RESUMO
BACKGROUND: Module-based teaching of ventilator-associated pneumonia (VAP) with a systematic, stratified approach is expected to have a promising role in teaching. We hypothesized it to improve the skill and knowledge of intensive care unit nurses. OBJECTIVES: The aim of this study was to determine the efficacy of the teaching module with debriefing sessions on the VAP bundle care approach, and the secondary objective was to estimate the improvement in individual components of the VAP bundle. METHODS: A total of 200 paramedical staff were exposed to a teaching module consisting of pretest didactic lectures, debriefing sessions, reflection by participants, and feedback. Posttest analysis was done to assess knowledge. Skill assessment was done with directly observed procedural skills (DOPS) assessment, and feedback was taken from participants. Follow-up was done at 6 months to assess decay in knowledge and skills. RESULTS: Preworkshop and postworkshop DOPS scores were analyzed using the Mann-Whitney U test. Subgroup analysis was performed using the paired t test. Median pretest and posttest scores were 6 (interquartile range, 4-8) and 13 (interquartile range, 11-15), respectively (P < .001). Comparing DOPS scores before and after exposure to the teaching module, the number of subjects with scores that were below expectations was 24 and 4; meeting expectations was 94 and 24; borderline expectations were 36 and 104; and above expectations was 46 and 58, respectively, between the groups (P < .001). A decay in knowledge and skills was noted in the follow-up. CONCLUSION: A validated teaching module with debriefing sessions is useful in training bundle care approaches to intensive care unit nurses.
RESUMO
BACKGROUND: Spinal anesthesia is a safe anesthetic technique commonly practiced. However, it is associated with hypotension (33%), bradycardia (13%), and shivering which are induced by hypovolemia, sympathetic blockade, and Bezold-Jarisch reflex through intracardiac serotonin (5HT3) receptors and vagus nerve. AIM: To study the effect of intravenous (i.v.) ondansetron on hypotension and bradycardia induced by spinal anesthesia. SETTING AND DESIGN: This was a randomized controlled double-blinded study done in a tertiary care teaching hospital. METHODS: Of 140 patients, 70 in Group A received 2 mL of i.v. ondansetron 4 mg and 70 in the Group B received 2 mL of i.v. normal saline. 3 mL of 0.5% hyperbaric bupivacaine was injected intrathecally. Measurements of blood pressure and heart rate (HR) were taken every 3 min for 30 min after spinal anesthesia was performed. Mean arterial pressure (MAP) drop more than 20% was considered as incidence of hypotension and ephedrine 6 mg i.v. was given. HR drop >20% was regarded as bradycardia and atropine 0.5 mg i.v. was given. STATISTICAL TESTS: Quantitative data were analyzed using ANOVA test and qualitative data were analyzed using Chi-square test. RESULTS: Both groups are comparable in demographic data. Four (5.7%) patients in Group B and no patients in Group A had incidence of bradycardia and atropine requirement (P = 0.120). There was no statistically significant difference in systolic blood pressure, diastolic blood pressure, and MAP. 19 (27%) patients in Group A and 33 (47.1%) in Group B required ephedrine with P = 0.029. 12 (17.1%) in Group B and no patients in Group A had shivering with P = 0.0001. CONCLUSION: Our study indicates that prophylactic use of ondansetron before spinal anesthesia significantly reduces the requirement of ephedrine and shivering.