Exploring Validation and Verification: How they Different and What They Mean to Healthcare Simulation.

STATEMENT: The healthcare simulation (HCS) community recognizes the importance of quality management because many novel simulation devices and techniques include some sort of description of how they tested and assured their simulation's quality. Verification and validation play a key role in quality management; however, literature published on HCS has many different interpretations of what these terms mean and how to accomplish them. The varied use of these terms leads to varied interpretations of how verification process is different from validation process. We set out to explore the concepts of verification and validation in this article by reviewing current psychometric science description of the concepts and exploring how other communities relevant to HCS, such as medical device manufacturing, aviation simulation, and the fields of software and engineering, which are building blocks of technology-enhanced HCS, use the terms, with the focus of trying to clarify the process of verification. We also review current literature available on verification, as compared with validation in HCS and, finally, offer a working definition and concept for each of these terms with hopes to facilitate improved communication within, and with colleagues outside, the HCS community.

An Observational Study of 3 Different Transfusion Medicine Teaching Methods for Medical Students.

Knowledge deficits of transfusion medicine are prevalent among learners and practicing physicians. In the past, the transfusion medicine community has thoughtfully defined the content of transfusion medicine curriculums through Transfusion Medicine Academic Award Group and The Academy of Clinical Laboratory Physicians and Scientists. The manner in which the curriculum should be delivered has been less carefully examined and defined. We completed an observational study in which we analyzed 3 different teaching techniques: in-person faculty-led simulation curriculum consisting of didactic session and simulation ("Simulation group"); hybrid education with a combination of online materials and short in-person simulation ("Hybrid group"); and online-only education module, which delivered the whole curricular content through a variety of online materials and videos ("Online-only group"). Knowledge acquisition was assessed with a 10-question multiple-choice questionnaire, and satisfaction was assessed by a 9-question online student satisfaction survey. A total of 276second-year medical students participated in the study. There was statistically significant difference between pre- and posttest results and in knowledge gain favoring the Simulation group as compared with the Online-only group (P=.03, P<.0001) and favoring the Simulation group as compared with the Hybrid group (P=.004, P<.0001). The Simulation group and Hybrid group medical students were also more satisfied with the education activity as compared with the Online-only group (P<.0001, P<.001). Our study demonstrated that a faculty-run transfusion medicine simulation curriculum consisting of an in-person didactic session and simulation session for the second-year medical students produced greater immediate knowledge acquisition compared with an online only or a hybrid curriculum. Furthermore, any curriculum that contained in-person teaching by faculty was preferred over the online only education.

Oral dexmedetomidine for preoperative sedation in an adult uncooperative autistic patient.

We describe preoperative sedation with oral dexmedetomidine 5 mcg/kg in an uncooperative adult with autism and developmental delay. The sedation with oral dexmedetomidine achieved good sedation level (Ramsey 4-5), allowing for calm transfer of the patient to the operating room and uneventful induction of anesthesia.

Unrecognized bilateral temporomandibular joint dislocation after general anesthesia with a delay in diagnosis and management: a case report.

INTRODUCTION: Anterior bilateral temporomandibular joint dislocation is not an uncommon occurrence and has been reported before. However, its diagnosis can easily be overlooked, especially by clinicians who are unfamiliar with this pathology. Continuous discussion of the pathology is required to prevent delays in diagnosis, which can lead to long-term sequelae for the patient. CASE PRESENTATION: We present the case of a 66-year-old Somali woman who experienced a bilateral anterior temporomandibular joint dislocation after a general anesthetic for an exploratory laparotomy for excision of a pelvic sarcoma. She first presented in the intensive care unit with preauricular pain and an inability to close her mouth, and was initially misdiagnosed and treated for a muscle spasm. The cause of her misdiagnosis was multifactorial - opioid-related sedation, language and cultural barrier, and unfamiliarity with the pathology. Her diagnosis was proven 18 hours after the completion of surgery with a plain X-ray. A manual closed reduction was performed with minimal sedation by oral surgery. CONCLUSION: We provided an in-depth discussion of temporomandibular joint dislocation and suggest a simple test that would prevent delayed diagnosis of temporomandibular joint dislocation in any patient undergoing general anesthesia. A normal mandibular excursion should be tested in every patient after surgery in the postoperative care unit, by asking the patient to open and close their mouth during the immediate postoperative recovery period or passively performing the range of motion test.

Nuclear factor-[kappa]B inhibition provides additional protection against ischaemia/reperfusion injury in delayed sevoflurane preconditioning.

BACKGROUND AND OBJECTIVE: Sevoflurane anaesthetic preconditioning (SPC) has been shown to limit nuclear factor-[kappa]B (NF-[kappa]B) activation and the production of inflammatory cytokines during myocardial ischaemia/reperfusion (I/R). Similarly, pharmacological inhibition of NF-[kappa]B using parthenolide is effective in limiting I/R injury. We, therefore, postulated that the protective effect of delayed SPC would be enhanced by pharmacological NF-[kappa]B inhibition during I/R. METHODS: Hearts from 2-month-old male Fisher 344 rats were exposed to 25 min global ischaemia followed by 60 min reperfusion. Rats were divided into four groups prior to I/R: control group; parthenolide group, treated with the I[kappa]B kinase inhibitor parthenolide intraperitoneally 10 min prior to heart isolation; SPC group, treated for 60 min with sevoflurane 48 h prior to heart isolation; and SPC + parthenolide group, treated with SPC for 1 h followed by parthenolide 48 h later. Infarct area, left ventricular function and Ca2+(i) were measured after I/R. RESULTS: Delayed SPC + parthenolide resulted in greater protection than either intervention alone, resulting in a significant reduction in infarct area and left ventricular developed pressure (mmHg; 84 +/- 19 compared with 15 +/- 14 in control hearts; P = 0.007). Left ventricular end-diastolic pressure also remained close to baseline values (9 +/- 2 mmHg, P = 0.02) during I/R, and the increase in Ca2+(i) seen with I/R was significantly blunted (P = 0.005). CONCLUSION: SPC followed by parthenolide provides a significant protection from I/R injury in this model. As each intervention alone limits NF-[kappa]B activation with I/R, these data are consistent with additive effects of these dual modalities in limiting I/R injury due to NF-[kappa]B activation.