Evaluation of facial features on particle inhalation.
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Computational fluid dynamics (CFD) and numerical investigations of particle inhalability and contaminant exposure have used simple geometrical surrogates for a breathing human form, but the effect of eliminating facial features has not been investigated. In this work, the velocity field and particle aspiration associated with two differently shaped mannequins were investigated to determine if an elliptical form was sufficient to represent the complexity of fluid flow associated with an inhaling human. Laser Doppler anemometry was used to measure velocity, and both optical sizing and gravimetric analysis were used to measure particle aspiration from an aerosol source. All tests were performed with continuous inhalation through the mouth, with the mannequin facing the 0.3 m s(-1) freestream. Although limitations in the laser Doppler optics prevented velocity measurements at distances <11 mm in front of the mannequin mouth opening, significant velocity differences were identified up to 20 mm in front of the mouth opening. This indicated that facial features affected the flow field near the face only. Owing to these differences, particle aspiration was compared between mannequins for three different velocity ratio conditions using an aerosol source. Even with relatively large variability in the aspirated concentration in this study, the aspirated mass concentration was significantly less for the anatomical mannequin relative to the elliptical form. Thus, the simplified elliptical cylinder does not sufficiently characterize the fluid dynamics near the mouth of an inhaling human form at these limited test conditions. Future CFD and numerical simulations to investigate human aspiration of particles should incorporate the complex features of the human face to investigate adequately particle aspiration in low velocity environments. (+info)
The effects of finger rest positions on hand muscle load and pinch force in simulated dental hygiene work.
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One of the techniques taught in dental and dental hygiene programs is to use finger rests to stabilize the instrument while performing dental scaling or other types of dental work. It is believed that finger rests may also reduce muscle stress and prevent injury due to muscle fatigue. In this study the effects of three different finger rest positions on hand muscle activity and thumb pinch force were compared. Twelve predental students performed simulated dental scaling tasks on a manikin using three different finger rest positions: 1) no finger rest, 2) one finger rest, and 3) two finger rests. Muscle activity and thumb pinch force were measured by surface electromyography and a pressure sensor, respectively. Using two finger rests was always associated with reduced thumb pinch force and muscle activity, as compared to not using any finger rests (p<0.05), while using one finger rest reduced thumb pinch force and muscle activity in most cases. Hence, using finger rests plays an important role in reducing the muscle load of the hand in students performing simulated dental hygiene work. It is concluded that dental and dental hygiene students may benefit from instructions for using finger rests at an early stage of their clinical training. Including biomechanical and ergonomic principles in dental and dental hygiene curricula will raise awareness of ergonomics among dental practitioners and help them incorporate these principles into daily practice. (+info)
Neonatal resuscitation 3: manometer use in a model of face mask ventilation.
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BACKGROUND: Adequate ventilation is the key to successful neonatal resuscitation. Positive pressure ventilation (PPV) is initiated with manual ventilation devices via face masks. These devices may be used with a manometer to measure airway pressures delivered. The expiratory tidal volume measured at the mask (V(TE(mask))) is a good estimate of the tidal volume delivered during simulated neonatal resuscitation. AIM: To assess the effect of viewing a manometer on the peak inspiratory pressures used, the volume delivered, and leakage from the face mask during PPV with two manual ventilation devices in a model of neonatal resuscitation. METHODS: Participants gave PPV to a modified resuscitation mannequin using a Laerdal infant resuscitator and a Neopuff infant resuscitator at specified pressures ensuring adequate chest wall excursion. Each participant gave PPV to the mannequin with each device twice, viewing the manometer on one occasion and unable to see the manometer on the other. Data from participants were averaged for each device used with the manometer and without the manometer separately. RESULTS: A total of 7767 inflations delivered by the 18 participants were recorded and analysed. Peak inspiratory pressures delivered were lower with the Laerdal device. There were no differences in leakage from the face mask or volumes delivered. Whether or not the manometer was visible made no difference to any measured variable. CONCLUSIONS: Viewing a manometer during PPV in this model of neonatal resuscitation does not affect the airway pressure or tidal volumes delivered or the degree of leakage from the face mask. (+info)
Neonatal resuscitation 2: an evaluation of manual ventilation devices and face masks.
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BACKGROUND: The key to successful neonatal resuscitation is effective ventilation. Little evidence exists to guide clinicians in their choice of manual ventilation device or face mask. The expiratory tidal volume measured at the mask (V(TE(mask))) is a good estimate of the tidal volume delivered during simulated neonatal resuscitation. AIM: To compare the efficacy of (a) the Laerdal infant resuscitator and the Neopuff infant resuscitator, used with (b) round and anatomically shaped masks in a model of neonatal resuscitation. METHODS: Thirty four participants gave positive pressure ventilation to a mannequin at specified pressures with each of the four device-mask combinations. Flow, inspiratory tidal volume at the face mask (V(TI(mask))), V(TE(mask)), and airway pressure were recorded. Leakage from the mask was calculated from V(TI(mask)) and V(TE(mask)). RESULTS: A total of 10,780 inflations were recorded and analysed. Peak inspiratory pressure targets were achieved equally with the Laerdal and Neopuff resuscitators. Positive end expiratory pressure was delivered with the Neopuff but not the Laerdal device. Despite similar peak pressures, V(TE(mask)) varied widely. Mask leakage was large for each combination of device and mask. There were no differences between the masks. CONCLUSION: During face mask ventilation of a neonatal resuscitation mannequin, there are large leaks around the face mask. Airway pressure is a poor proxy for volume delivered during positive pressure ventilation through a mask. (+info)
Neonatal resuscitation 1: a model to measure inspired and expired tidal volumes and assess leakage at the face mask.
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BACKGROUND: Neonatal resuscitation is a common and important intervention, and adequate ventilation is the key to success. In the delivery room, positive pressure ventilation is given with manual ventilation devices using face masks. Mannequins are widely used to teach and practise this technique. During both simulated and real neonatal resuscitation, chest excursion is used to assess tidal volume delivery, and leakage from the mask is not measured. OBJECTIVE: To describe a system that allows measurement of mask leakage and estimation of tidal volume delivery. METHODS: Respiratory function monitors, a modified resuscitation mannequin, and a computer were used to measure leakage from the mask and to assess tidal volume delivery in a model of neonatal resuscitation. RESULTS: The volume of gas passing through a flow sensor was measured at the face mask. This was a good estimate of the tidal volume entering and leaving the lung in this model. Gas leakage between the mask and mannequin was also measured. This occurred principally during inflation, although gas leakage during deflation was seen when the total leakage was large. A volume of gas that distended the mask but did not enter the lung was also measured. CONCLUSION: This system can be used to assess the effectiveness of positive pressure ventilation given using a face mask during simulated neonatal resuscitation. It could be useful for teaching neonatal resuscitation and assessing ventilation through a face mask. (+info)
Teaching antiarrhythmic therapy and ECG in simulator-based interdisciplinary undergraduate medical education.
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BACKGROUND: Third-year students in the Dresden Medical School Programme undergo a 6 week course 'Basics of Drug Therapy' in a problem-based learning curriculum. As part of this course a practical seminar about antiarrhythmic drugs and ECG was set up. This study was conducted to evaluate the use of a simulator in this course. METHODS: A total of 234 students were randomly allocated to receive instructions with (Group S) or without (Group C [control]) the use of a simulator. After a lecture on antiarrhythmic drugs, arrhythmias were presented to Group S using an advanced life support (ALS) manikin. The students were asked to administer a drug or to defibrillate, and the outcome was shown on the monitor. The students in Group C were presented with ECG charts without a simulator. The course was evaluated by a questionnaire and multiple-choice questions (MCQ) about arrhythmias. RESULTS: We received 222 questionnaires. The content-time ratio was rated almost perfect in both groups, but the students in Group S rated the course better suited to link theory and practice. Students in Group S considered the simulator helpful and a good tool for teaching, and the extra effort to be worthwhile. A significantly higher number of students in Group S preferred electric cardioversion as therapy for ventricular tachycardia. CONCLUSIONS: An ALS manikin can be an effective tool in teaching clinical pharmacology. (+info)
Relationship between performance in dental school and performance on a dental licensure examination: an eight-year study.
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This study assessed relationships between academic performance in dental school and "first attempt" performance on a state dental licensure examination for 1996-2003 graduates from the University of Florida College of Dentistry (UFCD). The 524 graduates were ranked into quartiles based on graduating GPA. Using analysis of variance (ANOVA), the students' mean exam score (or exam section score) for each respective quartile (n=131) was compared with mean score for graduates in the combined four quartiles (n=524). ANOVA assessments, by quartile, were performed for the following six measures: 1) overall composite score on the dental licensure exam, 2) clinical periodontics section, 3) clinical amalgam section, 4) combination of clinical periodontics and clinical amalgam, 5) laboratory (manikin exam) with a written prosthodontic exam, and 6) manikin exam without the prosthodontic exam. For the overall exam and all exam sections, a significant (p<0.001) relationship was found between higher mean exam scores and academic ranking in quartile 1. A significant relationship was found between performance (lower mean scores) and ranking in quartile 4 for all exam sections, with the exception of the clinical periodontal section. The results of this study indicate a correlation between performance in dental school and performance on the Florida dental licensure exam for 1996-2003 UFCD graduates. (+info)
To lead or not to lead? Prospective controlled study of emergency nurses' provision of advanced life support team leadership.
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BACKGROUND AND OBJECTIVES: In many emergency departments advanced life support (ALS) trained nurses do not assume a lead role in advanced resuscitation. This study investigated whether emergency nurses with previous ALS training provided good team leadership in a simulated cardiac arrest situation. METHODS: A prospective study was conducted at five emergency departments and one nurses' association meeting. All participants went through the same scenario. Details recorded included baseline blood pressure and pulse rate, time in post, time of ALS training, and subjective stress score (1 = hardly stressed; 10 = extremely stressed). Scoring took into account scenario understanding, rhythm recognition, time to defibrillation, appropriateness of interventions, and theoretical knowledge. RESULTS: Of 57 participants, 20 were ALS trained nurses, 19 were ALS trained emergency senior house officers (SHOs), and 18 were emergency SHOs without formal ALS training. The overall mean score for doctors without ALS training was 69.5%, compared with 72.3% for ALS trained doctors and 73.7% for ALS trained nurses. Nurses found the experience less stressful (subjective stress score 5.78/10) compared with doctors without ALS training (6.5/10). The mean time taken to defibrillate from the appearance of a shockable rhythm on the monitor by the nurses and those SHOs without ALS training was 42 and 40.8 seconds, respectively. CONCLUSION: ALS trained nurses performed as well as ALS trained and non ALS trained emergency SHOs in a simulated cardiac arrest situation and had greater awareness of the potentially reversible causes of cardiac arrest. Thus if a senior or middle grade doctor is not available to lead the resuscitation team, it may be appropriate for experienced nursing staff with ALS training to act as ALS team leaders rather than SHOs. (+info)