The prevalence and patterns of hearing loss in Jordan: A cross-sectional study.

BACKGROUND: Hearing loss is known to be a serious issue that impedes human communication. The World Health Organization (WHO) estimates that approximately 20 in 100,000 newborns demonstrate congenital hearing impairments, leading to severely impacted language, academic, and social abilities of these children. OBJECTIVE: The reduced quality of life and work productivity among hearing-impaired individuals eventually affects societal outcomes and development. Since limited studies address the nature of hearing-impaired individuals in Jordan, this research aimed to define the prevalence and nature of hearing loss in Jordan, highlighting important facts about hearing loss epidemiology across Jordanians. METHODS: The current research focused on assessing hearing function for 1000 individuals over 12 years to define the rate, most prominent configurations, and the most common characteristics of hearing difficulties in Jordan. RESULTS: The results showed that sixty-three per 1,000 people have hearing loss, most frequently sensorineural hearing loss. The age range of people with hearing loss was 12 to 89 years old, with a median age of 51. The incidence of hearing loss appeared at a later age (33.33%, X2 = 15.74, p<0.05). The percentages of hearing loss were similar across the main Jordanian governorates (X2 = 7.14, p>0.05), with sensorineural hearing loss reported to be the most common type of hearing loss (N = 46, 73.00%), and mild is the most frequent severity (N = 25, X2 = 23.58, p<0.05). No statistical variation was reported in the prevalence of hearing loss based on gender. CONCLUSION: The rate of hearing loss in Jordan is higher than worldwide prevalence, which was assumed to be due to genetic factors impacting the auditory system. These findings will assist in creating effective hearing conservation programs to reasonably prevent or minimize the spread of hearing loss in Jordan.

Temporal trends in the incidence and outcomes of shock-refractory ventricular fibrillation out-of-hospital cardiac arrest.

Aim: We aimed to describe trends in the incidence and outcomes of refractory ventricular fibrillation (RVF) compared to non-refractory ventricular fibrillation (non-RVF) in out-of-hospital cardiac arrest (OHCA). Methods: Between 2010 and 2019, we included all OHCA cases involving adults ≥ 16 years old with an initial shockable rhythm and who received an attempted resuscitation by Emergency Medical Services (EMS) or a bystander shock prior to EMS arrival in Victoria, Australia. Trends in incidence and survival outcomes over the study period were examined. Adjusted logistic regression analyses were conducted to examine factors associated with RVF, as well as the association of RVF on survival to hospital discharge. RVF refers to patients receiving three or more consecutive shocks without a return of spontaneous circulation (ROSC). Results: Of the 57,749 OHCA attended by EMS, 7,267 met the inclusion criteria. Of these, 4,168 (57.4%) were non-RVF and 3,099 (42.6%) were RVF. The incidence of RVF decreased significantly from 7.7 per 100,000 population in 2010 to 5.6 per 100,000 population in 2019 (p-trend = 0.01). Survival to hospital discharge increased significantly for both the RVF and non-RVF groups (26% vs 41% in 2010 to 31% vs 53% in 2019, p-trend = 0.004 for RVF; and p-trend = 0.01 for non-RVF). Compared to non-RVF, RVF was associated with reduced odds of survival to hospital discharge (Odds Ratio = 0.503 [95% confidence interval 0.448 - 0.565]). Factors associated with a lower likelihood of RVF and improved survival to hospital discharge included being witnessed to arrest by EMS, receiving bystander defibrillation and bystander cardiopulmonary resuscitation (CPR). Conclusion: The incidence of RVF is declining, and survival rates are improving. Early treatment of VF patients with bystander CPR and defibrillation is likely to reduce RVF incidence.

Knowledge and willingness of schoolteachers in Jordan to perform CPR: a cross-sectional study.

OBJECTIVES: This study aimed to assess the cardiopulmonary resuscitation (CPR) knowledge and willingness of schoolteachers in Jordan. DESIGN: This was a cross-sectional study conducted using an online questionnaire. SETTING: For inclusion in this study, schoolteachers must be currently teaching at any level in schools across the country. Responses were collected from 1 April 2021 to 30 April 2021. PARTICIPANTS: All schoolteachers actively working in public or private schools were included in our study. PRIMARY AND SECONDARY OUTCOME MEASURES: Continuous variables were summarised as means and SD, whereas categorical variables were reported as frequencies and percentages (%). A χ2 test for independence, independent sample t-tests and analysis of variance were used appropriately. A p-value less than 0.05 was used to determine statistical significance. RESULTS: A total of 385 questionnaires were eligible for analyses. Only 14.5% of the participants received CPR training and overall correct knowledge answers were 18.8% of the total score. Those participants with previous CPR training had higher mean knowledge scores (2.34 vs 1.15, p<0.001). Trained participants were also more likely to provide hands-only CPR to various patient groups than untrained participants (p<0.05). Participants were more willing to provide standard CPR to family members than hands-only CPR (p<0.001), but more willing to provide hands-only CPR to friends (p<0.001), students (75.1% vs 58.2%, p<0.001), neighbour (p<0.001), stranger (p=0.001) and patient from the opposite gender (p<0.001). CONCLUSIONS: Schoolteachers in Jordan possess limited knowledge of CPR. However, the study participants showed a positive attitude towards performing CPR. The study revealed that they were more inclined to provide hands-only CPR than standard CPR. Policymakers and public health officials can take advantage of these findings to incorporate CPR training programmes for schoolteachers, either as a part of their undergraduate studies or as continuing education programmes with an emphasis on hands-only CPR.

The effect of the COVID-19 pandemic on the incidence and survival outcomes of EMS-witnessed out-of-hospital cardiac arrest.

AIM: We sought to examine the impact of the COVID-19 pandemic on the incidence and survival outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) in Victoria, Australia. METHODS: We performed an interrupted time-series analysis of adult EMS-witnessed OHCA patients of medical aetiology. Patients treated during the COVID-19 period (1st March 2020 to 31st December 2021) were compared to a historical comparator period (1st January 2012 and 28th February 2020). Multivariable poisson and logistic regression models were used to examine changes in incidence and survival outcomes during the COVID-19 pandemic, respectively. RESULTS: We included 5,034 patients, 3,976 (79.0%) in the comparator period and 1,058 (21.0%) in the COVID-19 period. Patients in the COVID-19 period had longer EMS response times, fewer public location arrests and were significantly more likely to receive mechanical CPR and laryngeal mask airways compared to the historical period (all p < 0.05). There were no significant differences in the incidence of EMS-witnessed OHCA between the comparator and COVID-19 periods (incidence rate ratio 1.06, 95% CI: 0.97-1.17, p = 0.19). Also, there was no difference in the risk-adjusted odds of survival to hospital discharge for EMS-witnessed OHCA occurring during COVID-19 period compared to the comparator period (adjusted odd ratio 1.02, 95% CI: 0.74-1.42; p = 0.90). CONCLUSION: Unlike the reported findings in non-EMS-witnessed OHCA populations, changes during the COVID-19 pandemic did not influence incidence or survival outcomes in EMS-witnessed OHCA. This may suggest that changes in clinical practice that sought to limit the use of aerosol generating procedures did not influence outcomes in these patients.

The impact of a high-performance cardiopulmonary resuscitation protocol on survival from out-of-hospital cardiac arrests witnessed by paramedics.

Aim: In this study, we examine the effect of a high-performance cardiopulmonary resuscitation (HP-CPR) protocol on patient outcomes following out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical services (EMS) personnel. Methods: We performed a retrospective cohort study of adult, EMS witnessed OHCA patients of medical aetiology in Victoria, Australia. Patients treated after the introduction of a HP-CPR protocol and training programme between February 2019 and January 2020 were compared to historical controls between January 2015 and January 2019. The effect of a HP-CPR protocol on survival to hospital discharge was examined using logistic regression models adjusted for arrest factors. Results: A total of 1,561 and 420 EMS witnessed OHCA patients were treated in the control and intervention periods, respectively. Baseline characteristics were mostly balanced across study periods, except for an initial arrest rhythm of asystole which was more frequent during the intervention period (20.2% vs 15.9%; p-value = 0.04). Unadjusted survival to hospital discharge was similar across control and intervention periods for the overall population (32.1% vs 29.4%, p-value = 0.27), but significantly higher during the intervention period for initial shockable arrests (76.9% vs 66.6%; p-value = 0.03). After adjustment for confounders, cases in the intervention period were associated with an improvement in the adjusted odds of survival to hospital discharge for overall arrests (adjusted odds ratio [AOR] 1.37, 95% CI: 1.00-1.88) and initial shockable arrests (AOR 1.70, 95% CI: 1.03-2.82). Conclusion: The implementation of a HP-CPR protocol was associated with a significant improvement in survival from EMS witnessed OHCA. Efforts to improve CPR performance could yield further improvements in patient outcomes.

Survival outcomes in emergency medical services witnessed traumatic out-of-hospital cardiac arrest after the introduction of a trauma-based resuscitation protocol.

AIM: In this study, we examine the impact of a trauma-based resuscitation protocol on survival outcomes following emergency medical services (EMS) witnessed traumatic out-of-hospital cardiac arrest (OHCA). METHODS: We included EMS-witnessed OHCAs arising from trauma and occurring between 2008 and 2019. In December 2016, a new resuscitation protocol for traumatic OHCA was introduced prioritising the treatment of potentially reversible causes before conventional cardiopulmonary resuscitation. The effect of the new protocol on survival outcomes was assessed using adjusted multivariable logistic regression models. RESULTS: Paramedics attempted resuscitation on 490 patients, with 341 (69.6%) and 149 (30.4%) occurring during the control and intervention periods, respectively. A reduction in the proportion of cases receiving cardiopulmonary resuscitation and epinephrine administration were found in the intervention period compared to the control period, whereas trauma-based interventions increased significantly, including blood administration (pre-arrest: 17.9% vs 3.7%; intra-arrest: 24.1% vs 2.7%), splinting (pre-arrest: 38.6% vs 17.1%; intra-arrest: 20.7% vs 5.2%), and finger thoracostomy (pre-arrest: 13.1% vs 0.6%; intra-arrest: 22.8% vs 0.9%), respectively, with p-values < 0.001 for all comparisons. After adjustment, the trauma-based resuscitation protocol was not associated with an improvement in survival to hospital discharge (AOR 1.29, 95% CI: 0.51-3.23), event survival (AOR 0.72, 95% CI: 0.41-1.28) or prehospital return of spontaneous circulation (AOR 0.63, 95% CI: 0.39-1.03). CONCLUSION: In our region, the introduction of a trauma-based resuscitation protocol led to an increase in the delivery of almost all trauma interventions; however, this did not translate into better survival outcomes following EMS-witnessed traumatic OHCA.

Challenges facing users of hearing aids during the COVID-19 pandemic.

OBJECTIVES: To explore the difficulties and obstacles of hearing-technology users during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: Descriptive, cross-sectional study. STUDY SAMPLE: Individuals with permanent hearing loss (n = 278) answered a questionnaire designed to identify potential obstacles caused by using hearing aids during the COVID-19 pandemic, along with the reasons and deleterious effects associated with the devices. Each category reflected challenges in communicating, learning, and working during the pandemic. Different response categories were compared using descriptive and inferential statistics. RESULTS: The duration of daily device usage before the imposed lockdown was significantly higher than that during (Z = -2.01, p < 0.05), potentially attributable to the pandemic-induced difficulties faced by hearing-technology users. Such challenges include the shortage of batteries for hearing devices, limited access to repair or programming services of said devices and accessories, termination of speech therapy sessions, and obstacles to employment and education. CONCLUSIONS: Among audiologists, efficiency and professionalism are required to educate the public and private health sectors regarding the prevalent challenges and their harmful impact on hearing-technology users during the COVID-19 pandemic. To overcome these issues, awareness of telepractice and its importance in providing audiological services to hard of hearing individuals should be raised.

Impact of a trauma-focused resuscitation protocol on survival outcomes after traumatic out-of-hospital cardiac arrest: An interrupted time series analysis.

AIM: In this study, we examine the impact of a trauma-focused resuscitation protocol on survival outcomes following adult traumatic out-of-hospital cardiac arrest (OHCA). METHODS: We included adult traumatic OHCA patients aged >16 years occurring between 2008 and 2019. In December 2016, a new resuscitation protocol for traumatic OHCA was introduced prioritising the treatment of potentially reversible causes before conventional cardiopulmonary resuscitation (CPR). The effect of the new protocol on survival outcomes was assessed using adjusted interrupted time series regression. RESULTS: Over the study period, paramedics attempted resuscitation on 996 patients out of 3,958 attended cases. Of the treated cases, 672 (67.5%) and 324 (32.5%) occurred during pre-intervention and intervention periods, respectively. The frequency of almost all trauma interventions was significantly higher in the intervention period, including external haemorrhage control (15.7% vs 7.6; p-value <0.001), blood administration (3.8% vs 0.2%; p-value <0.001), and needle thoracostomy (75.9% vs 42.0%; p-value <0.001). There was also a significant reduction in the median time from initial patient contact to the delivery of needle thoracostomy (4.4 min vs 8.7 min; p-value <0.001) and splinting (8.7 min vs 17.5 min; p-value = 0.009). After adjustment, the trauma-focused resuscitation protocol was not associated with a change in the level of survival to hospital discharge (adjusted odds ratio [AOR] 0.98; 95% confidence interval [CI]: 0.11-8.59), event survival (AOR 0.82; 95% CI: 0.33-2.03), or prehospital return of spontaneous circulation (AOR 1.30; 95% CI: 0.61-2.76). CONCLUSION: Despite an increase in trauma-based interventions and a reduction in the time to their administration, our study did not find a survival benefit from a trauma-focused resuscitation protocol over initial conventional CPR. However, survival was low with both approaches.

Impact of temporal changes in the epidemiology and management of traumatic out-of-hospital cardiac arrest on survival outcomes.

AIM: We aimed to investigate the impact of temporal changes in the epidemiology and management of traumatic out-of-hospital cardiac arrest (OHCA) on emergency medical service (EMS) attempted resuscitations and survival outcomes. METHODS: A retrospective observational study of traumatic OHCA cases involving patients aged > 16 years in Victoria, Australia, who arrested between 2001 and 2018. Unadjusted and adjusted logistic regression was performed to assess trends in survival outcomes over the study period. RESULTS: Between 2001 and 2018, the EMS attended 5,631 cases of traumatic OHCA, of which 1,237 cases (22.0%) received an attempted resuscitation. EMS response times increased significantly over time (from 7.0 min in 2001-03 to 9.8 min in 2016-18; p trend < 0.001) as did rates of bystander cardiopulmonary resuscitation (CPR) (from 37.8% to 63.6%; p trend < 0.001). Helicopter EMS attendance on scene increased from 7.1% to 12.4% (p trend = 0.01), and transports of patients with return of spontaneous circulation (ROSC) to designated major trauma centres also increased from 36.6% to 82.4% (p trend < 0.001). The frequency of EMS trauma-specific interventions increased over the study period, including needle thoracostomy from 7.7% to 61.6% (p trend < 0.001). Although the risk-adjusted odds of ROSC (OR 1.06, 95% CI: 1.03-1.10) and event survival (OR 1.05, 95% CI: 1.01-1.09) increased year-on-year, there were no temporal changes in survival to hospital discharge. CONCLUSION: Despite higher rates of bystander CPR and EMS trauma interventions, rates of survival following traumatic OHCA did not change over time in our region. More studies are needed to investigate the optimal EMS interventions for improved survival in traumatic OHCA.

Paediatric traumatic out-of-hospital cardiac arrest: A systematic review and meta-analysis.

AIM: In this study, we sought to quantitatively describe the survival outcomes, incidence rates, and predictors of survival after paediatric traumatic out-of-hospital cardiac arrest (OHCA). METHODS: We systematically searched MEDLINE, EMBASE, EMCARE, and CINAHL to identify observational or interventional studies reporting relevant data for paediatric traumatic OHCA. The Joanna Briggs Institute critical appraisal tool for prognostic studies was used to assess study quality. We analysed the survival outcomes and pooled incidence rates per 100,000 person-years using random-effect models. RESULTS: Nineteen articles met the eligibility criteria involving 705 Emergency Medical Service (EMS)-attended and 973 EMS-treated traumatic paediatric OHCAs across an estimated serviceable population of 15.2 million. Four studies were conducted in the Asia-pacific region, seven in Europe, and eight in North America. Nine studies were assessed as low quality. Overall pooled survival to hospital discharge or 30-day survival for the EMS-treated cases was 1.2% (n = 6 studies; 95% confidence interval (CI): 0.1%, 3.1%; I2 = 26.1%). The pooled rate of return of spontaneous circulation in four studies was 22.1% (95% CI: 18.4%, 26.1%; I2 = 0.0%), and the pooled rate of event survival was 18.8% (n = 3 studies; 95% CI: 15.2%, 22.7%; I2 = 0.0%). The pooled incidence of EMS-treated paediatric traumatic OHCA was 1.6 cases per 100,000 person-years (n = 10 studies; 95% CI: 1.1, 2.2; I2 = 98.1%). No study reported on the impact of epidemiological or clinical factors on survival. CONCLUSION: Survival outcomes of paediatric traumatic OHCA are poor and existing studies report varying incidence rates. The absence of large prospective and international registry data hinders the development of novel strategies to improve survival rates.

A descriptive analysis of the epidemiology and management of paediatric traumatic out-of-hospital cardiac arrest.

AIM: Paediatric traumatic out-of-hospital cardiac arrest (OHCA) is a rare event with few survivors. We examined long-term trends in the incidence and outcomes of paediatric traumatic OHCA and explored the frequency and timing of intra-arrest interventions. METHODS: We retrospectively analysed data from the Victorian Ambulance Cardiac Arrest Registry for cases involving traumatic OHCA in patients aged ≤16 years arresting between January 2000 to December 2017. Trends were assessed using linear regression and a non-parametric test for trend. RESULTS: A total of 292 cases were attended by emergency medical services (EMS), of which 166 (56.9%) received an attempted resuscitation. The overall incidence of EMS-attended cases was 1.4 cases per 100,000 person-years, with no significant changes over time. Unadjusted outcomes also remained unchanged, with 23.5% achieving return of spontaneous circulation and 3.7% surviving to hospital discharge. The frequency of trauma-specific interventions increased between 2000-2005 and 2012-2017, including needle thoracostomy from 10.5% to 51.0% (p trend <0.001), crystalloid administration from 31.6% to 54.9% (p trend = 0.004) and blood administration from 0.0% to 6.3% (p trend = 0.01). The median time from emergency call to the delivery of interventions were: 12.9 min (IQR: 8.5, 20.0) for cardiopulmonary resuscitation, 19.7 min (IQR: 10.7, 39.6) for external haemorrhage control, 29.8 min (IQR: 22.0, 35.4) for crystalloid administration and 31.5 min (IQR: 21.0, 38.0) for needle thoracostomy. CONCLUSION: The incidence and outcomes of paediatric traumatic OHCA remained unchanged over an 18 year period. Early correction of reversible causes by reducing delays to the delivery of trauma-specific interventions may yield additional survivors.