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Recommendations and Guidelines for the Use of Simulation to Address Structural Racism and Implicit Bias

Vora, Samreen; Dahlen, Brittany; Adler, Mark; Kessler, David O; Jones, V Faye; Kimble, Shelita; Calhoun, Aaron
SUMMARY STATEMENT/CONCLUSIONS:Simulation-based education is a particularly germane strategy for addressing the difficult topic of racism and implicit bias due to its immersive nature and the paradigm of structured debriefing. Researchers have proposed actionable frameworks for implicit bias education, particularly outlining the need to shift from recognition to transformation, with the goal of changing discriminatory behaviors and policies. As simulation educators tasked with training health care professionals, we have an opportunity to meet this need for transformation. Simulation can shift behaviors, but missteps in design and implementation when used to address implicit bias can also lead to negative outcomes. The focus of this article is to provide recommendations to consider when designing simulation-based education to specifically address racism and implicit bias.
PMID: 34398114
ISSN: 1559-713x
CID: 5032412

Causes for Pauses During Simulated Pediatric Cardiac Arrest

Kessler, David Oren; Peterson, Dawn Taylor; Bragg, Alexis; Lin, Yiqun; Zhong, John; Duff, Jonathan; Adler, Mark; Brown, Linda; Bhanji, Farhan; Davidson, Jennifer; Grant, David; Cheng, Adam
OBJECTIVES/OBJECTIVE:Pauses in cardiopulmonary resuscitation negatively impact clinical outcomes; however, little is known about the contributing factors. The objective of this study is to determine the frequency, duration, and causes for pauses during cardiac arrest. DESIGN/METHODS:This is a secondary analysis of video data collected from a prospective multicenter trial. Twenty-six simulated pediatric cardiac arrest scenarios each lasting 12 minutes in duration were analyzed by two independent reviewers to document events surrounding each pause in chest compressions. SETTING/METHODS:Ten children's hospitals across Canada, the United, and the United Kingdom. SUBJECTS/METHODS:Resuscitation teams composed of three healthcare providers trained in cardiopulmonary resuscitation. INTERVENTIONS/METHODS:A simulated pediatric cardiac arrest case in a 5 year old. MEASUREMENTS AND MAIN RESULTS/RESULTS:The frequency, duration, and associated factors for each pause were recorded. Communication was rated using a four-point scale reflecting the team's shared mental model. Two hundred fifty-six pauses were reviewed with a median of 10 pauses per scenario (interquartile range, 7-12). Median pause duration was 5 seconds (interquartile range, 2-9 s), with 91% chest compression fraction per scenario (interquartile range, 88-94%). Only one task occurred during most pauses (66%). The most common tasks were a change of chest compressors (25%), performing pulse check (24%), and performing rhythm check (15%). Forty-nine (19%) of the pauses lasted greater than 10 seconds and were associated with shock delivery (p < 0.001), performing rhythm check (p < 0.001), and performing pulse check (p < 0.001). When a shared mental model was rated high, pauses were significantly shorter (mean difference, 4.2 s; 95% CI, 1.6-6.8 s; p = 0.002). CONCLUSIONS:Pauses in cardiopulmonary resuscitation occurred frequently during simulated pediatric cardiac arrest, with variable duration and underlying causes. A large percentage of pauses were greater than 10 seconds and occurred more frequently than the recommended 2-minute interval. Future efforts should focus on improving team coordination to minimize pause frequency and duration.
PMID: 28598948
ISSN: 1529-7535
CID: 5032272

A major pain in the … Back and epigastrium: an unusual case of spontaneous celiac artery dissection

Patel, Kumkum Sarkar; Benshar, Orel; Vrabie, Raluca; Patel, Anik; Adler, Marc; Hines, George
A 60-year-old woman with mitral valve prolapse, chronic low back pain, and a 30-pack year smoking history presented for a second admission of poorly controlled mid-back pain 10 days after her first admission. She had concomitant epigastric pain, sharp/burning in quality, radiating to the right side and to the mid-back, not associated with food nor improving with pain medications. She denied nausea, vomiting, diarrhea, constipation, dark stools, or blood per rectum. Our purpose was to determine the cause of the patient's epigastric pain. Physical examination revealed epigastric and mid-back tenderness on palpation. Labs were normal except for a hemoglobin drop from 14 to 12.1 g/dL over 2 days. Abdominal ultrasound and subsequent esophagogastroduodenoscopy were normal. Contrast-enhanced abdominal computed tomographic (CT) scan revealed the development of a spontaneous celiac artery dissection as the cause of the epigastric pain. The patient was observed without stenting and subsequent CT angiography 4 days later did not reveal worsening of the dissection. She was discharged on aspirin and clopidogrel with outpatient follow-up. Thus far, less than 100 cases of isolated spontaneous celiac artery dissections have been reported. The advent of CT scans and magnetic resonance imaging has increasingly enabled its detection. Risk factors may include hypertension, arteriosclerosis, smoking, and cystic medial necrosis. There is a 5:1 male to female ratio with an average presenting age of 55. Management of dissections may include surgical repair, endovascular stenting, and selective embolization. Limited dissections can be managed conservatively with anti-platelet and/or anticoagulation agents and strict blood pressure control, as done in our patient.
PMID: 25432642
ISSN: 2000-9666
CID: 3426422

A Major Pain in the ... Back and Epigastrium: An Unusual Case of Spontaneous Celiac Artery Dissection [Meeting Abstract]

Patel, Kumkum; Benshar, Orel; Vrabie, Raluca; Patel, Anik; Adler, Marc; Hines, George
ISSN: 0002-9270
CID: 3496032