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.

[Is the use of virtual reality in otorhinolaryngology teaching automatically positively rated by students? : A questionnaire-based evaluation among students]. / Wird der Einsatz der virtuellen Realität in der HNO-Heilkunde-Lehre von Studierenden automatisch positiv bewertet? : Eine Fragebogenevaluation bei Studierenden.

BACKGROUND: Analogous to the situation in other disciplines, digital ENT teaching made significant progress during the pandemic. Most ENT clinics nationwide were able to offer a complete virtual teaching program in time. Innovative teaching methods were also used early on. This was recognized in student teaching evaluations. Due to the expansion of virtual reality (VR) in medical teaching, even greater satisfaction should be expected through improved teaching quality. MATERIALS AND METHODS: Surveys were performed with students (n = 180) of the ENT block internship in the summer semester of 2023. The aim of the evaluation was to determine the students' satisfaction with and subjective effectiveness of the newly implemented VR digital teaching method for teaching ear anatomy and coniotomy. A survey was also carried out among resident physicians. RESULTS: The ENT teaching was perceived favorably by the students, with an average rating of 11.7 out of 15. The learning effectiveness and the value of VR in the ENT learning portfolio was evaluated varyingly by the students. The physicians' assessment was different, with a more positive perception. CONCLUSION: Virtual reality represents an innovative component in the teaching portfolio of otolaryngology. This new teaching method is viewed and accepted as a future-oriented tool. Remarkably, the physicians involved voted consistently positively, while the students gave more critical assessments and pointed out limitations in the individual and subjective areas. These findings are in contrast to the further development of innovative teaching methods demanded by student interest groups.

[Traumatology-an interdisciplinary task: exclusively for educational purposes?] / Traumatologie ­ eine interdisziplinäre Aufgabe: nur in der Lehre?

BACKGROUND: Traumatology of the head and neck region is not only a part of otorhinolaryngology, but also has a large overlap with neighboring disciplines of the head and neck region. In Freiburg, an interdisciplinary lecture on "ENT emergencies" was implemented in the 21/22 winter semester. The aim was to provide an even more realistic view on interdisciplinary patient care and to make evident the areas of intersection of four of the major head disciplines (otorhinolaryngology, neurosurgery, ophthalmology, and maxillofacial surgery). MATERIALS AND METHODS: A new, special lecture in otorhinolaryngology was implemented as part of the regular online lecture series accompanying the semester. With reference to the clinical care of ENT emergencies, possible overlaps with neighboring disciplines were identified and explained by the discipline representatives or discussed in front of and with the auditorium. At the end of the semester, all participating students (n = 173) were invited to evaluate the seminar using the survey tool "EvaSys" (EvaSys GmbH, Lüneburg, Germany). In total, 78 students participated in the evaluation process. RESULTS: The new lecture concept was very well accepted and immediately ranked top among the interdisciplinary lecture titles within the ENT lecture series. The clear communication of the term "interdisciplinarity" in the sense of a complementary clinical cooperation was also very successful and was appreciated accordingly by students during the evaluation process. CONCLUSION: Pragmatic presentation of ideal clinical patient care using an interdisciplinary approach is possible within the regular ENT lecture series. This realistic portrayal, beyond any technical and/or professional differences, is of great interest to students and is considered clinically relevant. Thus, interdisciplinary lectures provide a valuable tool to teach the fundamental values of clinical interdisciplinary management for the best possible patient care.

A randomized, phase II trial of cetuximab with or without PX-866, an irreversible oral phosphatidylinositol 3-kinase inhibitor, in patients with relapsed or metastatic head and neck squamous cell cancer.

BACKGROUND: The phosphotidylinositol-3 kinase (PI3K)/serine-threonine kinase/mammalian target of rapamycin signaling pathway is frequently altered in head and neck squamous cell cancer (HNSCC). PX-866 is an oral, irreversible, pan-isoform inhibitor of PI3K. A phase I trial demonstrated tolerability of this combination. This randomized phase II study evaluated PX-866 combined with cetuximab in patients with advanced, refractory HNSCC. METHODS: Patients with recurrent or metastatic HNSCC who had received at least one and no more than two prior systemic treatment regimens were randomized (1 : 1) to cetuximab with or without PX-866 (8 mg p.o. daily; arms A and B, respectively). The primary end point was progression-free survival (PFS). Secondary end points included objective response rate (ORR), overall survival (OS), toxicity, and correlation of key biomarkers with efficacy outcomes. RESULTS: Eighty-three patients were enrolled. There was a similar response rate between arms (10% versus 7%). Of patients for whom tissue was assessable, 57% were human papillomavirus (HPV) positive. Median PFS was 80 days in both arms and there was no difference in OS between the two arms (211 versus 256 days). Overall toxicity was higher in arm A compared with arm B, especially in terms of nausea (53% versus 23%), vomiting (45% versus 15%), fatigue (43% versus 23%), diarrhea (40% versus 21%), and hypokalemia (25% versus 10%). Grade 3 or higher adverse events were infrequent, but more common in the combination arm although without a specific pattern. PIK3CA mutations were observed in 17% of the cases assessed, and PTEN loss was infrequently observed. CONCLUSION: The addition of PX-866 to cetuximab did not improve PFS, RR, or OS in patients with advanced, refractory HNSCC enrolled without molecular preselection. In this contemporary cohort, HPV-positive patients comprised the majority, and neither HPV-positive nor HPV-negative patients derived clinical benefit for the addition of cetuximab plus PX-866.

[Long-term automatic blood pressure measurement in clinical management]. / Automatische Blutdruck-Langzeitmessung im Klinikbetrieb.

Blood pressure control in arterial hypertension, as has been shown in randomized studies in 43,000 patients, based on a reduction of diastolic blood pressure of 5.8 mm Hg associated with a 40% reduction in stroke, is of substantial prognostic importance. Cardiac events were reduced insignificantly by 9%. Major problems with treatment are the limited acceptance of a lifelong therapy--in the Munich High Blood Pressure Study from 1982 well controlled and effective treatment was found in only 22% of the men and 16% of the women--uncertainty with regard to the indication and the question of whether the observed blood pressure elevation is situational or persistent in particular, in view of one study reporting that after three years of placebo in 48% of patients entered with diastolic values between 95 and 105 mm Hg, the blood pressure was found to lie in the normal range. Blood pressure determinations by the patients themselves may reflect resting values throughout the day but blood pressure fluctuations which can be substantial, can only be detected by ambulatory monitoring. The aim of this study, in addition to assessment of the reliability of the system employed, was to compare the response of the monitored blood pressure in patients with various stages of hypertension and in normal subjects at rest and during physical exertion to identify more accurately those in need of antihypertensive treatment. For ambulatory blood pressure monitoring, the SpaceLabs Model ICR 5200 was used. If Korotkoff sounds are not detected, the unit switches to oscillatory measuring. The storage capacity accommodates 200 measurements of systolic, diastolic and mean arterial pressure, heart rate and time of measurement.(ABSTRACT TRUNCATED AT 250 WORDS)