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Azevedo LSL, Ribeiro LG, Schmidt A, Pazin Filho A. Impact of training in Advanced Cardiac Life Support (ACLS) in the professional career and work environment. CIENCIA & SAUDE COLETIVA 2018. [PMID: 29538568 DOI: 10.1590/1413-81232018233.13762016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We sought to evaluate the impact of Advanced Cardiac Life Support (ACLS) training in the professional career and work environment of physicians who took the course in a single center certified by the American Heart Association (AHA). Of the 4631 students (since 1999 to 2009), 2776 were located, 657 letters were returned, with 388 excluded from the analysis for being returned lacking addressees. The final study population was composed of 269 participants allocated in 3 groups (< 3 years, 3-5 and > 5years). Longer training was associated with older age, male gender, having undergone residency training, private office, greater earnings and longer time since graduation and a lower chance to participate in providing care for a cardiac arrest. Regarding personal change, no modification was detected according to time since taking the course. The only change in the work environment was the purchase of an automated external defibrillator (AED) by those who had taken the course more than 5 years ago. In multivariable analysis, however, the implementation of an AED was not independently associated with this group, which showed a lower chance to take a new ACLS course. ACLS courses should emphasize also how physicians could reinforce the survival chain through environmental changes.
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Affiliation(s)
- Lunia Sofia Lima Azevedo
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP). Av. Bandeirantes 3900, Monte Alegre. 14049-900 Ribeirão Preto SP Brasil.
| | - Lucas Gaspar Ribeiro
- Fundação de Amparo ao Ensino, Pesquisa e Assistência (FAEPA), Hospital das Clínicas, FMRP, USP. Ribeirão Preto SP Brasil
| | - André Schmidt
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP). Av. Bandeirantes 3900, Monte Alegre. 14049-900 Ribeirão Preto SP Brasil.
| | - Antônio Pazin Filho
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP). Av. Bandeirantes 3900, Monte Alegre. 14049-900 Ribeirão Preto SP Brasil.
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Improving the Success Rate of Chest Compression-Only CPR by Untrained Bystanders in Adult Out-of-Hospital Cardiac Arrest: Maintaining Airway Patency May Be the Way Forward. Anesth Analg 2017; 126:351-353. [PMID: 28708668 DOI: 10.1213/ane.0000000000002300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Puri L, Das J, Pai M, Agrawal P, Fitzgerald JE, Kelley E, Kesler S, Mate K, Mohanan M, Okrainec A, Aggarwal R. Enhancing quality of medical care in low income and middle income countries through simulation-based initiatives: recommendations of the Simnovate Global Health Domain Group. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017. [DOI: 10.1136/bmjstel-2016-000180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BackgroundQuality of medical care in low income and middle income countries (LMICs) is variable, resulting in significant medical errors and adverse patient outcomes. Integration of simulation-based training and assessment may be considered to enhance quality of patient care in LMICs. The aim of this study was to consider the role of simulation in LMICs, to directly impact health professions education, measurement and assessment.MethodsThe Simnovate Global Health Domain Group undertook three teleconferences and a direct face-to-face meeting. A scoping review of published studies using simulation in LMICs was performed and, in addition, a detailed survey was sent to the World Directory of Medical Schools and selected known simulation centres in LMICs.ResultsStudies in LMICs employed low-tech manikins, standardised patients and procedural simulation methods. Low-technology manikins were the majority simulation method used in medical education (42%), and focused on knowledge and skills outcomes. Compared to HICs, the majority of studies evaluated baseline adherence to guidelines rather than focusing on improving medical knowledge through educational intervention. There were 46 respondents from the survey, representing 21 countries and 28 simulation centres. Within the 28 simulation centres, teachers and trainees were from across all healthcare professions.DiscussionBroad use of simulation is low in LMICs, and the full potential of simulation-based interventions for improved quality of care has yet to be realised. The use of simulation in LMICs could be a potentially untapped area that, if increased and/or improved, could positively impact patient safety and the quality of care.
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Rottenberg EM. Two-thirds receive no bystander cardiopulmonary resuscitation: could head rotation be the solution? Am J Emerg Med 2016; 34:2011-2013. [PMID: 27496369 DOI: 10.1016/j.ajem.2016.07.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 11/24/2022] Open
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Santos SV, Margarido MRRA, Caires IS, Santos RAN, Souza SG, Souza JMA, Martimiano RR, Dutra CSK, Palha P, Zanetti ACG, Pazin-Filho A. Basic life support knowledge of first-year university students from Brazil. ACTA ACUST UNITED AC 2015; 48:1151-5. [PMID: 26397971 PMCID: PMC4661033 DOI: 10.1590/1414-431x20154667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 06/22/2015] [Indexed: 11/22/2022]
Abstract
We aimed to evaluate knowledge of first aid among new undergraduates and whether it
is affected by their chosen course. A questionnaire was developed to assess knowledge
of how to activate the Mobile Emergency Attendance Service - MEAS (Serviço de
Atendimento Móvel de Urgência; SAMU), recognize a pre-hospital emergency situation
and the first aid required for cardiac arrest. The students were also asked about
enrolling in a first aid course. Responses were received from 1038 of 1365 (76.04%)
new undergraduates. The questionnaires were completed in a 2-week period 1 month
after the beginning of classes. Of the 1038 respondents (59.5% studying biological
sciences, 11.6% physical sciences, and 28.6% humanities), 58.5% knew how to activate
the MEAS/SAMU (54.3% non-biological vs 61.4% biological, P=0.02),
with an odds ratio (OR)=1.39 (95%CI=1.07-1.81) regardless of age, sex, origin, having
a previous degree or having a relative with cardiac disease. The majority could
distinguish emergency from non-emergency situations. When faced with a possible
cardiac arrest, 17.7% of the students would perform chest compressions (15.5%
non-biological vs 19.1% biological first-year university students,
P=0.16) and 65.2% would enroll in a first aid course (51.1% non-biological
vs 74.7% biological, P<0.01), with an OR=2.61
(95%CI=1.98-3.44) adjusted for the same confounders. Even though a high percentage of
the students recognized emergency situations, a significant proportion did not know
the MEAS/SAMU number and only a minority had sufficient basic life support skills to
help with cardiac arrest. A significant proportion would not enroll in a first aid
course. Biological first-year university students were more prone to enroll in a
basic life support course.
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Affiliation(s)
- S V Santos
- Programa de Educação Tutorial, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M R R A Margarido
- Programa de Educação Tutorial, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - I S Caires
- Programa de Educação Tutorial, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R A N Santos
- Programa de Educação Tutorial, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - S G Souza
- Programa de Educação Tutorial, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J M A Souza
- Programa de Educação Tutorial, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R R Martimiano
- Programa de Educação Tutorial, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C S K Dutra
- Programa de Educação Tutorial, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P Palha
- Programa de Educação Tutorial, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A C G Zanetti
- Programa de Educação Tutorial, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A Pazin-Filho
- Programa de Educação Tutorial, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Understanding and improving low bystander CPR rates: a systematic review of the literature. CAN J EMERG MED 2015; 10:51-65. [DOI: 10.1017/s1481803500010010] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjectives:Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training.Methods:For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence.Results:We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatch-assisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's self-training video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone.Conclusion:We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.
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He Z, Wynn P, Kendrick D. Non-resuscitative first-aid training for children and laypeople: a systematic review. Emerg Med J 2013; 31:763-8. [DOI: 10.1136/emermed-2013-202389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Meaney PA, Sutton RM, Tsima B, Steenhoff AP, Shilkofski N, Boulet JR, Davis A, Kestler AM, Church KK, Niles DE, Irving SY, Mazhani L, Nadkarni VM. Training hospital providers in basic CPR skills in Botswana: acquisition, retention and impact of novel training techniques. Resuscitation 2012; 83:1484-90. [PMID: 22561463 DOI: 10.1016/j.resuscitation.2012.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/18/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana. METHODS HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6 months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation. RESULTS Of 214 HCP trained, 40% resuscitate ≥ 1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p<0.01; adult 28% vs. 48%, p<0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p<0.01) and 6 months (38% vs. 67%, p<0.01), and adult CPR skills were retained to 3 months (34% vs. 51%, p=0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance. CONCLUSIONS HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction.
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Affiliation(s)
- Peter A Meaney
- Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
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Abstract
Aaron Orkin and colleague describe their collaboration that developed, delivered, and studied a community-based first response training program in a remote indigenous community in northern Canada.
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Cost-efficiency assessment of 3 different pediatric first-aid training models for caregivers and teachers in Shanghai. Pediatr Emerg Care 2011; 27:357-60. [PMID: 21494170 DOI: 10.1097/pec.0b013e318216a5f0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The object of this study was to assess, in cost-effective measures, 3 different models for pediatric first-aid training among caregivers and teachers. METHODS Quasi-experimental design was used. A stratified random sampling method was used to obtain 1282 teachers working at nurseries and kindergartens in Shanghai that consists of 18 districts and 1 county. One thousand two hundred eighty-two teachers were allocated randomly to the 3 models of training: 441 to interactive training model (group A), 441 to lecture-based training model (group B), and 400 to video instruction training model (group C). The first-aid knowledge in the 3 models was evaluated before and after the training. RESULTS There was a statistical significance in the results of postassessment among the 3 training models. In group A, 329 (87.3%) trainees passed the course; in group B, 294 (81.7%) passed; and in group C, 262 (79.4%) passed. The total cost of group A was ¥2361 per edition, the total cost of group B was ¥1955 per edition, and the total cost of group C was ¥1064 per edition (P < 0.001). The cost per passed student was ¥151 in group A, ¥74 in group B, and ¥41 in group C (P < 0.001). CONCLUSIONS Although interactive training model may slightly increase the rate of trainees who passed the course, the cost-effectiveness of video instruction training model is clearly superior.
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Ammirati C, Gignon M, Amsallem C, Mercieca JM, Jarry G, Douay B, Nemitz B. Use of an automated external defibrillator: a prospective observational study of first-year medical students. Resuscitation 2010; 82:195-8. [PMID: 21122974 DOI: 10.1016/j.resuscitation.2010.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 09/17/2010] [Accepted: 10/13/2010] [Indexed: 11/15/2022]
Abstract
UNLABELLED This study evaluated the ability of young adults to respond to a simulated cardiac arrest using an automated external defibrillator (AED). METHOD The study population was first-year medical students. None had received their mandatory training in emergency medicine. They role-played in pairs and entered a room in which a third person was lying on the floor and simulating unconsciousness and respiratory arrest. An AED and the corresponding poster-format instructions were clearly visible in the room, next to a telephone. The actions of pairs of responders were recorded. RESULTS Interpretable results were obtained for 90 pairs of subjects. Most (96%) assessed vital signs and 20% performed this assessment correctly. Chest compressions were performed by 57%, 71% called emergency services, 4.5% removed the AED from the wall (but only one pair used it) and 8.9% did nothing. For 41% of the pairs, at least one member already had a cardiopulmonary resuscitation (CPR) certificate. The only statistically significant difference between students with and without a CPR certificate concerned use of the telephone to call emergency services. DISCUSSION Despite the presence of an AED next to the telephone, the defibrillator was almost never used by the participants. Four out of ten pairs did not start chest compressions. The absence of any significant differences in performance between students with and without a CPR certificate casts doubt on the efficacy of the CPR training they had received. CONCLUSION Results indicate the need for greater awareness of how to deal with cardiac arrest and the use of an AED when one is available.
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Affiliation(s)
- C Ammirati
- Emergency Medicine Department, Amiens University Hospital, Amiens, France.
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Markenson D, Ferguson JD, Chameides L, Cassan P, Chung KL, Epstein JL, Gonzales L, Hazinski MF, Herrington RA, Pellegrino JL, Ratcliff N, Singer AJ. Part 13: First aid: 2010 American Heart Association and American Red Cross International Consensus on First Aid Science With Treatment Recommendations. Circulation 2010; 122:S582-605. [PMID: 20956261 DOI: 10.1161/circulationaha.110.971168] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mancini ME, Soar J, Bhanji F, Billi JE, Dennett J, Finn J, Ma MHM, Perkins GD, Rodgers DL, Hazinski MF, Jacobs I, Morley PT. Part 12: Education, implementation, and teams: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S539-81. [PMID: 20956260 DOI: 10.1161/circulationaha.110.971143] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Soar J, Mancini ME, Bhanji F, Billi JE, Dennett J, Finn J, Ma MHM, Perkins GD, Rodgers DL, Hazinski MF, Jacobs I, Morley PT. Part 12: Education, implementation, and teams: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010; 81 Suppl 1:e288-330. [PMID: 20956038 PMCID: PMC7184565 DOI: 10.1016/j.resuscitation.2010.08.030] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol,United Kingdom.
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Resuscitation training in developing countries: a systematic review. Resuscitation 2010; 81:1462-72. [PMID: 20727656 DOI: 10.1016/j.resuscitation.2010.06.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 06/18/2010] [Accepted: 06/28/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate whether the inclusion of any specific resuscitation training educational strategy in developing countries improves outcomes. METHODS As part of the International Liaison Committee on Resuscitation evidence evaluation process, a systematic review of the literature was conducted. The Cochrane database of systematic reviews; Medline; Google Scholar and EmBASE were searched using multiple search strategies. RESULTS Forty-four papers were relevant to review, including 38 studies that provided support for the use of resuscitation training programs in developing countries. All studies that examined self-efficacy (15 studies) and student satisfaction (8 studies) reported improvement. There was no consistent testing method for educational outcomes across studies and few studies examined both educational outcomes and patient outcome (1 of 15 self-efficacy, 0 of 18 cognitive knowledge, 0 of 8 psychomotor skills, 0 of 5 simulated operational performance). Fourteen of 15 studies that examined patient survival were either newborn or trauma resuscitation, 1 adult resuscitation, and none were in pediatric resuscitation. Increased patient survival after resuscitation training was variable, with an absolute risk reduction that ranged from 0% to 34%. CONCLUSIONS Resuscitation training in developing countries was well received and viewed as valuable training by the students and local counterparts. Important student, training environment characteristics, educational outcomes and patient outcomes were inconsistently defined and reported. Institution of training in trauma and newborn resuscitation in developing countries has significantly reduced mortality, but this has not been demonstrated with other training programs.
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Van de Velde S, Heselmans A, Roex A, Vandekerckhove P, Ramaekers D, Aertgeerts B. Effectiveness of Nonresuscitative First Aid Training in Laypersons: A Systematic Review. Ann Emerg Med 2009; 54:447-57, 457.e1-5. [DOI: 10.1016/j.annemergmed.2008.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 11/12/2008] [Accepted: 11/12/2008] [Indexed: 11/17/2022]
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Ertl L, Christ F. Significant improvement of the quality of bystander first aid using an expert system with a mobile multimedia device. Resuscitation 2007; 74:286-95. [PMID: 17376581 DOI: 10.1016/j.resuscitation.2007.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 12/23/2006] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Better quality bystander first-aid could improve outcome rates for emergency victims significantly. In this case-control study, we hypothesised that expert knowledge presented step-by-step to untrained helpers using a personal digital assistant (PDA), would improve the quality of bystanders basic life support. METHOD We confronted 101 lay-helpers with two standard emergency situations. (1) An unconscious trauma victim with severe bleeding. (2) Cardiopulmonary resuscitation (CPR). Performance was assessed using an Objective Structured Clinical Examination (OSCE). One group was supported by a PDA providing visual and audio instructions, whereas the control group acted only with their current knowledge. The expert system was programmed in HTML-code and displayed on the PDA's Internet browser. RESULTS The maximum score obtainable was 24 points corresponding to optimal treatment. The control group without the PDA reached 14.8+/-3.5 (mean value+/-standard deviation), whereas the PDA supported group scored significantly higher (21.9+/-2.7, p<0.01). The difference in performance was measurable in all criteria tested and particularly notable in the items: placing in recovery position, airway management and quality of CPR. CONCLUSION The PDA based expert system increased the performance of untrained helpers supplying emergency care significantly. Since Internet compatible mobile devices have become widely available, a significant quality improvement in bystander first-aid seems possible.
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Affiliation(s)
- Lorenz Ertl
- European HEMS and Air Ambulance Committee e.V., Schillerstr. 53, 80336 München, Germany.
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Robak O, Kulnig J, Sterz F, Uray T, Haugk M, Kliegel A, Holzer M, Herkner H, Laggner AN, Domanovits H. CPR in medical schools: learning by teaching BLS to sudden cardiac death survivors--a promising strategy for medical students? BMC MEDICAL EDUCATION 2006; 6:27. [PMID: 16646966 PMCID: PMC1479344 DOI: 10.1186/1472-6920-6-27] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 04/28/2006] [Indexed: 05/08/2023]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) training is gaining more importance for medical students. There were many attempts to improve the basic life support (BLS) skills in medical students, some being rather successful, some less. We developed a new problem based learning curriculum, where students had to teach CPR to cardiac arrest survivors in order to improve the knowledge about life support skills of trainers and trainees. METHODS Medical students who enrolled in our curriculum had to pass a 2 semester problem based learning session about the principles of cardiac arrest, CPR, BLS and defibrillation (CPR-D). Then the students taught cardiac arrest survivors who were randomly chosen out of a cardiac arrest database of our emergency department. Both, the student and the Sudden Cardiac Death (SCD) survivor were asked about their skills and knowledge via questionnaires immediately after the course. The questionnaires were then used to evaluate if this new teaching strategy is useful for learning CPR via a problem-based-learning course. The survey was grouped into three categories, namely "Use of AED", "CPR-D" and "Training". In addition, there was space for free answers where the participants could state their opinion in their own words, which provided some useful hints for upcoming programs. RESULTS This new learning-by-teaching strategy was highly accepted by all participants, the students and the SCD survivors. Most SCD survivors would use their skills in case one of their relatives goes into cardiac arrest (96%). Furthermore, 86% of the trainees were able to deal with failures and/or disturbances by themselves. On the trainer's side, 96% of the students felt to be well prepared for the course and were considered to be competent by 96% of their trainees. CONCLUSION We could prove that learning by teaching CPR is possible and is highly accepted by the students. By offering a compelling appreciation of what CPR can achieve in using survivors from SCD as trainees made them go deeper into the subject of resuscitation, what also might result in a longer lasting benefit than regular lecture courses in CPR.
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Affiliation(s)
- Oliver Robak
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Johannes Kulnig
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Thomas Uray
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Moritz Haugk
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Andreas Kliegel
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Anton N Laggner
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Austria Waehringer Guertel 18-20, 1090 Vienna, Austria
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Abstract
The mass media have become a powerful force throughout the world and strongly influence how people see themselves and others. This is particularly true for adolescents. This article discusses how the media affect body image and self-esteem and why the media seem to have such strong effects on adolescents. The differences in responses to the media in adolescents of different ethnic, racial, and cultural backgrounds are discussed. Although this article focuses primarily on teenage girls, the data for adolescent boys is reviewed as well. Finally, this article discusses possible ways to help adolescents become more active viewers of the media and help prevent the decrease in body esteem that so often occurs during adolescence.
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Affiliation(s)
- Claire V Wiseman
- Department of Psychology, Trinity College, Hartford, CT 06106, USA.
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20
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Abstract
OBJECTIVE The American Academy of Pediatrics (AAP) has published simple guidelines for the first aid management of ill or injured children. We determined knowledge of these first aid practices in parents. METHODS Design-Descriptive survey. PARTICIPANTS A convenience sample of adult parents presenting to the emergency department. SURVEY INSTRUMENT Standardized collection of demographics was performed and adults were given a multiple-choice questionnaire concerning the proper management of stings and bites, burns and scalds, eye injuries, fractures and sprains, fever, head injuries, fainting, poisoning, dental emergencies, nosebleeds, seizures, and skin wounds. OUTCOMES Percentage of adults responding to questions appropriately based on AAP guidelines. DATA ANALYSIS Descriptive statistics and chi2 tests. RESULTS Six hundred fifty-four adults were surveyed. Mean age (SD) was 38.5 (13.8), 56% were female, 69% were white, 56% had at least a high school education. None of those surveyed answered all questions correctly with roughly half being familiar with 60% of the questions. Knowledge of specific guidelines ranged from 21% to 92%. Subjects especially lacked knowledge regarding the need to rapidly remove all bee stingers (only 36% aware); keep wounds moist and covered (79% felt that drying wounds was beneficial); the need to cover victims of large burns (only 43% aware); and the need to seek medical attention after tick bites (only 47% aware). Knowledge was unaffected by age, gender, and education. CONCLUSIONS Many adults are unfamiliar with AAP first aid measures according to the AAP guidelines and most believe that wounds should be allowed to dry. Further education is required to improve knowledge of first aid practices.
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Affiliation(s)
- Adam J Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY 11794, USA.
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Gabrielli A, Layon AJ, Wenzel V, Dorges V, Idris AH. Alternative ventilation strategies in cardiopulmonary resuscitation. Curr Opin Crit Care 2002; 8:199-211. [PMID: 12386498 DOI: 10.1097/00075198-200206000-00002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The introduction of the 2000 Guidelines for Cardiopulmonary Resuscitation emphasizes a new, evidence-based approach to the science of ventilation during cardiopulmonary resuscitation (CPR). New laboratory and clinical science underemphasizes the role of ventilation immediately after a dysrhythmic cardiac arrest (arrest primarily resulting from a cardiovascular event, such as ventricular defibrillation or asystole). However, the classic airway patency, breathing, and circulation (ABC) CPR sequence remains a fundamental factor for the immediate survival and neurologic outcome of patients after asphyxial cardiac arrest (cardiac arrest primarily resulting from respiratory arrest). The hidden danger of ventilation of the unprotected airway during cardiac arrest either by mouth-to-mouth or by mask can be minimized by applying ventilation techniques that decrease stomach gas insufflation. This goal can be achieved by decreasing peak inspiratory flow rate, increasing inspiratory time, and decreasing tidal volume to approximately 5 to 7 mL/kg, if oxygen is available. Laboratory and clinical evidence recently supported the important role of alternative airway devices to mask ventilation and endotracheal intubation in the chain of survival. In particular, the laryngeal mask airway and esophageal Combitube proved to be effective alternatives in providing oxygenation and ventilation to the patient in cardiac arrest in the prehospital arena in North America. Prompt recognition of supraglottic obstruction of the airway is fundamental for the management of patients in cardiac arrest when ventilation and oxygenation cannot be provided by conventional methods. "Minimally invasive" cricothyroidotomy devices are now available for the professional health care provider who is not proficient or comfortable with performing an emergency surgical tracheotomy or cricothyroidotomy. Finally, a recent device that affects the relative influence of positive pressure ventilation on the hemodynamics during cardiac arrest has been introduced, the inspiratory impedance threshold valve, with the goal of maximizing coronary and cerebral perfusion while performing CPR. Although the role of this alternative ventilatory methodology in CPR is rapidly being established, we cannot overemphasize the need for proper training to minimize complications and maximize the efficacy of these new devices.
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Affiliation(s)
- Andrea Gabrielli
- Department of Anesthesiology, University of Florida, Gainesville, Florida 32610, USA.
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