Editorial
Should we “dumb it down”… or “train it up”?… Breaking barriers and changing the culture of resuscitation
¿Debemos simplificar el método o, por el contrario, entrenar más y mejor?… Rompiendo barreras y cambiando la cultura de la Reanimación
a Department of Pediatrics, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
b Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
c IPSS-INSPIRE-CHOP Simulation Fellowship, Children's Hospital of Philadelphia, Philadelphia, United States
d Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
Read
4175
Timeswas read the article
1912
Total PDF
2263
Total HTML
Share statistics
array:23 [ "pii" => "S2341287918301625" "issn" => "23412879" "doi" => "10.1016/j.anpede.2018.08.006" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "2511" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2018;89:263-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 989 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 596 "PDF" => 274 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S1695403318303424" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2018.08.005" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "2511" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2018;89:263-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2521 "formatos" => array:3 [ "EPUB" => 126 "HTML" => 1765 "PDF" => 630 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">EDITORIAL</span>" "titulo" => "¿Debemos simplificar el método o, por el contrario, entrenar más y mejor?... Rompiendo barreras y cambiando la cultura de la Reanimación" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "263" "paginaFinal" => "264" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Should we “dumb it down”… or “train it up”?… Breaking barriers and changing the culture of resuscitation" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier Trastoy-Quintela, Geethanjali Ramachandra, Vinay Nadkarni" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Trastoy-Quintela" ] 1 => array:2 [ "nombre" => "Geethanjali" "apellidos" => "Ramachandra" ] 2 => array:2 [ "nombre" => "Vinay" "apellidos" => "Nadkarni" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287918301625" "doi" => "10.1016/j.anpede.2018.08.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301625?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403318303424?idApp=UINPBA00005H" "url" => "/16954033/0000008900000005/v1_201811020624/S1695403318303424/v1_201811020624/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2341287918301182" "issn" => "23412879" "doi" => "10.1016/j.anpede.2018.06.002" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "2329" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2018;89:265-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1718 "formatos" => array:3 [ "EPUB" => 151 "HTML" => 1219 "PDF" => 348 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "A first step to teaching basic life support in schools: Training the teachers" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "265" "paginaFinal" => "271" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un primer paso en la enseñanza del soporte vital básico en las escuelas: la formación de los profesores" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1445 "Ancho" => 2006 "Tamanyo" => 168869 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mean rate and depth of chest compressions before and after a brief training.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Pichel López, Santiago Martínez-Isasi, Roberto Barcala-Furelos, Felipe Fernández-Méndez, David Vázquez Santamariña, Luis Sánchez-Santos, Antonio Rodríguez-Nuñez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "María" "apellidos" => "Pichel López" ] 1 => array:2 [ "nombre" => "Santiago" "apellidos" => "Martínez-Isasi" ] 2 => array:2 [ "nombre" => "Roberto" "apellidos" => "Barcala-Furelos" ] 3 => array:2 [ "nombre" => "Felipe" "apellidos" => "Fernández-Méndez" ] 4 => array:2 [ "nombre" => "David" "apellidos" => "Vázquez Santamariña" ] 5 => array:2 [ "nombre" => "Luis" "apellidos" => "Sánchez-Santos" ] 6 => array:2 [ "nombre" => "Antonio" "apellidos" => "Rodríguez-Nuñez" ] 7 => array:1 [ "colaborador" => "en nombre del Grupo de trabajo Proyecto ANXOS" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403317304484" "doi" => "10.1016/j.anpedi.2017.11.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403317304484?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301182?idApp=UINPBA00005H" "url" => "/23412879/0000008900000005/v1_201811020629/S2341287918301182/v1_201811020629/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Should we “dumb it down”… or “train it up”?… Breaking barriers and changing the culture of resuscitation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "263" "paginaFinal" => "264" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Trastoy-Quintela, Geethanjali Ramachandra, Vinay Nadkarni" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Javier" "apellidos" => "Trastoy-Quintela" "email" => array:2 [ 0 => "javier.trastoy@gmail.com" 1 => "javier.trastoy.quintela@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Geethanjali" "apellidos" => "Ramachandra" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Vinay" "apellidos" => "Nadkarni" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Department of Pediatrics, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Krishna Institute of Medical Sciences, Secunderabad, Telangana, India" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "IPSS-INSPIRE-CHOP Simulation Fellowship, Children's Hospital of Philadelphia, Philadelphia, United States" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Debemos simplificar el método o, por el contrario, entrenar más y mejor?… Rompiendo barreras y cambiando la cultura de la Reanimación" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Practice makes perfect! When life is at stake, perfect practice can improve confidence, willingness to act, competence and performance. Cardiac arrest represents a major cause of death worldwide, and a prompt and effective rescuer response is the key determinant for a good outcome. Bystanders initiate basic life support (BLS) in less than 50% of the cases. They are at least “<span class="elsevierStyleItalic">TRY</span>standers”! Poor outcomes are frequent, with less than 10% of patients surviving with favorable neurologic outcome. Nevertheless, huge variability in outcomes are reported between geographic regions, suggesting that “try-stander” and Emergency Medical Services (EMS) response and hospital care are modifiable key factors that can affect recovery.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> As cardiopulmonary resuscitation (CPR) techniques and training evolve, assessment and transformation of target populations for training need to concurrently evolve. To optimize the outcome of cardiac arrest victims, simple techniques and learning methods need to be deployed targeted to the capabilities of the “try-standers” and healthcare rescuers. It is clear that <span class="elsevierStyleUnderline">g</span>ood BLS beats bad advanced life support (ALS), and vice versa. To train effective life savers, we are constantly faced with the question: Do we “dumb it down” … or do we “train it up”?</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleItalic">Anales Pediatria</span>, two studies address fundamentals of BLS training: one targets school-based CPR “<span class="elsevierStyleItalic">try</span>-stander” training,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and the other novice nurse healthcare providers.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> School based CPR programs have been established as high impact because of the potential to reach a large portion of the society who live at home where the majority of out-of-hospital cardiac arrests occur, and targets a population who are well positioned to become the future generations of life savers. Pichel López et al. explored and assessed who might be able to provide this training and whether school teachers are capable of acquiring current “try-stander” BLS skills after a short, simulation-based course.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Eighty-one volunteer primary and secondary education teachers underwent a brief 2 hour combined theory-practical training course on BLS sequence and hands only CPR (HO-CPR) with manikin practice. Two hours after completing the session, they were evaluated for correct execution of the BLS sequence and quality of HO-CPR. Although only half of the teacher's acquired the ability to perform the precise sequence of BLS skills, the vast majority were capable of performing BLS with proficiency similar to that previously reported by skilled EMS providers with a duty to respond. The study provided an exquisitely detailed protocol and a well-reasoned rationale for the significance of the proposed community intervention. However, several limitations were noted by the authors including that the volunteer subjects of the study were highly motivated to participate, and were not from the general pool of teachers in the public education environment. In addition, readers should note that evaluation of teachers was performed right after the course (acquisition of skills), but did not test retention of knowledge and skills. Perhaps the main limitation is that the authors assume that good CPR performance skill acquisition in a teacher is essential and will translate to capacity to train students. Does this short and practical intervention actually make these teachers capable of providing good CPR training to the students? Perhaps the next step is to measure the quality of CPR provided by the students after having learned from these teachers. If the teachers with better CPR skills do a better job of training students, then perhaps there could be selection and targeted intervention by a subset of the best school CPR instructors instead of expecting all teachers to participate.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The manuscript by Santos-Folgar et al. addresses another critical factor in pediatric resuscitation: ventilation by novice healthcare providers. Although quality and quantity of ventilation has been de-emphasized in adult resuscitation, ventilation remains critically important for infants and children.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Several recent studies have identified difficulties in achieving effective healthcare provider bag-mask ventilation for newborn infants.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> Nursing students previously trained in ALS performed CPR for an infant manikin using 2 different approaches: mouth-to-mouth-and-nose, and bag-mask ventilation. Surprisingly, <span class="elsevierStyleItalic">better</span> quality of ventilation and CPR was delivered with the mouth-to-mouth-and-nose approach. Is this an artifact of studying manikins, who are easy to ventilate with mouth to nose technique? Is this a function of novice providers with very limited or inadequate bag-mask practice and experience? Would we have had similar results if subjects included were professionals from the EMS or more experienced hospital healthcare providers? In addition, social factors including rescuer reluctance to contact secretions of non-family member cardiac arrest victims need to be considered.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Life support education and implementation, like society, is continuously evolving. Are simple and basic life support interventions performed better and thus more effective? Or should we take the time and effort to intensively train more complex interventions, like bag-mask ventilation? Prompt actions by rescuers determine cardiac arrest patient's outcomes, but we are not sure what the best approach to achieve these objectives is. To support <span class="elsevierStyleItalic">try</span>-standers and rescuers of the next generation, these two manuscripts force us to consider whether we should “<span class="elsevierStyleItalic">dumb it down</span>” or “<span class="elsevierStyleItalic">train it up</span>”.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Trastoy-Quintela J, Ramachandra G, Nadkarni V. ¿Debemos simplificar el método o, por el contrario, entrenar más y mejor?… Rompiendo barreras y cambiando la cultura de la Reanimación. An Pediatr (Barc). 2018;89:263–264.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resuscitation education science: educational strategies to improve outcomes from cardiac arrest: a scientific statement from the American Heart Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Cheng" 1 => "V.M. Nadkarni" 2 => "M.B. Mancini" 3 => "E.A. Hunt" 4 => "E.H. Sinz" 5 => "R.M. Merchant" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCEP.117.005959" "Revista" => array:3 [ "tituloSerie" => "Circulation" "fecha" => "2018" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29752376" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A first step to teaching basic life support in schools: training the teachers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Pichel Lopez" 1 => "S. Martinez-Isasi" 2 => "R. Barcala-Furelos" 3 => "F. Fernandez-Mendez" 4 => "D. Vazquez Santamarina" 5 => "L. Sanchez-Santos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2018" "volumen" => "89" "paginaInicial" => "265" "paginaFinal" => "271" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilation during cardiopulmonary resuscitation in the infant mouth to mouth and nose, or bag-valve-mask? A quasi-experimental study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Santos-Folgar" 1 => "M. Otero-Agra" 2 => "F. Fernandez-Mendez" 3 => "M.T. Hermo-Gonzalo" 4 => "R. Barcala-Furelos" 5 => "A. Rodriguez-Nunez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2018" "volumen" => "89" "paginaInicial" => "272" "paginaFinal" => "278" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Establishing ventilation in the delivery room: T-piece resuscitator versus self-inflating bag" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.E. Foglia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/apa.13722" "Revista" => array:5 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2017" "volumen" => "106" "paginaInicial" => "684" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28121052" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.E. Niles" 1 => "C. Cines" 2 => "E. Insley" 3 => "E.E. Foglia" 4 => "O.U. Elci" 5 => "C. Skare" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2017.03.035" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2017" "volumen" => "115" "paginaInicial" => "102" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28411062" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008900000005/v1_201811020629/S2341287918301625/v1_201811020629/en/main.assets" "Apartado" => array:4 [ "identificador" => "25501" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008900000005/v1_201811020629/S2341287918301625/v1_201811020629/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301625?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 10 | 15 |
| 2024 October | 36 | 45 | 81 |
| 2024 September | 38 | 36 | 74 |
| 2024 August | 37 | 60 | 97 |
| 2024 July | 35 | 41 | 76 |
| 2024 June | 35 | 39 | 74 |
| 2024 May | 31 | 48 | 79 |
| 2024 April | 30 | 34 | 64 |
| 2024 March | 33 | 28 | 61 |
| 2024 February | 20 | 29 | 49 |
| 2024 January | 30 | 21 | 51 |
| 2023 December | 23 | 21 | 44 |
| 2023 November | 21 | 25 | 46 |
| 2023 October | 23 | 22 | 45 |
| 2023 September | 16 | 25 | 41 |
| 2023 August | 18 | 14 | 32 |
| 2023 July | 22 | 25 | 47 |
| 2023 June | 24 | 25 | 49 |
| 2023 May | 20 | 16 | 36 |
| 2023 April | 23 | 15 | 38 |
| 2023 March | 35 | 23 | 58 |
| 2023 February | 28 | 17 | 45 |
| 2023 January | 15 | 16 | 31 |
| 2022 December | 41 | 30 | 71 |
| 2022 November | 42 | 29 | 71 |
| 2022 October | 50 | 37 | 87 |
| 2022 September | 23 | 19 | 42 |
| 2022 August | 37 | 43 | 80 |
| 2022 July | 25 | 38 | 63 |
| 2022 June | 48 | 27 | 75 |
| 2022 May | 54 | 33 | 87 |
| 2022 April | 29 | 26 | 55 |
| 2022 March | 42 | 53 | 95 |
| 2022 February | 26 | 27 | 53 |
| 2022 January | 32 | 40 | 72 |
| 2021 December | 51 | 44 | 95 |
| 2021 November | 43 | 38 | 81 |
| 2021 October | 57 | 64 | 121 |
| 2021 September | 50 | 38 | 88 |
| 2021 August | 27 | 31 | 58 |
| 2021 July | 14 | 24 | 38 |
| 2021 June | 27 | 29 | 56 |
| 2021 May | 28 | 42 | 70 |
| 2021 April | 78 | 82 | 160 |
| 2021 March | 38 | 26 | 64 |
| 2021 February | 17 | 12 | 29 |
| 2021 January | 18 | 20 | 38 |
| 2020 December | 15 | 17 | 32 |
| 2020 November | 17 | 13 | 30 |
| 2020 October | 13 | 21 | 34 |
| 2020 September | 22 | 17 | 39 |
| 2020 August | 15 | 15 | 30 |
| 2020 July | 16 | 20 | 36 |
| 2020 June | 9 | 3 | 12 |
| 2020 May | 26 | 12 | 38 |
| 2020 April | 18 | 17 | 35 |
| 2020 March | 11 | 12 | 23 |
| 2020 February | 18 | 8 | 26 |
| 2020 January | 18 | 12 | 30 |
| 2019 December | 32 | 13 | 45 |
| 2019 November | 24 | 6 | 30 |
| 2019 October | 21 | 8 | 29 |
| 2019 September | 25 | 10 | 35 |
| 2019 August | 26 | 14 | 40 |
| 2019 July | 24 | 12 | 36 |
| 2019 June | 17 | 15 | 32 |
| 2019 May | 30 | 15 | 45 |
| 2019 April | 37 | 26 | 63 |
| 2019 March | 19 | 18 | 37 |
| 2019 February | 30 | 18 | 48 |
| 2019 January | 34 | 21 | 55 |
| 2018 December | 39 | 26 | 65 |
| 2018 November | 172 | 29 | 201 |
| 2018 October | 40 | 27 | 67 |
Show all
