Evaluation of a 3D serious game for advanced life support retraining

ObjectiveAdvanced life support (ALS) knowledge and skills decrease in as little as three months, but only a few ALS providers actually attend retraining courses. We assess the effectiveness of a 3D serious game as a new tool for frequent ALS retraining.MethodsWe developed a 3D serious game for scenario-based ALS retraining. The serious game, called EMSAVE, was designed to promote self-correction while playing. We organized a retraining course in which 40 ALS providers played two cardiac arrest scenarios with EMSAVE and took a test with 38 multiple-choice questions before and after playing. We administered the same test again 3 months later to evaluate retention. Participants also rated EMSAVE and the overall retraining experience.ResultsAfter using EMSAVE, the number of correct answers per participant increased by 4.8 (95%CI +3.4, +6.2, p < 0.001) and all but one participant improved. After 3 months, despite an expected decrease in ALS knowledge and skills (?1.9 correct answers, 95%CI ?0.6, ?3.3, p < 0.01), there was a significant retention benefit (+2.9 correct answers per participant, 95%CI +1.5, +4.2, p < 0.001). Moreover, all but one participant regarded EMSAVE as a valuable tool to refresh ALS knowledge and skills, and 85% of participants were also willing to devote 1 h/month to retrain with the serious game.ConclusionsA 3D serious game for scenario-based retraining proved effective to retrain in ALS and supported retention of acquired knowledge and skills at 3 months. EMSAVE also positively engaged and motivated participants.     

Secondary prevention of cryptogenic stroke in patients with patent foramen ovale: a systematic review and meta-analysis

The aim of our study is to compare patent foramen ovale (PFO) closure versus medical treatment and antiplatelet versus anticoagulant therapy in patients with cryptogenic stroke (CS) and PFO. We conducted a systematic review and meta-analysis with trial sequential analysis (TSA) of randomized trials. Primary outcomes are stroke or transient ischemic attack (TIA) and all-cause mortality. Secondary outcomes are peripheral embolism, bleeding, serious adverse events, myocardial infarction and atrial dysrhythmias. We performed an intention to treat meta-analysis with a random-effects model. We include six trials (3677 patients, mean age 47.3 years, 55.8% men). PFO closure is associated with a lower recurrence of stroke or TIA at a mean follow-up of 3.88 years compared to medical therapy [risk ratio (RR) 0.55, 95% CI 0.38–0.81; I²?=?40%]. The TSA confirms this result. No difference is found in mortality (RR 0.74, 95% CI 0.35–1.60; I²?=?0%), while PFO closure is associated with a higher incidence of atrial dysrhythmias (RR 4.55, 95% CI 2.16–9.60; I²?=?25%). The rate of the other outcomes is not different among the two groups. The comparison between anticoagulant and antiplatelet therapy shows no difference in terms of stroke recurrence, mortality and bleeding. There is conclusive evidence that PFO closure reduces the recurrence of stroke or TIA in patients younger than 60 years of age with CS. More data are warranted to assess the consequences of the increase in atrial dysrhythmias and the advantage of PFO closure over anticoagulants.     

Influence of indinavir on virulence and growth of Cryptococcus neoformans

Indinavir selectively inhibited production of some virulence factors of Cryptococcus neoformans, such as urease and protease, but not melanin and phospholipase; moreover, it interfered with capsule formation. These effects led to increased susceptibility of C. neoformans to intracellular killing by natural effector cells. Prolonged incubation with indinavir resulted in inhibition of fungal growth. Indinavir can attenuate the virulence of the fungus, thus augmenting its susceptibility to the antimicrobial activity of natural effector cells. The reduction in cryptococcal infections in human immunodeficiency virus-positive patients might also be related to the antifungal activity of highly active antiretroviral therapy.     

Iliopsoas abscess in adolescents with type 1 diabetes mellitus

Iliopsoas abscesses have been reported in adult diabetic patients, but only one case has been so far reported in the pediatric diabetic literature. We report three cases of iliopsoas abscesses in three adolescents with type 1 diabetes mellitus, suggesting that an increased awareness of this condition is required for its early recognition and prompt treatment.