Browsing by Author "Lin, Yiqun"

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    Conducting multicenter research in healthcare simulation: Lessons learned from the INSPIRE network
    (2017-02-28) Cheng, Adam; Kessler, David; Mackinnon, Ralph; Chang, Todd P; Nadkarni, Vinay M; Hunt, Elizabeth A; Duval-Arnould, Jordan; Lin, Yiqun; Pusic, Martin; Auerbach, Marc
    Abstract Simulation-based research has grown substantially over the past two decades; however, relatively few published simulation studies are multicenter in nature. Multicenter research confers many distinct advantages over single-center studies, including larger sample sizes for more generalizable findings, sharing resources amongst collaborative sites, and promoting networking. Well-executed multicenter studies are more likely to improve provider performance and/or have a positive impact on patient outcomes. In this manuscript, we offer a step-by-step guide to conducting multicenter, simulation-based research based upon our collective experience with the International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE). Like multicenter clinical research, simulation-based multicenter research can be divided into four distinct phases. Each phase has specific differences when applied to simulation research: (1) Planning phase, to define the research question, systematically review the literature, identify outcome measures, and conduct pilot studies to ensure feasibility and estimate power; (2) Project Development phase, when the primary investigator identifies collaborators, develops the protocol and research operations manual, prepares grant applications, obtains ethical approval and executes subsite contracts, registers the study in a clinical trial registry, forms a manuscript oversight committee, and conducts feasibility testing and data validation at each site; (3) Study Execution phase, involving recruitment and enrollment of subjects, clear communication and decision-making, quality assurance measures and data abstraction, validation, and analysis; and (4) Dissemination phase, where the research team shares results via conference presentations, publications, traditional media, social media, and implements strategies for translating results to practice. With this manuscript, we provide a guide to conducting quantitative multicenter research with a focus on simulation-specific issues.
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    Distributed practice for cardiopulmonary resuscitation (CPR) training: improving educational efficiency and cost-effectiveness in clinical settings
    (2019-04-12) Lin, Yiqun; Hecker, Kent; Cheng, Adam; Grant, Vincent J.; Currie, Gillian R.
    Cardiac arrest is a major health problem; high-quality cardiopulmonary resuscitation (CPR) is one of the most important determinants of survival and survival with good neurological outcomes of the victims. Despite annual training, healthcare providers struggle to conduct guideline compliant CPR during the management of cardiac arrests. Increased likelihood of survival from cardiac arrest depends upon the integration of medical science, educational efficiency and local implementation (of science and education). There is some evidence to suggest that the use of distributed practice (i.e. separating the training into small portions dispersed over time) and real-time feedback (on compression depth, rate, and recoil) can improve CPR quality in healthcare providers and medical trainees. The aim of this research is to explore the efficacy and cost-effectiveness of distributed CPR training with real-time feedback relative to current CPR training practices. To accomplish this, the following work was completed: (1) designing a randomized trial to compare a new CPR training program incorporating workplace-based distributed CPR practice and real-time feedback with a group receiving conventional Heart and Stroke Foundation of Canada (HSFC) Basic Life Support (BLS) course; (2) describing the key components of, and approaches to economic evaluation in the context of simulation-based medical education; and (3) exploring the cost-effectiveness of distributed training program relative to conventional training to inform the decision whether or not to adopt the new CPR training program. This research shows that (1) workplace-based distributed CPR training significantly improves the acquisition and retention of CPR skills in practicing acute care providers and (2) this training method results in decreased training costs and increased learning outcomes in our local context. This research provides evidence to support the educational efficiency of distributed CPR training and informs the decision on implementation of this educational strategy by addressing the cost-effectiveness. Importantly, this research is the first study that comparing distributed CPR training with conventional training and longitudinally analyzing the CPR performance to address skill retention. Furthermore, this research represents the first economic evaluation studies in resuscitation training.
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    Impact of the PEARLS Healthcare Debriefing cognitive aid on facilitator cognitive load, workload, and debriefing quality: a pilot study
    (2022-12-12) Meguerdichian, Michael; Bajaj, Komal; Ivanhoe, Rachel; Lin, Yiqun; Sloma, Audrey; de Roche, Ariel; Altonen, Brian; Bentley, Suzanne; Cheng, Adam; Walker, Katie
    Abstract Background The Promoting Excellence and Reflective Learning in Simulation (PEARLS) Healthcare Debriefing Tool is a cognitive aid designed to deploy debriefing in a structured way. The tool has the potential to increase the facilitator’s ability to acquire debriefing skills, by breaking down the complexity of debriefing and thereby improving the quality of a novice facilitator’s debrief. In this pilot study, we aimed to evaluate the impact of the tool on facilitators’ cognitive load, workload, and debriefing quality. Methods Fourteen fellows from the New York City Health + Hospitals Simulation Fellowship, novice to the PEARLS Healthcare Debriefing Tool, were randomized to two groups of 7. The intervention group was equipped with the cognitive aid while the control group did not use the tool. Both groups had undergone an 8-h debriefing course. The two groups performed debriefings of 3 videoed simulated events and rated the cognitive load and workload of their experience using the Paas-Merriënboer scale and the raw National Aeronautics and Space Administration task load index (NASA-TLX), respectively. The debriefing performances were then rated using the Debriefing Assessment for Simulation in Healthcare (DASH) for debriefing quality. Measures of cognitive load were measured as Paas-Merriënboer scale and compared using Wilcoxon rank-sum tests. Measures of workload and debriefing quality were analyzed using mixed-effect linear regression models. Results Those who used the tool had significantly lower median scores in cognitive load in 2 out of the 3 debriefings (median score with tool vs no tool: scenario A 6 vs 6, p=0.1331; scenario B: 5 vs 6, p=0.043; and scenario C: 5 vs 7, p=0.031). No difference was detected in the tool effectiveness in decreasing composite score of workload demands (mean difference in average NASA-TLX −4.5, 95%CI −16.5 to 7.0, p=0.456) or improving composite scores of debriefing qualities (mean difference in DASH 2.4, 95%CI −3.4 to 8.1, p=0.436). Conclusions The PEARLS Healthcare Debriefing Tool may serve as an educational adjunct for debriefing skill acquisition. The use of a debriefing cognitive aid may decrease the cognitive load of debriefing but did not suggest an impact on the workload or quality of debriefing in novice debriefers. Further research is recommended to study the efficacy of the cognitive aid beyond this pilot; however, the design of this research may serve as a model for future exploration of the quality of debriefing.
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    Reducing the impact of intensive care unit mattress compressibility during CPR: a simulation-based study
    (2017-11-16) Lin, Yiqun; Wan, Brandi; Belanger, Claudia; Hecker, Kent; Gilfoyle, Elaine; Davidson, Jennifer; Cheng, Adam
    Abstract Background The depth of chest compression (CC) during cardiac arrest is associated with patient survival and good neurological outcomes. Previous studies showed that mattress compression can alter the amount of CCs given with adequate depth. We aim to quantify the amount of mattress compressibility on two types of ICU mattresses and explore the effect of memory foam mattress use and a backboard on mattress compression depth and effect of feedback source on effective compression depth. Methods The study utilizes a cross-sectional self-control study design. Participants working in the pediatric intensive care unit (PICU) performed 1 min of CC on a manikin in each of the following four conditions: (i) typical ICU mattress; (ii) typical ICU mattress with a CPR backboard; (iii) memory foam ICU mattress; and (iv) memory foam ICU mattress with a CPR backboard, using two different sources of real-time feedback: (a) external accelerometer sensor device measuring total compression depth and (b) internal light sensor measuring effective compression depth only. CPR quality was concurrently measured by these two devices. The differences of the two measures (mattress compression depth) were summarized and compared using multilevel linear regression models. Effective compression depths with different sources of feedback were compared with a multilevel linear regression model. Results The mean mattress compression depth varied from 24.6 to 47.7 mm, with percentage of depletion from 31.2 to 47.5%. Both use of memory foam mattress (mean difference, MD 11.7 mm, 95%CI 4.8–18.5 mm) and use of backboard (MD 11.6 mm, 95% CI 9.0–14.3 mm) significantly minimized the mattress compressibility. Use of internal light sensor as source of feedback improved effective CC depth by 7–14 mm, compared with external accelerometer sensor. Conclusion Use of a memory foam mattress and CPR backboard minimizes mattress compressibility, but depletion of compression depth is still substantial. A feedback device measuring sternum-to-spine displacement can significantly improve effective compression depth on a mattress. Trial registration Not applicable. This is a mannequin-based simulation research.