A randomized trial of continuous versus interrupted chest compressions in out-of-hospital cardiac arrest: rationale for and design of the Resuscitation Outcomes Consortium Continuous Chest Compressions Trial.

The Resuscitation Outcomes Consortium is conducting a randomized trial comparing survival with hospital discharge after continuous chest compressions without interruption for ventilation versus currently recommended American Heart Association cardiopulmonary resuscitation with interrupted chest compressions in adult patients with out-of-hospital cardiac arrest without obvious trauma or respiratory cause. Emergency medical services perform study cardiopulmonary resuscitation for 3 intervals of manual chest compressions (each ~2 minutes) or until restoration of spontaneous circulation. Patients randomized to the continuous chest compression intervention receive 200 chest compressions with positive pressure ventilations at a rate of 10/min without interruption in compressions. Those randomized to the interrupted chest compression study arm receive chest compressions interrupted for positive pressure ventilations at a compression:ventilation ratio of 30:2. In either group, each interval of compressions is followed by rhythm analysis and defibrillation as required. Insertion of an advanced airway is deferred for the first ≥6 minutes to reduce interruptions in either study arm. The study uses a cluster randomized design with every-6-month crossovers. The primary outcome is survival to hospital discharge. Secondary outcomes are neurologically intact survival and adverse events. A maximum of 23,600 patients (11,800 per group) enrolled during the post-run-in phase of the study will provide ≥90% power to detect a relative change of 16% in the rate of survival to discharge, 8.1% to 9.4% with overall significance level of 0.05. If this trial demonstrates improved survival with either strategy, >3,000 premature deaths from cardiac arrest would be averted annually.

Assuming Personal Responsibility for Sexual Victimization: Harmful But Potentially Adaptive for College Women?

Survivors of sexual trauma often experience pervasive adverse cognitive attributions, such as assuming responsibility for victimization. In fact, these negative outcomes were recently included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criterion for posttraumatic stress disorder (PTSD) and have garnered substantial research attention devoted toward investigating the effectiveness of empirically supported trauma treatments in altering and reducing maladaptive belief systems. However, less is known about the ways that these negative cognitions may be inadvertently serving an adaptive role in young women's healing and recovery from sexual trauma. The present study examined relationships between situational aspects of sexual victimization, personal responsibility, self-esteem, perceived future control, and perceived future likelihood of assault recurrence using path analysis in a sample of college women (n = 347) who had experienced sexual victimization. Increased physical harm, decreased intoxication of the male, increased survivor intoxication, and decreased clarity of nonconsent were associated with increased personal responsibility, which was positively associated with self-esteem and perceived future control. Self-esteem mediated a negative relationship between personal responsibility and perceived future likelihood of assault recurrence, while perceived future control mediated a positive relationship. Findings suggest that college women's tendency to assume personal responsibility for sexual victimization experiences is a complicated double-edged sword with both harmful and adaptive effects. Innovative, comprehensive, and sophisticated approaches to sexual assault prevention and treatment are needed to more effectively address this issue and support young women's healing and recovery from victimization.

If It Wasn't Rape, Was It Sexual Assault? Comparing Rape and Sexual Assault Acknowledgment in College Women Who Have Experienced Rape.

The present study investigated (a) comparisons in rates of rape and sexual assault acknowledgment and (b) a comprehensive multivariate multinomial logistic model predicting rape and sexual assault acknowledgment in a sample of 174 college women who had experienced rape. Significantly more women acknowledged having experienced sexual assault than rape. Greater perceived perpetrator force was associated with increased likelihood of rape and sexual assault acknowledgment. Increased age and greater perceived emotional impact were associated with increased odds of rape acknowledgment. Implications for policy, education, and practice within university settings are discussed.

Classification of cardiopulmonary resuscitation chest compression patterns: manual versus automated approaches.

OBJECTIVES: New chest compression detection technology allows for the recording and graphical depiction of clinical cardiopulmonary resuscitation (CPR) chest compressions. The authors sought to determine the inter-rater reliability of chest compression pattern classifications by human raters. Agreement with automated chest compression classification was also evaluated by computer analysis. METHODS: This was an analysis of chest compression patterns from cardiac arrest patients enrolled in the ongoing Resuscitation Outcomes Consortium (ROC) Continuous Chest Compressions Trial. Thirty CPR process files from patients in the trial were selected. Using written guidelines, research coordinators from each of eight participating ROC sites classified each chest compression pattern as 30:2 chest compressions, continuous chest compressions (CCC), or indeterminate. A computer algorithm for automated chest compression classification was also developed for each case. Inter-rater agreement between manual classifications was tested using Fleiss's kappa. The criterion standard was defined as the classification assigned by the majority of manual raters. Agreement between the automated classification and the criterion standard manual classifications was also tested. RESULTS: The majority of the eight raters classified 12 chest compression patterns as 30:2, 12 as CCC, and six as indeterminate. Inter-rater agreement between manual classifications of chest compression patterns was κ = 0.62 (95% confidence interval [CI] = 0.49 to 0.74). The automated computer algorithm classified chest compression patterns as 30:2 (n = 15), CCC (n = 12), and indeterminate (n = 3). Agreement between automated and criterion standard manual classifications was κ = 0.84 (95% CI = 0.59 to 0.95). CONCLUSIONS: In this study, good inter-rater agreement in the manual classification of CPR chest compression patterns was observed. Automated classification showed strong agreement with human ratings. These observations support the consistency of manual CPR pattern classification as well as the use of automated approaches to chest compression pattern analysis.

Translating a multifactorial fall prevention intervention into practice: a controlled evaluation of a fall prevention clinic.

Although multifactorial fall prevention interventions have been shown to reduce falls and injurious falls, their translation into clinical settings has been limited. This article describes a hospital-based fall prevention clinic established to increase availability of preventive care for falls. Outcomes for 43 adults aged 65 and older seen during the clinic's first 6 months of operation were compared with outcomes for 86 age-, sex-, and race-matched controls; all persons included in analyses received primary care at the hospital's geriatrics clinic. Nonsignificant differences in falls, injurious falls, and fall-related healthcare use according to study group in multivariate adjusted models were observed, probably because of the small, fixed sample size. The percentage experiencing any injurious falls during the follow-up period was comparable for fall clinic visitors and controls (14% vs 13%), despite a dramatic difference at baseline (42% of clinic visitors vs 15% of controls). Fall-related healthcare use was higher for clinic visitors during the baseline period (21%, vs 12% for controls) and decreased slightly (to 19%) during follow-up; differences in fall-related healthcare use according to study group from baseline to follow-up were nonsignificant. These findings, although preliminary because of the small sample size and the baseline difference between the groups in fall rates, suggest that being seen in a fall prevention clinic may reduce injurious falls. Additional studies will be necessary to conclusively determine the effects of multifactorial fall risk assessment and management delivered by midlevel providers working in real-world clinical practice settings on key outcomes, including injurious falls, downstream fall-related healthcare use, and costs.