Short Training Course Research Articles

Use of Ultrasonography vs Clinical Assessment to Confirm Endotracheal Tube Placement by Emergency Physicians

Airway management skills are indispensable for an emergency physician. Unrecognized airway accidents such as oesophageal intubation tend to occur more in emergency room, where it is reported as 6%-16%. Various studies have compared methods used for distinguishing between endotracheal and oesophageal placement of the tube. The aim of this study is to assess the diagnostic accuracy and timeliness of ultrasonography by static method only for identification of Endo tracheal tube (ET Tube) placement in trachea in an emergency setting vs existing clinical methods. This prospective study was carried out in the emergency room from March 2020 till end of October 2022. The ultrasonography was performed 120 emergency patients only after the intubation had been completed i.e. static phase. A linear probe was used over neck to identify the predefined signs of ET intubation. Residents who perform ultrasound examination fill a form after assessment of each patient. It was found that Tracheal Intubation-USG Sensitivity was 99.1, Specificity was 91.7, Positive Predictive Value: 99.1, Negative Predictive Value was 91.7 and Accuracy was 98.3%. Ultrasonography can be used as an adjunct tool to verify the ETT position by Emergency Physicians which can be performed easily after a briefing or short-course training. This study demonstrates that US imaging has a high diagnostic accuracy to immediately confirm proper ETT placement post-intubation in an emergency setup. Therefore, it seems that ultrasonography using static technique only is a proper screening tool in determining endotracheal tube placement. Keywords: Endotracheal intubation, emergency, ultrasonography, USG Sensitivity

Impact of hands-on training in STATA for data management and data analysis: How much knowledge gained among health-care professionals?

Objectives: Data management and statistical analysis are integral parts of any research. But there is difficulty in cleaning, organizing, and maintaining data in a systematic and meaningful way for accurate analysis without any tool. Hence, there is a need to learn a tool such as SPSS, STATA, R, SAS and so many for understanding the data. This study focused on the impact of short-course training on STATA on healthcare eye professionals and found an improvement in their competency to use computer-based statistical software packages for data management and analysis and identify the major challenges for participants and suggestions to improve the training. Materials and Methods: We organized a 10-day short course on data management and data analysis using STATA. A pre and post-test evaluation was done every day to find the impact. The questionnaire covered several areas of research methodology from data management to statistics. Categorical data were described in frequency and percentage whereas continuous data was described in median and interquartile range (IQR). Wilcoxon signed-rank test was applied to find out the significant improvement in the knowledge. Results: The 10 days cumulative median score for pre- and post-test was 43 (IOR = 39-47.5) and 72.5 (IOR = 69-77) respectively and was statistically significant (P = 0.012). Male participants, younger age groups, experience, and prior knowledge were identified as major determinants to improve the knowledge and performance in the usage of STATA. We observed that advanced training in the usage of STATA is highly beneficial to people interested/involved in research to gain autonomy in data management and analysis. Conclusion: The evaluation of the training confirms that hands-on training in the use of STATA software does have a significant impact on the knowledge, self-efficacy, and attitude of the learner. Since Stata is very user-friendly, we recommend that researchers and medical students should be offered a comprehensive training course in STATA.

The effect of short-course point-of-care echocardiography training on the performance of medical interns in children.

Point-of-care ultrasound (POCUS) can add complementary information to physical examination. Despite its development in several medical specialties, there is a lack of similar studies on children by medical interns and cardiologists. Therefore, investigators aimed to assess the effect of short-course training on the performance of medical interns in point-of-care echocardiography in children. This analytic cross-sectional study was conducted on 161 hospitalized children in 17 Shahrivar children's hospital, Iran, from January 2021 to May 2021. Seven interns (trainees) participated in a short course of point-of-care echocardiography to assess left ventricular ejection fraction (LVEF), inferior vena cava collapsibility index (IVCCI), and the presence of pericardial effusion (PEff). Each patient underwent point-of-care echocardiography by one of the trainees. Then, in less than one hour, the echocardiography was performed by a single cardiologist. Agreement between the cardiologist and trainees was examined using Cohen's kappa coefficient and Prevalence-Adjusted Bias-Adjusted Kappa (PABAK). For numerical variables, the agreement was examined using the concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC). Results showed that the cardiologist and trainees detected LVEF >50, IVCCI >50%, and the absence of PEff in most of the participants. A good agreement in terms of ICC and CCC for LVEF (0.832 and 0.831, respectively) and a good agreement in terms of ICC and CCC for IVCCI (0.878 and 0.877, respectively) were noted. Using categorical scoring of LVEF and IVCCI showed 94.4% and 87.6% complete agreement, respectively. Furthermore, using categorical scoring of LVEF and IVCCI, Cohen's kappa coefficient was 0.542 (moderate) and 0.619 (substantial), respectively. The PABAK for LVEF and IVCCI were 0.886 (almost perfect) and 0.752 (substantial), respectively. For PEff, Cohen's kappa and PABAK were 0.797 (moderate) and 0.988 (almost perfect), respectively, and the complete agreement was noted in 160 patients (99.4%). This study showed that a short teaching course could help medical interns to assess LVEF, IVCCI, and PEff in children. Therefore, it seems that adding this course to medical interns' curricula can be promising.

SERI PELATIHAN PEMBUATAN POT RAMAH LINGKUNGAN: UPAYA PEMBERDAYAAN PETANI ANGGREK DI PAPUA DAN PAPUA BARAT

Papuan orchid species have triggered orchid enthusiasts to be hunted for many purposes such as ornamental plants, medicinal plants and even to breeding program. This intention has encouraged locals who have the resources to trade orchids and extracted from their natural habitat without taking into consideration on how to sustain this resources for the future. Efforts should be conducted in order to enlighten the community not only to preserve this resources but also to encourage locals on how to gain benefit economically using orchids as income generate to support their daily life. Adding to this attempts, extension program such as using materials to create media to grow orchids from coconut waste and sago disposal as basic materials. We employed extension program, focus group discussion, short training course and practicum during the implementation of the activities in each location. Six sites were chosen where the orchid growers and nurseries run by locals and communities living in reserve and non-reserve areas. Five sites located in Jayapura Regency, Jayapura City, Keerom Regency, Biak Regency of Papua Province and Manokwari Regency at West Papua Province. Materials to create media to grow orchids comes from coconut waste and sago disposal as basic materials. Wires and metal screen were used to make frame for potting. We also use tools such as clipper to cut wire. All participants were actively showing their enthusiast to gain knowledge during the course. Some have ask about species name whereas others addressing question of how to reproduce the orchids as well as how to maintain the orchids using home made pot.Keywords: Extension program; community empowerment; organic waste; orchids

Community Preparation and Competency Development for Ecotourism Management in the Wang Nam Khiao-Pha Khao Phu Luang Forest Reserve

This study focused on supporting the officers of Wang Nam Khiao – Khao Phu Luang forest reserve and the local community with ecotourism management training using a six-day short-course based on the Experiential Learning Theory (ELT). As part of the need for assessment and training topics, 173 forest reserve officers, representatives of government authorities, and members of the local community, completed surveys consisting of five-point Likert-type scale items. The short-course training program was developed and implemented in the Wang Nam Khiao – Khao Phu Luang forest reserve. There were 46 attendees who participated in the short course program held in 2017; these included officers, local community leaders, and representatives. Pre- and post-tests were conducted before and after each training session. A one-way ANOVA was conducted to compare the pre- and post-test scores of the trainees and the ecotourism readiness in the Wang Nam Khiao - Pha Khao Phu Luang forest reserve among three groups of attendees. The results of the study showed that the training helped to form wider collaboration between locals and national park rangers, assisting in ecotourism management and natural resource management in the forest reserve.

Reliability of point-of-care ultrasound for measuring quadriceps femoris muscle thickness.

Point-of-care ultrasound can be used to assess muscle thickness. However, its reliability has not been fully evaluated. This study aimed to assess the intrarater and inter-rater reliability of point-of-care ultrasound for the estimation of quadriceps and rectus femoris thickness in patients from a rehabilitation setting. This is a cross-sectional study. This study was conducted at the Department of Physical Medicine and Rehabilitation of a tertiary care hospital. Twenty-nine inpatients consecutively selected after admission. Four observers, two trained and two untrained, used point-of-care ultrasound to measure quadriceps femoris and rectus femoris thickness. Each observer performed two measurements followed by a second set of two measurements three hours later. Intraclass correlation coefficients (ICC) were then calculated. Both intrarater and inter-rater ICC were higher than 0.888 for both quadriceps and rectus femoris measurements. Reliability was highest when ICC were calculated based on the average of two measurements, with the intrarater ICC being of 0.956 (95% CI: 0.937-0.970) for rectus femoris and of 0.966 (95% CI: 0.951-0.976) for quadriceps femoris; and with the inter-rater ICC being of 0.919 (95% CI: 0.863-0.957) for rectus femoris and 0.945 (95% CI: 0.907- 0.971) for quadriceps femoris. Trained and untrained observers did not have significantly different ICC values. These results suggest that point-of-care ultrasound is a reliable option to measure muscle thickness of knee extensors by the same or different observers. Measuring knee extensors thickness may aid to adequately modulate treatment choices in patients with disability. This study suggests that quadriceps and rectus femoris muscle thickness measured after a short training course, by either an experienced or inexperienced clinician, presents high reliability. Reliability can be increased if the average of two measurements is used. Besides being inexpensive and portable, point-of-care ultrasound is a reliable tool for measuring knee extensors' thickness, rendering it potentially adequate to be used in clinical practice.

Self-evaluation of Conflict Management Skills: A Cross-Sectional Study Among Vietnamese Nurses in 2021.

Effective conflict management requires various skills. However, evidence suggests that nurses are unprepared to deal with conflicts at work. Accordingly, this study aimed to examine nurses' evaluations of their conflict management skills. This cross-sectional descriptive study involved 202 nurses who were enrolled in short professional training courses at the Faculty of Nursing, Thai Nguyen University of Medicine and Pharmacy (TUMP). From March to June 2021, they completed self-administered questionnaires which included evaluations of ten common conflict management skills. The four-point rating scale ranged from very bad (0 points) to very good (3 points). Descriptive statistics, Mann-Whitney U, Kruskal-Wallis, and Spearman's rho tests were used for data analysis. The nurses ranked their ability to identify their and others' emotions and feelings as the highest [mean (SD): 1.99 (0.42)]. Their ability to self-manage conflict-induced stress was rated as the lowest [1.86 (0.56)], with managing own feelings and emotions [1.88 (0.56)], and negotiation [1.90 (0.53)] rated as second and third lowest, respectively. There were no differences in skills between nurses based on gender (Mann-Whitney U = 2814.50, p = 0.720), department (Kruskal-Wallis = 5.89, df = 3, p = 0.117), job position (Mann-Whitney U = 1502.50, p = 0.522), and education (Mann-Whitney U = 3304.00, p = 0.394). Additionally, nurses who demonstrated better skills reported higher effectiveness in previous conflict management (r = 0.45, p < 0.001). Conflict management skills varied and seemed suboptimal. Important areas that require proper attention include emotional intelligence and negotiations.

The Development of Critical Thinking Skills in Mobile Learning: Fact-Checking and Getting Rid of Cognitive Distortions

The study aims to reveal the attitude of students and teachers to mobile learning; explore the possibility of developing critical thinking skills in mobile learning; and also evaluate knowledge after a short training course involving the use of mobile technologies in the context of the development of critical thinking. The research relies on an interview and a test. It was attended by 275 people (93 teachers and 182 students). The results showed that 58% of teachers and 55% of students believe that mobile learning does not contribute to the development of critical thinking. The test results showed that the study participants who pre-listened to the course of lectures on their mobile devices did not cope with the questions well enough, and cognitive errors were identified. The research has shown that improving the skills of interpreting, analyzing, evaluating and explaining information can increase the effectiveness of mobile learning. The research is a contribution to the study of various aspects of the impact of mobile learning on students and will be of interest to teachers, students, academic administration, parents, as well as to those who are interested in modern pedagogy and educational psychology.

Can Medical Students Learn and Perform POCUS in the Pediatric Emergency Department? Implementation of a Short Curriculum.

Purpose: To determine medical student ability to accurately obtain and interpret POCUS exams of varying difficulty in the pediatric population after a short didactic and hands-on POCUS course. Methods: Five medical students were trained in four POCUS applications (bladder volume, long bone for fracture, limited cardiac for left ventricular function, & inferior vena cava collapsibility) and enrolled pediatric ED patients. Ultrasound-fellowship-trained emergency medicine physicians reviewed each scan for image quality and interpretation accuracy using the American College of Emergency Physicians' quality assessment scale. We report acceptable scan frequency and medical student vs. Ultrasound-fellowship-trained emergency medicine physician interpretation agreement with 95% confidence intervals (CI). Results: Ultrasound-fellowship-trained emergency medicine physicians graded 51/53 bladder volume scans as acceptable (96.2%; 95% CI 87.3-99.0%) and agreed with 50/53 bladder volume calculations (94.3%; 95% CI 88.1-100%). Ultrasound-fellowship-trained emergency medicine physicians graded 35/37 long bone scans as acceptable (94.6%; 95% CI 82.3-98.5%) and agreed with 32/37 medical student long bone scan interpretations (86.5%; 95% CI 72.0-94.1%). Ultrasound-fellowship-trained emergency medicine physicians graded 116/120 cardiac scans as acceptable (96.7%; 95% CI 91.7-98.7%) and agreed with 111/120 medical student left ventricular function interpretations (92.5%; 95% CI 86.4-96.0%). Ultrasound-fellowship-trained emergency medicine physicians graded 99/117 inferior vena cava scans as acceptable (84.6%; 95% CI 77.0-90.0%) and agreed with 101/117 medical student interpretations of inferior vena cava collapsibility (86.3%; 95% CI 78.9-91.4%). Conclusions: Medical students demonstrated satisfactory ability within a short period of time in a range of POCUS scans on pediatric patients after a novel curriculum. This supports the incorporation of a formal POCUS education into medical school curricula and suggests that novice POCUS learners can attain a measure of competency in multiple applications after a short training course.

Describing the learning curve of novices for the diagnosis of paediatric distal forearm fractures using point-of-care ultrasound.

The learning curve of nurse practitioners (NPs) to accurately diagnose paediatric distal forearm fractures using point-of-care ultrasound (POCUS) was investigated. Each NP's learning curve was calculated as cumulative diagnostic accuracy against a number of scans performed. The curve's plateau represented the attainment of competency. Secondary outcomes were the comparisons before and after this cut-off of diagnostic accuracy, classification of diagnostic errors, pain scores, duration and preference. Five NPs performed 201 POCUS studies with diagnostic accuracy plateauing at 90%, providing a 'cut-off' point at scan 15. Accuracy of POCUS scanning before and after the fifteenth scan was 81% (95% CI 70%-89%) and 90% (95% CI 84%-94%), respectively, demonstrating 9% improvement (P = 0.07). There was a 10% reduction in image interpretation errors. After fifteen scans, POCUS became faster (mean difference (MD) 2.6 min [95% CI 2.0-3.3], P < 0.001), less painful (MD 0.61 points FPSR scale [95% CI 0.04-1.18], P = 0.04) and more preferred by NPs (63% vs 77%, P = 0.03). The learning curve of POCUS-novice NPs independently scanning paediatric distal forearm injuries plateaued with mean diagnostic accuracy of 90% after 15 scans, suggesting competency was attained at this cut-off, supported by higher accuracy, being faster, less painful and more preferred by NPs. Future training packages in forearm POCUS should further address image interpretation and provide ongoing expert feedback. The findings from this study suggest that competency in paediatric distal forearm POCUS can be attained by novices after a short training course and approximately 15 scans.

Training future Korean medicine doctors to perform bee venom acupuncture and obtain informed consent using an objective structured clinical examination

Objectives: This study describes the implementation of a training course that aimed to increase the competency of undergraduate students of Korean medicine at a single college to obtain informed consent and perform bee venom acupuncture using an objective structured clinical examination (OSCE).Methods: We developed and implemented a short training course for 111 fourth-year students of Korean medicine during their clinical rotation at the Department of Acupuncture and Moxibustion Medicine. Lectures were conducted on the effects of and hypersensitivity reactions to bee venom acupuncture, obtaining informed consent, performing skin test and bee venom acupuncture. Due to the COVID-19 pandemic, some students were offered online lectures, and some could not experience the performance of OSCE in person. A survey with 16 closed and three open questions was used to investigate self-efficacy, opinions about the online lectures, and the OSCE.Results: Out of 111 questionnaires, 104 were completed (94%). Students were generally satisfied with the online lectures and OSCE. For the subjective questionnaire about what was helpful in the training of bee venom acupuncture techniques and OSCE, the authenticity of the teaching method was recorded the highest.Conclusions: This study showed that online lectures were effective in teaching clinical skills of Korean Medicine. It is necessary to produce standard educational materials for clinical skills of Korean Medicine, and studies to analyze the reliability and validity of OSCE are needed.

Self-administered acupressure for insomnia disorder: A randomized controlled trial

BackgroundInsomnia is a significant health problem in the community. Self-administered acupressure (SAA) may be an alternative strategy to alleviate insomnia. PurposeThis study is the first to investigate the effects of SAA delivered through a training course in alleviating insomnia disorder compared with sleep hygiene education (SHE). MethodsA randomized controlled trial was conducted on 200 participants with insomnia disorder. The eligible participants were randomized into the SAA or SHE group. Both groups attended the allocated training courses (two sessions, 2 h each) and then were followed up at weeks 4 and 8. The primary outcome was the severity of insomnia symptoms and related daytime impairment as measured by the Insomnia Severity Index (ISI). Other measures included a 7-day sleep diary and actigraphy, Hospital Anxiety and Depression Scale (HADS), and Short-Form Six-Dimension (SF6D). ResultsThe SAA group showed a significantly greater improvement in ISI score than the SHE group at week 4 (mean difference: -1.89 units, 95% CI: 0.85, 2.93; Cohen's d = 0.51, p < 0.001) and week 8 (mean difference: -2.89 units, 95% CI: 1.67, 4.11; d = 0.67, p < 0.001). In addition, the SAA group showed a greater reduction in the HADS anxiety score and HADS depression score and increase in SF6D at week 8. ConclusionsSAA taught in a short training course is a feasible and effective approach to improve sleep and related daytime impairment and mood problems in individuals with insomnia disorder.

И. Ивкович-Кихич, М. Рид, Ш. Рэйн, А. Ковачевич «Компрессоры и их системы». Итоги конференции = I. Ivkovic-Kihic, M. Read, Sh. Rane, A. Kovacevic «Compressors and their systems». Post conference report / пер. с англ. М. А. Федоровой

The article presents an overview report of the 12th International Conference on Compressors and their systems which was held in a hybrid format from September 6 to 8, 2022 in the City, University of London, UK. At this prestigious scientific and educational forum, within the framework of the plenary session, world experts made reports in the field of compressor technology and de-carbonization, as well as presentations at several technical and panel sessions on such topics as screw, scroll, vane and piston compressors; compressor systems and their diagnostic and control systems; turbo-machines; mathematical modeling and optimization of compressors, expanders and their systems. In addition, within the framework of the conference, a traditional short training course and a Forum on CFD (gas dynamic calculations) in rotary positive displacement machines were held. The introductory session was devoted to the basics of CFD implementation using the finite volume method. New studies in the field of CFD in rotary volumetric machines were presented, including those based on such programmes as ANSYS Forte and OpenFOAM. Complex modeling approaches, such as SCORG and GT-Suite, also attracted the attention of participants. Information about the next conference on Compressors and their systems, which will be held in 2023, is presented.

Effectiveness of training program in manual material handling: A health promotion approach

BACKGROUND:Even in an era of automation and digitalization, Manual Material Handling (MMH) can be called the most common industrial task. The aim of this study was to evaluate the prevalence of musculoskeletal disorders (MSDs) induced by manual handling tasks on the workers of a printing factory in Tehran in 2017 and then to evaluate the effectiveness of a training intervention based on health promotion.MATERIALS AND METHODS:This study had quasi experimental design and was conducted on 40 men. First, demographic data were collected and the Nordic questionnaire was used to determine the prevalence of MSDs in workers. Then, MMH tasks were assessed using Manual Handling Assessment Chart (MAC). A short training course was designed to promote health. Finally, the same MMH tasks were re-evaluated 3 months after the training intervention.RESULTS:Among the various tasks, the highest prevalence of work-related MSDs (WMSDs) was observed in the lower back (77.5%) and shoulder (62.5%). Based on the final scores of the MAC method, the jobs that received the highest scores were cutting (individual lifting), with 22 scores and action level “immediately necessary,” cutting (individual load carrying), with 15 scores with action level “urgently needed.” Arranging the forms (individual lifting) received a similar score. After the training intervention, the estimated risk level reduced by 12, 9, and 6 points, respectively, reaching a safe action level, i.e., “necessary in the future.”CONCLUSION:The results demonstrated that educational interventions might be equally effective in low-technology work environments. More in general, the MAC method can be used to make informed planning of educational interventions against WMSDs risk in MSDs. This health promotion approach is critical for care of human recourse.

Inter operator variability of machine learning researchers predicting all-cause mortality in patients admitted to intensive care unit

Abstract Background The number of publications using machine learning (ML) to predict cardiovascular outcomes and identify clusters of patients at greater risk has risen dramatically in recent years. However, research papers which use ML often fail to provide sufficient information about their algorithms to enable results to be replicated by others in the same or different datasets. Aim To test the reproducibility of results from ML algorithms given three different levels of information commonly found in publications: model type alone, a description of the model, and complete algorithm. Methods MIMIC-III is a healthcare dataset comprising detailed information from over 60,000 intensive care unit (ICU) admissions from the Beth Israel Deaconess Medical Centre between 2001 and 2012. Access is available to everyone pending approval and completion of a short training course. Using this dataset, three models for predicting all-cause in-hospital mortality were created, two from a PhD student working in ML, and one from an existing research paper which used the same dataset and provided complete model information. A second researcher (a PhD student in ML and cardiology) was given the same dataset and was tasked with reproducing their results. Initially, this second researcher was told what type of model was created in each case, followed by a brief description of the algorithms. Finally, the complete algorithms from each participant were provided. In all three scenarios, recreated models were compared to original models using Area Under the Receiver Operating Characteristic Curve (AUC). Results After excluding those younger than 18 years and events with missing or invalid entries, 21,139 ICU admissions remained from 18,094 patients between 2001 and 2012, including 2,797 in-hospital deaths. Three models were produced: two Recurrent Neural Networks (RNNs) which differed significantly in internal weights and variables, and a Boosted Tree Classifier (BTC). The AUC of the first reproduced RNN matched that of the original RNN (Figure 1), however the second RNN and the BTC could not be reproduced given model type alone. As more information was provided about these algorithms, the results from the reproduced models matched the original results more closely. Conclusions In order to create clinically useful ML tools with results that are reproducible and consistent, it is vital that researchers share enough detail about their models. Model type alone is not enough to guarantee reproducibility. Although some models can be recreated with limited information, this is not always the case, and the best results are found when the complete algorithm is shared. These findings have huge relevance when trying to apply ML in clinical practice. Funding Acknowledgement Type of funding sources: None.

The influence of a course in inclusive education on changing pre-service teachers’ readiness to work with students with SEN

Understanding teachers’ perspective towards inclusive education is seen as a decisive factor in making schools more inclusive. Given the increasing need to prepare pre-service teachers to face inclusion in the classroom as soon as they enter the teaching career, we consider appropriate to assess to which extend can a training course have an impact on the level of pre-service teachers to teach in inclusive classrooms. In this respect, final year students from Education Science degree that finalized a study course on the topic of inclusive education were invited to participate into this research by filling in a questionnaire based on the teacher efficacy for inclusive practices (TEIP) scale. Results show that even after taking a relatively short training course, it can bring about some statistically significant changes in pre-service teachers’ knowledge, attitudes and confidence level towards inclusion. Pre-service teachers that have participated to this study are generally in favor of going through training courses to acquire a special set of skills to thereby be able to work in an inclusive learning environment.

The Model Development of Evaluating the Effectiveness of Short and Medium Term Training Courses in Mazandaran University of Medical Sciences

The Model Development of Evaluating the Effectiveness of Short and Medium Term Training Courses in Mazandaran University of Medical Sciences

THE IMPACT OF TARGETED TRAINING OF MEDICAL INTERNS ON THE SURVIVAL OF CARDIAC ARREST IN THE EMERGENCY ROOM

Introduction:The prognosis of patients with cardiac arrest is closely related to the quality of cardiopulmonary resuscitation (CPR). The aim of this work was to assess the impact of targeted training on CPR, in accordance with the latest international recommendations, on the management of cardiac arrests in SAUV. Methods:This is a prospective study carried out between January 1 and December 31, 2011 at the SAUV of Ibn Sina University Hospital in Rabat, including all adult patients who experienced cardiac arrest after admission. The main primary objective is to evaluate the impact of targeted training of medical interns on the survival of cardiac arrest in the ER expressed by the Hospital Discharge Survival (HDS) rate. Secondary objectives include the rate of recovery of circulatory activity (RCA), 48-hour survival, and quality of CPR performance. Results:342 patients were included, 159 before and 183 after training. There was no significant difference in terms of recovery from spontaneous circulation, 48h survival or discharge rate at home without sequelae. On the other hand, there was a statistically significant improvement in all the quality criteria for performing CPR. Conclusion:This work shows that the introduction of short training courses such improves the quality of CPR. The lack of impact on the improvement of patient survival seems to be related to numerous shortcomings, in particular basic medical training in emergency medicine, organization and protocolization of care, equipment of emergency rooms, supervision of emergency clerkship and the existence of a CA national registry. These are all areas to be developed in order to improve the prognosis of CA in our hospital structure.

Problem-based learning for in-service training on breastfeeding in Friuli Venezia Giulia, Italy

BackgroundProblem-Based Learning (PBL) is extensively used in pre- and post-graduate teaching programmes. However, it has been seldom used for in-service training and continuing medical education. We aimed to develop a PBL curriculum for a short in-service training on breastfeeding for maternal and child health professionals, and to assess the effect of these courses on their knowledge and skills. Also, the project aimed at increasing exclusive breastfeeding rates and duration in an Italian region.MethodsAfter initial training on PBL and an assessment of the learning needs of about 400 health professionals, a small working group developed learning objectives, designed a curriculum, produced manuals, and shaped assessment tools for a new PBL course on breastfeeding. The field test of the new course allowed selection of the tutors for the scaling up of the training to the whole region. During this extension phase, participants were asked to complete an evaluation questionnaire. In addition, the health professionals who attended the PBL courses in 2019 were asked to complete an online survey to assess knowledge, attitudes and practices (KAP) just before, soon after the course, and 4–6 months later.ResultsThe new 29 − hour PBL course, to be delivered in four days over four consecutive weeks, gives priority to tutorial groups and practical activities (71% of the total time). Supervised clinical practices absorb 16% of time. Ethics, communication and woman-centred clinical management content run throughout the four days and all activities. The three manuals, for tutors, participants and practical activities, facilitate the tasks and performance of tutors and participants. After the field test, 32 regional tutors ran courses for 562 health professionals. The analysis of the evaluation showed a high level of satisfaction for perceived effectiveness, relevance to practice, and educational quality. The KAP questionnaires indicated a general improvement after the course and retention after 4–6 months.ConclusionsDespite some predictable shortcomings, this new PBL approach for short in-service training courses on breastfeeding showed encouraging results as far as participants’ satisfaction and KAP are concerned. The possible effects on rates and duration of exclusive breastfeeding need further research.

Home-based (virtual) rehabilitation improves motor and cognitive function for stroke patients: a randomized controlled trial of the Elements (EDNA-22) system

BackgroundHome-based rehabilitation of arm function is a significant gap in service provision for adult stroke. The EDNA-22 tablet is a portable virtual rehabilitation-based system that provides a viable option for home-based rehabilitation using a suite of tailored movement tasks, and performance monitoring via cloud computing data storage. The study reported here aimed to compare use of the EDNA system with an active control (Graded Repetitive Arm Supplementary Program—GRASP training) group using a parallel RCT design.MethodsOf 19 originally randomized, 17 acute-care patients with upper-extremity dysfunction following unilateral stroke completed training in either the treatment (n = 10) or active control groups (n = 7), each receiving 8-weeks of in-home training involving 30-min sessions scheduled 3–4 times weekly. Performance was assessed across motor, cognitive and functional behaviour in the home. Primary motor measures, collected by a blinded assessor, were the Box and Blocks Task (BBT) and 9-Hole Pegboard Test (9HPT), and for cognition the Montreal Cognitive Assessment (MoCA). Functional behaviour was assessed using the Stroke Impact Scale (SIS) and Neurobehavioural Functioning Inventory (NFI).ResultsOne participant from each group withdrew for personal reasons. No adverse events were reported. Results showed a significant and large improvement in performance on the BBT for the more-affected hand in the EDNA training group, only (g = 0.90). There was a mild-to-moderate effect of training on the 9HPT for EDNA (g = 0.55) and control (g = 0.42) groups, again for the more affected hand. In relation to cognition, performance on the MoCA improved for the EDNA group (g = 0.70). Finally, the EDNA group showed moderate (but non-significant) improvement in functional behaviour on the SIS (g = 0.57) and NFI (g = 0.49).ConclusionA short course of home-based training using the EDNA-22 system can yield significant gains in motor and cognitive performance, over and above an active control training that also targets upper-limb function. Intriguingly, these changes in performance were corroborated only tentatively in the reports of caregivers. We suggest that future research consider how the implementation of home-based rehabilitation technology can be optimized. We contend that self-administered digitally-enhanced training needs to become part of the health literacy of all stakeholders who are impacted by stroke and other acquired brain injuries.Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12619001557123. Registered 12 November 2019, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378298&isReview=true