Objective: To improve skills of tracheal intubation and tracheotomy on medical corpsmen using SimMan simulation and experiments on living goats. Methods: A total of 90 medical corpsmen from one certain group army were trained for the skills of tracheal intubation and tracheotomy using medical simulator and experiments on living goats. Both theoretical tests and practical examinations were performed on all medics to evaluate the efficacy of such training program. Results: Only 25.6% and 15.6% of all medics have previously received trainings related to tracheal intubation and tracheotomy, respectively. Before training, these medics got an average score of 35.3 marks in the theoretical test, and the successful rate of tracheal intubation was only 18.9%. Their performances in both tests, however, increased to 85.2% and 81.1% respectively after training. All these differences were of statistical significance compared to those before training (p<0.01). In a further practical test related to tracheotomy, 14 randomly selected medical corpsmen reached a 71.4% successful rate after training compared to only 14.3% before training (p<0.01). Conclusion:Training modules combined both simulator and goat experiments are effective in improving tracheal intubation techniques on medics especially those from primary units.

Ventilator-Associated Pneumonia in Elderly with Acute Cerebral InfarctionTo investigate the risk factors of ventilator-associated pneumonia in elderly patients with acute cerebral infarction and to provide guidance for clinical prevention and treatment is the main objective. Gramnegative bacteria 38 strains (67.86 %), Gram-positive bacteria 15 strains (26.79 %) and fungi 3 strains (5.36 %) were detected by pathogenic bacteria culture. There was no significant difference in age, gender, body mass index, smoking, drinking, hypertension, diabetes and coronary heart disease between ventilator-associated pneumonia group and non-ventilator-associated pneumonia group (p>0.05); there were significant differences between ventilator-associated pneumonia group and non-ventilator-associated pneumonia group in antibiotic prophylactic use, time of ventilator use, acute physiology and chronic health evaluation II score and serum albumin level (p<0.05). The receiver operating characteristic curve was drawn and the results showed that the sensitivity of acute physiology and chronic health evaluation II score in predicting ventilator-associated pneumonia in patients with acute cerebral infarction was 93.71 %, the specificity was 77.61 % and the area under the curve value was 0.894. The sensitivity and specificity of albumin in predicting ventilator-associated pneumonia in elderly patients with acute cerebral infarction were 78.51 %, 76.92 % and 0.857 respectively. Multivariate logistic analysis showed that prophylactic use of antibiotics and high serum albumin level could effectively reduce the risk of ventilator-associated pneumonia in elderly patients with acute cerebral infarction undergoing endotracheal intubation and mechanical ventilation (p<0.05), while prolonged time of ventilator use and increased acute physiology and chronic health evaluation II score would increase the risk of ventilator-associated pneumonia in elderly patients with undergoing endotracheal intubation and mechanical ventilation (p<0.05). There are many factors influencing the occurrence of ventilator-associated pneumonia in the elderly patients with acute cerebral infarction undergoing endotracheal intubation and mechanical ventilation, and the intervention according to the risk factors has a positive preventive effect.