Improving Nasopharyngeal Swab Technique via Simulation for Frontline Workers.

OBJECTIVES/HYPOTHESIS: Nasopharyngeal swabs currently remain the gold standard for COVID-19 sample collection. A surge in testing volume has resulted in a large number of health care workers who are unfamiliar with nasal anatomy performing this test, which can lead to improper collection practices culminating in false-negative results and complications. Therefore, we aimed to assess the accuracy and educational potential of a realistic 3D-printed nasal swab simulator to expedite health care workers' skill acquisition. STUDY DESIGN: Prospective pre-post interventional study. METHODS: A nasal swab task trainer (NSTT) was developed to scale from computed tomography data with a deviated septum. Frontline workers at COVID-19 testing sites in Ontario, Canada, were recruited to use the NSTT for nasopharyngeal swab training. Integrated video recording capability allowed participants to self-evaluate procedure accuracy. A five-point Likert scale was collected regarding the NSTT's educational value and procedural fidelity. RESULTS: Sixty-two frontline workers included in the study were primarily registered nurses (52%) or paramedics (16%). Following simulator use, self-assessed accuracy improved in 77% of all participants and 100% of participants who expressed low confidence before training. Ninety-four percent reported that the NSTT provided a complete educational experience, and 82% regarded the system as a more effective training approach than what is currently available. Eighty-one indicated that the simulator should be used at all COVID-19 testing sites, with 77% stating province-wide implementation was warranted. CONCLUSIONS: The nasal swab task trainer is an effective educational tool that appears well-suited for improved skill acquisition in COVID-19 testing and may be useful for training other nasal swab applications. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:38-42, 2023.

Skill Transference of a Probe-Tube Placement Training Simulator.

BACKGROUND: Probe-tube placement is a necessary step in hearing aid verification which needs ample hands-on experience and confidence before performing in clinic. To improve the methods of training in probe-tube placement, a manikin-based training simulator was developed consisting of a 3D-printed head, a flexible silicone ear, and a mounted optical tracking system. The system is designed to provide feedback to the user on the depth and orientation of the probe tube, and the time required to finish the task. Although a previous validation study was performed to determine its realism and teachability with experts, further validation is required before implementation into educational settings. PURPOSE: This study aimed to examine the skill transference of a newly updated probe-tube placement training simulator to determine if skills learned on this simulator successfully translate to clinical scenarios. RESEARCH DESIGN: All participants underwent a pretest in which they were evaluated while performing a probe-tube placement and real-ear-to-coupler difference (RECD) measurement on a volunteer. Participants were randomized into one of two groups: the simulator group or the control group. During a two-week training period, all participants practiced their probe-tube placement according to their randomly assigned group. After two weeks, each participant completed a probe-tube placement on the same volunteer as a posttest scenario. STUDY SAMPLE: Twenty-five novice graduate-level student clinicians. DATA COLLECTION AND ANALYSIS: Participants completed a self-efficacy questionnaire and an expert observer completed a questionnaire evaluating each participant's performance during the pre- and posttest sessions. RECD measurements were taken after placing the probe tube and foam tip in the volunteer's ear. Questionnaire results were analyzed through nonparametric t-tests and analysis of variance, whereas RECD results were analyzed using a nonlinear mixed model method. RESULTS: Results suggested students in the simulator group were less likely to contact the tympanic membrane when placing a probe tube, appeared more confident, and had better use of the occluding foam tip, resulting in more improved RECD measurements. CONCLUSIONS: The improved outcomes for trainees in the simulator group suggest that supplementing traditional training with the simulator provides useful benefits for the trainees, thereby encouraging its usage and implementation in educational settings.

Face and Content Validity of a Probe Tube Placement Training Simulator.

BACKGROUND: Probe tube placement is an important skill audiologists must learn to make real-ear measurements in an audiology clinic. With current evidence-based guidelines recommending insertion of the probe tube within 5 mm of the tympanic membrane (TM) for proper acoustical measurements, students must be well trained to ensure they are capable to perform this placement in clinical practice. This is not always the case as it has been found that real-ear measurements are not performed in a clinic as often as required. To address this, a simulator consisting of a 3D-printed ear model and an optical tracking system was developed to provide a training system for students to practice probe tube placement and to provide a method to evaluate competency before starting clinical practicum placements. Two simulators were developed, an adult model and a pediatric model. PURPOSE: To assess the face and content validity of the two probe tube placement simulators (adult and pediatric) and define barriers and facilitators to implementing this system into an educational setting. RESEARCH DESIGN: Participants followed the setup and operating instructions designed to guide them through each functionality of the simulator. A questionnaire was used to assess face and content validity, applicability to an educational setting, and to determine perceived barriers and facilitators to using the probe tube simulators for training purposes. Five additional probe tube placements with each simulator were performed in which distance-to-TM was recorded. STUDY SAMPLE: Twelve participants with significant probe tube placement experience. DATA COLLECTION AND ANALYSIS: Participants rated each question in the questionnaire from 0% to 100% depending on their level of agreement. Averages and standard deviations (SDs) were compiled and presented for each section (face validity, content validity, and applicability to an educational setting). Final facilitators and barriers for the simulator were compiled and the top answers of each are presented. The five quantitative probe tube placement measurements for each participant were averaged, SDs were calculated, and contacts with the TM while placing the probe tube were recorded. RESULTS: The average face validity score over all questions for the adult model was 65% (SD = 18.2) whereas the pediatric model received a score of 64% (16.4). The overall content validity average score was 78.7% (17) and applicability to an educational setting had an average score of 80% (5.33). The average distance-to-TM across all trials and participants was 3.74 mm (1.82) for the adult model and 2.77 mm (0.94) for the pediatric model with only one participant exceeding the recommended maximum of 5 mm. Listed shortcomings of the current simulator included realism of the 3D-printed ear, ease of insertion of an otoscope tip into the ear, ability to visualize the ear canal "landmarks" and the TM, and foam tip insertion experience. CONCLUSIONS: Results were generally very positive for the simulator, and future iterations will look to improve the flexibility and texture of the ear, as well as the otoscopic view of the ear canal and TM.

Evaluation of Cochlear Duct Length Computations Using Synchrotron Radiation Phase-Contrast Imaging.

HYPOTHESIS: Evaluation of cochlear duct length (CDL) using novel imaging techniques will help improve the accuracy of existing CDL equations. BACKGROUND: Various relationships relating A value measured from a patient's computed tomography scan and CDL have been proposed to aid in preoperative electrode selection and frequency mapping. METHODS: Ten cadaveric temporal bones were scanned using synchrotron radiation phase-contrast imaging. Reference CDL values were calculated by placing points representing the organ of Corti (OC), lateral wall (LW), and electrode location (I) on the synchrotron radiation phase-contrast imaging slices along the length of the cochlea. The CDL estimates from the existing three equations (OC, LW, I) in addition to two newly proposed equations (OC and LW) were compared with reference CDL values at each respective location. RESULTS: When compared with reference CDL values, the new OC equation improved the CDL estimates from a 6.2% error to a 5.1% error while the new LW equation improved the CDL estimate error from 3.9 to 3.6%. Bland-Altman plots revealed both new equations increased similarity to reference values and brought more samples to within clinically significant ranges. Validation of the original electrode location equation to the reference values showed a 4.6% difference. CONCLUSION: The newly proposed equations for LW and OC provided an improvement over past equations for determining CDL from the A value by showing improved agreement with reference values. Therefore, these equations can provide quick and accurate preoperative estimates of CDL for improving customized frequency mapping.

Measuring Cochlear Duct Length - a historical analysis of methods and results.

BACKGROUND: Cochlear Duct Length (CDL) has been an important measure for the development and advancement of cochlear implants. Emerging literature has shown CDL can be used in preoperative settings to select the proper sized electrode and develop customized frequency maps. In order to improve post-operative outcomes, and develop new electrode technologies, methods of measuring CDL must be validated to allow usage in the clinic. PURPOSE: The purpose of this review is to assess the various techniques used to calculate CDL and provide the reader with enough information to make an informed decision on how to conduct future studies measuring the CDL. RESULTS: The methods to measure CDL, the modality used to capture images, and the location of the measurement have all changed as technology evolved. With recent popularity and advancement in computed tomography (CT) imaging in place of histologic sections, measurements of CDL have been focused at the lateral wall (LW) instead of the organ of Corti (OC), due to the inability of CT to view intracochlear structures. After analyzing results from methods such as directly measuring CDL from histology, indirectly reconstructing the shape of the cochlea, and determining CDL based on spiral coefficients, it was determined the three dimensional (3D) reconstruction method is the most reliable method to measure CDL. 3D reconstruction provides excellent visualization of the cochlea and avoids errors evident in other methods. Due to the number of varying methods with varying accuracies, certain guidelines must be followed in the future to allow direct comparison of CDL values between studies. CONCLUSION: After summarizing and analyzing the interesting history of CDL measurements, the use of standardized guidelines and the importance of CDL for future cochlear implant developments is emphasized for future studies.

Understanding quality patient care and the role of the practicing nurse.

Nurses play a vital role in improving the safety and quality of patient care. The authors provide the front-line nurse providers with an overview of critical concepts related to quality management of patient care. A historical approach provides the reader with an overview of the trajectory or the quality in health care movement. Furthermore, the article provides the nurse with a basic understanding of national and international organizations that focus on quality patient care. A brief introduction of measures of quality care is presented as well as implications for nursing practice.

Self-reported training needs of emergency responders in disasters requiring military interface.

OBJECTIVE: The purpose of this study is to identify perceived training needs of emergency responders to understand their needs to interface effectively with military operations for emergency response in the event of a disaster. DESIGN: A Web-based survey with civilian medical practitioners and public health professionals was conducted to identify their perceptions of training needs related to civilian-military interface in disaster response. SETTING: Lists of potential survey participants were obtained from local health departments and LISTSERVS in the two regions of interest: the South and the Midwest. PARTICIPANTS: Participants (n = 673) included health practitioners (medical, emergency care, and public health personnel) from hospitals, public service, and other nonprofit and governmental workers. MAIN OUTCOME MEASURE(S): Outcomes include perceived training needs, barriers to training, and preferred training formats and modalities. RESULTS: Data indicate a perceived knowledge gap of civilian healthcare providers to interface effectively with military healthcare providers. Nearly three-fourths of respondents did not feel well-trained to work with the military during a disaster response or were unsure if they were well trained. Key areas for training include communication, chain of command during a disaster, and logistics of working with military personnel. Barriers to training include expense; ineffective, boring formats; and excessive time requirements. Most respondents favor interactive exercises rather than didactic training. CONCLUSIONS: Poor communication and lack of familiarity with military operations create barriers to effective coordinated response between military units and civilian responders in federal disaster response. Identifying gaps and training needs for these responders have far-reaching implications in public health's ability to coordinate medical response as part of Emergency Support Function-8.