不同培训方式对医务人员基础生命支持培训效果的影响

目的探讨不同培训方式对医务人员基础生命支持培训的效果。方法初训389人、复训148人用理论授课与示范练习相结合方式;初训491人、复训145人用集中授课结合边看视频边练习方式;复训154人用边看视频边练习方式。比较各种培训方式的有效性和对培训结果的影响。结果3种不同方式均可达到培训目的,以边看视频边练习方式为佳。结论边看视频边练习用于基础生命支持初训和复训可提高培训效果。     

心血管病专科护士基础生命支持培训效果及分析

目的探讨全军心血管病护理示范基地专科护士基础生命支持的培训模式。方法 2013年5月,选择参加沈阳军区总医院全军培训基地心血管病专科护士班护士52名为研究对象,按随机数字表法分成观察组和对照组,每组各26名。观察组采用美国心脏协会(American Heart Association,AHA)培训模式,而对照组采用全军心血管病护理示范基地专科护士传统培训模式,在培训结束时进行理论和技能考核。结果观察组护士的基础生命支持理论和技能操作考核通过率高于对照组,差异有统计学意义(P0.05)。结论采用AHA培训模式,有利于全军心血管病护理示范基地专科护士掌握基础生命支持理论及技能,特别有助于提高对儿童和婴儿的急救和复苏技能,实用性强,可广泛推广及应用。     

基础生命支持

一、概论 心肺复苏(Cardio-pulmonary Resuscitation,CPR)又称基础生命支持(Basic Life Support,BLS)是指用人工的办法尽快给心跳呼吸骤停的病人建立呼吸及循环,从而保证脑等重要脏器的血氧供应,为进一步挽救病人的生命打下基础。心肺复苏中最主要的步骤为A、B、C,即开放气道(airway)、人工呼吸(Brathing)、人工循环(Circulation)。心肺复苏是急诊     

普及"高级创伤生命支持"培训提高医护人员灾难应对能力

"高级创伤生命支持(ATLS)"是美国外科医师学会举办的专业培训,是发达国家临床医生必备的技能.ATLS培训课程关注细节、强调合作、规范程序、统一标准,使医师能够迅速、有效、正确地诊治创伤患者,从而提高救治效率、降低死亡率,在大灾难的医疗急救中发挥重要的作用.伤害已成为威胁我国居民健康的重要公共卫生问题,我国每年需要就医的各类伤害约为6 200万人次,我国还是世界上自然灾害频发的国家,平均每年有3亿人次因各类自然灾害受灾.然而,我国的创伤救治尚没有统一的标准,也缺乏规范化的培训,使得抢救效率低下.因此,我国亟待在医务人员中普及"高级创伤生命支持"培训,从而提高应对灾难和伤害的医疗救治水平.     

基础生命支持PowerPoint课件的设计与应用

目的:探讨《2005国际心肺复苏与心血管急救指南》之基础生命支持的临床护理业务学习方法.方法:运用计算机设计PowerPoint课件讲解心肺复苏临床新进展.结果:PowerPoint课件有助于临床教学,使护理人员在短时间内能掌握其所有内容.结论:多媒体课件具有全面性、完整性、配套性、开放性、共享性与实用性,运用PowerPoint课件激发了护理人员学习的积极性与思考意识,提高了业务学习质量及临床实践性,同时认识了多媒体技术带来的好处.     

情景模拟教学法在低年资护士基础生命支持培训中的应用

目的探讨情景模拟教学法对急诊科低年资护士基础生命支持培训的实践效果和应用体会。方法应用情景模拟教学法对我科24名N0、N1级护理人员进行理论和操作培训,培训结束后予以考核。并对培训前后急诊临床教学质量及各级医护人员的满意度进行评价。结果自实行情景模拟教学法培训以来,护理人员的心肺复苏考核成绩较前有较大提升(P0.01);各级医护人员的满意度均有所提高,受训护士自身满意度与情景模拟教学培训前比较,差异有统计学意义(P0.05)。结论情景模拟教学因材施教,效果显著,增进了急诊科教学效果,提高了急诊教学满意度。     

微格教学用于初级生命支持技能培训的Meta分析

目的系统评价微格教学在医护人员初级生命支持(BLS)技能培训中的应用效果。方法检索知网、万方、中国生物医学文献数据库、中国科技期刊全文数据库及PubMed、EMBASE、Cochrane图书馆等数据库收集国内外发表的相关随机对照试验(RCT),检索时间从建库至2020年9月。对纳入文献采用RevMan5.4软件进行Meta分析。结果共纳入12个RCT,包含805名医护人员。其中微格教学组404名,传统教学组401名,Meta分析结果显示,与传统教学相比,微格教学可以提高医护人员的操作考试成绩[SMD=2.03,95%CI(1.33,2.73),P<0.00001]、理论考试成绩[SMD=1.50,95%CI(0.81,2.18),P<0.0001],以及满意度[RR=1.37,95%CI(1.11,1.68),P=0.03]。Egger s检验结果显示存在发表偏倚(P=0.01)。结论微格教学优于传统教学。但纳入研究质量偏低,异质性较大,且可能存在发表偏倚,本研究结果应谨慎对待,仍需更高质量研究予以证实。     

Perceptions of Basic,Advanced, and Pediatric Life Support Training In a United States Medical School

Background

Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) are integral parts of emergency resuscitative care. Although this training is usually reserved for residents, introducing the training in the medical student curriculum may enhance acquisition and retention of these skills.

Objectives

We developed a survey to characterize the perceptions and needs of graduating medical students regarding BLS, ACLS, and PALS training.

Methods

This was a study of graduating 4^th-year medical students at a U.S. medical school. The students were surveyed prior to participating in an ACLS course in March of their final year.

Results

Of 152 students, 109 (71.7%) completed the survey; 48.6% of students entered medical school without any prior training and 47.7% started clinics without training; 83.4% of students reported witnessing an average of 3.0 in-hospital cardiac arrests during training (range of 0–20). Overall, students rated their preparedness 2.0 (SD 1.0) for adult resuscitations and 1.7 (SD 0.9) for pediatric resuscitations on a 1–5 Likert scale, with 1 being unprepared. A total of 36.8% of students avoided participating in resuscitations due to lack of training; 98.2%, 91.7%, and 64.2% of students believe that BLS, ACLS, and PALS, respectively, should be included in the medical student curriculum.

Conclusions

As per previous studies that have examined this topic, students feel unprepared to respond to cardiac arrests and resuscitations. They feel that training is needed in their curriculum and would possibly enhance perceived comfort levels and willingness to participate in resuscitations.     

初级心肺复苏44例分析

目的:分析本院两年来急诊初级心肺复苏情况,为进一步提高心肺复苏成功率提供依据。方法:回顾性分析本科2004年1月～2005年12月间44例心肺复苏病例。观察其心跳骤停发生地点、骤停时间、病因、肾上腺素用量、有无电除颤及机械通气等指标。结果:成功组复苏前骤停时间比失败组短(P<0.05);在院内发生骤停的复苏成功率比院外要高(P<0.01);成功组需要的胸外按压时间和肾上腺素总量均低于失败组(P<0.05)。结论:影响心肺复苏成功的基础因素包括心肺复苏前骤停的时间、地点、基础病,在心肺复苏过程中是否及时开放气道、进行胸外按压的时间、肾上腺素的用量等可预测复苏的成功率。     

Basic Life Support Training for undergraduate nursing students: An integrative review

The aim of this review was to identify the role of basic life support training interventions in international undergraduate nursing education, that support optimal acquisition and retention of knowledge, psychomotor skills and resuscitation self-efficacy. Twenty-four articles were identified and analysed using an integrative review approach. Studies were reviewed for quality using a Critical Appraisal Skills Programme checklist. Common objective and standardised methods of basic life support education practice were identified: instructor led, simulation experiences, self-directed learning, skills training combined with clinical practicum, and computer-based training. Evaluation of competency was collected primarily from multiple-choice questionnaires or researcher-designed checklists, with a lack of objective performance data noted. Importantly, current teaching approaches do not guarantee acquisition or retention of basic life support skills. Objective feedback from technologies supporting cardiopulmonary resuscitation training may be useful in acquisition and retention of psychomotor skills, and therefore requires further exploration. Development of robust, psychometrically sound instruments are needed to accurately and consistently measure nursing students' skills performance.     

12-lead Electrocardiograms during Basic Life Support Care

Objectives

Prehospital 12-lead electrocardiograms (PTLs) decrease time to thrombolytics. Paramedics have performed them successfully for years, but emergency medical technicians (EMTs) have not typically performed them. To determine whether PTLs could be considered a basic life support (BLS) skill, the authors conducted a pilot study to determine whether scene times are lengthened when EMTs obtain PTLs, whether EMTs can appropriately select patients for PTLs, and what value physicians place on prehospital PTLs.

Methods

The authors prospectively evaluated PTL performance in four BLS agencies. EMTs provided standard cardiac care to patients on even days. On odd days, they additionally performed a PTL. Scene times of patients receiving a PTL (n = 77) were compared with scene times of similar patients not receiving one (n = 100).

Results

EMTs attempted to perform 101 PTLs, of which 77 were eligible for inclusion. The mean scene time [95% confidence interval] of patients on even days (no 12-lead) was 11.9 [11.0, 12.8] minutes, compared with 16.9 [15.8, 18.0] minutes for patients who received a PTL. Scene times increased by 5.0 [3.6, 6.4] minutes when a PTL was added to the evaluation. Physician feedback was received on 63 of 77 PTLs. Receiving physicians agreed that 59 of 63 (93.6%) patients needed the PTL and found them moderately helpful (3.56 on a 1 to 5 scale).

Conclusion

When EMTs performed PTLs, scene times increased approximately 5 minutes. Most physicians agreed that the PTL was indicated. PTL acquisition by EMTs appears feasible with slightly lengthened scene times, but evaluation in other BLS agencies is necessary to validate this conclusion.     

家属支持辅导对脑卒中后抑郁患者生活质量的影响

目的探讨家属支持辅导对脑卒中后抑郁患者生活质量的影响。方法将68例脑卒中后抑郁患者分为观察组和对照组,各34例。两组患者均接受常规诊疗和护理,同时对观察组患者家属实施同步健康教育,比较两组患者的康复效果。结果观察组患者治疗后的汉密尔顿抑郁量表(HAMD)评分明显低于对照组(P<0.01)。结论家属支持辅导能提高患者的生活质量。     

Retention of Basic Life Support in Laypeople: Mastery Learning vs. Time-based Education

Objective: To compare the effectiveness of a mastery learning (ML) versus a time-based (TB) BLS course for the acquisition and retention of BLS knowledge and skills in laypeople. Methods: After ethics approval, laypeople were randomized to a ML or TB BLS course based on the American Heart Association (AHA) Heartsaver course. In the ML group, subjects practiced and received feedback at six BLS stations until they reached a pre-determined level of performance. The TB group received a standard AHA six-station BLS course. All participants took the standard in-course BLS skills test at the end of their course. BLS skills and knowledge were tested using a high-fidelity scenario and knowledge questionnaire upon course completion (immediate post-test) and after four months (retention test). Video recorded scenarios were assessed by two blinded, independent raters using the AHA skills checklist. Results: Forty-three subjects were included in analysis (23ML;20TB). For primary outcome, subjects' performance did not change after four months, regardless of the teaching modality (TB from (median[IQR]) 8.0[6.125;8.375] to 8.5[5.625;9.0] vs. ML from 8.0[7.0;9.0] to 7.0[6.0;8.0], p = 0.12 for test phase, p = 0.21 for interaction between effect of teaching modality and test phase). For secondary outcomes, subjects acquired knowledge between pre- and immediate post-tests (p < 0.005), and partially retained the acquired knowledge up to four months (p < 0.005) despite a decrease between immediate post-test and retention test (p = 0.009), irrespectively of the group (p = 0.59) (TB from 63.3[48.3;73.3] to 93.3[81.7;100.0] and then 93.3[81.7;93.3] vs. ML from 60.0[46.7;66.7] to 93.3[80.0;100.0] and then 80.0[73.3;93.3]). Regardless of the group after 4 months, chest compression depth improved (TB from 39.0[35.0;46.0] to 48.5[40.25;58.0] vs. ML from 40.0[37.0;47.0] to 45.0[37.0;52.0]; p = 0.012), but not the rate (TB from 118.0[114.0;125.0] to 120.5[113.0;129.5] vs. ML from 119.0[113.0;130.0] to 123.0[102.0;132.0]; p = 0.70). All subjects passed the in-course BLS skills test. Pass/fail rates were poor in both groups at both the simulated immediate post-test (ML = 1/22;TB = 0/20; p = 0.35) and retention test (ML pass/fail = 1/22, TB pass/fail = 0/20; p = 0.35). The ML course was slightly longer than the TB course (108[94;117] min vs. 95[89;102] min; p = 0.003). Conclusions: There was no major benefit of a ML compared to a TB BLS course for the acquisition and four-month retention of knowledge or skills among laypeople.     

Basic Cardiac Life Support Providers Checking the Carotid Pulse: Performance, Degree of Conviction, and Influencing Factors

The American Heart Association recently abolished the carotid pulse check during cardiopulmonary resuscitation for lay rescuers, but not for health care providers. OBJECTIVES: The aim of the study was to evaluate health care providers' performance, degree of conviction, and influencing factors in checking the carotid pulse. METHODS:Sixty-four health care providers were asked to check the carotid pulse for 10 or 30 seconds on a computerized mannequin simulating three levels of pulse strength (normal, weak, and absent). Health care providers were asked whether they felt a pulse and how certain were they that they felt a pulse. Performance was evaluated, as well as degree of conviction about the answer, using a visual analog scale. Data were compared by using a general linear model procedure. RESULTS: In the pulseless situations, the answers were correct in 58% and 50% when checking the pulse for 10 and 30 seconds, respectively. In the situation with a weak pulse, the answer was correct in 83% when checking the pulse for 10 seconds. In situations with a normal pulse, the answers were correct in 92%, 84%, and 84%, respectively, when checking the pulse for 10 (twice) and 30 seconds. The exactitude of the answer was correlated with the pulse strength (p < 0.05). The degree of conviction about the answer was correlated with the exactitude of the answer (p < 0.01) and the pulse strength (p < 0.0001). CONCLUSIONS: These results question the routine use of the carotid pulse check during cardiopulmonary resuscitation, including for health care providers.