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Introducción. La hipercolesterolemia familiar (HcF) es una patología causada por diversas mutaciones con una incidencia variable dependiendo de su forma heterocigota u homocigota. Sin embargo, pocos casos son diagnosticados y no todo el personal de salud conoce sobre la enfermedad. Materiales y Método. Se realizó una encuesta en línea basada en Google Forms para medir el nivel de conocimiento del personal de salud sobre la HcF en la República Dominicana. Se utilizó un cuestionario confeccionado por los autores basado en los criterios DUCTH de hipercolesterolemia. Resultados. El predominio del personal de salud que llenó el cuestionario fue de nutriólogos; el conocimiento sobre los valores de corte adecuado para el diagnóstico de HcF fue reportado en 30% de la muestra. Conclusiones. Es imperativo incrementar el conocimiento del personal de salud sobre HcF con el objetivo de disminuir la muerte cardiovascular prematura.

Introducción: La salud cardiovascular comprende un conjunto de variables que interactúan entre sí (entre factores no modificables y factores modificables) para modificar el riesgo de padecer un evento cardiovascular (EVC). Material y Métodos: Se realizó una encuesta en línea basada en Google Forms para medir la salud cardiovascular en la población adulta en la República Dominicana. Se utilizó un cuestionario confeccionado por los autores basado en los criterios DUCTH de hipercolesterolemia. Resultados: Las características sociodemográficas de los participantes fueron heterogéneas, 60% de los participantes tenía antecedente familiar patológico, 55% reportó inactividad física, las prácticas dietéticas de nuestra muestra no fueron apropiadas, observando que 70% no ingería o ingería pocas veces yogur, patrón observado en el 44% con respecto a la ingesta de leche, sin embargo, el 94% ingería con frecuencia carne. Conclusión: La salud cardiovascular de los dominicanos posee una menor calidad asociada a un mayor consumo de carnes y tabaco y menor cantidad de ejercicio; dicho comportamiento puede haber estado influido por la pandemia del COVID-19 o las características de la región.

La presente investigación indagó en los incidentes críticos que emergen de las voces de educadoras diferenciales y de docentes de educación general básica respecto del trabajo de coenseñanza en el aula, en el marco del programa de integración escolar. Metodológicamente, se recurrió a un enfoque cualitativo con un alcance descriptivo para una muestra conformada por 15 docentes de educación general básica y 15 educadoras de educación diferencial, quienes respondieron una pauta de incidentes críticos. El análisis se focalizó en aquellos incidentes reportados y se llevó a cabo por medio de un análisis de contenido intra e intergrupo. Los resultados dan cuenta de cuatro categorías de incidentes críticos: estrategias de enseñanza, procesos de evaluación de aprendizaje, medidas disciplinarias y presencia efectiva. Si bien estos resultados se encuentran presentes en la bibliografía existente, se concluye la necesidad de no individualizar las problemáticas, sino de analizarlas dentro de un marco comprensivo, donde una dinámica social propicia las condiciones para que estas emerjan. De tal modo, son necesarias futuras investigaciones respecto de la política pública y los marcos para la coenseñanza, para focalizar en la interacción situada de los actores educativos como forma de abordaje de los conflictos.

Se analiza la producción de materiales didácticos para la enseñanza del mapuzugun en contextos formales y no formales, desde la experiencia y perspectivas de enseñantes/educadores. Se realizaron entrevistas semiestructuradas, siguiendo la práctica del nütram (expresión del arte verbal mapuche), a diez educadores/as mayoritariamente mapuche. Mediante un estudio de casos múltiples y análisis cualitativo, se identificaron aspectos como el origen del material y modalidad de producción, fuentes y contenidos socioculturales, tipos de materiales, criterios para elaboración y perspectiva de las y los educadores/as. Los resultados revelan el carácter ampliado de los materiales didácticos, donde todo lo que circunda el contexto educativo es considerado como tal. La recurrencia del territorio como tema central plantea el desafío de traducir didácticamente estos recursos. Asimismo, se advierte una noción extendida de materiales vinculada con la participación de estudiantes como coproductores. Sin comparar los contextos, se informan las especificidades y aspectos comunes destacados.

Este artículo analiza la metodología narrativo-visual conocida como “Fotovoz” a partir de su implementación y uso en dos casos, en el contexto de un plan de desarrollo escolar inclusivo basado en los planteamientos de la Guía para la Inclusión Educativa. Este plan busca propiciar, mediante la participación de la propia comunidad escolar y el levantamiento de la voz del estudiantado, la producción de un plan para abordar las barreras para la inclusión detectadas por el colectivo. Metodológicamente se procede través de dos casos, la producción de información se lleva a cabo por medio de notas de campo de cada una de las sesiones por parte del equipo de asesores colaborativos, siendo complementada por el material producido por los propios estudiantes y una entrevista final al equipo. Por medio de un análisis cualitativo se identifican tres categorías centrales, a saber: Diseño, Implementación, Aportes y barreras en el proceso de autoexploración. Cada una de estas categorías está asociada a problemáticas y estrategias adoptadas para su solución, así como también a potencialidades para el abordaje de la diversidad. Los resultados permiten dar cuenta de un enfoque que facilita tanto la participación como la construcción de un conocimiento de la escuela en un plano de la experiencia sensible que irrumpe en el espacio escolar problematizando una serie de elementos que escapan al uso de cuestionarios como estrategia privilegiada.

Este artículo analiza las concepciones sobre el cambio educativo en docentes participantes de un proyecto de desarrollo inclusivo, en escuelas municipales de Santiago de Chile. Este proyecto busca propiciar, mediante la participación de la propia comunidad escolar, la creación de estrategias para abordar las barreras detectadas por el colectivo. Se identifican, mediante un estudio de casos y un análisis cualitativo, las concepciones de los participantes a partir de dos ejes centrales Transformación/Transacción e Integralidad/Fragmentación. Emergen a partir de un análisis tipológico, cuatro posiciones dinámicas y articuladas acerca del cambio educativo: Cambio Comunitario, Integracionista, Eficiente y Burocrático. Cada una de estas configuraciones con visiones propias que anticipan trayectorias y desafíos posibles. Los resultados permiten problematizar las condiciones de la escuela y sus participantes para favorecer un trabajo desde una perspectiva inclusiva, en el contexto de la educación municipal.

Uno de los criterios utilizados para evaluar programas de educación superior consiste en conocer la importancia que los egresados otorgan a las diferentes competencias planteadas en los contenidos curriculares. El objetivo de este trabajo es determinar el grado de importancia que los egresados del Master en educación secundaria de la Universidad de Vigo dan a un conjunto de competencias instrumentales, presentando los resultados de un cuestionario aplicado a una muestra representativa. Las competencias instrumentales evaluadas se formularon a partir de los contenidos curriculares de dicho Master y comprenden habilidades cognitivas, capacidades metodológicas, destrezas tecnológicas y habilidades lingüísticas.

The Technologies of Information and Communication (ICT) become in the information society a change agent. In this context, ICTs should become teaching tools in order to help the teacher to achieve quality education.Being aware of the importance of the teachers' mastery of the digital skills, we have conducted a study about the mastery of the ICTs that the students in the third year of the degree of teacher training of the University of Vigo have. In order to do this we have taken into account the knowledge acquired, the frequency of use of certain tools, their level of proficiency in four areas of knowledge: technological literacy, intellectual working tools, processing and dissemination of information and as communication tools. As well as their motivations, interests and obstacles found in their development in order to develop proposals for initial training.We can conclude that, in general, students do not have a specific training on the use of computers. About the degree of knowledge in the different skills, the students know the most basic and commonly used (open or download a file, create or print a document, install a program or send an e-mail). They usually use the mail as a working tool, while the messaging and social networks are more used for leisure time.Their attitudes towards ICTs are very positive and their motivations are focused essentially on the technologies which are useful for improving their learning and for their professional future.

The Technologies of Information and Communication (ICT) become in the information society a change agent. In this context, ICTs should become teaching tools in order to help the teacher to achieve quality education.Being aware of the importance of the teachers' mastery of the digital skills, we have conducted a study about the mastery of the ICTs that the students in the third year of the degree of teacher training of the University of Vigo have. In order to do this we have taken into account the knowledge acquired, the frequency of use of certain tools, their level of proficiency in four areas of knowledge: technological literacy, intellectual working tools, processing and dissemination of information and as communication tools. As well as their motivations, interests and obstacles found in their development in order to develop proposals for initial training.We can conclude that, in general, students do not have a specific training on the use of computers. About the degree of knowledge in the different skills, the students know the most basic and commonly used (open or download a file, create or print a document, install a program or send an e-mail). They usually use the mail as a working tool, while the messaging and social networks are more used for leisure time.Their attitudes towards ICTs are very positive and their motivations are focused essentially on the technologies which are useful for improving their learning and for their professional future.Las Tecnologías de la información y comunicación (TIC) se convierten en la sociedad de la Información en un agente de cambio. En este contexto las TIC deben transformarse en herramientas pedagógicas al servicio del profesor con el fin de lograr una educación de calidad. Conscientes de la importancia de que los profesores dominen las competencias digitales, hemos realizado un estudio sobre el dominio de las tecnologías de la información y la comunicación (TIC) que poseen los estudiantes de tercer curso de la titulación de Magisterio de la Universidad de Vigo. Para ello se han tenido en cuenta los conocimientos adquiridos, la frecuencia en la utilización de determinadas herramientas, su nivel de dominio en cuatro ámbitos de conocimiento: Alfabetización tecnológica, Instrumentos de trabajo intelectual, Tratamiento y difusión de la información y como Herramientas de comunicación. Así como sus motivaciones e intereses y los obstáculos encontrados en su desarrollo con el fin de establecer propuestas para la formación inicial. Podemos concluir que, en general, el alumnado no tiene una formación específica sobre el funcionamiento de los ordenadores. Sobre el grado de conocimiento de las diferentes destrezas el alumno conoce las más básicas y las que utilizan habitualmente (abrir o bajar un archivo, crear o imprimir un documento, instalar un programa o enviar un e-mail). Utilizan habitualmente el correo como una herramienta de trabajo, mientras que la mensajería y las redes sociales las utilizan más en tiempos de ocio. Sus actitudes hacia las TIC son muy positivas y sus motivaciones se centran fundamentalmente en que las tecnologías son útiles para mejorar su aprendizaje y para su futuro laboral.

Foreign body airway obstruction (FBAO) is a relatively common emergency and a potential cause of sudden death both in children and older people; bystander immediate action will determine the victim's outcome. Although many school children's basic life support (BLS) training programs have been implemented in recent years, references to specific training on FBAO are lacking. Therefore, the aim was to assess FBAO-solving knowledge acquisition in 10-13-year-old school children. A quasi-experimental non-controlled simulation study was carried out on 564 ten-to-thirteen-year-old children from 5 schools in Galicia (Spain). Participants received a 60-min training led by their physical education teachers (5 min theory, 15 min demonstration by the teacher, and 30 min hands-on training) on how to help to solve an FBAO event. After the training session, the school children's skills were assessed in a standardized adult's progressive FBAO simulation scenario. The assessment was carried out by proficient researchers utilizing a comprehensive checklist specifically designed to address the variables involved in resolving a FBAO event according with current international guidelines. The assessment of school children's acquired knowledge during the simulated mild FBAO revealed that 62.2% of participants successfully identified the event and promptly encouraged the simulated patient to cough actively. When the obstruction progressed, its severity was recognized by 86.2% and back blows were administered, followed by abdominal thrusts by 90.4%. When the simulated victim became unconscious, 77.1% of children identified the situation and immediately called the emergency medical service and 81.1% initiated chest compressions. No significant differences in performance were detected according to participants' age.  Conclusion: A brief focused training contributes to prepare 10-13-year-old school children to perform the recommended FBAO steps in a standardized simulated patient. We consider that FBAO should be included in BLS training programs for school children. What is Known: • Kids Save Lives strategy states that school children should learn basic life support (BLS) skills because of their potential role as first responders. • This BLS training does not include content for resolving a foreign body airway obstruction (FBAO). What is New: • Following a 60-min theoretical-practical training led by physical education teachers, 10-13-year-old school children are able to solve a simulated FBAO situation. • The inclusion of FBAO content in BLS training in schools should be considered., (© 2023. The Author(s).)

Background: The aim of this study was to determine the ability of the Sequential Organ Failure Assessment score (SOFA) and modified SOFA score (mSOFA) as predictive tools for 2-day and 28-day mortality and ICU admission in patients with acute neurological pathology treated in hospital emergency departments (EDs)., Methods: An observational, prospective cohort study in adults with acute neurological disease transferred by ambulance to an ED was conducted from 1 January 2019 to 31 August 2022 in five hospitals in Castilla-León (Spain). Score discrimination was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the score., Results: A total of 640 adult patients with neurological disease were included. For the prediction of 2-day mortality (all-cause), mSOFA presented a higher AUC than SOFA (mSOFA = 0.925 vs. SOFA = 0.902). This was not the case for 28-day mortality, for which SOFA was higher than mSOFA (mSOFA = 0.852 vs. SOFA = 0.875). Finally, ICU admission showed that SOFA was higher than mSOFA (mSOFA = 0.834 vs. SOFA = 0.845)., Conclusion: Both mSOFA and SOFA presented similar predictive ability, with mSOFA being the best predictor for short-term mortality and SOFA being the best predictor for medium-term mortality, as well as for ICU admission. These results in a cohort of patients with acute neurological pathology pave the way for the use of both predictive tools in the ED. The inclusion of these tools could improve the clinical assessment and further treatment of neurological patients, who commonly present the worst outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Donoso-Calero, Sanz-García, Polonio-López, Maestre Miquel, Durantez Fernández, Mordillo-Mateos, Mohedano-Moriano, Conty-Serrano, Otero-Agra, Jorge-Soto, Martín-Conty and Martín-Rodríguez.)

Introduction: Drowning is a public health problem. Interrupting the drowning process as soon as possible and starting cardiopulmonary resuscitation (CPR) can improve survival rates. Inflatable rescue boats (IRBs) are widely used worldwide to rescue drowning victims. Performing CPR in special circumstances requires adjusting the position based on the environment and space available. The aim of this study was to assess the quality of over-the-head resuscitation performed by rescuers aboard an IRB in comparison to standard CPR., Methods: A quasi-experimental, quantitative, cross-sectional pilot study was conducted. Ten professional rescuers performed 1 min of simulated CPR on a QCPR Resuscy Anne manikin (Laerdal, Norway) sailing at 20 knots using two different techniques: 1) standard CPR (S-CPR) and 2) over-the-head CPR (OTH-CPR). Data were recorded through the APP QCPR Training (Laerdal, Norway)., Results: The quality of CPR was similar between S-CPR (61%) and OTH-CPR (66%), with no statistically significant differences (p = 0.585). Both the percentage of compressions and the percentage of correct ventilations did not show significant differences (p > 0.05) between the techniques., Conclusion: The rescuers can perform CPR maneuvers with acceptable quality in the IRB. The OTH-CPR technique did not show inferiority compared to S-CPR, making it a viable alternative when boat space or rescue conditions do not allow the conventional technique to be performed., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to compare the ability to predict 30-day in-hospital mortality of lactate versus the modified Rapid Emergency Medicine Score (mREMS) versus the arithmetic sum of the mREMS plus the numerical value of lactate (mREMS-L)., Methods: A prospective, multicentric, emergency department delivery, pragmatic study was conducted. To determine the predictive capacity of the scales, lactate was measured and the mREMS and mREMS-L were calculated in adult patients (aged>18 years) transferred with high priority by ambulance to the emergency department in five hospitals of Castilla y Leon between 1 January 2020 and 31 December 2021. The area under the receiver operating characteristic (ROC) curve of each of the scales was calculated in terms of mortality for 30 days., Results: A total of 5371 participants were included, and the in-hospital mortality rate at 30 days was of 11.4% (615 cases). The best cut-off point determined in the mREMS was 7.0 points (sensitivity of 67% and specificity of 84%), and for lactate, the cut-off point was 1.4 mmol/L (sensitivity of 88% and specificity of 67%). Finally, the combined mREMS-L showed a cut-off point of 7.9 (sensitivity of 83% and a specificity of 83%). The area under the ROC curve of the mREMS, lactate and mREMS-L for 30-day mortality was 0.851, 0.853, and 0.903, respectively (p < 0.001 in all cases)., Conclusions: The new score generated, mREMS-L, obtained better statistical results than its components (mREMS and lactate) separately., (© 2023 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.)

Since a great number of infant cardiopulmonary arrests occur outside of the hospital, it is crucial to train laypersons in cardiopulmonary resuscitation techniques, especially those professionals that will work with infants and children. The main objective of this study was to evaluate the efectiveness of ventilations performed by professional training students. The secondary objective was to analyze the preference between different ventilation and chest-compression methods. The sample consisted of 32 professional training students, 15 preschool students, and 17 physical education students. The activity was conducted separately for each group, and we provided a 10 min theoretical training about infant basic life support followed by a 45 min practical training using a Laerdal Little Anne QCPR CPR manikin. A practical test in pairs was organized to record the ventilation as performed by the participants, establishing the difference between the efficacious and the non-efficacious ones. Furthermore, we handed out a survey before and after training to evaluate their knowledge. More than 90% of the students completely agreed with the importance of learning cardiopulmonary resuscitation techniques for their professional future. More than half of the sample considered that they perform the rescue breathings with the mouth-to-mouth method better. We observed that through mouth-to-mouth-nose ventilations, the number of effective ventilations was significantly higher than the effective ventilations provided by a self-inflating bag and mask (EffectiveMtoMN 6.42 ± 4.27 vs. EffectiveMask 4.75 ± 3.63 ( p = 0.007)), which was the preferred method. In terms of the compression method, hands encircling the chest was preferred by more than 85% of students. Mouth-to-mouth nose ventilation is more efficient than bag-face-mask ventilation in CPR as performed by professional training and physical activity students. This fact must be considered to provide higher-quality training sessions to professional training students.

Background: The aim of this study was to examine the attitudes, fears, and anxiety level of nursing students faced with a critical clinical simulation (cardiopulmonary reanimation) with and without personal protective equipment (PPE)., Methods: A pilot before-after study as conducted from 21 to 25 June 2021, with 24 students registered in the nursing degree of the Faculty of Health Sciences of the Castilla-La Mancha University (UCLM) in the city of Talavera de la Reina (Toledo, Spain). From 520 possible participants, only 24 were selected according to the exclusion and inclusion criteria. The STAI Manual for the State-Trait Anxiety Inventory, a self-evaluation questionnaire, was used to study trait STAI (basal anxiety), trait STAI before CPR, state STAI after CPR, total STAI before CPR, and total STAI after CPR as the main variables. A t -test was used to study the STAI variables according to sex and the physiological values related to the anxiety level of participants. An ANOVA statistical test was used to perform a data analysis of the STAI variables., Results: A total of 54.2% of participants (IC 95% 35.1-72.1) suffered from global anxiety before the cardiopulmonary reanimation maneuvers (CPR). The results of the STAI before CPR maneuvers showed significant differences according to gender in state anxiety ( p = 0.04), with a higher level of anxiety in women (22.38 ± 7.69 vs. 15.82 ± 7.18)., Conclusions: This study demonstrates different levels of anxiety in terms of gender suffered by nursing students in high-pressure environments, such as a CPR situation.

Objective: Evaluating the usefulness of a chat bot as an assistant during CPR care by laypersons., Methods: Twenty-one university graduates and university students naive in basic life support participated in this quasi-experimental simulation pilot trial. A version beta chatbot was designed to guide potential bystanders who need help in caring for cardiac arrest victims. Through a Question-Answering (Q&A) flowchart, the chatbot uses Voice Recognition Techniques to transform the user's audio into text. After the transformation, it generates the answer to provide the necessary help through machine and deep learning algorithms. A simulation test with a Laerdal Little Anne manikin was performed. Participants initiated the chatbot, which guided them through the recognition of a cardiac arrest event. After recognizing the cardiac arrest, the chatbot indicated the start of chest compressions for 2 min. Evaluation of the cardiac arrest recognition sequence was done via a checklist and the quality of CPR was collected with the Laerdal Instructor App., Results: 91% of participants were able to perform the entire sequence correctly. All participants checked the safety of the scene and made sure to call 112. 62% place their hands on the correct compression point. A media time of 158 s (IQR: 146-189) was needed for the whole process. 33% of participants achieved high-quality CPR with a median of 60% in QCPR (IQR: 9-86). Compression depth had a median of 42 mm (IQR: 33-53) and compression rate had a median of 100 compressions/min (IQR: 97-100)., Conclusion: The use of a voice assistant could be useful for people with no previous training to perform de out-of-hospital cardiac arrest recognition sequence. Chatbot was able to guide all participants to call 112 and to perform continuous chest compressions. The first version of the chatbot for potential bystanders naive in basic life support needs to be further developed to reduce response times and be more effective in giving feedback on chest compressions., Competing Interests: Declaration of Competing Interest All the authors declare that there is no conflict of interest., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aims: The aim of this study was to compare the ability to predict 2-, 7-, 14-, and 30-day in-hospital mortality of lactate vs the National Early Warning Score 2 (NEWS2) vs the arithmetic sum of the NEWS2 plus the numerical value of lactate (NEWS2-L)., Methods: This was a prospective, multicentric, emergency department delivery, pragmatic cohort study. To determine the predictive capacity of lactate, we calculated the NEWS2 and NEWS2-L in adult patients (aged &gt;18 years) transferred with high priority by ambulance to the emergency department in five hospitals of Castilla y Leon (Spain) between November 1, 2019, and September 30, 2020. The area under the receiver operating characteristic curve of each of the scales was calculated in terms of mortality for every time frame (2, 7, 14, and 30 days). We determined the cut-off point of each scale that offered highest sensitivity and specificity using the Youden index., Results: A total of 1716 participants were included, and the in-hospital mortality rates at 2, 7, 14, and 30 days were of 7.8% (134 cases), 11.6% (200 cases), 14.2% (243 cases), and 17.2% (295 cases), respectively. The best cut-off point determined in the NEWS2 was 6.5 points (sensitivity of 97% and specificity of 59%), and for lactate, the cut-off point was 3.3 mmol/L (sensitivity of 79% and specificity of 72%). Finally, the combined NEWS2-L showed a cut-off point of 11.7 (sensitivity of 86% and a specificity of 85%). The area under the receiver operating characteristic curve of the NEWS2, lactate, and NEWS2-L in the validation cohort for 2-day mortality was 0.889, 0.856, and 0.923, respectively (p&lt;0.001 in all cases)., Conclusions: The new score generated, NEWS2-L, obtained better statistical results than its components (NEWS2 and lactate) separately., (Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Anticipating and avoiding preventable intrahospital cardiac arrest and clinical deterioration are important priorities for international healthcare systems and institutions. One of the internationally followed strategies to improve this matter is the introduction of the Rapid Response Systems (RRS). Although there is vast evidence from the international community, the evidence reported in a Spanish context is scarce., Methods: A nationwide cross-sectional research consisting of a voluntary 31-question online survey was performed. The Spanish Society of Intensive, Critical and Coronary Care Medicine (SEMICYUC) supported the research., Results: We received 62 fully completed surveys distributed within 13 of the 17 regions and two autonomous cities of Spain. Thirty-two of the participants had an established Rapid Response Team (RRT). Common frequency on measuring vital signs was at least once per shift but other frequencies were contemplated (48.4%), usually based on professional criteria (69.4%), as only 12 (19.4%) centers used Early Warning Scores (EWS) or automated alarms on abnormal parameters. In the sample, doctors, nurses (55%), and other healthcare professionals (39%) could activate the RRT via telephone, but only 11.3% of the sample enacted this at early signs of deterioration. The responders on the RRT are the Intensive Care Unit (ICU), doctors, and nurses, who are available 24/7 most of the time. Concerning the education and training of general ward staff and RRT members, this varies from basic to advanced and specific-specialized level, simulating a growing educational methodology among participants. A great number of participants have emergency resuscitation equipment (drugs, airway adjuncts, and defibrillators) in their general wards. In terms of quality improvement, only half of the sample registered RRT activity indicators. In terms of the use of communication and teamwork techniques, the most used is clinical debriefing in 29 centers., Conclusions: In terms of the concept of RRS, we found in our context that we are in the early stages of the establishment process, as it is not yet a generalized concept in most of our hospitals. The centers that have it are in still in the process of maturing the system and adapting themselves to our context.

(1) Background: The aim was screening the performance of nine Early Warning Scores (EWS), to identify patients at high-risk of premature impairment and to detect intensive care unit (ICU) admissions, as well as to track the 2-, 7-, 14-, and 28-day mortality in a cohort of patients diagnosed with an acute neurological condition. (2) Methods: We conducted a prospective, longitudinal, observational study, calculating the EWS [Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), VitalPAC Early Warning Score (ViEWS), Modified Rapid Emergency Medicine Score (MREMS), Early Warning Score (EWS), Hamilton Early Warning Score (HEWS), Standardised Early Warning Score (SEWS), WHO Prognostic Scored System (WPSS), and Rapid Acute Physiology Score (RAPS)] upon the arrival of patients to the emergency department. (3) Results: In all, 1160 patients were included: 808 patients were hospitalized, 199 cases (17%) required ICU care, and 6% of patients died (64 cases) within 2 days, which rose to 16% (183 cases) within 28 days. The highest area under the curve for predicting the need for ICU admissions was obtained by RAPS and MEWS. For predicting mortality, MREMS obtained the best scores for 2- and 28-day mortality. (4) Conclusions: This is the first study to explore whether several EWS accurately identify the risk of ICU admissions and mortality, at different time points, in patients with acute neurological disorders. Every score analyzed obtained good results, but it is suggested that the use of RAPS, MEWS, and MREMS should be preferred in the acute setting, for patients with neurological impairment.

Previous pilot experience has shown the ability of visually impaired and blind people (BP) to learn basic life support (BLS), but no studies have compared their abilities with blindfolded people (BFP) after participating in the same instructor-led, real-time feedback training. Twenty-nine BP and 30 BFP participated in this quasi-experimental trial. Training consisted of a 1 h theoretical and practical training session with an additional 30 min afterwards, led by nurses with prior experience in BLS training of various collectives. Quantitative quality of chest compressions (CC), AED use and BLS sequence were evaluated by means of a simulation scenario. BP's median time to start CC was less than 35 s. Global and specific components of CC quality were similar between groups, except for compression rate (BFP: 123.4 + 15.2 vs. BP: 110.8 + 15.3 CC/min; p = 0.002). Mean compression depth was below the recommended target in both groups, and optimal CC depth was achieved by 27.6% of blind and 23.3% of blindfolded people ( p = 0.288). Time to discharge was significantly longer in BFP than BP (86.0 + 24.9 vs. 66.0 + 27.0 s; p = 0.004). Thus, after an adapted and short training program, blind people were revealed to have abilities comparable to those of blindfolded people in learning and performing the BLS sequence and CC.

The ability of COVID-19 to compromise the respiratory system has generated a substantial proportion of critically ill patients in need of invasive mechanical ventilation (IMV). The objective of this paper was to analyze the prognostic ability of the pulse oximetry saturation/fraction of inspired oxygen ratio (SpO2/FiO2) and the ratio of SpO2/FiO2 to the respiratory rate-ROX index-as predictors of IMV in an emergency department in confirmed COVID-19 patients. A multicenter, retrospective cohort study was carried out in four provinces of Spain between March and November 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using a derivation sub-cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation sub-cohort. A total of 2040 patients were included in the study. The IMV rate was 10.1%, with an in-hospital mortality rate of 35.3%. The performance of the SpO2/FiO2 ratio was better than the ROX index-AUC = 0.801 (95% CI 0.746-0.855) and AUC = 0.725 (95% CI 0.652-0.798), respectively. In fact, a direct comparison between AUCs resulted in significant differences ( p = 0.001). SpO2 to FiO2 ratio is a simple and promising non-invasive tool for predicting risk of IMV in patients infected with COVID-19, and it is realizable in emergency departments.

Background: The aim was to assess future schoolteachers' basic life support (BLS) knowledge and willingness to include this content in school lessons. The aim was also to determine the learning effect of a brief BLS hands-on training session, supported by real-time feedback., Methods: A convenience sample of 98 University students of Educational Sciences and Sports were recruited. The training program consisted of brief theoretical and hands-on interactive sessions with a 2/10 instructor/participants ratio. Knowledge and willingness was assessed by means of a survey. Chest compressions (CC) and ventilation quality were registered in 47 cases during 1 min cardiopulmonary resuscitation (CPR) tests., Results: Fifty-eight percent of subjects declared to know how to perform CPR, 62% knew the correct chest compression/ventilation ratio but only one in four knew the CC quality standards. Eighty-eight percent knew what an automated external defibrillator (AED) was; willingness to use the device improved from 70% to 98% after training. Almost half of CCs were performed atan adequate rate. Men performed deeper compressions than women (56.1 ± 4.03 mm vs. 52.17 ± 5.51 mm, p = 0.007), but in both cases the mean value was within recommendations. Full chest recoil was better in women (72.2 ± 32.8% vs. 45.4 ± 32.9%, p = 0.009). All CCs were delivered with correct hand positions., Conclusions: Brief hands-on training supported by real-time feedback of CPR quality helps future schoolteachers improve their knowledge, self-confidence and CPR skills. BLS training should be implemented in University curricula for schoolteachers in order to promote their engagement in effective BLS training of schoolchildren.

Aim: Early defibrillation should achieve the highest survival rates when applied within the first minutes after the collapse. Public access defibrillation programs have increased the population awareness of the importance of defibrillation. Schoolchildren should be trained in basic life support (BLS) skills and some countries have included BLS in their school syllabus. However, little is known of the current knowledge and ability of schoolchildren to use an automated external defibrillator (AED)., Methods: A multicentric descriptive study, 1295 children from 6 to 16 years of age without previous BLS or AED training. Subjects performed a simulation with an AED and a manikin with no training or feedback and were evaluated by means of a checklist., Results: A total of 258 participants (19.9%) were able to simulate an effective and safe defibrillation in less than 3min and 52 (20.1% of this group) performed it successfully. A significant correlation between objective and age group was observed (G=0.172) (p<0.001). The average time to deliver a shock was 83.3±26.4s; that time decreased significantly with age [6 YO (108.3±40.4) vs. 16 YO (64.7±18.6)s] (p<0.001)., Conclusions: Around 20% of schoolchildren without prior training are able to use an AED correctly in less than 3min following the device's acoustic and visual instructions. However, only one-fifth of those who showed success managed to complete the procedure satisfactorily. These facts should be considered in order to provide a more accurate definition and effective implementation of BLS/AED teaching and training at schools., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To assess the ability of schoolchildren to use a automated external defibrillator (AED) to provide an effective shock and their retention of the skill 1 month after a training exercise supported by audiovisual materials., Material and Methods: Quasi-experimental controlled study in 205 initially untrained schoolchildren aged 6 to 16 years old. SAEDs were used to apply shocks to manikins. The students took a baseline test (T0) of skill, and were then randomized to an experimental or control group in the first phase (T1). The experimental group watched a training video, and both groups were then retested. The children were tested in simulations again 1 month later (T2)., Results: A total of 196 students completed all 3 phases. Ninety-six (95.0%) of the secondary school students and 54 (56.8%) of the primary schoolchildren were able to explain what a SAED is. Twenty of the secondary school students (19.8%) and 8 of the primary schoolchildren (8.4%) said they knew how to use one. At T0, 78 participants (39.8%) were able to simulate an effective shock. At T1, 36 controls (34.9%) and 56 experimental-group children (60.2%) achieved an effective shock (P< .001). At T2, 53 controls (51.4%) and 61 experimental-group children (65.6%) gave effective shocks (P=.045). All the students completed the tests in 120 seconds. Their average times decreased with each test. The secondary school students achieved better results., Conclusion: Previously untrained secondary school students know what a AED is and half of them can manage to use one in simulations. Brief narrative, audiovisual instruction improves students' skill in managing a SAED and helps them retain what they learned for later use.

Introduction: Immediate bystander cardiopulmonary resuscitation (CPR) is essential for survival after out-of-hospital cardiac arrest. Down syndrome (DS) citizens have improved their active engagement in society. The objective of this pilot trial was to investigate if they are able to perform quality chest compression-only CPR after a brief training., Methods: Nineteen DS young people (15-30 year old) and 20 University level subjects (18-29 year old) were trained by means of a short video and a brief hands-on session on manikins, to perform chest compression-only CPR. All participants were naïve in CPR. Chest compression (CC) quality (percentage of correct CC, CC rate and depth and chest complete release) was measured during a 2min test. CPR quality goal was according to 2010 European Resuscitation Council guidelines., Results: DS people had similar weight, lower height and a higher BMI than controls. They were able to deliver chest compression-only CPR but with higher mean CC rate (140±30 vs 123±12CC/min, p=0.03), less mean CC depth (35.4±10.3 vs 47.2±9.6mm, p=0.03) and lower % of full correct CC (13±18 vs 39±37, p=0.02) than controls. Differences were maintained when first and second minute of test were compared., Conclusions: After a short instruction based on a brief video and hands-on session DS people were able to deliver CC but with poor quality., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)