PURPOSE: There is a clinical need for shortened door-to-needle time (DNT) for intravenous thrombolysis, but effective training methods are missing. Simulation training improves teamwork and logistics in numerous fields. Still, it is not clear if simulation improves logistics in stroke. METHODS: To evaluate the efficiency of a simulation training programme, the DNT of participating centres was compared with the rest of stroke centres in the Czech Republic. Patients' data were prospectively collected from the nationally used Safe Implementation of Treatments in Stroke Registry. The outcome was an improvement in DNT in 2018 as compared with 2015 (after and before the simulation training). Scenarios were based on real clinical cases, and simulation courses were conducted in a standardly equipped simulation centre. FINDINGS: Between 2016 and 2017, 10 courses were conducted for stroke teams from 9 of all 45 stroke centres. DNT data were available both in 2015 and 2018 from 41 (91%) stroke centres. The simulation training improved the DNT in 2018 as compared with 2015 by 30 min (95% CI 25.7 to 34.7) and as compared with 20 min (95% CI 15.8 to 24.3) in stroke centres without the simulation training (p=0.01). Any parenchymal haemorrhage occurred in 5.4% and 3.5% of patients treated in centres without and with simulation training (p=0.054), respectively. CONCLUSIONS: DNT was considerably shortened nationally. It was feasible to implement simulation as a nationwide training programme. The simulation was associated with improved DNT; however, other studies should confirm that such an association is causal.

• Klíčová slova
• Healthcare quality improvement, Simulation, Team training,
• MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• cévní mozková příhoda * terapie   MeSH
• intravenózní podání MeSH
• lidé MeSH
• tréninková simulace * MeSH
• trombolytická terapie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Due to the COVID-19 pandemic, Basic Life Support (BLS) training has been limited to compression-only or bag-mask ventilation. The most breathable nanofiber respirators carry the technical possibility for inflation of the mannequin. The aim of this study was to assess the efficacy of mouth-to-mouth breathing through a FFP2 respirator during BLS. METHODS: In the cross-over simulation-based study, the medical students performed BLS using a breathable nanofiber respirator for 2 min on three mannequins. The quantitative and qualitative efficacy of mouth-to-mouth ventilation through the respirator in BLS training was analyzed. The primary aim was the effectivity of mouth-to-mouth ventilation through a breathable respirator. The secondary aims were mean pause, longest pause, success in achieving the optimal breath volume, technique of ventilation, and incidence of adverse events. RESULTS: In 104 students, effective breath was reached in 951 of 981 (96.9%) attempts in Adult BLS mannequin (Prestan), 822 of 906 (90.7%) in Resusci Anne, and 1777 of 1857 (95.7%) in Resusci Baby. In Resusci Anne and Resusci Baby, 28.9%/15.9% of visible chest rises were evaluated as low-, 33.0%/44.0% as optimal-, and 28.8%/35.8% as high-volume breaths. CONCLUSIONS: Mouth-to-mouth ventilation through a breathable respirator had an effectivity greater than 90%.

• Klíčová slova
• COVID-19, life support, mouth-to-mouth breathing, resuscitation, training,
• Publikační typ
• časopisecké články MeSH

In this paper, a new stochastic optimization algorithm is introduced, called Driving Training-Based Optimization (DTBO), which mimics the human activity of driving training. The fundamental inspiration behind the DTBO design is the learning process to drive in the driving school and the training of the driving instructor. DTBO is mathematically modeled in three phases: (1) training by the driving instructor, (2) patterning of students from instructor skills, and (3) practice. The performance of DTBO in optimization is evaluated on a set of 53 standard objective functions of unimodal, high-dimensional multimodal, fixed-dimensional multimodal, and IEEE CEC2017 test functions types. The optimization results show that DTBO has been able to provide appropriate solutions to optimization problems by maintaining a proper balance between exploration and exploitation. The performance quality of DTBO is compared with the results of 11 well-known algorithms. The simulation results show that DTBO performs better compared to 11 competitor algorithms and is more efficient in optimization applications.

• MeSH
• algoritmy * MeSH
• lidé MeSH
• počítačová simulace MeSH
• řešení problému MeSH
• řízení motorových vozidel * MeSH
• učení MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: Minimally invasive surgery (MIS) in neonates and infants presents technical challenges and is still unfamiliar to many paediatrics surgeons. This study aims to identify currently available simulators for neonatal/infant MIS training, to assess their validity, level of evidence, and related recommendations. METHODS: The review followed PRISMA guidelines and was registered in PROSPERO (CRD420250581050). Electronic search limited to English articles was performed through PubMed/MEDLINE, SCOPUS, Web of Science and Cochrane Database from January 2010 to June 2024. RESULTS: Out of 1084 identified records, 72 studies met the inclusion criteria and were analysed across general, gastrointestinal, thoracic, and urological MIS specialties. Recent efforts have led to the development of 3D-printed, animal-based, and hybrid models several of which showed high fidelity, skill differentiation, and educational value. Despite promising results, no universal MIS training model exists for neonate/infant patients, highlighting the need for structured, proficiency-based curricula. Overall, studies demonstrated moderate levels of evidence and recommendation, supporting integration of cost-effective simulation into paediatrics MIS training CONCLUSION: This systematic review highlights the need for validated, standardized simulation models and proficiency-based curricula to optimize neonate and infant MIS training and guide future research toward improving model fidelity, accessibility, and long-term educational outcomes.

• Klíčová slova
• (MIS) in neonates and infants, Laparoscopic surgery, Minimally invasive surgery, Simulation models, Simulation-based training, Thoracoscopic surgery,
• MeSH
• klinické kompetence MeSH
• kojenec MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony * výchova   MeSH
• novorozenec MeSH
• pediatrie * výchova   MeSH
• tréninková simulace * metody   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

This study aims to provide an updated overview of medical error taxonomies by building on a robust review conducted in 2011. It seeks to identify the key characteristics of the most suitable taxonomy for use in high-fidelity simulation-based postgraduate courses in Critical Care. While many taxonomies are available, none seem to be explicitly designed for the unique context of healthcare simulation-based education, in which errors are regarded as essential learning opportunities. Rather than creating a new classification system, this study proposes integrating existing taxonomies to enhance their applicability in simulation training. Through data from surveys of participants and tutors in postgraduate simulation-based courses, this study provides an exploratory analysis of whether a generic or domain-specific taxonomy is more suitable for healthcare education. While a generic classification may cover a broad spectrum of errors, a domain-specific approach could be more relatable and practical for healthcare professionals in a given domain, potentially improving error-reporting rates. Seven strong links were identified in the reviewed classification systems. These correlations allowed the authors to propose various simulation training strategies to address the errors identified in both the classification systems. This approach focuses on error management and fostering a safety culture, aiming to reduce communication-related errors by introducing the principles of Crisis Resource Management, effective communication methods, and overall teamwork improvement. The gathered data contributes to a better understanding and training of the most prevalent medical errors, with significant correlations found between different medical error taxonomies, suggesting that addressing one can positively impact others. The study highlights the importance of simulation-based education in healthcare for error management and analysis.

• MeSH
• chybná zdravotní péče * klasifikace   prevence a kontrola   MeSH
• lidé MeSH
• tréninková simulace * MeSH
• zdravotnický personál * výchova   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: This simulation-based study aimed to evaluate the efficacy of ventilation during paediatric cardiopulmonary resuscitation (CPR) provided by healthcare professionals (HCPs) and lay rescuers (LRs). The objective was to assess the number of effective breaths delivered during the initial sequence of CPR. Effective ventilation plays a critical role during paediatric CPR as most cardiac arrests are secondary to hypoxia in origin. The recommendations on initial resuscitation in unresponsive, non-breathing children differ worldwide. The European Resuscitation Council (ERC) guidelines recommend five breaths before starting the chest compressions. Yet, this recommendation was based on the expert consensus historically and has not changed since 2000 because of the lack of evidence. This research addresses the identified knowledge gap, with potential implications for improving resuscitation practices and ultimately enhancing patient outcomes. METHODS: HCPs and LRs performed 90 s of CPR involving two mannequins: 5-kg Baby and 20-kg Junior. Both groups (HCPs and LRs) performed the task before and after structured CPR training, and the efficacy of ventilation before and after the training was compared. The HCPs provided bag-mask ventilation; LR performed dispatcher-assisted CPR with mouth-to-mouth ventilation. RESULTS: The number of participants that reached the primary outcome before and after the training in Baby was 26 (65%) vs. 40 (100%) in HCPs and 28 (60.9%) vs. 45 (97.8%) in LRs (improvement in both p < 0.001), respectively. The number of participants that reached the primary outcome before and after the training in the Junior mannequin was 31 (77.5%) vs. 32 (82.1%) in HCPs (p = 0.77) and 32 (82.1%) vs. 37 (94.9%) in LRs (p = 0.005), respectively. DISCUSSION: This simulation-based study is the first to investigate ventilation efficacy during paediatric CPR provided by HCPs and LRs. Ventilation represents an important aspect of good-quality CPR in children. The concept of initiating paediatric CPR with initial breaths, as stated in ERC guidelines 2021, is justifiable. Trained HCPs and LRs providing dispatcher-assisted CPR could deliver effective ventilation to paediatric mannequins. These findings can contribute to future research in this area and address identified knowledge gaps concerning resuscitation guidelines, given the unique practical application of simulation as a research tool.

• Klíčová slova
• CPR, cardiopulmonary resuscitation, paediatric, simulation, ventilation,
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To assess microsurgical and diagnostic cerebral angiography modules and their corresponding objective assessment scales as educational tools for European neurosurgical residents at the European Association of Neurosurgical Societies Resident Vascular Neurosurgery course, which was held in Prague, Czech Republic, on September 2013. Microsurgical skills and cerebral angiography are fundamental skills in vascular neurosurgery. There is a need to develop a simulation-based curriculum focusing on these skills for neurosurgical trainees worldwide. METHODS: The course consisted of 2 modules: microanastomosis and diagnostic cerebral angiography. In addition to an initial screening survey, each module was divided into 3 components: 1) a before didactic cognitive knowledge and technical skills testing, 2) a didactic lecture, and 3) an after didactic cognitive knowledge and technical skills testing. We compared the trainees' cognitive and technical scores from the before and after testing phases. Wilcoxon sum rank test was used to test statistical significance. RESULTS: The knowledge test median scores increased from 63% and 68% to 80% and 88% (P < 0.01) on the microanastomosis and cerebral angiography modules, respectively. The practical hands-on simulation assessment median scores increased from 42% and 50% to 50.5% and 68% (P < 0.01) on the microanastomosis and cerebral angiography modules, respectively. CONCLUSIONS: Our course suggests that a simulation-based vascular neurosurgery curriculum is feasible and may enhance resident knowledge and technical proficiency.

• Klíčová slova
• Angiography, Education, Innovation, Microanastomosis, Neurosurgery, Resident, Simulation, Training,
• MeSH
• anastomóza chirurgická výchova   MeSH
• anatomické modely MeSH
• klinické kompetence MeSH
• kognice * MeSH
• kurikulum MeSH
• lidé MeSH
• mikrochirurgie výchova   MeSH
• mozková angiografie * MeSH
• neurochirurgické výkony výchova   MeSH
• výkony cévní chirurgie výchova   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

OBJECTIVE: This study aimed to investigate the validity of simulation-based assessment of robotic-assisted cardiac surgery skills using a wet lab model, focusing on the use of a time-based score (TBS) and modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. METHODS: We tested 3 wet lab tasks (atrial closure, mitral annular stitches, and internal thoracic artery [ITA] dissection) with both experienced robotic cardiac surgeons and novices from multiple European centers. The tasks were assessed using 2 tools: TBS and mGEARS score. Reliability, internal consistency, and the ability to discriminate between different levels of competence were evaluated. RESULTS: The results demonstrated a high internal consistency for all 3 tasks using mGEARS assessment tool. The mGEARS score and TBS could reliably discriminate between different levels of competence for the atrial closure and mitral stitches tasks but not for the ITA harvesting task. A generalizability study also revealed that it was feasible to assess competency of the atrial closure and mitral stitches tasks using mGEARS but not the ITA dissection task. Pass/fail scores were established for each task using both TBS and mGEARS assessment tools. CONCLUSIONS: The study provides sufficient evidence for using TBS and mGEARS scores in evaluating robotic-assisted cardiac surgery skills in wet lab settings for intracardiac tasks. Combining both assessment tools enhances the evaluation of proficiency in robotic cardiac surgery, paving the way for standardized, evidence-based preclinical training and credentialing. CLINICAL TRIAL REGISTRY NUMBER: NCT05043064.

• Klíčová slova
• assessment, robotic cardiac surgery, simulation, validity, wet lab,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Simulation-based training has gained distinction in cardiothoracic surgery as robotic-assisted cardiac procedures evolve. Despite the increasing use of wet lab simulators, the effectiveness of these training methods and skill acquisition rates remain poorly understood. OBJECTIVES: This study aimed to compare learning curves and assess the robotic cardiac surgical skill acquisition rate for cardiac and noncardiac surgeons who had no robotic experience in a wet lab simulation setting. METHODS: In this prospective cohort study, participants practiced 3 robotic tasks in a porcine model: left atriotomy closure, internal thoracic artery harvesting and mitral annular suturing. Participants were novice robotic cardiac and noncardiac surgeons alongside experienced robotic cardiac surgeons who established performance benchmarks. Performance was evaluated using the time-based score and modified global evaluative assessment of robotic skills (mGEARS). RESULTS: The participants were 15 novice surgeons (7 cardiac; 8 noncardiac) and 4 experienced robotic surgeons. Most novices reached mastery in 52 (±22) min for atrial closure, 32 (±18) for internal thoracic artery harvesting and 34 (±12) for mitral stitches, with no significant differences between the cardiac and noncardiac surgeons. However, for mGEARS, noncardiac novices faced more challenges in internal thoracic artery harvesting. The Thurstone learning curve model indicated no significant difference in the learning rates between the groups. CONCLUSIONS: Wet lab simulation facilitates the rapid acquisition of robotic cardiac surgical skills to expert levels, irrespective of surgeons' experience in open cardiac surgery. These findings support the use of wet lab simulators for standardized, competency-based training in robotic cardiac surgery.

• Klíčová slova
• learning curves, robotic cardiac surgery, surgical training, wet lab simulation,
• Publikační typ
• časopisecké články MeSH

In this paper, a new human-based metaheuristic algorithm called Technical and Vocational Education and Training-Based Optimizer (TVETBO) is introduced to solve optimization problems. The fundamental inspiration for TVETBO is taken from the process of teaching work-related skills to applicants in technical and vocational education and training schools. The theory of TVETBO is expressed and mathematically modeled in three phases: (i) theory education, (ii) practical education, and (iii) individual skills development. The performance of TVETBO when solving optimization problems is evaluated on the CEC 2017 test suite for problem dimensions equal to 10, 30, 50, and 100. The optimization results show that TVETBO, with its high abilities to explore, exploit, and create a balance between exploration and exploitation during the search process, is able to provide effective solutions for the benchmark functions. The results obtained from TVETBO are compared with the performances of twelve well-known metaheuristic algorithms. A comparison of the simulation results and statistical analysis shows that the proposed TVETBO approach provides better results in most of the benchmark functions and provides a superior performance in competition with competitor algorithms. Furthermore, in order to measure the effectiveness of the proposed approach in dealing with real-world applications, TVETBO is implemented on twenty-two constrained optimization problems from the CEC 2011 test suite. The simulation results show that TVETBO provides an effective and superior performance when solving constrained optimization problems of real-world applications compared to competitor algorithms.

• Klíčová slova
• education, exploitation, exploration, human-based, metaheuristic, optimization, technical and vocational education and training,
• Publikační typ
• časopisecké články MeSH