Awareness and attitude of final year students towards the learning and practice of cardiopulmonary resuscitation at the University of Ibadan in Nigeria

An evaluation of basic life support training among medical students in Southwest Nigeria: A web-based study

Background

Basic Life Support (BLS) is considered a lifesaving measure and sound knowledge is expected among health professionals. Studies conducted among medical doctors and students in many developing countries show deficiencies in knowledge and practice of essential BLS skills. This study assessed the awareness, knowledge, perception, practice, accessibility and barriers to BLS training amongst medical students in South-Western Nigeria, exposing skill gaps and training challenges to inform appropriate solutions.

Methods

This was a cross-sectional descriptive e-survey involving 2^nd - 6^th year medical students enrolled in 12 regional medical schools. Overall, 553 responses were received over a 3-month period from November 2020 to January 2021 and analyzed using IBM-SPSS 26.

Results

Of the 553 respondents, 79.2% were aware of BLS however only 160 (29%) respondents had good knowledge of BLS principles. Increasing age, higher level of study, prior BLS training and being enrolled in College of Medicine, University of Lagos (CMUL) were significantly associated with a higher knowledge score (p<0.05). Majority (99.5%) considered BLS training necessary however, only 51.3% had prior training. Increased level of study correlated with prior BLS training (p<0.05) alongside higher BLS uptake by respondents from CMUL (26.7%) and College of Medicine, University of Ibadan (20.9%) compared to respondents from other schools (p<0.05). Only 35.4% had ever done Cardiopulmonary Resuscitation. Most respondents reported no confidence in performing BLS (67.1%) or in using an Automated External Defibrillator (85.7%). Unavailability of training opportunities in state (35%), town (42%) and cost (27%) were major barriers to BLS training identified.

Conclusion

Despite a high level of awareness of BLS training, knowledge of BLS principles and its practice is poor among Nigerian medical students, reflecting a need to integrate stand-alone/structured BLS trainings into the medical curriculum to increase participation and accessibility by medical students.

Lifesaving skills training in schools - A qualitative study to explore students, teachers, and parent's perceived opportunities and challenges

OBJECTIVE

The objective of this study is to explore the perception of teachers, parents and students' regarding implementation of a school-based lifesaving skills program and help predict potential barriers and solutions.

METHODS

This qualitative exploratory study was conducted in Karachi, Pakistan, from December 2020- to October 2021. We included students, teachers, and parents of secondary (grades VIII, IX, and X) and higher secondary level students (grades XI and XII) in Karachi, Pakistan's public and private schools and colleges. We selected one public, two semi-private, and two private schools. We recruited students, teachers, and parents through convenience sampling. We conducted fifteen focus group discussions (FGDs) with the students, six FGDs with the teachers, and eighteen in-depth interviews (IDIs) with parents. We transcribed the data from audio recordings and translated it into the English language. Finally, we manually analyzed the data using thematic analyses.

RESULTS

This study found that bystanders' main barriers to performing lifesaving skills are lack of knowledge, fear of legal involvement, fear of hurting the patient by incorrect technique, lack of empathy among community stakeholders, and gender bias. However, the participants had a positive and supportive attitude toward implementing lifesaving skills training in schools. They suggested starting student training in the early teenage years, preferred medical staff as trainers, and suggested frequent small sessions in English/Urdu both or Urdu language and training via theory and practical hands-on drills. Furthermore, the training was proposed to be integrated into the school curriculum to make it sustainable. Finally, the government needs to support the program and make the legal environment more conducive for bystanders.

CONCLUSION

This study identified the significant barriers to performing lifesaving skills in an emergency in a low- and middle-income country (LMIC). The participants supported implementing a national lifesaving skills program in schools and colleges. However, the participants expressed that support is needed by the government for sustainability, integrating lifesaving skills into the school curriculum, providing legal support to the bystanders, and creating awareness among the general public.

Periodic reinforcement of knowledge and attitude towards basic life support skills among the medical undergraduates: A necessity of undergraduate medical education

Introduction and Aim: A sudden cardiac arrest can be a life-threatening emergency with poor survival rates. By learning basic life support (BLS) and practicing simple cardiopulmonary resuscitation (CPR), the patient is likely to survive until arrival of expert medical help. The study therefore aims to determine if trained medical undergraduate students retain knowledge and attitude regarding skills.   Methods: About 150 students in the first year of medical school participated in the current study. The students attended two BLS training sessions of three hours each. The students were evaluated at six weeks and followed up at six months following the initial training session. The psychomotor skills were check-listed, and the performance was scored between 0 to 5. Data on knowledge and attitudes were collected with a pre-validated self-administered questionnaire.   Results: Among the participants, 69% were males, and 33% were females. The mean age group of study subjects was 21 ± three years. The skill scores (p=0.001) and knowledge scores (p=0.001) were significantly different at six weeks and six months after the initial training. Six weeks after the initial training session, the percentage of correct responses for knowledge questions was significantly higher than six months later. Approximately 86.3% of participants felt the BLS training was adequate to perform resuscitation confidently, while only 66.7% were confident after six months of training (p=0.001). Also, the number of students confident to give BLS during a medical emergency was significantly higher at six weeks after the initial training session than six months (p=0.001).   Conclusion: The study shows significant decay in psychomotor skills and knowledge and attitude among the medical undergraduates. Therefore, regular hands-on training with certifiable courses is required to reinforce skills and update knowledge regarding BLS.

Basic life support, a necessary inclusion in the medical curriculum: a cross-sectional survey of knowledge and attitude in Uganda

BACKGROUND

Uganda continues to depend on a health system without a well-defined emergency response system. This is in the face of the rising cases of out-of-hospital cardiac arrest contributed largely to the high incidence of road traffic accidents. Non-communicable diseases are also on the rise further increasing the incidence of cardiac arrest. Medical students are key players in the bid to strengthen the health system which warrants an assessment of their knowledge and attitude towards BLS inclusion in their study curriculum.

METHODS

A descriptive cross-sectional study was conducted in 2021 among undergraduate medical students across eight public and private universities in Uganda. An online-based questionnaire was developed using Google forms and distributed via identified WhatsApp groups. Chi-square or Fisher's exact test and logistic regression were performed in STATA 15 to assess the association between knowledge of BLS and demographics. P < 0.05 was considered statistically significant.

RESULTS

Out of the total 354 entries obtained, 351 were analyzed after eligibility screening. Of these, (n = 250, 71.2%) were male less than 25 years (n = 273, 77.8%). Less than half (n = 150, 42.7%) participants had undergone formal BLS training. Less than a third of participants (n = 103, 29.3%) had good knowledge (≥ 50%) with an overall score of 42.3 ± 12.4%. Age (p = 0.045), level of academic progress (p = 0.001), and prior BLS training (p = 0.033) were associated with good knowledge. Participants with prior training were more likely to have more BLS knowledge (aOR: 1.7, 95% CI: 1.1-2.7, p = 0.009). The majority (n = 348, 99.1%) believed that BLS was necessary and would wish (n = 343, 97.7%) to have it included in their curriculum.

CONCLUSIONS

Undergraduate medical students have poor BLS knowledge but understand its importance. Institutions need to adopt practical teaching methods such as clinical exposures, field experience in collaboration with local implementers, and participating in community health promotion campaigns.

A Review of the Commercially Available ECG Detection and Transmission Systems-The Fuzzy Logic Approach in the Prevention of Sudden Cardiac Arrest

Sudden cardiac death (SCD) constitutes a major clinical and public health problem, whose death burden is comparable to the current worldwide pandemic. This comprehensive review encompasses the following topics: available rescue systems, wearable electrocardiograms (ECG), detection and transmission technology, and a newly developed fuzzy logic algorithm (FA) for heart rhythm classification which is state-of-the art in the field of SCD prevention. Project "PROTECTOR", the Polish Rapid Transtelephonic ECG to Obtain Resuscitation for development of a rapid rescue system for patients at risk of sudden cardiac arrest (SCA), is presented. If a lethal arrhythmia is detected on the basis of FA, the system produces an alarm signal audible for bystanders and transmits the alarm message along with location to the emergency medical center. Phone guided resuscitation can be started immediately because an automated external defibrillator (AED) localization map is available. An automatic, very fast diagnosis is a unique feature of the PROTECTOR prototype. The rapid detection of SCA is based on a processor characterized by 100% sensitivity and 97.8% specificity (as measured in the pilot studies). An integrated circuit which implements FA has already been designed and a diagnosis is made within few seconds, which is extremely important in ischemic brain damage prophylaxis. This circuit could be implemented in smart implants (Sis).