Recent discussions
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Виктория Антонова
Thanks for this clear recommendation due to limited and low evidence. A not mentionned article [van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?. J Athl Train. 2012;47(4):435–443.] conclude also: "Based on our review, evidence from RCTs to support the use of compression in the treatment of acute ankle sprains is limited. No information can be provided about the best way, amount, and duration of compression or the position in which the compression treatment is given (recumbent or elevated)." -
Ali Ramadan
Thank you for the amazing studies in first aid field. I hope you respond on my email. ( About reviewer mentey ) ..... About the study I think it will be more readable if edit the writing, following tips of effective writing ex Original text " For the critical outcome free from walking pain after 4 days and 8 days (measured as having pain during walking, yes or no), we have identified very-low-certainty evidence from 1 non-randomized trial (Linde 1984 177) enrolling 100 adult patients with ankle sprains, not showing benefit from the use of a compression bandage, when compared with not using a compression bandage (RR, 1.25; 95%CI, 0.78–2.11, P=0.33 and RR, 1.39; 95%CI, 0.98–1.95, P=0.06, respectively). Edited text " Linde 1984 , (Non-RCT, n=100 ankle sprain) shows No benefit from the use of a compression bandage, compared with not using the compression bandage. - very-low-certainty evidence - ## I think it can be more easier and readable . -
Виктория Антонова
We welcome the range of interventions explored for this topic and useful analysis. We agree that there are significant gaps in research, and given the practical limitations of immersion, indicators of the most effective of the other options, including combinations, will indeed be useful and important going forward. A further concern is the possibility of different treatment pathways for exertion and non-exertion/classic heat stroke hyperthermia. For lay responder educational purposes, does the Task Force consider it necessary for the lay responder to differentiate or can the same treatment recommendations be applied (perhaps as good practice points) as for exertional hyperthermia? -
Виктория Антонова
1. The recommendation to immerse adults with exertional heat exhaustion or stroke in ice slush carries considerable resource implications and will generally only be available in large "fun run" type events 2. I would suggest in the knowledge gaps that research on the effect of the rate of cooling on the recovery from heat exhaustion or stroke is needed as well -
Виктория Антонова
Agree with the recommendations given the evidence that is presented. Appreciate the discussions from experienced neonatal providers, but at present the evidence points towards no advantage for immediate DL in non-vigorous infants with or without tracheal suctioning. These are recommendations and as the evidence is low, discretion is still in the hands of the providing physician. -
Виктория Антонова
Excellent update. Balanced and rigorous. Recommendations allow for individual decision-making. -
Виктория Антонова
Congratulations for the outstanding work. The results of the doing the systematic review and meta-analysis studies made me be convinced that it is about time to stop doing (regular) tracheal intubation and aspiration on every non-vigorous newborn. -
Виктория Антонова
Meconium in the amniotic fluid is a flag for increased risk to the depressed baby at birth, and the time for suctioning will vary. The key is to be prepared to suction below the cords if the airway is obstructed - with laryngoscope, endotracheal tube, suction, meconium adapter - when needed; this may be initially, or after going through the steps of MRSOPA. The wording of the current recommendation does allow this. -
Виктория Антонова
Taking into consideration the results of the systematic review and the meta-analysis, and until future RCT´s prove oyherwise, I think it is about time to stop recommending routine tracheal intubation and aspiration in every non vigorous baby born with meconium-stained amniotic fluid. Being a NRP instructor in Brazil for a long time, I have testified the great difficulty most of the trainees have to perform intubation in 20 seconds and in his first attemp. It sounds better to teach how to ventilate properly these babies rather than wasting time trying to intubate. -
Виктория Антонова
The data(do not intubation and do not suction) are weak. I alway knews intubation and suctioning to be helpful in the delivery room or ER. and I have found that infants that get intubated and their airway cleared do much better. I understand that if you do not have someone that is good at intubation, it can waste valuable time. if you have capable staff for intubation, the infant recovers much faster and a lot of them do not need to have prolonged stays in intensive care unit for long because of an effective resuscitation. and also the motive to eliminate this step (suctioning) was more to protect hospitals for not having trained providers in the hospital in cases of meconium stained fluid. Better to educate and train than keep dumbing down the standards.