Auburn Research Day 2022

S imu l a t i on Resea rch | VCOM Facu l t y A Virtual End-Of-Life Simulation: An Effective Methology for Learners

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Dr. Tiffani Chidume, RN, CCRN-K, CHSE, CHSOS Auburn University School of Nursing

There is a deficit in prelicensure learner knowledge regarding empathy and communication with families experiencing death and dying of a loved one. The purpose of this virtual telecommunication (VT) pilot simulation-based experience (SBE) was to address the gap of learner experiences communicating with the family of a dying loved one and produce feelings of empathy virtually, due to COVID-19. Often, the empathy component does not translate from the scenario to the learner(s), as they tend to concentrate more on completing patient care tasks than comforting the patient and family members. A virtual telecommunication simulation-based experience was written, designed, and piloted for prelicensure BSN students, due to the cancellation of face-to-face learning related to the Covid-19 pandemic. The Zoom platform was used to conduct the sessions. Standardized patients played a pivotal role in the SBE and helped draw feelings of empathy and sympathy from learners. The Zoom format was adequate to host the simulation-based experience that focused on the end-of-life. Producing feelings of empathy may be difficult in any setting, especially virtually. The well- written script and utilization of standardized patients enhanced the experience and was very realistic. Standardized patients were able to emotionally connect with their character from past experience

from the loss of a loved one. Students completed the experience individually and many revealed they had never provided a patient update to anyone, to the experience was appreciated. Almost ninety- three percent of the learners strongly agreed that they felt more confident communicating the patient status after the SBE. When comparing faculty and student feedback, the virtual SBE was more beneficial than the previous face-to-face one. The virtual telecommunication simulation-based experience was an effective modality for learners to gain experience talking to families of a dying patient. The practicality of the script and the SPs’ ability to transfer their emotions to learners were vital for the success of this SBE. The simulation was more beneficial than the previous face-to-ace modality because the students had to concentrate on having a difficult conversation that most had not yet experienced in the clinical setting. In the previous end-of-life simulation, learner objectives included caring for the patient as well as communicating with a family member. Learners disclosed they never considered having this conversation with family members and felt more confident giving patient updates after the SBE. Due to the achievement of this SBE and the modality, the course leader has requested the end-of-life simulation remain virtual, even after normal face-to-face university procedures resume.

Bradley A. Ruple 1 ; Morgan A. Smith 1 ; Shelby C. Osburn 1 ; Casey L. Sexton 1 ; Joshua S. Godwin 1 ; Michael D. Roberts 1,2 ; Kaelin C. Young 1,2 1 School of Kinesiology, Auburn University; 2 Department of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine – Auburn Campus Cl i n i ca l Resea rch | Gr adua te/Undergr adua te St udent Agreement Between Mri, Ultrasound, and Histology in Detecting Size Changes of the Vastus Lateralis Following Resistance Training 20

The size and change in size of the vastus lateralis (VL) muscle is commonly analyzed using a variety of imaging techniques including magnetic resonance imaging (MRI) and B-mode ultrasonography (US) with MRI being perceived as the gold standard for its ability to segment tissue compartments at a high resolution. The common method of assessing myofiber hypertrophy is by quantifying fiber cross-sectional area (fCSA). We tested whether these methods were accurate and reliable at detecting skeletal muscle hypertrophic changes following resistance training. Twelve healthy, untrained, college-aged males (20±1 y; BMI: 26.9±5.4 kg/m 2 ) had VL assessments via MRI, B-mode ultrasound (thickness and cross-sectional area) prior to (PRE) and after 10 weeks of resistance training (POST). Muscle biopsies were obtained at the site of imaging at PRE and POST for mean fCSA determination. Agreement between MRI mCSA (mCSA MRI ) and panoramic-based ultrasound mCSA (mCSA US ) at PRE and POST as well as change scores in these variables were examined using Bland-Altman plots for mean bias and 95% limits of agreement (LOA) as well as Lin’s concordance correlation coefficients (CCC). The relationship between fCSA with mCSA MRI , mCSA US , and B-mode ultrasound thickness (VL Thick ), as well as VL Thick and mCSA MRI were tested with Pearson’s correlations. Both mCSA MRI and VL Thick significantly increased following training

(28.1±6.1 to 31.1±6.9cm 2 (p=0.005) and 2.35±0.35 to 2.63±0.39cm (p=0.001), respectively). mCSA US and fCSA did not significantly increase with training (26.3±6.4 to 28.3±7.5cm 2 (p=0.064), and 4896±901.3 5443.2±1449.3µm 2 (p=0.12), respectively). Bland-Altman analysis revealed a small mean bias in mCSA US relative to MRI (-2.29 m 2 , 95% LOA: -8.74, 4.15 cm 2 ). Concordance between mCSA US and mCSA MRI taken at PRE and POST time points were excellent (CCC=0.83). Bland-Altman analysis revealed good agreement between change scores in mCSA US and mCSA MRI (-1.08cm 2 , 95% LOA: -5.49, 3.33 cm 2 ). There was a moderate concordance between mCSA US and mCSA MRI change scores (CCC=0.70). A positive, moderate correlation was found between percent change in both VL Thick and mCSA MRI as well as VL Thick and mCSA US (r=0.39, p=0.071 and r=0.52, p=0.080, respectively). A negative correlation was found between percent changes in fCSA and mCSA MRI (r= -0.569, p=0.054). Finally, correlations were not significant between percent changes in VL Thick and fCSA (r=0.053, p=0.871) or fCSA and mCSA US (r= -0.271, p=0.394). These data suggest that, relative to MRI, panoramic ultrasound is a reliable method to track mCSA changes of the VL. However, fCSA changes do not associate with tissue level changes, and this discordance warrants further research.

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