Assessment of the effectiveness of medical simulators in the practical training of medical students: Preliminary results in MU-Varna

INTRODUCTION: Nowadays, simulators have become part of most medical universities’ educational strategy. In recent years, Medical University of Varna has been equipped with the most modern medical simulators, aiming to meet the practical training needs of all specialties taught at the university.AIM: The aim of this study is to perform an initial assessment of the effectiveness in the use of simulators, as well as simulation-based training provided at the Medical University of Varna. MATERIALS AND METHODS: We developed a set of criteria to evaluate the effectiveness of the simulation training including: simulators accessibility, complexity and safety, as well as training environment and trainers’ preparedness. Based on these criteria, a questionnaire was developed and a survey conducted to study the students’ opinion on the training quality with two medical simulators: dental and anesthesiology. RESULTS AND CONCLUSION: Two groups of medical students - 73 students in dental medicine and 186 students in anesthesiology and intensive care, were enrolled in the study. The results showed a strong relationship between the students’ specialty and simulation training in all evaluation criteria except one. The results revealed that medical simulators play an essential role in the practical training of medical students, and may substantially improve their future medical performance. Medical University of Varna effectively integrates simulation medicine into its educational program

Ectonucleotidases in Solid Organ and Allogeneic Hematopoietic Cell Transplantation

Extracellular nucleotides are ubiquitous signalling molecules which modulate distinct physiological and pathological processes. Nucleotide concentrations in the extracellular space are strictly regulated by cell surface enzymes, called ectonucleotidases, which hydrolyze nucleotides to the respective nucleosides. Recent studies suggest that ectonucleotidases play a significant role in inflammation by adjusting the balance between ATP, a widely distributed proinflammatory danger signal, and the anti-inflammatory mediator adenosine. There is increasing evidence for a central role of adenosine in alloantigen-mediated diseases such as solid organ graft rejection and acute graft-versus-host disease (GvHD). Solid organ and hematopoietic cell transplantation are established treatment modalities for a broad spectrum of benign and malignant diseases. Immunological complications based on the recognition of nonself-antigens between donor and recipient like transplant rejection and GvHD are still major challenges which limit the long-term success of transplantation. Studies in the past two decades indicate that purinergic signalling influences the severity of alloimmune responses. This paper focuses on the impact of ectonucleotidases, in particular, NTPDase1/CD39 and ecto-5′-nucleotidase/CD73, on allograft rejection, acute GvHD, and graft-versus-leukemia effect, and on possible clinical implications for the modulation of purinergic signalling after transplantation

Indentation behavior of superelastic hard carbon

Supererlastic hard carbon particles up to 1 mmin size were produced by fullerene collapse upon high-pressure high-temperature treatment with simultaneous sintering of metal-matrix composite materials (CM) reinforced by such particles. The hardness of carbon particles can be varied in a wide range by changing the parameters of their structure, which consists of curved graphene planes or their packets of different sizes. Such carbon phase was called “nanoclusterd graphene phase” (NGP) [1]. The properties of the carbon particles were controlled by changing treatment pressure (5 and 8 GPa) and temperature (1100-1800 K), composition of parent fullerites (C60 or C60/70), and pre-treatment (ball milling) of parent fullerites. The carbon particles formed from fullerites under pressure are close to diamond-like carbon coatings in mechanical properties (combination of high hardness and high elasticity), but they are sufficiently large for their microhardness testing at rather high loads. The mechanical characteristics of the carbon particles were tested with a DUH 211S (Shimadzu) tester according to ISO14577 with a Vickers indenter at loads of 10-1970 mN in load-unload regime at a strain rate of 70 mN/sec. The Martens hardness HM measured at a load of 500 mN on the carbon particles of 28 CMsamples was varied from 2700 to 13600 N/mm2; the corresponding indentation hardness HIT changes from 8100 to 42400 N/mm2, i.e., for the carbon material under consideration, HIT/HM = ~3. Such great difference between the above hardness parameters is due to a great contribution of the elastic deformation to the total deformation upon indentation. The ratio between the corresponding deformation works hIT = Welast/Wtotal (%) with increasing hardness decreases from 87 to 78%, but still remains very high, exhibiting the superelastic behavior of the NGP carbon particles. All samples are characterized by the indentation size effect (ISE), which manifests itself as decreasing HM, HIT, and EIT with increasing Fmax. The ISE becomes more pronounced with increasing hardness of the carbon particles, for example, HM of the least and most hard particles with increasing Fmax decreases by a factor of 1.7 (from 3900 to 2300 N/mm2) and 5.4 (from 40200 to 7400 N/mm2), respectively. The intensity of hardness reduction in the range of small loads (10-250 N) is significantly higher than in a range of 250-1970 N. The elastic recovery upon indentation expressed as hIT at Fmax ranging between 250 and 1970 N is virtually unchanged while, at lower loads, the dependence of hIT on Fmax is non-monotonic, with a small peak at Fmax = 50 N in all cases. Indentation creep CIT (%) was measured at Fmax = 500, 1000, and 1970 N, the holding times at Fmax were 60, 300, and 600 sec. For all samples, CIT decreases with increasing Fmax and increases with holding time. The time dependence curves of CIT tend to saturation with increasing Fmax. CIT increases with increasing hardness of the superelastic hard carbon particles

Current Role and Potential of Oesophogeal and Gastric Fluoroscopy in the Choice of Surgical Treatment for Achalasia of Cardia

Background. Fluoroscopy of the esophagus and stomach provides a reliable assessment of the specific radiological criteria for achalasia (of cardia), which underlie the classification of the disease by stages. The stage of achalasia is one of the key factors to determine the management of treatment, including the choice of a specific type of surgical intervention. However, no methodological standards for performing and interpreting fluoroscopy of the esophagus and stomach in achalasia have been developed.Objectives. Creation of a unified protocol for performing and interpreting fluoroscopy of esophagus and stomach in achalasia and development of an algorithm for diagnosing achalasia based on fluoroscopy of the esophagus and stomach, which will help to determine the appropriate surgery.Methods. The developed algorithm was applied in a study of 104 patients. The examination was carried out using Duodiagnost X-ray machine by Philips, equipped with a remote control. The X-ray technician’s workplace was tooled with a personal computer, a digital identifier (ID) and a digitizer-scanning device. Drystardt 5000B film (by AGFA) was used for X-ray examinations. The description of X-ray examination was carried out by a radiologist in a separate office equipped with two workstations.Results. A protocol for fluoroscopy of the esophagus and stomach in patients with achalasia and a checklist for the description of fluoroscopy in achalasia have been developed. Conclusion. The developed algorithm for diagnosing achalasia of cardia based on fluoroscopy of the esophagus and stomach showed its high efficiency for clarifying the stage of the disease, and, consequently, choosing the right treatment and method of surgical intervention, as well as for providing objective control over the dynamics of the disease after surgery. In addition, the introduction of the developed algorithm into the widespread practice of radiologists will ensure continuity at all stages of treatment of patients with achalasia in different medical institutions: from diagnosis to dynamic monitoring of the patient’s condition after surgical treatment in specialized centers

Personers erfarenheter av att genomgå ECT. : En litteraturstudie.

Bakgrund: ECT är en behandling som används vid olika typer av allvarliga psykiatriska tillstånd. Fördomar om själva proceduren skapar rädsla och oro samt leder till tveksam inställning inför behandlingen. Utan kunskap eller direkt felaktiga uppfattningar om ECT skapas onödig oro, vilket kan försvåra för de personer som behöver behandling. Tanken med detta arbete är att öka kunskapen om personers erfarenheter och därmed få en ökad förståelse om omvårdnaden i samband med ECT, vilket kan bidra till vidareutveckling av sjuksköterskans personcentrerade arbetssätt. Syfte: Syftet med litteraturstudien var att belysa personers erfarenheter av att genomgå ECT-behandling. Metod: Litteraturstudien sammanställdes efter granskning av åtta kvalitativa artiklar där analysen visade på skillnader och likheter i artiklarnas resultat. Litteratursökning genomfördes i Cinahl, PsycInfo och PubMed. Resultat: Analysen resulterade i fyra kategorier: Fördomar, Information,Bemötande och Följder. Stigmatisering, bristande information samt dåligt bemötande gav följder som obehag och missnöje. Medan tydlig information och gott bemötande bidrog till tillfredsställande följder. Konklusion: Erfarenheter av ECT är individuella och skiljer sig mellan individer. De har erfarenhet av att gott bemötande och korrekt information bidrar till god omvårdnad. Nyckelord: Elektrokonvulsiv terapi, erfarenheter, patientBackground: ECT is a treatment used in various types of severe mental health conditions. Preconceived opinions about the procedure itself create fear and anxiety and lead to doubtful attitude towards the treatment. Without knowledge or direct misconceptions about ECT, unnecessary anxiety is created, which can make it difficult for those who need treatment. The idea behind this work is to increase the knowledge of people's experiences and thereby gain an increased understanding of the nursing in connection with ECT, which can contribute to the further development of the nurse's person-centered approach. Purpose: The purpose of this study is to illuminate people's experiences of undergoing ECT treatment. Method: The literature study was compiled after reviewing eight qualitative articles, where the analysis showed differences and similarities in the articles' results. Literature search was conducted in Cinahl, PsycInfo and PubMed. Result: The analysis resulted in four categories: Prejudice, Information, Conduct and Consequences. Stigmatization, lack of information and poor treatment gave consequences such as discomfort and dissatisfaction. While clear information and good response contributed to satisfactory effects. Conclusion: Experiences of ECT are individual and differ between individuals. They have the experience that good treatment and accurate information contribute to good care. Keywords: Electroconvulsive therapy, Experiences, Patien