Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care.

Survival to hospital discharge among patients with out-of-hospital cardiac arrest (OHCA) is low and important regional differences in treatment practices and survival have been described. Since the 2017 publication of the Canadian Cardiovascular Society's position statement on OHCA care, multiple randomized controlled trials have helped to better define optimal post cardiac arrest care. This working group provides updated guidance on the timing of cardiac catheterization in patients with ST-elevation and without ST-segment elevation, on a revised temperature control strategy targeting normothermia instead of hypothermia, blood pressure, oxygenation, and ventilation parameters, and on the treatment of rhythmic and periodic electroencephalography patterns in patients with a resuscitated OHCA. In addition, prehospital trials have helped craft new expert opinions on antiarrhythmic strategies (amiodarone or lidocaine) and outline the potential role for double sequential defibrillation in patients with refractory cardiac arrest when equipment and training is available. Finally, we advocate for regionalized OHCA care systems with admissions to a hospital capable of integrating their post OHCA care with comprehensive on-site cardiovascular services and provide guidance on the potential role of extracorporeal cardiopulmonary resuscitation in patients with refractory cardiac arrest. We believe that knowledge translation through national harmonization and adoption of contemporary best practices has the potential to improve survival and functional outcomes in the OHCA population.

[Experience in the use of videos for the promotion of physical exercise at home in online mode in older adults in Chile during the COVID-19 pandemic]. / Experiencia en el uso de videos para la promoción de ejercicio físico en el hogar en modalidad online en personas mayores en Chile durante la pandemia COVID-19.

OBJECTIVE: Describe the usability, actionability and understanding of videos to promote exercise at home online during the COVID-19 pandemic, analyzing the characteristics of the population, their satisfaction, adherence and barriers to physical exercise. MATERIAL AND METHODS: A descriptive, non-experimental and cross-sectional observational design study, with a quantitative approach. Home-based videos of physical exercise and education about pain were created for people over 60 years old and distributed in the Metropolitan Region (Chile) during the months of October to December 2020. Participants had to use these videos independently at home during 4 weeks. A sample who received these videos were then voluntarily surveyed. RESULTS: Thirty-four participants rated the videos as understandable and actionable. Usability was lower in people who perceived a lower level of technological management. Average adherence was 2 days a week for 2.5 weeks. The main perceived barrier was the lack of will, which showed a greater tendency in people who performed physical exercise in a group way before the restrictions due to the COVID-19 pandemic. CONCLUSIONS: The videos were well evaluated by the elderly population, however the technological gap can be a limitation to favor an easy and simple use. Among the strategies, interventions that favor social interaction should be considered to promote interpersonal motivation, especially in people who prefer group modalities of exercise.

Patient-Reported Experience in the Pediatric Emergency Department: What Matters Most?

INTRODUCTION: Although the Child Hospital Consumer Assessment of Healthcare Providers and Systems is a validated tool for the inpatient experience, it may not address features unique to the pediatric emergency department (PED). There is currently no publicly available validated patient-reported experience survey for the PED, and what matters most in this setting remains unknown. METHODS: Twelve semistructured interviews were conducted with a convenience sample of parents of children younger than 14 years at a Canadian PED. Data analysis was performed using inductive thematic analysis to identify aspects of patient-reported experiences that matter most to parents in the PED. RESULTS: Five themes were identified: (1) making waiting a positive experience, (2) taking the time to provide care, (3) forging a positive partnership, (4) speak up for safe care, and (5) making the environment feel safer. Parents highlighted that while waiting for care is not desirable, it is made more acceptable through the communication of wait time estimates and the presence of child activities in the waiting room. Furthermore, although interactions with providers are brief, parents emphasized the importance of creating an environment of partnership with open communication, taking the time to examine their child, and actively demonstrating the provision of safe, quality care. CONCLUSIONS: Results from this study suggest that a patient-reported experience survey in the PED may need to embed elements not currently captured in Child Hospital Consumer Assessment of Healthcare Providers and Systems, such as waiting room experience, comprehensiveness of health assessments, and observations of safety measures. Future studies can use these findings to develop a patient-reported experience survey for use in the PED.

Professional Attitudes in Health Professions' Education: The Effects of an Anatomy Near-Peer Learning Activity.

Interprofessional attitudes existing between healthcare disciplines can negatively impact communication and collaboration in the clinical setting. While human anatomy is a topic central to healthcare trainees, the potential of the anatomy laboratory to minimize negative interprofessional attitudes has yet to be characterized. This study aimed to assess the effects of an anatomy interprofessional near-peer learning activity (AIP-NPLA) on medical and nursing students' interprofessional attitudes at McGill University. The authors employed a convergent parallel mixed methods study to explore participants' AIP-NPLA experiences. The Attitudes to Health Professionals Questionnaire (AHPQ) was used pre- and post-AIP-NPLA to assess participants' attitudes toward their own and their counterpart profession. In addition, a focus group was held immediately following the AIP-NPLA to explore participants' experiences and interprofessional perceptions. Quantitative results using a principal components analysis demonstrated significant changes in nursing students' responses between pre- and post-AIP-NPLA scoring, rating the medical profession as being more caring overall. Medical students' responses pre- and post-AIP-NPLA demonstrated no significant differences. Qualitative results also suggested a breakdown of negative attitudes, an increased understanding of inter- and intra-professional roles, and the importance of interprofessional collaboration and mutual learning for their careers. These findings revealed that attitudes among healthcare trainees may be positively restructured in the anatomy laboratory, allowing for collaborative care to predominate in current and future clinical practices.

Nursing and medical students near-peer activity in the anatomy laboratory: format for success.

BACKGROUND/AIMS: An anatomy interprofessional near-peer learning activity (AIP-NPLA) between nursing and medical students was piloted to assess its implementability. This study aimed to: (1) identify key factors of feasibility and (2) describe student-group perceptions of their experience of the interprofessional education (IPE) activity. METHODS: A total of 59 medical and 179 nursing students participated in the AIP-NPLA whereby medical students were asked to facilitate and lead group discussions with their nursing students colleagues on an anatomical topic using a donor cadaver. Each AIP-NPLA session lasted a total of two hours. A mixed methods approach was employed using both quantitative and qualitative means of assessment. Variables such as Readiness for Interprofessional Learning, Professional Self-Identity, Clinical Teaching Preference, and Near-Peer Teaching and Learning Experience were assessed quantitatively using validated surveys. Qualitative measures included thematic content analysis of focus group interviews conducted following the AIP-NPLA to capture the perceptions of the student groups' experience in the IPE activity. RESULTS: The results of this investigation demonstrated that there are key factors to consider when designing successful and sustainable IPE activities; the level of clinical exposure and therefore student-group pairing based on professional self-identify scores, optimal tutor-to-tutee group ratios and an activity format that maintained an informal, flexible and free forum for discussion on a topic of common knowledge. Focus group interviews also revealed reflections on professional stereotypes. CONCLUSION: These findings suggest that early implementation of IPE activities outside of a clinical setting are beneficial and can foster both learning from one another and positive perceptions of interprofessional roles when carefully designed.

Factores familiares relacionados con habilidades sociales en adolescentes de una institución educativa estatal en Lima / Family factors related to social skills in teenagers of a educational institution in Lima

Objetivo: este estudio analiza los factores familiares relacionados a habilidades sociales en adolescentes de una Institución Educativa Estatal en Lima. Marco teórico: la familia es el elemento natural y fundamental de la sociedad y tiene de-recho a la protección de la sociedad y del Estado, de tal manera, que es el lugar primordial donde se comparten y gestionan los riesgos sociales de sus miembros. Las habilidades sociales constituyen conductas emitidas por un individuo en un contexto interpersonal que expresa sus sentimientos, actitudes, deseos de un modo adecuado a la situación. Material y métodos: estudio de enfoque cuantitativo, correlacional y transversal; la mues-tra fue de 236 adolescentes de una institución educativa estatal en Lima, siendo seleccio-nada mediante muestreo probabilístico aleatorio. Se realizó la recolección de datos a través de la aplicación de cuestionarios que incluyeron al Apgar Familiar y el Test de Habilidades Sociales, el análisis de los datos se efectuó aplicando estadística descriptiva e inferencial a través de Chi cuadrada. Resultados: los factores familiares de los adolescentes son en unos 66% desfavorables y un 34% favorables, como consecuencia de la estructura familiar el 47% son monoparentales, a su vez el 51% tiene disfunción moderada y el 66,00% trato inadecuado. En relación a las habilidades sociales las adolescentes presentan un 32% de nivel promedio, seguida del 20% de promedio bajo, el 18% bajo y 6% muy bajo. Los resultados del análisis correlacional evidencian una relación significativa entre los factores familiares y las habilidades sociales de las adolescentes