Purpose: This report describes the development of a simulation scenario for medical student that incorporates cultural diversity within the context of family presence during resuscitation (FPDR). Methods: Using a hybrid simulation approach, we designed a scenario focusing on communication with a family that immigrated from Korea to the United States during cardiopulmonary resuscitation (CPR). The scenario objectives were for learners to perform CPR with family presence, communicate with the family, and understand and negotiate cultural needs. Following a pilot scenario with two inexperienced volunteer medical students as learners, the program was evaluated through anonymous surveys and informal focus group feedback. Results: Students noted that this simulation differed from previous experiences as compared with emphasizing family communication rather than patient diagnosis or treatment. Students valued experiencing the practical application of cultural competence concepts. The suggestions for scenario improvement included balancing two student participation roles, adjusting the timeline, and utilizing a standardized family member. Conclusion This pilot study suggests that an FPDR simulation program can be effectively repeated with multiple medical students and applied to CPR simulations involving diverse cultural backgrounds.

Purpose: This report describes the development of a simulation scenario for medical student that incorporates cultural diversity within the context of family presence during resuscitation (FPDR). Methods: Using a hybrid simulation approach, we designed a scenario focusing on communication with a family that immigrated from Korea to the United States during cardiopulmonary resuscitation (CPR). The scenario objectives were for learners to perform CPR with family presence, communicate with the family, and understand and negotiate cultural needs. Following a pilot scenario with two inexperienced volunteer medical students as learners, the program was evaluated through anonymous surveys and informal focus group feedback. Results: Students noted that this simulation differed from previous experiences as compared with emphasizing family communication rather than patient diagnosis or treatment. Students valued experiencing the practical application of cultural competence concepts. The suggestions for scenario improvement included balancing two student participation roles, adjusting the timeline, and utilizing a standardized family member. Conclusion This pilot study suggests that an FPDR simulation program can be effectively repeated with multiple medical students and applied to CPR simulations involving diverse cultural backgrounds.

Purpose: This report describes the development of a simulation scenario for medical student that incorporates cultural diversity within the context of family presence during resuscitation (FPDR). Methods: Using a hybrid simulation approach, we designed a scenario focusing on communication with a family that immigrated from Korea to the United States during cardiopulmonary resuscitation (CPR). The scenario objectives were for learners to perform CPR with family presence, communicate with the family, and understand and negotiate cultural needs. Following a pilot scenario with two inexperienced volunteer medical students as learners, the program was evaluated through anonymous surveys and informal focus group feedback. Results: Students noted that this simulation differed from previous experiences as compared with emphasizing family communication rather than patient diagnosis or treatment. Students valued experiencing the practical application of cultural competence concepts. The suggestions for scenario improvement included balancing two student participation roles, adjusting the timeline, and utilizing a standardized family member. Conclusion This pilot study suggests that an FPDR simulation program can be effectively repeated with multiple medical students and applied to CPR simulations involving diverse cultural backgrounds.

Purpose: This report describes the development of a simulation scenario for medical student that incorporates cultural diversity within the context of family presence during resuscitation (FPDR). Methods: Using a hybrid simulation approach, we designed a scenario focusing on communication with a family that immigrated from Korea to the United States during cardiopulmonary resuscitation (CPR). The scenario objectives were for learners to perform CPR with family presence, communicate with the family, and understand and negotiate cultural needs. Following a pilot scenario with two inexperienced volunteer medical students as learners, the program was evaluated through anonymous surveys and informal focus group feedback. Results: Students noted that this simulation differed from previous experiences as compared with emphasizing family communication rather than patient diagnosis or treatment. Students valued experiencing the practical application of cultural competence concepts. The suggestions for scenario improvement included balancing two student participation roles, adjusting the timeline, and utilizing a standardized family member. Conclusion This pilot study suggests that an FPDR simulation program can be effectively repeated with multiple medical students and applied to CPR simulations involving diverse cultural backgrounds.

Objective: We investigated the possible association between lower serum lactate to albumin ratio upon hospital arrival and out-of-hospital cardiac arrest (OHCA) outcome. Methods: Records from the Japanese Association for Acute Medicine–Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry were used for this multicenter observational study. Enrolled patients were ≥18 years old with OHCA of medical etiology who were hospitalized after spontaneous circulation returned between June 1, 2014, and December 31, 2021. We excluded those with missing data or those who failed to meet predefined inclusion criteria. The primary outcome was a cerebral performance category scale of 1 or 2 which indicated 30-day survival with favorable neurological outcome. Patients were divided into quartiles based on serum lactate to albumin ratios. The multivariable logistic regression analysis included adjustment for multiple factors. Results: Data from 4,413 patients were analyzed. The primary outcome was achieved by 558 of 1,104 patients (50.5%) in the first quartile (lactate to albumin ratio, ≤2.23), 240 of 1,111 patients (21.6%) in the second quartile (lactate to albumin ratio >2.23–3.39), 96 of 1,096 patients (8.8%) in the third quartile (lactate to albumin ratio >3.39–4.70), and 24 of 1,102 patients (2.2%) in the fourth quartile (lactate to albumin ratio, >4.70). Adjusted odds ratios (95% confidence intervals) for the primary outcome in the second, third, and fourth quartile compared with the first quartile were 0.33 (0.26–0.42), 0.19 (0.14–0.26), and 0.07 (0.04–0.11), respectively. Conclusion A statistically significant association between categorization in the lower lactate to albumin ratio quartile group and favorable neurological outcome after OHCA was identified.

Background: Standardized exposure assessments were conducted to quantify the historical occupational exposure to hand-arm vibration of workers in the German construction, underground coal mining, woodworking, and metalworking industries. Methods: A two-step approach was used to assess historical vibration exposure. In the first step, individual work histories were reconstructed by standardized personal interviews. The interview focused on the identification of relevant power tools used throughout the working life. In the second step, an equipment-exposure-matrix was constructed by industrial hygiene measurements. By linking the power tools in the work history to the equipment-exposure-matrix, individual daily, and long-term vibration exposures can be quantified. Results and conclusionsA total of 423 power tools were identified for 5,115 exposure segments over a period of 50 years. 97.2% of the vibration values were based on industrial hygiene measurements. The total vibration value (ahv) of the power tools used varied between 0.8 m/s2 and 65.2 m/s2 with a median value of 14.2 m/s2. The median value of cumulative vibration exposure is Dhv = 121,971 (range: 23-3,374,640) m2/s4·day, corresponding to a daily vibration exposure of ahv(8) = 7 m/s2 for 2489 working days (11.3 years).This study provides a detailed description of hand-arm vibration exposure among workers in the related industries studied. Our analyses indicate that the quantification of daily vibration exposure is often uncertain and should be interpreted with caution. In contrast, cumulative vibration exposure is a more reliable exposure parameter for describing general working conditions and for guiding the prevention and compensation of vibration-related health problems.

Currently, pharmacists must learn the basic skills and knowledge required to conduct physical assessment (PA) in order to obtain patient information. To address this need, Kindai University Faculty of Pharmacy requires students to enroll in a training course for PA. One component of the course for 4th grade 155 students is the use of Web Test that is designed assess student performance of pharmacotherapy with PA. This paper reports on Web Test results. The 15-question Web Test is conducted on Moodle. The Web Test is administered three times (pretest, posttest (after training course) and follow-up test (two month later)). The averages for each Web Test were respectively, 9.5 ± 2.0, 12.9 ± 0.9, 11.9 ± 2.7, which indicates positive results for posttest and follow-up test (p<0.01, Tukey test). This result suggests that the PA training course is raising student awareness regarding PA.

BACKGROUND: Few studies have examined the association of layperson characteristics with cardiopulmonary resuscitation (CPR) provision. Previous studies suggested provider characteristics, including age and gender, were associated with CPR quality, particularly chest compression (CC) depth. We sought to determine the association of subject characteristics, including age and gender with layperson CPR quality during an unannounced simulated CPR event. We hypothesized shallower CC depth in females, and older-aged subjects. METHODS: As part of a larger multicenter randomized controlled trial of CPR training for cardiac patients' caregivers, CPR skills were assessed 6 months after training. We analyzed associations between subject characteristics and CC rate, CC depth and no-flow time. Each variable was analyzed independently; significant predictors determined via univariate analysis were assessed in a multivariate regression model. RESULTS: A total of 521 laypersons completed a 6-month CPR skills assessment and were included in the analysis. Mean age was 51.8±13.7 years, 75% were female, 57% were Caucasian. Overall, mean CC rate was 88.5±25.0 per minute, CC depth was 50.9±2.0 mm, and mean no-flow time was 15.9±2.7 sec/min. CC depth decreased significantly in subjects >62 years (P<0.001). Male subjects performed deeper CCs than female subjects (47.5±1.7 vs. 41.9±0.6, P<0.001). CONCLUSION: We found that layperson age >62 years and female gender are associated with shallower CC depth.

Introduction: Fundamental Simulation Instructional Methods (FunSim) is an international simulation faculty development course for Japanese healthcare educators, with English and Japanese language versions. The objectives of this study were to assess post-course outcomes of international "FunSim" , and identify barriers to the implementation of simulation-based education (SBE) for Japanese simulation educators.

Methods: Using a 73-item web-based questionnaire, FunSim course outcomes were assessed at Kirkpatrick model level one (Reaction) ; two (Learning) ; and three (Behavior) . A Likert-type rating scale (1-7) was used for course evaluation (level one) , and for confidence and competency (level two) ; four different types of Yes-No question were used for level three. A Likert-type rating scale (1-5) was used to rate twelve pre-defined potential barriers to the implementation of SBE methods.

Results: A total of 178 (63%) of 283 participants responded; FunSim language was 47.8% English (E) and 57.3% Japanese (J) , with no differences between (E) and (J) "language barrier" responses. Eighty-eight percent of ratings for the 7-course evaluation items were > 4. Confidence and competency scores decreased "at the time of the survey" compared to "at the end of the course" (P<0.05) . Pre/Post-course participants who were active simulation faculty members increased from 68 to 112 (P<0.001) . Human factors such as "Simulation specialist availability" , " Time for teaching and faculty development" , " Number of trained faculty" , "Faculty development availability" , and "Faculty skill" were predominant barriers compared to other issues.

Conclusion: FunSim participants reported positive course feedback and no critical language barriers. Barriers to the implementation of SBE are primarily human factors. Work release, hiring simulation specialists, and faculty development must be addressed to establish effective SBE systems.