ABSTRACT
In the increasing number of medical education topics taught with virtual reality (VR), the prehospital management of ST-segment elevation myocardial infarction (STEMI) had not been considered. This article proposes an implemented VR system for STEMI training and introduces it in an institutional course addressed to emergency nurses and case manager (CM) doctors. The system comprises three different applications to, respectively, allow (a) the course instructor to control the conditions of the virtual patient, (b) the CM to communicate with the nurse in the virtual field and receive from him/her the patient's parameters and electrocardiogram, and (c) the nurse to interact with the patient in the immersive VR scenario. We enrolled 17 course participants to collect their perceptions and opinions through a semistructured interview. The thematic analysis showed the system was appreciated (n = 17) and described as engaging (n = 4), challenging (n = 5), useful to improve self-confidence (n = 4), innovative (n = 5), and promising for training courses (n = 10). Realism was also appreciated (n = 13), although with some drawbacks (e.g., oversimplification; n = 5). Overall, participants described the course as an opportunity to share opinions (n = 8) and highlight issues (n = 4) and found it useful for novices (n = 5) and, as a refresh, for experienced personnel (n = 6). Some participants suggested improvements in the scenarios' type (n = 5) and variability (n = 5). Although most participants did not report usage difficulties with the VR system (n = 13), many described the need to get familiar with it (n = 13) and the specific gestures it requires (n = 10). Three suffered from cybersickness.
ABSTRACT
This article proposes a series of insights that are drawn from the most up-to-date scientific literature and functional for an optimal implementation of Audit & Feedback (A&F). The focus is on the "feedback" component of the methodology. Some key issues of the feedback are the capability to address changes perceived as priorities for the recipients, recommend actions that bring real improvements, and allow the people to whom recommendations are addressed to manage them. Other suggestions concern how to share the data: it is important to provide feedback as soon as possible, multiple times, starting from individual rather than general data, and including comparisons able to promote the desired change. Other operational indications concern the most effective way to display the feedback, such as tightly linking the graphical representation and the summary message, presenting the feedback in multiple ways, and simplifying the message to minimize cognitive overload. Finally, some suggestions are about how to transmit feedback: tailor interventions according to the specific barriers of a given clinical-organizational context, provide short and easily understandable messages followed by more details, emphasize the credibility of information, increase motivation to change practice, and encourage participatory feedback construction rather than passive delivery. It also proposes an analysis of some of the challenges related to the design of A&F interventions translatable into improvements in practice starting from the context of the Easy-Net network program.
ABSTRACT
Aim: The aims of this study were to examine the requests for influenza molecular tests processed by the Virology Laboratory of the University Hospital of Udine during the 2018-19 influenza season and to assess the test results and to estimate costs. Subjects and methods: We analyzed various administrative databases of the hospital health information system, which can be deterministically linked at the individual level through an anonymous stochastic key. Requests for influenza molecular tests from November 1, 2018, to April 15, 2019, and test results were described by week and, for hospitalized patients, hospital ward. Previous vaccination status of tested patients, outcomes and estimated test costs were assessed. Results: In the 2018-19 influenza season, 979 influenza A and B virologic tests were processed by the laboratory, corresponding to 758 patients. Requests had more than doubled compared with the previous influenza season. Rapid real-time PCR tests, routinely available at the University Hospital of Udine since January 2019, represented 17% of requests. Six hundred forty-eight patients were hospitalized. Medical wards requested the test after a median of 1 day after admission, whereas requests were delayed for surgical and oncologic patients. The number of tests, proportion of positivity and consumption of rapid tests varied by medical specialty. Overall consumption of oseltamivir was similar to that of the previous influenza season. Conclusions: This analysis, benefiting from the availability of integrated health administrative databases, provided useful information to support public health decision-making and managing the supply and demand for diagnostic tests.
