"A breath of fresh air" for tackling chronic disease in Ireland? An evaluation of a self-management support service for people with chronic respiratory diseases.

OBJECTIVE: To describe the impact of a nurse-led telephone self-management support (SMS) service for people with asthma and COPD in Ireland. METHODS: A cross-sectional survey of all (442) SMS users, July 2016 to May 2017, described user demographics, self-reported experience, process and outcome. Population utilisation was estimated and compared across groups. Factors associated with key outcomes were identified. RESULTS: The response rate was 162 (36.7%). Utilisation varied across population groups. Reported satisfaction was high, and 56.0% of users without a written action plan reported developing one. Most users reported positive cognitive and affective outcomes indicating effective patient activation. Information pack receipt was independently associated with better outcomes (odds ratio = 11.4 (95% CI, 2.0, 216.6), p < 0.05). CONCLUSION: A nurse-led telephone SMS intervention positively impacted self-management for people with asthma and COPD in Ireland. PRACTICE IMPLICATIONS: Roll-out of SMS should include staff training to promote positive service user experience and should include routine monitoring and evaluation to assure equitable reach and quality of key evidence-based care processes.

Benchmarking life quality support interventions in long-term care using the Long-Term Care Quality of Life scale.

We aimed to develop a graphical procedure for benchmarking quality of life care results using the Long-Term Care Quality of Life (LTC-QoL) scale. While clinical care quality benchmarking is now well established, similar research for quality of life (QOL) aged care benchmarking has received scant attention. Data from 10 facilities utilizing the LTC-QoL scale were analysed to establish baseline statistics for developing a graphical procedure for QOL benchmarking. Client LTC-QoL records were tested with varimax rotation factor analysis revealing three viable benchmarking themes: B1 (Self-efficacy), B2 (supporting relationships), and B3 (outlook on life) were selected for benchmark development utilizing Analysis of Means to generate graphical outputs using Minitab version 17.3.1. In this way, in the absence of verified industry standards, it is possible to compare organizations providing similar services using the same indicators, against group averages. In conclusion, the benchmarking protocol produced comparative information on three benchmarks for 10 facilities. Similar analysis is feasible for a single facility over time. The results of these analyses provide evidence for on-site discussion of quality of life care quality performance.

Availability of Life Support Equipment and its Utilization by Ambulance Drivers.

BACKGROUND: An effective ambulance is a vital requirement for providing an emergency medical service. Well-equipped ambulances with trained paramedics can save many lives during the golden hours of trauma care. The objective was to document the availability and utilization of basic life support equipment in the ambulances and to assess knowledge on first aid among the drivers. METHODS: Descriptive design was used. Total of 109 ambulances linked to B.P. Koirala Institute of Health Sciences were enrolled using purposive sampling method. Self- constructed observation checklist and semi structured interview schedule was used for data collection. RESULTS: More than half of the respondents had less than five years of experience and were not trained in first aid. About two-third of the respondents had adequate knowledge on first aid. About 90% of the ambulance had oxygen cylinder and adult oxygen mask which was 'usually' used equipment. More than half of ambulance had equipment less than 23% as compared to that of national guidelines. There was significant association of knowledge with the experience (p = 0.004) and training (p = 0.001). Availability of equipment was associated with training received (p = 0.007),organization (p= 0.032)and district (p = 0.023) in which the ambulance is registered. CONCLUSIONS: The study concludes that maximum ambulance linked to BPKIHS, Nepal did not have even one fourth of the equipment for basic life support. Equipment usually used was oxygen cylinder and oxygen mask. Majority of driver had adequate knowledge on first aid and it was associated with training and experience.

Conocimientos y disposición para realizar soporte vital básico por agentes de la policía local / Knowledge and willingness to perform basic life support by local police officers

Fundamento: Determinar los conocimientos de los agentes de la policía local (PL) sobre la reanimación cardiopulmonar (RCP) y su disposición para realizarla, así como explorar la asociación entre la formación en RCP y estas variables. Sujetos y método: Estudio transversal sobre una muestra de 390 agentes de la PL de Asturias (España). Se utilizó un cuestionario anónimo que midió nueve aspectos básicos sobre la RCP del Consejo Europeo de Reanimación y cuatro indicadores de la disposición para realizarla en situaciones reales. También se recogió información sobre la formación en RCP y su periodicidad, así como variables sociodemográficas y laborales básicas. Resultados: El 19,7% de los PL no había recibido formación en RCP y el 36,4% la había recibido hacía más de dos. El 24,1% habían realizado al menos una RCP en situación real, de los cuales el 9,6% no estaba formado. Los aspectos de la RCP menos recordados fueron la profundidad (11%) y la frecuencia de las compresiones (24,4%). El 49,7% de los agentes se siente con suficiente preparación para realizar una RCP. Los conocimientos y la disposición se asociaron significativamente con haber realizado cursos de formación con una periodicidad menor de dos años. Conclusiones: Dado que los agentes de PL deben intervenir con frecuencia en situaciones de parada cardiorrespiratoria como primeros intervinientes, la formación específica en RCP de los agentes de PL debería ser obligatoria y periódica, con al menos un curso cada dos años. Sería interesante determinar qué instrumentación didáctica es más eficiente para difundir estos cursos entre los policías (AU)

Background: To determine the knowledge and willingness of local police officers (PO) to perform cardiopulmonary resuscitation (CPR), as well as to explore the association between CPR training and these variables. Methods: Cross-sectional study with a sample of 390 PO from Asturias (Spain). An anonymous questionnaire was used to measure nine basic aspects of CPR from the European Resuscitation Council and four indicators of attitude towards performing CPR in a real context. Information on CPR training and its periodicity was also collected, as well as basic socio-demographic and occupational variables. Results: Lack of CPR training was seen in 19.7% of PO, and 36.4% had received such training more than two years ago. Almost one out of four PO had performed at least one CPR in a real situation (24.1%), of which 9.6% had not been trained. The least remembered aspects of CPR were depth (11%) and frequency of chest compressions (24.4%). Only 49.7% of the agents felt sufficiently prepared to perform a CPR. Knowledge and disposition were significantly associated with having received training with a periodicity of less than two years. Conclusions: Given that PO are frequently first responders in situations of out-of-hospital cardiorespiratory arrest, specific training in CPR should be mandatory and periodic, with at least one course every two years. It would be interesting to determine which didactic instrumentation is most efficient for disseminating these training courses among police officers (AU)

Suport vital bàsic i avançat pediàtric 2015 / No disponible

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SEOM Clinical Guideline for the treatment of pancreatic cancer (2016)

Pancreatic cancer remains an aggressive disease with a 5 year survival rate of 5%. Only 15% of patients with pancreatic cancer are eligible for radical surgery. Evidence suggests a benefit on survival with adjuvant chemotherapy (gemcitabine o fluourouracil) after R1/R0 resection. Adjuvant chemoradiotherapy is also a valid option in patients with positive margins. Borderline resectable pancreatic cancer is defined as the involvement of the mesenteric vasculature with a limited extension. These tumors are technically resectable, but with a high risk of positive margins. Neoadjuvant treatment represents the best option for achieving an R0 resection. In advanced disease, two new chemotherapy treatment schemes (Folfirinox or Gemcitabine plus nab-paclitaxel) have showed improvements in overall survival compared with gemcitabine alone. Progress in pancreatic cancer treatment will require a better knowledge of the molecular biology of this disease, focusing on personalized cancer therapies in the near future (AU)

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[Acute care of critically ill children in general hospitals: organisation and training]. / Acute opvang van kinderen in algemene ziekenhuizen.

OBJECTIVE: To gain insight into how the acute care of critically ill children at general hospitals is organised, whether staff is sufficiently trained and whether the necessary materials and medications are present. DESIGN: Questionnaire combined with a site visit. METHOD: Questionnaires were sent to all primarily involved specialists (emergency room specialists and paediatricians), and to the auxiliary anaesthetists and intensivists involved, at the nine general hospitals in Southeast Netherlands. Two researchers performed standardised interviews with the lead paediatricians on site and checked for materials and medication present in the emergency and paediatric departments. RESULTS: Of the 195 questionnaires sent, 97 (49.7%) were deemed suitable for analysis. The response from the primary specialists involved (77.6%) was more than twice that of the auxiliary specialists (31.9%). At 7 hospitals, verbal agreements on the organisation of acute care were maintained, 1 hospital had a written protocol, and 2 hospitals had a task force addressing this topic. One out of 5 respondents was unaware of the verbal agreements and 1 out of 3 mistakenly assumed that a protocol existed. Two out of 3 primary specialists involved were certified for Advanced Paediatric Life Support (APLS); 1 out of 13 of the auxiliary specialists had such a certificate. Scenario training was being conducted at 8 hospitals. A paediatric resuscitation cart was available at both the emergency and paediatric departments of 8 hospitals, 3 of which were fully stocked at both departments. Laryngeal mask airways and PEEP-valves (Positive End Expiratory Pressure) were lacking at 6 of the 9 hospitals. The medication stock was complete at all the hospitals. CONCLUSION: The organisation of and training for the acute care of critically ill children and presence of materials - the aspects we investigated - need attention at all general hospitals evaluated. It appeared that many specialists are not APLS certified and written protocols concerning organisation and training were lacking. The establishment of a task force responsible for the acute care of children is one measure that could result in rapid improvement. Another measure could be the introduction of a standardised list of inventory needed for acute care.

[Intergeneration continuity and adherence to the traditions of fundamental physiological science--the basis for present and guarantee of future advancements in space physiology and medicine].

Sprung from the national physiological science and aviation medicine, space physiology and medicine of today is an intensely evolving discipline cradled and fostered by the Russian scientists who made major contributions both to individual branches of physiology and general research methodology. Upholding the best traditions, space physiology and medicine specialists retain leadership in many areas and ensure intergeneration continuity in research work. Among these areas are investigations into the physiological mechanisms of water-electrolyte turnover in animals and humans in the course of space flight and ground-based model experiments.

Withdrawal of life-sustaining treatment in a mixed intensive care unit: most common in patients with catastropic brain injury.

OBJECTIVE: To determine the incidence of withdrawal of life-sustaining treatment in various groups of patients in a mixed intensive care unit (ICU). DESIGN: Observational retrospective. SETTING: University hospital mixed medical, neurological, neurosurgical and surgical ICU. PATIENTS: All patients admitted to the ICU between 1 November 2006, and 31 October 2007. RESULTS: 1,353 Patients were admitted to our ICU between 1 November 2006, and 31 October 2007. During this period, 218 (16.1%) patients died in the ICU, 10 of which were excluded for further analysis. In 174 (83.7%) of the remaining 208 patients, life-sustaining treatment was withdrawn. Severe CNS injury was in 86 patients (49.4%) being the reason for withdrawal of treatment, followed by MODS in 67 patients (38.5%). Notably, treatment was withdrawn in almost all patients (95%) who died of CNS failure. Patients who died in the ICU were significantly older, more often admitted for medical than surgical reasons, and had higher SOFA and APACHE II scores compared with those who survived their ICU stay. Also, SOFA scores before discharge/death were significantly different from admission scores. Of the 1,135 patients who survived their ICU stay, only 51 patients (4.5%) died within 28 days after ICU discharge. CONCLUSIONS: In 83, 7% of patients who die in the mixed ICU life-sustaining treatment is withdrawn. Severe cerebral damage was the leading reason to withdraw life-sustaining treatment.

Comparing emergency medical service systems--a project of the European Emergency Data (EED) Project.

AIM: The aim of this prospective study was the comparison of four emergency medical service (EMS) systems-emergency physician (EP) and paramedic (PM) based-and the impact of advanced live support (ALS) on patients status in preclinical care. METHODS: The EMS systems of Bonn (GER, EP), Cantabria (ESP, EP), Coventry (UK, PM) and Richmond (US, PM) were analysed in relation to quality of structure, process and performance when first diagnosis on scene was cardiac arrest (OHCA), chest pain or dyspnoea. Data were collected prospectively between 01.01.2001 and 31.12.2004 for at least 12 month. RESULTS: Over all 6277 patients were included in this study. The rate of drug therapy was highest in the EP-based systems Bonn and Cantabria. Pain relief was more effective in Bonn in patients with severe chest pain. In the group of patients with chest pain and tachycardia ≥ 120 beats/min, the heart rate was reduced most effective by the EP-systems. In patients with dyspnoea and S(p)O(2) <90% the improvement of oxygen saturation was most effective in Bonn and Richmond. After OHCA significant more patients reached the hospital alive in EMS systems with EPs than in the paramedic staffed (Bonn = 35.6%, Cantabria = 30.1%; Coventry = 11.9%, Richmond = 9.2%). The introduction of a Load Distributing Band chest compression device in Richmond improved admittance rate after OHCA (21.7%) but did not reach the survival rate of the Bonn EMS system. CONCLUSIONS: Higher qualification and greater training and experience of ALS unit personnel increased survival after OHCA and improved patient's status with cardiac chest pain and respiratory failure.

Basic life support with four different compression/ventilation ratios in a pig model: the need for ventilation.

BACKGROUND: During cardiac arrest the paramount goal of basic life support (BLS) is the oxygenation of vital organs. Current recommendations are to combine chest compressions with ventilation in a fixed ratio of 30:2; however the optimum compression/ventilation ratio is still debatable. In our study we compared four different compression/ventilation ratios and documented their effects on the return of spontaneous circulation (ROSC), gas exchange, cerebral tissue oxygenation and haemodynamics in a pig model. METHODS: Study was performed on 32 pigs under general anaesthesia with endotracheal intubation. Arterial and central venous lines were inserted. For continuous cerebral tissue oxygenation a Licox PtiO(2) probe was implanted. After 3 min of cardiac arrest (ventricular fibrillation) animals were randomized to a compression/ventilation-ratio 30:2, 100:5, 100:2 or compressions-only. Subsequently 10 min BLS, Advanced Life Support (ALS) was performed (100%O(2), 3 defibrillations, 1mg adrenaline i.v.). Data were analyzed with 2-factorial ANOVA. RESULTS: ROSC was achieved in 4/8 (30:2), 5/8 (100:5), 2/8 (100:2) and 0/8 (compr-only) pigs. During BLS, PaCO(2) increased to 55 mm Hg (30:2), 68 mm Hg (100:5; p=0.0001), 66 mm Hg (100:2; p=0.002) and 72 mm Hg (compr-only; p<0.0001). PaO(2) decreased to 58 mmg (30:2), 40 mm Hg (100:5; p=0.15), 43 mm Hg (100:2; p=0.04) and 26 mm Hg (compr-only; p<0.0001). PtiO(2) baseline values were 12.7, 12.0, 11.1 and 10.0 mm Hg and decreased to 8.1 mm Hg (30:2), 4.1 mm Hg (100:5; p=0.08), 4.3 mm Hg (100:2; p=0.04), and 4.5 mm Hg (compr-only; p=0.69). CONCLUSIONS: During BLS, a compression/ventilation-ratio of 100:5 seems to be equivalent to 30:2, while ratios of 100:2 or compressions-only detoriate peripheral arterial oxygenation and reduce the chance for ROSC.

[Current status of life support systems for cosmonauts and ways of their enhancement in near future].

The paper reviews the results of efforts undertaken so far to develop three types of life support systems: fill-and-draw and physicochemical reclamation systems for space flights of up to one year in duration, and systems for more extended missions. The authors point to the engineering and logistical issues that should be given the highest priority in the next decades.

Pro/con debate: is the scoop and run approach the best approach to trauma services organization?

You are asked to be involved in organizing a trauma service for a major urban center. You are asked to make a decision on whether the services general approach to trauma in the city (which does have a well-established trauma center) will be scoop and run (minimal resuscitation at the scene with a goal to getting the patient to a trauma center as quickly as possible) or on-the-scene resuscitation with transfer following some degree of stabilization.

[Biological systems of life support for space crews: some results and anticipations].

One of the challenges for space biology and medicine is resolution of lots of problems of biomedical support of humans in the extreme environment of space flight. These problems include also designing of robust and efficiently functioning life support systems (LSS). The paper gives an overview of the investigations of ground-based BLSS with human subjects conducted in Russia and other countries. Also, it contains the basic data of studying the BLSS photoautotrophic components (higher plants) in the series of experiments with the total duration of 630 days fulfilled on orbital complex Mir and the series of experiments with the total duration of 820 days in the ISS Russian segment. Analysis of the results from the BLSS investigations on Earth and in space flights drives to the conclusion that some of the BLSS components, greenhouses specifically, can be integrated even now into the currently used systems of space crew life support.

Basic life support on small boats at sea.

The present study examined the ability of the crew of small fast rescue boats to perform basic life support (BLS) at sea. Tests were undertaken aboard a 67m emergency response and rescue vessel (ERRV), a 9.1m (30ft) and 11.6m (38ft) fast rescue craft ("daughter craft" (DC)). It was hypothesised that the ability to perform BLS on a DC would be significantly impaired when compared with that seen on the ERRV. Nine DC crew volunteered for the study. These tests were undertaken in sea states ranging from 0.5 to 6 (13cm to 4m wave height). Wind speeds ranged between 0 and 35knots. The deterioration observed in the performance of BLS on board the DC compared to that seen on the ERRV was significant (P<0.05) and was due, in part, to a tendency to over-inflate during rescue breathing, and under-compress during BLS when on the DC. Chest compression (CC) was impaired significantly above a sea state 3 (wave height 61-92cm). It is concluded that the performance of BLS on small boats, in particular rescue breathing, is significantly adversely affected by two major factors, motion-induced interruption and early fatigue. As a consequence, the likelihood of conducting fully effective continuous BLS on a small boat in a seaway for any length of time, with a good chance of a successful outcome, is considered to be poor. However, this should not deter rescuers from attempting to make such efforts where practicable.

MARS--does it stand the test of time?

Artificial liver support systems have been tested for decades in the management of liver failure. Generally, after some promising results published as case series, the device either disappears or fails to show significant benefit in controlled trials. Recently, the molecular absorbent recycling systems (MARS) or extracorporeal albumin dialysis (ECAD) technique appears to have broken this trend. Responding to the title one could summarize by saying this technique so far has stood the test of time. Data in support of its use in acute liver failure (ALF) is still scant and difficult to assess. However, in a well known but not very well defined entity of acute on chronic liver failure (AOCLF) the ECAD technique has been shown to improve survival compared to a similar randomized control group receiving standard supportive therapy. This well tolerated liver support system has real potential for widespread application if further well designed multicenter clinical trials continue to support its effectiveness. Its future lies probably in the management of the moribund hospitalized patient on the transplant list awaiting a donor liver.

Management strategies for cardiogenic shock.

PURPOSE OF REVIEW: Cardiogenic shock remains the most serious complication of acute MI, with an incidence of 6 to 8% and a 30-day mortality rate that remains close to 50%. While cardiogenic shock is due primarily to left ventricular failure, other causes such as acute mitral regurgitation and ventricular septal rupture must always be considered as emergency surgery may be life saving. The purpose of this review is to summarize recent advances in the care of these critically ill patients including the consideration of etiology and pathophysiology as well as the influence of age and adjunctive therapies. RECENT FINDINGS: Early revascularization is now an American College of Cardiology/American Heart Association guideline class 1 indication for percutaneous coronary intervention (PCI) particularly for younger patients in cardiogenic shock. Recent studies suggest there may also be a benefit in elderly patients with cardiogenic shock. SUMMARY: Prompt triage of all patients in cardiogenic shock for early angiography, intra-aortic balloon pump counterpulsation, and early revascularization with PCI or bypass surgery is now the preferred management strategy.

Maintaining life-support and non-life-support equipment. What do JCAHO's new requirements mean?

As part of its new "Shared Visions--New Pathways" initiative, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires accredited healthcare facilities to demonstrate that life-support equipment receives a high priority in their equipment-maintenance programs. JCAHO has also revised its overall accreditation scoring system. Some of our member hospitals have asked ECRI for advice on how to deal with these changes. JCAHO's intent, as we understand it, is not to impose burdensome new requirements on hospitals, but simply to ensure that life-support equipment receives the necessary equipment-maintenance priority. We believe that any facility that has been meeting JCAHO's requirements up to now won't need to significantly change its equipment-management program, though it will need to revise its documentation procedures. In this article, we describe the changes to JCAHO's requirements and outline the steps that hospitals need to take to meet the requirements--as well as the steps they don't need to take.

Withholding and withdrawing life prolonging treatment in the intensive care unit: a current European perspective.

BACKGROUND: Many deaths are now preceded by an end of life decision, particularly in the intensive care unit (ICU), but such practices vary considerably between countries, ICUs and individuals, depending on many factors including cultural and religious background, family and peer pressure and local practice. AIMS: In this review, we will discuss the application of the four key ethical principles--beneficence, nonmaleficence, autonomy and distributive justice--to withdrawing/withholding decisions. METHODS: Drawing data from several national and international studies, we then summarize the current situation across Europe regarding such practices before making some suggestions as to how we could facilitate the often difficult decision making process by improved communication between staff, patient and relatives.