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Adverse eventsFootnote 1 are common in hospitals all over the world. They cause higher mortality and morbidity, along with more pain and increased healthcare costs [1]. Since 2004, the number of reported adverse events in Denmark has increased and has stabilised at a relatively high level [2]. The Danish Patient Safety Strategy [3] has an organisational approach that addresses adverse events by providing knowledge through guidelines, e-learning, and newsletters [4, 5]. Providing knowledge implies that adverse events might be avoided through enhanced guidelines and safety procedures. However, several studies find that adverse events often occur in non-routine, complex environments due to interactions between humans and the systems in which they work. These interactions are modifiable due to learning skills (e.g. leadership-followership, decision-making and coordination) rather than lack of knowledge [6,7,8,9]. The medical simulation and patient safety literature most often refer to these aspects as non-technical skills, crisis resource management or interpersonal relations [9,10,11,12,13,14]. These common concepts are too limited, however, since they specifically define competence in terms of what is lacking (non-technical skills), what it is for (crises resource management) or interaction between people (interpersonal relations). The comprehensive concept of human factors includes broader aspects of human interaction, including social skills, cognitive skills and decision-making. It emphasises how the environment, the organisation and human psychology interact [15, 16]. Based on this reflection, this article will use human factors skills (HFS) as the terminology for the skills in focus. Patient safety reports and root cause analysis indicate that adverse events occur in interactions between technology, organisation and human factors, and adverse events are about understanding the interactions among humans and other elements of a system, including social and cognitive structures [1, 2, 17]. An example is the relocation of healthcare personnel from their everyday work to COVID-19 units [18]. This challenged even highly competent personnel and might have caused an increased number of human errors. Personnel had to adapt to unfamiliar technical and cognitive procedures and new surroundings, complications, colleagues and workflows. The Danish Patient Safety Database shows a 32% increase in reported adverse events in 2020 [19], with a peak at the beginning of the COVID-19 pandemic.


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Included studies were published between 2004 and 2021 and were conducted mostly (n = 70) in Western countries. The 72 studies used 51 different assessment methods to measure the outcome of the team training interventions, including pre-tests, peri-tests and post-tests, (un)blinded ratings, self-assessments, surveys and interviews. The methods were validated (n = 30), non-validated or no information about validation (n = 14) and modified versions of validated (n = 9) instrument. The studies reported SBT settings such as simulation centres (n = 36), in-situ training (n = 24) and the use of both centre and in-situ training (n = 7). A broad variation was seen in the size and range of the studies (n = 7 to 675 participants) and represented SBT within seven different in-hospital medical specialisms: anaesthesiology (n = 7), emergency medicine (n = 20), intensive care (n = 9), internal medicine (n = 2), obstetrics (n = 12), paediatrics (n = 6) and surgery (n = 15). A range of teaching methods were used: SBT (n = 30); SBT and didactics (n = 34); SBT, didactics and workshops (n = 6); and SBT and workshops (n = 1).

Abstract:The COVID-19 pandemic has motivated the rapid development of numerous vaccines that have proven effective against SARS-CoV-2. Several of these successful vaccines are based on the adenoviral vector platform. The mass manufacturing of these vaccines poses great challenges, especially in the context of a pandemic where extremely large quantities must be produced quickly at an affordable cost. In this work, two baseline processes for the production of a COVID-19 adenoviral vector vaccine, B1 and P1, were designed, simulated and economically evaluated with the aid of the software SuperPro Designer. B1 used a batch cell culture viral production step, with a viral titer of 5 1010 viral particles (VP)/mL in both stainless-steel and disposable equipment. P1 used a perfusion cell culture viral production step, with a viral titer of 1 1012 VP/mL in exclusively disposable equipment. Both processes were sized to produce 400 M/yr vaccine doses. P1 led to a smaller cost per dose than B1 ($0.15 vs. $0.23) and required a much smaller capital investment ($126 M vs. $299 M). The media and facility-dependent expenses were found to be the main contributors to the operating cost. The results indicate that adenoviral vector vaccines can be practically manufactured at large scale and low cost.Keywords: process simulation; techno-economic analysis; COVID-19; adenovirus; vaccine; viral vector

The series objective is to review various clinical conditions/ presentations, including the latest evidence on management, and to dispel common myths. In the process, core knowledge and management principles are enhanced. A clinical case will be presented. Cases will be drawn from real life but phrased in a context that is applicable to the Special Operations Forces (SOF) or tactical emergency medical support (TEMS) environment. Details will be presented in such a way that the reader can follow along and identify how they would manage the case clinically depending on their experience and environment situation. Commentary will be provided by currently serving military medical technicians. The medics and author will draw on their SOF experience to communicate relevant clinical concepts pertinent to different operational environments including SOF and TEMS. Commentary and input from active special operations medical technicians will be part of the feature.

Background: Excessive ventilation of sick and injured patients is associated with increased morbidity and mortality. Combat Medical Systems (CMS) is developing a new bag-valve-mask (BVM) designed to limit ventilation rates. The purpose of this study was to compare ventilation rates between a standard BVM device and the CMS device. Methods: This was a prospective, observational, semirandomized, crossover study using Army Medics. Data were collected during Brigade Combat Team Trauma Training classes at Camp Bullis, Texas. Subjects were observed during manikin simulation training in classroom and field environments, with total duration of manual ventilation and number of breaths given recorded for each device. Analysis was performed on overall ventilation rate in breaths per minute (BPM) and also by grouping the subjects by ventilation rates in low, correct, and high groups based on an ideal rate of 10-12 BPM. Results: A total of 89 Medics were enrolled and completed the classroom portion of the study, with a subset of 36 evaluated in the field. A small but statistically significant difference in overall BPM between devices was seen in the classroom (ρ .05). The study device significantly decreased the incidence of high ventilation rates when compared by groups in both the classroom (ρ Conclusion: The study device effectively reduced rates of excessive ventilation in the classroom and the field.

Background: An Army Reserve Combat Medic's training is focused on knowledge attainment, skill development, and building experience and training to prepare them to perform in austere conditions with limited resources like on the battlefield. Unfortunately, the exposure to skills they may be responsible for performing is limited. Research shows that greater than 90% of battlefield deaths occur in the prehospital setting, 24% of which are potentially survivable. Literature demonstrates that 91% of these deaths are related to hemorrhage; the remaining are related to other causes, including airway compromise. The skill and decision-making of this population are prime targets to optimize outcomes in the battlefield setting. Methods: Army Reserve combat medics were selected to voluntarily participate in an educational intervention provided by anesthesia providers focusing on airway management. Participants completed a preintervention assessment to evaluate baseline knowledge levels as well as comfort with airway skills. Medics then participated in a simulated difficult airway scenario. Next, airway management was reviewed, and navigation of the difficult airway algorithm was discussed. The presentation was followed by simulations at four hands-on stations, which focused on fundamental airway concepts such as bag-mask ventilation and placement of oral airways, tracheal intubation, placement of supraglottic airways, and cricothyrotomy. Pre/post knowledge assessments and performance evaluation tools were used to measure the effectiveness of the intervention. Results: Statistically significant results were found in self-reported confidence levels with airway skills (z = -2.803, p = .005), algorithm progression (z = -2.807, p = .005), and predicting difficulty with airway interventions based on the patient's features (z = -2.809, p = .005). Establishment of ventilation was completed faster after the intervention. More coherent and effective airway management was noted, new knowledge was gained, and implications from psychological research applied. Conclusion: Supplementing the training of Army Reserve Combat Medics with the utilization of anesthesia providers is an effective platform. This exercise imparted confidence in this population of military providers. This is critical for decision-making capabilities, performance, and the prevention of potentially survivable mortality on the battlefield. 041b061a72


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