scholarly journals Low-Cost Model for Battlefield Wound and Hemorrhage Training

2022 ◽  
Author(s):  
James T Bates ◽  
Christopher W Kelly ◽  
Joshua E Lane

ABSTRACT Introduction Exsanguination is the leading cause of preventable death on the battlefield and in austere environments. Multiple courses have been developed to save lives by stopping hemorrhage. Training for this requires simulation models; however, many models are expensive, preventing the further expansion of this life-saving training. We present a low-cost model for hemorrhage training and realistic moulage based on simple medical supplies and grocery store meats. Materials and Methods Wound packing training was completed by use of a block of pork shoulder roast with an incision simulating a wound and IV tubing connected to a syringe with fake blood. Hemostasis was obtained with proper wound packing by the student, causing the bleeding to be tamponaded. Wound moulage utilized remaining supplies of pork roast being attached to patient actors or mannequins and adorned with fake blood creating wounds with the appearance and feel of real tissues. Results Tactical Combat Casualty Care (TCCC) training was completed at a small military medical facility with a start-up cost of less than $70 and a single course as cheap as $15. These methods have been utilized to establish other TCCC training centers while keeping costs low. Conclusions We present low-cost models for simulating massive hemorrhage for wound packing with pork roast and realistic moulage. These methods can be utilized for other hemorrhage training courses such as TCCC, Advanced Wilderness Life Support, and Stop the Bleed.

2020 ◽  
Vol 49 (12) ◽  
pp. 971-977
Author(s):  
Ziwei Lin ◽  
Crystal Harn Wei Soh ◽  
Mui Teng Chua ◽  
Jingping Lin ◽  
Cheryl Jing Yi Ho ◽  
...  

Abstract Introduction: Pericardiocentesis is a potentially life-saving procedure. We compared two low-cost models—an agar-based model and a novel model, Centesys—in terms of ultrasound image quality and realism, effectiveness of the model, and learners’ confidence and satisfaction after training. Methods: In this pilot randomised 2x2 crossover trial stratified by physician seniority, participants were assigned to undergo pericardiocentesis training either with the agar-based or Centesys model first, followed by the other model. Participants were asked to rate their confidence in performing ultrasound-guided pericardiocentesis, clarity and realism of cardiac structures on ultrasound imaging, and satisfaction on a 7-point Likert scale before and after training with each model. Results: Twenty participants with median postgraduate year of 4 (interquartile range [IQR] 3.75–6) years were recruited. Pre-training, participants rated themselves a median score of 2.5 (IQR 2–4) for level of confidence in performing pericardiocentesis, which improved to 5 (IQR 4–6) post-training with Centesys (P=0.007). Centesys was recognised to be more realistic in simulating cardiac anatomy on ultrasound (median 5 [IQR 4–5] versus 3.5 [IQR 3–4], P=0.002) than the agar-based model. There was greater satisfaction with Centesys (median 5 [IQR 5–6] versus 4 [IQR 3.75–4], P<0.001). All 20 participants achieved successful insertion of a pericardial drain into the simulated pericardial sac with Centesys. Conclusion: Centesys achieved greater learner satisfaction as compared to the agar-based model, and was an effective tool for teaching ultrasound-guided pericardiocentesis and drain insertion. Keywords: Cardiac tamponade, emergency medicine, medical education, pericardial effusion, ultrasonography


2019 ◽  
Vol 35 (6) ◽  
pp. 258-269
Author(s):  
Casey R. Tak ◽  
Jaewhan Kim ◽  
Karen Gunning ◽  
Catherine M. Sherwin ◽  
Nancy A. Nickman ◽  
...  

Background: Rates of zoster vaccination in US adults aged 60+ were approximately 30.6% in 2015. Out-of-pocket cost-sharing has been identified as a major barrier to vaccination for patients. To date, herpes zoster vaccine cost-sharing requirements for adults aged 60 to 64 has not been described. Objective: Compare the cost-sharing requirements for zoster vaccination in adults aged 60 to 64 and adults aged 65+. Methods: A retrospective cohort design examined pharmacy claims for zoster vaccination from the Utah All Payer Claims Database for adults aged 60+. Descriptive statistics and a 2-part cost model compared cost-sharing requirements for adults aged 60 to 64 and adults 65+. Results: Of the 30 293 zoster vaccine claims, 13 398 (45.8%) had no cost-sharing, 1716 (5.9%) had low cost-sharing (defined as $1 to less than $30), and 14 133 (48.3%) had high cost-sharing (defined as $30 or more). In the cost models, adults aged 65+ had higher odds of any cost-sharing (odds ratio = 39.86) and 29% higher cost-sharing as compared with adults aged 60 to 64. Conclusions: Adults aged 60 to 64 encounter lower cost-sharing requirements than adults aged 65+. Providers should be cognizant of this dynamic and encourage zoster vaccination prior to the age of 65.


2018 ◽  
Vol 55 (4) ◽  
pp. 375-379
Author(s):  
Daniel Araujo Kramer de MESQUITA ◽  
Erika Feitosa QUEIROZ ◽  
Maria Allyce de OLIVEIRA ◽  
Carlos Magno Queiroz da CUNHA ◽  
Fernanda Martins MAIA ◽  
...  

ABSTRACT BACKGROUND: Paracentesis is a routine medical procedure quite relevant in clinical practice. There are risks of complications related to paracentesis, so it is essential a proper trainee for the younger practicer. OBJECTIVE: The article describes the construction and the application of a low cost paracentesis simulator for undergraduate medical students and it also describes the perception of students about the simulator as well. METHODS: A low-cost model was developed by the Program of Tutorial Education for training medical students during three editions of an undergraduate theoretical-practical course of bedside invasive procedures. The authors constructed a model from very low-cost and easily accessible materials, such as commercial dummy plus wooden and plastic supports to represent the abdomen, synthetic leather fabric for the skin, upholstered sponge coated with plastic film to represent the abdominal wall and procedure gloves with water mixed with paint to simulate the ascitic fluid and other abdominal structures. One semi-structured form with quantitative and qualitative questions was applied for medical specialists and students in order to evaluate the paracentesis simulator. RESULTS: The paracentesis model has an initial cost of US$22.00 / R$70.00 for 30 simulations and US$16.00 / R$50.00 for every 30 additional simulations. It was tested by eight medical doctors, including clinical medicine, general surgeons and gastroenterologists, and all of them fully agreed that the procedure should be performed on the manikin before in the actual patient, and they all approved the model for undergraduate education. A total of 87 undergraduate medical students (56% male) individually performed the procedure in our simulator. Regarding the steps of the procedure, 80.5% identified the appropriate place for needle puncture and 75.9% proceeded with the Z or traction technique. An amount of 80.5% of the students were able to aspire the fluid and another 80.5% of students correctly performed the bandage at the end of the procedure. All the students fully agreed that simulated paracentesis training should be performed prior to performing the procedure on a real patient. CONCLUSION: The elaboration of a teaching model in paracentesis provided unique experience to authors and participants, allowing a visible correlation of the human anatomy with synthetic materials, deepening knowledge of this basic science and developing creative skills, which enhances clinical practice. There are no data on the use of paracentesis simulation models in Brazilian universities. However, the procedure is quite accomplished in health services and needs to be trained. The model described above was presented as qualified with low cost and easily reproducible.


2018 ◽  
Vol 5 ◽  
pp. 238212051880158 ◽  
Author(s):  
Ankita Gupta ◽  
Silvia Herrera ◽  
Stephanie Kanitsch ◽  
Laurie Kane

Objective: The aim of this study is to develop a simulation model for the Le Fort partial colpocleisis. Introduction: One in 9 women will undergo surgery for incontinence or prolapse by age 80 with 30% of these requiring an additional prolapse surgery. With a success rate of over 90% and recurrence rate of 4.2%, obliterative procedures hold a significant place in the management of pelvic organ prolapse in elderly women who are no longer sexually active. For new trainees, the Le Fort colpocleisis may be difficult to conceptually visualize, requiring the need to develop models as teaching tools. Method: A low-cost model was developed using easily available craft supplies to simulate the Le Fort partial colpocleisis with the uterus in situ to treat procidentia. The cost of each model was under US $14 and time to make was approximately 1 hour. The video presents the construction and use of this model. Conclusions: The Le Fort partial colpocleisis technique has been in use for over a century. The aging population as well as the high risk of recurrence after prolapse repairs makes colpocleisis an important technique for trainees to master. Simulation models have proven their efficacy as a training tool. This simple model will allow trainees to fully comprehend the steps of this procedure. Using this video, educators can construct a model and use it to orient trainees to the Le Fort partial colpocleisis procedure.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Theo Wiggers ◽  
Tahmina Nazari

Abstract Aim Based on an international European survey, residents prefer to study inguinal hernia repair through lectures or video-demonstrations or want to practice either on simulation or cadaveric models. Simulation models in inguinal hernia are scarce or expensive. Material and Methods A low-cost model was developed that can be produced everywhere with the aid of the instruction video: “How to build an inguinal hernia model”. Initially, the model was designed to practice the Lichtenstein technique but after some minor modifications (adding the conjoint tendon, enough slack in the transversalis fascia) it was also possible to practice the Shouldice technique on the same model. It only needs the removal of the stitches of the third and fourth layer before the Lichtenstein can be performed. Results The model was used for several studies with students and residents and proved to be realistic and was approved by an international survey among experienced hernia surgeons. It has been used once in a national training session of residents. Conclusions The video shows the execution of both procedures on the same model.


Atmosphere ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 91
Author(s):  
Santiago Lopez-Restrepo ◽  
Andres Yarce ◽  
Nicolás Pinel ◽  
O.L. Quintero ◽  
Arjo Segers ◽  
...  

The use of low air quality networks has been increasing in recent years to study urban pollution dynamics. Here we show the evaluation of the operational Aburrá Valley’s low-cost network against the official monitoring network. The results show that the PM2.5 low-cost measurements are very close to those observed by the official network. Additionally, the low-cost allows a higher spatial representation of the concentrations across the valley. We integrate low-cost observations with the chemical transport model Long Term Ozone Simulation-European Operational Smog (LOTOS-EUROS) using data assimilation. Two different configurations of the low-cost network were assimilated: using the whole low-cost network (255 sensors), and a high-quality selection using just the sensors with a correlation factor greater than 0.8 with respect to the official network (115 sensors). The official stations were also assimilated to compare the more dense low-cost network’s impact on the model performance. Both simulations assimilating the low-cost model outperform the model without assimilation and assimilating the official network. The capability to issue warnings for pollution events is also improved by assimilating the low-cost network with respect to the other simulations. Finally, the simulation using the high-quality configuration has lower error values than using the complete low-cost network, showing that it is essential to consider the quality and location and not just the total number of sensors. Our results suggest that with the current advance in low-cost sensors, it is possible to improve model performance with low-cost network data assimilation.


1984 ◽  
Vol 106 (4) ◽  
pp. 287-291
Author(s):  
H. F. Brose

Renewed interest and planning for a Space Station, probably NASA’s next major space activity, poses a new challenge for ETCLS technology not previously emphasized. Over the past two decades, regenerative life support technology development for Space Station has been underway. This development effort was always aimed at regenerative (closed loop) life support for a full capability Space Station. The level of priority for manned space presence and current budgetary pressures dictate the need for a low cost profile program with an evolutionary growth Space Station. The initial capability may be a small station with a crew of 2 or 3. This station could grow in size and capability by the addition of modules to a station with a crew of 8 to 12 with the possibility of multiple stations in orbit. Depending upon the selected missions, the early station may be best served by an open or only partially closed loop ETCLS whereas the final station may need a completely closed loop ETCLS. The challenge would be to grow in-orbit the ETCLS system capability in a “no-throw-away” fashion in order to minimize annual and total program cost. This paper discusses a possible ETCLS system evolutionary growth scenario, the Space Station architecture variations influencing the ETCLS system design, and a technology preparedness plan for Space Station ETCLS.


Author(s):  
Elvira Albert ◽  
Jesús Correas ◽  
Pablo Gordillo ◽  
Guillermo Román-Díez ◽  
Albert Rubio

Abstract We present the main concepts, components, and usage of Gasol, a Gas AnalysiS and Optimization tooL for Ethereum smart contracts. Gasol offers a wide variety of cost models that allow inferring the gas consumption associated to selected types of EVM instructions and/or inferring the number of times that such types of bytecode instructions are executed. Among others, we have cost models to measure only storage opcodes, to measure a selected family of gas-consumption opcodes following the Ethereum’s classification, to estimate the cost of a selected program line, etc. After choosing the desired cost model and the function of interest, Gasol returns to the user an upper bound of the cost for this function. As the gas consumption is often dominated by the instructions that access the storage, Gasol uses the gas analysis to detect under-optimized storage patterns, and includes an (optional) automatic optimization of the selected function. Our tool can be used within an Eclipse plugin for which displays the gas and instructions bounds and, when applicable, the gas-optimized function.


2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Harkanwal Randhawa ◽  
Yuding Wang ◽  
Jen Hoogenes ◽  
Michael Uy ◽  
Bobby Shayegan ◽  
...  

Introduction: Suprapubic catheterization (SPC) is a fundamental skill required of urology trainees. A lack of affordable simulation models and unpredictability of bedside SPCs limit experiential learning opportunities. Our objective was to develop and initially validate a re-usable, low-cost, ultrasound (US)-compatible SPC simulator for acquiring skills that transfer to the bedside. Methods: The model was constructed using six components. Staff urologists and interventional radiologists (IRs) conducted a SPC and rated the model on three domains with multiple subcategories on a five-point Likert scale: anatomic realism; usefulness as a training tool; and global/overall reaction. Participants in our first-year urology “boot camp” received SPC training, practiced, and were evaluated via an objective structured clinical examination (OSCE). Staff ratings and OSCE scores determined the model’s initial face and content validity. Results: Twelve staff physicians participated in the study. The mean scores for urologists and IRs, respectively, were: anatomical realism: 4.10 and 3.70; usefulness as a training tool: 4.23 and 4.24; and overall reaction: 4.40 and 4.44. Staff strongly agreed that the model should be incorporated into the residency curriculum. Over the past four years, 25 boot camp participants scored a mean of 99.7% (±1.8) on the OSCE, with high technical performance and entrustment scores (4.8 and 4.7, respectively). The model cost $55 CAD. Conclusions: This novel, multiple-use, low-cost, easily reproducible US-compatible SPC simulator demonstrated initial face and content validity via high staff urologist and IR ratings and OSCE scores of first-year urology residents. Additional research is required for construct validation.


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