The state of distance healthcare simulation during the COVID-19 pandemic: results of an international survey.

BACKGROUND: The coronavirus pandemic continues to shake the embedded structures of traditional in-person education across all learning levels and across the globe. In healthcare simulation, the pandemic tested the innovative and technological capabilities of simulation programs, educators, operations staff, and administration. This study aimed to answer the question: What is the state of distance simulation practice in 2021? METHODS: This was an IRB-approved, 34-item open survey for any profession involved in healthcare simulation disseminated widely and internationally in seven languages from January 14, 2021, to March 3, 2021. Development followed a multistep process of expert design, testing, piloting, translation, and recruitment. The survey asked questions to understand: Who was using distance simulation? What driving factors motivated programs to initiate distance sim? For what purposes was distance sim being used? What specific types or modalities of distance simulation were occurring? How was it being used (i.e., modalities, blending of technology and resources and location)? How did the early part of the pandemic differ from the latter half of 2020 and early 2021? What information would best support future distance simulation education? Data were cleaned, compiled, and analyzed for dichotomized responses, reporting frequencies, proportions, as well as a comparison of response proportions. RESULTS: From 32 countries, 618 respondents were included in the analysis. The findings included insights into the prevalence of distance simulation before, during, and after the pandemic; drivers for using distance simulation; methods and modalities of distance simulation; and staff training. The majority of respondents (70%) reported that their simulation center was conducting distance simulation. Significantly more respondents indicated long-term plans for maintaining a hybrid format (82%), relative to going back to in-person simulation (11%, p < 0.001). CONCLUSION: This study gives a perspective into the rapid adaptation of the healthcare simulation community towards distance teaching and learning in reaction to a radical and quick change in education conditions and environment caused by COVID-19, as well as future directions to pursue understanding and support of distance simulation.

Evaluating multisite multiprofessional simulation training for a hyperacute stroke service using the Behaviour Change Wheel.

BACKGROUND: Stroke is a clinical priority requiring early specialist assessment and treatment. A London (UK) stroke strategy was introduced in 2010, with Hyper Acute Stroke Units (HASUs) providing specialist and high dependency care. To support increased numbers of specialist staff, innovative multisite multiprofessional simulation training under a standard protocol-based curriculum took place across London. This paper reports on an independent evaluation of the HASU training programme. The main aim was to evaluate mechanisms for behaviour change within the training design and delivery, and impact upon learners including potential transferability to the clinical environment. METHODS: The evaluation utilised the Behaviour Change Wheel framework. Procedures included: mapping training via the framework; examination of course material; direct and video-recorded observations of courses; pre-post course survey sheet; and follow up in-depth interviews with candidates and faculty. RESULTS: Patient management skills and trainee confidence were reportedly increased post-course (post-course median 6 [IQ range 5-6.33]; pre-course median 5 [IQ range 4.67-5.83]; z = 6.42, P < .001). Thematic analysis showed that facilitated 'debrief' was the key agent in supporting both clinical and non-clinical skills. Follow up interviews in practice showed some sustained effects such as enthusiasm for role, and a focus on situational awareness, prioritization and verbalising thoughts. Challenges in standardising a multi-centre course included provision for local context/identity. CONCLUSIONS: Pan-London simulation training under the London Stroke Model had positive outcomes in terms of self-reported skills and motivation. These effects persisted to an extent in practice, where staff could recount applications of learning. The evaluation demonstrated that a multiple centre simulation programme congruent with clinical practice can provide valuable standard training opportunities that support patient care.

Synthesis and anti-inflammatory activity of fluorinated phenyl styryl ketones and N-phenyl-5-substituted aryl-3-p-(fluorophenyl) pyrazolins and pyrazoles.

Various N-phenyl-5-substituted aryl-3-p-(fluorophenyl) pyrazolins and pyrazoles were synthesized by cyclization of the corresponding 4-(fluorophenyl) styryl and 4-(fluorophenyl) dibromostyryl ketones. These compounds were characterized by elemental analysis and UV, infrared, and nuclear magnetic spectral data. All substituted p-(fluorophenyl) styryl ketones [250 mg/kg orally (po)] possessed anti-inflammatory activity, as reflected by their ability to provide protection (51-70%) against carrageenin-induced edema in rat paw. Indomethacin (10 mg/kg, po) and dehydrozingerone (70 mg/kg, po), used as standard reference drugs, provided 97 and 60% protection, respectively. All compounds (0.20 mM) showed ability to denature bovine serum albumin, as observed in in vitro inhibition studies. Inhibition ranged from 7 to 59% for substituted p-(fluorophenyl) styryl ketones and from 12 to 21% for pyrazoles. No correlation was found between the anti-inflammatory activity of p-(fluorophenyl) styryl ketones or substituted pyrazoles and their effectiveness at inhibiting bovine serum albumin denaturation. The low toxicity of p-(fluorophenyl) styryl ketones was reflected by the dose that was lethal in 50% of the cases tested (2000-2500 mg/kg).

Mesosalpingeal vessel ligation for conservative treatment of ectopic pregnancy.

Mesosalpingeal vessel ligation improves hemostasis during conservative tubal surgery for ectopic pregnancy. We used this method is a series of 39 patients to reduce the risk of recurrent hemorrhage from the fallopian tube.