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Kishimoto N, Ujita T, Tran SD, Sanuki T, Seo K. Simulation training for medical emergencies: Evaluation of dentists' long-term learning skills and confidence. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:689-697. [PMID: 38379393 DOI: 10.1111/eje.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/31/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION As the population ages and more patients experience medical emergencies during dental treatments, dentists must competently and confidently manage these situations. We developed a simulation training course for medical emergencies in the dental setting using an inexpensive vital sign simulation app for smartphones/tablets without the need for an expensive simulator. However, the duration for which this effect is maintained is unclear. This study was performed to evaluate the long-term educational effect at 3, 6, and 12 months after taking the course. MATERIALS AND METHODS Thirty-nine dental residents participated in this course. Scenarios included vasovagal syncope, anaphylaxis, hyperventilation syndrome, and acute coronary syndrome, each of which the participants had to diagnose and treat. The participants were evaluated using a checklist for anaphylaxis diagnosis and treatment skills immediately after and 3, 6, and 12 months after the course. The participants were also surveyed about their confidence in diagnosing and treating these conditions by questionnaire before, immediately after, and 3, 6, and 12 months after the course. RESULTS The checklist scores for anaphylaxis were significantly lower at 3, 6, and 12 months after the course than immediately after the course. The percentage of participants who provided a correct diagnosis and appropriate treatment for vasovagal syncope, hyperventilation syndrome, and acute coronary syndrome was lower at all reassessments than immediately after the course. CONCLUSION Because medical emergency management skills and confidence declined within 3 months, it would be useful to introduce a refresher course approximately 3 months after the initial course to maintain skills and confidence.
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Affiliation(s)
- Naotaka Kishimoto
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Tomoaki Ujita
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Simon D Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Takuro Sanuki
- Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, Japan
| | - Kenji Seo
- Division of Dental Anesthesiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Paquette S, Kilcullen M, Hoffman O, Hernandez J, Mehta A, Salas E, Greilich PE. Handoffs and the challenges to implementing teamwork training in the perioperative environment. Front Psychol 2023; 14:1187262. [PMID: 37397334 PMCID: PMC10310998 DOI: 10.3389/fpsyg.2023.1187262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.
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Affiliation(s)
- Shannon Paquette
- Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
| | - Molly Kilcullen
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Olivia Hoffman
- Division of Critical Care Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jessica Hernandez
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Ankeeta Mehta
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Philip E. Greilich
- Department of Anesthesiology and Pain Management, Health System Chief Quality Office, Office of Undergraduate Medical Education, UT Southwestern Medical Center, Dallas, TX, United States
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Jensen TW, Ersbøll AK, Folke F, Wolthers SA, Andersen MP, Blomberg SN, Andersen LB, Lippert F, Torp-Pedersen C, Christensen HC. Training in Basic Life Support and Bystander-Performed Cardiopulmonary Resuscitation and Survival in Out-of-Hospital Cardiac Arrests in Denmark, 2005 to 2019. JAMA Netw Open 2023; 6:e233338. [PMID: 36929397 PMCID: PMC10020888 DOI: 10.1001/jamanetworkopen.2023.3338] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
IMPORTANCE Strategies to improve survival from out-of-hospital cardiac arrest (OHCA) include mass education of laypersons with no official duty to respond to OHCA. In Denmark, basic life support (BLS) course attendance has been mandated by law in October 2006 for obtaining a driver's license for all vehicles and in vocational education programs. OBJECTIVES To examine the association between yearly BLS course participation rate and bystander cardiopulmonary resuscitation (CPR) and 30-day survival from OHCA and to examine if bystander CPR rate acted as a mediator on the association between mass education of laypersons in BLS and survival from OHCA. DESIGN, SETTING, AND PARTICIPANTS This cohort study included outcomes for all OHCA incidents from the Danish Cardiac Arrest Register between 2005 and 2019. Data concerning BLS course participation were supplied by the major Danish BLS course providers. MAIN OUTCOMES AND MEASURES The main outcome was 30-day survival of patients who experienced OHCA. Logistic regression analysis was used to examine the association between BLS training rate, bystander CPR rate, and survival, and a bayesian mediation analysis was conducted to examine mediation. RESULTS A total of 51 057 OHCA incidents and 2 717 933 course certificates were included. The study showed that the annual 30-day survival from OHCA increased by 14% (odds ratio [OR], 1.14; 95% CI, 1.10-1.18; P < .001) when BLS course participation rate increased by 5% in analysis adjusted for initial rhythm, automatic external defibrillator use, and mean age. An average mediated proportion of 0.39 (95% QBCI, 0.049-0.818; P = .01). In other words, the last result indicated that 39% of the association between mass educating laypersons in BLS and survival was mediated through an increased bystander CPR rate. CONCLUSIONS AND RELEVANCE In this cohort study of Danish BLS course participation and survival, a positive association was found between annual rate of mass education in BLS and 30-day survival from OHCA. The association of BLS course participation rate on 30-day survival was mediated by the bystander CPR rate; approximately 60% of the association of BLS course participation rate on 30-day survival was based on factors other than increased CPR rates.
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Affiliation(s)
- Theo Walther Jensen
- Prehospital Center Region Zealand, Næstved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Cardiology, Herlev Gentofte University Hospital, Gentofte, Denmark
| | - Signe Amalie Wolthers
- Prehospital Center Region Zealand, Næstved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Stig Nikolaj Blomberg
- Prehospital Center Region Zealand, Næstved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | | | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Prehospital Center Region Zealand, Næstved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Clinical Quality Program (RKKP), National Clinical Registries, Department of Clinical Medicine, Denmark
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Hosomi S, Kitamura T, Sobue T, Zha L, Kiyohara K, Oda J. Epidemiology and Outcome of Pediatric Out-of-Hospital Cardiac Arrest after Traffic Collision in Japan: A Population-Based Study. J Clin Med 2022; 11:jcm11030831. [PMID: 35160282 PMCID: PMC8836665 DOI: 10.3390/jcm11030831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/27/2023] Open
Abstract
The epidemiological and clinical characteristics, treatments, and outcomes of patients with traumatic out-of-hospital cardiac arrests (OHCAs) following traffic collisions have not been adequately investigated in Japan. We analyzed the All-Japan Utstein Registry data of 918 pediatric patients aged < 20 years with OHCAs following traffic collisions who were resuscitated by bystanders or emergency medical service personnel and were subsequently transported to hospitals between 2013 and 2019. Multiple logistic regression analysis was used to assess factors potentially associated with 1-month survival after OHCA. The 1-month survival rate was 3.3% (30/918), and the rate of neurologically favorable outcomes was 0.7% (60/918). The proportion of 1-month survival of all OHCAs after traffic collision origin did not significantly increase (from 1.9% (3/162) in 2013 to 4.5% (5/111) in 2019), and the adjusted odds ratio (OR) for a 1-year increment was 1.13 (95% confidence interval (CI) 0.93 to 1.37). In a multivariate analysis, ventricular fibrillation arrests and pulseless electrical activity (PEA) were significant predictors of 1-month outcome after OHCAs due to traffic collision. From a large OHCA registry in Japan, we demonstrated that 1-month survival after OHCAs due to traffic collision origin was approximately 3%, and some children even gained full recovery of neurological function.
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Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamada-oka, Suita 565-0871, Japan; (S.H.); (J.O.)
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.S.); (L.Z.)
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.S.); (L.Z.)
- Correspondence: ; Tel.: +81-6-6879-3922
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.S.); (L.Z.)
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (T.S.); (L.Z.)
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, 12 Sanban-cho, Chiyoda-ku, Tokyo 102-8357, Japan;
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamada-oka, Suita 565-0871, Japan; (S.H.); (J.O.)
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Ali AA, Miller E, Musallam E, Ballman K. Acute Care Nurse Practitioner Students' Perceptions of a Debriefing Experience After a Cardiac Emergency High-Fidelity Simulation: A Qualitative Study. AACN Adv Crit Care 2021; 32:264-274. [PMID: 34490451 DOI: 10.4037/aacnacc2021376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Acute care nurse practitioners need specialized training to prepare for their advanced role. Limited research investigates acute care nurse practitioners' leadership skills related to team dynamics and evidence-based practices. This study explored students' perceptions of a simulation and debriefing experience and the effects of debriefing on their ability to transfer their leadership-related learning. A qualitative exploratory approach was used. Students (N = 28) were divided between a video-assisted debriefing group (n = 16) and a verbal debriefing group (n = 12). Focus group interviews were conducted in order to explore students' experience of acting as team leader when managing emergency dysrhythmias during high-fidelity simulation code scenarios. Three themes emerged: leadership training, video-assisted debriefing and verbal debriefing, and transferability. This study adds valuable information about how simulation technology could be used in leadership skills learning by and training for nurse practitioners.
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Affiliation(s)
- Abeer Alhaj Ali
- Abeer Alhaj Ali is Assistant Professor, University of Cincinnati College of Nursing, 3110 Vine St, Cincinnati, OH 45221
| | - Elaine Miller
- Elaine Miller is Professor of Nursing, University of Cincinnati College of Nursing, Cincinnati, Ohio
| | - Eyad Musallam
- Eyad Musallam is Associate Professor, Department of Nursing, Miami University, Oxford, Ohio
| | - Kathleen Ballman
- Kathleen Ballman is Associate Professor of Clinical Nursing, University of Cincinnati College of Nursing, Cincinnati, Ohio
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Pellegrino JL, Vance J, Asselin N. The Value of Songs for Teaching and Learning Cardiopulmonary Resuscitation (CPR) Competencies: A Systematic Review. Cureus 2021; 13:e15053. [PMID: 34141503 PMCID: PMC8204400 DOI: 10.7759/cureus.15053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/15/2021] [Indexed: 11/05/2022] Open
Abstract
We sought to summarize, in a systematic review, the effectiveness of songs to support learning, performance, and recall of quality characteristics of cardiopulmonary resuscitation (CPR) compression rate, and depth. We systematically reviewed the literature from eight academic indexes from the fields of medicine, nursing, allied health, and education, from 2014 to 2020 to identify studies that evaluated an intervention of song use during CPR training against control and reported outcomes of compression rate and depth. There were 185 studies initially identified for review, eight met criteria for inclusion and analysis. For the critical outcome of compression depth, a pooled song group (n=446) when compared to a non-song group (n=443) demonstrated higher odds of being in the recommended range (OR 3.47). All studies, however, performed an average compression depth shallower than recommended guidelines in each arm. The available literature, we found, utilized heterogenous methodology and was at high risk of bias. When pooled, there were trends towards improved CPR metric performance in groups who were exposed to songs during treatment, though this only reached significance when groups were tested at >30 days from initial exposure. Findings of lower compression rates in the song groups suggest that song selection should favor beats per minute closer to the midpoint of the 100-120 ideal range to allow for variation when used as mental metronomes.
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Affiliation(s)
- Jeffrey L Pellegrino
- School of Disaster Sciences and Emergency Services, University of Akron, Akron, USA
| | - Jennifer Vance
- Nursing, Aultman College of Nursing and Health Sciences, Canton, USA
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Matsuyama T, Scapigliati A, Pellis T, Greif R, Iwami T. Willingness to perform bystander cardiopulmonary resuscitation: A scoping review. Resusc Plus 2020; 4:100043. [PMID: 34223318 PMCID: PMC8244432 DOI: 10.1016/j.resplu.2020.100043] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
Background Despite the proven effectiveness of rapid initiation of cardiopulmonary resuscitation (CPR) for patients with out-of-hospital cardiac arrest (OHCA) by bystanders, fewer than half of the victims actually receive bystander CPR. We aimed to review the evidence of the barriers and facilitators for bystanders to perform CPR. Methods This scoping review was conducted as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. This review included studies assessing barriers or facilitators for the lay rescuers to perform CPR in actual emergency settings and excluded studies that overlapped with other ILCOR systematic reviews/scoping reviews (e.g. dispatcher instructed CPR etc). The key findings were classified into three kinds of factors: personal factors; CPR knowledge; and procedural issues. Results We identified 18 eligible studies. Of these studies addressing the reduced willingness to respond to cardiac arrest, 14 related to "personal factors", 3 to "CPR knowledge", and 2 to "procedural issues". On the other hand, we identified 5 articles assessing factors increasing bystanders' willingness to perform CPR. However, we observed significant heterogeneity among study populations, methodologies, factors definitions, outcome measures utilized and outcomes reported. Conclusions We found that a number of factors were present in actual settings which either inhibit or facilitate lay rescuers' performance of CPR. Interventional strategies to improve CPR performance of lay rescuers in the actual settings should be established, taking these factors into consideration.
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Affiliation(s)
- Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Andrea Scapigliati
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Robert Greif
- Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland.,Medical Education, School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
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Kim SY, Shin D, Kim HJ, Karm MH. Changes of knowledge and practical skills before and after retraining for basic life support: Focused on students of Dental School. Int J Med Sci 2020; 17:3082-3090. [PMID: 33173429 PMCID: PMC7646099 DOI: 10.7150/ijms.47343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/07/2020] [Indexed: 11/06/2022] Open
Abstract
Background: Considering the increasing possibility of emergency situations in dental clinics over time, we conducted this study to evaluate the changes in the knowledge and practical skills of students of dental school before and after retraining for 2 years after the initial education on basic life support (BLS) of the American Heart Association (AHA). Methods: All third-year students of dental school who had received the same education on BLS provider training of the AHA 2 years earlier were included in this study. Among them, 98 students were asked to answer a questionnaire about BLS knowledge and conduct a practical skills assessment of high-quality cardiopulmonary resuscitation using Little Anne QCPR before and after retraining. Results: After retraining, the level of BLS knowledge increased in all 7 categories, and BLS performance increased in all 19 subcategories. Comparison of the QCPR numerical data items before and after retraining showed that all items after retraining met the criteria recommended by the AHA. Conclusion: Students of dental school had low levels of knowledge and practical skills of BLS before retraining after 2 years from the initial education and had high levels after retraining. Therefore, BLS training must be updated periodically, and more effective education methods are required to maintain BLS knowledge and practical skills.
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Affiliation(s)
- Seo-Yoon Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Dongmin Shin
- Department of Emergency Medical Service, Korea National University of Transportation, Chungcheongbuk-do, Republic of Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S222-S283. [PMID: 33084395 DOI: 10.1161/cir.0000000000000896] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, Bhanji F, Wyllie J, Zideman D, Neumar RW, Perkins GD, Castrén M, Morley PT, Montgomery WH, Nadkarni VM, Billi JE, Merchant RM, de Caen A, Escalante-Kanashiro R, Kloeck D, Wang TL, Hazinski MF. Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S2-S27. [PMID: 33084397 DOI: 10.1161/cir.0000000000000890] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, Bhanji F, Wyllie J, Zideman D, Neumar RW, Perkins GD, Castrén M, Morley PT, Montgomery WH, Nadkarni VM, Billi JE, Merchant RM, de Caen A, Escalante-Kanashiro R, Kloeck D, Wang TL, Hazinski MF. Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A1-A22. [PMID: 33098915 PMCID: PMC7576314 DOI: 10.1016/j.resuscitation.2020.09.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC, Baldi E, Beck S, Beckers SK, Blewer AL, Boulton A, Cheng-Heng L, Yang CW, Coppola A, Dainty KN, Damjanovic D, Djärv T, Donoghue A, Georgiou M, Gunson I, Krob JL, Kuzovlev A, Ko YC, Leary M, Lin Y, Mancini ME, Matsuyama T, Navarro K, Nehme Z, Orkin AM, Pellis T, Pflanzl-Knizacek L, Pisapia L, Saviani M, Sawyer T, Scapigliati A, Schnaubelt S, Scholefield B, Semeraro F, Shammet S, Smyth MA, Ward A, Zace D. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A188-A239. [PMID: 33098918 DOI: 10.1016/j.resuscitation.2020.09.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Patterson JK, Girnary S, North K, Data S, Ishoso D, Eilevstjønn J, Bose CL. Innovations in Cardiorespiratory Monitoring to Improve Resuscitation With Helping Babies Breathe. Pediatrics 2020; 146:S155-S164. [PMID: 33004638 DOI: 10.1542/peds.2020-016915h] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Ninety percent of intrapartum-related neonatal deaths are attributable to respiratory depression, with the vast majority of these deaths occurring in low- and lower-middle-income countries. Neonatal resuscitation training with Helping Babies Breathe (HBB) decreases mortality from respiratory depression. Cardiorespiratory monitoring in conjunction with HBB can provide valuable resuscitation feedback for both training and bedside purposes. In this article, we discuss 3 innovations that couple cardiorespiratory monitoring with HBB: NeoNatalie Live, the Augmented Infant Resuscitator, and NeoBeat. NeoNatalie Live is a high-fidelity manikin that facilitates bag mask ventilation training through case scenarios of varying difficulty. The Augmented Infant Resuscitator is added in-line between a face mask and ventilation bag during bag mask ventilation training to provide users with real-time feedback on ventilation quality. NeoBeat is a battery-operated heart rate meter that digitally displays the newborn heart rate during bedside resuscitations. For each innovation, we review details of the device, implementation in the field, and areas for further research. Using early experience implementing these devices, we suggest building blocks for effective translation of training into improved care. We also highlight general challenges in implementation of devices in facilities in low- and lower-middle-income countries including considerations for training, adaptations to existing workflow, and integration into the ecosystem. Although the devices highlighted in this article hold promise, more data are needed to understand their impact on newborn outcomes.
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Affiliation(s)
- Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | - Krysten North
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Santorino Data
- Mbarara University of Science and Technology, Mbarara, Uganda; and
| | - Daniel Ishoso
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Carl L Bose
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Saunders R, Wood E, Coleman A, Gullick K, Graham R, Seaman K. Emergencies within hospital wards: An observational study of the non-technical skills of medical emergency teams. Australas Emerg Care 2020; 24:89-95. [PMID: 32747297 DOI: 10.1016/j.auec.2020.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/28/2020] [Accepted: 07/10/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medical emergency teams are essential in responding to acute deterioration of patients in hospitals, requiring both clinical and non-technical skills. This study aims to assess the non-technical skills of medical emergency teams during hospital ward emergencies and explore team members perceptions and experiences of the use non-technical skills during medical emergencies. METHODS A multi-methods study was conducted in two phases. During phase one observation and assessment of non-technical skills used in medical emergencies using the Team Emergency Assessment Measure (TEAM™) was conducted; and in the phase two in-depth interviews were undertaken with medical emergency team members. RESULTS Based on 20 observations, mean TEAM™ ratings for non-technical skill domains were: 'leadership' 5.0 out of 8 (±2.0); 'teamwork' 21.6 out of 28 (±3.6); and 'task management' 6.5 out of 8 (±1.4). The mean 'global' score was 7.5 out of 10 (±1.5). The qualitative findings identified three areas, 'individual', 'team' and 'other' contributing factors, which impacted upon the non-technical skills of medical emergency teams. CONCLUSION Non-technical skills of hospital medical emergency teams differ, and the impact of the skill mix on resuscitation outcomes was recognised by team members. These findings emphasize the importance non-technical skills in resuscitation training and well-developed processes for medical emergency teams.
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Affiliation(s)
- Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Emma Wood
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Adam Coleman
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Karen Gullick
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Renée Graham
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
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15
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Abstract
Aim Although evidence supports brief, frequent CPR training, optimal training intervals have not been established. The purpose of this study was to compare nursing students’ CPR skills (compressions and ventilations) with 4 different spaced training intervals: daily, weekly, monthly, and quarterly, each for 4 times in a row. Methods Participants were nursing students (n = 475) in the first year of their prelicensure program in 10 schools of nursing across the United States. They were randomly assigned into the 4 training intervals in each of the schools. Students were trained in CPR on a Laerdal Resusci Anne adult manikin on the Resuscitation Quality Improvement (RQI) mobile simulation station. The outcome measures were quality of compressions and ventilations as measured by the RQI program. Results Although students were all certified in Basic Life Support prior to the study, they were not able to adequately perform compressions and ventilations at pretest. Overall compression scores improved from sessions 1 to 4 in all training intervals (all p < .001), but shorter intervals (daily training) resulted in larger increases in compression scores by session 4. There were similar findings for ventilation skills, but at session 4, both daily and weekly intervals led to better skill performance. Conclusion For students and other novices learning to perform CPR, the opportunity to train on consecutive days or weeks may be beneficial: if learners are aware of specific errors in performance, it may be easier for them to correct performance and refine skills when there is less time in between practice sessions.
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16
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Au K, Lam D, Garg N, Chau A, Dzwonek A, Walker B, Tremblay L, Boet S, Bould MD. Improving skills retention after advanced structured resuscitation training: A systematic review of randomized controlled trials. Resuscitation 2019; 138:284-296. [PMID: 30928503 DOI: 10.1016/j.resuscitation.2019.03.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/10/2019] [Accepted: 03/15/2019] [Indexed: 11/17/2022]
Abstract
AIMS To systematically evaluate the literature on interventions that improve skills retention following advanced structured resuscitation training programs designed for healthcare professionals. METHODS A systematic review of MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, ERIC, and Scopus was performed. Only randomized controlled trials investigating skills retention following advanced structured resuscitation training programs for healthcare professionals between inception to November 21, 2018 were included. Publications that assessed only knowledge acquisition were excluded. Relevant data from included studies were extracted and study quality was critically appraised, both independently and in duplicate by multiple reviewers. The risk of bias was assessed with the Cochrane Risk of Bias tool and the Medical Education Research Study Quality Instrument (MERSQI). Due to significant clinical heterogeneity in SRT training, study designs and interventions, a qualitative synthesis was used to summarize findings. MAIN RESULTS Sixteen studies, with a combined total of 1192 participants, were included in the final analysis. The majority of studies were conducted in North America and involved trainees or novice learners. ACLS was the most extensively studied, followed by NRP, ALS, and ATLS. Skills retention at 6 months was the most commonly used primary endpoint assessed using a simulated resuscitation checklist with either an adopted or created assessment tool. Most studies demonstrated a positive impact on skills retention when an interactive intervention or simulation was used. However, merely having a high-fidelity mannequin alone for simulation was found to have minimal effect on skills retention in the absence of other changes in content delivery. Booster sessions were found to be minimally effective in reinforcing long-term skills retention; however, most studies examining this intervention had small sample sizes and were underpowered. CONCLUSIONS Simulation-based interventions, refresher courses and adjustments to the content delivery of advanced structured resuscitation training courses were found to have the greatest impact on skills retention. However, due to significant heterogeneity and methodological flaws in the available studies, no definitive conclusions can be made regarding other interventions. Overall, there is a paucity of skills retention research and further high-quality randomized controlled trials are needed to determine the optimal intervention and design for resuscitation training that would maximize skills retention.
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Affiliation(s)
- Kelly Au
- Department of Anesthesiology, BC Women's Hospital, Vancouver, BC, Canada.
| | - Darren Lam
- Department of Anesthesiology Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Nitan Garg
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Anthony Chau
- Department of Anesthesiology, BC Women's Hospital, Vancouver, BC, Canada; Department of Anesthesiology Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Agata Dzwonek
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Benjamin Walker
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Luc Tremblay
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - M Dylan Bould
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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17
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Smith MW, Abarca Rondero D. Predicting electrocardiogram interpretation performance in Advanced Cardiovascular Life Support simulation: comparing knowledge tests and simulation performance among Mexican medical students. PeerJ 2019; 7:e6632. [PMID: 30891369 PMCID: PMC6422014 DOI: 10.7717/peerj.6632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/16/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Simulation plays a key role in assessing performance in Advanced Cardiovascular Life Support (ACLS). Traditional knowledge tests are also important for assessing the cognitive elements of ACLS performance. However, the association between the two has not been established. In this study, we focus on one important element in ACLS-interpretation of electrocardiograms (ECG)-and the potential of knowledge tests to serve as predictors of improvement in ACLS performance. METHODS We looked at the correlation between Mexican medical students' improvement in ECG interpretation performance in ACLS megacode simulations (from the start of the semester to the end of the semester), and their scores on ECG interpretation knowledge tests. RESULTS We found significant improvement in ECG interpretation in ACLS megacode simulation (from pre-semester to post-semester), but this was not predicted by the ECG interpretation knowledge test scores. The correlation was .079 (p = 0.66). CONCLUSIONS These results suggest that even cognitive tasks such as ECG interpretation can be expressed and assessed differently in simulation versus traditional knowledge testing.
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Affiliation(s)
- Michael William Smith
- Department of Industrial and Mechanical Engineering, Universidad de las Américas Puebla, San Andres Cholula, Puebla, Mexico
| | - David Abarca Rondero
- Department of Health Sciences, Universidad de las Américas Puebla, San Andres Cholula, Puebla, Mexico
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18
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Della Bona M, Crawford G, Nimmo L, Leavy JE. What does 'Keep Watch' mean to migrant parents? Examining differences in supervision, cardiopulmonary resuscitation training and water familiarisation. Int J Public Health 2019; 64:755-762. [PMID: 30603940 DOI: 10.1007/s00038-018-1197-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/13/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Drowning is a public health challenge. Children of migrants may be at increased risk as parents may be unaware of local water safety issues. This study explores differences between Australian-born and migrant parents in Western Australia for: (1) swimming ability; (2) supervision; (3) water familiarisation; and (4) cardiopulmonary resuscitation (CPR) training. METHODS A cross-sectional survey of parents and carers of children aged under 5 years residing in WA (n = 1506) captured demographics, knowledge of appropriate supervision, water safety knowledge and skills. Logistic regression was conducted. RESULTS Migrants were significantly less likely to identify adequate supervision (p = 0.004); have participated in child water familiarisation programmes (p = 0.000); or perceived themselves as able swimmers (p = 0.000). Significantly less migrants had also undertaken CPR training (p = 0.000). CONCLUSIONS Findings add to the small but growing body of literature highlighting the importance of tailored drowning prevention strategies for migrants in countries such as Australia with a strong aquatic culture.
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Affiliation(s)
- Malena Della Bona
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Lauren Nimmo
- Health Promotion and Research, Royal Life Saving Society Western Australia Inc, PO Box 28, Floreat, WA, 6014, Australia
| | - Justine E Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
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19
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Jensen TW, Møller TP, Viereck S, Roland Hansen J, Pedersen TE, Ersbøll AK, Lassen JF, Folke F, Østergaard D, Lippert F. A nationwide investigation of CPR courses, books, and skill retention. Resuscitation 2019; 134:110-121. [DOI: 10.1016/j.resuscitation.2018.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/16/2018] [Accepted: 10/28/2018] [Indexed: 11/30/2022]
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20
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Wong MAME, Chue S, Jong M, Benny HWK, Zary N. Clinical instructors' perceptions of virtual reality in health professionals' cardiopulmonary resuscitation education. SAGE Open Med 2018; 6:2050312118799602. [PMID: 30245815 PMCID: PMC6144504 DOI: 10.1177/2050312118799602] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/13/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives: Cardiopulmonary resuscitation (CPR) is lifesaving. Yet, cardiac arrest survival remains low despite CPR intervention. Education has been highlighted as a strategy to overcome this issue. Virtual Reality technology has been gaining momentum in the field of clinical education. Published studies report benefits of virtual reality for CPR education; yet, perceptions of CPR instructors towards virtual reality remain unexplored. CPR instructors are key stakeholders in CPR education and their perceptions are valuable for the design and adoption of virtual reality-enhanced learning. The purpose of this study is therefore to understand the perceptions of CPR instructors towards using virtual reality for health professionals’ CPR education. The aim was addressed via three research questions: (1) What are the perceptions of CPR instructors towards current health professionals’ CPR education? (2) What are the perceptions of CPR instructors towards features of virtual reality ideal for health professionals’ CPR education? (3) What are the perceptions of CPR instructors towards the potential role of virtual reality in health professionals’ CPR education? Methods: A total of 30 CPR instructors were surveyed on their views towards current health professionals’ CPR education and the use of virtual reality for health professionals’ CPR education, before and after interacting with a CPR virtual reality simulation. Responses were analysed using interpretative thematic analysis. Results: CPR instructors perceived current health professionals’ CPR education as limited due to unideal test preparation (resources, practice, motivation, and frame of mind) and performance. They perceived fidelity, engagement, resource conservation, and memory enhancement as features of virtual reality ideal for health professionals’ CPR education. Virtual reality was viewed by CPR instructors as having potential as a blended learning tool, targeting both ‘novice’ and ‘experienced’ health professionals. Conclusion: The study highlighted the gaps in current health professionals’ CPR education that can be addressed using virtual-reality-enabled learning. Future research could investigate virtual reality simulations with features desirable for CPR education of target populations.
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Affiliation(s)
| | - Shien Chue
- Centre for Research and Development in Learning, Nanyang Technological University, Singapore
| | - Michelle Jong
- Department of Endocrinology, Tan Tock Seng Hospital, National Healthcare Group, Singapore
| | - Ho Wye Kei Benny
- School of Electronics & Info-Comm Technology, Institute of Technical Education College Central, Singapore
| | - Nabil Zary
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Centre for Research and Development in Learning, Nanyang Technological University, Singapore
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21
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Best Practices in the Management of Central Vascular Access Devices: An Observational Study in Areas With a High Prevalence of Trained Nurses. JOURNAL OF INFUSION NURSING 2018; 41:319-325. [PMID: 30188454 DOI: 10.1097/nan.0000000000000297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since 2009, the Department of Continuing Education at the Orthopedic and Trauma Center Hospital in Turin, Italy, has provided a training course for nurses in the management of central vascular access devices (CVADs). The course focuses on dressing and flushing procedures, as well as compliance with other CVAD guidelines. An observational study was conducted among nurses to determine the level of best practices in areas with a high prevalence of nurses trained in the management of CVADs. A correlation was observed between best practices and having attended the course, but other variables also influenced best practices.
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22
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Organizational Perspectives on Rapid Response Team Structure, Function, and Cost: A Qualitative Study. Dimens Crit Care Nurs 2018; 36:3-13. [PMID: 27902655 DOI: 10.1097/dcc.0000000000000222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Understanding how an organization determines structure and function of a rapid response team (RRT), as well as cost evaluation and implications, can provide foundational knowledge to guide decisions about RRTs. OBJECTIVES The objectives were to (1) identify influencing factors in organizational development of RRT structure and function and (2) describe evaluation of RRT costs. METHODS Using a qualitative, ethnographic design, nurse executives and experts in 15 moderate-size hospitals were interviewed to explore their decision-making processes in determining RRT structure and function. Face-to-face interviews were audio recorded and transcribed verbatim and verified for accurateness. Using content analysis and constant comparison, interview data were analyzed. Demographic data were analyzed using descriptive statistics. RESULTS The sample included 27 participants from 15 hospitals in 5 south-central states. They described a variety of RRT responders and functions, with the majority of hospitals having a critical care charge nurse attending all RRT calls for assistance. Others described a designated RRT nurse with primary RRT duties as responder to all RRT calls. Themes of RRT development from the data included influencers, decision processes, and thoughts about cost. DISCUSSION It is important to understand how hospitals determine optimal structure and function to enhance support of quality nursing care. Determining the impact of an RRT on costs and benefits is vital in balancing patient safety and limited resources. Future research should focus on clarifying differences between team structure and function in outcomes as well as the most effective means to estimate costs and benefits.
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23
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Hunziker S, O'Connell KJ, Ranniger C, Su L, Hochstrasser S, Becker C, Naef D, Carter E, Stockwell D, Burd RS, Marsch S. Effects of designated leadership and team-size on cardiopulmonary resuscitation: The Basel-Washington SIMulation (BaWaSim) trial. J Crit Care 2018; 48:72-77. [PMID: 30172964 DOI: 10.1016/j.jcrc.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE During cardiopulmonary resuscitation (CPR), it remains unclear whether designating an individual person as team leader compared with emergent leadership results in better team performance. Also, the effect of CPR team size on team performance remains understudied. METHODS This randomized-controlled trial compared designated versus emergent leadership and size of rescue team (3 vs 6 rescuers) on resuscitation performance. RESULTS We included 90 teams with a total of 408 students. No difference in mean (±SD) hands-on time (seconds) were observed between emergent leadership (106 ± 30) compared to designated leadership (103 ± 27) groups (adjusted difference - 2.97 (95%CI -15.75 to 9.80, p = 0.645), or between smaller (103 ± 30) and larger teams (106 ± 26, adjusted difference 3.53, 95%CI -8.47 to 15.53, p = 0.56). Emergent leadership groups had a shorter time to circulation check and first defibrillation, but the quality of CPR based on arm and shoulder position was lower. No differences in CPR quality measures were observed between smaller and larger teams. CONCLUSIONS Within this international US/Swiss trial, leadership designation and larger team size did not improve hands-on time, but emergent leadership teams initiated defibrillation earlier. Improvements in performance may be more likely to be achieved by optimization of emergent leadership than increasing the size of cardiac arrest teams.
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Affiliation(s)
- Sabina Hunziker
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland.
| | | | - Claudia Ranniger
- Clinical Learning and Simulation Skills (CLASS) Center, The George Washington University, Washington, DC, United States
| | - Lillian Su
- Children's National Medical Center, Washington, DC, United States
| | - Seraina Hochstrasser
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland
| | - Christoph Becker
- Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Daryl Naef
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland
| | - Elizabeth Carter
- Children's National Medical Center, Washington, DC, United States
| | - David Stockwell
- Patient Safety and the Pediatric Intensive Care Unit, Children's National Medical Center, Washington, DC, United States
| | - Randall S Burd
- Children's National Medical Center, Department of Surgery, Washington, DC, United States
| | - Stephan Marsch
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland
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24
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Hsieh MJ, Chiang WC, Jan CF, Lin HY, Yang CW, Ma MHM. The effect of different retraining intervals on the skill performance of cardiopulmonary resuscitation in laypeople—A three-armed randomized control study. Resuscitation 2018; 128:151-157. [DOI: 10.1016/j.resuscitation.2018.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/19/2018] [Accepted: 05/09/2018] [Indexed: 12/11/2022]
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25
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Nakahara S, Sakamoto T. Female rescuers faced difficulties in resuscitating a collapsed man in the Sumo ring. Resuscitation 2018; 129:e16. [PMID: 29859219 DOI: 10.1016/j.resuscitation.2018.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/26/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Shinji Nakahara
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo 173-8606, Japan.
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo 173-8606, Japan
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26
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Fuchs SM, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N. Advocating for Life Support Training of Children, Parents, Caregivers, School Personnel, and the Public. Pediatrics 2018; 141:peds.2018-0705. [PMID: 29793985 DOI: 10.1542/peds.2018-0705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric cardiac arrest in the out-of-hospital setting is a traumatic event for family, friends, caregivers, classmates, and school personnel. Immediate bystander cardiopulmonary resuscitation and the use of automatic external defibrillators have been shown to improve survival in adults. There is some evidence to show improved survival in children who receive immediate bystander cardiopulmonary resuscitation. Pediatricians, in their role as advocates to improve the health of all children, are uniquely positioned to strongly encourage the training of children, parents, caregivers, school personnel, and the lay public in the provision of basic life support, including pediatric basic life support, as well as the appropriate use of automated external defibrillators.
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Affiliation(s)
| | - Joseph Wright
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Terry Adirim
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Michael S.D. Agus
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - James Callahan
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Toni Gross
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Natalie Lane
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Lois Lee
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Suzan Mazor
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Prashant Mahajan
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nathan Timm
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
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27
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Romig M, Duval-Arnould J, Winters BD, Newton H, Sapirstein A. Intensivist Presence at Code Events Is Associated with High Survival and Increased Documentation Rates. Crit Care Clin 2018; 34:259-266. [DOI: 10.1016/j.ccc.2017.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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McKittrick JT, Kinney S, Lima S, Allen M. The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session. Nurse Educ Pract 2017; 28:115-120. [PMID: 29078106 DOI: 10.1016/j.nepr.2017.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 04/01/2017] [Accepted: 10/16/2017] [Indexed: 12/01/2022]
Abstract
Inadequate resuscitation leads to death or brain injury. Recent recommendations for resuscitation team training to complement knowledge and skills training highlighted the need for development of an effective team resuscitation training session. This study aimed to evaluate and revise an interprofessional team training session which addressed roles and performance during provision of paediatric resuscitation, through incorporation of real-time, real team simulated training episodes. This study was conducted applying the principles of action research. Two cycles of data collection, evaluation and refinement of a 30-40 minute resuscitation training session for doctors and nurses occurred. Doctors and nurses made up 4 groups of training session participants. Their responses to the training were evaluated through thematic analysis of rich qualitative data gathered in focus groups held immediately after each training session. Major themes included the importance of realism, teamwork, and reflective learning. Findings informed important training session changes. These included; committed in-situ training; team diversity; realistic resources; role flexibility, definition and leadership; increased debriefing time and the addition of a team goal. In conclusion, incorporation of interprofessional resuscitation training which addresses team roles and responsibilities into standard medical and nursing training will enhance preparedness for participation in paediatric resuscitation.
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Affiliation(s)
- Joanne T McKittrick
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia; The University of Melbourne, Melbourne, Victoria, 3010, Australia.
| | - Sharon Kinney
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia; The University of Melbourne, Melbourne, Victoria, 3010, Australia.
| | - Sally Lima
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia.
| | - Meredith Allen
- The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia.
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Perkins GD, Neumar R, Monsieurs KG, Lim SH, Castren M, Nolan JP, Nadkarni V, Montgomery B, Steen P, Cummins R, Chamberlain D, Aickin R, de Caen A, Wang TL, Stanton D, Escalante R, Callaway CW, Soar J, Olasveengen T, Maconochie I, Wyckoff M, Greif R, Singletary EM, O'Connor R, Iwami T, Morrison L, Morley P, Lang E, Bossaert L. The International Liaison Committee on Resuscitation-Review of the last 25 years and vision for the future. Resuscitation 2017; 121:104-116. [PMID: 28993179 DOI: 10.1016/j.resuscitation.2017.09.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 01/08/2023]
Abstract
2017 marks the 25th anniversary of the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1992 to create a forum for collaboration among principal resuscitation councils worldwide. Since then, ILCOR has established and distinguished itself for its pioneering vision and leadership in resuscitation science. By systematically assessing the evidence for resuscitation standards and guidelines and by identifying national and regional differences, ILCOR reached consensus on international resuscitation guidelines in 2000, and on international science and treatment recommendations in 2005, 2010 and 2015. However, local variation and contextualization of guidelines are evident by subtle differences in regional and national resuscitation guidelines. ILCOR's efforts to date have enhanced international cooperation, and progressively more transparent and systematic collection and analysis of pertinent scientific evidence. Going forward, this sets the stage for ILCOR to pursue its vision to save more lives globally through resuscitation.
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Affiliation(s)
- Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK.
| | - Robert Neumar
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Koenraad G Monsieurs
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Swee Han Lim
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Maaret Castren
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Jerry P Nolan
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Vinay Nadkarni
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Bill Montgomery
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Petter Steen
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Richard Cummins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Douglas Chamberlain
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Richard Aickin
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Allan de Caen
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Tzong-Luen Wang
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - David Stanton
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Raffo Escalante
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Clifton W Callaway
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Jasmeet Soar
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Theresa Olasveengen
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Ian Maconochie
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Myra Wyckoff
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Robert Greif
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Eunice M Singletary
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Robert O'Connor
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Taku Iwami
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Laurie Morrison
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Peter Morley
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Eddy Lang
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Leo Bossaert
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
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- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
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Wang CH, Huang CH, Chang WT, Tsai MS, Yu PH, Wu YW, Chen WJ. Outcomes of adults with in-hospital cardiac arrest after implementation of the 2010 resuscitation guidelines. Int J Cardiol 2017; 249:214-219. [PMID: 28916353 DOI: 10.1016/j.ijcard.2017.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/02/2017] [Accepted: 09/07/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND The 2015 guidelines for cardiopulmonary resuscitation (CPR) are based on an update of the 2010 guidelines with minor revisions. It is important to assess the 2010 guidelines to ensure their efficacy, which may help promote widespread adoption of the 2015 guidelines. METHODS We conducted a retrospective observational study in a single center that evaluated patients with in-hospital cardiac arrest (IHCA) between 2006 and 2014. Multivariable logistic regression analysis was used to evaluate associations between independent variables and outcomes. RESULTS A total of 1525 patients were included. For patients with initial non-shockable rhythms, the elapsed time to first adrenaline injection was significantly shorter for patients who received CPR according to the 2010 guidelines (2010-CPR) than for those who were treated according to the 2005 guidelines (2005-CPR). During post-cardiac arrest care, the percentage of patients with fever was significantly lower and the implementation of critical interventions was significantly higher in patients who received 2010-CPR than in those who received 2005-CPR. After adjusting for the effects of confounding factors, patients who received 2010-CPR had improved neurological outcomes (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.05-2.93; p=0.03) and survival (OR, 1.50; 95% CI, 1.06-2.12; p=0.02) at hospital discharge than patients who received 2005-CPR. CONCLUSIONS Hospital adoption of the 2010 guidelines may improve the neurological and survival outcomes for IHCA patients. This improvement might result from an emphasis on the importance of high-quality CPR, post-cardiac arrest care, and teamwork in the 2010 guidelines.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ping-Hsun Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine, Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Emergency Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan.
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Onan A, Simsek N, Elcin M, Turan S, Erbil B, Deniz KZ. A review of simulation-enhanced, team-based cardiopulmonary resuscitation training for undergraduate students. Nurse Educ Pract 2017; 27:134-143. [PMID: 28892727 DOI: 10.1016/j.nepr.2017.08.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 08/16/2017] [Accepted: 08/31/2017] [Indexed: 11/25/2022]
Abstract
Cardiopulmonary resuscitation training is an essential element of clinical skill development for healthcare providers. The International Liaison Committee on Resuscitation has described issues related to cardiopulmonary resuscitation and emergency cardiovascular care education. Educational interventions have been initiated to try to address these issues using a team-based approach and simulation technologies that offer a controlled, safe learning environment. The aim of the study is to review and synthesize published studies that address the primary question "What are the features and effectiveness of educational interventions related to simulation-enhanced, team-based cardiopulmonary resuscitation training?" We conducted a systematic review focused on educational interventions pertaining to cardiac arrest and emergencies that addressed this main question. The findings are presented together with a discussion of the effectiveness of various educational interventions. In conclusion, student attitudes toward interprofessional learning and simulation experiences were more positive. Research reports emphasized the importance of adherence to established guidelines, adopting a holistic approach to training, and that preliminary training, briefing, deliberate practices, and debriefing should help to overcome deficiencies in cardiopulmonary resuscitation training.
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Affiliation(s)
- Arif Onan
- Department of Medical Education and Informatics, Hacettepe University, Faculty of Medicine, Sihhiye Campus, 06100 Altindag, Ankara, Turkey.
| | - Nurettin Simsek
- Department of Computer Education & Instructional Technology, Ankara University, Institute of Educational Sciences, 06590 Cebeci, Ankara, Turkey.
| | - Melih Elcin
- Department of Medical Education and Informatics, Hacettepe University, Faculty of Medicine, Sihhiye Campus, 06100 Altindag, Ankara, Turkey.
| | - Sevgi Turan
- Department of Medical Education and Informatics, Hacettepe University, Faculty of Medicine, Sihhiye Campus, 06100 Altindag, Ankara, Turkey.
| | - Bülent Erbil
- Department of Emergency Medicine, Hacettepe University Faculty of Medicine, Sihhiye Campus 06100 Altindag, Ankara, Turkey.
| | - Kaan Zülfikar Deniz
- Graduate School of Educational Sciences, Ankara University, Institute of Educational Sciences 06590 Cebeci, Ankara, Turkey.
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Cariou G, Pelaccia T. Are they trained? Prevalence, motivations and barriers to CPR training among cohabitants of patients with a coronary disease. Intern Emerg Med 2017; 12:845-852. [PMID: 27350627 DOI: 10.1007/s11739-016-1493-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
Out-of-hospital cardiac arrest occurs most often at home and often in the presence of family members of the patient who witness the event. Cardiopulmonary resuscitation (CPR) training of the next of kin of at-risk patients is thus potentially beneficial. The aim of our study was to document the prevalence of appropriate training among cardiac patients' cohabitants, as well as the motivations or obstacles to seeking training. 153 cohabitants of 127 patients who were hospitalized 1 year prior for confirmed coronary disease in a cardiology department (Paris, France) were interviewed using a structured questionnaire between October 2013 and March 2014. 38 % of interrogated cohabitants had received CPR training, and in two-thirds of the cases, their training was undertaken prior to the onset of the patient's heart disease. The training received was often a single instruction session. Half took place more than 5 years prior to the interview. For two-thirds of interrogated families, the reasons they sought training were related to professional or military duties. Training undertaken solely due to cohabitation with a patient affected by coronary disease represented only 3.5 % of the trained respondents. A lack of information regarding existing training programs and a lack of concrete propositions were given as the main barriers to seeking training. The families of patients who are at-risk for cardiac arrests that were interrogated in our study are inadequately trained in CPR. The creation of dedicated training programs at cardiac rehabilitation services for patients' next of kin or the use of alternative methods such as self-instruction kits could potentially remedy this situation.
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Affiliation(s)
- Guillaume Cariou
- Mobile Palliative Care Team, Cochin University Hospital, Paris Hospitals Public Assistance, 27 rue du Faubourg-Saint-Jacques, 75014, Paris, France
| | - Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFR-PS), Faculty of Medicine, University of Strasbourg, 4 rue Kirschleger, 67085, Strasbourg, France.
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, PO Box 426, 67200, Strasbourg, France.
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Abstract
Supplemental digital content is available in the text. Introduction Training emergency care skills is critical for patient safety but cost intensive. Serious games have been proposed as an engaging self-directed learning tool for complex skills. The objective of this study was to compare the cognitive skills and motivation of medical residents who only used a course manual as preparation for classroom training on emergency care with residents who used an additional serious game. Methods This was a quasi-experimental study with residents preparing for a rotation in the emergency department. The “reading” group received a course manual before classroom training; the “reading and game” group received this manual plus the game as preparation for the same training. Emergency skills were assessed before training (with residents who agreed to participate in an extra pretraining assessment), using validated competency scales and a global performance scale. We also measured motivation. Results All groups had comparable important characteristics (eg, experience with acute care). Before training, the reading and game group felt motivated to play the game and spent more self-study time (+2.5 hours) than the reading group. Game-playing residents showed higher scores on objectively measured and self-assessed clinical competencies but equal scores on the global performance scale and were equally motivated for training, compared with the reading group. After the 2-week training, no differences between groups existed. Conclusions After preparing training with an additional serious game, residents showed improved clinical competencies, compared with residents who only studied course material. After a 2-week training, this advantage disappeared. Future research should study the retention of game effects in blended designs.
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Simulation in Canadian postgraduate emergency medicine training – a national survey. CAN J EMERG MED 2017; 20:132-141. [DOI: 10.1017/cem.2017.24] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectivesSimulation-based education (SBE) is an important training strategy in emergency medicine (EM) postgraduate programs. This study sought to characterize the use of simulation in FRCPC-EM residency programs across Canada.MethodsA national survey was administered to residents and knowledgeable program representatives (PRs) at all Canadian FRCPC-EM programs. Survey question themes included simulation program characteristics, the frequency of resident participation, the location and administration of SBE, institutional barriers, interprofessional involvement, content, assessment strategies, and attitudes about SBE.ResultsResident and PR response rates were 63% (203/321) and 100% (16/16), respectively. Residents reported a median of 20 (range 0–150) hours of annual simulation training, with 52% of residents indicating that the time dedicated to simulation training met their needs. PRs reported the frequency of SBE sessions ranging from weekly to every 6 months, with 15 (94%) programs having an established simulation curriculum. Two (13%) of the programs used simulation for resident assessment, although 15 (94%) of PRs indicated that they would be comfortable with simulation-based assessment. The most common PR-identified barriers to administering simulation were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Interprofessional involvement in simulation was strongly valued by both residents and PRs.ConclusionsSBE is frequently used by Canadian FRCPC-EM residency programs. However, there exists considerable variability in the structure, frequency, and timing of simulation-based activities. As programs transition to competency-based medical education, national organizations and collaborations should consider the variability in how SBE is administered.
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Noveanu J, Amsler F, Ummenhofer W, von Wyl T, Zuercher M. Assessment of Simulated Emergency Scenarios: Are Trained Observers Necessary? PREHOSP EMERG CARE 2017; 21:511-524. [DOI: 10.1080/10903127.2017.1302528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Factors associated with the outcome of out-of-hospital cardiopulmonary arrest among people over 80 years old in Japan. Resuscitation 2017; 113:63-69. [PMID: 28185923 DOI: 10.1016/j.resuscitation.2017.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/27/2016] [Accepted: 01/14/2017] [Indexed: 11/23/2022]
Abstract
AIM To determine if termination of resuscitation should be considered for older individuals, we sought to identify factors associated with clinical outcome following out-of-hospital cardiac arrest (OHCA) in people ≥80 years old and over. METHODS A prospective, population-based, observational study was conducted for ≥80-year-old individuals who experienced out-of-hospital cardiac arrest and to whom resuscitation was provided by emergency responders between January 1, 2005 and December 31, 2012 (n=377,577). The primary endpoint was 1-month survival. Signal detection analysis was applied to estimate predictive factors among 17 variables. RESULTS Among all out-of-hospital cardiac arrest cases, 59.4% were of cardiac origin, and 1-month survival rate was 3.3%. Following signal detection analysis, cases of both cardiac and non-cardiac origin were categorized into three subgroups defined by return of spontaneous circulation (ROSC) and epinephrine use. One-month survival ranged between 1.2 and 41.0% for the three subgroups of cardiac origin and between 2.0 and 41.1% for the three subgroups of non-cardiac origin. CONCLUSIONS ROSC was the most significant predictor of 1-month survival among patients with cardiac and non-cardiac OHCA who were ≥80 years old. Absence of ROSC might be an important factor to the termination of resuscitation rule for OHCA in individuals who are ≥80years old.
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Real-time visual feedback during training improves laypersons' CPR quality: a randomized controlled manikin study. CAN J EMERG MED 2017; 19:480-487. [PMID: 28115027 DOI: 10.1017/cem.2016.410] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The chances of surviving an out-of-hospital cardiac arrest depend on early and high-quality cardiopulmonary resuscitation (CPR). Our aim is to verify whether the use of feedback devices during laypersons' CPR training improves chest compression quality. METHODS Laypersons totalling 450 participating in Basic Life Support and Automated External Defibrillation (BLS/AED) courses were randomly divided into three groups: group No Feedback (NF) attended a course without any feedback, group Short Feedback (SF) a course with 1-minute training with real-time visual feedback, and group Long Feedback (LF) a course with 10-minute training with real-time visual feedback. At the end of each course, we recorded 1 minute of compression-only CPR. The primary end point was the difference in the percentage of compressions performed with correct depth. RESULTS There was a significant improvement in the percentage of compressions with correct depth in the groups receiving feedback compared to the other (NF v. LF, p=0.022; NF v. SF, p=0.005). This improvement was also present in the percentage of compressions with a complete chest recoil (71.7% in NF, 86.6% in SF, and 88.8% in LF; p<0.001), compressions with the correct hand position (93.2% in NF, 98.2% in SF, and 99.3% in LF; p<0.001), and in the Total CPR Score (79.4% in NF, 90.2% in SF, and 92.5% in LF; p<0.001). There were no significant differences for all of the parameters between group SF and group LF. CONCLUSIONS Real-time visual feedback improves laypersons' CPR quality, and we suggest its use in every BLS/AED course for laypersons because it can help achieve the goals emphasized by the International Liaison Committee on Resuscitation recommendations.
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Abstract
Numerous factors contribute to neonatal morbidity and mortality, and inexperienced providers managing crisis situations is one major cause. Simulation-based medical education is an excellent modality to employ in community hospitals to help refine and refresh resuscitation skills of providers who infrequently encounter neonatal emergencies. Mounting evidence suggests that simulation-based education improves patient outcomes. Academic health centers have the potential to improve neonatal outcomes through collaborations with community hospital providers, sharing expertise in neonatal resuscitation and simulation. Community outreach programs using simulation have been successfully initiated in North America. Two examples of programs are described here, including the models for curricular development, required resources, limitations, and benefits. Considerations for initiating outreach simulation programs are discussed. In the future, research demonstrating improved neonatal outcomes using outreach simulation will be important for personnel conducting outreach programs. Neonatal outreach simulation is a promising educational endeavor that may ultimately prove important in decreasing neonatal morbidity and mortality.
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Affiliation(s)
- Bobbi J Byrne
- Section of Neonatal-Perinatal Medicine, Indiana University School of Medicine, 699 Riley Hospital Dr, RR 208, Indianapolis, IN 46202.
| | - Deepak Manhas
- Department of Paediatrics, Children's and Women's Hospital of British Columbia, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Are Pediatric Emergency Physicians More Knowledgeable and Confident to Respond to a Pediatric Disaster after an Experiential Learning Experience? Prehosp Disaster Med 2016; 31:551-6. [DOI: 10.1017/s1049023x16000704] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesPediatric hospital disaster responders must be well-trained and prepared to manage children in a mass-casualty incident. Simulations of various types have been the traditional way of testing hospital disaster plans and training hospital staff in skills that are used in rare circumstances. The objective of this longitudinal, survey-based, observational study was to assess the effect of disaster response and management-based experiential learning on the knowledge and confidence of advanced learners.MethodsA simulation-based workshop was created for practicing Pediatric Emergency Medicine (PEM) physicians, senior PEM physicians, and critical care and pediatric surgery residents to learn how to manage a disaster response. Given that this particular group of learners had never been exposed to such a disaster simulation, its educational value was assessed with the goal of improving the quality of the hospital pediatric medical response to a disaster by increasing the responders’ knowledge and confidence. Objective and subjective measures were analyzed using both a retrospective, pre-post survey, as well as case-based evaluation grids.ResultsThe simulation workshop improved the learners’ perceived ability to manage patients in a disaster context and identified strengths and areas needing improvement for patient care within the disaster context.ConclusionAdvanced learners exposed to an experiential learning activity believed that it improved their ability to manage patients in a disaster situation and felt that it was valuable to their learning. Their confidence was preserved six months later.BankI, KhalilE. Are pediatric emergency physicians more knowledgeable and confident to respond to a pediatric disaster after an experiential learning experience?Prehosp Disaster Med. 2016;31(5):551–556.
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Nolan JP, Hazinski MF, Aickin R, Bhanji F, Billi JE, Callaway CW, Castren M, de Caen AR, Ferrer JME, Finn JC, Gent LM, Griffin RE, Iverson S, Lang E, Lim SH, Maconochie IK, Montgomery WH, Morley PT, Nadkarni VM, Neumar RW, Nikolaou NI, Perkins GD, Perlman JM, Singletary EM, Soar J, Travers AH, Welsford M, Wyllie J, Zideman DA. Part 1: Executive summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2016; 95:e1-31. [PMID: 26477703 DOI: 10.1016/j.resuscitation.2015.07.039] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cant RP, Porter JE, Cooper SJ, Roberts K, Wilson I, Gartside C. Improving the non-technical skills of hospital medical emergency teams: The Team Emergency Assessment Measure (TEAM™). Emerg Med Australas 2016; 28:641-646. [DOI: 10.1111/1742-6723.12643] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 05/23/2016] [Accepted: 06/02/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Robyn P Cant
- School of Nursing and Midwifery; Monash University; Narre Warren Victoria Australia
| | - Joanne E Porter
- School of Nursing, Midwifery and Healthcare; Federation University Australia; Churchill Victoria Australia
| | - Simon J Cooper
- School of Nursing, Midwifery and Healthcare; Federation University Australia; Churchill Victoria Australia
| | - Kate Roberts
- Emergency Department; Central Gippsland Health Service; Sale Victoria Australia
| | - Ian Wilson
- Emergency Department; Northeast Health (Wangaratta); Wangaratta Victoria Australia
| | - Christopher Gartside
- Emergency Department; Northeast Health (Wangaratta); Wangaratta Victoria Australia
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A Qualitative Study Exploring Moral Distress Among Pediatric Resuscitation Team Clinicians: Challenges to Professional Integrity. Pediatr Crit Care Med 2016; 17:e303-8. [PMID: 27182784 DOI: 10.1097/pcc.0000000000000773] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our study objectives were to explore moral distress among pediatric team clinicians within the context of resuscitation experiences, and determine whether there were any distinctively ethical perspectives on moral distress that could be conceptualized as challenges to professional integrity, rather than to previously described psychological responses of clinicians. DESIGN Descriptive, exploratory qualitative study. SETTING A large tertiary pediatric academic hospital in Houston, TX. SUBJECTS Twenty-five PICU resuscitation team clinicians were interviewed from December 2012 to April 2013. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All clinicians reported experiencing moral distress during certain resuscitations. Twenty-one of 25 clinicians reflected and acknowledged that their sense of professional integrity had been challenged during those resuscitation events. Four main components of resuscitation experience that induced moral distress were identified: 1) experiences where there was lack of understanding of the big picture; 2) experiences where there was suboptimal team leadership; 3) experiences where there was variable meanings to the word "resuscitation"; and 4) experiences were there was uncertainty of role responsibility. CONCLUSIONS The perception of moral distress exists among pediatric clinicians during resuscitations and could be conceptualized as challenges to professional integrity. This ethical framework offers an alternative approach to understanding and investigating the complex layers of moral distress.
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Rosenman ED, Branzetti JB, Fernandez R. Assessing Team Leadership in Emergency Medicine: The Milestones and Beyond. J Grad Med Educ 2016; 8:332-40. [PMID: 27413434 PMCID: PMC4936849 DOI: 10.4300/jgme-d-15-00400.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Team leadership is a critical skill for emergency medicine physicians that directly affects team performance and the quality of patient care. There exists a robust body of team science research supporting team leadership conceptual models and behavioral skill sets. However, to date, this work has not been widely incorporated into health care team leadership education. OBJECTIVE This narrative review has 3 aims: (1) to synthesize the team science literature and to translate important concepts and models to health care team leadership; (2) to describe how team leadership is currently represented in the health care literature and in the Accreditation Council for Graduate Medical Education Milestones for emergency medicine; and (3) to propose a novel, evidence-based framework for the assessment of team leadership in emergency medicine. METHODS We conducted a narrative review of the team science and health care literature. We summarized our findings and identified a list of team leadership behaviors that were then used to create a framework for team leadership assessment. RESULTS Current health care team leadership measurement tools do not incorporate evidence-based models of leadership concepts from other established domains. The emergency medicine milestones include several team leadership behaviors as part of a larger resident evaluation program. However, they do not offer a comprehensive or cohesive representation of the team leadership construct. CONCLUSIONS Despite the importance of team leadership to patient care, there is no standardized approach to team leadership assessment in emergency medicine. Based on the results of our review, we propose a novel team leadership assessment framework that is supported by the team science literature.
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Affiliation(s)
- Elizabeth D. Rosenman
- Corresponding author: Elizabeth D. Rosenman, MD, University of Washington School of Medicine, Box 359702, 325 9th Avenue, Seattle, WA 98104, 206.744.8337,
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Zinckernagel L, Malta Hansen C, Rod MH, Folke F, Torp-Pedersen C, Tjørnhøj-Thomsen T. What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools? A qualitative study. BMJ Open 2016; 6:e010481. [PMID: 27113236 PMCID: PMC4853997 DOI: 10.1136/bmjopen-2015-010481] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Cardiopulmonary resuscitation (CPR) training in schools is recommended to increase bystander CPR and thereby survival of out-of-hospital cardiac arrest, but despite mandating legislation, low rates of implementation have been observed in several countries, including Denmark. The purpose of the study was to explore barriers to implementation of CPR training in Danish secondary schools. DESIGN A qualitative study based on individual interviews and focus groups with school leadership and teachers. Thematic analysis was used to identify regular patterns of meaning both within and across the interviews. SETTING 8 secondary schools in Denmark. Schools were selected using strategic sampling to reach maximum variation, including schools with/without recent experience in CPR training of students, public/private schools and schools near to and far from hospitals. PARTICIPANTS The study population comprised 25 participants, 9 school leadership members and 16 teachers. RESULTS School leadership and teachers considered it important for implementation and sustainability of CPR training that teachers conduct CPR training of students. However, they preferred external instructors to train students, unless teachers acquired the CPR skills which they considered were needed. They considered CPR training to differ substantially from other teaching subjects because it is a matter of life and death, and they therefore believed extraordinary skills were required for conducting the training. This was mainly rooted in their insecurity about their own CPR skills. CPR training kits seemed to lower expectations of skill requirements to conduct CPR training, but only among those who were familiar with such kits. CONCLUSIONS To facilitate implementation of CPR training in schools, it is necessary to have clear guidelines regarding the required proficiency level to train students in CPR, to provide teachers with these skills, and to underscore that extensive skills are not required to provide CPR. Further, it is important to familiarise teachers with CPR training kits.
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Affiliation(s)
- Line Zinckernagel
- Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark
| | - Morten Hulvej Rod
- Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark
- Emergency Medical Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | | | - Tine Tjørnhøj-Thomsen
- Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Eldridge AJ, Ford R. Perimortem caesarean deliveries. Int J Obstet Anesth 2016; 27:46-54. [PMID: 27103543 DOI: 10.1016/j.ijoa.2016.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/25/2016] [Indexed: 11/17/2022]
Abstract
Although cardiac arrest in pregnancy is rare, it is important that all individuals involved in the acute care of pregnant women are suitably trained, because the outcome for both mother and fetus can be affected by the management of the arrest. Perimortem caesarean delivery was first described in 715 BC. Initially the procedure was performed principally for religious or political reasons. Although the potential for fetal survival was proposed, it was rarely successful, probably because the delivery was delayed until maternal death was established. However, in recent decades, case reports have suggested improved maternal as well as fetal survival if perimortem caesarean section was performed rapidly once maternal arrest has occurred. While evidence for this is largely based on case reports, the physiological advantages including removing inferior caval obstruction, and hence improving venous return to the heart, reducing oxygen requirement and improving chest compliance appear compelling. Factors that reduce errors and minimise the delay in performance of caesarean delivery are discussed, in particular the importance of training, organizational factors within a hospital and the use of prompts during an arrest. While evidence is limited, it is probable that both maternal and fetal survival are improved with early delivery by perimortem caesarean delivery. More importantly, no evidence was found from case report reviews that either maternal or fetal survival was worsened. Perimortem caesarean delivery therefore remains a key consideration in the management of maternal arrest from the mid second trimester.
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Affiliation(s)
- A J Eldridge
- Anaesthetic Department, Queen Alexandra Hospital, Portsmouth, Hampshire, UK.
| | - R Ford
- Anaesthetic Department, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
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Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, Castren M, de Caen AR, Ferrer JME, Finn JC, Gent LM, Griffin RE, Iverson S, Lang E, Lim SH, Maconochie IK, Montgomery WH, Morley PT, Nadkarni VM, Neumar RW, Nikolaou NI, Perkins GD, Perlman JM, Singletary EM, Soar J, Travers AH, Welsford M, Wyllie J, Zideman DA. Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2016; 132:S2-39. [PMID: 26472854 DOI: 10.1161/cir.0000000000000270] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bhanji F, Donoghue AJ, Wolff MS, Flores GE, Halamek LP, Berman JM, Sinz EH, Cheng A. Part 14: Education: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S561-73. [PMID: 26473002 DOI: 10.1161/cir.0000000000000268] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Accuracy of instructor assessment of chest compression quality during simulated resuscitation. CAN J EMERG MED 2016; 18:276-82. [DOI: 10.1017/cem.2015.104] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectivesThe 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario.MethodsThis is a prospective observational study in which objective chest compression quality data (rate, depth, and fraction) were collected from the simulation manikin and compared to subjective instructor assessment. Data were collected during weekly simulation training sessions for residents, medical students, and nursing students.ResultsWe included data from 24 simulated resuscitation scenarios assessed by 1 of 15 instructors. Subjective assessment of chest compression quality identified an adequate compression rate (100–120 compressions per minute) with a sensitivity of 0.17 (confidence interval [CI] 0.02–0.32) and specificity of 0.06 (CI −0.04–0.15), adequate depth (>50 mm) with a sensitivity of 0 and specificity of 0.38 (CI 0.18–0.57), and adequate fraction (>80%) with a sensitivity of 1 and a specificity of 0.25 (CI 0.08–0.42).ConclusionInstructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators.
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Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, Cabanas JG, Cone DC, Diercks DB, Foster J(J, Meeks RA, Travers AH, Welsford M. Part 4: Systems of Care and Continuous Quality Improvement. Circulation 2015; 132:S397-413. [DOI: 10.1161/cir.0000000000000258] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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