作者感谢安娜 Ciullo, 医学博士为她的课程开发和执行提供帮助。这份报告没有外部资金。

本报告所述的所有方法均被认为不受《机构审查委员会审查。
1. 1 天-测试前评估
<ol><li>打印重要的行动清单, 预先测试的信心调查, 预先认识的多选择考试。</li>
	<li>在 ICU 病床上放置三人-病人模拟器, 其名称如下: 急性呼吸窘迫综合征 (ARDS), 完全肺不张, 继发粘液堵塞和气胸。将模拟器设置在单独的房间里, 或者在很远的距离内, 学习者将无法轻松地听到其他同时执行的会话。将模拟器放置在一个专用的学习空间中。</li>
	<li>插管的人-病人模拟器。不要将气管插管放在模拟器的气管内, 而是通过模拟器内部脸颊上的一个孔, 导致模拟器颈部的背面。<ol>
<li>将波纹气道导管从肺模拟器连接到现在隐藏在模拟器颈部后面的气管导管。一旦连接, 肺模拟器现在功能。用枕头掩盖这个连接。</li>
	</ol>
</li>
	<li>打开肺模拟器。从 "病人库" 文件夹的菜单中选择选定的病理状态。在肺模拟器上启动选定的病理学。<ol>
<li>将机械通气机连接到从模拟器口中出来的气管导管。如果呼吸机连接到气管插管前启动肺病理学软件程序, 呼吸机将无法正常工作。</li>
		<li>将人体模拟器与呼吸模拟器连接起来。将插管病人模拟器连接到机械通气机。</li>
	</ol>
</li>
	<li>每个病人模拟器放置一个模拟病人监视器。在肺模拟器程序中选择重要的标志软件。选择合适的初始生命体征来模拟病人的表现。启用生命体征监视器。</li>
	<li>上传预先选定的病人的生命体征, 便携式胸部 X 线图像, 心电图和动脉血气测量每一个病人的情况下, 每个病人的监护仪 (如, autoPEEP 图像上传到人-病人模拟器被指定为 autoPEEP 患者)。</li>
	<li>为每个学习者在每一个工作站上设置关键动作检查表, 在任何教员将观察到的情况下。这可能是在一个单向的玻璃或床边的桌子后面, 但在足够的距离, 学习者将无法阅读清单。分配一名教员到每个车站。</li>
	<li>让每个学习者挑选一个四位数的识别码用于信心调查、认知测验和关键行动清单。这些代码可用于以匿名方式查看收集的数据。学习者可以选择任何四位的代码, 他们将始终记住整个课程。</li>
	<li>在一个单独的房间里, 对学习者进行5分钟的预测信心调查。完成后, 对学习者进行25分钟的认知多选考试。</li>
	<li>让学习者向一个电台报告, 每个电台都有一个学生在场。其余的学生可以在单独的房间里等。让学习者为他们的关键行动清单提供四位的识别码。</li>
	<li>让教员们把这个案例读给学习者听。允许学习者每站最多十分钟的时间来完成一个场景。不要在案例中管理反馈。在该方案结束时, 开除学习者返回各自的房间。</li>
	<li>在每个案例完成后, 教师必须为每个学习者填写关键的行动清单。将学习者单独轮换到所有的工作站, 直到所有的学习者都完成所有的工作站。通过纸或电子邮件向学习者分发补充读物。</li>
</ol>2. 2 天-课程和教育干预
<ol><li>如上文所述, 设置五个工作站, 其中有人体模拟器、呼吸器、通风机和监视器。</li>
	<li>为每个工作站分配下列主题之一: ARDS、粘液堵塞继发肺不张、气胸、药物过量后的精神状态改变和动态恶性通货膨胀。在三人的群体中安排学习者。分配一名教员到每个车站。</li>
	<li>允许每个团队10分钟处理案例场景。给教员35分钟提供反馈和床边指导。通过其余四个工作站旋转学习者。</li>
</ol>3. 3 天-测试后评估
<ol><li>打印关键动作清单, 前后信心调查, 测试后认知多选考试。如上文所述, 设置三个工作站, 其中有人体模拟器、呼吸器、通风机和监视器。为每个工作站分配以下主题之一: ARDS, 肺不张, 粘液堵塞, 气胸。</li>
	<li>上传生命体征, 便携式胸部 X 线图像, 心电图和动脉血气测量每一个病人的情况下, 每个病人的监护仪 (例如, autoPEEP 图像上传到人-病人模拟器指定为 autoPEEP病人)。</li>
	<li>在每个工作站上为每个学习者设置关键动作清单。分配一名教员到每个车站。管理5分钟后测试信心调查和25分钟前后认知多选考试。</li>
	<li>让学习者向一个电台报告, 每个电台都有一个学生在场。其余的学生可以在单独的房间里等。让学习者为他们的关键行动清单提供四位的识别码。</li>
	<li>让教员们把这个案例读给学习者听。允许学习者每站最多十分钟的时间来完成一个场景。不要在案例中管理反馈。在该方案结束时, 开除学习者返回各自的房间。</li>
	<li>在每个案例完成后, 教师必须为每个学习者填写关键的行动清单。将学习者单独轮换到所有的工作站, 直到所有的学习者都完成所有的工作站。对所有学习者进行10分钟的后课程调查。</li>
</ol>

<ol>
	<li>Slutsky, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+of+mechanical+ventilation.+From+vesalius+to+ventilator-induced+lung+injury.">History of mechanical ventilation. From vesalius to ventilator-induced lung injury.</a> Am J Respir Crit Care Med. 191 (10), 1106-1115 (2015).</li><li>Ahmed, N., Devitt, K. S., Keshet, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Systematic+Review+of+the+Effects+of+Resident+Duty+Hour+Restrictions+in+Surgery.">A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery.</a> Ann Surg. 259 (6), 1041-1053 (2014).</li><li>Ziv, A., Wolpe, P. R., Small, S. D., Glick, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-Based+Medical+Education:+An+Ethical+Imperative.">Simulation-Based Medical Education: An Ethical Imperative.</a> Acad Med. 78 (8), 783-788 (2003).</li><li>Duwat, A., Hubert, V., Deransy, R., Dupont, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Difficult+airway+management:+assessment+of+knowledge+and+experience+in+anaesthesiology+residents.">Difficult airway management: assessment of knowledge and experience in anaesthesiology residents.</a> Ann Fr Anesth Reanim. 32 (40), 231-234 (2013).</li><li>Lee, M. O., Brown, L. L., Bender, J., Machan, J. T., Overly, F. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+medical+simulation-based+educational+intervention+for+emergency+medicine+residents+in+neonatal+resuscitation.">A medical simulation-based educational intervention for emergency medicine residents in neonatal resuscitation.</a> Acad Emerg Med. 19 (5), 577-585 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Caprio, T., McGaghie, W. C., Simuni, T., Wayne, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+residents'+lumbar+puncture+skills.">Simulation-based education with mastery learning improves residents' lumbar puncture skills.</a> Neurology. 79 (2), 132-137 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Vozenilek, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+paracentesis+skills.">Simulation-based education with mastery learning improves paracentesis skills.</a> J Grad Med Educ. 4 (1), 23-27 (2012).</li><li>Sohmer, B., Hudson, C., Hudson, J., Posner, G. D., Naik, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transesophageal+echocardiography+simulation+is+an+effective+tool+in+teaching+psychomotor+skills+to+novice+echocardiographers.">Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers.</a> Can J Anaesth. 61 (3), 235-241 (2014).</li><li>Sigounas, V. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+simulation-based+training+model+on+vascular+anastomotic+skills+for+surgical+residents.">Evaluation of simulation-based training model on vascular anastomotic skills for surgical residents.</a> Simul Healthc. 7 (6), 334-338 (2012).</li><li>Dawe, S. R., Windsor, J. A., Broeders, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+surgical+skills+transfer+after+simulation-based+training:+laparoscopic+cholecystectomy+and+endoscopy.">A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy.</a> Ann Surg. 259 (2), 236-248 (2014).</li><li>Spadaro, S., Karbing, D. S., Fogagnolo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation+Training+for+Residents+Focused+on+Mechanical+Ventilation.">Simulation Training for Residents Focused on Mechanical Ventilation.</a> Simul Healthc. , (2017).</li><li>Yee, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+Ventilation+Boot+Camp:+A+Simulation-Based+Pilot+Study.">Mechanical Ventilation Boot Camp: A Simulation-Based Pilot Study.</a> Crit Care Res Pract. 2016, (2016).</li><li>Ryoo, E. N., Ha, E. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Importance+of+Debriefing+in+Simulation-Based+Learning:+Comparison+Between+Debriefing+and+No+Debriefing.">The Importance of Debriefing in Simulation-Based Learning: Comparison Between Debriefing and No Debriefing.</a> Comput Inform Nurs. 33 (12), 538-545 (2015).</li><li>Shinnick, M. A., Woo, M., Horwich, T. B., Steadman, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Debriefing:+The+Most+Important+Component+in+Simulation?.">Debriefing: The Most Important Component in Simulation?.</a> Clin Simul Nurs. 7 (3), e105-e111 (2011).</li></ol>

作者没有什么可透露的。

新兵训练营由三个独立的疗程组成。在第一天, 学习者完成测试前的信心调查和医学知识测试, 然后再进行五分钟的情况。教师使用预先确定的关键动作评估学习者。下学习者在2天之前被给予异步读取。第二天由干预阶段组成, 2-3 名学习者组通过五种不同的方案进行工作。教职员在床边提供即时和个性化的反馈。第三天是测试后评估, 学习者完成测试后的信心调查和医学知识测试。然后, 他们经历?...

这个新兵训练营是为了教居民如何管理机械通气的病人, 以及诊断呼吸机警报。管理这个病人的人群可能会恐吓新手医生可能有有限的经验与危重病人。通过国家工作小时限制, 在床边教授重要的护理原则使其更加困难1,2, 法医有关3在美国。模拟是一种有效的方法来开发和提炼关键照顾技能4,5, 以及侵入程序6,7,8,9,10.通过模拟, 学习者可能会体验到他们的医疗决策所带来的后果, 而不会让病人处于危险之中。本课程允许各种不同的学习方式, 包括床边教学从一个 intensivist, 实践与呼吸机和补充异步阅读。
以前的研究显示, 在机械通气的基于人体模型的教育中, 有更多的知识11,12。斯巴达et 。11比较了基于计算机的训练与基于人体模型的麻醉学人员在机械通气模拟教学中的训练。接受过人体模型训练的居民有更高的关键行动和全球评分评分。正如我们以前的研究12所指出的, 第一年的居民在这个新兵训练营课程结束后表现出了更好的知识、信心和能力。
如文所写, 这三天的课程允许教育工作者在第一天评估学习者的基线知识, 并评估三天课程完成后的能力、知识和信心的变化。三天是专门为评估, 而第二天的重点是床边教学的内容专家。病理状况 (急性呼吸窘迫综合征 [ARDS], 肺不张继发粘液和气胸) 用于初步评估和最终测试天数, 而改变精神状态站增加在教学一天回顾呼吸机基础。在教学日还增加了动态恶性通货膨胀, 以加强呼吸机诊断和管理, 包括在高原压力高的患者中考虑。教育者可以根据自己的教学需要来替代病理学。
在准备过程中, 模拟教员举行了一个初步的排练日, 以确保所有参与的教育工作者都知道他们的作用, 并确保设备的工作是适当的。当我们使用模拟教员进行评估和危重护理医生的教学时, 教育工作者可以调整教师的角色, 因为资源的支配。这个新兵训练营的执行需要准备后勤规划。第一年的居民应该被安排保护时间, 以确保他们能够完成所有三天的课程。Intensivists 需要提前安排时间去参加床边的教学课程。模拟设备如呼吸模拟器、机械通气机和人体模拟器可能需要购买、租用或借用。

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mechanical ventilation boot camp curriculum

机械通气病人的医疗管理对新手提供者是一个挑战。对这一人口的不正确管理可能导致发病率和死亡率的增加。一个三天的基于模拟的引导营服务于提供一对一的指导和关键的护理提供者。这些 intensivists 可能会免除个性化的即时反馈, 因为学习者使用真正的机械通气机进行实际操作。多种不同的病理可以被审查, 可能不会遇到在临床设置。学习者可以直观地看到他们的行为的直接后果, 并且在安全的学习环境中进行疑难解答和提问。我们描述了使用的人-病人模拟器连接到呼吸模拟器和机械通气机。潜在的课程执行器应该知道设备的成本和献身于新兵训练营实施所需的时间;然而, 这种密集的交互式培训已经显示, 以提高提供者的能力, 知识和信心的通风机管理。本课程大纲为如何执行基于模拟的训练营, 培训提供者管理机械通气病人提供指导。

正如在怡和et al中所指出的那样, 第一年在接受这个引导营的居民中显示出了显著提高的信心、知识和性能12。认知知识, 由干预前后的多项选择测试所评估, 从平均分数40.3% 增加到 67.1%, 平均分数变化为 +26.8% (图 1)。
在1和3天, 教师们对关键行动进行了评估。ARDS 病例在1天 (总共5人)...

Watch this Scientific Journal Video about Mechanical Ventilation Boot Camp Curriculum at JoVE.com

Mechanical Ventilation Boot Camp Curriculum

本课程概述了如何执行基于模拟的新兵训练营, 教导提供者如何管理机械通气病人。

机械通气训练营课程

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased ...

mechanical-ventilation-boot-camp-curriculum

Research

Education

JoVE Core

JoVE Journal

Medical-Surgical Nursing

Medicine

Unit 1

Fundamentals of Respiratory Care: Techniques and Management

SCIENTISTS IN ACTION

10.0K 次观看.  The Ohio State University. 本课程概述了如何执行基于模拟的新兵训练营, 教导提供者如何管理机械通气病人。

视频: Mechanical Ventilation Boot Camp Curriculum

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit.
Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.
A 13 year old patient was taken to the operating room for incision and drainage of a neck abcess and direct laryngobronchoscopy. After preoxygenation, anesthesia was induced intravenously. Mask ventilation was found to be extremely difficult because of the swelling of the soft tissue. The face mask could not fit properly on the face due to significant facial swelling as well. A direct laryngoscopy was attempted with no visualization of the larynx. Oxygen saturation was difficult to maintain, with saturations falling to 80%. In order to oxygenate and ventilate the patient, an endotracheal tube was then inserted nasally after nasal spray with nasal decongestant and lubricant. The tube was pushed gently and blindly into the hypopharynx. The mouth and nose of the patient were sealed by hand and positive pressure ventilation was possible with 100% O2 with good oxygen saturation during that period of time. Once the patient was stable and well sedated, a rigid bronchoscope was introduced by the otolaryngologist showing extensive subglottic and epiglottic edema, and a mass effect from the abscess, contributing to the airway compromise. The airway was secured with an ETT tube by the otolaryngologist.This video will show a simulation of the technique on a patient undergoing general anesthesia for dental restorations.

We describe a technique to maintain oxygenation and ventilation using an endotracheal tube inserted nasally to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.

一个新型插管困难和困难通风救援技术

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which ...

科研

医学

Pressure Controlled Ventilation to Induce Acute Lung Injury in Mice

Murine models are extensively used to investigate acute injuries of different organs systems (1-34). Acute lung injury (ALI), which occurs with prolonged mechanical ventilation, contributes to morbidity and mortality of critical illness, and studies on novel genetic or pharmacological targets are areas of intense investigation (1-3, 5, 8, 26, 30, 33-36). ALI is defined by the acute onset of the disease, which leads to non-cardiac pulmonary edema and subsequent impairment of pulmonary gas exchange (36). We have developed a murine model of ALI by using a pressure-controlled ventilation to induce ventilator-induced lung injury (2). For this purpose, C57BL/6 mice are anesthetized and a tracheotomy is performed followed by induction of ALI via mechanical ventilation. Mice are ventilated in a pressure-controlled setting with an inspiratory peak pressure of 45 mbar over 1 - 3 hours. As outcome parameters, pulmonary edema (wet-to-dry ratio), bronchoalveolar fluid albumin content, bronchoalveolar fluid and pulmonary tissue myeloperoxidase content and pulmonary gas exchange are assessed (2). Using this technique we could show that it sufficiently induces acute lung inflammation and can distinguish between different treatment groups or genotypes (1-3, 5). Therefore this technique may be helpful for researchers who pursue molecular mechanisms involved in ALI using a genetic approach in mice with gene-targeted deletion.

A murine model for ventilator induced lung injury is an important tool to study an acute lung injury in vivo. Here, we report an easy applicable in situ model for acute lung injury using high-pressure mechanical ventilation to induce acute failure of the lung.

压力控制通气诱导小鼠急性肺损伤

Murine models are extensively used to investigate acute injuries of different organs systems (1-34). Acute lung injury (ALI), which occurs with prolonged ...

Repeated Measurement of Respiratory Muscle Activity and Ventilation in Mouse Models of Neuromuscular Disease

Accessory respiratory muscles help to maintain ventilation when diaphragm function is impaired. The following protocol describes a method for repeated measurements over weeks or months of accessory respiratory muscle activity while simultaneously measuring ventilation in a non-anesthetized, freely behaving mouse. The technique includes the surgical implantation of a radio transmitter and the insertion of electrode leads into the scalene and trapezius muscles to measure the electromyogram activity of these inspiratory muscles. Ventilation is measured by whole-body plethysmography, and animal movement is assessed by video and is synchronized with electromyogram activity. Measurements of muscle activity and ventilation in a mouse model of amyotrophic lateral sclerosis are presented to show how this tool can be used to investigate how respiratory muscle activity changes over time and to assess the impact of muscle activity on ventilation. The described methods can easily be adapted to measure the activity of other muscles or to assess accessory respiratory muscle activity in additional mouse models of disease or injury.

This paper introduces a method for repeated measurements of ventilation and respiratory muscle activity in a freely behaving amyotrophic lateral sclerosis (ALS) mouse model throughout disease progression with whole-body plethysmography and electromyography via an implanted telemetry device.

在神经肌肉疾病的模型小鼠呼吸肌肉活动和通风的重复测量

Accessory respiratory muscles help to maintain ventilation when diaphragm function is impaired. The following protocol describes a method for repeated ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

机器人手术中的紧急脱位: 一个模拟课程

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Mechanical Micronization of Lipoaspirates for Regenerative Therapy

Stromal vascular fraction (SVF) has become a regenerative tool for various diseases; however, legislation strictly regulates the clinical application of cell products using collagenase. Here, we present a protocol to generate an injectable mixture of SVF cells and native extracellular matrix from adipose tissue by a purely mechanical process. Lipoaspirates are put into a centrifuge and spun at 1,200 x g for 3 min. The middle layer is collected and separated into two layers (high-density fat at the bottom and low-density fat on the top). The upper layer is directly emulsified by intersyringe shifting, at a rate of 20 mL/s for 6x to 8x. The emulsified fat is centrifuged at 2,000 x g for 3 min, and the sticky substance under the oil layer is collected and defined as the extracellular matrix (ECM)/SVF-gel. The oil on the top layer is collected. Approximately 5 mL of oil is added to 15 mL of high-density fat and emulsified by intersyringe shifting, at a rate of 20 mL/s for 6x to 8x. The emulsified fat is centrifuged at 2,000 x g for 3 min, and the sticky substance is also ECM/SVF-gel. After the transplantation of the ECM/SVF-gel into nude mice, the graft is harvested and assessed by histologic examination. The result shows that this product has the potential to regenerate into normal adipose tissue. This procedure is a simple, effective mechanical dissociation procedure to condense the SVF cells embedded in their natural supportive ECM for regenerative purposes.

Here, we present a protocol to obtain stromal vascular fraction from adipose tissue through a series of mechanical processes, which include emulsification and multiple centrifugations.

再生疗法用脂质吸入剂的机械微化

Stromal vascular fraction (SVF) has become a regenerative tool for various diseases; however, legislation strictly regulates the clinical application of ...

Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and unexpected, to patients and family members without any previous relationship. Unskilled death notification after unexpected events can lead to the development of pathologic grief and posttraumatic stress disorder. It is paramount for Emergency Medicine physicians to be trained in and practice death notification techniques. The GRIEV_ING curriculum provides a conceptual framework for death notification. The curriculum has demonstrated improvement in learners&#8217; confidence and competence when delivering bad news. Rapid Cycle Deliberate Practice is a simulation-based medical education technique that uses within the scenario debriefing. This technique uses the concepts of mastery learning and deliberate practice. It allows educators to pause a scenario, provide directed feedback, and then let learners continue the simulation scenario the &#8220;right way.&#8221; The purpose of this scholarly work is to describe how to apply the Rapid Cycle Deliberate Practice debriefing technique to the GRIEV_ING death notification curriculum to more effectively train learners in the delivery of bad news.

The goal is to demonstrate how to apply the rapid cycle deliberate practice debriefing technique to the GRIEV_ING death notification curriculum.

快速循环故意练习死亡通知课程的设置和执行

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and ...

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ quality exacerbated by excessive geographic transportation distance and stringent donor organ acceptance criteria pose limitations to current LTx efforts. Ex situ lung perfusion (ESLP) is an innovative technology that has shown promise in attenuating these limitations. The physiologic ventilation and perfusion of the lungs outside of the inflammatory milieu of the donor body affords ESLP several advantages over traditional cold static preservation (CSP). There is evidence that negative pressure ventilation (NPV) ESLP is superior to positive pressure ventilation (PPV) ESLP, with PPV inducing more significant ventilator-induced lung injury, pro-inflammatory cytokine production, pulmonary edema, and bullae formation. The NPV advantage is perhaps due to the homogenous distribution of intrathoracic pressure across the entire lung surface. The clinical safety and feasibility of a custom NPV-ESLP device have been demonstrated in a recent clinical trial involving extender criteria donor (ECD) human lungs. Herein, the use of this custom device is described in a juvenile porcine model of normothermic NPV-ESLP over a 12 h duration, paying particular attention to management techniques. Pre-surgical preparation, including ESLP software initialization, priming, and de-airing of the ESLP circuit, and the addition of anti-thrombotic, anti-microbial, and anti-inflammatory agents, is specified. The intraoperative techniques of central line insertion, lung biopsy, exsanguination, blood collection, cardiectomy, and pneumonectomy are described. Furthermore, particular focus is paid to anesthetic considerations, with anesthesia induction, maintenance, and dynamic modifications outlined. The protocol also specifies the custom device's initialization, maintenance, and termination of perfusion and ventilation. Dynamic organ management techniques, including alterations in ventilation and metabolic parameters to optimize organ function, are thoroughly described. Finally, the physiological and metabolic assessment of lung function is characterized and depicted in the representative results.

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

This paper describes a porcine model of negative pressure ventilation ex situ lung perfusion, including procurement, attachment, and management on the custom-made platform. Focus is made on anesthetic and surgical techniques, as well as troubleshooting.

非原位负压通气肺灌注：肺功能和代谢的评估

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ ...

Mechanical Control of Relaxation Using Intact Cardiac Trabeculae

Diastolic dysfunction is a common phenotype across cardiovascular disease presentations. In addition to elevated cardiac stiffness (elevated left ventricular end-diastolic pressure), impaired cardiac relaxation is a key diagnostic indicator of diastolic dysfunction. While relaxation requires the removal of cytosolic calcium and deactivation of sarcomeric thin filaments, targeting such mechanisms has yet to provide effective treatments. Mechanical mechanisms, such as blood pressure (i.e., afterload), have been theorized to modify relaxation. Recently, we showed that modifying the strain rate of a stretch, not afterload, was both necessary and sufficient to modify the subsequent relaxation rate of myocardial tissue. The strain rate dependence of relaxation, called the mechanical control of relaxation (MCR), can be assessed using intact cardiac trabeculae. This protocol describes the preparation of a small animal model, experimental system and chamber, isolation of the heart and subsequent isolation of a trabecula, preparation of the experimental chamber, and experimental and analysis protocols. Evidence for lengthening strains in the intact heart suggests that MCR might provide new arenas for better characterization of pharmacological treatments, along with a method to assess myofilament kinetics in intact muscles. Therefore, studying the MCR may elucidate a path to novel approaches and new frontiers in the treatment of heart failure.

Rapid myocardial and cardiac relaxation is essential for normal physiology. Mechanical relaxation mechanisms are now known to be dependent on strain rate. This protocol provides an overview of the acquisition and analysis of experiments to further study the mechanical control of relaxation.

使用完整的心脏小梁机械控制松弛

Diastolic dysfunction is a common phenotype across cardiovascular disease presentations. In addition to elevated cardiac stiffness (elevated left ...

超声评估膈肌功能障碍和监测治疗

Measuring Diaphragm Thickness and Function Using Point-of-Care Ultrasound

The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes affected individuals to respiratory failure. In mechanically ventilated patients, the diaphragm is susceptible to atrophy and dysfunction through disuse and other mechanisms. This contributes to failure to wean and poor long-term clinical outcomes. Point-of-care ultrasound provides a valid and reproducible method for evaluating diaphragm thickness and contractile activity (thickening fraction during inspiration) that can be readily employed by clinicians and researchers alike. This article presents best practices for measuring diaphragm thickness and quantifying diaphragm thickening during tidal breathing or maximal inspiration. Once mastered, this technique can be used to diagnose and prognosticate diaphragm dysfunction, and guide and monitor response to treatment over time in both healthy individuals and acute or chronically ill patients.

作者聚焦：揭示机械通气对隔膜功能和患者预后的影响 

Diaphragm thickness and function can be assessed in healthy individuals and critically ill patients using point-of-care ultrasound. This technique offers an accurate, reproducible, feasible, and well-tolerated method for evaluating diaphragm structure and function.

使用床旁超声测量隔膜厚度和功能

The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes ...