Fellowship Accreditation: Experiences From Health Care Simulation Experts.

Background The field of health care simulation continues to grow, accompanied by a proliferation of fellowship programs, leading to fellowship accreditation efforts. There is controversy around the best approach to accreditation. Objective The authors sought to understand perspectives of simulation leaders on fellowship accreditation to best inform the growth and maturation of fellowship accreditation. Methods In 2020, simulation leaders identified through snowball sampling were invited to participate in a qualitative study. During one-on-one semistructured interviews, participants were asked about experiences as simulation leaders and their perspective on the purpose and impact of accreditation. The interviews were audio recorded and transcribed. Thematic analysis informed by a phenomenology framework was performed using a masked open coding technique with iterative refinement. The resulting codes were organized into themes and subthemes. Results A total of 45 simulation experts participated in interviews ranging from 25 to 67 minutes. Participants described discord and lack of consensus regarding simulation fellowship accreditation, which included a spectrum of opinions ranging from readiness for accreditation pathways to concern and avoidance. Participants also highlighted how context drove the perception of accreditation value for programs and individuals, including access to resources and capital. Finally, potential impacts from accreditation included standardization of training programs, workforce concerns, and implications for professional societies. Conclusions Simulation leaders underscored how the value of accreditation is dependent on context. Additional subthemes included reputation and resource variability, balancing standardization with flexibility and innovation, and implications for professional societies.

Numerical analysis of magnetohydrodynamics in an Eyring-Powell hybrid nanofluid flow on wall jet heat and mass transfer.

The customization of hybrid nanofluids to achieve a particular and controlled growth rate of thermal transport is done to meet the needs of applications in heating and cooling systems, aerospace and automotive industries, etc. Due to the extensive applications, the aim of the current paper is to derive a numerical solution to a wall jet flow problem through a stretching surface. To study the flow problem, authors have considered a non-Newtonian Eyring-Powell hybrid nanofluid with water and CoFe2O4and TiO2nanoparticles. Furthermore, the impact of a magnetic field and irregular heat sink/source are studied. To comply with the applications of the wall jet flow, the authors have presented the numerical solution for two cases; with and without a magnetic field. The numerical solution is derived with a similarity transformation and MATLAB-based bvp4c solver. The value of skin friction for wall jet flow at the surface decreases by more than 50% when the magnetic fieldMA=0.2is present. The stream function value is higher for the wall jet flow without the magnetic field. The temperature of the flow rises with the dominant strength of the heat source parameters. The results of this investigation will be beneficial to various applications that utilize the applications of a wall jet, such as in car defrosters, spray paint drying for vehicles or houses, cooling structures for the CPU of high-processor laptops, sluice gate flows, and cooling jets over turbo-machinery components, etc.

A tale of two intensive care units (ICUs): Baseline Staphylococcus aureus colonization and mupirocin susceptibility in neonatal and pediatric patients requiring intensive care.

OBJECTIVE: To assess the incidence rate of S. aureus colonization at baseline along with the mupirocin susceptibility (or resistance) rate in patients in a neonatal intensive care unit (NICU) and a pediatric intensive care unit (PICU) in conjunction with the implementation of universal decolonization as the standard of care. DESIGN: Prospective cohort study. SETTING: Children's Hospital of Michigan (CHM) inpatient intensive care units (ICUs). PARTICIPANTS: Newly admitted pediatric patients to the CHM NICU or PICU aged between 1 day and ≤21 years. INTERVENTIONS: Baseline and follow-up S. aureus screening cultures were obtained before patients underwent universal decolonization with mupirocin 2% antibiotic ointment (intranasal and umbilical) and chlorhexidine baths as standard of care to reduce CLABSI rates. RESULTS: Baseline S. aureus colonization rates of new admissions to the CHM NICU and PICU were high at 32% and 29%, respectively. Baseline mupirocin susceptibility to any S. aureus growth was 98.4%. All baseline culture isolates whether positive for MRSA or MSSA, with one exception, had minimum inhibitory concentrations (MICs) of ≤0.19 µg/mL. All follow-up study cultures after universal decolonization at 7 days or beyond with any S. aureus growth had mupirocin MICs of ≤0.125 µg/mL. CONCLUSIONS: Baseline S. aureus colonization rates of new admissions to the CHM ICUs were high as was baseline mupirocin susceptibility. Follow-up cultures, albeit limited in number, did not detect increasing mupirocin MICs over 1 year, despite broad mupirocin exposure due to the implementation of universal decolonization.

Supporting the Quadruple Aim Using Simulation and Human Factors During COVID-19 Care.

The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.

Core outcome sets for use in effectiveness trials involving people with bipolar and schizophrenia in a community-based setting (PARTNERS2): study protocol for the development of two core outcome sets.

BACKGROUND: In the general population the prevalence of bipolar and schizophrenia is 0.24% and 1.4% respectively. People with schizophrenia and bipolar disorder have a significantly reduced life expectancy, increased rates of unemployment and a fear of stigma leading to reduced self-confidence. A core outcome set is a standardised collection of items that should be reported in all controlled trials within a research area. There are currently no core outcome sets available for use in effectiveness trials involving bipolar or schizophrenia service users managed in a community setting. METHODS: A three-step approach is to be used to concurrently develop two core outcome sets, one for bipolar and one for schizophrenia. First, a comprehensive list of outcomes will be compiled through qualitative research and systematic searching of trial databases. Focus groups and one-to-one interviews will be completed with service users, carers and healthcare professionals. Second, a Delphi study will be used to reduce the lists to a core set. The three-round Delphi study will ask service users to score the outcome list for relevance. In round two stakeholders will only see the results of their group, while in round three stakeholders will see the results of all stakeholder group by stakeholder group. Third, a consensus meeting with stakeholders will be used to confirm outcomes to be included in the core set. Following the development of the core set a systematic literature review of existing measures will allow recommendations for how the core outcomes should be measured and a stated preference survey will explore the strength of people's preferences and estimate weights for the outcomes that comprise the core set. DISCUSSION: A core outcome set represents the minimum measurement requirement for a research area. We aim to develop core outcome sets for use in research involving service users with schizophrenia or bipolar managed in a community setting. This will inform the wider PARTNERS2 study aims and objectives of developing an innovative primary care-based model of collaborative care for people with a diagnosis of bipolar or schizophrenia.

Acceleration-based joint stability parameters for total knee arthroplasty that correspond with patient-reported instability.

There is no universally accepted definition of human joint stability, particularly in nonperiodic general activities of daily living. Instability has proven to be a difficult parameter to define and quantify, since both spatial and temporal measures need to be considered to fully characterize joint stability. In this preliminary study, acceleration-based parameters were proposed to characterize the joint stability. Several time-statistical parameters of acceleration and jerk were defined as potential stability measures, since anomalous acceleration or jerk could be a symptom of poor control or stability. An inertial measurement unit attached at the level of the tibial tubercle of controls and patients following total knee arthroplasty was used to determine linear acceleration of the knee joint during several activities of daily living. The resulting accelerations and jerks were compared with patient-reported instability as determined through a standard questionnaire. Several parameters based on accelerations and jerks in the anterior/posterior direction during the step-up/step-down activity were significantly different between patients and controls and correlated with patient reports of instability in that activity. The range of the positive to negative peak acceleration and infinity norm of acceleration, in the anterior/posterior direction during the step-up/step-down activity, proved to be the best indicators of instability. As time derivatives of displacement, these acceleration-based parameters represent spatial and temporal information and are an important step forward in developing a definition and objective quantification of human joint stability that can complement the subjective patient report.

A comparison of patient and tumour characteristics in two UK bladder cancer cohorts separated by 20 years.

OBJECTIVES: To compare patient and tumour characteristics at presentation from two large bladder cancer cohorts, with recruitment separated by 15-20 years To identify significant differences in the West Midlands' urothelial cancer of the bladder (UCB) population during this period. PATIENTS AND METHODS: Data were collected prospectively from 1478 patients newly diagnosed with UCB in the West Midlands from January 1991 to June 1992 (Cohort 1), and from 1168 patients newly diagnosed with UBC within the same region from December 2005 to April 2011 (Cohort 2). Gender, age, smoking history, and tumour grade, stage, type, multiplicity and size at presentation were compared using a Pearson chi-square test or Cochran-Armitage trend test, as appropriate. RESULT: Cohort 2 had a higher proportion of male patients (P = 0.021), elderly patients (P < 0.001), grade 3 tumours (P < 0.001), Ta/T1 tumours (P = 0.008), multiple tumours (P < 0.001), and tumours of ≤2 cm in diameter (P < 0.001). CONCLUSIONS: There were significant differences between the cohorts. These differences are potentially explained by an ageing population, changes in grading practices, improved awareness of important symptoms, improved cystoscopic technology, and reductions in treatment delays. Regional cohorts remain important for identifying changes in tumour and patient characteristics that may influence disease management in the UK and beyond.

The potential of accelerometers in the evaluation of stability of total knee arthroplasty.

An accelerometer attached to the anterior proximal tibia was investigated as an evaluation of knee stability of Total Knee Arthroplasty (TKA) patients while performing daily activities. Acceleration data of 38 TKA knees with a minimum follow up of 6months were compared with 34 control knees. The activities performed were: walking three steps forward and coming to a sudden stop; turning in the direction of non-tested knee; sit-to-stand; and stepping up and down from a 7 inch step. The acceleration results showed significant differences between TKA and controls while stepping down and while turning in the non-tested knee direction. The higher accelerations with the TKA group may have represented an objective measure of stability, even if this was not directly discernible to the patient.

Genetic marker polymorphisms on chromosome 8q24 and prostate cancer in the Dutch population: DG8S737 may not be the causative variant.

Prostate cancer is the most commonly diagnosed cancer in men in Europe and Northern America. Genome-wide association studies (GWAS) have detected an association with markers on chromosome 8q24. Allele -8 of microsatellite DG8S737 with 22 repeats and allele A of the single-nucleotide polymorphism (SNP) rs1447295 have been found to be significantly associated with prostate cancer. As GWAS are subjected to type 1 error, confirmation studies are required to validate the results. Here, we analysed the same markers in 277 cases and 282 controls from the Netherlands using a nested case-control study. Incident prostate cancer cases and controls selected were identified in the population of the Netherlands Cohort Study. We also investigated clinical features of the disease by stratifying by tumour stage. We did not replicate the association with the SNP rs1447295-A allele (P=0.10), although the effect estimate was in the same direction as previous studies (odds ratio (OR), 1.38). Interestingly a statistically significant decreased risk was observed for DG8S737 allele -8 (OR, 0.62; P=0.03). The apparent protective effect of the DG8S737 -8 allele observed in this study contrasts with the Amundadottir study. This suggests that DG8S737 and rs1447295 might be tightly linked markers flanking the actual causative variant and that there may be potentially more than one high-risk haplotype present in the Caucasian population. This short report highlights the importance of validation, although further confirmation is still needed.