ParaVR: A Virtual Reality Training Simulator for Paramedic Skills maintenance

This document is the Accepted Manuscript version of a Published Work that appeared in final form in Journal of Paramedic Practice, copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see https://www.paramedicpractice.com/features/article/paravr-a-virtual-reality-training-simulator-for-paramedic-skills-maintenance.Background, Virtual Reality (VR) technology is emerging as a powerful educational tool which is used in medical training and has potential benefits for paramedic practice education. Aim The aim of this paper is to report development of ParaVR, which utilises VR to address skills maintenance for paramedics. Methods Computer scientists at the University of Chester and the Welsh Ambulance Services NHS Trust (WAST) developed ParaVR in four stages: 1. Identifying requirements and specifications 2. Alpha version development, 3. Beta version development 4. Management: Development of software, further funding and commercialisation. Results Needle Cricothyrotomy and Needle Thoracostomy emerged as candidates for the prototype ParaVR. The Oculus Rift head mounted display (HMD) combined with Novint Falcon haptic device was used, and a virtual environment crafted using 3D modelling software, ported (a computing term meaning transfer (software) from one system or machine to another) onto Oculus Go and Google cardboard VR platform. Conclusion VR is an emerging educational tool with the potential to enhance paramedic skills development and maintenance. The ParaVR program is the first step in our development, testing, and scaling up of this technology

Distensibility index of the inferior vena cava in experimental acute respiratory distress syndrome

We determined the accuracy of distensibility index of inferior vena cava (dIVC) for evaluation of fluid responsiveness in rats with acute respiratory distress syndrome (ARDS) and validated this index for use in rat models. In protocol 1, E. coli lipopolysaccharide was administered in Wistar rats (n=7). After 24h, animals were mechanically ventilated, and stroke volume (SV) and dIVC quantified after blood drainage and subsequent volume expansion (albumin 20%). A receiver operating characteristic (ROC) curve was plotted to determine the optimal dIVC cutoff. In protocol 2, rats (n=10) were divided into fluid-responders (SV increase >5%) and nonresponders (SV increase <5%). The dIVC cutoff obtained from protocol 1 was 25%. Fluid responders had a 2.5 relative risk of low dIVC (<25%). The sensitivity, specificity, positive predictive, and negative predictive values for dIVC were 74%, 62%, 59%, and 76%, respectively. In conclusion, a dIVC threshold <25% was associated with positive response after volume expansion and could be used to titrate fluids in endotoxin-induced ARDS

Tratamento com radio e quimioterapia do carcinoma epidermóide do canal anal: experiência do hospital Barão de Lucena Radiochemotherapy for squamous cell carcinoma of the anal canal: Barao de Lucena hospital experience

Objetivos: Apresentar os resultados e analisar as variáveis implicadas no tratamento e prognóstico do carcinoma epidermóide do canal anal tratado através da radio e quimioterapia no Hospital Barão de Lucena-SUS-PE. Metodologia: Análise dos prontuários de pacientes com diagnóstico de câncer do canal anal submetidos a tratamento radioquimioterápico. O período de acompanhamento foi de junho de 1989 a junho de 2005. Foram incluídos os pacientes com diagnóstico histológico de câncer de canal anal, enquadrados nos estadios I, II, IIIa e IIIb, submetidos a dois ciclos de quimioterapia com 5-fluorouracil (5-FU) na dose de 1g/m²/dia em infusão contínua de 96 horas e cisplatino na dose de 100mg/m² administrado em 6 horas no segundo dia de infusão de cada ciclo, administrados na primeira e terceira semanas do esquema de tratamento radioterápico. Resultados: Avaliamos 108 prontuários de pacientes que preencheram os critérios do protocolo. O tempo médio de seguimento foi de 51 meses (1-182 meses). Houve predomínio do gênero feminino (81,5% dos pacientes). A idade variou de 33 a 83 anos (média de 59 anos). O tipo histológico mais freqüente foi o carcinoma de células escamosas (80,6% dos casos). Em 21 pacientes, foi diagnosticado carcinoma basalóide. Quanto ao grau de diferenciação, prevaleceu o tipo moderadamente diferenciado (61% dos pacientes com carcinoma de células escamosas). O índice de resposta inicial completa foi de 89,8%. Onze pacientes persistiram com tumor após o tratamento radio e quimioterápico. O índice de resposta inicial completa foi menor nos estadios IIIa e IIIb em relação aos estadios I e II com significância estatística (p<0,05). 14 pacientes evoluíram com recidiva tumoral, oito com recidiva local (7,4%) e seis (5,5%) com recidiva linfática e à distância. CONCLUSÕES: O tratamento radioquimioterápico exclusivo do carcinoma epidermóide do canal anal, tem índice de resposta completo bastante elevado com morbidade aceitável. O tratamento cirúrgico ainda tem seu valor nos casos de persistência da lesão e/ou de recidiva local, com resultados satisfatórios.<br>Objectives: To present the results and analyze the variables involved in the treatment and prognosis of squamous cell carcinoma of the anal canal treated by radiotherapy and chemotherapy at the Hospital Barao de Lucena-SUS-PE. Methodology: Analysis of medical records of patients diagnosed with anal cancer treated by chemoradiation. The monitoring period was from June 1989 to June 2005. We included patients with histologically confirmed cancer of the anal canal, framed in stages I, II, IIIa and IIIb, underwent two cycles of chemotherapy with 5-fluorouracil (5-FU) at a dose of 1g / m² / day continuous infusion 96 hours and cisplatin at a dose of 100 mg / m² administered at 6 hours the second day of infusion of each cycle, administered on the first and third weeks of radiotherapy treatment regimen. Results: We evaluated records of 108 patients who met the criteria of the protocol. The mean follow-up was 51 months (1-182 months). There were more females (81.5% of patients). The age ranged from 33 to 83 years (mean 59 years). The most common histological type was squamous cell carcinoma (80.6% of cases). In 21 patients, was diagnosed Basaloid carcinoma. Regarding the degree of differentiation, the most prevalent type was moderately differentiated (61% of patients with squamous cell carcinoma). The rate of initial complete response was 89.8%. Eleven patients had persistent tumor after radiotherapy and chemotherapy. The initial response rate was lower in complete stages IIIa and IIIb compared to stages I and II with statistical significance (p <0.05). 14 patients developed recurrence, eight with local recurrence (7.4%) and six (5.5%) with lymphatic recurrence and distance. CONCLUSIONS: The chemoradiation treatment of unique cell carcinoma of the anal canal, have complete response rate very high with acceptable morbidity. Surgical treatment still has its value in cases of persistent injury and / or local recurrence, with satisfactory results