Practical examination of bystanders performing Basic Life Support in Germany: a prospective manikin study

<p>Abstract</p> <p>Background</p> <p>In an out-of-hospital emergency situation bystander intervention is essential for a sufficient functioning of the chain of rescue. The basic measures of cardiopulmonary resuscitation (Basic Life Support – BLS) by lay people are therefore definitely part of an effective emergency service of a patient needing resuscitation. Relevant knowledge is provided to the public by various course conceptions. The learning success concerning a one day first aid course ("LSM" course in Germany) has not been much investigated in the past. We investigated to what extent lay people could perform BLS correctly in a standardised manikin scenario. An aim of this study was to show how course repetitions affected success in performing BLS.</p> <p>Methods</p> <p>The "LSM course" was carried out in a standardised manner. We tested prospectively 100 participants in two groups (<b>Group 1: </b>Participants with previous attendance of a BLS course; <b>Group 2: </b>Participants with no previous attendance of a BLS course) in their practical abilities in BLS after the course. Success parameter was the correct performance of BLS in accordance with the current ERC guidelines.</p> <p>Results</p> <p>Twenty-two (22%) of the 100 investigated participants obtained satisfactory results in the practical performance of BLS. Participants with repeated participation in BLS obtained significantly better results (<b>Group 1: </b>32.7% vs. <b>Group 2: </b>10.4%; p < 0.01) than course participants with no relevant previous knowledge.</p> <p>Conclusion</p> <p>Only 22% of the investigated participants at the end of a "LSM course" were able to perform BLS satisfactorily according to the ERC guidelines. Participants who had previously attended comparable courses obtained significantly better results in the practical test. Through regular repetitions it seems to be possible to achieve, at least on the manikin, an improvement of the results in bystander resuscitation and, consequently, a better patient outcome. To validate this hypothesis further investigations are recommended by specialised societies.</p

Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review

<p>Background: To enable older people to make decisions about the appropriateness of cardiopulmonary resuscitation (CPR), information is needed about the predictive value of pre-arrest factors such as comorbidity, functional and cognitive status on survival and quality of life of survivors. We systematically reviewed the literature to identify pre-arrest predictors for survival, quality of life and functional outcomes after out-of-hospital (OHC) CPR in the elderly.</p><p>Methods: We searched MEDLINE (through May 2011) and included studies that described adults aged 70 years and over needing CPR after OHC cardiac arrest. Prognostic factors associated with survival to discharge and quality of life of survivors were extracted. Two authors independently appraised the quality of each of the included studies. When possible a meta-analysis of odd's ratios was performed.</p><p>Results: Twenty-three studies were included (n = 44,582). There was substantial clinical and statistical heterogeneity and reporting was often inadequate. The pooled survival to discharge in patients > 70 years was 4.1% (95% CI 3.0-5.6%). Several studies showed that increasing age was significantly associated with worse survival, but the predictive value of comorbidity was investigated in only one study. In another study, nursing home residency was independently associated with decreased chances of survival. Only a few small studies showed that age is negatively associated with a good quality of life of survivors. We were unable to perform a meta-analysis of possible predictors due to a wide variety in reporting and statistical methods.</p><p>Conclusions: Although older patients have a lower chance of survival after CPR in univariate analysis (i.e. 4.1%), older age alone does not seem to be a good criterion for denying patients CPR. Evidence for the predictive value of comorbidities and for the predictive value of age on quality of life of survivors is scarce. Future studies should use uniform methods for reporting data and pre-arrest factors to increase the available evidence about pre arrest factors on the chance of survival. Furthermore, patient-specific outcomes such as quality of life and post-arrest cognitive function should be investigated too.</p>

Diviseurs sur les courbes réelles

Dans un article sur les sommes de carrés, Scheiderer a prouvé que pour toute courbe algébrique, réelle, projective, irréductible, lisse, ayant des points réels, il existait un entier N tel que tout diviseur de degré plus grand que N soit linéairement équivalent à un diviseur dont le support est totalement réel. Ensuite Huisman et Monnier ont montré que dans le cas des courbes avec beaucoup de composantes connexes, ie. celle en ayant au moins autant que le genre g, ici supposé strictement positif, de la courbe, on pouvait prendre N égal à 2g 1. Monnier a également abordé la question pour les cas des courbes singulières : il en a exhibé pour lesquelles un tel entier n'existait pas et d'autres pour lesquelles il existait. Dans cette thèse on étend la classe des courbes singulières pour lesquelles un tel entier existe, essentiellement des courbes avec des noeuds ou des cusps, et on arrive dans certains cas a contrôlé explicitement cet entier en fonction du genre de la courbe et du nombre de ces singularités. Pour y parvenir on utilise d'une part une " singularisation successive " et d'autre part une variante de l'invariant où l'on demande qu'en plus les points du support soient deux-à-deux distincts. Pour ce nouvel invariant, on étend tel quel les résultats sur les courbes ayant beaucoup de composantes et on traite celui des courbes de genre 2 ayant une seule composante, le " premier " cas jusqu'alors inconnu : dans ce cas la borne 3 est impossible en général, mais par contre 5 convient.In an article about sums of squares, Scheiderer proved that for every real, algebraic, projective, irreducible, smooth curve with some real points, their exists an integer N such that every divisor of degre not lower than N is linearly equivalent to a divisor whose support is totally real. Then Huisman and Monnier proved that for real curves with many components, ie. those with at least as many components as the genus g, assumed here to be positive, of the curve, one can choose N equal to 2g 1. Monnier also dealed with singular curves: he showed that for some of them such an integer does not exist and gave some others where it does exist. In this thesis we extend the classe of singular curves for wich such an integer exists, essentially those with nodes and cusps, and we sometimes manage to bound such an integer in terms of the genus. To do so, an "iterative singularisation" is used and also a slightly different invariant where we ask the real points of the support to be distinct from each-other. We extend the results about curves with many components to that new invariant and deal with curves of genus 2 having only one component, which is the "very first" unknown case so far: in that case, 3 cannot bound the invariant, but 5 does.ANGERS-BU Lettres et Sciences (490072106) / SudocSudocFranceF