Impact of simulation-based learning on family caregivers during the rehabilitation period of individuals with spinal cord injury.

STUDY DESIGN: Mixed-methods study. OBJECTIVE: Evaluate the knowledge that family caregivers of individuals with spinal cord injuries acquired through the use of a high-fidelity simulation-based learning (SBL) program. SETTING: The study was comprised of three phases: a previous qualitative research study detecting training needs, one in which clinical simulation scenarios were designed, and a final quasi-experimental phase in which ten caregivers of individuals with spinal cord injuries were trained in their care using simulations at the Toledo National Hospital for Paraplegics (Spain). METHODS: The competences acquired by the family were evaluated before and after the simulation training. A researcher-validated tool for each scenario was utilized for this evaluation. RESULTS: Four learning scenarios were designed based on the needs identified through the caregiver interviews. Following the training of the caregivers with SBL, an increase in their knowledge and skills was identified. For all the scenarios, the caregivers obtained a higher average score on the post test than on the pre test, and these differences were significant (p < 0.001). CONCLUSIONS: Simulation training is a useful and efficient learning tool for caregivers of individuals with a spinal cord injury.

Comparative study of a simulated incident with multiple victims and immersive virtual reality.

OBJECTIVES: The main objective of the study is to determine the efficiency in the execution of the START (Simple Triage and Rapid Treatment) triage, comparing Virtual Reality (VR) to Clinical Simulation (CS) in a Mass Casualty Incident (MCI). The secondary objective is to determine the stress produced in the health professionals in the two situations described. MATERIALS: A comparative study on the efficiency and the stress during triage in a MSI was conducted. The basal and post levels of salivary α-amylase (sAA) activity were measured in all the participants before and after the simulation. RESULTS: The percentage of victims that were triaged correctly was 87.65% (SD = 8.3); 88.3% (SD = 9.65) for the Clinical Simulation with Actors (CSA) group and 87.2% (SD = 7.2) for the Virtual Reality Simulation (VRG) group, without any significant differences (p = 0.612) between both groups. The basal sAA was 103.26 (SD = 79.13) U/L with a significant increase (p < 0.001) with respect to the post-simulation levels (182.22, SD = 148.65 U/L). The increase of sAA was 80.70 (SD = 109.67) U/mL, being greater for the CSA group than the VRG group. CONCLUSION: The results show that virtual reality method is as efficient as clinical simulation for training on the execution of basic triage (START model). Also, based on the sAA results, we can attest that clinical simulation creates a more stressful training experience for the student, so that is should not be substituted by the use of virtual reality, although the latter could be used as a complementary activity.

Relatives of people with spinal cord injury: a qualitative study of caregivers' metamorphosis.

STUDY DESIGN: Qualitative study. OBJECTIVE: To detect the major challenges and needs reported by family member caregivers of people with spinal cord injury (SCI). SETTING: Family member caregivers of people with SCI and expert professionals were evaluated. This study was conducted in Spain, and most of the participants attended the National Paraplegics Hospital of Toledo. METHODS: We performed 25 semi-structured interviews. The data were analyzed from a phenomenological perspective using the Colaizzi method. RESULTS: The metamorphosis of the caregiver is a complex personal and family-related process. Analysis of the adjustment phase of the caregiving role allowed us to describe three stages, patterns, and trends. Five basic needs were identified. CONCLUSIONS: People with SCI and their primary caregivers experienced changes in every sphere of their lives. Their most important needs were psychological support, social support, economic resources, information, training throughout the process of suffering, and the creation of informal groups of mutual aid.

Differences in lung function after the use of 2 extrication systems: a randomized crossover trial. / Análisis de las variaciones en la función respiratoria tras la utilización de dos sistemas de extricación.

OBJECTIVES: The main purpose of this study in healthy volunteers was to compare the lung function effects of 2 extrication devices that use spinal vests: the Kendrick Extrication Device (KED) and the Ferno KED-XT board. MATERIAL AND METHODS: Randomized crossover trial in 50 healthy adult volunteers. The subjects were placed in the KED and KED-XT devices for 5 minutes each and rested for 10 minutes between devices. Assignment to the first device was randomized. Each subject underwent spirometry at baseline and after placement of each device. The subjects were seated for all tests. The main outcome measures were the mean absolute differences between baseline and other measurements of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the FVC/FEV1 ratio. RESULTS: Use of the devices led to statistically significant mean decreases from baseline FVC (KED-XT, -0.48 L; 95% CI, -0.16 to -0.81 L [P=.016] and KED, -0.79 L; 95% CI, -0.44 to -1.13 L [P<.001]) and from baseline FEV1 (KED-XT, -0.35 L/s; 95% CI, -0.14 to -0.56 L/s [P=.002] and KED, -0.52 L/s; 95% CI, -0.31 to -0.72 L/s [P<.001]). The decrease in FVC was greater after use of the KED device (mean difference, KED vs KED-XT, -0.30 L; 95% CI, -0.08 to -0.69 L [P<.016]). CONCLUSION: The use of spinal vests leads to decreases in lung function variables. The KED vest causes a greater decrease in FVC than the new KED-XT board, possibly because the crossed straps on the board compress the abdomen less.

OBJETIVO: El objetivo principal del estudio fue comparar el efecto en la función pulmonar de dos chalecos espinales (Kendrick Extrication Device® ­KED­ y Ferno-XT® ­KED-XT­) entre sujetos voluntarios sanos. METODO: Ensayo clínico aleatorizado de un solo brazo cruzado que se llevó a cabo en 50 sujetos adultos voluntarios sanos. Se aplicó cada uno de los dispositivos, KED y KED-XT, durante 5 minutos con un periodo de descanso entre ellos de 10 minutos. Se realizó una espirometría basal y otra después de la aplicación de cada uno de los dispositivos en sedestación. Las variables de resultado principales fueron la diferencia absoluta de medias de la capacidad vital forzada (FVC), el volumen espiratorio forzado en el primer segundo (FEV1) y el coeficiente FEV1/FVC entre el momento basal y tras la aplicación de los dispositivos KED y KED-XT. RESULTADOS: La aplicación de los dispositivos hizo disminuir de forma estadísticamente significativa respecto a la situación basal la FVC (diferencia de medias de FCV KED-XT = ­0,48 l [IC95% ­0,16 a ­0,81 l]; p = 0,016 y diferencia de medias de FCV KED = ­0,79 l [IC95% ­0,44 a ­1,13 l]; p < 0,001) y la FEV1 (diferencia de medias de FEV1 KED-XT = ­0,35 l/s [IC95% ­0,14 a ­0,56 l/s]; p = 0,002 y diferencia de medias de FCV KED = ­0,52 l/s [IC95% ­0,31 a ­0,72 l/s]; p < 0,001). El KED produjo una mayor disminución de la FVC que el KED-XT (diferencia de medias de FCV KED vs KED-XT = ­0,30 l [IC95% ­0,08 a ­0,69 l]; p < 0,016). CONCLUSIONES: Los chalecos espinales producen una diminución de los parámetros de la función pulmonar. El dispositivo KED produjo una mayor disminución de la FVC, en comparación con el nuevo dispositivo KED-XT, posiblemente por el diseño de fijaciones oblicuas que no comprimen tanto el abdomen.

Analysis of performance and stress caused by a simulation of a mass casualty incident.

OBJECTIVE: To determine the stress that is potentially produced in professional health workers due to a mass casualty incident (MCI) simulated exercise, and its relation to prior academic training and the role played in the simulation. METHODS: Observational study of stress in a MCI. For this work, two MCI drills comprised of 40 victims each were conducted. Two randomized groups of 36 students each were created: Master's Students Group (MSG) and Undergraduate Student Group (USG). The role performed by each student (triage or sectorization) was assessed. The stress level was determined by prior and subsequent measurements of alpha-amylase (αA), HR, SBP and DBP. RESULTS: The percentage of victims that were correctly triaged was 88.6%, 91.84% for MSG and 83.76% for the USG (p=0.004). The basal αA was 97,107.50±72,182.67IU/L and the subsequent αA was 136,195.55±90,176.46±IU/L (p<0.001). The baseline HR was 78.74±14.92beats/min and the subsequent HR was 95.65±23.59beats/min (p=0.000). We found significant differences in the αA between students who performed the triage and those who performed sectorization but there were no differences between undergraduate and Masters' students. CONCLUSION: Conducting a simulated exercise caused stress in personnel involved in the MCI, with a greater impact on participants who performed triage, although it was not influenced by their prior academic level. The stress level in our case did not affect or determine the performance of acquired skills.

Randomised clinical simulation designed to evaluate the effect of telemedicine using Google Glass on cardiopulmonary resuscitation (CPR).

AIM: Through a clinical simulation, this study aims to assess the effect of telematics support through Google Glass (GG) from an expert physician on performance of cardiopulmonary resuscitation (CPR) performed by a group of nurses, as compared with a control group of nurses receiving no assistance. METHODS: This was a randomised study carried out at the Catholic University of Murcia (November 2014-February 2015). Nursing professionals from the Emergency Medical Services in Murcia (Spain) were asked to perform in a clinical simulation of cardiac arrest. Half of the nurses were randomly chosen to receive coaching from physicians through GG, while the other half did not receive any coaching (controls). The main outcome of the study expected was successful defibrillation, which restores sinus rhythm. RESULTS: Thirty-six nurses were enrolled in each study group. Statistically significant differences were found in the percentages of successful defibrillation (100% GG vs 78% control; p=0005) and CPR completion times: 213.91 s for GG and 250.31 s for control (average difference=36.39 s (95% CI 12.03 to 60.75), p=0.004). CONCLUSIONS: Telematics support by an expert through GG improves success rates and completion times while performing CPR in simulated clinical situations for nurses in simulated scenarios.

[Randomized clinical simulation trial of a Google Glass telemedicine application to assist orotracheal intubation]. / Ensayo de simulación clínica aleatorizado para evaluar el efecto de la telemedicina, a través de las Google Glass®, en la intubación orotraqueal.

OBJECTIVES: To assess the effect of a Google Glass telemedicine application to allow a medical expert to make corrections in simulated out-of-hospital intratracheal intubations performed by nurses. MATERIAL AND METHODS: Randomized clinical simulation trial designed by the Universidad Católica de Murcia between November 2014 and February 2015. Volunteer nurses from the emergency medicine service of Murcia, Spain, were randomized to an intervention group to simulate intubations with telemedicine assistance (n=25) or a control group that did not receive assistance (n=25). The main outcome variable was satisfactory orotracheal intubation. RESULTS: We observed statistically significant between-group differences in percentages of satisfactory intubation (telemedicine group, 96%, vs control group, 72%; P=.024) and time required to intubate the trachea (mean difference, 94.3 seconds, 95% CI, 40.7-147.9 seconds; P=.001). CONCLUSION: Telemedicine assistance from an expert by way of a Google Glass application improves the success rate and completion times of nurses performing out-of-hospital intratracheal intubations in clinical simulations.

OBJETIVO: Evaluar el efecto de la ayuda telemática, a través de las Google Glass® (GG), de un médico experto para la correcta intubación orotraqueal (IOT) realizada en simulación clínica por enfermeros de extrahospitalaria. METODO: Ensayo aleatorizado de simulación clínica desarrollado en la Universidad Católica de Murcia de noviembre 2014 a febrero 2015. Se distribuyó aleatoriamente a los enfermeros voluntarios de la Gerencia de Emergencias 061 de Murcia en un grupo de 25 enfermeros con ayuda telemática mediante las GG (GpG) y un grupo de 25 enfermeros sin ayuda (GpC). La variable principal del estudio fue la correcta IOT. RESULTADOS: Se hallaron diferencias significativas entre ambos grupos en los porcentajes de IOT correcta (96% GpG vs 72% GpC; p = 0,024) y en el tiempo de ejecución de la IOT [diferencia de medias 94,3 (IC95% 40,7-147,9) s; p = 0,001]. CONCLUSIONES: La ayuda telemática de un médico experto, a través de las GG, mejora los porcentajes y tiempos de la IOT correcta de los enfermeros de extrahospitalaria en situaciones clínicas simuladas.

[Unmanned aerial vehicles: usefulness for victim searches and triage in disasters]. / Utilidad de los vehículos aéreos no tripulados en la búsqueda y triaje de personas en situaciones de catástrofe.

OBJECTIVES: To analyze the influence of drones equipped with thermal cameras for finding victims and aiding triage during disasters. MATERIAL AND METHODS: We carried out a prospective, cross-sectional analysis and 6 experimental simulations, each with 25 victims to locate and triage. Nurses were randomized to a control group or a drone group. Drone-group nurses were given access to images from the thermal cameras 10 minutes before the exercise started. RESULTS: The mean (SD) distance the nurses searched in the control group (1091.11 [146.41] m) was significantly greater than the distance searched by nurses in the drone group (920 [ 71.93] m (P = .0031). The control group found a mean of 66.7% of the victims, a significantly smaller percentage than the drone group's mean of 92% (P = .0001). Triage quality (undertriage and overtriage) was similar in the 2 groups as shown by maneuvers undertaken to open airways and control bleeding. CONCLUSION: Drones with thermal cameras were useful in searching for victims of simulated disasters in this study, although they had no impact on the quality of the nurses' triage.

OBJETIVO: Analizar la influencia del uso de un dron con cámara térmica en la localización y triaje de las víctimas en una situación de catástrofe. METODO: Se ha llevado a cabo un estudio analítico, experimental, prospectivo y transversal, donde se realizaron 6 simulacros de búsqueda de víctimas y triaje (cada uno de ellos con 25 víctimas). De manera aleatoria se hicieron dos grupos: Grupo Control (GC) y Grupo Dron (GD). Los profesionales del GD pudieron disponer de las imágenes de la cámara térmica instalada en un dron 10 minutos antes de comenzar el ejercicio. RESULTADOS: La distancia media recorrida por el GC fue de 1091,11 (DE: 146,41) metros, significativamente mayor (p = 0,0031) que la del GD 920 (DE: 71,93) metros. El porcentaje medio de víctimas encontradas por cada uno de los profesionales del GC fue del 66,7%, significativamente menor (p = 0,0001) que las encontradas por cada uno de los profesionales del GD, que ascendió al 92%. En la calidad del triaje (infra y supratriaje), apertura de la vía aérea y control de hemorragias no se encontraron diferencias entre los dos grupos analizados. CONCLUSIONES: El uso de drones con cámaras térmicas, en condiciones experimentales, es útil en la búsqueda y localización de víctimas en catástrofes, aunque no tiene impacto sobre la calidad del triaje realizado por los profesionales participantes en el estudio.