Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: A randomised controlled trial

Background: Survivors of a cardiac arrest frequently have cognitive and emotional problems and their quality of life is at risk. We developed a brief nursing intervention to detect cognitive and emotional problems, provide information and support, promote self-management, and refer them to specialised care if necessary. This study examined its effectiveness. Methods: Multicentre randomised controlled trial with measurements at two weeks, three months and twelve months after cardiac arrest. 185 adult cardiac arrest survivors and 155 caregivers participated. Primary outcome measures were societal participation and quality of life of the survivors at one year. Secondary outcomes were the patient's cognitive functioning, emotional state, extended daily activities and return to work, and the caregiver's well-being. Data were analysed using 'intention to treat' linear mixed model analyses. Results: After one year, patients in the intervention group had a significantly better quality of life on SF-36 domains Role Emotional (estimated mean differences (EMD) = 16.38, p = 0.006), Mental Health (EMD = 6.87, p = 0.003) and General Health (EMD = 8.07, p = 0.010), but there was no significant difference with regard to societal participation. On the secondary outcome measures, survivors scored significantly better on overall emotional state (HADS total, EMD = -3.25, p = 0.002) and anxiety (HADS anxiety, EMD = -1.79, p = 0.001) at one year. Furthermore, at three months more people were back at work (50% versus 21%, p = 0.006). No significant differences were found for caregiver outcomes. Conclusion: The outcomes of cardiac arrest survivors can be improved by an intervention focused on detecting and managing the cognitive and emotional consequences of a cardiac arrest. Trial registration: Current controlled trials, ISRCTN74835019. (C) 2015 Elsevier Ireland Ltd. All rights reserved

A marine biological valuation map for the Belgian part of the North Sea

Policy makers and marine managers request reliable and meaningful biological baseline maps to be able to make well-deliberated choices concerning sustainable use and conservation in the marine environment. When such maps are lacking one is often obliged to base value assessments on the best available expert judgment. Biological valuation maps compile and summarize all available biological and ecological information for a marine area and allocate an integrated biological value to subzones. Derous et al. (in press) developed a valuation concept around a selected set of valuation criteria (rarity, fitness consequences, aggregation, naturalness and proportional importance). The concept allows the assessment of the intrinsic value of the subzones within an area, on a relative basis. In order to develop a marine biological valuation map for the Belgian part of the North Sea (BPNS), a protocol for the practical application of this valuation concept was developed. After dividing the area into subzones and collecting the available biological data, the protocol allows the scoring of the valuation criteria by answering specific assessment questions. These questions are relevant for the different criteria and incorporate all organizational levels of biodiversity (from the genetic to the ecosystem level). Applying this protocol to the data of the BPNS allowed producing a full-coverage biological valuation map for the area, which integrates knowledge on seabirds, macrobenthos, demersal fish and epibenthos. Separate valuation maps for each ecosystem component are also available, next to reliability maps for each valuation map. These maps can be used as baseline maps for future spatial planning in the BPNS

Cognitive impairments after cardiac arrest: Implications for clinical daily practice

Rehabilitation Medicin

'Stand still ..., and move on', an early neurologically-focused follow-up for cardiac arrest survivors and their caregivers: a process evaluation

BACKGROUND: A cardiac arrest can lead to hypoxic-ischaemic brain injury which can result in cognitive and emotional impairments and may negatively affect daily functioning, participation in society and quality of life. Furthermore, the impact on the family of the patient can be high. We designed an intervention called ‘Stand still …, and move on’, which is a concise, individualised, semi-structured intervention for survivors of cardiac arrest and their caregivers, consisting of between one and six face-to-face consultations provided by a trained nurse. The intervention is directed at early detection of cognitive and emotional problems, provision of information, promotion of self-management and referral to specialised care if necessary. The effectiveness of the intervention is being examined in a randomised controlled trial [ISRCTN74835019]. Alongside this trial we performed a process evaluation which aims to investigate the feasibility of the intervention by assessing: 1) the attendance and dose delivered; 2) performance according to protocol; and 3) the opinion of patients, caregivers and nurses on the intervention. METHODS: Participants of this process evaluation were 97 patients allocated to the intervention group of the RCT, their 91 caregivers, and six nurses who conducted the intervention. Measurement instruments used were evaluation forms for patients and caregivers, registration and evaluation forms for nurses, and semi-structured interviews with nurses. RESULTS: Seventy-nine of the patients (81%) allocated to the intervention group and 65 caregivers (71%) participated in the intervention. The mean (SD) number of consultations per patient was 1.8 (1.0), and most consultations were conducted at the patients’ home. The intervention was performed largely according to protocol, except that the intervention usually started later than intended, consultations were longer than expected, and the topic of self-management was not regularly addressed. Patients marked the quality of the intervention with a mean score of 7.5 and the performance of the nurse with an 8.0 out of ten. Overall, the intervention was positively evaluated by patients, caregivers and nurses. CONCLUSIONS: The intervention ‘Stand still …, and move on’ is a promising intervention which was performed largely according to protocol and seems feasible for implementation after some adaptations, if it is found to be effective

Application of the protocol for marine biological valuation to selected case study areas

Marine biological valuation integrates all biological and ecological information that is available for a study area into a relative biological value. The resulting biological valuation map (BVM) is easy to interpret and translates complex scientific data into a tool that can be used by policy makers as a baseline layer for spatial planning at sea. When such BVM is lacking, managers can only trust on the available best expert judgement to include biological aspects into their decisions, a process which lacks transparency and objectivity. The development of an acceptable and practical valuation protocol can only be established when it is iteratively applied to different test cases.In this paper, three case study areas are biologically valuated: the Belgian part of the North Sea (BPNS), the Isles of Scilly in the UK (IoS) and the Dutch part of the North Sea (DPNS). The paper specifically explores how the methodology deals with different levels of data availability by comparing highly monitored areas like the BPNS with less data rich areas as the BPNS and the IoS. Two types of valuation maps are constructed for the IoS, one based on quantitative data and one on qualitative presence/absence data, to see whether the quality of the data has any impact on the outcome of the valuation.The final BVMs indicated clear patterns in biological value, with coastal areas harbouring the highest biological value in all case studies. Low data quality and quantity does not seem to hamper the development of preliminary BVMs, although the reliability of these maps is low. Subzone size selection is a crucial step in the valuation protocol and relevance for the ecosystem components under consideration should always be preferred to practical considerations to obtain better valuation coverage of the area.Despite some weaknesses of the methodology, the availability of BVMs gives the opportunity to answer policy questions related to the biological value of areas in a transparent, objective way

Biological valuation: guidelines for a transparant and generally applicable protocol for the marine environment

Policy makers and marine managers request reliable and meaningful biological baseline maps to be able to make well-deliberated choices concerning sustainable use and conservation in the marine environment. Biological valuation maps aim at the compilation of all available biological and ecological information for a selected study area and allocate an integrated biological value to subzones. They can therefore be used as baseline maps for future spatial planning at sea. This paper gives guidelines on the practical application of the concept of marine biological valuation to a study area. All steps in the valuation protocol are described, starting from the selection of the valuation criteria over the determination of the appropriate assessment questions and practical algorithms to evaluate the criteria to the final scoring of all assessment questions. The marine biological valuation protocol is illustrated using a hypothetical study area

European Resuscitation Council Guidelines 2021: Executive summary

Perkins GD, Gräsner J-T, Semeraro F, et al. European Resuscitation Council Guidelines 2021: Executive summary. Resuscitation. 2021;161:1-60.Informed by a series of systematic reviews, scoping reviews and evidence updates from the International Liaison Committee on Resuscitation, the 2021 European Resuscitation Council Guidelines present the most up to date evidence-based guidelines for the practice of resuscitation across Europe. The guidelines cover the epidemiology of cardiac arrest; the role that systems play in saving lives, adult basic life support, adult advanced life support, resuscitation in special circumstances, post resuscitation care, first aid, neonatal life support, paediatric life support, ethics and education