SUMMARY Review date: 1969 to 2003, 34 years. Background and context: Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Objectives: Review and synthesize existing evidence in educational science that addresses the question, ‘What are the features and uses of high-fidelity medical simulations that lead to most effective learning?’. Search strategy: The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the ‘grey literature’ were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Inclusion and exclusion criteria: Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data extraction: Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Data synthesis: Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. Headline results: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following:

/pdf/features-and-uses-of-high-fidelity-medical-simulations-that-51wb8k5opy.pdf

Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review

Naomi P. O'Grady, M.D., Mary Alexander, R.N. Lillian A. Burns, M.T., M.P.H., C.I.C. E. Patchen Dellinger, M.D. Jeffery Garland, M.D., S.M. Stephen O. Heard, M.D. Pamela A. Lipsett, M.D. Henry Masur, M.D. Leonard A. Mermel, D.O., Sc.M. Michele L. Pearson, M.D. Issam I. Raad, M.D. Adrienne Randolph, M.D., M.Sc. Mark E. Rupp, M.D. Sanjay Saint, M.D., M.P.H. and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

/pdf/guidelines-for-the-prevention-of-intravascular-catheter-4xarsoczlz.pdf

Guidelines for the prevention of intravascular catheter-related infections, 2011

Together with an explosive growth of the mobile applications and emerging of cloud computing concept, mobile cloud computing (MCC) has been introduced to be a potential technology for mobile services. MCC integrates the cloud computing into the mobile environment and overcomes obstacles related to the performance (e.g., battery life, storage, and bandwidth), environment (e.g., heterogeneity, scalability, and availability), and security (e.g., reliability and privacy) discussed in mobile computing. This paper gives a survey of MCC, which helps general readers have an overview of the MCC including the definition, architecture, and applications. The issues, existing solutions, and approaches are presented. In addition, the future research directions of MCC are discussed. Copyright © 2011 John Wiley & Sons, Ltd.

A survey of mobile cloud computing: architecture, applications, and approaches

Methods: A cross-sectional analysis was conducted on a nationally random sample of 1217103 Medicare feefor-service beneficiaries aged 65 and older living in the United States and enrolled in both Medicare Part A and Medicare Part B during 1999. Multiple logistic regression was used to analyze the influence of age, sex, and number of types of chronic conditions on the risk of incurring inpatient hospitalizations for ambulatory care sensitive conditions and hospitalizations with preventable complications among aged Medicare beneficiaries. Results: In 1999, 82% of aged Medicare beneficiaries had 1 or more chronic conditions, and 65% had multiple chronic conditions. Inpatient admissions for ambulatory care sensitive conditions and hospitalizations with preventable complications increased with the number of chronic conditions. For example, Medicare beneficiaries with 4 or more chronic conditions were 99 times more likely than a beneficiary without any chronic conditions to have an admission for an ambulatory care sensitive condition (95% confidence interval, 86-113). Per capita Medicare expenditures increased with the number of types of chronic conditions from $211 among beneficiaries without a chronic condition to $13973 among beneficiaries with 4 or more types of chronic conditions. Conclusions: The risk of an avoidable inpatient admission or a preventable complication in an inpatient setting increases dramatically with the number of chronic conditions. Better primary care, especially coordination of care, could reduce avoidable hospitalization rates, especially for individuals with multiple chronic conditions.

/pdf/prevalence-expenditures-and-complications-of-multiple-4mi1gwp4mw.pdf

Prevalence, expenditures, and complications of multiple chronic conditions in the elderly

ContextHospital computerized physician order entry (CPOE) systems are widely
regarded as the technical solution to medication ordering errors, the largest
identified source of preventable hospital medical error. Published studies
report that CPOE reduces medication errors up to 81%. Few researchers, however,
have focused on the existence or types of medication errors facilitated by
CPOE.ObjectiveTo identify and quantify the role of CPOE in facilitating prescription
error risks.Design, Setting, and ParticipantsWe performed a qualitative and quantitative study of house staff interaction
with a CPOE system at a tertiary-care teaching hospital (2002-2004). We surveyed
house staff (N = 261; 88% of CPOE users); conducted 5 focus groups
and 32 intensive one-on-one interviews with house staff, information technology
leaders, pharmacy leaders, attending physicians, and nurses; shadowed house
staff and nurses; and observed them using CPOE. Participants included house
staff, nurses, and hospital leaders.Main Outcome MeasureExamples of medication errors caused or exacerbated by the CPOE system.ResultsWe found that a widely used CPOE system facilitated 22 types of medication
error risks. Examples include fragmented CPOE displays that prevent a coherent
view of patients’ medications, pharmacy inventory displays mistaken
for dosage guidelines, ignored antibiotic renewal notices placed on paper
charts rather than in the CPOE system, separation of functions that facilitate
double dosing and incompatible orders, and inflexible ordering formats generating
wrong orders. Three quarters of the house staff reported observing each of
these error risks, indicating that they occur weekly or more often. Use of
multiple qualitative and survey methods identified and quantified error risks
not previously considered, offering many opportunities for error reduction.ConclusionsIn this study, we found that a leading CPOE system often facilitated
medication error risks, with many reported to occur frequently. As CPOE systems
are implemented, clinicians and hospitals must attend to errors that these
systems cause in addition to errors that they prevent.

https://jamanetwork.com/journals/jama/articlepdf/200498/JOC42133.pdf

Role of computerized physician order entry systems in facilitating medication errors.

Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95

Recently, the career changes and challenges facing managers have gained almost critical mass. From modernisation to The NHS Plan, from the Learning from Bristol report to Shifting The Balance Of Power, it seems the only constant is change. Change which will make or mar the NHS' future. How well conceived are the new plans? Is there meaningful consultation? What will be the effects on the future career of managers? Is there a forum for dialogue and discussion, when new ideas are felt to be unwise, ill-founded or just plain wrong? Can managers feel free to speak out if they wish? In a desire to see these questions given due attention, British Journal of Health Care Management has asked a range of experienced figures to voice their concerns. A commentary on these views is given by respected US health care academic Professor Ted Marmor (who will give December's Rock-Carling Lecture).

Across the great divide: discussing the undiscussable

The phrase ‘Health Gain’ is a snappy way of saying that our country should become healthier; and every few years the government of the day issues a White Paper, giving their version of how this should be done. This invaluable monograph helps us see the wood for the trees.

Improving Population Health in Industrialised Nations

Is your name Alan Milburn? Right, you've got a job ahead of you to oversee real improvements in the NHS. You have four-and-a-half years. It's delivery time, and we are not talking Consignia. So what are you going to do, and more importantly, what are you going to stop doing?

Andrew Wall

Papers

Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95

Across the great divide: discussing the undiscussable

Improving Population Health in Industrialised Nations

The last chance (again): how to get the NHS right