Development and training of non-technical skills through medical simulation models in Disaster Medicine (Bibliographic Review)

Εισαγωγή: Εξαιτίας του δυναμικού περιεχομένου και της φύσης της ιατρικής καταστροφών απαιτείται η κατοχή πολλών και σύνθετων μη τεχνικών δεξιοτήτων οι οποίες μπορούν τόσο να διδαχθούν στη βασική τους μορφή, όσο και να εξασκηθούν, με τη βοήθεια των τεχνολογιών προσομοίωσης. Οι μη τεχνικές δεξιότητες στην ιατρική καταστροφών αφορούν διάφορες κατηγορίες, όπως πχ η αντίληψη της εκάστοτε κρίσιμης κατάστασης, η ταχύτητα λήψης αποφάσεων, η συντονισμένη ομαδική εργασία και ικανότητα άσκησης ηγεσίας. Σκοπός της συγκεκριμένης εργασίας είναι η συγκέντρωση των διαθέσιμων δεδομένων στην ανάπτυξη και εκπαίδευση των μη τεχνικών δεξιοτήτων στην ιατρική καταστροφών κυρίως μέσω προγραμμάτων προσομοίωσης . Υλικό – Μέθοδοι : Πραγματοποιήθηκε συστηματική αναζήτηση της βιβλιογραφίας της τελευταίας δεκαετίας και συστηματική αξιολόγηση αυτής. Συμπεράσματα: Με τη ραγδαία εξέλιξη της τεχνολογίας, η διάδοση και εφαρμογή της προσομοίωσης για την τελειοποίηση – ανάπτυξη μη τεχνικών δεξιοτήτων αναμένεται να είναι συνεχώς αυξανόμενη. μέχρι στιγμής δεν υπάρχει ξεκάθαρη απόδειξη ότι η εκπαιδευτική προσομοίωση μπορεί να ανατρέψει πλήρως λανθασμένες συμπεριφορές, δεξιότητες, αποφάσεις ή και επιδόσεις. Οι θετικές ερευνητικές ενδείξεις που υπάρχουν καταδεικνύουν την ανάγκη για περισσότερη έρευνα τα επόμενα χρόνια σε αυτήν την κατεύθυνση.Introduction: Due to the dynamic nature and nature of disaster medicine, it is necessary to have many and complex non-technical skills that can be taught in their basic form and practiced with the help of simulation technologies. Nontechnical skills in medical disaster relate to various categories, such as perception of critical condition, decision-making speed, coordinated teamwork, and leadership. The purpose of this work is to gather the available data in the development and training of non-technical skills in medical disasters, mainly through simulation programs. Material - Methods: A systematic search of the literature of the last decade and its systematic evaluation has been carried out. Conclusions: With the rapid development of technology, the dissemination and implementation of simulation for refinement - the development of non-technical skills are expected to be continuously increasing. Hush far there is no clear evidence that educational simulation can completely reverse the wrong behaviors, abilities, decisions and/or performance. The positive research evidence that exists suggests the need for more research in the coming years in this direction

Fitness Characteristics of Jordanian Emergency Medical Technicians

Introduction: Emergency medical technicians (EMTs) should be always prepared to deal with the stressful condition of treating patients with serious physical and emotional injuries. Given that EMTs consider safety the first priority, they must pay adequate attention to their own physical well-being and fitness to practice. Objective: The present study was conducted to analyze the fitness of Jordanian EMTs. Method: The present prospective study was conducted to evaluate the well-being of Jordanian paramedics. The survey was designed using Google forms, which were completed by the participants. The data collection tools comprised an already-designed checklist, including items such as age, gender as well as height and weight, which are used for calculating body mass index (BMI). In addition, the presence of chronic diseases such as hypertension, diabetes mellitus, renal failure and cardiorespiratory diseases as well as the history of surgeries and disabilities were investigated. The participants were also asked about their smoking status and other health-related habits. Results: Out of 115 surveys conducted, 7 were discarded owing to loss of information or making completion mistakes. Out of the remaining 108 respondents, 82 (75.9%) were male and below 10% were over the age of 30 years. BMI was over 25 in 40.7% of the respondents, and only 4 (3.7%) had chronic diseases. Moreover, 46 (42.6%) respondents were smokers, and only 30 (27.8%) performed regular exercise. Conclusion: The present findings suggest health problems in a small percentage of the EMTs, potentially due to the appropriate support provided by the employers or university authorities in this regard. The major health problem was overweight and unhealthy lifestyle, including smoking and not doing regular exercise

Diet supplementation with fish‐derived extracts suppresses diabetes and modulates intestinal microbiome in a murine model of diet‐induced obesity

Metabolic syndrome-related diseases affect millions of people worldwide. It is well established that changes in nutritional habits and lifestyle can improve or prevent metabolic-related pathologies such as type-2 diabetes and obesity. Previous reports have shown that nutritional supplements have the capacity to limit glucose intolerance and suppress diabetes development. In this study, we investigated the effect of dietary supplementation with fish-derived extracts on obesity and type 2 diabetes and their impact on gut microbial composition. We showed that nutritional supplements containing Fish Complex (FC), Fish Complex combined with Cod Powder (FC + CP), or Cod Powder combined with Collagen (CP + C) improved glucose intolerance, independent of abdominal fat accumulation, in a mouse model of diet-induced obesity and type 2 diabetes. In addition, collagen-containing supplements distinctly modulate the gut microbiome in high-fat induced obesity in mice. Our results suggest that fish-derived supplements suppress diet-induced type 2 diabetes, which may be partly mediated through changes in the gut microbiome. Thus, fish-derived supplements and particularly the ones containing fish collagen have potential beneficial properties as dietary supplements in managing type 2 diabetes and metabolic syndrome via modulation of the gut microbiome.publishedVersio

Diet supplementation with fish‐derived extracts suppresses diabetes and modulates intestinal microbiome in a murine model of diet‐induced obesity

Metabolic syndrome-related diseases affect millions of people worldwide. It is well established that changes in nutritional habits and lifestyle can improve or prevent metabolic-related pathologies such as type-2 diabetes and obesity. Previous reports have shown that nutritional supplements have the capacity to limit glucose intolerance and suppress diabetes development. In this study, we investigated the effect of dietary supplementation with fish-derived extracts on obesity and type 2 diabetes and their impact on gut microbial composition. We showed that nutritional supplements containing Fish Complex (FC), Fish Complex combined with Cod Powder (FC + CP), or Cod Powder combined with Collagen (CP + C) improved glucose intolerance, independent of abdominal fat accumulation, in a mouse model of diet-induced obesity and type 2 diabetes. In addition, collagen-containing supplements distinctly modulate the gut microbiome in high-fat induced obesity in mice. Our results suggest that fish-derived supplements suppress diet-induced type 2 diabetes, which may be partly mediated through changes in the gut microbiome. Thus, fish-derived supplements and particularly the ones containing fish collagen have potential beneficial properties as dietary supplements in managing type 2 diabetes and metabolic syndrome via modulation of the gut microbiome.publishedVersio

Salivary Markers for Oral Cancer Detection

Oral cancer refers to all malignancies that arise in the oral cavity, lips and pharynx, with 90% of all oral cancers being oral squamous cell carcinoma. Despite the recent treatment advances, oral cancer is reported as having one of the highest mortality ratios amongst other malignancies and this can much be attributed to the late diagnosis of the disease. Saliva has long been tested as a valuable tool for drug monitoring and the diagnosis systemic diseases among which oral cancer. The new emerging technologies in molecular biology have enabled the discovery of new molecular markers (DNA, RNA and protein markers) for oral cancer diagnosis and surveillance which are discussed in the current review

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Study on the expression levels of mRNA biomarkers in the saliva of oral squamous cell carcinoma patients and correlation with the early detection of the disease

Despite the fact that oral cancer refers to a readily accessible area, the five-year survival rate is not significantly improved in recent years and continues to be at low levels of about 50- 62%. There are several types of oral cancers, but approximately 90% of cases detected are classified as squamous cell carcinomas. Τhe World Health Organization has placed special emphasis on early detection of malignancies involving the oral cavity and to date, there have been determined efforts to discover and develop reliable biomarkers for the diagnosis of squamous cell carcinoma especially in the early stages of its development, the latter of which are carried out in the saliva.Saliva is a valuable body fluid that has been used both for the diagnosis and for the therapeutic monitoring of various diseases. Its use appears to be preferable than blood for disease detection and diagnosis due to the non-invasive nature of its collection. In the recent years, several studies have highlighted the use of biomarkers for the detection of squamous cell carcinoma of the oral cavity, including the mRNA markers. Some researchers, however, have drawn attention towards some important aspects of the process of biomarker development in oral squamous cell carcinoma. Among them, oral potentially malignant disorders are included and which should not be overlooked in the research. The most common form of potentially malignant disorder is oral leukoplakia that can be accompanied or not by mild, moderate or severe dysplasia.The aim of the present study was to determine whether saliva can serve as a tool for the detection of patients with oral squamous cell carcinoma and segregate them from patients with oral leukoplakia with mild, moderate, severe dysplasia and in situ Ca (the most common potentially malignant disorder) by measuring the expression levels of the OAZ, SAT, IL-8 and IL-1B mRNAs in it. Until now, no single biomarker (protein, DNA or RNA marker) was found to give a high predictive ability for the detection of patients with oral squamous cell carcinoma. The current trend is the combination of several biomarkers wich will yield high values of detection.In the current study we show that from a sample of 34 patients with oral squamous cell carcinoma, 20 patients with leukoplakia and mild, moderate, severe dysplasia and in situ Ca and 31 healthy-control subjects:Saliva contains RNA in a good quality and quantity but mainly degraded. The combination of four biomarkers OAZ, SAT, IL-8 και IL-1B (four markers’ model) gave us a very high detection ability of 80% (AUC=0.799, p=0.002) of patients with oral squamous cell carcinoma at an early stage, without involving among them patients with oral leukoplakia with dysplasia or in situ Ca. The analysis in this study also revealed that a good prediction can be also obtained by considering a set of only two markers: IL-8 and SAT (AUC=0.755, p=0.007), leading not only to the reduced cost of a screening test for the early detection of the squamous cell carcinoma, but also the health cost to half.Παρά το γεγονός ότι ο καρκίνος της στοματικής κοιλότητας εντοπίζεται σε μια εύκολα προσβάσιμη περιοχή, το ποσοστό πενταετούς επιβίωσης δεν έχει παρουσιάσει σημαντική βελτίωση τα τελευταία χρόνια και εξακολουθεί να παραμένει σε χαμηλά επίπεδα περίπου στο 50- 62%. Υπάρχουν διάφοροι τύποι κακοηθειών που εντοπίζονται στη στοματική κοιλότητα, αλλά περίπου το 90% των περιπτώσεων που ανιχνεύονται κατατάσσονται στη κατηγορία του ακανθοκυτταρικού καρκινώματος. Ο Παγκόσμιος Οργανισμός Υγείας έχει δώσει ιδιαίτερη έμφαση στην έγκαιρη ανίχνευση των κακοηθειών που αφορούν στη στοματική κοιλότητα και μέχρι σήμερα, έχουν γίνει επισταμένες προσπάθειες για την ανακάλυψη και ανάπτυξη βιοδεικτών για την διάγνωση του ακανθοκυτταρικού καρκινώματος, κυρίως στα αρχικά στάδια της εξέλιξής του. Οι τελευταία μελέτες επικεντρώνονται στο σάλιο. Το σάλιο είναι ένα πολύτιμο σωματικό υγρό που έχει χρησιμοποιηθεί για τη διάγνωση αλλά και τη θεραπευτική παρακολούθηση διαφόρων ασθενειών. Η χρήση του είναι προτιμότερη από το αίμα για την ανίχνευση και τη διάγνωση νοσημάτων λόγω της μη-διεισδυτικής φύσης της συλλογής του.Τα τελευταία χρόνια έχουν πραγματοποιηθεί αρκετές μελέτες που έχουν αναδείξει τη χρήση βιοδεικτών για την ανίχνευση του ακανθοκυτταρικού καρκινώματος της στοματικής κοιλότητας, μεταξύ των οποίων οι mRNA δείκτες. Κάποιοι ερευνητές ωστόσο έχουν επιστήσει την προσοχή προς ορισμένες σοβαρές πτυχές της διαδικασίας της ανάπτυξης των βιοδεικτών στο ακανθοκυτταρικό καρκίνωμα της στοματικής κοιλότητας. Μεταξύ αυτών, περιλαμβάνονται οι δυνητικώς κακοήθεις διαταραχές του στόματος οι οποίες δεν πρέπει να παραβλέπονται στην έρευνα. Η πιο κοινή μορφή δυνητικώς κακοήθους διαταραχής είναι η λευκοπλακία του στόματος που μπορεί να συνοδεύεται ή όχι από ήπια, μέτρια ή σοβαρή δυσπλασία. Ο σκοπός της παρούσας μελέτης ήταν: Να προσδιορίσει εάν το σάλιο μπορεί να χρησιμεύσει ως εργαλείο για την ανίχνευση ασθενών με ακανθοκυτταρικό καρκίνωμα του στόματος διαχωρίζοντας τους από τους ασθενείς με λευκοπλακία με ήπια, μέτρια, βαριά δυσπλασία/in situ Ca (η πιο κοινή δείκτες. Κάποιοι ερευνητές ωστόσο έχουν επιστήσει την προσοχή προς ορισμένες σοβαρές πτυχές της διαδικασίας της ανάπτυξης των βιοδεικτών στο ακανθοκυτταρικό καρκίνωμα της στοματικής κοιλότητας. Μεταξύ αυτών, περιλαμβάνονται οι δυνητικώς κακοήθεις διαταραχές του στόματος οι οποίες δεν πρέπει να παραβλέπονται στην έρευνα. Η πιο κοινή μορφή δυνητικώς κακοήθους διαταραχής είναι η λευκοπλακία του στόματος που μπορεί να συνοδεύεται ή όχι από ήπια, μέτρια ή σοβαρή δυσπλασία. Ο σκοπός της παρούσας μελέτης ήταν: Να προσδιορίσει εάν το σάλιο μπορεί να χρησιμεύσει ως εργαλείο για την ανίχνευση ασθενών με ακανθοκυτταρικό καρκίνωμα του στόματος διαχωρίζοντας τους από τους ασθενείς με λευκοπλακία με ήπια, μέτρια, βαριά δυσπλασία/in situ Ca (η πιο κοινή Τα αποτελέσματα της παρούσας μελέτης αποκάλυψαν επίσης ότι εξίσου υψηλή δυνατότητα ανίχνευσης των ασθενών με ακανθοκυτταρικό καρκίνωμα μπορεί να μας δώσει ο συνδυασμός των δύο μόνο mRNA βιοδεικτών IL-8 και SAT (AUC=0.764, p=0.006) μειώνοντας το οικονομικό κόστος ενός τεστ πρώιμης ανίχνευσης ακανθοκυτταρικού καρκινώματος αλλά και το κόστος σε επίπεδο υγείας στο μισό