clinicaltrials.gov Identifier: NCT01587274.

We found a significant, albeit modest, difference between simulation training and lecture training on the total SAGAT score of situation awareness mainly because of the improvement in perception ability. Simulation may be a superior method of teaching situation awareness.

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curriculum -MENTOR (Making Every New Trainee Our Responsibility) (Piech JD, Fire Engineering, 2004). Methods: MENTOR is a structured, one year program for new APPs. The program begins with a pre-test to assess baseline ICU knowledge. The first quarter consists of weekly scheduled lectures and activities along with direct clinical supervision by a senior APP or MD. The second through fourth quarters evolve to biweekly educational activities with progressive clinical autonomy by the APP. At the conclusion of each quarter, the new APP will undergo a performance review to assure quarterly objectives are met and to identify any educational needs. At the completion of the program, a post-test is given and clinical and procedural competence will be determined. Results: Within the upcoming year, six new SICU APPs will formally enter the MENTOR program above. Expected outcomes with implementation of the program include: improvement in critical care knowledge evidenced by post-test scores and clinical evaluation, procedural competence and hospital credentialing complete at one year, competency in overall critical care management, improved APP retention/reduced turnover rates, and improved employee satisfaction. Conclusions: The MENTOR curriculum is a roadmap for skill acquisition as well as competency training of APPs. Other expected outcomes with specialty trained APPs include improved: hospital and ICU length of stay, performance measure compliance, communication, and decreased morbidity, mortality and readmission rates.Learning Objectives: Pneumothorax in the ICU can be a life-threatening event if it is not diagnosed and treated in a timely manner. There are often significant delays from the time a chest xray order is placed until the film is taken, uploaded, and read by radiology. Compared to plain films, ultrasound (US) has been shown to be more sensitive in the detection of pneumothorax. In addition, US has limited radiation, minimal cost, can be rapidly performed, and can be interpreted at bedside by the clinician. Critical care providers vary in the amount of training they receive in lung US. Purpose: To determine if the comfort and knowledge level of nurse practitioners/physician assistants (NP/PAs) in the use of US to detect pneumothorax can be increased by a short intervention. Methods: Teaching intervention for NP/PAs was targeted for evening shift change in order to reach as many persons as possible. Subjects took a pre-test which asked them about their overall comfort level and formal training in US as well as four knowledge questions on lung US. An EM/CCM physician with formal training in US gave a 10-15 minute presentation on the basics of using US to detect a pneumothorax. This was followed by a hands-on demonstration using a volunteer to show normal lung sliding. Finally, a post-test was administered. The intervention lasted about 30 min. Results: Fourteen NP/PAs participated. Their yr in clinical practice ranged from 36 yr to less than one year. Initial comfort with lung US was based on a scale of 1 to ...

Methods: This observational study was conducted at an ED with an annual census of 80,000 visits, with approximately 400 for AIS. The cohort consisted of adult patients who presented to the ED within 24 hours of stroke symptom onset. Blood pressure measured at triage by a nurse blinded to the study. Stroke severity was measured using the National Institutes of Health Scale (NIHSS).Results: The cohort consisted of 653 patients of which 37% was Hispanic, 16% Black, and 43% White. Fifty-four percent were male. The median systolic BP (sBP) was 157 mmHg with an interquartile range of 136-186. The Median NIHSS was 4, with an IQR between 1-11. Patients with higher sBP had significantly lower NIHSS scores (P¼0.0044). This association was significant even after adjusting for age and sex. By contrast, the diastolic BP did not appear to impact stroke severity. The median dBP was 82 mmHg, with an IQR between 70-93. There was no difference in dBP values between men and women.Conclusions: There appears to be a protective effect of systolic blood pressure, where a higher sBP is associated with lower stroke severity. This reinforces the concept of permissive hypertension in the acute phase of ischemic stroke.