Quality and Simulation Professionals Should Collaborate.

Simulation is underutilized as a tool to improve healthcare quality and safety despite many examples of its effectiveness to identify and remedy quality and safety problems, improve teamwork, and improve various measures of quality and safety that are important to healthcare organizations, eg, patient safety indicators. We urge quality and safety and simulation professionals to collaborate with their counterparts in their organizations to employ simulation in ways that improve the quality and safety of care of their patients. These collaborations could begin through initiating conversations among the quality and safety and simulation professionals, perhaps using this article as a prompt for discussion, identifying one area in need of quality and safety improvement for which simulation can be helpful, and beginning that work.

Call to Action: Quality and Simulation Professionals Should Collaborate.

Simulation is underutilized as a tool to improve healthcare quality and safety despite many examples of its effectiveness to identify and remedy quality and safety problems, improve teamwork, and improve various measures of quality and safety that are important to healthcare organizations, eg, patient safety indicators. We urge quality and safety and simulation professionals to collaborate with their counterparts in their organizations to employ simulation in ways that improve the quality and safety of care of their patients. These collaborations could begin through initiating conversations among the quality and safety and simulation professionals, perhaps using this article as a prompt for discussion, identifying one area in need of quality and safety improvement for which simulation can be helpful, and beginning that work.

Integrating behavioral assessment in instructional design for competency-based medical education.

As institutions continuously strive to align with the standards set forth within competency-based medical education, there is an increased need to produce evidence of learner achievement in the form of observable behaviors. However, the complexity of healthcare education and clinical environments make it challenging to generate valid and reliable behavioral assessments. In this article, we utilize our interdisciplinary knowledge from the perspectives of experts in medical education, assessment, and academic administration to provide tips to successfully incorporate behavioral assessments into instructional designs.

Child Access Prevention Laws and Pediatric Firearm Injury: A Rapid Review.

Introduction: US child firearm fatality rates have risen since 2013. Child Access Prevention (CAP) laws aimed at reducing minors' access to firearms have existed since the 1980s. However, specific requirements for safe storage of firearms, standards of negligence, and penalties for offenders vary significantly by state, yielding a heterogeneous body of CAP legislation.

A review of the American College of Surgeons accredited education institutes' assessment practices for learners, faculty, and continuous program improvement.

Purpose: Simulation is an instructional modality that offers opportunities for assessment across many domains. The American College of Surgeons created the Accredited Education Institutes (AEIs) to build a community of high-quality simulation centers focused around improving surgical education and training. The goals of this project were to identify assessment methods used by AEIs, discuss how these methods align with established assessment frameworks, identify best practices, and provide guidance on best practice implementation.

Team FIRST framework: Identifying core teamwork competencies critical to interprofessional healthcare curricula.

Interprofessional healthcare team function is critical to the effective delivery of patient care. Team members must possess teamwork competencies, as team function impacts patient, staff, team, and healthcare organizational outcomes. There is evidence that team training is beneficial; however, consensus on the optimal training content, methods, and evaluation is lacking.

Maternal epigenetic clocks measured during pregnancy do not predict gestational age at delivery or offspring birth outcomes: a replication study in metropolitan Cebu, Philippines.

Adverse birth outcomes, such as early gestational age and low birth weight, can have lasting effects on morbidity and mortality, with impacts that persist into adulthood. Identifying the maternal factors that contribute to adverse birth outcomes in the next generation is thus a priority. Epigenetic clocks, which have emerged as powerful tools for quantifying biological aging and various dimensions of physiological dysregulation, hold promise for clarifying relationships between maternal biology and infant health, including the maternal factors or states that predict birth outcomes.

At-home medical student simulation: achieving knot-tying proficiency using video-based assessment.

Purpose: Due to the pandemic, we restructured our medical student knot-tying simulation to a virtual format. This study evaluated curriculum feasibility and effectiveness.

Methods: Over 4 weeks, second-year medical students ( = 229) viewed a video tutorial (task demonstration, errors, scoring) and self-practiced to proficiency (no critical errors, < 2 min) using at-home suture kits (simple interrupted suture, instrument tie, penrose drain model).

Adaptive Surgical Robotic Training Using Real-Time Stylistic Behavior Feedback Through Haptic Cues.

Surgical skill directly affects surgical procedure outcomes; thus, effective training is needed to ensure satisfactory results. Many objective assessment metrics have been developed that provide the trainee with descriptive feedback about their performance however, often lack feedback on how to improve performance. The most effective training method is one that is intuitive, easy to understand, personalized to the user,and provided in a timely manner.

Arranging Hospice Care from the Emergency Department: A Single Center Retrospective Study.

Background: Arranging hospice services from the Emergency Department (ED) can be difficult due to physician discomfort, time constraints, and the intensity of care coordination needed. We report patient and visit characteristics associated with successful transition from the ED directly to hospice.

Methods: Setting: Academic ED with 82,000 annual visits.

Distinct macrophage populations and phenotypes associated with IL-4 mediated immunomodulation at the host implant interface.

The host macrophage response to implants has shown to be affected by tissue location and physio-pathological conditions of the patient. Success in immunomodulatory strategies is thus predicated on the proper understanding of the macrophage populations participating on each one of these contexts. The present study uses an in vivo implantation model to analyze how immunomodulation via an IL-4 eluting implant affects distinct macrophage populations at the tissue-implant interface and how this may affect downstream regenerative processes.

Overarching themes from ACS-AEI accreditation survey best practices 2011-2019.

The American College of Surgeons launched the Accredited Education Institutes (ACS-AEIs) in 2005 to create a network of simulation centers to offer the highest-quality surgical education and training and to pursue cutting-edge scholarship. Specific standards and criteria were developed to accredit simulation centers, and decisions made based on the application, site surveyor visit, and ACS-AEI Accreditation Committee review. In addition to granting accreditation and providing recommendations for improvement, site surveyors and the Accreditation Committee identified best practices defined as areas far exceeding the accreditation standards or novel methods of advancing high-quality, impactful education.

Probabilistic Assessment of the Failure Risk of the Europa Clipper Spacecraft due to Radiations.

The Europa mission approved in 2019 is still in the development phase. It is designed to conduct a detailed reconnaissance of that moon of Jupiter as it could possibly support life as we know it. This article is based on a top-down approach (mission → system → subsystems → components) to model the probability of mission failure.

Reliability of Intraoperative Testing During Deep Brain Stimulation Surgery.

Introduction: Deep brain stimulation (DBS) is an effective treatment for medically refractory Parkinson's disease (PD). During DBS surgery, intraoperative testing is performed to confirm optimal lead placement by determining the stimulation thresholds for symptom improvement and side effects. However, the reliability of intraoperative testing in predicting distant postoperative thresholds is unknown.

No Medical Student Left Behind: A Study to Examine the Effects of Structured Step 1 Support within our Curriculum.

This article was migrated. The article was marked as recommended. The University of Texas Southwestern Medical School (UT Southwestern) developed a required, pass/fail Step 1 preparation course in conjunction with their new curriculum to support students with structure, encouragement, and accountability.

Antenatal sonographic diagnosis of semilobar holoprosencephaly with associated cleft lip and palate.

Routine antenatal Level II ( anomaly scan) scanning done in a 36-year-old pregnant patient with no history of birth defects in the previous pregnancy showed a 19 weeks fetus with deformed cerebral ventricular cavities, fusion of thalami and craniofacial abnormalities. Diagnosis of semilobar holoprosencephaly with midline cleft lip-cleft palate was given and termination of the ongoing pregnancy was advised in view of the unfavourable outcome.

Assessing quality and resources during campus-wide simulation integration.

Introduction: Our simulation center, supported by four departments (Surgery, OB/GYN, Urology, and Anesthesiology), is accredited as a comprehensive Accredited Educational Institute (AEI) and is now expanding to accommodate all departments on campus.

Methods: A 61-point questionnaire was administered to 44 stakeholders, representing all of UME and GME. Data were compared for AEI vs.

Automatic and near real-time stylistic behavior assessment in robotic surgery.

Purpose: Automatic skill evaluation is of great importance in surgical robotic training. Extensive research has been done to evaluate surgical skill, and a variety of quantitative metrics have been proposed. However, these methods primarily use expert selected features which may not capture latent information in movement data.

Automatic Surgical Skill Rating Using Stylistic Behavior Components.

A gold standard in surgical skill rating and evaluation is direct observation, which a group of experts rate trainees based on a likert scale, by observing their performance during a surgical task. This method is time and resource intensive. To alleviate this burden, many studies have focused on automatic surgical skill assessment; however, the metrics suggested by the literature for automatic evaluation do not capture the stylistic behavior of the user.

Frailty predicts mortality and complications in chronologically young patients with traumatic orthopaedic injuries.

Background: As morbidity and mortality from traumatic orthopaedic injuries continues to rise, increased research is being conducted on how to best predict complications in at risk patients. Recently, frailty indices have been validated in a variety of surgical subspecialties as predictors of morbidity and mortality. However, the vast majority of research has been conducted on geriatric patient populations, with little evidence on patients who are chronologically young.

Meaningful Assessment of Robotic Surgical Style using the Wisdom of Crowds.

Objective: Quantitative assessment of surgical skills is an important aspect of surgical training; however, the proposed metrics are sometimes difficult to interpret and may not capture the stylistic characteristics that define expertise. This study proposes a methodology for evaluating the surgical skill, based on metrics associated with stylistic adjectives, and evaluates the ability of this method to differentiate expertise levels.

Methods: We recruited subjects from different expertise levels to perform training tasks on a surgical simulator.

Neurovascular toxicity of N-methyl-d-aspartate is markedly enhanced in the developing mouse central nervous system.

Penumbral perfusion is critical to brain viability. Proximal arterial occlusion and deep brain stroke has variable effect on cortical dysfunction. Cortical microvessel collaterals may be recruited and at times sufficient for partial parenchymal perfusion.