116 research outputs found
Co-expression of lung alveolar epithelial type I and II cell-selective proteins in response to injury
The internal surface of the lung is covered by alveolar epithelial type I (ATI) and II
(ATII) cells. In response to injury ATII cells proliferate and transdifferentiate to ATI
cells. Currently, there are no simple methods to identify transdifferentiation in vivo.
This study used a novel combination of ATI and ATII cell-selective antibodies to
investigate the phenotype of the alveolar epithelium following Staphylococcus aureusinduced 'direct' lung injury. Imaging using confocal laser scanning microscopy with 2D
and 3D image analysis allowed qualitative and quantitative investigation of the
epithelial response to injury. Following distal airway instillation of S. aureus, the
alveolar epithelium was covered with ATII cells (MMC4/RTIIââ-positive cells) and ATI
cells (RTIââ-positive cells) as seen in control lungs. However, the surface area covered
by ATII cells was significantly increased, while the surface area covered by ATI cells
was significantly decreased, in comparison with controls. Ultrastructural studies
confirmed the decrease in ATI cell numbers following S. aMrews-inoculation. The
alveolar wall of S. awrews-injured lungs also contained cells that co-stained with a
unique combination of ATI and ATII cell proteins, RTIââ and MMC4. To determine
whether RTIââ/MMC4-positive cells were likely to be intermediates in the transition of
ATII to ATI cells I examined ATII cells as they transformed to ATI-like cells in culture
(day 0 to 5). Only cells on day 1 of culture were RTIââ/MMX^l positive. I also examined
the developing lung for RTIââ/MMCd positive cells. Co-staining cells were not found in
the developing alveolar epithelium, but they were present in small airways. I also
developed a rat model of haemorrhagic shock induced 'indirect' alveolar epithelial
injury as a platform for future work. Here I have developed a robust technique for
imaging ATII cell transdifferentiation in vivo and in vitro. This work has identified a
novel alveolar epithelial phenotype, RTIââ/MMC4, in repairing lungs and in ATII cells
as they transdifferentiate to ATI-like cells in vitro. These data suggest that
RTIââ/MMC4-positive cells can be used to both visualize alveolar epithelial
intermediates in vivo and to investigate the regulation of ATII cell transdifferentiation
following injury
Theorising survivorship after intensive care:A systematic review of patient and family experiences
Association of measures of socioeconomic position with survival following out-of-hospital cardiac arrest: a systematic review
Attitudes towards bystander cardiopulmonary resuscitation:Results from a cross-sectional general population survey
Survival from out-of-hospital cardiac arrest (OHCA) varies across the developed world. Although not all OHCA are recoverable, the survival rate in Scotland is lower than in comparable countries, with higher average survival rates of 7.9% in England and 9% across Europe. The purpose of this paper is to explore the barriers, facilitators and public attitudes to administering bystander cardiopulmonary resuscitation (CPR) which could inform future policy and initiatives to improve the rate of bystander CPR. Data was collected via a cross-sectional general population survey of 1027 adults in Scotland. 52% of respondents had been trained in CPR. Of those who were not trained, two fifths (42%) expressed a willingness to receive CPR training. Fewer than half (49%) felt confident administering CPR, rising to 82% if they were talked through it by a call handler. Multivariate analyses identified that people in social grade C2DE were less likely than those in social grade ABC1 to be CPR trained and less confident to administer CPR if talked through by a call handler. The older a person was, the less likely they were to be CPR trained, show willingness to be CPR trained or be confident to administer bystander CPR with or without instruction from an emergency call handler. These findings are particularly relevant considering that most OHCA happen in the homes of older people. In a developed country such as Scotland with widely available CPR training, only half of the adult population reported feeling confident about administering bystander CPR. Further efforts tailored specifically for people who are older, unemployed and have a lower social grade are required to increase knowledge, confidence and uptake of training in bystander CPR
Association of socioeconomic status with 30-day survival following out-of-hospital cardiac arrest in Scotland, 2011-2020
BACKGROUND AND AIMS: The aim of this study was to investigate the crude and adjusted association of socioeconomic status with 30-day survival after out-of-hospital cardiac arrest (OHCA) in Scotland and to assess whether the effect of this association differs by sex or age.METHODS: This is a population-based, retrospective cohort study, including non-traumatic, non-Emergency Medical Services witnessed patients with OHCA where resuscitation was attempted by the Scottish Ambulance Service, between April 1, 2011 and March 1, 2020. Socioeconomic status was defined using the Scottish Index of Multiple Deprivation (SIMD). The primary outcome was 30-day survival after OHCA. Crude and adjusted associations of SIMD quintile with 30-day survival after OHCA were estimated using logistic regression. Effect modification by age and sex was assessed by stratification.RESULTS: Crude analysis showed lower odds of 30-day survival in the most deprived quintile relative to least deprived (OR 0.74, 95%CI 0.63-0.88). Adjustment for age, sex and urban/rural residency decreased the relative odds of survival further (OR 0.56, 95%CI 0.47-0.67). The strongest association was observed in males < 45 years old. Across quintiles of increasing deprivation, evidence of decreasing trends in the proportion of those presenting with shockable initial cardiac rhythm, those receiving bystander cardiopulmonary resuscitation and 30-day survival after OHCA were found.CONCLUSIONS: Socioeconomic status is associated with 30-day survival after OHCA in Scotland, favouring people living in the least deprived areas. This was not explained by confounding due to age, sex or urban/rural residency. The strongest association was observed in males < 45 years old.</p
Factors affecting public access defibrillator placement decisions in the United Kingdom: A survey study
AIM: This study aimed to understand current community PAD placement strategies and identify factors which influence PAD placement decision-making in the United Kingdom (UK). METHODS: Individuals, groups and organisations involved in PAD placement in the UK were invited to participate in an online survey collecting demographic information, facilitators and barriers to community PAD placement and information used to decide where a PAD is installed in their experiences. Survey responses were analysed through descriptive statistical analysis and thematic analysis. RESULTS: There were 106 included responses. Distance from another PAD (66%) and availability of a power source (63%) were most frequently used when respondents are deciding where best to install a PAD and historical occurrence of cardiac arrest (29%) was used the least. Three main themes were identified influencing PAD placement: (i) the relationship between the community and PADs emphasising community engagement to create buy-in; (ii) practical barriers and facilitators to PAD placement including securing consent, powering the cabinet, accessibility, security, funding, and guardianship; and (iii) ârisk assessmentâ methods to estimate the need for PADs including areas of high footfall, population density and type, areas experiencing health inequalities, areas with delayed ambulance response and current PAD provision. CONCLUSION: Decision-makers want to install PADs in locations that maximise impact and benefit to the community, but this can be constrained by numerous social and infrastructural factors. The best location to install a PAD depends on local context; work is required to determine how to overcome barriers to optimal community PAD placement
Closed-loop communication during out-of-hospital resuscitation:Are the loops really closed?
Training for effective communication in high-stakes environments actively promotes targeted communicative strategies. One oft-recommended strategy is closed-loop communication (CLC), which emphasises three components â call-out, checkback, and closing of the loop â to signal understanding. Using CLC is suggested to improve clinical outcomes, but research indicates that medical practitioners do not always apply CLC in team communication. Our paper analyses a context in which speakersâ linguistic choices are guided by explicit recommendations during training, namely out-of-hospital cardiac arrest (OHCA) resuscitation. We examined 20 real-life OHCA resuscitations to determine whether paramedics adopt CLC in the critical first five minutes after the arrival of the designated team leader (a paramedic specially trained in handling OHCA resuscitation), and what other related communication strategies may be used. Results revealed that standard form CLC was not consistently present in any of the resuscitations despite opportunities to use it. Instead, we found evidence of non-standard forms of CLC and closed-ended communication (containing the first two components of standard CLC). These findings may be representative of what happens when medical practitioners communicate in time-critical, real-life contexts where responses to directives can be immediately observed, and suggest that CLC may not always be necessary for effective communication in these contexts
Incidence, characteristics and outcomes of out-of-hospital cardiac arrests in patients with psychiatric illness:A systematic review
AIM: To conduct a systematic literature review of the existing evidence on incidence, characteristics and outcomes after out-of-hospital cardiac arrest (OHCA) in patients with psychiatric illness. METHODS: We searched Embase, Medline, PsycINFO and Web of Science using a comprehensive electronic search strategy to identify observational studies reporting on OHCA incidence, characteristics or outcomes by psychiatric illness status. One reviewer screened all titles and abstracts, and a second reviewer screened a random 10%. Two reviewers independently performed data extraction and quality assessment. RESULTS: Our search retrieved 11,380 studies, 10 of which met our inclusion criteria (8 retrospective cohort studies and two nested case-control studies). Three studies focused on depression, whilst seven included various psychiatric conditions. Among patients with an OHCA, those with psychiatric illness (compared to those without) were more likely to have: an arrest in a private location; an unwitnessed arrest; more comorbidities; less bystander cardiopulmonary resuscitation; and an initial non-shockable rhythm. Two studies reported on OHCA incidence proportion and two reported on survival, showing higher risk, but lower survival, in patients with psychiatric illness. CONCLUSION: Psychiatric illness in relation to OHCA incidence and outcomes has rarely been studied and only a handful of studies have reported on OHCA characteristics, highlighting the need for further research in this area. The scant existing literature suggests that psychiatric illness may be associated with higher risks of OHCA, unfavourable characteristics and poorer survival. Future studies should further investigate these links and the role of potential contributory factors such as socioeconomic status and comorbidities
Increasing lay-peopleâs intentions to initiate CPR in out of hospital cardiac arrest:Results of a mixed-methods âbefore and afterâ pilot study of a behavioural text message intervention (BICeP)
BACKGROUND: Prompt, effective cardio-pulmonary resuscitation (CPR) increases survival in out-of-hospital cardiac arrest. However, CPR is often not provided, even by people with training. Low confidence, perceptions of risks and high emotion can prevent initiation of CPR. Behaviour-change techniques may be helpful in increasing CPR rates. AIM: To pilot a text-message behavioural intervention designed to increase intentions to initiate CPR, explore participant responses and pilot methods for future randomised controlled trial of effectiveness. METHODS: A âbefore and afterâ pilot study plus qualitative interviews was undertaken. Participants were lay-people who had undertaken CPR training in previous 2 years. Participants were sent an intervention, comprising 35 text-messages containing 14 behaviour-change techniques, to their mobile phone over 4â6 weeks. Primary outcome: intentions to initiate CPR assessed in response to 4 different scenarios. Secondary outcomes: theory-based determinants of intention (attitudes, subjective norms, perceived behavioural control and self-efficacy) and self-rated competence. RESULTS: 20 participants (6 female, 14 male), aged 20â84 provided baseline data. 17 received the full suite of 35 text messages.15 provided follow-up data. Intentions to perform CPR in scenarios where CPR was indicated were high at baseline and increased (18.1 ± 3.2â19.5 ± 1.8/21) after the intervention, as did self-efficacy and self-rated competency. Self-efficacy, attitudes, perceived behavioural control and subjective norms were positively correlated with intentions. Qualitative data suggest the intervention was perceived as useful. Additional options for delivery format and pace were suggested. CONCLUSIONS: Pilot-testing suggests a text-message intervention delivered after CPR training is acceptable and may be helpful in increasing/maintaining intentions to perform CPR
Effective strategies in emergencies:First responders' views on communicating and coordinating with the public
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