ObjectiveThe aim of this study was to investigate the feasibility of using augmented reality (AR) glasses in central line simulation by novice operators and compare its efficacy to standard central line simulation/teaching.DesignThis was a prospective randomized controlled study enrolling 32 novice operators. Subjects were randomized on a 1:1 basis to either simulation using the augmented virtual reality glasses or simulation using conventional instruction.SettingThe study was conducted in tertiary-care urban teaching hospital.SubjectsA total of 32 adult novice central line operators with no visual or auditory impairments were enrolled. Medical doctors, respiratory therapists, and sleep technicians were recruited from the medical field.Measurements and main resultsThe mean time for AR placement in the AR group was 71±43 s, and the time to internal jugular (IJ) cannulation was 316±112 s. There was no significant difference in median (minimum, maximum) time (seconds) to IJ cannulation for those who were in the AR group and those who were not (339 [130, 550] vs 287 [35, 475], p=0.09), respectively. There was also no significant difference between the two groups in median total procedure time (524 [329, 792] vs 469 [198, 781], p=0.29), respectively. There was a significant difference in the adherence level between the two groups favoring the AR group (p=0.003).ConclusionAR simulation of central venous catheters in manikins is feasible and efficacious in novice operators as an educational tool. Future studies are recommended in this area as it is a promising area of medical education.

Introduction: Patient satisfaction has become an essential metric in addition to the type of care they receive. Phone calls, emails, and text to patients after their healthcare visit are the typical way of obtaining the data reflecting patient satisfaction. The purpose of this retrospective quality improvement study is to compare the traditional post-outpatient clinic survey method with an onsite concise two-question survey using a tablet method immediately after the patient visit using Net Promoter Score (NPS) questions. Methods: Data were collected retrospectively from February to August 2018 from an outpatient subspecialty clinic in southern California using an existing database from two different sources: the traditional method (TM) and the tablet-based tool (TBT), using NPS. The TM data were obtained from a third-party company using two questions via phone, email, and text collected 2-4 weeks after the patient's visit. The TBT has only two questions that were given to patients upon their visit check-out. These two questions assessed both provider and clinic's performance using the NPS method. Results: In total, there were 1708 patients seen from February to August 2018. In the TM, the total outgoing messages during this period were 580 (34.0%) with 156 responses (27%). In the TBT, 648 out of 1708 (37.9%) surveys were collected with a 100% response rate. The NPS score showed that 99.2% of the providers were promoters. The NPS score for the clinic was 96% which reflects a promoter score. Conclusion: Our results indicate that when using the TBT immediately after their visit to the clinic, a higher response rate was noted. In addition, both methods had similar outcomes in terms of patient satisfaction NPS scores. Future prospective studies with a larger sample size are warranted to evaluate the effectiveness of the TBT tool in assessing patient satisfaction.

BACKGROUND:The current variety of medication inhaler devices can be confusing to patients due to the many different delivery systems. Many health-care professionals who prescribe these devices may not be educated properly about the administration techniques for different inhalers. The objectives of this study were to evaluate various health-care providers' knowledge of specific inhaler devices and to assess their ability to retain this knowledge for a minimum period of 3 months. METHODS: This was a prospective study that included 4 different health-care professional groups (physicians, respiratory therapists, registered nurses, and pharmacists). All subjects underwent baseline written and practical tests. A checklist was developed for the practicum test for each inhaler on the correct delivery method. The written examination tested knowledge of 4 different inhaler techniques with true or false questions. Then subjects watched an instructional video that demonstrated the correct method of delivery for each device. Last, subjects were retested on the practicum and written tests after a minimum lapse of 3 months. RESULTS: The distribution of written and practical scores at baseline and postintervention was approximately normal (P > .05). The baseline written scores were significantly different across groups (P ‫؍‬ .002). The mean written score of respiratory therapists was significantly higher than those of registered nurses and physicians (P ‫؍‬ .02 and .01, respectively). Similarly, the baseline practical scores were significantly different across groups (P < .001). The mean practical score of respiratory therapists was significantly higher compared with those of registered nurses and physicians (P ‫؍‬ .002 and P < .001, respectively). CONCLUSIONS: We found a suboptimal number of medical professionals who have the proper knowledge base and technical skill to teach different inhaler device techniques. In order to increase the simplicity and effectiveness of delivering inhaler medication, we hope that the industry will provide more uniformity for future inhaler devices.

Background: The risk of failing or delaying endotracheal intubation in critically ill patients has commonly been associated with inadequate procedure preparation. Clinicians and trainees in simulation courses for tracheal intubation are encouraged to recall the steps of how to intubate in order to mitigate the risk of a failed intubation. The purpose of this study was to assess the effectiveness of using optical head mounted display augmented reality (AR) glasses as an assistance tool to perform intubation simulation procedure. Methods: A total of 32 subjects with a mean age of 30±7.8, AR (n 1 =15) vs non-augmented reality(non-AR) (n 2 =17). The majority were males (n=22, 68.7%). Subjects were randomly assigned into two groups: the AR group and the non-AR group. Both groups reviewed a video on how to intubate following the New England Journal of Medicine (NEJM) intubation guidelines. The AR group had to intubate using the AR glasses head mount display compared to the non-AR where they performed regular intubation. Results: The AR group took longer median (min, max) time (seconds) to ventilate than the non-AR group (280 (130,740) vs 205 (100,390); η 2 =1.0, p =0.005, respectively). Similarly, there was a higher percent adherence of NEJM intubation checklist (100% in the AR group vs 82.4% in the non-AR group; η 2 =1.8, p <0.001). Conclusion: The AR glasses showed promise in assisting different health care professionals on endotracheal intubation simulation. Participants in the AR group took a longer time to ventilate but scored 100% in the developed checklist that followed the NEJM protocol. This finding shows that the AR technology can be used in a simulation setting and requires further study before clinical use.

Asthma is a chronic inflammatory disorder of the airway that is characterized by bronchial hyperresponsiveness and variable airflow limitation. Approximately 235 million people are affected by asthma worldwide and 5–10% are considered to be refractory to standard asthma treatment. These patients are known to have repeated exacerbations requiring multiple courses of systemic corticosteroids and as a result, are at risk for increased adverse effects (i.e., osteoporosis, infections). Several new medications known as biologic agents have been approved for the treatment of moderate-to-severe asthmatics. These biologic agents target essential parts of the cell-mediated allergic and to a lesser degree non-allergic immune response (IgE, IL-5, and IL-4/IL-13). They are gaining more favor in the treatment of moderate-to-severe asthma due to their efficacy and excellent safety profile. Despite the most common adverse events being minor, such as injection site reactions, upper respiratory infections, or headaches, these agents carry a small risk of more severe complications such as anaphylaxis and decreased defense against parasitic infections (PI). The incidence of PI compared with other rare adverse events is not well reported, and there are no consensus guidelines for risk prevention of PI in asthmatics undergoing evaluation for, or currently using, biologic therapy. Thus, this article sets out to review the incidence of reported PI and other rare adverse events among asthmatics using current FDA-approved biologic therapies. Secondly, we discuss the clinical implications for the importance of risk prevention of PI with the use of biologic therapies in asthmatics. Lastly, we share an educational handout to assist providers in informing their patients of behaviors that could potentially increase their risk of PI while being on a biologic agent.

Background: This study examined the effects of smartphones addiction on cervical posture, and compared the cervical range of motion (ROM) between addicted and non-addicted boys and girls 8 to 13 years of age.Methods: Twenty-four boys and 26 girls were assigned to 2 groups; addicted group (score > 32, n=32) and non-addicted group (score ≤ to 32, n=18). Craniovertebral Angle (CVA) was assessed using side view photographs, forward head posture (FHP) was measured using ImageJ 64 software, and cervical ROM in each direction was measured using a cervical (CROM) device.Results: A forward multiple regression showed that addiction score and body mass index (BMI) were significant predictors of CVA (R2 =0.31, p<0.001). Twenty-three percent of the variability in CVA was related to addiction score. A forward logistic regression showed that addiction to smartphone use and BMI were significant predictors of having FHP, and participants who were addicted were more than four times as likely to have FHP than those who were not: Odds Ratio (OR) with 95 % confidence interval (CI)=4.5 (1.2, 10.7), p= 0.03. A significant reduction was found in mean cervical angle in addicted versus non-addicted boys (49.4±6.7 vs. 55.5±7.6,η2=0.5, p=0.03) and girls (47.3±6.3 vs. 52.9±6.1,η2=0.9, p=0.02). A significantly more limited cervical ROM found in most neck movements in addicted participants with FHP compared to participants without FHP. Conclusion:Children who are addicted to smartphones may develop faulty habitual posture due to constant neck flexion downward, which may place them at high risk of spine abnormalities.

Asthma continues to be a complex respiratory disease to control for many despite optimal standard inhaler therapy. The increased dependence on steroid-sparing biologic treatments in the 21 st century has created a dilemma between identifying the patient's intrinsic biomarkers and their "life markers." With Tezepelumab being the most recent FDA-approved biologic for asthma, it is even more critical for asthma specialists to better understand and establish a framework to determine which biologic would work best for their patients. While cost and payor approvals limit access to certain asthma biologics, medical decisions on which biologic to select should be centered around shared decision-making, the rationale for biologic initiation, and critical biologic education to help achieve successful asthma control.

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