Purpose: Senior nursing and medical interns’ lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needlestick or sharp injuries may harm themselves. Trainees’ self-reported needlestick or sharp injury rate was known to be especially high during the first 2 months of internship in Taiwan. This prospective cohort study aimed to assess the effect of newly developed virtual reality (VR) game, which uses Gagne’s learning model to improve universal precaution for needlestick or sharp injury prevention and decrease the rates of needle stick or sharp injuries in new-coming medical and nursing interns in Taiwan.Methods: From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational needlestick or sharp injury prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors.Results: In comparison with medical interns, a higher proportion of nursing interns had past experiences of deep occupational needlestick or sharp injury. Before VR training, the familiarity and confidence for needlestick or sharp injury prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep needlestick or sharp injury exhibited better performance on the accuracy rate and time needed to complete 20 decisions than those without past experiences in VR practice. All trainees showed an improved performance after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about needlestick or sharp injury prevention.Conclusion: This self-developed VR game system using Gagne’s flow improved universal precaution for needlestick or sharp injury prevention and reduced the needlestick or sharp injury rates in the first 2 months of nursing and medical internship.

Purpose: Lack of confidence in suturing/ligature skills due to insufficient practice and assessments is common among novice Chinese medical interns. This study aimed to improve the skill acquisition of medical interns through a new intervention program. Methods: In addition to regular clinical training, expert-led or expert-led plus artificial intelligence (AI) system tutoring courses were implemented during the first 2 weeks of the surgical block. Interns could voluntarily join the regular (no additional tutoring), expert-led tutoring, or expert-led+AI tutoring groups freely. In the regular group, interns (n=25) did not receive additional tutoring. The expert-led group received 3-hour expert-led tutoring and in-training formative assessments after 2 practice sessions. After a similar expert-led course, the expert-led+AI group (n=23) practiced and assessed their skills on an AI system. Through a comparison with the internal standard, the system automatically recorded and evaluated every intern’s suturing/ligature skills. In the expert-led+AI group, performance and confidence were compared between interns who participated in 1, 2, or 3 AI practice sessions.Results: The end-of-surgical block objective structured clinical examination (OSCE) performance and self-assessed confidence in suturing/ligature skills were highest in the expert-led+AI group. In comparison with the expert-led group, the expert-led+AI group showed similar performance in the in-training assessment and greater improvement in the end-of-surgical block OSCE. In the expert-led+AI group, the best performance and highest post-OSCE confidence were noted in those who engaged in 3 AI practice sessions.Conclusion: This pilot study demonstrated the potential value of incorporating an additional expert-led+AI system–assisted tutoring course into the regular surgical curriculum.

Apoptosis is one of the events that are involved in liver fibrogenesis. Thus, factors that affect apoptosis may be used to modulate liver fibrosis. We have recently reported that Salvia miltiorrhiza plays a protective role in carbon tetrachloride (CCl4)-induced hepatic fibrosis. In this study, we aimed to evaluate whether S. miltiorrhiza modulated CCl4-induced hepatic apoptosis in rats. Male Wistar rats were given orally either vehicle or water-extract of S. miltiorrhiza (50 mg kg−1 twice daily) for nine weeks beginning from the start of CCl4 administration. A group of normal rats was included for comparison. Hepatocyte DNA fragmentation and cytosolic caspase-3 and caspase-8 activity were determined in the experimental animals. Hepatic cytosolic Bax, Bcl-2, cytochrome c, and calpain-μ expressions were measured by Western blot analysis. Hepatic mitochondrial glutathione levels were assessed by colorimetric assay. Compared with normal rats, rats receiving CCl4 alone showed profound DNA fragmentation associated with an increased cytosolic fraction of cytochrome c and calpain-μ protein expressions and a decreased mitochondrial glutathione level. In contrast, a decreased laddering of DNA fragmentation was noted in rats receiving CCl4 plus S. miltiorrhiza extract. The mitochondrial glutathione level was significantly increased in rats receiving CCl4 plus S. miltiorrhiza extract compared with those receiving CCl4 alone. Additionally, cytosolic caspase-3 activity and cytosolic fractions of Bax, Bcl-2, cytochrome c, and calpain-μ protein expressions were decreased in rats receiving CCl4 plus S. miltiorrhiza extract compared with those receiving CCl4 alone. The cytosolic caspase-8 activity in rats receiving CCl4 alone was no different from those receiving CCl4 plus S. miltiorrhiza extract. These results indicated that chronic administration of S. miltiorrhiza ameliorated CCl4-mediatd hepatic apoptosis in rats. This effect may be related to the antioxidant properties of S. miltiorrhiza.