Simulation-Based Education Enhances Patient Safety Behaviors During Central Venous Catheter Placement.

OBJECTIVE: We describe the effect of simulation-based education on residents' adherence to protocols for and performance of central venous access. METHODS: Internal medicine and emergency medicine residents underwent a central venous access course that included a lecture, video presentation, readings, and simulation demonstrations presented by faculty. Baseline data were collected before the course was initiated. After a skills session where they rehearsed their ultrasound-guided central venous access skills, residents were evaluated using a procedural checklist and written knowledge exam. Residents also completed questionnaires regarding confidence in performing ultrasound-guided central venous access and opinions about the training course. RESULTS: Residents demonstrated significant improvement on the written knowledge exam (P < 0.0001) and Standard Protocol Checklist (P < 0.0001) after the training course. Training improved a number of patient safety elements, including adherence to sterile technique, transparent dressing, discarding sharps, and ordering postprocedure x-rays. However, a number of residents failed to wash their hands, prepare with chlorhexidine, drape the patient using a sterile technique, anesthetize the site, and perform a preprocedure time-out. Significant improvement in procedural skills was also noted for reduction in skin-to-vein time (P < 0.003) as well as a reduction in number of residents who punctured the carotid artery (P < 0.02). CONCLUSIONS: Simulation-based education significantly improved residents' knowledge and procedural skills along with their confidence. Adherence to the protocol also improved. This study illustrates that simulation-based education can improve patient safety through training and protocols.

Unreliable block span reveals simulated intellectual disability on the stanford-binet intelligence scales-fifth edition.

Previously developed validity measures are largely lacking in their ability to accurately distinguish malingerers from individuals with genuine intellectual disabilities (ID). The purpose of the present study was to develop a validity index for the Stanford-Binet Intelligence Scales-Fifth Edition (SB-5) aimed at detecting malingered ID. Fifty-four college students were instructed to feign impairment consistent with mental retardation while completing the SB-5. Simulated malingerers performed significantly poorer on the Block Span task of the SB-5 than did individuals with genuine impairment. A Block Span Validity Index (BSVI) cutoff score of less than 10 showed perfect specificity by correctly identifying all persons with true ID and demonstrated 52% sensitivity in identifying persons feigning impairment. For the detection of malingered ID, the BSVI yielded favorable results, although more research is needed to validate the BSVI using a known-groups study design.

Delusional parasitosis as a presenting feature of HIV dementia: a case study.

Delusional parasitosis (DP) is a rare form of somatic delusions where a person believes that he or she is infected with worms, bugs, or other parasites. In the literature, DP has been discussed as a presenting feature of cortical dementias but has not been documented as a presenting feature in subcortical dementias such as HIV-associated dementia. We present a case of a 56-year-old male referred from the dermatology clinic for neuropsychological assessment after presenting with persisting claims that he was infected with "bugs" despite evidence to the contrary. The patient had a history of HIV and substance abuse. The patient was diagnosed with dementia due to HIV disease and psychosis due to dementia (i.e., DP) based on the neuropsychological evaluation. This case report suggests that neuropsychological evaluations may be indicated for patients presenting with DP and risk factors for either cortical or subcortical dementias such as HIV-associated dementia.