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Health simulation

Wayne W Morriss, Miodrag S Milenovic, Faye M Evans
There are inadequate numbers of anesthesia providers in many parts of the world. Good quality educational programs are needed to increase provider numbers, train leaders and teachers, and increase knowledge and skills. In some countries, considerable external support may be required to develop self-sustaining programs. There are some key themes related to educational programs in low- and middle-income countries:(1) Programs must be appropriate for the local environment-there is no "one-size-fits-all" program...
April 2018: Anesthesia and Analgesia
Elizabeth G Mosher, John A Butman, Les R Folio, Nadia M Biassou, Choonsik Lee
OBJECTIVE: Radiation exposure of the lens during neck CT may increase a patient's risk of developing cataracts. Radiologists at the National Institutes of Health worked with technicians to modify the neck CT scanning procedure to include a reduction in the scanning range, a reduction in the tube potential (kilovoltage), and a change in neck positioning using a head tilt. We objectively quantified the organ dose changes after this procedure modification using a computer simulation. MATERIALS AND METHODS: We retrospectively analyzed CT images of 40 patients (20 men and 20 women) scanned before and after the procedure change...
March 16, 2018: AJR. American Journal of Roentgenology
Augustine Tee, Wai Leng Chow, Colin Burke, Guruprasad Basavarajaiah
INTRODUCTION: In light of the growing evidence base for better clinical results with the use of the dual bronchodilator indacaterol/glycopyrronium (IND/GLY) over inhaled corticosteroid-containing salmeterol/fluticasone combination (SFC), this study aimed to evaluate the cost-effectiveness of IND/GLY over SFC in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) who are at low risk of exacerbations in the Singapore healthcare setting. METHODS: A previously published patient-level simulation model was adapted for use in Singapore by applying local unit costs...
March 16, 2018: Singapore Medical Journal
Andras P Durko, Ruben L Osnabrugge, Nicolas M Van Mieghem, Milan Milojevic, Darren Mylotte, Vuyisile T Nkomo, A Pieter Kappetein
Aims: The number of transcatheter aortic valve implantation (TAVI) procedures is rapidly increasing. This has a major impact on health care resource planning. However, the annual numbers of TAVI candidates per country are unknown. The aim of this study was to estimate current and future number of annual TAVI candidates in 27 European countries, the USA and Canada. Methods and results: Systematic literature searches and meta-analyses were performed on aortic stenosis (AS) epidemiology and decision-making in severe symptomatic AS...
March 12, 2018: European Heart Journal
Natalia A Trayanova, Patrick M Boyle, Plamen P Nikolov
The goal of this article is to review advances in computational modeling of the heart, with a focus on recent non-invasive clinical imaging- and simulation-based strategies aimed at improving the diagnosis and treatment of patients with arrhythmias and structural heart disease. Following a brief overview of the field of computational cardiology, we present recent applications of the personalized virtual-heart approach in predicting the optimal targets for infarct-related ventricular tachycardia and atrial fibrillation ablation, and in determining risk of sudden cardiac death in myocardial infarction patients...
March 2018: Current Opinion in Biomedical Engineering
Weicheng Ren, Xiaofei Ye, Hong Su, Wei Li, Dongbing Liu, Mohammad Pirmoradian, Xianhuo Wang, Bo Zhang, Qiang Zhang, Longyun Chen, Man Nie, Yao Liu, Bin Meng, Huiqiang Huang, Wenqi Jiang, Yixin Zeng, Wenyu Li, Kui Wu, Yong Hou, Klas G Wiman, Zhiming Li, Huilai Zhang, Roujun Peng, Shida Zhu, Qiang Pan-Hammarström
Hepatitis B virus (HBV) infection is endemic in some parts of Asia, Africa and South America and remains to be a significant public health problem in these areas. It is known as a leading risk factor for the development of hepatocellular carcinoma, but epidemiological studies have also shown that the infection may increase the incidence of several types B-cell lymphoma. Here, by characterizing altogether 275 Chinese diffuse large B-cell lymphoma (DLBCL) patients, we showed that patients with concomitant HBV infection (surface antigen positive, HBsAg+ ) are characterized by a younger age, a more advanced disease stage at diagnosis and a reduced overall survival...
March 15, 2018: Blood
Franck Maunoury, Aurore Clément, Chizoba Nwankwo, Laurie Levy-Bachelot, Armand Abergel, Vincent Di Martino, Eric Thervet, Isabelle Durand-Zaleski
OBJECTIVE: To assess the cost-effectiveness of the elbasvir/grazoprevir (EBR/GZR) regimen in patients with genotype 1 chronic hepatitis C virus (HCV) infection with severe and end-stage renal disease compared to no treatment. DESIGN: This study uses a health economic model to estimate the cost-effectiveness of treating previously untreated and treatment experienced chronic hepatitis C patients who have severe and end stage renal disease with the elbasvir-grazoprevir regimen versus no treatment in the French context...
2018: PloS One
Dehbia Benkerrou, Matteo Ceccarelli
One of the greatest health threats facing modern medicine is the emergence of new bacterial strains which are increasingly resistant to almost all currently available antibiotics. According to a CDC (Center for Disease Control and Prevention) report published in 2013, 63% of Acinetobacter species have been identified as Multidrug resistant strains. As for other Gram-negative bacteria, the presence of an outer membrane increases the intrinsic resistance of A. baumannii to most antibiotics. The outer membrane of A...
March 15, 2018: Physical Chemistry Chemical Physics: PCCP
Scott Pardo, Rimma M Shaginian, David A Simmons
BACKGROUND: Diabetes treatment is intended to maintain near-normal glycemic levels. Self-monitoring of blood glucose (SMBG) allows patients to track their BG levels compared with glycemic targets and is associated with improved health outcomes. Because of the importance of SMBG, it is essential that results are accurate to prevent errors in nutritional intake and drug dosing. This study presents a new methodology to evaluate the accuracy of BG monitoring systems (BGMSs). METHODS: Sensitivity analyses were performed using real and simulated BGMS data to compute probabilities that, for any BG value, the BGMS result would be within prescribed error bounds and confidence limits compared with laboratory reference values...
March 1, 2018: Journal of Diabetes Science and Technology
Soojin Park, Esra Kürüm
Randomized experiments are often complicated because of treatment noncompliance. This challenge prevents researchers from identifying the mediated portion of the intention-to-treated (ITT) effect, which is the effect of the assigned treatment that is attributed to a mediator. One solution suggests identifying the mediated ITT effect on the basis of the average causal mediation effect among compliers when there is a single mediator. However, considering the complex nature of the mediating mechanisms, it is natural to assume that there are multiple variables that mediate through the causal path...
March 15, 2018: Statistics in Medicine
S O Edeki, O O Akanbi
The datasets contained in this article are simulated data with respect to Sickle Cell Anaemia (SCA) in order to examine the mathematical inheritance formation of the SCA disease. The simulation is done using Monte Carlos Simulation (MCS) Technique to complement the Physical Simulation Smith's Statistical (PSSS) package used as random number generator for birth simulation. One hundred and fifty-six (156) births for seven (7) generations were considered in the simulation alongside non-gestating reproductive females with fertile male adults while immigration and emigration are not permitted...
February 2018: Data in Brief
Román Rodríguez-Aguilar, José Antonio Marmolejo-Saucedo, Sonia Tavera-Martínez
Background: The objective of this work is to estimate the financial impact of increasing the monitoring period for breast cancer, which is financed by the Sistema de Protección Social en Salud (SPSS-Social Protection System in Health). Methods: A micro-simulation model was developed to monitor a cohort of patients with breast cancer, and also an estimation was made on the probability of surviving the monitoring period financed by the SPSS. Using the Monte Carlo simulation, the maximum expected cost was estimated to broaden such monitoring...
2018: Cost Effectiveness and Resource Allocation: C/E
Catriona Crossan, Hakim-Moulay Dehbi, Hilarie Williams, Neil Poulter, Anthony Rodgers, Stephen Jan, Simon Thom, Joanne Lord
INTRODUCTION: The 'Use of a Multi-drug Pill in Reducing cardiovascular Events' (UMPIRE) trial was a randomised controlled clinical trial evaluating the impact of a polypill strategy on adherence to indicated medication in a population with established cardiovascular disease (CVD) of or at high risk thereof. The aim of Researching the UMPIRE Processes for Economic Evaluation in the National Health Service (RUPEE NHS) is to estimate the potential health economic impact of a polypill strategy for CVD prevention within the NHS using UMPIRE trial and other relevant data...
March 14, 2018: BMJ Open
Ronald J Maughan, Louise M Burke, Jiri Dvorak, D Enette Larson-Meyer, Peter Peeling, Stuart M Phillips, Eric S Rawson, Neil P Walsh, Ina Garthe, Hans Geyer, Romain Meeusen, Lucas J C van Loon, Susan M Shirreffs, Lawrence L Spriet, Mark Stuart, Alan Vernec, Kevin Currell, Vidya M Ali, Richard Gm Budgett, Arne Ljungqvist, Margo Mountjoy, Yannis P Pitsiladis, Torbjørn Soligard, Uğur Erdener, Lars Engebretsen
Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes, and dietary supplements can make a minor contribution to this nutrition programme. Nonetheless, supplement use is widespread at all levels of sport. Products described as supplements target different issues, including (1) the management of micronutrient deficiencies, (2) supply of convenient forms of energy and macronutrients, and (3) provision of direct benefits to performance or (4) indirect benefits such as supporting intense training regimens...
March 14, 2018: British Journal of Sports Medicine
Samir S Soneji, Hai-Yen Sung, Brian A Primack, John P Pierce, James D Sargent
BACKGROUND: Electronic cigarettes (e-cigarettes) may help cigarette smokers quit smoking, yet they may also facilitate cigarette smoking for never-smokers. We quantify the balance of health benefits and harms associated with e-cigarette use at the population level. METHODS AND FINDINGS: Monte Carlo stochastic simulation model. Model parameters were drawn from census counts, national health and tobacco use surveys, and published literature. We calculate the expected years of life gained or lost from the impact of e-cigarette use on smoking cessation among current smokers and transition to long-term cigarette smoking among never smokers for the 2014 US population cohort...
2018: PloS One
Julie A Poore, Justine C Dawson, Dawne-Marie Dunbar, Kathryn Parrish
As the health care environment increases in complexity and patient acuity rises, health profession graduates need to be prepared to work collaboratively to improve patient outcomes. The interprofessional debriefing tool (Debriefing Interprofessionally: Recognition & Reflection) presented in this article allows any simulation to be transformed into an interprofessional learning opportunity. The debriefing tool frames questions for both uniprofessional and multiprofessional simulation and is aligned with the Core Competencies for Interprofessional Collaborative Practice and with Quality and Safety Education for Nurses...
March 14, 2018: Nurse Educator
Neina F Ferguson, Julie M Estis
Purpose: The purpose of this study was to determine if brief video-recorded patient simulation training increased students' ability to assess feeding skills in preterm infants. Method: Baccalaureate-level nursing students (N = 52) and graduate-level speech-language pathology students (N = 42) were randomized to 1 of 2 groups: didactic training (N = 51) or didactic training plus video simulation (N = 43). Outcome measures included knowledge test scores, calculated clinical judgment scores, and clinical marker documentation accuracy...
March 9, 2018: American Journal of Speech-language Pathology
Agne Tubeleviciute-Aydin, Libin Zhou, Gyanesh Sharma, Ishankumar V Soni, Sergey N Savinov, Jeanne A Hardy, Andrea C LeBlanc
The cysteine protease Caspase-6 (Casp6) is a potential therapeutic target of Alzheimer Disease (AD) and age-dependent cognitive impairment. To assess if Casp6 is essential to human health, we investigated the effect of CASP6 variants sequenced from healthy humans on Casp6 activity. Here, we report the effects of two rare Casp6 amino acid polymorphisms, R65W and G66R, on the catalytic function and structure of Casp6. The G66R substitution eliminated and R65W substitution significantly reduced Casp6 catalytic activity through impaired substrate binding...
March 13, 2018: Scientific Reports
Simone A Dijkland, Daphne C Voormolen, Esmee Venema, Bob Roozenbeek, Suzanne Polinder, Juanita A Haagsma, Daan Nieboer, Vicky Chalos, Albert J Yoo, Jennifer Schreuders, Aad van der Lugt, Charles B L M Majoie, Yvo B W E M Roos, Wim H van Zwam, Robert J van Oostenbrugge, Ewout W Steyerberg, Diederik W J Dippel, Hester F Lingsma
BACKGROUND AND PURPOSE: The utility-weighted modified Rankin Scale (UW-mRS) has been proposed as a new patient-centered primary outcome in stroke trials. We aimed to describe utility weights for the mRS health states and to evaluate the statistical efficiency of the UW-mRS to detect treatment effects in stroke intervention trials. METHODS: We used data of the 500 patients enrolled in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands)...
March 13, 2018: Stroke; a Journal of Cerebral Circulation
Joanne Brooke, Claire Manneh
AIMS: To explore the lived experience of caring for a patient during an acute episode of delirium by nurses working in cardiology, elderly care, renal, or respiratory specialities. BACKGROUND: A missed or delayed diagnosis of delirium in an acute hospital setting adversely impacts on patient outcomes. Nurses are the best placed health care professionals to identify a change in patient's cognitive status but struggle to do so. DESIGN: Inductive interpretative phenomenology...
March 12, 2018: International Journal of Nursing Practice
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