Hands-on Training Research Articles

A Quasi Experimental Study to Assess the Effectiveness of Basic First Aid Training Programme in Terms of Knowledge and Skills among Students in Selected Schools of Gurugram

Introduction: This quasi-experimental study aimed to evaluate the effectiveness of a Basic First Aid Training Program among students in selected schools of Gurugram, focusing on both knowledge acquisition and practical skills development. Objective: The research involved a pre-test/post-test design with an intervention group that received the first aid training and a control group without any intervention. Methods: The sample comprised students from diverse backgrounds in selected schools of Gurugram, ensuring a representative mix of participants. The Basic First Aid Training Program was meticulously designed, incorporating theoretical knowledge sessions and hands-on practical training. The curriculum covered essential first aid techniques such as cardiopulmonary resuscitation (CPR), wound care, choking response, and emergency response protocols. Results: The finding of the study showed that pre to posttest was improves gradually and the mean difference shows the result was statistically significant. There was an association between the education of mother with knowledge and skills of basic first aid among students. Conclusion: Basic first aid training programme shows effectiveness on knowledge and skills among the school students. The present study was intended to assess the effectiveness of basic first aid knowledge and skills training in school students of schools of Gurugram.

UYGULAMALI GİRİŞİMCİLİK EĞİTİMLERİNİN İL, DÜZEY-I VE DÜZEY-II BÖLGELERİ BAZINDA BULANIK BWM VE AROMAN YÖNTEMLERİYLE DEĞERLENDİRİLMESİ

The level of a country's entrepreneurship ecosystem is an important indicator that serves the economic development of that country. In today's world, governments resort to various instruments to strengthen the entrepreneurship infrastructure. In Türkiye, a significant part of these activities is implemented by KOSGEB. Since 2010, Hands-On Entrepreneurship Trainings are one of the initiatives that contribute to this objective. In this study, the performances of each province, NUTS-I regions and NUTS-II regions in Türkiye in terms of benefiting from entrepreneurship supports are analysed. The criteria used during the evaluation are weighted by Fuzzy BWM method where the most important criterion is determined as “number of enterprises supported following the trainings". In the performance ranking performed by AROMAN method TR6, TR3 and TR4 regions are ranked in the first three order as the most successful NUTS-I regions. In addition, a similar evaluation is carried out in terms of provinces and NUTS-II regions.

Read the Feed: High-Emotion Simulation of Preterm Feeding to Enhance Graduate-Level Training.

Therapeutic bottle feeding is a critical skill for speech-language pathologists (SLPs) managing the increasing and medically complex neonatal intensive care unit (NICU) and early intervention caseloads. Thus, we explored the role of a high-emotion preterm simulator, known as "Paul," to increase knowledge, skills, and confidence related to infant feeding management for speech-language pathology graduate students. A randomized controlled study compared learning outcomes of 27 participants following either a 1-hr lecture or 1-hr training with a preterm simulator. Outcomes included knowledge demonstrated on written examination, accuracy in identifying stress cues during simulated feeding, and self-reported anxiety levels related to clinically assessing infant feeding. No baseline group differences were found on written examination or during a simulated bottle feeding. Both groups improved in written examination scores and identification of stress cues (p < .001). Gains in written examination scores did not significantly differ between groups; however, after training, the simulator group correctly identified more stress cues during a simulated bottle feeding (p < .001), and the lecture group reported reduced anxiety related to clinically evaluating infant feeding compared to simulator-trained students (p < .05). All students demonstrated gains in written knowledge and identification of stress cues; however, simulation-based training was superior in developing the feeders' ability to identify stress cues during a hands-on simulated bottle-feeding scenario. Lecture-based training may have inflated students' perceptions in their clinical skills as they were less accurate in identifying stress cues during a simulated feeding but reported significantly reduced anxiety for administering a clinical evaluation of infant feeding compared to simulation-trained students. Hands-on training using high-fidelity simulation may capitalize on experiential learning to better build clinical feeding skills for future SLPs who may serve in NICU and early intervention settings, while eliminating the risk of potential errors during learning that could affect fragile neonates.

Barriers and Facilitators to Teledermatology and Tele-Eye Care in Department of Veterans Affairs Provider Settings: Qualitative Content Analysis.

Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members' engagement in telespecialty care. This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services). In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion. In total, 3 themes were identified from participants' experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward. This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans.

The Integration of 3D Virtual Reality and 3D Printing Technology as Innovative Approaches to Preoperative Planning in Neuro-Oncology.

Our study explores the integration of three-dimensional (3D) virtual reality (VR) and 3D printing in neurosurgical preoperative planning. Traditionally, surgeons relied on two-dimensional (2D) imaging for complex neuroanatomy analyses, requiring significant mental visualization. Fortunately, nowadays advanced technology enables the creation of detailed 3D models from patient scans, utilizing different software. Afterwards, these models can be experienced through VR systems, offering comprehensive preoperative rehearsal opportunities. Additionally, 3D models can be 3D printed for hands-on training, therefore enhancing surgical preparedness. This technological integration transforms the paradigm of neurosurgical planning, ensuring safer procedures.

Implementation of a high fidelity simulation based training program for physicians of children requiring long term invasive home ventilation: a study by ISPAT team.

The number of children requiring long-term invasive home ventilation (LTIHV) has increased worldwide in recent decades. The training of physicians caring for these children is crucial since they are at high risk for complications and adverse events. This study aimed to assess the efficacy of a comprehensive high-fidelity simulation-based training program for physicians caring for children on LTIHV. A multimodal training program for tracheostomy and ventilator management was prepared by ISPAT (IStanbul PAediatric Tracheostomy) team. Participants were subjected to theoretical and practical pre-tests which evaluated their knowledge levels and skills for care, follow-up, and treatment of children on LTIHV. Following the theoretical education and hands-on training session with a simulation model, theoretical and practical post-tests were performed. Forty-three physicians from 7 tertiary pediatric clinics in Istanbul were enrolled in the training program. Seventy percent of them had never received standardized training programs about patients on home ventilation previously. The total number of correct answers from the participants significantly improved after the theoretical training (p < 0.001). The number of participants who performed the steps correctly also significantly increased following the hands-on training session (p < 0.001). All of the 43 participants who responded rated the course overall as good or excellent. The knowledge and skills of clinicians caring for children on LTIHV can be enhanced through a comprehensive training program consisting of theoretical training combined with hands-on training in a simulation laboratory.

A survey on practices of embalming techniques and usage of soft embalming methods in Indian medical institutes

BackgroundSoft cadavers are becoming increasingly popular for surgical skills development in competency-based medical education curricula. However, few studies evaluate this strategy's viability, dependability, and validity, particularly in India. This study intends to investigate embalming procedures and procedural skills practices at medical institutions. MethodsA validated questionnaire gathered information on demographic details, embalming practices, surgical skill training, willingness to adopt modern embalming techniques and awareness and practice of soft embalming methods. A total of 350 Indian medical institutions were forwarded the questionnaire via email. Responses were analyzed using SPSS version 16, and the Chi-square test was used to examine the association between the two categorical variables. ResultsA study of 350 Indian medical institutions found a 62% response rate. In the studied population, 53.5% (N = 116) of institutes demonstrated procedural skills in undergraduate education as a part of early clinical experience. A total of 54.4% (N = 118) of institutes conducted hands-on surgical training. For postgraduates in surgical departments, voluntary cadaver dissection was offered at 53.9% (N = 117) of institutes. In 78.3% (N = 170) of the institutes, surgical training was performed on formaldehyde-embalmed cadavers. Institutions used proprietary solutions, fresh frozen approaches, Thiel solution, phenol, and saturated salt solutions for embalming. ConclusionThe study highlights disparities in undergraduate teaching and surgical skill training in medical institutes, emphasizing the need for re-evaluating embalming practices to ensure the safety and educational quality. It also highlights underutilization of soft embalming methods, highlighting need for improved training programs and strategies to enhance medical education quality.

실용보컬 기초발성과 호흡 훈련의 실기교육 사례 연구

This study applied and guided systematic vocal education through private lessons for practical vocal majors through actual cases, qualitatively analyzed post-student feedback, and argued this. For this purpose, an objective vocal theory that can be commonly applied to classical vocal music and practical music vocals was presented, and based on this, ‘Concone’ and parts of Berklee College of Music’s vocal textbook were used as students’ assignments. Additional breathing exercises were also conducted to help with vocalization. After completing 15 weeks of practical training, all students responded to a survey that these vocal tasks had a positive effect and help on their singing, indicating that these vocal training tools are meaningful training tools in practical music vocal instruction. It can be seen as meaning. In addition, it was indirectly confirmed that 1:1 apprenticeship classes that allow interaction and intensive hands-on training between instructors and students are very effective in practical music vocal education.

A Novel Approach for Free, Affordable, and Sustainable Microsurgery Laboratory Training for Low- and Middle-Income Countries: University of Wisconsin-Madison Microneurosurgery Laboratory Experience.

In low- and middle-income countries (LMICs), approximately 5 million essential neurosurgical operations per year remain unaddressed. When compared with high-income countries, one of the reasons for this disparity is the lack of microsurgery training laboratories and neurosurgeons trained in microsurgical techniques. In 2020, we founded the Madison Microneurosurgery Initiative to provide no-cost, accessible, and sustainable microsurgery training opportunities to health care professionals from LMICs in their respective countries. We initially focused on enhancing our expertise in microsurgery laboratory training requirements. Subsequently, we procured a wide range of stereo microscopes, light sources, and surgical instrument sets, aiming to develop affordable, high-quality, and long-lasting microsurgery training kits. We then donated those kits to neurosurgeons across LMICs. After successfully delivering the kits to designated locations in LMICs, we have planned to initiate microsurgery laboratory training in these centers by providing a combination of live-streamed, offline, and in-person training assistance in their institutions. We established basic microsurgery laboratory training centers in 28 institutions across 18 LMICs. This was made possible through donations of 57 microsurgery training kits, including 57 stereo microscopes, 2 surgical microscopes, and several advanced surgical instrument sets. Thereafter, we organized 10 live-streamed microanastomosis training sessions in 4 countries: Lebanon, Paraguay, Türkiye, and Bangladesh. Along with distributing the recordings from our live-streamed training sessions with these centers, we also granted them access to our microsurgery training resource library. We thus equipped these institutions with the necessary resources to enable continued learning and hands-on training. Moreover, we organized 7 in-person no-cost hands-on microanastomosis courses in different institutions across Türkiye, Georgia, Azerbaijan, and Paraguay. A total of 113 surgical specialists successfully completed these courses. Our novel approach of providing microsurgery training kits in combination with live-streamed, offline, and in-person training assistance enables sustainable microsurgery laboratory training in LMICs.

Digitally enhanced hands-on surgical training (DEHST) enhances the performance during freehand nail distal interlocking.

Freehand distal interlocking of intramedullary nails remains a challenging task. Recently, a new training device for digitally enhanced hands-on surgical training (DEHST) was introduced, potentially improving surgical skills needed for distal interlocking. To evaluate whether training with DEHST enhances the performance of novices (first-year residents without surgical experience in freehand distal nail interlocking). Twenty novices were randomly assigned to two groups and performed distal interlocking of a tibia nail in mock operation under operation-room-like conditions. Participants in Group 1 were trained with DEHST (five distal interlocking attempts, 1 h of training), while those inGroup 2 did not receive training. Time, number of X-rays shots, hole roundness in the X-rays projection and hit rates were compared between the groups. Time to complete the task [414.7s (range290-615)] and X-rays exposure [17.8µGcm2 (range9.8-26.4)] were significantly lower in Group 1 compared to Group 2 [623.4s (range339-1215), p = 0.041 and 32.6µGcm2 (range16.1-55.3), p = 0.003]. Hole projections were significantly rounder in Group 1 [95.0% (range91.1-98.0) vs. 80.8% (range70.1-88.9), p < 0.001]. In Group 1, 90% of the participants achieved successful completion of the task in contrast to a 60% success rate in Group 2. This difference was not statistically significant (p = 0.121). In a mock-operational setting, training with DEHST significantly enhanced the performance of novices without surgical experience in distal interlocking of intramedullary nails and hence carries potential to improve safety and efficacy of this important and demanding surgical task to steepen the learning curve without endangering patients. II.

Tri Hita Karana for environmental resilience: Enhancing coral reef conservation and sustainable practices in Mengiat Beach Bali

This collaborative international community service initiative applies the Tri Hita Karana philosophy to improve coral reef conservation at Bali''s Mengiat Beach. The collaboration between Universitas Ngurah Rai and the University of Canberra integrates traditional wisdom and innovative methods, promoting resilience, sustainable practices, and economic growth while adhering to Tri Hita Karana''s holistic principles. The initiative program combines Marine Protected Areas (MPAs) and the Mars Assisted Restoration System (MARRS) to safeguard coral ecosystems. Participatory Action Research (PAR) empowers communities, aligning with the holistic principles of Tri Hita Karana. The methodology encompasses preparation, education, hands-on training, beach clean-ups, and continuous evaluation, reinforcing coral preservation while promoting sustainable practices and ecological well-being. These strategies align with the Tri Hita Karana philosophy, promoting local engagement and resource management. The donation of Reef Stars by the universities to the Bali Coastal and Marine Biodiversity Foundation reflects a commitment to environmental well-being and long-term harmony. The Mengiat Beach collaboration by two universities and the Bali Coastal and Marine Biodiversity Foundation integrates traditional wisdom and modern methods within the Tri Hita Karana philosophy. Through education, training, and reef restoration, the initiative emphasizes community engagement and ecological resilience.

Strengthening health service delivery and governance through institutionalizing 'Urban Health Atlas'-A geo-referenced Information Communication and Technology tool: Lessons learned from an implementation research in three cities in Bangladesh.

Urban health governance in Bangladesh is complex as multiple actors are involved and no comprehensive data are currently available on infrastructure, services, or performance either in public and private sectors of the healthcare system. The Urban Health Atlas (UHA)-a novel and interactive geo-referenced, web-based visualization tool was developed in Bangladesh to provide geospatial and service information to decision makers involved in urban health service planning and governance. Our objective was to study the opportunities for institutionalization of the UHA into government health systems responsible for urban healthcare delivery and document the facilitators and barriers to its uptake. This implementation research was carried out during 2017-2019 in three cities in Bangladesh: Dhaka, Dinajpur and Jashore. During the intervention period, six hands-on trainings on UHA were provided to 67 urban health managers across three study sites. Thirty in-depth and twelve key informant interviews were conducted to understand user experience and document stakeholder perceptions of institutionalizing UHA. Capacity building on UHA enhanced understanding of health managers around its utility for service delivery planning, decision making and oversight. Findings from the IDIs and KIIs suggest that UHA uptake was challenged by inadequate ICT infrastructure, shortage of human resources and lack of ICT skill among managers. Motivating key decision makers and stakeholders about the potential of UHA and engaging them from its inception helped the institutionalization process. While uptake of UHA by government health managers appears possible with dedicated capacity building initiatives, its use and regular update are challenged by multiple factors at the implementation level. A clear understanding of context, actors and system readiness is foundational in determining whether the institutionalization of health ICTs is timely, realistic or relevant.

Operational Challenges in Conducting a Subnational TB Prevalence Survey in India: Lessons Learned for Resource-Limited, High-Burden Settings.

Estimating the burden of TB at the subnational level is critical to planning and prioritizing resources for TB control activities according to the local epidemiological situation. We report the experiences and operational challenges of implementing a TB prevalence survey at the subnational level in India. Information was collected from research reports that gathered data from periodic meetings, informal discussions with study teams, letters of communication, and various site visit reports. During the implementation of the survey, several challenges were encountered, including frequent turnover in human resources, lack of survey participation and community engagement, breakdown of X-ray machines, laboratory issues that delayed sputum sample testing, delays in X-ray reading, and network and Internet connectivity issues that impeded data management. To help ensure the survey was implemented in a timely manner, we developed several solutions, including planning ahead to anticipate challenges, ensuring timely communication, having a high commitment from all stakeholders, having strong team motivation, providing repetitive hands-on training, and involving local leaders to increase community engagement. This experience may help future states and countries that plan to conduct TB prevalence surveys to address these anticipated challenges and develop alternative strategies well in advance.

Examining employer experiences in the polytechnic sector's industrial training program

Purpose: Industrial training, a structured educational program, provides supervised hands-on training within specified time frames and is available in both the private sector and government settings. Its primary aim was to bridge the gap between theoretical knowledge and practical skills, enabling participants to apply classroom learning in real-world scenarios. This experiential approach fosters competency development and a deeper understanding of industrial practices, teamwork, and professional ethics, ultimately preparing individuals for successful careers in various sectors. Research Methodology: Data analysis was conducted using a statistical software tool tailored for predictive modeling and analysis. This dedicated software package was employed to scrutinize and interpret the dataset, allowing for the extraction of meaningful insights and predictions. This analytical approach involves a series of statistical techniques, algorithms, and models to uncover patterns, correlations, and trends within the data. Results: From the perspective of instructors, industrial training has been noted as a catalyst for enhancing students' proficiency in both formal and informal communication, aiding them in identifying suitable research areas for their projects and honing their abilities in socialization and relationship-building. Limitations: The applicable and functional setting for the findings of this study lies within the realm of educational settings. Contribution: Our conclusions highlight the pivotal role of industrial training in enhancing students' abilities and knowledge following their training programs. We advocate recognizing industrial training as a valuable instrument for augmenting employees' skills and capabilities.

P227 The learning curve for using intestinal ultrasonography

Abstract Background The use of intestinal ultrasonography (IUS) is recommended for suspected or known inflammatory bowel disease (IBD), but the technique is challenging to learn. This prospective study examined how the accuracy of IUS increases with operator experience (“learning curve”) and if prior abdominal ultrasound experience facilitates the learning process. Methods The study included five gastroenterologists: four trainees and one expert sonographer. Two trainees had limited abdominal ultrasound experience (&amp;lt; 50 exams) and two had extensive experience (&amp;gt; 500 exams); none had IUS experience. The trainees received an eight-hour course on IUS and one week of hands-on training with the expert sonographer on approximately 50 IUS exams. Thereafter, over a four-week period, each trainee performed 99 examinations and reported four IUS findings. The expert sonographer repeated the exam, and concordance (k) between the expert and trainees was assessed in three consecutive testing periods of 33 exams each. Results A progressive improvement in concordance was observed for all IUS findings from Period 1 to Period 3, overall and for both groups of trainees, although those with experience in abdominal ultrasound had faster learning curves. The minimum number of examinations required to achieve concordance with the expert operator (after the initial 50 exams) for detecting increased bowel wall thickness was 34 and detecting bowel dilatation was 29. However, a minimum of 47 examinations was necessary to achieve concordance for detecting intra-abdominal complications, considered an advanced IUS competence. The number of examinations required to achieve concordance was higher for trainees without than with abdominal ultrasound experience. Conclusion Basic competence in IUS can be acquired with relatively few examinations, while advanced competence requires more extensive training, particularly for gastroenterologists without abdominal ultrasound experience. These findings have implications for the development of training programs and the establishment of proficiency levels in IUS.

Identifying predictors of patient safety competency based on sleep quality in student faculty of nursing and midwifery during the internship period: a multidisciplinary study

BackgroundEnsuring patient safety is of paramount importance in healthcare services. Sleep disorders not only have detrimental effects on the health of healthcare students but also significantly impair their performance, leading to an increased risk of medication errors. These errors can pose a grave threat to the safety and well-being of patients. It is crucial to address and mitigate sleep disorders among internship healthcare students to safeguard the quality of care and minimize potential patient harm.ObjectivesThis study aimed to investigate the predictors of Patient Safety Competency (PSC) based on the sleep quality of internship healthcare students.MethodsA study was conducted on 331 students from the Ardabil School of Nursing and Midwifery at Ardabil University of Medical Sciences in northwest Iran from August to December 2022. The participants were selected by stratified random sampling. Data were collected using a demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Health Professional Education in Patient Safety Survey (H-PEPSS). The collected data were analyzed using SPSS software version 22.0. Person correlation coefficients were used to examine the relationship between PSC level, its dimensions, and sleep quality, while multiple linear regression was conducted to identify the predictors of PSC.ResultsThe competency of nurses in patient safety was average in both classroom and clinical settings. However, their ability to work as a team with other healthcare professionals scored the lowest. In addition, the quality of sleep was found to be a predictor of patient safety competency among healthcare students during their internships.ConclusionsIt is important to note that healthcare students tend to have moderate patient safety competence (PSC), which is positively correlated with their sleep quality. Therefore, it is vital to identify the key factors that directly affect PSC. This would enable nursing and midwifery faculty administrators to take preventive measures to enhance patient safety competence in both classroom and clinical settings. Additionally, organizing educational workshops that engage students and improve their sleep quality could improve patient care. Practical courses are recommended for health professionals and students in clinical settings to enhance patient safety competencies. Additionally, student internships should receive hands-on training to improve teamwork and rest conditions.

Learning curve of ultrasound-guided surgeon-administered transversus abdominis plane (UGSA-TAP) block on a porcine model

BackgroundSurgeons commonly perform ultrasound-guided Transversus Abdominis Plane blocks to manage acute pain following abdominal surgeries. There is no consensus on whether surgeons should undergo basic hands-on training to perform TAP blocks or if video-based learning is sufficient. We theorized that simulation-based learning is superior to video-based learning. In the present study, we present the analysis of technical skills of UGSA-TAP block performance on a live porcine model by general surgery trainees after undergoing video or simulation-based learning. MethodsWe performed a prospective, double-blinded, randomized study. Ten surgery residents and two surgery critical-care fellows (n = 12) without prior experience in performing the TAP block were recruited. The participants were randomized either into a video-based or simulation-based training group. After that, all participants performed a TAP block on a live anesthetized pig, which was recorded and scored by three blinded anesthesiologists. All participants completed a post-performance survey to assess their confidence in gaining competency in the UGSA-TAP block. Statistical analyses were performed to assess the differences between the two groups. P < 0.05 was considered statistically significant. ResultsAll simulation-based learning participants successfully performed a survey scan, identified the three muscular layers of the abdominal wall, and identified the transversus abdominis plane compared to 50 %, 50 %, and 33 % video-based learning group participants for the respective parameters (p < 0.05). While some performance metrics showed no statistically significant differences between the groups, substantial effect sizes (Cohen's ℎ up to 1.07) highlighted notable differences in participants' performance. Both groups exhibited confidence in core competencies, with varied rates of satisfactory skill execution. Performance assessed using a global rating scale revealed a higher passing rate for the simulation group (83 % vs. 33 %). Participant feedback via the Likert scale reflected confidence post-training. Inter-rater reliability (0.83–1) confirmed the robustness of study evaluations. ConclusionThe UGSA-TAP block curriculum should be introduced into the surgical residency programs with an emphasis on simulation-based learning to enhance the procedural skills of the trainees before transitioning to surgical patients.

A pilot study to assess medical students' perception of their osteopathic manipulative therapy (OMT) education

ObjectiveThe aim of this pilot study was to determine which factors (both positive and negative) of a medical students' OMT training influenced their perception of OMT and their intent to use it in the future. MethodsA computer-based survey was distributed to medical students (years 1–4) at two different campuses of an Osteopathic Medical School based in the United States. Multiple factors affecting students' perception of OMT were assessed, including experiences prior to medical school or during their pre-clinical years, virtual/in-person learning, OMT club, OMT clerkship, and OMT fellowship. Students were also asked about their confidence in using OMT, overall perception of OMT, and future intent to use OMT. ResultsFactors that appeared to positively influence medical students' perception of OMT were in-person hands-on training (76 %), prior medical school experiences (31 %), OMT club activities (19 %), and OMT fellowship (9 %). Those that appeared to negatively influence their perception were virtual learning (47 %) and pre-clinical lecture hours (46 %). Medical students' overall perception of OMT diminished when comparing first-year to third- and fourth-year students. Selecting an osteopathic school for OMT training also had a positive influence on a students' perception of OMT. Students who were satisfied and confident in their training reported a higher likelihood of using OMT in the future. ConclusionsStudents' attitude toward OMT and their reported likelihood of future use of OMT were improved by hands-on/in-person learning, clinical OMT opportunities, and OMT experiences prior to medical school. Greater attention must be focused on these forms of OMT education.

Identifying leadership practices to support the uptake of reusable elastomeric half mask respirators in health delivery settings.

An increase in reusable Elastomeric Half Mask Respirators (EHMRs) among healthcare personnel has been documented during pandemic emergencies; however, research has not detailed leadership practices to support their use. Forty-three organizations implemented EHMRs received from the United States federal government which prompted interviews with 73 individuals who managed respirator distribution and fit testing between October 2021 and November 2022. Interview data was qualitatively analyzed. Themes around organizational culture and leadership practices emerged when discussing how elastomeric half mask respirators were integrated into health delivery settings including communication and outreach methods to aid worker support. Example included on-line and hands-on training, peer support, leadership support, and a culture that supports respirator use. To support a shift to reusable respiratory protection being procured and implemented, organizational- and individual-level perspectives are needed. Employee engagement, respirator champions, and updated verbal and written communication mechanisms are important takeaways for leaders to consider during any routine or emergency scenario.

Misuse of Tourniquets in Ukraine may be Costing More Lives and Limbs than they Save.

Hands-on training and social media sites have heavily emphasized the use of tourniquets to treat limb injuries during the Ukraine war. Tourniquet overuse or misuse can lead to significant tragedy-limb loss, physiologic complications, and even death. Casualty evacuation in Ukraine often exceeds 6 hours, and the liberal use of limb tourniquets may have unintentionally increased morbidity. Tourniquet application was appropriate in 24.6% of the wounded with tourniquets in one recent publication by a Ukrainian vascular surgeon. The longer a limb tourniquet is in place raises the risk of compartment syndrome, vascular thrombosis, rhabdomyolysis, and irreversible myonecrosis resulting in major tissue loss and often necessitating limb amputation. If bleeding is controlled with a tourniquet, attempts to remove the tourniquet as early as possible to avoid the negative consequences are essential. Training in tourniquet use without explaining possible limb loss and other complications resulting from tourniquets left in situ more than 2 hours makes use risky. Tourniquets should be loosened at one hour if the tactical situation allows, and the injury assessed to determine if major bleeding persists or to determine if other methods of hemostasis would be effective. Ukraine must improve the training so that everyone becomes aware of the risks of prolonged or improper tourniquet use. This tourniquet training information must be transmitted to military medical leaders, Ukrainian military medics, civilian volunteers, volunteers in Ukraine, and NATO trainers in allied countries conducting medical training for Ukrainian soldiers. A trauma registry and tracking through echelons of care can enhance performance improvement through timely feedback.