ObjectiveTo determine the quality and diagnostic accuracy of in-hospital adult clinical emergency calls.DesignProspective observational study.SettingThree National Health Service acute hospitals in ...England.ParticipantsAdult patients sustaining an in-hospital cardiac arrest (CA) or medical emergency (ME) which required activation of the hospital resuscitation team between 1 December 2009 and 30 April 2010.Main outcome measuresEmergency call duration, emergency team dispatch time, diagnostic accuracy of emergency call (sensitivity/specificity), thematic analysis of emergency call, patient outcomes (return of spontaneous circulation and survival to hospital discharge).ResultsThere were 426 adult resuscitation team activations. There was variability in emergency call duration ranging from 6 to 92 s (median 15 s; IQR 12–19). The sensitivity and specificity of calls for a CA was 91% (86.4–94.6%) and 62% (55.5–68.7%), respectively. Sensitivity did not change with call duration but specificity increased from 38% (25.8–51.0%) for the shortest calls to 82% (69.5–89.6%) for longer calls; p=0.03. The return of spontaneous circulation rate was 38% for calls when the patient was confirmed as in CA upon arrival of the resuscitation team. Survival to hospital discharge rates was higher in patients with shorter call durations (26%) than calls with longer call duration (12%); p=0.028. Five themes emerged identifying reasons for the increased call delay.ConclusionThere is variability in duration and diagnostic accuracy of in-hospital emergency calls. This is associated with delayed activation of the emergency response. The attempt to differentiate between ME and CA is a source of confusion. A single clinical emergency response for CA and ME calls may provide a more focused and timely emergency response.
Summary Background The cardiac arrest scenario test (CASTest) is a central component of the assessment strategy on the Advanced Life Support Course. The aim of this study was to establish equivalence ...between the four different CASTest scenarios and investigate the impact of profession, candidate order and course centre on the pass rate. Materials and methods This was a cluster randomised study. CASTest scenarios were randomly allocated to candidates stratified by course centre. Candidate demographics and performance were recorded on the criterion referenced check list along with the final assessment outcome (pass/fail). Differences in pass rates according scenario; profession, course centre and candidate order were examined by Chi-squared and multiple logistic regression. Results Two thousand, four hundred and forty-nine assessments from 65 course centres were evaluated. There was no difference in pass rate between scenarios (average pass rate 74.4%). Pass rates according to course centre varied widely (40–93%, P < 0.0001) as did professional group (42–100%, P < 0.0001). The order that candidates took the test did not influence the pass rate. Conclusion The CASTest assessment scenarios used during ALS testing appear equivalent in terms of difficulty. In contrast, the professional background of the candidate and centre at which the assessment is performed do significantly influence the likelihood of passing the assessment. Further evaluation of the reasons for differences between course centres is required.
Advanced life support update Husselbee, Natalie; Davies, Robin P.; Perkins, Gavin D.
British medical bulletin,
03/2009, Letnik:
89, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Introduction Cardiac arrest is a common emergency in acute hospitals. The Resuscitation Council (UK) Advanced Life Support Guidelines provide a systematic approach to cardiac arrest recognition, ...treatment and aftercare. This review provides an update on the current treatment guidelines and identifies areas where these may be strengthened. Methods The evidence informing the 2005 Resuscitation Guidelines is reviewed. New evidence since the publication of the guidelines was identified by searching Medline (December 2005–December 2008) with the term heart arrest or advanced life support. Results Opportunities for strengthening the chain of survival exist for each link. These include better recognition of critically ill patients at risk of cardiac arrest, improved quality of cardiopulmonary resuscitation, defibrillation strategies, which minimize pre- and post-shock pauses and development of post-resuscitation care bundles. Conclusion Emerging evidence suggests opportunities where Resuscitation Guidelines could be strengthened by focusing on specific aspects of the chain of survival.
“Emerging Nanomaterials for Healthcare”, a one-day conference held at the University of Warwick on 28 November 2014, brought together over 80 academics, postgraduates and industrialists from 17 ...institutions and organisations from across the UK. The aim of the meeting was to provide an interdisciplinary forum to discuss research towards solving current problems in healthcare using “smart” treatments based on nanomaterials. In addition to stories of success, an emphasis was also placed on lessons learned, as well as visions for future directions in this rapidly expanding field. Seven speakers and over twenty poster presentations directed discussion throughout the day, while the meeting closed with an interactive panel discussion.
The Resuscitation Council (UK) Advanced Life Support (ALS) Course is a multidisciplinary training course which teaches participants how to manage the resuscitation of a patient at risk of or in ...cardiac arrest. To reduce variability in assessments, four standardised patient scenarios have been developed with common performance criteria. The aim of the study was to establish how much candidates remembered about their test in order to assess the potential for collusion. Eighty-nine candidates were asked immediately after testing what they remembered about their ALS scenario. Recall of the underlying problem with the simulated patient was good (85 96%). Forty-two 47% correctly remembered the initial cardiac arrest rhythm and 55 61% the subsequent cardiac arrest rhythm. Fifty-nine 60% candidates passed the assessment. Candidates who passed the assessment were significantly more likely to correctly recall the initial and subsequent cardiac arrest rhythms than those who did not. However, even in this group, the overall recall of all elements of the scenario was correct in only 49% of instances. This study demonstrated that immediately after testing candidates had good recall of the initial clinical scenario with which they were presented, but poor recall of cardiac arrest rhythms during the simulated resuscitation attempt. These findings provide some reassurance that the likelihood of successful collusion improving subsequent candidates performance is likely to be small as recall of the scenario progression is limited.
NKG2D plays a major role in controlling immune responses through the regulation of natural killer (NK) cells, αβ and γδ T-cell function. This activating receptor recognizes eight distinct ligands ...(the MHC Class I polypeptide-related sequences (MIC) A andB, and UL16-binding proteins (ULBP)1-6) induced by cellular stress to promote recognition cells perturbed by malignant transformation or microbial infection. Studies into human cytomegalovirus (HCMV) have aided both the identification and characterization of NKG2D ligands (NKG2DLs). HCMV immediate early (IE) gene up regulates NKGDLs, and we now describe the differential activation of ULBP2 and MICA/B by IE1 and IE2 respectively. Despite activation by IE functions, HCMV effectively suppressed cell surface expression of NKGDLs through both the early and late phases of infection. The immune evasion functions UL16, UL142, and microRNA(miR)-UL112 are known to target NKG2DLs. While infection with a UL16 deletion mutant caused the expected increase in MICB and ULBP2 cell surface expression, deletion of UL142 did not have a similar impact on its target, MICA. We therefore performed a systematic screen of the viral genome to search of addition functions that targeted MICA. US18 and US20 were identified as novel NK cell evasion functions capable of acting independently to promote MICA degradation by lysosomal degradation. The most dramatic effect on MICA expression was achieved when US18 and US20 acted in concert. US18 and US20 are the first members of the US12 gene family to have been assigned a function. The US12 family has 10 members encoded sequentially through US12-US21; a genetic arrangement, which is suggestive of an 'accordion' expansion of an ancestral gene in response to a selective pressure. This expansion must have be an ancient event as the whole family is conserved across simian cytomegaloviruses from old world monkeys. The evolutionary benefit bestowed by the combinatorial effect of US18 and US20 on MICA may have contributed to sustaining the US12 gene family.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract only
Introduction:
Competency in advanced life support (ALS) is a core component of health care curricula. We explored a blended solution which combines e-learning and face to face ...instructor training.
ISRCTN86380392
Hypothesis:
In participants seeking ALS training is a blended solution to training which uses e-learning and face to face training non-inferior to traditional (face to face) ALS training?
Methods:
We conducted an open-label, non-inferiority, randomised controlled trial. Participants seeking ALS training at 30 centres in England, Wales, Scotland and Australia were randomised to the 2 day standard ALS course or a hybrid e-learning course with 1 day face to face training (e-ALS). The primary outcome was success rate in the end of course cardiac arrest simulation test. Secondary outcomes were overall course pass rate and performance in knowledge / skill based tests. The primary analysis was intention to treat.
Results:
1033 (74%) of participants passed the cardiac arrest simulation assessment in the e-learning arm compared to 1146 (80%) in the traditional arm (adjusted odds ratio is 0.698 (95% CI is (0.559, 0.872). Within the performance criteria scores for the peri-arrest management domain the e-ALS group score was higher than c-ALS group (P < 0.0001). By contrast the management of non-shockable rhythms was less than the score of the c-ALS group (P = 0.0495). There was no significant difference in the cardiac arrest management score for shockable rhythms (P= 0.13). Performance in the pre-course MCQ (taken immediately prior to the face to face course) was marginally better in the e-ALS group (mean (SE) % score 92.44 (6.58) vs 88.27 (6.76), P<001). There was no significant difference in the end of course multiple choice knowledge or skill tests. After remedial teaching the final overall course pass rate was 94% in the e-ALS arm had passed and 96% in the conventional arm (P=0.0018). Participants' preferences marginally favoured traditional training.
Conclusion:
A blended approach to ALS training which includes e-learning reduced the duration of face to face training by half at the costs of one additional participant failing to successfully complete the course per 50 course participants.
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