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Sudden cardiac arrest is one of the leading causes of death globally. The recommended clinical management in out-of-hospital cardiac arrest cases is the immediate initiation of high-quality cardiopulmonary resuscitation (CPR). Training mannequins should be combined with technology that provides students with detailed immediate feedback on the quality of CPR performance. This study aimed to verify the impacts of the type of feedback (basic or detailed) the responders receive from the device while learning CPR and how it influences the quality of their performance and the motivation to improve their skills. The study was conducted at the Medical University of Lublin among 694 multi-professional health students during first aid classes on basic life support (BLS). The students first practiced on an adult mannequin with a basic control panel, afterward, the same mannequin was connected to a laptop, ensuring a detailed record of the performed activities through a projector. Next, the participants expressed their subjective opinion on how the feedback provided during the classes, basic vs. detailed, motivated them to improve the quality of their CPR performance. Additionally, during the classes, the instructor conducted an extended observation of students’ work and behavior. In the students’ opinion, the CPR training with detailed feedback devices provided motivation for learning and improving CPR proficiency than that with a basic control panel. Furthermore, the comments given from devices seemed to be more acceptable to the students, who did not see any bias in the device’s evaluation compared to that of the instructor. Detailed device feedback motivates student health practitioners to learn and improve the overall quality of CPR. The use of mannequins that provide detailed feedback during BLS courses can improve survival in out-of-hospital cardiac arrest.

Human patient simulation uses technology to add advancements to learning that traditional learning methods cannot. Many programs are fast-paced and do not provide students with many hands-on experiences before clinical experiences. The literature notes the benefits of human patient simulation in other healthcare programs, yet limited studies exist in occupational therapy. This study examined student perspectives on the use of human patient simulators in occupational therapy curriculum. 146 first year master of occupational therapy students completed an open-ended survey after an evaluation experience with a physiologically based human patient simulator. Responses were collected during four consecutive years. Transcripts were analyzed using qualitative content analysis. Four themes emerged and centered on the value of hands-on learning, team and family dynamics, the human experience, and relevance of clinically applicable skills. Findings indicate that students perceive this type of learning as beneficial before taking the next step towards fieldwork, and programs should consider offering a variety of simulated patient cases throughout the curriculum.

Fındık, Meliha (Balikesir Author), Background: Video laryngoscopy (VL) has recently been put into clinical use to minimize the limitations of direct laryngoscopy and assist physicians interested in airway management. However, the high cost is the biggest constraint especially in countries with limited resources. To lower the cost, a custom-made VL obtained by attaching a USB-endoscope camera ($8.5) to the Macintosh laryngoscope (USB-L) can be used. Material and Methods: All intubations were performed in a difficult intubation model. Intubations were carried out by two emergency physicians. A Glidescope as a VL and a custom-made USB-L were used. In addition to these devices, one bougie to facilitate the advancement of the tube was used. The total intubation time was evaluated. Results: Correct tube placement for both operators was 100% for both devices. A difference between the operators in the duration of intubations could not be found. Also, there is no difference in the duration of intubations between the devices for both operators. Conclusion: It was concluded that the USB-L and VL are not statistically different in terms of intubation time in the difficult intubation model using bougie. For countries with limited resources, the low-cost USB-L has come to the forefront due to the high cost of VL and difficulty of access. © 2021 Via Medica.

Rhinopharyngeal swab collection is used to test patients for COVID-19; unfortunately, the false negative rate is around 30% in symptomatic patients, and maybe even higher in asymptomatic ones. A correct swab collection is consequently critical. Swabs are usually performed by dedicated personnel, but at the present moment, the methods for its training are not standardized. In a Letter to the Editor recently published in the European Archives of Otorhinolaringology, Tagliabue et al. describe the training method used in their Institution: the personnel dedicated to swab collection increases its confidence with the procedure by observing endoscopic anatomy, while an otolaryngologist performs rigid endoscopy. Although we found this paper interesting, we think that the author's proposal has timing and financial drawbacks that should be considered in daily activity, especially in an emergency period like the pandemic we are experiencing. In this Letter to the Editor, we discuss some pre-analytic and analytic issues that should be considered while performing rhinopharyngeal swabs, and we propose the use of a mannequin to train personnel, thus reducing the risk of infection for health workers, and patient's discomfort.

Background Cardiopulmonary resuscitation (CPR) is an emergency procedure that can increase survival after a cardiac arrest. Performing CPR effectively requires both procedural knowledge and manual skills. Traditional CPR training methodology includes lessons led by instructors and supervised practice on mannequins, thus requiring considerable resources. Objective This paper proposes a new methodology for low-cost CPR training based on virtual reality (VR) with and without the addition of a physical mannequin. Moreover, it describes an experimental evaluation of the methodology that assessed gain in manual skills during training, transfer of procedural knowledge and manual skills in a final assessment, and changes in self-efficacy with three measurements over time (pre-training, post-training, and post-assessment). Methods We implemented a VR application that supports the proposed methodology, and can thus be used with or without a mannequin. The experimental evaluation involved 30 participants who tried CPR in VR twice, performing two repetitions of 30 chest compressions per trial. Half participants tried the VR application with the mannequin and half without it. Final assessment required all participants to perform CPR on the mannequin without the assistance of VR. To assess self-efficacy, participants filled in a questionnaire at the three times of measurement. Results Mixed-design ANOVAs showed effects of repetition, effects of group, or interaction between the two variables on manual skills assessed during training. In the final assessment, participants in both groups correctly remembered most of the steps of the procedure. ANOVAs revealed differences between the two groups only in pressure-related skills (better with mannequin) and in the number of wrong steps added to the procedure (better without mannequin). Mixed-design ANOVA showed a self-efficacy increase in both groups after training, which was maintained after final assessment. Conclusions The proposed VR methodology for CPR training has a positive effect on procedural knowledge, manual skills, and self-efficacy, with as well as without the physical mannequin. Trials on a mannequin are required to understand the correct pressure for chest compression. This supports the adoption of the proposed VR methodology to reduce instructor and mannequin time required to teach CPR to trainees.

Purpose of the study Pleural diseases are common in clinical practice. Doctors in training often encounter these patients and are expected to perform diagnostic and therapeutic pleural procedures with confidence and safely. However, pleural procedures can be associated with significant complications, especially when performed by less experienced. Structured training such as use of training manikin and procedural skills workshop may help trainee doctors to achieve competence. However, high costs involved in acquiring simulation technology or attending a workshop may be a hurdle. We hereby describe a training model using a simple manikin developed in our institution and provide an effective way to document skill acquisition and assessment among trainee medical officers. Study design This was a prospective observational study. The need for training, competence and confidence of trainees in performing pleural procedures was assessed through an online survey. Trainees underwent structured simulation training through a simple manikin developed at our institute. Follow-up survey after the training was then performed to access confidence and competence in performing pleural procedures. Results Forty-seven trainees responded to an online survey and 91% of those expressed that they would like further training in pleural procedure skills. 81% and 85% of responders, respectively, indicated preferred method of training is either practising on manikin or performing the procedure under supervision. Follow-up survey showed improvement in the confidence and competence. Conclusion Our pleural procedure training manikin model is a reliable, novel and cost-effective method for acquiring competences in pleural procedures.

Background Trivial pain or minor soreness commonly follows neck manipulation and has been estimated at one in three treatments. In addition, rare catastrophic events can occur. Some of these incidents have been ascribed to poor technique where the neck is rotated too far. The aims of this study were to design an instrument to measure competency of neck manipulation in beginning students when using a simulation mannequin, and then examine the suitability of using a simulation mannequin to teach the early psychomotor skills for neck chiropractic manipulative therapy. Methods We developed an initial set of questionnaire items and then used an expert panel to assess an instrument for neck manipulation competency among chiropractic students. The study sample comprised all 41 fourth year 2014 chiropractic students at Murdoch University. Students were randomly allocated into either a usual learning or mannequin group. All participants crossed over to undertake the alternative learning method after four weeks. A chi-square test was used to examine differences between groups in the proportion of students achieving an overall pass mark at baseline, four weeks, and eight weeks. Results This study was conducted between January and March 2014. We successfully developed an instrument of measurement to assess neck manipulation competency in chiropractic students. We then randomised 41 participants to first undertake either “usual learning” (n = 19) or “mannequin learning” (n = 22) for early neck manipulation training. There were no significant differences between groups in the overall pass rate at baseline (χ2 = 0.10, p = 0.75), four weeks (χ2 = 0.40, p = 0.53), and eight weeks (χ2 = 0.07, p = 0.79). Conclusions This study demonstrates that the use of a mannequin does not affect the manipulation competency grades of early learning students at short term follow up. Our findings have potentially important safety implications as the results indicate that students could initially gain competence in neck manipulation by using mannequins before proceeding to perform neck manipulation on each other.

There are limited data on the effectiveness of mannequin-based simulations in pediatrics. This study developed a training program using a high-fidelity child mannequin to simulate critical cases in an emergency department, and examined the learning gains derived from this simulation. Eighteen pediatric residents, as pairs, participated in a high-fidelity simulation pretest, training session and a posttest. The training session, developed based on participants' pretest performance, included videotape review, feedback, and hands-on practice, and focused on the improvement of management skills for shock and tachydyspnea. The pre- and posttest performances were scored for task-specific technical skills and behaviors. The learning gains between the pre- and posttests were significant (p0.001) for task-specific technical skills (from 64 +/- 15% to 93 +/- 4%) and behaviors (from 65 +/- 18% to 85 +/- 12%). This study suggests that high-fidelity simulation can enhance learning about how to manage critical cases in the pediatric emergency department.

Objective Some cardiopulmonary resuscitation (CPR) monitoring devices were released in recent years. Some of them are motion sensors. There are no guidelines were to position future or present sensors during CPR. We evaluate the possible influence of the location of motion sensors by a high-speed camera during a CPR on a manikin. Material and methods We performed a motion analysis by a high-speed camera during chest compression (CC) on a manikin to quantify chest inhomogeneous displacements and rescuer motion. Results Midline chest was found to have an inhomogeneous depth during CC (19 mm for the upper sternum, 27 mm for the middle of the sternum, and 47 mm for the xiphoid). Rescuer anatomy has a complex motion. Conclusion The direct application of the sensor under the hand performing CC seems to be the more accurate solution if the device allows it.

Background. We aimed at comparing the performance of the C-MAC (R), Airtraq (R), and Macintosh laryngoscopes when performing tracheal intubation in patients undergoing neck immobilization using manual inline axial cervical spine stabilization. Methods. Ninety consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a C-MAC (R) (n = 30), Airtraq (R) (n = 29), or Macintosh (n = 31) laryngoscope. All patients were intubated by one anaesthetist experienced in the use of each laryngoscope. Results. The Airtraq (R) laryngoscope performed best in these patients, reducing the Intubation Difficulty Scale score, improving the Cormack and Lehane glottic view, and reducing the need for optimization manoeuvres, compared with both the Macintosh and the C-MAC (R). The C-MAC (R) and Macintosh laryngoscopes performed similarly. There were no differences in success rates or haemodynamic profiles post-intubation between any of the devices tested. Conclusions. The Airtraq (R) laryngoscope performed better than the C-MAC (R) and Macintosh laryngoscopes in patients undergoing cervical immobilization.

Summary With concerns about the potential for the aerosol and airborne transmission of infectious agents, particularly influenza, more attention is being focused on the effectiveness of infection control procedures to prevent hospital-acquired infections by this route. More recently a number of different techniques have been applied to examine the temporal–spatial information about the airflow patterns and the movement of related, suspended material within this air in a hospital setting. Closer collaboration with engineers has allowed clinical microbiologists, virologists and infection control teams to assess the effectiveness of hospital isolation and ventilation facilities. The characteristics of human respiratory activities have also been investigated using some familiar engineering techniques. Such studies aim to enhance the effectiveness of such preventive measures and have included experiments with human-like mannequins using various tracer gas/particle techniques, real human volunteers with real-time non-invasive Schlieren imaging, numerical modelling using computational fluid dynamics, and small scale physical analogues with water. This article outlines each of these techniques in a non-technical manner, suitable for a clinical readership without specialist airflow or engineering knowledge.

32ième congrès de la Société de Biomécanique, LYON, FRANCE, 28-/08/2007 - 29/08/2007; The WorldSID program was set up to develop a new, worldwide acceptable, advanced technology, side impact crash test dummy for improved assessment of injury risk to car occupants in lateral collisions. Following the release of the mid-sized male WorldSID, the development of the small female WorldSID dummy was initiate under the European Commission Integrated Project 'APROSYS' (Been et al. 2006, 2007). The main specifications and requirements of the new dummy have been defined in terms of anthropometry, biomechanical response and instrumentation capabilities in general and per body segment, by the APROSYS WP5.2 team. The prototype was subjected to an extensive set of biomechanical, durability and sensitivity tests using, pendulum, linear guided mass impactor and sled. The paper consists of the results performed at the pelvis with a linear guided impactor and the comparison of dummy prototype responses and its response requirements.

Monique Cachia,1 Michael Pace-Bardon,2 Gabriella Balzan,2 Russel Tilney,2 Josef Micallef,2 Martin Balzan2 1Department of Medicine, 2Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta Background: A study evaluating subjective trainee responses to simulation training organized by the Malta Foundation Program in particular whether this changed their clinical practice. Method: Feedback using a standardized questionnaire was obtained from 120 (M=55%) participants. A 0–10 Likert scale was used to evaluate responses. Results: Participants scored the simulation sessions as “useful” at 7.7 (95% confidence interval [CI] 7.4–8.0), rated “the overall experience” at 7.5 (95% CI 7.2–7.8), and thought it made a change in “daily practice” at 5.83 (95% CI 5.4–6.3). The score for the tutor “creating a satisfactory learning environment” and “quality of simulator equipment” was 7.8 (95% CI 7.6–8.1) and 7.7 (95% CI 7.4–8), respectively. Trainees rated “how close was the simulation to a real-life scenario” as 6.24 (95% CI 5.9–6.6). When asked whether the presence of colleagues hindered or helped, the majority were neutral 50 (41.7%), 36 (30%) said it hindered, while only 21 (28.3%) felt it helped. In contrast, 94 (78.33%) stated it was useful to observe colleagues while only 5 (4.2%) stated it was not. Likelihood for future participation was 7.4 (95% CI 7–7.8). Trainees recommended a median of 3 (interquartile range 2–5) simulations per year. Conclusion: Trainees rated the sessions as useful and asked for more sessions possibly at an undergraduate level. Rating for equipment and tutors was positive; however, some felt that the effect on daily practice was limited. Most were comfortable observing others and uncomfortable being observed. The value of increasing sessions to 3–4 per year, timing them before clinical attachments and audiovisual prebriefing for candidates naïve to simulation needs to be evaluated in future studies. Keywords: simulation, foundation, training, acute, medical, mannequin

The Airtraq((R)) laryngoscope is a novel single use tracheal intubation device. We compared the Airtraq((R)) with the Macintosh laryngoscope in patients deemed at low risk for difficult intubation in a randomised, controlled clinical trial. Sixty consenting patients presenting for surgery requiring tracheal intubation were randomly allocated to undergo intubation using a Macintosh (n = 30) or Airtraq((R)) (n = 30) laryngoscope. All patients were intubated by one of four anaesthetists experienced in the use of both laryngoscopes. No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, was successfully intubated on the first attempt. There was no difference between groups in the duration of intubation attempts. In comparison to the Macintosh laryngoscope, the Airtraq((R)) resulted in modest improvements in the intubation difficulty score, and in ease of use. Tracheal intubation with the Airtraq((R)) resulted in less alterations in heart rate. These findings demonstrate the utility of the Airtraq((R)) laryngoscope for tracheal intubation in low risk patients.

Background Airway management is of essential importance in emergency care. Training and skill retention of endotracheal intubation (ETI) - the technique considered as the "gold standard" -, poses a problem especially among care providers experiencing a low frequency of airway management situations. Therefore, alternative airway devices such as the laryngeal tube (LT) with potentially steeper learning curves have been developed and studied. Our aim was to evaluate in a manikin model the use of LT after no other training than written instructions only. Methods To evaluate the amount of training required to use the LT in a scenario of airway compromise, we assessed the feasibility of providing written instructions and pictures showing its use to 67 out- and in-hospital emergency care providers attending an Emergency Care conference. The majority of the participants were either nurses or firemen with a median of 5 years' history of work in emergency care. Results In this study 55% of all participants inserted the LT on the first attempt without additional instructions. An additional 42% required verbal instructions before successful insertion. Overall, 97% of the participants successfully inserted the LT with two attempts. In logistic regression analysis, no relationship was detected between background variables (basic education, experience of emergency work, frequency of bag-valve-mask ventilation (BVM) and frequency of ETI) and successful insertion of the LT in less than 30 seconds, ability to maintain normoventilation (7 l/min) and need for further instructions during the test. Conclusions We found that in this pilot study majority of emergency care providers could insert LT with one or two attempts with written instructions, pictures and verbal instruction. This may provide an option to simplify the training of airway management with LT.