Recent high school graduates support mandatory cardiopulmonary resuscitation education in Australian high schools

Objective : To evaluate recent high school graduates' opinions on mandatory cardiopulmonary resuscitation (CPR) training in the high school curriculum as a solution to improving bystander CPR rates. Methods : Participants completed questionnaires assessing their CPR training history during their high school education, their willingness to learn CPR during their high school years and their opinion on making CPR training mandatory for high school curricula. Results : Of the 178 participants in this study, 60% had undertaken CPR training during their high school education. Of those who had not undertaken CPR training, 75% reported that they would have been willing to learn CPR had they been provided with the opportunity. A total of 97% of participants were in support of mandatory CPR training in high school education. Conclusion : Implementing mandatory CPR training in high school education would be embraced by students. Implications for public health : Findings of this study support our recommendation to implement mandatory CPR training in the high school curriculum. This will likely increase the number of bystanders in the community who would spontaneously administer CPR, thereby improving outcomes for patients experiencing out‐of‐hospital cardiac arrest.     

A new method without reference channels used for ventricular fibrillation detection during cardiopulmonary resuscitation

Ventricular fibrillation (VF) is observed as the initial rhythm in the majority of patients suffering from sudden cardiac arrest. It is vitally important to accurately recognize the initial VF rhythm and then implement electrical defibrillation. However, artifacts produced by chest compression during cardiopulmonary resuscitation (CPR) make the VF detection algorithms utilized by current automated external defibrillators (AEDs) unreliable. CPR must be traditionally interrupted for a reliable diagnosis. However, interruptions in chest compression have a deleterious effect on the success of defibrillation. The elimination of the CPR artifacts would enable compressions to continue during AED VF detection and thereby increase the likelihood of resuscitation success. We have estimated a model of this artifact by adaptively incorporating noise-assisted multivariate empirical mode decomposition (NA-MEMD) and least mean squares (LMS) and then removing the artifact from the corrupted ECGs. The simulation experiment indicated that the CPR artifact could be accurately modeled without any reference channels. We constructed a BP neural network to evaluate the results. A total of 372 VF and 645 normal sinus rhythm (SR) ECG samples were included in the analysis, and 24 CPR artifact signals were used to construct corrupted ECGs. The results indicated that at different SNR levels ranging from 0 to ?12 dB, the sensitivity and specificity were always above 95 and 80 %, respectively.     

《2015美国心脏学会心肺复苏与心血管急救指南(更新版) 》儿童基础生命支持部分解读

2015年10月公布了最新的《2015美国心脏病协会心肺复苏及心血管急救指南(更新版)》(以下简称为《2015更新》)。本指南采用了新的系统性审查流程和新的建议级别(COR)及证据水平(LOE)。同时,对其中儿童基础生命支持(PBLS)部分的内容,也进行了调整。为了加强儿科医务人员的心肺复苏(CPR)急救技能的掌握,笔者拟简要介绍《2015更新》中,关于PBLS部分的主要更新内容,包括：①明确PBLS的适用人群;②重申胸外按压-开放气道-人工通气(C-A-B)的CPR操作顺序;③提供新的专业人员单人和多人施救流程;④限定胸外按压深度：青少年不超过6 cm;⑤建议按压频率为100～120次/min;⑥比较传统CPR与单纯胸外按压式CPR的优势与劣势;⑦强调高质量的CPR等,旨在提高临床对患儿进行CPR的成功率及患儿生存率。     

PICU心搏骤停患儿心肺复苏失败的相关因素分析

目的 探讨影响儿科重症监护病房(PICU)心搏骤停患儿心肺复苏失败的相关因素.方法 随机选取2013年1月至2016年12月在温州市中心医院儿科重症监护病房住院的心搏骤停患儿90例,对其:①系统相关因素;②心搏骤停出现前的相关因素;③CPR期间的相关因素进行观察,并对相关因素进行分析.结果 全组中有28例(31.11%)心肺复苏失败患儿.入住儿科重症监护病房时间(χ2=5.15)、心搏骤停前有无给予镇静药物(χ2=15.56)、有无进行中心静脉通路(χ2=3.02)、心肺复苏时间(χ2=21.13)、心肺复苏操作时有无进行胸外按压(χ2=4.06)、有无进行正压通气(χ2=8.05)、有无气管插管(χ2=5.03)及补碱(χ2=10.42)因素下,其患儿心肺复苏失败率均存在明显差异(均P<0.05);而心搏骤停出现时间、心搏骤停出现前有无进行机械通气、有无给予镇痛或血管活性药物、有无补钙、有无给予抗心律失常药物及心肺复苏时有无给予肾上腺素因素下,其患儿心肺复苏失败率均无明显差异(均P>0.05);经多因素Logistic回归分析结果表明,心搏骤停前给予镇静药物(OR=12.24)、心肺复苏时间(OR=0.02)、心肺复苏操作时进行胸外按压(OR=0.07)、正压通气(OR=312.05)、补碱(OR=0.02)与心肺复苏失败存在相关关系(均P<0.05).结论 心肺复苏时间超过30min、心肺复苏操作时进行胸外按压及补碱的心搏骤停患儿出现心肺复苏失败率较高.因此,患儿出现心搏骤停前应给予其镇静药物并在心肺复苏期间应进行正压通气,有助于减少心肺复苏失败率.     

Self‐management abilities and quality of life among frail community‐dwelling individuals: the role of community nurses in the Netherlands

The objective of the study was to determine whether community nurses in the Netherlands improve self‐management abilities and quality of life of frail community‐dwelling people. This longitudinal study was performed in the context of a larger evaluation study of the ‘Zichtbare Schakels’(Visible Link) programme, conducted to determine the quality of care provided by community nurses to community‐dwelling frail people in Rotterdam, the Netherlands. For the current study, clients seen by community workers in Rotterdam between July 2013 and November 2014 participated. Data were gathered via personal interviews by the community nurses as part of care delivery at the start (T0; n = 220) and end of care delivery (T1; n = 111 – the remaining 109 clients were still receiving care) to evaluate and improve quality of care. We measured client's quality of life (using the EQ5D), self‐management abilities (using the Self‐Management Ability Scale) and background characteristics. Results showed that clients seen by the community nurses especially experience problems when it comes to usual activities and pain/discomfort. Furthermore, quality of life was much worse among clients of the community nurses (0.51) than among frail older (aged ≥70 years) people in Rotterdam (0.61), Dutch patients with chronic illnesses [CVD (0.83), COPD (0.79) or diabetes (0.83)] and older (aged ≥65 years) people who had recently been hospitalised (0.80). Significant improvements were seen in client's self‐management and quality of life over time. Self‐management abilities at T0 and changes in self‐management abilities (T1 – T0) clearly predicted quality of life at T1. Investing in community health nurses may be beneficial for the improvement of self‐management abilities and quality of life among very frail people in the community.     

Corpuls cpr resuscitation device generates superior emulated flows and pressures than LUCAS II in a mechanical thorax model

The provision of sufficient chest compression is among the most important factors influencing patient survival during cardiopulmonary resuscitation (CPR). One approach to optimize the quality of chest compressions is to use mechanical-resuscitation devices. The aim of this study was to compare a new device for chest compression (corpuls cpr) with an established device (LUCAS II). We used a mechanical thorax model consisting of a chest with variable stiffness and an integrated heart chamber which generated blood flow dependent on the compression depth and waveform. The method of blood-flow generation could be changed between direct cardiac-compression mode and thoracic-pump mode. Different chest-stiffness settings and compression modes were tested to generate various blood-flow profiles. Additionally, an endurance test at high stiffness was performed to measure overall performance and compression consistency. Both resuscitation machines were able to compress the model thorax with a frequency of 100/min and a depth of 5 cm, independent of the chosen chest stiffness. Both devices passed the endurance test without difficulty. The corpuls cpr device was able to generate about 10–40% more blood flow than the LUCAS II device, depending on the model settings. In most scenarios, the corpuls cpr device also generated a higher blood pressure than the LUCAS II. The peak compression forces during CPR were about 30% higher using the corpuls cpr device than with the LUCAS II. In this study, the corpuls cpr device had improved blood flow and pressure outcomes than the LUCAS II device. Further examination in an animal model is required to prove the findings of this preliminary study.     

Cardiac Resuscitation Procedures in US Nursing Facilities: Time to Reevaluate the Standard of Care?

Although the use of automated external defibrillators (AEDs) in out-of-hospital cardiac arrest (OHCA) response has become the standard of care in many community settings over the past 20+ years, the adoption of AEDs in US nursing facilities is variable and the current number of facilities with AEDs is unknown. Recent research into the use of AEDs as part of cardiopulmonary resuscitation (CPR) procedures for nursing facility residents with sudden cardiac arrest demonstrates improved outcomes in the limited cohort with witnessed arrests, early bystander CPR, and an initial amenable rhythm, shocked with an AED before the arrival of Emergency Medical Services (EMS) personnel. This article reviews data about outcomes of CPR in older adults and nursing facility settings and proposes that standard procedures for CPR attempts in US nursing facilities should be reevaluated and continue to evolve, commensurate with the evidence and community standards.     

Addressing Gaps in Cardiopulmonary Resuscitation Education: Training Middle School Students in Hands‐Only Cardiopulmonary Resuscitation

BACKGROUND

Training middle school students to perform hands‐only cardiopulmonary resuscitation (HOCPR) is a potential method to increase overall rates of bystander cardiopulmonary resuscitation (CPR). We aimed to examine the feasibility of teaching this population CPR using teacher‐implemented education sessions guided by American Heart Association (AHA) training kits and resources.

METHODS

We conducted a national HOCPR training campaign in middle schools during the 2014‐2015 school year. Participating schools utilized AHA CPR training kits to train seventh and eighth grade students. We assessed pretest/posttest knowledge and comfort in performing HOCPR.

RESULTS

We recruited 1131 schools and trained approximately 334,610 students in HOCPR. The average pretest score on knowledge questions was 50% and the average posttest score was 84%. Most students (76%) felt comfortable performing HOCPR after the education session. Overall, 98% of teachers said they would continue to implement CPR training in the future.

CONCLUSIONS

Large‐scale, teacher‐implemented CPR education sessions in the middle school setting are a successful approach to increase middle school student's knowledge and comfort in performing HOCPR and to increase overall bystander CPR rates.

     

萨勃心肺复苏机在急诊的临床使用分析简

目的：观察心肺复苏机对心脏停搏患者的救治效果。方法：分析80例使用萨勃心肺复苏机和78例采用人工胸外按压心肺复苏的患者,比较两种方法患者的血压、脉搏、血氧饱和度、肋骨骨折发生率,比较两组患者的心肺复苏成功率、心跳恢复时间及存活率。结果：萨勃心肺复苏机心肺复苏组生理参数优于人工按压组,复苏成功率较人工按压组高,并发症发生率低于人工胸外按压组。结论：萨勃心肺复苏机在维持患者生理参数稳定、减少并发症方面效果优于传统人工心肺复苏,建议普及使用。     

军队干休所人员实施院外心肺复苏意愿的调查

目的 了解军队干休所保健人员实施院外心肺复苏的意愿及培训需求.方法 采用自行研制的调查问卷对在某军医大学受训的干休所保健人员进行调查,了解一般情况、以往心肺复苏学习情况、实际操作经历及在院外面对陌生人或亲朋发生心搏骤停时的急救意愿及不施救的可能原因.结果 绝大多数学员有既往学习经历和职后训练经历.仅34%曾实施过心肺复苏,96%认为今后仍有必要进行复训.对院外陌生人或亲朋发生心搏骤停的情况,学员的行为选择有差异,对陌生人施救时更少选择做口对口人工呼吸、胸外心脏按压和病情判断,有更多的人选择旁观(均P<0.001).不施救的可能原因是担心技术不过关.结论 军队干休所保健人员对实施院外心肺复苏仍存在疑虑,对其进行职后反复心肺复苏技能再训练可能提高施救意愿.     

Telemedicine and cardiopulmonary resuscitation: the value of video-link and telephone instruction to a mock bystander

We evaluated cardiopulmonary resuscitation (CPR) performed by persons with no previous experience on a resuscitation dummy. Subjects were randomized into four groups, one of which had no instruction. The other three groups were instructed for 3 min in mock CPR by a supervisor using a telephone, a video-link, or directly in person. They were compared with a group which had had previous CPR training. The main outcome measures were the number of correct ventilations, chest compressions and compressions with correct hand position. Video-link instruction was associated with significantly higher median scores for all three outcome measurements (P < 0.05), whereas telephone instruction and previous CPR training were associated with higher scores on only one, namely ventilations (P < 0.05). Video-link instruction was comparable with direct observer instruction. There was no significant difference between previously trained subjects and the intervention groups. Video-link instruction can produce significant improvements in the quality of CPR in mock resuscitations for persons with no resuscitation training.     

Trends in health screening participation and lifestyle behaviours after participation in a free,access‐enhanced screening intervention in a low‐income Singaporean rental‐flat community

Our objective was to evaluate the impact of an access‐enhanced health screening intervention on screening adherence in a rental‐flat community. In Singapore, public rental flats provide heavily subsidised rentals for the needy who cannot afford to own their own homes; with a majority of Singaporeans (≥85%) staying in owner‐occupied public housing. We observed trends in health screening adherence and health behaviours among residents of a multi‐ethnic public rental‐flat community in Singapore from 2013 to 2017, after participation in a free, access‐enhanced multi‐modality screening programme in 2011. Residents staying in neighbouring owner‐occupied housing who participated in the same screening programme served as a basis of comparison. A total of 478 rental‐flat residents and 505 owner‐occupied flat residents participated. In the rental‐flat community, hypertension screening rates improved from 18.3% (24/131) in 2013, to 61.2% (52/85) in 2015 and 44.2% (34/77) in 2017 (p < .001). For diabetes, rates improved from 26.2% (43/164) → 47.0% (54/115) → 49.5% (45/91; p < .001). For dyslipidaemia screening, rates improved from 18.2% (31/170) → 39.6% (38/96) → 47.5% (38/80; p < .001). In the owner‐occupied community (n = 505), screening rates largely remained stagnant (hypertension: 52.2% → 75.0% → 54.5%, p = .059; diabetes: 66.0% → 56.5% → 66.7%, p = .434; dyslipidaemia: 53.1% → 50.0% → 57.1%, p = .818). In the rental‐flat community, unhealthy behaviours increased from 2013 to 2017, with higher proportions of overweight (30.4% → 24.8% → 52.1%, p < .001), higher smoking (11.7% → 36.9% → 32.5%, p < .001) and higher drinking rates (1.4% → 0.7% → 8.1%, p < .001). This shift was also reflected in the owner‐occupied community, with higher percentages of overweight and higher drinking rates (p < .001).     

Non‐pharmacological interventions to prevent hospital or nursing home admissions among community‐dwelling older people with dementia: A systematic review and meta‐analysis

Older people with dementia more frequently experience episodes of hospital care, transferal to nursing home and adverse events when they are in these environments. This study synthesised the available evidence examining non‐pharmacological interventions to prevent hospital or nursing home admissions for community‐dwelling older people with dementia. Seven health science databases of all dates were searched up to 2 December 2019. Randomised controlled trials and comparative studies investigating non‐pharmacological interventions for older people with dementia who lived in the community were included. Meta‐analyses using a random‐effect model of randomised controlled trials were used to assess the effectiveness of interventions using measures taken as close to 12 months into follow‐up as reported. Outcomes were risk and rate of hospital and nursing home admissions. Risk ratio (RR) or rate ratios (RaR) with 95% confidence interval were used to pool results for hospital and nursing home admission outcomes. Sensitivity analyses were conducted to include pooling of results from non‐randomised trails. Twenty studies were included in the review. Community care coordination reduced rate of nursing home admissions [(2 studies, n = 303 people with dementia and 86 patient–caregiver dyads), pooled RaR = 0.66, 95% CI (0.45, 0.97), I² = 0%, p = .45]. Single interventions of psychoeducation and multifactorial interventions comprising of treatment and assessment clinics indicated no effect on hospital or nursing home admissions. The preliminary evidence of community care coordination on reducing the rate of nursing home admissions may be considered with caution when planning for community services or care for older people living with dementia.     

X‐Chromosome Genetic Association Test Accounting for X‐Inactivation,Skewed X‐Inactivation,and Escape from X‐Inactivation

X‐chromosome inactivation (XCI) is the process in which one of the two copies of the X‐chromosome in females is randomly inactivated to achieve the dosage compensation of X‐linked genes between males and females. That is, 50% of the cells have one allele inactive and the other 50% of the cells have the other allele inactive. However, studies have shown that skewed or nonrandom XCI is a biological plausibility wherein more than 75% of cells have the same allele inactive. Also, some of the X‐chromosome genes escape XCI, i.e., both alleles are active in all cells. Current statistical tests for X‐chromosome association studies can either account for random XCI (e.g., Clayton's approach) or escape from XCI (e.g., PLINK software). Because the true XCI process is unknown and differs across different regions on the X‐chromosome, we proposed a unified approach of maximizing likelihood ratio over all biological possibilities: random XCI, skewed XCI, and escape from XCI. A permutation‐based procedure was developed to assess the significance of the approach. We conducted simulation studies to compare the performance of the proposed approach with Clayton's approach and PLINK regression. The results showed that the proposed approach has higher powers in the scenarios where XCI is skewed while losing some power in scenarios where XCI is random or XCI is escaped, with well‐controlled type I errors. We also applied the approach to the X‐chromosomal genetic association study of head and neck cancer.     

Was it good for you too? Impediments to conducting university‐based collaborative research with communities experiencing disadvantage

Objective: Collaborative and participatory research (CPR) models are increasingly recognised as methodologically, ethically and practically appropriate to conducting health and welfare research involving disadvantaged communities. This paper identifies impediments to CPR and proposes measures to support and encourage future CPR in Australian universities.
Methods: This paper draws on a small qualitative study of university-based CPR projects in Melbourne. The study involved a literature review and interviews with 23 participants, comprising university-based researchers and community liaison officers, and community representatives involved in university-based research projects.
Results: The paper outlines four main difficulties encountered by university-based researchers and community liaison staff in conducting CPR. These are: managing community sensitivities, the time-consuming nature of the work and diverse tasks involved, difficulty securing adequate research funding, and a concern that CPR was detrimental to academic careers.
Conclusion: CPR in universities might be supported in the future through providing CPR training for researchers, employing additional community liaison staff, recognising community reports within the Australian research quality evaluation system Excellence in Research for Australia, adopting supportive policies within universities and provision of dedicated CPR funding.
Implications: In the current Australian university context of competitive funding, further research into CPR nationally, alongside dedicated resources and policies are required to maximise the benefits of this approach.     

Investigation of 2‐stage meta‐analysis methods for joint longitudinal and time‐to‐event data through simulation and real data application

Background

Joint modelling of longitudinal and time‐to‐event data is often preferred over separate longitudinal or time‐to‐event analyses as it can account for study dropout, error in longitudinally measured covariates, and correlation between longitudinal and time‐to‐event outcomes. The joint modelling literature focuses mainly on the analysis of single studies with no methods currently available for the meta‐analysis of joint model estimates from multiple studies.

Methods

We propose a 2‐stage method for meta‐analysis of joint model estimates. These methods are applied to the INDANA dataset to combine joint model estimates of systolic blood pressure with time to death, time to myocardial infarction, and time to stroke. Results are compared to meta‐analyses of separate longitudinal or time‐to‐event models. A simulation study is conducted to contrast separate versus joint analyses over a range of scenarios.

Results

Using the real dataset, similar results were obtained by using the separate and joint analyses. However, the simulation study indicated a benefit of use of joint rather than separate methods in a meta‐analytic setting where association exists between the longitudinal and time‐to‐event outcomes.

Conclusions

Where evidence of association between longitudinal and time‐to‐event outcomes exists, results from joint models over standalone analyses should be pooled in 2‐stage meta‐analyses.     

自动体外除颤仪——角色与应用

介绍了自动体外除颤仪（Automated External Defibrillator，AED）的实用功能与便捷操作以及它在“公众启动除颤”计划中所扮演的角色。阐述了如何在急救中将AED与心肺复苏有机地衔接起来，即救援人员力争尽快使用AED对可除颤性心脏骤停实施早期电除颤，并立即接以胸部心脏按压。指出了中国AED的应用现状与不足，并对AED的发展前景进行了展望。     

People with dementia attending farm‐based day care in Norway – Individual and farm characteristics associated with participants’ quality of life

Farm‐based day care for people with dementia is supposed to improve the participants quality of life by using activities and resources of the farm environment to promote mental and physical health. In this paper, we describe the characteristics of those attending farm‐based day care services in Norway and explore the association between individual and farm characteristics and the quality of life. A sample of 94 people with dementia who attended farm‐based day care was recruited from 25 farms between January 2017 and January 2018. The data collection was performed using standardized instruments. Information about the farms was retrieved from a former study. The association between the participants’ quality of life and their individual and/or farm characteristics was examined with a linear multilevel regression model. The participants had a mean age of 76 years, 62% were men, and 68% had additional education after primary school. Most of them had mild (54.3%) or questionable dementia (18.3%). A few participants used antipsychotics (3.7%), tranquilizers (9.9%) and painkillers (13.6%), while a higher number used antidepressants (30.9%). Quality of life was associated with the experience of having social support (p = .023), a low score on depressive symptoms (p < .001), and spending time outdoors at the farm (p < .001). The variation between the farm‐based day care services in the participants’ reported quality of life was related to time spent outdoors at the farm. In light of the present study, it seems as farm‐based day care is addressing people with dementia in an early stage, dominated by men, with quite good physical and medical condition. The strong association between quality of life and spending time outdoors underscores that facilitation for outdoor activity should be prioritized in all types of dementia care.     

Nursing Home Versus Community Resuscitation After Cardiac Arrest: Comparative Outcomes and Risk Factors

ObjectiveTo investigate the characteristics and outcomes of patients who experienced cardiac arrest in nursing homes compared with those in private residences and determine prognostic factors for survival.DesignThis was a retrospective study that analyzed data from an Utstein-style registry of the Tokyo Fire Department.Setting and ParticipantsWe identified patients aged ≥65 years who experienced cardiac arrest in a nursing home or private residence from the population-based registry of out-of-hospital cardiac arrests in Tokyo, Japan, from 2014 to 2018.MethodsPatients were grouped into the nursing home or the private residence groups according to their cardiac arrest location. We compared the characteristics and outcomes between the 2 groups and determined prognostic factors for survival in the nursing home group. The primary outcome was 1-month survival after cardiac arrest.ResultsIn total, 37,550 patient records (nursing home group = 6271; private residence group = 31,279) were analyzed. Patients in the nursing home group were significantly older and more often had witnessed arrest, bystander cardiopulmonary resuscitation (CPR), and shock delivery using an automated external defibrillator. The 1-month survival rate was significantly higher in the nursing home group (2.6% vs 1.8%, P < .001). In the best scenario (daytime emergency call, witnessed cardiac arrest, bystander CPR provided), the 1-month survival rate after cardiac arrest in the nursing home group was 8.0% (95% confidence interval 6.4–9.9%), while none survived if they had neither witness nor bystander CPR.Conclusions and ImplicationsSurvival outcome was significantly better in the nursing home group than in the private residence group and was well stratified by 3 prognostic factors: emergency call timing, witnessed status, and bystander CPR provision. Our results suggest that a decision to withhold vigorous treatment solely based on nursing home residential status is not justified, while termination of resuscitation may be determined by considering significant prognostic factors.