Immersive virtual reality (VR) training increases the self-efficacy of in-hospital healthcare providers and patient families regarding tracheostomy-related knowledge and care skills: A prospective pre-post study.

BACKGROUND: Virtual reality (VR)-based simulation in hospital settings facilitates the acquisition of skills without compromising patient safety. Despite regular text-based training, a baseline survey of randomly selected healthcare providers revealed deficiencies in their knowledge, confidence, comfort, and care skills regarding tracheostomy. This prospective pre-post study compared the effectiveness of regular text- and VR-based intervention modules in training healthcare providers' self-efficacy in tracheostomy care skills. METHODS: Between January 2018 and January 2020, 60 healthcare providers, including physicians, nurses, and respiratory therapists, were enrolled. For the intervention, a newly developed head-mounted display (HMD) and web VR materials were implemented in training and clinical services. Subsequently, in-hospital healthcare providers were trained using either text or head-mounted display virtual reality (HMD-VR) materials in the regular and intervention modules, respectively. For tracheostomy care skills, preceptors directly audited the performance of trainees and provided feedback. RESULTS: At baseline, the degree of trainees' agreement with the self-efficacy-related statements, including the aspects of familiarity, confidence, and anxiety about tracheostomy-related knowledge and care skills, were not different between the control and intervention groups. At follow-up stage, compared with the regular group, a higher percentage of intervention group' trainees reported that they are "strongly agree" or "somewhat agree" that the HMD-VR simulation increases their self-efficacy, including the aspects of familiarity and confidence, and reduced their anxiety about tracheostomy-related knowledge and care skills. After implementation, a higher degree of trainees' average satisfaction with VR-based training and VR materials was observed in the intervention group than in the regular group. Most reported that VR materials enabled accurate messaging and decreased anxiety. The increasing trend of the average written test and hands-on tracheostomy care skills scores among the intervention group trainees was significant compared to those in the regular group. The benefits of HMD-VR simulations and web-VR material-based clinical services for in-hospital healthcare providers and patient families persisted until 3 to 4 weeks later. CONCLUSION: The current study suggests that VR materials significantly enhance trainees' self-efficacy (increased familiarity, increased confidence, and reduced anxiety) and their satisfaction with the training, while motivating them to use acquired knowledge and skills in clinical practice.

Household cleaning products poisoning in a pediatric emergency center: A 10- year cross-sectional study and literature review.

BACKGROUND: Poisoning by household cleaning products(HCPs) is common in children. Some HCPs are toxic and may cause severe complications. We assessed HCP poisonings treated in a pediatric emergency department(PED). METHODS: This was a retrospective study of patients aged under 18 years with HCP poisoning admitted to the largest PED in Taiwan from 2011 to 2020 were recruited. RESULTS: The records over a 10-year period from 103 children admitted to the PED because of HCP poisoning(70 boys [68%] and 33 girls [32%]), mean age 3.54 years(standard deviation [SD] = 3.15 years) were evaluated. Most poisonings were unintentional(99%, n = 102) and occurred at home(96%, n = 99). The HCPs included alkaline(74%, n = 76), acidic(25%, n = 26), and neutral(1%, n = 1) agents. Most were orally ingested(86%, n = 89). Panendoscopy was performed in 25 patients(24%), and the endoscopic(Zargar) grade was used to determine the severity of injury. Medications(steroids [9%, n = 9], antibiotics [10%, n = 10], or antacids [30%, n = 23]) were prescribed. Alkaline HCP ingestion induced severe esophageal injury(p = 0.04) and esophageal stricture(p = 0.04). Five patients(5%) exhibited esophageal strictures and required balloon dilation. On multivariate analysis, alkaline HCP ingestion(p = 0.04), severe esophageal caustic injury(Zargar grade ≥ 3) (p < 0.001), and medications(steroids [p < 0.001], antibiotics [p < 0.001], and antacids [p = 0.001]) were associated with esophageal stricture. CONCLUSION: Alkaline HCP ingestion and severe esophageal caustic injury(Zargar grade ≥ 3) were associated with esophageal stricture. Physicians tended to prescribe medications(steroids, antibiotics, or antacids) for patients with severe esophageal injuries to reduce the risk of esophageal stricture. The usefulness of these medications requires further study.

Hypoxia, hypotension, and bradycardia induced by povidone-iodine ingestion: A pediatric case report and literature review.

Povidone-iodine (PI) is a disinfectant and antiseptic agent commonly used to sterilize skin, mucous membranes, and wounds. PI intoxication is very rare, but the complications may be severe. We report a pediatric patient who presented in the emergency department with hypoxia, hypotension, and bradycardia after unintentional PI ingestion.

Comparison of cardiac autonomic nervous system disturbed by sleep deprivation in sex and menstrual phase.

Sleep deprivation (SD) leads to cardiovascular risk by disturbing autonomic nervous system (ANS). Whether sex or menstrual cycle influences cardiac ANS interfered by SD remained unclear. This investigation was to further clarify the effects of different menstrual phases on cardiac autonomic nervous activity disturbed by SD. Methodologically, cardiac autonomic modulation before and after 30 h of total SD was determined by spectral analysis of heart rate variability in 10 healthy females during the mid-follicular (FF) and mid-luteal (FL) phases and 10 healthy males. The result showed that before SD, the FF subjects, but not FL, had higher normalized high frequency (nHF) (vagal activity) or lower ratio of low frequency (LF) to high frequency(HF) power (sympathetic activity) while performing deep breathing or Valsalva maneuver (40 mmHg) than the male subjects did. However, the SD for 30 h in the FF group significantly increased the LF/HF ratio and decreased nHF level at rest and in responses to deep breathing and Valsalva maneuver, despite no significant change of HRV in either male or FL group. Simultaneously, the SD substantially lowered venous PCO2 in the FF group, and the decreased PCO2 level was associated with the increased LF/HF ratio following SD. We concluded that 30-h acute SD promotes sympathetic and depresses [corrected] parasympathetic activities in female during the follicular phase rather than the luteal phase. Compared to FF, SD-triggered cardiac sympathetic activation is blunted in FL. The study provides further insight into the physiology of acute SD in different sex and menstrual phases.

Co-production of gamma-glutamylcysteine and glutathione by mutant strain Saccharomyces cerevisiae FC-3 and its kinetic analysis.

Co-production of gamma -glutamylcysteine (gamma -GC) and glutathione (GSH) by a novel mutant strain Saccharomyces cerevisiae FC-3 and its kinetic analysis were investigated. The strain could produce gamma -GC and GSH with high yields (4.22 and 14.3 mg/g-DCW, respectively) in batch submerged cultures. Effects of medium components and cultivation conditions on cell growth and the contents of intracellular gamma -GC and GSH were examined. Results show that 2% (w/v) sucrose and 2.5% (w/v) yeast extract are the best carbon and nitrogen sources, respectively, and supplement of three amino acids (glycine, cysteine and glutamate), each at 0.08% (w/v), in the medium could enhance gamma -GC and GSH production. In addition, optimal operating conditions are at the initial pH value of 7.0, 30 degrees C and 200 rev/min. Moreover, results obtained from kinetic analyses reveal that gamma -GC production is mixed-type growth associated, but GSH production is growth-associated.