Abstract 13248: The Impact of Instructions for Covering the Mouth and the Nose on Dispatch-Assisted Cardiopulmonary Resuscitation

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Hidetada Fukushima ◽  
Hideki Asai ◽  
Koji Yamamoto ◽  
Yasuyuki Kawai
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Median Time ◽  
Chest Compression ◽  
Fire Department ◽  
Emergency Call ◽  
Time Interval ◽  
Time Intervals ◽  
Median Time Interval ◽  
Study Results ◽  
The Impact

Introduction: Under the SARS-CoV-2 pandemic, rescuers are recommended to cover their mouth and nose with a facemask or a cloth as well as victim’s mouth and nose when performing cardiopulmonary resuscitation (CPR). However, its impact on dispatch-assisted CPR (DACPR) has not been investigated well. Hypothesis: DACPR including the instruction for covering the rescuer’s and the victim’s mouth and nose can significantly delay the start of the first chest compression. Methods: We retrospectively analyzed DACPR records of the Nara Wide Area Fire Department, covering population of 853,000/3361km 2 , in Japan. We investigated the key time intervals of 505 DACPR records between May 2020 and March 2021. We also compared the results to that of the same period in 2019 (535 records). Results: Dispatchers failed to provide mask instruction in 322 cases (63.8%). The median time interval from the emergency call and the start of CPR instruction was longer in 2020 (197 seconds vs 190 seconds, p=0.641). The time to the first chest compression was also delayed in 2020 (264 seconds vs 246 seconds, p=0.015). Among the cases that dispatchers successfully provided mask instruction (183 cases, 36.2%), median time intervals to the start of instruction and the first chest compression were relatively faster than cases without mask instruction (177 seconds vs 211 seconds and 254 seconds vs 269.5 seconds, respectively). Conclusions: Dispatchers failed to provide mask instruction in the majority of CA cases. However, our study results indicate that the impact of mask instruction on DACPR can be minor in terms of immediate CPR provision.

The Feasibility and Impact of Prospective Medication Review in the Emergency Department

2017 ◽  
Vol 31 (1) ◽  
pp. 22-28
Author(s):  
Billy Sin ◽  
Kwong Lau ◽  
Richard Tong ◽  
Josel Ruiz ◽  
Kimberly Sarosky ◽  
...  
Keyword(s):  
Emergency Department ◽  
Median Time ◽  
Medication Review ◽  
Retrospective Cohort ◽  
Medication Use ◽  
Time Interval ◽  
Time Intervals ◽  
Cost Avoidance ◽  
Median Time Interval ◽  
Effective Use

Objective: We evaluated the feasibility and impact of prospective medication review (PMR) in the emergency department (ED). Methods: This was a retrospective cohort study of all nonadmitted ED patients who were prescribed medication orders by ED clinicians from September 2014 to September 2015 to determine the time intervals utilized during each step of the medication use process and quantify the number of interventions conducted by the pharmacist and cost avoidance accrued from the interventions. Results: A total of 834 medication orders were included for evaluation. The median time for order verification, order verification to dispense, and dispense to administration were 3 minutes (interquartile range [IQR] = 1-7 minutes), 20 minutes (IQR = 7-45 minutes), and 10 minutes (IQR = 6-16 minutes). The median time interval for order verification was longer during the overnight pharmacy shift (median = 5 minutes, IQR = 2-9 minutes) compared to the day and evening shifts (median = 3 minutes, IQR = 1-6 minutes). A total of 563 interventions were recommended by the pharmacists and accepted by ED clinicians. These interventions equated to US$47 585 worth of cost avoidance. Conclusion: The PMR is a feasible process that resulted in safe and effective use of medications without causing delays to patient care.

scholarly journals Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthias Balk ◽  
Robin Rupp ◽  
Konstantin Mantsopoulos ◽  
Moritz Allner ◽  
Philipp Grundtner ◽  
...  
Keyword(s):  
Survival Rate ◽  
Adjuvant Therapy ◽  
Head And Neck ◽  
Neck Dissection ◽  
Median Time ◽  
Adjuvant Treatment ◽  
Oncologic Outcome ◽  
Time Interval ◽  
Median Time Interval ◽  
The Impact

Abstract Introduction In contrast to head and neck squamous cell carcinoma (HNSCC), the effect of treatment duration in HNSCC-CUP has not been thoroughly investigated. Thus, this study aimed to assess the impact of the time interval between surgery and adjuvant therapy on the oncologic outcome, in particular the 5-year overall survival rate (OS), in advanced stage, HPV-negative CUPs at a tertiary referral hospital. 5-year disease specific survival rate (DSS) and progression free survival rate (PFS) are defined as secondary objectives. Material and methods Between January 1st, 2007, and March 31st, 2020 a total of 131 patients with CUP were treated. Out of these, 59 patients with a confirmed negative p16 analysis were referred to a so-called CUP-panendoscopy with simultaneous unilateral neck dissection followed by adjuvant therapy. The cut-off between tumor removal and delivery of adjuvant therapy was set at the median, i.e. patients receiving adjuvant therapy below or above the median time interval. Results Depending on the median time interval of 55 days (d) (95% CI 51.42–84.52), 30 patients received adjuvant therapy within 55 d (mean 41.69 d, SD = 9.03) after surgery in contrast to 29 patients at least after 55 d (mean 73.21 d, SD = 19.16). All patients involved in the study were diagnosed in advanced tumor stages UICC III (n = 4; 6.8%), IVA (n = 27; 45.8%) and IVB (n = 28; 47.5%). Every patient was treated with curative neck dissection. Adjuvant chemo (immune) radiation was performed in 55 patients (93.2%), 4 patients (6.8%) underwent adjuvant radiation only. The mean follow-up time was 43.6 months (SD = 36.7 months). The 5-year OS rate for all patients involved was 71% (95% CI 0.55–0.86). For those patients receiving adjuvant therapy within 55 d (77, 95% CI 0.48–1.06) the OS rate was higher, yet not significantly different from those with delayed treatment (64, 95% CI 0.42–0.80; X2(1) = 1.16, p = 0.281). Regarding all patients, the 5-year DSS rate was 86% (95% CI 0.75–0.96). Patients submitted to adjuvant treatment in less than 55 d the DSS rate was 95% (95% CI 0.89–1.01) compared to patients submitted to adjuvant treatment equal or later than 55 d (76% (95% CI 0.57–0.95; X2(1) = 2.32, p = 0.128). The 5-year PFS rate of the entire cohort was 72% (95% CI 0.59–0.85). In the group < 55 d the PFS rate was 78% (95% CI 0.63–0.94) and thus not significantly different from 65% (95% CI 0.45–0.85) of the group ≥55 d; (X2(1) = 0.29, p = 0.589). Conclusions The results presented suggest that the oncologic outcome of patients with advanced, HPV-negative CUP of the head and neck was not significantly affected by a prolonged period between surgery and adjuvant therapy. Nevertheless, oncologic outcome tends to be superior for early adjuvant therapy.

scholarly journals Clinical Outcome of Spine Surgery Complicated by Accidental Dural Tears: Meta-Analysis of the Literature

2020 ◽  
pp. 219256822091487
Author(s):  
Zeiad A. F. Alshameeri ◽  
El-Nasri Ahmed ◽  
Vinay Jasani
Keyword(s):  
Back Pain ◽  
Clinical Outcome ◽  
Spinal Surgery ◽  
Short Form ◽  
Meta Analysis ◽  
Systemic Review ◽  
Time Interval ◽  
Time Intervals ◽  
Dural Tears ◽  
The Impact

Study Design: Systemic review and meta-analysis. Objectives: Several studies have reported the impact of accidental dural tears (DT) on the outcome of spinal surgery, some with conflicting results. Therefore, the aim of this study was to carry out a systemic review and meta-analysis of the literature to establish the overall clinical outcome of spinal surgery following accidental DT. Method: A systemic literature search was carried out. Postoperative improvement in Oswestry Disability Index (ODI), Short-Form 36 survey (SF36), leg pain visual analogue scale (VAS), and back pain VAS were compared between patients with and without DT at different time intervals. Results: Eleven studies were included in this meta-analysis. There was a slightly better improvement in ODI and leg VAS score (standardized mean difference of −0.06, 95% confidence interval [CI] −0.12 to −0.01, and −0.06, 95% CI −0.09 to −0.02, respectively) in patients without DT at 12 months postsurgery, but this effect was not demonstrated at any other time intervals up to 4 years. There were no differences in the overall SF36 (function) score at any time interval or back pain VAS at 12 months. Conclusion: Based on this study, accidental DT did not have an overall significant adverse impact on the short-term clinical outcome of spinal surgery. More studies are needed to address the long-term impact and other outcome measures including other immediate complications of DT.

Carotid Endarterectomy: Are We Meeting the Two Week Target?

2009 ◽  
Vol 54 (2) ◽  
pp. 27-29 ◽  
Author(s):  
RV Guest ◽  
JMJ Richards ◽  
SCA Fraser ◽  
RTA Chalmers
Keyword(s):  
Health Services ◽  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Median Time ◽  
Retrospective Review ◽  
Stroke Prevention ◽  
Time Interval ◽  
Median Time Interval ◽  
Timing Of Onset ◽  
Prevention Benefit

Objective It has been recommended that carotid endarterectomy should be carried out within fourteen days of the index event if maximum stroke prevention benefit is to be achieved. The aim of this study was to see whether this target was being met in our region and where in the pathway delays occurred. Methods This was a retrospective review of all patients (n=75) undergoing carotid endarterectomy in 2006 in a regional vascular unit. Eleven patients were excluded as the timing of onset of symptoms was unclear, leaving 64 patients for further analysis. Results The median time-interval from onset of symptoms to surgery was 47 days (interquartile range 32-65 days). Five of 64 patients (4.5%) had a carotid endarterectomy within 14 days. Median time from onset of symptoms to presentation to health services was one day (IQR 0-7 days), from presentation to health services to neurovascular clinic was 16 days (IQR 10-23 days), from neurovascular clinic to vascular surgery clinic was 13 days (IQR 9-24 days), and from vascular surgery clinic to operation was 13 days (IQR 8-22 days). Fifteen of the 51 patients (29%) attending a neurovascular clinic and five of the 57 patients (9%) attending a vascular surgery clinic were seen within 14 days. Conclusion The fourteen-day target is difficult to achieve due to the number of steps in the referral pathway. This delay may be jeopardising outcome. Reduction in the delay to surgery would require a multi-disciplinary approach and should involve education of the general public.

scholarly journals Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction

2018 ◽  
Vol 146 (5) ◽  
pp. 594-599 ◽  
Author(s):  
I. A. Turiac ◽  
F. Fortunato ◽  
M. G. Cappelli ◽  
A. Morea ◽  
M. Chironna ◽  
...  
Keyword(s):  
Laboratory Investigation ◽  
Median Time ◽  
Surveillance System ◽  
Case Reports ◽  
Quality Data ◽  
Time Interval ◽  
System Sensitivity ◽  
Apulia Region ◽  
Median Time Interval ◽  
Capture Recapture

AbstractThis study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture–recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75–87). Completeness was >98% for mandatory variables and 57% for ‘genotyping’. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.

Analysis of Inpatient and Emergency Department Serial Troponin Testing Intervals in the United States

2020 ◽  
Author(s):  
Andrew Fletcher ◽  
Erik Forsman ◽  
Brian R Jackson
Keyword(s):  
United States ◽  
Emergency Department ◽  
Median Time ◽  
Emergency Departments ◽  
The United States ◽  
Published Data ◽  
Time Interval ◽  
Time Intervals ◽  
Convenience Sample ◽  
Facility Level

Abstract Background Serial measurement of cardiac troponins (cTn) is central to the diagnosis of myocardial infarction. The time intervals between individual measurements may impact the speed and reliability of diagnosis. Published recommendations exist for these time intervals, but there is little previously published data on actual intervals in routine clinical settings. Methods Retrospective analysis of cTn testing intervals was performed from a convenience sample of 37 hospitals. All 37 provided data on inpatient tests and 19 also provided separate data for tests ordered in their emergency departments. Facilities included both academic and community hospitals across the United States. For each facility, the median time interval between serial cTn order collections was determined separately for inpatient orders and emergency department orders. Results The facility-level median time intervals between serial inpatient cTn test orders ranged from 3.17 to 7.32 hours. Facility-level median time intervals between serial emergency department cTn orders ranged from 1.48 to 4.23 hours. There was no observed difference between academic and nonacademic facilities. Conclusion Typical time intervals between serial cTn orders varied widely across hospitals, and in many cases reflected suboptimal care. Time intervals were generally shorter for cTn testing ordered in emergency departments. Existing testing protocols should be re-examined.

Competing Swarms of Autonomous Vehicles: Intruders Versus Guardians

2017 ◽  
Author(s):  
Daigo Shishika ◽  
Katarina Sherman ◽  
Derek A. Paley
Keyword(s):  
Protected Area ◽  
Autonomous Vehicles ◽  
Payoff Function ◽  
Time Interval ◽  
Design Strategies ◽  
Time Intervals ◽  
Aerial Vehicles ◽  
Zero Sum ◽  
The Impact ◽  
Probability Of Capture

We consider a competition between two swarms of aerial vehicles, where multiple intruder vehicles try to approach and then leave an area that multiple guardian vehicles are protecting. Pre-existing swarming strategies for the guardians to maximize the probability of capturing a single intruder are summarized. This work considers the case where multiple intruders approach the protected area sequentially with varied time intervals, to study the impact of intrusion frequency on the probability of capture. In addition, we formulate a payoff function treating the competition as a zero-sum game, and use this function to design strategies for the intruders, i.e., how to optimize the time interval between intrusions. We propose an intrusion strategy and demonstrate its performance with numerical simulations.

Abstract 12035: Effect of 10-minute Dispatch-Assisted Cardiopulmonary Resuscitation Training in Addition to a Standard Course: A Simulation Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hidetada Fukushima ◽  
Hideki Asai ◽  
Kazunobu Norimoto ◽  
Tadahiko Seki ◽  
Yasuyuki Kawai ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Median Time ◽  
Simulation Study ◽  
Time Interval ◽  
Standard Group ◽  
Chest Compressions ◽  
Resuscitation Training ◽  
Group A ◽  
Cpr Training

Introduction: Immediate bystander cardiopulmonary resuscitation (CPR) is essential for the good outcome of sudden cardiac arrest victims. Current guidelines recommend dispatch-assisted CPR (DA-CPR), which can double the frequency of bystander CPR. Laypersons, however, are not familiar with how dispatchers provide CPR instructions. DA-CPR training may be effective at spreading DA-CPR, but this needs to be validated. The aim of this study was to determine the effectiveness of brief DA-CPR training in addition to a standard CPR training course. Methods: We conducted a DA-CPR simulation study. Participants with no prior CPR training within 1 year were assigned randomly to one of two 90-min CPR training courses (DA-CPR Group: a standard CPR course with 10-min DA-CPR training or Standard Group: a standard CPR course with a simple introduction to how dispatchers deal with emergency calls). In the DA-CPR Group, the participants practiced the role of a dispatcher and an emergency caller. At 6 months after training, the subjects performed CPR for 2 min under instruction from off-duty dispatchers. Results: Of the 66 participants, 59 (DA-CPR Group, 30; Standard Group, 29) completed the simulation at 6 months after training. The median time intervals between call receipt and cardiac arrest recognition or instruction for chest compressions by dispatchers were similar between both groups. However, the subjects in the DA-CPR Group provided the first compression more quickly (median time interval between call receipt and the first dispatch-assisted compression: 108 vs. 129 s, respectively, p < 0.05 Mann-Whitney U test). The quality of chest compressions was, however, similar between both groups. Conclusions: All participants could perform DA-CPR at 6 months after training, but those in the DA-CPR Group started chest compressions more quickly. DA-CPR training might be effective for the immediate development of better cooperation between a layperson and a dispatcher.

Controlling Grass Weeds on Hard Surfaces: Effect of Time Intervals between Flame Treatments

2012 ◽  
Vol 26 (1) ◽  
pp. 83-88 ◽  
Author(s):  
Anne M. Rask ◽  
Palle Kristoffersen ◽  
Christian Andreasen
Keyword(s):  
Perennial Ryegrass ◽  
Aboveground Biomass ◽  
Plant Biomass ◽  
Time Interval ◽  
Time Intervals ◽  
Short Treatment ◽  
Annual Bluegrass ◽  
Treatment Interval ◽  
Effect Of Treatment ◽  
The Impact

An experiment was conducted on a specially designed hard surface to study the impact of time interval between flaming treatments on the regrowth and flower production of two grass weeds. The goal of this experiment was to optimize the control of annual bluegrass and perennial ryegrass, both species that are very difficult to control without herbicides. Aboveground biomass from 72 plants per treatment was harvested and dry weights were recorded at regular intervals to investigate how the plants responded to flaming. Regrowth of the grasses was measured by harvesting aboveground biomass 2 wk after the second flaming treatments that were implemented at different time intervals. Flaming treatments decreased plant biomass of both species and also the ratio of flowering annual bluegrass plants. However, few plants were killed. The first flaming treatment affected aboveground biomass more than the second flaming treatment. A treatment interval of 7 d provided the greatest reduction in regrowth of perennial ryegrass, whereas the effect of treatment interval varied between the first and second repetitions of this experiment for annual bluegrass. In general, short treatment intervals (3 d) should be avoided, as they did not increase the reduction of aboveground biomass compared with the 7-d treatment interval. Knowledge on the regrowth of grass weeds after flaming treatments provided by this study can help improve recommendations given to road keepers and park managers for management on these weeds.

scholarly journals Analysis of chest compression depth and rate during cardiopulmonary resuscitation with and without a feedback device

2018 ◽  
Vol 25 (4) ◽  
pp. 179-184
Author(s):  
Magdalena Fronczek-Wojciechowska ◽  
Karolina Kopacz ◽  
Anna Jaźwińska ◽  
Gianluca Padula ◽  
Tomasz Gaszyński
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
T Test ◽  
Compression Depth ◽  
Group A ◽  
Level Of Significance ◽  
Group B ◽  
The Impact ◽  
Levene Test ◽  
Dependent Samples

Background: Many feedback devices have been designed to improve the resuscitation outcomes. None have been implemented as a standard in patient care. Objectives: The aim of this study was to evaluate the chest compression depth and rate during cardiopulmonary resuscitation with and without a feedback device and to evaluate differences regarding the impact of a feedback device based on provider experience. Methods: The study was performed on 20 men divided into two groups: group A (n = 10)—paramedics; group B (n = 10)—non-paramedics, trained to provide resuscitation. Participants were examined during resuscitation with Ambu Megacode manikin and with or without the feedback device—CPRmeter. Depth of compressions was evaluated in the first and fourth minute of resuscitation with a BTS Smart DX7000 motion capture system. For statistical analysis, summary statistics, Shapiro–Wilk Test of normality, dependent samples t-test, Levene test, t-test for independent samples, or Welch’s t-test were used. Accepted level of significance was α = 0.05. Results: Statistically significant greater depth of chest compressions in group A was observed in the first minute of resuscitation with the device versus the first minute without the device. Significant differences in compressions rate between attempts with and without the device were observed in both groups in the first and fourth minute. Conclusion: Only the group of paramedics showed in time some benefits of the device related to the depth, whereas for the group of non-paramedics, the device seemed to have even a deleterious effect. The group of paramedics met the 2015 recommendations related to compressions rate all the time, while the non-paramedics only in the fourth minute of the procedure.

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