Out-of-hospital cardiac arrest: comparing organised groups to individual first responders: A qualitative focus group study.

BACKGROUND: Fast delivery of high-quality cardiopulmonary resuscitation is crucial in improving patient outcome after out of hospital cardiac arrest. First responders (trained laypersons) are dispatched to shorten time to basic life support and can be organised in groups or individually. OBJECTIVE: A comparison of factors enabling or impairing first responders' engagement in groups and as individuals are unknown. Therefore, we investigated these factors. DESIGN: Qualitative comparison. SETTING: We set up six focus groups from March to June 2017 in the Canton of Bern, Switzerland. Thirteen group and 13 individual first responders participated. INTERVENTION: Interviews were audio-recorded, transcribed, coded and analysed following a thematic analytic approach. Two researchers coded the transcripts separately, identified, discussed and adjusted categories, themes and subthemes. RESULTS: Factors supporting first responders' engagement are: additional training, support from peers and society, satisfaction of personal desires (all important for all first responders), interdisciplinary collaboration (important for group first responders).Factors impairing first responders' engagement are: individual first responders lack training opportunities and collaboration, individual first responders lack support from peers and society, all first responders report lack of medical knowledge/skills and technical problems, confidentiality issues, legal insecurity and ethical concerns bother all first responders, intimidation by 'professional first responders' and professional burden. First responders organised in groups benefit from more training, enhanced peer support and collaboration with other groups. Individual first responders lack training opportunities and collaboration with emergency medical services. CONCLUSION: Team spirit and peer-support engages group first responders, whereas individual first responders are impaired by lack of social support. Involvement with society triggers both first responder types to become and stay first responders. As first responders in groups have substantial additional benefits, enhancing such groups might strengthen current first responder systems.

Self-learning basic life support: A randomised controlled trial on learning conditions.

AIM OF THE STUDY: To investigate whether pure self-learning without instructor support, resulted in the same BLS-competencies as facilitator-led learning, when using the same commercially available video BLS teaching kit. METHODS: First-year medical students were randomised to either BLS self-learning without supervision or facilitator-led BLS-teaching. Both groups used the MiniAnne kit (Laerdal Medical, Stavanger, Norway) in the students' local language. Directly after the teaching and three months later, all participants were tested on their BLS-competencies in a simulated scenario, using the Resusci Anne SkillReporter™ (Laerdal Medical, Stavanger, Norway). The primary outcome was percentage of correct cardiac compressions three months after the teaching. Secondary outcomes were all other BLS parameters recorded by the SkillReporter and parameters from a BLS-competence rating form. RESULTS: 240 students were assessed at baseline and 152 students participated in the 3-month follow-up. For our primary outcome, the percentage of correct compressions, we found a median of 48% (interquartile range (IQR) 10-83) for facilitator-led learning vs. 42% (IQR 14-81) for self-learning (p = 0.770) directly after the teaching. In the 3-month follow-up, the rate of correct compressions dropped to 28% (IQR 6-59) for facilitator-led learning (p = 0.043) and did not change significantly in the self-learning group (47% (IQR 12-78), p = 0.729). CONCLUSIONS: Self-learning is not inferior to facilitator-led learning in the short term. Self-learning resulted in a better retention of BLS-skills three months after training compared to facilitator-led training.

Can We Reduce Negative Blood Cultures With Clinical Scores and Blood Markers? Results From an Observational Cohort Study.

Only a small proportion of blood cultures routinely performed in emergency department (ED) patients is positive. Multiple clinical scores and biomarkers have previously been examined for their ability to predict bacteremia. Conclusive clinical validation of these scores and biomarkers is essential.This observational cohort study included patients with suspected infection who had blood culture sampling at ED admission. We assessed 5 clinical scores and admission concentrations of procalcitonin (PCT), C-reactive protein (CRP), lymphocyte and white blood cell counts, the neutrophil-lymphocyte count ratio (NLCR), and the red blood cell distribution width (RDW). Two independent physicians assessed true blood culture positivity. We used logistic regression models with area under the curve (AUC) analysis.Of 1083 patients, 104 (9.6%) had positive blood cultures. Of the clinical scores, the Shapiro score performed best (AUC 0.729). The best biomarkers were PCT (AUC 0.803) and NLCR (AUC 0.700). Combining the Shapiro score with PCT levels significantly increased the AUC to 0.827. Limiting blood cultures only to patients with either a Shapiro score of ≥4 or PCT > 0.1 µg/L would reduce negative sampling by 20.2% while still identifying 100% of positive cultures. Similarly, a Shapiro score ≥3 or PCT >0.25 µg/L would reduce cultures by 41.7% and still identify 96.1% of positive blood cultures.Combination of the Shapiro score with admission levels of PCT can help reduce unnecessary blood cultures with minimal false negative rates.The study was registered on January 9, 2013 at the 'ClinicalTrials.gov' registration web site (NCT01768494).