ABSTRACT
Purpose: The purpose of the study was to evaluate the knowledge and perception of health-care professionals (HCPs), such as doctors/surgeons, pharmacists, nurses, optometrists, and lab technicians, on clinical trials (CTs) in India. Methods: The study was a pan-Indian cross-sectional survey initiated by the Indian Ophthalmology Clinical Trial Network (IOCTN) by using a previously validated questionnaire for three months of data collection. An online survey was used to record information regarding demographics, CT knowledge, and CT perception among HCPs. Results: A total of 630 responses were recorded from HCPs: 207 doctors and surgeons, 159 pharmacists, and 264 laboratory technicians, nurses, and optometrists across India. Over 90% of HCPs had a clear knowledge on the purpose of CTs, the informed consent (IC) process, ethical approval by the Drugs Controller General of India (DCGI). About 80% and 90% were aware of confidentiality of patients, voluntariness of participation, and good clinical practice. Surprisingly, less than 50% had lesser knowledge regarding monetary incentives of CT participants (CTPs). A slightly positive perception was observed regarding the potential benefits of CTPs, compensation related to injury, and importance of obtaining IC. Less than 50% had a negative perception that monetary compensation to CTPs led to bias and deprivation of standard treatments. However, no significant difference was observed between other aspects of demographics and perception regarding CTs. Conclusion: We observed doctors and surgeons to be having the highest regarding CTs, followed by pharmacists. The survey highlighted the necessity of scheduling awareness programs among the HCPs, which would improve their misconceptions and perception of CTs while interacting with patients for CT enrollment.
ABSTRACT
Background Of The Study: Worldwide, 136 million babies are born annually. 10 million require some stimulation at birth to breathe, while 6 million require basic resuscitation with a bag and mask. Evidence shows that 1 million neonatal deaths occur yearly on the day of birth. Near about 2 million babies die in the rst week of life and 4 million die in the neonatal period, which accounts for 46% of under-ve mortality. This mortality is estimated to increase to 52% in 2030 unless strategic interventions are implemented. To assess the effect of a simulation-based teaching Objective: program on knowledge and skill regarding basic neonatal resuscitation procedures among female health workers of selected areas. Pre-experimental one group pre-test post-test research design will be used. The duration of the study will Methodology: be one month. 60 female health workers from selected primary health centres and sub-health centres of Nagpur district will be selected as a sample through the simple random sampling technique. The structured questionnaire and standardized observational checklist will be used to assess the knowledge and skill respectively. Validity and reliability of the tool will be determined with appropriate standardized methods. Enhance knowledge and skill after simulation-based Expected Result: teaching program. Female health workers working in primary health centres and sub-health centres of Nagpur Limitation: district will be included in this study. The study ndings will reect the need for simulation based education to Conclusion: enhance the knowledge and skill of female health workers to identify birth asphyxia and its potential complications leading to neonatal mortality during the rst few hours after birth.
ABSTRACT
Objective: To assess the effect of maternal audiotaped voice on clinical parameters of sedated children. Methods: A randomized controlled trial was conducted on 25 sedated critically ill children admitted to the pediatric intensive care unit. An audiotaped maternal voice was played to the children in the experimental group (n=13) via a headphone for 15 minutes, twice a day for 3 days. Children in the control group (n=12) received routine care without any additional auditory stimulation. Clinical and hemodynamic variables were recorded at 5 minutes interval three times. Results: Significant changes were observed in the mean (SD) heart rate (per minute) at 10 minutes [129.83 (19.14) vs 124.29 (14.90), P=0.051], respiratory rate at 5 minutes [44.38 (17.79) vs 34.65 (7.64), P=<0.001] and 10 minutes [42.79 (13.89) vs 35.44 (7.65) P=<0.001], systolic blood pressure at 5 minutes [95.24 (15.01) vs 101.02 (19.83) P=0.045], and mean blood pressure at 15 minutes [68.66 (13.61) vs 73.61 (17.59) P=0.051] mmHg between the experimental and the control group, respectively. Conclusion: Listening to recorded maternal voice had a positive effect on clinical parameters of sedated critically ill children.
ABSTRACT
Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).
ABSTRACT
Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.
ABSTRACT
Background: Acquired dermal melanocytosis is a heterogenous group of hyperpigmented lesioins which predominantly involve the face. Aim: The aim of this study was to study the clinical presentation and histopathology of cases with extra-facial acquired dermal melanocytosis. Methods: Retrospective record analysis was performed between May 2016 to August 2019 to retrieve cases of extra-facial acquired dermal melanocytosis seen at the out-patient department of dermatology at the All India Institute of Medical Sciences, Jodhpur. Consecutive cases with histopathologically proven diagnosis of acquired dermal melanocytosis were included. Documentation of variation in clinical presentation and histopathologic findings was done in light of the existing literature. Results: Overall, four cases of extra-facial acquired dermal melanocyosis (female:male = 1:3) were seen during the study period. The lone case on head and neck involved the ear lobule and peri-auricular area. The other three cases had involvement of the hand. The histopathology confirmed the diagnosis of dermal melanocytosis but revealed peculiar findings of angiotropic melanocytes and dilated capillaries. Limitations: Small sample size and lack of comparison with perilesional normal skin were the limitations of this study. Conclusion: The findings of angiotropic melanocytes may be unique to extra-facial acquired dermal melanocytosis. This might indicate interaction between dermal melanocytes and capillary endothelial cells. This finding along with dermal capillary ectasia may indicate a possible role for vascular lasers in the management of these disorders
ABSTRACT
This retrospective observational study was aimed at defining the demographic and clinical characteristics as well as severity profile of COVID-19 disease in children admitted to dedicated COVID-19 tertiary care hospital in Mumbai, India, during the second wave. COVID-19 infection detected in children (1 month-12 years) by the rapid antigen test or reverse transcriptase polymerase chain reaction or TRUENAT from March 1 to July 31, 2021 on throat/nasopharyngeal samples were enrolled and their clinical features and outcomes were studied. During the study period, 77 children with COVID-19 infection were admitted, of whom two-third (59.7%) were <5 yr old. The common presenting symptom was fever (77%), followed by respiratory distress. Comorbidities were noted in 34 (44.2%) children. Most of the patients belonged to the mild severity category (41.55%). While 25.97 per cent of patients presented in severe category and 19.48 per cent were asymptomatic. Admission to intensive care was needed in 20 (25.9%) patients, with 13 patients needing invasive ventilation. Nine patients succumbed while 68 were discharged. The results might help understand the course, severity profile and outcomes of the second wave of the COVID-19 pandemic in the paediatric population.
ABSTRACT
INTRODUCTION: Ovarian fibroma is a solid tumor that belongs to sex-cord stromal cell tumor of ovary commonest benign tumor of ovarian stroma. A 43-year-old female admitted in obstetric and gynecologyCASE REPORT: department with complain of abdominal pain for 2 months and heavy menses. Ovarian fibroma areDISCUSSION: common benign ovarian tumor accounts for approximately 1-4% of ovarian tumor usually unilateral but bilateral ovarian fibroma is rare entity. Large ovarian fibroma can be associated with ascites and right sided pleural effusion (Meigs syndrome)
ABSTRACT
Purpose: To analyze the clinical presentations, risk factors, and management outcomes in patients presenting with dysthyroid optic neuropathy (DON). Methods: This is a retrospective, single?center study carried out on consecutive patients presenting with DON over a period of 4 years (2013–2016). The VISA classification was used at the first visit and subsequent follow?ups. The diagnosis was based on optic nerve function tests and imaging features. Demographic profiles, clinical features, risk factors, and management outcomes were analyzed. Results: Thirty?seven eyes of 26 patients diagnosed with DON were included in the study. A significant male preponderance was noted (20, 76.92%). Twenty patients (76.9%, P = 0.011) had hyperthyroidism, and 15 (57.69%, P = 0.02) were smokers. Decreased visual acuity was noted in 28 eyes (75.6%). Abnormal color vision and relative afferent pupillary defects were seen in 24 (64.86%) eyes, and visual field defects were seen in 30 (81.01%) eyes. The visual evoked potential (VEP) showed a reduced amplitude in 30 (96.77%, P = 0.001) of 31 eyes and delayed latency in 20 (64.51%, P = 0.0289) eyes. Twenty?six (70.27%) patients were treated with intravenous methyl prednisolone (IVMP) alone, whereas 11 (29.72%) needed surgical decompression. The overall best?corrected visual acuity improved by 0.2 l logMARunits. There was no statistically significant difference in outcome between medically and surgically treated groups. Four patients developed recurrent DON, and all of them were diabetics. Conclusion: Male gender, hyperthyroid state, and smoking are risk factors for developing DON. VEP, apical crowding, and optic nerve compression are sensitive indicators for diagnosing DON. Diabetics may have a more defiant course and are prone to develop recurrent DON.
ABSTRACT
INTRODUCTIONThe novel coronavirus also known as severe acute respiratory syndrome coronavirus-2(SARS-COV2) causes a severe respiratory disease known as covid 19 because this strain wasdiscovered in December 2019, in Wuhan, China [1,2]. It was reported first on the 31st ofDecember, 2019, by the WHO and regarded as a global pandemic on 11th march 2020[3]. Itcrossed boundaries worldwide and affected millions of people all over the world. In India, theaverage daily cases are nearly 98000 cases and the numbers are rising every day.MATERIALS AND METHODSIt is a questionnaire-based survey, taken by a total of 80 respondents, who were posted innon-patient care areas of a tertiary care hospital and the questionnaire was framed usinginformation from the world health organization (WHO), UpToDate, Indian council ofmedical research (ICMR), Centre for disease control (CDC) and National Institute of Health(NIH) website resources.RESULTOut of 80 workers, 51.25% workers were permanently employed in the setup (figure 1).Highest in the job category of store manager, tailor and chowkidar, while the highest numberof contractual workers were employed as supervisor, there were no contractual workersemployed as tailor, chowkidar and store manager in the hospital. Out of 80 workers, highestnumber of workers were employed in the category of administrators (16.25%) followed bykitchen staff (13.75%).CONCLUSIONTo conclude, the degree of awareness portrayed by the staff posted in non-patient care areasof the hospital is adequate to some extent, yet it lacks in certain dimensions like covid-19transmission and awareness regarding myths and beliefs. Based on this survey it isrecommended that all non-frontline workers posted in non-patient care areas of the hospitalshould at least be trained in order to increase their awareness and knowledge on thetransmission modes and prevention of COVID-19.
ABSTRACT
Background : “Infertility is defined as the inability to conceive within a year with normal frequency of sexual intercourse and no contraceptives.” Relatively little is known about the effect of nutritional content on fertility. Objective : To study the correlation of level of AMH and AFC with dietary habits especially protein intake in patients of infertility. Material and Methods : It is hospital based study. Design of study : Cross sectional study. Place of study : Teerthankar Mahaveer Medical College & Research Centre, Moradabad, India . Number of Patients : 95 patients of infertility included in the study .Patients were between 30 and 45 years. Time Period : 18 months from January 2020-July 2021. Method : All cases underwent full history taking; clinical examination and all completed a questionnaire consisting of demographic characteristics, FFQ (Food Frequency Questionnaire). Main Outcome Measures : Moderate to high protein intake in diet corresponds to those having met their more than 20% calorie intake by protein had a higher mean AMH as well as had a higher mean AFC. Result : Based on the results of the current study the effects of higher protein intake was found to be significant on the level of ovarian reserve . Conclusion : This study suggests that good and healthy Nutrition, rich in proteins , in fertility treatment is required for better outcome and also helps in limiting the financial burden
ABSTRACT
Background: Non-Hodgkin抯 Lymphoma is a common hematological malignancy. Its incidence and distribution in India are slightly different from developed nations. The study was initiated to obtain the epidemiological, clinical and histopathological spectrum of lymphoma in a single tertiary care hospital of North India. Methods: 104 eligible consecutive cases of lymphoma were retrospectively analyzed from January 2016 to March 2020. Morphology and immunohistochemistry were performed and clinical details were captured from hospital information system. Cases were reclassified according to WHO classification of Tumors of Hematopoietic and Lymphoid Tissue 2017 and also clinically as nodal and extra nodal lymphomas and analyzed. Results: Among the included patients 14.4% patients are diagnosed as Hodgkin抯 lymphoma (HL) while 85.5% belonged to non-Hodgkin抯 lymphoma (NHL). Median age for NHL is 52.5 years. Male outnumbered females in both NHL and HL with ratio of 1.87 and 1.5. Majority of NHL are mature B-cell neoplasm (83.1%), while mature T-cell and NK cell neoplasm are less (14.6%). Most common subtype found is Diffuse large B-cell lymphoma (52.8%) followed by Primary diffuse large B cell lymphoma of CNS (15.7%). Primarily nodal Vs extranodal involvement is seen in 51.9% and 48% of cases. Most common extranodal site is CNS followed by GIT and spine. Conclusion: In the present study DLBL is the most common subtype seen in 52.8% of cases in concordance with other studies but the sticking difference here is low incidence of follicular lymphoma and CLL/SLL and a much higher incidence of Primary DLBCL of CNS. There is an Inherited selection bias because the cases are collected from single institution; however, causes and reasons should be more extensively investigated.
ABSTRACT
Abstract Background and objectives Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed orthopedic procedures. The ability to perform ACLR on an outpatient basis is largely dependent on an effective analgesic regimen. The aim of the study was to compare the analgesic effect between continuous adductor canal block (cACB) and femoral nerve block (cFNB) during arthroscopy guided ACLR. Method In this prospective, randomized, controlled clinical trial, 60 ASA I/II patients for arthroscopic ACLR were recruited. Patients in Group I received cACB and those in Group II cFNB. A bolus dose of 20 cc 0.5% levobupivacaine followed by 0.125% 5 mL.h-1 was started for 24 hours. Rescue analgesia in the form of paracetamol 1 g intravenous (IV) was given. Parameters assessed were time of first rescue analgesia, total analgesic requirement in 24 hours, and painless range of motion of the knee (15 degrees of flexion to further painless flexion). Results The time-to-first postoperative analgesic request (hours) was earlier in Group II (14.40 ± 4.32) than Group I (16.90 ± 3.37) and this difference was statistically significant (p< 0.05). The cumulative 24-h analgesic consumption (paracetamol in g) was 0.70 ± 0.47 in Group I and 1.70 ± 0.65 in Group II (p< 0.001). The painless range of motion (degree) was 55.67 ± 10.40 in Group I and 40.00 ± 11.37 in Group II (p< 0.001). Conclusion The findings of this study suggest that continuous adductor canal block provides superior analgesia in patients undergoing arthroscopic ACLR when compared to continuous femoral nerve block.
Subject(s)
Humans , Arthroscopy/methods , Nerve Block/methods , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Prospective Studies , Femoral Nerve , Analgesics , Analgesics, Opioid , AcetaminophenABSTRACT
Abstract Introduction Patients with a history of or active COVID-19 infection are predisposed to the development of opportunist bacterial and fungal infections. A rising incidence of a rare occurring fungal infection earlier, called mucormycosis, has been reported in abundance across the globe since March 2021, especially in India just as the second wave of COVID-19 began, caused by the trifecta of hyperglycemia (new-onset or exacerbation of pre-existing diabetes), oxygen therapy (invasive or noninvasive ventilation), and prolonged intake of steroids. Objective The present study aimed at assessing the prevalence of post-COVID mucormycosis in males of younger age group and spread of rhino-orbital-cerebral mucormycosis (ROCM). Methods A case-control study was performed over a period of 3 months among 60 male patients with confirmed diagnosis of mucormycosis. Individuals < 40 years old were included in the case group (n = 30), while those > 40 years old were included as controls (n = 30). Disease spread was assessed in three types of ROCM, that is, rhinomaxillary, rhino-orbital, and rhino-orbito-cerebral mucormycosis. Results In the control group, the mean age was 48.47 years old, the mean HbA1c was 10.62 ± 1.88%, with most of them suffering from rhino-orbital mucormycosis. In the case group, the mean age was 31.57 years old, with a mean HbA1c of 10.11 ± 2.46%, and most patients had rhinomaxillary mucormycosis. The duration of steroid intake and mode of oxygen therapy were found to be significant in the severity of ROCM. Conclusion Rising cases of post-COVID mucormycosis have brought to light the fatal consequences of prolonged use of steroids and oxygen therapy towards the development and spread of ROCM among young and middle-aged males.
ABSTRACT
Formative research creates evidence. Evidence-based interventions are implemented in community settings. In the past, evidence-based interventions have failed to get desired outcomes. The tuberculosis control program despite being evidence based did not succeed at the beginning. Similarly, evidence-based treatment of hypertension and diabetes has not yet controlled these diseases. This is where the role of implementation research (IR) starts. IR either as part of evidence-based research or independently should be a part of health programs so that the program shall be able to ensure feasibility, fidelity, penetration, acceptability, sustainability, efficiency, effectiveness, and equity
ABSTRACT
Proteases are ubiquitously present and are among the largest groups of commercially important enzymes. Here, we investigated a wood-rot basidiomycete Trametes versicolor (L.) Lloyd [Syn. Coriolus versicolor (L.) Quél.; Polyporus versicolor (L.) Fr.] as a source of the enzyme serine protease, its production, and optimized to obtain a higher yield of the enzyme.. The significant variables with optimized values for maximum production of the enzyme were temperature (30?C), incubation time (120 h) and wheat bran (10 g). The yield increased by 30.76% by statistically optimizing the media. The optimized temperature and pH for the maximum protease activity was 50?C and pH 7.0, respectively. The enzyme was purified through ion exchange (using DEAE cellulose 52 resin) and gel filtration chromatography (using Superdex 200 column). The purified enzyme had a retention time of 7 min in RP-HPLC. The enzyme was stable at a broad range of temperature (30-60?C) and pH (5.0-8.0) with a half-life of 58.72 min, Vmax of 37.17 ?M min/mL and Km of 0.657 mg/mL. Its activity was enhanced by Na+, Ca2+, Mg2+ ions and SDS surfactant. These properties make this enzyme a valuable candidate for industrial applications
ABSTRACT
Background: We report a case of primary cervical dystocia managed successfully with Ayurveda therapy. The classical Ayurveda lexicons comprise detailed descriptions regarding Prasava (labor) and its management based on which the present case was intervened which resulted in achieving progressive improvement in cervical dilatation and achieving normal labor. Case Presentation: The case reported in this study is primigravidae, 25 years’ old visited prasutitantra OPD, NIA hospital with 37.2 weeks gestational age complaining of labor pains. Since her contraction and per vaginal findings were suggestive of onset of labor, she was hospitalized for further monitoring and awaited spontaneous progress of labor. Repeated Per vaginal examination revealed no progress in cervical dilatation even after 28 hours and she was diagnosed with primary cervical dystocia. Intervention of Kebuka taila yonipichu-25ml 2 hourly was made which resulted in remarkable cervical dilatation equivalent to mean standard rate following 3 interventions of yonipichu within 6 hours. Conclusion: The status of the cervix during labor is a significant determinant of mode and ease of labor. Ayurveda therapeutic strategy of Kebuka taila yoni-pichu can effectively prime the cervix due to the Garbhashayaka sankochaka and estrogenic properties of Kebuka and the activation of Ferguson's reflex by Yoni-pichu.
ABSTRACT
Background: Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of the jaw following a peripheral facial nerve palsy. The increased orbicularis tone due to aberrant connections between the cranial nerve (CN) V and CN VII results in an undesirable wink with major psychosocial impact. Purpose: Most cases in literature were either observed or administered botulinum toxin injection to the orbicularis muscle. There are few sporadic reports of surgical interventions with successful outcomes.Hence there was a need to generate awareness regarding various modes of management of this rare entity. Synopsis: We present a video on the clinical presentation and management of six such patients, of whom one was bilateral. Five patients were females. Traumatic facial nerve paralysis and Bell’s palsy was previously diagnosed in one and five patients respectively. The mean age was 52 ± 9.48 years. The mean MRD (margin reflex distance) 1 and MRD 2 was 3.17 ± 0.60 and 5.33± 0.65 mm respectively. On smiling or on movement of the jaw the MRD 1 and 2 was reduced by 2. 50±0.40 and 1.50+/-0.40 mm respectively. Of the six patients four patients opted for nil intervention. Highlights: Botulinum toxin injection and preseptal orbicularis resection in the upper and lower eyelid along with blepharoplasty was performed in 1 patient each. Satisfactory reduction in the synkinetic movement was achieved in both. Marin-Amat syndrome is a rare often underdiagnosed synkinetic disorder following peripheral facial nerve palsy. Botulinum toxin injection and preseptal orbicularis resection are viable management options
ABSTRACT
The Government of India had launched the Janani Shishu Suraksha Karyakram (JSSK) Scheme in June 2011 to benefi t pregnant women during their ante-natal, intra-natal and post-natal period including the new-born up to age of one year. In this quasi-experimental (pre-test, post-test, control group design) study, a total of 60 mothers (30 each in experimental and control group) attending ante-natal clinic at district hospital, Faridabad were enrolled using simple random sampling (lottery method). A self-developed, pre-tested and validated tool based on knowledge and utilisation about JSSK scheme was used for data collection. Mean post-test knowledge scores of experimental group and control group were 22.4 and 12 respectively with a mean difference of 10.4. The obtained mean difference was found to be statistically signifi cant as evident from the ' t' value of 3.96 at 0.05 level of signifi cance. The mean post-test utilisation score of experimental group (23.57) was higher than the mean post-test utilisation scores of control group (20.6) with a mean difference of 2.97. The obtained mean difference was found to be statistically signifi cant as evident from the ' t' value of 3.96 at 0.05 level of signifi cance. Chi value computed between knowledge scores and utilisation scores of JSSK Scheme and selected demographic variables indicated that there was no signifi cant association. This shows that health education package was effective in enhancing the knowledge of participant mothers regarding JSSK health scheme so that they were able to utilise the scheme in a better way. There is a need of IEC activity to increase the knowledge of benefi ciaries to enhance the utilisation of JSSK health services.
ABSTRACT
BACKGROUND Coronavirus disease 2019 (Covid-19) is an evolving disease with newly generated evidence related to the clinical management of Covid-19 patients. We aimed to compare two online learning schedules for disseminating new cardiopulmonary resuscitation (CPR) guidelines in terms of knowledge gain and acceptability among nurses. METHODS In a prospective randomized controlled study, 61 nurses trained in comprehensive cardiopulmonary life support (CCLS) were randomized to synchronous (n=31) and asynchronous learning groups (n= 30). The enhanced training module on CPR (ETMCPR) prepared by a team of experts was used to impart training to the nurses. Baseline data and pre-intervention knowledge of participants were collected using a structured demographic sheet and knowledge questionnaire (25 items) in a google form. Nurses in the synchronous group were provided training using ETMCPR through a licensed Zoom platform, while the nurses in the asynchronous group had access to the uploaded ETMCPR module in the e-learning platform. At the end of the intervention, the knowledge of the nurses was assessed along with their acceptability to the online learning schedule. RESULTS Both schedules of online learning were effective in improving the knowledge scores of the nurses (11.93 [3.26] v. 21.15 [1.90], p=0.01 and 11.71 [3.12] v. 20.32 [1.71], p=0.01). The mean acceptability scores of nurses in the asynchronous group were statistically lower than in the synchronous group (38.93 [2.50] v. 42.5 [3.08], p=0.007). CONCLUSION Both synchronous and asynchronous schedules of online learning were effective in disseminating updated CPR guidelines; however, nurses in the synchronous group were more satisfied with the learning schedule.