A Train-the-Trainer Simulation Program Implemented Between Two International Partners.

With the expansion of global health initiatives focused on healthcare professional training, it is important to ensure that such training is scalable and sustainable. Simulation-based education (SBE) is a highly effective means to achieve these goals. Although SBE is widely used in the United States, its integration globally is limited, which can impact the potential of SBE in many countries. The purpose of this perspective piece is to demonstrate how a train-the-trainer program can help in the development of an international SBE program and specifically what unique issues must be considered in operationalizing this strategy.

Creation of an International Interprofessional Simulation-enhanced Mechanical Ventilation Course.

Background: Evidence shows poor adherence to strategies for reducing morbidity and mortality in intensive care unit (ICU) patients receiving mechanical ventilation globally. Best practice management relies on training all members of the interprofessional ICU team, each with complementary roles in patient management. Objectives: To develop and evaluate a novel two-phase, train-the-trainer, interprofessional and multicultural "Best Practice Management of the Ventilated ICU Patient" multimodality, simulation-enhanced curriculum for Thai education leaders in critical care. Methods: In phase 1 (Oregon Health and Science University cohort), two groups of nine ICU nurses and one critical care physician representing experts in critical care and education from a large hospital system in Thailand participated in a weeklong, immersive course consisting of didactic, simulation, and in situ immersive sessions focused on best practice management of mechanically ventilated ICU patients, as well as training in our educational techniques. Outcomes were assessed with pre- and postcourse knowledge assessments and overall course evaluation. In phase 2 (Thai cohort), participants from phase 1 returned to Thailand and implemented a lower fidelity curriculum in two hospitals, using the same pre- and posttest knowledge assessment in 41 participants, before the onset of the coronavirus disease (COVID-19) 6 pandemic. Results: In the Oregon Health and Science University cohort, the mean pretest knowledge score was 58.4 ± 13.2%, with a mean improvement to 82.5 ± 11.6% after completion of the course (P , 0.05). The greatest improvements were seen in respiratory physiology and advanced/disease-specific concepts, which demonstrated absolute improvements of 30.4% and 30.6%, respectively (P < 0.05). Participants had a high degree of satisfaction, with 90% rating the course as "excellent" and .90% reporting that the course "greatly improved" their understanding of best practices and comfort in managing mechanical ventilation. The Thai cohort had a mean baseline score of 45.4 ± 15.0% and a mean improvement to 70.3 ± 19.1% after training (P < 0.05). This cohort also saw the greatest improvement in respiratory physiology and advanced/disease-specific concepts, with 26.2% and 26.3% absolute improvements, respectively (P < 0.05). Conclusion: A novel, two-phase, interprofessional, multicultural, simulation-enhanced train-the-trainer curriculum was feasible and effective in improving education in best practice management of mechanically ventilated patients and may be a useful model for improving the care of ICU patients across the world.

Physician Engagement before and during the COVID-19 Pandemic in Thailand.

The COVID-19 pandemic has affected not only the quality of care and patient safety but also physician engagement. The aim of this study was to investigate physician engagement before and during the COVID-19 pandemic and to identify the areas to improve regarding physician engagement. An online survey was conducted from April 2019 to September 2020 among the physicians of 44 hospitals under the Bangkok Dusit Medical Services Public Company Limited (BDMS) before and during the COVID-19 pandemic. The results were analyzed using an independent T-test and one-way ANOVA to compare the continuous variables across groups. Multiple linear regression was used to identify and adjust the variables to determine the areas for improvement. Among the 10,746 respondents, physician engagement during the COVID-19 pandemic was significantly higher than in the pre-COVID-19 period (4.12 vs. 4.06, p-value < 0.001). The top three recommendations to promote physician engagement during the COVID-19 situation comprised (1) marketing (70%), (2) intra-and inter-organizational communication (69%), and (3) the competency of clinical staff (67%). During the COVID-19 pandemic, the positive outcomes toward physician engagement focused on infra-organizational development. These results can be considered in a strategy to optimize physician engagement, which affects the quality of care and patient safety.

Public familiarity with, knowledge of, and predictors of negative attitudes toward epilepsy in Thailand.

The purpose of this nationwide survey was to assess familiarity with and knowledge of epilepsy, as well as to identify predictors of negative attitudes toward people with epilepsy, in Thailand. Of the 1581 people interviewed, 80.8% were familiar with the word epilepsy, but few knew anyone with the condition. The main reason given for avoiding helping a seizure victim was a lack of proper first-aid knowledge, not a negative attitude toward the person. The factors predicting negative attitudes in the Thai population were low educational level, unfamiliarity with epilepsy, and the misconception that epilepsy is a form of insanity. Different from most previous studies worldwide, the attitudes of friends and parents toward people with epilepsy were strongly positive. Social awareness of the public organization Epilepsy Society of Thailand was low; only 4.6% of the respondents knew about it. These data should be considered in a nationwide strategy to alleviate social discrimination against people with epilepsy.

Kleine-Levin syndrome: the first typical case in Thailand.

Kleine-Levin syndrome (KLS) is a rare disorder characterized by periodic hypersomnia, cognitive and behavioral disturbances. Other unique symptoms in KLS are megaphagia, hypersexuality and some psychiatric disturbances such as compulsion and depression. Definite diagnosis requires the elimination of other potential etiologies. We reported a typical case of KLS in a young Thai man who suffered from seven episodes of periodic hypersomnia within 1.5 years and eventually he was diagnosed with Kleine-Levin syndrome after excluding known possible neurological conditions and sleep disorders.

Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings.

PURPOSES: To determine the occurrence of nonconvulsive seizures (NCS) in the Pediatric Intensive Care Unit (PICU); to ascertain the relationship of NCS to past medical history, etiology, EEG, and brain imaging; and to determine the concordance between abnormal EEG findings and neuroimaging abnormalities. METHODS: A retrospective review was conducted of all pediatric patients who were admitted or transferred to the PICU from January 2000 to December 2003 with an unexplained decrease in level of consciousness, no overt clinical seizures, and EEG recordings performed within the 24 h of onset of an altered state of consciousness. RESULTS: Twenty-three of 141 patients who met criteria for inclusion in the study (16.3%) were found to have NCS. The male to female ratio was 1.9:1. The largest group of patients (43%) had no preexisting neurological condition prior to the onset of NCS. In the remainder, the etiology of NCS included: acute structural brain lesion (48%), acute nonstructural brain lesion (22%), epilepsy-related seizure (13%), and others (17%). Epileptic foci were lateralized to the right side in 39.2%, the left side in 30.4%, and were bilateral in 30.4%. Of 23 patients with NCS, 18 (78.3%) demonstrated abnormal neuroimaging. In 10 of 18 of these patients (55.6%), the findings on neuroimaging were concordant with the lateralization found on EEG (p < 0.05, Fisher's exact test). CONCLUSIONS: NCS are not uncommon in pediatric patients with an altered state of consciousness. Almost half of the patients were previously healthy especially if they were under 6 months of age. This report highlights the importance of clinical awareness of NCS in the PICU.

Grandpa and I have dystrophinopathy?: approach to asymptomatic hyperCKemia.

This report describes three males from a single kinship, ages 7, 8, and 67 years with clinically asymptomatic dystrophinopathy. The index case was an 8-year-old male evaluated for asymptomatic but persistently elevated serum creatine kinase levels. Muscle biopsy demonstrated a mild myopathy, without necrotic fibers. Immunostaining for dystrophin revealed a slight reduction in sarcolemmal reactivity for the amino terminus of dystrophin. Dystrophin gene analysis revealed a deletion of exon 45 to exon 51. Genetic analysis identified two other affected males (age 7 years and 67 years), as well as four female carriers in the same family. The 7-year-old male had mildly increased creatine kinase levels with normal muscle strength. The 67-year-old grandfather had normal neuromuscular examination and serum creatine kinase levels. Asymptomatic dystrophinopathy in late adulthood is exceptionally rare, and highlights the importance of consideration of dystrophin mutation analysis in patients with hyperCKemia, even in the absence of muscle weakness.