The state of distance healthcare simulation during the COVID-19 pandemic: results of an international survey.

BACKGROUND: The coronavirus pandemic continues to shake the embedded structures of traditional in-person education across all learning levels and across the globe. In healthcare simulation, the pandemic tested the innovative and technological capabilities of simulation programs, educators, operations staff, and administration. This study aimed to answer the question: What is the state of distance simulation practice in 2021? METHODS: This was an IRB-approved, 34-item open survey for any profession involved in healthcare simulation disseminated widely and internationally in seven languages from January 14, 2021, to March 3, 2021. Development followed a multistep process of expert design, testing, piloting, translation, and recruitment. The survey asked questions to understand: Who was using distance simulation? What driving factors motivated programs to initiate distance sim? For what purposes was distance sim being used? What specific types or modalities of distance simulation were occurring? How was it being used (i.e., modalities, blending of technology and resources and location)? How did the early part of the pandemic differ from the latter half of 2020 and early 2021? What information would best support future distance simulation education? Data were cleaned, compiled, and analyzed for dichotomized responses, reporting frequencies, proportions, as well as a comparison of response proportions. RESULTS: From 32 countries, 618 respondents were included in the analysis. The findings included insights into the prevalence of distance simulation before, during, and after the pandemic; drivers for using distance simulation; methods and modalities of distance simulation; and staff training. The majority of respondents (70%) reported that their simulation center was conducting distance simulation. Significantly more respondents indicated long-term plans for maintaining a hybrid format (82%), relative to going back to in-person simulation (11%, p < 0.001). CONCLUSION: This study gives a perspective into the rapid adaptation of the healthcare simulation community towards distance teaching and learning in reaction to a radical and quick change in education conditions and environment caused by COVID-19, as well as future directions to pursue understanding and support of distance simulation.

[Epidemiology of out-of-hospital sudden cardiac arrest in « Basse-Normandie ¼ according to RéAC registry]. / Épidémiologie des arrêts cardiaques extrahospitaliers recensés en Basse-Normandie par le registre RéAC.

OBJECTIVE: Identify from the RéAC registry, out-of-hospital sudden cardiac arrest in Caen and it's suburbs, to study epidemiology and assess our medical practices. STUDY DESIGN: Observational, prospective and monocentric study. PATIENTS AND METHODS: From March 2012 to March 2013, we identified 151 patients. Demographic parameters, delays until treatment, drugs given and patient outcomes were analyzed from the RéAC data registry. Depending on the variable studied, the statistical analysis used Mann-Whitney or the Chi(2) tests. RESULTS: Twenty-two patients were excluded (no resuscitation attempt and patients who were transported to hospital with chest compressions only, in the absence of spontaneous circulation). One hundred and twenty-nine sudden cardiac arrests were analyzed: 107 (83%) with medical origin and 22 (17%) with traumatic origin. Direct witnesses were present for 94 (73%) of them. Basic life support actions were begun for 59 (46%) patients and a telephone advice was issued by the medical response team for 47 (36%) of them. After an advanced life support, 74 (57%) patients died on the spot. Of the 55 patients reaching the hospital alive, 39 (71%) died in the intensive care unit and 16 (29%) were discharged alive from hospital, of whom 14 (88%) with a favorable neurological outcome. CONCLUSION: RéAC national registry has allowed us to analyze epidemiological data on out-of-hospital sudden cardiac arrests in our center. This register has also allowed us to highlight areas for improvement. They should be taken into account to improve our medical practices.

Mechanisms involved in the desflurane-induced post-conditioning of isolated human right atria from patients with type 2 diabetes.

BACKGROUND: Desflurane triggers post-conditioning in the diabetic human myocardium. We determined whether protein kinase C (PKC), mitochondrial adenosine triphosphate-sensitive potassium (mitoK(ATP)) channels, Akt, and glycogen synthase kinase-3ß (GSK-3ß) were involved in the in vitro desflurane-induced post-conditioning of human myocardium from patients with type 2 diabetes. METHODS: The isometric force of contraction (FoC) of human right atrial trabeculae obtained from patients with type 2 diabetes was recorded during 30 min of hypoxia followed by 60 min of reoxygenation. Desflurane (6%) was administered during the first 5 min of reoxygenation either alone or in the presence of calphostin C (PKC inhibitor) or 5-hydroxydecanoate (5-HD) (mitoK(ATP) channel antagonist). Phorbol 12-myristate 13-acetate (PKC activator) and diazoxide (a mitoK(ATP) channel opener) were superfused during early reoxygenation. The FoC at the end of the 60 min reoxygenation period was compared among treatment groups (FoC(60); mean and sd). The phosphorylation of Akt and GSK-3ß was studied using western blotting. RESULTS: Desflurane enhanced the recovery of force [FoC(60): 79 (3)% of baseline] after 60 min of reoxygenation when compared with the control group (P>0.0001). Calphostin C and 5-HD abolished the beneficial effect of desflurane-induced post-conditioning (both P<0.0001). Phorbol 12-myristate 13-acetate and diazoxide enhanced the FoC(60) when compared with the control group (both P<0.0001). Desflurane increased the level of phosphorylation of Akt and GSK-3ß (P<0.0001). CONCLUSIONS: Desflurane-induced post-conditioning in human myocardium from patients with type 2 diabetes was mediated by the activation of PKC, the opening of the mitoK(ATP) channels, and the phosphorylation of Akt and GSK-3ß.