Nursing training and retraining on cardiopulmonary resuscitation: a theoretical-practical intervention.

OBJECTIVE: To analyze the retention of knowledge and skills of nursing professionals following training and retraining on cardiopulmonary resuscitation. METHOD: This is an intervention, prospective, and analytical study in which 56 nursing professionals received theoretical and practical training in in-service cardiopulmonary resuscitation. Nine months after the first training (T1), these professionals participated in a retraining (T2). They were followed up for 18 months. The linear trend of knowledge and skills in the period following training was calculated and the Wilcoxon test was applied. RESULTS: Interventions increased the knowledge and skills of professionals significantly; however, in the subsequent period, skills decreased. Despite this, after a period of nine months, they were still higher than those identified before the study. There was a reduction of 18.2% in knowledge in the theoretical test after T1 vs 13.0% after T2 (p < 0.01) and a reduction of 7.6% in skills on the practical test after T1 vs 5.3% after T2 (p < 0.01). CONCLUSION: Nurses were able to retain more knowledge and skills on cardiopulmonary resuscitation after retraining, which stresses the importance of regular training and continuing education in health.

Nursing training and retraining on cardiopulmonary resuscitation: a theoretical-practical intervention / Entrenamiento y reentrenamiento sobre reanimación cardiopulmonar para enfermería: una intervención teórico-práctica / Treinamento e retreinamento sobre ressuscitação cardiopulmonar para enfermagem: uma intervenção teórico-prática

ABSTRACT Objective: To analyze the retention of knowledge and skills of nursing professionals following training and retraining on cardiopulmonary resuscitation. Method: This is an intervention, prospective, and analytical study in which 56 nursing professionals received theoretical and practical training in in-service cardiopulmonary resuscitation. Nine months after the first training (T1), these professionals participated in a retraining (T2). They were followed up for 18 months. The linear trend of knowledge and skills in the period following training was calculated and the Wilcoxon test was applied. Results: Interventions increased the knowledge and skills of professionals significantly; however, in the subsequent period, skills decreased. Despite this, after a period of nine months, they were still higher than those identified before the study. There was a reduction of 18.2% in knowledge in the theoretical test after T1 vs 13.0% after T2 (p < 0.01) and a reduction of 7.6% in skills on the practical test after T1 vs 5.3% after T2 (p < 0.01). Conclusion: Nurses were able to retain more knowledge and skills on cardiopulmonary resuscitation after retraining, which stresses the importance of regular training and continuing education in health.

RESUMEN Objetivo: Analizar la retención del conocimiento y habilidades de los profesionales de enfermería tras entrenamiento y reentrenamiento sobre reanimación cardiopulmonar (RCP). Método: Estudio de intervención, prospectivo y analítico en el cual 56 profesionales de enfermería recibieron entrenamiento teórico y práctico de RCP en servicio. Nueve meses tras el primer entrenamiento (E1), esos profesionales participaron de un reentrenamiento (E2). Ellos fueron acompanados por 18 meses. La tendencia lineal del conocimiento y habilidades en el período subsecuente a los entrenamientos fue calculada y se aplicó el test de Wilcoxon. Resultados: Las intervenciones aumentaron significativamente el conocimiento y las habilidades de los profesionales, sin embargo, en el periodo subsecuente las competencias se redujeron. A pesar de ello, tras un período de nueve meses ellas todavía se mantuvieron superiores a aquellas identificadas previamente al estudio. Hubo reducción del 18,2% tras E1 contra el 13,0% tras E2 (p < 0,01) del conocimiento en el test teórico y del 7,6% tras E1 contra el 5,3% tras E2 (p < 0,01) de las habilidades en el test práctico. Conclusión: Los profesionales de enfermería lograron retener más conocimiento y habilidades en RCP tras el reentrenamiento, lo que refuerza la importancia de la regularidad de cursos de capacitación y de la educación continua en salud.

RESUMO Objetivo: Analisar a retenção do conhecimento e habilidades dos profissionais de enfermagem após treinamento e retreinamento sobre ressuscitação cardiopulmonar. Método: Estudo de intervenção, prospectivo e analítico no qual 56 profissionais de enfermagem receberam treinamento teórico e prático de RCP em serviço. Nove meses após o primeiro treinamento (T1), esses profissionais participaram de um retreinamento (T2). Eles foram acompanhados por 18 meses. A tendência linear do conhecimento e habilidades no período subsequente aos treinamentos foi calculada e aplicou-se o teste de Wilcoxon. Resultados: As intervenções aumentaram significativamente o conhecimento e as habilidades dos profissionais; no entanto, no período subsequente, as competências reduziram. Apesar disso, após um período de nove meses elas ainda se mantiveram superiores àquelas identificadas previamente ao estudo. Houve redução de 18,2% após T1 vs 13,0% após T2 (p < 0,01) do conhecimento no teste teórico e de 7,6% após T1 vs 5,3% após T2 (p < 0,01) das habilidades no teste prático. Conclusáo: Os profissionais de enfermagem conseguiram reter mais conhecimento e habilidades em ressuscitação cardiopulmonar após o retreinamento, o que reforça a importância da regularidade das capacitações e da educação continuada em saúde.

Retenção das Habilidades de Ressuscitação Cardiopulmonar nos Estudantes de Medicina / Retention of Cardiopulmonary Resuscitation Skills in Medical Students

Resumo Fundamento A redução da mortalidade e das sequelas de uma vítima de parada cardíaca depende de um atendimento eficaz, rápido e iniciado o mais precocemente possível. O suporte básico de vida (SBV) compreende uma série de etapas que podem ser iniciadas fora do ambiente hospitalar, e ensinadas para qualquer pessoa em cursos específicos. Porém, é importante que o socorrista retenha o conhecimento e as habilidades, pois nunca se sabe quando será necessário realizar uma ressuscitação cardiopulmonar (RCP). Entretanto, estudos mostram que existe uma perda das habilidades em executar uma RCP já com 30 dias após o treinamento, com variações segundo algumas características das pessoas e da atividade profissional. Objetivo Avaliar se os estudantes de medicina são capazes de reter as habilidades por mais de seis meses. Métodos Estudo prospectivo, caso controle, observacional. Estudantes de medicina realizaram um curso sobre morte súbita e parada cardíaca de 40 horas. A avaliação das habilidades foi realizada imediatamente após o curso e seis meses depois. Foram comparadas as notas individuais entre dois momentos, foi avaliada a porcentagem de acerto em cada etapa e uma análise global do atendimento foi classificado como ótimo, bom e ruim. Os avaliadores e critérios foram os mesmos nos dois momentos. Os dados foram analisados pelos teste-t pareado e teste de McNemar, onde para um nível de confiança de 95% o critério para significância foi p < 0,05. Resultados Cinquenta estudantes (27 do sexo feminino) do primeiro ano, com idade entre 18 e 24 anos (média 21), realizaram o curso. O número de etapas cumpridas de forma correta após seis meses foi significativamente menor que logo após o curso (10,8 vs 12,5 p < 0,001). O sexo e idade não interferiram nos resultados. A qualidade global foi considerada ótima em 78% dos atendimentos realizados logo após o curso, significativamente, maior que os 40% após seis meses (p < 0,01). Após seis meses, maior número de erros foi observado nas etapas relacionadas às habilidades mais práticas (como posicionamento das mãos). Conclusão Seis meses após o curso observamos uma perda significativa das habilidades, entre estudantes de medicina, prejudicando a eficácia global do atendimento.

Abstract Background Reduction of mortality and sequelae of cardiac arrest depends on an effective and fast intervention, started as soon as possible. Basic life support involves a series of steps that may be initiated out of the hospital setting and taught to any person in specific courses. However, it is important that the rescuers retain the knowledge and skills to perform cardiopulmonary resuscitation (CPR), as one never knows when they will be required. Studies have shown that a loss of skills occurs as early as 30 days after the training course, with variations according to personal and professional characteristics. Objectives to assess whether medical students are able to retain skills acquired in a BLS course for more than six months. Methods Prospective, case-control, observational study. Medical students attended a 40-hour course on sudden death and cardiac arrest. Skills acquired during the course were evaluated immediately after and six months after the course. Students' individual scores were compared between these time points, the percentage of correct answers was evaluated, and overall performance was rated as excellent, good, and poor. Observers and evaluation criteria were the same immediately after the course and six months later. Data were analyzed using the paired t-test and the McNemar test. The 95% confidence interval was established, and a p < 0.05 was set as statistically significant. Results Fifty students (27 female) in the first year of medical school aged from 18 to 24 years (mean of 21 years) attended the course. The number of steps successfully completed by the students at six months was significantly lower than immediately after the course (10.8 vs 12.5 p < 0.001). Neither sex nor age affected the results. Overall performance of 78% of the students was considered excellent immediately after the course, and this percentage was significantly higher than six months later (p < 0.01). After six months, the steps that the students failed to complete at six months were those related to practical skills (such as a correct hand positioning). Conclusion A significant loss of skills was detected six months after the BLS course among medical students, compromising their overall performance.

Retention of Cardiopulmonary Resuscitation Skills in Medical Students. / Retenção das Habilidades de Ressuscitação Cardiopulmonar nos Estudantes de Medicina.

BACKGROUND: Reduction of mortality and sequelae of cardiac arrest depends on an effective and fast intervention, started as soon as possible. Basic life support involves a series of steps that may be initiated out of the hospital setting and taught to any person in specific courses. However, it is important that the rescuers retain the knowledge and skills to perform cardiopulmonary resuscitation (CPR), as one never knows when they will be required. Studies have shown that a loss of skills occurs as early as 30 days after the training course, with variations according to personal and professional characteristics. OBJECTIVES: to assess whether medical students are able to retain skills acquired in a BLS course for more than six months. METHODS: Prospective, case-control, observational study. Medical students attended a 40-hour course on sudden death and cardiac arrest. Skills acquired during the course were evaluated immediately after and six months after the course. Students' individual scores were compared between these time points, the percentage of correct answers was evaluated, and overall performance was rated as excellent, good, and poor. Observers and evaluation criteria were the same immediately after the course and six months later. Data were analyzed using the paired t-test and the McNemar test. The 95% confidence interval was established, and a p < 0.05 was set as statistically significant. RESULTS: Fifty students (27 female) in the first year of medical school aged from 18 to 24 years (mean of 21 years) attended the course. The number of steps successfully completed by the students at six months was significantly lower than immediately after the course (10.8 vs 12.5 p < 0.001). Neither sex nor age affected the results. Overall performance of 78% of the students was considered excellent immediately after the course, and this percentage was significantly higher than six months later (p < 0.01). After six months, the steps that the students failed to complete at six months were those related to practical skills (such as a correct hand positioning). CONCLUSION: A significant loss of skills was detected six months after the BLS course among medical students, compromising their overall performance.

FUNDAMENTO: A redução da mortalidade e das sequelas de uma vítima de parada cardíaca depende de um atendimento eficaz, rápido e iniciado o mais precocemente possível. O suporte básico de vida (SBV) compreende uma série de etapas que podem ser iniciadas fora do ambiente hospitalar, e ensinadas para qualquer pessoa em cursos específicos. Porém, é importante que o socorrista retenha o conhecimento e as habilidades, pois nunca se sabe quando será necessário realizar uma ressuscitação cardiopulmonar (RCP). Entretanto, estudos mostram que existe uma perda das habilidades em executar uma RCP já com 30 dias após o treinamento, com variações segundo algumas características das pessoas e da atividade profissional. OBJETIVO: Avaliar se os estudantes de medicina são capazes de reter as habilidades por mais de seis meses. MÉTODOS: Estudo prospectivo, caso controle, observacional. Estudantes de medicina realizaram um curso sobre morte súbita e parada cardíaca de 40 horas. A avaliação das habilidades foi realizada imediatamente após o curso e seis meses depois. Foram comparadas as notas individuais entre dois momentos, foi avaliada a porcentagem de acerto em cada etapa e uma análise global do atendimento foi classificado como ótimo, bom e ruim. Os avaliadores e critérios foram os mesmos nos dois momentos. Os dados foram analisados pelos teste-t pareado e teste de McNemar, onde para um nível de confiança de 95% o critério para significância foi p < 0,05. RESULTADOS: Cinquenta estudantes (27 do sexo feminino) do primeiro ano, com idade entre 18 e 24 anos (média 21), realizaram o curso. O número de etapas cumpridas de forma correta após seis meses foi significativamente menor que logo após o curso (10,8 vs 12,5 p < 0,001). O sexo e idade não interferiram nos resultados. A qualidade global foi considerada ótima em 78% dos atendimentos realizados logo após o curso, significativamente, maior que os 40% após seis meses (p < 0,01). Após seis meses, maior número de erros foi observado nas etapas relacionadas às habilidades mais práticas (como posicionamento das mãos). CONCLUSÃO: Seis meses após o curso observamos uma perda significativa das habilidades, entre estudantes de medicina, prejudicando a eficácia global do atendimento.

Major Cardiac-Psychiatric Drug-Drug Interactions: a Systematic Review of the Consistency of Drug Databases.

PURPOSE: Major depressive disorder (MDD) and anxiety disorders (AD) are both highly prevalent among individuals with arrhythmia, ischemic heart disease, heart failure, hypertension, and dyslipidemia. There should be increased support for MDD and AD diagnosis and treatment in individuals with cardiac diseases, because treatment rates have been low. However, cardiac-psychiatric drug interaction can make pharmacologic treatment challenging. METHODS: The objective of the present systematic review was to investigate cardiac-psychiatric drug interactions in three different widely used pharmacological databases (Micromedex, Up to Date, and ClinicalKey). RESULTS: Among 4914 cardiac-psychiatric drug combinations, 293 significant interactions were found (6.0%). When a problematic interaction is detected, it may be easier to find an alternative cardiac medication (32.6% presented some interaction) than a psychiatric one (76.9%). Antiarrhythmics are the major class of concern. The most common problems produced by these interactions are related to cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest), increased exposure of cytochrome P450 2D6 (CYP2D6) substrates, or reduced renal clearance of organic cation transporter 2 (OCT2) substrates and include hypertensive crisis, increased risk of bleeding, myopathy, and/or rhabdomyolysis. CONCLUSION: Unfortunately, there is considerable inconsistency among the databases searched, such that a clinician's discretion and clinical experience remain invaluable tools for the management of patients with comorbidities present in psychiatric and cardiac disorders. The possibility of an interaction should be considered. With a multidisciplinary approach, particularly involving a pharmacist, the prescriber should be alerted to the possibility of an interaction. MDD and AD pharmacologic treatment in cardiac patients could be implemented safely both by cardiologists and psychiatrists. TRIAL REGISTRATION: PROSPERO Systematic Review Registration Number: CRD42018100424.

The Heart and COVID-19: What Cardiologists Need to Know. / O Coração e a COVID-19: O que o Cardiologista Precisa Saber.

In face of the pandemic of the novel coronavirus disease 2019 (COVID-19), the management of patients with cardiovascular risk factors and/or disease is challenging. The cardiovascular complications evidenced in patients with COVID-19 derive from several mechanisms, ranging from direct viral injury to complications secondary to the inflammatory and thrombotic responses to the infection. The proper care of patients with COVID-19 requires special attention to the cardiovascular system aimed at better outcomes.

Frente à pandemia da doença causada pelo novo coronavírus (COVID-19), o manejo do paciente com fator de risco e/ou doença cardiovascular é desafiador nos dias de hoje. As complicações cardiovasculares evidenciadas nos pacientes com COVID-19 resultam de vários mecanismos, que vão desde lesão direta pelo vírus até complicações secundárias à resposta inflamatória e trombótica desencadeada pela infecção. O cuidado adequado do paciente com COVID-19 exige atenção ao sistema cardiovascular em busca de melhores desfechos.

O Coração e a COVID-19: O que o Cardiologista Precisa Saber / The Heart and COVID-19: What Cardiologists Need to Know

Resumo Frente à pandemia da doença causada pelo novo coronavírus (COVID-19), o manejo do paciente com fator de risco e/ou doença cardiovascular é desafiador nos dias de hoje. As complicações cardiovasculares evidenciadas nos pacientes com COVID-19 resultam de vários mecanismos, que vão desde lesão direta pelo vírus até complicações secundárias à resposta inflamatória e trombótica desencadeada pela infecção. O cuidado adequado do paciente com COVID-19 exige atenção ao sistema cardiovascular em busca de melhores desfechos.

Abstract In face of the pandemic of the novel coronavirus disease 2019 (COVID-19), the management of patients with cardiovascular risk factors and/or disease is challenging. The cardiovascular complications evidenced in patients with COVID-19 derive from several mechanisms, ranging from direct viral injury to complications secondary to the inflammatory and thrombotic responses to the infection. The proper care of patients with COVID-19 requires special attention to the cardiovascular system aimed at better outcomes.

The Heart and COVID-19: What Cardiologists Need to Know

In face of the pandemic of the novel coronavirus disease 2019 (COVID-19), the management of patients with cardiovascular risk factors and/or disease is challenging. The cardiovascular complications evidenced in patients with COVID-19 derive from several mechanisms, ranging from direct viral injury to complications secondary to the inflammatory and thrombotic responses to the infection. The proper care of patients with COVID-19 requires special attention to the cardiovascular system aimed at better outcomes.

O Coração e a COVID-19: O que o Cardiologista Precisa Saber

Frente à pandemia da doença causada pelo novo coronavírus (COVID-19), o manejo do paciente com fator de risco e/ou doença cardiovascular é desafiador nos dias de hoje. As complicações cardiovasculares evidenciadas nos pacientes com COVID-19 resultam de vários mecanismos, que vão desde lesão direta pelo vírus até complicações secundárias à resposta inflamatória e trombótica desencadeada pela infecção. O cuidado adequado do paciente com COVID-19 exige atenção ao sistema cardiovascular em busca de melhores desfechos.

Fatores de risco cardiovascular: o diagnóstico e prevenção devem iniciar nas crianças e adolescentes / Cardiovascular risk factors: diagnosis and prevention muststart in children and adolescents

A infância e a adolescência são períodos que compreendem a transição para a vida adulta, no qual ocorrem mudanças no âmbito físico, psicológico, emocional e social. Nesse período tão crucial para o desenvolvimento, fatores ambientais e doenças aos quais os jovens estão expostos podem refletir na vida adulta, gerando maiores chances de desenvolvimento de doenças crônicas, incluindo a doença cardiovascular (DCV). A principal etiologia das doenças cardiovasculares é a aterosclerose, que tem seu início na infância. Dessa forma, é reconhecido atualmente que a prevenção cardiovascular primordial deve iniciar precocemente, na infância e adolescência, antes da instalação da doença de fato, de modo a diminuir a prevalência e incidência das DCV na idade adulta.

Childhood and adolescence constitute the transition to adult life, where changes occur in the physical, psychological, emotional and social spheres. In such a crucial period of deve-lopment, environmental factors and diseases to which young people are exposed may have repercussions in adulthood, increasing the chances of developing chronic diseases, including cardiovascular disease (CVD). The main etiology of cardiovascular diseases is atheroscle-rosis, which has its onset in childhood. Accordingly, it is currently recognized that primordial prevention of cardiovascular disease should begin early, i.e. in childhood and adolescence, prior to its actual onset, in order to reduce the prevalence and incidence of CVD in adulthood.

High-density lipoprotein-cholesterol functionality and metabolic syndrome: Protocol for review and meta-analysis.

INTRODUCTION: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events. One function of high-density lipoprotein (HDL) cholesterol (HDL-C) is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-C-efflux capacity, they would have a better handle on the role of HDL in atherosclerosis. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between HDL-C functionality and MetS. The aim of this study is to examine this association of HDL-C functionality with MetS in different ages and sex. METHODS AND ANALYSIS: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar). Studies that examined the association between HDL-C functionality and MetS; focused on cohort, case-control, and cross-sectional studies; were conducted among in adults aged 40 to 70 years; provided sufficient data for calculating odds ratio or relative risk with a 95% confidence interval; were published as original articles written in English or other languages; and have been published until January 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators. ETHICS AND DISSEMINATION: Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42018083465).

High-density lipoprotein-cholesterol functionality and metabolic syndrome: Protocol for review and meta-analysis

INTRODUCTION: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events. One function of high-density lipoprotein (HDL) cholesterol (HDL-C) is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-C-efflux capacity, they would have a better handle on the role of HDL in atherosclerosis. However, there are no systematic analyses or well-conducted meta-analyses to evaluate the relationship between HDL-C functionality and MetS. The aim of this study is to examine this association of HDL-C functionality with MetS in different ages and sex. METHODS AND ANALYSIS: The update systematic review and meta-analysis will be conducted using published studies that will be identified from electronic databases (i.e., PubMed, EMBASE, Web of Science, and Google Scholar). Studies that examined the association between HDL-C functionality and MetS; focused on cohort, case-control, and cross-sectional studies; were conducted among in adults aged 40 to 70 years; provided sufficient data for calculating odds ratio or relative risk with a 95% confidence interval; were published as original articles written in English or other languages; and have been published until January 2018 will be included. Study selection, data collection, quality assessment, and statistical syntheses will be conducted based on discussions among investigators.