Cardiopulmonary resuscitation standards for clinical practice and training in the UK

Professional Rescuers' experiences of motivation for cardiopulmonary resuscitation: A qualitative study

Rescuers' psychological competence, particularly their motivation, can improve the cardiopulmonary resuscitation outcomes. Data were collected using semistructured interviews with 24 cardiopulmonary resuscitation team members and analyzed through deductive content analysis based on Vroom's expectancy theory. Nine generic categories were developed: (i) estimation of the chance of survival; (ii) estimation of self-efficacy; (iii) looking for a sign of effectiveness; (iv) supportive organizational structure; (v) revival; (vi) acquisition of external incentives; (vii) individual drives; (viii) commitment to personal values; and (ix) avoiding undesirable social outcomes. When professional rescuers were called to perform cardiopulmonary resuscitation, they subjectively evaluated the patient's chance of survival, the likelihood of achieving of the desired outcome, and the ability to perform cardiopulmonary resuscitation interventions. If their evaluations were positive, and the consequences of cardiopulmonary resuscitation were considered favorable, they were strongly motivated to perform it. Beyond the scientific aspects, the motivation to perform cardiopulmonary resuscitation was influenced by intuitive, emotional, and spiritual aspects.

Hospital cardiac arrest resuscitation practice in the United States: a nationally representative survey

BACKGROUND

In-hospital cardiac arrest (IHCA) outcomes vary widely between hospitals, even after adjusting for patient characteristics, suggesting variations in practice as a potential etiology. However, little is known about the standards of IHCA resuscitation practice among US hospitals.

OBJECTIVE

To describe current US hospital practices with regard to resuscitation care.

DESIGN

A nationally representative mail survey.

SETTING

A random sample of 1000 hospitals from the American Hospital Association database, stratified into 9 categories by hospital volume tertile and teaching status (major teaching, minor teaching, and nonteaching).

SUBJECTS

Surveys were addressed to each hospital's cardiopulmonary resuscitation (CPR) committee chair or chief medical/quality officer.

MEASUREMENTS

A 27-item questionnaire.

RESULTS

Responses were received from 439 hospitals with a similar distribution of admission volume and teaching status as the sample population (P = 0.50). Of the 270 (66%) hospitals with a CPR committee, 23 (10%) were chaired by a hospitalist. High frequency practices included having a rapid response team (91%) and standardizing defibrillators (88%). Low frequency practices included therapeutic hypothermia and use of CPR assist technology. Other practices such as debriefing (34%) and simulation training (62%) were more variable and correlated with the presence of a CPR committee and/or dedicated personnel for resuscitation quality improvement. The majority of hospitals (79%) reported at least 1 barrier to quality improvement, of which the lack of a resuscitation champion and inadequate training were the most common.

CONCLUSIONS

There is wide variability among hospitals and within practices for resuscitation care in the United States with opportunities for improvement.

Assessment of a group of nigerian dental students' education on medical emergencies

BACKGROUND

The training of dental students in the management of medical emergencies is of utmost importance as they may encounter some of these emergencies at some point in their career.

AIM

The aim of this study was to evaluate the medical emergency education in a Nigerian Dental School.

SUBJECTS AND METHODS

This descriptive cross-sectional study was carried out among 124 final year dental students of the University of Benin, Benin City. Data was collected using a self-administered questionnaire. The questionnaire elicited information on demography, knowledge of inclusion of a medical emergency in the dental curriculum, knowledge of guidelines on medical emergency formulated by any dental authority, opinion on the comprehensiveness of the present training on medical emergency, type of medical emergency training received, previous encounter with a medical emergency, previous participation in emergency drills and knowledge of the content of an emergency kit. Descriptive statistics was carried out on the collected data.

RESULTS

Only 58.1% (72/124) respondents were aware of the inclusion of a medical emergency in the dental curriculum and fewer, 17.7% (22/124), were aware of guidelines on medical emergency formulated by any dental authority. Fifty-two out of all the respondents (41.9%) claimed not to have received any form of training on medical emergency. Only 22.6% (28/123) had previously participated in an emergency drills and just 34.7% (43/124) had ever seen an emergency kit.

CONCLUSIONS

It can be concluded from this study that the level of training and level of knowledge on medical emergencies of the studied dental students is below desirable standard. It is therefore necessary to put proper strategies in place to strengthen their identified areas of weakness.

Audits of emergency trolleys’ contents in selected hospitals in Botswana

Cardiac arrest is a life-threatening emergency situation. The outcome depends on timely and effective cardio-pulmonary resuscitation (CPR). Successful CPR attempts in hospitals require well-equipped emergency trolleys and properly functioning equipment, as well as staff members skilled in performing CPR. The study aimed to determine whether the emergency trolleys in Botswana’s hospitals’ wards or units met the expected standards. The contents of the emergency trolleys in 20 wards or units of two referral government hospitals in Botswana were audited by using a standardised checklist. No hospital ward or unit had all the expected equipment or drugs on its emergency trolley, some units failed to check their emergency trolleys’ contents daily. All 20 hospital wards or units that participated in this study, needed to improve the contents and maintenance of their emergency trolleys, otherwise in-hospital CPR efforts in Botswana might be doomed to failure, losing lives that could have been saved if emergency trolleys’ equipment and supplies had been up to standard.OpsommingHartarres is ‘n lewensbedreigende noodsituasie. Die uitkoms word bepaal deur tydige en effektiewe kardio-pulmonale resussitasie (KPR). Suksesvolle KPR pogings in hospitale vereis goed toegeruste noodtrollies en toerusting wat behoorlik funksioneer, asook personeellede wat bedrewe is in die uitvoering van KPR. Die studie het gepoog om te bepaal of die noodtrollies in Botswana se hospitaalsale of eenhede aan die verwagte standaarde voldoen. Die inhoud van die noodtrollies in 20 sale of enhede van twee van Botswana se hospitale is ge-ouditeer deur ‘n gestandardiseerde kontrolelys te benut. Geen hospitaalsaal of eenheid het al die verwagte toerusting of drogerye op sy noodtrollie gehad nie, sommige eenhede het nie hulle noodtrollies se inhoud gereeld gekontroleer nie. Al 20 hospitaalsale of eenhede wat aan die studie deelgeneem het, moet die inhoud en instandhouding van hulle noodtrollies verbeter, anders kan in-hospitaal KPR pogings in Botswana tot mislukkings gedoem wees, waardeur lewens verloor word wat gered kon gewees het, indien die noodtrollies se inhoud op standaard was.

Do our newly graduated medical doctors have adequate knowledge about neonatal resuscitation?

CONTEXT AND OBJECTIVE

Neonatal resuscitation should be part of medical school curriculums. We aimed to evaluate medical school graduates' knowledge of neonatal resuscitation.

DESIGN AND SETTING

Cross-sectional study on the performance of candidates sitting a medical residency exam at Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, in 2004.

METHODS

There were two questions on neonatal resuscitation. One question in the theory test aimed at evaluating basic knowledge on the initial approach towards newly born infants. The question in the practical exam was designed to evaluate the candidate's ability to perform the initial steps of resuscitation and to establish bag-mask ventilation.

RESULTS

Out of 642 candidates from 74 medical schools, 151 (23.5%) answered the theory question correctly. Significantly more physicians from public medical schools in the State of São Paulo answered correctly than did those from other schools in Brazil (52.5% versus 9.2%; p < 0.05). A total of 436 candidates did the practical exam. The grades among graduates from medical schools belonging to the State of São Paulo were significantly higher than among those from other schools (5.9 +/- 2.6 versus 4.1 +/- 2.1; p < 0.001). The grades for the practical question among candidates who had answered the theory question correctly were significantly higher than those obtained by candidates who had given wrong answers (p < 0.05).

CONCLUSION

Medical school graduates' knowledge of neonate resuscitation in the delivery room is quite precarious. Emphasis on neonatal resuscitation training is urgently needed in medical schools.