Recent discussions
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John Mouw
The comparators are AED for CPR first after drowning. The reviewers acknowledged that good practice recommendation is based on "The rationale for a CPR first strategy is due to the hypoxic mechanism of cardiac arrest" despite lack of conclusive evidence. Experience has taught us that people (Instructors and rescuers) when reading a recommendation tend to follow and teach in the order a recommendation is presented. Understanding the importance of both CPR and AED, I suggest reversing the order of the sentences in the recommendation to: "CPR should be started first and continued until an AED has been obtained and is ready for use. When available, we recommend an AED is used in cardiac arrest following drowning in adults and children." -
ARTHUR JACKSON
We seem to be waffling around the AHA suggestion of the collection of qualitative data from individual training through actual application in or out of hospital application. We need data on the whole resuscitation system and not just one part of it. -
Tunnel Vision Goggles
Studies had to compare at least two different CPR methods from the eligible interventions; studies without a comparator were excluded. https://athomeautismproduct.com/#section-47c707a3 -
Alan Williams
This is an important area as the investigation into, and reviews of pedagogic interventions is less developed and in my opinion primary research can be more subjective. This limitation does not reflect the review process, nor investigators and teams who share their primary research, and relates to challenges presented (methodological, measuring outcomes etc) when investigating learning and education. Despite these general challenges this is a worthy review and I look forward to reading the final article. I declare a potential conflict of interest as an elected member of the Resuscitation Council UK Executive Committee. Thanks. Alan -
benyam seifu
thank you -
Dianne Hennig
Having taught for 30+ years I can tell you that the blended approach is not ideal. As an Instructor, I can tell you that I end up having to repeat everything in the info section anyway because people don't remember as well when the info is independent of the practical. My strong recommendation based on many years of experience is that blended learning should NOT be used unless there is no other option. I may be a dinosaur but having seen the changes since the 1970's and getting feedback from my students - real learning takes place when info and practice are reinforced at a single training session, when done properly. That is my nickel's worth. -
Gerard Esposito
The benefits of Blended Learning are apparent when you consider that the recipient of the course has the opportunity to review the material. When the student prepares with online material (Videos), it is much easier to understand new fabric if you have prepared before the in-classroom session. In October 2021, AHA attenuated the classroom session by providing online classroom videos. This allows classroom time for the educator to answer questions with concept examples and ensure that the student has achieved a level of understanding within their scope of practice. Many students downplay the importance of preparation before a class. Making the material available before the classroom session will encourage the student to study the material before class. When it comes to Distance skill learning and testing, there are options. AHA has allowed Virtual Training during the Covid Pandemic. For the classroom session, the Virtual process worked great. The Skills Practise and Testing was still dome in the classroom with the educator present. For Distance learning, some presumptions help the process work, even with skills testing. If a facility in a remote location wishes to train its staff, the Blended Learning method works well for the classroom session. With well-written materials and Video support, 75% of the classroom portion can be done online effectively (in my opinion, much better than classroom only.) If students have less confidence in a part of the course, they can review the material anytime. A properly placed webcam and an educator can view the same as they were present. If the educator has a similar device, they can even instruct as if they were present. As for Distance Skills, learning and testing would only require the proper manikins needed for practice and testing and a webcam. I enjoy teaching, and I want to reach as many students as possible; Not for monetary value, but to ensure well-managed, adequately trained individuals are available to help us all. -
Alexei Birkun
The following randomised study (indexed in Scopus) seems to be eligible for the review, but wasn't covered: Birkun A.A., Altukhova I.V., Perova E.A., Frolova L.P., Abibullayev L.R. Blended Distance-classroom Training as an Alternative to the Traditional Classroom Training in Basic Cardiopulmonary Resuscitation and Automated External Defibrillation. Russian Sklifosovsky Journal "Emergency Medical Care". 2019;8(2):145-151. https://doi.org/10.23934/2223-9022-2019-8-2-145-151 -
Rossiclei de Pinheiro
A manutenção da temperatura do RN é um tem ame constante discussão, entretanto precisamos individualizar cada um conforme a vitalidade. Existem 2 variáveis importantes: A imaturidade do centro termo regulador do pré-termo, além da necessidades de ressuscitação ou não, dificultando a manutenção da temperatura desejada por muito tempo. Nos hospitais Amigo da Criança no Brasil, o passo 4 tem sido um indicador de qualidade, portanto experiência bem-sucedida do contato pele a pele tem mostrado muita relevância e um papel importante no sucesso da amamentação. Nos muito prematuros a decisão de colocar todos no saco plástico já tem sido uma rotina, porém colocar os bebes a termo pode interferir no contato pele a pele e ainda demorar o inicio da respiração. -
Amol Joshi
Methods of recording of temperature in preterm babies (1) 1. Average time taken by conventional clinical thermometer is 3 – 5 minutes. 2. Time taken by an electronic thermometer by axillary skin temperature is lesser and varies with make and temperature of the baby. 3. We need a method to record the temperature which should be simple, rapid, non-invasive, reproducible(2), cost-effective and accurately reflect the neonate's core body temperature (3), preferably without uncovering the baby. In extremely preterm babies, we recommend using food-grade plastic for transport from the labor room to NICU to prevent hypothermia. 4. The infrared tympanic thermometer has been shown to accurately reflect core temperatures when used in a pediatric population aged 6 months to 15 years. The limited data regarding its accuracy in neonates have reported promising results. The tympanic measurements were significantly higher than electronic axillary temperatures by 0.19 to 0.22°C (4). However, only 12 neonates were included within this study and hence larger-scale studies are needed to determine its accuracy in preterm babies. When mid-forehead measurements were compared to electronic axillary thermometry in neonates nursed in incubators, temperatures measured by the two methods did not differ to a clinically significant degree(5). However, a study in healthy preterm neonates compared the axillary with tympanic membrane temperature recordings noted that they are safe, accurate, easy, and comfortable for the baby sites(6). 5. The methods for recording temperature may vary in facility based and community settings and for spot and continuous recording of temperatures. Methods to keep baby warm: A portable, non-electric, ready to use, and air-activated warm blanket that is designed specifically to support premature, low birth weight newborn children to maintain thermoneutral temperature during transport. It gets activated with a exothermic reaction on exposure to air. It is a single use device capable of maintaining warm temperature for 6- 8 hours. Evidence is lacking. https://parisodhana.org/NeoWarm/#home 1. Lei D, Tan K, Malhotra A. Temperature Monitoring Devices in Neonates. Frontiers in Pediatrics. 2021:890. 2. Jirapaet V, Jirapaet K. Comparisons of tympanic membrane, abdominal skin, axillary, and rectal temperature measurements in term and preterm neonates. Nurs Health Sci. (2000) 2:1–8. doi: 10.1046/j.1442-2018.2000.00034.x 3. Bailey J, Rose P. Axillary and tympanic membrane temperature recording in the preterm neonate: a comparative study. J Adv Nurs. (2001) 34:465–74. doi: 10.1046/j.1365-2648.2001.01775.x 4. Weiss ME. Tympanic infrared thermometry for fullterm and preterm neonates. Clin Pediatr. (1991) 30(4 Suppl):42–5; discussion 9. doi: 10.1177/0009922891030004S12 5. Smith J. Are electronic thermometry techniques suitable alternatives to traditional mercury in glass thermometry techniques in the paediatric setting? J Adv Nurs. (1998) 28:1030–9. doi: 10.1046/j.1365-2648.1998.00745.x 6. Bailey J, Rose P. Axillary and tympanic membrane temperature recording in the preterm neonate: a comparative study. Journal of advanced nursing. 2001 May 7;34(4):465-74.