Abstract 12921: One Hand Open Palm Technique for Infant Cardiopulmonary Resuscitation: A Randomized Crossover Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Shruti Patel ◽  
Shilpa Balikai ◽  
Timothy G Elgin ◽  
Elizabeth A Newell ◽  
Tarah T Colaizy ◽  
...  
Keyword(s):  
Chest Compression ◽  
Nurse Practitioners ◽  
Healthcare Providers ◽  
Rest Period ◽  
Heart Association ◽  
Spontaneous Circulation ◽  
Difficulty Level ◽  
Care Providers ◽  
Compression Depth ◽  
Pediatric Resuscitation

Introduction: The American Heart Association (AHA) CPR guidelines states that effective chest compression depth, rate and recoil are essential factors for establishment of return of spontaneous circulation. A recent survey from an international pediatric resuscitation collaborative showed that healthcare providers failed to meet the metrics of the AHA guidelines, with the greatest difficulty in achieving targeted chest compression depth in infants. The recommended techniques for infant compression include two finger (TFT) or two-thumb technique (TTT). We hypothesized using the heel of one palm (open palm technique, OPT) in infants will result in improved chest compression depth with decreased provider fatigue. Methods: Each participant performed three techniques including TFT, TTT, and novel open-palm technique (OPT) with randomization for sequence of techniques for each participant. Each technique was performed for 2 minutes followed by a 5-minute rest period on an infant manikin. Data were collected through Zoll R series defibrillators on chest compression depth, rate, and fraction. At the end of the study, each participant filled out a survey for difficulty level, finger fatigue, and rescuer fatigue. Results: Thirty pediatric critical care providers participated in the study consisting of 16 nurses, 9 respiratory therapists, 3 fellows, 2 nurse practitioners. The mean chest compression depth for OPT was significantly deeper (2.61 ± 0.63 cm) in comparison to TFT (2.25 ± 0.54 cm, p= 0.0004) but not significantly deeper in comparison to TTT (2.43 ± 0.46 cm, p= 0.0820). There were no significant differences between the three techniques in chest compression rate or chest compression fraction. The finger fatigue and rescuer fatigue surveys were graded from 0-10 with 10 being the most fatigue. OPT showed significantly less finger and rescuer fatigue in comparison to TTT and TFT (p<0.05). Conclusion: This study demonstrated that OPT generated improved chest compression depth with considerably less rescuer and finger fatigue. However, chest compression depth with all three techniques failed to meet the AHA infant goal of 4 cm. Further research is needed to optimize CPR performance to achieve the targeted chest compression depth in infants.

scholarly journals Effect of the Use of Metronome Feedback on the Quality of Pediatric Cardiopulmonary Resuscitation

2021 ◽  
Vol 18 (15) ◽  
pp. 8087
Author(s):  
Dongjun Yang ◽  
Wongyu Lee ◽  
Jehyeok Oh
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Healthcare Providers ◽  
Compression Rate ◽  
Audio Feedback ◽  
Simple Method ◽  
Compression Depth ◽  
Pediatric Resuscitation ◽  
Cpr Quality

Although the use of audio feedback with devices such as metronomes during cardiopulmonary resuscitation (CPR) is a simple method for improving CPR quality, its effect on the quality of pediatric CPR has not been adequately evaluated. In this study, 64 healthcare providers performed CPR (with one- and two-handed chest compression (OHCC and THCC, respectively)) on a pediatric resuscitation manikin (Resusci Junior QCPR), with and without audio feedback using a metronome (110 beats/min). CPR was performed on the floor, with a compression-to-ventilation ratio of 30:2. For both OHCC and THCC, the rate of achievement of an adequate compression rate during CPR was significantly higher when performed with metronome feedback than that without metronome feedback (CPR with vs. without feedback: 100.0% (99.0, 100.0) vs. 94.0% (69.0, 99.0), p < 0.001, for OHCC, and 100.0% (98.5, 100.0) vs. 91.0% (34.5, 98.5), p < 0.001, for THCC). However, the rate of achievement of adequate compression depth during the CPR performed was significantly higher without metronome feedback than that with metronome feedback (CPR with vs. without feedback: 95.0% (23.5, 99.5) vs. 98.5% (77.5, 100.0), p = 0.004, for OHCC, and 99.0% (95.5, 100.0) vs. 100.0% (99.0, 100.0), p = 0.003, for THCC). Although metronome feedback during pediatric CPR could increase the rate of achievement of adequate compression rates, it could cause decreased compression depth.

Healthcare Providers Face Numerous Challenges in Treating Patients with Psoriasis: Results from a Mixed-Methods Study

2021 ◽  
pp. 247553032110628
Author(s):  
Suzanne Murray ◽  
Jeffrey Crowley ◽  
Melinda J. Gooderham ◽  
Alan Kivitz ◽  
Vinod Chandran ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Nurse Practitioners ◽  
Paradigm Shift ◽  
Primary Care Physicians ◽  
Healthcare Providers ◽  
Continuing Professional Development ◽  
Physician Assistants ◽  
Care Providers ◽  
Starting Point ◽  
Practice Gaps

Background The paradigm shift toward biologic medications in psoriasis care requires healthcare providers (HCPs) to become acquainted with mechanisms of action and safety profiles of these new treatments to confidently use them in practice. A better understanding of this paradigm shift is necessary to provide adequate education for HCPs in psoriasis care. Objectives This study assessed clinical practice gaps and challenges experienced by HCPs caring for patients with psoriasis. Methods A mixed-methods approach was used to identify practice gaps and clinical challenges of dermatologists, rheumatologists, primary care physicians, physician assistants, and nurse practitioners with various levels of clinical experience in academic and community-based settings. Qualitative and quantitative data were collected sequentially. Interviews were transcribed and thematically analyzed. Results A total of 380 psoriasis care providers in Canada and the US participated in this study. Analysis revealed challenges in establishing an accurate diagnosis of psoriasis (including screening for sub-type and distinguishing psoriasis from other skin conditions), selecting treatment (particularly regarding recently approved treatments), monitoring side effects, and collaborating with other HCPs involved in psoriasis care. Conclusion These findings highlight educational needs of HCPs involved in psoriasis care that could have repercussions on accurate and timely diagnosis of the condition, treatment initiation, side effect monitoring, and continuity of care. Findings provide a starting point for clinicians to reflect on their practice and for the improvement of continuing professional development interventions that would bridge these gaps.

Abstract 229: Cardiopulmonary Resuscitation Compliance of Clinical Nurses Using Feedback Technology from the Zoll R Series Defibrillator

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Martha A Boudreau
Keyword(s):  
Visual Feedback ◽  
Chest Compression ◽  
Technology Use ◽  
Healthcare Providers ◽  
Rest Period ◽  
Visual Display ◽  
Chest Compressions ◽  
Compression Performance ◽  
Clinical Nurses ◽  
Use Of Technology

Use of technology driven devices aimed at providing audio-visual feedback during CPR have been developed, however research is limited to their usefulness effecting chest compression quality of clinical nurses who are often first to respond and begin chest compression on patients experiencing cardiac arrest. This study aimed to examine CPR chest compression compliance of nurses with and without feedback from the Zoll R Series® defibrillator on a manikin. Hypothesis: Audio-visual feedback technology use from the Zoll R Series defibrillator improves the percentage of appropriate chest compression depth and rate of nurses during a CPR manikin demonstration exercise. Methods: Thirty-four nurses participated using an AHA approved manikin. Each nurse performed two minutes of uninterrupted chest compressions without feedback, followed by a rest period and two minutes of uninterrupted chest compressions using feedback technology from the defibrillator. Compression data for rate and depth and total compressions in target within AHA 2015 ECC Guidelines were recorded by the defibrillator and entered into Zoll RescueNet® software. Demographics obtained for years of BLS and ACLS certification. Results: Of the 34 nurses, mean years of ACLS certification was 3.4 years and 11.7 certified years of BLS. Compressions performed with feedback showed a higher percentage of compressions in target (M = 87.37, SD= 15.95) including rate (M= 86.33, SD =15.13) and depth (M= 97.12, SD = 5.63) of compressions compared to percent compressions in target without feedback (M= 64.42, SD = 30.54) including rate (M= 65.73, SD = 32.44) and depth (M=93.34, SD = 19.99) of compressions. Twenty nine or 85% of the 34 nurses improved chest compression performance using feedback. No significant correlation found between years of BLS and ACLS certification and pre and post feedback compliance. Conclusions: Defibrillators offering verbal encouragement and a visual display allow for adjustments in rate and depth of compressions to maintain chest compressions compliance within ECC Guidelines. Further studies should investigate whether the incorporation of feedback technology use in mock code and CPR training sessions could improve CPR performance of healthcare providers including nurses.

Students’ lack of knowledge regarding healthcare providers’ duties, and their preferences for information when selecting new providers

2015 ◽  
Vol 3 (1) ◽  
pp. 113 ◽  
Author(s):  
Evan Perrault
Keyword(s):  
College Students ◽  
Nurse Practitioners ◽  
Personal Information ◽  
Healthcare Providers ◽  
Physician Assistants ◽  
Primary Care Providers ◽  
Health Centers ◽  
Care Providers ◽  
Web Based ◽  
Midwestern Usa

Rationale, aims and objectives: When USA college students need medical care, their first destinations are usually campus health centers. Normally, staffed by a variety of care providers (e.g., nurse practitioners, physician assistants, physicians), students may be confused about who they may need to see and possibly hesitant to receive care. The present study sought to determine students’ knowledge about primary care providers and the qualities they would like to know about them prior to consultations. The goal of this paper is to improve the information campus health centers in terms of their ability to provide students health solutions when and where they need them. Methods: 534 USA college students from a large Midwestern USA university completed a web-based survey about their knowledge, attitudes and information preferences regarding their various care providers. They also viewed 3 experimentally manipulated biographies of providers and chose the provider they would want to visit. Results: The majority of students did not know the differences between physicians, physician assistants and nurse practitioners and the types of care that they could provide. About 9% stated they would not seek care and 16% would delay seeking care if unable to see a physician immediately. The most important pieces of information desired were providers’ philosophies of care, certifications, areas of specialization and length of time practising medicine. As students perceived greater similarities due to more personal information provided in the biographies, they viewed, uncertainty was reduced leading to higher levels of anticipated patient satisfaction and quality of care. Conclusions: USA college students need greater levels of education regarding the care that can be received from a variety of healthcare professionals. Information provided should also include more personal information about the providers to help reduce students’ uncertainty and to enable students to access services that are person-centered in their nature.

Evaluation of an Inter-Professional Educational Intervention to Improve the Use of Arthritis Best Practices in Primary Care

2011 ◽  
Vol 38 (5) ◽  
pp. 931-937 ◽  
Author(s):  
SYDNEY C. LINEKER ◽  
MARY J. BELL ◽  
ELIZABETH M. BADLEY
Keyword(s):  
Primary Care ◽  
Best Practices ◽  
Nurse Practitioners ◽  
Professional Education ◽  
Best Practice ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Rehabilitation Professionals ◽  
Knee Oa

Objective.To describe the evaluation of a community-based continuing health education program designed to improve the management of rheumatoid arthritis (RA) and osteoarthritis (OA), and to examine the results by discipline.Methods.The Getting a Grip on Arthritis©program was based on clinical practice guidelines adapted for the primary care environment (best practices). The program consisted of an accredited inter-professional workshop and 6 months of activities to reinforce the learning. Analyses compared best practice scores derived from responses to 3 standardized case scenarios (early and late RA; moderate knee OA) at baseline and 6 months post-workshop using the ACREU Primary Care Survey.Results.In total, 553 primary care providers (nurses/licensed practical nurses 30.9%, rehabilitation professionals 22.5%, physicians 22.5%, nurse practitioners 10.9%, other healthcare providers/non-clinical staff/students 13.1%) attended one of 27 workshops across Canada; 275 (49.7%) completed followup surveys. Best practice scores varied by discipline at baseline (p < 0.05) and improved for all 3 case scenarios, with nurse practitioners and rehabilitation therapists improving the most (p ≤ 0.05).Conclusion.Results suggest that inter-professional education may be an effective method for dissemination of guidelines and has potential to improve the delivery of arthritis care, particularly when nurse practitioners and rehabilitation therapists are involved in the care of patients.

scholarly journals A Comprehensive Guide to Virtual Care (Preprint)

2020 ◽  
Author(s):  
Andy Wong ◽  
Rashaad Bhyat ◽  
Siddhartha Srivastava ◽  
Lysa Lomax ◽  
Simon Hagens ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Video Conferencing ◽  
Healthcare Providers ◽  
Continuing Care ◽  
Care Providers ◽  
Virtual Care ◽  
Regulatory Standards ◽  
Healthcare It

UNSTRUCTURED Virtual Care, using video conferencing technology to connect with patients, has become critical in providing continuing care for patients in the contemporary COVID-19 pandemic. Virtual care is now adopted by healthcare providers across the spectrum, including physicians, residents, nurse practitioners, nurses, and allied health. Virtual care is novel and nuanced when compared to in-person care. Most of the health care providers that are delivering or expected to deliver virtual care have little to no prior experience. The nuances with virtual care involve regulatory standards, platforms, technology and troubleshooting, patient selection, etiquette, and workflow that all comprise critical points to the provision of healthcare. It is important that high quality and professional virtual care is delivered consistently to give patients the trust they need to continue following up in these trying times. We have adopted virtual care in our clinical practice for over two years now. In partnership with Canada Health Infoway, we have put together a primer for virtual care that can serve as a guide for any health care provider in Canada and globally, with the goal of providing seamless transitions between in-person and virtual care.

scholarly journals CHEST COMPRESSION METHODS SIMULATED COVID-19 PATIENT RESUSCITATION: A RANDOMIZED CROSS-OVERSIMULATION TRIAL

2020 ◽  
Vol 18 (6) ◽  
pp. 669-675
Author(s):  
T. Evrin ◽  
◽  
K. Bielski ◽  
A. Dabrowska ◽  
J. Smereka ◽  
...  
Keyword(s):  
Medical Students ◽  
Chest Compression ◽  
Medical Personnel ◽  
Quality Parameters ◽  
Spontaneous Circulation ◽  
Medical Procedures ◽  
Compression Technique ◽  
Compression Depth ◽  
Personal Protection Equipment ◽  
Manual Chest Compression

Background: High-quality chest compression is one of the key elements of resuscitation to return of spontaneous circulation. In the COVID-19 era, medical personnel should wear personal protective equipment (PPE) against aerosol generating procedures (AGP) during resuscitation. However, the use of this personal protection equipment may reduce the effectiveness of medical procedures performed. Objective: We aimed to compare chest compression quality parameters between standard manual chest compression and chest compression with TrueCPR feedback device performed by medical students wearing full personal protractive equipment against aerosol generating procedure.Methods: The study was designed as a randomized, cross-over, single-blinded simulation study. Thirty-two medical students wearing PPE-AGP performed 2-min continuous chest compression on an adult simulator with and without TrueCPR feedback device.Results: Median chest compression depth with and without TrueCPR feedback device varied and amounted to 46 (IQR; 42-53) vs. 41 (IQR; 36-45) mm (MCC vs. TrueCPR, respectively). The manual chest compression rate was 117 (IQR; 112-125) compressions per minute (CPM) and was higher than with TrueCPR feedback device - 107 (IQR; 102-115; p = 0.017). Full chest relaxation in the manual's chest compression technique (without TrueCPR) was 33 (IQR; 26-42)% and was lower than with chest compression with TrueCPR feedback device - 58 (IQR; 40-75)% (p=0.002). Conclusions: We conclude that a TrueCPR feedback device improves chest compression quality during simulated COVID-19 resuscitation performed by medical students wearing PPE-AGP.

scholarly journals Current Guideline of Chest Compression Depth for Children of All Ages May Be Too Deep for Younger Children

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Jang Hee Lee ◽  
Sang Kuk Han ◽  
Ji Ung Na
Keyword(s):  
Computed Tomography ◽  
Chest Compression ◽  
Age Groups ◽  
Adult Patients ◽  
Current Guideline ◽  
Compression Depth ◽  
Chest Computed Tomography ◽  
Pediatric Resuscitation ◽  
Resuscitation Guidelines ◽  
The Mean

Aim. To determine whether the chest compression depth of at least 1/3 of the Anteroposterior (AP) diameter of the chest and about 5 cm is appropriate for children of all age groups via chest computed tomography. Methods. The AP diameter of the chest, anterior chest wall diameter, and compressible diameter (Cd) were measured at the lower half of the sternum for patients aged 1-18 years using chest computed tomography. The mean ratio of 5 cm compression to the Cd of adult patients was used as the lower limit, and the mean ratio of 6 cm compression to the Cd of adult patients was used as the upper limit. Also, the depth of chest compression resulting in a residual depth <1 cm was considered to cause internal injury potentially. With the upper and lower limits, the compression ratios to the Cd were compared when compressions were performed at a depth of 1/3 the AP diameter of the chest and 5 cm for patients aged 1-18 years. Results. Among children aged 1-7 years, compressing 5 cm was deeper than 1/3 the AP diameter. Also, among children aged 1-5 years, 5 cm did not leave a residual depth of 1 cm, potentially causing intrathoracic injury. Conclusion. Current pediatric resuscitation guidelines of chest compression depth for children were too deep for younger children aged 1-7 years.

scholarly journals A Multi-Center Structural Equation Modeling Approach to Investigate Interpersonal Violence Screening for Public Health Promotion

2021 ◽  
Vol 9 ◽  
Author(s):  
Lan Jiang ◽  
Melissa A. Sutherland ◽  
M. Katherine Hutchinson ◽  
Bing Si
Keyword(s):  
Public Health ◽  
Health Care ◽  
Theory Of Planned Behavior ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Interpersonal Violence ◽  
Structural Equation ◽  
Healthcare Providers ◽  
Care Providers ◽  
Screening Behavior

Background: Interpersonal violence is a significant public health issue. Routine health screening is a cost-effective strategy that may reduce harmful physical and mental consequences. However, existing research finds consistently low rates of violence screening offered by healthcare providers, e.g., nurses, nurse practitioners, physicians. There is a critical need for research that helps understand how providers' screening behaviors are impacted by individual-level and organizational-level factors to promote the uptake of routine screening for interpersonal violence. Two recent studies, i.e., The Health Care Providers study and Nurse Practitioners Violence Screening study, involved quantitative data collected to measure providers' screening behavior and multi-level factors impacting violence screening.Methods: The current analysis includes a combination of multi-center data collected from The Health Care Providers and Nurse Practitioners Violence Screening studies, respectively. The total sample is 389 providers across the United States. The proposed research develops a system-level multi-center structural equation model framework to rigorously integrate data from the two studies and examine providers' screening behavior for interpersonal violence based upon Theory of Planned Behavior from a quantitative perspective.Results &amp; Conclusions: We successfully examine the efficacy of the Theory of Planned Behavior proposed by Ajzen to predict healthcare providers' screening behavior for interpersonal violence. Organizational factors, e.g., availability of policy for interpersonal violence screening, organizational priority given to violence screening relative to other priorities, and if providers within the health center are interested in improving care quality, were significantly associated with providers' screening behavior. The knowledge and insights generated from our study may facilitate the design and optimization of health professional training and practice environment, and lead to improved women's health and quality of care.

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