The impact of introducing a videolaryngoscope in the initial training of laryngoscopy for undergraduate medical students: a simulation randomized trial

Abstract Introduction: Adequate and continuous airway management by health professionals is fundamental to ensure patient safety and protection. Among several techniques, laryngoscopy for orotracheal intubation is considered a basic skill, so it is taught and learned in medical school and used during the future years of professional practice. However, in some clinical scenarios, physical and anatomical characteristics can make laryngoscopy exceedingly difficult. In the last decade, some new devices have emerged to apply indirect or video-assisted imaging systems, so-called videolaryngoscopes. They have shown great efficiency in difficult intubation cases and have improved teaching and training. Our study introduced a videolaryngoscope, the McGrathTM MAC, in the regular laryngoscopy training rotation for 3rd-year undergraduate medical students and evaluated whether there was any associated optimization of the students' performance. Method: Students from two different classes and years (2017 and 2018) were randomly divided into two groups and received theoretical and practical training in the techniques of Direct Laryngoscopy (DL) and Videolaryngoscopy (VL). The students in each group applied the manoeuvres and simulated three tracheal intubation attempts on mannequins. They were evaluated for their success rate on the first attempt, the time required to finalize the intubation, and the visualization of the glottic structures according to the classification of Cormack-Lehane (C&L). Results: Two hundred and four students with an average age of 21 ± 2 years participated in the study; the groups were similar. There was a significant difference between the VL and DL groups in the 1st attempt success rate (97% and 89.4%, respectively, p = 0.0497 - 95% CI), but such a difference was not seen for the other attempts or regarding the number of oesophageal intubations (3% and 7.7%). The students in the VL group were faster than those in the DL group in all intubation attempts; in parallel, the vast majority of the VL group reported excellent visualization conditions, with 75% of the attempts classified as Cormack-Lehane grade 1. Conclusion: The introduction of a videolaryngoscope in medical students' training improved the visualization of anatomical structures and allowed tracheal intubation maneuvers to be performed faster and with a higher success rate on the first attempt. Thus, under the conditions of this prospective study, the videolaryngoscope had a positive impact on training and proved to be a promising tool for teaching laryngoscopy.

Tendencias actuales en la enseñanza de la reanimación cardiopulmonar básica / Current trends in the teaching of basic cardiopulmonary resuscitation / Current trends in the teaching of basic cardiopulmonary resuscitation

Introducción: La enseñanza de la reanimación cardiopulmonar se basa en el estudio de conceptos, teorías y prácticas que son evaluados con el objetivo de medir el nivel de retención de los individuos. Objetivo: Caracterizar el impacto de las tendencias actuales en la enseñanza de la reanimación cardiopulmonar básica. Métodos: Se realizó una revisión bibliográfica de artículos científicos pertenecientes a las bases de datos Medline, PubMed, SciELO Regional y SciELO Cuba. Se utilizaron descriptores en español e inglés y se revisaron 29 citas. Resultados: Las tendencias actuales implican la aplicación de las nuevas tecnologías, la autopreparación y el poco desarrollo de entornos presenciales. Se consideran las escuelas como lugares clave para las nuevas formas de enseñanza. Los simuladores permiten la formación bajo situaciones clínicas reales. El autoaprendizaje garantiza la consolidación de las habilidades prácticas trasmitidas por el instructor y asimiladas por el estudiante. Conclusiones: La reanimación cardiopulmonar garantiza una mejor calidad de vida de la población en general. Con el avance tecnológico se ha abierto una nueva etapa en la formación de habilidades, donde ha primado la autonomía; aunque existen notables desventajas. Entonces se necesita un asesoramiento con instructor, que ofrezca los conocimientos teóricos y prácticos básicos compaginados con un nivel de autonomía del aprendizaje. Este proceso debe seguirse y controlarse. A la vez que la formación no se detiene ahí, la formación sistemática en cualquier lugar permite la reafirmación de lo aprendido. De este modo, los avances tecnológicos desempeñarán su mejor beneficio(AU)

Introduction: The teaching of cardiopulmonary resuscitation is based on the study of concepts, theories and practices evaluated with the aim of measuring the retention level of individuals. Objective: To characterize the impact of current trends in the teaching of cardiopulmonary resuscitation. Methods: A bibliographic review of scientific articles from Medline, PubMed, SciELO Regional and SciELO Cuba databases was carried out. Descriptors in Spanish and English were used, as well as 29 citations were reviewed. Results: Current trends involve the application of new technologies, self-training and little development of face-to-face settings. Schools are considered as key places for new forms of teaching. Simulators allow training under real clinical situations. Self-learning guarantees the consolidation of practical skills transmitted by the instructor and assimilated by the student. Conclusions: Cardiopulmonary resuscitation guarantees better quality of life for the general population. Technological progress has opened a new stage in the training of skills, in which autonomy has prevailed; however, there are significant disadvantages. Therefore, there is a need for instructor-led counseling, offering basic theoretical and practical knowledge combined with a level of learning autonomy. This process must be monitored and controlled. While training does not stop at such point, systematic training at any location allows reaffirmation of what has been learned. In this way, technological advances will permit to take the best advantage(AU)

Simulación de intubación pediátrica con videolaringoscopio de bajo costo en contexto de pandemia por COVID-19 / Simulation of pediatric intubation using a low-cost videolaryngoscope in the setting of the COVID-19 pandemic

En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo.Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,7­60,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica

In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope.Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8-148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001).A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice

Red reflex technique training simulator in newborns / Simulador para o treinamento da técnica do reflexo vermelho em recém-nascidos

Abstract: Introduction: The Red Reflex Test (RRT) consists of visualizing the reflection that light causes in the retina when it passes through the pupil. It is a screening test for pathologies that can lead to blindness, which still have great social and economic impact on families and the government. Teaching through simulators allows students and health professionals to acquire and improve their clinical skills. Objective: The aim of the study is to develop a low-cost dummy, 3D printed and based on the Arduino platform, for the training of the red reflex technique (RRT) in newborns and evaluate its educational effectiveness. Method: A RRT dummy was presented to 7 expert judges: 6 pediatricians and 1 ophthalmologist to evaluate its applicability in medical learning. For this purpose, they used a 14-item Likert scale of 5 points. Subsequently, 40 individuals participated in a course: 33 medical students, 5 pediatric residents, a nurse and a general physician. The participants were randomly assigned to two groups: control (CG) and experimental (EG) group. Each group consisted of 20 participants. The EG went through 4 stages: 1) theoretical background; 2) handling of the simulator; 3) simulated clinical practice and; 4) evaluation in real-life patients. Whereas the CG went through the following teaching methodological processes: 1) theoretical background; 2) direct training in real-life patients and; 4) practical evaluation in a real-life patient. After each respective group intervention, both groups were assessed on their learning in 40 newborns at Santa Casa de Misericórdia do Pará Foundation in Belém, state of Pará, Brazil. Results: At the judges' evaluation regarding the simulator positive items (design, similarity, interest, relevance, content, memorization, didactics, previous reminiscence, comprehension and application), 49.2% answered 'strongly agree' and 44.4%, 'agree'. Regarding the negative questions (difficulty in understanding, information overload, abstraction, difficulty in handling and clarity of operation), 40.0% answered 'strongly disagree', and 57.1%, 'disagree'. The judges were 94.9% favorable to the use of the simulator in medical education. However, comparing the two groups of students, regarding the time of exam, the results showed no statistically significant difference (p-value = 0.29). Conclusions: The dummy showed its applicability for the learning of RRT, with the advantage of being able to perform the exam without having to disturb a real-life patient.

Resumo: Introdução: O Teste do Reflexo Vermelho (TRV) consiste em visualizar o reflexo que a luz causa na retina ao passar pela pupila. Dessa forma, o TRV tria patologias que levam à cegueira e pode reduzir o impacto social e econômico das famílias e do governo. O ensino por meio de simuladores permite que estudantes e profissionais de saúde adquiram e melhorem as habilidades clínicas. Objetivos: Este estudo teve como objetivos desenvolver um manequim de baixo custo, impresso em 3D e baseado na plataforma Arduino, para o treinamento do TRV em recém-nascidos e avaliar a eficácia educacional desse exame. Métodos: Um manequim do TRV foi apresentado a sete juízes especialistas - seis pediatras e um oftalmologista - que avaliaram a aplicabilidade do teste na aprendizagem médica. Para isso, utilizaram a escala Likert de 14 itens de 5 pontos. Posteriormente, 40 participantes participaram de um curso: 33 estudantes de Medicina, cinco residentes em pediatria, uma enfermeira e um médico generalista. Dividiram-se aleatoriamente os participantes em dois grupos: controle (GC) e experimental (GE). Cada grupo foi composto por 20 participantes. Submeteu-se o GC ao ensino convencional em pacientes reais. O GE passou por quatro etapas: 1. fundamentação teórica, 2. manipulação do simulador, 3. prática clínica simulada e 4. avaliação nos pacientes reais. No GC, adotaram-se os seguintes passos: 1. fundamentação teórica, 2. treinamento direto em pacientes reais e 3. avaliação em pacientes reais. Após a intervenção de cada grupo, os dois grupos foram avaliados quanto à aprendizagem em 40 recém-nascidos da Fundação Santa Casa de Misericórdia do Pará, em Belém, no Pará. Resultados: Na avaliação dos juízes em relação aos itens positivos para o simulador (design, similaridade, interesse, relevância, conteúdo, memorização, didática, reminiscência anterior, compreensão e aplicação), 49,2% afirmaram que concordavam fortemente e 44,4% mencionaram apenas que concordavam. Nas questões negativas (dificuldade de entendimento, sobrecarga de informação, abstração, dificuldade de manuseio e clareza de operação), 40,0% discordaram fortemente e 57,1% discordaram. Os juízes concordaram em 94,9% a favor do uso do simulador na educação médica. Porém, comparando os dois grupos de estudantes, em relação ao tempo de exame, os resultados não mostraram diferença estatisticamente significante (p = 0,29). Conclusão: O manequim mostrou aplicabilidade na aprendizagem do TRV, com a vantagem de realizar o exame sem que o paciente real fosse incomodado.

Desenvolvimento de protótipo de reanimação cardiopulmonar para educação em saúde / Development of a cardiopulmonary resuscitation prototype for health education / Desarrollo de un prototipo de reanimación cardiopulmonar para la educación en salud

Objetivo: desenvolver e validar um protótipo de baixo custo para reanimação cardiopulmonar em adultos, com ênfase nos fluxos arteriais e venosos para fins educacionais. Método: trata-se de estudo oriundo de trabalho de conclusão de curso, utilizando abordagem do design thinking para elaboração do protótipo, realizado em uma universidade pública federal no sul do Brasil, entre setembro e novembro de 2019. Na validação, participaram 13 indivíduos com expertise em Urgência e Emergência, sendo utilizado um instrumento com escala Likert, composto por sete itens sobre aparência e usabilidade. Resultados: o protótipo foi idealizado usando um manequim de exposição de roupas como estrutura principal. Além do tórax permitir compressões, uma rede de ductos que simulam os fluxos sanguíneos demonstrou visualmente a circulação sanguínea e a injeção de medicações intravenosas. Conclusão: o protótipo possui capacidade de potencializar o processo de ensinoaprendizagem em suporte básico e avançado de vida, especialmente quando sustentado por metodologias ativas.

Objective: to develop and validate a low-cost prototype for cardiopulmonary resuscitation in adults, with an emphasis on arterial and venous flows, for educational purposes. Method: this study, which originated from a course conclusion project to develop a prototype using the design-thinking approach, was conducted at a federal public university in southern Brazil between September and November 2019. Thirteen individuals with expertise in emergency care took part in validation, using a Likert scale instrument consisting of seven items on appearance and usability. Results: the prototype was designed using a clothing display mannequin as the main structure. Compressions could be performed on the chest, and a network of ducts simulated blood flows visually, demonstrating blood circulation and intravenous medication injections. Conclusion: the prototype was able to enhance teaching and learning on basic and advanced life support, especially when supported by active methodologies.

Objetivo: desarrollar y validar un prototipo de bajo costo para reanimación cardiopulmonar en adultos, con énfasis en los flujos arteriales y venosos, con fines educativos. Método: este estudio, que se originó a partir de un proyecto de conclusión de curso para desarrollar un prototipo utilizando el enfoque de pensamiento de diseño, se realizó en una universidad pública federal en el sur de Brasil entre septiembre y noviembre de 2019. En la validación participaron trece personas con experiencia en atención de emergencias , utilizando un instrumento de escala Likert que consta de siete ítems sobre apariencia y usabilidad. Resultados: el prototipo se diseñó utilizando un maniquí de exhibición de ropa como estructura principal. Se podían realizar compresiones en el pecho y una red de conductos simulaba visualmente los flujos sanguíneos, lo que demostraba la circulación sanguínea y las inyecciones de medicación intravenosa. Conclusión: el prototipo fue capaz de mejorar la enseñanza y el aprendizaje sobre soporte vital básico y avanzado, especialmente cuando fue apoyado por metodologías activas.

Fibreoptic intubation in airway management: a review article

Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management.

Protective effect of glucosamine and risedronate (alone or in combination) against osteoarthritic changes in rat experimental model of immobilized knee / 대한해부학회지

Study on the effect of a cold environment on the quality of three video laryngoscopes: McGrath MAC, GlideScope Ranger, and Pentax Airway Scope

OBJECTIVE: Several environmental factors influence the prehospital use of video laryngoscopes (VLs). For example, fogging of the VL lens can occur in cold environments, and the low temperature can cause the VLs to malfunction. As relevant research on the effect of environment on VLs is lacking, we aimed to study the effect of a cold environment on three commonly used VLs.METHODS: McGrath MAC, Pentax Airway Scope (AWS), and GlideScope Ranger were exposed to temperatures of -5°C, -10°C, -20°C, and -25°C for 1 hour each and then applied to a manikin in a thermohydrostat room 5 times. Immediately after turning on the power and inserting the blade, the time until an appropriate glottic image appeared on the screen was measured.RESULTS: McGrath MAC was able to accomplish immediate intubation regardless of the temperature drop. However, GlideScope Ranger required an average of 4.9 seconds (-5°C to -20°C) and 10.1 seconds (-25°C) until appropriate images were obtained for intubation. AWS showed adequate image acquisition immediately after blade insertion despite slight fogging at -20°C, but at -25°C, images suitable for intubation did not appear on the screen for an average of 4.7 minutes.CONCLUSION: All three devices appear to be usable without any limitations up to -20°C. However, GlideScope Ranger and AWS may not produce images immediately at temperatures below -25°C. Thus, medical practitioners performing VL in a cold environment should be aware of the characteristics of the VL devices in advance.

Factors Affecting Self-efficacy of Cardiopulmonary Resuscitation(CPR) in Adults / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was factors affecting self-efficacy of cardiopulmonary resuscitation (CPR) in adults. Therefore, the provide basic data for strategy development to improve the performance rate of bystander CPR. METHODS: The data were collected from 164,165 adults of the 2016 Korean Community Health Survey. The survey method was 1:1 interview with households, and the survey period was from August 16, 2016 to October 31, 2016. The survey variables were as follows: self-efficacy of CPR, awareness of CPR, training experience of CPR, demographic characteristics, medical characteristics, health promoting behaviors, and safety practices. RESULTS: The rate of self-efficacy of CPR in adults was 60.6%. Factors affecting self-efficacy of CPR were age, sex, residence, education level, occupation, marital status, any CPR training, CPR training within the last 2 years, CPR training with manikin within the last 2 years, emergency room visit within the last 1 year, physical activity status, drive a bicycle, seat belts on rear seat, seat belts when riding a bus were statistically significant. CONCLUSIONS: In conclusion, in order to improve the self-efficacy of CPR in adults, the recent experience rate of CPR education, the practice rate of health promotion behavior, and the practice rate of safety behavior should be improved. The government should expand the provision of education programs to improve the self-efficacy of CPR and actively prepare national-level public advertisements strategies.

Comparison of fiberoptic bronchoscope and video stylet during endotracheal intubation: simulation study

OBJECTIVE: The UE Video Stylet VL400-S2 (UE Medical Devices, Newton, MA, USA) and Ambu aScope (Ambu, Copenhagen, Denmark) were recently introduced rigid video stylets and single-use fiberoptic bronchoscopes, respectively. To compare the utility of the two sets of equipment, this study conducted a randomized cross-over study using a manikin. METHODS: Twenty-eight novice doctors performed tracheal intubation on an airway trainer manikin (Laerdal, Stavanger, Norway). The sequence of intubation devices was randomized. The following data were measured and recorded: time to complete tracheal intubation (primary end point), overall success rate, time to see the glottis, and time to tube passage. RESULTS: The video stylet (24 seconds; interquartile range [IQR] 18–36) showed a significantly shorter completion time of the tracheal intubation than the fiberoptic bronchoscope (43 seconds; IQR, 32–84) (P<0.001). The overall success rate of tracheal intubation was 96.4% (27/28) in the video stylet and 82.1% (23/28) in the fiberoptic bronchoscope, and the cumulative success rate over time to complete intubation was significantly higher in the video stylet (P<0.001). CONCLUSION: The video stylet was superior to the fiberoptic bronchoscope in terms of the time to complete and the cumulative success rate of intubation for novice operators in manikin model. Further research will be needed to determine the degree of education required to use fiberoptic bronchoscopy.

Simulation of healthcare provider's safety on emergency transportation using advanced airway: extension tube usage or not

OBJECTIVE: Healthcare providers are exposed to risky environments during prehospital transportation when they give O₂ supply to patients. This study examined the problems with risky environments during prehospital transportation and suggests safe and efficient O₂ supply methods through extension tube simulation. METHODS: Fifty-seven volunteers participated the study. The volunteer's back angle was measured during transportation simulation. This study measured the grip strength difference and forearm circumference difference in two situations. Without an extension tube and with extension tube, the participants measured the grip strength and forearm circumference before and after giving an O₂ supply to the mannequin for 5 minutes. The participants replied which body part showed the most discomfort. RESULTS: In the without extension tube group, participants leaned forward on average. On the other hand, the mean of anterior angle was 0° with an extension tube group. Without an extension tube, the grip strength decreased by whereas it decreased by with an extension tube. The decrease in grip strength was similar in both groups (P<0.05), and there was no significant difference in the forearm circumference. With the extension tube, 43.9% of participants reported no discomfort when they gave an O₂ supply. CONCLUSION: The extension tube improved the healthcare provider's safety and O₂ supply convenience during pre-hospital transportation.

A Real Situation Experimental Study on The Thermal Protection Performance of Firefighter Clothes and Gloves

PURPOSE: This study aimed to evaluate the thermal protective function of firefighter clothes and gloves through real scale fire simulations. METHODS: Firstly, the fire simulation by real scale flame was performed for firefighter clothes. A manikin equipped with firefighter clothes was directly exposed to flames which energy average is 84 Kw/m2. for 22 seconds. Heat flux gauges attached on the body measured surface temperature elevation. Secondly, we also performed the other fire simulation by hot plate exposure to firefighter gloves. Firefighter gloves with heat flux gauges exposed hot plate which temperature is 300℃ in both dry and moist conditions. Primary outcome was surface temperature change of manikin body (first simulation) and hand (second simulation) over times. RESULTS: In the first flame simulation, the surface temperature of face and shoulders elevated more rapidly comparing with the other body surface area when initial period of flame shutter open. After 18sec of shutter open, the surface temperature of upper trunk elevated rapildy. After shutter closure, high surface temperature kept continuously on right side of face and left shoulder. In the second hot plate simulation, fingers and palms showed higher surface temperature than the other areas of hands in the both dry and wet conditions. CONCLUSION: This study suggests that the real scale flame enables firefighter clothes to lose their heat protective function suddenly after 18 seconds. Additionally, the protective function of firefighter gloves were relatively weaker in the palmar side of fingers than the other parts of hand. There should be additional study for evaluate thermal protection performance of firefighter clothes. And, further effort for reinforce palmar side of fingers of firefighter gloves should be done.

Exposure to Needlestick and Sharp Injuries, Anxiety during Injection Practice and Experience of Injecting Human Beings in Fundamental Injection Practice / 기본간호학회지

PURPOSE: This study was done to understand nursing students' exposure of needlestick and sharp injuries (NSSI), level of anxiety as well as experience of practicing injection with human beings during Fundamentals of Nursing (FN) practice. METHODS: Data consisted of self-report questionnaires completed by 571 nursing students who had completed an injection practice in FN. The questionnaire included questions on general characteristics, exposure to NSSI, experience of practicing injections with human beings, level of anxiety and other experiences. Data were analyzed using descriptive statistics and content analysis. RESULTS: Of the students, 17.5% experienced NSSI and 83.2% performed invasive injection procedures in the FN practice. The level of anxiety was 4.62–6.46/10 points when injecting a classmate and 1.27–1.93/10 points when using manikins. The feeling most often reported was worried about making a mistake that could hurt my classmate (57.2%). CONCLUSION: Nursing students are exposed to NSSI and experience a high degree of anxiety in invasive injection practice. These results indicate that it is necessary to develop and implement standardized NSSI prevention and anxiety reduction programs in FN.

Augmented Reality to Localize Individual Organ in Surgical Procedure / 대한의료정보학회지

OBJECTIVES: Augmented reality (AR) technology has become rapidly available and is suitable for various medical applications since it can provide effective visualization of intricate anatomical structures inside the human body. This paper describes the procedure to develop an AR app with Unity3D and Vuforia software development kit and publish it to a smartphone for the localization of critical tissues or organs that cannot be seen easily by the naked eye during surgery. METHODS: In this study, Vuforia version 6.5 integrated with the Unity Editor was installed on a desktop computer and configured to develop the Android AR app for the visualization of internal organs. Three-dimensional segmented human organs were extracted from a computerized tomography file using Seg3D software, and overlaid on a target body surface through the developed app with an artificial marker. RESULTS: To aid beginners in using the AR technology for medical applications, a 3D model of the thyroid and surrounding structures was created from a thyroid cancer patient's DICOM file, and was visualized on the neck of a medical training mannequin through the developed AR app. The individual organs, including the thyroid, trachea, carotid artery, jugular vein, and esophagus were localized by the surgeon's Android smartphone. CONCLUSIONS: Vuforia software can help even researchers, students, or surgeons who do not possess computer vision expertise to easily develop an AR app in a user-friendly manner and use it to visualize and localize critical internal organs without incision. It could allow AR technology to be extensively utilized for various medical applications.

Stress among medical students during simulation training at King Saud bin Abdulaziz University for Health Sciences

Background: Simulation training is increasingly being used as a safe format to instruct students and trainees in different skills and procedures in the field of medicine. In this study, we recorded stress levels among medical students during simulation training for a lumbar puncture [LP] procedure performed on a mannequin and investigated the association between stress and performance

Methodology: This study was conducted on 39 fourth year female medical students. Students wore a galvanic skin response [GSR] sensor on their wrist before being asked to attempt the LP procedure on the mannequin on two separate occasions. Students' performance was assessed using a validated LP checklist on each attempt. Data were compared across all simulation attempts and for each student

Results: Collectively, mean wrist GSR levels increased from the mental rehearsal phase 0.31 mS +/- 0.40, during the first attempt 0.48 mS +/- 0.62 and continued to increase significantly [P = 0.007] during the second attempt 0.60 mS +/- 0.80. There were no significant differences [P = 0.32] between the checklist scores of the first and second attempts

Conclusion: The results of our study support the previous evidence that linked simulation training with emotional and physiological stress. Performing highly intense procedures such as LP is considered to be a potential source of stress. Our findings showed that there was a continuous increase in the level of stress associated with repeated attempts during the LP simulation that had no significant impact on clinical performance. As the practice of medicine involves exposure to a remarkable number of stressors and critical conditions, we emphasize the importance of training medical students in ways to cope more effectively with these situations

Development of Korean Social Affective Visual Stimuli / 수면정신생리

OBJECTIVES: The current study aims to develop Korean Social Affective Visual Stimuli (K-SAVS) to arouse social affect. METHODS: K-SAVS is composed of pictures of social situations among East Asians. Each picture contains a negative, positive, or neutral affect. Positive and negative stimuli were presented to one group of subjects. Negative and neutral stimuli were presented to another group of subjects. All subjects were required to fill out Affective Valence and Arousal Manikin. RESULTS: In the initial test, 18 positive affective stimuli pictures (1 set) and 36 negative affective stimuli pictures (2 sets) were chosen from 95 stimuli pictures. Positive affective stimuli pictures showed higher valence (p < 0.001) and lower arousal (p < 0.001) than negative affective stimuli pictures. In the confirmatory test, 18 neutral stimuli pictures (1 set) were additionally selected out of the total of 79 pictures of neutral stimuli pictures and the pictures used in the former experiment. Neutral stimuli pictures showed higher valence (p < 0.001) and lower arousal (p < 0.001) than negative affective stimuli pictures. CONCLUSION: K-SAVS can be a valid and useful tool for inducing specific social affects of Koreans.

Easy-to-learn cardiopulmonary resuscitation training programme: a randomised controlled trial on laypeople's resuscitation performance

<p><b>INTRODUCTION</b>Simplifying the learning of cardiopulmonary resuscitation (CPR) is advocated to improve skill acquisition and retention. A simplified CPR training programme focusing on continuous chest compression, with a simple landmark tracing technique, was introduced to laypeople. The study aimed to examine the effectiveness of the simplified CPR training in improving lay rescuers' CPR performance as compared to standard CPR.</p><p><b>METHODS</b>A total of 85 laypeople (aged 21-60 years) were recruited and randomly assigned to undertake either a two-hour simplified or standard CPR training session. They were tested two months after the training on a simulated cardiac arrest scenario. Participants' performance on the sequence of CPR steps was observed and evaluated using a validated CPR algorithm checklist. The quality of chest compression and ventilation was assessed from the recording manikins.</p><p><b>RESULTS</b>The simplified CPR group performed significantly better on the CPR algorithm when compared to the standard CPR group (p < 0.01). No significant difference was found between the groups in time taken to initiate CPR. However, a significantly higher number of compressions and proportion of adequate compressions was demonstrated by the simplified group than the standard group (p < 0.01). Hands-off time was significantly shorter in the simplified CPR group than in the standard CPR group (p < 0.001).</p><p><b>CONCLUSION</b>Simplifying the learning of CPR by focusing on continuous chest compressions, with simple hand placement for chest compression, could lead to better acquisition and retention of CPR algorithms, and better quality of chest compressions than standard CPR.</p>

Is it possible to reduce intra-hospital transport time for computed tomography evaluation in critically ill cases using the Easy Tube Arrange Device?

OBJECTIVE: Patients are often transported within the hospital, especially in cases of critical illness for which computed tomography (CT) is performed. Since increased transport time increases the risks of complications, reducing transport time is important for patient safety. This study aimed to evaluate the ability of our newly invented device, the Easy Tube Arrange Device (ETAD), to reduce transport time for CT evaluation in cases of critical illness. METHODS: This prospective randomized control study included 60 volunteers. Each participant arranged five or six intravenous fluid lines, monitoring lines (noninvasive blood pressure, electrocardiography, central venous pressure, arterial catheter), and therapeutic equipment (O2 supply device, Foley catheter) on a Resusci Anne mannequin. We measured transport time for the CT evaluation by using conventional and ETAD method. RESULTS: The median transport time for CT evaluation was 488.50 seconds (95% confidence interval [CI], 462.75 to 514.75) and, 503.50 seconds (95% CI, 489.50 to 526.75) with 5 and 6 fluid lines using the conventional method and 364.50 seconds (95% CI, 335.00 to 388.75), and 363.50 seconds (95% CI, 331.75 to 377.75) with ETAD (all P < 0.001). The time differences were 131.50 (95% CI, 89.25 to 174.50) and 148.00 (95% CI, 116.00 to 177.75) (all P < 0.001). CONCLUSION: The transport time for CT evaluation was reduced using the ETAD, which would be expected to reduce the complications that may occur during transport in cases of critical illness.

Comparison of Intubation Efficiency by Suction Device in a Hemorrhagic Airway Manikin Model: Yankauer Suction Tip vs. Polyvinyl Chloride Catheter Suction Tip

PURPOSE: Tracheal intubation in a hemorrhagic airway is a difficult procedure because the visibility can be obscured by blood or vomitus. Several devices and methods have been developed to overcome such obstacles, but they are not available at all practical sites. Therefore, this study was conducted to assess the time and success rate of tracheal intubation according to the type of suction tip used in a hemorrhagic airway manikin model. METHODS: This study was a randomized crossover manikin simulation study. We recruited 18 emergency physicians to perform intubation with suction using a Yankauer suction tip and a polyvinyl chloride (PVC) catheter suction tip in a hemorrhagic airway manikin model. We then measured the time and success rate of intubation for each suction tip. RESULTS: The mean intubation time using the Yankauer suction tip was 42.3 seconds, and the mean intubation time using the PVC catheter suction tip was 91.1 seconds (p < 0.001). Two cases of esophageal intubation occurred when the PVC catheter suction tip was used (success rate, 88.9%). In contrast, there was no esophageal intubation when the Yankauer suction tip was used (success rate, 100%) (p=0.217). CONCLUSION: Intubation of a hemorrhagic airway manikin model can be performed in a shorter time when a Yankauer suction tip is used than when a PVC catheter suction tip is used.

Modelo artesanal para treinamento de acesso vascular / Handmade model for peripheral vascular access training

Contexto: O acesso vascular é o procedimento mais comum realizado entre pacientes hospitalizados. Assim, na tentativa de minimizar complicações e aliar conhecimento técnico ao conhecimento teórico, os modelos de simulação são capazes de oferecer um ambiente seguro para profissionais em formação e evitar os dilemas éticos de treinamento direto em pacientes. Com esse objetivo, surgiram diversos manequins de treinamento, mas devido ao seu alto custo eles não são acessíveis a todos, e com frequência os profissionais em formação da área da saúde realizam procedimentos sem que tenham um treinamento prévio. Objetivo: Desenvolver um modelo de ensino e treinamento de acesso vascular periférico, utilizando um modelo de baixo custo para fins educacionais. Método: Para reproduzir a via periférica de acesso, utilizou-se um macarrão de polietileno com equipos de infusão, com uma extremidade em fundo cego e a outra conectada a duas bolsas de 500 mL de soro fisiológico acrescido de corante. A bolsa foi instalada em um suporte metálico. Resultado: O formato sugerido para o modelo apresentou semelhança com a anatomia do antebraço simplificada. O modelo se mostrou prático na punção e, devido à sua extensão, tem-se a possibilidade de puncionar diversas vezes o mesmo modelo, facilitando o treinamento. Conclusão: O modelo proposto permite o treinamento de acesso vascular periférico, sendo uma alternativa de baixo custo que pode ser utilizada para fins educacionais

Background: Vascular access is the procedure performed with greatest frequency in hospitalized patients. Simulation models are intended to minimize complications and combine technical and theoretical knowledge, offering a safe environment for training health professionals that avoids the ethical dilemmas of conducting initial training with patients. Many different training dolls have been developed to achieve this objective, but their high cost means they are not universally available, and it is common for unqualified health professionals to perform procedures on patients with no previous practice. Objective: To develop a low-cost educational model for teaching and training peripheral vascular access. Method: Peripheral access routes were reproduced using a polyethylene foam noodle and infusion kits, each with one extremity sealed off and the other connected to one of two 500 mL packs of saline, dyed red or blue. The packs were hung on a metal stand. Results: The structure chosen for the model was similar to a simplified version of the anatomy of the forearm. The model proved to be practical for puncture and, because of its length, the same model can be punctured multiple times, facilitating training. Conclusions: The model proposed here enables training of peripheral vascular access and is a low-cost option that can be used for educational purposes