A study on the application of diffuse axonal multi-axis general evaluation for brain injury assessment in small overlap barrier crash test.

PURPOSE: Head injury criterion (HIC) companied by a rotation-based metric was widely believed to be helpful for head injury prediction in road traffic accidents. Recently, the Euro-New Car Assessment Program utilized a newly developed metric called diffuse axonal multi-axis general evaluation (DAMAGE) to explain test device for human occupant restraint (THOR) head injury, which demonstrated excellent ability in capturing concussions and diffuse axonal injuries. However, there is still a lack of comprehensive understanding regarding the effectiveness of using DAMAGE for Hybrid Ⅲ 50th percentile male dummy (H50th) head injury assessment. The objective of this study is to determine whether the DAMAGE could capture the risk of H50th brain injury during small overlap barrier tests. METHODS: To achieve this objective, a total of 24 vehicle crash loading curves were collected as input data for the multi-body simulation. Two commercially available mathematical dynamic models, namely H50th and THOR, were utilized to investigate the differences in head injury response. Subsequently, a decision method known as simple additive weighting was employed to establish a comprehensive brain injury metric by incorporating the weighted HIC and either DAMAGE or brain injury criterion. Furthermore, 35 sets of vehicle crash test data were used to analyze these brain injury metrics. RESULTS: The rotational displacement of the THOR head is significantly greater than that of the H50th head. The maximum linear and rotational head accelerations experienced by H50th and THOR models were (544.6 ± 341.7) m/s2, (2468.2 ± 1309.4) rad/s2 and (715.2 ± 332.8) m/s2, (3778.7 ± 1660.6) rad/s2, respectively. Under the same loading condition during small overlap barrier (SOB) tests, THOR exhibits a higher risk of head injury compared to the H50th model. It was observed that the overall head injury response during the small overlap left test condition is greater than that during the small overlap right test. Additionally, an equation was formulated to establish the necessary relationship between the DAMAGE values of THOR and H50th. CONCLUSION: If H50th rather than THOR is employed as an evaluation tool in SOB crash tests, newly designed vehicles are more likely to achieve superior performance scores. According to the current injury curve for DAMAGE and brain injury criterion, it is highly recommended that HIC along with DAMAGE was prioritized for brain injury assessment in SOB tests.

Assessing the quality of chest compressions with a DIY low-cost manikin (LoCoMan) versus a standard manikin: a quasi-experimental study in primary education.

Extending the access to cardiopulmonary resuscitation (CPR) training to a wider public is an important step in increasing survivability of out-of-hospital cardiac arrest. However, often price and maintenance of CPR manikins are barriers that prevent training at schools. This study aims to evaluate the learning of hands-only (HO) CPR by practicing with a low-cost manikin (LoCoMan) with visual qualitative feedback and to compare the results with the skills acquired by practice on a conventional manikin. A quasi-experimental study with 193 schoolchildren (10 to 12 years old) who were allocated to two groups: the LoCoMan group was taught via an integrative approach (science combined with physical education (PE)) and practiced on a handmade manikin, and a control group practiced in a traditional setting with a commercial manikin (Resusci Junior, Laerdal, Norway). All participants practiced for 1 hands-on skill session before performing a post-test on an instrumented CPR manikin. The outcomes including HO-CPR performance variables were compared between groups. The LoCoMan and control groups both achieved acceptable percentage of HO-CPR quality (57% and 71%, p = 0.004). Among 6th-graders, there were no significant differences in HO-CPR quality between LoCoMan 68% and control 71%, p = 0.66. The control group achieved better chest compression depth while the LoCoMan group showed more compressions with adequate chest recoil.     Conclusion: Schoolchildren are able to build and use a low-cost manikin with visual feedback. The integrative learning approach used in this study may be a feasible alternative methodology for training and learning HO-CPR in schools when commercial manikins are not available. What is Known: • Access to CPR training should be universal and independent of age, location, financial means, or access to qualified instructors. • Scientific societies promote the implementation of CPR in schools, so that teachers and schoolchildren can play a multiplier role in their environment, but the gap in CPR learning is related to cultural, economic factors or access to resources and materials. What is New: • LoCoMan may be a useful device for teaching and learning CPR in schoolchildren from the age of 10 and upwards. • LOCOMAN shows that it is feasible and possible to build a low-cost manikin (about €5 in the European Region) and to integrate it into an integrative educational project, and outlines how this could be done. this approach can be an incentive for teachers to attempt teaching CPR, but also for education outside the formal environment.

A Cost-Utility Analysis Comparing Traditional Clinical, Manikin-Based Simulation, and Screen-Based Virtual Simulation Activities.

BACKGROUND: Simulation activities are used increasingly in nursing education to augment or replace traditional clinical experiences. Educators and regulators are called on to make evidence-based decisions about the use of limited clinical and simulation resources. METHOD: This cost-utility analysis addresses the final aim of a study comparing cognitive learning, patient care performance, and self-perceptions of how well learning needs were met among students who were exposed to 4 hours of traditional clinical experience, 2 hours of manikin-based simulation, or 2 hours of screen-based virtual simulation. The costs of each activity were calculated and divided by a composite measure of the utility of each activity. RESULTS: The cost-utilities for 4 hours of traditional clinical experience, 2 hours of manikin-based simulation, and 2 hours of screen-based virtual simulation were $0.15, $0.62, and $0.38, respectively, in U.S. dollars per unit of utility. CONCLUSION: The data provide evidence for educators and administrators to make effective and efficient use of limited resources to prepare nurses for practice. [J Nurs Educ. 2024;63(2):79-85.].

Instrumented Pre-Hospital Care Simulation Mannequin for Use in Spinal Motion Restrictions Scenarios: Validation of Cervical and Lumbar Motion Assessment.

BACKGROUND: A mid-fidelity simulation mannequin, equipped with an instrumented cervical and lumbar spine, was developed to investigate best practices and train healthcare professionals in applying spinal motion restrictions (SMRs) during the early mobilization and transfer of accident victims with suspected spine injury. The study objectives are to (1) examine accuracy of the cervical and lumbar motions measured with the mannequin; and (2) confirm that the speed of motion has no bearing on this accuracy. METHODS: Accuracy was evaluated by concurrently comparing the orientation data obtained with the mannequin with that from an optoelectronic system. The mannequin's head and pelvis were moved in all anatomical planes of motion at different speeds. RESULTS: Accuracy, assessed by root-mean-square error, varied between 0.7° and 1.5° in all anatomical planes of motion. Bland-Altman analysis revealed a bias ranging from -0.7° to 0.6°, with the absolute limit of agreement remaining below 3.5°. The minimal detectable change varied between 1.3° and 2.6°. Motion speed demonstrated no impact on accuracy. CONCLUSIONS: The results of this validation study confirm the mannequin's potential to provide accurate measurements of cervical and lumbar motion during simulation scenarios for training and research on the application of SMR.

Usefulness of a low-cost simulation model for teaching internal manual aortic compression. A survey-based mannequin evaluation.

OBJECTIVE: To evaluate the users' opinion on internal manual aortic compression (IMAC) training, using a low-cost simulation model. METHODS: An educational strategy was designed to teach IMAC, which included: (1) guided reading of educational material and viewing an explanatory video of IMAC; (2) an introductory lecture with the anatomical considerations, documentation of the cessation of femoral arterial flow during IMAC, and real clinical cases in which this procedure was used; and (3) simulated practice of IMAC with a new low-cost manikin. The educational strategy was applied during three postpartum hemorrhage workshops in three Latin American countries and the opinions of the participants were measured with a survey. RESULTS: Almost all of the participants in the IMAC workshop, including the simulation with the low-cost mannikin, highlighted the usefulness of the strategy (scores of 4/5 and 5/5 on the Likert scale) and would recommend it to colleagues. CONCLUSION: We present a low-cost simulation model for IMAC as the basis of an educational strategy perceived as very useful by most participants. The execution of this strategy in other populations and its impact on postpartum hemorrhage management should be evaluated in further studies.

Assessment of pediatric shoulder range of motion and loading response to evaluate the biofidelity of the Large Omni-directional Child (LODC) anthropomorphic test device (ATD) shoulder design.

The shoulder girdle complex, through engagement with the seat belt, influences motor vehicle occupant upper body movement during frontal impacts, affecting the movement of the head and spine. The recently developed Large Omni-directional Child (LODC) anthropomorphic test device (ATD) was designed with flexible shoulder girdle structures that capture the unique kinematics in pediatric occupants. However, the LODC shoulder has not been evaluated for biofidelity due to the lack of biomechanical data available on pediatric shoulder responses. This study evaluated quasi-static pediatric shoulder girdle complex responses through non-invasive displacement measurements. These data were obtained to evaluate, and, if necessary, improve the biofidelity of the LODC ATD. Shoulder range of motion and anthropometric measurements were obtained from 25 pediatric volunteers, ages 8-12 years old. Loads were applied bilaterally exclusively to the shoulder complexes in increments of 25 N up to 150 N per shoulder at 90 and 135 degrees of shoulder flexion. Still photos were used to determine shoulder displacement in the sagittal plane from images captured prior to and following the load applications. Data analysis consisted of motion tracking to evaluate the absolute and relative displacement of the right acromion and T1. The displacements for each volunteer were normalized based on the volunteer's shoulder width compared to the shoulder width of the LODC ATD. For the 90° load, the acromion moved relative to T1 an average of 28.1 mm forward and 3.1 mm downward at maximum displacement. For the 135° load, the acromion moved relative to T1 an average of 15.5 mm forward and 42.7 mm upward at maximum displacement. Similar displacements at higher loads indicated that the volunteers achieved their maximum range of motion. The results of this study will be compared to the LODC ATD, assessing the biofidelity of the shoulder complex.

Abdominal biofidelity assessment of 5th percentile female ATD responses relative to recently developed belt and bar loading corridors.

OBJECTIVE: The objective of this study was the quantitative evaluation and comparison of the responses of the Hybrid III 5th percentile female (HIII-05F) and the 5th percentile female Test Device for Human Occupant Restraint (THOR-05F) anthropomorphic test devices (ATDs) subjected to abdominal loading conditions. METHOD: The HIII-05F and THOR-05F were subjected to 3 different abdominal loading conditions: fixed-back belt pull (low compression), fixed-back belt pull (high compression), and free-back rigid bar impact at 6 m/s. The stroke of the impact was controlled to represent injurious and noninjurious loading conditions as observed in the experiments with postmortem human subjects (PMHS). Quantitative comparisons were made between the ATD abdominal force and compression responses and biofidelity corridors obtained from matched-pair PMHS tests under identical loading conditions, using the most recent version of the NHTSA Biofidelity Ranking System (BRS). RESULTS: The overall THOR-05F BRS scores across all tests (BRS score = 1.84) indicated good biofidelity. For the belt loading test conditions, the average BRS scores for both THOR-05F (BRS scores = 1.45 and 1.34) and HIII-05F (BRS scores = 1.42 and 1.01) showed good biofidelity. For the rigid bar loading condition, the THOR-05F (BRS score = 2.74) showed better biofidelity compared to HIII-05F (BRS score = 10.63), with the HIII-05F exhibiting poor performance in this condition. The average pressures recorded by the abdomen pressure twin sensors (APTS) in the current study ranged from 45 to 130 kPa, increasing proportionally with higher stroke and loading rate. CONCLUSIONS: Overall, the THOR-05F BRS scores were better than the HIII-05F BRS scores, which suggests improved biofidelity of the THOR-05F abdomen. The abdominal insert in the HIII-05F did not provide enough room for compression, leading to higher stiffness and occupant motion as observed in the rigid bar tests. Because of practical challenges in measuring abdomen deflection in a soft ATD abdomen component, use of APTS in THOR-05F provides the ability to measure the restraint loading to the abdomen and assess the risk of abdominal injury. With good BRS scores observed in this study for THOR-05F, pressure and other measurements included in the THOR-05F may be used to develop abdominal injury risk functions in the future.

Assessment of over-the-head resuscitation method in an inflatable rescue boat sailing at full speed. A non-inferiority pilot study.

INTRODUCTION: Drowning is a public health problem. Interrupting the drowning process as soon as possible and starting cardiopulmonary resuscitation (CPR) can improve survival rates. Inflatable rescue boats (IRBs) are widely used worldwide to rescue drowning victims. Performing CPR in special circumstances requires adjusting the position based on the environment and space available. The aim of this study was to assess the quality of over-the-head resuscitation performed by rescuers aboard an IRB in comparison to standard CPR. METHODS: A quasi-experimental, quantitative, cross-sectional pilot study was conducted. Ten professional rescuers performed 1 min of simulated CPR on a QCPR Resuscy Anne manikin (Laerdal, Norway) sailing at 20 knots using two different techniques: 1) standard CPR (S-CPR) and 2) over-the-head CPR (OTH-CPR). Data were recorded through the APP QCPR Training (Laerdal, Norway). RESULTS: The quality of CPR was similar between S-CPR (61%) and OTH-CPR (66%), with no statistically significant differences (p = 0.585). Both the percentage of compressions and the percentage of correct ventilations did not show significant differences (p > 0.05) between the techniques. CONCLUSION: The rescuers can perform CPR maneuvers with acceptable quality in the IRB. The OTH-CPR technique did not show inferiority compared to S-CPR, making it a viable alternative when boat space or rescue conditions do not allow the conventional technique to be performed.

A manikin-based assessment of loose-fitting powered air-purifying respirator performance at variable flow rates and work rates.

Loose-fitting powered air-purifying respirators (PAPRs) are used in healthcare settings, although barriers to routine, everyday usage remain, including usability concerns and potential interference with work activities. Loose-fitting PAPRs are approved by the National Institute for Occupational Safety and Health (NIOSH) and must meet minimum performance requirements, including a minimum airflow requirement of 170 L/min. One course of action to address usability concerns is to allow for the use of PAPRs designed with reduced airflow rates. The primary objective of this study was to assess the effect of PAPR flow rate and user work rate on PAPR performance, using a manikin-based assessment method. PAPR performance was quantified using the "Manikin Fit Factor" (mFF), a ratio of the challenge aerosol concentration to the in-facepiece concentration. Flow rates from 50-215 L/min and low, moderate, and high work rates were tested. Two models of NIOSH Approved loose-fitting facepiece PAPRs were tested, both having an Occupational Safety and Health Administration Assigned Protection Factor (APF) or expected level of protection, of 25. A two-way analysis of variance with an effect size model was run for each PAPR model to analyze the effects of work rate and flow rate on PAPR performance. Flow rate and work rate were found to be significant variables impacting PAPR performance. At low and moderate work rates and flow rates below the NIOSH minimum of 170 L/min, mFF was greater than or equal to 250, which is 10 times the OSHA APF of 25 for loose-fitting facepiece PAPRs. At high work rates and flow rates below 170 L/min, mFF was not greater than or equal to 250. These results suggest that some loose-fitting facepiece PAPRs designed with a flow rate lower than the current NIOSH requirement of 170 L/min may provide respirator users with expected protection at low and moderate work rates. However, when used at high work rates, some loose-fitting facepiece PAPRs designed with lower flow rates may not provide the expected level of protection.

A current assessment of the THOR 50M in rear impacts.

OBJECTIVE: This study presents a comparison of the Test Device for Human Occupant Restraint (THOR) 50M and Hybrid III (HIII) 50M anthropomorphic test device (ATD) geometries and rear impact head and neck biofidelity to each other and to postmortem human surrogate (PMHS) data to evaluate the usefulness of the THOR in rear impact testing. METHODS: Both ATDs were scanned in a seated position on a rigid bench seat. A series of rear impact sled tests with the rigid bench seat with no head restraint support were conducted with a HIII-50M at 16 and 24 kph. Tests at each speed were performed twice with the THOR-50M to allow an assessment of the repeatability of the THOR-50M. A comparison of the test results from THOR-50M testing were made to the results of a previous study that included PMHS. Rear impact sled tests with both ATDs in a modern seat were then conducted at 40 kph. RESULTS: The THOR-50M head was 48.4 mm rearward and 60.1 mm higher than the HIII-50M head when seated in the rigid bench seat. In the repeated rigid bench testing at 16 and 24 kph, the THOR-50M head longitudinal and vertical accelerations, upper neck moment, and overall kinematics showed good test-to-test repeatability. In the rigid bench tests, the THOR-50M neck experienced flexion prior to extension in the 16 kph tests, where the neck of the HIII only experienced extension. At 24 kph both ATDs only experienced extension. The THOR-50M head displaced more rearward at both test velocities. The rigid bench tests show that the THOR-50M neck allows for more extension motion or articulation than the HIII-50M neck. The rigid bench test also shows that the head longitudinal and vertical accelerations, angular head kinematics, and upper neck moments were reasonably comparable between the ATDs. The THOR-50M results were closer to the average of the PMHS results than the HIII-50-M results, with the exception of the upper neck. In the 40 kph tests, with a modern seat design, the THOR-50M resulted in more deformation of the seatback with greater head restraint loading than the HIII-50M. The THOR-50M head backset distance was less. CONCLUSION: This study provides insight into the differences and similarities between the THOR and the HIII-50M ATD geometries, instrumentation responses, and kinematics, as well as the repeatability of the THOR-50M in rear impacts testing. The overall geometries of the THOR-50M and the HIII-50M are similar. The seated head position of the THOR-50M is slightly further rearward and higher than the HIII-50M. The results indicate that the THOR-50M matches the PMHS results more closely than the HIII-50M and may have improved neck biofidelity in rear impact testing. The results indicate that the studied THOR-50M responses are repeatable within expected test-to-test variations in rear impacts. Early data suggest that the THOR-50M can be used in rear impact testing, though a more complete understanding of the THOR-50M differences to the HIII ATDs will allow for better correlation to the existing body of HIII rear impact testing.

Assessment of debriefing in high-fidelity mannequin simulation: study among students in cardiology.

INTRODUCTION: Debriefing is the fundamental step in the learning process when teaching by simulation. The Debriefing Assessment for Simulation in Healthcare (DASH) guide is a tool designed to assess and develop the debriefing skills of trainers using healthcare simulation. AIM: To evaluate the debriefing in high-fidelity mannequin simulation in the management of cardiological emergency by the DASH tool, student version. METHODS: This was a bicentric, prospective, cross-sectional and evaluative study including five groups of students in the first year of the second cycle of medical studies completing their internship in the cardiology departments of the Habib Thameur hospital and the Internal Security Forces Hospital of Marsa during the first semester of the 2021-2022 academic year. The simulation scenario included the diagnosis and emergency management of degenerative syncopal atrioventricular block. RESULTS: Forty-four students completed the DASH assessment form (28 female, 16 male). According to the students, the trainers had maintained a climate conducive to learning (6.51±0.74). They had conducted the debriefing in a structured way (6.35±0.75). They had aroused engagement in the exchange leading the learner to analyze his performance (6.01±1.03). They had effectively identified the learner's strengths and areas for improvement as well as their reasons (6.39±1.04). The trainers had helped the learners to consider how to improve or maintain a good level of performance (6.57±0.77). The mean DASH score evaluating the trainers was 6.36±0.88. CONCLUSION: The DASH tool allows trainers to highlight the strengths and areas for improvement in the debriefing, which is the key step in the simulation to optimize the clinical reasoning process and improve the quality of care.

Integrated Assessment of Discrepancy Between Tracheal Tube and Tube Exchanger as Advancement: A Manikin Simulation Study.

BACKGROUND: Advancing a tracheal tube over a tracheal tube exchanger into the trachea frequently causes difficulties because of the tube impingement on laryngeal structures. In the present study, we measured the resistance of tube advancement both objectively and subjectively with a variety of combinations of tube exchanger sizes and tracheal tubes using a manikin simulator. METHODS: Lubricated 7.5 mm ID standard and Parker Flex-Tip (PFT) tracheal tubes were railroaded over the tube exchangers (OD 1-6 mm) into the trachea through the oral route in a manikin. Consequently, 12 combinations of tracheal tube-exchanger tube assemblies were evaluated. Tube advancing resistance at the laryngeal inlet was subjectively evaluated. The objective tube advancing resistance (force) at the laryngeal inlet was evaluated using a digital force gauge. The execution of each tracheal tube-exchanger trial was conducted 10 times. RESULTS: With a 1-mm tube exchanger, all intubation attempts with both standard and PFT tubes failed. Esophageal intubation or severe impingement at the right arytenoid accompanied with a bent tracheal tube was observed. With a 2-mm tube exchanger, during intubation with a standard tracheal tube, rotation of the tube was sometimes required; however, all other intubations were done without problems. When PFT tubes were used, all intubation attempts were performed without problems. The rest of the trials were successfully performed regardless of the combinations of tube exchangers and tracheal tubes; however, one attempt of intubation with a combination of a 5 mm tube exchanger and a standard tracheal tube required withdrawal and rotation of the tube because of impingement at the epiglottis. In cases where there was no gap resistance, which means tube advancing resistance generated by a gap between an introducer and a tracheal tube, the pressing force was approximately less than 10 N. However, in the cases requiring some interventions to overcome the gap, the pressing force reached around 15 N. When intubation failed, for example when the tube bent, or esophageal intubation, the pressing force reached around 30 N. CONCLUSIONS: Impingement due to the gap between the tube exchanger and the tracheal tube is thought to occur in the PFT tube less frequently. Once an impingement occurs, we can feel approximately twice the amount of resistance as usual, which may be a chance to consider taking some interventions. When the impingement is not released, regardless of interventions, excessive force may result in esophageal intubation or tracheal injury.

Development and Validation of a Novel Ultra-Compact and Cost-Effective Device for Basic Hands-On CPR Training: A Randomized, Sham-Controlled, Blinded Trial.

To examine the performance of a novel low-cost, ultra-compact, and attractive auditory feedback device for training laypeople in external chest compressions (ECCs), we conducted a quasi-experimental cross-sectional study from September to November 2021 at the Faculty of Nursing of Albacete, University of Castille-La Mancha, Spain. The ECC sequence was performed in the laboratory with the new device for basic hands-on CPR training. Results: One hundred college students were included in this study. The compression rate/min with the new device was 97.6, and the adequate %ECC was 52.4. According to the status of body mass index (BMI) and muscle strength of the upper limbs in the bivariate analysis, it was observed that the new device discriminated between those who performed correct ECCs according to their BMI and muscle strength and those who did not, which led to significantly influenced results in terms of the percentage of ECCs with correct depth. Conclusions: The new ultra-compact auditory feedback device "Salvando a Llanetes®" demonstrated utility for teaching and learning ECCs in basic CPR. We can affirm that the analyzed device is an adequate, safe and economical method for teaching "CPR Hands-Only™" to the general population.

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)

Low-cost do-it-yourself (DIY) mannequin for blood collection: A comprehensive evaluation about its use in teaching.

The use of mannequins to practice different clinical procedures in undergraduate students complies with the 3R principle (Replacement, Reduction, Refinement) without affecting professional competencies. However, commercial solutions are often expensive and therefore, not available for many schools. The main aim of this study was to describe the development and validation of an economical Do-It-Yourself mannequin for jugular blood collection from dogs. The use of the mannequin was evaluated by (1) assessment of the opinion of students and experts and (2) by conducting a pilot study where salivary biomarkers of stress were determined in students and dogs. The costs of the materials needed for the mannequin confection were less than 60 Euros and it was easily built in less than 1 h. The mannequin was very well accepted and scored by both, students and experts, being mostly liked a lot and considered it to be very useful for the practices (Scored 8, 9 or 10/10). Students that could first practice with the mannequin reported a self-perceived higher level of confidence and had lower levels of alpha-amylase in saliva after the procedure. Overall, the mannequin enables the initiation of blood sampling skills in agreement with 3R principles and is easy to perform, economically affordable and sustainable. This model could be adapted to other vein simulations and animal species, and has the potential to help students deal with stressful situations such as taking blood samples from a live animal.

Quantitative assessment of chest compression techniques on an infant manikin.

BACKGROUND: Current cardiopulmonary resuscitation (CPR) guidelines recommend the two-finger technique (TFT) of chest compression (CC) in infants for a single rescuer. We hypothesized that healthcare providers cannot achieve adequate CC depth with TFT, even if using real-time visual feedback (RVF). METHODS: This was a cross-over study, randomizing participants to perform three sets of 2-min continuous CC, comparing (i) TFT with RVF, (ii) the one-hand technique (OHT) without RVF, and (iii) OHT with RVF. A standard CPR trainer manikin of a 3-month-old infant and a monitor/defibrillator that displays and records the quantitative CC quality were used. We set a target compression depth of 40-50 mm and a target compression rate of 100-120/min. Data were analyzed using the Friedman test and Bonferroni correction. Statistical significance was defined as P-value of< 0.05. RESULTS: Fifty-nine healthcare providers participated in the study. The mean compression depth was 24 mm (interquartile range [IQR], 22-26 mm) in TFT with RVF and 43 mm (IQR, 38-48 mm) in OHT without RVF, P < 0.001. The proportion of adequate CC depth was 0% (IQR, 0-0%) in TFT with RVF, 22% (IQR, 5-54%) in OHT without RVF, and 62% (IQR, 29-83%) in OHT with RVF. The mean compression rate was within the target range in all three techniques. CONCLUSIONS: The TFT cannot produce the CC depth that meets the recommendation of the current CPR guidelines for an infant with RVF, whereas the OHT does.

An assessment of introducers used for airway management.

Different introducers are available to assist with tracheal intubation. Subtle differences in the design of introducers can have a marked effect on safety and performance. The Difficult Airway Society's Airway Device Evaluation Project Team proposal states that devices should only be purchased for which there is at least a case-control study on patients assessing airway devices. However, resources are not currently available to carry out a case-control study on all introducers available on the market. This study comprised a laboratory and manikin-based investigation to identify introducers that could be suitable for clinical investigation. We included six different introducers in laboratory-based assessments (design characteristics) and manikin-based assessments involving the participation of 30 anaesthetists. Each anaesthetist attempted placement in the manikin's trachea with each of the six introducers in a random order. Outcomes included first-time insertion success rate; insertion success rate; number of attempts; time to placement; and distance placed. Each anaesthetist also completed a questionnaire. First-time insertion success rate depended significantly on the introducer used (p = 0.0016) and varied from 47% (Armstrong and P3) to 77% (Intersurgical and Frova). Median time to placement (including oesophageal placement) varied from 10 s (Eschmann and Frova) to 20 s (P3) (p = 0.0025). Median time to successful placement in the trachea varied from 9 s (Frova) to 22 s (Armstrong) (p = 0.037). We found that the Armstrong and P3 devices were not as acceptable as other introducers and, without significant improvements to their design and characteristics, the use of these devices in studies on patients is questionable. The study protocol is suitable for differentiating between different introducers and could be used as a basis for assessing other types of devices.

Mid-fidelity manikins improve first-year pharmacy students' confidence and accuracy with performing physical assessment.

INTRODUCTION: As clinical roles for pharmacists expand, effective physical assessment training for pharmacy students is essential. The study objective was to determine whether doctor of pharmacy students taught physical assessment using mid-fidelity manikins improved in confidence and accuracy. Long-term retention of skills was also measured. METHODS: First-year (P1) pharmacy students were enrolled in a case-based course over two semesters between August 2018 and May 2019. Manikins were incorporated into the fall semester course for students to perform physical assessment as part of the individual case workup process. Students completed surveys before and after the course to evaluate differences in their confidence and accuracy with detecting normal vs. abnormal vital signs. After 21 weeks of no manikin exposure, students were again surveyed and assessed to evaluate long-term retention of physical assessment skills. RESULTS: Fifty-six students were included. Student confidence in assessing heart rate, blood pressure (BP), and lung sounds improved significantly between pre-exposure and post-exposure (34%, 39%, and 71% improvement, respectively), and accuracy in assessing BP and lung sounds improved significantly between pre-exposure and post-exposure (28% and 23% improvement, respectively). Confidence and accuracy were maintained throughout the study including follow-up. CONCLUSIONS: Early introduction of mid-fidelity manikins to P1 pharmacy students in a case-based, spaced learning strategy provided a successful approach to teach physical assessment skills.

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