The role of clinical simulation in preparing for a pandemic.
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ABSTRACT:
SUBMITTER: Shelton C
PROVIDER: S-EPMC7836946 | biostudies-literature | 2021 May
REPOSITORIES: biostudies-literature
Publications
The role of clinical simulation in preparing for a pandemic.
BJA education 20210115 5
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Project description:BackgroundThe COVID-19 pandemic has highlighted the importance of evidence-based clinical decision-making. Clinical management guidelines (CMGs) may help reduce morbidity and mortality by improving the quality of clinical decisions. This systematic review aims to evaluate the availability, inclusivity, and quality of pandemic influenza CMGs, to identify gaps that can be addressed to strengthen pandemic preparedness in this area.MethodsOvid Medline, Ovid Embase, TRIP (Turning Research Into Practice), and Guideline Central were searched systematically from January 2008 to 23rd June 2022, complemented by a grey literature search till 16th June 2022. Pandemic influenza CMGs including supportive care or empirical treatment recommendations were included. Two reviewers independently extracted data from the included studies and assessed their quality using AGREE II (Appraisal of Guidelines for Research & Evaluation). The findings are presented narratively.ResultsForty-eight CMGs were included. They were produced in high- (42%, 20/48), upper-middle- (40%, 19/48), and lower-middle (8%, 4/48) income countries, or by international organisations (10%, 5/48). Most CMGs (81%, 39/48) were over 5 years old. Guidelines included treatment recommendations for children (75%, 36/48), pregnant women (54%, 26/48), people with immunosuppression (33%, 16/48), and older adults (29%, 14/48). Many CMGs were of low quality (median overall score: 3 out of 7 (range 1-7). All recommended oseltamivir; recommendations for other neuraminidase inhibitors and supportive care were limited and at times contradictory. Only 56% (27/48) and 27% (13/48) addressed oxygen and fluid therapy, respectively.ConclusionsOur data highlights the limited availability of up-to-date pandemic influenza CMGs globally. Of those identified, many were limited in scope and quality and several lacked recommendations for specific at-risk populations. Recommendations on supportive care, the mainstay of treatment, were limited and heterogeneous. The most recent guideline highlighted that the evidence-base to support antiviral treatment recommendations is still limited. There is an urgent need for trials into treatment and supportive care strategies including for different risk populations. New evidence should be incorporated into globally accessible guidelines, to benefit patient outcomes. A 'living guideline' framework is recommended and further research into guideline implementation in different resourced settings, particularly low- and middle-income countries.
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Project description:Molecular dynamics simulations of membrane proteins have grown dramatically in the last 20 years. Running these simulations first requires embedding the protein's three-dimensional structure in a lipid bilayer of a suitable composition, one that resembles its native environment. This step is far from trivial, especially for modeling heterogeneous mixtures of lipids. CHARMM-GUI, a webserver for simulation system preparation greatly simplifies this step, allowing for the construction of complex heterogeneous and/or asymmetric membranes. Here, we demonstrate how to use CHARMM-GUI to build the membrane for the outer-membrane protein BamA.
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Project description:IntroductionThis simulation on cardiopulmonary bypass (CPB) introduces learners to the relevant critical actions and concepts involved in going onto and off of CPB. It is intended that junior residents experience this simulation immediately prior to beginning their cardiac anesthesia rotation. Thus, this simulation serves to segue to the trainee's initial clinical experience with CPB.MethodsThe case is fully presented for facilitators in the simulation case file, which includes a brief narrative description of the case, learning objectives to be covered by the simulation, and a summary of critical actions to be performed by the learner during the educational activity. It is optimal to run this simulation using a high-fidelity human patient simulator with anesthesia machine and relevant monitors.ResultsThe simulation was carried out by eight CA-1 or CA-2 residents during the 2016 academic year. Cardiac anesthesia faculties observed a significantly improved learning curve for trainees who had experienced this simulation prior to their first clinical case.DiscussionOverall, this simulation has been found to be a very effective learning tool at the University of Iowa. To that end, this simulation has been incorporated into the cardiac anesthesia curriculum, and all junior residents experience this simulation prior to beginning their rotation.
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Project description:The medical affairs function represents one of the scientific interfaces in a pharmaceutical organization. Over the last two decades, medical affairs has evolved from being a support function to a strategic pillar within organizational business units. The COVID-19 pandemic has given rise to unforeseen circumstances resulting in a dramatic change in external stakeholder engagements, catapulting the medical affairs function into leading the way on scientific engagements and patient-centric endeavors. The changes in stakeholder interactions and behavior as a result of the pandemic last year are likely to persist in the foreseeable future for which medical affairs professionals need to enhance existing skill sets and acquire expertise in newer domains. In this paper, the transformation of the medical affairs team to a key strategic partner and the skills required to strengthen this transition, in the next normal of a post-COVID world, is explored.
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Project description:ContextThe COVID-19 emergency warrants reflection on how to improve future infectious disease pandemic preparedness and response (PPR). U.S. States took diverse approaches to COVID-19, with Florida's approach characterized by fewer restrictions on businesses and individuals. Despite the profound effects of the pandemic, there is a dearth of stakeholder-informed recommendations for PPR at the state level. This study aims to empirically examine stakeholder perspectives on PPR in Florida.Methods25 semi-structured interviews were conducted with former and current leaders from government, academia, and the private sector in Florida. Participants were asked about challenges encountered during COVID-19 and considerations for what should be done for future pandemics. Interview transcripts and notes were analyzed using qualitative content analysis (QCA).FindingsResults were organized into four main categories (recommendations for future actions, challenges in PPR, successes and failures during the COVID-19 response), across which six sub-categories were identified: public health systems capacities; mitigation of disease transmission; roles and relationships; messaging and information dissemination; minimizing other adverse effects of a pandemic; and public health culture. Considering the neglect of existing pandemic plans and jurisdictional tensions around decision-making during COVID-19, participants proposed implementing a pandemic playbook that delineates the responsibilities of relevant agencies and processes of waiving standard procedures. While many suggested closures and restrictions to avoid the spread of disease, others questioned the extent to which such strategies should be implemented.ConclusionsThis study corresponds with the need for consensus-building across ideological divisions, revealing tensions among federal, state, and county-level entities, as well as across state-level agencies. Participants defined successful pandemic response as not only comprising the mitigation of disease transmission, but also the minimization of adverse social and economic effects. Participants discussed strategies for a unified, well-coordinated approach to future pandemics that balances health and economic concerns.
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Project description:BACKGROUND: Little is known about how faculty, residents, and fellows practice for oral presentations at academic meetings. We sought to categorize presenters' practice styles and the impact of feedback. METHODS: We surveyed oral presenters at 5 annual academic general internal medicine meetings between 2008 and 2010, using a cross-sectional design. Main measures were frequency and settings of practice, most helpful practice setting, changes made in response to feedback, impact of feedback, and perceived quality of presentation. RESULTS: The response rate was 63% (333/525 responders). Respondents represented 59 academic medical centers. Presenters reported practicing in a mean ± SD of 2.3 (±1.3) of 5 different settings. Of the 46% of presenters (152/333) who practiced in front of a group of more experienced colleagues, 80% of presenters (122/152) reported it was the most helpful setting. Eighty-one percent of presenters (268/333) practiced alone, and 25% of presenters (82/333) reported practicing alone was the most helpful setting. The mean numbers of change types reported by faculty were fewer than those reported by residents and fellows (mean 2.3 ± 1.8, and 3.1 ± 2.0, respectively; P < .001). Practicing alone was not associated with changes in content (P = .30), visual aids (P = .12), or delivery style (P = .53). CONCLUSIONS: Practicing in front of a group of experienced colleagues was the most helpful setting in which to prepare for an oral academic meeting presentation, but it was not universally utilized. Feedback given at these sessions was more likely to result in changes made to the presentation; however, broader implementation of such sessions 5 require institutional support.
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Project description:ObjectiveCoronavirus disease 2019 (COVID-19) and future pandemics have become a reality, and planners must understand how attitudes during COVID-19 may influence future preparedness activities. This study explores how personal experiences of Americans during the pandemic, attitudes about institutions, and views of social change could either pose challenges or help with planning for the next pandemic.MethodsA longitudinal survey capturing health attitudes and COVD-19-related experiences was fielded 3 times over the course of the pandemic among historically underserved individuals in US society (racial/ethnic minority and low-income populations).ResultsCOVID-19-related experiences increased over time. Attitudes about federal and state government and businesses' ability to respond to the pandemic varied by COVID-19-related experience and having any COVID-19-related experience was associated with a lower likelihood of reporting positive attitudes about institutions. Respondents generally perceived that COVID-19 presented an opportunity for positive social change, and those with COVID-19-related experiences had the greatest likelihood of selecting "reduce income inequality" as their top prioritized change. Those with COVID-19-related experiences were less likely to endorse other policy priorities such as protecting freedoms.ConclusionsAnticipating potential backlash or other sentiments could improve pandemic responsiveness. Strengthening public institutions is crucial to ensuring their effectiveness during a pandemic. Pandemic planning could exploit opportunities to take other social policy actions where views seem to converge.
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Project description:Assuring home care staff competencies through simulation has the potential to improve care transitions and clinical outcomes. Recreating a home environment can be used for orientation of home care staff and to meet other learning needs. Lessons learned from the use of simulation in a geriatric nursing course in a prelicensure program can be used to prepare clinicians for transitioning patients across care settings. With simulation, learners can identify challenges in patient safety, pain management, and management of patients' cognitive decline as well as learn how to communicate with patients, family members, and the healthcare team. Simulation, as an interactive pedagogy, provides opportunities for learners to practice assessment, monitoring, and patient care in a controlled, safe, risk-free environment. Following participation in a simulation, learners are given the opportunity to reflect on ways to improve patient care when transitioning from acute to home care settings. Simulations described in this article can be used for orientation of staff to a home healthcare agency because they allow clinicians to hone the skills necessary for patient care in the home. Staff educators can also use simulation to validate staff competencies in caring for patients at home.
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Project description:BackgroundDoes the brain become more resilient after a first stroke to reduce the consequences of a new lesion? Although recurrent strokes are a major clinical issue, whether and how the brain prepares for a second attack is unknown. This is due to the difficulties to obtain an appropriate dataset of stroke patients with comparable lesions, imaged at the same interval after onset. Furthermore, timing of the recurrent event remains unpredictable.MethodsHere, we used a novel clinical lesion simulation approach to test the hypothesis that resilience in brain networks increases during stroke recovery. Sixteen highly selected patients with a lesion restricted to the primary motor cortex were recruited. At 3 time points of the index event (10 days, 3 weeks, 3 months), we mimicked recurrent infarcts by deletion of nodes in brain networks (resting-state functional magnetic resonance imaging). Graph measures were applied to determine resilience (global efficiency after attack) and wiring cost (mean degree) of the network.ResultsAt 10 days and 3 weeks after stroke, resilience was similar in patients and controls. However, at 3 months, although motor function had fully recovered, resilience to clinically representative simulated lesions was higher compared to controls (cortical lesion P=0.012; subcortical: P=0.009; cortico-subcortical: P=0.009). Similar results were found after random (P=0.012) and targeted (P=0.015) attacks.ConclusionsOur results suggest that, in this highly selected cohort of patients with lesions restricted to the primary motor cortex, brain networks reconfigure to increase resilience to future insults. Lesion simulation is an innovative approach, which may have major implications for stroke therapy. Individualized neuromodulation strategies could be developed to foster resilient network reconfigurations after a first stroke to limit the consequences of future attacks.
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