Validation and determination of the influence of a virtual simulator on the acquisition of ultrasound skills and comparison of learning curves of those using simulation- supported training with a conventional training approach

Delivery of ultrasound training remains a challenge. This thesis presents a series of projects that investigated a new approach in acquiring transvaginal ultrasound skills (TVS) in obstetrics and gynaecology using a novel virtual reality simulator (ScanTrainer®, Medaphor plc, Cardiff, Wales). Aims and objectives:(1) To evaluate the validity and reliability of the simulator,(2)to assess the learning curves of trainees’ competence in performing TVS, and (3) to define potential benefits and limitations of simulation training from the trainee’s perspective. These were achieved by undertaking the following studies (1) face, content and construct validity of the simulator, (2) reliability of scoring systems developed for the assessment of ultrasound in obstetrics and gynaecology, (3) validation of simulation scoring system against experts, and (4) evaluating the role of simulation on TVUS skill acquisition (learning curve) in the clinical training environment. Methods: The projects included observational, comparative and semi-qualitative studies and randomised controlled trial (RCT) comparing conventional with simulation supported training. Results: (1) Face and content validity study demonstrated high acceptability of the simulator. (2) Construct validity study showed significant differences between inovices and experts’ performances, p0.75). (4) In the RCT, the overall analysis according to the randomisation arm showed no statistically significant difference between the intervention and control groups. (5) Fifty-seven percent of trainees agreed that simulation was a flexible learning platform in practicing TVUS as an adjunct to clinical training. Conclusion: The ScanTrainer® simulator has high face, content and constructs' validity that support the research hypotheses. It also has a potential role in the assessment of clinical skills. However, the impact of simulation on the learning curves requires further evaluation

The optimal oral body temperature cutoff and other factors predictive of sepsis diagnosis in elderly patients

INTRODUCTION: The aim of this study was to identify the optimal oral temperature cut-off value and other factors predictive of sepsis in elderly patients presenting to emergency department. METHODS: A hospital-based retrospective study was performed on all elderly patients who presented to the Adult Emergency Department at King Abdulaziz Medical City in Riyadh (January to December 31, 2018). RESULTS: Of total of 13,856 patients, 2170 (15.7%) were diagnosed with sepsis. The associated area under the curve estimate was 0.73, 95% confidence interval (CI) 0.72–0.74. Body temperature ≥37.3 was found as optimal cut-point with sensitivity = 50.97% and specificity = 87.22% and 82.39% of patients with sepsis will be correctly classified using this cut-off. An increase of 1° in body temperature was associated with an odds ratio of 9.95 (95% CI 8.95–11.06, P < 0.0001). Those aged ≥100 years having 11.12 (95% CI 2.29–20.88, P < 0.0001) times the likelihood for sepsis diagnosis compared with those aged 60–69 years. People admitted in weather such as winter, spring, or autumn were more likely to develop sepsis than people admitted in summer. CONCLUSION: The risk factors of sepsis such as age, temperature, and seasonal variation inform important evidence-based decisions. The hospitals dealing with sepsis patients should assess older patients for other severe illnesses or co-morbid that might lead to sepsis if left untreated. Therefore, older patients need to be prioritized over younger patients. The body temperature of patients admitted to hospitals needs to be monitored critically and it is important to consider seasonal fluctuations while managing cases of sepsis and allocating resources. Our findings suggest that clinicians should explore the possibility of sepsis in elderly patients admitted to emergency units with oral temperature ≥37.3°C. Risk factors for sepsis reported in this study could inform evidence-based decisions

Investigating the impact of integrated care models involving pharmacists, nurses, and laboratories on healthcare quality and efficiency

Background: The inclusion of healthcare professionals, such as pharmacists, nurses, and labs, in patient care has received more attention recently since it has the potential to enhance the quality and effectiveness of healthcare. Nonetheless, it is important to conduct a thorough examination of the current research in order to ascertain the effects of integrated care models that include these professions. Aim: This study seeks to examine the effects of integrated care models that include pharmacists, nurses, and labs on the quality and efficiency of healthcare. More precisely, the evaluation aims to combine current research about patient outcomes, cost reductions, and healthcare use in these models. Furthermore, the study seeks to analyze the distinct responsibilities and contributions of pharmacists, nurses, and labs in the context of integrated care. Method: A methodical search technique was used to locate relevant studies in electronic databases, such as PubMed, MEDLINE, and Cochrane Library. The inclusion criteria were centered on studies that documented the effects of integrated care models, which included the involvement of pharmacists, nurses, and labs, on the quality and efficiency of healthcare. Both quantitative and qualitative research were taken into account for inclusion

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population