Virtual reality cricothyrotomy - a case-control study on gamification in emergency education.

BACKGROUND: Cricothyrotomy is an invasive and rare emergency intervention to secure the airway in a "cannot intubate, cannot ventilate" situation. This leads to lack of routine. Cricothyrotomy is performed only hesitantly. Therefore, we aim to improve teaching by including a virtual reality (VR) cricothyrotomy as a learning tool. METHODS: We programmed the VR cricothyrotomy in the C# programming language on the open-source Unity platform. We could include 149 students that we randomly assigned to either a study group (VR cricothyrotomy) or control group (educational video). We asked the study group to subjectively rate the VR cricothyrotomy. To evaluate our intervention (VR cricothyrotomy) we took the time participants needed to perform a cricothyrotomy on a plastic model of a trachea and evaluated the correct procedural steps. RESULTS: The majority of students that performed the VR simulation agreed that they improved in speed (81%) and procedural steps (92%). All participants completed the cricothyrotomy in 47s ± 16s and reached a total score of 8.7 ± 0.7 of 9 possible points. We saw no significant difference in time needed to perform a cricothyrotomy between study and control group (p > 0.05). However, the total score of correct procedural steps was significantly higher in the study group than in the control group (p < 0.05). CONCLUSIONS: Virtual reality is an innovative learning tool to improve teaching of emergency procedures. The VR cricothyrotomy subjectively and objectively improved correct procedural steps. Digitized education fills an educational gap between pure haptic experience and theoretical knowledge. This is of great value when focusing on extension of factual knowledge. TRIAL REGISTRATION: DRKS00031736, registered on the 20th April 2023.

Nonsteroidal anti-inflammatory drug hypersensitivity syndrome. A multicenter study. I. Clinical findings and in vitro diagnosis.

BACKGROUND: We present the results obtained from the largest series of in vitro diagnostic tests ever reported in patients with clinically validated hypersensitivity to acetylsalicylic acid (ASA)/nonsteroidal anti-inflammatory drugs (NSAID) compared with various categories of controls tolerating ASA/NSAIDs. This multicenter study, which was performed within the framework of the European Network for Drug Allergy (ENDA) group, showed that the basophil activation test (BAT), particularly when used with the 3 NSAIDs aspirin (ASA), diclofenac (DIC), and naproxen (NAP), allows us to confirm the diagnosis of NSAID hypersensitivity syndrome. The results of the cellular allergen stimulation test (CAST) frequently correlate with those of the BAT, although not always. An unexpected finding was that basophil activation by NSAIDs is not an all-or-nothing phenomenon restricted to clinically hypersensitive patients, but that it also occurs in a dose-related manner in some NSAID-tolerant control individuals.Therefore, NSAID hypersensitivity appears as a shift in the normal pharmacological response to NSAIDs. These findings allow us to formulate a new rational hypothesis about the mechanism of NSAID hypersensitivity syndrome, a mechanism that most authors continue to describe as "unknown." METHODS: We enrolled 152 patients with a history of hypersensitivity to NSAIDs and 136 control participants in 11 different centers between spring 2003 and spring 2006. Flowcytometric BAT was performed. RESULTS: The most noteworthy results of our study were that 57% of 140 patients presented very clear-cut positive BAT results to multiple NSAIDs, and 16% were entirely negative. In about 27% of cases, positive results were obtained with 1 or 2 concentrations of a single NSAID. There is clearly a correlation between the results of BAT and CAST. CONCLUSIONS: BAT seems particularly indicated in patients with a clinical history of NSAID intolerance, and in whom a provocation test is not advisable for ethical, clinical, or other reasons. Clear-cut positive results can be considered as confirming a history of NSAID hypersensitivity, although negative results may not exclude it.

[In vitro evaluation of hemolytic effects with use of infusion pumps with finger peristaltic action of blood pumping]. / In-vitro-Bewertung hämolytischer Effekte beim Einsatz von Infusions-pumpen mit Fingerperistaltik zur Blutförderung.

INTRODUCTION: Blood cells pumped by technical systems are exposed to non-physiological mechanical stress. Haemolysis or subhaemolytic damage may occur. Interaction between cells and the artificial material as well as the shear stress are the main reasons for this traumatisation. Up to now in vitro evaluation is the method of choice as no profound theory of mechanical cell damage has existed yet and, furthermore, haemolytic effects exhibit al large biological variability. METHODS: This study deals with the mechanically induced haemolysis due to blood pumping by infusion pumps (type INCA; Fresenius AG) in dependence on device related as well as blood preserve related (donor, storage time) factors. RBC count, MCV, MCHC, hematocrit, total and extracellular haemoglobin were obtained before and after pumping the blood sample. RESULTS: At a pump rate of 1000 ml/h, 0.06% of RBC (storage duration of 1-3 days) and 0.3% (storage duration of 34-36 days) were destroyed, respectively. Furthermore, it was shown that only gravity induced perfusion of the Intra-Air-system and the tubing system without any pumping lead to a minor, but significant elevation of extracellular haemoglobin concentration. In contrast, a volume flow rate of 2000 ml/h or the 10 times repeated pump process (1000 ml/h) increases haemolysis by only 27% or 520% respectively. CONCLUSION: It was concluded that any extrapolation from given experimental conditions to other ones must be performed with great caution due to the complex nature of the haemolysis process. Infusion pumps of the INCA-type stress RBC only slightly and may therefore be used for controlled blood transfusion.

Anti-ulcer and secretion-inhibitory properties of the tricyclic derivative doxepin in rats and dogs.

The anti-ulcer and antisecretory properties of 3-(dibenz[b,e] oxepin - 11(6H)-ylidene)-N,N- dimethylpropylamine hydrochloride (doxepin) were investigated in a series of acute experiments in rats with gastric and duodenal ulcer. Acute gastric ulceration induced by immobilisation and stress (waterbath), and by non-steroidal anti-inflammatory agents, was reduced by doxepin to the same extent as by pirenzepine and cimetidine. Doxepin and cimetidine showed a weak but significant effect against serotonin-induced ulcers in the rat, but pirenzepine did not. Duodenal ulcer caused by increased acid production (pentagastrin plus carbachol induced) was suppressed by pirenzepine, doxepin and cimetidine. The inhibition of gastric secretion by doxepin was studied in anaesthetised rats and conscious dogs. In the Lai rat, doxepin decreased carbachol-induced secretion of hydrochloric acid more effectively than cimetidine. Doxepin was as ineffective as pirenzepine against histamine- or pentagastrin-induced secretion. In the dog with gastric fistula, doxepin inhibited the acid production induced by 2-desoxy-d-glucose more effectively, and for longer periods, than that induced by pentagastrin or histamine. In the dog with a Heidenhain pouch, doxepin reduced the acid secretion stimulated by pentagastrin and carbachol, and by histamine, less effectively and for a shorter time, than cimetidine. The antagonism of doxepin to the action of carbachol in the rat and that of 2-desoxy-d-glucose in the dog appears to be an important factor in its mode of action. To inhibit the secretion of saliva and to delay intestinal transport, a dose of doxepin 3-10 times greater than that required for anti-ulcerative and secretion-inhibitory effects was necessary.