Can CO2 be used as an indicator of the probability of cross-infection?

The validity of using CO2 as an indicator of airborne infection probability was studied. Tracer gas measurements were conducted in a field lab with two breathing thermal manikins resembling "infected” and "susceptible” persons seated at desks. The room was ventilated with a mixing air distribution. Experiments were performed at three ventilation rates. CO2 gas was dosed into the air exhaled by the manikins to simulate the metabolic CO2 generation by people. Simultaneously, nitrous oxide (N2O) tracer gas was dosed into the air exhaled by one of the manikins ("infected person”) to simulate the emission of exhaled infectious particles. CO2 and N2O concentrations were measured at several points. The probability of infection was calculated based on the concentration of CO2 and N2O measured in the air inhaled by the exposed manikin ("susceptible person”). The results did not confirm that CO2 can be used as a proxy to assess the infection probability. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

SASA 2023 Congress

The proceedings contain 34 papers. The topics discussed include: comparison of intra-arterial blood pressures versus two noninvasive measuring systems: a cross-sectional analytic study employing Bland-Altman and error grid analyses;prevalence of vitamin D deficiency amongst anesthesia providers at the Universitas Academic Hospital;chemical and physical stability of an admixture of anesthetic drugs;postoperative pulmonary complications in adult surgical patients in low- and middle-income countries: a systematic review and meta-analysis;the prevalence of SARS-CoV-2 infection in an academic department of anesthesiology;evaluation of the use of a 3D printed video laryngoscope for tracheal intubation in a manikin;the prevalence of caregiver anxiety in theatre at universitas academic hospital;the spectrum of disease and short-term outcomes of obstetric patients with cardiac disease at a tertiary hospital in South Africa;and almost 30% reduction in carbon footprint using volatile anesthesia - a quality improvement project introducing low-flow anesthesia in a regional hospital.

Simulation training for medical emergencies of dental patients: A review of the dental literature.

In recent years, due to the aging of the population, the number of dental patients with comorbidities such as hypertension and diabetes has increased. Although it has been reported that these patients are increasingly developing medical emergencies during their dental treatments, many dental providers still do not possess the skills to manage medical emergencies appropriately. Simulation training is essential to improve this situation however, there is no report describing how to conduct an effective simulation in detail for dental office medical emergencies. The purpose of this review is to provide information on simulations that is effective and practical. The authors will highlight the key characteristics for providing effective simulation trainings, such as the selection of simulators, simulation locations, instructors, debriefings, methods for evaluating educational effectiveness, and the use of telesimulation as a method for simulation training due to the global COVID-19 pandemic. In addition, this review provides recommendations on tailoring an ideal simulation training course for those who wish to create one. The authors hope that this review will promote the spread of effective simulation training and in turn, contribute to improving the medical safety of dental patients.

Consumer Visual and Affective Bias for Soothing Dolls.

Soothing dolls are becoming increasingly popular in a society with a lot of physical and mental stress. Many products are also combined with soothing dolls to stimulate consumers' desire for impulse buying. However, there is no research on the relationship between consumers' purchasing behavior, consumers' preference for soothing dolls, and visual preference. The purpose of this study was to examine the possible factors that affect the emotional and visual preferences of soothing dolls. Two local stores' sales lists were used to extract three different types of dolls. The 2D and 3D versions of these three dolls were used. Subjective emotional preferences were examined by the self-assessment manikin (SAM) scale, with 5-point Likert scales for valence and arousal factors. An eye tracker was used to examine visual preferences, both before and after positive/negative emotion stimulation by the International Affective Picture System (IAPS). There were 37 subjects involved, with an age range of 20-28 years. The experimental results show that the average valence/arousal scores for 2D/3D dolls were (3.80, 3.74) and (2.65, 2.68), respectively. There was no statistical difference, but both 2D and 3D pictures had high valence scores. Eye tracker analysis revealed no gaze difference in visual preference between 2D and 3D dolls. After negative emotional picture stimulation, the observation time of the left-side doll decreased from 2.307 (std 0.905) to 1.947 (std 1.038) seconds, p < 0.001; and that of the right-side picture increased from 1.898 (std 0.907) to 2.252 (std 1.046) seconds, p < 0.001. The average observation time ratio of the eye on the 3D doll was 40.6%, higher than that on the 2D doll (34.3%, p = 0.02). Soothing dolls may be beneficial for emotion relaxation. Soothing dolls always have high valence features according to the SAM evaluation's measurement. Moreover, this study proposes a novel research model using an eye-tracker and the SAM for the SOR framework.

Evaluation of the Effect of Intubation Box use on Tracheal Intubation Difficulty with King Vision® and Truview Videolaryngoscope in Manikin in a Tertiary Care Hospital.

Background: The procedures of introducing an airway by intubation are associated with increased risk of aerosolisation of SARS-CoV-2 virus, posing a high risk to the personnel involved. Newer and novel methods such as the intubation box have been developed to increase the safety of healthcare workers during intubation. Methods design: In this study, 33 anaesthesiologist and critical care specialists intubated the trachea of the airway manikin (US Laerdal Medical AS™) 4 times using a King Vision® videolaryngoscope and TRUVIEW PCD™ videolaryngoscope (with and without an intubation box as described by Lai). Intubation time was primary outcome. Secondary outcomes were first-pass intubation success rate, percentage of glottic opening (POGO) score and peak force to maxillary incisors. Results: Intubation time and the number of times a click was heard during tracheal intubation were considerably higher in both groups when an intubation box was used (Table 1). When comparing the two laryngoscopes, the King Vision® videolaryngoscope enabled much less time to intubate than did the TRUVIEW laryngoscope, both with and without the intubation box. (P<0.001) In both laryngoscope groups, first-pass successful intubation was higher without the intubation box, although the difference was statistically insignificant. POGO score was not affected by intubation box but a higher score was observed with King Vision® laryngoscope (Tables 1,2). Conclusion: This study indicates that use of an intubation box makes intubation difficult and increases the time needed to perform it. King Vision® videolaryngoscope results in lesser intubation time and better glottic view as compared to TRUVIEW laryngoscope.

Simulated Learning Experiences Impact on Acute Care Confidence Development in Students with Low Resiliency

PURPOSE/HYPOTHESIS: The COVID-19 pandemic has taken a toll on the psychological resilience of healthcare workers across the world but has also had a significant impact on healthcare professionals in training. The pandemic has required educators to adapt how they teach but also to take into consideration innovative learning activities to increase students' resiliency. The purpose of this study was to assess the impact of high-fidelity human simulation (HFHS) sessions on acute care confidence in a critical care setting in physical therapy students' who rate their resiliency at low levels. NUMBER OF SUBJECTS: Eighty-one DPT students. MATERIALS AND METHODS: One week prior to the HFHS sessions each subject completed the Acute Care Confidence Survey (ACCS) and the Brief Resiliency Scale (BRS). All subjects participated in 2 HFHS sessions in a 3-member team and were given objectives and a case history 1 week prior to each HFHS experience. The HFHS used the Laerdal's SimMan 3G manikin equipped with an oxygen delivery system, lines and tubes and a monitor displaying vitals. The format for each simulation lab included a 15-minute pre-brief session, a 20-minute SimMan encounter and an immediate 15-minute debrief session. Following the completion of the HFHS learning experience each student completed a second ACCS. RESULT(S): A Kruskal-Wallis test was used to compare confidence score across low, normal, and high resilience groups. Low and normal resiliency level students had significantly lower confidence in manual skills prior to simulation (P< 05) compared to their high resiliency counterparts. Following simulation, all resiliency groups demonstrated confidence improvement that resulted in no significant differences between the groups. A Wilcoxon Signed Ranks Test revealed significant improvement in all confidence scores for each group following simulation. CONCLUSION(S): Resiliency levels did not impact students' ability to gain confidence from simulation training. HFHS when graded has been shown to increase stress and decrease confidence in students. These HFHS learning activity exposures were not graded which may have allowed those students with lower resiliency to learn in a less stressful environment and still develop confidence. A positive change in student confidence may be more related to a graded exposure to an acute care setting that allows skill development in a low stress environment. CLINICAL RELEVANCE: The simulation sessions increased student confidence by providing a realistic clinical environment and expectations, with confidence being less impacted by a student's resiliency. This low stake learning environment provided a valuable opportunity for students to improve clinical confidence regardless of their self-rated resiliency level.

A review of feedback on simulation sessions while following COVID-19 SopS

Aims: To assess The usefulness of simulation sessions with social distancing in managing critical issues on a surgical ward. Method(s): Simulations sessions were run from September 2020 to April 2021 for The foundation doctors and medical students following standard social distancing rules and using mannequins for patients. A feedback questionnaire was sent over to The candidates after each session and The data was analyzed. Result(s): 4 sessions were held with a total of 20 participants. The feedback response rate was 100%. on The Likert scale of 0-10, The majority (Score range 9-10) responded that they were likely to recommend these sessions. 90% were likely to change and improve their daily practice based on their responses.70% rated The sessions as excellent and all The rest as very good no negative response was received. A 100% agreement was seen among all participants on The arrangements to be well coordinated and organised.95% found The training staff very helpful.75% of The participants thought The allocated time was just about right while 15% thought it was slightly short. In response to an open question, The majority of participants appreciated The concept of simulation while following social distancing rules and enjoyed The session as a whole. Conclusion(s): Overallwereceived positive feedback.Although thenumber of participants was limitedineach session butpositiveresponses fromThe participants imply that sessions could be easily carried out with social distancing without compromising The learning outcome. Carrying out more sessions was strongly favored by a vast majority.

The Effects of Personality Traits on Rumors

The spread of rumors has often been linked to major social and political impacts with consequences that oftentimes may prove to be severe. While there are multiple factors that could make a rumor more believable, this paper focuses on investigating the effects of personality traits on believing or disbelieving rumors. Participants were given a survey which included rumors relating to a single topic, COVID-19, to avoid topic-bias. Participants were also given a personality test which assessed the participants’ traits based on the Big 5 Model and categorized them as high or low. The effect of valence (pleasure) and arousal (excitement) on believing or disbelieving rumors was also explored, along with how this effect differs from one trait to another. The results showed that people with high agreeableness tend to believe rumors more than people with low agreeableness and that there was a correlation between valence and believing rumors for people with high neuroticism and people with low agreeableness. No correlation was found between arousal and believing rumors for any of the personality traits. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A study of video demonstration vs manikin based demonstration of handling trauma and first aid in final year MBBS students

There are a lot of changes that are happening in the field of Medical Education. Gone are the days where only lecture used to happen and the whole batch of students used to attend the same. Video based are being used to teach. But is it effective? What was the student’s perception? To know the answer to this question this effort has been put.

SHARING IS CARING - PEER TO PEER EDUCATION

Background During the COVID-19 pandemic Ayrshire Hospice piloted a training course for personal carers in North Ayrshire focusing on palliative and end-of-life care. The course was delivered online, comprising four 90 minutes sessions. One of the sessions focused specifically on the practical aspects of carrying out personal care towards the end of a person's life, and featured a demonstration by two of the hospice's senior care assistants using a training mannequin. Aims The pilot aimed to increase knowledge and understanding of the principles of palliative and end-of-life care for personal carers. The aim of this particular session was to share, peer to peer, the specialist knowledge and skills required in caring for someone towards the end of their life. Methods During this particular session, two experienced senior care assistants gave a practical demonstration of how they would provide personal care for someone nearing the end of their life, using a mannequin. They shared the practical skills they employ, emphasising the importance of care being carried out gently and slowly, and discussed how they used this as an opportunity to simultaneously assess the person's condition;looking for any signs of distress, pain, issues regarding skin integrity and oral health. Outcomes Sharing best practice through example peer to peer was well received. Ultimately this will benefit the people being cared for, whilst also building the skills and confidence of all involved. Links were formed, with the hospice now viewed as an invaluable resource. The online nature of the training proved successful, in terms of ease of access for participants, and the flexibility to include demonstrations from hospice team members. Sessions evaluated positively. Further training has since been progressed in North Ayrshire, with the hope that it will be adopted across Ayrshire over the next 18 months.

SASA 2022 Virtual Conference Abstracts

The proceedings contain 23 papers. The topics discussed include: petroleum jelly as an alternative coupling medium in focus assessed transthoracic echocardiography;perspectives on desflurane;use of high-flow nasal oxygenation outside COVID-19: a rural hospital experience;fitness for purpose of South African anesthesiologists;the effect of caregiver's recorded voice on emergence delirium in children undergoing dental surgery;perioperative outcomes of mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital;comparison of a novel low-cost hyperangulated optic intubation stylet with the Bonfils fiberscope: a simulated difficult airway manikin study;the awareness of local anaesthetic systemic toxicity amongst registrars from surgical disciplines in a tertiary hospital, South Africa;and SARS-CoV-2 infection prevalence in healthcare workers, administrative and support staff: the first wave experience at three academic hospitals in the Tshwane District of Gauteng.

How COVID-19 Taught Us to Address Self-identified Learning Gaps: A Simulation Based Approach

Background: The COVID-19 pandemic presented a variety of challenges to learners at all levels of training. The fall and winter seasons are when Pediatric trainees are exposed to a high volume of respiratory illnesses such as bronchiolitis, croup and asthma. However the advent of social distancing and use of face masks showed a significant decrease in the burden of infectious diseases. A multi-center study using the Pediatric Health Information System (PHIS) showed that ED visit rates decreased by 45.7% during the pandemic as compared to the three years prior(1). At our institution we saw a 90% reduction in bronchiolitis cases after the stay-at-home order went into effect March 30, 2020 compared to 2019 data for the same time period. With less hands-on experience, trainees are struggling to identify, triage and manage respiratory distress. Methods: Given the missed learning opportunities associated with COVID-19 and a low volume respiratory season, interns requested an expansion of the simulation curriculum to include specific content review for respiratory distress. The session started with a brief fifteen minute overview in the Just-in-Time-Teaching (JiTT) style(2). Learning objectives included recognizing the signs and symptoms of respiratory distress, reviewing the differential diagnoses, initiating treatment for the various differentials and escalating care in a timely fashion. Interns then moved on to the simulated cases. We used a high-fidelity baby mannequin for a bronchiolitis case and pediatric mannequin for an asthma case. Cases were debriefed in the Advocacy-Inquiry Method and interns were asked to share one piece of practice changing knowledge. Results: Interns (n=17) were anonymously surveyed before and after the session with responses measured on the 5- point Likert scale(3). 80% of interns reported that the COVID-19 pandemic impacted their medical education and, following the completion of cases, 94% strongly agreed that simulations were a helpful way to supplement their medical training. Two interns completed a post-survey but did not complete a pre-survey. Before the simulation, 13% of interns reported not feeling adequately prepared to identify respiratory distress and only 6% felt adequately prepared to manage it. After the simulation, 82% of interns felt adequately prepared to identify respiratory distress and 82% felt prepared to manage it. Conclusion: Public health mandates during the COVID-19 pandemic proved effective for controlling disease spread, but created a knowledge gap for Pediatric trainees regarding commonly encountered respiratory diseases. We addressed this gap in real time by modifying our simulation curriculum to include a content review of respiratory distress. Interns showed improved self-reported confidence in their diagnostic and treatment abilities. Continued use of JiTT in the simulation setting could be a helpful way to bridge resident-identified knowledge gaps on a more routine basis. Further work needs to be done to establish the long-term effectiveness of this flexible, learner-specific curriculum.

A Randomized-controlled Simulation based Pilot Trial of Patient Barrier Devices on Resuscitation Quality for Patients Under Investigation for COVID-19

Background: The COVID-19 pandemic had placed constraints on cardiopulmonary resuscitation (CPR), including early intubation, minimizing bag-valve mask ventilation1, and using protective equipment and barriers during resuscitation. Patient barrier devices have been introduced in emergency departments and operating rooms, consisting of plastic drapes over the patient9, or the use of an acrylic box.2 Both of these adjuncts reduce aerosolization of oropharyngeal particles from the patient, and can facilitate video-based intubation.2,3 However, it is unknown whether these devices help or hinder the ultimate resuscitation quality in cardiopulmonary arrest patients. Our specific question addresses the effect of a patient barrier device and COVID-19 resuscitation recommendations on resuscitation quality. We hypothesize that a simple patient barrier consisting of a plastic drape reduces healthcare worker (HCW) contamination without affecting resuscitation quality. Methods: This was a single-center randomized controlled pilot trial, in which in-hospital teams of 4 to 6 HCWs were randomized to either use a plastic drape (intervention) or no plastic drape (control) for a simulated adolescent cardiopulmonary arrest. The manikin was modified to emanate simulated viral particles (GloGerm®, Moab, UT) from the trachea detectable using ultraviolet light. Teams managed a cardiopulmonary arrest until intubation, using Personal Protective Equipment (PPE) and PALS/ACLS algorithms. Data were captured via arbitrated video review. Resuscitation data included time-to-bagging, time-to-intubation, and chest compression quality metrics - depth, rate, and lean. Contamination data were collected visually, marking the number of PPE equipment with visible fluorescence. Mean NASA-TLX and NOTECHS scores measured workload and team performance. Descriptive and univariate statistics were used to determine differences between intervention and control teams. Results: Fifteen simulations were conducted from 2020 to 2021;one was excluded from analysis as a performance outlier, leaving 7 intervention vs. 7 control teams. Scenarios lasted an average of 10.4+/- 3 minutes. Time-to-bagging, time-to-intubation, and intubation duration were not different between groups (72.1+/-22.4 vs 56.7+/-30.9 sec, 536+/-289 vs 544+/-127 sec, 78.9+/-73.0 vs 95.7+/-113 sec, p>0.3), and CPR quality for mean depth, rate, and lean were also not different (36.1+/-11.6 vs 30.9+/-13.2 cm, 108+/-13 vs 112+/-8/min, 8.7+/-5.2 vs 4.5+/-4.3 cm, p>0.14). Contamination rates were lower for the intubating physician (2.3+/-0.5 vs 4.1+/-0.9 surfaces, p<0.001) and for all participants (2.8+/-0.7 vs 3.7+/-0.9 surfaces, p=0.05) when using a barrier. No other contamination rate changes were observed. Participants noted no differences in team performance (22.4+/-1.6 vs 20.8+/-1.8, p=0.5) but a slight trend towards higher workload with the plastic barrier (+9.5+/-7.7 vs -0.1+/-11.5, p=0.09). Conclusion: The use of a plastic drape as a patient barrier appears to reduce simulated virus contamination for HCWs, particularly for the intubation physician during a simulated cardiopulmonary arrest without affecting resuscitation performance. Perceived workload increases with the drape, and further studies are needed to substantiate these findings in larger samples and in different settings.

Bag-mask ventilation by low- or untrained rescuers during resuscitation: a randomised cross-over study

Objective: Bag-mask ventilation (BMV) forms a cornerstone during advanced cardiopulmonary resuscitation (CPR), as opposed to lay settings applying mouth-to-mouth ventilation. The latter is contraindicated in case of potential disease transmission (COVID pandemic). This study explores the degree of training needed for rescuers to effectively perform BMV during CPR. Methods: We performed a randomized crossover manikin study (Laerdal’s Resusci Anne QCPR - Resusci Baby QCPR) with 112 medical students: 60 first years (untrained) and 52 fourth years (low-trained), excluding BLS certificate holders or lifeguards. After dividing students into duos within their year and a 15 minute just-in-time training in full CPR-cycle using BMV, each pair was tested during 5 cycles of 2-person CPR following the ERC guidelines. In infants, initial rescue breaths used 1-person BMV. Correct ventilations included tidal volumes of 300– 600 ml (adults) and 20–60 ml (infants). Results: Correctly administered ventilations during adult CPR using BMV showed no statistically significant difference between low- and untrained rescuers (first years: 63,0%;fourth years: 59,5%;proportional difference − 3.5% [−12.8;5.9]). A significant difference was observed in infant CPR, both in effective ventilations (first years: 55,5%;fourth years: 72,3%;proportional difference 16.8 [7.25;26.21]) and initial rescue breaths (first years: 54,1%;fourth years: 72,0%;proportional difference 17.9 [5.36;30.50]). Of the remaining 39 pairs after exclusion of 17 (n = 56) for incorrect numbers of ventilation or uninterpretable values, 15 duo’s (38,5%) accomplishes efficient ventilations using BMV. Comparison by year unveils 40,9% untrained rescuers performing efficient ventilations versus 35,3% low-trained rescuers. Inclusion of all 56 groups shows 27,8% performing correct ventilations. Conclusion:With 1/3 of low- and untrained participants performing effective BMV during CPR following a just-in-time training prior to testing, the difference between both groups was small, reaching significance in infant ventilations. In conclusion, 2-person BMV is a complex skill requiring sufficient and regular training

Influence of air supply velocity and room temperature conditions on bioaerosols distribution in a class I operating room

Surgical site infections (SSIs) have gained increasing prominence in recent decades. Bioaerosols are an important factor causing such intraoperative infections. Their distribution can be affected by environmental parameters in the operating room (OR), such as the air supply velocity and room temperature. The research object of this study was a Class I operating room, which has the strictest cleanliness requirements. Four different air supply velocities (0.16, 0.24, 0.29, and 0.33 m/s) and four different room temperatures (18 °C, 20 °C, 22 °C, and 24 °C) formed seven orthogonal experiment cases. The bioaerosols release experiments conducted in an environmental chamber to simulate a full-scale operating room. The experiments could well verify the computational fluid dynamics-based numerical simulation using the renormalization group (RNG) k-ε model as a turbulence model. The experimental and numerical results confirmed that an increase in the air supply velocity would increase the dispersion of bioaerosols particles. An air supply velocity greater than 0.24 m/s can ensure greater cleanliness in the surgical area. Whereas, when the air supply velocity continues to increase (0.33 m/s), it will increase the bioaerosols deposition in the surgical area. In terms of controlling the concentration of bioaerosols in a certain area, 0.24 m/s-0.29 m/s is the optimal range of air supply velocity. However, the distribution of bioaerosols particles is not sensitive to the response of OR room temperature changes.

Comparative Study to Evaluate the Effect of Intubation Box on Tracheal Intubation Difficulty with King Vision ® and Truview Video Laryngoscope in Manikin in a Tertiary Care Hospital

Background: The procedures related to airway can be associated with increased risk of aerosolization of SARS-CoV-2 virus posing a high risk to the personnels involved. Novel methods like the intubation box have been developed to increase the safety of healthcare workers during intubation. Methods: In this study, 33 anaesthesiologist and critical care specialists intubated the trachea of the airway manikin (US Laerdal Medical AS) 4 times using a King Vision ® videolaryngoscope and TRUVIEW PCD TM videolaryngoscope (with and without an intubation box as described by Lai). Intubation time was primary outcome. Secondary outcomes were first-pass intubation success rate, percentage of glottic opening (POGO) score and peak force to maxillary incisors measured with a pressure sensing device. Results: Intubation time and the pressure exerted on the incisors (detected by a click sound) were considerably higher in both groups when an intubation box was used. (Table 1) When comparing the two laryngoscopes, intubation time with the King Vision ® video laryngoscope was lower than that of TRUVIEW laryngoscope, both with and without the intubation box. (P<0.001) In both groups, rate of first pass successful intubation was higher without the intubation box, although the difference was statistically insignificant. POGO Score was not affected by intubation box but higher score was observed with King Vision ® laryngoscope. (Table 1,2). Conclusion: This study indicates that use of an intubation box makes intubation difficult and increases the time. King Vision ® videolaryngoscope results in lesser intubation time and better glottic view as compared to TRUVIEW laryngoscope.

Dental students' perception and attitudes about the impact of the COVID-19 pandemic on the practical training and clinical work

Background and Aim: Coronavirus pandemic has caused unpredictable changes in dental education and healthcare system worldwide. In March and April 2020 due to the COVID - 19 outbreak, University of Dental medicine Zagreb, Croatia, temporary closed its door to its students. However, theoretical parts of the curriculum were held online, but practical training was canceled to reduce the risk of infection. This research aimed to assess student's attitudes and perception towards importance of practical training and their preparedness for the work as a clinician. Methods: This cross-sectional observational study was conducted using an online survey on a population of undergraduate students enrolled in academic year 2019/20. Results: 352 students participated and completed the survey. 186 students (65%) were students who were supposed to start clinical courses of which 52 (14.3%) were students of the last year of the school. The loss of clinical courses in summer semester of the academic year 2019/20 will not affect preparedness and self-confidence when working with patients in only 5.2% students of 4th and 5th year. Regardless of the extraordinary period caused by the pandemic, 56.7% students of 4th and 5th year and 46.2% students of the last year are looking forward to start clinical courses and work with patients. However, fear and discomfort with regards to start to work with patients at a time of a pandemic felt 9.6% students of the last year. Conclusions: Practical courses that were canceled because of emergency measures impacted on all of students, especially the ones who were about to start with clinical work. Although practical skills are trained on mannequins as well, working with patients is irreplaceable part of education for future dentists.

Comparison of endotracheal intubation with Macintosh versus King Vision video laryngoscope using coronavirus disease 2019 barrier box on manikins: A randomized crossover study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) virus usually spreads through aerosol and close contact. Frontline health-care workers handle aerosol-generating procedures like endotracheal intubation. To reduce this risk, COVID-19 barrier box came into the picture. However, the COVID-19 barrier box may compromise easy and successful intubation, and their limitation must be studied. OBJECTIVES: The objective of this study was to assess the time to successful intubation with or without the COVID-19 barrier box using the Macintosh laryngoscope and King Vision video laryngoscope (KVVL). We also assessed the first-pass success rate, ease of intubation, Cormack-Lehane (CL) grade, and requirement of external laryngeal manipulation. METHODS: We conducted this manikin-based randomized crossover study to assess the time to successful intubation by anesthesiologists (22) and emergency physicians (11) having 1 year or more experience with or without COVID-19 barrier box by using the Macintosh laryngoscope and KVVL. Our study randomized the sequence of the four different intubation scenarios. RESULTS: The comparison of mean duration of intubation between KVVL (13.21 ± 4.05 s) and Macintosh laryngoscope (12.89 ± 4.28 s) with COVID-19 barrier box was not statistically significant (95% confidence interval: 1.21-0.97). The ease of intubation, number of attempts, and requirement of external laryngeal manipulation were not statistically significant. Intubations were statistically significant more difficult with barrier box in view of higher CL grade. CONCLUSION: Time to intubation was longer with COVID-19 barrier box using KVVL as compared to Macintosh laryngoscope which was statistically not significant.

REMOTE SIM: RECONFIGURING EDUCATION TO MEDICAL OFFICERS WITH TELE-ENABLED SIMULATION

Background: Public health restrictions during the COVID-19 pandemic create a need to restructure education delivery to health professionals. Simulation is a fundamental education mode for teams and individuals.1 An Australian scoping review published by Heffernan and colleagues in 2021 suggests the remote delivery of simulation may be both feasible and effective for participants and facilitators.2 The education unit of a tertiary hospital in Perth, Western Australia, sought to develop a method to deliver remote tele-simulation using existing local resources. There are similarly equipped units across Australasia with dedicated simulation suites that could benefit from the REMOTE Sim framework. Aim: The aim of the project was to develop a tele-simulation method that preserved the benefits of simulation education for medical staff when inperson delivery was not possible. A secondary objective was to leverage existing simulation suite infrastructure to enhance the tele-simulation format. Method: Authors reviewed an existing, locally evaluated, in-person simulation program designed to improve multidisciplinary collaboration in recognising and responding to ward-based acute clinical deterioration. By applying principles from established simulation frameworks, authors adapted in-person delivery to a tele-simulation format. Key frameworks included advocacy-inquiry, tag-team, and stop-and-go simulation.3-5 Results: The existing in-person simulation programme divided participants into two groups. One group participated as responders to a simulated scenario, while the other observed via a live audio-visual feed. Observers viewed live audio and video of the simulation, as well the simulated patient's clinical monitoring. In REMOTE Sim, this existing audio-visual feed is shared via video conferencing software. This enables remote participants to observe the simulated patient room and clinical monitoring in real time. Faculty members are located in the simulation suite and participants connect via video conferencing individually in their own environment. Faculty comprises of four or more members allocated to the roles of simulation director, manikin operator, confederate first responder, confederate second responder and so on. Participants are divided into two groups, and undertake a pre-brief that includes an overview of the format and video-conferencing etiquette. During scenarios participants are asked to direct confederate faculty to perform tasks at intervals guided by the simulation director. For example, when the first responder enters the room, group one would be asked by the simulation director to provide direction. Participants might identify the patient is speaking but in respiratory distress, and direct the relevant faculty member to apply 15L of oxygen via a non-rebreather mask. At the next interval, group two would be asked to provide direction to confederate faculty. This maintains the engagement of both groups of participants, using principles of stop-and-go and tag-team simulation.3,4 During these intervals learning points can also be discussed. Following each scenario a simulation debrief is performed with all participants via video-conference. Conclusion: The adapted tele-simulation format described aims to maintain the beneficial use of simulation suite infrastructure when in-person delivery is not possible. Validation of the format is developing, with particular focus on the impact of technology on participant engagement, critical thinking, psychological safety, and learning and reflection during the simulation and debrief.

Effect of Skin Protectants on the Total Inward Leakage of N95 Respirators: Testing with an Advanced Static Headform

The COVID-19 pandemic introduced considerable challenges for respiratory protection of different population groups. Disposable medical masks and NIOSH-approved N95 filtering facepiece respirators (FFRs) are typically their only defense against the virus. At the same time, continuous wearing of these devices, especially some N95 FFR models cause damage to the facial skin, such as skin irritation, swelling, and scaling. Skin protectants are becoming increasingly popular and effective in providing a protective barrier for the skin that reduces direct contact between a wearer???s face and respirator. Recent pilot studies involving human subjects have examined the effect of skin protectants on the performance of respirators/masks through fit testing, but their findings are heavily impacted by between-subject variability. This investigation deployed a standardized protocol that utilized the NIOSH advanced static manikin headform connected to a Breathing Recording and Simulation System (BRSS), producing a predetermined breathing pattern. The effect of skin protectants on the total inward leakage (TIL) was evaluated for three N95 FFR models, five different skin protectants, and two breathing flow rates. The aerosol particle concentrations inside and outside the respirator were measured with NaCl serving as the challenge aerosol. The TIL was shown to be significantly affected by the interaction of the skin protectant type, breathing flow rate and FFR models. The data suggest that different skin protectants may influence the performance of disposable N95 FFRs in different ways - by either increasing or decreasing the TIL value relative to one with no skin protectants applied. No negative effects on the TIL was observed for either tape- or gel/cream-type protectants when testing with 3M 8210 or 3M 1870+ FFRs;however, the use of skin protectants of either group with the AOSafety 1050 FFR may compromise its performance as quantified by the TIL.