The impact of small-group virtual patient simulator training on perceptions of individual learning process and curricular integration: a multicentre cohort study of nursing and medical students.

BACKGROUND: The COVID-19 pandemic has precipitated rapid changes in medical education to protect students and patients from the risk of infection. Virtual Patient Simulators (VPS) provide a simulated clinical environment in which students can interview and examine a patient, order tests and exams, prioritize interventions, and observe response to therapy, all with minimal risk to themselves and their patients. Like high-fidelity simulators (HFS), VPS are a tool to improve curricular integration. Unlike HFS, VPS require limited infrastructure investment and can be used in low-resource settings. Few studies have examined the impact of VPS training on clinical education. This international, multicenter cohort study was designed to assess the impact of small-group VPS training on individual learning process and curricular integration from the perspective of nursing and medical students. METHODS: We conducted a multi-centre, international cohort study of nursing and medical students. Baseline perceptions of individual learning process and curricular integration were assessed using a 27-item pre-session questionnaire. Students subsequently participated in small-group VPS training sessions lead by a clinical tutor and then completed a 32-item post-session questionnaire, including 25 paired items. Pre- and post-session responses were compared to determine the impact of the small-group VPS experience. RESULTS: Participants included 617 nursing and medical students from 11 institutions in 8 countries. At baseline, nursing students reported greater curricular integration and more clinical and simulation experience than did medical students. After exposure to small-group VPS training, participants reported significant improvements in 5/6 items relating to individual learning process and 7/7 items relating to curricular integration. The impact of the VPS experience was similar amongst nursing and medical students. CONCLUSIONS: In this multi-centre study, perceptions of individual learning process and curricular integration improved after exposure to small-group VPS training. Nursing and medical students showed similar impact. Small-group VPS training is an accessible, low-risk educational strategy that can improve student perceptions of individual learning process and curricular integration.

Application of Lucilia sericata Larvae in Debridement of Pressure Wounds in Outpatient Settings.

Biological therapy using Lucilia sericata larvae has numerous advocates worldwide, yet it is still fairly unknown and not commonly applied in daily practice because of the limited awareness and insufficient experience of medical and nursing personnel. There are case reports suggesting that maggot therapy can be applied and supported by lay caregivers, provided they are supervised and informed by physicians/nurses. The foregoing observation suggests that the method should be considered for implementation by a wider group of caregivers if accepted and meticulously supervised by trained and experienced medical staff. The concerns related to the therapeutic use of maggots in certain regions seem understandable, but are not supported by scientific facts. It should be noted that many therapeutic agents (including brood) used in medicine are of natural origin, and are associated with low production costs and high possibilities of implementation in the course of therapy. By analyzing the literature and using our own clinical and research experience, we have come to conclusions related to using larvae therapy, as a quick and safe method providing cleaning and revitalization in the process of treating wounds of various etiologies, especially pressure ulcers. In the current study, medical-grade Lucilia sericata maggots were applied to remove necrotic tissue from deep pressure sores. The treatment is mostly accepted by both caregivers and patients. In most cases, it is conducted by trained and experienced medical personnel in home and outpatient settings. Over the course of the conducted analyzes involving the collected specimens, there were no statistically significant relationships (p> 0.05) confirmed between the wound surface successfully cleared by brood and variables, such as time from wound formation, location, surface size, and the depth of damage to the tissue structure. The lack of statistical dependence may result from the small size of the studied group. Based on the current findings, we have formulated the following conclusions: Maggot Debridement Therapy (MDT) is a fast and effective method enabling the preparation of the wound bed. The use of MDT in outpatient settings is safe and acceptable for patients and their caregivers.

The Relationship between Selected Body Composition Components and Cardiopulmonary Resuscitation Parameters in Nurses: An Observational Simulation Study.

The provision of cardiopulmonary resuscitation (CPR) may be related to the physical parameters of the medical personnel, including fat mass (FM) and fat-free mass (FFM) components. In this study, we aimed to assess the relationship between selected body composition components and chest compression and ventilation parameters provided by medical staff. An observational simulation study was undertaken between December 2017 and January 2019 at the Center for Innovative Research in Medical and Natural Sciences of Rzeszów. In all participants (505 nurses, 37.71 y ± 12.16), the body weight and height were measured and the body mass index (BMI) was calculated. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101. Afterwards, all participants performed CPR sequences (30 chest compressions and rescue for 2 breaths) for 2 min on a Laerdal Resusci Anne simulator placed on an examination couch with a self-inflating bag and a face mask. Our observations proved that high values of the anthropometric, nutritional and body composition parameters of the medical staff demonstrated a positive significant correlation with the depth and rate chest parameters and were inversely related to the chest adequate recoil. No statistically significant differences were found between the FM or FFM components and ventilation parameters. This study showed that nutritional status and body composition components may be important factors affecting the quality of CPR.

Use of Selected Telemedicine Tools in Monitoring Quality of In-Hospital Cardiopulmonary Resuscitation: A Prospective Observational Pilot Simulation Study.

BACKGROUND The aim of this study was to assess the quality of in-hospital cardiopulmonary resuscitation components performed by nurses under simulated conditions, with the use of selected telemedicine tools. MATERIAL AND METHODS This prospective observational pilot simulation study was carried out with a group of 48 nurses working in hospital wards specializing in conservative treatment (HOS/C=22; mean age of 30.27 years; SD 9.30) or interventional therapy (HOS/I=26 nurses; mean age of 30.35 years; SD 9.77). Each nurse performed CPR for two minutes (a sequence of 30 compressions: 2 breaths) on a Laerdal Resusci-Anne manikin that was positioned on an examination couch using a self-inflating bag and face mask in accordance with their knowledge of and skills related to in-hospital resuscitation. The study was conducted in two stages, separated with an intervention (refresh online training by using Polycom RealPresence Group Devices). Analyses of selected chest compression and relaxation parameters were performed with the use of the TrueCPR Coaching Device. RESULTS The finding showed improved compression depth (HOS/C: 46.68 mm vs. 51.50 mm; HOS/I: 46.92 mm vs. 50.57 mm), improved full recoil (HOS/C: 81.68% vs. 94.67%; HOS/I: 75.92% vs. 82.13%), and sustained standard compression rate (HOS/C: 115.23/min vs. 105.11/min; HOS/I: 113.65/min vs. 111.04/min) in the study group, 2 months after the intervention. A significant difference between the groups was observed in the rate of chest compressions with complete recoil (HOS/C: 94.67% vs. HOS/I: 82.13%; p<0.042). CONCLUSIONS The use of selected telemedicine tools leads to improved chest compression  and relaxation parameters during in-hospital sudden cardiac arrest.