Full-body patient simulators provide the technology and the environment necessary for excellent clinical education while eliminating risk to the patient. The extension of simulator-based training into management of basic and critical situations in complex patient populations is natural. We describe the derivation of an infant cardiovascular model through the redefinition of a complete set of parameters for an existing adult model. Specifically, we document a stepwise parameter estimation process, explicit simplifying assumptions, and sources for these parameters. The simulated vital signs are within the target hemodynamic variables, and the simulated systemic arterial pressure wave form and left ventricular pressure volume loop are realistic. The system reacts appropriately to blood loss, and incorporation of aortic stenosis is straightforward. This infant cardiovascular model can form the basis for screen-based educational simulations. The model is also an essential step in attaining a full-body, model-driven infant simulator.
Full-body patient simulators provide a technological basis for clinical education without risk to real patients. In a previous study, we described a model for educational simulation of infant cardiovascular physiology. Using essentially the same methodology, we derive a mathematical model for the cardiovascular system of a healthy 1-week-old neonate. Computer simulations of this model result in vital signs that are close to target hemodynamic variables. Simulated systemic arterial pressure waveform and left ventricular pressure-volume loop are realistic, and the system reacts appropriately to blood loss. We also adapt the model structure and change its parameters to reflect the congenital heart defects: patent ductus arteriosus, tetralogy of Fallot, complex coarctation of the aorta with patent foramen ovale, and transposition of the great arteries. Simulated vital signs are again close to target hemodynamic variables. The resulting model for neonatal cardiovascular pathophysiology is an essential step in attaining a full-body, model-driven neonatal acute care simulator.
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RESUMOIntrodução: O suporte básico de vida é uma manobra fundamental em situação de paragem cardíaca com grande impacto na sobrevida da vítima. Este estudo investiga o conhecimento do público geral sobre os fundamentos do suporte básico de vida e a sua associação com o treino/educação prévia e a autoperceção do conhecimento. Um segundo objetivo é avaliar a opinião sobre as necessidades de treino. Material e Métodos: Trata-se de um estudo transversal, exploratório e descritivo, utilizando uma amostra de conveniência de 655 indivíduos. A ferramenta de recolha de dados consistiu num questionário contendo 21 questões. Uma análise estatística descritiva e inferencial explorou as possíveis associações entre variáveis. Resultados: O conhecimento geral teve uma pontuação (75,9% ± 14,2%) estatisticamente significativa (p < 0,001) superior ao conhecimento técnico (31,2% ± 29,7). Considerando o conhecimento total, a pontuação média foi de 49,0% ± 20,3%, com 100 (15,3%) inquiridos com pontuação igual ou superior a 70% e apenas 12 (1,8%) respondendo corretamente a todas as questões. Menos de 30% da amostra teve treino prévio em suporte básico de vida. Discussão: O conhecimento em suporte básico de vida tem associações importantes e estatisticamente significativas com a proveniência do conhecimento e o tempo decorrido do treino anterior. A associação da autoperceção do conhecimento e as pontuações reais mostraram, em geral, que os participantes têm uma perceção correta do seu conhecimento. As pontuações de conhecimento indicam uma falta de treino e conhecimento na população em geral. Conclusão: Os resultados deste estudo reforçam a necessidade de treino prático e regular de suporte básico de vida, idealmente no local de trabalho e no início da vida. Os participantes reconhecem que o seu conhecimento em suporte básico de vida é residual ou baixo e estão motivados a participar em cursos de treino e/ou revalidação. Palavras-chave: Conhecimentos, Atitudes eABSTRACT Introduction: Basic life support is a key manoeuvre in a cardiac arrest situation that can often save a victim's life. This study investigates the general public's knowledge about the fundamentals of basic life support, and its association with previous training/education on basic life support and self-perception of knowledge. A secondary goal is to assess the opinion on training needs. Material and Methods: This is a cross-sectional, exploratory, and descriptive study, using a convenience sample of 655 individuals. A survey containing 21 questions was applied. A descriptive and inferential statistical analysis explored potential associations between variables. Results:The mean score for general knowledge (75.9% ± 14.2%) was statistically significantly higher (p < 0.001) than for technical knowledge (31.2% ± 29.7). Considering the overall knowledge, the mean score was 49.0% ± 20.3%, with 100 (15.3%) respondents scoring equal or higher than 70%, and only 12 (1.8%) answering all questions correctly. Less than 30% of the sample had previous training in basic life support. ...
We identified errors in the software implementation of the mathematical model presented in: Sá Couto CD, van Meurs WL, Goodwin JA, Andriessen P. A model for educational simulation of neonatal cardiovascular pathophysiology. Simul Healthcare 2006;1:4-12. Simulation results obtained with corrected code are presented for future reference. All but one of the simulation results do not differ by more than 9% from the previously published results. The heart rate response to acute loss of 30% of blood volume, simulated with corrected code is stronger than published target data. This modeling error was masked by errors in code implementation. We improved this response and the model by adjusting the gains and adding thresholds and saturations in the baroreflex model. General considerations on identification of model and code errors and model validity are presented.
RESUMOA simulação biomédica é uma ferramenta educativa para a formação nas ciências da saúde, com aplicação nos vários níveis de ensino. Proporciona experiências ativas e sistemáticas de aprendizagem com o treino de conhecimentos, habilidades e atitudes, de forma segura, pedagogicamente orientada e eficiente. Neste contexto, a simulação biomédica proporciona habilidades e experiência que facilitam a transferência de competências cognitivas, psicomotoras e de comunicação, mudando assim o comportamento e atitudes, aumentando, em última instância, a segurança do doente. Para além do impacto sobre o desempenho individual e de equipa, a simulação proporciona o ambiente ideal para o estudo de falhas organizacionais e teste de melhorias nos desempenhos dos sistemas. Nas últimas décadas, a simulação na área da saúde cresceu lentamente, mas de forma constante, com um amadurecimento significativo nos últimos 10 anos. A comunidade de simulação deve continuar a liderar o estabelecimento de standards nesta área, assim como o desenvolvimento de estratégicas e políticas para assegurar a sua implementação coordenada e custo-efetiva, no aumento da segurança do doente. Este artigo apresenta os movimentos evolutivos da simulação biomédica, incluindo uma revisão das iniciativas portuguesas e programas nacionais. Para nivelar o conhecimento e padronizar a terminologia, são apresentados conceitos básicos, mas essenciais, da simulação clínica, juntamente com algumas considerações sobre avaliação, validação e fiabilidade. As seções finais discutem os desafios atuais e as iniciativas e estratégias futuras, cruciais para a integração de programas de simulação no movimento global de promoção da segurança do paciente. Palavras-chave: Competência Clínica; Educação Médica/métodos; Portugal; Segurança do Doente; Simulação por Computador; Simulação de Doente; Treino por Simulação. ABSTRACTBiomedical simulation is an effective educational complement for healthcare training, both at undergraduate and postgraduate level. It enables knowledge, skills and attitudes to be acquired in a safe, educationally orientated and efficient manner. In this context, simulation provides skills and experience that facilitate the transfer of cognitive, psychomotor and proper communication competences, thus changing behavior and attitudes, and ultimately improving patient safety. Beyond the impact on individual and team performance, simulation provides an opportunity to study organizational failures and improve system performance. Over the last decades, simulation in healthcare had a slow but steady growth, with a visible maturation in the last ten years. The simulation community must continue to provide the core leadership in developing standards. There is a need for strategies and policy development to ensure its coordinated and cost-effective implementation, applied to patient safety. This paper reviews the evolutionary movements of biomedical simulation, including a review of the Portuguese initiatives and nationwide programs. For leveling knowledge and standar...
Introduction: There is a paucity of quantitative studies objectively comparing debriefing and feedback as methods for post-scenario discussion and its impact on healthcare teams’ acquisition and retention of non-technical skills. The main purpose of this study is to provide some insight on this research question, using a sample of medical students. A secondary objective explores students’ opinion and preference on the post-scenario discussion.Material and Methods: Forty-five medical students were distributed among 15 teams, and randomly allocated to two groups. Each team participated in three different simulated scenarios, with similar levels of difficulty and opportunities to apply specific non-technical skills: leadership, communication, and task management. To assess the acquisition and retention of skills, scenarios occurred on days one (baseline), two (acquisition) and 20 (retention). Team performance was objectively evaluated by an observer, using scenario recordings. Students individually assessed different aspects of debriefing and feedback.Results: Both debriefing and feedback groups showed similar overall increase in objective scores, with significant increase between days one and two (acquisition), and a smaller increase between days two and 20 (retention). Students indicated debriefing as the preferred discussion method.Conclusion: Debriefing and feedback are effective post-scenario discussion methods, promoting acquisition and retention of non-technical skills, by undergraduate students. Allying debriefing reflexive practice with feedback directive style, and shifting appropriately between facilitation and instruction, can be a good compromise to achieve a timely and educationally meaningful discussion.
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