Subject(s)
Cardiopulmonary Resuscitation , Health Education , Educational Status , Humans , ResuscitationABSTRACT
BACKGROUND: Even in western developed countries, the probability of survival after out-of-hospital cardiac arrest (OHCA) is only 6-10%. In order to improve survival after OHCA, early initiation of cardiopulmonary resuscitation (CPR) by laypersons is essential. Introduction of CPR training in schoolchildren seems to be effective to increase lay-CPR rates. OBJECTIVE: The objective of the present investigation was to elucidate educational aspects of teaching schoolchildren in CPR and to summarize campaigns related to a comprehensive establishment of lay-CPR worldwide. MATERIALS AND METHODS: A literature research in PubMed was performed, the cutoff date was 27 February 2017. Overall, 192 abstracts were analyzed; 51 articles were considered relevant and included in the manuscript. An additional keyword research in Google revealed >230,000 entries, and 20 of those were included in the present manuscript. RESULTS: A minimum age of 12-13 years is required to achieve a comparable quality of CPR to adult basic life support (BLS). Key issues are (i) the correct detection of a cardiac arrest, (ii) a correctly performed call for help, (iii) thoracic compressions and (iv) if applicable, the initiation of adequate mouth-to-mouth ventilation. Practical training showed a significantly higher CPR quality compared to theoretical training only or to the use of instruction or online videos only. Worldwide implementation of a 2-h BLS training per year in children from the age of 12 or younger is recommended by the "Kids Save Lives"- statement since 2015. In Germany, implementation at the level of the federal states has progressed to different degrees.
Subject(s)
Resuscitation/education , Adolescent , Age Factors , Audiovisual Aids , Cardiopulmonary Resuscitation , Child , Female , Germany , Heart Arrest/diagnosis , Humans , Male , Out-of-Hospital Cardiac Arrest/mortality , Out-of-Hospital Cardiac Arrest/therapy , SchoolsABSTRACT
PURPOSE: Clostridium difficile associated diarrhoea (CDAD) is the most common cause of health-care-associated infectious diarrhoea. In the context of the German health-care system, direct and indirect costs of an initial episode of CDAD and of CDAD recurrence are currently unknown. METHODS: We defined CDAD as presence of diarrhoea (≥3 unformed stools/day) in association with detection of Clostridium difficile toxin in an unformed faecal sample. Patients treated with metronidazole (PO or IV) and/or vancomycin (PO) were included. Comprehensive data of patients were retrospectively documented into a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). Patients with CDAD were matched to control patients in a 1:1 ratio. Analysis was split in three groups: incidence group (CDAD patients without recurrence), recurrence group (CDAD patients with ≥1 recurrence) and control group (matched non-CDAD patients). RESULTS: Between 02/2010 and 12/2011, 150 patients with CDAD (114 patients in the incidence and 36 (24 %) in the recurrence group) and 150 controls were analysed. Mean length of stay was: 32 (95 %CI: 30-37), 94 (95 %CI: 76-112) and 24 days (95 %CI: 22-27; P = <0.001), resulting in mean overall direct treatment costs per patient of 18,460 (95 %CI: 14,660-22,270), 73,900 (95 %CI: 50,340-97,460) and 14,530 (95 %CI: 11,730-17,330; P = <0.001). In the incidence and recurrence group, the mean cumulative number of antibiotic CDAD treatment days was 11 (95 %CI: 10-12) and 36 (95 %CI: 27-45; P = <0.001). CONCLUSIONS: Especially CDAD recurrence was associated with excessive costs, which were mostly attributable to a significantly longer overall length of stay. Innovative treatment strategies are warranted to reduce treatment costs and prevent recurrence of CDAD.
Subject(s)
Clostridioides difficile/isolation & purification , Clostridium Infections/economics , Cost of Illness , Diarrhea/economics , Adult , Aged , Aged, 80 and over , Clostridium Infections/epidemiology , Clostridium Infections/microbiology , Diarrhea/epidemiology , Diarrhea/microbiology , Female , Germany/epidemiology , Humans , Length of Stay , Male , Middle Aged , Retrospective Studies , Tertiary Care Centers , Young AdultABSTRACT
In the past three decades there has been rapid growth in crisis intervention services. This article describes the development of a hospital-based crisis service for adolescents. This Crisis/Assessment Unit (CAU) has met a community need for a responsive program for adolescents in acute psychiatric crises. The development of the CAU is described and critiqued. In addition, a typical case admitted for crisis services is presented.