Search Results (58)

Neonatal endotracheal intubation (ETI) is a complex medical procedure that demands extensive training before practicing on real patients. Clinical studies indicate that the conventional training approach, typically conducted in idealized conditions with task trainers, has a low skill transferability rate compared to performance in the dynamic environments common in intensive care units (ICUs). According to cognitive load theory, novices encounter difficulties in multitasking scenarios, exhibiting performance declines due to competition among tasks for cognitive resources; experts, having achieved automaticity, have more cognitive resources to handle additional tasks present in high-stress environments and therefore exhibit less performance degradation. Current ETI skill assessment methods do not capture these differences in expertise. To bridge this gap, we develop an innovative dual-task mixed-reality (MR) simulator to evaluate the influence of cognitive distractors on ETI and substantiate effective performance measurement metrics. Results affirm that experts demonstrate superior proficiency in handling extraneous cognitive loads compared to novices. This has important implications for understanding how to measure novice performance in ETI settings. Taken together, the dual-task ETI training simulator and the associated automated skill evaluation metric system hold promise for enhancing training in neonatal ETI practice and ultimately leading to improved patient care outcomes. Full article

Background/Objectives: Transferring non-mobile patients from the ground to a stretcher represents one of the riskiest tasks for musculoskeletal disorders among emergency medical technicians–paramedics (EMT-Ps), but there is little information available on how they perform in real-life work situations. Methods: This study aimed to describe EMT-Ps’ patterns of behavior observed from field data and highlight safe work operations. A secondary analysis was conducted on 27 videos collected during EMT-Ps’ responses to live calls. Contextual variables (workspace and external assistance), operations during the preparation subtask (move patient or interfering objects and adjust stretcher’s height and position), and movements and postures related to the transfer subtask were extracted from the videos. Results: The results demonstrate that despite stratification based on similar contextual factors (equipment and limited workspace), EMT-Ps’ behavior varied between interventions during the preparation and transfer subtasks. Several operations to adjust the patient–stretcher configuration before the lifting phase were carried out to facilitate patient transfer, but these were not always optimal from a safety perspective. Strategies such as fast loading (1 out of 4) and the use of external assistance (6 out of 15) were beneficial in certain circumstances. Conclusions: EMT-Ps demonstrated their ability to analyze the situation, organize accordingly, and adapt their behavior by applying these safety skills. Full article

Background/Objectives: New nurses often face challenges in adapting to clinical environments, particularly in mastering electronic medical record (EMR) systems, which are critical for effective patient care and communication. This study aimed to evaluate the effectiveness of a practice-oriented EMR education program designed to improve new nurses’ EMR competencies. Methods: A quasi-experimental pretest–post-test design with a non-equivalent control group was employed. Fifty-four new nurses employed for less than a year participated, with 25 in the intervention group and 29 in the comparison group. The intervention group underwent five weekly sessions focused on core EMR tasks, including admission nursing, operation/procedure documentation, patient transfer/discharge, night duties, and SBAR handovers. The program, led by clinical nurse educators, incorporated lectures, practical exercises, and Q&A sessions. EMR competencies were assessed using a validated 5-point Likert scale. Results: The intervention group showed significant improvements across all assessed domains, with post-program scores significantly higher than those of the comparison group. The most notable improvements were in operation/procedure documentation and patient transfer/discharge tasks. The comparison group’s gains were limited, likely reflecting natural skill acquisition through clinical experience. Conclusions: The practice-oriented EMR education program effectively enhanced new nurses’ EMR competencies. The program’s structured approach, which combined theoretical instruction with extensive hands-on practice and department-specific adaptations, proved particularly effective in improving complex documentation tasks. The integration of comprehensive EMR training into nursing curricula and the expansion of such programs to other institutions are recommended for broader implementation. Full article

Background/Objectives: The use of simulated learning as a teaching approach has been used and embedded in nursing theoretical curriculum for many years. There is a wealth of evidence to support the positive impact simulated learning or simulated-based education can have on the student experience, developing skill competency and enhancing patient outcomes. However, the evidence on the use of simulation as a replacement for clinical practice learning in undergraduate nursing education is limited. In response to the challenges posed by the COVID-19 pandemic, the authors introduced virtual simulated practice learning experiences (SPLE) for a cohort of year one pre-registration adult and mental health nursing students. The SPLE project aimed to assess the effectiveness of simulated practice learning as a viable alternative to traditional clinical practice learning and to explore student satisfaction with the new practice learning experience approach. Methods: All year one student nurses attending the four simulated practice learning experience (SPLE) weeks were invited to participate and complete a generated questionnaire within the virtual practice environment on their final day of each SPLE week. The questionnaire employed a mix of both quantitative and qualitative questions across key areas to evaluate the effectiveness of the SPLE and explore student satisfaction with their overall practice learning experience. Results: A total of 216 students participated in the simulated practice learning weeks across the spring semester in 2023 with a response rate of 98–100% across all four SPLE weeks. Students reported an overall satisfaction score of 88%, highlighting their preparedness and positive feedback on the organisation, delivery, and content of the SPLE. Qualitative analysis revealed key themes, including the development of transferable skills and personal growth, the value of peer learning, the benefits of a virtual environment, and appreciation of service user and healthcare professional input. Students reported significant personal growth, improved communication skills, and a deeper understanding of holistic care through interactive and collaborative learning experiences. Conclusions: This evaluation underscores the innovative potential of simulated practice learning to enhance nursing practice education, emphasising the importance of integrating emerging technologies and diverse pedagogical approaches. The findings suggest that SPLEs can effectively prepare nursing students for the complexities of clinical practice while addressing the evolving demands of healthcare. Future research should focus on longitudinal studies to assess the sustained impact of simulated learning on clinical experiences and professional development. Full article

Background/objectives: Point-of-care ultrasound (POCUS) in the intensive care unit (ICU) has gained much attention in the last few years as an alternative to the classic ways of assessing and diagnosing life-threatening conditions in critical patients. During the COVID-19 pandemic, we proposed a POCUS protocol based on the airway, breathing, and circulation (ABC) approach to quickly evaluate and diagnose life-threatening diseases in critical patients with acute respiratory failure and shock, and later, we used it as a curriculum to teach POCUS to anesthesia and intensive care trainees. Methods: We developed an evaluation protocol where evaluators with experience in POCUS in critically ill patients had to assess the trainee’s ultrasound scan; this was based on the ABC protocol taught in the simulation laboratory and applied in a clinical setting at the bedside. Results: Statistically significant differences were observed in some categories evaluated regarding independence and diagnosis. Conclusion: Initial POCUS simulation-based training using an ABC POCUS protocol (that demonstrated good results in the simulation laboratory) is useful when transferring US skills to the bedside and is applicable in daily clinical practice with good results in terms of operator independence. Full article

Meticillin-resistant Staphylococcus aureus (MRSA) is a significant cause of hospital-acquired infections (HAIs), posing a serious threat to healthcare workers (HCWs). All touching behavior data were from a clinical skills competition of a medical school in Hong Kong; more than 12,000 touches involving 3 patients (infusion, critically ill, and agitation) and 25 HCWs were collected. A fomite transmission model considering real touch behaviors was established to simulate the MRSA transmission in an emergency room, then the MRSA exposure risk of HCWs and effectiveness of interventions were analyzed. HCWs had a low touch frequency of facial mucous (doctors: 1.7 times/h; nurses: 1.1 times/h). The MRSA intake fractions for doctors were 2–4 times higher than those for nurses. Handwashing twice per hour could reduce the MRSA intake fraction by 7%. Effectiveness of disinfecting only the top 10 high-risk public surfaces was 83% to 98% of the efficiency when disinfecting all public surfaces. MRSA mainly transferred via hand contact contributed over 89% of pathogen transmission. Therefore, disinfecting public surfaces or replacing them with antimicrobial surfaces was not effective. The findings highlight the importance of prioritizing hand hygiene among HCWs and optimizing interventions to enhance infection-control protocols in emergency rooms. And this study provides scientific evidence for the development of precise interventions for MRSA prevention and control in hospital emergency rooms. Full article

Soft exoskeletons (exosuits) are expected to provide a comfortable wearing experience and compliant assistance compared with traditional rigid exoskeleton robots. In this paper, an exosuit with twisted string actuators (TSAs) is developed to provide high-strength and variable-stiffness actuation for hemiplegic patients. By formulating the analytic model of the TSA and decoding the human impedance characteristic, the human-exosuit coupled dynamic model is constructed. An adaptive impedance controller is designed to transfer the skills of the patient’s healthy limb (HL) to the bilateral impaired limb (IL) with a mirror training strategy, including the movement trajectory and stiffness profiles. A reinforcement learning (RL) algorithm is proposed to optimize the robotic assistance by adapting the impedance model parameters to the subject’s performance. Experiments are conducted to demonstrate the effectiveness and superiority of the proposed method. Full article

Plastic surgery is a diverse speciality relevant to non-plastic doctors, as plastic surgeons frequently collaborate with other specialities and its basic principles are transferable across multiple specialities. Foundation-year (FY) doctors are the most junior doctors in the workforce and may need to apply plastic surgery knowledge and principles during their clinical duties. Despite this, formal plastic surgery education for junior doctors is limited, resulting in an educational gap. This study gains insight into the perceived confidence, knowledge gaps, skills, educational activities and needs related to plastic surgery. This qualitative study uses phenomenology through semi-structured individual interviews with eight FY doctors. Data was analysed using reflexive thematic analysis. This study revealed that plastic surgery features diversely in the work life of FYs, who often manage patients with a lack of knowledge and confidence, influencing patient care and FY wellbeing. FYs primarily acquire knowledge and confidence through experiential learning and individual initiative. A need for curriculum improvements was expressed. FYs are an essential part of the workforce who exhibited educational gaps and a lack of confidence in plastic surgery knowledge. We suggest improved integration of plastic surgery into the FY curriculum for improved FY knowledge and patient care. Full article

Background: Nurse education plays an essential role in preparing future nurses to engage with quality improvement (QI) initiatives in their organisations and improve patient care. However, frontline nurses continue to report that a lack of QI knowledge hinders their abilities to engage in improvement work. In the UK, student nurses are now trained in QI within their degree to enable them to contribute to improvements once qualified. Objectives: This qualitative follow-up study investigated the sustainability of QI engagement in nurses who undertook QI training and a QI project during their degree and explored the factors influencing their engagement in QI once qualified. Methods: This paper followed the COREQ criteria to report upon 10 semi-structured interviews undertaken with registered nurses and focuses on their experiences of QI engagement post-registration. The data were investigated using an inductive thematic analysis and Nvivo 14. Findings: Five themes emerged: transition to a newly qualified nurse, QI knowledge decline, influencing factors (hierarchy, leadership, COVID-19 pandemic, data access and location), and skill transferability. Conclusions: This study showed that qualified nurses can sustain their QI knowledge and remain engaged with QI where they experience positive QI leadership and were exposed to ongoing QI activity in their preceptorship year. However, a lack of QI opportunities and a culture which does not consider QI a responsibility of new nurses is seen to hinder engagement. Educational institutions and practice partners require careful collaboration to assess and develop ongoing QI learning activities that support new nurses to engage in QI. Full article

Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. Methods: The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included “dynamic repair”, “late-stage facial paralysis”, “nerve and muscle transplantation”, “muscle flap”, and “tendon transposition”. Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Results: Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Conclusions: Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies. Full article

Optimizing work shifts in healthcare is crucial for maintaining high standards of service delivery and fostering professional development. This study delves into the emerging field of skill-oriented work shift optimization, focusing specifically on radiographers within the healthcare sector. Through the development of Skills Retention Monitoring (SRH), this research aims to enhance skill monitoring, workload management, and organizational performance. In this study, several key highlights emerged: (a) Introduction of the SRH tool: The SRH tool represents a resource-efficient solution that harnesses existing software infrastructure. A preliminary version, focusing on the radiographers’ professional profile, was released, and after several months of use, it demonstrated effectiveness in optimizing work based on competency monitoring. (b) The SRH tool has thus demonstrated the capacity to generate actionable insights in the organizational context of radiographers. By generating weekly reports, the SRH tool streamlines activity management and optimizes resource allocation within healthcare settings. (c) Application of a Computer-Assisted Web Interviewing (CAWI) tool for pre-release feedback during a training event. (d) Strategic importance of a maintenance and monitoring plan: This plan, rooted in a continuous quality improvement approach and key performance indicators, ensures the sustained effectiveness of the SRH tool. (e) Strategic importance of a transfer plan: Involving professional associations and employing targeted questionnaires, this plan ensures the customization of the tool from the perspective of each profession involved. This is a crucial point, as it will enable the release of tool versions tailored to various professions operating within the hospital sector. As a side result, the tool could allow for a more tailored and personalized medicine both by connecting the insights gathered through the SRH tool with the right competencies for healthcare professionals and with individual patient data. This integration could lead to better-informed decision making, optimizing treatment strategies based on both patient needs and the specific expertise of the healthcare provider. Future directions include deploying the SRH tool within the Pisa hospital network and exploring integration with AI algorithms for further optimization. Overall, this research contributes to advancing work shift optimization strategies and promoting excellence in healthcare service delivery. Full article

Prosthetic socket manufacturing is experiencing a revolutionary shift towards using digital methods, such as 3D scanning and 3D printing. However, using digital methods requires the clinician to transfer their skills from making sockets by hand to making sockets with a computer. This shift in practice may change the socket geometry and fit; however, to what extent is unknown. Thus, the aim of this study was to explore the feasibility of analyzing geometric and clinical differences between digitally- and manually-designed sockets. Nine adult inpatients with below-knee amputation were recruited. Two sockets were 3D printed for each participant from 3D socket models that were developed from: (1) 3D scanning a manually-modified hand-casted positive mold of the residuum; and (2) a digitally-modified 3D scan of the residuum. Manual and digital procedures were compared for three measures: final socket geometry, the Socket Comfort Score, and a patient experience survey. Feasibility data were collected to measure protocol implementation fidelity to inform a future larger study. These data revealed that 89% of participants followed the intended protocol, no participants dropped out, and only one adverse event was report. As no significant geometric differences were found and participants experienced similar comfort scores between manually- and digitally-designed sockets, study feasibility was determined to be successful. Thus, a randomized control trial study will be conducted to draw statistically relevant conclusions from these outcome measures that may provide meaningful information for improving digital design procedures. Full article

Background/Objectives: The absence of validated tools to assess the skill transfer from laparoscopy to robotic surgery remains an unsolved issue in the context of robot-assisted partial nephrectomy (RAPN). We aimed to describe and validate a novel proficiency score to critically evaluate the surgical quality of RAPN with the Hugo™ RAS System (Medtronic, Minneapolis, MN, USA). Methods: Between October 2022 and September 2023, 27 consecutive patients underwent off-clamp RAPN for localized renal tumors at our institution. To analyze the learning curve (LC), the cohort was chronologically divided into two phases of 6 months each. Proficiency was defined as the achievement of trifecta while maintaining a comparable intraoperative time in the interquartile range of laparoscopic partial nephrectomy performed by the same surgeon. A logistic binary regression model was built to identify predictors of proficiency achievement. Results: A proficiency score was achieved in 14 patients (74.1%). At univariable analysis, number of consecutive procedures > 12 (OR 13.7; 95%CI 2.05–21.1, p = 0.007), pathological tumor size (OR 0.92; 95%CI 0.89–0.99, p = 0.04) and essential blood hypertension (OR 0.16; 95%CI 0.03–0.82, p = 0.02) were found to be predictors of proficiency score. At multivariable analysis, after adjusting for potential confounding factors, number of consecutive procedures > 12 (OR 8.1; 95%CI 1.44–14.6, p = 0.03) was the only independent predictor of proficiency score achievement. Conclusions: Our results showed that the skills of an experienced laparoscopic surgeon are transferrable to the novel Hugo™ RAS System in the context of nephron-sparing surgery. Improved surgical quality may be expected after completing the first 12 consecutive procedures. Full article

Our professional activity is constantly under pressure from a multitude of elements and factors that can be classified into the four components of the VUCA phenomenon—volatility, uncertainty, complexity, and ambiguity—components that define the turbulence and challenges of the external environment. Considering the general elements of this phenomenon, we designed a new VUCA dimension specific to the healthcare field within which we have identified and analyzed all the factors that can influence the main actors of the doctor–patient relationship and the effects that can occur within the healthcare system in which this relationship is born. In this context, we generated the VUCA treatment in healthcare capable of mitigating the impact of this phenomenon; this treatment involves essential elements in overcoming possible crises and vulnerabilities of the medical profession. The VUCA treatment in healthcare requires combating volatility, uncertainty, complexity, and ambiguity through vision, understanding, clarity, and agility, which are grounded in the doctor’s need to acquire cross-functional competencies (soft skills). These competencies are applicable by using functional mechanisms and techniques that support the doctor in developing adaptability and anticipation skills, understanding the patient’s needs and addressing them, and ensuring the functionality and efficiency of the healthcare system by transferring these elements from micro-management to macro-management levels. Full article

Rectal examination through proctoscopy or rigid sigmoidoscopy is a common investigation in clinical practice. It is an important diagnostic tool for the workup and management of anorectal pathologies. Performing the examination can be daunting not only for patients but also for junior doctors. There are associated risks with the procedure, such as pain, diagnostic failure, and perforation of the bowel. Simulation-based training is recognised as an important adjunct in clinical education. It allows students and doctors to practice skills and techniques at their own pace in a risk-free environment. These skills can then be transferred to and developed further in clinical practice. There is extensive research published regarding the role of simulation-based training in endoscopy, however, we identified no published study regarding simulation-based training in rigid sigmoidoscopy or proctoscopy. This study aims to establish the initial face, content, and construct validity of a tool-based visual anorectal examination advanced simulator model for proctoscopy and rigid sigmoidoscopy. This innovative, highly realistic simulated environment aims to enhance the training of healthcare professionals and improve the efficiency of detecting and diagnosing distal colorectal disease. Full article