Training Of Health Care Personnel Research Articles

587. An Intervention to Improve COVID-19 Vaccination Rates Among Inpatients at a Veterans Affairs Hospital

BackgroundHospitalizations are an opportunity to increase vaccine uptake and hospital-based strategies have been effective at increasing influenza and pneumococcal vaccination. Offering COVID-19 vaccination at discharge can reduce barriers to vaccination and target patients at high risk for severe illness and death. We evaluated a COVID-19 vaccine intervention implemented as part of routine discharge planning. MethodsWe trained healthcare personnel during April 2021 to review and document vaccine eligibility and interest for adult inpatients on medical, surgical, or psychiatric wards at the Atlanta VA Medical Center during discharge planning using a templated note in the electronic medical record (EMR). Outpatient vaccination center personnel were deployed to the participating wards daily (except Sundays) to facilitate vaccine administration at discharge. We measured the percentage of discharged patients with vaccine eligibility documented using the template and compared the number of patients vaccinated at discharge in the 4 weeks pre- and post-training. All Georgia adults became eligible for COVID-19 vaccines on March 25, 2021, prior to our intervention. ResultsOf the 769 patients discharged from one of the participating wards during the 4-week post-training, 474 (62%) had vaccine eligibility documented (Table 1). Of the 474 patients with documentation, 88 (19%) were eligible. Reasons for ineligibility included prior vaccination (n=266, 69%), patient refusal (n=103, 27%), and acute COVID infection (n=12, 3%). Of the 88 eligible patients, 61 (69%) received vaccination before discharge. In total, 16 of 793 inpatients in the pre-training period and 61 of 769 in the post-training period (2% vs 8%; p< 0.05) were vaccinated prior to discharge. Table 1. COVID-19 vaccine eligibility and vaccination before discharge during the post-training period, reported by week ConclusionWe found relatively high and sustained uptake of an intervention to screen hospitalized patients for COVID-19 vaccination eligibility. Creating a templated note in the EMR resulted in vaccination of nearly 70% of eligible patients prior to hospital discharge.Disclosures All Authors: No reported disclosures

Simulation Technology in Anesthesiology.

Simulation Technology in Anesthesiology.

Improving Early Colostrum Feeding in a Tertiary Neonatal Intensive Care Unit: A Quality Improvement Initiative.

Background and Objective: Colostrum feeding is known for its immune benefits for reduction in nosocomial sepsis, necrotizing enterocolitis, and ventilator-associated pneumonias. Colostrum feeding also helps in improving breastfeeding rates and early discharge of vulnerable neonatal intensive care unit (NICU) babies. The objective of this study was to improve early colostrum feeding/oropharyngeal colostrum administration in a busy tertiary NICU in India. Methods: Multiple plan-do-study-act (PDSA) cycles were conducted from January 2020 to September 2020 to improve early colostrum feeding rates in NICU babies to >60%. We tested change ideas such as training of health care personnel, counseling of mothers and families about importance of colostrum expression and feeding, bedside collection of colostrum, safe transportation of colostrum to the NICU, and electronic data handling. Sustainability of the interventions was studied from October 2020 to March 2021 and data were analyzed. Results: Early colostrum feeding rates improved from a baseline of 4.36-68.21% after six PDSA cycles through 9 months. After counseling of mothers and families of NICU babies, rates of breastfeeding and colostrum feeding improved to 98.8% and 97.11%, respectively. The early breast stimulation and colostrum expression rates also improved to 87.28% and 68.2%, respectively. Early colostrum feeding rate was 87.5% after 6 months through the sustainability phase. Conclusions: Quality improvement interventions significantly improved the rate of early colostrum feeding in sick babies admitted to a busy NICU, and the improvement was sustained for 6 months.

Novel Bilayer Microarray Patch‐Assisted Long‐Acting Micro‐Depot Cabotegravir Intradermal Delivery for HIV Pre‐Exposure Prophylaxis

AbstractInjectable long‐acting cabotegravir (CAB LA) is effective and safe for pre‐exposure HIV prophylaxis. It is recently approved for clinical use in those at high risk of contracting HIV. However, injections are invasive and access to trained healthcare personnel to administer CAB LA can be limited, especially in low‐income countries (LICs). Herein, for the first time, the development of a bilayer microarray patch (MAP) with unique design and novel formulation as a potential alternative self‐administrated intradermal delivery system for CAB is reported. The novel MAP has a high drug load (≈3 mg/0.5 cm2 of CAB LA or its micronized sodium salt) and fast‐dissolving tips (&lt;30 min) and shows good mechanical properties and skin insertion capabilities. Importantly, in preclinical in vivo studies using Sprague Dawley rats, this MAP is able to implant the drug‐loaded tips in the skin, forming micro‐depots. Both drug forms are then released in a sustained manner, maintaining human therapeutic levels in the rats for one month after a single application. Weekly repeated MAP dosing in the rats showed the MAPs to be reproducible and well‐tolerated. This bilayer MAP presents a promising minimally‐invasive, self‐administered, alternative delivery system for CAB for enhanced HIV prevention, especially in LICs.

BREAKING BARRIER TO ACHIEVE GLOBAL HEALTH PERSPECTIVE WITH REFERENCE TO CHILD HEALTH CARE

Anumber of nancial and non-nancial barriers may delay or prevent poor households from seeking health care for their sick infants and children. Such obstacles are common in low- and middle-income countries and include distance, nancial barriers, socio-cultural norms, language barriers, and lack of knowledge and awareness. These difculties affect all age groups and can lead to low demand for and use of services, particularly by the poor. Inequalities in child survival are not the result of a lack of technological solutions. Rather, poor children continue to suffer because costeffective child health interventions fail to reach them. It has been estimated that taking existing child health interventions to scale can result in a two-thirds reduction in child mortality. Infants, children, and adolescents face unique barriers to accessing care for several reasons. First, in many societies, the young full a submissive social role relative to their elders. This power imbalance results in the subjugation of young people to their parents, relatives, and elder siblings. When at the bottom of the social structure in a family with limited resources, this can mean that priority will be given to others when medical care is needed. Similarly, children lack full adult rights which can lead to further reliance on others for appropriate care In addition, many health problems that occur in children require specialized health care procedures by specially trained health care personnel. For example, in the United States, paediatricians must specialize and train differently from general practitioners, and paediatric sub-specialists exist within all other specialties (surgery, ENT, ophthalmology, etc.). Access to these highly-trained physicians and healthcare workers may be limited or nonexistent in low- and middle-income countries, creating unique barriers for children in need.

Evaluation of Predictive Values of an Automatic Device Measuring Oximetry in Free Flaps

Summary:Free-flap monitoring is challenging to perform in some centers. It requires the availability of trained health care personnel for 24 hours a day and seven days a week. Many methods had been proposed for flap monitoring, and none of them are superior to clinical evaluation. This study aimed to present a murine model to evaluate the accuracy (sensitivity, specificity, and the positive or negative predictive values) of a device. Wistar rats weighing 240–490 g were included for intervention and data collection. A murine model of left inferior epigastric vessel flaps was implemented. Intermittent pedicle clamping was performed to calculate the accuracy of the device that detects flow obstruction. The general variables studied were age, weight, and gender. The sensitivity, specificity, and negative or predictive values were calculated. The results showed a sensitivity of 97%, a specificity of 95% with a positive predictive value of 95%, and negative predictive value of 97%. The sensitivity and specificity showed excellent results within the range of clinical security. We require more data to analyze the multiparameter monitoring to see if it is feasible and cost-effective.

Developing and delivering high quality surgery into community in LMIC: Experience in Kerala, India

The road to the delivery of high-quality cleft surgery into communities in the LMIC is beset with numerous hurdles. These include the availability of trained health care personnel, the availability of infrastructure in health care, parent awareness of the need for timely interventions in these children, presence of affordable treatment centres with adequate means of transport to and from these facilities for patients coming from the interior rural locations, but most importantly, the financial considerations that are the underlying limitations in most of these above mentioned considerations. We would like to approach this problem by describing the evolution of our own centre over several decades. Our centre, The Charles Pinto Centre for Cleft lip and palate at the Jubilee Mission Hospital is located in Thrissur, in the beautiful state of Kerala.In the late 1950s, Dr HS Adenwalla who had trained under experts in the art of Cleft Lip and Palate Surgery in Mumbai joined the hospital and transformed it through sheer dedication and meticulous clinical expertise into a major hub for treatment and also training in this speciality. In this endeavour he was greatly helped by non governmental organizations of which Smile Train deserves special mention in view of its model of functioning, empowering local partners by adequate funding for treatment, training and establishment of infrastructure, while ensuring strict adherence to safety standards.We believe that it is essential that there should be trained and dedicated health care personnel who are willing to treat such patients without an eye on the monetary benefits accrued, and also enough funding either from the government or from the NGOs to provide equipment and infrastructure for safe, high quality and accessible treatment and the establishment of multidisciplinary management. Lastly, the patients should also be made aware of the need for timely treatment and long-term follow- up.

Validation of the German version of the needs assessment tool: progressive disease-heart failure

BackgroundThe Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) is a tool created to assess the needs of people living with heart failure and their informal caregivers to assist delivering care in a more comprehensive way that addresses actual needs that are unmet, and to improve quality of life. In this study, we aimed to (1) Translate the tool into German and culturally adapt it. (2) Assess internal consistency, inter-rater reliability, and test–retest reliability of the German NAT: PD-HF. (3) Evaluate whether and how patients and health care personnel understand the tool and its utility. (4) Assess the tool’s face validity, applicability, relevance, and acceptability among health care personnel.MethodsSingle-center validation study. The tool was translated from English into German using a forward–backward translation. To assess internal consistency, we used Cronbach´s alpha. To assess inter-rater reliability and test–retest reliability, we used Cohen´s kappa, and to assess validity we used face validity.ResultsThe translated tool showed good internal consistency. Raters were in substantial agreement on a majority of the questions, and agreement was almost perfect for all the questions in the test–retest analysis. Face validity was rated high by health care personnel.ConclusionThe German NAT: PD-HF is a reliable, valid, and internally consistent tool that is well accepted by both patients and health care personnel. However, it is important to keep in mind that effective use of the tool requires training of health care personnel.

Assessment of Infection Prevention and Control Implementation in Primary and Secondary Health Care Facilities in Rivers State

Background: Controlling infections in healthcare facilities is necessary for reducing infection transmission. There is limited data on the status of Infection Prevention and Control (IPC) programme in healthcare facilities in Rivers State. An assessment of IPC implementation in health facilities in Rivers State was therefore conducted.Methods: In this cross-sectional study, stratified sampling technique was applied to select 99 healthcare facilities. Health personnel in-charge of selected facilities were interviewed using the validated Infection Prevention and Control Assessment Framework (IPCAF) tool. It was modified to focus on four out of eight core components areas and graded using the World Health Organization IPCAF guidelines.Results: Twenty (20.2%) facilities had IPC programmes with clearly defined objectives and activity plans. A copy of the IPC guidelines was available in 56 (56.6%) facilities, however, only 13 (13.1%) monitored implementation of the guidelines. Forty (40.4%) facilities had healthcare workers that were trained based on updated IPC guidelines. Supply of personal protective equipment was adequate in 29 (29.3%) facilities and a mixed method of healthcare waste disposal was practiced in 46 (46.4%) facilities. Overall, 56 (56.6%) of the facilities had scores within the basic IPC level of practice while 43 (43.4%) had scores within the intermediate level of IPC practice.Conclusion: Findings from this study indicate that IPC committees should be set up in all healthcare facilities with the obligation of updating IPC guidelines, training healthcare personnel, and implementing IPC activities in respective healthcare facilities.

Positive attitudes to advance care planning \u2013 a Norwegian general population survey

BackgroundAuthorities recommend advance care planning and public acceptance of it is a prerequisite for widespread implementation. Therefore, we did the first study of the Norwegian public with an aim of getting knowledge on their attitudes to issues related to advance care planning.MethodsAn electronic survey to a nationally representative web panel of Norwegian adults.ResultsFrom 1035 complete responses (response rate 40.7%), we found that more than nine out of ten of the general public wanted to participate in advance care planning, believed it to be useful for many, and wanted to make important healthcare decisions themselves. Almost nine out of ten wanted to be accompanied by next of kin during advance care planning. Most (69%) wanted health care personnel to initiate advance care planning and preferred it to be timed to serious illness with limited lifetime (68%). Only about 9% stated that health care personnel should have the final say in healthcare decisions in serious illness.ConclusionsDeveloping and implementing advance care planning as a public health initiative seems warranted based on the results of this study. Patient perspectives should be promoted in decision-making processes. Nevertheless, training of health care personnel should emphasise voluntariness and an individual approach to initiating, timing and conducting advance care planning because of individual variations.

SARS-CoV-2 saliva testing is a useful tool for Covid-19 diagnosis

SARS-CoV-2 is the etiologic agent of coronavirus disease 2019 (COVID-19) and is mainly detected by RT-PCR methods from upper respiratory specimens, as recommended by the World Health Organization. Oro/nasopharyngeal swabbing can be discomfortable to the patients, requires trained healthcare personnel and may generate aerosol, increasing the risk of nosocomial infections. In this study, we describe two SARS-CoV-2 RNA extraction-free single RT-PCR protocols on saliva samples and compared the results with the paired oro/nasopharyngeal swab specimens from 400 patients. The two saliva protocols demonstrated a substantial agreement when compared to the oro/nasopharyngeal swab protocol. Moreover, the positivity rate of saliva protocols increased according to the disease period. The 95 % limit of detection of one of the therefore implemented saliva protocol was determined as 9441 copies/mL. Our results support the conclusion that RNA extraction-free RT-PCR using self-collected saliva specimens is an alternative to nasopharyngeal swabs, especially in the early phase of symptom onset.

Self-Collected Gargle Lavage Allows Reliable Detection of SARS-CoV-2 in an Outpatient Setting.

ABSTRACTCurrent procurement of specimens for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection requires trained personnel and dedicated equipment. We compared standard nasopharyngeal swabs with self-collected gargle lavage fluid obtained from 80 mostly symptomatic outpatients. After RNA extraction, RT-PCR to detect SARS-CoV-2 was performed. Qualitative results obtained with the paired samples from individual outpatients were 100% congruent. Therefore, self-collected gargle lavage fluid can serve as a suitable specimen for coronavirus disease 2019 (COVID-19) testing in outpatients.IMPORTANCE The SARS-CoV-2 pandemic still strains health care systems worldwide. While COVID-19 testing is considered an essential pillar in combating this infectious disease, shortages in supplies and trained health care personnel often limit the procurement of patient samples, in particular in outpatient settings. Here, we compared the simple self-collection of gargle lavage fluid with the gold standard nasopharyngeal swab as a specimen for COVID-19 testing. By finding complete congruence of results obtained with paired samples of a sizeable patient cohort, our results strongly support the idea that the painless self-collection of gargle lavage fluid provides a suitable and uncomplicated sample for reliable SARS-CoV-2 detection.

Prospects for healthcare personnel training in the public health system of Ukraine

Purpose: scientific substantiation of training of medical personnel for the public health system of Ukraine. During 2017-2020, the Department of Public Health conducted a systematic analysis of public health staffing in Ukraine, developed countries and Europe. For the first time, a model of formation of specialists' competencies for the public health system of Ukraine in the postgraduate education program with a multidisciplinary approach to training is substantiated and developed, which includes such disciplines as epidemiology, hygiene, medical statistics, laboratory diagnostics, information technology, legal law and others. This enables to reveal the tools and methods of system management, improve the availability and quality of work during the formation and development of the industry. The need for medical education for public health specialists who are ready to perform basic operational functions to preserve and strengthen the health of the population of Ukraine has been established. For the first time, methodological approaches to the improvement of higher medical education at the undergraduate and postgraduate levels have been scientifically substantiated, taking into account modern requirements for the functioning of the public health system; competence models of the public health specialist in modern conditions of realization of his activity are created; standards of higher education at the first (bachelor's) and second (master's) levels in the specialty 229 “Public health” in the field of knowledge 22 “Health Care” have been developed.

"DOFFICERS": An Innovative Rapid-response Approach to Train and Protect Healthcare Personnel During the Pandemic

Background: Education and training of healthcare personnel on appropriate choice and use of personal protective equipment (PPE) to prevent the spread of infectious organisms and diseases have been key to a successful infection prevention program. At the start of the novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic, the demand for education on how to use PPE by staff increased beyond the capacity of the existing infection prevention team. It became evident that additional resources would need to be activated to meet the requests for staff training. This led to the creation of the DOFFICERS' Rapid Response Program (DRRP). The new word "DOFFICER", derived from the words: donning, doffing, and officer, was created to refer to trained healthcare personnel who would be responding to requests for PPE training and education.Methods: As hospitals cancelled non-urgent procedures, this freed up healthcare professionals such as nurses, surgical technicians, and certified nursing assistants to be trained by the infection prevention team on proper donning and donning of PPE, safe cleaning, disinfection, and storage of critical PPE supplies. Two Controlled Air-Purifying Respirator (CAPR) carts were rolled out with helmets, face shields, gowns, gloves, cleaning, and disinfecting supplies used for training by nine recruited DOFFICERS.Results: The DRRP was able to successfully train the entire hospital's healthcare personnel expeditiously; unit by unit, at all shifts, seven days a week. This was supported by the absence of SARS-CoV-2 transmission within this hospital.Conclusions: By educating highly trainable healthcare workers to be DOFFICERS, the infection prevention team was able to replicate itself and respond to the training demands of the healthcare facility. This created a safe environment and a healthcare team that felt supported and confident to handle the medical care needs of patients who are suspected to have or confirmed to be infected with SARS-CoV-2.

Accuracy of a Novel SARS-CoV-2 Antigen-Detecting Rapid Diagnostic Test from Standardized Self-Collected Anterior Nasal Swabs.

Background Antigen-detecting rapid diagnostic tests (Ag-RDT) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) offer new opportunities for the quick and laboratory-independent identification of infected individuals for control of the SARS-CoV-2 pandemic. Despite the potential benefits, nasopharyngeal sample collection is frequently perceived as uncomfortable by patients and requires trained healthcare personnel with protective equipment. Therefore, anterior nasal self-sampling is increasingly recognized as a valuable alternative. Methods We performed a prospective, single-center, point of care validation of an Ag-RDT using a polypropylene absorbent collector for standardized self-collected anterior nasal swabs. Real-time polymerase chain reaction (RT-PCR) from combined oropharyngeal/nasopharyngeal swabs served as a comparator. Primary endpoint was sensitivity of the standardized Ag-RDT in symptomatic patients with medium or high viral concentration (≥1 million RNA copies on RT-PCR for SARS-CoV-2). Results Between 12 February and 22 March 2021, 388 participants were enrolled. After exclusion of 9 patients for which no PCR result could be obtained, the novel Ag-RDT was evaluated based on 379 participants, of whom 273 were symptomatic and 106 asymptomatic. In 61 samples from symptomatic patients with medium or high viral load (≥1 million RNA copies), the sensitivity of the standardized Ag-RDT was 96.7% (59/61; 95% confidence interval (CI): 88.7–99.6%) for the primary endpoint. In total, 62 positive Ag-RDT results were detected out of 70 RT-PCR positive individuals, yielding an overall sensitivity of 88.6% (95% CI: 78.7–94.9%). Specificity was 99.7% (95% CI: 98.2–100%) in 309 RT-PCR negative individuals. Conclusions Here, we present a validation of a novel Ag-RDT with a standardized sampling process for anterior nasal self-collection, which meets World Health Organisation (WHO) criteria of ≥80% sensitivity and ≥97% specificity. Although less sensitive than RT-PCR, this assay could be beneficial due to its rapid results, ease of use, and suitability for standardized self-testing.

Etravirine-loaded dissolving microneedle arrays for long-acting delivery

A key challenge of HIV treatment with multiple antiretroviral drugs is patient adherence. Thus, there is an urgent need for long-acting depot systems for delivering drugs over an extended duration. Although the parenteral route is preferred for depot systems, it is associated with obvious drawbacks, such as painful injections, potentially-contaminated sharps waste, and the necessity of trained healthcare personnel for administration. Amongst a small number of alternatives in development microneedles are versatile delivery systems enabling systemic drug delivery and potentially improving patient adherence due to their capacity for self-administration. We have developed dissolving microneedle (DMNs) embedded with etravirine nanosuspension (ETR NS) as a long-acting HIV therapy to improve patient adherence. The ETR NS prepared by sonoprecipitation yielded particle sizes of 764 ± 96.2 nm, polydispersity indices of of 0.23 ± 0.02, and zeta potentials of −19.75 ± 0.55 mV. The DMNs loaded with ETR NS demonstrated 12.84 ± 1.33% ETR deposition in ex-vivo neonatal porcine skin after 6 h application. In in vivo rat pharmacokinetic studies, the Cmax exhibited by DMNs loaded with ETR powder and ETR NS were 158 ± 10 ng/mL and 177 ± 30 ng/mL, respectively. DMN groups revealed a higher t1/2, Tmax, and mean residence time compared to intravenous ETR solutions, suggesting the long-acting potential of etravirine delivered intradermally using DMNs.

Management of oxygen saturation monitoring in preterm newborns in the NICU: the Italian picture

BackgroundAlthough many studies emphasize the importance of using oxygen saturation (SpO2) targets in the NICUs, there is a wide variability in used saturation ranges among centers. Primary aim was to draw a representative picture on how the management of oxygen monitoring is performed in the Italian NICUs. Second aim was to identify healthcare-professionals related factors associated with oxygen targeting in the preterm population.MethodsCross-sectional study with data collection via an electronic survey form. A questionnaire containing pre-piloted and open questions on monitoring and management of the SpO2 was administered to neonatologists across the network of the Italian Society of Neonatology. The questions focused on: the infrastructure, specific training, healthcare professionals and patients-related factors. The results of the survey were anonymously collected, summarized and analyzed.ResultsOut of 378 questionnaires, 93 were correctly filled. Thirty-six different SpO2 ranges were observed. Centers using written standard operating procedures on oxygen management and SpO2 monitoring maintained a correct average range of SpO2 90–95%, avoided hyperoxia and reconsidered saturation targets in relation to comorbidities. 39.8% of responders disabled alarms during neonatal care. One center used biomarkers for complete monitoring of neonatal oxygenation status.ConclusionsThere is considerable variation in SpO2 targets for preterm infants in the Italian NICUs. Standard operating procedures and specific training for health care personnel are the main factors playing a role for the correct maintenance of the recommended oxygen targets in preterms.

Post-infection depressive, anxiety and post-traumatic stress symptoms: A prospective cohort study in patients with mild COVID-19

BackgroundIt remains unclear whether COVID-19 is associated with psychiatric symptoms during or after the acute illness phase. Being affected by the disease exposes the individual to an uncertain prognosis and a state of quarantine. These factors can predispose individuals to the development of mental symptoms during or after the acute phase of the disease. There is a need for prospective studies assessing psychiatric symptoms in COVID-19 patients in the post-infection period. MethodsIn this prospective cohort study, nasopharyngeal swabs for COVID-19 tests were collected at patients' homes under the supervision of trained healthcare personnel. Patients who tested positive for COVID-19 and were classified as mild cases (N = 895) at treatment intake were further assessed for the presence of psychiatric symptoms (on average, 56.6 days after the intake). We investigated the association between the number of COVID-19 symptoms at intake and depressive, anxiety and post-traumatic symptoms approximately two months later, adjusting for previous mental health status, time between baseline and outcome, and other confounders. Multivariate logistic regression and generalized linear models were employed for categorical and continuous outcomes, respectively. ResultsA clinically significant level of depressive, anxiety and post-traumatic stress symptoms were reported by 26.2% (N = 235), 22.4% (N = 201), and 17.3% (N = 155) of the sample. Reporting an increased number of COVID-related symptoms was associated with the presence of clinically significant levels of depressive (aOR = 1.059;95%CI = 1.002–1.119), anxiety (aOR = 1.072;95%CI = 1.012–1.134), and post-traumatic stress (aOR = 1.092;95%CI = 1.024–1.166) symptoms. Sensitivity analyses supported findings for both continuous and categorical measures. ConclusionExposure to an increased number of COVID-19 symptoms may be associated with depressive, anxiety and post-traumatic symptoms after the acute phase of the disease. These patients should be monitored for the development of psychiatric symptoms after COVID-19 treatment discharge. Early interventions, such as brief interventions of psychoeducation on coping strategies, could benefit these individuals.

Overweight in Swedish show dogs\u2013prevalence and association with performance in competition

BackgroundThe prevalence of overweight and obesity is increasing in companion dogs, but little is known of these conditions in show dogs. This study assessed body condition score (BCS) of show dogs of six selected popular breeds at a major Swedish dog show event and examined the association between BCS and performance in competition.ResultsAt one of Sweden’s largest dog shows, BCS of 120 dogs of six different breeds was assessed by trained animal healthcare personnel, using a 9-point BCS scale with conditional cut-off for overweight set to BCS ≥ 6. Prevalence of overweight in the cohort was 32% but all overweight dogs except one displayed only slight overweight (BCS 6) and no dog was assessed as obese (BCS 8–9). Prevalence of overweight differed significantly between breeds (P < 0.0001) with Labrador retrievers, Golden retrievers and French bulldogs showing the highest mean BCS (5.6–5.7) and highest prevalence of overweight (50–67%). Lean and overweight dogs received awards and higher show awards (certificates) to the same extent, and no significant association between slight overweight and performance in competition was found.ConclusionsPrevalence of overweight in Swedish show dogs was relatively high and in the same range as in the Swedish dog population as a whole. Dog owners, breeders and judges should be made aware of canine obesity problems and trained in BCS assessment, to better prevent canine overweight and associated health risks. This is particularly important for retriever and brachycephalic breeds, which showed high prevalence of slight overweight and have breed-specific health problems exacerbated by overweight. Owners and breeders of traditionally sturdy dog breeds should be informed that overweight dogs do not outperform lean dogs in competition.

Mass-Casualty Training Exercise Using High-Fidelity Computerized Simulators and Involving Time and Resource Limitation.

Training emergency department (ED) personnel in the care of victims of mass-casualty incidents (MCIs) is a highly challenging task requiring unique and innovative approaches. The purpose of this study was to retrospectively explore the value of high-fidelity simulators in an exercise that incorporates time and resource limitation as an optimal method of training health care personnel in mass-casualty care. Mass-casualty injury patterns from an explosive blast event were simulated for 12 victims using high-fidelity computerized simulators (HFCS). Programmed outcomes, based on the nature of injuries and conduct of participants, ranged from successful resuscitation and survival to death. The training exercise was conducted five times with different teams of health care personnel (n = 42). The exercise involved limited time and resources such as blood, ventilators, and imaging capability. Medical team performance was observed and recorded. Following the exercise, participants completed a survey regarding their training satisfaction, quality of the exercise, and their prior experiences with MCI simulations. The Likert scale responses from the survey were evaluated using mean with 95% confidence interval, as well as median and inter-quartile range. For the categorical responses, the frequency, proportions, and associated 95% confidence interval were calculated. The mean rating on the quality of experiences related trainee survey questions (n = 42) was between 4.1 and 4.6 on a scale of 5.0. The mean ratings on a scale of 10.0 for quality, usefulness, and pertinence of the program were 9.2, 9.5, and 9.5, respectfully. One hundred percent of respondents believed that this type of exercise should be required for MCI training and would recommend this exercise to colleagues. The five medical team (n = 5) performances resulted in the number of deaths ranging from two (including the expectant victims) to six. Eighty percent of medical teams attempted to resuscitate the "expectant" infant and exhausted the O- blood supply. Sixty percent of medical teams depleted the supply of ventilators. Forty percent of medical teams treated "delayed" victims too early. A training exercise using HFCS for mass casualties and employing limited time and resources is described. This exercise is a preferred method of training among participating health care personnel.