A fully automated image analyzing system was developed for the quantitative study of cells in culture. It was able to count cells, to classify cells according to their morphological characteristics and to follow cell culture development. A specific procedure was designed to process Hoffman modulation contrast images. It detects local gray level differences while using conditional dilation techniques. We were able to successfully detect aggregated unstained cells, presently a technical limit in image segmentation. Living cells can be studied in a noninvasive and nondestructive way with this system. An improved automatic focusing algorithm was developed which ensured an accurate prediction of the optimal focus position. A strictly defined sampling procedure was applied to estimate unbiasedly cell density and obtain precisely cell contours. The evaluation of the system was carried out on Chinese hamster ovary (CHO-NTR) cell cultures treated with a newly developed neurotensin agonist JMV449. Chinese hamster ovary cell division was found to be retarded 20 hours after the JMV449 treatment, while the morphology of CHO-NTR cells has already undergone significant changes 12 hours after the treatment. This image analyzing system provides the possibility to follow cell culture development (e.g., cell density evolution, cell morphological changes) under various experimental conditions.

BackgroundTranscutaneous cardiac pacing (TCP) is recommended to treat unstable bradycardia. Simulation might improve familiarity with this low-frequency procedure. Current mannequins fail to reproduce key features of TCP, limiting their usefulness. The objective of this study was to measure the impact of a modified high-fidelity mannequin on the ability of junior residents to achieve six critical tasks for successful TCP.MethodsFirst-year residents from various postgraduate programs taking an advanced cardiovascular life support (ACLS) course were enrolled two consecutive years (2015 and 2016). Both cohorts received the same standardized course content. An ALS simulator® mannequin was used to demonstrate and practice TCP during the bradycardia workshop of the first cohort (control cohort, 2015) and a modified high-fidelity mannequin that reproduces key features of TCP was used for the second cohort (intervention cohort, 2016). Participants were tested after training with a simulation scenario requiring TCP. Performances were graded based on six critical tasks. The primary outcome was the successful use of TCP, defined as having completed all tasks.ResultsEighteen participants in the intervention cohort completed all tasks during the simulation scenario compared to none in the control cohort (36 vs 0%, p < 0.001). Participants in the intervention cohort were more likely to recognize when pacing was inefficient (86 vs 12%), obtain ventricular capture (48 vs 2%), and check for a pulse rate to confirm capture (48 vs 0%).ConclusionsTCP is a difficult skill to master for junior residents. Training using a modified high-fidelity mannequin significantly improved their ability to establish TCP during a simulation scenario.Electronic supplementary materialThe online version of this article (10.1186/s41077-018-0082-5) contains supplementary material, which is available to authorized users.

Introduction: We used eye-tracking technology to explore the visual perception of clinicians during a high-fidelity simulation scenario. We hypothesized that physicians who were able to successfully manage a critical situation would have a different visual focus compared to those who failed. Methods: A convenience sample of 18 first-year emergency medicine residents were enrolled voluntarily to participate in a high-fidelity scenario involving a patient in shock with a 3rd degree atrioventricular block. Their performance was rated as pass or fail and depended on the proper use of the pacing unit. Participants were wearing pre-calibrated eye-tracking glasses throughout the 9-min scenario and infrared (IR) markers installed in the simulator were used to define various Areas of Interest (AOI). Total View Duration (TVD) and Time to First Fixation (TFF) by the participants were recorded for each AOI and the results were used to produce heat maps. Results: Twelve residents succeeded while six failed the scenario. The TVD for the AOI containing the pacing unit was significantly shorter (median [quartile]) for those who succeeded compared to the ones who failed (42 [31–52] sec vs. 70 [61–90] sec, p = 0.0097). The TFF for the AOI containing the ECG and vital signs monitor was also shorter for the participants who succeeded than for those who failed (22 [6–28] sec vs. 30 [27–77] sec, p = 0.0182). Discussion: There seemed to be a connection between the gaze pattern of residents in a high-fidelity bradycardia simulation and their performance. The participants who succeeded looked at the monitor earlier (diagnosis). They also spent less time fixating the pacing unit, using it promptly to address the bradycardia. This study suggests that eye-tracking technology could be used to explore how visual perception, a key information-gathering element, is tied to decision-making and clinical performance.

Introduction: Transcutaneous cardiac pacing (TCP), a skill taught in Advanced Cardiovascular Life Support (ACLS) courses, is recommended to treat unstable bradycardia. Training manikins currently available fail to reproduce key features of TCP and might be suboptimal to teach this procedure.The objective of this study was to measure the impact of a modified high-fidelity manikin on junior residents’ TCP competency during an ACLS course. We hypothesized that the use of this high-fidelity manikin improves junior residents’ performances. Methods: This prospective cohort study was conducted at the Université de Montréal in July 2015 and 2016. First-year residents undergoing their mandatory ACLS course were enrolled. The control group (2015) received the traditional curriculum, which includes hands-on teaching on Advanced Life Support manikins. The intervention group (2016) received a similar curriculum, but used a modified high-fidelity manikin that reproduces key features of TCP (e.g. use of multifunction pads, TCP induced patient twitching, ECG artifacts). Cohorts were tested with a simulation scenario requiring TCP. Performances were graded based on six critical tasks: turns on pacer function, applies multifunction pads, recognizes TCP is ineffective, achieves captures, verifies mechanical capture and prescribes sedation. Our primary outcome was successful use of TCP defined as having completed all tasks. Secondary outcomes were the success rates for each task. These were compared using Pearson’s chi-squared test. We anticipated that the success rate of TCP would increase from 20% to 50%. To obtain a power of more than 90%, 48 participants were needed in both cohorts. Results: A total of 50 residents were recruited in both cohorts. No resident that received the traditional curriculum was able to successfully establish TCP while 18 residents trained on the modified high-fidelity manikin succeeded (0 vs 36%, P&lt;0.001). Furthermore, the latter were more likely to recognize when pacing was inefficient (12 vs 86%, P&lt;0.001), obtain ventricular capture (2 vs 48%, P&lt;0.001), and check for a pulse rate to confirm capture (0 vs 48%, P&lt;0.001). Conclusion: Successful use of TCP is a difficult skill to master for junior residents. A modified high-fidelity manikin during ACLS training significantly improves their ability to establish effective pacing.

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