which are connected with relative increase of left ventricle myocardium mass. Optimization of geometrical shape of heart of healthy people is connected with paculiarities of energy supply for heart activity determined by constitutional characteristics and the condition of vascular hemodynamic.
Цель: оценить особенности изменений регионального кровообращения у лиц с разным уровнем АД за 10-летний период. Материалы и методы. Проведено продольное проспективное исследование состояния микроциркуляции в средней трети предплечья и голени у лиц с нормальным АД (группа 1), предгипертонией (группа 2) и артериальной гипертонией 1 ст. (группа 3) методом окклюзионной плетизмографии. Результаты. Исходно величина кровотока в соответствующих регионах у лиц с разным уровнем АД не отличалась. За 10-летний период наблюдается достоверное увеличение объемного кровотока в регионах предплечья и голени только в 1-й группе. Наблюдается увеличение сопротивления в сосудах микроциркуляторного русла по мере повышения АД как в регионе предплечья, так и голени. Среднее капиллярное давление увеличилось за 10-летний период во всех группах. Коэффициент капиллярной фильтрации в покое за период наблюдения достоверно не изменился. Через 10 лет у практически здоровых лиц количество функционирующих капилляров (КФК) в регионах не изменяется, у лиц с предгипертонией происходит достоверное увеличение числа открытых капилляров в голени, в предплечье КФК не меняется, а у лиц с гипертонией достоверно увеличивается КФК в предплечье. Исходно при сравнении исследуемых групп достоверных отличий гетерогенности микроциркуляции не выявлено. Через 10 лет происходит достоверное увеличение гетерогенности микроциркуляции у лиц 1-й группы в обоих регионах. Выводы. Наибольшие изменения выявлены у лиц с нормальным уровнем АД, однако при этом сохраняется естественное соотношение между транскапиллярным и конвективным кровотоком в обоих регионах. У лиц с предгипертонией и гипертонией наблюдается асинхронная перестройка микроциркуляции регионов.
To characterize chest compression (CC) pause duration during the last 5 minutes of pediatric cardiopulmonary resuscitation (CPR) prior to extracorporeal-CPR (E-CPR) cannulation and the association with survival outcomes.Cohort study from a resuscitation quality collaborative including pediatric E-CPR cardiac arrest events ≥ 10 min with CPR quality data. We characterized CC interruptions during the last 5 min of defibrillator-electrode recorded CPR (prior to cannulation) and assessed the association between the longest CC pause duration and survival outcomes using multivariable logistic regression.Of 49 E-CPR events, median age was 2.0 [Q1, Q3: 0.6, 6.6] years, 55% (27/49) survived to hospital discharge and 18/49 (37%) with favorable neurological outcome. Median duration of CPR was 51 [43, 69] min. During the last 5 min of recorded CPR prior to cannulation, median duration of the longest CC pause was 14.0 [6.3, 29.4] sec: 66% >10 sec, 25% >29 sec, 14% >60 sec, and longest pause 168 sec. Following planned adjustment for known confounders of age and CPR duration, each 5-sec increase in longest CC pause duration was associated with lower odds of survival to hospital discharge [adjusted OR 0.89, 95 %CI: 0.79-0.99] and lower odds of survival with favorable neurological outcome [adjusted OR 0.77, 95 %CI: 0.60-0.98].Long CC pauses were common during the last 5 min of recorded CPR prior to E-CPR cannulation. Following adjustment for age and CPR duration, each 5-second incremental increase in longest CC pause duration was associated with significantly decreased rates of survival and favorable neurological outcome.
This article juxtaposes the history of the book to the current discussions about lay health information on the Internet in order to thoroughly open up the notion of “reliability” that underlies these discussions. It uses the parallels between the two media to improve understanding of what actors are involved and what issues are at stake, as well as how this is consequential for the reliability that is constructed.
For best survival and quality of life, pediatric basic life support (BLS) should be part of a community effort that includes prevention, early cardiopulmonary resuscitation (CPR), prompt access to the emergency response system, and rapid pediatric advanced life support (PALS), followed by integrated post–cardiac arrest care. These 5 links form the American Heart Association (AHA) pediatric Chain of Survival (Figure 1), the first 3 links of which constitute pediatric BLS.
FIGURE 1.
Pediatric Chain of Survival.
Rapid and effective bystander CPR can be associated with successful return of spontaneous circulation (ROSC) and neurologically intact survival in children following out-of-hospital cardiac arrest.1,–,3 Bystander resuscitation may have the greatest impact for out-of-hospital respiratory arrest,4 because survival rates >70% have been reported with good neurologic outcome.5,6 Bystander resuscitation may also have substantial impact on survival from primary ventricular fibrillation (VF), because survival rates of 20% to 30% have been documented in children with sudden out-of-hospital witnessed VF.7
Overall about 6%8 of children who suffer an out-of-hospital cardiac arrest and 8% of those who receive prehospital emergency response resuscitation survive, but many suffer serious permanent brain injury as a result of their arrest.7,9,–,14 Out-of-hospital survival rates and neurological outcome can be improved with prompt bystander CPR,3,6,15,–,17 but only about one third to one half of infants and children who suffer cardiac arrest receive bystander CPR.3,9,12,18 Infants are less likely to survive out-of-hospital cardiac arrest (4%) than children (10%) or adolescents (13%), presumably because many infants included in the arrest figure are found dead after a substantial period of time, most from sudden infant death syndrome (SIDS).8 As in adults, survival is …
Introduction/Background Teamwork failures and breakdowns in communication are consistently associated with adverse events in patient care.1,2 According to statistics released by the Joint Commission in 2004, communication failures are the primary root cause in over 70% of sentinel events.3 Studies have shown that simulation can be used effectively to teach teamwork skills and that skills acquired through simulation can improve student performance in clinical environments.4–9 The purpose of this study was to evaluate the effectiveness of an interprofessional CPR team behavior simulation program in introducing professional entry students at the University of Arizona Health Sciences Center (AHSC) to vital elements of interprofessional collaborative practice.10 In particular, we wanted to assess the impact of this course on student perception of teamwork skills such as closed-loop communication, constructive intervention, knowledge sharing, re-evaluation and summarizing,and mutual respect in the context of a critical code scenario. Methods In the seventh year of the program, we enrolled 374 students from the Colleges of Medicine (n=114), Nursing (n=163) and Pharmacy (n=97) in a cardiopulmonary resuscitation (CPR) simulation course. Simulation exercises were conducted simultaneously over a four week period at the Arizona Simulation Technology and Education Center (ASTEC) and the Steele Innovation Learning Center (SILC) at the University of Arizona. Prior to the simulation exercise, students were provided with the American Heart Association CPR video, reading material and a CPR lecture detailing the critical elements of effective resuscitation team dynamics.11 The students were then assigned to interprofessional teams of five to eight students for a one hour CPR simulation in which the team worked to resuscitate a human patient simulator that had gone into cardiac arrest. The composition of each team was designed to maximize professional heterogeneity. Students were assigned one of the following roles irrespective of their professional training: team leader, chest compressor (2), ventilator, defibrillator, IV/medication administrator, and code recorder. Roles were rotated in repeated iterations of the CPR simulation; each student was given the opportunity to be the team leader. A short debriefing was conducted by trained facilitators after each simulation to reinforce the elements of team dynamics and to discuss ways to improve teamwork in subsequent simulations. Retrospective pre-post surveys were collected to assess the effectiveness of the training on the students’ understanding and perception of core competencies in interprofessional collaborative practice. Survey items were rated on a 5-point qualitative Likert scale. These Results are based on an 81% survey response rate (n=303). Student’s self ratings showed significant improvement in understanding the elements of effective team dynamics (Pre 2.59±1.03, Post 4.14±0.74; P<0.001) and the different roles and responsibilities of the various healthcare providers during CPR (Pre 2.55±1.00, Post 4.11±0.81; P<0.001). Self perceived understanding of behaviors necessary to be an effective team leader during crisis management increased significantly post-training (Pre 3.09±0.92, Post 4.36±0.64; P<0.001). Eighty-nine percent of students felt that the simulation helped them understand the degree to which clear communication leads to better patient outcomes. Pharmacy students rated their initial knowledge lower than medicine and nursing students in all survey questions. Results: Conclusion The interprofessional CPR team behavior simulation provided an effective platform to combine professional students from three colleges in the Healthcare Sciences to emphasize the importance of interdisciplinary collaboration and teamwork in crisis management situations. The simulation improved the student’s knowledge of vital team and communication skills and attitudes towards working in interprofessional teams. References 1. Leonard MW, Frankel AS. Role of effective teamwork and communication in delivering safe, high-quality care. Mt Sinai J Med 2011;78(6):820-6. 2. Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13(Suppl 1):i85-90. 3. Joint Commission on Accreditation of Healthcare Organizations. National patient safety goals for 2005 and 2004, Available at: www.jcaho.org/accredited+organizations/patient+safety/npsg.htm. 4. Shrader S, Kern D, Zoller J, Blue A. Interprofessional teamwork skills as predictors of clinical outcomes in a simulated healthcare setting. J Allied Health 2013;42(1):e1-6. 5. Brock D, Abu-Rish E, Chiu CR, Hammer D, Wilson S, Vorvick L, Blondon K, Schaad D, Liner D, Zierler B. Interprofessional education in team communication: working together to improve patient safety. BMJ Qual Saf 2013;22(5):414-23. 6. Solomon P, Salfi J. Evaluation of an interprofessional education communication skills initiative. Educ Health 2011;24(2):616. 7. O’Donnell JM, Goode JS Jr, Henker R, Kelsey S, Bircher NG, Peele P, Bradle J, Close J, Engberg R, Sutton-Tyrrell K. Effect of a simulation educational intervention on knowledge, attitude, and patient transfer skills: from the simulation laboratory to the clinical setting. Simul Healthc 2011;6(2):84-93. 8. Robertson B, Kaplan B, Atallah H, Higgins M, Lewitt MJ, Ander DS. The use of simulation and a modified TeamSTEPPS curriculum for medical and nursing student team training. Simul Health 2010;5(6):332-7. 9. Shapiro MJ, Morey JC, Small SD, Langford V, Kaylor CJ, Jagminas L, Suner S, Sallisbury ML, Simon R, Jay GD. Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to existing didactic teamwork curriculum. Qual Saf Health Care 2004;13(6):417-21. 10. Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: Report of an expert panel, 2011. Washington, D.C.: Interprofessional Education Collaborative. 11. Field JM, Gonzales L, Hazinski MF. Advanced Cardiovascular Life Support. Provider Manual. Part 3. Effective Resuscitation Team Dynamics. American Heart Association 2006: 11-17. Disclosures Karl Storz Endoscopy - America I provide medical director oversight to area9, a Danish education company. These duties do not overlap with this academic work. Karl Storz Endoscopy - America Karl Storz Endoscopy - America.
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