A Cross-sectional Study Among Healthcare and Non-healthcare Students in Slovenia and Croatia About Do-not Resuscitate Decision-making

Health Care Providers' Attitudes Toward Do-Not-Resuscitate Order in COVID-19 Patients: An Ethical Dilemma in Iran

This study aimed to investigate the health care providers' attitudes toward the Do-Not-Resuscitate order (DNR) in COVID-19 patients. This study was conducted on 332 health care providers (HCPs) at the COVID-19 referral hospital in Shahroud, Iran by convenience sampling method. The study tools included a demographic information form and the DNR attitude questionnaire. Significance level was considered 0.05 for all tests. The mean scores of attitudes toward DNR order, the procedure of DNR, some aspects of passive euthanasia, and religious and cultural factors were 25.27 ± 2.78, 40.61 ± 5.99, 11.26 ± 2.51, and 6.12 ± 1.27, respectively. The death of relatives due to COVID-19 and female gender were associated with high and low scores of attitudes toward DNR order, respectively. Extended working hours and more work experience were correlated with high scores of DNR procedure. The history of COVID-19 increased the mean score of attitudes toward some aspects of passive euthanasia. In addition, an increase in following COVID-19 news decreased the score of religious and cultural factors affecting DNR order. Despite the legal ban on implementation of the DNR in Iran, the attitude of Iranian HCPs toward this was positive in COVID-19 patients.

Ethical Dilemmas in Neonatal Care at the Limit of Viability

Advances in neonatal care have pushed the limit of viability to incrementally lower gestations over the last decades. However, surviving extremely premature neonates are prone to long-term neurodevelopmental handicaps. This makes ethics a crucial dimension of periviable birth management. At 22 weeks, survival ranges from 1 to 15%, and profound disabilities in survivors are common. Consequently, there is no beneficence-based obligation to offer any aggressive perinatal management. At 23 weeks, survival ranges from 8 to 54%, and survival without severe handicap ranges from 7 to 23%. If fetal indication for cesarean delivery appears, the procedure may be offered when neonatal resuscitation is planned. At a gestational age ≥24 weeks, up to 51% neonates are expected to survive the neonatal period. Survival without profound neurologic disability ranges from 12 to 38%. Beneficence-based obligation to intervene is reasonable at these gestations. Nevertheless, autonomy of parents should also be respected, and parental consent should be sought prior to any intervention. Optimal counselling of parents involves harmonized cooperation of obstetric and neonatal care providers. Every fetus/neonate and every pregnant woman are different and have the right to be considered individually when treatment decisions are being made.

Effects of Cardiopulmonary Resuscitation with Automated External Defibrillator Training among Schoolchildren in Slovenia: A Pre- and Post-test Cohort Study

Introduction

A low proportion of bystanders in Slovenia are willing to provide resuscitation to people experiencing cardiac arrest. We measured knowledge acquired after cardiopulmonary resuscitation training among Slovenian children in the final three grades of primary school.

Methods

This pre- and post-test cohort study included 566 schoolchildren aged 12-15 years. From April to May 2018, we administered a 15-item questionnaire to children in 15 primary schools, to assess the effects of theoretical and practical cardiopulmonary resuscitation training on their knowledge of cardiopulmonary resuscitation at 1-2 months after training. Data were processed using univariate, bivariate, and multivariate analyses.

Results

A significantly greater level of post-training knowledge was noted in all three equally sized school grade groups (p=0.001). The youngest group (mean age 12.5 years) exhibited the greatest increase in knowledge, with test scores increasing by an average 2.65 (range 0-15) points. Age (p=0.001), body mass index (p=0.037), female sex (p=0.006), and previous resuscitation training (p=0.024) were significant independent predictors of pre-training knowledge level. Sex was the only predictor significantly influencing knowledge levels after training (p=0.002); girls scored up to 0.7 points higher than boys, both before and after training.

Conclusions

Among Slovenian schoolchildren aged 12-15 years, a significantly improved level of theoretical knowledge was demonstrated after cardiopulmonary resuscitation training. The introduction of cardiopulmonary training may be most effective in children aged 12.5 years (seventh graders). Early, compulsory resuscitation training might reduce social barriers to performing resuscitation, which may eventually translate into better post-cardiac arrest outcomes.