A longitudinal interprofessional simulation curriculum for critical care teams: Exploring successes and challenges.

Interprofessional care teams are the backbone of intensive care units (ICUs) where severity of illness is high and care requires varied skills and experience. Despite this care model, longitudinal educational programmes for such workplace teams rarely include all professions. In this article, we report findings on the initial assessment and evaluation of an ongoing, longitudinal simulation-based curriculum for interprofessional workplace critical care teams. The study had two independent components, quantitative learner assessment and qualitative curricular evaluation. To assess curriculum effectiveness at meeting learning objectives, participant-reported key learning points identified using a self-assessment tool administered immediately following curricular participation were mapped to session learning objectives. To evaluate the curriculum, we conducted a qualitative study using a phenomenology approach involving purposeful sampling of nine curricular participants undergoing recorded semi-structured interviews. Verbatim transcripts were reviewed by two independent readers to derive themes further subdivided into successes and barriers. Learner self-assessment demonstrated that the majority of learners, across all professions, achieved at least one intended learning objective with senior learners more likely to report team-based objectives and junior learners more likely to report knowledge/practice objectives. Successes identified by curricular evaluation included authentic critical care curricular content, safe learning environment, and team comradery from shared experience. Barriers included unfamiliarity with the simulation environment and clinical coverage for curricular participation. This study suggests that a sustainable interprofessional curriculum for workplace ICU critical care teams can achieve the desired educational impact and effectively deliver authentic simulated work experiences if barriers to educational engagement and participation can be overcome.

Sharing experiences to improve bereavement support and clinical care after stillbirth: report of the 7th annual meeting of the International Stillbirth Alliance.

Stillbirth remains a global health challenge which is greatly affected by social and economic inequality, particularly the availability and quality of maternity care. The International Stillbirth Alliance (ISA) exists to raise awareness of stillbirth and to promote global collaboration in the prevention of stillbirth and provision of appropriate care for parents whose baby is stillborn. The focus of this ISA conference was to share experiences to improve bereavement support and clinical care. These issues, relevant throughout the globe, are not discrete but closely interrelated, with both similarities and differences depending on the specific country and cultural context. Counting stillbirths and understanding the causes of stillbirth are essential not only for providing optimal care and support to parents whose babies die, but also for reducing the future burden of stillbirth. This summary highlights novel work from obstetricians, midwives, psychologists, parents and peer support organizations that was presented at the ISA meeting. It covers topics including the bereavement process, peer support for parents, support and training for staff, evidence for clinical care, and the need for accurate data on stillbirths and perinatal audits. Representatives from the maternity services of the region presented their outcome data and shared their experiences of clinical and bereavement care. Data and developments in practice within stillbirth and bereavement care must be widely disseminated and acted upon by those responsible for maternity care provision, both to prevent stillbirths and to provide high-quality care when they do occur.

I Have to/Get to Teach Counseling: Now What? A Personal Essay.

Faculty receiving the assignment to teach a course in counseling to Au.D. students often have limited background in teaching the requisite skills and knowledge associated with counseling. A period of self-reflection regarding transferable skills for counseling as well as guidance from colleagues may assist in developing core concepts for the content of the class. Theoretical underpinnings, understanding and respecting patient values, and listening and valuing are significant perspectives for students to develop as they approach the broad content of a counseling course.

The first successful DeBakey VAD child implantation as a bridge to transplant.

A 14-year-old boy with repaired transposition of the great arteries and ventricular septal defect presented with atrial flutter and severe congestive heart failure. Despite successful cardioversion and optimal medical therapy, the patient deteriorated and was supported with extracorporeal membrane oxygenation (ECMO). Two days after initiating ECMO support, we implanted the DeBakey VAD Child ventricular assist device (MicroMed Technology, Inc., Houston, TX) under the Humanitarian Device Exemption program. Later, he was able to pursue normal daily activities including physical rehabilitation and ambulation in the hospital. After 56 days, he underwent a successful cardiac transplantation. After 3 months, he had good cardiac function and no evidence of rejection. The DeBakey VAD Child device is a valuable option for cardiac support as a bridge to transplantation.

Big help for small hearts.

The ACH Heart Center is a comprehensive, full-service resource for infants and children with congenital and acquired heart disease. UAMS physicians and nurses and ACH nurses and staff are here to care for these children both directly and by providing support to pediatricians and primary care physicians within Arkansas and the surrounding states.

Levetiracetam in the treatment of Lennox-Gastaut syndrome.

Lennox-Gastaut syndrome is an epileptic encephalopathy characterized by multiple seizure types, mental retardation, and a slow spike-and-wave pattern on electroencephalography. Medical intractability is common. We identified a case series of six patients diagnosed with Lennox-Gastaut syndrome in which levetiracetam was initiated as add-on therapy for the management of seizures. At follow-up, four patients experienced 100% reduction of their myoclonic seizures; two patients had greater than 50% reduction of their atonic seizures, and four patients experienced 100% reduction in their generalized tonic-clonic seizures. Tonic seizures were not responsive to treatment. The most common side effect was irritability; the most positive change involved alertness. In this small sample, levetiracetam appeared effective in reducing seizures in Lennox-Gastaut syndrome. This preliminary study is limited by its retrospective design and small number of patients, but positive findings warrant a larger scale, multicenter study.

Spouse perceptions of patient self-reported vertigo severity and dizziness.

OBJECTIVE: The present investigation was conducted in an effort to assess the level of congruence between patients and spouses for the patient's self-reported vertigo severity and dizziness handicap. STUDY DESIGN: Prospective study. PATIENTS: Fifty consecutive patients, and their spouses, evaluated in our Balance Disorders Laboratory in the Division of Vestibular Sciences. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory (DHI), Spouse version of the DHI (DHI-SP), Vertigo Symptom Scale (VSS), Spouse version of the VSS (VSS-SP), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The mean DHI and DHI-SP total scores were not statistically different from one another (t49 = 1.58, p = 0.16) and were strongly correlated (r = 0.79, p < 0.01). The VSS and VSS-SP scores were statistically different (t49 = 2.33, p = 0.02) but were still moderately correlated (r = 0.56, p < 0.01). Spouses tended to overestimate vertigo severity. We observed an increase in the frequency of occurrence of clinically significant anxiety and depression not only in patients but in spouses as well. Furthermore, anxious patients tended to be married to anxious spouses, and depressed patients tended to be married to depressed spouses. Finally, the mean DHI scores were significantly greater for patients with clinically significant anxiety and/or depression, but the presence of patient anxiety and/or depression did not affect spousal congruence. CONCLUSION: The results attest to the congruence of patient and spouse perceptions of vertigo severity and dizziness handicap.