Mary M. Wyckoff

Use of mobile learning module improves skills in chest tube insertion

BACKGROUND Just-In-Time Learning is a concept increasingly applied to medical education, and its efficacy must be evaluated. MATERIALS AND METHODS A 3-minute video on chest tube insertion was produced. Consenting participants were assigned to either the video group, which viewed the video on an Apple® iPod Touch immediately before chest tube insertion, or the control group, which received no instruction. Every participant filled out a questionnaire regarding prior chest tube experience. A trained clinician observed participants insert a chest tube on the TraumaMan® task simulator, and assessed performance using a 14-item skills checklist. RESULTS Overall, 128 healthcare trainees participated, with 50% in the video group. Participants included residents (34.4%, n = 44), medical students (32.8%, n = 42), and U.S. Army Forward Surgical Team members (32.8%, n = 42). Sixty-nine percent of all participants responded that they had never placed a chest tube, but 7% had placed more than 20. Only 25% of the participants had previously used TraumaMan®. Subjects who viewed the video scored better on the skills checklist than the control group (11.09 ± 3.09 versus 7.17 ± 3.56, P < 0.001, Cohens D = 1.16). Medical students (9.33 ± 2.65 versus 4.52 ± 3.64, P < 0.001), Forward Surgical Team members (10.07 ± 2.52 versus 8.57 ± 3.22, P < 0.001), anesthesia residents (8.25 ± 2.56 versus 5.9 ± 2.23, P = 0.017), and subjects who had placed fewer than 10 chest tubes (9.7 ± 3 versus 6.6 ± 3.9, P < 0.001) performed significantly better with the video. CONCLUSIONS The procedural animation video is an effective medium for teaching procedural skills. Embedding the video on a mobile device, and allowing trainees to access it immediately before chest tube insertion, may enhance and standardize surgical education for civilians and military personnel.

effectiveness of stepwise interventions targeted to decrease central catheter-associated bloodstream infections*

Objective: Determine the impact of three stepwise interventions on the rate of central catheter-associated bloodstream infections. Design: Quasi-experimental study. Setting: Three surgical intensive care units (general surgery, trauma, and neurosurgery) at a 1500-bed county teaching hospital in the Miami metro area. Patients: All consecutive central catheter-associated bloodstream infection cases as determined by the Infection Control Department. Interventions: Three interventions aimed at catheter maintenance were implemented at different times in the units: chlorhexidine “scrub-the-hub,” chlorhexidine daily baths, and daily nursing rounds aimed at assuring compliance with an intensive care unit goal-oriented checklist. Measurements and Main Results: The primary outcome was the monthly intensive care unit rate of central catheter-associated bloodstream infections (infections per 1000 central catheter days). Over 33 months of follow-up (July 2008 to March 2011), we found decreased rates in each of the three intensive care units evaluated during the interventions, especially after implementation of chlorhexidine daily baths. Rates in unit A decreased from a rate of 8.6 to 0.5, unit B from 6.9 to 1.6, and unit C from 7.8 to 0.6. Secondary bloodstream infection rates remained unchanged throughout the observation period in units A and B; however, unit C had a decrease in its rates over time. Conclusions: We report the progressive reduction of central catheter-associated bloodstream infection rates after the stepwise implementation of chlorhexidine “scrub-the-hub” and daily baths in surgical intensive care units, suggesting effectiveness of these interventions.

Mobile Learning Module Improves Knowledge of Medical Shock for Forward Surgical Team Members

OBJECTIVE Acute trauma care is characterized by dynamic situations that require adequate preparation to ensure success for military health professionals. The use of mobile learning in this environment can provide a solution that standardizes education and replaces traditional didactic lectures. METHODS A comparative evaluation with a pre-post test design regarding medical shock was delivered via either a didactic lecture or a mobile learning video module to U.S. Army Forward Surgical Team (FST) members. Participants completed a pretest, were randomly assigned to treatment group by FST, and then completed the post-test and scenario assessment. RESULTS One-hundred and thirteen FST members participated with 53 in the mobile learning group and 60 in the lecture group (control). The percent mean score for the mobile learning group increased from 43.6 to 70 from pretest to post-test, with a scenario mean score of M = 56.2. The percent mean score for the control group increased from 41.5 to 72.5, with a scenario mean score of M = 59.7. The two-way analysis of variance mean score difference was 26.4 for the mobile learning group and 31.0 for the control, F = 2.18, (p = 0.14). CONCLUSIONS Mobile learning modules, coupled with a structured assessment, have the potential to improve educational experiences in civilian and military settings.

Neonatal herpes simplex virus type II.

This description of a tragic case of infection with neonatal herpes simplex virus type II is presented to alert professional nurses to the fact that this disease is sometimes difficult to recognize, but must be considered when a newborn has any unusual symptoms. Neonatal herpes simplex type II may have a slow and insidious onset, and be masked by many other symptoms. Even though the virus might be present in a newborn, the symptoms might not be apparent until several days after birth; this is a problem because infants are now leaving hospitals much earlier and can become ill after hospital discharge. Parents, especially first-time parents, may not recognize subtle signs of illness in their child. Therefore, the onus is on the health care provider to evaluate each infant for symptomatology and provide education to parents along with instructions to obtain early follow-up care for all newborns.