40 results on '"Kristin Fraser"'
Search Results
2. Canadian Sleep Society/Canadian Thoracic Society position paper on the use of portable monitoring for the diagnosis of obstructive sleep apnea/hypopnea in adults
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Adam Blackman, Catherine McGregor, Robert Dales, Helen S Driver, Ilya Dumov, Jon Fleming, Kristin Fraser, Charlie George, Atul Khullar, Joe Mink, Murray Moffat, Glendon E Sullivan, John A Fleetham, Najib Ayas, T Douglas Bradley, Michael Fitzpatrick, John Kimoff, Debra Morrison, Frank Ryan, Robert Skomro, Frederic Series, and Willis Tsai
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Diseases of the respiratory system ,RC705-779 - Abstract
The present position paper on the use of portable monitoring (PM) as a diagnostic tool for obstructive sleep apnea/hypopnea (OSAH) in adults was based on consensus and expert opinion regarding best practice standards from stakeholders across Canada. These recommendations were prepared to guide appropriate clinical use of this new technology and to ensure that quality assurance standards are adhered to. Clinical guidelines for the use of PM for the diagnosis and management of OSAH as an alternative to in-laboratory polysomnography published by the American Academy of Sleep Medicine Portable Monitoring Task Force were used to tailor our recommendations to address the following: indications; methodology including physician involvement, physician and technical staff qualifications, and follow-up requirements; technical considerations; quality assurance; and conflict of interest guidelines. When used appropriately under the supervision of a physician with training in sleep medicine, and in conjunction with a comprehensive sleep evaluation, PM may expedite treatment when there is a high clinical suspicion of OSAH.
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- 2010
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3. Exploring the Study of Simulation as a Continuing Professional Development Strategy for Physicians
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Walter Tavares, Dominique Piquette, Dorothy Luong, Michelle Chiu, Christopher Dyte, Kristin Fraser, and Marcia Clark
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General Medicine ,Education - Published
- 2022
4. Predicting CPAP failure in patients with suspected sleep hypoventilation identified on ambulatory testing
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Willis H. Tsai, Sachin R. Pendharkar, Kristin Fraser, Michael V Braganza, and Patrick J. Hanly
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Polysomnography ,Sleep hypoventilation ,Internal medicine ,medicine ,Humans ,In patient ,Retrospective Studies ,Obesity hypoventilation syndrome ,Continuous Positive Airway Pressure ,business.industry ,Sleep apnea ,Hypoventilation ,medicine.disease ,Scientific Investigations ,respiratory tract diseases ,Obstructive sleep apnea ,Neurology ,Ambulatory ,Cardiology ,Neurology (clinical) ,medicine.symptom ,Sleep ,business ,Hypercapnia - Abstract
STUDY OBJECTIVES: Home sleep apnea testing (HSAT) is commonly used to diagnose obstructive sleep apnea, but its role in identifying patients with suspected hypoventilation or predicting their response to continuous positive airway pressure (CPAP) therapy has not been assessed. The primary objective was to determine if HSAT, combined with clinical variables, could predict the failure of CPAP to correct nocturnal hypoxemia during polysomnography in a population with suspected hypoventilation. Secondary objectives were to determine if HSAT and clinical parameters could predict awake or sleep hypoventilation. METHODS: A retrospective review was performed of 142 consecutive patients who underwent split-night polysomnography for suspected hypoventilation after clinical assessment by a sleep physician and review of HSAT. We collected quantitative indices of nocturnal hypoxemia, patient demographics, medications, pulmonary function tests, as well as arterial blood gas data from the night of the polysomnography . CPAP failure was defined as persistent obstructive sleep apnea, hypoxemia (oxygen saturation measured by pulse oximetry < 85%), or hypercapnia despite maximal CPAP. RESULTS: Failure of CPAP was predicted by awake oxygen saturation and arterial blood gas results but not by HSAT indices of nocturnal hypoxemia. Awake oxygen saturation ≥ 94% ruled out CPAP failure, and partial pressure of oxygen measured by arterial blood gas ≥ 68 mmHg decreased the likelihood of CPAP failure significantly. CONCLUSIONS: In patients with suspected hypoventilation based on clinical review and HSAT interpretation by a sleep physician, awake oxygen saturation measured by pulse oximetry and partial pressure of oxygen measured by arterial blood gas can reliably identify patients in whom CPAP is likely to fail. Additional research is required to determine the role of HSAT in the identification and treatment of patients with hypoventilation. CITATION: Braganza MV, Hanly PJ, Fraser KL, Tsai WH, Pendharkar SR. Predicting CPAP failure in patients with suspected sleep hypoventilation identified on ambulatory testing. J Clin Sleep Med. 2020;16(9):1555–1565.
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- 2020
5. Summative Assessment of Interprofessional 'Collaborative Practice' Skills in Graduating Medical Students: A Validity Argument
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Sylvain Coderre, Alyshah Kaba, Marlene Donahue, Pamela Veale, Kevin McLaughlin, Irina Charania, Kristin Fraser, and Kent G. Hecker
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Psychometrics ,020205 medical informatics ,Objective structured clinical examination ,Interprofessional Relations ,02 engineering and technology ,Structural equation modeling ,Education ,03 medical and health sciences ,Professional Competence ,0302 clinical medicine ,Health care ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Cooperative Behavior ,Competence (human resources) ,Patient Care Team ,Medical education ,business.industry ,Reproducibility of Results ,General Medicine ,Confirmatory factor analysis ,Checklist ,Summative assessment ,Clinical Competence ,Educational Measurement ,Psychology ,business ,Education, Medical, Undergraduate - Abstract
Purpose To describe how the authors developed an objective structured clinical examination (OSCE) station to assess aspects of collaborative practice competency and how they then assessed validity using Kane's framework. Method After piloting the collaborative practice OSCE station in 2015 and 2016, this was introduced at the Cumming School of Medicine in 2017. One hundred fifty-five students from the class of 2017 and 22 students from the class of 2018 participated. To create a validity argument, the authors used Kane's framework that views the argument for validity as 4 sequential inferences on the validity of scoring, generalization, extrapolation, and implications, RESULTS: Scoring validity is supported by psychometric analysis of checklist items and the fact that the contribution of rater specificity to students' ratings was similar to OSCE stations assessing clinical skills alone. The claim of validity of generalization is backed by structural equation modeling and confirmatory factor analysis that identified 5 latent variables, including 3 related to collaborative practice ("provides an effective handover," "provides mutual support," and "shares their mental model"). Validity of extrapolation is argued based upon the correlation between the rating for "shares their mental model" and the rating on in-training evaluations for "relationship with other members of the health care team," in addition to the association between performance on the collaborative practice OSCE station and the subsequent rating of performance during residency. Finally, validity of implications is supported by the fact that pass/fail decisions on the collaborative practice station were similar to other stations and by the observation that ratings on different aspects of collaborative practice associate with pass/fail decisions. Conclusions Based upon the validity argument presented, the authors posit that this tool can be used to assess the collaborative practice competence of graduating medical students and the adequacy of training in collaborative practice.
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- 2020
6. A Randomized Controlled Trial of an Alternative Care Provider Clinic for Severe Sleep-disordered Breathing
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W. Ward Flemons, Ada Ip-Buting, Sachin R. Pendharkar, Willis H. Tsai, Erika Penz, Jenny Kelly, Patrick J. Hanly, Maria J. Santana, and Kristin Fraser
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Waiting Lists ,Cost-Benefit Analysis ,Polysomnography ,Severity of Illness Index ,law.invention ,03 medical and health sciences ,Sleep Apnea Syndromes ,0302 clinical medicine ,Occupational Therapists ,Healthcare delivery ,Randomized controlled trial ,law ,medicine ,Humans ,Patient Reported Outcome Measures ,030212 general & internal medicine ,Alternative care ,Intensive care medicine ,Aged ,Continuous Positive Airway Pressure ,business.industry ,Middle Aged ,Treatment Outcome ,030228 respiratory system ,Patient Satisfaction ,Quality of Life ,Sleep disordered breathing ,Breathing ,Patient Compliance ,Female ,business ,Healthcare providers - Abstract
Rationale: Lack of timely access to diagnosis and treatment of sleep-disordered breathing (SDB) has sparked interest in using nonphysician providers. Previous studies of these alternative care prov...
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- 2019
7. Helping Canadian health care providers to optimize Sleep Disordered Breathing management for their patients during the COVID-19 pandemic
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Kristin Fraser, Eleni Giannouli, Najib T. Ayas, Tetyana Kendzerska, Debra Morrison, Marcus Povitz, Brandy N. Lachmann, Annie C. Lajoie, Caroline Minville, Indra Narang, Robert Skomro, Patrick J. Hanly, Kathy F. Spurr, and Sherri L. Katz
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.disease ,Critical Care and Intensive Care Medicine ,Sleep in non-human animals ,Chronic disorders ,nervous system diseases ,respiratory tract diseases ,Obstructive sleep apnea ,Pandemic ,Health care ,medicine ,Sleep disordered breathing ,Intensive care medicine ,business - Abstract
Sleep Disordered Breathing (SDB) is a common chronic disorder and encompasses a range of diseases including obstructive sleep apnea (OSA) (by far the most common), and central sleep disorders (eg, ...
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- 2020
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8. Key Highlights From the Canadian Thoracic Society's Position Statement on Optimizing the Management of Sleep Disordered Breathing During the Coronavirus Disease 2019 Pandemic
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Marcus Povitz, Sherri L. Katz, Annie C. Lajoie, Tetyana Kendzerska, Debra Morrison, Najib T. Ayas, Robert Skomro, Kristin Fraser, Caroline Minville, Indra Narang, Brandy N. Lachmann, Eleni Giannouli, Patrick J. Hanly, and Kathy F. Spurr
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Position statement ,Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Canada ,Consensus ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,Critical Care and Intensive Care Medicine ,Article ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Sleep Apnea Syndromes ,Pandemic ,Medicine ,Humans ,Disease management (health) ,Intensive care medicine ,Pandemics ,Societies, Medical ,business.industry ,SARS-CoV-2 ,COVID-19 ,Disease Management ,Thoracic Surgery ,030228 respiratory system ,Sleep disordered breathing ,business ,Cardiology and Cardiovascular Medicine ,Coronavirus Infections ,030217 neurology & neurosurgery - Published
- 2020
9. Pneumothorax in chronically ventilated neuromuscular and chest wall restricted patients: A case series
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Raymond Tye, Karen P. Rimmer, Kristin Fraser, and Andrea H. S. Loewen
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Pulmonary and Respiratory Medicine ,Mechanical ventilation ,Airway clearance ,Neuromuscular disease ,business.industry ,medicine.medical_treatment ,food and beverages ,respiratory system ,Critical Care and Intensive Care Medicine ,medicine.disease ,respiratory tract diseases ,Lung recruitment ,Pneumothorax ,Anesthesia ,medicine ,business - Abstract
RATIONALE: Pneumothorax can occur in chronically ventilated neuromuscular and chest wall-restricted patients using noninvasive home mechanical ventilation (HMV) and airway clearance techniques. Lim...
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- 2018
10. Pneumothoraces in collagen VI-related dystrophy: a case series and recommendations for management
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Daniel J. Lesser, A. Reghan Foley, Scott Wong, Kristin Fraser, Carsten G. Bönnemann, Sameer Chhibber, Anne Rutkowski, and Carla Grosmann
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Ullrich congenital muscular dystrophy ,Population ,lcsh:Medicine ,03 medical and health sciences ,0302 clinical medicine ,Collagen VI ,medicine ,education ,Muscle contracture ,education.field_of_study ,business.industry ,lcsh:R ,Bethlem myopathy ,Dystrophy ,Original Articles ,medicine.disease ,Thoracostomy ,Surgery ,030104 developmental biology ,Pneumothorax ,business ,030217 neurology & neurosurgery - Abstract
Collagen VI-related dystrophy (collagen VI-RD) is a rare neuromuscular condition caused by mutations in the COL6A1, COL6A2 or COL6A3 genes. The phenotypic spectrum includes early-onset Ullrich congenital muscular dystrophy, adult-onset Bethlem myopathy and an intermediate phenotype. The disorder is characterised by distal hyperlaxity and progressive muscle weakness, joint contractures and respiratory insufficiency. Respiratory insufficiency is attributed to chest wall contractures, scoliosis, impaired diaphragmatic function and intercostal muscle weakness. To date, intrinsic parenchymal lung disease has not been implicated in the inevitable respiratory decline of these patients. This series focuses on pneumothorax, an important but previously under-recognised disease manifestation of collagen VI-RD. We describe two distinct clinical presentations within collagen VI-RD patients with pneumothorax. The first cohort consists of neonates and children with a single pneumothorax in the setting of large intrathoracic pressure changes. The second group is made up of adult patients with recurrent pneumothoraces, associated with chest computed tomography scan evidence of parenchymal lung disease. We describe treatment challenges in this unique population with respect to expectant observation, tube thoracostomy and open pleurodesis. Based on this experience, we offer recommendations for early identification of lung disease in collagen VI-RD and definitive intervention., Collagen VI-RD patients may experience unprovoked or recurrent pneumothorax from parenchymal lung changes http://ow.ly/ZL3h30ce0Bk
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- 2017
11. Using Cognitive Load Theory to Optimize Simulation Design
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Jeffrey J. H. Cheung, Laura M. Naismith, Rodrigo B. Cavalcanti, Matthew Sibbald, Walter Tavares, Kristin Fraser, and Faizal A. Haji
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Optimal learning ,Computer science ,Working memory ,Human–computer interaction ,Process (engineering) ,Perspective (graphical) ,Cognitive load ,Simulation design - Abstract
For learners, engaging in a simulation activity is a complex information-processing activity that involves various sensory elements. Cognitive load theory (CLT) provides an important framework for considering how to design these activities to take into account learners’ limited working memory resources and promote optimal learning. This chapter reviews learning from the perspective of cognitive psychology and introduces foundational concepts and principles in CLT, including the distinction between intrinsic and extraneous load, and the role of germane processing. Four evidence-based guidelines, with examples from both procedural and immersive theater-based simulation, are used to illustrate how these principles can be applied to optimize simulation design. This chapter also discusses and provides strategies for mitigating common challenges that may arise during this process.
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- 2019
12. Are we at risk of groupthink in our approach to teamwork interventions in health care?
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Ian Wishart, Alyshah Kaba, Kristin Fraser, Sylvain Coderre, and Kevin McLaughlin
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Evidence-based practice ,020205 medical informatics ,Attitude of Health Personnel ,Social loafing ,Interprofessional Relations ,media_common.quotation_subject ,Clinical Decision-Making ,education ,Psychological intervention ,Collaborative Care ,Context (language use) ,02 engineering and technology ,Education ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Outcome Assessment, Health Care ,Health care ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,Medicine ,030212 general & internal medicine ,Cooperative Behavior ,Intersectoral Collaboration ,Problem Solving ,Quality of Health Care ,media_common ,Patient Care Team ,Teamwork ,business.industry ,Professional Practice ,General Medicine ,Interprofessional education ,Group Processes ,Research Design ,Evidence-Based Practice ,Clinical Competence ,business ,Delivery of Health Care - Abstract
Context The incidence of medical error, adverse clinical events and poor quality health care is unacceptably high and there are data to suggest that poor coordination of care, or teamwork, contributes to adverse outcomes. So, can we assume that increased collaboration in multidisciplinary teams improves performance and health care outcomes for patients? Methods In this essay, the authors discuss some reasons why we should not presume that collective decision making leads to better decisions and collaborative care results in better health care outcomes. Results Despite an exponential increase in interventions designed to improve teamwork and interprofessional education (IPE), we are still lacking good quality data on whether these interventions improve important outcomes. There are reasons why some of the components of ‘effective teamwork’, such as shared mental models, team orientation and mutual trust, could impair delivery of health care. For example, prior studies have found that brainstorming results in fewer ideas rather than more, and hinders rather than helps productivity. There are several possible explanations for this effect, including ‘social loafing’ and cognitive overload. Similarly, attributes that improve cohesion within groups, such as team orientation and mutual trust, may increase the risk of ‘groupthink’ and group conformity bias, which may lead to poorer decisions. Conclusions In reality, teamwork and IPE are not inherently good, bad or neutral; instead, as with any intervention, their effect is modified by the persons involved, the situation and the interaction between persons and situation. Thus, rather than assume better outcomes with teamwork and IPE interventions, as clinicians and educators we must demonstrate that our interventions improve the delivery of health care.
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- 2016
13. Effects of Wait Times on Treatment Adherence and Clinical Outcomes in Patients With Severe Sleep-Disordered Breathing
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Christina S. Thornton, W. Ward Flemons, Willis H. Tsai, Patrick J. Hanly, Sachin R. Pendharkar, Maria J. Santana, Kristin Fraser, and Erika Penz
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Sleep disorder ,medicine.medical_specialty ,business.industry ,Epworth Sleepiness Scale ,Sleep apnea ,General Medicine ,Odds ratio ,medicine.disease ,law.invention ,Patient satisfaction ,Quality of life ,Randomized controlled trial ,law ,Internal medicine ,Positive airway pressure ,Medicine ,business - Abstract
Importance Sleep-disordered breathing (SDB) is common and associated with substantial adverse health consequences. Long wait times for SDB care are commonly reported; however, it is unclear whether wait times for care are associated with clinical outcomes. Objective To evaluate the association of wait times for care with clinical outcomes for patients with severe SDB. Design, Setting, and Participants This study is a secondary analysis of a randomized clinical noninferiority trial comparing management by alternative care practitioners (ACPs) with traditional sleep physician–led care between October 2014 and May 2017. The study took place at Foothills Medical Centre Sleep Centre, a tertiary care multidisciplinary sleep clinic at the University of Calgary. Patients with severe SDB (defined as a respiratory event index ≥30 events per hour during home sleep apnea testing, mean nocturnal oxygen saturation ≤85%, or suspected sleep hypoventilation syndrome) were recruited for the study. Patients were excluded if they were suspected of having a concomitant sleep disorder other than SDB or had previously been treated with positive airway pressure (PAP) therapy for SDB. Data were analyzed from October 2017 to January 2020. Main Outcomes and Measures Outcomes were assessed 3 months after treatment initiation with adherence to PAP therapy as the primary outcome. Secondary outcomes included Epworth Sleepiness Scale score, health-related quality of life, and patient satisfaction measured using the Visit-Specific Satisfaction Instrument–9. Multiple regression models were used to assess the associations between wait times and each of the outcomes.ttests were used to compare wait times for patients who were adherent to PAP therapy (≥4 hours per night for 70% of nights) with those for nonadherent patients. Results One hundred fifty-six patients (112 [71.8%] men; mean [SD] age, 56 [12] years) were included in the analysis. The mean time from referral to initial visit was 88 days (95% CI, 79 to 96 days), and the mean time to treatment was 123 days (95% CI, 112 to 133 days). Shorter wait time to treatment initiation was associated with adherence to PAP therapy (odds ratio, 0.99; 95% CI, 0.98 to 0.99;P = .04), greater improvement in Epworth Sleepiness Scale score (mean coefficient, −9.37; 95% CI, −18.51 to −0.24;P = .04), and higher Visit-Specific Satisfaction Instrument–9 score (mean coefficient, −0.024; 95% CI, −0.047 to −0.0015;P = .04) at 3 months. Compared with nonadherent patients, those who were adherent to treatment waited a mean of 15 fewer days (95% CI, 12 to 19 days) for initial assessment (P = .07) and 30 fewer days (95% CI, 23 to 35 days) for treatment initiation (P = .008). Conclusions and Relevance Earlier initiation of treatment for severe SDB was associated with better PAP adherence and greater improvements in daytime sleepiness and patient satisfaction. These findings suggest that system interventions to improve timely access may modify patient behavior and improve clinical outcomes. Trial Registration ClinicalTrials.gov Identifier:NCT02191085
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- 2020
14. Temporal pattern of emotions and cognitive load during simulation training and debriefing
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Kristin Fraser and Kevin McLaughlin
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Male ,Medical psychology ,Students, Medical ,020205 medical informatics ,Formative Feedback ,education ,Applied psychology ,Emotions ,MEDLINE ,02 engineering and technology ,Education ,Simulation training ,Formative assessment ,03 medical and health sciences ,0302 clinical medicine ,Cognition ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Simulation Training ,Debriefing ,General Medicine ,Observational study ,Female ,Clinical Competence ,Psychology ,Cognitive load - Abstract
In the simulated clinical environment, there is a perceived benefit to the emotional activation experienced by learners; however, potential harm of excessive and/or negative emotions has also been hypothesized. An improved understanding of the emotional experiences of learners during each phase of the simulation session will inform instructional design.In this observational study, we asked 174 first-year medical students about their emotional state upon arrival to the simulation lab (t1). They were then trained on a standard simulation scenario, after which they rated their emotional state and perceived cognitive load (t2). After debriefing, we then asked them to again rate their emotions and cognitive load (t3).Students reported that their experience of tranquility (a positive and low-arousal state) dropped from pre-scenario (t1) to post-scenario (t2), and returned to baseline levels after debriefing (t3), from 0.69 (0.87) to 0.14 (0.78) to 0.62 (0.78). Post scenario cognitive load was rated to be moderately high at 6.62 (1.12) and scores increased after debriefing to 6.90 (1.05) d = 0.26, p 0.001. Cognitive load was associated with the simultaneous measures of emotions at both t2 and t3.Participant emotions are significantly altered through the experience of medical simulation and emotions are associated with subjective ratings of cognitive load.
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- 2018
15. Cognitive Load Theory for debriefing simulations: implications for faculty development
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Vincent Grant, Jolene T. Haws, Michael Meguerdichian, Adam Cheng, Kristin Fraser, and Komal Bajaj
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Medical personnel--Training of ,020205 medical informatics ,Applied psychology ,02 engineering and technology ,lcsh:Computer applications to medicine. Medical informatics ,Affect (psychology) ,03 medical and health sciences ,0302 clinical medicine ,Synthetic training devices ,Cognitive psychology ,0202 electrical engineering, electronic engineering, information engineering ,ComputingMilieux_COMPUTERSANDEDUCATION ,030212 general & internal medicine ,Innovation ,ComputingMilieux_THECOMPUTINGPROFESSION ,Debriefing ,Professional development ,Workload ,General Medicine ,Career development ,Human resource management ,lcsh:R858-859.7 ,Faculty development ,Psychology ,Cognitive load - Abstract
The debriefing is an essential component of simulation-based training for healthcare professionals, but learning this complex skill can be challenging for simulation faculty. There are multiple competing priorities for a debriefer’s attention that can contribute to a high mental workload, which may adversely affect debriefer performance and consequently learner outcomes. In this paper, we conceptualize the debriefer as a learner of debriefing skills and we discuss Cognitive Load Theory to categorize the many potential mental loads that can affect the faculty debriefer as learner. We then discuss mitigation strategies that can be considered by faculty development programmes to enhance professional development of debriefing staff.
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- 2018
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16. Impact of processing technique on bronchoalveolar lavage cellular analysis
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Kerri A. Johannson, Margaret M. Kelly, Leila Barss, and Kristin Fraser
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Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,030204 cardiovascular system & hematology ,Bronchoalveolar Lavage ,03 medical and health sciences ,0302 clinical medicine ,Bronchoalveolar lavage ,030228 respiratory system ,medicine ,business ,Bronchoalveolar Lavage Fluid - Abstract
BALF cellular analysis results are greatly impacted by processing technique #AdvancesinILD @ERSTalk http://ow.ly/u9js30i1dUP
- Published
- 2017
17. The Emotional and Cognitive Impact of Unexpected Simulated Patient Death
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Joanne McIlwrick, James Huffman, Kristin Fraser, Irene W. Y. Ma, Bruce Wright, Matthew Sobczak, and Kevin McLaughlin
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Pulmonary and Respiratory Medicine ,Educational measurement ,medicine.medical_specialty ,business.industry ,Objective structured clinical examination ,education ,Cognition ,Critical Care and Intensive Care Medicine ,Affect (psychology) ,Simulated patient ,law.invention ,Surgery ,Randomized controlled trial ,law ,Physical therapy ,Medicine ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Cognitive load - Abstract
Background Observational studies suggest that emotions experienced during simulation training may affect cognitive load and learning outcomes. The objective of this study was to manipulate emotions during simulation training and assess the impact on cognitive load and learning. Methods In this prospective randomized trial, 116 final-year medical students received training in a simulated scenario of a 70-year-old woman presenting with reduced consciousness due to aminosalicylic acid ingestion. Training groups were randomly allocated to one of two endings for the scenario: The patient was transferred to another service, or she experienced a cardiorespiratory arrest and died. Participants rated their emotions and cognitive load after training. Three months later, we evaluated their performance on a simulation Objective Structured Clinical Examination station of a 60-year-old man presenting with reduced consciousness due to ethylene glycol ingestion. Results Emotions tended to be more negative for students in training groups where the simulated patient died. These students also reported a higher cognitive load (mean ± SD, 7.63 ± 0.97 vs 7.25 ± 0.84; P = .03; d = 0.42) and were less likely to be rated as competent to diagnose and manage a patient with reduced consciousness due to toxin ingestion (OR, 0.37; 95% CI, 0.14-0.95; P = 0.04) 3 months later. Conclusions Students exposed to unexpected simulated patient death reported increased cognitive load and had poorer learning outcomes. Educators need to expose learners to negative experiences; therefore, further studies are needed on how best to use negative emotional experiences during simulation training.
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- 2014
18. Diagnostic performance 1 h after simulation training predicts learning
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Kevin McLaughlin, Anna Consoli, Matthew Sobczak, Irene W. Y. Ma, Kristin Fraser, and Bruce Wright
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Male ,Chest Pain ,medicine.medical_specialty ,Time Factors ,education ,Manikins ,Chest pain ,Education ,Simulation training ,Heart disorder ,Acute onset ,Internal medicine ,Positive predicative value ,medicine ,Humans ,Learning ,cardiovascular diseases ,Probability ,British Columbia ,Heart Murmurs ,business.industry ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Predictive value ,Pulmonary embolism ,Stenosis ,cardiovascular system ,Cardiology ,Physical therapy ,Female ,Clinical Competence ,Curriculum ,Educational Measurement ,medicine.symptom ,Pulmonary Embolism ,business ,Education, Medical, Undergraduate - Abstract
Although simulation training improves post-training performance, it is unclear how well performance soon after simulation training predicts longer term outcomes (i.e., learning). Here our objective was to assess the predictive value of performance 1 h post-training of performance 6 weeks later. We trained 84 first year medical students a simulated case of chest pain due to aortic stenosis. They then received training on a case of acute onset dyspnea due to pulmonary embolism, after which we evaluated diagnostic performance on their trained murmur followed by novel murmur. We repeated the evaluation of diagnostic performance on the same murmurs 6 weeks later. One hour post-training 88.1 % of students identified the training murmur, compared to 60.7 % for the novel murmur. Six weeks after training the corresponding results were 89.3 and 65.5 %, respectively (p < 0.0001 for both time periods). The probability of students diagnosing their training murmur 6 weeks post-training if they diagnosed this after 1 h (positive predictive value) was 0.89 [0.87, 0.93], and the probability of misdiagnosing their trained murmur 6 weeks post-training if they misdiagnosed this after 1 h (negative predictive value) was 0.10 [0.01, 0.40]. The corresponding positive and negative predictive values for the novel murmur were 0.69 [0.55, 0.80] and 0.39 [0.24, 0.57], respectively. Students who successfully diagnosed a cardiac murmur 1 h after simulation training were very likely to recognize the same murmur 6 weeks later, suggesting that we can use performance 1 h post-training as a learning outcome.
- Published
- 2012
19. Cognitive Load and Stress in Simulation
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Kristin Fraser, Denis Oriot, and Choon Looi Bong
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Working memory ,Long-term memory ,education ,030208 emergency & critical care medicine ,03 medical and health sciences ,Improved performance ,0302 clinical medicine ,Stress (linguistics) ,Heart rate variability ,Memory consolidation ,Psychology ,030217 neurology & neurosurgery ,Cognitive load ,Physiological stress ,Cognitive psychology - Abstract
Simulation-based education (SBE) has all the requisite elements for a stressful experience: being novel, unpredictable, imparting a sense of lack of control, and potentially threatening the participant’s ego. Indeed, SBE has been shown to evoke a physiological stress response in learners, which can be measured objectively using physiological or biological means, or subjectively using self-report questionnaires. The interaction between stress and cognitive load on performance and learning in the simulation environment is complex and not yet fully elucidated. At an appropriate level of cognitive load and moderate level of stress, simulation challenges and engages the learner, contributing to improved performance and learning outcomes. On the other hand, excessive stress can contribute to cognitive overload, attentional narrowing and distractibility, all of which are associated with impaired performance. Despite this detrimental effect of stress, learning can still be reinforced at high-stress levels through the enhancement on memory consolidation.
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- 2016
20. Emotion, cognitive load and learning outcomes during simulation training
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Kristin Fraser, Elise Teteris, Bruce Wright, Kevin McLaughlin, Heather Baxter, and Irene W. Y. Ma
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medicine.medical_specialty ,Educational measurement ,education ,Cognition ,General Medicine ,Odds ratio ,Audiology ,Confidence interval ,Education ,Odds ,Tranquillity ,Linear regression ,medicine ,Psychology ,Social psychology ,Cognitive load - Abstract
factor analysis to identify the principal components of emotion, and then studied the associations between these components of emotion and cognitive load and diagnostic performance. RESULTS We identified two principal components of emotion, which we felt represented invigoration and tranquillity. Both of these were associated with cognitive load with adjusted regression coefficients of 0.63 (95% confidence interval [CI] 0.28–0.99; p = 0.001) and ) 0.44 (95% CI ) 0.77 to ) 0.10; p = 0.009), respectively. We found a significant negative association between cognitive load and the odds of subsequently identifying the trained murmur (odds ratio 0.27, 95% CI 0.11–0.67; p = 0.004). CONCLUSIONS We found that increased invigoration and reduced tranquillity during simulation training were associated with increased cognitive load, and that the likelihood of correctly identifying a trained murmur declined with increasing cognitive load. Further studies are needed to evaluate the impact on performance of strategies to alter emotion and cognitive load during simulation training.
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- 2012
21. Learning during simulation training is prone to retroactive interference
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Murray Lee, Irene W. Y. Ma, Elise Teteris, Bruce Wright, Kristin Fraser, and Kevin McLaughlin
- Subjects
Protocol (science) ,congenital, hereditary, and neonatal diseases and abnormalities ,Communication ,medicine.medical_specialty ,Recall ,business.industry ,education ,Interference theory ,General Medicine ,Audiology ,Education ,Odds ,Simulation training ,law.invention ,Improved performance ,Randomized controlled trial ,law ,cardiovascular system ,Heart murmur ,medicine ,cardiovascular diseases ,medicine.symptom ,business - Abstract
Medical Education 2012: 46: 299–305 Context Retroactive interference occurs when newly acquired information inhibits recall of previously learned information. This has been shown to influence recall of sounds, tastes and word associations, and is typically seen when learners receive training on one area of content and are then exposed to new content before being evaluated on the original content. Thus far, retroactive interference has received little attention in medical education and has not been studied during simulation training. Our objective was to evaluate whether retroactive interference occurs during simulation training. Methods We randomised 167 Year 1 medical students to one of two training protocols. After training on a cardiac murmur, participants were tested either on the same cardiac murmur followed by a novel murmur (the non-interference protocol), or on the novel murmur followed by the training murmur (the interference protocol). We evaluated performance on both murmurs at 1 hour and 6 weeks post-training. Results We found a significant interaction between training protocol and diagnostic performance on training versus novel murmurs at both testing time-points. Students in the non-interference protocol had increased odds of achieving success on the training murmur relative to the novel murmur at 1 hour (odds ratio [OR] 4.96; p
- Published
- 2012
22. Does training learners on simulators benefit real patients?
- Author
-
Kevin McLaughlin, Elise Teteris, Kristin Fraser, and Bruce Wright
- Subjects
medicine.medical_specialty ,Medical education ,Knowledge management ,Education, Medical ,business.industry ,Cost effectiveness ,media_common.quotation_subject ,Medical simulation ,Teaching method ,education ,Psychological intervention ,Fidelity ,General Medicine ,Education ,Transfer of training ,Health care ,medicine ,Humans ,business ,Transfer of learning ,Computer-Assisted Instruction ,Quality of Health Care ,media_common - Abstract
Despite limited data on patient outcomes, simulation training has already been adopted and embraced by a large number of medical schools. Yet widespread acceptance of simulation should not relieve us of the duty to demonstrate if, and under which circumstances, training learners on simulation benefits real patients. Here we review the data on performance of healthcare providers or trainees following simulation training, and discuss ways of enhancing transfer of learning from simulated to real patients. While there is tremendous potential for simulation in medical education and healthcare, further studies are needed to identify if and when simulation training improves the quality of care delivered to patients, and to compare the cost-effectiveness of simulated learning experiences to lower fidelity and less expensive interventions.
- Published
- 2011
23. Can we avoid the guilt of shame in medical education?
- Author
-
Kevin McLaughlin and Kristin Fraser
- Subjects
Psychotherapist ,media_common.quotation_subject ,Shame ,General Medicine ,Psychology ,Education ,media_common - Published
- 2014
24. Canadian Sleep Society/Canadian Thoracic Society position paper on the use of portable monitoring for the diagnosis of obstructive sleep apnea/hypopnea in adults
- Author
-
Frank Ryan, Debra Morrison, Michael Fitzpatrick, Catherine McGregor, Helen S. Driver, Ilya Dumov, T. Douglas Bradley, Najib T. Ayas, Robert Skomro, Murray Moffat, John Kimoff, Willis H. Tsai, Jon Fleming, Frédéric Sériès, Atul Khullar, John A. Fleetham, Glendon Edward Sullivan, Joe Mink, Charlie George, Robert Dales, Adam Blackman, and Kristin Fraser
- Subjects
Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Quality Assurance, Health Care ,Polysomnography ,Best practice ,Sleep medicine ,Diseases of the respiratory system ,Special Article ,Health care ,medicine ,Humans ,Intensive care medicine ,Referral and Consultation ,Sleep Medicine Specialty ,Sleep Apnea, Obstructive ,RC705-779 ,medicine.diagnostic_test ,Conflict of Interest ,business.industry ,Sleep apnea ,medicine.disease ,Obstructive sleep apnea ,Position paper ,Medical emergency ,business ,Hypopnea - Abstract
The present position paper on the use of portable monitoring (PM) as a diagnostic tool for obstructive sleep apnea/hypopnea (OSAH) in adults was based on consensus and expert opinion regarding best practice standards from stakeholders across Canada. These recommendations were prepared to guide appropriate clinical use of this new technology and to ensure that quality assurance standards are adhered to. Clinical guidelines for the use of PM for the diagnosis and management of OSAH as an alternative to in-laboratory polysomnography published by the American Academy of Sleep Medicine Portable Monitoring Task Force were used to tailor our recommendations to address the following: indications; methodology including physician involvement, physician and technical staff qualifications, and follow-up requirements; technical considerations; quality assurance; and conflict of interest guidelines. When used appropriately under the supervision of a physician with training in sleep medicine, and in conjunction with a comprehensive sleep evaluation, PM may expedite treatment when there is a high clinical suspicion of OSAH.
- Published
- 2010
25. Cognitive Load Theory for the Design of Medical Simulations
- Author
-
Paul Ayres, Kristin Fraser, and John Sweller
- Subjects
Models, Educational ,Education, Medical ,Epidemiology ,Computer science ,Instructional design ,business.industry ,Teaching ,MEDLINE ,Medicine (miscellaneous) ,Education ,Memory ,Modeling and Simulation ,ComputingMilieux_COMPUTERSANDEDUCATION ,Humans ,Learning ,Software engineering ,business ,computer ,Simulation Training ,Simulation ,Cognitive load ,Simula ,computer.programming_language - Abstract
Simulation-based education (SBE) has emerged as an effective and important tool for medical educators, but research about how to optimize training with simulators is in its infancy. It is often difficult to generalize results from experiments on instructional design issues in simulation because of the heterogeneity of learner groups, teaching methods, and rapidly changing technologies. We have found that cognitive load theory is highly relevant to teaching in the simulation laboratory and a useful conceptual framework to reference when designing or researching simulation-based education. Herein, we briefly describe cognitive load theory, its grounding in our current understanding of cognitive architecture, and the evidence supporting it. We focus our discussion on a few well-established cognitive load effects with examples from simulation training and recommend some instructional applications with theoretical potential to improve learning outcomes.
- Published
- 2015
26. Sleep Disturbances among Medical Students: A Global Perspective
- Author
-
Muhammad Chanchal Azad, Kristin Fraser, Tanvir Chowdhury Turin, Patrick J. Hanly, Ahmad Faris Abdullah, Nahid Rumana, and Nahid Shahana
- Subjects
Pulmonary and Respiratory Medicine ,Sleep Wake Disorders ,medicine.medical_specialty ,Internationality ,Students, Medical ,media_common.quotation_subject ,education ,Alternative medicine ,Sleep medicine ,Surveys and Questionnaires ,medicine ,Prevalence ,Humans ,Quality (business) ,Psychiatry ,Review Articles ,media_common ,Medical education ,Perspective (graphical) ,Mental health ,Poor sleep ,Neurology ,Neurology (clinical) ,Sleep (system call) ,Psychology - Abstract
Medical students carry a large academic load which could potentially contribute to poor sleep quality above and beyond that already experienced by modern society. In this global literature review of the medical students' sleep experience, we find that poor sleep is not only common among medical students, but its prevalence is also higher than in non-medical students and the general population. Several factors including medical students' attitudes, knowledge of sleep, and academic demands have been identified as causative factors, but other potential mechanisms are incompletely understood. A better understanding about the etiology of sleep problems in medical trainees is essential if we hope to improve the overall quality of medical students' lives, including their academic performance. Sleep self-awareness and general knowledge appear insufficient in many studied cohorts, so increasing education for students might be one beneficial intervention. We conclude that there is ample evidence for a high prevalence of the problem, and research in this area should now expand towards initiatives to improve general sleep education for medical students, identify students at risk, and target them with programs to improve sleep.
- Published
- 2015
27. Are Internal Medicine Residents' Skills in Noninvasive Ventilation for Acute Respiratory Failure Improved After Small Group Practice Using a Respiratory Patient Simulator?
- Author
-
Lawrence B. Gutman, Kristin Fraser, Andrea H.S. Loewen, and Irina Charania
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine ,Acute respiratory failure ,Noninvasive ventilation ,Respiratory system ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,Intensive care medicine ,business ,Patient simulation - Published
- 2017
28. Evaluation of an alternative care provider clinic for severe sleep-disordered breathing: a study protocol for a randomised controlled trial
- Author
-
Maria J. Santana, Willis H. Tsai, Erika Penz, Ada Ip-Buting, Sachin R. Pendharkar, W. Ward Flemons, Jenny Kelly, Patrick J. Hanly, and Kristin Fraser
- Subjects
Complementary Therapies ,Male ,medicine.medical_specialty ,Waiting Lists ,Cost-Benefit Analysis ,medicine.medical_treatment ,Sleep medicine ,law.invention ,Positive-Pressure Respiration ,SLEEP MEDICINE ,03 medical and health sciences ,Sleep Apnea Syndromes ,0302 clinical medicine ,Quality of life (healthcare) ,Patient satisfaction ,Randomized controlled trial ,law ,Health care ,Positive airway pressure ,Pulmonary Medicine ,Protocol ,medicine ,Humans ,Continuous positive airway pressure ,Respiratory Medicine ,Research ethics ,Continuous Positive Airway Pressure ,Information Dissemination ,business.industry ,General Medicine ,3. Good health ,Treatment Outcome ,030228 respiratory system ,Patient Satisfaction ,Sample Size ,Emergency medicine ,Quality of Life ,Physical therapy ,Patient Compliance ,Female ,business ,030217 neurology & neurosurgery - Abstract
Introduction Despite the high prevalence of sleep-disordered breathing (SDB) and the significant health consequences associated with untreated disease, access to diagnosis and treatment remains a challenge. Even patients with severe SDB (severe obstructive sleep apnoea or hypoventilation), who are at particularly high risk of adverse health effects, are subject to long delays. Previous research has demonstrated that, within a sleep clinic, management by alternative care providers (ACPs) is effective for patients with milder forms of SDB. The purpose of this study is to compare an ACP-led clinic (ACP Clinic) for patients with severe SDB to physician-led care, from the perspective of clinical outcomes, health system efficiency and cost. Methods and analysis The study is a randomised, controlled, non-inferiority study in which patients who are referred with severe SDB are randomised to management by a sleep physician or by an ACP. ACPs will be supervised by sleep physicians for safety. The primary outcome is positive airway pressure (PAP) adherence after 3 months of therapy. Secondary outcomes include: long-term PAP adherence; clinical response to therapy; health-related quality of life; patient satisfaction; healthcare usage; wait times from referral to treatment initiation and cost-effectiveness. The economic analysis will be performed using the perspective of a publicly funded healthcare system. Ethics and dissemination Ethics approval was obtained from the Conjoint Health Research Ethics Board (ID: REB13-1280) at the University of Calgary. Results from this study will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals. Trial registration number NCT02191085; Pre-results.
- Published
- 2017
29. Pulmonary Hypertension and Cardiac Function in Adult Cystic Fibrosis
- Author
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Zion Sasson, Kristin Fraser, Robert H. Hyland, Kristine S. Thornley, Patrick J. Hanly, and D. Elizabeth Tullis
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Respiratory disease ,Doppler echocardiography ,Critical Care and Intensive Care Medicine ,medicine.disease ,Pulmonary hypertension ,Surgery ,Pulmonary function testing ,Hypoxemia ,Coronary artery disease ,Blood pressure ,medicine.artery ,Internal medicine ,Pulmonary artery ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Study objectives To determine (1) the prevalence of pulmonary hypertension and cardiac dysfunction in adult cystic fibrosis (CF) patients with severe lung disease, (2) the relationship between these cardiovascular abnormalities and hypoxemia, and (3) the impact of subclinical pulmonary hypertension on survival. Design Single-blind, cross-sectional study. Setting Ambulatory clinic of the Adult CF program at a tertiary-level hospital. Patients Clinically stable patients with severe lung disease (FEV1 Measurements and results Eighteen patients with severe lung disease (FEV1 28 ± 7% of predicted normal value) were initially studied. Each patient had overnight polysomnography, pulmonary function tests, and Doppler echocardiography. Arterial oxygen saturation (Sao2) was reduced during wakefulness (87.1 ± 6.1%) and fell during sleep (84.0 ± 6.6%) while transcutaneous Pco2 was normal during wakefulness (41.1 ± 6.9 mm Hg) and increased during sleep (46.6 ± 4.7 mm Hg). Left ventricular size, systolic function, and diastolic function were normal except in one patient who had had a previous silent myocardial infarction due to coronary artery disease. Qualitative assessment of right ventricular function was normal in all patients. Pulmonary artery systolic pressure (PASP) was increased (> 35 mm Hg) in seven patients without clinical evidence of cor pulmonale. Regression analysis was performed by combining these data with data from an additional 15 CF patients with moderately severe lung disease (FEV1 56.3 ± 8.9% predicted normal) who were recruited to a modified study protocol that included overnight oximetry, pulmonary function tests, and Doppler echocardiography. None of these patients had evidence of hypoxemia and only three had mild elevation of PASP (36, 37, and 39 mm Hg). Linear regression analysis revealed that PASP was significantly correlated with FEV1(r = −0.44; p=0.013), and Sao2 during wakefulness (r = −0.60; p=0.0003), during sleep (r = −0.56; p=0.0008), and after 6 min of exercise (r = −0.75; p Conclusions In adult CF patients with severe stable lung disease, left and right ventricular function is well maintained in the absence of significant coronary artery disease; pulmonary hypertension develops in a significant proportion of patients and is strongly correlated with oxygen status, independent of lung function; and subclinical pulmonary hypertension is associated with an increased mortality.
- Published
- 1999
30. The emotional and cognitive impact of unexpected simulated patient death: a randomized controlled trial
- Author
-
Kristin, Fraser, James, Huffman, Irene, Ma, Matthew, Sobczak, Joanne, McIlwrick, Bruce, Wright, and Kevin, McLaughlin
- Subjects
Male ,Students, Medical ,Emotions ,Middle Aged ,Patient Simulation ,Cognition ,Death, Sudden, Cardiac ,Humans ,Learning ,Female ,Clinical Competence ,Curriculum ,Educational Measurement ,Prospective Studies ,Stress, Psychological ,Aged ,Education, Medical, Undergraduate ,Follow-Up Studies - Abstract
Observational studies suggest that emotions experienced during simulation training may affect cognitive load and learning outcomes. The objective of this study was to manipulate emotions during simulation training and assess the impact on cognitive load and learning.In this prospective randomized trial, 116 final-year medical students received training in a simulated scenario of a 70-year-old woman presenting with reduced consciousness due to aminosalicylic acid ingestion. Training groups were randomly allocated to one of two endings for the scenario: The patient was transferred to another service, or she experienced a cardiorespiratory arrest and died. Participants rated their emotions and cognitive load after training. Three months later, we evaluated their performance on a simulation Objective Structured Clinical Examination station of a 60-year-old man presenting with reduced consciousness due to ethylene glycol ingestion.Emotions tended to be more negative for students in training groups where the simulated patient died. These students also reported a higher cognitive load (mean ± SD, 7.63 ± 0.97 vs 7.25 ± 0.84; P = .03; d = 0.42) and were less likely to be rated as competent to diagnose and manage a patient with reduced consciousness due to toxin ingestion (OR, 0.37; 95% CI, 0.14-0.95; P = 0.04) 3 months later.Students exposed to unexpected simulated patient death reported increased cognitive load and had poorer learning outcomes. Educators need to expose learners to negative experiences; therefore, further studies are needed on how best to use negative emotional experiences during simulation training.
- Published
- 2013
31. Hepatic Abscess due to Burkholderia (Pseudomonas) cepacia in Cystic Fibrosis
- Author
-
D. Elizabeth Tullis, Robert H. Hyland, and Kristin Fraser
- Subjects
Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,biology ,RC705-779 ,business.industry ,Hepatic abscess ,Pseudomonas ,biology.organism_classification ,medicine.disease ,Cystic fibrosis ,respiratory tract diseases ,Diseases of the respiratory system ,Causative organism ,Burkholderia ,Medicine ,In patient ,business ,Complication ,Hepatic Abscesses - Abstract
Burkholderia (Pseudomonas) cepaciahas been cultured from bronchial secretions of patients with cystic fibrosis with varying frequency. The overall prevalence in patients over 18 years old at the authors’ centre in Toronto is 51%. Extrapulmonary infections are rare in nonimmunosuppressed patients with cystic fibrosis andB cepaciahas been the causative organism in only three previous reports. Two patients with cystic fibrosis are described who developed hepatic abscesses clue toB cepacia. One patient is the sibling of two brothers in whom this complication was previously described.
- Published
- 1995
32. Learning during simulation training is prone to retroactive interference
- Author
-
Kristin, Fraser, Irene, Ma, Elise, Teteris, Murray, Lee, Bruce, Wright, and Kevin, McLaughlin
- Subjects
Male ,Students, Medical ,Heart Murmurs ,Retention, Psychology ,Manikins ,Memory, Short-Term ,Memory ,Mental Recall ,Humans ,Learning ,Attention ,Female ,Clinical Competence ,Psychomotor Performance ,Education, Medical, Undergraduate - Abstract
Retroactive interference occurs when newly acquired information inhibits recall of previously learned information. This has been shown to influence recall of sounds, tastes and word associations, and is typically seen when learners receive training on one area of content and are then exposed to new content before being evaluated on the original content. Thus far, retroactive interference has received little attention in medical education and has not been studied during simulation training. Our objective was to evaluate whether retroactive interference occurs during simulation training.We randomised 167 Year 1 medical students to one of two training protocols. After training on a cardiac murmur, participants were tested either on the same cardiac murmur followed by a novel murmur (the non-interference protocol), or on the novel murmur followed by the training murmur (the interference protocol). We evaluated performance on both murmurs at 1 hour and 6 weeks post-training.We found a significant interaction between training protocol and diagnostic performance on training versus novel murmurs at both testing time-points. Students in the non-interference protocol had increased odds of achieving success on the training murmur relative to the novel murmur at 1 hour (odds ratio [OR] 4.96; p0.001) and at 6 weeks (OR 4.23; p = 0.001) after training. By comparison, students in the interference protocol did not demonstrate improved performance on the training murmur relative to the novel murmur at either evaluation (1 hour post-training: OR 0.56 [p = 0.08]; 6 weeks post-training: OR 0.66 [p = 0.23]).Consistent with the theory of retroactive interference, students who encountered a novel murmur between training and evaluation on the murmur on which they had been trained showed no improvement in diagnostic performance following simulation training. These findings should serve to warn educators to consider retroactive interference when designing simulation training sessions.
- Published
- 2012
33. Simulation training improves diagnostic performance on a real patient with similar clinical findings
- Author
-
Louis Girard, Kristin Fraser, Lisa Welikovich, Bruce Wright, Janet Tworek, Mike Paget, and Kevin McLaughlin
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Chest Pain ,Heart malformation ,education ,Aortic Diseases ,Critical Care and Intensive Care Medicine ,Chest pain ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Prospective Studies ,Mitral regurgitation ,Analysis of Variance ,medicine.diagnostic_test ,business.industry ,Mitral Valve Insufficiency ,Auscultation ,medicine.disease ,Pulmonary embolism ,Patient Simulation ,Stenosis ,Aortic valve stenosis ,cardiovascular system ,Physical therapy ,Cardiology ,Heart murmur ,Female ,Clinical Competence ,Educational Measurement ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Education, Medical, Undergraduate - Abstract
Background Training on a cardiopulmonary simulator improves subsequent diagnostic performance on the same simulator. But data are lacking on transfer of learning. The objective of this study was to determine whether training on a cardiorespiratory simulator improves diagnostic performance on a real patient. Methods We randomly allocated first-year medical students at the University of Calgary to simulator training in one of three clinical scenarios of acute-onset chest pain: pulmonary embolism with right ventricular strain but no murmur, symptomatic aortic stenosis, or myocardial ischemia causing mitral regurgitation. Simulation sessions ran for 20 min, after which participants had a standardized debriefing session and reviewed the physical findings. Immediately following the training sessions, students assessed the auscultatory findings of a real patient with mitral regurgitation. Our outcome measures were accuracy of identifying abnormal auscultatory findings and diagnosing the underlying cardiac abnormality (mitral regurgitation). Results Eighty-six students participated in the study. Students trained on mitral regurgitation were more likely to identify and diagnose these findings on a real patient with mitral regurgitation than those who had trained on aortic stenosis or a scenario with no cardiac murmur. The accuracy (SD) of identifying clinical features of mitral regurgitation for these three groups was 74.0 (36.4) vs 56.2 (34.3) vs 36.8 (33.1), respectively (P = .0005), and for diagnosing mitral regurgitation, the accuracy was 68.0 (45.4) vs 51.6 (50.0) vs 29.9 (40.7), respectively (P = .01). Conclusions Simulator training on mitral regurgitation increases the likelihood of diagnosing this abnormality on a real patient
- Published
- 2010
34. The effect of simulator training on clinical skills acquisition, retention and transfer
- Author
-
Ian Walker, Mike Paget, Kristin Fraser, Kevin McLaughlin, Adam D. Peets, Bruce Wright, and Janet Tworek
- Subjects
medicine.medical_specialty ,education ,Statistics as Topic ,Cardiology ,Chest pain ,Education ,law.invention ,Undergraduate methods ,Cardiovascular Physiological Phenomena ,Randomized controlled trial ,law ,medicine ,Humans ,Computer Simulation ,Patient simulation ,Simulation ,business.industry ,Cardiorespiratory fitness ,Cognition ,General Medicine ,Patient Simulation ,Cardiovascular Diseases ,Physical therapy ,Respiratory Physiological Phenomena ,Clinical Competence ,Curriculum ,Educational Measurement ,medicine.symptom ,business ,Clinical skills ,Education, Medical, Undergraduate - Abstract
Context Prior research has demonstrated that residents have poor clinical skills in cardiology and respirology. It is not clear how these skills can be improved because the number of patients with suitable clinical findings whose cooperation might help residents to better develop these clinical skills is limited. Objectives Our objective was to evaluate the effect of training on a cardiorespiratory simulator (CRS) on skills acquisition, retention and transfer. Methods We randomly allocated 146 students to CRS training in either chest pain or dyspnoea and compared each student’s performance on the clinical presentation in which he or she had received CRS training with performance on the control presentation. Results Immediately after training, students were more accurate in identifying abnormal clinical findings on the CRS (70.0% versus 52.2%; d = 7.6, P
- Published
- 2009
35. CHRONIC OBSTRUCTIVE PULMONARY DISEASE Prevention, early detection, and aggressive treatment can make a difference
- Author
-
Kristin Fraser and Kenneth Chapman
- Subjects
Spirometry ,medicine.medical_specialty ,medicine.medical_treatment ,Pulmonary disease ,Early detection ,Airflow obstruction ,Quality of life ,Risk Factors ,Humans ,Medicine ,In patient ,Lung Diseases, Obstructive ,Intensive care medicine ,COPD ,medicine.diagnostic_test ,business.industry ,Decision Trees ,Vaccination ,Oxygen Inhalation Therapy ,General Medicine ,medicine.disease ,Survival Analysis ,respiratory tract diseases ,Primary Prevention ,Treatment Outcome ,Disease Progression ,Quality of Life ,Smoking cessation ,Smoking Cessation ,business ,Algorithms - Abstract
COPD is common, and certainly its impact on healthcare systems is significant. It is imperative to diagnose COPD early in patients with or without respiratory symptoms. This requires office spirometry performed periodically in persons at risk, such as long-time cigarette smokers over 40 years of age. Once airflow obstruction has been identified, smoking cessation is the priority to prevent further deterioration. Our increased understanding of the underlying physiology of COPD and recent developments in medical and surgical treatments have resulted in many new therapeutic options. Many of these treatments have the potential to alleviate symptoms, reduce healthcare utilization, improve quality of life, and extend survival.
- Published
- 2000
36. Death of a Manikin: Adverse Effects on Learning and Mechanisms
- Author
-
James Huffman, Kristin Fraser, Joann McIlwrick, Kevin McLaughlin, Irene W. Y. Ma, and Bruce Wright
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,Intensive care medicine ,Adverse effect ,business - Published
- 2011
37. Simulator Training for Recognition of Murmurs: Response
- Author
-
Kristin Fraser, Lisa Welikovich, Mike Paget, Bruce Wright, Janet Tworek, Louis Girard, and Kevin McLaughlin
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Training (meteorology) ,Medicine ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,business ,Simulation - Published
- 2011
38. OUTPATIENT MANAGEMENT OF PRIMARY SPONTANEOUS PNEUMOTHORAX: A PILOT STUDY
- Author
-
Douglas Helmersen, Bryan C. Young, Kristin Fraser, Alain Tremblay, Naushad Hirani, Gaetane Michaud, and Charlene D. Fell
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Emergency medicine ,medicine ,Primary spontaneous pneumothorax ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,Outpatient management ,business - Published
- 2006
39. A Breath of Fresh Air 2015 / Une Boufée D’air Frais 2015
- Author
-
kristin fraser
40. Sleep and shiftwork. I
- Author
-
Ne, Thurston, Sm, Tanguay, and kristin fraser
- Subjects
Canada ,Sleep Disorders, Circadian Rhythm ,Work Schedule Tolerance ,Humans ,Feeding Behavior ,Nursing Staff, Hospital ,Personnel Selection ,Workplace
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