Kernholmes9038

Variability persists in intraoperative red blood cell (RBC) transfusion rates, despite evidence supporting associated adverse sequelae. We evaluated whether beliefs concerning transfusion risk and safety are independently associated with the inclination to transfuse. We surveyed intraoperative transfusion decision-makers from 33 cardiac surgery programs in Michigan. The primary outcome was a provider's reported inclination to transfuse (via a six-point Likert Scale) averaged across 10 clinical vignettes based on Class IIA or IIB blood management guideline recommendations. Survey questions assessed hematocrit threshold for transfusion ("hematocrit trigger"), demographic and practice characteristics, years and case-volume of practice, knowledge of transfusion guidelines, and provider attitude regarding perceived risk and safety of blood transfusions. Linear regression models were used to estimate the effect of these variables on transfusion inclination. Mixed effect models were used to quantify the variation attributed to provider specialties and hematocrit triggers. The mean inclination to transfuse was 3.2 (might NOT transfuse) on the survey Likert scale (SD .86) across vignettes among 202/413 (48.9%) returned surveys. Hematocrit triggers ranged from 15% to 30% (average 20.4%; SE .18%). The inclination to transfuse in situations with weak-to-moderate evidence for supporting transfusion was associated with a provider's hematocrit trigger (p less then .01) and specialty. Providers believing in the safety of transfusions were significantly more likely to transfuse. Provider specialty and belief in transfusion safety were significantly associated with a provider's hematocrit trigger and likelihood for transfusion. Our findings suggest that blood management interventions should target these previously unaccounted for blood transfusion determinants.The utilization of simulators for training is increasing in the professions associated with cardiac surgery. Before applying these simulators to high-stakes assessment, the simulator's output data must be validated. The aim of this study is to validate a Cardiopulmonary Bypass (CPB) simulator by comparing the simulated hemodynamic and technical outputs to published clinical norms. Three Orpheus™ CPB simulators were studied and compared to a published reference of physiologic and technical metrics that are managed during clinical CPB procedures. The limits of the simulators user modifiable variables were interrogated across their full range and the results were plotted against the published clinical norms. The data generated with the simulator conforms to validated clinical parameters for patients between 50 and 110 kg. For the pre- and post-CPB periods, the independent variables of central venous pressure (CVP), heart rate (HR), contractility, and systemic vascular resistance (SVR) must be operated between the limits of 7 and 12 mmHg, 65 and 110 beats/min, 28% and 65%, and 6 and 32 units respectively. During full CPB the arterial pump flows should be maintained between 3.5 and 5.5 LPM and SVR between 18 and 38 units. Validated technical parameters during cardioplegia delivery are expected at solution flow rates between 250 and 400 mL/min and 100 and 225 mL/min for antegrade and retrograde delivery routes, respectively. We have identified the limits for user-modifiable settings that produce data conforming to the physiologic and technical parameter limits reported in the peer reviewed literature. These results can inform the development of simulation scenarios used for high stakes assessments of personnel, equipment, and technical protocols.Perfusion education programs use simulation to provide students with clinical skills prior to entering the operating room. To teach the psychomotor execution of skills in a simulation lab requires a list of validated skills and deconstructed sub-steps to fully optimize adult learning. A list of the fundamental skills of adult cardiopulmonary bypass (CPB) was recently published; however, no defined list exists regarding pediatric CPB skills. The purpose of this survey is to form a definitive list of skills fundamental to pediatric CPB. A survey of 23 proposed pediatric CPB clinical skills and 291 proposed skill sub-steps was developed. Proposed pediatric CPB skills were evaluated using an established frequency and harm index. If the skill is performed >50% of the time (frequency), and if >50% believe that if the skill is performed incorrectly patient harm is probable (risk), then the skill is accepted as fundamental. The survey content was validated by subject matter experts and then distributed to practicing perfusionists between September 2020 and December 2020. Of the 125 survey respondents, 57.9% had 10 or more years in the field. 35.2% of respondents are American Society of Extracorporeal Technology (AmSECT) Fellows of Pediatric Perfusion (FPP) and pediatric CPB represents >50% of the annual caseload for 69.7% of respondents. 22 of the 23 proposed skills were accepted as fundamental in the conduct of pediatric CPB and 258 of the 291 proposed sub-steps associated with CPB skills were accepted as integral to skill performance. By surveying practicing pediatric perfusionists, this study identifies 22 skills as fundamental to the safe execution of pediatric CPB. In addition, skill sub-elements were identified as necessary for skill execution. This knowledge will assist perfusion programs in developing a pediatric simulation curriculum that matches current clinical execution of pediatric skills.The dramatic increase in the use of extracorporeal membrane oxygenation (ECMO) over the last decade with the concomitant need for ECMO competent perfusionists has raised questions of how well perfusion education programs are preparing entry-level perfusionists to participate in ECMO. While all perfusion schools teach ECMO principles, there is no standardized or systematic approach to the delivery of didactic knowledge and clinical skills in ECMO. Given this variability of ECMO education across and within perfusion schools, the CES-A exam may provide a metric for comparing curricular approaches. The purpose of this study is to examine three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). We examined three different curricular approaches to prepare new perfusion graduates to master the Adult ECMO Specialist Certification exam (CES-A). PF-04957325 PDE inhibitor We hypothesized that there would be no difference in CES-A pass rate, exam score, Rasch measure,mpletion of the ECMO Capstone experience compared to the program standard ECMO-related curricula in the two perfusion programs participating in this study. From this observation a structured ECMO simulation-based program appears to be equally effective as a traditional, typical lecture-only, clinical perfusion preceptorship, while demonstrating a more satisfactory experience with a higher reported case experience. In this study the standard perfusionist education curriculum prepared the new graduate to be successful on the CES-A exam. The three curricular approaches appear to prepare perfusionist graduates to be successful on the Adult ECMO Specialist exam.Wollack et al. (2015) suggested the erasure detection index (EDI) for detecting fraudulent erasures for individual examinees. Wollack and Eckerly (2017) and Sinharay (2018) extended the index of Wollack et al. (2015) to suggest three EDIs for detecting fraudulent erasures at the aggregate or group level. This article follows up on the research of Wollack and Eckerly (2017) and Sinharay (2018) and suggests a new aggregate-level EDI by incorporating the empirical best linear unbiased predictor from the literature of linear mixed-effects models (e.g., McCulloch et al., 2008). A simulation study shows that the new EDI has larger power than the indices of Wollack and Eckerly (2017) and Sinharay (2018). In addition, the new index has satisfactory Type I error rates. A real data example is also included.The multiple response structure can underlie several different technology-enhanced item types. With the increased use of computer-based testing, multiple response items are becoming more common. This response type holds the potential for being scored polytomously for partial credit. However, there are several possible methods for computing raw scores. This research will evaluate several approaches found in the literature using an approach that evaluates how the inclusion of scoring related to the selection/nonselection of both relevant and irrelevant information is incorporated extending Wilson's approach. Results indicated all methods have potential, but the plus/minus and true/false methods seemed the most promising for items using the "select all that apply" instruction set. Additionally, these methods showed a large increase in information per time unit over the dichotomous method.The presence of rapid guessing (RG) presents a challenge to practitioners in obtaining accurate estimates of measurement properties and examinee ability. In response to this concern, researchers have utilized response times as a proxy of RG and have attempted to improve parameter estimation accuracy by filtering RG responses using popular scoring approaches, such as the effort-moderated item response theory (EM-IRT) model. However, such an approach assumes that RG can be correctly identified based on an indirect proxy of examinee behavior. A failure to meet this assumption leads to the inclusion of distortive and psychometrically uninformative information in parameter estimates. To address this issue, a simulation study was conducted to examine how violations to the assumption of correct RG classification influences EM-IRT item and ability parameter estimation accuracy and compares these results with parameter estimates from the three-parameter logistic (3PL) model, which includes RG responses in scoring. Two RG misclassification factors were manipulated type (underclassification vs. overclassification) and rate (10%, 30%, and 50%). Results indicated that the EM-IRT model provided improved item parameter estimation over the 3PL model regardless of misclassification type and rate. Furthermore, under most conditions, increased rates of RG underclassification were associated with the greatest bias in ability parameter estimates from the EM-IRT model. In spite of this, the EM-IRT model with RG misclassifications demonstrated more accurate ability parameter estimation than the 3PL model when the mean ability of RG subgroups did not differ. This suggests that in certain situations it may be better for practitioners to (a) imperfectly identify RG than to ignore the presence of such invalid responses and (b) select liberal over conservative response time thresholds to mitigate bias from underclassified RG.This study offers an approach to testing for differential item functioning (DIF) in a recently developed measurement framework, referred to as D-scoring method (DSM). Under the proposed approach, called P-Z method of testing for DIF, the item response functions of two groups (reference and focal) are compared by transforming their probabilities of correct item response, estimated under the DSM, into Z-scale normal deviates. Using the liner relationship between such Z-deviates, the testing for DIF is reduced to testing two basic statistical hypotheses about equal variances and equal means of the Z-deviates for the reference and focal groups. The results from a simulation study support the efficiency (low Type error and high power) of the proposed P-Z method. Furthermore, it is shown that the P-Z method is directly applicable in testing for differential test functioning. Recommendations for practical use and future research, including possible applications of the P-Z method in IRT context, are also provided.