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MedEdPublish (2016) 2023With an increase in simulation being used in healthcare education, there is a need to ensure the quality of simulation-based education is high. This scoping review was...
With an increase in simulation being used in healthcare education, there is a need to ensure the quality of simulation-based education is high. This scoping review was conducted to answer the question: What are the current approaches to the evaluation of the quality of health-care simulation-based education provision? Databases PubMed, Cochrane, ERIC, CINAHL and Medline were searched in March 2023 to retrieve peer-reviewed healthcare research and review articles written in the English language within the last 20 years. All data were extracted from six studies, themed and presented in the main text and in tabular form. Two scoping reviews, one systematic review and three research articles were included. Three main themes were found: adherence to existing design frameworks, lack of validation of these frameworks and lack of evaluation frameworks, and a proposed evaluation framework. Many of the excluded articles focussed on gaining participant feedback to evaluate simulation activities, rather than evaluating the quality of the design and implementation of the simulation. Benchmarking of current United Kingdom (UK) healthcare simulation against UK and international simulation standards is required to increase its quality, therefore, an agreed UK template framework to evaluate simulation packages is recommended.
PubMed: 38188096
DOI: 10.12688/mep.19758.1 -
Acta Anaesthesiologica Scandinavica Apr 2024Awake proning in spontaneously breathing patients with hypoxemic acute respiratory failure was applied during the coronavirus disease 2019 (COVID-19) pandemic to improve... (Meta-Analysis)
Meta-Analysis Review
Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.
BACKGROUND
Awake proning in spontaneously breathing patients with hypoxemic acute respiratory failure was applied during the coronavirus disease 2019 (COVID-19) pandemic to improve oxygenation while avoiding tracheal intubation. An updated systematic review and meta-analysis on the topic was published.
METHODS
The Clinical practice committee (CPC) of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) assessed the clinical practice guideline "Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: A rapid practice guideline" for possible endorsement. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) II tool was used.
RESULTS
Four out of six SSAI CPC members completed the appraisal. The individual domain totals were: Scope and Purpose 90%; Stakeholder Involvement 89%; Rigour of Development 74%; Clarity of Presentation 85%; Applicability 75%; Editorial Independence 98%; Overall Assessment 79%.
CONCLUSION
The SSAI CPC endorses the clinical practice guideline "Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: A rapid practice guideline". This guideline serves as a useful decision aid for clinicians caring for critically ill patients with COVID-19-related acute hypoxemic respiratory failure and can be used to provide guidance on use of prone positioning in this group of patients.
Topics: Humans; COVID-19; Anesthesiology; Wakefulness; Critical Care; Respiratory Insufficiency; Prone Position
PubMed: 38131369
DOI: 10.1111/aas.14367 -
Journal of Athletic Training Dec 2023Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this back-to-back...
A systematic review on oral rehydration beverages for treating exerciseassociated dehydrationPart II. The effectiveness of alternatives to carbohydrate-electrolyte drinks.
OBJECTIVE
Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this back-to-back review demonstrated that commercial sports drinks can be suggested for effective restoration of fluid balance in dehydrated persons. This systematic review was undertaken to compare alternative liquids, such as milk, beer, and coconut water, with water for effective oral rehydration after prolonged exercise.
DATA SOURCES
Cochrane Library, PubMed, and Embase were searched for relevant literature in June 2022.
STUDY SELECTION
Controlled experimental and observational studies involving adults and children were included when dehydration was induced by physical exercise and oral rehydration fluids were administered and compared with regular water. No additional food intake accompanied the rehydration drinks or water. Articles in all languages were included if an English abstract was available.
DATA EXTRACTION
The study design, study population, intervention, outcome measures, and study limitations were extracted from each included article.
DATA SYNTHESIS
Out of 3485 records, 11 studies were included comparing skim or low-fat milk, coconut water, and beer (0-5% alcohol) with water. Four studies showed that drinking skim or low-fat milk, without additional food intake, led to a statistically significant improved volume/hydration status when compared with drinking water. In three trials, no significant differences were shown at multiple timepoints for outcomes related to volume and hydration status following rehydration with fresh coconut water compared with water. Lastly, there is insufficient evidence to recommend beer for rehydration (0-5% alcohol).
CONCLUSIONS
Consuming skim or low-fat cow's milk without additional food as compared with water appears to improve volume/hydration status in persons with exercise-induced dehydration. However, evidence is of very low certainty and should be interpreted with caution.
PubMed: 38116818
DOI: 10.4085/1062-6050-0686.22 -
Journal of Athletic Training Dec 2023Exercise-associated dehydration is a common problem, especially at sporting events. Although there are recommendations to drink a certain volume per kg body mass lost...
OBJECTIVE
Exercise-associated dehydration is a common problem, especially at sporting events. Although there are recommendations to drink a certain volume per kg body mass lost after exercise, there is no clear guidance about the type of rehydration beverage. The aim of this systematic review is to assess the effectiveness of carbohydrate-electrolyte solutions as a rehydration solution for exercise-associated dehydration.
DATA SOURCES
Medline (via the PubMed interface), Embase and the Cochrane Library were searched for relevant studies. The search is up to date until June 2022.
STUDY SELECTION
Controlled trials involving adults and children were included if dehydration was the result of physical exercise and if drinking carbohydrate-electrolyte solutions, of any percentage carbohydrate, was compared with drinking water. All languages were included as long as an English abstract was available.
DATA EXTRACTION
Data on study design, study population, interventions, outcome measures and study limitations were extracted from each included article. Certainty was assessed using GRADE.
DATA SYNTHESIS
Out of 3485 screened articles, 19 studies were included that assessed carbohydrate-electrolyte solutions (0% - 9% carbohydrate) compared with water. Although there is variability amongst the identified studies, drinking 0-3.9% and, especially, 4-9% carbohydrate-electrolyte (CE) solution may be effective for rehydration.
CONCLUSIONS
A potential beneficial effect of drinking CE drinks compared with water was seen for many of the reviewed outcomes. Commercial CE drinks (ideally 4-9% CE drinks or alternatively 0-3.9% CE drinks) could be suggested for rehydration in persons with exercise associated dehydration when whole foods are not available.
PubMed: 38116803
DOI: 10.4085/1062-6050-0682.22 -
British Paramedic Journal Dec 2023The current Joint Royal Colleges Ambulance Liaison Committee guidelines in the United Kingdom provide clear national guidance for low-voltage electrical injury patients....
INTRODUCTION
The current Joint Royal Colleges Ambulance Liaison Committee guidelines in the United Kingdom provide clear national guidance for low-voltage electrical injury patients. While patients can be considered safe to discharge with an apparently 'normal' initial electrocardiogram (ECG), some evidence questions the safety profile of these patients with a risk of a 'delayed arrhythmia'. This review aims to examine this as well as identifying the frequency and common arrhythmias that require patients to be conveyed to hospital for further monitoring post electrical injury. It will also aim to improve the understanding of potentially clinically significant arrhythmias that may require clinical intervention or even admission within an in-hospital environment.
METHODS
A systematic review using three electronic databases (CINAHL, MEDLINE, AMED) was conducted in January 2022. A preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was used to identify relevant studies with a suitable quality to support a critical review of the topic. A modified Critical Appraisal Skills Programme quality assessment checklist was used across suitable studies and a descriptive statistics approach was adopted to present the findings.
RESULTS
Seven studies, largely retrospective reviews, met the inclusion criteria. The findings showed 26% of patients had an arrhythmia on initial presentation (n = 364/1234) with incidences of sinus tachycardia, sinus bradycardia and premature ventricular contractions. However, making definitive statements is challenging due to the lack of access to individual patients' past ECGs. Within these arrhythmias' ST segment changes, atrial fibrillation and long QT syndrome could be considered potentially significant, however associated prognosis with these and electrical injuries is unknown. Only six (0.5%) patients required treatment by drug therapy, and a further three died from associated complications. Most patients with a normal ECG were discharged immediately with only a limited follow-up. No presentation of a 'delayed arrhythmia' was identified throughout the studies.
CONCLUSION
The data for low-voltage electrical injuries are limited, but the potential arrhythmias for this patient group seldom require intervention. The entity of the 'delayed arrhythmia' may not be a reason to admit or monitor patients for prolonged periods. Further studies should consider the safety profile of discharging a patient with a normal ECG.
PubMed: 38046790
DOI: 10.29045/14784726.2023.12.8.3.27 -
Journal of Global Health Dec 2023Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from...
BACKGROUND
Prior research has demonstrated that low- and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature.
METHODS
A search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020.
RESULTS
A total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%).
CONCLUSIONS
This review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings.
REGISTRATION
PROSPERO CRD42019146802.
Topics: Infant; Adult; Humans; Child; Aged; Critical Illness; Delivery of Health Care; Poverty; Critical Care
PubMed: 38033248
DOI: 10.7189/jogh.13.04141 -
Annals of Emergency Medicine May 2024Traumatic injury causes a significant number of deaths due to bleeding. Tranexamic acid (TXA), an antifibrinolytic agent, can reduce bleeding in traumatic injuries and... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
Traumatic injury causes a significant number of deaths due to bleeding. Tranexamic acid (TXA), an antifibrinolytic agent, can reduce bleeding in traumatic injuries and potentially enhance outcomes. Previous reviews suggested potential TXA benefits but did not consider the latest trials.
METHODS
A systematic review and bias-adjusted meta-analysis were performed to assess TXA's effectiveness in emergency traumatic injury settings by pooling estimates from randomized controlled trials. Researchers searched Medline, Embase, and Cochrane Central for randomized controlled trials comparing TXA's effects to a placebo in emergency trauma cases. The primary endpoint was 1-month mortality. The methodological quality of the trials underwent assessment using the MASTER scale, and the meta-analysis applied the quality-effects method to adjust for methodological quality.
RESULTS
Seven randomized controlled trials met the set criteria. This meta-analysis indicated an 11% decrease in the death risk at 1 month after TXA use (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.84 to 0.95) with a number needed to treat of 61 to avoid 1 additional death. The meta-analysis also revealed reduced 24-hour mortality (OR 0.76, 95% CI 0.65 to 0.88) for TXA. No compelling evidence of increased vascular occlusive events emerged (OR 0.96, 95% CI 0.73 to 1.27). Subgroup analyses highlighted TXA's effectiveness in general trauma versus traumatic brain injury and survival advantages when administered out-of-hospital versus inhospital.
CONCLUSIONS
This synthesis demonstrates that TXA use for trauma in emergencies leads to a reduction in 1-month mortality, with no significant evidence of problematic vascular occlusive events. Administering TXA in the out-of-hospital setting is associated with reduced mortality compared to inhospital administration, and less mortality with TXA in systemic trauma is noted compared with traumatic brain injury specifically.
Topics: Humans; Tranexamic Acid; Randomized Controlled Trials as Topic; Hemorrhage; Antifibrinolytic Agents; Brain Injuries, Traumatic; Vascular Diseases
PubMed: 37999653
DOI: 10.1016/j.annemergmed.2023.10.004 -
BMC Emergency Medicine Nov 2023One of the most significant advantages of Helicopter Emergency Medical Service (HEMS) in disaster relief efforts is their ability to reach inaccessible or remote areas...
BACKGROUND
One of the most significant advantages of Helicopter Emergency Medical Service (HEMS) in disaster relief efforts is their ability to reach inaccessible or remote areas quickly. This is especially important in the aftermath of natural disasters such as earthquakes, floods, or hurricanes, where roads may be blocked or damaged, and conventional ground transportation may not be available. There are many factors can affect the performance of Helicopter Emergency Medical Service (HEMS) in disasters. This study aims to investigate the factors affecting the Helicopter Emergency Medical Service (HEMS) in disasters.
METHODS
The systematic search in Cochran Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, and Google Scholar databases between the first of January in 1975 and the thirty-first of May in 2023. The articles were selected based on the keywords of the authors. At last, the criteria were extracted from the selected ones.
RESULTS
The primary search included 839 articles. After studying their title, abstract, and full context, only nine articles, including two qualitative and seven quantitative ones, were chosen for analysis. After analysis and extracting data from the final studies, the preparation factors were categorized into 6 general classes of human resources: training and practicing, management, instructions and standards, equipment, and structure. Among these, the role of training is highlighted by holding practice and maneuvers to improve and prepare the personnel and manage disasters and incidents.
CONCLUSION
The results obtained from this systematic review provide a total view of the factors affecting the preparation of the air ambulance during disasters and incidents. It is recommended that senior managers and policy makers use the findings of the present study to identify the factors which affect preparedness of HEMS in disasters and take the necessary measures to eliminate to obstacles.
Topics: Humans; Emergency Medical Services; Aircraft; Air Ambulances; Disasters; Earthquakes
PubMed: 37953223
DOI: 10.1186/s12873-023-00908-5 -
Prehospital and Disaster Medicine Dec 2023The use of telemedicine for the prehospital management of emergency conditions, especially stroke, is increasing day by day. Few studies have investigated the... (Review)
Review
INTRODUCTION
The use of telemedicine for the prehospital management of emergency conditions, especially stroke, is increasing day by day. Few studies have investigated the applications of telemedicine in Emergency Medical Services (EMS). A comprehensive study of the applications of this technology in stroke patients in ambulances can help to build a better understanding. Therefore, this systematic review was conducted to investigate the use of telemedicine in ambulances for stroke patients in 2023.
METHODS
A systematic search was conducted in PubMed, Cochrane, Scopus, ProQuest, Science Direct, and Web of Science from 2013 through March 1, 2023. The authors selected the articles based on keywords and criteria and reviewed them in terms of title, abstract, and full text. Finally, the articles that were related to the study aim were evaluated.
RESULTS
The initial search resulted in the extraction of 2,795 articles. After review of the articles, and applying the inclusion and exclusion criteria, seven articles were selected for the final analysis. Three (42.85%) studies were on the feasibility and intervention types. Also, randomized trials, feasibility, feasibility and prospective-observational, and feasibility and retrospective-interventional studies were each one (14.28%). Six (85.71%) of the studies were conducted in the United States. The National Institutes of Health Stroke Scale (NIHSS) and RP-Xpress were the most commonly used tools for neurological evaluations and teleconsultations.
CONCLUSION
Remote prehospital consultations, triage, and sending patient data before they go to the emergency department can be provided through telemedicine in ambulances. Neurological evaluations via telemedicine are reliable and accurate, and they are almost equal to in-person evaluations by a neurologist.
Topics: Humans; United States; Ambulances; Retrospective Studies; Prospective Studies; Telemedicine; Emergency Medical Services; Stroke
PubMed: 37877359
DOI: 10.1017/S1049023X23006519 -
The Cochrane Database of Systematic... Oct 2023Outcome after acute spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is influenced by haematoma volume. ICH expansion occurs in about 20% of people with acute... (Review)
Review
BACKGROUND
Outcome after acute spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is influenced by haematoma volume. ICH expansion occurs in about 20% of people with acute ICH. Early haemostatic therapy might improve outcome by limiting ICH expansion. This is an update of a Cochrane Review first published in 2006, and last updated in 2018.
OBJECTIVES
To examine 1. the effects of individual classes of haemostatic therapies, compared with placebo or open control, in adults with acute spontaneous ICH, and 2. the effects of each class of haemostatic therapy according to the use and type of antithrombotic drug before ICH onset.
SEARCH METHODS
We searched the Cochrane Stroke Trials Register, CENTRAL (2022, Issue 8), MEDLINE Ovid, and Embase Ovid on 12 September 2022. To identify further published, ongoing, and unpublished randomised controlled trials (RCTs), we scanned bibliographies of relevant articles and searched international registers of RCTs in September 2022.
SELECTION CRITERIA
We included RCTs of any haemostatic intervention (i.e. procoagulant treatments such as clotting factor concentrates, antifibrinolytic drugs, platelet transfusion, or agents to reverse the action of antithrombotic drugs) for acute spontaneous ICH, compared with placebo, open control, or an active comparator.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcome was death/dependence (modified Rankin Scale (mRS) 4 to 6) by day 90. Secondary outcomes were ICH expansion on brain imaging after 24 hours, all serious adverse events, thromboembolic adverse events, death from any cause, quality of life, mood, cognitive function, Barthel Index score, and death or dependence measured on the Extended Glasgow Outcome Scale by day 90.
MAIN RESULTS
We included 20 RCTs involving 4652 participants: nine RCTs of recombinant activated factor VII (rFVIIa) versus placebo/open control (1549 participants), eight RCTs of antifibrinolytic drugs versus placebo/open control (2866 participants), one RCT of platelet transfusion versus open control (190 participants), and two RCTs of prothrombin complex concentrates (PCC) versus fresh frozen plasma (FFP) (47 participants). Four (20%) RCTs were at low risk of bias in all criteria. For rFVIIa versus placebo/open control for spontaneous ICH with or without surgery there was little to no difference in death/dependence by day 90 (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.74 to 1.05; 7 RCTs, 1454 participants; low-certainty evidence). We found little to no difference in ICH expansion between groups (RR 0.81, 95% CI 0.56 to 1.16; 4 RCTs, 220 participants; low-certainty evidence). There was little to no difference in all serious adverse events and death from any cause between groups (all serious adverse events: RR 0.81, 95% CI 0.30 to 2.22; 2 RCTs, 87 participants; very low-certainty evidence; death from any cause: RR 0.78, 95% CI 0.56 to 1.08; 8 RCTs, 1544 participants; moderate-certainty evidence). For antifibrinolytic drugs versus placebo/open control for spontaneous ICH, there was no difference in death/dependence by day 90 (RR 1.00, 95% CI 0.93 to 1.07; 5 RCTs, 2683 participants; high-certainty evidence). We found a slight reduction in ICH expansion with antifibrinolytic drugs for spontaneous ICH compared to placebo/open control (RR 0.86, 95% CI 0.76 to 0.96; 8 RCTs, 2866 participants; high-certainty evidence). There was little to no difference in all serious adverse events and death from any cause between groups (all serious adverse events: RR 1.02, 95% CI 0.75 to 1.39; 4 RCTs, 2599 participants; high-certainty evidence; death from any cause: RR 1.02, 95% CI 0.89 to 1.18; 8 RCTs, 2866 participants; high-certainty evidence). There was little to no difference in quality of life, mood, or cognitive function (quality of life: mean difference (MD) 0, 95% CI -0.03 to 0.03; 2 RCTs, 2349 participants; mood: MD 0.30, 95% CI -1.98 to 2.57; 2 RCTs, 2349 participants; cognitive function: MD -0.37, 95% CI -1.40 to 0.66; 1 RCTs, 2325 participants; all high-certainty evidence). Platelet transfusion likely increases death/dependence by day 90 compared to open control for antiplatelet-associated ICH (RR 1.29, 95% CI 1.04 to 1.61; 1 RCT, 190 participants; moderate-certainty evidence). We found little to no difference in ICH expansion between groups (RR 1.32, 95% CI 0.91 to 1.92; 1 RCT, 153 participants; moderate-certainty evidence). There was little to no difference in all serious adverse events and death from any cause between groups (all serious adverse events: RR 1.46, 95% CI 0.98 to 2.16; 1 RCT, 190 participants; death from any cause: RR 1.42, 95% CI 0.88 to 2.28; 1 RCT, 190 participants; both moderate-certainty evidence). For PCC versus FFP for anticoagulant-associated ICH, the evidence was very uncertain about the effect on death/dependence by day 90, ICH expansion, all serious adverse events, and death from any cause between groups (death/dependence by day 90: RR 1.21, 95% CI 0.76 to 1.90; 1 RCT, 37 participants; ICH expansion: RR 0.54, 95% CI 0.23 to 1.22; 1 RCT, 36 participants; all serious adverse events: RR 0.27, 95% CI 0.02 to 3.74; 1 RCT, 5 participants; death from any cause: RR 0.49, 95% CI 0.16 to 1.56; 2 RCTs, 42 participants; all very low-certainty evidence).
AUTHORS' CONCLUSIONS
In this updated Cochrane Review including 20 RCTs involving 4652 participants, rFVIIa likely results in little to no difference in reducing death or dependence after spontaneous ICH with or without surgery; antifibrinolytic drugs result in little to no difference in reducing death or dependence after spontaneous ICH, but result in a slight reduction in ICH expansion within 24 hours; platelet transfusion likely increases death or dependence after antiplatelet-associated ICH; and the evidence is very uncertain about the effect of PCC compared to FFP on death or dependence after anticoagulant-associated ICH. Thirteen RCTs are ongoing and are likely to increase the certainty of the estimates of treatment effect.
Topics: Adult; Humans; Hemostatics; Antifibrinolytic Agents; Fibrinolytic Agents; Cerebral Hemorrhage; Stroke; Anticoagulants
PubMed: 37870112
DOI: 10.1002/14651858.CD005951.pub5