bluuebunny/crossref_metadata_2025_split huggingface dataset:
USING SIMULATION TO IMPROVE PROFESSIONAL PERFORMANCE OF CRITICAL CARE NURSES AT KING ABDUL-AZIZ MEDICAL CITY, RIYADH
Authors: Aljuaid Maha 
Published: May 2015

IntroductionHealth care institutions strive to develop orientation programs that are effective and efficient to prepare nurses entering to critical care. Clinical education must have combined knowledge of physical, behavioural and technical clinical education (American Association of Critical Care Nurses, 2004).Objectives:1. To identify the effect of simulation based education in standardizing nursing orientation2. To share the experience of KAMC-R in utilizing simulation education to improve patient safety and the quality of careBackgroundSimulation provides safe learning environment, allows debriefing, and stimulates critical thinking skills (Critical Care Nursing, 2007). Neuro Critical Care unit (NCCU) at King Abdul-Aziz Medical City (KAMC-R) faces influx of new nurses; therefore continuous education is imperative to those nurses. Simulation education strategy is utilized to improve technical and non-technical skills for new nurses. The critical care collaborative leadership adopted simulation based education to replace the old nursing orientation. The new‖orientation program piloted in Trauma ICU and Surgical ICU for two months, it was then implemented into all adult critical care units.MethodologyClinical resource nurses (CRNs) are the educators who run the program to the new staff. Clinical skills are validated by using Mosby skills checklist in which nurses demonstrate the skills on high fidelity simulation manikins.ResultsDecember 2010, nurses' anecdotal reports used to evaluate the experience of NCCU in utilizing simulation education. 32 nurses reported increase nursing knowledge, and improve technical skills. April 2014, survey was conducted to evaluate the effectiveness of the new orientation participated by CRNs, practice facilitators, and new nurses. The result showed that using of simulation enhances nursing knowledge and skills, simulation activities are engaging, and staffs build more confidence.ConclusionA healthy learning environment is essential for optimal nursing training. Nursing orientation requires abundant resources to ensure patient safety and competency of critical care nurses.
AN INTRODUCTION TO DEBRIEFING
Authors: Davies Joanne 
Published: May 2015

The interactive workshop will cover the basic elements of Debriefing. Introduce a tool that can guide debriefs. Allow time for expert modelling and practice using the tools provided.Learning ObjectivesBy the end of this session participants should be able to:1. Identify the three different approaches to debriefing2. Identify the defining criteria for using the different approaches3. Describe the value of exploring participant frames4. Describe the RUST model5. Use the OPIC (Observation, Point of View, Inquiry/Curiosity) Cognitive aid to practice debriefing in the learning activityThe Sidra Sim Team would run this interactive session with 4–5 team members.
THE EFFICACY OF MEDICAL SIMULATION COURSE ON IMPROVING ULTRASOUND—GUIDED CENTRAL VENOUS CATHETER INSERTION
Authors: Alyousef Sawsan M , Almaani Mohammed , Zahraa Jihad , Hassan Ali , Lababidi Hani 
Published: May 2015

BackgroundWhile insertion of CVC (central venous catheter) is common, it is an intricate procedure and not risk-free. Traditionally, inexperienced residents learn to insert CVC on real patients and thus can put patients' life at risk. One way to reduce medical errors is to use high-fidelity simulation for training tomorrow's practitioners on ultrasound-guided CVC insertion.ObjectiveTo evaluate the efficacy of medical simulation based learning course on knowledge and skills improvement on ultrasound-guided CVC insertion.MethodsA pre-assessment was performed through a pre-test and hands-on skill assessment for central line insertion under U/S guidance (Internal Jugular, Subclavian or Femoral lines) utilizing a standardized checklist. All candidates then attended one day course that included theoretical and hands-on simulation training using phantoms. A post-test and hands-on assessment was performed at the end of the day.ResultsTwenty residents from Internal Medicine and Paediatrics were enrolled in the study at King Fahad Medical City Simulation Center. There was significant improvement in the knowledge based training: 90% showed significant increase in their MCQ scores (p<0.001), 10% had equal scores and none showed decline in their scores. For the hands-on skills: All 20 candidates showed significant improvement in their skills (p<0.001).ConclusionA one day simulation course on CVC insertion under ultrasound guidance significantly improves the knowledge and skills for residents in training programs.RecommendationsSuch courses and other similar should be compulsory for all Residents training programs as it is called safe training.
TEACHING THE TEACHERS—WHAT EDUCATION AND TRAINING NEEDS ARISE AMONG TEACHERS THROUGH THE USE OF SIMULATION IN THE EDUCATION OF EMS PERSONNEL IN THE GERMAN HEALTH CARE SYSTEM
Authors: Wessels Michael , Geuen Manuel 
Published: May 2015

Background & PurposeThe professional qualifications of paramedics in the emergency services are not uniform at the federal level across Germany. Federalism leads to a considerable heterogeneity of regional regulations and curricula for training at the state-approved emergency services School. This results in an uneven transfer of knowledge of action skills, scientific findings as well as inconsistent application of appropriate teaching methods. Finally, this culminates in an inconsistent qualification of EMS personnel.To illustrate the needs of teachers in simulation in training and continuing education of EMS personnel.MethodsBased on a systematic literature review and expert interviews on training and further education of non-medical personnel in emergency care simulation was analysed as a teaching method from an educational perspective. For a standardized carrying out of the interviews a unified interview guide was used. The statements of the experts were analysed with the software MAXQDA.ResultsThrough simulation, in conjunction with debriefings an outstanding benefit for the direct learning from mistakes is made possible, both in the whole group as well as in the setting of reality (train where you work). This supports a long-needed culture of errors in emergency service as well as improving patient safety in emergency response. This requires intensive training of the teaching staff in pedagogy and technology. Further research needs were identified for potential fields of application of simulation in the training of EMS personnel.ConclusionsSimulation provides for the training of emergency services personnel, particularly in view of the new profession of emergency paramedics (Notfallsanitäter) and their advanced performance skills extensive opportunities. With the help of simulation abilities and skills as well as inter-professional teamwork can be taught and improved individualized. In fact, simulation contributes to improving patient safety and guideline- based care of emergency patients.
HOW TO IMPLEMENT SIMULATION BASED EDUCATION IN A NEW MEDICAL SCHOOL
Authors: Raad Vanda Abi 
Published: May 2015

BackgroundSimulation based Education has become an integral part of medical education from undergraduate to postgraduate levels.Summary of workThe integration of simulation into a medical curriculum requires informed implementation in ways that take advantage of simulation's unique ability to facilitate guided application of new knowledge. Simulation offers an experiential learning environment that is ideally suited to the goal-directed learning needed in undergraduate and postgraduate education. Various types of curricula might be developed such as cognitive, communication and procedural skills. Also, a broad range of simulation methodologies can be employed to service the specific educational programs. Part-task trainers, mannequin-based simulation, virtual reality, in-situ techniques, hybrid configurations, screen-based simulations and encounters with ‘standardized’ patients, nurses or physician colleagues all can play a role in the anaesthesia curriculum. Determining which components of a curriculum are enhanced using simulation-based education, and incorporating the exercises into the existing model, result in more goal directed and sustained use of the tool.Summary of resultsExamples of the integration of simulation based education in the undergraduate and postgraduate curriculum at the Lebanese American University-School of Medicine will be discussed.ConclusionsTo optimize both the learning and assessment experience of simulation, educators should remember the principles of effective simulation, the advantages/disadvantages of simulation as well as the goals-tools match.
DEVELOPMENT OF A JOINT INJECTION/ASPIRATION SIMULATION COURSE FOR SPECIALITY TRAINEES IN RHEUMATOLOGY
Authors: Omer Rasha , Sabanathan Anetha , Dunkley Lisa , Purva Makani 
Published: May 2015

BackgroundThe JRCPTB* Training curriculum for Rheumatology mandates that trainees should be able to:1. Describe the surface anatomy of the musculoskeletal system2. Gain competences in joint and soft tissue injections.This is usually achieved in an informal basis. Simulation can provide a realistic learning opportunity to develop this skill. We designed and ran a simulation course to aid trainees in achieving these competencies.Methodology10 junior rheumatology trainees were invited to participate. The course started with a lecture which covered indications and contraindications to procedures including a summary of results from a regional survey of Rheumatology consultants and registrars on joint injection techniques. Faculty consisted of 4 Rheumatology Consultants and 3 Senior Registrars. At least one faculty member per station was present to provide instructions. Actors were used to demonstrate knee, shoulder and ankle/foot surface anatomy. Instructors demonstrated elbow, hand and wrist anatomy on themselves. Self-reported level of confidence using Likert score Pre and Post workshop questionnaires were used for evaluation.Results9/10 of the trainees felt that the session met their learning objectives. Confidence levels increased non-significantly in performing wrist, carpel tunnel, glenohumeral, subacromial and knee injection. Confidence levels increased significantly in performing ankle, acromoclavicular, elbow and epicondyle injections.ConclusionsIt is possible to successfully run a simulated joint injection course which can improve confidence levels in trainees.
REVIEW OF A PILOT STUDY, INTRODUCING LAB TUTOR™ SOFTWARE TO FINAL YEAR NURSING STUDENTS (N=95) WITH THE AIM OF IMPROVING THEIR SIMULATED LEARNING EXPERIENCE
Authors: Simpson Jack 
Published: May 2015

BackgroundOnline simulation provides an alternative approach to hands-on simulation and a number of software packages are becoming available to educators. Lab Tutor™ is an online, immersive learning platform, which aims to bridge the gap between theory and practice, by using real patient case studies along with interactive exercises. We introduced Lab Tutor™ software as an integral part of our year 3 clinical skills module, alongside the use of the SimMan 3G Advanced Human Patient Simulator (AHPS), with the aim of providing students with a more immersive simulation experience.MethodologyWe introduced LabTutor™ to final year nursing students at the beginning of an 11-week clinical skills module. On completion of the module we evaluated the use of the software and whether the students considered that using the interactive software improved their knowledge of disease processes and management of patients.ResultsWe will present the evaluation results from this pilot study. However, early feedback from students indicates that the introduction of LabTutor™ improved understanding of disease processes as well as their management. We are also in the process of developing a number of patient scenarios, using existing LabTutor™ patients, for use on the SimMan 3G AHPS. We also hope to present the early outcomes of this development.
Does transport time help explain the high trauma mortality rates in rural areas? New and traditional predictors assessed by new and traditional statistical methods
Authors: Røislien Jo , Lossius Hans Morten , Kristiansen Thomas 
Published: May 2015

BackgroundTrauma is a leading global cause of death. Trauma mortality rates are higher in rural areas, constituting a challenge for quality and equality in trauma care. The aim of the study was to explore population density and transport time to hospital care as possible predictors of geographical differences in mortality rates, and to what extent choice of statistical method might affect the analytical results and accompanying clinical conclusions.MethodsUsing data from the Norwegian Cause of Death registry, deaths from external causes 1998–2007 were analysed. Norway consists of 434 municipalities, and municipality population density and travel time to hospital care were entered as predictors of municipality mortality rates in univariate and multiple regression models of increasing model complexity. We fitted linear regression models with continuous and categorised predictors, as well as piecewise linear and generalised additive models (GAMs). Models were compared using Akaike's information criterion (AIC).ResultsPopulation density was an independent predictor of trauma mortality rates, while the contribution of transport time to hospital care was highly dependent on choice of statistical model. A multiple GAM or piecewise linear model was superior, and similar, in terms of AIC. However, while transport time was statistically significant in multiple models with piecewise linear or categorised predictors, it was not in GAM or standard linear regression.ConclusionsPopulation density is an independent predictor of trauma mortality rates. The added explanatory value of transport time to hospital care is marginal and model-dependent, highlighting the importance of exploring several statistical models when studying complex associations in observational data.
Republished: Antiplatelet therapy for secondary prevention of coronary artery disease
Authors: Pilgrim Thomas , Windecker Stephan 
Published: May 2015

ABSTRACT
The choice and duration of antiplatelet therapy for secondary prevention of coronary artery disease (CAD) is determined by the clinical context and treatment strategy. Oral antiplatelet agents for secondary prevention include the cyclo-oxygenase-1 inhibitor aspirin, and the ADP dependent P2Y12 inhibitors clopidogrel, prasugrel and ticagrelor. Aspirin constitutes the cornerstone in secondary prevention of CAD and is complemented by clopidogrel in patients with stable CAD undergoing percutaneous coronary intervention. Among patients with acute coronary syndrome, prasugrel and ticagrelor improve net clinical outcome by reducing ischaemic adverse events at the expense of an increased risk of bleeding as compared with clopidogrel. Prasugrel appears particularly effective among patients with ST elevation myocardial infarction to reduce the risk of stent thrombosis compared with clopidogrel, and offered a greater net clinical benefit among patients with diabetes compared with patients without diabetes. Ticagrelor is associated with reduced mortality without increasing the rate of coronary artery bypass graft (CABG)-related bleeding as compared with clopidogrel. Dual antiplatelet therapy should be continued for a minimum of 1 year among patients with acute coronary syndrome irrespective of stent type; among patients with stable CAD treated with new generation drug-eluting stents, available data suggest no benefit to prolong antiplatelet treatment beyond 6 months.
Quantifying the Landscape for Development and Cancer from a Core Cancer Stem Cell Circuit
Authors: Li Chunhe , Wang Jin 
Published: May 2015

Abstract
Cancer presents a serious threat to human health. The understanding of the cell fate determination during development and tumor-genesis remains challenging in current cancer biology. It was suggested that cancer stem cell (CSC) may arise from normal stem cells or be transformed from normal differentiated cells. This gives hints on the connection between cancer and development. However, the molecular mechanisms of these cell-type transitions and the CSC formation remain elusive. We quantified landscape, dominant paths, and switching rates between cell types from a core gene regulatory network for cancer and development. Stem cell, CSC, cancer, and normal cell types emerge as basins of attraction on associated landscape. The dominant paths quantify the transition processes among CSC, stem cell, normal cell, and cancer cell attractors. Transition actions of the dominant paths are shown to be closely related to switching rates between cell types, but not always to the barriers in between, because of the presence of the curl flux. During the process of P53 gene activation, landscape topography changes gradually from a CSC attractor to a normal cell attractor. This confirms the roles of P53 of preventing the formation of CSC through suppressing self-renewal and inducing differentiation. By global sensitivity analysis according to landscape topography and action, we identified key regulations determining cell-type switchings and suggested testable predictions. From landscape view, the emergence of the CSCs and the associated switching to other cell types are the results of underlying interactions among cancer and developmental marker genes. This indicates that the cancer and development are intimately connected. This landscape and flux theoretical framework provides a quantitative way to understand the underlying mechanisms of CSC formation and interplay between cancer and development. Cancer Res; 75(13); 2607–18. ©2015 AACR.
Response to MET Inhibitors in Patients with Stage IV Lung Adenocarcinomas Harboring MET Mutations Causing Exon 14 Skipping
Authors: Paik Paul K. , Drilon Alexander , Fan Pang-Dian , Yu Helena , Rekhtman Natasha , Ginsberg Michelle S. , Borsu Laetitia , Schultz Nikolaus , Berger Michael F. , Rudin Charles M. , Ladanyi Marc 
Published: May 2015

Abstract
Mutations in the MET exon 14 RNA splice acceptor and donor sites, which lead to exon skipping, deletion of the juxtamembrane domain containing the CBL E3-ubiquitin ligase-binding site, and decreased turnover of the resultant aberrant MET protein, were previously reported to be oncogenic in preclinical models. We now report responses to the MET inhibitors crizotinib and cabozantinib in four patients with stage IV lung adenocarcinomas harboring mutations leading to MET exon 14 skipping, highlighting a new therapeutic strategy for the 4% of lung adenocarcinoma patients whose tumors harbor this previously underappreciated genetic alteration.
Significance: Oncogenic mutations in the MET exon 14 splice sites that cause exon 14 skipping occur in 4% of lung adenocarcinomas. We report responses to the MET inhibitors crizotinib and cabozantinib in patients with lung adenocarcinomas harboring MET exon 14 splice site mutations, identifying a new potential therapeutic target in this disease. Cancer Discov; 5(8); 842–9. ©2015 AACR.
See related commentary by Ma, p. 802.
See related article by Frampton et al., p. 850.
This article is highlighted in the In This Issue feature, p. 783
Activation of MET via Diverse Exon 14 Splicing Alterations Occurs in Multiple Tumor Types and Confers Clinical Sensitivity to MET Inhibitors
Authors: Frampton Garrett M. , Ali Siraj M. , Rosenzweig Mark , Chmielecki Juliann , Lu Xinyuan , Bauer Todd M. , Akimov Mikhail , Bufill Jose A. , Lee Carrie , Jentz David , Hoover Rick , Ou Sai-Hong Ignatius , Salgia Ravi , Brennan Tim , Chalmers Zachary R. , Jaeger Savina , Huang Alan , Elvin Julia A. , Erlich Rachel , Fichtenholtz Alex , Gowen Kyle A. , Greenbowe Joel , Johnson Adrienne , Khaira Depinder , McMahon Caitlin , Sanford Eric M. , Roels Steven , White Jared , Greshock Joel , Schlegel Robert , Lipson Doron , Yelensky Roman , Morosini Deborah , Ross Jeffrey S. , Collisson Eric , Peters Malte , Stephens Philip J. , Miller Vincent A. 
Published: May 2015

Abstract
Focal amplification and activating point mutation of the MET gene are well-characterized oncogenic drivers that confer susceptibility to targeted MET inhibitors. Recurrent somatic splice site alterations at MET exon 14 (METex14) that result in exon skipping and MET activation have been characterized, but their full diversity and prevalence across tumor types are unknown. Here, we report analysis of tumor genomic profiles from 38,028 patients to identify 221 cases with METex14 mutations (0.6%), including 126 distinct sequence variants. METex14 mutations are detected most frequently in lung adenocarcinoma (3%), but also frequently in other lung neoplasms (2.3%), brain glioma (0.4%), and tumors of unknown primary origin (0.4%). Further in vitro studies demonstrate sensitivity to MET inhibitors in cells harboring METex14 alterations. We also report three new patient cases with METex14 alterations in lung or histiocytic sarcoma tumors that showed durable response to two different MET-targeted therapies. The diversity of METex14 mutations indicates that diagnostic testing via comprehensive genomic profiling is necessary for detection in a clinical setting.
Significance: Here we report the identification of diverse exon 14 splice site alterations in MET that result in constitutive activity of this receptor and oncogenic transformation in vitro. Patients whose tumors harbored these alterations derived meaningful clinical benefit from MET inhibitors. Collectively, these data support the role of METex14 alterations as drivers of tumorigenesis, and identify a unique subset of patients likely to derive benefit from MET inhibitors. Cancer Discov; 5(8); 850–9. ©2015 AACR.
See related commentary by Ma, p. 802.
See related article by Paik et al., p. 842.
This article is highlighted in the In This Issue feature, p. 783
STAT1-Induced HLA Class I Upregulation Enhances Immunogenicity and Clinical Response to Anti-EGFR mAb Cetuximab Therapy in HNC Patients
Authors: Srivastava Raghvendra M. , Trivedi Sumita , Concha-Benavente Fernando , Hyun-bae Jie , Wang Lin , Seethala Raja R. , Branstetter Barton F. , Ferrone Soldano , Ferris Robert L. 
Published: May 2015

AbstractThe goal of this study was to characterize the molecular mechanisms underlying cetuximab-mediated upregulation of HLA class I antigen-processing machinery components in head and neck cancer (HNC) cells and to determine the clinical significance of these changes in cetuximab-treated HNC patients. Flow cytometry, signaling studies, and chromatin immunoprecipitation (ChIP) assays were performed using HNC cells treated with cetuximab alone or with Fcγ receptor (FcγR)-bearing lymphocytes to establish the mechanism of EGFR-dependent regulation of HLA APM expression. A prospective phase II clinical trial of neoadjuvant cetuximab was used to correlate HLA class I expression with clinical response in HNC patients. EGFR blockade triggered STAT1 activation and HLA upregulation, in a src homology-containing protein (SHP)-2–dependent fashion, more prominently in HLA-B/C than in HLA-A alleles. EGFR signaling blockade also enhanced IFNγ receptor 1 (IFNAR) expression, augmenting induction of HLA class I and TAP1/2 expression by IFNγ, which was abrogated in STAT1−/− cells. Cetuximab enhanced HNC cell recognition by EGFR853–861-specific CTLs, and notably enhanced surface presentation of a non-EGFR peptide (MAGE-3271–279). HLA class I upregulation was significantly associated with clinical response in cetuximab-treated HNC patients. EGFR induces HLA downregulation through SHP-2/STAT1 suppression. Reversal of HLA class I downregulation was more prominent in clinical responders to cetuximab therapy, supporting an important role for adaptive immunity in cetuximab antitumor activity. Abrogating EGFR-induced immune escape mechanisms and restoring STAT1 signaling to reverse HLA downregulation using cetuximab should be combined with strategies to enhance adaptive cellular immunity. Cancer Immunol Res; 3(8); 936–45. ©2015 AACR.