44 research outputs found
Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial
Objective: To determine if real-time compression feedback using a non-automated hand-held device improves
patient outcomes from in-hospital cardiac arrest (IHCA).
Methods: We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in
the mixed medicalĂąâŹâsurgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard
manual chest compressions or compressions performed with real-time feedback using the Cardio First AngelĂąâÂą (CFA)
device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes were
survival to ICU and hospital discharge.
Results: One thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC was
significantly improved in the CFA group (66.7% vs. 42.4%, P < 0.001), as was survival to ICU discharge (59.8% vs. 33.6%)
and survival to hospital discharge (54% vs. 28.4%, P < 0.001). Outcomes were not affected by intra-group comparisons
based on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-group
comparisons of non-intubated patients, but not intubated ones.
Conclusion: Use of the CFA compression feedback device improved event survival and survival to ICU and hospital
discharge
Training in crisis communication and volcanic eruption forecasting:Design and evaluation of an authentic role-play simulation
We present an interactive, immersive, authentic role-play simulation designed to teach tertiary geoscience students
in New Zealand to forecast and mitigate a volcanic crisis. Half of the participating group (i.e., the Geoscience Team)
focuses on interpreting real volcano monitoring data (e.g., seismographs, gas output etc.) while the other half of the
group (i.e., the Emergency Management Team) forecasts and manages likely impacts, and communicates emergency
response decisions and advice to local communities. These authentic learning experiences were aimed at enhancing
upper-year undergraduate studentsâ transferable and geologic reasoning skills. An important goal of the simulation was
specifically to improve studentsâ science communication through interdisciplinary team discussions, jointly prepared,
and delivered media releases, and real-time, high-pressure, press conferences.
By playing roles, students experienced the specific responsibilities of a professional within authentic organisational
structures. A qualitative, design-based educational research study was carried out to assess the overall student experience
and self-reported learning of skills. A pilot and four subsequent iterations were investigated.
Results from this study indicate that students found these role-plays to be a highly challenging and engaging learning
experience and reported improved skills. Data from classroom observations and interviews indicate that the students
valued the authenticity and challenging nature of the role-play although personal experiences and team dynamics
(within, and between the teams) varied depending on the studentsâ background, preparedness, and personality.
During early iterations, observation and interviews from students and instructors indicate that some of the goals of the
simulation were not fully achieved due to: A) lack of preparedness, B) insufficient time to respond appropriately, C)
appropriateness of roles and team structure, and D) poor communication skills. Small modifications to the design of
Iterations 3 and 4 showed an overall improvement in the studentsâ skills and goals being reached.
A communication skills instrument (SPCC) was used to measure self-reported pre- and post- communication competence
in the last two iterations. Results showed that this instrument recorded positive shifts in all categories of self-perceived
abilities, the largest shifts seen in students who participated in press conferences. Future research will be aimed
at adapting this curricula to new volcanic and earthquake scenarios
The effector T cell response to influenza infection
Influenza virus infection induces a potent initial innate immune response, which serves to limit the extent of viral replication and virus spread. However, efficient (and eventual) viral clearance within the respiratory tract requires the subsequent activation, rapid proliferation, recruitment, and expression of effector activities by the adaptive immune system, consisting of antibody producing B cells and influenza-specific T lymphocytes with diverse functions. The ensuing effector activities of these T lymphocytes ultimately determine (along with antibodies) the capacity of the host to eliminate the viruses and the extent of tissue damage. In this review, we describe this effector T cell response to influenza virus infection. Based on information largely obtained in experimental settings (i.e., murine models), we will illustrate the factors regulating the induction of adaptive immune T cell responses to influenza, the effector activities displayed by these activated T cells, the mechanisms underlying the expression of these effector mechanisms, and the control of the activation/differentiation of these T cells, in situ, in the infected lungs
Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study
<p>Abstract</p> <p>Background</p> <p>One of the factors that limits survival from out-of-hospital cardiac arrest is the interruption of chest compressions. During ventricular fibrillation and tachycardia the electrocardiogram reflects the probability of return of spontaneous circulation associated with defibrillation. We have used this in the current study to quantify in detail the effects of interrupting chest compressions.</p> <p>Methods</p> <p>From an electrocardiogram database we identified all intervals without chest compressions that followed an interval with compressions, and where the patients had ventricular fibrillation or tachycardia. By calculating the mean-slope (a predictor of the return of spontaneous circulation) of the electrocardiogram for each 2-second window, and using a linear mixed-effects statistical model, we quantified the decline of mean-slope with time. Further, a mapping from mean-slope to probability of return of spontaneous circulation was obtained from a second dataset and using this we were able to estimate the expected development of the probability of return of spontaneous circulation for cases at different levels.</p> <p>Results</p> <p>From 911 intervals without chest compressions, 5138 analysis windows were identified. The results show that cases with the probability of return of spontaneous circulation values 0.35, 0.1 and 0.05, 3 seconds into an interval in the mean will have probability of return of spontaneous circulation values 0.26 (0.24â0.29), 0.077 (0.070â0.085) and 0.040(0.036â0.045), respectively, 27 seconds into the interval (95% confidence intervals in parenthesis).</p> <p>Conclusion</p> <p>During pre-shock pauses in chest compressions mean probability of return of spontaneous circulation decreases in a steady manner for cases at all initial levels. Regardless of initial level there is a relative decrease in the probability of return of spontaneous circulation of about 23% from 3 to 27 seconds into such a pause.</p