Acquisition of skills in critical emergency medicine: an experimental study on the SIAARTI Academy CREM experience.

BACKGROUND: In 2019 the SIAARTI developed a seven-days course for residents, focused on critical emergency medicine (CREM) in a hostile environment, that grounds on simulation-based education and training with hands-on simulation, high-fidelity simulators and part-task trainers. This project aimed to evaluate the efficacy of this course in comparison to traditional learning programs in term of technical (TS) and non-technical (NTS) skills. We assessed the improvement in TS and NTS over time, and the ability to involve trainees in corporate activities. METHODS: Three-hundred and twenty-seven trainees completed the study. Trainees were allocated into three groups: those who joined the SIAARTI-Academy-CREM course and received a study kit (SA-kit, N.=124), those who received only a study kit (kit, N.=108), and control (N.=95). Eighty-five tests were administered to investigate skills at three timepoints: T0 (baseline), T1 (post-training/kit), and T2 (four months later). RESULTS: TS differed among groups (P<0.0001), with the highest points in the SA-kit group at T1 (post-hoc comparison, P<0.0001 vs. kit; P<0.0001 vs. control), and T2 (post-hoc comparison, P<0.0001 vs. kit; P<0.0001 vs. control). NTS differed among groups (P=0.0406), with the highest points in the SA-kit group at T1 (post-hoc comparison, P=0.0337 vs. kit; P=0.0416 vs. control), and T2 (post-hoc comparison, P=0.0073 vs. kit; P=0.3308 vs. control). SA-kit group significantly improved TS (P<0.0001) and NTS (P=0.0006) over time. Involvement in corporate activities of SA-kit was significantly higher than kit and control (P=0.0012). CONCLUSIONS: SA-kit improvement in TS and NTS was higher than kit and control and was maintained over time. Participation in this course implemented participation in corporate activities among attendees.

Improving communication toward ICU families to facilitate understanding and reduce stress. Protocol for a multicenter randomized and controlled Italian study.

OBJECTIVE: Families of ICU patients have a pressing need for information: they find themselves suddenly in a complex technical environment often because of a life-threatening illness of a loved one. Some evidence suggests that specific communication tools (like websites or brochures) could improve the experience of ICU families. DESIGN: Randomized, multicenter, stepped wedge trial for large-scale assessment of the effectiveness of a multitasking intervention to improve communication with families of critically ill patients. MAIN OUTCOME: correct understanding of the prognosis. SECONDARY OUTCOMES: correct understanding of medical treatments, prevalence of anxiety, depression and post-traumatic stress symptoms in the first ICU week. Prevalence of PTSD 6 months from ICU discharge. Empathy and burnout among ICU staff. Prevalence of refusals for tissues/organ donation, and medical claims. SUBJECTS: 2100 ICU relatives of critically ill patients. INTERVENTIONS: The intervention employs specific tools especially designed to raise the correctness of information and to improve the quality of communication: a website presenting the ICU world and justifying the relatives' emotions, with a webpage specifically dedicated to each participating ICU; a standard brochure; eight posters for the families' waiting room and a signboard for the ICU door. MEASUREMENTS AND MAIN RESULTS: The study plans to assess these materials in up to 300 Italian ICUs that will participate, according to a five waves program, each one with randomized starting order. This way the effect of the intervention will be evaluated simultaneously. CONCLUSION: This is an educational study, aiming to spread good medical practices, while also verifying their real effectiveness in a large number of ICUs. TRIAL REGISTRATION NUMBER: NCT03438175.

Noninvasive Options.

Noninvasive ventilation (NIV) has assumed a central role in the treatment of selected patients with acute respiratory failure due to exacerbated chronic obstructive pulmonary disease or acute cardiogenic pulmonary edema. Recent advances in the understanding of physiologic aspects of NIV application through different interfaces and ventilator settings have led to improved patient-machine interaction, enhancing favorable NIV outcome. In recent years, the growing role of NIV in the acute care setting has led to the development of technical innovations to overcome the problems related to gas leakage and dead space, improving the quality of the devices and optimizing ventilation modes.

Long term results in late implanted adolescent and adult CI recipients.

The aim of the present study is to assess long-term outcomes of CI in prelingual deafened adolescents and adults, describing, where present, differences in performance, self perceived benefit and highlighting specific characteristics. Twenty-three patients were enrolled: 10 adolescents, 13 young adults. Each patient underwent speech perception/language development, psychological evaluation and structured interviews on self perception concerning CI. 70 % adolescents and 100 % adults used their cochlear implant for most of the day; two adolescents were partial users and one was a non-user. Adolescents' average word recognition and comprehension scores improved respectively from 7 to 29.8 % (p = 0.01) and 3 to 26 % (p = 0.1). Adults' average scores improved significantly from 1.5 to 41.9 % (p = 0.01) and from 18.5 to 52.7% (p = 0.001), respectively. None of the subjects showed a linguistic age adequate to the chronological one: average linguistic age was 7.6 years for adolescents and 19.3 for adults. Structured interviews showed improvement in self-esteem. Adults and most adolescents were fully or moderately satisfied with their implant. Cochlear implantation can be considered a valid option for the rehabilitation of highly motivated and well-selected pre-lingual deafened adolescents and adults. Although there is a substantial variability in both groups of patients and language skills are only marginally influenced by CI, there is still a significant improvement in speech perception. CI was described by both groups as having had a positive impact on their lives; nevertheless adolescents were the ones with a tendency to under-use CI, even those with better hearing outcomes.