Introduction We produced a group work training system using clinical map (CM) puzzles with contents of an initial treatment for stroke and used them as a case discussion under module D of the Immediate Stroke Life Support (ISLS) course and bed side learning (BSL). Methods one hundred and eighty seven medical workers and 69 medical students joined in this group work (GW). We divided a CM which represented a scenario of a 28 year-old female patient with a hemorrhagic stroke into a frame and elements. Each group of participants performed a CM puzzle game to place elements back into the partially or fully blank frame. We evaluated usefulness degree that participants felt for the CM puzzles and their GW with a questionnaire by visual analogue scale (VAS) and compared the values between doctors, nurses and students statistically. Results Both mean VAS values of satisfaction for CM puzzles and the GW were more than 70 % in students and all job categories. The both values were significantly higher in students than in other job categories, followed by nurses and then doctors and the emergency personnel. Conclusions The GW with CM puzzles can be useful to summarize a lot of medical knowledge concerning the initial management for a patient with severe hemorrhagic stroke.

View full abstract

Introduction We created a clinical map (CM) puzzle for medical students to use as a material of a case study of an emergency room (ER) patient with a severe hemorrhagic stroke, and used it to quantitatively evaluate the structure of their medical knowledge. Methods Sixty-three 5th-year medical students divided into 21 groups were asked to complete a CM puzzle by placing each of 19 elements in an exact position. We counted the number of incorrect, unused, and correct elements. Incorrect elements were classified into three categories：step errors, practice errors, and combined errors. Results Mean (standard deviation), maximum and minimum numbers of placements in the 21 groups were：1) incorrect (1) step errors：2.3 (2.0), 7, and 0, (2) practice errors：0.6 (1.1), 4, and 0, (3) combined errors：1.1 (1.2), 4, and 0, 2) Unused：0.6 (0.9), 3, and 0, 3) Correct：14.3 (2.6), 19, and 9. Discussion The results revealed several kinds of mistakes concerning the initial management of a patient with severe hemorrhagic stroke. We were able to use the results to quantitatively evaluate the students' structure of medical knowledge by counting the number of the different types of errors. Conclusions A CM puzzle may useful for quantitative evaluation of the structure of students' medical knowledge.

View full abstract

Introduction The goal of care for neurosurgical emergency diseases, including stroke, is to minimize brain damage and maximize patient recovery. Appropriate general management is needed before surgical treatment. That is why it is necessary for medical staff to be trained in correct management principles. In Japan, there is a simulation-based training system for emergency neurosurgical disease known as the PNLS (Primary Neurosurgical Life Support) course. 15 PNLS courses have been conducted in Japan since 2009. Four international PNLS courses have been conducted also. The international version of Primary Neurosurgical Life Support (PNLS) was held at the 11th Quadrennial Congress of The World Federation of Neuroscience Nurses. We discuss and report about this experience. Method Background and understanding of provider were surveyed in questionnaire about the international version of PNLS. Course of International PNLS included four modules that Coma Scale, Airway evaluation and stability, Neuroresuscitation and Case conference. Results 70 nurses participated in the PNLS. Nationality was varied including Japan, Australia, Saudi Arabia, New Zealand, China, Brazil, Uganda, Netherlands, etc. 49 questionnaires were returned (70%). The average of self-reported understanding was over 70%： Introduction, 72.1%； Coma Scale, 78.3%； Airway evaluation and stability, 77.9%； Neuroresuscitation, 73.3%； Case conference, 75.9%. Conclusion The PNLS course was developed by the Japan Society of Neurosurgical Emergency in 2008 to practice the skills of neuroresuscitation. The international version of Primary Neurosurgical Life Support (PNLS) was held at the 11th Quadrennial Congress of The World Federation of Neuroscience Nurses. These nurses from around the world participated. The PNLS course is a useful training course for neuroscience nurses to learn the skills of neuroresuscitation.

View full abstract

We developed a wireless triage and treatment system using information technology for disaster training. The system consists of a server, personal digital assistant (PDA) displays, exclusively designed software and a patient database. For realization of wireless triage and treatment, we designed chronological scenarios of standardized cases for installing in a computer server. The computer server provides information on the training field such as the localization, positioning, transportation and capacity of each facility. In this virtual training field, selected patient data is presented from the server computer to the PDA. Trainees perform a virtual triage and treat virtual patients on a PDA display. Also, they can request transportation. The trainer evaluates the virtual management performed by the trainees on the server computer.

View full abstract

Background Simulation exercises are widely used for disaster medical training. For establishing a more effective training program, we developed figurant cards as a tool to link live field and virtual field exercises in disaster simulation training. The objective of this study was to evaluate the feasibility and acceptance of figurant cards in live a field exercise. Methods Figurant cards were created to provide information on the severity of injury and the status of victims conforming to the patient database used in virtual disaster simulations. These cards were applied to mock patients in a live field exercise. Following the exercise, a questionnaire survey concerning figurant cards was administered to participants. Results The field exercise using figurant cards was executed satisfactorily. Fifty-eight participants completed the post exercise evaluation form. More than 80% of the participants agreed on the usefulness of figurant cards in informing the patients' current status, and 15.3% of the participants concluded that instructions concerning changes in the patients' condition with time and treatment intervention were insufficient. Conclusions Figurant cards appear to be useful for linking live field and virtual simulation exercises.

View full abstract

The Immediate Stroke Life Support (ISLS) curriculum teaches the evaluation and management of acute stroke syndromes. The ISLS was developed by the Japan ISLS task force, which was composed of representatives of the Japanese Association of Acute Medicine (JAAM) and Japanese Congress on Neurological Emergencies (JCNE) . The course incorporates role-play, mannequin simulation modalities, and clinical maps. ISLS complements the neurological skills and knowledge that are essential to cerebral resuscitation. An international version of the ISLS (ISLS-IN) has been developed through an intense collaborative process, which translated and adapted the Japanese model to English to accommodate North American students. The ISLS-IN introduces teachers to the techniques used in this course, through sequential train-the-trainer exercises in each of the integrated simulation techniques.

View full abstract

Introduction The Glasgow Coma Scale (GCS) is the most widely used tool to evaluate impaired consciousness in the acute phase. The best motor response of the GCS is difficult to learn because it is graded into a 6-point scale. Our aim was to facilitate mastery of the GCS by medical personnel with a new method called the Ajimi Exercise. We also showed its integrated achievement in a training course for learning the GCS. Methods We introduced a new method called the Ajimi Exercise to memorize 6 movements of the best motor response by acting only once. The Ajimi Exercise relates the posture of the upper limbs in each level of the best motor response to the corresponding number of that level. The Ajimi Exercise was used in the GCS skills section of the Japan Advanced Trauma Evaluation and Care (JATEC) course, which is a training course of trauma for medical doctors. Results The number of participants in the JATEC courses increased to more than 6,000 in 183 courses over the last 7 years. The GCS has become more popular in Japan because of JATEC and the Ajimi Exercise. Conclusion We conclude that the Ajimi Exercise is a useful method to learn the best motor response of the GCS. We also recommend that medical personnel revise their fundamental knowledge about neurophysiology to better understand the method.

View full abstract