Evaluation of a Hands-On Wrist Fracture Simulator for Fracture Management Training in Emergency Medicine Residents.

Background Fractures are common in the emergency department, and fracture management training poses certain challenges. Recent emergency medicine (EM) residency graduates feel only somewhat prepared to manage fractures. In this study, our objectives were to determine the effect of introducing a wrist fracture simulator (Sawbones®) to traditional EM fracture management education and to assess resident attitudes, comfort with fracture management, and perceptions of the simulator. Methodology This six-month prospective study involved postgraduate year one residents at two academic EM programs. For convenience, each residency was considered as one test group. One residency group was deemed the traditional group (n = 10), while the other was the intervention simulator group (n = 16). Identical traditional lectures and buddy splinting workshops were provided. The simulator group received supplemental training with the Sawbones® simulator. Groups were filmed using this simulator for fracture management before the teaching sessions and at six months. Grading utilized a 27-point scale, with a subscale covering reduction. Data were collected regarding attitudes, comfort with fracture management, and perceptions of the simulator. Results In total, 26 residents participated in the study. There was no significant difference between groups at six months in overall fracture management scores (traditional group: 15.8 ± 3.1; simulator group: 15.4 ± 3.9; p = 0.92). On the subscale of fracture reduction skills, the simulator group showed significant improvement (p = 0.0078), while the traditional training group did not (p = 0.065). Both groups reported satisfaction with the simulator, improved comfort, and knowledge of fracture management. Conclusions Fracture management is an essential competency, and prior research has shown that most graduating EM residents do not feel comfortable with these skills. All participating residents in this study struggled with adequate fracture management, even after the teaching session. Our study suggests that there is a benefit to supplementing traditional training with a fracture simulator.

Blood Product Transfusion in Adults: Indications, Adverse Reactions, and Modifications.

Millions of units of blood products are transfused annually to patients in the United States. Red blood cells are transfused to improve oxygen-carrying capacity in patients with or at high risk of developing symptomatic anemia. Restrictive transfusion thresholds with lower hemoglobin levels are typically clinically equivalent to more liberal thresholds. Transfusion of plasma corrects clinically significant coagulopathy in patients with or at high risk of bleeding. Mildly abnormal laboratory coagulation values are not predictive of clinical bleeding and should not be corrected with plasma. Transfused platelets prevent or treat bleeding in patients with thrombocytopenia or platelet dysfunction. Cryoprecipitate is transfused to treat hypofibrinogenemia. Many adverse reactions can occur during or after blood product transfusion. Transfusion-associated circulatory overload (i.e., volume overload) is the most common cause of mortality associated with blood products. Modifications to blood products can prevent or decrease the risks of transfusion-related adverse reactions. It is critical to quickly recognize when a reaction is occurring, stop the transfusion, assess, and support the patient. Reporting a reaction to the blood bank is part of ensuring patient safety and supporting hemovigilance efforts.

Augmented band gap tunability in indium-doped zinc sulfide nanocrystals.

Doping semiconductor nanocrystals is a powerful tool to impart new and beneficial optical and electrical properties to the host nanocrystals. Doping has been used to improve the performances of nanocrystal-based devices in applications as diverse as optics, magnetism, electronics, catalysis and sensing. In this work we present a low temperature colloidal synthesis of zinc sulfide (ZnS) nanocrystals doped with indium. Through optimization of the reaction parameters and the doping level, quantum confined (∼2 nm in size) crystalline colloids with highly tunable optical properties are achieved. Using a suite of characterization techniques including X-ray diffraction, high-resolution transmission electron microscopy, optical spectroscopies (absorption, emission, and Raman), compositional analyses and first principles simulations, we investigate the structural, morphological and optical properties of the synthesized nanocrystals. Indium dopants are found to heavily influence the band gap of ZnS. This strategy in addition to traditional methods of size control enables the synthesis of nanocrystals with finely tunable band gaps between ∼3.8 eV-4.3 eV. These doped ZnS nanocrystals are fabricated into selective UV thin-film absorbers and discriminatory proof-of-concept UVA-UVB/C photodetectors.