Major incidents and complications in otherwise healthy patients undergoing elective procedures: results based on 1.37 million anaesthetic procedures.

Background: Improved anaesthesia safety has made severe anaesthesia-related incidents, complications, and deaths rare events, but concern about morbidity and mortality in anaesthesia continues. This study examines possible severe adverse outcomes or death recorded in a large national surveillance system based on a core data set (CDS).

Methods: Cases from 1999 to 2010 were filtered from the CDS database.

The German Critical Incident Reporting System for Anesthesiology: CIRSains.

Background: In June 2010, the Helsinki Declaration was passed. As a result, an online nationwide critical incident reporting system named CIRSmedical Anaesthesiology (CIRSains) was implemented in Germany. The aim of the article is to evaluate CIRSains for practicability and to provide solutions to the problems detected during evaluation.

A knowledge- and model-based system for automated weaning from mechanical ventilation: technical description and first clinical application.

To describe the principles and the first clinical application of a novel prototype automated weaning system called Evita Weaning System (EWS). EWS allows an automated control of all ventilator settings in pressure controlled and pressure support mode with the aim of decreasing the respiratory load of mechanical ventilation. Respiratory load takes inspired fraction of oxygen, positive end-expiratory pressure, pressure amplitude and spontaneous breathing activity into account.

SBAR 'flattens the hierarchy' among caregivers.

As a young ensign in the US Navy on a nuclear submarine, Doug Bonacum had to brief the captain of the ship following his night-time shift, reporting about potentially dangerous situations that might emerge. He described the "situation, background, assessment, and recommendation". This nascent SBAR communication tool served temporarily to flatten the hierarchy between the ensign and the ship's captain.

CliniSpace: a multiperson 3D online immersive training environment accessible through a browser.

Immersive online medical environments, with dynamic virtual patients, have been shown to be effective for scenario-based learning (1). However, ease of use and ease of access have been barriers to their use. We used feedback from prior evaluation of these projects to design and develop CliniSpace.

Training healthcare personnel for mass-casualty incidents in a virtual emergency department: VED II.

Introduction: Training emergency personnel on the clinical management of a mass-casualty incident (MCI) with prior chemical, biological, radioactive, nuclear, or explosives (CBRNE) -exposed patients is a component of hospital preparedness procedures.

Objective: The objective of this research was to determine whether a Virtual Emergency Department (VED), designed after the Stanford University Medical Center's Emergency Department (ED) and populated with 10 virtual patient victims who suffered from a dirty bomb blast (radiological) and 10 who suffered from exposure to a nerve toxin (chemical), is an effective clinical environment for training ED physicians and nurses for such MCIs.

Methods: Ten physicians with an average of four years of post-training experience, and 12 nurses with an average of 9.

Exploring virtual worlds for scenario-based repeated team training of cardiopulmonary resuscitation in medical students.

Background: Contemporary learning technologies, such as massively multiplayer virtual worlds (MMVW), create new means for teaching and training. However, knowledge about the effectiveness of such training is incomplete, and there are no data regarding how students experience it. Cardiopulmonary resuscitation (CPR) is a field within medicine in high demand for new and effective training modalities.

High degree of realism in teaching percutaneous coronary interventions by combining a virtual reality trainer with a full scale patient simulator.

The virtual reality coronary angiography simulator "CATHI" (Catheter Instruction System, Mannheim, Germany) simulates coronary arteries with implemented vessel lesions in virtual patients. Like similar systems the software model runs on common PC systems, which are linked to the mechanical device for manual training. We combined the advantages of this skill trainer with the near to reality assembly of a cardiac catheterization laboratory (Cath-lab) by connecting it to a full scale simulator (HPS, METI, Sarasota, FL).

Design, development, and evaluation of an online virtual emergency department for training trauma teams.

Background: Training interdisciplinary trauma teams to work effectively together using simulation technology has led to a reduction in medical errors in emergency department, operating room, and delivery room contexts. High-fidelity patient simulators (PSs)-the predominant method for training healthcare teams-are expensive to develop and implement and require that trainees be present in the same place at the same time. In contrast, online computer-based simulators are more cost effective and allow simultaneous participation by students in different locations and time zones.

Virtual patient model for multi-person virtual medical environments.

We describe the architecture of a virtual patient model, the Virtual ED Patient, for scenarios in emergency medicine. The model is rule-based, and uses four vital signs as a representation of its state. The model is used in a multi-person learning environment based on online gaming technology.

[New perspectives in laparoscopic simulation: from students' skills lab to stress evaluation].

Background: Application of a LapSim-training model in the Students' Skills Lab as well as the objective evaluation of stress in a virtual operating room scenario offer new perspectives in laparoscopic simulation.

Methods: In a Students' Skills Lab , assessment of learning curves of laparoscopic basic skills and complex tasks was carried out with 28 individuals at a LapSim Virtual Reality (VR)-simulator in a training curriculum consisting of 9 units. In addition, in a virtual operating room scenario, stress evaluation was performed with 18 surgeons by means of a sympathicograph and, in that way, the laparoscopic error and complication rate were recorded.

[Simulation training for German anesthesiologists--case scenarios and training results].

Training of medical personnel using simulation techniques is an acknowledged measure of process optimization and quality assurance in a clinical setting. In 2006, a simulator-based training of anaesthesiologists was introduced in the University Medical Centre of Schleswig-Holstein, Campus Kiel, Germany. The training was performed on a human patient simulator (Meti, Sarasota, USA) and the course was conducted by instructors and engineers from the Simulation Centre Mainz in an operation room equipped with common anaesthesia devices.

Design and implementation of rule-based medical models: an In Silico patho-physiological trauma model for hypovolemic shock.

Trauma from 'Dirty' Bomb blasts presents complex clinical problems to healthcare providers who must make critical emergency care decisions with incomplete information, usually limited initially only to cursory observations and vital signs. A set of simple, HFSM patho-physiological models of hypovolemic shock based upon blood volume deficits and remedial therapeutic actions has been created for 10 Virtual World scenarios used for training healthcare personnel in the diagnosis and management of 'dirty' bomb victims. Several general rules define the models: * Virtual patients have individual characteristics of gender, age, health status.

Three different types of surgeon-specific stress reactions identified by laparoscopic simulation in a virtual scenario.

Background: Minimally invasive surgery causes higher mental strain for surgeons than conventional surgery and is significantly more stressful in consecutive cases. This study aimed to investigate whether individual stress responses are associated with intraoperative alterations of manual surgical skills and technical errors of the laparoscopic surgeon.

Methods: The LapSim virtual reality simulator was used.

Criterion-based training with surgical simulators: proficiency of experienced surgeons.

Objective: In our effort to establish criterion-based skills training for surgeons, we assessed the performance of 17 experienced laparoscopic surgeons on basic technical surgical skills recorded electronically in 26 modules selected in 5 commercially available, computer-based simulators.

Methods: Performance data were derived from selected surgeons randomly assigned to simulator stations, and practicing repetitively during one and one-half day sessions on 5 different simulators. We measured surgeon proficiency defined as efficient, error-free performance and developed proficiency score formulas for each module.

Virtual worlds and team training.

An important component of all emergency medicine residency programs is managing trauma effectively as a member of an emergency medicine team, but practice on live patients is often impractical and mannequin-based simulators are expensive and require all trainees to be physically present at the same location. This article describes a project to develop and evaluate a computer-based simulator (the Virtual Emergency Department) for distance training in teamwork and leadership in trauma management. The virtual environment provides repeated practice opportunities with life-threatening trauma cases in a safe and reproducible setting.

Virtual worlds for teaching the new CPR to high school students.

In this study we created a virtual 3D world for learning to manage medical emergencies and evaluated it with 24 high school students in the USA and Sweden. We found that students in both groups felt immersed and found the online simulation easy to use. Scores for flow and self-assessed flow were significantly higher for the RHS group as compared to the HG group (p=.

Avatars alive! The integration of physiology models and computer generated avatars in a multiplayer online simulation.

In a mass casualty incident, injured and at-risk patients will pass through a continuum of care from many different providers acting as a team in a clinical environment. As presented at MMVR 14 [Kaufman, et al 2006], formative evaluations have shown that simulation practice is nearly as good as, and in some cases better than, live exercises for stimulating learners to integrate their procedural knowledge in new circumstances through experiential practice. However, to date, multiplayer game technologies have given limited physiological fidelity to their characters, thus limiting the realism and complexity of the scenarios that can be practiced by medical professionals.

Implementing virtual worlds for systematic training of prehospital CPR in medical school.

We report on a study that investigates the relationship between repeated training of teams managing medical emergencies in the Virtual World and affective learning outcomes in a group of 12 medical students. The focus of the training was on individual actions, but also on interaction and behaviour in the team. Current CPR training seems to lack important team training aspects which this type of training is addressing.

[Combined simulation training: a new concept and workshop is useful for crisis management in gastrointestinal endoscopy].

Introduction: Crisis management as well as realistic emergency situations can be trained in the new developed simulation workshop "Gastrointestinal Endoscopy and Crisis Resource Management" by combining a full-scale simulator and the Erlanger Endoscopy Trainer. The aim of the current study was to evaluate the efficiency of the newly developed simulation workshop.

Methods: Endoscopists with more than 12 months experience can train their endoscopic skills and crisis resource management with the help of different simulators.

Comparison of training on two laparoscopic simulators and assessment of skills transfer to surgical performance.

Background: Several studies have investigated the transfer of surgical trainees' skills acquired on surgical simulators to the operating room setting. The purpose of this study was to compare the effectiveness of two laparoscopic surgery simulators by assessing the transfer of skills learned on simulators to closely matched surgical tasks in the animal laboratory.

Study Design: In this post-test-only Control group study design, 46 surgically naive medical student volunteers were randomly assigned to one of three groups: Tower Trainer group (n = 16), LapSim group (n = 17), and Control group (n = 13).