Simulation-based medical education training improves short and long-term competency in, and knowledge of central venous catheter insertion: A before and after intervention study.

BACKGROUND: Multimodal educational interventions have been shown to improve short-term competency in, and knowledge of central venous catheter (CVC) insertion. OBJECTIVE: To evaluate the effectiveness of simulation-based medical education training in improving short and long-term competency in, and knowledge of CVC insertion. DESIGN: Before and after intervention study. SETTING: University Geneva Hospital, Geneva, Switzerland, between May 2008 and January 2012. PARTICIPANTS: Residents in anaesthesiology aware of the Seldinger technique for vascular puncture. INTERVENTION: Participants attended a half-day course on CVC insertion. Learning objectives included work organization, aseptic technique and prevention of CVC complications. CVC insertion competency was tested pretraining, posttraining and then more than 2 years after training (sustainability phase). MAIN OUTCOME MEASURES: The primary study outcome was competency as measured by a global rating scale of technical skills, a hand hygiene compliance score and a checklist compliance score. Secondary outcome was knowledge as measured by a standardised pretraining and posttraining multiple-choice questionnaire. Statistical analyses were performed using paired Student's t test or Wilcoxon signed-rank test. RESULTS: Thirty-seven residents were included; 18 were tested in the sustainability phase (on average 34 months after training). The average global rating of skills was 23.4 points (±SD 4.08) before training, 32.2 (±4.51) after training (P < 0.001 for comparison with pretraining scores) and 26.5 (±5.34) in the sustainability phase (P = 0.040 for comparison with pretraining scores). The average hand hygiene compliance score was 2.8 (±1.0) points before training, 5.0 (±1.04) after training (P < 0.001 for comparison with pretraining scores) and 3.7 (±1.75) in the sustainability phase (P = 0.038 for comparison with pretraining scores). The average checklist compliance was 14.9 points (±2.3) before training, 19.9 (±1.06) after training (P < 0.001 for comparison with pretraining scores) and 17.4 (±1.41) (P = 0.002 for comparison with pretraining scores). The percentage of correct answers in the multiple-choice questionnaire increased from 76.0% (±7.9) before training to 87.7% (±4.4) after training (P < 0.001). CONCLUSION: Simulation-based medical education training was effective in improving short and long-term competency in, and knowledge of CVC insertion.

Breast cancer risk assessment using the Gail model: a Turkish study.

PURPOSE: This study was conducted to determine risk of developing of breast cancer among Turkish women. MATERIALS AND METHODS: Using a descriptive and cross-sectional approach, data were collected from 231 women. Breast cancer risk was calculated using the National Cancer Institute's on-line verson of called as the Breast Cancer Risk Assessment Tool or the Gail Risk Assesment Tool. RESULTS: The average age of women was 45.0±8.06 years. It was revealed that 6.1% of participants reported having first degree relatives who had had breast cancer, with only four women having more than one first-degree relative affected (1.7%). The mean five-year breast cancer risk for all women was 0.88±0.91%, and 7.4% of women had a five-year breast cancer risk >1.66% in this study. Mean lifetime breast cancer risk up to age 90 years was 9.3±5.2%. CONCLUSIONS: The breast cancer risk assessment tool can help in the clinical management of patient seeking advice concerning screening and prevention. Healthcare providers in Turkey can use this approach to estimate an individual's probability of developing breast cancer.

Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.

Central line-associated bloodstream infection (CLABSI) is the major complication of central venous catheters (CVC). The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001) after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days) in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22). Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI.

Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery.

BACKGROUND: Perioperative acute kidney injury (AKI) is associated with increased mortality and morbidity. Our aim was to evaluate the incidence and determinants of AKI using the risk, injury, failure, loss of function, and end-stage kidney disease (RIFLE) criteria in thoracic surgical patients. METHODS: We retrospectively analyzed a cohort of patients undergoing lung cancer surgery from 1996 to 2009. Patient management was protocol-driven, and postoperative complications were prospectively collected. The primary outcome was AKI within 3 days after surgery. A variety of patient comorbidities and operative characteristics were evaluated as potential predictors of AKI using a multiple logistic regression model. RESULTS: Complete data were obtained from 1,345 patients, and the incidence of AKI was 6.8%. Four independent risk factors for AKI were identified: American Society of Anesthesiologists classes 3 and 4 (odds ratio [OR] 2.60, 95% confidence interval [CI]: 1.03 to 6.55), forced expiratory volume in 1 second (OR 0.55, 95% CI: 0.32 to 0.96), the use of vasopressors (OR 1.015, 95% CI: 0.998 to 1.035), and the duration of anesthesia (OR 1.044, 95% CI: 1.001 to 1.008). Patients who experienced AKI were more frequently admitted to the intensive care unit (24.2% versus 3.5% for patients without AKI, p < 0.05); they had increased mortality (19.8% versus 1.1%, p < 0.05) and a threefold to fourfold higher incidence of cardiopulmonary complications. CONCLUSIONS: The RIFLE classification is a valuable tool to assess AKI after lung cancer surgery. The severity of perioperative renal impairment is associated with increased mortality and morbidity.