Basic life support training programme in schools by school nurses: How long and how often to train?

Background:Cardiopulmonary resuscitation (CPR) training in schools, despite being legislated in Spain, is not established as such within the subjects that children are taught in schools.Objective:to evaluate the acquisition of CPR skills by 11-year-old children after a brief theoretical-practical teaching programme taught by nurses at school.Methods:62 students were assessed in a quasi-experimental study on 2 cohorts (51.4% of the sample in control group [CG]). In total, 2 sessions were given, a theoretical one, and a practical training for skill development in children, in which the CG performed the CPR in 2-minute cycles and the intervention group in 1-minute cycles. The anthropometric variables recorded were weight and height, and the variables compression quality and ventilation quality were recorded using the Laerdal ResusciAnne manikin with Personal Computer/Wireless SkillReport.Results:The assessment showed better results, in terms of BLS sequence performance and use of automated external defibrillator, in the CG and after training, except for the evaluation of the 10-second breathing assessment technique. The quality of chest compressions was better in the CG after training, as was the quality of the ventilations. There were no major differences in CPR quality after training and 4 months after the 1-minute and 2-minute training cycles.Conclusions:11-year-old children do not perform quality chest compressions or ventilations but, considering their age, they are able to perform a BLS sequence correctly.     

Recommendations for improving cardiopulmonary resuscitation skills retention.

Massive community efforts are devoted to delivering cardiopulmonary resuscitation (CPR) training to health professionals and lay people. However, although most people can successfully learn to perform CPR, skills retention is universally poor. Beginning as early as 2 weeks after initial training, CPR skills begin to deteriorate in a wide variety of subjects including nurses, physicians, emergency medical technicians, family members of patients with cardiac disease, and other lay people. Methods tested to improve retention are reviewed, and the role of practice and review is examined. The failure of many factors to improve retention of CPR skills is discussed. Finally, suggestions for improvement in retention of CPR skills based on a review of the literature and pertinent theory are offered.     

Current concepts in cardiopulmonary resuscitation

For many people cardiac arrest is a natural ending of a long and productive life. A substantial number of humans, however, are struck by this event too early in life with tragic consequences including financial problems for both family and society. A recent review of in-hospital cardiac arrests found a wide variation in the reported survival to discharge ranging from 0% to 28.9% with a mean of 14%1. This is largely explained by underlying diseases. In out-of-hospital cardiac arrests the survival to discharge is similar2, 3. fewer than 3% of cardiac arrest victims leave the hospital alive and return to productive lives. The reasons for these depressing results are multifactorial including rapidity and sequence with which the resuscitation interventions are delivered. Bystander CPR is an important link in "the chain of survival" before more advanced interventions will be available at the scene. 4 CPR training programmes for lay people have been organised in many countries with millions of people trained in basic CPR. It is important to continue this education of lay people since at the moment early bystander CPR, besides defibrillation, is probably the single most important intervention. The concept of early activation of the emergency medical System, early basic life support (BLS), including precordial compression and artificial ventilation, early defibrillation, and early advanced cardiac life support (ACLS), could achieve 25-40% survival rates.3 These concepts for emergency cardiac care have been supported by the American Heart Association5 as well as the European Resuscitation Counil.6 Advanced cardiac life support protocols combine pharmacological and mechanical interventions to restore spontaneous circulation (ROSC) and is based on four components: early defibrillation, administration of drugs, ventilation (oxygenation), and circulatory support.     

A profile of BLS and ACLS instructors

STUDY OBJECTIVE: To examine factors that motivate people to become and remain basic life support (BLS) and advanced cardiac life support (ACLS) instructors. DESIGN: A questionnaire was mailed to 967 BLS and ACLS instructors. SETTING: The study was performed in the San Francisco Bay Area. TYPE OF PARTICIPANTS: All BLS and ACLS instructors whose names were registered with the Santa Clara County Affiliate of the American Heart Association. RESULTS: Although there is room for improvement, 81% of the instructors were satisfied with their jobs. "Satisfaction in performing a valuable service" was the predominant reason they became instructors. "Lack of time" was the main factor causing people to stop teaching. CONCLUSION: The majority of BLS and ACLS instructors surveyed were quite happy. The current system appears to be working in that the teachers themselves are satisfied. An accurate portrait of BLS and ACLS instructors is crucial for organizations such as the American Heart Association if they wish to attract and retain instructors.     

Effectiveness of Emergency Medical Services for Victims of Out-of-Hospital Cardiac Arrest: A Metaanalysis

Study objective: To determine the relative effectiveness of differences in response time interval, proportion of bystander CPR, and type and tier of emergency medical services (EMS) system on survival after out of hospital cardiac arrest. Methods: We performed a comprehensive literature search, excluding EMS systems other than those of interest (systems of interest were those comprising one tier with providers of basic life support [BLS] or advanced life support [ALS] and those comprising two tiers with providers of BLS or BLS-defibrillation followed by ALS), patient population of fewer than 100 cardiac arrests, studies in which we could not determine the total number of arrests of presumed cardiac origin, and studies lacking data on survival to hospital discharge. Metaanalysis using generalized linear model with dispersion estimation for random effects was then performed. Results: Increased survival to hospital discharge was significantly associated with tier (P<.01), response time interval (P <.01), and bystander CPR (P=.04). A significant interaction was detected between response time interval and bystander CPR (P=.02). For the studies analyzed, survival was 5.2% in a one-tier EMS system or 10.5% in a two-tier EMS system. A 1-minute decrease in mean response time interval was associated with absolute increases in survival rates of .4% and .7% in a one-tier and two-tier EMS systems, respectively. Conclusion: Increased survival to hospital discharge may be associated with decreased response time interval and with the use of a two-tier EMS system as opposed to a one-tier system. The data available for this analysis were suboptimal. Policymakers need more methodologically rigorous research to have more reliable and valid estimates of the effectiveness of different EMS systems. [Nichol G, Detsky AS, Stiell IG, O'Rourke K, Wells G, Laupacis A: Effectiveness of emergency medical services for victims of out-of-hospital cardiac arrest: A metaanalysis. Ann Emerg Med June 1996;27:700-710.]Heart disease is the most common cause of death in the United States.¹ Such deaths are often due to cardiac arrest, the sudden cessation of cardiac mechanical activity manifested by the absence of a detectable pulse, unresponsiveness, and lack of breathing.² Emergency medical services (EMS) systems have evolved into multifaceted advanced cardiac life support systems involving CPR, defibrillation, artificial ventilation, intubation, and administration of medication.Controversy exists about the effectiveness of different methods of emergency cardiac care because of wide variation in reported survival among centers³, ranging from 0%⁴ to 44%.⁵ This variation may be attributable to differences in the type of EMS system, proportion of victims receiving bystander CPR, response time intervals of providers, or geography of the city in question.⁶ Furthermore, different approaches to reporting survival make comparison of studies difficult. ^{[6] , [7] and [8]} A consensus conference has offered guidelines for uniform reporting of results to facilitate comparison of results.²The purpose of this analysis was to estimate the relative effectiveness of the type and tier of an EMS system, unit response time interval of providers, and rate of bystander CPR on survival after out-of-hospital cardiac arrest. Using a protocol developed a priori, we performed a metaanalysis based on conventional techniques. ^{[9] and [10]} The protocol comprised selection criteria for the primary studies, definitions of the primary endpoints, and an analysis plan.¹¹ The metaanalysis was part of a larger cost-effectiveness analysis of improvements to EMS systems for out-of-hospital cardiac arrest. The results of the cost-effectiveness analysis are reported elsewhere.¹²Definitions of terms The organization of an EMS system may vary both in the degree of training of the health care providers, as well as in the number of vehicles responding to a medical emergency. No universally accepted nomenclature exists for categorizing EMS systems, and some terms may have different meanings for different people.To facilitate clarity and understanding, the following terms are defined. Emergency health care providers vary in the degree of their training and may or may not transport patients to the hospital. Basic life support (BLS) providers administer oxygen and CPR to victims of cardiac arrest. Providers of BLS with defibrillation (BLS-D) defibrillate patients using automated or manual defibrillators. Finally, advanced life support (ALS) providers are trained to perform endotracheal intubation and to administer IV medications. BLS or BLS-D level care may be provided by emergency medical technicians (EMTs) in ambulances or by firefighters in pump vehicles or vans. Generally, ALS care is only provided by EMTs in ambulances. These personnel are referred to by others as "paramedics."The team that responds to a cardiac arrest in a given city may be part of a one-tier or two-tier EMS system. In a one-tier EMS system, a single provider and vehicle type responds to medical emergencies. In a two-tier system, two types of providers and/or vehicles respond. The vehicles may include ambulances, which respond from ambulance bases; or pump vehicles or vans, which respond from fire stations. In two-tier EMS systems, BLS providers (first tier) usually arrive more quickly because more generally are serving a community. In American cities with two-tier EMS systems, the second responding providers (second tier) have ALS capability. About 75% of the American urban population is served by a two-tier rather than by a one-tier EMS system.¹⁴In this analysis we considered five configurations of EMS systems: (1) one tier with BLS providers, (2) one tier with BLS-D providers, (3) one tier with ALS providers, (4) two tiers with BLS followed by ALS (BLS + ALS) providers, and (5) two tiers with BLS-D followed by ALS (BLS-D + ALS) providers.     

Teaching Basic Life Support to Students of Public and Private High Schools

Background

Despite being recommended as a compulsory part of the school curriculum, the teaching of basic life support (BLS) has yet to be implemented in high schools in most countries.

Objectives

To compare prior knowledge and degree of immediate and delayed learning between students of one public and one private high school after these students received BLS training.

Methods

Thirty students from each school initially answered a questionnaire on cardiopulmonary resuscitation (CPR) and use of the automated external defibrillator (AED). They then received theoretical-practical BLS training, after which they were given two theory assessments: one immediately after the course and the other six months later.

Results

The overall success rates in the prior, immediate, and delayed assessments were significantly different between groups, with better performance shown overall by private school students than by public school students: 42% ± 14% vs. 30.2% ± 12.2%, p = 0.001; 86% ± 7.8% vs. 62.4% ± 19.6%, p < 0.001; and 65% ± 12.4% vs. 45.6% ± 16%, p < 0.001, respectively. The total odds ratio of the questions showed that the private school students performed the best on all three assessments, respectively: 1.66 (CI95% 1.26-2.18), p < 0.001; 3.56 (CI95% 2.57-4.93), p < 0.001; and 2.21 (CI95% 1.69-2.89), p < 0.001.

Conclusions

Before training, most students had insufficient knowledge about CPR and AED; after BLS training a significant immediate and delayed improvement in learning was observed in students, especially in private school students.     

Retenção das Habilidades de Ressuscitação Cardiopulmonar nos Estudantes de Medicina

BackgroundReduction of mortality and sequelae of cardiac arrest depends on an effective and fast intervention, started as soon as possible. Basic life support involves a series of steps that may be initiated out of the hospital setting and taught to any person in specific courses. However, it is important that the rescuers retain the knowledge and skills to perform cardiopulmonary resuscitation (CPR), as one never knows when they will be required. Studies have shown that a loss of skills occurs as early as 30 days after the training course, with variations according to personal and professional characteristics.Objectivesto assess whether medical students are able to retain skills acquired in a BLS course for more than six months.MethodsProspective, case-control, observational study. Medical students attended a 40-hour course on sudden death and cardiac arrest. Skills acquired during the course were evaluated immediately after and six months after the course. Students’ individual scores were compared between these time points, the percentage of correct answers was evaluated, and overall performance was rated as excellent, good, and poor. Observers and evaluation criteria were the same immediately after the course and six months later. Data were analyzed using the paired t-test and the McNemar test. The 95% confidence interval was established, and a p < 0.05 was set as statistically significant.ResultsFifty students (27 female) in the first year of medical school aged from 18 to 24 years (mean of 21 years) attended the course. The number of steps successfully completed by the students at six months was significantly lower than immediately after the course (10.8 vs 12.5 p < 0.001). Neither sex nor age affected the results. Overall performance of 78% of the students was considered excellent immediately after the course, and this percentage was significantly higher than six months later (p < 0.01). After six months, the steps that the students failed to complete at six months were those related to practical skills (such as a correct hand positioning).ConclusionA significant loss of skills was detected six months after the BLS course among medical students, compromising their overall performance.     

CPR skills retention of lay basic rescuers

In 1979-1980, 950 telephone company personnel were trained and tested at the basic rescuer level on recording manikins. In October 1981, a random group of 40 were retested without warning on the recording manikin. Skills retention was measured by comparing the tapes from training and retesting. Sixteen (40%) of those retested were able to perform effective ventilations and compressions of the manikin with 60% to 70% average retention compared to their training scores. The remaining 24 (60%) had ineffective ventilations or compressions or both. The two groups did not differ in the performance level achieved during training, or in the time interval between training and retesting. Eleven individuals retested at 13 to 14 months did not perform better than those retested later, suggesting the maximum skills deterioration had occurred within the first year. However, the effective performance group on the average were younger, and the majority had first aid training in addition to their CPR training. Only one had CPR retraining. This study supports the following recommendations: 1) lay basic rescuers should be retrained within the first year; 2) further studies of the factors influencing retention are advisable; 3) the younger age groups should be the first priority for citizen CPR training; and 4) because first aid training appears to improve CPR retention, training in both should be encouraged.     

Non-resuscitative first aid training and assessment for junior secondary school students: A pre-post study

School-based first aid interventions can contribute to the number of adults trained in first aid in the community over time but few studies have examined the effectiveness of teaching non-resuscitative first aid on knowledge, attitudes and skills. Currently, there is no consensus on the optimal content and duration of first aid training for junior secondary students. The aim of this study was to evaluated the effectiveness of a 2.5 hour introductory non-resuscitative first aid course for junior secondary students.This prospective, single-centre, pre-post study included 140 students (11–13 years old). Students completed a questionnaire on first aid knowledge, attitude towards first aid and self-confidence to perform first aid before and after a training session. Six emergency medicine physicians taught practical first aid skills training. A game-based formative assessment was undertaken where the instructors assessed small teams of students’ role-playing injured classmates and first aid responders (and vice-versa) treating abrasions, ankle sprain, choking and a scald injury.Few students had prior first aid training (14%). After adjusting for student''s age, sex, prior first aid training and format delivery, the course was associated with increased mean knowledge score (pre-training 53%, post-training 88%; mean difference [MD] 35%, 95% CI: 32% to 38%), positive attitudes and more confidence in performing first aid after training (all P < .001). All teams showed a good level of competency in treating simulated injuries with first aid kits.This brief non-resuscitative first aid course was associated with noticeable and valuable changes in knowledge score and self-confidence level in performing first aid. The game-based formative assessment facilitated a positive learning environment for skill competency evaluation.     

Study of pre-hospital care of out of hospital cardiac arrest victims and their outcome in a tertiary care hospital in India

BackgroundIndia does not have a formal cardiac arrest registry or a centralized emergency medical system. In this study, we aimed to assess the prehospital care received by the patients with OHCA and predict the factors that could influence their outcome.MethodsOut-of-hospital cardiac arrest patients presenting to the emergency department in a tertiary care centre were included in the study. Prehospital care was assessed in terms of bystander cardiopulmonary resuscitation (CPR), mode of transport, resuscitation in ambulance. OHCA outcomes like Return of spontaneous circulation (ROSC), survival to hospital discharge and favourable neurological outcome at discharge were assessed.ResultsAmong 205 patients, the majority were male (71.2%) and were above 60 years of age (49.3%); Predominantly non-traumatic (82.4%). 30.7% of the patients had sustained cardiac arrest in transit to the hospital. 41.5% of patients reached hospital by means other than ambulance. Only 9.8% patients had received bystander CPR. Only 12.5% ambulances had BLS trained personnel. AED was used only in 1% of patients. The initial rhythm at presentation to the hospital was non-shockable (96.5%). Return of spontaneous circulation (ROSC) was achieved in 17 (8.3%) patients, of which only 3 (1.4%) patients survived till discharge. The initial shockable rhythm was a significant predictor of ROSC (OR 18.97 95%CI 3.83–93.89; p < 0.001) and survival to discharge (OR 42.67; 95%CI 7.69–234.32; p < 0.001).ConclusionThe outcome of OHCA in India is dismal. The pre-hospital care received by the OHCA victim needs attention. Low by-stander CPR rate, under-utilised and under-equipped EMS system are the challenges.     

Lay rescuer automated external defibrillator ("public access defibrillation") programs: lessons learned from an international multicenter trial: advisory statement from the American Heart Association Emergency Cardiovascular Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Council on Clinical Cardiology

Lay rescuer automated external defibrillator (AED) programs may increase the number of people experiencing sudden cardiac arrest who receive bystander cardiopulmonary resuscitation (CPR), can reduce time to defibrillation, and may improve survival from sudden cardiac arrest. These programs require an organized and practiced response, with rescuers trained and equipped to recognize emergencies, activate the emergency medical services system, provide CPR, and provide defibrillation. To determine the effect of public access defibrillation (PAD) programs on survival and other outcomes after SCA, the National Heart, Lung, and Blood Institute, the American Heart Association (AHA), and others funded a large prospective randomized trial. The results of this study were recently published in The New England Journal of Medicine and support current AHA recommendations for lay rescuer AED programs and emphasis on planning, training, and practice of CPR and use of AEDs. The purpose of this statement is to highlight important findings of the Public Access Defibrillation Trial and summarize implications of these findings for healthcare providers, healthcare policy advocates, and the AHA training network.     

Attitudes of BCLS instructors about mouth-to-mouth resuscitation during the AIDS epidemic

We surveyed 5,823 American Heart Association Virginia Affiliate basic cardiac life support (BCLS) instructors to assess the impact that the acquired immunodeficiency syndrome (AIDS) epidemic has had on their attitudes, beliefs, and behaviors with respect to the training and performance of mouth-to-mouth (MTM) ventilation. The response rate by those whose mail survey could be delivered to a valid address was 41% (women, 63%; men, 37%; mean age, 38 +/- 1 years; health care providers, 87%; laypersons, 11%; and public safety workers, 2%). Of those surveyed, 49% had performed CPR within the past three years. Of these, 40% reported having hesitated to provide MTM ventilation at least once. Of those who had hesitated, more than one half identified fear of exposure to disease as the reason for their hesitation. Forty percent of all respondents had witnessed another provider hesitate to provide MTM ventilation. When presented with mock rescue scenarios, the majority of respondents indicated that they would not perform or would hesitate to perform MTM ventilation on most adult strangers. More than half felt that there was some risk of contracting AIDS from ventilating a manikin, and 71% said that their attitudes about providing CPR to strangers had changed as a result of the AIDS epidemic. We conclude that concern about AIDS appears to be adversely affecting the attitudes, beliefs, and self-reported behaviors of BCLS instructors in Virginia regarding the use of MTM ventilation on strangers.     

Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death

BackgroundMany seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients.ObjectiveTo determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care.DesignOpen-label randomized controlled trial.PatientsPatients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed.InterventionBoth the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid.Main MeasureThe primary outcome was the proportion of patients who had a no-CPR order at 14 days after enrollment.Key ResultsWe recruited 200 patients between October 2017 and October 2018. Mean age was 77 years. There was no difference between the groups in no-CPR orders 14 days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, − 0.2%) (95% confidence interval − 11 to 10%; p = 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0–100 with lower scores reflecting less conflict).ConclusionsAmong seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care.Primary Funding SourceCanadian Frailty Network, The Ottawa Hospital Academic Medical Organization.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06605-y.     

Checking for breathing: evaluation of the diagnostic capability of emergency medical services personnel, physicians, medical students, and medical laypersons

STUDY OBJECTIVE: International guidelines for cardiopulmonary resuscitation (CPR) recommend determination of unconsciousness, breathlessness, and absence of pulse to diagnose cardiorespiratory arrest. Thus far, there have been no scientifically proven data available regarding the quality of assessing breathlessness. The study objective was to evaluate the effectiveness of checking for breathing in an emergency situation, to determine the necessary amount of time until diagnosis, and to document used techniques. METHODS: Four different populations were tested for their ability to assess breathlessness: emergency medical services (EMS) personnel, physicians, medical students, and laypersons. Each participant was asked to perform the diagnostic procedure twice, first with a breathing or not-breathing unresponsive test person and then with a modified megacode manikin (with the possibility of simulated respiratory function). The order of testing and the respiratory status were strictly randomized. Diagnostic accuracy, time interval to diagnosis, and used techniques were documented. RESULTS: A total of 261 persons were tested in 522 trials, with a median time interval of 12 seconds for obtaining a diagnosis. Regarding all participants, the correct diagnosis was achieved in 81.0% (EMS personnel, 89.7%; physicians, 84.5%; medical students, 78.4%; laypersons, 71.5%). Only 55.6% of all participants showed correct diagnostic skills (EMS personnel, 91.3%; physicians, 51.5%; medical students, 61.9%; laypersons, 18.5%). CONCLUSION: Checking for breathing was shown to be mostly inaccurate and unreliable. This diagnostic procedure takes more time than recommended in international guidelines. Therefore CPR training should focus more on the determination of breathlessness. Also, the guidelines for CPR should be revised.     

Medical aspects of lay resuscitaions in Rotterdam

In the Rotterdam system of prehospital care for patients withcirculatory failure, the cardiopulmonary resuscitation (CPR)training programme for lay persons contributes to the firstlink in the chain of care, i.e. the period of time spent awaitingthe arrival of professional staff. In this paper we describessome of the medical aspects of this programme. The materialused was obtained in a study of 5312 trainees who had followeda CPR course. Case histories were reconstructed of 91 victimswho had been resuscitated by 109 respondents. At least 20% ofresuscitated persons had collapsed as a result of non-cardiaccauses. In this category the longer term survival rates wererelatively the most favourable. In several instances the indicationfor resuscitation had been incorrect, while the technical proficiencyin the delivery of CPR was often inadequate. We conclude thatone course is sufficient for the development of the required‘skill’. We also conclude that the courses shoulddwell more elaborately on the non-cardiac causes of collapse,particularly in training programmes addressing the public atlarge. Attention is drawn to the need of designing and implementingspecial courses for family members and relatives of personsknown to be cardiac patients. The need for continuing evaluation,involving active contributions from lay resuscitators, is underlined.     

Community trends in CPR training and use: the Minnesota Heart Survey.

STUDY OBJECTIVE: To examine community changes in self-reported CPR training and use from 1980-82 to 1985-87 using data obtained from the Minnesota Heart Survey. A comparative investigation of CPR training among blacks and whites in 1985-86 also was completed. DESIGN: Data were obtained in 1980-81, 1981-82, 1985-86, and 1986-87 from four population-based samples drawn from the seven-county Minneapolis-St Paul metropolitan area. To increase sample sizes and to compare prevalences of CPR training and use in the early 1980s with prevalences in the mid-1980s, the four Minnesota Heart Survey surveys were combined into two time periods, 1980-82 and 1985-87. A separate survey of black individuals was conducted in 1985, and these data were used in the comparisons between blacks and whites in 1985-86. RESULTS: The prevalence of whites trained in CPR increased significantly between 1980-82 and 1985-87 in both nonhealth professionals (18.5% vs 30.9%) and health professionals (71.9% vs 86.8%). No significant change was observed between the two periods in the percentage of nonhealth professionals who had ever used their CPR skills (9.7% vs 10.7%), whereas use among health professionals increased significantly (40.2% vs 53.4%). Training within the prior two or three years decreased from 1980-82 to 1985-87 among nonhealth professionals, but increases in recent training were observed among health professionals. There were no significant differences between black and white nonhealth professionals in the prevalence of CPR training. Black trainees, however, reported a higher percentage of ever using CPR skills than white trainees (15.4% vs 9.8%, respectively). Black trainees also had higher rates of recent CPR training than white trainees. No differences were observed between black and white health professionals regarding CPR training and use, or recency of certification. CONCLUSION: These results suggest that the percentage of individuals trained in CPR is increasing. Improvement is needed, however, in the rates of recent certification among nonhealth professionals.     

The myocardial infarct status of a South German population: results of the Augsburg myocardial infarct register l985

The Augsburg Myocardial Infarction Register recorded in 1985, 999 coronary events (734 men, 265 women) occurring in 25-74-year-old residents of the city of Augsburg and the counties of Augsburg and Aichach-Friedberg (study population: 156,489 men and 171,093 women). On average, 444 men and 138 women per 100,000 of the population suffered an acute myocardial infarction (AMI) in 1985. The risk of morbidity increased with age in both men and women, but gained significance for women only after their 55th year of life. The 28-day case fatality was 54% for male AMI cases and 66% for females; 34% of the AMI patients died without ever reaching a hospital. Cardiopulmonary resuscitation (CPR) was attempted by a physician in one-in-three of these out-of-hospital deaths. Although one of two out-of-hospital deaths occurred in the presence of a medical lay person; lay CPR was the exception. Broader population education in CPR techniques may thus constitute one method of reducing the number of early AMI deaths. The median prehospital time for interviewed hospital patients (66%) was 5 h, and approximately 2 h for patients with systemic thrombolysis (n = 71). The combination of fatal coronary events from the official cause-of-death statistics and the results from the Augsburg register were used to estimate AMI morbidity for the whole of the FRG in 1985. This leads to an expected morbidity of 210,000 AMI, of which 141,000 AMI will be fatal (both sexes).     

Formación de población adulta lega en soporte vital básico. Una revisión sistemática

Introduction and objectivesBystander assistance is decisive to enhance the outcomes of out-of-hospital cardiac arrest. Despite an increasing number of basic life support (BLS) training methods, the most effective formula remains undefined. To identify a gold standard, we performed a systematic review describing reported BLS training methods for laypeople and analyzed their effectiveness.MethodsWe reviewed the MEDLINE database from January 2006 to July 2018 using predefined inclusion and exclusion criteria, considering all studies training adult laypeople in BLS and performing practical skill assessment. Two reviewers independently extracted data and evaluated the quality of the studies using the MERSQI (Medical Education Research Study Quality Instrument) scale.ResultsOf the 1263 studies identified, 27 were included. Most of them were nonrandomized controlled trials and the mean quality score was 13 out of 18, with substantial agreement between reviewers. The wide heterogeneity of contents, methods and assessment tools precluded pooling of data. Nevertheless, there was an apparent advantage of instructor-led methods, with feedback-supported hands-on practice, and retraining seemed to enhance retention. Training also improved attitudinal aspects.ConclusionsWhile there were insufficiently consistent data to establish a gold standard, instructor-led formulas, hands-on training with feedback devices and frequent retraining seemed to yield better results. Further research on adult BLS training may need to seek standardized quality criteria and validated evaluation instruments to ensure consistency.     

Standards of medical care for nursing home residents in Europe

ObjectiveNursing home inhabitants represent the most vulnerable and frail group of older people. They have more complex medical backgrounds and more significant care requirements. With an ever-ageing European population, the number of people requiring nursing home care will only increase. It is important then that we optimise the medical care of older people living in nursing homes.MethodsFormalized care standards are essential to optimal care but we feel that such guidelines are lacking. We decided to investigate this by means of a survey on nursing home care standards sent to the geriatric medicine societies around Europe.ResultsOnly five of 25 (20%) health services have a requirement for specific training in geriatric medicine for doctors in nursing homes, while only three of 25 (12%) countries have written medical care standards applicable to nursing home care provided by professional organizations. Four of 25 (16%) had a nursing home doctor society and one of these, The Netherlands, provided written medical care standards for nursing homes which were also adopted by the relevant general practitioner society.DiscussionThe Europe-wide deficiency of documented care standards for nursing homes is alarming. It should be a prerequisite that physicians dealing with these complex patients have undertaken some level of specific training in geriatric medicine. It is important that geriatricians, old age psychiatrists and family doctors across European countries engage more formally on the development of appropriate models for both developing care standards and specifying appropriate training and support for doctors working in nursing homes.     

Effective school food environment interventions for the prevention of childhood obesity: systematic review and meta-analysis

BackgroundThe food environment is a modifiable enabler of dietary choices that can have a great impact on the prevention of childhood obesity in the UK. It is defined as a combination of physical, economic, political, and sociocultural surroundings as well as opportunities and conditions that influence food choice. Many interventions have been undertaken at the school level but evidence of their effectiveness in the reduction of childhood obesity is scarce. Therefore, we aimed to synthesise and evaluate the evidence of food environmental interventions around and within schools to determine effective parameters that can aid in childhood obesity prevention.MethodsWe searched CINAHL, Embase, Global Health, MEDLINE, Scielo, and Cochrane databases. The considered population were children aged 18 years or younger. Interventions focused on modification of the food environment in schools to prevent obesity and improve dietary intake. Outcomes included anthropometrical measures and dietary intake. The protocol was registered with PROSPERO (CRD42019125039). A second reviewer did a reliability check on 10% of abstracts, bias, and full-text review.FindingsBetween Jan 1, 2000, to Feb 12, 2019, we retrieved 4307 studies, of which 21 were included after screening. Interventions (13; 62%), policies (two; 10%), and laws (three; 14%) from eight countries, including the UK, were included. Four (19%) interventions focused on vending machines. Study designs included natural experiments (one; 5%), quasi-experiments (two; 6%), non-randomised (one; 5%), and randomised (four; 19%). The main outcomes were body-mass index z score (13; 62%) and dietary intake (n=4, 19%). A positive association (p=0·0451) was found in 15 (71%) studies between 0·89% and 1·29% reduction in obesity prevalence. The most frequent interventions were vending machines, school stores, cafeterias, and menu offering regulations.InterpretationIdentified effective interventions in the prevention of childhood obesity were banning of sugary drinks in schools and an increase in availability and accessibility of fruits and vegetables for children from an early age. Multisystem approaches, such as stringent and monitored school meal programmes, alongside the collaboration, training, education, and integration of the school staff, parents, and students, increased acceptability and adaptability according to the local needs and sustainability of the food environment interventions. Changes in the environment lead to individual behaviour modifications.FundingEuropean Commission (H2020 SC2).