Training Thoracic Ultrasound Skills: A Randomized Controlled Trial of Simulation-Based Training versus Training on Healthy Volunteers

Respiration ◽  
2021 ◽  
Vol 100 (1) ◽  
pp. 34-43 ◽  
Author(s):  
Pia Iben Pietersen ◽  
Rasmus Jørgensen ◽  
Ole Graumann ◽  
Lars Konge ◽  
Søren Helbo Skaarup ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Clinical Performance ◽  
Simulated Patients ◽  
Control Group ◽  
Point Of Care Ultrasound ◽  
Practical Training ◽  
Performance Score ◽  
Thoracic Ultrasound ◽  
Significant Difference ◽  
Simulation Based

<b><i>Introduction:</i></b> As ultrasound becomes more accessible, the use of point-of-care ultrasound examinations performed by clinicians has increased. Sufficient theoretical and practical skills are prerequisites to integrate thoracic ultrasound into a clinical setting and to use it as supplement in the clinical decision-making. Recommendations on how to educate and train clinicians for these ultrasound examinations are debated, and simulation-based training may improve clinical performance. <b><i>Objectives:</i></b> The aim of this study was to explore the effect of simulation-based training in thoracic ultrasound compared to training on healthy volunteers. <b><i>Method:</i></b> A total of 66 physicians with no previous experience in thoracic ultrasound completed a training program and assessment of competences from November 2018 to May 2019. After a theoretical session in ultrasound physics, sonoanatomy, and thoracic ultrasound, the physicians were randomized into one of three groups for practical training: (1) simulation-based training, (2) training on a healthy volunteer, or (3) no training (control group). Primary outcome was difference in the clinical performance score after the training period. <b><i>Results:</i></b> Using a multiple comparison, ANOVA with Bonferroni correction for multiplicity, there was no statistical significant difference between the two trained groups’ performance score: 45.1 points versus 41.9 points (minimum 17 points, maximum 68 points; <i>p</i> = 0.38). The simulation-based training group scored significantly higher than the control group without hands-on training, 36.7 points (<i>p</i> = 0.009). <b><i>Conclusions:</i></b> The use of simulation-based training in thoracic ultrasound does not improve the clinical performance score compared to conventional training on healthy volunteers. As focused, thoracic ultrasound is a relatively uncomplicated practical procedure when taught; focus should mainly be on the theoretical part and the supervised clinical training in a curriculum. However, simulation can be used instead or as an add-on to training on simulated patients.

Safety evaluation of an antimalarial herbal product from Andrographis paniculata (AS201-01) in healthy volunteers

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Aty Widyawaruyanti ◽  
Arijanto Jonosewojo ◽  
Hilkatul Ilmi ◽  
Lidya Tumewu ◽  
Ario Imandiri ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Healthy Volunteers ◽  
Day Treatment ◽  
Phase 1 ◽  
Andrographis Paniculata ◽  
Control Group ◽  
Healthy Human ◽  
Double Blind ◽  
Random Blood Glucose ◽  
Significant Difference

Abstract Objectives Andrographis paniculata tablets (AS201-01) have previously been shown to have potent bioactivity as an antimalarial and to produce no unwanted side effects in animal models. Here, we present the phase 1 clinical trial conducted to evaluate the safety of AS201-01 tablets in healthy volunteers. Methods The study was a randomized, double-blind controlled cross-over, a placebo-controlled design consisting of a 4-day treatment of AS201-01 tablets. A total of 30 healthy human volunteers (16 males and 14 females) were divided into two groups, and each group was given 4 tablets, twice daily for 4 days. Group 1 received AS201-01, while group 2 received placebo tablets. Volunteers were given a physical examination before the treatment. The effects of AS201-01 on random blood glucose, biochemical, and hematological as well as urine profiles were investigated. Results There were no changes in observed parameters as a result of AS201-01 being administered. Statistical analysis showed no significant difference (p>0.05) between the test and control group regarding hematology profile, biochemical profile, and random blood glucose. Increased appetite and better sleep, which categorized as grade 1 adverse event was reported after treatment with AS201-01 tablet Conclusions The outcome supports our previous observation that the AS201-01 tablet, given twice a day for 4 days, is safe and nontoxic.

scholarly journals Skill retention with ultrasound curricula

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243086
Author(s):  
Lawrence Matthews ◽  
Krysta Contino ◽  
Charlotte Nussbaum ◽  
Krystal Hunter ◽  
Christa Schorr ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intervention Group ◽  
Controlled Study ◽  
Control Group ◽  
Point Of Care Ultrasound ◽  
Skill Retention ◽  
Thoracic Ultrasound ◽  
Internal Medicine Residents ◽  
Exam Scores ◽  
Practical Exam

Background Implementation of a point of care ultrasound curricula is valuable, but optimal integration for internal medicine residency is unclear. The purpose of this study was to evaluate if a structured ultrasound curriculum vs. structured ultrasound curriculum plus supervised thoracic ultrasounds would improve internal medicine residents’ skill and retention 6 and 12 months from baseline. Methods We conducted a randomized controlled study evaluating internal medical residents’ skill retention of thoracic ultrasound using a structured curriculum (control, n = 14) vs. structured curriculum plus 20 supervised bedside thoracic ultrasounds (intervention, n = 14). We used a stratified randomization based on program year. All subjects attended a half-day course that included 5 lectures and hands-on sessions at baseline. Assessments included written and practical exams at baseline, immediately post-course and at 6 and 12 months. Scores are reported as a percentage for the number of correct responses/number of questions (range 0–100%). The Mann Whitney U and the Friedman tests were used for analyses. Results Twenty-eight residents were enrolled. Two subjects withdrew prior to the 6-month exams. Written exam scores for all subjects improved, baseline median (IQR) 60 (46.47 to 66.67) post-course 80 (65 to 86.67), 6-month 80 (66.67 to 86.67) and 12-month 86.67 (80 to 88.34), p = <0.001. All subjects practical exam scores median (IQR) significantly improved, baseline 18.18 (7.95 to 32.95), post-course 59.09 (45.45 to 70.45), 6 month 71.74 (60.87 to 82.61) and 12-month 76.09 (65.22 to 88.05), p = <0.001. Comparing the control group to the intervention group, there were statistically significant higher scores, median (IQR), in the intervention group on the practical exam at 6 months 63.05 (48.92 to 69.57) vs. 82.61(72.83 to89.13), p = <0.001. Conclusion In this cohort, internal medicine residents participating in a structured thoracic ultrasound course plus 20-supervised ultrasounds achieved higher practical exam scores long-term compared to controls.

scholarly journals A143 IMPACT OF A SIMULATION-BASED AUGMENTED REALITY CURRICULUM ON POLYPECTOMY SKILLS AMONG NOVICE ENDOSCOPISTS: A RANDOMIZED CONTROLLED TRIAL

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 5-7
Author(s):  
R Khan ◽  
M A Scaffidi ◽  
N Gimpaya ◽  
D Tham ◽  
M Atalla ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Ad Hoc ◽  
Controlled Trial ◽  
Skill Training ◽  
Control Group ◽  
Small Group Teaching ◽  
Significant Difference ◽  
Simulation Based ◽  
Free Environment ◽  
The Impact

Abstract Background Polypectomy is an essential endoscopic skill. Training in polypectomy has been identified as a major deficiency for endoscopists worldwide as polypectomy occurs ad hoc during a colonoscopy when a polyp is detected, and a lack of standardized curricula. Augmented reality (AR), which superimposes computer-generated images on a user’s view of the world, can address these gaps by standardizing encounters with polyps while completing simulated procedures and enabling polypectomy-specific teaching. Aims Evaluate the impact of a simulation-based augmented reality curriculum on polypectomy performance among novice endoscopists. Methods This study includes two cohorts of participants from 2019 to 2020. In 2019, participants were randomized into either: (1) a control curriculum, involving 6 hours of simulation-based training (SBT) supplemented by expert feedback, interlaced with 4 hours of small group teaching on the theory of colonoscopy; or (2) the augmented reality curriculum (ARC), in involving the same curriculum with integrated AR, wherein participants engaged with an AR-enhanced video demonstrating relevant therapeutic and pathologic details during polypectomy. The SBT for all participants involved a progressive curriculum starting on a bench-top model and then moving to the EndoVR® virtual reality simulator. The primary outcome was polypectomy-specific performance using the Direct Observation of Polypectomy Skills (DOPyS) tool during a simulated polypectomy after training, with a maximum score of 100. Results Demographic characteristics are summarized in Table. In 2019, 21 novice endoscopists were enrolled. Immediately after training, the mean DOPyS score among ARC group participants was 76.2 (SD=17.9) compared to 71.8 (SD=13.2) among control group participants (Figure). In this interim analysis, there was no significant difference between groups. Data analysis will be completed after 2020 participants complete the study. Conclusions Interim results show a trend towards improved polypectomy performance with no significant difference. The results of this study have the potential to impact polypectomy education among novices. Simulation-based AR interventions may allow learners to progress towards achieving competency in polypectomy in a risk-free environment prior to first patient contact. Funding Agencies None

scholarly journals Effects of Early Warning Score (EWS) Tutorial Simulation on Nurses' Knowledge and Clinical Performance

2019 ◽  
Vol 9 (2) ◽  
pp. 231-241
Author(s):  
Roshy Damayanti ◽  
Yanny Trisyani ◽  
Aan Nuraeni
Keyword(s):  
Early Warning ◽  
Clinical Performance ◽  
Intervention Group ◽  
Early Warning Score ◽  
Control Group ◽  
Training Methods ◽  
Chi Square ◽  
Significant Difference ◽  
And Control ◽  
Nurses Knowledge

Background: The Early Warning Score (EWS) system has been recommended for early identification tool of deterioration. However, its implementation has not been optimal; one of which is due to the low level of knowledge and understanding of EWS among nurses.Purpose: This study aimed to determine the effects of EWS tutorial simulation on nurses’ knowledge and clinical performance.Methods: This study employed a pretest posttest quasi-experimental design with a control group. Purposive sampling was used to recruit the samples of 42 respondents each in the intervention group and control group. The data were collected using the questionnaires to measure the knowledge and clinical performance, and analyzed using Chi square, Wilcoxon and Mann-Whitney tests.Results: The results showed that there were differences in the pre-test and post-test of knowledge and clinical performance in the intervention group and control group (p<0.001). There was also a significant difference in clinical performance between the intervention group and the control group (p<0.001). However, no significant difference in knowledge was found between.Conclusions: Tutorial simulation of EWS had an effect on increasing nurses’ clinical performance. Although there was no significant difference in knowledge between the intervention group and the control group, but the intervention group showed a better value than the control group. EWS tutorial simulation can be used as one of the training methods to increase nurses' knowledge and clinical performance in EWS.

scholarly journals The effectiveness of training with an emergency department simulator on medical student performance in a simulated disaster

CJEM ◽  
2010 ◽  
Vol 12 (01) ◽  
pp. 27-32 ◽  
Author(s):  
Jeffrey Michael Franc-Law ◽  
Pier Luigi Ingrassia ◽  
Luca Ragazzoni ◽  
Francesco Della Corte
Keyword(s):  
Medical Students ◽  
Student Performance ◽  
Intervention Group ◽  
Command And Control ◽  
Disaster Medicine ◽  
Simulated Patients ◽  
Control Group ◽  
Number Of Patients ◽  
Simulation Based ◽  
And Control

ABSTRACT Objective: Training in practical aspects of disaster medicine is often impossible, and simulation may offer an educational opportunity superior to traditional didactic methods. We sought to determine whether exposure to an electronic simulation tool would improve the ability of medical students to manage a simulated disaster. Methods: We stratified 22 students by year of education and randomly assigned 50% from each category to form the intervention group, with the remaining 50% forming the control group. Both groups received the same didactic training sessions. The intervention group received additional disaster medicine training on a patient simulator (disastermed.ca), and the control group spent equal time on the simulator in a nondisaster setting. We compared markers of patient flow during a simulated disaster, including mean differences in time and number of patients to reach triage, bed assignment, patient assessment and disposition. In addition, we compared triage accuracy and scores on a structured command-and-control instrument. We collected data on the students' evaluations of the course for secondary purposes. Results: Participants in the intervention group triaged their patients more quickly than participants in the control group (mean difference 43 s, 99.5% confidence interval [CI] 12 to 75 s). The score of performance indicators on a standardized scale was also significantly higher in the intervention group (18/18) when compared with the control group (8/18) (p &lt; 0.001). All students indicated that they preferred the simulation-based curriculum to a lecture-based curriculum. When asked to rate the exercise overall, both groups gave a median score of 8 on a 10-point modified Likert scale. Conclusion: Participation in an electronic disaster simulation using the disastermed.ca software package appears to increase the speed at which medical students triage simulated patients and increase their score on a structured command-and-control performance indicator instrument. Participants indicated that the simulation-based curriculum in disaster medicine is preferable to a lecture-based curriculum. Overall student satisfaction with the simulation-based curriculum was high.

Relationship of peripheral neuropathy grades with increase of skin perfusion by compression therapy for breast cancer patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 182-182
Author(s):  
Tsuyoshi Ohno ◽  
Takashi Mine ◽  
Hiroki Yoshioka ◽  
Mikiko Kosaka ◽  
Sadayuki Matsuda ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Peripheral Neuropathy ◽  
Healthy Volunteers ◽  
Compression Therapy ◽  
Cytotoxic Agents ◽  
Control Group ◽  
Skin Perfusion ◽  
Medication Therapy ◽  
Significant Difference ◽  
The Mean

182 Background: Chemotherapy-induced peripheral neuropathy (CIPN) has become a substantial problem because of specific cytotoxic agents such as nab-paclitaxel, oxaliplatin, and eribulin. In addressing CIPN-related side effects caused by nab-PTX, we previously reported better CTCAE v4.0 grades and superior nab-PTX dose maintenance in breast cancer treatment adopting our 3S approach. Our 3S approach combines compression therapy (stockings and sleeves applied 24 hours from the beginning of nab-PTX administration) with medication therapy (selected prophylactic medications goshajinkigan, lafutidine, and mecobalamin applied over the course of treatment). In revisiting how stocking use restored skin perfusion levels decreased by nab-PTX chemotherapy, we examined whether the skin perfusion increases differ by CIPN grade. Methods: Using a laser Doppler blood flow meter with integrated probe (NL-101 Nahri Nexis Japan), we measured the skin perfusion of the lower limbs before and after stocking use across four groups: three groups of 3S prophylactics-treated nab-PTX patients divided by CIPN grade (Grade 0 [G0, n=12], Grade 1 [G1, n=20], Grades 2 and 3 combined [G2+3, n=12]), and one control group of healthy volunteers (GH, n=50). Results: In the control group (GH), the mean increase in skin perfusion level (mL/min/100g) after wearing stockings was 0.90 (SD= 3.36). For the 3S prophylactic treatment patients, the mean increase was 4.25 (4.98) in the G0 group, 2.11 (4.93) in the G1 group, and 2.69 (2.53) in the G2+3 group. ANOVA analysis indicated a significant difference in skin perfusion increase among the groups (p=0.0493). Analysis between the groups indicated significance in the G0 group increase over the control group increase (p=0.0255). Conclusions: CIPN was previously shown to decrease skin perfusion; in the current study skin perfusion responsiveness to stockings differed significantly between chemotherapy patients and healthy volunteers. Restorative skin perfusion increase is potentially related with alleviating CIPN grade, for which further evaluation is needed.

scholarly journals One-year clinical evaluation of IPS Empress CAD versus polished Celtra Duo ceramic Laminate veneers (randomized controlled clinical trial)

2021 ◽  
Vol 24 (3) ◽  
pp. 13p
Author(s):  
Hayat Elbanna ◽  
Mohammed Labib Zamzam ◽  
Jylan Fouad El-Guindy ◽  
Ahmed Soliman Idris
Keyword(s):  
Survival Rate ◽  
Fracture Resistance ◽  
Clinical Performance ◽  
Control Group ◽  
Marginal Adaptation ◽  
Anterior Teeth ◽  
Significant Difference ◽  
One Year ◽  
Laminate Veneers

Objective: To evaluate fracture resistance and survival rate of IPS Empress CAD versus Polished Celtra Duo ceramic laminate veneers. Material and Methods: Thirty-six ceramic laminate veneers were fabricated for maxillary anterior teeth. The patients were divided into two groups according to the material Group 1(control group) fabricated from IPS Empress CAD laminate veneers and group 2(intervention group) fabricated from Polished Celtra Duo laminate veneers. Standardized the same preparation with butt joint design and chamfer finish line located supra gingival were performed for all the teeth. The fabrication of the veneers was performed using Cad\Cam (Ceramill motion) machine, with software (Exocad). The veneers surfaces were treated and silanated according to the manufacture instruction of each ceramic and enamel surfaces were etched where total etch adhesive protocol was obeyed using BISCO. Follow up sessions were done every two months up to one year for each patient using dental probe and operator vision to evaluate the fracture, survival rate, marginal adaptation, sensitivity and caries. according to USPHS criteria (United States Public Health Service). This was performed by an experienced, blinded investigator. Results: Fracture resistance, marginal adaptation, retention, caries and sensitivity were evaluated according to the criteria of USPHS and we found there is no significant difference as both groups scaled zero score. Conclusion: Both IPS Empress Cad and Polished Celtra Duo laminate veneers revealed successful clinical performance in terms of fracture resistance, marginal adaptation, retention, and sensitivity after one year follow up period.   Keywords Ceramic laminate veneers; IPS Empress CAD; Celtra DUO; Clinical performance.

scholarly journals Magnetic resonance imaging study; does the olfactory bulb volume change in major depression?

2016 ◽  
Vol 30 (1) ◽  
pp. 98-103
Author(s):  
Nuriye Guzin Ozdemir ◽  
Ibrahim Burak Atci ◽  
Sevda Bag ◽  
Hakan Yilmaz ◽  
Yesim Karagoz ◽  
...  
Keyword(s):  
Major Depression ◽  
Olfactory Bulb ◽  
Healthy Volunteers ◽  
Imaging Study ◽  
Control Group ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Olfactory Bulb Volume ◽  
Significant Difference ◽  
Volume Measurements

Abstract Goal: The olfactory region function disorders and olfactory bulb volume changes in neurodegenerative and neuropsychiatric disorders are defined. In this study, the olfactory bulb values of patients diagnosed with major depression in accordance with DMS-IV criteria, are measured with MRI, and these values are compared with the values of healthy volunteers to see if there are any statistically significant changes. Method: The study was carried out with 20 healthy volunteers and 20 patients who had been diagnosed with acute major depression in accordance with ‘diagnostic and statistical manual of mental disorders’ (DMS) IV criteria and have been getting treatment for more than 2 years in Istanbul Education and Research Hospital. 1,5 Tesla MRI were used in 40 cases, and the olfactory bulb volume on two hemispheres were measured separately. Results: Contrary to the former studies, we found no statistically significant difference between the olfactory bulb volume measurements of the control group and the group diagnosed with major depression.

scholarly journals Effect of Clinical Skills Evaluation by Direct Observation of Procedural Skills (DOPS) Method on Clinical Performance of Operating Room Students

2021 ◽  
Vol 20 (3) ◽  
Author(s):  
Somayeh Nayyeri ◽  
Aliakbar Bozorgvar ◽  
Somaye Barzanouni ◽  
Toktam Masoumiyan
Keyword(s):  
Operating Room ◽  
Direct Observation ◽  
Clinical Performance ◽  
Clinical Skills ◽  
Intervention Group ◽  
Control Group ◽  
Procedural Skills ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Significant Difference

Background: Evaluation is an essential and integral part of medical education. Based on the evidence, the current common methods are less effective due to the lack of accurate assessment of students' clinical skills. Clinical evaluation of students in the form of direct observation in practical situations will increase their ability to deal with clinical events in specific patient situations. Objectives: In this study, the effectiveness of the direct observation of procedural skills (DOPS) method was compared with the common method in the clinical performance of operating room students. Methods: This quasi-experimental study was performed on 30 final-year operating room students in 2019 who had an internship course. Students were randomly assigned to two groups of control (n = 15) and intervention (n = 15). The evaluation of clinical skills was done by the traditional method in the control group and the DOPS method in the intervention group. Data collection was performed by a researcher-made checklist whose validity and reliability were confirmed. Statistical analysis of data was performed by SPSS-20 software using descriptive statistics and chi-square test, independent t-test, and Mann-Whitney test. Results: There was no significant difference between the two groups in terms of demographic characteristics including age, internship score, and gender (P > 0.05). Based on the results of the Mann-Whitney test, the mean rank of procedural techniques and clinical performance score was higher in the intervention group than in the control group (P < 0.05). Conclusions: The DOPS method can be more effective than routine methods for improving the clinical performance of operating room students. Therefore, it is suggested that the DOPS method be used as an alternative to traditional methods or even as a complementary method for evaluating the clinical performance of operating room students.

scholarly journals Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Ankeet D. Udani ◽  
Alex Macario ◽  
Kiruthiga Nandagopal ◽  
Maria A. Tanaka ◽  
Pedro P. Tanaka
Keyword(s):  
Clinical Performance ◽  
Mastery Learning ◽  
Deliberate Practice ◽  
Intervention Group ◽  
Control Group ◽  
Baseline Assessment ◽  
Simulation Based ◽  
Improved Performance ◽  
Time Required ◽  
Anesthesia Residents

Introduction.Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB.Methods.21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR).Results.Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P<0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P<0.03). The OR time required to perform SAB was not different between groups.Conclusions.The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

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