The Hospital Elder Life Program (HELP) has been shown to be highly efficient and (cost-)effective in reducing delirium incidence in the USA. HELP provides multicomponent protocols targeted at specific risk factors for delirium and introduces a different view on care organization, with trained volunteers playing a pivotal role. The primary aim of this study is the quantification of the (cost-)effectiveness of HELP in the Dutch health care system. The second aim is to investigate the experiences of patients, families, professionals and trained volunteers participating in HELP.
ObjectiveRepeated practice, or spacing, can improve various types of skill acquisition. Similarly, virtual reality (VR) simulators have demonstrated their effectiveness in fostering surgical skill acquisition and provide a promising, realistic environment for spaced training. To explore how spacing impacts VR simulator-based acquisition of surgical psychomotor skills, we performed a systematic literature review.MethodsWe systematically searched the databases PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, ERIC and CINAHL for studies investigating the influence of spacing on the effectiveness of VR simulator training focused on psychomotor skill acquisition in healthcare professionals. We assessed the quality of all included studies using the Medical Education Research Study Quality Instrument (MERSQI) and the risk of bias using the Cochrane Collaboration’s risk of bias assessment tool. We extracted and aggregated qualitative data regarding spacing interval, psychomotor task performance and several other performance metrics.ResultsThe searches yielded 1662 unique publications. After screening the titles and abstracts, 53 publications were retained for full text screening and 7 met the inclusion criteria. Spaced training resulted in better performance scores and faster skill acquisition when compared to control groups with a single day (massed) training session. Spacing across consecutive days seemed more effective than shorter or longer spacing intervals. However, the included studies were too heterogeneous in terms of spacing interval, obtained performance metrics and psychomotor skills analysed to allow for a meta-analysis to substantiate our outcomes.ConclusionSpacing in VR simulator-based surgical training improved skill acquisition when compared to massed training. The overall number and quality of available studies were only moderate, limiting the validity and generalizability of our findings.
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We investigated the effects of reflex-based self-defence training on police performance in simulated high-pressure arrest situations. Police officers received this training as well as a regular police arrest and self-defence skills training (control training) in a crossover design. Officers' performance was tested on several variables in six reality-based scenarios before and after each training intervention. Results showed improved performance after the reflex-based training, while there was no such effect of the regular police training. Improved performance could be attributed to better communication, situational awareness (scanning area, alertness), assertiveness, resolution, proportionality, control and converting primary responses into tactical movements. As officers trained complete violent situations (and not just physical skills), they learned to use their actions before physical contact for de-escalation but also for anticipation on possible attacks. Furthermore, they learned to respond against attacks with skills based on their primary reflexes. The results of this study seem to suggest that reflex-based self-defence training better prepares officers for performing in high-pressure arrest situations than the current form of police arrest and self-defence skills training. Practitioner Summary: Police officers' performance in high-pressure arrest situations improved after a reflex-based self-defence training, while there was no such effect of a regular police training. As officers learned to anticipate on possible attacks and to respond with skills based on their primary reflexes, they were better able to perform effectively.