Augmented reality (AR) has the potential to offer a novel approach to CPR training that supplements conventional training methods with gamification and a more interactive learning experience. This is done through computer-generated imagery superimposed on users' view of the real environment to simulate interactive training scenarios. We sought to test the feasibility of an AR CPR training system (CPReality) for health care providers (HCPs). In this feasibility trial, a CPR training manikin was integrated with a commercial AR device (Microsoft HoloLens) to provide participants with real-time audio-visual feedback via a holographic overlay of blood flow to vital organs dependent on CC quality. In this system, higher quality CC visually improved virtual blood circulation. HCPs performed a 2-minute cycle of hands-only CPR using only the AR system, and CC parameters were recorded. Descriptive data on participants' demographics, CC quality, and satisfaction with the training environment were reported using quantitative and qualitative analysis. Between 10/2018-11/2018, we enrolled a convenience sample of 51 HCPs. The median age of participants was 31 years (IQR 27-41), 71% (36/51) were female, and 67% (34/51) were registered nurses. CC rates (mean 126 ± 12.9 cpm), depths (median 53 mm, IQR 46-58), and percent with complete recoil (median 80%, IQR 12-100) were consistent with guideline recommendations for good quality CPR. Participants were predominantly satisfied with the system, with 82% perceiving the experience as realistic, 98% recognizing the visualizations as helpful for training, and 94% willing to use the application in future CPR training. As AR is increasingly applied in the healthcare setting, integration in CPR training offers a novel and promising educational approach. In this convenience sample of trained HCPs, high quality CC delivery was feasible using the AR CPR training system which was received favorably by most participants.

Bacterial central nervous system (CNS) infections are serious and carry significant morbidity and mortality. They encompass many syndromes, the most common being meningitis, which may occur spontaneously or as a consequence of neurosurgical procedures. Many classes of antimicrobials are in clinical use for therapy of CNS infections, some with established roles and indications, others with experimental reporting based on case studies or small series. This review delves into the specifics of the commonly utilized antibacterial agents, updating their therapeutic use in CNS infections from the pharmacokinetic and pharmacodynamic perspectives, with a focus on the optimization of dosing and route of administration that have been described to achieve good clinical outcomes. We also provide a concise synopsis regarding the most focused, clinically relevant information as pertains to each class and subclass of antimicrobial therapeutics. CNS infection morbidity and mortality remain high, and aggressive management is critical in ensuring favorable patient outcomes while averting toxicity and upholding patient safety.

BACKGROUND: Trauma-induced coagulopathy occurs in about 25% of injured patients and accounts for about 10% of deaths worldwide. Upon injury, hemostatic function may decline due to vascular dysfunction, clotting factor deficiencies, hyperfibrinolysis, and/or platelet dysfunction. We investigated agonist-induced calcium signaling in platelets obtained over time from trauma patients. METHODS: Platelets from trauma patients and healthy donors were monitored via intracellular calcium mobilization and flow cytometry markers (α_2bβ₃ activation, P-selectin display, and phosphatidylserine exposure) following stimulation with a panel of agonists (adenosine 5′-diphosphate sodium salt, U46619, convulxin, PAR-1/4 activating peptides, iloprost) used in isolation or in pairwise tests. Furthermore, healthy donor platelets were tested in heterologous plasma isolated from healthy subjects and trauma patients. RESULTS: When exposed to agonists over the first 24 hours postinjury, trauma patient platelets mobilized less calcium in comparison to healthy platelets. Partial recovery of platelet activity was observed in about a third of patients after 120 hours, although not fully obtaining healthy baseline function. Flow cytometry markers of trauma platelets were similar to healthy platelets prior to stimulation, but were depressed in trauma platelets stimulated with adenosine 5′-diphosphate sodium salt or convulxin. Also, washed healthy platelets showed a significant reduction in calcium mobilization when reconstituted in plasma from trauma patients, relative to healthy plasma, at all plasma doses tested. CONCLUSION: Platelet dysfunction in trauma patients included poor response to multiple agonists relevant to hemostatic function. Furthermore, the inhibitor effect of patient plasma on healthy platelets suggests that soluble plasma species may downregulate endogenous or transfused platelets during trauma.

Background: Guidelines-based cardiopulmonary resuscitation (CPR) during in-hospital cardiac arrest is a significant predictor of survival, yet the quality of healthcare provider (HCP) CPR (e.g., nurses, physicians etc.) has been shown to be poor. Studies have found that providing HCPs with simulated CPR refresher trainings can improve their CPR quality, however, no studies have compared the use of an augmented reality (AR) CPR refresher training with a standard audio-visual (AV) feedback manikin to improve HCP training. Objectives: In our pilot study, HCPs were randomized to a refresher CPR simulation training with either our AR CPR training application (CPReality) or a standard AV feedback manikin. All subjects completed 2 min of CPR on their respective CPR training modalities, followed by an additional 2 min post-simulation CPR evaluation with no feedback. We hypothesized that the AR CPR training application would confer improved CPR quality defined as chest compression rate and depth compared with the standard AV feedback training. Results: Between January 2019 and May 2019, 100 HCPs were enrolled (50 in the CPReality cohort and 50 in the standard AV manikin cohort). The mean chest compression (CC) rate for all subjects during the intervention was 118 ± 15 cpm, and CC depth was 50 ± 8; post-intervention the CC rate was 120 ± 13 and CC depth was 51 ± 8. The mean CC rate for those trained with CPReality was 121 ± 3 compared with the standard CPR manikin training which was 114 ± 1 cpm (p < 0.006); CC depth was 48 ± 1 mm vs. 52 ± 1 (p = 0.007), respectively. Post-simulation CPR quality with no feedback showed a mean CC rate for the CPReality application at 122 ± 15 cpm compared with the standard CPR manikin at 117 ± 11 cpm (p = 0.09); depth was 49 ± 8 mm vs. 52 ± 8 (p = 0.095), respectively. In the post-survey, 79% of CPReality subjects agreed that the AR application provided a realistic patient presence compared with 59% (p = 0.07) of subjects in the standard CPR manikin cohort. Conclusions: In a randomized trial of an AR CPR training application compared with a standard CPR manikin training, the AR CPR application did not improve the quality of CPR performed during a CPR refresher training compared with the standard training in HCPs. Future studies should investigate the use of this and other digital technologies for CPR training and education.

Background Older patients are at risk of increased morbidity and mortality from COVID-19 disease due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). There are few effective treatments for outpatients with COVID-19. Objective To evaluate the efficacy of hydroxychloroquine to reduce time in quarantine for symptomatic ≥40 years-old COVID-19 patients. Design A randomized, double-blind, placebo-controlled clinical trial. Setting Outpatients with polymerase chain reaction confirmed COVID-19 at a University of Pennsylvania affiliated testing center between April 15, 2020 and, July 14, 2020. Participants Out of 5511 SARS-CoV-2 positive patients, 1072 met initial eligibility criteria for telephone-based recruitment, but only 34 subjects were able to be randomized. Interventions Hydroxychloroquine 400 mg per twice daily (n=17) or matching placebo (n=17), taken orally for up to 14 days. Measurements The primary outcome was the time to release from quarantine. Secondary outcomes included the participant-reported secondary infection of co-inhabitants, hospitalization, treatment-related adverse events, time to symptom improvement, and incidence of cardiac arrhythmia. Results The median time to release from quarantine for HCQ-treated vs. placebo-treated participants was 8 days (range 4-19 days) vs. 11 days (4-18 days); z-score +0.58, p=n.s. This did not meet the pre-specified criteria for early termination, however, this study was terminated early due to lack of feasibility. There was no mortality in either study arm. Limitation Since this study was terminated early due to a lack of feasibility, no conclusion can be made about the efficacy of hydroxychloroquine as a treatment for COVID-19 patients 40 years of age or older quarantined at home. Conclusion The design of this remotely conducted study could guide testing of other more promising agents during the COVID-19 pandemic. Trial registration Clinicaltrials.gov identifier: NCT04329923