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2.
Ann Emerg Med ; 77(1): 1-10, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32893040

RESUMO

STUDY OBJECTIVE: Throughout the coronavirus disease 2019 pandemic, many emergency departments have been using passive protective enclosures ("intubation boxes") during intubation. The effectiveness of these enclosures remains uncertain. We sought to quantify their ability to contain aerosols using industry standard test protocols. METHODS: We tested a commercially available passive protective enclosure representing the most common design and compared this with a modified enclosure that incorporated a vacuum system for active air filtration during simulated intubations and negative-pressure isolation. We evaluated the enclosures by using the same 3 tests air filtration experts use to certify class I biosafety cabinets: visual smoke pattern analysis using neutrally buoyant smoke, aerosol leak testing using a test aerosol that mimics the size of virus-containing particulates, and air velocity measurements. RESULTS: Qualitative evaluation revealed smoke escaping from all passive enclosure openings. Aerosol leak testing demonstrated elevated particle concentrations outside the enclosure during simulated intubations. In contrast, vacuum-filter-equipped enclosures fully contained the visible smoke and test aerosol to standards consistent with class I biosafety cabinet certification. CONCLUSION: Passive enclosures for intubation failed to contain aerosols, but the addition of a vacuum and active air filtration reduced aerosol spread during simulated intubation and patient isolation.


Assuntos
/prevenção & controle , Controle de Infecções/instrumentação , Intubação Intratraqueal/instrumentação , Pneumonia Viral/prevenção & controle , Aerossóis , Infecção Hospitalar/prevenção & controle , Desenho de Equipamento , Filtração/instrumentação , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Manequins , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Vácuo
3.
J Dent Educ ; 85(1): 23-30, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32839963

RESUMO

INTRODUCTION: Producing radiographic images requires the use of ionizing radiation, which has been well documented for its potentially detrimental effects on human tissues. Therefore, dental hygiene students begin their radiographic training by practicing on manikins in a pre-clinical environment. Use of manikins does not allow for patient interaction factors. No published dental studies have examined factors important in helping dental hygiene students develop confidence during the transition from manikins to working with live patients in a clinical radiology setting. PURPOSE/OBJECTIVES: The purpose of this study was to identify students' perceived influences on confidence and ultimately on performance when transitioning from a pre-clinical radiology setting to working with live patients. Specific research questions that were answered by this qualitative study were (1) What pre-clinical radiographic experiences did students feel were beneficial for transitioning from manikins to live patients? (2) What were the primary factors that students felt they struggled with when initially taking radiographs on patients? METHODS: A qualitative study design was implemented in 2017. Data were obtained from students in a 2-year dental hygiene program. Survey responses, focus group feedback, and observation data were used to identify common themes. Emergent themes were reported using frequencies, emic and etic expressions. RESULTS: Four themes surfaced surrounding patient management, communication, appointment mechanics, and infection control. CONCLUSION: The use of standardized simulated patients may enhance clinical preparedness and confidence.


Assuntos
Manequins , Radiologia , Competência Clínica , Comunicação , Humanos , Pesquisa Qualitativa , Estudantes
4.
Med Educ Online ; 26(1): 1841982, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33135567

RESUMO

BACKGROUND: Simulation-Based Education (SBE) simulates specific physiological characteristics of a patient, allowing student practice in developing clinical skills and assessment of skill competency. Literature is limited regarding SBE's effectiveness in curriculum enrichment. This study investigated Blood Pressure (BP) measuring proficiency of second-year medical students with first-year SBE training and a second-year review, by comparing data from Simulation-Based assessments in 2017 and 2019. METHODS: Second-year medical students measured BP on three manikin arms, associated with distinct clinical contexts (healthy young male, young female experiencing hypotension, and older male suffering hypertension and diabetes). All manikins' BP settings were independent of clinical context. In January 2019, 108 second-year medical students who received traditional training, as well as SBE in 2017 and Simulation-Based practice in 2018, were divided into four groups (n = 32, 24, 24, and 28), with two groups each assessed on consecutive days. The proportions of correct BP values in each of three contexts were compared between experiments in 2017 and 2019. Additionally, systolic (SBP) and diastolic (DBP) blood pressure results were stratified into three groups: lower than setting value, correct, and higher than setting vgalue, with proportions for each group compared for the 2017 and 2019 studies using Fisher's Exact Tests. RESULTS: In Case Two and Three, the proportion of correct BP values significantly increased from 2017 (Case Two: 51%; Case Three: 55%) to 2019 (Case Two: 73%; Case Three: 75%). Additionally, proportions of students who reported lower SBP values than setting values were significantly decreased in Case One and Two, with five failing all contexts. CONCLUSIONS: Second-year student BP measurement skills were improved, not only due to repeated Simulation-Based practice but advancing basic science knowledge and mastery experience in ongoing curriculum. Simulation-Based assessment provided an effective tool for evaluating skill retention and proficiency in medical training.


Assuntos
Determinação da Pressão Arterial , Pressão Sanguínea , Competência Clínica , Estudantes de Medicina , Determinação da Pressão Arterial/métodos , Currículo , Educação Continuada , Feminino , Humanos , Masculino , Manequins , Exame Físico , Treinamento por Simulação
5.
Clin Oral Investig ; 25(1): 219-230, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32474807

RESUMO

OBJECTIVES: Whereas the key role of subgingival instrumentation in periodontal therapy is well known, the influence of operators' experience/training with different devices on treatment results is yet uncertain. Therefore, we assessed untrained undergraduate students, working on manikins, as to how effectively they learn to use curettes (GRA) and sonic scalers (AIR); hypothesizing that AIR will result in higher relative cleaning efficacy (RCE) than GRA. MATERIAL AND METHODS: Before baseline evaluation (T0), 30 operators (9 males, 21 females) received a 2-h theoretical lesson for both instruments, followed by a 12-week period with a weekly digitized training program for 45 min. During three sessions (T1-T3), the operators had to instrument six equivalent test teeth with GRA and AIR. At T0-T3, treatment time, proportion of removed simulated biofilm (RCE-b), and hard deposits (RCE-d) were measured. RESULTS: At T0, RCE-b was in mean(SD) 64.18(25.74) % for GRA, 62.25(26.69) % for AIR; (p = 0.172) and RCE-d 85.48(12.32) %/ 65.71(15.27) % (p < 0.001). At T3, operators reached highest RCE-b in both groups (GRA/AIR 71.54(23.90) %/71.75(23.05)%; p = 0.864); RCE-d GRA/AIR: 84.68(16.84) %/77.85(13.98) %; p < 0.001). Both groups achieved shorter treatment times after training. At T3, using curettes was faster (GRA/AIR 16.67(3.31) min/19.80(4.52) min; p < 0.001). CONCLUSIONS: After systematic digitized training, untrained operators were able to clean 70% of the root surfaces with curettes and sonic scalers. CLINICAL RELEVANCE: It can be concluded that a systematic digitized and interactive training program in manikin heads is helpful in the training of root surface debridement.


Assuntos
Raspagem Dentária , Raiz Dentária , Instrumentos Odontológicos , Feminino , Humanos , Aprendizagem , Masculino , Manequins , Aplainamento Radicular
7.
Arch Dis Child Fetal Neonatal Ed ; 106(1): 25-30, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32546543

RESUMO

BACKGROUND: T-piece resuscitators (TPRs) are used for primary newborn resuscitation in birthing and emergency rooms worldwide. A recent study has shown spikes in peak inflation pressure (PIP) over set values with two brands of TPRs inbuilt into infant warmer/resuscitation platforms. We aimed to compare delivered ventilation between two TPR drivers with inflation pressure spikes to a standard handheld TPR in a low test lung compliance (Crs), leak-free bench test model. METHODS: A single operator provided positive pressure ventilation to a low compliance test lung model (Crs 0.2-1 mL/cmH2O) at set PIP of 15, 25, 35 and 40 cmH2O. Two TPR devices with known spikes (Draeger Resuscitaire, GE Panda) were compared with handheld Neopuff (NP). Recommended settings for positive end-expiratory pressure (5 cmH2O), inflation rate of 60/min and gas flow rate 10 L/min were used. RESULTS: 2293 inflations were analysed. Draeger and GE TPR drivers delivered higher mean PIP (Panda 18.9-49.5 cmH2O; Draeger 21.2-49.2 cmH2O and NP 14.8-39.9 cmH2O) compared with set PIP and tidal volumes (TVs) compared with the NP (Panda 2.9-7.8 mL; Draeger 3.8-8.1 mL; compared with NP 2.2-6.0 mL), outside the prespecified acceptable range (±10% of set PIP and ±10% TV compared with NP). CONCLUSION: The observed spike in PIP over set values with Draeger and GE Panda systems resulted in significantly higher delivered volumes compared with the NP with identical settings. Manufacturers need to address these differences. The effect on patient outcomes is unknown.


Assuntos
Complacência Pulmonar/fisiologia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Desenho de Equipamento , Humanos , Recém-Nascido , Manequins
8.
Anesth Analg ; 132(1): 38-45, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315602

RESUMO

BACKGROUND: Numerous barrier devices have recently been developed and rapidly deployed worldwide in an effort to protect health care workers (HCWs) from exposure to coronavirus disease 2019 (COVID-19) during high-risk procedures. However, only a few studies have examined their impact on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19. METHODS: Two commonly used barrier devices, an intubation box and a clear plastic intubation sheet, were evaluated using a physiologically accurate cough simulator. Aerosols were modeled using a commercially available fog machine, and droplets were modeled with fluorescein dye. Both particles were propelled by the cough simulator in a simulated intubation environment. Data were captured by high-speed flash photography, and aerosol and droplet dispersion were assessed qualitatively with and without a barrier in place. RESULTS: Droplet contamination after a simulated cough was seemingly contained by both barrier devices. Simulated aerosol escaped the barriers and flowed toward the head of the bed. During barrier removal, simulated aerosol trapped underneath was released and propelled toward the HCW at the head of the bed. Usage of the intubation sheet concentrated droplets onto a smaller area. If no barrier was used, positioning the patient in slight reverse Trendelenburg directed aerosols away from the HCW located at the head of the bed. CONCLUSIONS: Our observations imply that intubation boxes and sheets may reduce HCW exposure to droplets, but they both may merely redirect aerosolized particles, potentially resulting in increased exposure to aerosols in certain circumstances. Aerosols may remain within the barrier device after a cough, and manipulation of the box may release them. Patients should be positioned to facilitate intubation, but slight reverse Trendelenburg may direct infectious aerosols away from the HCW. Novel barrier devices should be used with caution, and further validation studies are necessary.


Assuntos
/terapia , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Exposição por Inalação/prevenção & controle , Intubação Intratraqueal , Exposição Ocupacional/prevenção & controle , Equipamento de Proteção Individual , Aerossóis , Humanos , Exposição por Inalação/efeitos adversos , Intubação Intratraqueal/efeitos adversos , Manequins , Teste de Materiais , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador
9.
PLoS One ; 15(12): e0242704, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351854

RESUMO

In this study we present a kinematic approach for modeling needle insertion into soft tissues. The kinematic approach allows the presentation of the problem as Dirichlet-type (i.e. driven by enforced motion of boundaries) and therefore weakly sensitive to unknown properties of the tissues and needle-tissue interaction. The parameters used in the kinematic approach are straightforward to determine from images. Our method uses Meshless Total Lagrangian Explicit Dynamics (MTLED) method to compute soft tissue deformations. The proposed scheme was validated against experiments of needle insertion into silicone gel samples. We also present a simulation of needle insertion into the brain demonstrating the method's insensitivity to assumed mechanical properties of tissue.


Assuntos
Injeções/estatística & dados numéricos , Modelos Estatísticos , Agulhas , Silicones/análise , Fenômenos Biomecânicos , Encéfalo/anatomia & histologia , Simulação por Computador , Humanos , Injeções/instrumentação , Injeções/métodos , Manequins , Modelos Anatômicos , Silicones/química , Estresse Mecânico
10.
PLoS One ; 15(11): e0242154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33211728

RESUMO

Difficult airways can be managed with a range of devices, with video laryngoscopes (VLs) being the most common. The C-MAC® Video-Stylet (VS; Karl-Storz Germany), a hybrid between a flexible and a rigid intubation endoscope, has been recently introduced. The aim of this study is to investigate the performance of the VS compared to a VL (C-MAC Macintosh blade, Karl-Storz Germany) with regards to the learning curve for each device and its ability to manage a simulated difficult airway manikin. This is a single-center, prospective, randomized, crossover study involving twenty-one anesthesia residents performing intubations on a Bill 1™ (VBM, Germany) airway manikin model. After a standardized introduction, six randomized attempts with VL and VS were performed on the manikin. This was followed by intubation in a simulated difficult airway (cervical collar and inflated tongue) with both devices in a randomized fashion. The primary end-point of this study was the total time to intubation. All continuous variables were expressed as the median [interquartile range] and analyzed using the Mann-Whitney U test. A 2-way ANOVA with Bonferroni's post hoc test was used to compare both devices at each trial. All reported p values are two sided. The median total time to intubation on a simulated difficult airway was faster with the VS compared to VL (17 [13.5-25] sec vs 23 [18.5-26.5] sec, respectively; 95% CI; P = 0.031). Additionally, on a normal airway manikin, the VS has a comparable learning curve to the VL. In this manikin-based study, the novel VS was comparable to the VL in terms of learning curve in a normal airway. In a simulated difficult airway, the total time to intubation, though likely not clinically relevant, was faster with the VS to the VL. However, given the above findings, this study justifies further human clinical trials with the VS to see if similar benefits-faster time to intubation and similar learning curve to VL-are replicated clinically.


Assuntos
Anestesiologia/educação , Intubação Intratraqueal/instrumentação , Intubação/métodos , Laringoscopia/métodos , Curva de Aprendizado , Manequins , Anestesia , Vértebras Cervicais , Estudos Cross-Over , Glote/fisiologia , Humanos , Laringoscópios , Estudos Prospectivos , Língua , Gravação em Vídeo
12.
Medicine (Baltimore) ; 99(48): e23374, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235109

RESUMO

Potential attributes of virtual reality (VR) can be a breakthrough in the improvement of sudden cardiac arrest (SCA) training. However, interference with the virtual world is associated with the need of placing additional equipment on the trainee's body. The primary aim of the study was to evaluate if it does not affect the quality of chest compressions (CCs).91 voluntarily included in the study medical students participated twice in the scenario of SCA - Traditional Scenario (TS) and Virtual Reality Scenario (VRS). In both cases two minutes of resuscitation was performed.If VRS was the first scenario there were significant differences in CCs depth (VRS - Me = 47 mm [IQR 43 - 52] vs TS - Me = 48 mm [IQR 43 - 55]; P = .02) and chest relaxation (VRS - Me = 37% [IQR 5 - 91] vs TS - Me = 97% [IQR 87 - 100]; P < .001). 97.8% of respondents believe that training with the use of VR is more effective than a traditional method (P < .01). Most of the study group (91%, P < .01) denied any negative symptoms during the VR scenario.Virtual reality can be a safe and highly valued by medical students, method of hands-on CPR training. However additional VR equipment placed on the trainee's body may cause chest compressions harder to provide. If it is not preceded by traditional training, the use of VR may have an adverse impact on depth and full chest relaxation during the training. To make the best use of all the potential that virtual reality offers, future studies should focus on finding the most effective way to combine VR with traditional skill training in CPR courses curriculum.


Assuntos
Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/normas , Competência Clínica/normas , Parada Cardíaca/terapia , Realidade Virtual , Adolescente , Reanimação Cardiopulmonar/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Manequins , Estudantes de Medicina , Adulto Jovem
13.
Am J Emerg Med ; 38(10): 2019-2027, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33142168

RESUMO

OBJECTIVE: Lifeguard teams carry out their work in extremely hot conditions in many parts of the world. The aim of this study was to analyze the impact of high temperatures on physiological parameters during cardiopulmonary resuscitation (CPR). METHOD: A randomized quasi-experimental cross-over design was used to test physiological lifesaving demands (50 min acclimatization +10 min CPR) in two different thermal environments: Thermo-neutral environment (25 °C) vs Hyperthermic environment (37 °C). RESULTS: The data obtained from 21 lifeguards were included, this covers a total of 420 min of resuscitation. The CPR performance was constantly maintained during the 10 min. The Oxygen uptake (VO 2) ranged from 17 to 18 ml/min/kg for chest compressions (CC) and between 13 and 14 ml/min/kg for ventilations (V) at both 25 °C and 37 °C, with no significant difference between environments (p > 0.05). The percentage of maximum heart rate (%HR max) increased between 7% and 8% at 37 °C (p < 0.001), ranging between 75% and 82% of HR max. The loss of body fluids (LBF) was higher in the hyperthermic environment; LBF: (37 °C: 400 ± 187 g vs 25 °C: 148 ± 81 g, p < 0.001). Body temperature was 1 °C higher at the end of the test (p < 0.001). The perceived fatigue (RPE) increased by 37° an average of 2 points on a scale of 10 (p = 0.001). CONCLUSIONS: Extreme heat is not a limiting factor in CPR performance with two lifeguards. Metabolic consumption is sustained, with an increase in CC, so V can serve as active rest. Nevertheless, resuscitation at 37 °C results in a higher HR, is more exhausting and causes significant loss of fluids due to sweating.


Assuntos
Reanimação Cardiopulmonar/métodos , Calor Extremo/efeitos adversos , Esforço Físico/fisiologia , Trabalho de Resgate/normas , Adulto , Análise de Variância , Reanimação Cardiopulmonar/efeitos adversos , Estudos Cross-Over , Feminino , Humanos , Masculino , Manequins , Simulação de Paciente , Trabalho de Resgate/métodos , Trabalho de Resgate/estatística & dados numéricos , Espanha
14.
Am J Emerg Med ; 38(11): 2395-2399, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33039225

RESUMO

OBJECTIVE: Introducing a new, simple and inexpensive portable equipment for lifeguards, consisting of a pre-assembled full-size plastic blanket with a mask and HEPA filter, which could offer significant time-saving advantages to reduce COVID-19 risk transmission in the first few minutes of CPR after water rescue, avoiding the negative impact of delayed ventilation. METHOD: A pilot study was carried out to determine the feasibility of the pre-assembled kit of face-mask and HEPA filter adapted on a pre-set plastic-blanket. The first step consisted of washing hands, putting on safety glasses and gloves as the first personal protection equipment (PPE) and then covering the victim with an assembled plastic blanket. The second step consisted of 10 min of cardiopulmonary resuscitation (CPR) with PPE and plastic blanket, following the technical recommendations for ventilation during COVID-19. RESULTS: Ten rescuers took part in the pilot study. The average time to wear PPE and place the pre-assembly kit on the victim was 82 s [IC 58-105]. After 10 min the quality of the resuscitation (QCPR) was 91% [87-94]. Quality chest compressions (CC) were 22% better than ventilations (V). Most of the rescuers (60%) thought that placing the plastic blanket on the victim on the beach was somewhat simple or very simple. CONCLUSIONS: Resuscitation techniques in COVID-19 era at the beach have added complexities for the correct use of PPE. Plastic blanket plus basic ventilations equipment resource could be a new alternative to be considered for lifeguards to keep ventilation on use while reducing risk transmission.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Máscaras , Afogamento Iminente/terapia , Equipamento de Proteção Individual , Filtros de Ar , Praias , Reanimação Cardiopulmonar/métodos , Afogamento , Socorristas , Humanos , Manequins , Projetos Piloto , Plásticos
15.
Pediatrics ; 146(Suppl 2): S155-S164, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33004638

RESUMO

Ninety percent of intrapartum-related neonatal deaths are attributable to respiratory depression, with the vast majority of these deaths occurring in low- and lower-middle-income countries. Neonatal resuscitation training with Helping Babies Breathe (HBB) decreases mortality from respiratory depression. Cardiorespiratory monitoring in conjunction with HBB can provide valuable resuscitation feedback for both training and bedside purposes. In this article, we discuss 3 innovations that couple cardiorespiratory monitoring with HBB: NeoNatalie Live, the Augmented Infant Resuscitator, and NeoBeat. NeoNatalie Live is a high-fidelity manikin that facilitates bag mask ventilation training through case scenarios of varying difficulty. The Augmented Infant Resuscitator is added in-line between a face mask and ventilation bag during bag mask ventilation training to provide users with real-time feedback on ventilation quality. NeoBeat is a battery-operated heart rate meter that digitally displays the newborn heart rate during bedside resuscitations. For each innovation, we review details of the device, implementation in the field, and areas for further research. Using early experience implementing these devices, we suggest building blocks for effective translation of training into improved care. We also highlight general challenges in implementation of devices in facilities in low- and lower-middle-income countries including considerations for training, adaptations to existing workflow, and integration into the ecosystem. Although the devices highlighted in this article hold promise, more data are needed to understand their impact on newborn outcomes.


Assuntos
Asfixia Neonatal/terapia , Ressuscitação/educação , Frequência Cardíaca , Humanos , Recém-Nascido , Manequins , Monitorização Fisiológica , Respiração
16.
West J Emerg Med ; 21(6): 78-82, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-33052809

RESUMO

INTRODUCTION: The use of transparent plastic aerosol boxes as protective barriers during endotracheal intubation has been advocated during the severe acute respiratory syndrome coronavirus 2 pandemic. There is evidence of worldwide distribution of such devices, but some experts have warned of possible negative impacts of their use. The objective of this study was to measure the effect of an aerosol box on intubation performance across a variety of simulated difficult airway scenarios in the emergency department. METHODS: This was a randomized, crossover design study. Participants were randomized to intubate one of five airway scenarios with and without an aerosol box in place, with randomization of intubation sequence. The primary outcome was time to intubation. Secondary outcomes included number of intubation attempts, Cormack-Lehane view, percent of glottic opening, and resident physician perception of intubation difficulty. RESULTS: Forty-eight residents performed 96 intubations. Time to intubation was significantly longer with box use than without (mean 17 seconds [range 6-68 seconds] vs mean 10 seconds [range 5-40 seconds], p <0.001). Participants perceived intubation as being significantly more difficult with the aerosol box. There were no significant differences in the number of attempts or quality of view obtained. CONCLUSION: Use of an aerosol box during difficult endotracheal intubation increases the time to intubation and perceived difficulty across a range of simulated ED patients.


Assuntos
/prevenção & controle , Serviço Hospitalar de Emergência , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Intubação Intratraqueal/instrumentação , Equipamento de Proteção Individual , Treinamento por Simulação , /transmissão , Estudos Cross-Over , Medicina de Emergência/educação , Humanos , Internato e Residência , Manequins , Tempo para o Tratamento
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5455-5458, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019214

RESUMO

Neonatal endotracheal intubation (ETI) is an important, complex resuscitation skill, which requires a significant amount of practice to master. Current ETI practice is conducted on the physical manikin and relies on the expert instructors' assessment. Since the training opportunities are limited by the availability of expert instructors, an automatic assessment model is highly desirable. However, automating ETI assessment is challenging due to the complexity of identifying crucial features, providing accurate evaluations and offering valuable feedback to trainees. In this paper, we propose a dilated Convolutional Neural Network (CNN) based ETI assessment model, which can automatically provide an overall score and performance feedback to pediatric trainees. The proposed assessment model takes the captured kinematic multivariate time-series (MTS) data from the manikin-based augmented ETI system that we developed, automatically extracts the crucial features of captured data, and eventually provides an overall score as output. Furthermore, the visualization based on the class activation mapping (CAM) can automatically identify the motions that have significant impact on the overall score, thus providing useful feedback to trainees. Our model can achieve 92.2% average classification accuracy using the Leave-One-Out-Cross-Validation (LOOCV).


Assuntos
Intubação Intratraqueal , Redes Neurais de Computação , Criança , Retroalimentação , Humanos , Recém-Nascido , Manequins , Movimento (Física)
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2274-2278, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018461

RESUMO

We have refactored the Pulse Physiology Engine respiratory software with enhanced parameterization for improved simulation functionality and results. Realistic patient variability can be applied using discretized lumped-parameters that define lung volumes, compliances, and resistances. A new sigmoid compliance waveform helps meet validation of compartment pressures, flows, volumes, and substance values. Further parameterization and enhanced logic for the application of pathophysiology allows for more accurate modeling of both restrictive and obstructive diseases for mild, moderate, and severe cases.Clinical Relevance- This free and open model provides a well-validated respiratory system for integration with medical simulations and research. It improves the Pulse modeling software and allows for new, low-cost training and in silico testing use-cases. Applications include virtual/augmented environments, manikin-based simulations, and clinical explorations.


Assuntos
Pulmão , Software , Simulação por Computador , Humanos , Manequins , Volume de Ventilação Pulmonar
19.
Simul Healthc ; 15(6): 447-448, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33003128

RESUMO

STATEMENT: The dramatic outbreak of COVID-19 placed unprecedented strain on the critical care workforce of New York City. The enhanced precautions required to safely care for COVID-19 patients impacted the performance of even routine critical care procedures. Meanwhile, staff were stretched to care for exponentially rising case volume as COVID intensive care units (ICUs) expanded. Simulation was used to bridge these gaps-first to familiarize personnel within the Division of Pulmonary and Critical Care with revised COVID-19 care procedures, then to orient noncritical care clinicians volunteering from other specialties for COVID ICU deployment to general critical care and COVID-19 care principles. Using mannequin-based simulation scenarios followed by comprehensive debriefing sessions, simulation participants received high-intensity, high-fidelity training in respiratory failure, circulatory failure, bedside ultrasound, bedside ICU procedures, and elements of COVID-19-specific care. More than 200 physicians and advanced practice practitioners completed simulation training in preparation for deployment, supplementing and enhancing the ICU workforce at a decisive time during the outbreak.


Assuntos
/epidemiologia , Cuidados Críticos/organização & administração , Pessoal de Saúde/educação , Treinamento com Simulação de Alta Fidelidade/organização & administração , Unidades de Terapia Intensiva/organização & administração , Cuidados Críticos/normas , Humanos , Unidades de Terapia Intensiva/normas , Manequins , Pandemias , Insuficiência Respiratória/terapia , Choque/terapia
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