Evaluating the effects of comprehensive simulation on central venous catheterization training: a comparative observational study.

BACKGROUND: Simulation-based training (SBT) is vital to complex medical procedures such as ultrasound guided central venous catheterization (US-IJCVC), where the experience level of the physician impacts the likelihood of incurring complications. The Dynamic Haptic Robotic Trainer (DHRT) was developed to train residents in CVC as an improvement over manikin trainers, however, the DHRT and manikin trainer both only provide training on one specific portion of CVC, needle insertion. As such, CVC SBT would benefit from more comprehensive training. An extended version of the DHRT was created, the DHRT + , to provide hands-on training and automated feedback on additional steps of CVC. The DHRT + includes a full CVC medical kit, a false vein channel, and a personalized, reactive interface. When used together, the DHRT and DHRT + systems provide comprehensive training on needle insertion and catheter placement for CVC. This study evaluates the impact of the DHRT + on resident self-efficacy and CVC skill gains as compared to training on the DHRT alone. METHODS: Forty-seven medical residents completed training on the DHRT and 59 residents received comprehensive training on the DHRT and the DHRT + . Each resident filled out a central line self-efficacy (CLSE) survey before and after undergoing training on the simulators. After simulation training, each resident did one full CVC on a manikin while being observed by an expert rater and graded on a US-IJCVC checklist. RESULTS: For two items on the US-IJCVC checklist, "verbalizing consent" and "aspirating blood through the catheter", the DHRT + group performed significantly better than the DHRT only group. Both training groups showed significant improvements in self-efficacy from before to after training. However, type of training received was a significant predictor for CLSE items "using the proper equipment in the proper order", and "securing the catheter with suture and applying dressing" with the comprehensive training group that received additional training on the DHRT + showing higher post training self-efficacy. CONCLUSIONS: The integration of comprehensive training into SBT has the potential to improve US-IJCVC education for both learning gains and self-efficacy.

The impact of simulation-based training in medical education: A review.

Simulation-based training (SBT) has emerged as a transformative approach in medical education, significantly enhancing healthcare professionals' learning experience and clinical competency. This article explores the impact of SBT, tracing its historical development and examining the various types of simulations utilized today, including high-fidelity mannequins, virtual reality environments, standardized patients, and hybrid simulations. These methods offer a safe and controlled environment for students to practice and hone technical and non-technical skills, ultimately improving patient safety and clinical outcomes. The benefits of SBT are manifold, including enhanced skill acquisition, error reduction, and the opportunity for repeated practice without risk to actual patients. Immediate feedback and structured debriefing further solidify learning, making Simulation an invaluable tool in medical education. However, the implementation of SBT is challenging. It requires substantial financial investment, specialized equipment, and trained faculty. Additionally, there are concerns about the realism of simulations and the transferability of skills to real-world clinical settings. Despite these challenges, numerous case studies and empirical research underscore the effectiveness of SBT compared to traditional methods. Looking ahead, advancements in technology, such as artificial intelligence and improved virtual reality applications, promise to enhance the efficacy and accessibility of simulation training. The integration of Simulation with other training modalities and its adoption in diverse global contexts highlight its potential to revolutionize medical education worldwide. This article affirms the crucial role of SBT in preparing the next generation of healthcare professionals and its ongoing evolution driven by technological innovations.

Surgical Video Projection onto a Mannequin: An Educational Tool for Simulation Practice of Perioperative Anesthetic Management.

Simulation practice is known to be effective in anesthesiology education. In our simulation practice of general anesthesia for open cholecystectomy at the Tohoku University simulation center, we projected a surgical video onto a mannequin's abdomen. In this observational study, we investigated whether video-linked simulation practice improved students' performance. We retrospectively compared the general anesthesia simulation practice scores of fifth-year medical students in a video-linked or conventional group. In the simulation practice, we evaluated the performance of each group in three sections: perioperative analgesia, intraoperative bleeding, and arrhythmia caused by abdominal irrigation. The primary endpoint was the total score of the simulation practice. The secondary endpoints were their scores on each section. We also investigated the amount of bleeding that caused an initial action and the amount of bleeding when they began to transfuse. The video group had significantly higher total scores than the conventional group (7.5 [5-10] vs. 5.5 [4-8], p = 0.00956). For the perioperative analgesia and arrhythmia sections, students in the video group responded appropriately to surgical pain. In the intraoperative bleeding section, students in both groups scored similarly. The amount of bleeding that caused initial action was significantly lower in the video group (200 mL [200-300]) than in the conventional group (400 mL [200-500]) (p = 0.00056).Simulation practice with surgical video projection improved student performance. By projecting surgical videos, students could practice in a more realistic environment similar to an actual case.

The Effect of Changing the Angle of the Passenger Car Seat Backrest on the Head Trajectories of the 50th Percentile Male Dummy.

The aim of the study is to compare the head displacement of the KPSIT C50 dummy during a frontal collision at a speed of 20 km/h, along with the change in the angle of the car seat backrest. Passenger car manufacturers recommend setting the backrest angle of the car seat between 100 and 125 degrees. It should be noted that the driver's position is of great importance in the event of a collision injury. In the event of a rear-end collision, the position of the headrest of the car seat is an element that affects the degree of the driver's injuries. In extreme cases, incorrect positioning of the headrest, even at low speed, can lead to serious injuries to the cervical spine and even death. The article is part of a large-scale study on low-speed crash testing. The research problem concerned the influence of the seat backrest angle on the head displacement during a low-speed collision. The article compares the displacement of the head of the KPSIT C50 dummy during a series of crash tests, where the angle of the car seat backrest was changed. On the basis of the research, it was found that the optimal angle of the car seat backrest is 110 degrees. In addition, a preliminary analysis of the displacements of the dummy's head showed a high risk of whiplash injury in people sitting in a fully reclined seat.

The 2024 French guidelines for scenario design in simulation-based education: manikin-based immersive simulation, simulated participant-based immersive simulation and procedural simulation.

BACKGROUND: Simulation-based education in healthcare encompasses a wide array of modalities aimed at providing realistic clinical experiences supported by meticulously designed scenarios. The French-speaking Society for Simulation in Healthcare (SoFraSimS) has developed guidelines to assist educators in the design of scenarios for manikin- or simulated participant- based immersive simulation and procedural simulation, the three mainly used modalities. METHODS: After establishing a French-speaking group of experts within the SoFraSimS network, we performed an extensive literature review with theory-informed practices and personal experiences. We used this approach identify the essential criteria for practice-based scenario design within the three simulation modalities. RESULTS: We present three comprehensive templates for creating innovative scenarios and simulation sessions, each tailored to the specific characteristics of a simulation modality. The SoFraSimS templates include five sections distributed between the three modalities. The first section contextualizes the scenario by describing the practicalities of the setting, the instructors and learners, and its connection to the educational program. The second section outlines the learning objectives. The third lists all the elements necessary during the preparation phase, describing the educational method used for procedural simulation (such as demonstration, discovery, mastery learning, and deliberate practice). The fourth section addresses the simulation phase, detailing the behaviors the instructor aims to analyze, the embedded triggers, and the anticipated impact on simulation proceedings (natural feedback). This ensures maximum control over the learning experience. Finally, the fifth section compiles elements for post-simulation modifications to enhance future iterations. CONCLUSION: We trust that these guidelines will prove valuable to educators seeking to implement simulation-based education and contribute to the standardization of scenarios for healthcare students and professionals. This standardization aims to facilitate communication, comparison of practices and collaboration across different learning and healthcare institutions.

'What this article adds'1. The SoFraSimS provides guidelines to facilitate the development of simulation-based activities.2. These guidelines are theory-informed as well as evidence and experience-based.3. A detailed approach to writing a complete activity or scenario for procedural and immersive simulation including manikins or simulated participants is provided (the 'SoFraSimS templates').4. This work aims at standardizing practices and exchanging scenarios between simulation centers.

Evaluation of a 12-hole clock model for improving bronchoscopic skills in simulated normal and difficult airways among anesthesia residents: A randomized controlled study.

BACKGROUND: Simulation-based training is used to improve fiberoptic bronchoscopic skills for novices. We developed a nonanatomical task trainer (named 12-hole clock model) that focused on training manipulation of bronchoscopes. The aim of this study was to evaluate the training effect of this model on bronchoscopic skills and learning interests in simulated normal and difficult airways among anesthesia residents. METHODS: Forty-three anesthesia residents without experience in bronchoscopic intubation were randomly divided into control (n = 22) and intervention groups (n = 21). All participants received standard multimedia learning and a baseline test using a normal airway manikin. Then, the control and intervention groups engaged in 60 minutes of training via a traditional airway manikin or the clock model, respectively. After training, the participants completed bronchoscopic performance assessments in simulated normal and difficult airways, as well as an electronic questionnaire related to the course. RESULTS: During training, the total hands-on time of bronchoscopic practice recorded by trainees' themselves was longer in the intervention group than in the control group (1568 ±â€…478 seconds vs 497 ±â€…172 s, P < .0001). Posttraining, the time required to visualize the carina in simulated normal airways was longer in the intervention group than in the control group (22.0 [18.0, 29.0] vs 14.0 [10.8, 18.3], P < .0001), while it was shorter for simulated difficult airways (24.0 [16.0, 32.0] s vs 27.0 [21.0, 35.5] s, P = .0425). The survey results indicated that confidence in bronchoscopic intubation increased in both groups, without significant differences in satisfaction, acceptance, or perceived difficulty between the groups. However, the interest ratings were higher in the intervention group than in the control group. CONCLUSIONS: The 12-hole clock model is a simple and feasible method for improving bronchoscopic skills and promoting interest among trainees. TRIAL REGISTRATION: NCT05327842 at Clinicaltrials.gov.

A comparative study of 3D measuring methods for monitoring breast volume changes.

Three-dimensional (3D) imaging techniques are promising new tools for measuring breast volume, for example in gender-affirming therapy. Transgender individuals can be treated with gender-affirming hormone therapy (GAHT). A robust method for monitoring breast volume changes is critical to be able to study the effects of feminizing GAHT. The primary aim of this study was to compare the accuracy of three 3D devices (Vectra XT, Artec LEO and iPhone XR) for measuring modest breast volume differences using a mannequin. The secondary aim of this study was to evaluate these methods in several performance domains. We used reference prostheses of increasing volumes and compared the volumes using GOM-inspect software. For Vectra XT 3D images, manufacturer-provided software was used to calculate volumes as well. The scanning methods were ranked based on their performance in a total of five categories: volume estimations, costs, user-friendliness, test subject-friendliness and technical aspects. The 3D models analyzed with GOM-inspect showed relative mean estimate differences from the actual volumes of 9.1% for the Vectra XT, 7.3% for the Artec LEO and 14% for the iPhone XR. For the Vectra XT models analyzed with the built-in software this was 6.2%. Root mean squared errors (RMSE) calculated based on the GOM-inspect volume analyses showed mean RMSEs of 2.27, 2.54 and 8.93 for the Vectra XT, Artec LEO and iPhone XR, respectively. The Vectra software had a mean RMSE of 3.00. In the combined performance ranking, the Vectra XT had the most favorable ranking, followed by the Artec LEO and the iPhone XR. The Vectra XT and Artec LEO are the preferred scanners to monitor breast development due to the combination of higher accuracy and overall performance. The current study shows that 3D techniques can be used to adequately measure modest breast volume differences and therefore will be useful to study for example breast changes in transgender individuals using feminizing GAHT. These observations may also be relevant in other fields of 3D imaging research.

Passive and low-energy strategies to improve sleep thermal comfort and energy resilience during heat waves and cold snaps.

Sleep is a pillar of human health and wellbeing. In high- and middle-income countries, there is a great reliance on heating, ventilation, and air conditioning systems (HVAC) to control the interior thermal environment in the bedroom. However, these systems are expensive to buy, maintain, and operate while being energy and environmentally intensive-problems that may increase due to climate change. Easily-accessible passive and low-energy strategies, such as fans and electrical heated blankets, address these challenges but their comparative effectiveness for providing comfort in sleep environments has not been studied. We used a thermal manikin to experimentally show that many passive and low-energy strategies are highly effective in supplementing or replacing HVAC systems during sleep. Using passive strategies in combination with low-energy strategies that elevate air movement like ceiling or pedestal fans enhances the cooling effect by three times compared to using fans alone. We extrapolated our experimental findings to estimate heating and cooling effects in two historical case studies: the 2015 Pakistan heat wave and the 2021 Texas power crisis. Passive and low-energy strategies reduced sleep-time heat or cold exposure by 69-91%. The low-energy strategies we tested require one to two orders of magnitude less energy than HVAC systems, and the passive strategies require no energy input. These strategies can also help reduce peak load surges and total energy demand in extreme temperature events. This reduces the need for utility load shedding, which can put individuals at risk of hazardous heat or cold exposure. Our results may serve as a starting point for evidence-based public health guidelines on how individuals can sleep better during heat waves and cold snaps without relying on HVAC.

The effectiveness of Q6 and PIPER 6-year-old models on quantification of the change of child sitting posture with AEB and its impact on child's injures in frontal crash.

OBJECTIVE: Automatic Emergency Braking (AEB) has a direct impact on the effectiveness of the restraint systems in providing protection toward child occupants. The objective is to evaluate the effectiveness of Q6 and PIPER 6-year-old models in predicting the kinematic responses of child models, and further to quantify and analyze the child injuries during a frontal crash with and without AEB. METHODS: The finite element model of a booster seat has been validated through a full vehicle test. Based on the validated finite element model, two sled test finite element models for the rear seat booster seat with Q6 and PIPER 6-year-old models were constructed. AEB condition was imposed on above the two models and the kinematic responses of sitting posture including head, neck and chest have been compared in detail. The peak head displacement and neck curvature of Q6 dummy and PIPER 6-year-old models have been compared with the test data from child volunteers. Based on the child model with better predictive capability for kinematic response under AEB, child injuries were evaluated and analyzed for the 50 km/h frontal crash test with and without AEB. Last, this study discussed the effects of internal neck and chest structure difference between Q6 and PIPER 6-year-old models on child kinematic response and the injury risks. RESULTS: Under AEB condition, PIPER 6-year-old model has higher head displacement and lower trunk displacement than Q6 dummy model, and the peak head displacement and neck curvature of PIPER 6-year-old model are similar to the test data of child volunteers. During the 50 km/h frontal crash simulation with pre-crash AEB, the HIC15, Head acceleration 3 ms, Nij decrease 43.7%, 19.6% and 28.8%, respectively and the chest deflection increases 15.5% compared to the simulation without AEB. CONCLUSIONS: This study shows that PIPER 6-year-old model is more suitable for the quantification of sitting posture change under AEB due to its higher biofidelity. The pre-crash AEB can substantially reduce the head, neck injuries. But it also increases the chest injury due to the chest pre-compression. Future efforts are recommended to lower the child chest injury by integrating AEB with active pre-tensioning seatbelts.

Are instructors correctly gauging ventilation competence acquired by course attendees?

Achievement of adequate ventilation skills during training courses is mainly based on instructors' perception of attendees' capability to ventilate with correct rate and chest compression:ventilation ratio, while leading to chest raising, as evidence of adequate tidal volume. Accuracy in evaluating ventilation competence was assessed in 20 ACLS provider course attendees, by comparing course instructors' evaluation with measures from a ventilation feedback device. According to course instructors, all candidates acquired adequate ventilation competence. However, data from the feedback device indicated a ventilation not aligned with current guidelines, with higher tidal volume and lower rate (p < 0.01). Deploying quality ventilation during CPR is a skill whose acquisition starts with effective training. Therefore, course instructors' capability to accurately evaluate attendees' ventilation maneuvers is crucial.

Dispatcher-assistance in lay rescuer infant CPR: Promoting the enhancement of the guiding protocol.

In the 2021 guidelines of the European Resuscitation Council (ERC) on infant CPR, a two-thumb encircling technique (TTET) is advised instead of the former two-finger technique (TFT), even for single rescuers. It is however unclear if this is also feasible and effective in case of dispatcher-assisted CPR by untrained bystanders and was explored in a cross-over infant manikin study including CPR-trained students and lay people. Both groups performed the TTET and the TFT, with dispatcher-assistance (according to Belgian protocol) only being provided to the CPR-untrained group. Results suggest it is feasible to advice single lay rescuers to perform TTET as part of a dispatcher-assisted CPR protocol, although we identified an ongoing risk, regardless of the technique advised, of suboptimal compression depth. Further research should be performed to confirm these preliminary data and explore optimal protocols for dispatcher-assisted infant CPR.

A Randomized Controlled Trial Comparing the Effect of Tracheostomy Training using Mannequin-Based Simulation and Smartphone Application on Self-Efficacy and Anxiety of Caregivers.

Inefficient education is a cause of anxiety and low self-efficacy among caregivers, especially for those caring for patients with tracheostomy. This randomized controlled trial aimed to compare the outcomes of tracheostomy care education by mannequin-based simulation and smartphone application. The participants were 126 primary caregivers of tracheostomy patients being discharged home from hospitals affiliated with Tehran University of Medical Sciences. The control group received routine care. Caregiver self-efficacy was assessed using the Caregiver Inventory and the Hamilton Anxiety Rating Scale prior to the education and 1 month after. There were significant differences among the three groups regarding the mean scores of self-efficacy and anxiety. There was a significant increase in self-efficacy (P ≤ .0001) and a significant decrease in anxiety (P ≤ .0001) scores after the intervention. The intergroup comparison showed a significant difference between the intervention groups and the control group in terms of changes in the anxiety and self-efficacy scores of caregivers (P < .001).

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.

Basic life support training: Is student confidence enhanced by advanced levels of simulation?

BACKGROUND: Basic life support (BLS) is a mandatory skill for nurses. The confidence of the BLS provider should be enhanced by regular training. Traditionally, BLS training has used low-fidelity manikins, but more recent studies have suggested the use of high-fidelity manikins and alternative levels of simulation such as virtual reality. METHODS: A quasi-experimental study including 125 nursing students. Data on confidence levels in various elements of BLS were collected using pre-validated questionnaires and analysed using SPSSv23. RESULTS: The study revealed that high-fidelity simulation had a significant impact on the BLS learner's confidence levels. CONCLUSION: The study identified the importance of high-fidelity simulation in BLS training in preparing students for clinical practice. This highlights the need for further exploration of simulation technologies, such as virtual reality, to enable students to gain the knowledge, skills, confidence and competence required to enable safe and effective practice.

Efficacy of bougie first approach for endotracheal intubation with video laryngoscopy during continuous chest compression: a randomized crossover manikin trial.

BACKGROUND: Endotracheal intubation is challenging during cardiopulmonary resuscitation, and video laryngoscopy has showed benefits for this procedure. The aim of this study was to compare the effectiveness of various intubation approaches, including the bougie first, preloaded bougie, endotracheal tube (ETT) with stylet, and ETT without stylet, on first-attempt success using video laryngoscopy during chest compression. METHODS: This was a randomized crossover trial conducted in a general tertiary teaching hospital. We included anesthesia residents in postgraduate year one to three who passed the screening test. Each resident performed intubation with video laryngoscopy using the four approaches in a randomized sequence on an adult manikin during continuous chest compression. The primary outcome was the first-attempt success defined as starting ventilation within a one minute. RESULTS: A total of 260 endotracheal intubations conducted by 65 residents were randomized and analyzed with 65 procedures in each group. First-attempt success occurred in 64 (98.5%), 57 (87.7%), 56 (86.2%), and 46 (70.8%) intubations in the bougie-first, preloaded bougie, ETT with stylet, and ETT without stylet approaches, respectively. The bougie-first approach had a significantly higher possibility of first-attempt success than the preloaded bougie approach [risk ratio (RR) 8.00, 95% confidence interval (CI) 1.03 to 62.16, P = 0.047], the ETT with stylet approach (RR 9.00, 95% CI 1.17 to 69.02, P = 0.035), and the ETT without stylet approach (RR 19.00, 95% CI 2.62 to 137.79, P = 0.004) in the generalized estimating equation logistic model accounting for clustering of intubations operated by the same resident. In addition, the bougie first approach did not result in prolonged intubation or increased self-reported difficulty among the study participants. CONCLUSIONS: The bougie first approach with video laryngoscopy had the highest possibility of first-attempt success during chest compression. These results helped inform the intubation approach during CPR. However, further studies in an actual clinical environment are warranted to validate these findings. TRIAL REGISTRATION: Clinicaltrials.gov; identifier: NCT05689125; date: January 18, 2023.

Effectiveness of innovative chest compression on the emergency department stretcher by an alternative method: a randomized controlled crossover trial.

Comparison of the three methods standing-on-a-stool (SS), one knee kneeling on a stretcher (KS), and kneeling at the same height as the patient's bed on the kneeling stool (KK) to evaluate the yielded of highest CPR quality and rescuer comfortability. A prospective randomized cross-over study which compares the three different rescuer positions for their effectiveness of chest compression. Conducted at a tertiary care between 19 and 22 Aug 2022. Emergency personnel aged 18 years or older, who completed the AHA-approved BLS course. The chest compression data was obtained by the ALIVE AED manikin® and AED reporting system. The information on the CPR quality and post-test questionnaires assessing the participants' preference, satisfaction and modified Borg's scale score was collected. The three methods shown no statistically significant difference in adequate chest compression depth (percentage). KK was not superior than SS at chest compression rate (P = 0.05). The adequate full chest recoil achieved with KK and KS were significantly higher than that of SS. However, there were no statistical difference between the three methods in the modified Borg's scale score. Based on the satisfying score, the rescuers preferred KK to either SS (p 0.007) or KS (p 0.012). The three methods shown no statistically significant difference in adequate chest compression depth (percentage). Still, both KK and KS provided more adequate chest recoil, so we would recommend using these two methods in the ED.Clinical trial registry: This study was retrospective registration in thaiclinicaltrials.org (TCTR20230119002, 19/1/2023).

¿Es necesario utilizar protectores de gónadas durante la realización de radiografías de tórax en los lactantes? / Is the use of gonad protection protectors necessary during infants chest radiography?

Introducción y objetivos: Comparar las dosis de radiación en las gónadas con y sin protector gonadal y optimizar el uso de estos protectores al realizar radiografías de tórax a lactantes. Materiales y métodos: Se utilizan 2 maniquíes antropomórficos pediátricos, un sistema de rayos X KXO-50SS/DRX-3724HD, y un sistema de radiografía digital CALNEO Smart C12, con y sin protector de gónadas durante la realización de radiografías de tórax. Se coloca un dosímetro cutáneo en tiempo real en el sistema de rayos X y se inserta un dosímetro cutáneo en tiempo real en la cara anterior de la glándula mamaria, en la cara anterior y posterior de la pelvis verdadera, y en los ovarios y testículos. El sistema de rayos X se irradia 15 veces con maniquíes, con y sin el protector de gónadas. Se comparan los valores de las dosis de entrada del paciente medidos por el dosímetro cutáneo en tiempo real para cada maniquí, con y sin el protector de gónadas. Resultados: Los valores medios de las dosis a la entrada del paciente medidos para la cara anterior a nivel de la pelvis verdadera, con y sin el protector, son 10,00 y 5,00μGy en el recién nacido, y 10,00 y 0,00μGy al año, respectivamente. Los valores medios de las dosis a la entrada del paciente medidos para la cara posterior a nivel de la pelvis verdadera con y sin el protector son de 0,00 y 0,00μGy tanto en el recién nacido como al año, respectivamente. Las dosis a la entrada del paciente medidas no se pueden detectar en los ovarios y los testículos ni con el protector ni sin él. No se observan diferencias significativas en los valores de las dosis a la entrada del paciente medidas en la cara anterior y posterior de la pelvis, los ovarios y los testículos en el recién nacido y al año, con y sin el protector (p>0,05).(AU)

Introduction and objectives: To compare gonad doses with and without a gonad protector and to optimize the use of gonadal protectors in infants thorax radiography. Materials and methods: Two pediatric anthropomorphic phantoms are used: an X-ray system for KXO-50SS/DRX-3724HD, and a digital radiography system for CALNEO Smart C12, with and without a gonad protector during infants thorax radiography. A real time skin dosimeter is placed on the X-ray system, and a real time skin dosimeter is inserted on the front side of the mammary gland, the front and back sides of the true pelvis level, and on the ovaries and testes. The X-ray system is irradiated 15 times using phantoms with and without a gonad protector. The measured entrance patient doses values of for the real time skin dosimeter are compared for each phantom, with and without the gonad protector. Results: The medium of measured entrance patient doses values for front side dose of the true pelvis level with and without the protector are 10.00 and 5.00μGy at newborn, and 10.00 and 0.00μGy at one year, respectively. The medium of measured entrance patient doses values for the back side dose of the true pelvis level with and without the protector are 0.00 and 0.00μGy at both newborn one year, respectively. The measured entrance patient doses cannot be detected in the ovaries and testes with or without the protector. No significant differences are observed in the measured entrance patient doses values for the front and back side doses of the pelvis, ovaries, and testes at newborn and one year, with and without the protector (p>0.05). Conclusions: No significant difference was observed in gonad dose measurements with and without the gonad protector during infants chest radiography. We believe that gonadal protector wearing is not necessary.(AU)

Investigation on vehicle occupant dummy applicability for under-foot impact loading conditions.

PURPOSE: Under-foot impact loadings can cause serious lower limb injuries in many activities, such as automobile collisions and underbody explosions to military vehicles. The present study aims to compare the biomechanical responses of the mainstream vehicle occupant dummies with the human body lower limb model and analyze their robustness and applicability for assessing lower limb injury risk in under-foot impact loading environments. METHODS: The Hybrid III model, the test device for human occupant restraint (THOR) model, and a hybrid human body model with the human active lower limb model were adopted for under-foot impact analysis regarding different impact velocities and initial lower limb postures. RESULTS: The results show that the 2 dummy models have larger peak tibial axial force and higher sensitivity to the impact velocities and initial postures than the human lower limb model. In particular, the Hybrid III dummy model presented extremely larger peak tibial axial forces than the human lower limb model. In the case of minimal difference in tibial axial force, Hybrid III's tibial axial force (7.5 KN) is still 312.5% that of human active lower limb's (2.4 KN). Even with closer peak tibial axial force values, the biomechanical response curve shapes of the THOR model show significant differences from the human lower limb model. CONCLUSION: Based on the present results, the Hybrid III dummy cannot be used to evaluate the lower limb injury risk in under-foot loading environments. In contrast, potential improvement in ankle biofidelity and related soft tissues of the THOR dummy can be implemented in the future for better applicability.

The confidence and competence of primary school staff to administer an adrenaline auto-injector.

School teachers are often inadequately prepared to use an adrenaline auto-injector (AAI), resulting in potentially dangerous treatment delays. The purpose of this study was to assess the observed competence, and self-reported confidence, of primary school teachers in the Republic of Ireland (RoI) to use an AAI. An evaluation of whether there was a link between confidence and competence was also assessed. Teachers from four primary schools in the RoI completed a questionnaire to assess their prior level of experience, training, and confidence levels with AAI administration. The four steps in administrating trainer AAI to a mannequin simulator were then assessed. A total of 61 teachers participated (out of a population of 80). The mean self-reported confidence was 1.82 out of 5 (SD = 0.96). There was no significant difference in confidence between trained and untrained participants (U = 240.5, NS). Participants who had received AAI administration training performed significantly more of the steps correctly (mean = 3.85, SD = 0.95) as compared to those who had received no training (mean = 2.97, SD = 1.10; U = 180.5, p = 0.008). There was no correlation between confidence in administrating AAI and the percentage of steps in the procedure performed correctly (rho = -0.17, NS).  Conclusion: Improvements in readiness to administer AAIs can be achieved through the application of more effective approaches to teaching clinical skills, changes to school policies and practices, and consideration of the design of AAIs in order to make their operation safer and simpler. It is important that teachers have the confidence and competence to safely administer an AAI. What is Known: • Poor ability in adrenaline auto-injector use seen across population groups-healthcare professionals, patients, carers, and school staff • Training in the use of adrenaline auto-injectors has positive impact on competency What is New: • Irish school teachers show poor levels of competency in adrenaline auto-injector use • No observed correlation between reported confidence and competency.