IntroductionHigh Fidelity Simulations (HFS) are increasingly used to develop Non-Technical Skills (NTS) in healthcare providers, medical and nursing students. Instruments to measure NTS are needed to evaluate the healthcare providers’ (HCPs) performance during HFS. The aim of this systematic review is to describe the domains, items, characteristics and psychometric properties of instruments devised to evaluate the NTS of HCPs during HFS.MethodsA systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Studies were retrieved from PubMed, Cinahl, Web of Science, Cochrane Library, ProQuest and PubPsych. Studies evaluating the measurement properties of instruments used to assess NTS during HFS training were included. Pairs of independent reviewers determined the eligibility, extracted and evaluated the data. Risk of bias and appraisal of the methodological quality of the studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and the quality of the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).ResultsA total of 3,953 articles were screened. A total of 110 reports were assessed for eligibility and 26 studies were included. Studies were conducted in Europe/United Kingdom (n = 13; 50%), North America/Australia (n = 12; 46%) and Thailand (n = 1; 4%). The NTS instruments reported in this review included from 1 to 14 domains (median of 4, Q1 = 3.75, Q3 = 5) and from 3 to 63 items (median of 15, Q1 = 10, Q3 = 19.75). Out of 19 NTS assessment instruments for HFS, the Team Emergency Assessment Measure (TEAM) can be recommended for use to assess NTS. All the other instruments require further research to assess their quality in order to be recommended for use during HFS training. Eight NTS instruments had a positive overall rating of their content validity with at least a moderate quality of evidence.ConclusionAmong a large variety of published instruments, TEAM can be recommended for use to assess NTS during HFS. Evidence is still limited on essential aspects of validity and reliability of all the other NTS instruments included in this review. Further research is warranted to establish their performance in order to be reliably used for HFS.
Funding Acknowledgements Type of funding sources: None. Introduction Chronic conditions are the main causes of morbidity and mortality worldwide. Heart failure (HF) has a prevalence between 0.5% and 2% in the western population and the number is destined to increase from 25% in 2012 to 46% in 2030. Older adults affected by HF have difficulties to recognize signs and symptoms of the disease, bringing to a reduction of life expectancy. The voice is a complex coordination mechanism between systems and subsystems (i.e. glottis, lung, nose,..). Changes in voice parameters, measuring by algorisms of artificial intelligence, could be useful markers of HF exacerbation. To date, no prior studies have investigated the changing of voice parameters in HF patients and the relationships between voice parameter changes and the clinical course of HF. Aims Explore voice parameter differences between HF patients and healthy subjects; to investigate the relationships between voice parameter changes and the clinical course of the disease. Methods Observational study. Patients with HF and healthy subjects between 60 to 80 y/o will be enrolled in inpatient and outpatient settings. Patients and healthy participants will record voices by microphones and smartphones. Voice data will be analyzed with algorithms of artificial intelligence. Results This study will identify differences in voice parameters between HF patients and healthy participants, and the associations between the voice parameters and the clinical changes of HF patients. Conclusion Monitoring of voice parameters allows to clinicians to early identify, via voice changes, signs and symptoms of HF exacerbations, and to monitor patients at home.
Purpose Malnutrition is a common feature in critically ill children. Enteral nutrition (EN) is the main strategy to nutritionally support critical ill children, but its use can be hindered by the development of intolerance. The study aimed to assess the effectiveness and safety of amoxicillin/clavulanate (A/C) to treat EN intolerance. Methods We retrospectively evaluated patients admitted to the pediatric intensive care unit from October 2018 to October 2019. We conducted a case-control study: in the first 6 months (October 2018-April 2019) we implemented the nutritional protocol of our Institution with no drug, whereas in the second half (May 2019-October 2019) we employed A/C for 1 week at a dose of 10 mg/kg twice daily. Results Twelve cases were compared with 12 controls. At the final evaluation, enteral intake was significantly higher than that at baseline in the cases (from 2.1±3.7 to 66.1±27.4% of requirement, p =0.0001 by Wilcoxon matched-pairs signed rank test) but not in the controls (from 0.2±0.8 to 6.0±14.1% of the requirement, p =NS). Final gastric residual volume at the end of the observation was significantly lower in the cases than in the controls ( p =0.0398). The drug was well tolerated as shown by the similar safety outcomes in both cases and controls. Conclusion Malnutrition exposes critically ill children to several complications that affect the severity of disease course, length of stay, and mortality; all may be prevented by early EN. The development of intolerance to EN could be addressed with the use of A/C. Future prospective clinical trials are needed to confirm these conclusions.
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