What is the Effect of Frequent Basic Life Support Refresher Sessions on Health Care Professionals’ Retention of Cardiopulmonary Resuscitation Skills? A Systematic Review

Abbreviations: AED, Automated External Defibrillator; AHA, American Heart Association; BLS, Basic Life Support; CPR, Cardiopulmonary Resuscitation; EBL, Evidence Based Librarianship; IDG, Instructor Directed Group; NHMRC, National Health and Medical Research Council; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta- Analyses; RCT, Randomised Control Trial; RFST, Repetitive Sessions of Formative Self Testing; RFSTAP, Repetitive Sessions of Formative Self Testing with Additional Practice ROSC, Return of Spontaneous Circulation; SDG, Student Directed Group. Abstract Background: Cardiopulmonary resuscitation training is currently provided to health care professionals at biannual intervals to meet mandatory recertification in accordance with guidelines.  However, literature reports that resuscitation skills decline rapidly and sometimes long before recertification. Inadequate CPR may result in a decrease in the incidence of achieving return of spontaneous circulation and other devastating outcomes. Good quality training and education in cardiopulmonary resuscitation is paramount to patient survival. Brief refresher sessions may prevent skill decay among health care professionals, improving skill retention over time and improving patient outcomes. Objective: The aim of this systematic review is to determine the effect of frequent basic life support refresher sessions on health care professionals’ retention of cardiopulmonary resuscitation skills. Methods: A systematic review using narrative analysis was completed.  A database search was conducted to identify relevant studies for inclusion.  Databases searched include Medline, Embase, CINAHL and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the review. Results: Ten of the 11 studies in this paper concluded that basic life support refresher sessions may increase retention of cardiopulmonary resuscitation skills.  Two of the included studies discussed self-perceived confidence as a secondary outcome.  One of these two studies demonstrated a significant correlation between higher self-confidence and improved retention of cardiopulmonary resuscitation skills. Conclusion: Basic life support refresher sessions can have a positive impact on cardiopulmonary resuscitation skill retention among health care professionals.  However, the most effective method of delivering refresher sessions must be further clarified.  The optimal duration of these sessions as well as the optimal timing of delivering these sessions also requires further clarification through further research

Virtue and Video Games: False Pleasure in the Digital Age

This thesis examines video games as objects of pleasure and assesses the negative claim that certain video games can detract from the good life. It argues against the claim that all video games are 'wastes of time' or that they provide a kind of false pleasure, while recognising the heterogeneous nature of modern video games. To do so, this work focuses on the pleasure derived from these objects. It questions the nature of pleasure itself arguing that while some pleasures are essential for the good life, other pleasures can be detrimental to its pursuit. It argues that certain pleasures that detract from the good life can be considered false pleasures. Drawing on an analysis of the writings of Plato and Aristotle, this work proposes an original taxonomy of false pleasure. The taxonomy proposes four broad categories of false pleasure, they are: false pleasure of belief, false pleasure of experience, false pleasure of negative consequence, and false immoral pleasures. These categories are applied to video games to discover whether certain video games provide false pleasure. It is argued that while some video games in certain circumstances can be considered false pleasures, it does not hold that all video games are false pleasures. This thesis also questions the broader role mass media and technology has on the experience of pleasure in the modern world. It draws upon the writings of the Frankfurt School theorist who provided arguments critical of modern mass culture. I argue that these theorists considered mass media to systematically mislead individuals into making mistakes regarding pleasure and that these mistakes serve a political and social function. It is argued that the Frankfurt School critiques provide useful examples of the political and social function of false pleasure. However, it is shown that the some of their concerns are not new, rather they echo the concerns of Plato and Aristotle and can be accommodated within the proposed taxonomy of false pleasure. This work concludes that the notion of false pleasure is important when considering what makes the good life. However, the argument that all video games are false pleasures does not stand up to philosophical rigour. Moreover, it is shown that some video games, rather than being impediments to the good life, have a beneficial role to play in its pursuit

Development of core outcome sets for studies relating to awareness and clinical management of reduced fetal movement

Objective: This study aimed to create core outcome sets (COSs) for use in research studies relating to the awareness and clinical management of reduced fetal movement (RFM). Design: Delphi survey and consensus process. Setting: International. Population: A total of 128 participants (40 parents, 19 researchers and 65 clinicians) from 16 countries. Methods: A systematic literature review was conducted to identify outcomes in studies of interventions relating to the awareness and the clinical management of RFM. Using these outcomes as a preliminary list, stakeholders rated the importance of these outcomes for inclusion in COSs for studies of: (i) awareness of RFM; and (ii) clinical management of RFM. Main outcome measures: Preliminary lists of outcomes were discussed at consensus meetings where two COSs (one for studies of RFM awareness and one for studies of clinical management of RFM). Results: The first round of the Delphi survey was completed by 128 participants, 66% of whom (n = 84) completed all three rounds. Fifty outcomes identified by the systematic review, after multiple definitions were combined, were voted on in round one. Two outcomes were added in round one, and as such 52 outcomes were voted on in two lists in rounds two and three. The COSs for studies of RFM awareness and clinical management are comprised of eight outcomes (four maternal and four neonatal) and 10 outcomes (two maternal and eight neonatal), respectively. Conclusions: These COSs provide researchers with the minimum set of outcomes to be measured and reported in studies relating to the awareness and the clinical management of RFM.</p

Subjective and Objective Assessment of Taste and Smell Sensation in Advanced Cancer

Context: Taste and smell abnormalities (TSA) occur throughout the cancer trajectory regardless of cancer primary site and contribute to cancer-associated malnutrition. TSA etiology is poorly understood. Tumor-related inflammation is a possible cause. Objective: This study examined the prevalence, characteristics, and severity of TSA in advanced cancer and explored the relationship between TSA and nutritional status. No previous study combined subjective and objective measures for both taste and smell assessment in this population. Method: Consecutive advanced cancer hospice patients were recruited. A modified version of the “Taste and Smell Survey” assessed subjective TSA. Validated taste strips and “Sniffin’ Sticks” were the objective measures. The abridged patient-generated subjective global assessment evaluated nutritional status. Results: A 93% prevalence of TSA in 30 patients with advanced cancer was identified. When subjective and objective evaluations were combined, 28 had taste abnormalities, 24 smell abnormalities, and 24 both. Taste changes included “persistent bad taste” (n ¼ 18) and changes in how basic tastes were perceived. Half reported smell was not “as strong” as prediagnosis, while more than half (n ¼ 16) had an objective smell abnormality. Most (97%) were at risk of malnutrition. Fatigue, dry mouth, early satiety, and anorexia were common nutrition-impact symptoms. No statistically significant relationship was found between TSA and malnutrition scores. Conclusions: TSA were highly prevalent. Subjective taste and smell changes did not always accord with objective TSA, suggesting both assessments are valuable. TSA characteristics varied, and particular foods tasted and smelled different and were not enjoyed as before. TSA are common, high-impact problems in advanced cancer

Understanding a Low Vitamin D State in the Context of COVID-19

While a low vitamin D state has been associated with an increased risk of infection by SARS-CoV-2 in addition to an increased severity of COVID-19 disease, a causal role is not yet established. Here, we review the evidence relating to i) vitamin D and its role in SARS-CoV-2 infection and COVID-19 disease ii) the vitamin D status in the Irish adult population iii) the use of supplemental vitamin D to treat a deficient status and iv) the application of the Bradford-Hill causation criteria. We conclude that reverse causality probably makes a minimal contribution to the presence of low vitamin D states in the setting of COVID-19. Applying the Bradford-Hill criteria, however, the collective literature supports a causal association between low vitamin D status, SARS-CoV-2 infection, and severe COVID-19 (respiratory failure, requirement for ventilation and mortality). A biologically plausible rationale exists for these findings, given vitamin D’s role in immune regulation. The thresholds which define low, deficient, and replete vitamin D states vary according to the disease studied, underscoring the complexities for determining the goals for supplementation. All are currently unknown in the setting of COVID-19. The design of vitamin D randomised controlled trials is notoriously problematic and these trials commonly fail for a number of behavioural and methodological reasons. In Ireland, as in most other countries, low vitamin D status is common in older adults, adults in institutions, and with obesity, dark skin, low UVB exposure, diabetes and low socio-economic status. Physiological vitamin D levels for optimal immune function are considerably higher than those that can be achieved from food and sunlight exposure alone in Ireland. A window exists in which a significant number of adults could benefit from vitamin D supplementation, not least because of recent data demonstrating an association between vitamin D status and COVID-19. During the COVID pandemic, we believe that supplementation with 20-25ug (800–1000 IU)/day or more may be required for adults with apparently normal immune systems to improve immunity against SARS-CoV-2. We expect that higher monitored doses of 37.5–50 ug (1,500–2,000)/day may be needed for vulnerable groups (e.g., those with obesity, darker skin, diabetes mellitus and older adults). Such doses are within the safe daily intakes cited by international advisory agencies

The UHRF1 protein is a key regulator of retrotransposable elements and innate immune response to viral RNA in human cells

While epigenetic mechanisms such as DNA methylation and histone modification are known to be important for gene suppression, relatively little is still understood about the interplay between these systems. The UHRF1 protein can interact with both DNA methylation and repressive chromatin marks, but its primary function in humans has been unclear. To determine what that was, we first established stable UHRF1 knockdowns (KD) in normal, immortalized human fibroblasts using targeting shRNA, since CRISPR knockouts (KO) were lethal. Although these showed a loss of DNA methylation across the whole genome, transcriptional changes were dominated by the activation of genes involved in innate immune signalling, consistent with the presence of viral RNA from retrotransposable elements (REs). We confirmed using mechanistic approaches that 1) REs were demethylated and transcriptionally activated; 2) this was accompanied by activation of interferons and interferon-stimulated genes and 3) the pathway was conserved across other adult cell types. Restoring UHRF1 in either transient or stable KD systems could abrogate RE reactivation and the interferon response. Notably, UHRF1 itself could also re-impose RE suppression independent of DNA methylation, but not if the protein contained point mutations affecting histone 3 with trimethylated lysine 9 (H3K9me3) binding. Our results therefore show for the first time that UHRF1 can act as a key regulator of retrotransposon silencing independent of DNA methylation

Development of a core outcome set (COS) for studies relating to awareness and clinical management of reduced fetal movement: study protocol

From Springer Nature via Jisc Publications RouterHistory: received 2021-03-05, accepted 2021-11-17, registration 2021-11-17, collection 2021-12, pub-electronic 2021-12-09, online 2021-12-09Publication status: PublishedFunder: Tommy's Baby Charity; doi: http://dx.doi.org/10.13039/501100000306; Grant(s): R125598Abstract: Background: Concerns regarding reduced fetal movements (RFM) are reported in 5–15% of pregnancies, and RFM are associated with adverse pregnancy outcomes including fetal growth restriction and stillbirth. Studies have aimed to improve pregnancy outcomes by evaluating interventions to raise awareness of RFM in pregnancy, such as kick counting, evaluating interventions for the clinical management of RFM, or both. However, there is not currently a core outcome set (COS) for studies of RFM. This study aims to create a COS for use in research studies that aim to raise awareness of RFM and/or evaluate interventions for the clinical management of RFM. Methods: A systematic review will be conducted, to identify outcomes used in randomised and non-randomised studies with control groups that aimed to raise awareness of RFM (for example by using mindfulness techniques, fetal movement counting, or other tools such as leaflets or mobile phone applications) and/or that evaluated the clinical management of RFM. An international Delphi consensus will then be used whereby stakeholders will rate the importance of the outcomes identified in the systematic review in (i) awareness and (ii) clinical management studies. The preliminary lists of outcomes will be discussed at a consensus meeting where one final COS for awareness and management, or two discrete COS (one for awareness and one for management), will be agreed upon. Discussion: A well-developed COS will provide researchers with the minimum set of outcomes that should be measured and reported in studies that aim to quantify the effects of interventions