RESUMO
Background: Code status discussions (CSDs) in the intensive care unit (ICU) are frequently conducted by resident physicians. Cardiopulmonary resuscitation (CPR) videos when used to aid ICU patients and families in code status decision making have been shown to have a positive impact. The purpose of this study is to evaluate the impact of a CPR video, when made available to supplement trainee-patient CSDs, on ICU residents' comfort level when conducting these discussions. Objectives: To assess whether a CPR video as an intervention tool would increase residents' comfort level when conducting CSDs. Methods: This is a pre- and postintervention pilot study. A presurvey querying details about trainees' comfort level when conducting CSDs was administered to the residents at the beginning of the ICU rotation, and a CPR video was availed to them to supplement their trainee-patient CSDs. A postsurvey was administered to trainees at the end of their ICU rotation to evaluate and analyze the impact of the CPR video on residents' comfort level when conducting trainee-patient CSDs. Results: A total of 118 trainees rotated through the ICU with 43 (36%) answering the presurvey and 28 (24%) answering the postsurvey. Twenty-two (51%) presurvey respondents felt extremely comfortable and 18 (42%) felt somewhat comfortable conducting CSDs. Thirteen (46%) postsurvey respondents felt extremely comfortable and 12 (43%) felt somewhat comfortable conducting CSDs. Most postsurvey respondents (79%) almost never used the video and (67%) neither agree nor disagree that the video was useful. Conclusion: In our small cohort, CPR video when made available to supplement trainee-patient CSDs did not impact resident physicians' comfort level when conducting these discussions. The residents' low level of engagement with this video, among other factors, could explain our results.
RESUMO
UNLABELLED: The neural networks that generate stepping in complete spinal adult rats remain poorly defined. To address this problem, we used c-fos (an activity-dependent marker) to identify active interneurons and motoneurons in the lumbar spinal cord of adult spinal rats during a 30-min bout of bipedal stepping. Spinal rats were either step trained (30 min/day, 3 days/week, for 7.5 weeks) or not step trained. Stepping was enabled by epidural stimulation and the administration of the serotonergic agonists quipazine and 8-OHDPAT. A third group of spinal rats served as untreated (no stimulation, drugs, or stepping) controls. The numbers of activated cholinergic central canal cluster cells and partition neurons were higher in both step-trained and nontrained rats than in untreated rats and were higher in nontrained than in step-trained rats. The latter finding suggests that daily treatment with epidural stimulation plus serotonergic agonist treatment without step training enhances the excitability of a broader cholinergic interneuronal population than does step training. The numbers of activated interneurons in laminae II-VI of lumbar cross-sections were higher in both step-trained and nontrained rats than in untreated rats, and they were highest in step-trained rats. This finding suggests that this population of interneurons is responsive to epidural stimulation plus serotonergic treatment and that load-bearing induced when stepping has an additive effect. The numbers of activated motoneurons of all size categories were higher in the step-trained group than in the other two groups, reflecting a strong effect of loading on motoneuron recruitment. In general, these results indicate that the spinal networks for locomotion are similar with and without brain input. SIGNIFICANCE: We identified neurons within the spinal cord networks that are activated during assisted stepping in paraplegic rats. We stimulated the spinal cord and administered a drug to help the rats step. One group was trained to step and another was not trained. We observed a lower percentage of activated neurons in specific spinal cord regions in trained rats than in nontrained rats after a 1-hr stepping bout, suggesting that step training reduces activation of some types of spinal neurons. This observation indicates that training makes the spinal networks more efficient and suggests a "learning" phenomenon in the spinal cord without any brain input.
