ICMMS 2017

ORAL PRESENTATION: THAILANDAn Integrated Training Program of Mass Casualty and DisasterManagement (Yok-Pira-Rak) for the 4th Year Nursing Students ofthe Royal Thai Army Nursing CollegeNapasorn Srisattayawongsa, Parama PetchglamThe 4th year nursing student, The Royal Thai Army NursingCollege (RTANC), Thailand There are an increasing number of mass casualtyincidents both from man-made and natural causes. These incidentslead to high mortality rate and disability and require effectiveand timely management. Therefore, the integrated trainingprogram (Yok-Pira-Rak) was firstly initiated in the Royal ThaiArmyNursing College (RTANC) in April 2015 to develop nursing skillsrequired for mass casualty and disaster management in order to strengthen the identityand uniqueness of the RTANC in serving the Royal Thai Army, people and the nation inevery situation. This training program aims to develop nursing competency in Trauma andEmergency Nursing, especially for pre-hospital care, to strengthen the identity of expectinggraduates and the uniqueness of the institution, and to integrate nursing skills in various areasand apply these skills to manage situations, based on the scenarios under limited time andresources. It is a 5-day training program consisting of knowledge preparation and training,briefing, demonstration of decontamination procedure in case of Chemical, Biological,Radiological and Nuclear Warfare (CBRN), Tabletop exercise, 6 skill training stations andscenario-based training with various scenarios including military events, mass casualtiesand field hospital services. The 6 skill training stations included Triage, Basic LifeSupport, Basic Trauma Life Support, Airway Management, Transfer and Immobilizationand Psychological operation. In this session, all students were rotated to train in everyskill. In the last training day, students need to apply knowledge and skills trained tomanage various scenarios provided as a simulation based learning. In conclusion, theRTANC aims to prepare army nurses as the uniqueness in serving the Royal Thai Army,people and the nation in every situation including peace keeping, wartime and disaster events.Apart from developing nursing skills in the hospital settings, the RTANC is also looking foropportunities for nursing students to have experiences in pre-hospital care. Therefore, theintegrated training program is given for the 4th year nursing students. The training is named“Yok-Pira-Rak”, which means the valuable jade representing army nurses who conservethe brave warriors.ICMMS 2017 51

ORAL PRESENTATION: INDIASensitisation of Medical Undergraduates in Doctor-PatientRelationship Using a Simulated Standardized Family ModuleGunta Satya Preetham, Karuna Datta, Navdeep SethiArmed Forces Medical College, Pune, India Our college is following a structured module for teachingcommunication skills for medical undergraduates. An innovativestrategy using ‘Standardized Family module’ has been formulatedto sensitize students about the importance of understanding thepatient in context to his family members and society in general.Role-play with standardized family members are done for thestudents with specific objectives for each session. The objective ofthe session was to sensitize the students regarding the importance of language, non-verbalcommunication and importance of taking regular feedback from the patient by recheckingwhat he understood. The aim of this study was to assess the sensitization amongst studentsachieved using this module, if any. A survey form was administered after the sessionasking the students to respond on the acceptability of the module and effectiveness of themodule in enhancing doctor patient relationships apart from assessing if the objectives ofthe session were achieved. The survey form results showed 87% felt that communicationskills play a major role in enhancing therapeutics and diagnostics. 92% agreed that specialcourses should be offered to enhance communication skills, and a majority of them felt thatuse of simulated standardized family module is a good teaching method. They agreed thatlack of communication skills is the most important barrier in doctor patient communica-tion. The objectives of this module were achieved regarding the sensitization about theimportance of language, non-verbal communication as per their feedback.52 ICMMS 2017

ORAL PRESENTATION: CHINAExploration on the New Health Support System for China NavyOffshore OperationsRong-Bo Wen, Hai-Tao Sun, Jun-Nan Chen,Yi-Tan Zou, Jian ZhangSecond Military Medical University, China To treat the wounded, especially the critically woundedpatients in the shortest time after the injury, such as hemostasis andopening the airway, is the key to save lives and reduce the deathrate. Methods: When in the high seas combat, Forward surgicalteam (FST) implements “jump ship security”. Once people andmaterials are delivered to the ship, FST doesn’t need to rely on theestablishment of surgical facilities, and can work semi-independently. There are at least 4individuals in a single surgical module which includes one surgical surgeon who are skilledin the operation of the chest, abdomen, and extremities, one military surgeon who are familiarwith anesthesia or critical illness management, and the rest are nurses or health guards. Thematerials carried include mobile surgical equipment, mobile anesthesia or ventilator, generatoror power supply, pressure infusion, blood collection, defibrillation or blood biochemistryinstrument or mobile ultrasound, etc. Results: FST can treat the critically wounded patientsin the shortest time, avoid the death of the wounded on the way of evacuation and reducethe death rate. Conclusion: FST is the most effective mode to realize “medical treatment tobe with soldiers” and “time-effect treatment”.ICMMS 2017 53

54 ICMMS 2017

POSTER PRESENTATIONICMMS 2017 55

POSTER PRESENTATION: BANGLADESHSimulation-Based Medical Education and Military Medicine:The Key to Revolutionize MedicineMuntasha Mim, Md Khaledur RahmanArmed Forces Medical College, Bangladesh Simulation is a generic term that refers toan artificial representation of a real world processto achieve educational goals through experientiallearning. Simulation is an important methodologyin bridging the gap between theory and practicein medical education. Simulation based medicaleducation (SBME) can be used to teach anatomy, physical examination skills, procedures (frombasic to complex), clinical skills, disease recognition, medical team training and equipmentproficiency. At our medical college the acquaintance to such simulation based techniques arefirst encountered in the forms of isolated organs used in anatomy. Various simulators are alsoused to mimic the original clinical settings in clinical learning such as in- examination of therectum and vagina, ligation of the skin, insertion of the NG tube into the stomach, insertionof catheter into the bladder, catheterization in the central and peripheral vein etc. Side byside its use also expand to the fields of anesthesiology and bronchoscopy simulators. Themost commonly used SBME is the use of a simulated patient or standardized patient who istrained and equipped with real life-like symptoms or clinical problems including mental status,living situation and physical status. Simulated patients have been successfully used in ourmedical education to teach student about medical interviews for taking history or obtaininginformed consent and in some cases, basic physical examination such as auscultation andpalpation. We can practice and improve our clinical sessions with simulated patients and byfeedback provided from teachers and simulated patient before encounter with real patient.56 ICMMS 2017

POSTER PRESENTATION: CHINAA Preliminary Attempt in the Training of Cricothyrotomy inTCCC TeachingShuang Li, Jun-Nan Chen, Hai-Tao Sun, Rong-Bo Wen,Yi-Tan Zou, Li GuiDepartment of Emergency Nursing, School of Nursing, SecondMilitary Medical University, China The objective of this study is to introduce cricothyrotomytraining to TCCC teaching, in order to enhance the combat casualtycare ability of military medical students in dealing with airwayobstruction. We used the teaching model of “theoretical teaching +skill demonstration + practice in groups” to deliver the cricothyrotomytraining for our school graduates. Skill examination was conducted by selecting the simulationcase randomly. Some students were selected for qualitative interviews with teaching evaluations.In the descriptive statistical analysis for skill examination of cricothyrotomy, we found thatthe qualification rate was 95.2%. The correct rate of injury judgement was 81.0%, whilethat of the operation accuracy was only 9.5%. The qualitative interviews showed that thestudents regarded cricothyrotomy as crucial emergency measures in combat casualty careand approved of this teaching model. Besides, they recommended to be taught with the aidof video and the practice time should be increased so as to facilitate to master this skill. Inconclusion cricothyrotomy is the key measure to alleviate airway obstruction in the tacticalarea of TCCC. Our teaching model is benefit for students to learn this skill, but the assessmentscale should be more detailed to fully assess the level of students’ skill. Additionally, theteachers should strengthen the teaching according to the students’ weakness.ICMMS 2017 57

POSTER PRESENTATION: CHINAForward Surgical Team Training for Entry-level Undergraduatesof Naval Medical University of Chinese People’s Liberation ArmyHai-Tao Sun1, Jun-Nan Chen1, Rong-Bo Wen1, Yi-Tan Zou2,Shi-Guan Le3, Wang Xi3, Zhi-Nong Wang313rd Company, Faculty of Naval Medicine, Naval Medical University,China, 211th Company, Faculty of Clinical Medicine, Naval MedicalUniversity, China, 3Department of Cardiothoracic Surgery ChangzhengHospital, Naval Medical University, China Forward surgical team (FST) is a highly mobile andextremely agile medical unit for surgical missions in battlefield,which can perform surgical missions with relatively little need ofoutside support. FST training has been well held in many western countries. However, suchtraining in Chinese army is far from satisfaction. Relying on Naval Medical University andits Center for Clinical Skills Training, we are launching an entry-level training program for5th grade students, in order to improve their understandings on basic concepts of FST, as wellas their abilities to complete surgical missions on battlefield. In this training program, webuild several mini centers to simulate actual environment of battlefield, so that the traineescan have immersive experience. And we have already created combat casualty animalmodels and built libraries of Standard Wounded based on dogs, simulators and made thecorresponding criteria. The role of each student will rotate in training process, in order tomake all the students learn techniques of all the FST members. New training methods suchas problem-based learning (PBL) and surgical simulators, as well as new evaluating tools,are going to be taken into this program to cultivate qualified FSTs. Our training center wasestablished at 2010. 1,500 trainees have been trained in our center. The feedback showedthat the effect is positive and our students could incorporate into the team more smoothly.58 ICMMS 2017

POSTER PRESENTATION: CHINATopical Administration of Cryopreserved Living MicronizedAmnion Accelerates Wound Healing in Model Mice byModulating Local MicroenvironmentYi-Tan Zou, Rong-Bo Wen, Hai-Tao Sun, Jun-Nan Chen,Shichu Xiao, Yongjun ZhengSecond Military Medical University, China Chronic ulcer is a serious complication of combat injuryand burn. Even with the standard therapies including moist dressing,debridement, infection control, and wound offloading, these wounds stillslowly heal and 7-20% of patients will eventually need an amputation.The development of new therapies to treat chronic combat woundsis urgent. In our study, we used cryopreserved living micronizedamnion (300-600 μm) to treat wounds in mice models with chronic ulcer. We found thatpost-thaw micronized amnion retained high cell viability, as well as intact cell morphologyand membrane structure. When transplanted onto the wounds of mice, the cryopreservedliving micronized amnion greatly promoted wound healing in mice model mainly by secretinggrowth, inflammation, and chemotaxis-related factors that regulated macrophage migrationand phenotype switch, recruited CD34+ progenitor cells, and increased neovascularization.In addition, the micronized amnion matrix can exist in the dermis and serve as a longtermdermal scaffold. These results demonstrated the potential of the cryopreserved living micronizedamnion as a ready-to-use living dermal substitute that addresses.ICMMS 2017 59

POSTER PRESENTATION: INDIAEvaluation of First-Aid and Casualty Carriage by Medical Under-graduates as First Responders in a Simulated Disaster ScenarioMayank Plaha, R Shankaran, Biju K. VargheseArmed Forces Medical College, Pune, India Simulation based learning to provide immediate post-disaster support can become a crucial part of undergraduatecurriculum in Military Medical Schools. However, no universalteaching protocols exist for same. Moreover, such simulationshave never been evaluated for their reliability and validity. Hencewe embarked upon the present study. Medical Undergraduatesunderwent a simulation based learning of basic skills like bandagingand suturing for a period of 5 days. This was followed by teaching of triage and casualtycarriage in a simulated setting. In order to evaluate the simulations, a disaster scenariowas created. The undergraduates were divided into multiple teams. These teams werethen asked to provide first aid and do the casualty evacuation of standardized patients.An optimal time for this exercise was decided. All the teams were analysed based on thetime they spent to complete the exercise and an objective evaluation by experts. Also, themedical undergraduates did a subjective evaluation of the simulations. It was found thatthis simulation based teaching was effective as more than half of the teams were quiteclose to the optimal time of the exercise. Also the objective scoring of a majority ofundergraduates was good. Though not standardized, this simulation based teaching canbe effective in making medical undergraduates learn the skills of first-aid and casualtycarriage.60 ICMMS 2017

POSTER PRESENTATION: INDIAThe Effectiveness of Interactive Clinical Case Study Simulation(ICCSS) as a Teaching-Learning Tool in CardiopulmonaryResuscitation (CPR)Kriti Dargan, Mathews Jacob, K Mathangi, S HasnainArmed Forces Medical College, Pune, India Teaching in medicine should focus on enabling studentsto acquire knowledge and skill which translates in to best clinicaloutcomes. Class room based teachings or group discussions don’timpart principles of team work, coordination or decision makingwhich is prudent in an emergency situation. Simulation basedtraining provides with a low stressed learning environment whichbridges the gap between the theory & practice of medical educa-tion. A total of 21 medical students trained in basic life support underwent an algorithmbased classroom lecture on shockable rhythm following which they were randomly dividedin to two groups, 10 students were allocated to Non-simulation & 11 in HPS (Simulation)group. Non Simulation group had one ‘hands-on session’ based on conventional CPRmannequin for one clinical case scenario based on shockable rhythm. HPS groupunderwent one ‘inter-active clinical case scenario’ simulation (ICCSS) using human patientsimulator for the same scenario based on shakeable rhythm. A 21 point OSCE devel-oped based on AHA guidelines was used to test each group & students were scored basedon the number of successfully completed procedures. Chi square test or Mann-WhitneyU test was used to compare data and student t test was used to compare quantitative data.P values less than 0.05 was taken to be significant. In the HPS group 95% of the core skillswere met as compared to 62% in non simulation group. Hence human patient simulation isan effective teaching learning tool for shockable rhythms of cardiac arrest among medicalcollege students.ICMMS 2017 61

POSTER PRESENTATION: JAPANGenetic Analysis Revealed Intestinal Urate Excretion via ABCG2in Human: Serum Uric Acid could be a Useful Marker forIntestinal DiseasesAiri AkashiNational Defense Medical College, Japan Hyperuricemia is a common disease, which shows elevatedserum uric acid (SUA) level and induces gout. We previouslydemonstrated that common dysfunctional variants of ABCG2/BCRP,a urate exporter gene expressed in both intestine and kidney, causegout/hyperuricemia by decreasing urate excretion. Although werevealed the importance of ABCG2 for intestinal urate excretion usingAbcg2-knockout mice, those in humans remained to be clarified dueto urate degradation by bacterial flora. In this study, to investigate intestinal urate excretionvia ABCG2 in human, dysfunctional common variants of ABCG2, Q126X (rs72552713)and Q141K (rs2231142), were genotyped in hemodialysis and acute gastroenteritis patients.SUA levels were markedly increased in 106 hemodialysis patients (P = 1.1×10-4) by ABCG2dysfunction, which showed the physiological role of ABCG2 for intestinal urate excretionbecause their urate excretion must depend on intestinal excretion via ABCG2. SUA levelswere also significantly elevated in 67 acute gastroenteritis patients by ABCG2 dysfunction(P = 6.3×10-3) and the significant association between ABCG2 dysfunction and SUAremained after the adjustment for the degree of dehydration (P = 7.8 × 10-3), which showedthe pathophysiological role of ABCG2 in acute gastroenteritis. In conclusion, we firstdemonstrated ABCG2-mediated intestinal urate excretion in humans, and these findingsindicate the physiological and pathophysiological importance of intestinal epithelium as anexcretion pathway besides an absorption pathway. From these findings, increased SUA couldbe a useful marker not only for dehydration but also for estimating the degree of epithelialimpairment of intestine in patients with intestinal diseases.62 ICMMS 2017

POSTER PRESENTATION: MYANMARSimulation Based Medical Training in Defence Services MedicalAcademy (DSMA), Union of MyanmarTun Tun Naing, Ko Ko Lwin, Marlar Than, Ye Phyo AungDefence Services Medical Academy (DSMA), Union of Myanmar,Myanmar Use of simulation is playing an increasing role in medicaleducation in both civilian and military medical training. The mainpurpose of the simulation based training program in DSMA is toprovide an opportunity for the students to practice skills repeatedly ina risk-free environment in order to achieve confidence and proficiency.In DSMA’s newly revised M.B., B.S. curriculum, Simulation BasedTraining (SBT) program is incorporated throughout the 5 years course, beginning from 2018.SBT is incorporated in the Early Clinical Exposure (ECE) component in Years I and II, sothat the students gain the basic clinical skills and be prepared for the clinical years. Also inthe Military Medicine (MM) component, several simulated exercises in military medicine runlongitudinally throughout Years I, II and IV of the curriculum. A Clinical Skills Laboratoryhas been established and equipped with both low and high fidelity simulations, to providethe controlled and safe practice opportunities. The students gain experience by working withstandardized patients and practicing clinical skills and basic procedural skills on simulators,so that they gain confidence and proficiency to excel in their future career. Capacity buildingof trainers for ECE and SBT skills is of primary importance for the effectiveness of theprogram. The trainers need to become qualified in both pedagogical skills and simulationstrategies and should not get disappointment of feeling unskilled. Thus training of trainers isalso regularly given. SBT is expected to shape the acquisition of the graduates’ competencyin communication, clinical and military medicine skills.ICMMS 2017 63

POSTER PRESENTATION: USASimulation in Medical Education: From Matriculation to MDHolly Berkley, Michael Porambo, Joseph V. Lopreiato,Arthur L. Kellermann, Richard W. ThomasUniformed Services University, USA The objective of this poster presentation is to detail the roleof simulation throughout the medical curriculum at the UniformedServices University. Elements of medical simulation are interspersedthroughout all three phases of the curriculum to include the Pre-Clerkship, Clerkship, and Post-Clerkship curricula. Forms ofsimulation include but are not limited to simulated patients andobserved patient encounters, cut suits for trauma education, and high-fidelity simulators thatallow for procedures such as chest tubes and intubation. Areas in which simulations areutilized span both the traditional medical curriculum as well as the unique military medicalpractice and leadership curriculum.64 ICMMS 2017

POSTER PRESENTATION: VIETNAMOur Pathway to Become Military DoctorsThao Anh Pham PhuongVietnam Military Medical University, Vietnam VMMU, one of the highest ranking medical universities,is a dream of not only me but scores of high-school students. After being enrolled, we take part in a 6-month militarytraining with such heavy mental and physical challenges. Back toschool, we start our 6-year medical program with 3 periods: The first2 years, we approach 3 main subjects: Basic science, Fundamentaland Preclinical Medicine. We often study Basic Science in the wholeclass in lecture theatres and sometimes labs. Fundamental and preclinical medicine playsan important role as a bridge between basic and clinical medicine. During this time, weoften study in a simulation center which has models that mimic the human body. We learnanatomy easily with animated plastic organ model. We study the fluctuation of pulse, breathrate and blood pressure on animal simulating traumatic shock condition in Pathophysiologyor evaluate the memory of a mouse by experiment in Physiology department. We practicenursing skills (intravenous or intramuscular injection) on patterns with technical devicewhich notifies us our skills good or bad. We also practice cardio pulmonary resuscitation,first aid in simulation center to perform it skillfully in urgent cases. We experience clinical practice in the next 3 years. We are often divided into smallgroups to study on patients: ask their medical history, examine to detect symptoms, decidediagnosis, prognosis and suggest treatment for their diseases. This helps us study effectively. Military Medicine is typical of Military Doctor. We spend last 2 years focusingon 11 subjects like Military Physiology, Hygiene, Medicine and Surgery, Toxicology andRadiology, Epidemiology, etc. There’re some significant extra-curricular activities to improve students’ skills andknowledge. I’m impressed most with “Clinical Skills Competition” and “Young ScientistsConference”. Finally, after experiencing final course rehearsal, we graduate to become VN’sMilitary Doctors, serve our compatriots and contribute to the development of my country.ICMMS 2017 65

POSTER PRESENTATION: THAILANDWater Treatment Reduced Prevalence of Blastocystis Infection;A Comparison of Two Consecutive YearsThathai Cherdkiadtikul1, Toon Ruang-areerate2, AnupongSirirungreung3, Tawee Naaglor2, Paanjit Taamasri2, RamRangsin3, Phunlerd Piyaraj2, Picha Suwannahitatorn2,Nutchar Hempatawee3, Saovanee Leelayoova21Medical cadet, Phramongkutklao College of Medicine,2Department of Parasitology, Phramongkutklao College ofMedicine, 3Department of Military and Community Medicine,Phramongkutklao College of Medicine, Thailand Blastocystis sp. is one of the most common intestinal protozoa globally reported inhumans with high prevalence in developing countries. Blastocystis sp. is feco-oral transmittedmostly via waterborne route. In Thailand, the prevalences of Blastocystis infection weredifferent in each community and population. The objective of this study was to identifyprevalence, incidence, and risk factors of Blastocystis infection in primary schoolchildrenin a rural community, central Thailand and also determine the effect of water treatmenton this infection. Two cross-sectional studies were conducted in 4 schools located in thiscommunity in year 2015 and 2016. Stool cultivation using Jones’ medium was performed todetect Blastocystis infection. Standardized questionnaires were used to assess risk behaviors.After the first survey, various kinds of water treatment, mainly filtration system have beenimplemented in these schools. Water samples from each school were examined using PCRtechnique. The prevalence of Blastocystis infection was decreased from 12.8% in 2015 to4.7% in 2016. The cumulative incidence of Blastocystis infection was 2.1%. The incidencedensity of Blastocystis infection was 1.8 /100-person-year (95%CI = 0.5-4.6). One particularschool was statistically significant association with the infection in both years (AdjustedOR = 6.13; 95%CI = 1.5-25.6, p = 0.013 in 2015 and Adjusted OR = 6.1; 95%CI = 1.5-25.6,p = 0.013 in 2016). Blastocystis sp. was not found in all water supply samples collectingfrom the schools after the water treatment programs have been launched. Our results indicatethat water treatment would be helpful to prevent and control Blastocystis infection in thispopulation.66 ICMMS 2017

POSTER PRESENTATION: THAILANDNovel Teaching of BioweaponsPiyanate KesakomolDepartment of Microbiology, Phramongkutklao College of Medicine,Thailand The Department of Microbiology has established learningprograms complying with Phramongkutklao College of Medicine’svision – “to be a leader of military-specializing medical school inAsia”. Biological weapon was included into the curriculum since2008. As a new topic, it challenges students to integrate and applymicrobiology knowledge to military medicine. Throughout the past,our department has continuously improved teaching methods to facilitate competency-basedlearning, aiming students able to use knowledges and skills for benefit military medicine.ICMMS 2017 67

POSTER PRESENTATION: THAILANDComparative Study of Hearing Loss between Using and Not Using5-wing Type Ear Protection of Thai Military Training ConscriptsWatcharaporn Bourchom, Pongthep Hanchumpol,Pariyanan JaruchindaDepartment of Otorhinolaryngology, Phramongkutklao Hospital,Thailand At present, ear protective devices during gunfire by Thaimilitary training conscripts are not routinely used. The 5-wing typeear protection was invented to protect them from hearing loss withlower cost and better transmitted speaking voice. This randomizedcontrol trial (RCT) study was aimed to determine the effectivenessof 5-wing type ear protection in shielding sensorineural hearing loss (SNHL) from militaryshooting training. Sixty conscripts during routine training were enrolled and randomized in2 groups; not using ear protection and 5-wings type ear protection groups as they routinelytrained. Audiogram and Distortion Product Otoacoustic Emission (DPOAE) was performedbefore, after fire within 24 hr, 3rd day and 7th day in both groups. Immediately after gunfire,the not using ear protection group had SNHL more than the other group at a high frequency(53.2% vs. 0%, p < 0.05). At day 3, the hearing levels were gradually improved at allfrequencies except 6,000 Hz. At day 7 three conscripts (10%) in the not using ear protectiongroup still had SNHL detected by audiogram, 12 individuals (40%) had abnormal outer haircell (OHCs) function detected by DPOAE. In conclusion, the 5-wing type ear protectioncould prevent SNHL immediately after gunfire training. DPOAE had higher sensitivity thanaudiograms in detecting OHCs deficiency up to 30%.68 ICMMS 2017

POSTER PRESENTATION: THAILANDAn Application of Military Sport Medicine in“SMART SOLDIER 4.0” for Royal Thai Army PersonnelAttasit SittitawornPhysical Medicine and Rehabilitation Department,Phramongkutklao Hospital, Thailand We have applied sport medicine to enhance physical fitnessin RTA personnel. This program has been designed to develop militarystyle and preventive programs for healthy RTA personnel to be “SMARTSOLDIER 4.0”. First step we identified and analyzed the medicalproblem of RTA personnel that made them lack of exercise such asmusculoskeletal pain, cardiovascular problems, diabetics, obesity,etc. Then their underlying problems have been controlled to ensure the safety of exerciseprogram. Graded exercise program from light to moderate intensity has been applied forweight reduction. Training of core muscle strengthening exercise and enhancing physicalfitness with army training exercise program have been then implemented. After applying thisprogram, all RTA personnel recruited in this project has gained physical fitness improvementand passed the annual RTA physical fitness test without severe medical problem. In conclusion,military sport medicine can improve the physical fitness in RTA personnel, reduction ofseverity of the underlying disease and make them become a “SMART SOLDIER 4.0”.ICMMS 2017 69

POSTER PRESENTATION: THAILANDIn Vitro Assessment of Frozen Red Blood Cells Processed bySimple Modified Cryopreservation MethodTshering Yangdon1, Warunee Ngren-ngram-lert1,Rachanee Udomsangpetch2, Aungkura Supokawej3,Apapan Srisarin3, Preamrudee Chaisuwirat41Department of Community Medical Technology, 2Departmentof Research & Innovation, 3Department of Clinical Microscopy,Faculty of Medical Technology, Mahidol University,4Army Institute of Pathology, Phramongkutklao Medical Center,Bangkok, Thailand In blood transfusion, frozen red blood cells (FRBCs) can be used as blood reservesin meeting blood demand. The Naval Blood Research Laboratory (NBRL) method forFRBCs is widely used in large Blood Centers, especially in Military settings. Due to therequirement of an automated cell processor, the NBRL method is not available in all bloodcenters. A simple modified cryopreservation method has been developed for small bloodcenters with lack of the automation. The aim of this study was to assess the properties ofFRBCs processed by the modified technique and compare to leukodepleted packed red cells(LDPRCs). LDPRCs were obtained from donor bloods. Ten units of LDPRC were frozenwith 40% glycerol for the FRBCs preparation. Used as controls; four units of LDPRCwere stored at 40C refrigerator. The RBC properties including RBC count, Hb, Hct, RBCindices, osmotic fragility and intracellular pH were evaluated in FRBCs and refrigeratedLDPRCs at Day 0. Relied on RBC indices, No significant difference in morphology wasnoted between FRBCs and LDPRCs (p > 0.05). The mean pH value of FRBCs was lower(6.5 ± 0.13) than LDPRCs (7.7 ± 0.06). Osmotic fragility was markedly increased in FRBCs(p < 0.05). However, several studies demonstrated the changes in pH and osmotic fragilityhave no significant adverse effects on red cell quality. These findings imply that the modifiedtechnique can be possibly implemented in small blood centers for freezing the RBCs.70 ICMMS 2017

POSTER PRESENTATION: THAILANDDNA Sequence Analysis, Culture and Identification ofIntermediate Leptospira spp. from Water and Soil SamplesSangjun Noppadon, Komanee Pat, Sudsavart Yuttapong,Eza Anuparp, Ruengnarong Pisit, Morakotjaratring Mana,Pooyindee Manop, Saha Anusorn, Krairojananan Panadda,Pulsuksombuti DuangpornArmed Forces Research Institute of Medical Sciences, Thailand Leptospirosis is worldwide zoonotic diseases which causedby pathogenic leptospires. Humans become infected via exposure topathogenic Leptospira spp. from contact with water or soil contaminatedwith urine of shedding animals. However, the isolation of leptospiresfrom the environment was usually unsuccessful due to the overgrowth of contaminants andthe slow growth of Leptospira. Then, modified leptospires isolation techniques were carriedout to enhance the growth of this organism. In 2014-2015, the collection of environmentalsamples was performed in three sites, rice field of Army veterinary school demonstration,rice field of Chulachomklao Royal Millitary Academy (CRMA) demonstration; Nakornnayokprovince and one Soccer field, Bangkok. The tubes containing soil samples, 30 mL ofsterile water was added, followed by mixing. Both water and soil mixture samples werekept in a vertical position for 1 day to allow the sediments to settle. Then, 2 x 1.0 mLof supernatant from each sample was filtered by 0.45-μm-pore-size membrane filter, andcentrifuged, discarded 0.7 mL of each supernatant , mixed the rest and inoculated to EMJHmedium with 5-fluorouracil followed by incubation at 30°C. The tubes were observed dailyaverage 5 to 14 days. The leptospire cultures were filtered by 0.2-μm-pore-size membranefilter, and the filtrates were added to new tubes containing 5.0 ml of fresh EMJH medium.The final leptospire cultures were analyzed by real-time PCR and DNA sequencing. A totalof 132 samples were collected from three sites. The organism which showed thin helicalstructures with prominent hooked ends and characteristic motility, were found under dark-field microscopy in the cultures of 11 samples, 6 samples from Soccer field; Bangkok and5 samples from rice field of CRMA demonstration; Nakornnayok. The real-time PCRproduct revealed 11 non-pathogenic leptospires. Finally, the DNA sequencing showed 10non-pathogenic and 1 intermediate leptospires. This technique assisted to reduce contaminantand get more purified leptospies to be further identified by molecular techniques. Thismodification and combination method is powerful technique for isolation and identificationof leptospires from samples collected from environment.ICMMS 2017 71

POSTER PRESENTATION: THAILANDBody Painting in Anatomical Class for Army Medical Non-commissioned Officer Student at Army Medical Field ServiceSchool, Royal Thai Army Medical DepartmentPhutsapong Srisawat, Peetirat Hiranrusme,Theerawut Sawangwaree, Smin Boonlikit,Pramote ImwattanaArmy Medical Field Service School, Royal Thai Army MedicalDepartment, Thailand Body painting in the medical education context is the paintingof internal structures on the surfaces of the body. It has many educationalbenefits, such as a fun learning activity, promoting retention of knowledge,highly memorable experience and impact to future clinical practice ofstudents. The army non-commissioned officer (NCO) students of medical corps study regularlyin the 6 months course at army medical NCO student battalion, Lopburi province. After thegraduation, they would be the combat medics who work in the medical units throughout Thailand.Because of the short period of the course and diversity of the students, the new teaching methodfor anatomical class was performed by body painting. Thus, the objective was to study theoutcome of anatomical class for medical army NCO students by the body painting method. Therewere 120 male NCO students in the class and were separated into 60 small groups (5 students/group). After the basic anatomical lecture of musculoskeletal system (total period = 8 hours),the body painting workshop was assigned to each student group to draw the upper extremitypart (shoulder region) in 40 minutes. This part was selected to be the prototype because it wouldbe the future clinical practice of the army medical NCO students, namely the intramuscularinjection at Deltoid muscle, the chest needle decompression for tension pneumothorax at 2ndintercostal space. These procedures are the essential basic procedures in the tactical combatcasualty care (TCCC). There was one student as a model in each group and four students werethe drawer at both sides of model. The equipment of drawing was non-toxic color pens (blackand red). Finally the contest among groups was performed by agreement between studentvote and mentor. The winner group of the contest was rewarded by the small gift. After theclass, the self-reported questionnaire was used to evaluate this teaching method by all NCOstudents. The ten components of self-reported questionnaire were clarified: objectives, clarifiedassessment, synchronized with the core content, continuity of subjective, easy understanding,appropriateness time, knowledge of mentor, answer & question capability, appropriateness ofequipment, conclusion period. Each component was rated to score 1-5. The response rate was100%. The mean scores in each component were 4.70, 4.58, 4.54, 4.50, 4.48, 4.54, 4.64, 4.54,4.51, 4.54, respectively. The average score was 4.56 (excellent). In conclusion, the teachingmethod by body painting in anatomical class is the effective alternative tool for medical armyNCO students. “Draw what can’t be seen, watch what’s never been done, and tell thousands about it without saying a word.” - Frank Netter, M.D.72 ICMMS 2017

POSTER PRESENTATION: THAILANDThe Effectiveness of Using Innovative Intercostal Drainage CareModelAnn Thaiudom, Suweena BohplianThe Royal Thai Army Nursing College, Thailand Intercostal drainage is an important life-saving procedure.Patients with intercostal drainage system are at risk of some potentialcomplications if not appropriately cared for. Therefore, nursing personnelneed to have knowledge and skills necessary to provide care for thepatients. Due to lack of practice model and the need of pre-clinicalskill requirement, the Royal Thai Army Nursing College developedArmy Nurse Chest Drain Model for teaching and training nursingskills for intercostal drainage care for nursing students and nursing personnel to promotehigh quality of nursing care and the patient safety. This training model aims to develop aninnovative chest drainage model used to enhance knowledge and nursing skills requiredfor taking care of patients with intercostal drainage and to evaluate the effectiveness of thedeveloped model and users’ satisfaction. As for the methodology, the literature review andexpert consultation were done before developing the model. The model corrections andimprovement were done to ensure real-like appearance and functions. Then, the model wasused to teach nursing students. Finally the model was evaluated in terms of the effectivenessand users’ satisfaction. Results showed that the average score of perceived knowledge andskills of nursing students increased from 3.11 to 4.54 which the total score was 5.00. Theaverage knowledge score measured by the test significantly increase from 18.38 to 26.95from the total score of 31.00. The average satisfaction of nursing students and nursinginstructors were at very good level (4.63 and 4.88 out of 5.00 respectively). In conclusion,the innovative intercostal drainage care model was effective to increases knowledge andnursing skills for providing care to the patients and the users were highly satisfied with thedeveloped model.ICMMS 2017 73

AUTHOR INDEXAbu Noman Mohammed Mosleh Uddin 35 Miriam E. Bar-on............................... 23, 39Airi Akashi............................................... 62 Morakotjaratring Mana............................ 71Anintita Pongsaboripat............................. 45 Muntasha Mim......................................... 56Ann Thaiudom......................................... 73 Napasorn Srisattayawongsa..................... 51Anupong Sirirungreung..................... 38, 66 Navdeep Sethi.............................. 33, 47, 52Apapan Srisarin........................................ 70 Nguyen Thai Linh.................................... 40Ariful Bashar............................................ 30 Norihiko Yamada..................................... 28Arthur L. Kellermann......................... 44, 64 Nutchar Hempatawee............................... 66Aticha Udomdech.................................... 45 Ornida Angsawetrungruang..................... 45Attasit Sittitaworn.................................... 69 Paanjit Taamasri....................................... 66Aungkura Supokawej............................... 70 Panadda Hatthachote................................ 45Biju K Varghese................................. 37, 60 Panithan Kwangwaropas.......................... 23Chizu Sanjoba.......................................... 30 Parama Petchglam.................................... 51Danfeng Zhang......................................... 50 Pariyanan Jaruchinda............................... 68Do Quyet.................................................. 31 Peetirat Hiranrusme................................. 72Dusit Staworn.......................................... 23 Phunlerd Piyaraj................................. 45, 66Eisei Noiri................................................ 30 Phutsapong Srisawat................................ 72Eza Anuparp............................................. 71 Picha Suwannahitatorn............................. 66Gunta Satya Preetham.............................. 52 Piyanate Kesakomol................................. 67Hai-Tao Sun........................... 53, 57, 58, 59 Pongthep Hanchumpol............................. 68Holly Berkley..................................... 44, 64 Pooyindee Manop.................................... 71Huu Duc Nguyen..................................... 42 Pramote Imwatana............................. 23, 72Jian Zhang................................................ 53 Prapaipim Thirakhupt............................. 26Joseph O. Lopreiato........................... 22, 23 Preamrudee Chaisuwirat.......................... 70Joseph V. Lopreiato............................ 44, 64 Proggananda Nath.................................... 30Jun-Nan Chen......................... 53, 57, 58, 59 Pulsuksombuti Duangporn....................... 71K Mathangi.............................................. 61 R Shankaran............................................. 60Kang Virak............................................... 34 Rachanee Udomsangpetch....................... 70Karuna Datta................................ 41, 47, 52 Ram Rangsin................................ 38, 45, 66Ko Ko Lwin....................................... 32, 63 Richard W. Thomas............................ 44, 64Komanee Pat............................................ 71 Rong-Bo Wen......................... 53, 57, 58, 59Krairojananan Panadda............................ 71 Ruengnarong Pisit.................................... 71Kriti Dargan............................................. 61 S Hasnain................................................. 61Lakshmi Renganathan.............................. 47 Saha Anusorn........................................... 71Li Gui....................................................... 57 Sangjun Noppadon................................... 71Marlar Than............................................. 63 Saovanee Leelayoova............................... 66Mathews Jacob......................................... 61 Selina Banu.............................................. 30Mayank Plaha........................................... 60 Shichu Xiao.............................................. 59Md Abdul Alim........................................ 30 Shi-Guan Le............................................. 58Md Abu SayeedSarker............................. 30 Shuang Li................................................. 57Md Bahanur Rahman............................... 30 Sin Daro................................................... 48Md Fashiur Rahman................................. 30 Smin Boonlikit......................................... 72Md Jahangir Alam.................................... 30 Sudsavart Yuttapong................................ 71Md Jalal Uddin......................................... 30 Supanat Puangjit...................................... 45Md Khaledur Rahman.............................. 56 Suthee Intharachat.................................... 23Michael Porambo............................... 44, 64 Suthee Panichkul...................................... 3874 ICMMS 2017

Suweena Bohplian................................... 73 Wang Xi................................................... 58Tasnuva Tarannum................................... 49 Wang Zhinong.......................................... 27Tawee Naaglor......................................... 66 Warunee Ngren-ngram-lert...................... 70Thao Anh Pham Phuong.......................... 65 Wataru Terabaru....................................... 46Thathai Cherdkiadtikul............................ 66 Watcharaporn Bourchom......................... 68Theerawut Sawangwaree......................... 72 William M. Roberts.................................. 29Toon Ruang-areerate................................ 66 Ye Phyo Aung.......................................... 63Toshiaki Ishizuka..................................... 36 Yi-Tan Zou............................. 53, 57, 58, 59Tshering Yangdon.................................... 70 Yongjun Zheng......................................... 59Tun Tun Naing......................................... 63 Yoshitsugu Matsumoto............................ 30Wahida Rahman....................................... 35 Zhi-Nong Wang........................................ 58ICMMS 2017 75

EDITORIAL BOARDCol. Asst.Prof. Chantrapa Sriswasdi Editor-in-ChiefCol. Prof. Mathirut Mungthin Deputy Editor-in-ChiefCol. Asst.Prof. Pipat SritanabutrLt.Col. Wisit Kaewput Editorial SecretaryLt.Col. Pongthorn NarongroeknawinLt.Col. Nutchol CharoenponMS. Pornpen KanlangwatCol. Asst.Prof. Phunphen Napradit 76 ICMMS 2017