Lower chest compression fraction among patients with longer downtime and ROSC was not due to peri-shock pause

Letter to the Editor Sir, In our paper entitled “Lower chest compression fraction associated with ROSC in OHCA patients with longer downtimes” [1] we reported a significant, inverse relationship between chest compression fraction (CCF) and return of spontaneous circulation (ROSC); furthermore this relationship was shown to vary with downtime from onset of arrest to the provision of CPR by paramedics. We found specifically that in the group with a downtime of greater than 15 min, a lower CCF during the first three minutes of cardiopulmonary resuscitation (CPR) was significantly associated with ROSC. In this Letter to the Editor we present some additional data for pre-, post- and peri-shock pause [2] that was not included in our previously published work. The reason that it was not included was because there were few cases in our cohort that received a shock during the first three minutes of CPR quality data capture. However, we believe that presentation of this additional shock pause data aids in demonstrating that the significantly lower CCF observed among patients who achieved ROSC in the group with a downtime of greater than 15 min was not due to more time spent administering defibrillations

Types and anatomical locations of injuries among mountain bikers and hikers: A systematic review

Background Mountain biking and hiking continue to grow in popularity. With new participants to these sports, it is likely the number of injuries will increase. To assist medical personnel in the management of these patients we attempted to quantify the types and locations of injuries sustained by mountain bikers and hikers. Objective The objective of this systematic review is to identify the type and anatomical location of injuries for both mountain bikers and hikers. Methods A systematic search was undertaken using CINAHL, Cochrane, ProQuest, PubMed and Scopus databases. Reviewers assessed the eligibility of articles by a title/abstract review and final full-text review. Studies were included if the types of injuries were reported by medical personnel and contained anatomical locations. Studies were excluded if it did not take place on a trail or if the injuries were self-reported. Risk of bias was assessed utilising the Joanna Briggs Institute (JBI) checklists for study quality. No meta-analysis or comparison between mountain bikers and hikers was possible due to the high heterogeneity of the definition of injury. Results A total of 24 studies met the inclusion criteria, 17 covering mountain biking and 7 hiking. This represented 220,935 injured mountain bikers and 17,757 injured hikers. The most common type of injuries sustained by mountain bikers included contusions, abrasions and minor lacerations, which made up between 45–74% of reported injuries in studies on competitive racing and 8–67% in non-competitive studies. Fractures represented between 1.5–43% of all reported injuries. The most injured region was the upper limbs reported in 10 of 17 studies. For hikers the most common injuries included blisters and ankle sprains with blisters representing 8–33% of all reported injuries. The most common body location to be injured by hikers was a lower limb in all 7 studies. Conclusions This is the first systematic review to report on the injury epidemiology of the two most common trail users; mountain bikers and hikers. For participants in both activities the majority of injuries were of minor severity. Despite this, the high proportions of upper limb fractures in mountain bikers and ankle sprains in hikers cannot be ignored. Trial registration Registration: This systematic review was prospectively registered with the University of York PROSPERO database on the 12/4/2021 (CRD42021229623) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021229623

A situational analysis of current antimicrobial governance, regulation, and utilization in South Africa

The Global Action Plan on antimicrobial resistance calls for the use of antimicrobial medicines in human and animal health to be optimized, in tandem with a strengthening of the knowledge and evidence base through surveillance and research. However, there is a paucity of consumption data for African countries such as South Africa. Determining antimicrobial consumption data in low-resource settings remains a challenge. This article describes alternative mechanisms of assessing antimicrobial consumption data, such as the use of Intercontinental Marketing Services (IMS) data and contract data arising from tenders (an open Request for Proposal, RFP), as opposed to the international norms of daily defined doses per 100 patient-days or per 1000 population. Despite their limitations, these serve as indicators of antimicrobial exposure at the population level and represent an alternative method for ascertaining antimicrobial consumption in human health. Furthermore, South Africa has the largest antiretroviral treatment programme globally and carries a high burden of tuberculosis. This prompted the inclusion of antiretroviral and anti-tuberculosis antibiotic consumption data. Knowledge of antimicrobial utilization is imperative for meaningful future interventions. Baseline antimicrobial utilization data could guide future research initiatives that could provide a better understanding of the different measures of antibiotic use and the level of antibiotic resistance. Keywords: Antimicrobial governance, DOTS, Antibiotic consumption, Developing country, Antimicrobial exposur

Le cancer en Suisse, rapport 2015: état des lieux et évolution

En Suisse, 38'000 nouveaux cas de cancer sont diagnostiqués annuellement. Chaque année, 16'000 personnes meurent du cancer. Ce second rapport sur le cancer en Suisse présente la situation actuelle du cancer et son évolution au cours des 30 dernières années. Après un aperçu général de l'ensemble des cancers, les cancers principaux chez les adultes et les enfants sont détaillés. Le rapport présente les taux de morbidité et de mortalité due au cancer ainsi que le nombre de patients touchés. Il montre également l'évolution des taux de morbidité, de mortalité et de survie au cours des dernières années et les différences géographiques. Ces chiffres sont complétés par la description des facteurs de risque recensés dans la littérature scientifique. Les méthodes utilisées pour établir ce rapport font l'objet d'une publication séparée. Celle-ci contient également des indications sur les classifications, les sources de données, la qualité des données ainsi que sur la littérature scientifique

The EXACT protocol: A multi-centre, single-blind, randomised, parallel-group, controlled trial to determine whether early oxygen titration improves survival to hospital discharge in adult OHCA patients

Background: Experimental and observational research suggests hyperoxia following resuscitation from cardiac arrest is associated with neurological injury and worse clinical outcomes. This paper describes the rationale and design of the EXACT trial. EXACT aims to determine whether reducing oxygen in the acute phase of post-resuscitation care for out-of-hospital cardiac arrest (OHCA) improves survival. Methods: EXACT is a multi-centre, randomised (1:1), single-blind, parallel trial. Presumed cardiac OHCA cases who achieve a return of spontaneous circulation will be eligible if they are comatose, with an advanced airway and have an oxygen saturation (SpO2) ≥95% on >10 L/min (or 100% oxygen). Paramedics will randomise 1416 eligible cases to receive oxygen therapy targeting an SpO2 of 90–94% (intervention) or 98–100% (control). Study treatment will continue until admission to an intensive care unit or hospital ward. The primary outcome is survival to hospital discharge. Secondary outcomes include 12-month survival and quality of life. Results: The study has commenced in the Australian states of Victoria and South Australia, and has enrolled 167 eligible cases to date (80 intervention and 87 control). Further sites are due to commence in 2019, recruitment is expected to take three years. Conclusion: This study will determine if early reduction of oxygen leads to improved outcomes in OHCA. Such a finding may potentially change clinical practice with implications on future OHCA survival outcomes. Trial registration number: NCT03138005

"Sorry, what did you say?" Communicating defibrillator retrieval and use in OHCA emergency calls.

BACKGROUND The defibrillator prompt, which directs callers to retrieve a defibrillator during out-of-hospital-cardiac arrest, is crucial to the emergency call because it can save lives. We evaluated communicative effectiveness of the prompt instated by the Medical Priority Dispatch System ™ version 13, namely: if there is a defibrillator (AED) available, send someone to get it now, and tell me when you have it. METHODS Using Conversation Analysis and descriptive statistics, we examined linguistic features of the defibrillator sequences (call-taker prompt and caller response) in 208 emergency calls where non-traumatic out of hospital cardiac arrest was confirmed by the emergency medical services, and they attempted resuscitation, in the first six months of 2019. Defibrillator sequence durations were measured to determine impact on time to CPR prompt. The proportion of cases where bystanders retrieved defibrillators was also assessed. RESULTS There was low call-taker adoption of the Medical Priority Dispatch System ™ version 13 prompt (99/208) compared to alternative prompts (86/208) or no prompt (23/208). Caller responses to the version 13 prompt tended to be longer, more ambiguous or unrelated, and have more instances of repair (utterances to address comprehension trouble). Defibrillators were rarely brought to the scene irrespective of defibrillator prompt utilised. CONCLUSION While the version 13 prompt aims to ensure the use of an available automatic external defibrillator, its effectiveness is undermined by the three-clause composition of the prompt and exclusion of a question structure. We recommend testing of a re-phrased defibrillator prompt in order to maximise comprehension and caller action