8th International Conference on

Healthcare Simulation

Scientific Program

Keynote Session:

Meetings International -  Conference Keynote Speaker Lawrence Wierzbowski photo

Lawrence Wierzbowski

Avatrode LLC, USA

Title: The potential value of simulation for intraoperative neurophysiologic monitoring

Biography:

Lawrence Wierzbowski is a neurophysiologist for over 25 years has numerous published peer reviewed articles and has contributed to book chapters on IONM.  He earned his doctorate degree from the University of Florida. He has been an invited speaker multiple times for several organizations including ICCN, ASET, ASNM, CSET, SSET, and SNACC at the World Congress of Anesthesiologists. He earned the DABNM and BCS-IOM board certifications. He reviews for the Journal of Clinical Neurophysiology and was awarded Fellowship in ASNM for his research and service to the profession. He has served as IONM faculty in both Canada and Australia for college level IONM courses.

Abstract:

There are many surgeries that utilize Intraoperative Neurophysiologic Monitoring (IONM) but most surgery has a low incidence of potentially catastrophic neural complications. Diab et al., reviewed adolescent idiopathic scoliosis surgery and reported a low complication rate of 0.69%. How does an IONM neurophysiologist gain the knowledge and skills to optimize patient safety when there are so few events that lead to paraplegia? Rodriguez-Paz comments that current medical training is insufficient and presents a source of preventable harm to patients. They propose that any training paradigm must include a medically simulated environment. Prior studies have reported that a major advantage of simulation is “Time Compression”. Our present study constructed a virtual reality environment that includes all elements of surgical neurophysiologic monitoring from the initial patient interview up to a possible iatrogenic surgical event requiring the simulation participant to make a major decision and then explore the consequences of that decision. This process was compared to actual surgical times for a like event and essentially 1.75 hours of surgery was compressed to 6 minutes. This study showed a simulated surgery can be practiced multiple times and consequences of both good and bad decisions can be examined. It is recommended that relative to a control group, practitioners using surgical simulation be evaluated post-training for benefits in declarative knowledge, procedural knowledge, long term retention and self-efficacy.

Meetings International -  Conference Keynote Speaker Swapnil Pawar photo

Swapnil Pawar

St George Hospital, Australia

Title: Identification of latent safety threats through simulation – Making hospital a safer place

Biography:

Swapnil Pawar is well recognized expert in simulation and currently undertaking PhD to evaluate effects of emotion on working memory resource depletion. He has completed his advance training in Simulation at CMS Boston and is currently clinical lead for Simulation at St George Hospital and UNSW. He has recently received grant of 170,000 AUD for simulation based research project to evaluate latent safety threats prior to transitioning to new ICU facility.

Abstract:

Transitioning to a new hospital facility represents a significant challenge to clinicians and institutional leadership, and represents a risk to patient safety if the planned systems, models of care and physical environment are not tested prior to the transition. The challenge is complex - involving workers, the workplace (including technology, equipment, and physical environment), work processes, and the patients who benefit from the work. Healthcare simulation offers a range of methodologies to examine this complex system, identify latent safety threats, and engage clinicians in a shared problem-solving approach. Latent safety threats (LST)s, can be defined as “system-based threats to patient safety that can materialize at any time,” and often go unrecognized by health care professionals, unit directors, or hospital administration. These errors in design, organization, training, or maintenance may have a significant impact on patient safety and, if not recognized and mitigated, could potentially delay management in an emergency situation and/or possibly result in patient harm. Immersive, full-environment (‘‘in situ’’) simulation exercises make it possible to prospectively determine whether newly built clinical facilities allow workflow patterns that foster safe and well-coordinated patient care.

Meetings International -  Conference Keynote Speaker Kerada Krainuwat photo

Kerada Krainuwat

Mahidol University, Thailand

Title: 3D: Health promotion and disease prevention intervention to reduce NCDs problems in primary health care settings

Biography:

Kerada Krainuwat has completed her PhD from School Of Nursing, University of Wisconsin-Madison, USA. She is the Head of Public Health Nursing Department, Faculty of Nursing, Mahidol University, Bangkok, Thailand. She has been worked with community stakeholders and serves as an editorial board member of repute.

Abstract:

NCDs are responsible for deaths and premature deaths worldwide. In Thailand, NCDs results in many serious health problems and decreased patients’ quality of life.  This calls for an immediate action from all NCDs stakeholders to reduce adverse consequences from the diseases and restore quality of life for people with NCDs. Primary care nurse practitioners are one of the health care staff who create and deliver various types of health promotion and disease prevention interventions for patients with NCDs in the primary care settings. “3NO” is a health promotion and disease prevention intervention created to promote healthy diet consumption and reduce unhealthy diet consumption as well. The main idea of the intervention is to reduce the excessive sugar and salt intake for patients, at risk groups, and general population in the community. The “3NO” consists of 3 different actions. The first NO is no consumption of sweeten drinks and beverages, such as soda, concentration fruit and vegetable juice, 3 in 1 mixed coffee and tea. The second NO is any dips served with fresh sweet fruit. The final NO is no extra salt, including fish source, soy source, or additives, added in cooked food, ready to eat meal, or a La Crete. The “3NO” has been implemented at a sub-district local health promoting hospital at Nakhonpathom province in 2011 for feasibility test. This intervention has been accepted by community stakeholders and others. It also supports the health promotion concepts in terms of building a healthy public policy, creating a supportive environment, and strengthening community action to promote healthy lifestyle and reduce the adverse effects of NCDs on people. Today, the “3NO” is upgraded to an excellence model for health promotion and disease prevention, and the intervention has been expanded to many local health departments. The local health promoting hospital has been promoted as a center for teaching-learning center for health promotion and disease prevention for nurses and other health care professions.

Title: Sim mobile unit in primary healthcare

Biography:

Uros Zafosnik is a Registered Nurse. He was working as head nurse of emergency services in CHC Maribor for four years before starting work in emergency services of CHC Ljubljana, where he worked for three years. Curently he is Head and Coordinator of SIM Centre now for five years. He is also international ITLS and MTS instructor and besides that he was involved in a working group designing standards for triage at Ministry of Health Slovenia. He is also a lecturer at Faculty of health sciences Novo Mesto.

Abstract:

The team in family practice often meets life-risk patients. Simulation is an excellent way for health care workers to train their skills in a safe environment. It is an effective, ethical and safe way to practice theoretical knowledge. Trainees acquire experience in simulation in life threatening situation, how to approach acute situation and situations where decisions have consequences. This way we approach the clinical environment as close as we can. But sadly, learning with simulations in healthcare is usually not available to professionals. Contributing factors to this problem are the lack of knowledge and poor equipment combined with high education costs and time shortage in medical teams. We have developed a mobile simulation unit (SIM mobile) that will enable all medical teams in primary healthcare access to modern simulation equipment. We have used SIM mobile to conduct simulations in over 20 diferent locations in Slovenia (Comunity health centres, prehospital units). Participants were doctors of family medicine, nurses and EMT workers. The study was caried out from june 2018 to august 2018. SIM mobile was avaliable for 120 hours in 10 days. Total training time was 120 hours and was used 100% of the time by the participants of the study. SIM mobile provides opportunities for outstanding educational experiences that translate into better patient care and improved provider safety. A mobile simulation experience that can be brought to healthcare professionals in rural and frontier communities, thus reducing the need for providers to travel for training.

Oral Session 1:

  • Primary Healthcare in Nursing | Primary Health Care and Preventive Medicine | Primary Care in Epidemiology | Primary Care and Family Medicine | Clinical Simulation
Speaker

Chair

Kerada Krainuwat

Mahidol University, Thailand

Speaker

Co-Chair

Swapnil Pawar

St George Hospital, Australia

Meetings International -  Conference Keynote Speaker Thomas Sharon photo

Thomas Sharon

Mind Body Solutions, USA

Title: Evidentiary basis for the use of pulsed electromagnetic therapy (PEMF) in primary care for healing and prevention in people with complications of diabetes and in improving cardiac output in patients with congestive heart failure thereby preventing myocardial infarction and death

Biography:

Thomas Sharon has completed his DNP from Brandman University, Irvine, California in October 2015. He is board certified by the American Nurses Credentialing Center in Adult-Gerontological Primary Care. In 2014, while a nurse practitioner student, he was awarded a diabetes research grant by the American Association of Nurse Practitioners for his pioneering work in utilizing pulsed electromagnetic therapy to stimulate angiogenesis in the plantar skin of people with diabetic neuropathy. He is the first researcher to use laser doppler technology for objective measurement of the proficiency of microcirculation. He has published 3 books and more than 12 journal articles. He is currently a primary care provider at Mind Body Solutions in Las Vegas, Nevada, USA and he is developing new research projects.

Abstract:

Diabetic lower extremity ischemia (DLEI) causes approximately 90,000 leg amputations each year in the United States. A review of the literature revealed that sufficient evidence exists to consider using pulsed electromagnetic field (PEMF) therapy as a non-invasive curative modality that could prevent many of these amputations. However, the staggering number of leg amputations following lengthy episodes of ischemic deterioration suggests a lack of consensus as to the efficacy of PEMF. Therefore, the purpose of this study is to provide an evidentiary basis for using PEMF therapy in a primary care setting to promote microvascular angiogenesis and thereby prevent skin ulceration. In this study, 7 people between the ages 54 and 65 who have diabetes mellitus type 2 and some level DLEI underwent 10 to 22 treatments with a Diapulse® PEMF device. Each participant was tested for microvascular red blood cell (RBC) perfusion (Q), volume concentration of moving RBCs (V), RBC speed (U) and temperature (T) in the plantar skin. These parameters were measured using a laser Doppler flowmeter before and after the course of treatment. The Wilcoxon Signed Rank Test showed significant increases in V and decreases in U (p = 0.018 for both) with Q being slightly above the significance level at p = 0.063. These findings are consistent with those found in the literature. Therefore, the use of PEMF for treating chronic wounds should be considered for inclusion in standard Advanced Practice Registered Nursing (APRN) guidelines for evidenced-based practice. However, the results of the pilot study do need to be confirmed by repeating the experiment with a larger sample size. This paper also provides a review of the evidence in the medical literature that demonstrates the development of angiogenesis in heart muscle as a means of reversing congestive heart failure following myocardial ischemia resulting from atherosclerosis in the minute coronary circulation. The available evidence suggests that achieving new collateral circulation in ischemic heart muscle is highly achievable.

Meetings International -  Conference Keynote Speaker Hilda Shilubane photo

Hilda Shilubane

University of Venda, South Africa

Title: Challenges affecting the implementation of the integrated approach to mental health care at PHC setting

Biography:

Hilda Shilubane has completed her PhD from Maastricht University, The Netherlands in 2013. She is an associate professor in the Department of Advanced Nursing at the University of Venda, South Africa and has published more than 28 papers in reputed journals.

Abstract:

The implementation of the integrated approach to mental health care at primary health care (PHC) clinics could pose a challenge to PHC nurses. The study explored the perceptions of the professional nurses on the challenges affecting the implementation of the integrated approach to mental health care.  A qualitative, descriptive and exploratory design was used. The population comprised of PHC nurses working in the Mutale sub-district PHC facilities in Limpopo Province, South Africa. Probability systematic random sampling and purposive sampling were used to obtain a sample of six PHC clinics and 45 PHC nurses respectively. Ethical principles were taken into account. Focus groups and individual interviews were used to collect data. Data analysis was done using Tesch’s open coding method.  Poor management of PHC resources and difficulties in managing psychotic patients were found to affect the implementation of the integrated approach to mental health care at PHC clinics. The study suggests that staff development programs be instituted and staff trained to acquire skills to handle aggressive mentally ill patients.

Meetings International -  Conference Keynote Speaker Visava Srinuttapong photo

Visava Srinuttapong

Luangporpern Community Hospital, Thailand

Title: Development of the health care practice guideline for stroke patients at sub-acute stage using care map in Luangporpern Hospital, Nakhon Pathom Province

Biography:

Dr. Visava Srinuttapong is the second class honors degree, MD, Faculty of Medicine, Chulalongkorn University.Chie of PCT[Patient Care Team], Intermediate care unit, and Paliative care team, Luangporphern Hospital, Nakhonpathom.

Abstract:

This participatory action research conceptualized from problems of subacute stage in stroke patients admitted at Luangporpern hospital for intensive rehabilitation program and found that ADL decreased after discharged. Objective was to develop health care practice guideline for treatment of subacute stroke patients using care map applied from 12 steps conceptual framework of the NHMRC, Australia1. The health care practice guidelines developed by researcher included SOP, stroke clinical care manuals and care map, contents validated by 3 experts (CVR=1). Two sample groups included 10 patients and 12 multidisciplinary personnel, data collection using questionnaires; 1) effectiveness assessment of SOP and care map; 2) satisfaction assessment form by 12 multidisciplinary personnel and 10 patients / relatives; 3) ADL and personal care skills assessment by 10 patients / relatives. Data analysis using frequency distribution: The results showed that: 1. SOP consists of 6 elements2: 1) Protection of patients' rights and ethics. 2) Patient condition assessment. 3) Patients management for receiving rehabilitation and discharge planning. 4) Health care knowledge provided. 5) Home visits and continuous care. 6) Development of health service quality. 2. Care map and SOP were transparency, convenient and easy to follow. The satisfaction assessment of both sample groups was high (80%). Patients and relatives had well health care skills, knowledge and ability to follow care manuals correctly (80%). ADL score of patients after discharged increased upon the follow up at 1 month (100%) as well as no diseases complications. The extension of care map using in other diseases at sub-acute stage suggested.

Meetings International -  Conference Keynote Speaker Ross Horley photo

Ross Horley

University of Notre Dame, Australia

Title: An effective simulation centre – Getting the design right

Biography:

Ross Horley has been involved in the development and deployment of simulation-based training for medical and surgical skills for over 19 years. A pioneer in many areas, he has been involved in the design of over 30 advanced clinical skills and simulation training facilities around the world, including the Royal College of Surgeons of England, Royal Australasian College of Surgeons, the National Health Service in the UK, the Chinese University of Hong Kong, the Third Military Medical University Hospital Chongqing and SingHealth to name a few. He has developed award-winning virtual reality simulators for medical procedures and created an innovative process of training course development, which forms the basis of benchmarking skills for ongoing accreditation. He is an Adjunct Senior Lecturer for the School of Medicine in the University of Notre Dame, Australia, and a contributing author for an Oxford University Press-published book, “Manual of Simulation in Healthcare” first and second editions.

Abstract:

With the increase in the use of simulation as a viable training technology there is considerable need to provide areas where simulation can be effectively and efficiently deployed. The level of complexity required for those spaces for the utilization of various simulators varies greatly from a total immersive environment to just a desk. A considerable effort is required in the planning of simulator based training areas to maximize the benefits of the technology. Flexibility is one of the key criteria as well as a high degree of future proofing. In many cases simulation equipment and associated systems are shoehorned into existing areas therefore the need for creative design and a detailed understanding of simulation based training is more critical. More challenges exist with low budgets, non recurring funding. There are some basic design rules which are very applicable in meeting the challenges as well as technological solutions. The process of identifying what technology and design s works and what wont is based on a needs analysis with the outcomes weighted against financial, technological and educational criteria. The process is not just area design but a multifaceted approach.

Meetings International -  Conference Keynote Speaker Candice Hendricks photo

Candice Hendricks

University of Cape Town, South Africa

Title: The impact of exercise and education on health outcomes in women with osteoarthritis

Biography:

Candice Hendricks is currently completing her PhD in physiotherapy and is a lecturer at the University of Cape Town, South Africa. She has a special teaching and research interest in orthopaedics and specifically, in non-pharmacological management of osteoarthritis at primary healthcare level.

Abstract:

The aim of the study was to examine the impact of a six- week exercise, education and self-management intervention on pain and physical function in women with OA at a local primary health care clinic in Cape Town. A randomized control trial, single blinded, pre-test-post-test design was used. Women (N=63) with osteoarthritis (OA) were recruited (EXP=31, CON=32) and completed a six-week intervention and the 12 week follow-up testing. Furthermore, the groups were similar in age, personal and socio-economic characteristics at baseline testing.There was a significant difference between the groups over the 12 week study. For the primary outcome measure, function and disability according to WHODAS, a significant reduction in scores were evident at week 12 (p<0.01) between groups. For the lower limb functional tests according to Aggregated locomotor function tests (ALF), a significant improvement in scores were noticed at week 6 (p<0.01) between groups. In addition, there was a significant effect over the 12 weeks with improvements in scores for pain severity (p=0.02) and pain interference (p<0.01) of the BPI at weeks 6 and 12. This study found that the six-week intervention had significantly reduced the functional disability scores, reduced the overall time to complete the functional tests (walking, climbing stairs, sit-to-stand) and reduced the pain severity and interference scores, thereby improving pain and physical function in women with OA in the EXP group. This intervention could be appropriate to implement at PHC clinics to help reduce pain and improve physical function in women suffering from osteoarthritis.

Meetings International -  Conference Keynote Speaker Uros Zafosnik & Davorin Markovic photo

Uros Zafosnik & Davorin Markovic

Simulation Centre, Slovenia

Title: Sim mobile unit in primary healthcare

Biography:

Uros Zafosnik is a Registered Nurse. He was working as head nurse of emergency services in CHC Maribor for four years before starting work in emergency services of CHC Ljubljana, where he worked for three years. Curently he is Head and Coordinator of SIM Centre now for five years. He is also international ITLS and MTS instructor and besides that he was involved in a working group designing standards for triage at Ministry of Health Slovenia. He is also a lecturer at Faculty of health sciences Novo Mesto.

Abstract:

The team in family practice often meets life-risk patients. Simulation is an excellent way for health care workers to train their skills in a safe environment. It is an effective, ethical and safe way to practice theoretical knowledge. Trainees acquire experience in simulation in life threatening situation, how to approach acute situation and situations where decisions have consequences. This way we approach the clinical environment as close as we can. But sadly, learning with simulations in healthcare is usually not available to professionals. Contributing factors to this problem are the lack of knowledge and poor equipment combined with high education costs and time shortage in medical teams. We have developed a mobile simulation unit (SIM mobile) that will enable all medical teams in primary healthcare access to modern simulation equipment. We have used SIM mobile to conduct simulations in over 20 diferent locations in Slovenia (Comunity health centres, prehospital units). Participants were doctors of family medicine, nurses and EMT workers. The study was caried out from june 2018 to august 2018. SIM mobile was avaliable for 120 hours in 10 days. Total training time was 120 hours and was used 100% of the time by the participants of the study. SIM mobile provides opportunities for outstanding educational experiences that translate into better patient care and improved provider safety. A mobile simulation experience that can be brought to healthcare professionals in rural and frontier communities, thus reducing the need for providers to travel for training.