Can high school students teach their peers high quality cardiopulmonary resuscitation (CPR)?

Background: If adolescents can teach each other cardiopulmonary resuscitation (CPR) during school hours, this may be a cost-effective approach to CPR training. The aim of this study was to evaluate CPR quality among students trained by student instructors in CPR. Material and methods: Three high schools participated. Recruited student instructors (SIs) were given a two-day course by professional instructors. Theoretic knowledge was acquired through an e-learning program. The SIs then trained fellow students in a 90-minute practical CPR session during physical education classes. All participants performed a 4-minutes test of CPR performance. Data was collected using Little Anne QCPR manikins with QCPR classroom software (Laerdal Medical Inc, Norway). Statistical equivalence in CPR performance was assessed applying the two one-sided tests (TOST)-procedure. Results: Eight professional instructors trained 76 SIs who trained approximately 2650 students in CPR. The number of available tests for analysis of student performance was 982. The compression rates were within guideline recommendations for SIs (mean 110.6, SD 5.4) and students (mean 118.6, SD 8.6). The corresponding numbers for mean compression depth were 7.2 cm (SD 0.7) and 7 cm (SD 1.0). Students demonstrated greater variation in mouth-to-mouth (MTM) skills, with only 41% performing at least 15 successful ventilations during the test. Except for the total number of MTM ventilations (mean difference -5.6), CPR performance was deemed statistically equivalent between professional instructors, SIs and students. Conclusions: High school students can be trained as CPR instructors and teach fellow students CPR with good quality, with some variation in MTM-ventilation skills.

Effect of socioemotional stress on the quality of cardiopulmonary resuscitation during advanced life support in a randomized manikin study.

OBJECTIVE: The aim of this study was to evaluate whether socioemotional stress affects the quality of cardiopulmonary resuscitation during advanced life support in a simulated manikin model. DESIGN: A randomized crossover trial with advanced life support performed in two different conditions, with and without exposure to socioemotional stress. SETTING: The study was conducted at the Stavanger Acute Medicine Foundation for Education and Research simulation center, Stavanger, Norway. SUBJECTS: Paramedic teams, each consisting of two paramedics and one assistant, employed at Stavanger University Hospital, Stavanger, Norway. INTERVENTIONS: A total of 19 paramedic teams performed advanced life support twice in a randomized fashion, one control condition without socioemotional stress and one experimental condition with exposure to socioemotional stress. The socioemotional stress consisted of an upset friend of the simulated patient who was a physician, spoke a foreign language, was unfamiliar with current Norwegian resuscitation guidelines, supplied irrelevant clinical information, and repeatedly made doubts about the paramedics' resuscitation efforts. Aural distractions were supplied by television and cell telephone. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the quality of cardiopulmonary resuscitation: chest compression depth, chest compression rate, time without chest compressions (no-flow ratio), and ventilation rate after endotracheal intubation. As a secondary outcome, the socioemotional stress impact was evaluated through the paramedics' subjective workload, frustration, and feeling of realism. There were no significant differences in chest compression depth (39 vs. 38 mm, p = .214), compression rate (113 vs. 116 min⁻¹, p = .065), no-flow ratio (0.15 vs. 0.15, p = .618), or ventilation rate (8.2 vs. 7.7 min⁻¹, p = .120) between the two conditions. There was a significant increase in the subjective workload, frustration, and feeling of realism when the paramedics were exposed to socioemotional stress. CONCLUSION: In this advanced life support manikin study, the presence of socioemotional stress increased the subjective workload, frustration, and feeling of realism, without affecting the quality of cardiopulmonary resuscitation.

SNP detection exploiting multiple sources of redundancy in large EST collections improves validation rates.

MOTIVATION: Single nucleotide polymorphism (SNP) detection exploiting redundancy in expressed sequence tag (EST) collections that arises from the presence of transcripts of the same gene from different individuals has been used to generate large collections of SNPs for many species. A second source of redundancy, namely that EST collections can contain multiple transcripts of the same gene from the same individual, can be exploited to distinguish true SNPs from sequencing error. In this article, we demonstrate with Atlantic salmon and pig EST collections that splitting the EST collection in two, detecting SNPs in both subsets, then accepting only cross-validated SNPs increases validation rates. RESULTS: In the pig data set, 676 cross-validated putative SNPs were detected in a collection of 160,689 ESTs. When validating a subset of these by genotyping on MassARRAY 85.1% of SNPs were polymorphic in successful assays. In the salmon data set, 856 cross-validated putative SNPs were detected in a collection of 243,674 ESTs. Validation by genotyping showed that 81.0% of the cross-validated putative SNPs were polymorphic in successful assays. AVAILABILITY: Cross-validated SNPs are available at dbSNP (http://www.ncbi.nlm.nih.gov/projects/SNP/), ss69371838-ss69372575 for the salmon SNPs and ss69372587-ss69373226 for the pig SNPs.