An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions: design and methodology

<p>Abstract</p> <p>Background</p> <p>Cardiac arrest is the leading cause of mortality in Canada, and the overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. Bystander cardiopulmonary resuscitation (CPR) has been shown to increase survival for cardiac arrest victims. However, bystander CPR rates remain low in Canada, rarely exceeding 15%, despite various attempts to improve them. Dispatch-assisted CPR instructions have the potential to improve rates of bystander CPR and many Canadian urban communities now offer instructions to callers reporting a victim in cardiac arrest. Dispatch-assisted CPR instructions are recommended by the International Guidelines on Emergency Cardiovascular Care, but their ability to improve cardiac arrest survival remains unclear.</p> <p>Methods/Design</p> <p>The overall goal of this study is to better understand the factors leading to successful dispatch-assisted CPR instructions and to ultimately save the lives of more cardiac arrest patients. The study will utilize a before-after, prospective cohort design to specifically: 1) Determine the ability of 9-1-1 dispatchers to correctly diagnose cardiac arrest; 2) Quantify the frequency and impact of perceived agonal breathing on cardiac arrest diagnosis; 3) Measure the frequency with which dispatch-assisted CPR instructions can be successfully completed; and 4) Measure the impact of dispatch-assisted CPR instructions on bystander CPR and survival rates.</p> <p>The study will be conducted in 19 urban communities in Ontario, Canada. All 9-1-1 calls occurring in the study communities reporting out-of-hospital cardiac arrest in victims 16 years of age or older for which resuscitation was attempted will be eligible. Information will be obtained from 9-1-1 call recordings, paramedic patient care reports, base hospital records, fire medical records and hospital medical records. Victim, caller and system characteristics will be measured in the study communities before the introduction of dispatch-assisted CPR instructions (before group), during the introduction (run-in phase), and following the introduction (after group).</p> <p>Discussion</p> <p>The study will obtain information essential to the development of clinical trials that will test a variety of educational approaches and delivery methods for telephone cardiopulmonary resuscitation instructions. This will be the first study in the world to clearly quantify the impact of dispatch-assisted CPR instructions on survival to hospital discharge for out-of-hospital cardiac arrest victims.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov NCT00664443</p

The association of educational attainment, cognitive level of job, and leisure activities during the course of adulthood with cognitive performance in old age: the role of openness to experience

Background: The relevance of mental health for everyday life functioning and well-being is crucial. In this context, higher educational attainment, higher cognitive level of one's occupation, and more engaging in stimulating leisure activities have been found to be associated with better cognitive functioning in old age. Yet, the detailed pattern of the potential interplay of such a cognitively engaged lifestyle with personality dimensions, such as openness to experience, in their relations to cognitive functioning remains unclear. Methods: Two thousand eight hundred and twelve older adults served as sample for the present study. Psychometric tests on verbal abilities and processing speed were administered. In addition, individuals were retrospectively interviewed on their educational attainment, occupation, and regarding 18 leisure activities that had been carried out in mid-life. Moreover, openness to experience was assessed. Results: We found that the effect of openness to experience on cognitive functioning was mediated by educational attainment, cognitive level of job, and engaging in different leisure activities. Data were not better described by alternative moderation models testing for interactive (i.e. dependent) effects of openness to experience and cognitively stimulating engagement. Conclusions: To explain interindividual differences in cognitive functioning in old age, present data are in line with a mechanism in which individuals with high openness to experience may have been more engaged in stimulating activities in early and mid-life. Possibly by increasing their cognitive reserve throughout adulthood, this may finally enhance their cognitive performance level later in old age

Activités physiques et maintien des fonctions cognitives

International audienceA l’heure où le vieillissement de la population devient une préoccupation grandissante, avec ses enjeux économiques, sociétaux, et de politique de santé, les recherches portant sur les possibles facteurs de protection tel que l’activité physique (AP) s’intensifient. Objectifs : La présente étude examine l’impact de la pratique d’une AP au cours de la vie sur les performances cognitives. Plus spécifiquement, il s’agit d’évaluer dans quelle mesure l’effet de l’AP régulière change selon l’âge au cours du vieillissement et diffère selon le type de fonction cognitive considérée. Méthodologie : Plus de 120 participants en bonne santé habituelle âgés de 18 à 82 ans ont participé à l’étude. Ils ont complétés des questionnaires sur leur pratique de l’AP et ont été catégorisés en sédentaires ou actifs selon leur niveau d’activité physique récente (6 derniers mois) et antérieure (tout au long de la vie). Ils ont réalisés diverses tâches cognitives notamment exécutives évaluant l’inhibition, la mise à jour et la flexibilité mentale. Résultats : Les résultats met en évidence un effet positif de l’AP récente sur la cognition. Cependant, cet effet n’est pas le même selon l’âge et le sexe des participants. Cet effet est spécifique au type de processus exécutif impliqué dans les tâches. Enfin, l’activité antérieure ne semble pas influencer les résultats. Conclusion : Cette étude révèle l’importante hétérogénéité qui semble apporter un éclairage nouveau quant à la réflexion sur le rôle d’une AP adaptée dans la prévention des troubles cognitifs

Associations of educational attainment and cognitive level of job with old age verbal ability and processing speed: The mediating role of chronic diseases

We investigated whether the relation of educational attainment and cognitive level of job to performance in verbal ability and processing speed in old age was mediated via the number of chronic diseases. A total of 2,812 older adults participated. Psychometric tests on verbal ability and processing speed were administered. Individuals were interviewed regarding their education, midlife occupation, and chronic diseases in old age. Higher educational attainment and higher cognitive level of job were correlated with better performance in verbal ability and processing speed (.15 ≤ r ≤ .33, ps < .001). 1.4 to 7.3% of these relations was mediated via the number of chronic diseases (β = .01, ps < .026). In conclusion, individuals with higher educational attainment and higher cognitive level of job may possibly suffer from fewer chronic diseases later in life. Possibly, this may finally be related to better performance in verbal ability and processing speed in those individuals in old age

Cognitive reserve and cognition in old age: the mediating role of chronic diseases

The present study is the first so far in empirically testing the recent conceptual view that the number of chronic diseases may mediate between the build-up of cognitive reserve (e.g., by educational attainment and cognitive level of job) on the one hand and cognitive performance on the other. We assessed Psychometric tests on processing speed and verbal ability in 2812 older adults (mean age = 77.9 years) from Switzerland. Individuals were interviewed regarding their education, occupation, and chronic diseases. Results showed that higher educational attainment and higher cognitive level of job were significantly related to better performance in processing speed (rs >= .15, ps = .27, ps < .001). These relations were significantly mediated via the number of chronic diseases. Mediation effects of the relation of educational attainment to cognitive performance were 5.3% exerted indirectly (β = .01, p = .007) for processing speed and 1.5% exerted indirectly (β = .01, p = .014) for verbal ability. Mediation effects of the relation of cognitive level of job to cognitive performance were 7.3% exerted indirectly (β = .01, p = .004) for processing speed and 1.8% exerted indirectly (β = .01, p = .015) for verbal ability. In conclusion, individuals with higher educational attainment and higher cognitive level of job in early and midlife may suffer from fewer chronic diseases later in life. This may finally preserve their performance in verbal ability and processing speed in old age

Associations of educational attainment and cognitive level of job with old age verbal ability and processing speed: The mediating role of chronic diseases

We investigated whether the relation of educational attainment and cognitive level of job to performance in verbal ability and processing speed in old age was mediated via the number of chronic diseases. A total of 2,812 older adults participated. Psychometric tests on verbal ability and processing speed were administered. Individuals were interviewed regarding their education, midlife occupation, and chronic diseases in old age. Higher educational attainment and higher cognitive level of job were correlated with better performance in verbal ability and processing speed (.15 ≤ r ≤ .33, ps < .001). 1.4 to 7.3% of these relations was mediated via the number of chronic diseases (β = .01, ps < .026). In conclusion, individuals with higher educational attainment and higher cognitive level of job may possibly suffer from fewer chronic diseases later in life. Possibly, this may finally be related to better performance in verbal ability and processing speed in those individuals in old age.This publication benefited from the support of the Swiss National Centre of Competences in Research LIVES – Overcoming vulnerability: Life course perspectives, which is financed by the Swiss National Science Foundation (grant number: 51NF40-160590).Peer reviewe

Associations of educational attainment and cognitive level of job with old age verbal ability and processing speed: The mediating role of chronic diseases

<p>We investigated whether the relation of educational attainment and cognitive level of job to performance in verbal ability and processing speed in old age was mediated via the number of chronic diseases. A total of 2,812 older adults participated. Psychometric tests on verbal ability and processing speed were administered. Individuals were interviewed regarding their education, midlife occupation, and chronic diseases in old age. Higher educational attainment and higher cognitive level of job were correlated with better performance in verbal ability and processing speed (.15 ≤ <i>r</i> ≤ .33, <i>p</i>s < .001). 1.4 to 7.3% of these relations was mediated via the number of chronic diseases (<i>β</i> = .01, <i>p</i>s < .026). In conclusion, individuals with higher educational attainment and higher cognitive level of job may possibly suffer from fewer chronic diseases later in life. Possibly, this may finally be related to better performance in verbal ability and processing speed in those individuals in old age.</p