Hypothermia therapy improves neurological outcome following out-of-hospital cardiac arrest (OOHCA... more Hypothermia therapy improves neurological outcome following out-of-hospital cardiac arrest (OOHCA). Standard surface cooling (SC) with ice packs and cold water blankets is readily available, but is labor intensive and often overcools the patient. The Arctic Sun® (AS) surface cooling system uses enhanced energy transfer pads and close computer control of patient temperature (temp). The objective of this study was to compare the AS to SC for treatment of patients with OOHCA. We hypothesized that a greater proportion of patients treated using the AS would reach 34°C within 4 hours of starting cooling (primary outcome) and AS treated patients would be less likely to be out of target range (32–34°C) during 24 hours of cooling than patients treated with SC. This multicenter trial enrolled unresponsive, hemodynamically stable patients resuscitated from witnessed OOHCA of presumed cardiac cause, with any initial rhythm. After randomization, sedation and paralysis, cooling devices were set t...
OBJECTIVE : To evaluate the impact of cardiocerebral resuscitation (CCR), an alternative emergenc... more OBJECTIVE : To evaluate the impact of cardiocerebral resuscitation (CCR), an alternative emergency medical services (EMS) protocol, on out-of-hospital cardiac arrest (OOHCA) survival in the state of Arizona. CCR, emphasizes 200 preshock chest compressions, a single defibrillator shock (when indicated) followed immediately by 200 postshock chest compressions, early intravenous epinephrine and delayed endotracheal intubation. METHODS : The Save Hearts in Arizona Registry and Education (SHARE) program collected Utstein style data from 38 different fire departments (FDs) servicing approximately 70% of Arizona’s population. 2671 consecutive OOHCAs, of which 1847 were adult and presumed cardiac etiology were enrolled between October, 2004 and December, 2006. The CCR protocol was implemented in 11/38 (29%) FDs and the remaining FDs 27/38 (72%) utilized standard ACLS. The primary end-point was survival to hospital discharge of all cardiac arrests and for the subgroup with witnessed arrest a...
Introduction: The benefit of epinephrine administration by emergency medical services providers (... more Introduction: The benefit of epinephrine administration by emergency medical services providers (EMS) during resuscitation of patients with out-of-hospital-cardiac arrest (OHCA) is controversial. To address the association of the timing of epinephrine administration and outcome, we accessed the Save Hearts in Arizona Register and Educational (SHARE) program registry, and analyzed the time between 9-1-1 dispatches, the first dose of epinephrine and survival to hospital discharge. Methods: A retrospective analysis of prospectively collected statewide OHCA data using the SHARE database between October 2004 and December 2013. Results: There were 2,213 OHCA with a shockable initial rhythm who received epinephrine by EMS. Logistic regression was performed adjusted for age, gender, witnessed, bystander CPR, arrival time (dispatch to scene), and dispatch to defibrillation time, year, and method of ventilation. Of these, 396 (17.8%) survived to discharge. The times from dispatch to first epi...
Background: Bystander CPR is provided in ~25% of out of hospital cardiac arrests in the US. To im... more Background: Bystander CPR is provided in ~25% of out of hospital cardiac arrests in the US. To improve this low rate, the Save Hearts in Arizona Registry & Education program has initiated a multifaceted, statewide public chest compression only (CCO) CPR education campaign. It is unclear whether a statewide CCO-CPR campaign changes the intention of bystanders to perform CPR. It’s further unknown if this initiative affects willingness in populations with lowest survival and CPR performance. Objective: Evaluate the willingness to perform CPR, in various income demographics, following a statewide CPR intervention. Methods: Adult Arizona residents were surveyed at an academic medical center regarding performing CPR. They were asked their attitudes and feelings concerning performing CPR on strangers and family. Demographics were collected including age, gender, education, race and zip code which was used to incorporate census data for median income (separated as quartiles). Inclusion crit...
PurposeCost-avoidance studies are common in pharmacy practice literature. This scoping review sum... more PurposeCost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists’ interventions in acute care settings.MethodsAn Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice.ResultsThe database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the...
ObjectiveTo evaluate the effect of audio‐prompted rate guidance during chest compressions on the ... more ObjectiveTo evaluate the effect of audio‐prompted rate guidance during chest compressions on the performance of cardiopulmonary resuscitation (CPR) on children.MethodsThis 24‐month prospective study occurred in the pediatric intensive care units of a university hospital and a children's hospital. Intubated children with nontraumatic cardiac arrest were eligible. After placement of an infrared capnometer between the endotracheal tube and resuscitation bag, an audiotape instructed the resuscitator to perform chest compressions at 100 per minute or 140 per minute for one minute, followed by another minute at the other rate. End‐tidal carbon dioxide partial pressure () was recorded prior to audiotape instruction and after one minute of CPR at each rate.ResultsSix patients, two boys and four girls, with a mean age of 15 ± 13 months (range 2‐36 months) were studied. All had asystole or pulseless electrical activity. CPR was provided for 14 ± 9 minutes prior to institution of the study...
The curriculum for medical student education is continuously evolving to emphasize knowledge acqu... more The curriculum for medical student education is continuously evolving to emphasize knowledge acquisition with critical problem-solving skills. Medical schools have started to implement curricula to teach point-of-care ultrasound skills. To our knowledge, the expansion into head and neck sonography for medical student education is novel and has never been studied. Our objective was to determine the feasibility of implementing point-of-care head and neck sonography and critical problem-solving instruction for medical student education. Methods This was a cross-sectional study enrolling third-year medical students with minimal prior ultrasound experience. A one-day educational curriculum focusing on the use of head and neck ultrasound for clinical problem-solving was integrated into one of the week-long intersessions. The components of point-of-care ultrasound workshop included asynchronous learning, onehour didactic lecture, followed by a pre-test assessment, then a one-day hands-on workshop, and finally a post-test assessment administered at the end of the training session.
Medical graduates entering residency often lack confidence and competence in procedural skills. I... more Medical graduates entering residency often lack confidence and competence in procedural skills. Implementation of ultrasound (US)-guided procedures into undergraduate medical education is a logical step to addressing medical student procedural competency. The objective of our study was to determine the impact of an US teaching workshop geared toward training medical students in how to perform three distinct US-guided procedures. Cross-sectional study at an urban academic medical center. Following a 1-h didactic session, a sample of 11 students out of 105 (10.5 %) were asked to perform three procedures each (total 33 procedures) to establish a baseline of procedural proficiency. Following a 1-h didactic session, students were asked to perform 33 procedures using needle guidance with ultrasound to establish a baseline of student proficiency. Also, a baseline survey regarding student opinions, self-assessment of skills, and US procedure knowledge was administered before and after the educational intervention. After the educational workshop, students' procedural competency was assessed by trained ultrasound clinicians. One-hundred-and-five third-year medical students participated in this study. The average score for the knowledge-based test improved from 46 % (SD 16 %) to 74 % (SD 14 %) (p \ 0.05). Students' overall confidence in needle guidance improved from 3.1 (SD 2.4) to 7.8 (SD 1.5) (p \ 0.05). Student assessment of procedural competency using an objective and validated assessment tool demonstrated statistically significant (p \ 0.05) improvement in all procedures. The one-day US education workshop employed in this study was effective at immediately increasing third-year medical students' confidence and technical skill at performing US-guided procedures.
Hypothermia therapy improves neurological outcome following out-of-hospital cardiac arrest (OOHCA... more Hypothermia therapy improves neurological outcome following out-of-hospital cardiac arrest (OOHCA). Standard surface cooling (SC) with ice packs and cold water blankets is readily available, but is labor intensive and often overcools the patient. The Arctic Sun® (AS) surface cooling system uses enhanced energy transfer pads and close computer control of patient temperature (temp). The objective of this study was to compare the AS to SC for treatment of patients with OOHCA. We hypothesized that a greater proportion of patients treated using the AS would reach 34°C within 4 hours of starting cooling (primary outcome) and AS treated patients would be less likely to be out of target range (32–34°C) during 24 hours of cooling than patients treated with SC. This multicenter trial enrolled unresponsive, hemodynamically stable patients resuscitated from witnessed OOHCA of presumed cardiac cause, with any initial rhythm. After randomization, sedation and paralysis, cooling devices were set t...
OBJECTIVE : To evaluate the impact of cardiocerebral resuscitation (CCR), an alternative emergenc... more OBJECTIVE : To evaluate the impact of cardiocerebral resuscitation (CCR), an alternative emergency medical services (EMS) protocol, on out-of-hospital cardiac arrest (OOHCA) survival in the state of Arizona. CCR, emphasizes 200 preshock chest compressions, a single defibrillator shock (when indicated) followed immediately by 200 postshock chest compressions, early intravenous epinephrine and delayed endotracheal intubation. METHODS : The Save Hearts in Arizona Registry and Education (SHARE) program collected Utstein style data from 38 different fire departments (FDs) servicing approximately 70% of Arizona’s population. 2671 consecutive OOHCAs, of which 1847 were adult and presumed cardiac etiology were enrolled between October, 2004 and December, 2006. The CCR protocol was implemented in 11/38 (29%) FDs and the remaining FDs 27/38 (72%) utilized standard ACLS. The primary end-point was survival to hospital discharge of all cardiac arrests and for the subgroup with witnessed arrest a...
Introduction: The benefit of epinephrine administration by emergency medical services providers (... more Introduction: The benefit of epinephrine administration by emergency medical services providers (EMS) during resuscitation of patients with out-of-hospital-cardiac arrest (OHCA) is controversial. To address the association of the timing of epinephrine administration and outcome, we accessed the Save Hearts in Arizona Register and Educational (SHARE) program registry, and analyzed the time between 9-1-1 dispatches, the first dose of epinephrine and survival to hospital discharge. Methods: A retrospective analysis of prospectively collected statewide OHCA data using the SHARE database between October 2004 and December 2013. Results: There were 2,213 OHCA with a shockable initial rhythm who received epinephrine by EMS. Logistic regression was performed adjusted for age, gender, witnessed, bystander CPR, arrival time (dispatch to scene), and dispatch to defibrillation time, year, and method of ventilation. Of these, 396 (17.8%) survived to discharge. The times from dispatch to first epi...
Background: Bystander CPR is provided in ~25% of out of hospital cardiac arrests in the US. To im... more Background: Bystander CPR is provided in ~25% of out of hospital cardiac arrests in the US. To improve this low rate, the Save Hearts in Arizona Registry & Education program has initiated a multifaceted, statewide public chest compression only (CCO) CPR education campaign. It is unclear whether a statewide CCO-CPR campaign changes the intention of bystanders to perform CPR. It’s further unknown if this initiative affects willingness in populations with lowest survival and CPR performance. Objective: Evaluate the willingness to perform CPR, in various income demographics, following a statewide CPR intervention. Methods: Adult Arizona residents were surveyed at an academic medical center regarding performing CPR. They were asked their attitudes and feelings concerning performing CPR on strangers and family. Demographics were collected including age, gender, education, race and zip code which was used to incorporate census data for median income (separated as quartiles). Inclusion crit...
PurposeCost-avoidance studies are common in pharmacy practice literature. This scoping review sum... more PurposeCost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists’ interventions in acute care settings.MethodsAn Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice.ResultsThe database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the...
ObjectiveTo evaluate the effect of audio‐prompted rate guidance during chest compressions on the ... more ObjectiveTo evaluate the effect of audio‐prompted rate guidance during chest compressions on the performance of cardiopulmonary resuscitation (CPR) on children.MethodsThis 24‐month prospective study occurred in the pediatric intensive care units of a university hospital and a children's hospital. Intubated children with nontraumatic cardiac arrest were eligible. After placement of an infrared capnometer between the endotracheal tube and resuscitation bag, an audiotape instructed the resuscitator to perform chest compressions at 100 per minute or 140 per minute for one minute, followed by another minute at the other rate. End‐tidal carbon dioxide partial pressure () was recorded prior to audiotape instruction and after one minute of CPR at each rate.ResultsSix patients, two boys and four girls, with a mean age of 15 ± 13 months (range 2‐36 months) were studied. All had asystole or pulseless electrical activity. CPR was provided for 14 ± 9 minutes prior to institution of the study...
The curriculum for medical student education is continuously evolving to emphasize knowledge acqu... more The curriculum for medical student education is continuously evolving to emphasize knowledge acquisition with critical problem-solving skills. Medical schools have started to implement curricula to teach point-of-care ultrasound skills. To our knowledge, the expansion into head and neck sonography for medical student education is novel and has never been studied. Our objective was to determine the feasibility of implementing point-of-care head and neck sonography and critical problem-solving instruction for medical student education. Methods This was a cross-sectional study enrolling third-year medical students with minimal prior ultrasound experience. A one-day educational curriculum focusing on the use of head and neck ultrasound for clinical problem-solving was integrated into one of the week-long intersessions. The components of point-of-care ultrasound workshop included asynchronous learning, onehour didactic lecture, followed by a pre-test assessment, then a one-day hands-on workshop, and finally a post-test assessment administered at the end of the training session.
Medical graduates entering residency often lack confidence and competence in procedural skills. I... more Medical graduates entering residency often lack confidence and competence in procedural skills. Implementation of ultrasound (US)-guided procedures into undergraduate medical education is a logical step to addressing medical student procedural competency. The objective of our study was to determine the impact of an US teaching workshop geared toward training medical students in how to perform three distinct US-guided procedures. Cross-sectional study at an urban academic medical center. Following a 1-h didactic session, a sample of 11 students out of 105 (10.5 %) were asked to perform three procedures each (total 33 procedures) to establish a baseline of procedural proficiency. Following a 1-h didactic session, students were asked to perform 33 procedures using needle guidance with ultrasound to establish a baseline of student proficiency. Also, a baseline survey regarding student opinions, self-assessment of skills, and US procedure knowledge was administered before and after the educational intervention. After the educational workshop, students' procedural competency was assessed by trained ultrasound clinicians. One-hundred-and-five third-year medical students participated in this study. The average score for the knowledge-based test improved from 46 % (SD 16 %) to 74 % (SD 14 %) (p \ 0.05). Students' overall confidence in needle guidance improved from 3.1 (SD 2.4) to 7.8 (SD 1.5) (p \ 0.05). Student assessment of procedural competency using an objective and validated assessment tool demonstrated statistically significant (p \ 0.05) improvement in all procedures. The one-day US education workshop employed in this study was effective at immediately increasing third-year medical students' confidence and technical skill at performing US-guided procedures.
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