Molecular and Functional Characterization of Human Intestinal Organoids and Monolayers for Modeling Epithelial Barrier.

BACKGROUND: Patient-derived organoid (PDO) models offer potential to transform drug discovery for inflammatory bowel disease (IBD) but are limited by inconsistencies with differentiation and functional characterization. We profiled molecular and cellular features across a range of intestinal organoid models and examined differentiation and establishment of a functional epithelial barrier. METHODS: Patient-derived organoids or monolayers were generated from control or IBD patient-derived colon or ileum and were molecularly or functionally profiled. Biological or technical replicates were examined for transcriptional responses under conditions of expansion or differentiation. Cell-type composition was determined by deconvolution of cell-associated gene signatures and histological features. Differentiated control or IBD-derived monolayers were examined for establishment of transepithelial electrical resistance (TEER), loss of barrier integrity in response to a cocktail of interferon (IFN)-γ and tumor necrosis factor (TNF)-α, and prevention of cytokine-induced barrier disruption by the JAK inhibitor, tofacitinib. RESULTS: In response to differentiation media, intestinal organoids and monolayers displayed gene expression patterns consistent with maturation of epithelial cell types found in the human gut. Upon differentiation, both colon- and ileum-derived monolayers formed functional barriers, with sustained TEER. Barrier integrity was compromised by inflammatory cytokines IFN-γ and TNF-α, and damage was inhibited in a dose-dependent manner by tofacitinib. CONCLUSIONS: We describe the generation and characterization of human colonic or ileal organoid models capable of functional differentiation to mature epithelial cell types. In monolayer culture, these cells formed a robust epithelial barrier with sustained TEER and responses to pharmacological modulation. Our findings demonstrate that control and IBD patient-derived organoids possess consistent transcriptional and functional profiles that can enable development of epithelial-targeted therapies.

Do Head-Mounted Augmented Reality Devices Affect Muscle Activity and Eye Strain of Utility Workers Who Do Procedural Work? Studies of Operators and Manhole Workers.

OBJECTIVE: The objective was to determine the effect of two head-mounted display (HMD) augmented reality (AR) devices on muscle activity and eye strain of electric utility workers. The AR devices were the Microsoft HoloLens and RealWear HMT-1. BACKGROUND: The HoloLens is an optical see-through device. The HMT-1 has a small display that is mounted to the side of one eye of the user. METHOD: Twelve power plant operators and 13 manhole workers conducted their normal procedural tasks on-site in three conditions: HoloLens, HMT-1, and "No AR" (regular method). Duration of test trials ranged up to 30 s for operators and up to 10 min for manhole workers. Mean and peak values of surface electromyographic (sEMG) signals from eight neck muscles were measured. A small eye camera measured blink rate of the right eye. RESULTS: In general, there were no differences in sEMG activity between the AR and "No AR" conditions for both groups of workers. For the manhole workers, the HoloLens blink rate was 8 to 11 blinks per min lower than the HMT-1 in two tasks and 6.5 fewer than "No AR" in one task. Subjective assessment of the two AR devices did not vary in general. CONCLUSION: The decrease in blink rate with the HoloLens may expose utility manhole workers to risk of eye strain or dry-eye syndrome. APPLICATION: HMD AR devices should be tested thoroughly with respect to risk of eye strain before deployment by manhole workers for long-duration procedural work.

Using online game-based platforms to improve student performance and engagement in histology teaching.

BACKGROUND: Human morphology is a critical component of dental and medical graduate training. Innovations in basic science teaching methods are needed to keep up with an ever-changing landscape of technology. The purpose of this study was to investigate whether students in a medical and dental histology course would have better grades if they used gaming software Kahoot® and whether gamification effects on learning and enjoyment. METHODS: In an effort to both evoke students' interest and expand their skill retention, an online competition using Kahoot® was implemented for first-year students in 2018 (n = 215) at the University of Eastern Finland. Additionally, closed (160/215) or open-ended (41/215) feedback questions were collected and analyzed. RESULTS: The Kahoot® gamification program was successful and resulted in learning gains. The overall participant satisfaction using Kahoot® was high, with students (124/160) indicating that gamification increased their motivation to learn. The gaming approach seemed to enable the students to overcome individual difficulties (139/160) and to set up collaboration (107/160); furthermore, gamification promoted interest (109/160), and the respondents found the immediate feedback from senior professionals to be positive (146/160). In the open-ended survey, the students (23/41) viewed collaborative team- and gamification-based learning positively. CONCLUSION: This study lends support to the use of gamification in the teaching of histology and may provide a foundation for designing a gamification-integrated curriculum across healthcare disciplines.

Psychometric testing of a checklist for procedural training of peripheral intravenous insertion.

BACKGROUND: Nurses, medical technologists, nuclear medicine technologists, pre-hospital providers, and medical students are a few groups of healthcare learners asked to learn intravenous (IV) cannulation in their training (J Surg Educ. 69:536-43, 2012). Despite the fact that IV cannulation has been taught to several health professions, it is difficult to find a psychometrically validated checklist to guide teaching this skill in the simulated procedural training (Pediatrics 124: 610-9, 2009, J Assoc Vasc Access 21: 196-204, 2016). In the absence of a pragmatic, valid checklist for the initial teaching of peripheral IV skills in the simulation procedural skills lab, this investigation sought to describe the process and create a psychometrically valid checklist. METHODS: Expert raters used Lawshe's method for identifying valid items from the universe of items for IV insertion. Gwet's AC2 and generalizability (G) theory was used assess inter-rater reliability. RESULTS: The literature and in-house IV checklists were examined for steps to inserting a peripheral IV, and the steps were compiled into a survey and sent to experts who rated each item. Of the 37 potential steps, 16 steps were identified as being psychometrically valid. The checklist content validity index was .82. Inter-rater reliability was .94 (95% CI .91-.98). Good inter-rater reliability was confirmed using generalizability theory. CONCLUSIONS: This study created and provided evidence of content validity and reliability for this checklist using Lawshe's methodology. As such, this method of evaluating a checklist for validity and reliability evidence can be followed for other healthcare checklists. This checklist can be used for teaching IV placement in healthcare students in the simulation procedural training lab.

Evaluating Nurse-Physician Communication With a Rubric: A Pilot Study.

Poor communication is a leading cause of sentinel events. The aims of this pilot study were to determine whether the ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Interprofessional Communication Rubric (IICR) was a reliable tool among nurses and to examine the communication performance of new graduate nurses in a hospital-based simulation center. The IICR demonstrated reliability among raters in this setting (rs = .91). The new graduate RNs' communication performance scores were low, warranting continued professional development. The IICR may be used to guide continued education and development for nurse-physician communication. [J Contin Educ Nurs. 2019;50(4):163-169.].

Development and Student Evaluation of an Anatomically Correct High-Fidelity Calf Leg Model.

Obstetrical chain placement requires location of specific landmarks and a certain dexterity that must be practiced. Use of low-fidelity models may not always provide students with a realistic experience. In this study we developed an anatomically correct high-fidelity calf leg model that would serve as a better teaching model for pre-clinical veterinary students than a pre-existing low-fidelity polyvinyl chloride (PVC) model. One hundred and twenty pre-clinical veterinary students were instructed how to use obstetrical chains with a low-fidelity PVC model and the anatomically correct high-fidelity calf leg model. After a 45-minute lab, students were surveyed on their experience with both models. Overall students felt the anatomically correct high-fidelity calf leg model increased accuracy in chain placement and provided more accurate landmarks, a more realistic model, and more real-life scenario training.

Design and Validation of a Three-Dimensional Printed Flexible Canine Otoscopy Teaching Model.

INTRODUCTION: A teaching model was sought to improve canine otoscopy skill and reduce use of teaching dogs. METHODS: An otoscopy teaching model was printed in a flexible medium on a desktop three-dimensional printer from a magnetic resonance image of a canine external ear canal. The model was mounted in a polyvinyl dog mannequin. Validation of the teaching model was sought from student, faculty, and dog perspective. Student perception of prelaboratory training was assessed using a survey regarding their experience. Otoscopy skill was assessed by faculty grading the ear anatomy visualized as well as the time required to prepare for and perform otoscopy and the time to the dog's first sign of aversion. The time data were used to assess whether there was a reduction in use of teaching dogs. Data from students exposed to the otoscopy model as part of their prelaboratory training (n = 20) were compared with those that were not exposed to the model (n = 19). RESULTS: The students found prelaboratory training with the model significantly more helpful than prelaboratory training without the model in all aspects of otoscopy (P < 0.05). Use of the model did not alter otoscopy skill (structures seen or time taken) or decrease dog use. CONCLUSIONS: The students found the model helpful, but the best that can be said is the model did not negatively impact their otoscopy skill acquisition. Although the outcome of the study did not indicate a reduction in teaching dog use, the model has replaced live dog otoscopy in the institute's teaching program for initial canine otoscopy exposure.

A Mixed-Methods, International, Multisite Study to Develop and Validate a Measure of Nurse-to-Physician Communication in Simulation.

AIM: This study examined the reliability and validity of the ISBAR Interprofessional Communication Rubric (IICR). BACKGROUND: Improving education regarding communication in health care is a global priority. Communication is difficult to measure and no evaluation rubrics were located that uniquely focused on nurse-to-physician communication in simulation. METHOD: This study used a mixed-methods design and included five sites. RESULTS: The IICR was determined reliable among nurse educator raters (r = 0.79). The scale was found valid as assessed by nurse and physician experts (content validity index = 0.92). When describing their experience of using the tool, nurse educator raters described three categories: overall acceptability of the tool, ease of use, and perceptions of the importance of communication skills for patient safety. CONCLUSION: Teaching and evaluating communication in simulation with a standardized rubric is a research area in need of further exploration and refinement.

Use of virtual clinical simulation to improve communication skills of baccalaureate nursing students: a pilot study.

BACKGROUND: According to The Joint Commission (2012), the leading cause of sentinel events in the United States was miscommunication. Lack of thorough and accurate communication remains a serious challenge in healthcare and an educational priority in schools of nursing. Virtual clinical simulation is an online educational approach where students use avatars to practice various skills. OBJECTIVES: The purpose of this pilot study was to evaluate the educational innovation of using virtual clinical simulation to improve communication skills of BSN students. The objectives of the simulations were to 1) recognize significant patient data and 2) accurately perform the ISBAR communication technique. DESIGN: The study used a within-group, time-series design with eight students. Students participated in two synchronous virtual simulations in an online virtual clinical environment called CliniSpace. Students performed in groups of four to five students. METHODS: Students performed in two virtual simulations in groups of four to five students. Student performances were scored by two raters using the CliniSpace ISBAR Rating Sheet. Field notes from debriefing sessions were analyzed for content. RESULTS: Mean group student performance scores more than doubled from performance one to performance two. This change was found to be statistically significant, p<.001. Field notes revealed that students listened to how their peers communicated and learned from them. Students expressed having less anxiety, knowing what to expect, and having "better flow" with communication. Students verbalized learning to assess the patient prior to calling the physician and to give a recommendation to the physician.

SBAR 'flattens the hierarchy' among caregivers.

As a young ensign in the US Navy on a nuclear submarine, Doug Bonacum had to brief the captain of the ship following his night-time shift, reporting about potentially dangerous situations that might emerge. He described the "situation, background, assessment, and recommendation". This nascent SBAR communication tool served temporarily to flatten the hierarchy between the ensign and the ship's captain. Years later at KP, Bonacum developed SBAR for facilitating effective conversations between obstetricians and nurses. SBAR has been implemented in "real-world" environments with excellent results. We are implementing SBAR to facilitate communication in CliniSpace among caregivers in this 3D immersive, virtual learning environment.

Literature review: instructional design and pedagogy science in healthcare simulation.

This article is a review of the literature focused on simulation as an educational intervention in healthcare. The authors examined the literature based on four key levels: (1) the validity and reliability of the simulator, (2) the validity and reliability of the performance evaluation tool, (3) the study design, and (4) the translational impact. The authors found that the majority of research literature in healthcare simulation does not address the validity and reliability of the simulator or the performance evaluation tool. However, there are well-designed research studies that address the translation into clinical settings and have positive patient safety outcomes.

An evaluation of bag-valve-mask ventilation using an ergonomically designed facemask among novice users: a simulation-based pilot study.

PURPOSE: We sought to compare the ability of novice operators to provide artificial ventilation using a standard facemask and a new ergonomically designed facemask. Whether or not proper technique was used was also assessed. METHODS: Thirty-two allied-health students used both masks in random crossover fashion to ventilate an airway trainer. Breaths were delivered by a mechanical ventilator and exhaled tidal volume was recorded for each of 12 breaths for each participant for each mask. The effect of each mask during ventilation over time was assessed using repeated-measures ANOVA. Assessment of mask technique among participants and association between mask type and hand repositioning were analyzed using the Wilcoxon-Rank Sum Test and McNemar's paired proportions test, respectively. RESULTS: The tidal volume achieved when participants used the ergonomic mask was higher than when participants used the standard mask by the fourth breath (361+/-104 mL vs. 264+/-163 mL; Bonferroni adjusted p-value=0.040) and increased over time. The repeated-measures ANOVA showed that the ergonomic mask consistently resulted in higher tidal volumes than the standard mask regardless of rescuer's gender. Over time the standard mask resulted in a linear decrease in tidal volume of -10 mL/breath (estimated difference in decay of 10 mL/breath versus the ergonomic mask; p<0.001). CONCLUSION: Novice airway operators were better able to provide facemask ventilation using an ergonomically designed mask than with a traditional facemask. We conclude that better hand position facilitating improved mask seal and less operator fatigue account for our findings.