Post Session Research Articles

Dual coding theory and its application in healthcare facility

The gap between verbal and non-verbal learning has always been a task for trainers and finding new ways for the same. Dual Coding Theory as a theory has been quite popular for past several years but still has not yet made its place in the daily education concepts. This paper focuses on application of the concept of Dual Coding Theory in which visuals were integrated into the content delivery and pre & post session evaluation using questionnaire having visuals to bring down the cognitive load on the mind of learners when being introduced to a new concept. Learners were healthcare workers and administrative staff who belonged to diversified departments. Content delivery was on Radiation Safety in Healthcare Facility to which they could be directly or indirectly encountering during their course of working. Attendees were appreciative of the visual dynamic components (Hand Drawn Images on Digital/Physical White Boards) for ease of understanding, interactive delivery and real time evaluation tools.

Comparing the pre–post knowledge score of health-care professionals on a simulation course for COVID-19 PCR sampling

Background: This study describes the effectiveness of a simulation course for polymerase chain reaction (PCR) sampling for coronavirus disease of 2019 (COVID-19) on a heterogeneous cohort of 37 health-care professionals (HCPs) in North Lebanon. Materials and Methods: A pre–post repeated measure on a simulation course PCR sampling for COVID-19 was designed and conducted on a sample of 37 HCPs involved in COVID-19 PCR sampling in Lebanon. Attendees anonymously completed pre–post course questionnaires following the simulation training session. Data collected were analyzed on SPSS using the Wilcoxon signed-rank test and McNemar’s test to compare the knowledge score (Kscore) of participants and their perceptions measures related to the training. Results: Kscore increased and was significantly different pre (µ = 2.22,) and post-session (µ = 5.54). A Wilcoxon signed-rank test showed that post-session, only two remained the same, whereas all the rest (35) had higher post score. The proportion of correctly answered questions varied significantly pre–post session for all six questions. Years of experience and gender did not have an effect on Kscore pre–post session. The Kscore also varied for participants with previous COVID-19 PCR swab training or with current role related to COVID-19 with higher pre-Kscore and surprisingly lower post-Kscore. Conclusion: Our study shows that a simulation course regarding COVID-19 testing should be a requirement, regardless of years of experience or previous training, before allowing HCPs to perform sampling techniques on a patient having or suspected to have COVID-19 in order to ensure international standards.

THE EFFECTS OF 3D MODELING ON PLANNING OF MAXILLOFACIAL SURGERY: A Preliminary CBCT STUDY

Abstract: Objectives: The aim is to evaluate the contribution of 3D modeling data to the planning of the maxillofacial surgery and to determine the indications of 3D modeling. Materials and Methods: In this preliminary study, CBCT images of 2 patients with the Kodak 9000 3D (Kodak Carestream Health, Trophy, France) system were used. The segmentation procedures of the pathologies were performed manually, and was followed by the construction of the 3D models. A questionnaire was prepared by consensus of the research team, including the parameters which are critical in preoperative maxillofacial surgery planning. Five oral and maxillofacial surgeons independently evaluated both the traditional CBCT data and 3D model assisted data under the same viewing conditions. The extent of their decision change was scored using a 2 point Likert scale. Conventional (pre 3D model) versus 3D model assisted data (post 3D model) scores were analyzed. Pair-wise comparisons were completed using Fisher’s exact test (P < 0.05). Kappa was used to measure inter-observer agreement. Results: In both of the evaluation sessions (pre and post 3D model), operation time, defect size and complication risk factors showed the highest variation for both patients. The difference between the decision change proportions for the variables of pre and post 3D model sessions were not statistically significant (p>0.05). Except 2 observers with excellent agreement for both evaluations (p=0.036), the agreement rates were fair without statistical significance. Conclusions: The results confirmed that personalized 3D modeling constructed by CBCT data may lead to changes in surgical treatment planning protocol of complex cases.

Prefrontal cortex hemodynamic response to acute high intensity intermittent exercise during executive function processing

We investigated prefrontal cortex (PFC) hemodynamic response, through functional near infrared spectroscopy (fNIRS) during executive function (EF) processing in response to acute high intensity intermittent exercise (HIIE) in young adults. We also assessed the associated sex differences in the cognitive scores and related PFC hemodynamic functions in response to HIIE. 49 young healthy adult participants (32 women, 17 men) were randomly assigned to either control or HIIE intervention groups. HIIE group participants performed 4 × 4 minutes of HIIE on cycle ergometer with 3 minutes of active recovery between the bouts; control group relaxed for the time equivalent to intervention. fNIRS data was collected during the performance of the EF tests including Color Word Stroop Test (CWST) and Trail Making Test (TMT) in pre and post sessions in both the groups. Results indicated a significant change in the hemodynamic response in the form of increased oxygenated and decreased deoxygenated hemoglobin in the PFC areas specific to the EF tasks, with improved CWST and TMT scores in response to HIIE intervention. PFC activation was different in men and women in response to HIIE, however similar scores of task performance were observed in men and women during the performance of executive functions in response to HIIE. The study concludes that an acute HIIE session improves executive function which is associated with an increase activation of PFC. Sex differences exist in the activation of PFC in response to HIIE during EF processing. Our study adds to the current evidence regarding exercise and cognition.

716 A MULTIDISCIPLINARY SIMULATED TEACHING PROGRAMME ON TREATMENT ESCALATION PLANNING IN THE CONTEXT OF FRAILTY

Abstract Introduction We designed a simulated teaching session to enable participants to learn more about Treatment Escalation Planning (TEP) and do not attempt resuscitation (DNACPR) orders in the context of frailty and to simulate communication of these decisions with the patient/relative. Method We designed a teaching session which started with discussion of the participants individual learning Objectives. The session involved group discussion surrounding frailty and ways to assess it, communication skills and tools and TEP/DNACPR. We also discussed specific communication issues during the pandemic. The session then moved onto simulated conversations with a patient/their relative using the skills just discussed. Every participant had the chance to complete the scenario. Each participant also had a ‘debrief’ lead by the authors and valued input from a Resuscitation Officer. To date, 5 sessions have been completed with 13 participants. Participants were medical doctors, advanced nurse practitioners and acute care of the elderly practitioners. Results The mean overall rating of the session was 9.4/10. Participants recorded confidence scores in 4 main areas pre and post session. We found that, by participating in the session, confidence improved in all 4 areas; confidence assessing level of frailty, how to agree TEP decisions, initiating conversations around TEP, discussing potential treatment options with patients/relatives. Conclusion We have developed a simulated teaching session, which has been rated highly and is shown to be effective in increasing the confidence of participants when discussing TEP in the context of frailty. Our next steps will be to expand the programme to deliver further sessions.

Comparative study of self-directed learning and traditional teaching method in understanding cardio- respiratory physiology among medical undergraduates

Introduction and Aim: Active and learner centred learning methods specially, self-directed learning is considered to be an important method of blended learning approach of imparting knowledge among under graduate medical students in new curriculum through integrated approach. The aim of the study is to analyse the impact and benefits of self-directed learning sessions for understanding cardio- respiratory physiology among phase one MBBS students. Design and Methods: This cross-sectional study was conducted among 250 students of Phase I MBBS for CVS and RS modules. Two groups of students were made Group A (n=125) was administered with self- directed learning sessions, while group B (n=125) was administered with normal didactic lecture session for the same topics. Following each session an objective assessment was conducted for all the topics covered in SDL and lecture sessions and the results were assessed and compared. Results: The maximum marks secured in objective assessment by Group A students post self-directed learning sessions for both cardiovascular and respiratory physiology modules were 31.2% (39/125) and 32.8% (41/125); while moderate marks were secured by 47.2% (59/125) and 48% (60/125). For assessment conducted after lecture sessions for both cardiovascular and respiratory physiology module, maximum marks were obtained by 25.6% (32/125) and 24% (30/125); while moderate marks were obtained by 21.6% (27/125) and 23.5% (29/125) respectively. Significant difference was found in the p values of marks for both modules(n=0.009) (n=0.008). The internal assessment scores showed considerable difference in the maximum marks obtained by students attending SDL sessions (80-89%) as compared to didactic learning sessions (70–79%) with p value = 0.0190, 0.01179 and 0.0192, a0.01184, respectively for both modules. Conclusion: Self-directed learning method seems to be more effective way of delivering the concept as compared to traditional lecture sessions.

Changes in college students’ health behaviors and substance use after a brief wellness intervention during COVID-19

College students exhibit low levels of physical activity, high levels of sedentary behavior, poor dietary behaviors, sleep problems, high stress, and increased substance use. On-campus resources offering programs to improve college students’ health have been limited during the pandemic. The purpose of this study was to test a brief intervention to improve multiple health behaviors among United States college students. The intervention was a single arm repeated measures study conducted over 12 weeks, utilizing the Behavior Image Model. The intervention involved three components: a survey, a 25-minute wellness specialist consult with a peer health coach, and a 15-minute goal planning session. Follow-up measures were completed at 2-, 6-, and 12-weeks post session to assess changes in wellness behaviors. Linear mixed effects models for repeated measures were used to analyze the association between intervention implementation on within-subject changes in physical activity, sedentary behavior, diet, general health, emotional wellness, and substance use. A total of 121 participants enrolled in the study and 90 (74.4%) completed the health coach session (71% female). At first follow-up, statistically significant increases were observed in vigorous physical activity days/week (coef. = 0.5,95%CI: 0.2,0.9), moderate physical activity days/week (coef. = 0.7, 95%CI: 0.2,1.1), general health (coef. = 4.8,95%CI: 2.1, 7.5), and emotional wellness (coef. = 8.6,95%CI: 5.8, 11.3). Statistically significant decreases in cannabis use (coef. = -2.3,95%CI:-4.1, −0.5) and alcohol consumption (coef. = -2.5,95%CI: −3.7,-1.3) were observed. Many of these changes were sustained at second and third follow-up. This brief wellness intervention shows promise to positively influence multiple health behaviors in college students.

225 First Contact: A Series of Zoom-Based, Virtual on Call Shifts

Abstract Aim COVID-19 has resulted in reduced exposure to on-call shifts where medical students could increase confidence and proficiency in task prioritisation and decision making. Existing ‘simulated on-calls’ provide a substitute in a controlled environment, however in person teaching has also been limited by COVID-19. Our virtual on-call sessions use ZOOM to replicate the higher-level learning experiences normally conferred by live simulation. Method We designed a series of virtual ‘on-calls’ for medical students. Participants were ‘on-call’, receiving ‘bleeps’ which were ‘answered’ by calling a facilitator via ZOOM. The facilitator would roleplay a scenario and the ‘Electronic Patient Record’ (EPR) on Google Forms contained patient notes and observations. Students needed to collect information from the facilitator and document a management plan into the EPR. Participants received ‘bleeps’ of varying complexity, urgency and relevance and were expected to prioritise and triage tasks accordingly. Evaluation was via a pre/post session quiz with separate feedback forms. Results 23 students from 18 universities participated. Students reported increased confidence in managing on-call scenarios, and average scores improved in the post session quiz. Positive feedback was paid to the variety of scenarios, the EPR system and the feeling of realism elicited from the need to triage and prioritise jobs. Conclusions Our framework uses readily accessible technology to provide interactive learning experience. Feedback suggested students engaged in higher order learning and thinking, achieving our stated aims. We aim to incorporate technologies such as automation software which will allow for a scalable, free, and accessible virtual on call.

Speech kinematic variability in adults who stutter is influenced by treatment and speaking style

AimWe tested whether completion of the Comprehensive Stuttering Program (CSP) is associated with a reduction in speech kinematic variability relative to pre-treatment when adults who stutter (AWS) use a casual speaking manner or fluency skills. RationalKinematic variability is higher in AWS suggesting a sensorimotor vulnerability; however, it is not clear whether high variability is a trait related to the underlying disorder or reflects the mutable state of stuttering. Speech restructuring intervention such as the CSP could support more consistent articulatory control and stable movement patterns. MethodologyThirteen AWS were tested before and after completing the CSP while 11 adults who do not stutter (AWNS) completed a single session. Participants were instructed to use a casual manner of speaking in the first post-treatment session. In the second post-treatment condition, the AWS employed their fluency skills at a control speaking rate. An optical tracking system captured lower lip movements while participants spoke two English phrases and a complex nonword. Across-utterance kinematic variability was measured using the spatiotemporal index (STI) and within-utterance variability was measured with recurrence quantification analysis (RQA). ResultsThere was a positive treatment outcome based on significant reductions in percentage syllables stuttered (%SS) during speaking and reading, decreases in stuttering severity and improved perceptions of stuttering and communication confidence. The STI of the AWS decreased significantly after treatment for both speaking styles. The RQA variables indicated that AWS used a less stereotyped and more flexible manner of speaking in the casual condition after treatment, but speech movement regularity increased when using fluency skills. ConclusionsThe AWS showed a significant decrease in labial kinematic variability alongside a successful treatment outcome involving speech restructuring and cognitive behavioral techniques. These changes in across-utterance and within-utterance kinematic indices demonstrate that effective stuttering treatment can promote speech motor stability along with fluent speech.

SafeSpace: what is the feasibility and acceptability of a codesigned virtual reality intervention, incorporating compassionate mind training, to support people undergoing cancer treatment in a clinical setting?

ObjectivesThe SafeSpace study codesigned and tested a virtual reality (VR) intervention, incorporating relaxation and compassionate mind training to determine acceptability/feasibility in an oncology setting and evaluate impact on physical/psychological well-being...

Effect of Educational Intervention on Knowledge among Female Nurses Regarding Pre and Post Angiographic Care

Background: Nurses knowledge plays a very important role in the pre and post angiography care in hospital settings. But unfortunately, there is less attention given to improve nurses’ knowledge. Objective: To assess the improvement in the knowledge among female nurses after intervention regarding pre and post angiography care. Methodology: A quasi experimental study was conducted at Faisalabad Institute of Cardiology in June to September 2021 on 40 female nurses via a convenient sampling technique used for data collection.16 weeks of planned sessions completed and each individual was facilitated with 16 hours learning hour’s organized in morning and evening shifts according to the participant’s availability. Relatively, pre and post intervention sessions were organized for four months. Results: The results of present interventional program showed a remarkable impact on nurses’ knowledge related to pre and post angiography care. The pre-score was inadequate regarding pre and post angiography care of the participants on the other hand, there was an improvement after 16 weeks of interventional lecture session in the nurses knowledge scores 97.5% (p≤0.00), SD= related to pre and post angiography care. Conclusion: The present study showed that there was a great impact on nurses’ knowledge scores after interventional lecture sessions regarding pre and angiography care. So, it is concluded that lecture sessions, seminars and workshops should be arranged on regular basis to keep the nurses knowledge up to date and to get better output. Key words: Nurses ‘Knowledge, Angiography, Care

Bioelectrical Impedance Vector and Creatine Phosphokinase Changes Induced by a High-Intensity Training Session in Rink Hockey Players

This study aimed to analyze anthropometric and whole-body/muscle-localized bioelectrical impedance vector analysis (BIVA) adaptations and their relation to creatine kinase (CK) as a biomarker of muscle damage in a group of seven male players in the maximum category of professional rink hockey. There were three checkpoint assessments in relation to a high-intensity training session: pre-session (PRE), post-session (POST), and 24 h-post-session (POST24H). The resistance, reactance, and impedance module were adjusted by height (R/h, Xc/h, and Z/h, respectively). The Wilcoxon signed-rank test was used to compare the data at baseline and follow-up, while Spearman correlation was used to explore the relationship between CK and the rest of the parameters. The results registered a decrease in body mass at POST (p = 0.03) and a reestablishment at POST24H (p = 0.02). Whole-body BIVA registered a significant increase in R/h between PRE–to–POST (p = 0.02) and returned to baseline values at POST24H (p = 0.02), which was expected since this parameter is related to hydration processes. Muscle-localized BIVA in the rectus femoris muscle showed an increase in both Xc/h and phase angle in POST (p = 0.04 and p = 0.03, respectively) and a decrease in Xc/h at POST24H (p = 0.02). CK correlated with R/h in the rectus femoris at all the checkpoints (PRE–to–POST: r = 0.75, p = 0.05; PRE–to–POST24H: r = 0.81, p = 0.03; POST–to–POST24H: r = 0.82, p = 0.02). Our results indicate that BIVA is a sensitive methodology to assess general and muscle-localized hydration induced by a high-intensity training session in rink hockey players. A correlation between BIVA and CK was also reported.

EFFECTIVENESS OF DRY NEEDLING ON THE LUMBAR PARASPINAL MUSCLE IN PATIENTS WITH MECHANICAL BACK PAIN: A RANDOMIZED CONTROLLED TRIAL

Abstract 
 Objective: The aim of this study was to compare the effect of dry needling and sustained pressure in the lumbar paraspinal trigger points in terms of pain threshold and muscle length.
 Methodology: 50 patients were randomly allocated in experimental and control group having lumbar paraspinal muscle trigger points. Experimental and control groups received dry needling and sustained pressure along with stretching and strengthening exercises. Patients were assessed at 1st pre and 4th post session using Oswestry disability index, paraspinal muscle length, visual analogue scale and pain pressure threshold using algometer.
 Results: Pain pressure threshold and visual analogue scale showed significant results whereas Oswestry disability index and paraspinal muscle length showed no significant results (P>0.01). Analysis within the group showed significant difference from pre to post intervention level (P<0.01) in terms of pain pressure threshold, paraspinal muscle length, Oswestry disability index and visual analogue scale in experimental and control group.
 Conclusion: Pain was improved using dry needling. However, no significant improvement was seen in patient’s disability and lumbar paraspinal muscle length.
 Key words: Dry needling, Oswestry disability index, Paraspinal muscle, Trigger points, Visual analogue scale.

Effect of chromotherapy on the anxiety level in the patients undergoing endodontic treatment: A randomized clinical study.

Background:Incorporation of chromotherapy is an established modality in medical science. However, its use in adult dentistry is an unexplored area.Aim:This study aimed to clinically evaluate and compare the effect of chromotherapy on anxiety levels in patients undergoing endodontic treatment.Materials and Methods:Using computer randomization, the included 90 patients were divided into three groups: Group – 1: Blue, Group – 2: Pink, and Group – 3: Control. Patients were given a preoperative Modified Dental Anxiety Scale questionnaire. Preoperative assessment of heart rate, systolic blood pressure (BP), and diastolic BP was followed by color therapy. Assessment of all the parameters was done at three levels, i.e., preoperative, post chromotherapy session, and after endodontic treatment.Statistical Analysis:Obtained data were tabulated and subjected to ANOVA and post hoc Tukey's test, with P < 0.05 considered statistically significant.Results:The present study demonstrated that patients subjected to blue and pink color therapy had a statistically significant reduction in anxiety as compared to the control group after chromotherapy and post endodontic treatment (P < 0.05). However, between the pink- and blue-colored groups, no statistically significant difference was found (P > 0.05).Conclusions:Chromotherapy plays a pivotal role in anxiety reduction before and during the dental treatment procedure and can be effectively incorporated during routine practice.

Make Movement Your Mission: Evaluation of an online digital health initiative to increase physical activity in older people during the COVID-19 pandemic.

ObjectiveTo formatively evaluate the Make Movement Your Mission (MMYM) digital health initiative to promote physical activity (PA) levels and help avert the negative consequences of sedentary behaviours in older adults during the SARS-CoV2 pandemic.MethodsMixed-method study to explore activity levels, changes in physical function and Activities of Daily Living (ADLs), quality-of-life, social engagement, technology use, and accessibility. Survey data were analysed descriptively. Qualitative interviews were analysed using framework analysis.ResultsForty-one respondents completed the survey (Mean age 68.4 (8.9) years; 34 Female), 68% aged ≥ 65 years. Average attendance was 14.3 sessions per week (3.5 h). 73% had been with MMYM for >1 year, 90% reported they were engaging in more movement on a typical day, and 75% reported improvement in ability to perform moderate PA. Since starting MMYM, participation in activities targeting strength, balance and flexibility increased (by 48%, 73% and 75%, respectively). 83% met strength and 90% balance PA guidelines for health (≥ 2x per week). Between 18% and 53% of respondents reported improvements in ADLs, 53% reported better quality-of-life, and 28% increased use of the internet.Eight participants were interviewed (Mean age 70.7 (6.7) years; 7 Female). Activity levels were promoted by having direct support from the instructor through Facebook messages pre and post live sessions, having group expectation about quality and level of engagement, having a sense of control and encouragement from others, MMYMs regularity, choice around level of engagement and accessibility. Noticing short-term outcomes in balance and posture helped boost confidence and continued participation.ConclusionClinical trials need to robustly assess its effectiveness and acceptability.

BPSS Award

Trans-cranial magnetic stimulation (TMS) can noninvasively modulate specific brain regions to dissipate auditory verbal hallucinations (AVH) in schizophrenia. Citing critical involvement of temporoparietal cortex (TPC) in AVH, we aimed to study the effect of continuous theta burst stimulation (cTBS) targeting bilateral TPC in schizophrenia subjects with AVH, on a randomized rater blinded placebo control trial. 59 patients were randomly allocated to active and sham groups. They received 20 cTBS sessions (2 per day: first right TPC, then left TPC) 5 days a week for 2 weeks. PANSS (Positive and Negative Syndrome Scale), AVHRS (Auditory vocal hallucination rating scale), PSYRAT-AH (Psychiatric symptoms rating scale- Auditory hallucinations scale), CDSS (Calgary depression scale for schizophrenia), SCoRS (Schizophrenia cognition rating scale), CGI-S (Clinical global impression-severity) were assessed at baseline, immediately post 20th session and 2 weeks post-TBS. 50 patients (25-active, 25-sham) completed the study. Conducting an intention to treat analysis, we found a significant group*time effect for PANSS, AVHRS, PSYRAT-AH, CDSS, SCoRS, CGI-S but when controlled for confounding variables, only PANSS-PS (F=26.617, p<0.001), PANSS-TOTAL (F=23.671, p<0.001), AVHRS (F=17.779, p<0.001), PSYRAT-AH (F=11.385, p<0.001) and CGI-S (F=28.462, p<0.001) retained significance. We conclude that cTBS over TPC is safe and has efficacy in AVH in schizophrenia.

Changes in Physical Fitness of Older People During the COVID-19 Pandemic in Germany: Objective Training Data

The purpose of this study was to analyze objective training data on changes in leg muscle training before and after the COVID-19 lockdown during spring 2020 in Germany. Overall, the training data of 4435 individuals in the age group (AG) 45-64 years (55±5 years, 66% ♀) and of 2853 in the AG 65-95 years (72±6 years, 54% ♀) were exported from chip-controlled exercise circuits. Training weight and number of repetitions performed on the leg extensor were used to calculate a leg score (LS), considering the last three training sessions before the lockdown (baseline) and the first ten individual sessions as well as the averaged sessions for August, September and October after individual training resumption. Based on the baseline LS, three training intensity groups (TG_low, medium, high) were defined, and analyzed for differences (ANOVA). The LS in TG_low remained stable after the lockdown, but increased compared to baseline in both AGs after the first ten sessions (p<0.05). In TG_medium, LS was reduced at the first post training session (p<0.05) and returned to baseline levels at training session eight in the younger and session two in the older adults. In both AGs, LS was reduced in the TG_high (p<0.001), and did not reach baseline levels by October. Hence, the LS of TG_high was identified as being particularly affected by the training interruption, irrespective of age. More individually tailored training recommendations should be made for these individuals to be able to regain their initial training levels and avoid long-term adverse health effects.

Effects of Awake Prone Positioning in Non-intubated Spontaneously Breathing COVID-19 Patients Requiring High Flow Oxygen Therapy in High Dependency Unit (HDU): An Observational Study.

Prone positioning increases oxygenation by recruiting dorsal lung regions and draining airway secretions and improves gas exchange and survival in ARDS. We describe the efficacy of prone positioning in awake non-intubated spontaneously breathing COVID-19 positive patients with hypoxemic acute respiratory failure. We studied 26 awake non-intubated spontaneously breathing patients with hypoxemic respiratory failure treated with prone positioning. Patients were kept in prone position for two hours in each session and four such sessions were given to patients in 24 hours. SPO2, PaO, 2RR and haemodynamics were measured before prone positioning (PRE), 60 minutes of prone positioning (PRONE), and one hour after the completion of each session (POST). 26 patients (12 males and 14 females) non-intubated spontaneously breathing with SPO2 <94% on 0.4 FiO2 were treated with prone positioning. One patient required intubation and was shifted to ICU, the rest (25 patients) were discharged from HDU. Mean hours of prone positioning were 19.4 ± 2.06 hr. There was significant improvement in oxygenation (increase in PaO2 from 53.15 ± 6.0 mmHg to 64.23 ± 6.96 mmHg in PRE and POST sessions respectively, likewise there was increase in SPO2). No complications were noted with various sessions. Prone positioning was feasible and improved oxygenation in awake non-intubated, spontaneously breathing COVID-19 patients with hypoxemic acute respiratory failure.

EMERGENCY CRICOTHYROIDOTOMY PROCEDURE: LECTURE ON SURGICAL ANATOMY AND BRIEFING OF THE PROCEDURE FOLLOWED BY SKILL ASSESSMENT IN FIRST SEMESTER MEDICAL STUDENTS

Introduction: Emergency Cricothyroidotomy (ECT) is a life-saving procedure where the cricothyroid membrane is incised to access the larynx to establish breathing in ‘can’t intubate, can’t ventilate’ situations. This procedure can be taught along with midline neck anatomy to the first semester medical students and their understanding and application of knowledge could be assessed on cadavers. Materials and methods: Total three sessions was organized to expose and assess the first semester medical students about the Emergency Cricothyroidotomy (ECT) procedure. In each session, a two hour long integrated lecture was delivered regarding the surgical anatomy and the procedure. After that, randomly selected students were assigned a cadaver to locate and puncture the cricothyroid membrane with a sharp pointed wide probe. The time was recorded and pre and post session questionnaire was distributed and response was analysed. Result: The total study participants were 154. Analysis revealed knowledge and confidence of performing the procedure was statistically significantly increased (p &lt;0.005) among the participants after the session. 90% participants successfully pierced the cricothyroid membrane as a team and the average time was 2 minutes 35 seconds. The most students gave a ‘good’ or ‘very good’ rating of this session. Conclusion: The medical students should be exposed to emergency life-saving procedures in relation to their anatomy course in earlier days of medical school. This could make them aware and oriented about the procedures which could be beneficial during their clinical training.

Waiting for “Good Care”. Biomedicine and the Elderly in North Sulawesi, Indonesia

Older persons in North Sulawesi (Indonesia) shared a long experience with biomedical health interventions during Soeharto’s New Order administration. These vertically and top-down structured development activities in health no longer fit current demographic, epidemiological, and social transformations in Indonesia. The rapidly aging communities, the sharp increase in non-communicable diseases, and aging impairments along with rapidly changing household assemblages call for a biomedical public health that ideally covers cure and care in equal shares. This understanding and vision of “good care” leads to a dynamic appropriation of biomedical services initiated by older persons. Here the monthly local health post sessions for elderly people occupy center stage of this appropriative process: a highly formalized and ritualized medical check-up based on the administration of drug which covers basic curative needs. In addition, the local cadres for aged persons play a significant role as intermediary and broker between an elderly patient, his/her caregiver(s), and the health professionals. Yet, except for the cadres’ home visits, the existing biomedical health system is not very concerned with eldercare (or social care) at household level—for ill older persons fully dependent on kin care truly a “missing link.” Biomedicine in turn increasingly attempts to appropriate elder health as its new market commodity. Thereby, the four fields of pharmaceuticalization, national health insurance scheme, biomedicalization as control and exercise of power in care, and commercialization of elder health support biomedicine in its pursuit of the hegemonic appropriation of older persons’ health and illness. However, dislocations and disjunctures due to the Covid-19 pandemic clearly reveal the structural vulnerability of this biomedical health system: Its sudden unreliability and unsustainability leads not only to a loss of trust in it, but also to a higher degree of vulnerability on the side of older persons in need of cure and care.