Recent discussions
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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. -
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Luciane Berti
I agree with the agent -
ANA CAVANHA
It seems reasonable to me to try to use a temperature of 23 degrees Celsius in the delivery room to reduce cases of hypothermia, as it would be a low-cost action. -
Gabriel Variane
Despite the paucity of evidence, our center recommends that room temperatures of 23oC be used at birth for late preterm ( ≥34 weeks' gestation) and term infants and also that skin to skin care be used immediately after birth. We do not routinely recommend the use of a plastic bag or wrap in addition to skin to skin care in this population, as the risk-benefit of specific interventions is unknown. I agree that studies examining the effectiveness of interventions are necessary to make these treatment recommendations and that standardizing the timing and method of temperature recording for all infants would be an important step. -
José Roberto Ramos
Very relevant and difficult topic to comment on. I believe there are 2 important variables in addition to all those mentioned: different preterm and term physiologies and resuscitation needs or not, making it difficult to maintain the desired temperature for a long time. The successful experience of skin-to-skin contact in Brazil has played an important role and the decision to put all terms in the plastic bag still seems to me to have an uncertain risk-benefit -
Andrea Lube
Maintaining the proper temperature is a major challenge. We have been practicing golden hour with maintaining skin-to-skin contact for about 1 hour or more. Yet we face problems with colleagues who want a low ambient temperature in these late preterm and especially term deliveries. Maternal temperature is often low, and we don't know how much this can impact the newborn's temperature. We occasionally use gel mattresses. But we are afraid of burning the skin or causing hyperthermia, as we have no control over the temperature of the mattress. The imported thermal mattress is expensive and single-use. The use of plastic bags may help us to maintain the proper temperature.