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3.
Am J Med Qual ; : 1062860620929419, 2020 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-32476456

RESUMO

The 2016 Accreditation Council for Graduate Medical Education Clinical Learning Environment Review report identified knowledge gaps for quality in the clinical environment. It suggested quality improvement (QI) training is necessary to develop skills to improve health care quality. However, at the authors' institution, there is limited department-level QI mentorship and engagement, thus limiting QI experiences for residents and fellows. The authors developed pediatric graduate medical education program director (PD) proficiency in QI through a fellowship-focused QI project. PDs underwent an 18-month QI curriculum consisting of focused online QI education, a half-day workshop, additional QI didactic sessions, project presentations, and individual QI coaching. QI knowledge in 9 domains and participants' confidence were assessed. Participants' self-perceived confidence and skills increased by at least 20% in most domains. Overall, PDs felt prepared to help with their fellows' future QI projects. Fellowship-focused QI projects and individual coaching were key to course engagement.

4.
Cleve Clin J Med ; 86(12): 807-814, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31821138

RESUMO

Tricyclic antidepressants (TCAs) were originally designed and marketed for treating depression, but over time they have been applied to a variety of conditions, mostly off-label. TCAs can serve as first-line or augmenting drugs for neuropathic pain, headache, migraine, gastrointestinal syndromes, fibromyalgia, pelvic pain, insomnia, and psychiatric conditions other than depression. This article reviews pharmacology, dosing, and safety considerations for these uses.


Assuntos
Antidepressivos Tricíclicos , Reposicionamento de Medicamentos/métodos , Antidepressivos Tricíclicos/farmacologia , Antidepressivos Tricíclicos/uso terapêutico , Humanos , Uso Off-Label
5.
J Am Assoc Lab Anim Sci ; 58(5): 589-593, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31462348

RESUMO

Meloxicam is the most frequently used NSAID in birds; however, its elimination t1/2 is highly variable among species. Because zebra finches that require analgesia could benefit from receiving meloxicam, we performed a pharmacokinetic study involving a single intramuscular dose of 1 or 2 mg/kg. Data analysis showed that Cmax, t1/2, and elimination rate constants were not significantly different between the 2 doses. In contrast, Cmax for 1- and 2-mg/kg doses of meloxicam approached a significant difference, and those for AUC0-∞ were significantly different. Importantly, a plasma concentration of 3500 ng/mL, considered a target level for meloxicam in other avian species, was maintained for approximately 9.5 h in finches that received 2 mg/kg, which was 4 h longer than in birds given 1 mg/kg. Both doses reached low plasma concentrations by 12 h after administration. Subsequently, 8 total doses of 1 or 2 mg/kg were administered to birds at 12-h intervals; these regimens caused no significant changes in select biochemical analytes or the Hct of meloxicam-treated birds. In addition, histopathologic changes for injection sites, kidney, liver, proventriculus, and ventriculus were minimal and similar between control and experimental groups after the multiple doses. These results suggest a 12-h or more frequent dosing interval is likely needed in zebra finches and that meloxicam at 1 or 2 mg/kg IM twice daily for 4 d is safe. The higher dose might provide longer analgesia compared with the lower dose, but a pharmacodynamics evaluation of meloxicam in zebra finches is needed to confirm analgesic efficacy.

6.
Front Neurol ; 10: 737, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31338061

RESUMO

Background and Purpose: To describe the final results of the TARGET Registry, a multicenter, real-world study of patients with intracranial aneurysms treated with new generation TARGET Coils. Methods: The TARGET Registry is a prospective, single-arm study with independent medical event monitoring and core-lab adjudication. Patients with de novo intracranial aneurysms were embolized with either TARGET-360° or helical coils in 12 US centers. The primary outcome was aneurysm packing density (PD), which was assessed immediately post-procedure. The secondary outcomes were immediate and long-term aneurysm occlusion rate using the Raymond Scale, and independent functional outcome using the modified Rankin Scale (mRS). A secondary analysis investigated the influence of the use of 100% 360-complex coils on clinical and angiographic outcomes. Results: 148 patients with 157 aneurysms met the inclusion and exclusion criteria. 58 (39.2%) patients with ruptured and 90 (61.8%) with unruptured aneurysms were treated using TARGET 360°, helical Coils, or both. Median age was 58.3 (IQR 48.1-67.4), 73% female, and 71.6% were Caucasian. Median follow-up time was 5.9 (IQR 4.0-6.9) months. The majority were treated with TARGET 360-coils (63.7%), followed by mixed and helical coils only. Peri-procedural morbidity and mortality was seen in 2.7% of patients. A good outcome at discharge (mRS 0-2) was seen in 89.9% of the full cohort, and in 84.5 and 93.3% in the ruptured and unruptured patients, respectively. The median packing density was 28.8% (IQR 20.3-41.1). Long-term complete and near complete occlusion rate was seen in 90.4% of aneurysms and complete obliteration was seen in 66.2% of the aneurysms. No significant difference in clinical and angiographic outcomes were noted between the pure 360-complex coiling vs. mixed 360-complex/Helical coiling strategies. In a multivariate analysis, predictors for long-term aneurysm occlusion were aneurysm location, immediate occlusion grade, and aneurysm size. The long-term independent functional outcome was achieved in 128/135 (94.8%) patients and all-cause mortality was seen in 3/148 (2%) patients. Conclusion: In the multicenter TARGET Registry, two-thirds of aneurysms achieved long-term complete occlusion and 91.0% achieved complete or near complete occlusion with excellent independent functional outcome. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01748903.

7.
J Am Podiatr Med Assoc ; 109(2): 122-126, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31135201

RESUMO

BACKGROUND: Increasing amounts of diabetes-focused content is being posted to YouTube with little regulation as to the quality of the content. Diabetic education has been shown to reduce the risk of ulceration and amputation. YouTube is a frequently visited site for instructional and demonstrational videos posted by individuals, advertisers, companies, and health-care organizations. We sought to evaluate the usefulness of diabetic foot care video information on YouTube. METHODS: YouTube was queried using the keyword phrase diabetic foot care. Original videos in English, with audio, less than 10 min long within the first 100 video results were evaluated. Two reviewers classified each video as useful or nonuseful/misleading. A 14-point usefulness criteria checklist was used to further categorize videos as most useful, somewhat useful, or nonuseful/misleading. Video sources were categorized by user type, and additional video metrics were collected. RESULTS: Of 87 included videos, 56 (64.4%), were classified as useful and 31 (35.6%) as nonuseful/misleading. A significant difference in the mean length of useful videos vs nonuseful/misleading videos was observed (3.33 versus 1.73 min; P < .0001). There was no significant difference in terms of popularity metrics (likes, views, subscriptions, etc) between useful and nonuseful/misleading videos. CONCLUSIONS: This study demonstrates that although most diabetic foot care videos on YouTube are useful, many are still nonuseful/misleading. More concerning is the lack of difference in popularity between useful and nonuseful videos. Podiatric physicians should alert patients to possibly misleading information and offer a curated list of videos.


Assuntos
Informação de Saúde ao Consumidor , Pé Diabético/terapia , Educação de Pacientes como Assunto , Autocuidado , Mídias Sociais , Humanos
8.
Stroke ; 50(7): 1911-1914, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31104620

RESUMO

Background and Purpose- Mobile Stroke Units (MSUs) provide innovative prehospital stroke care but their 24/7 operation has not been studied. Our study investigates 24/7 MSU diurnal variations related to transport frequency, patient characteristics, and stroke treatments. Methods- We compared transportation frequency, demographics, thrombolytic and mechanical thrombectomy administration, and treatment metrics across 8-hour shifts (morning, evening, and nocturnal) from our 24/7 MSU in Northwest Ohio prospective database. Results- One hundred ninety-five patients were transported by the MSU. Most transports occurred during the morning shift (52.3%) followed by evening shift (35.8%) and nocturnal shift (11.9%; Ptrend<0.001). Twenty-three patients (11.9%) received intravenous thrombolytic in the MSU, most frequently in the morning shift (56.5%). No cases of mechanical thrombectomy were performed on MSU patients in the nocturnal shift. Conclusions- Morning and evening shifts account for the majority of our MSU transports (88.1%) and therapeutic interventions. Understanding temporal variations in a resource-intensive MSU is critical to its worldwide implementation.


Assuntos
Unidades Móveis de Saúde/estatística & dados numéricos , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/tratamento farmacológico , Bases de Dados Factuais , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Fatores Socioeconômicos , Acidente Vascular Cerebral/epidemiologia , Trombectomia , Terapia Trombolítica , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêutico , Transporte de Pacientes
9.
Otolaryngol Clin North Am ; 52(1): 115-121, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30249446

RESUMO

Surgeons can use simulation to improve the safety of the systems they work within, around, because of, and despite. Health care is a complex adaptive system that can never be completely knowable; simulation can expose aspects of patient care delivery that are not necessarily evident prospectively, during planning, or retrospectively, during investigations or audits. The constraints of patient care processes and adaptive capacity of health care providers may become most evident during simulations conducted "in situ" using real teams and real equipment, in actual patient care locations.


Assuntos
Competência Clínica , Equipe de Assistência ao Paciente/organização & administração , Treinamento por Simulação/métodos , Humanos , Segurança do Paciente/normas , Melhoria de Qualidade
10.
J Am Assoc Lab Anim Sci ; 58(1): 16-20, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30538006

RESUMO

The typical daily water intake of common marmosets (Callithrix jacchus) in a research setting has not been well characterized. Because these New World primates are in demand as animal models for neurobehavioral experiments, which can include the potential use of fluid regulation for training, veterinary and research staff need to understand how marmosets keep hydrated under normal circumstances. In the current study, we measured the water consumption of older (age, 5 to 12 y; n = 11) and younger (age, 1 to 2 y; n = 11) marmosets every 3 h during the 12-h light phase in 2 different months (January and July). The overall daily water intake (mean ± 1 SD) was 61.3 ± 20.4 mL/kg (range, 36.3 to 99.0 mL/kg); water intake by an individual marmoset or cohoused pair was fairly consistent from day to day. Water intake did not change across the four 3-h periods measured during the day, and minimal water was consumed overnight when the room lights were off. In addition, daily water intake did not differ between the 2 mo of measurements. Older animals drank significantly more than the younger group, and weight was directly correlated with water intake. Water intake was not affected by body condition score or housing status. The variation in water consumption among marmosets underscores the need for individualization of fluid regulation guidelines.


Assuntos
Criação de Animais Domésticos , Callithrix/fisiologia , Ingestão de Líquidos , Envelhecimento , Animais , Peso Corporal , Ritmo Circadiano , Feminino , Masculino
11.
Simul Healthc ; 13(3): 221-224, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29621037

RESUMO

STATEMENT: In situ simulation is the practice of simulation in the actual clinical environment and has demonstrated utility in the assessment of system processes, identification of latent safety threats, and improvement in teamwork and communication. Nonetheless, performing simulated events in a real patient care setting poses potential risks to patient and staff safety. One integral aspect of a comprehensive approach to ensure the safety of in situ simulation includes the identification and establishment of "no-go considerations," that is, key decision-making considerations under which in situ simulations should be canceled, postponed, moved to another area, or rescheduled. These considerations should be modified and adjusted to specific clinical units. This article provides a framework of key essentials in developing no-go considerations.


Assuntos
Treinamento por Simulação/organização & administração , Comunicação , Tomada de Decisões , Processos Grupais , Humanos , Equipe de Assistência ao Paciente/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Gestão da Segurança/organização & administração , Treinamento por Simulação/normas , Fluxo de Trabalho , Carga de Trabalho
12.
Front Microbiol ; 9: 311, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29556221

RESUMO

Non-human primates (NHPs) for biomedical research are commonly infected with Shigella spp. that can cause acute dysentery or chronic episodic diarrhea. These animals are often prophylactically and clinically treated with quinolone antibiotics to eradicate these possible infections. However, chromosomally- and plasmid-mediated antibiotic resistance has become an emerging concern for species in the family Enterobacteriaceae. In this study, five individual isolates of multi-drug resistant Shigella flexneri were isolated from the feces of three macaques. Antibiotic susceptibility testing confirmed resistance or decreased susceptibility to ampicillin, amoxicillin-clavulanic acid, cephalosporins, gentamicin, tetracycline, ciprofloxacin, enrofloxacin, levofloxacin, and nalidixic acid. S. flexneri isolates were susceptible to trimethoprim-sulfamethoxazole, and this drug was used to eradicate infection in two of the macaques. Plasmid DNA from all isolates was positive for the plasmid-encoded quinolone resistance gene qnrS, but not qnrA and qnrB. Conjugation and transformation of plasmid DNA from several S. flexneri isolates into antibiotic-susceptible Escherichia coli strains conferred the recipients with resistance or decreased susceptibility to quinolones and beta-lactams. Genome sequencing of two representative S. flexneri isolates identified the qnrS gene on a plasmid-like contig. These contigs showed >99% homology to plasmid sequences previously characterized from quinolone-resistant Shigella flexneri 2a and Salmonella enterica strains. Other antibiotic resistance genes and virulence factor genes were also identified in chromosome and plasmid sequences in these genomes. The findings from this study indicate macaques harbor pathogenic S. flexneri strains with chromosomally- and plasmid-encoded antibiotic resistance genes. To our knowledge, this is the first report of plasmid-mediated quinolone resistance in S. flexneri isolated from NHPs and warrants isolation and antibiotic testing of enteric pathogens before treating macaques with quinolones prophylactically or therapeutically.

13.
J Med Case Rep ; 12(1): 19, 2018 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-29373994

RESUMO

BACKGROUND: Intravenous enzyme replacement therapy is a first-line therapy for Gaucher disease type 1, and substrate reduction therapy represents an oral treatment alternative. Both enzyme replacement therapy and substrate reduction therapy are generally used as monotherapies in Gaucher disease. However, one randomized study and several case reports have described combination therapy over short time periods. CASE PRESENTATION: We report two female Gaucher disease type 1 patients of mainly Anglo-Saxon descent, where combined enzyme replacement therapy and miglustat substrate reduction therapy were administered to overcome refractory clinical symptoms. The first patient was diagnosed at age 17 and developed Gaucher disease-related bone manifestations that worsened despite starting imiglucerase enzyme replacement therapy. After switching to miglustat substrate reduction therapy, her bone symptoms improved, but she developed tremors and eventually switched back to enzyme replacement therapy. Miglustat was later recommenced in combination with ongoing enzyme replacement therapy due to continued bone pain, and her bone symptoms improved along with maintained visceral manifestations. Enzyme replacement therapy was subsequently tapered off and the patient has since been successfully maintained on miglustat. The second patient was diagnosed aged 3, and commenced imiglucerase enzyme replacement therapy aged 15. After 9 years on enzyme replacement therapy she switched to miglustat substrate reduction therapy and her core symptoms were maintained/stable for 3 years. Imiglucerase enzyme replacement therapy was later added as a boost to therapy and her symptoms were subsequently maintained over a 2.3-year period. However, miglustat was discontinued due to her relocation, necessitating an increase in enzyme replacement therapy dose. Overall, both patients benefited from combination therapy. CONCLUSION: While the majority of Gaucher disease type 1 patients will not need treatment with both substrate reduction therapy and enzyme replacement therapy, the current case reports demonstrate that judicious use of combination therapy may be of benefit in some cases.


Assuntos
1-Desoxinojirimicina/análogos & derivados , Inibidores Enzimáticos/administração & dosagem , Terapia de Reposição de Enzimas/métodos , Doença de Gaucher/terapia , Glucosilceramidase/administração & dosagem , 1-Desoxinojirimicina/administração & dosagem , Adulto , Pré-Escolar , Terapia Combinada , Quimioterapia Combinada , Feminino , Hexosaminidases/sangue , Humanos , Trombocitopenia/sangue
14.
Simul Healthc ; 13(1): 16-26, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29346221

RESUMO

INTRODUCTION: Early recognition of sepsis remains one of the greatest challenges in medicine. Novice clinicians are often responsible for the recognition of sepsis and the initiation of urgent management. The aim of this study was to create a validity argument for the use of a simulation-based training course centered on assessment, recognition, and early management of sepsis in a laboratory-based setting. METHODS: Five unique simulation scenarios were developed integrating critical sepsis cues identified through qualitative interviewing. Scenarios were piloted with groups of novice, intermediate, and expert pediatric physicians. The primary outcome was physician recognition of sepsis, measured with an adapted situation awareness global assessment tool. Secondary outcomes were physician compliance with pediatric advanced life support (PALS) guidelines and early sepsis management (ESM) recommendations, measured by two internally derived tools. Analysis compared recognition of sepsis by levels of expertise and measured association of sepsis recognition with the secondary outcomes. RESULTS: Eighteen physicians were recruited, six per study group. Each physician completed three sepsis simulations. Sepsis was recognized in 19 (35%) of 54 simulations. The odds that experts recognized sepsis was 2.6 [95% confidence interval (CI) = 0.5-13.8] times greater than novices. Adjusted for severity, for every point increase in the PALS global performance score, the odds that sepsis was recognized increased by 11.3 (95% CI = 3.1-41.4). Similarly, the odds ratio for the PALS checklist score was 1.5 (95% CI = 0.8-2.6). Adjusted for severity and level of expertise, the odds of recognizing sepsis was associated with an increase in the ESM checklist score of 1.8 (95% CI = 0.9-3.6) and an increase in ESM global performance score of 4.1 (95% CI = 1.7-10.0). CONCLUSIONS: Although incomplete, evidence from initial testing suggests that the simulations of pediatric sepsis were sufficiently valid to justify their use in training novice pediatric physicians in the assessment, recognition, and management of pediatric sepsis.


Assuntos
Diagnóstico Precoce , Sepse/diagnóstico , Treinamento por Simulação/normas , Criança , Pré-Escolar , Humanos , Lactente , Entrevistas como Assunto , Avaliação de Resultados em Cuidados de Saúde/métodos , Pesquisa Qualitativa
15.
J Nutr Intermed Metab ; 14: 1-7, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31058204

RESUMO

Introduction: Childhood obesity remains high in prevalence. Sugar-sweetened beverages containing high fructose corn syrup (HFCS) are a common source of excess calories among children and adolescents. Fructose metabolism differs from glucose metabolism, which may also differ from fructose + glucose metabolism in HFCS consumption. The purpose of this study was to determine the acute metabolic effects of HFCS ingestion after soft drink consumption in adolescents who are lean, have overweight/obesity, or have type 2 diabetes (T2DM). Methods: Adolescents age 13-19 years were recruited into three groups: lean controls (n = 10), overweight/ obese without diabetes (n = 10), or uncomplicated T2DM on metformin monotherapy (n = 5). After an overnight fast, subjects drank 12 ounces of soda containing HFCS. Blood samples were collected at time zero and every 15 min for 120 min to be analyzed for fructose, glucose, and insulin levels. Results: Glucose and fructose concentrations rose quickly in the first 15 min. Fructose, which was very low at baseline, rose to 100-200 µM and remained higher than fasting concentrations even at 120 min in all groups. Glucose increased after soft drink consumption, with the highest concentrations among subjects with T2DM, but returned to baseline fasting levels at 120 min. Insulin levels increased 15 min after soft drink consumption and were the highest in the obese group. Lactate rose non-significantly in all subjects, with no differences between groups. Conclusion: Among adolescents who are lean, overweight/obese, or have T2DM, drinking an HFCS-containing soft drink exposes the liver to fructose. Glucose excursions in T2DM may be impacted by exaggerated glucose cycling, or fructose metabolism to glucose. The context of fructose consumption with or without other carbohydrates is an important consideration in studies of fructose metabolism.

16.
J Am Assoc Lab Anim Sci ; 56(6): 802-806, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29256376

RESUMO

Although zebra finches (Taeniopygia guttata) have been used in biomedical research for many years, no published reports are available about euthanizing these small birds. In this study, we compared 5 methods for zebra finch euthanasia: sodium pentobarbital (NaP) given intracoelomically with physical restraint but no anesthesia; isoflurane anesthesia followed by intracoelomic injection of NaP; and CO2 asphyxiation at 20%, 40%, and 80% chamber displacement rates (percentage of chamber volume per minute). Birds undergoing euthanasia were videorecorded and scored by 2 observers for behaviors potentially related to discomfort or distress. Time to recumbency and time until respiratory arrest (RA) were also assessed. RA was achieved faster by using NaP in a conscious bird compared to using isoflurane anesthesia followed by NaP; however, neither method caused behaviors that might affect animal welfare, such as open-mouth breathing, to any appreciable extent. Among the CO2 treatment groups, there was an inverse correlation between the chamber displacement rate used and the duration of open-mouth breathing, onset of head retroflexion, and time to RA. The results demonstrate that the intracoelomic administration of NaP in an awake, restrained zebra finch is a rapid and effective method of euthanasia. If CO2 is used to euthanize these birds, a high displacement rate (for example, 80%) will minimize the duration of the procedure and associated behaviors.


Assuntos
Bem-Estar do Animal , Dióxido de Carbono/administração & dosagem , Eutanásia Animal/métodos , Tentilhões/fisiologia , Isoflurano/administração & dosagem , Pentobarbital/administração & dosagem , Animais , Animais de Laboratório , Feminino , Tentilhões/classificação , Masculino
17.
Hosp Pediatr ; 7(4): 225-231, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28336579

RESUMO

BACKGROUND AND OBJECTIVES: Major adverse events (AEs) related to pediatric deep sedation occur at a low frequency but can be of high acuity. The high volume of deep sedations performed by 3 departments at our institution provided an opportunity to reduce variability and increase safety through implementation of a procedural sedation safety checklist. We hypothesized that implementation of a checklist would improve compliance of critical safety elements (CSEs) (primary outcome variable) and reduce the sedation-related AE rate (secondary outcome variable). METHODS: This process improvement project was divided into 5 phases: a retrospective analysis to assess variability in capture of CSE within 3 departments that perform deep sedation and the association between noncapture of CSE and AE occurrence (phase 1), design of the checklist and trial in simulation (phase 2), provider education (phase 3), implementation and interim analysis of checklist completion (phase 4), and final analysis of completion and impact on outcome (phase 5). RESULTS: We demonstrated interdepartmental variability in compliance with CSE completion prechecklist implementation, and we identified elements associated with AEs. Completion of provider education was 100% in all 3 departments. Final analysis showed a checklist completion rate of 75%, and its use significantly improved capture of several critical safety elements. Its use did not significantly reduce AEs (P = .105). CONCLUSIONS: This study demonstrates that the implementation of a sedation checklist improved process adherence and capture of critical safety elements; however, it failed to show a significant reduction in sedation-related AEs.


Assuntos
Lista de Checagem , Sedação Profunda/efeitos adversos , Segurança do Paciente , Comportamento de Redução do Risco , Criança , Humanos , Corpo Clínico Hospitalar/educação , Recursos Humanos de Enfermagem no Hospital/educação , Ohio , Avaliação de Programas e Projetos de Saúde
18.
Adv Simul (Lond) ; 2: 21, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29450022

RESUMO

Simulation is traditionally used to reduce errors and their negative consequences. But according to modern safety theories, this focus overlooks the learning potential of the positive performance, which is much more common than errors. Therefore, a supplementary approach to simulation is needed to unfold its full potential. In our commentary, we describe the learning from success (LFS) approach to simulation and debriefing. Drawing on several theoretical frameworks, we suggest supplementing the widespread deficit-oriented, corrective approach to simulation with an approach that focusses on systematically understanding how good performance is produced in frequent (mundane) simulation scenarios. We advocate to investigate and optimize human activity based on the connected layers of any setting: the embodied competences of the healthcare professionals, the social and organizational rules that guide their actions, and the material aspects of the setting. We discuss implications of these theoretical perspectives for the design and conduct of simulation scenarios, post-simulation debriefings, and faculty development programs.

19.
Simul Healthc ; 11(2): 94-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27043094

RESUMO

STATEMENT: On October 10, 2014, a health care worker exposed to Ebola traveled to Akron, OH, where she became symptomatic. The resulting local public health agencies and health care organization response was unequalled in our region. The day this information was announced, the emergency disaster response was activated at our hospital. The simulation center had 12 hours to prepare simulations to evaluate hospital preparedness should a patient screen positive for Ebola exposure. The team developed hybrid simulation scenarios using standardized patients, mannequin simulators, and task trainers to assess hospital preparedness in the emergency department, transport team, pediatric intensive care unit, and for interdepartmental transfers. These simulations were multidisciplinary and demonstrated gaps in the system that could expose staff to Ebola. The results of these simulations were provided rapidly to the administration. Further simulation cycles were used during the next 2 weeks to identify additional gaps and to evaluate possible solutions.


Assuntos
Pessoal de Saúde/educação , Doença pelo Vírus Ebola/prevenção & controle , Hospitais Pediátricos/organização & administração , Melhoria de Qualidade/organização & administração , Treinamento por Simulação/organização & administração , Cuidados Críticos/organização & administração , Planejamento em Desastres/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Doença pelo Vírus Ebola/terapia , Doença pelo Vírus Ebola/transmissão , Humanos , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva Pediátrica/organização & administração , Manequins , Equipe de Assistência ao Paciente/organização & administração , Equipamento de Proteção Individual , Transporte de Pacientes
20.
Curr Probl Pediatr Adolesc Health Care ; 45(12): 382-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26549146

RESUMO

In the quest to continually improve the health care delivered to patients, it is important to understand "what went wrong," also known as Safety-I, when there are undesired outcomes, but it is also important to understand, and optimize "what went right," also known as Safety-II. The difference between Safety-I and Safety-II are philosophical as well as pragmatic. Improving health care delivery involves understanding that health care delivery is a complex adaptive system; components of that system impact, and are impacted by, the actions of other components of the system. Challenges to optimal care include regular, irregular and unexampled threats. This article addresses the dangers of brittleness and miscalibration, as well as the value of adaptive capacity and margin. These qualities can, respectively, detract from or contribute to the emergence of organizational resilience. Resilience is characterized by the ability to monitor, react, anticipate, and learn. Finally, this article celebrates the importance of humans, who make use of system capabilities and proactively mitigate the effects of system limitations to contribute to successful outcomes.


Assuntos
Hospitais Pediátricos/organização & administração , Segurança do Paciente/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Gestão da Segurança/organização & administração , Pesquisa sobre Serviços de Saúde , Hospitais Pediátricos/normas , Humanos , Cultura Organizacional
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