Aljuwaiser Sameera, Abdel-Fattah Abdel Rahman, Brown Craig, Kane Leia, Cooper Jamie, Mostafa Alyaa
School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
Cambridge University, Cambridge, UK.
Adv Simul (Lond). 2024 Feb 29;9(1):11. doi: 10.1186/s41077-024-00283-6.
Ischaemic strokes are medical emergencies, and reperfusion treatment, most commonly intravenous thrombolysis, is time-critical. Thrombolysis administration relies on well-organised pathways of care with highly skilled and efficient clinicians. Simulation training is a widespread teaching modality, but results from studies on the impact of this intervention have yet to be synthesised. This systematic review and meta-analysis aimed to synthesise the evidence and provide a recommendation regarding the effects of simulation training for healthcare professionals on door-to-needle time in the emergency thrombolysis of patients with ischaemic stroke.
Seven electronic databases were systematically searched (last updated 12th July 2023) for eligible full-text articles and conference abstracts. Results were screened for relevance by two independent reviewers. The primary outcome was door-to-needle time for recombinant tissue plasminogen activator administration in emergency patients with ischaemic stroke. The secondary outcomes were learner-centred, improvements in knowledge and communication, self-perceived usefulness of training, and feeling 'safe' in thrombolysis-related decision-making. Data were extracted, risk of study bias assessed, and analysis was performed using RevMan™ software (Web version 5.6.0, The Cochrane Collaboration). The quality of the evidence was assessed using the Medical Education Research Study Quality Instrument.
Eleven studies were included in the meta-analysis and nineteen in the qualitative synthesis (n = 20,189 total patients). There were statistically significant effects of simulation training in reducing door-to-needle time; mean difference of 15 min [95% confidence intervals (CI) 8 to 21 min]; in improving healthcare professionals' acute stroke care knowledge; risk ratio (RR) 0.42 (95% CI 0.30 to 0.60); and in feeling 'safe' in thrombolysis-related decision-making; RR 0.46 (95% CI 0.36 to 0.59). Furthermore, simulation training improved healthcare professionals' communication and was self-perceived as useful training.
This meta-analysis showed that simulation training improves door-to-needle times for the delivery of thrombolysis in ischaemic stroke. However, results should be interpreted with caution due to the heterogeneity of the included studies.
缺血性中风是医疗急症，再灌注治疗（最常见的是静脉溶栓）对时间要求严格。溶栓治疗的实施依赖于组织有序的护理路径以及技术精湛、效率高的临床医生。模拟培训是一种广泛应用的教学方式，但关于这种干预措施影响的研究结果尚未进行综合分析。本系统评价和荟萃分析旨在综合证据，并就模拟培训对医疗保健专业人员在缺血性中风患者紧急溶栓治疗中从入院到溶栓时间的影响提供建议。
系统检索了七个电子数据库（最后更新时间为2023年7月12日），以获取符合条件的全文文章和会议摘要。由两名独立评审员筛选结果的相关性。主要结局是缺血性中风急诊患者接受重组组织型纤溶酶原激活剂治疗的从入院到溶栓时间。次要结局是以学习者为中心的知识和沟通改善、对培训自我感知的有用性以及在溶栓相关决策中感觉“安全”。提取数据，评估研究偏倚风险，并使用RevMan™软件（网络版5.6.0，Cochrane协作网）进行分析。使用医学教育研究质量工具评估证据质量。
荟萃分析纳入了11项研究，定性综合分析纳入了19项研究（总共20189例患者）。模拟培训在缩短从入院到溶栓时间方面有统计学显著效果；平均差异为15分钟[95%置信区间（CI）8至21分钟]；在提高医疗保健专业人员的急性中风护理知识方面；风险比（RR）为0.42（95%CI 0.30至0.60）；以及在溶栓相关决策中感觉“安全”方面；RR为0.46（95%CI 0.36至0.59）。此外,模拟培训改善了医疗保健专业人员的沟通，并且自我感知培训是有用的。
这项荟萃分析表明，模拟培训可缩短缺血性中风溶栓治疗的从入院到溶栓时间。然而,由于纳入研究的异质性,对结果应谨慎解释
