept of a business model as a potentially promising way of shaping the contribution of businesses to sustainable development. A systematic literature review method was used to identify, analyze and critically evaluate the first theoretical proposals for the concept of a sustainable business model. Fundamental differences between the proposed conceptualizations were identified, stemming from different understandings of the business model concept on the one hand, and from its embedding in different, partly contradictory approaches, to corporate contributions to sustainable development, on the other. The article adapts the holistic approach of corporate sustainability and the understanding of the business model as a representation of the essence of business including the proposition, creation, delivery and capture of value. As a result, key elements of the emerging new ontology of the sustainable business model have been identified and defined. The proposed concept of a sustainable business model primarily means adopting a different logic of business, and the basis for defining the various elements of the business model is the reconstruction of the concept of value. The sustainability of a business model is thus referred to the extent to which this model maximizes benefits while reducing economic, social, and environmental damage, and creates value not only for the company and its customers but also for various stakeholder groups. The main part of the article is a systematic identification of the opportunities and challenges associated with the new proposal. These are discussed according to the key elements of the sustainable business model, which are: the value proposition, value creation and value capture.The concept of sustainable development is considered one of the most important and urgent challenges facing humanity today. Therefore, solutions that promote sustainable business are of particular importance. The purpose of this article was to explore the concept of a business model as a potentially promising way of shaping the contribution of businesses to sustainable development. A systematic literature review method was used to identify, analyze and critically evaluate the first theoretical proposals for the concept of a sustainable business model. Fundamental differences between the proposed conceptualizations were identified, stemming from different understandings of the business model concept on the one hand, and from its embedding in different, partly contradictory approaches, to corporate contributions to sustainable development, on the other. The article adapts the holistic approach of corporate sustainability and the understanding of the business model as a representation of the essence of business including the proposition, creation, delivery and capture of value. As a result, key elements of the emerging new ontology of the sustainable business model have been identified and defined. The proposed concept of a sustainable business model primarily means adopting a different logic of business, and the basis for defining the various elements of the business model is the reconstruction of the concept of value. The sustainability of a business model is thus referred to the extent to which this model maximizes benefits while reducing economic, social, and environmental damage, and creates value not only for the company and its customers but also for various stakeholder groups. The main part of the article is a systematic identification of the opportunities and challenges associated with the new proposal. These are discussed according to the key elements of the sustainable business model, which are: the value proposition, value creation and value capture

Are we well prepared to examine patients with left ventricular assist device in emergency conditions? — a simulation-based pilot study

Introduction: Left ventricular assist device (LVAD) therapy is becoming more and more important. There is now increasing number of patients on LVAD therapy. This means that they will also be more frequent patients in emergency departments. There are several differences in cardiovascular function in these patients. An examination performed according to the well-known ABCDE algorithm, can be difficult to interpret and result in incorrect decisions. The aim of this pilot study was to preliminarily assess the ability of medical university students to examine a patient with LVAD. Material and methods: The authors designed a simulation study. The aim of the scenario was to assess the unconscious, spontaneously breathing patient with LVAD and provide assistance appropriate to the patient’s condition. Ten groups of students from different polish medical universities participated in the study. Results: All teams implemented the ABCDE examination protocol. Seven teams started chest compressions due to absence of pulse despite spontaneous breathing. Out of seven teams that started compressions, two terminated after discussion within the team. Half of the teams completed the driveline and LVAD device check. Four teams contacted the LVAD coordinator. Three teams in the study did not perform perfusion assessment. Conclusions: An examination according to the ABCDE algorithm can be performed in a patient with LVAD. However, there is a need to modify the standard algorithm to adjust for the characteristics of an LVAD patient. Consideration should be given to inadequate skills in interpreting the results ABCDE examination. Simulation-based learning should be an important part of pre- and postgraduate education