In Situ Simulation for Adoption of New Technology to Improve Sepsis Care in Rural Emergency Departments.

Objectives: The aims of the study were to evaluate whether in situ (on-site) simulation training is associated with increased telemedicine use for patients presenting to rural emergency departments (EDs) with severe sepsis and septic shock and to evaluate the association between simulation training and telehealth with acute sepsis bundle (SEP-1) compliance and mortality.

Methods: This was a quasi-experimental study of patients presenting to 2 rural EDs with severe sepsis and/or septic shock before and after rollout of in situ simulation training that included education on sepsis management and the use of telehealth. Unadjusted and adjusted analyses were conducted to describe the association of simulation training with sepsis process of care markers and with mortality.

A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model.

Background: New technologies for clinical staff are typically introduced via an "in-service" that focuses on knowledge and technical skill. Successful adoption of new healthcare technologies is influenced by multiple other factors as described by the Consolidated Framework in Implementation Research (CFIR). A simulation-based introduction to new technologies provides opportunity to intentionally address specific factors that influence adoption.

A Simple Low-Cost Method to Integrate Telehealth Interprofessional Team Members During In Situ Simulation.

Introduction: With the growth of telehealth, simulation personnel will be called upon to support training that integrates these new technologies and processes. We sought to integrate remote telehealth electronic intensive care unit (eICU) personnel into in situ simulations with rural emergency department (ED) care teams. We describe how we overcame technical challenges of creating shared awareness of the patient's condition and the care team's progress among those executing the simulation, the care team, and the eICU.

Arteriovenous malformation of the foot: a case presentation.

Arteriovenous malformations have been reported as rare clinical entities in the foot. When these lesions present, they are most often found in the brain, lungs, and pelvis/thigh of the lower extremity and develop as a result of failed fetal vascular development. Arteriovenous malformations can present with a variety of dermatologic and osseous manifestations.

Techniques of digital arthrodesis: revisiting the old and discovering the new.

Digital surgery is commonplace for foot and ankle surgeons. The techniques of arthrodesis are more exacting and complex than techniques of arthroplasty. They are generally performed in cases of more severe deformity or underlying biomechanical abnormalities, which strongly influence the development and propagation of the deformity.

Syme's amputation. Surgical technique, prosthetic considerations, and case reports.

Amputation at the level of the ankle joint is a valuable but underused procedure for a variety of conditions affecting the foot and ankle. The procedure provides a comfortable and durable stump that allows the lower-extremity amputee to function with minimal disability. This article reviews the indications for Syme's amputation, provides a detailed surgical description of the procedure, and discusses postoperative prosthetic considerations.