Racial disparities in emergency care for seizures in the United States

2021 ◽  
Vol 11 (3) ◽  
pp. 62-66
Author(s):  
Sriman Gaddam
Keyword(s):  
Relative Risk ◽  
Racial Disparities ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Life Support ◽  
The United States ◽  
Chi Square ◽  
Time Critical ◽  
To Receive ◽  
White Patients

Background Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure. Aims This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure. Methods This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk. Findings On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients. Conclusions Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

Racial disparities in emergency care for seizures in the United States

2021 ◽  
Vol 13 (9) ◽  
pp. 373-377
Author(s):  
Sriman Gaddam
Keyword(s):  
Relative Risk ◽  
Racial Disparities ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Life Support ◽  
The United States ◽  
Chi Square ◽  
Time Critical ◽  
To Receive ◽  
White Patients

Background: Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure. Aims: This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure. Methods: This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk. Findings: On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients. Conclusions: Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

scholarly journals Keynote Session: Reducing Racial Disparities in Oncology—Recommendations for Implementing Guideline-Adherent Cancer Care

2021 ◽  
Vol 19 (5.5) ◽  
pp. 598-600
Author(s):  
Shonta Chambers ◽  
Elizabeth Harrington ◽  
Lisa A. Lacasse ◽  
Robert Winn ◽  
moderated by Alyssa A. Schatz
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Racial Disparities ◽  
Policy Change ◽  
Cancer Care ◽  
Working Group ◽  
The United States ◽  
To Receive ◽  
White Patients

Research shows that racial disparities exist in the delivery of guideline-adherent cancer care, and that non-White patients are less likely to receive guideline-concordant care than White patients, leading to worse health outcomes. However, these disparities are not often addressed. The Elevating Cancer Equity initiative aims to address these disparities through policy-change recommendations developed by a working group and informed by data from patients/caregivers and oncologists. The hope is that the results of these surveys and the resultant recommendations will be a step toward cancer care equity in the United States.

scholarly journals Development, validation and assessment of the test on knowledge about basic life support and use of automated external defibrillator among schoolchildren

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Vesna Borovnik Lesjak ◽  
Andrej Šorgo ◽  
Matej Strnad
Keyword(s):  
Basic Life Support ◽  
Life Support ◽  
Statistical Significance ◽  
Automated External Defibrillator ◽  
Multiple Choice Questions ◽  
Chi Square ◽  
Before And After ◽  
Baseline Knowledge ◽  
Potential Improvement ◽  
External Defibrillator

Abstract Background Educating lay public can significantly strengthen the Chain of Survival after out of hospital cardiac arrest. Schoolchildren are an accessible population for learning basic life support (BLS) and use of an automated external defibrillator (AED) and can be regarded as multipliers of knowledge that can reach the whole population. This study aimed to develop and validate a test for examining levels of knowledge about BLS and AED among schoolchildren that can be used to uniformly present reliable data. Methods A knowledge test about BLS and AED consisting of 10 multiple-choice questions was developed and implemented before and after a 2-h BLS and AED course consisting of an interactive lecture and a practical workshop for 783 students in seventh and ninth grades of elementary schools in Maribor, Slovenia. Each question was analyzed and presented with descriptive statistics and educometric parameters (difficulty and discriminating indices). All variables were checked for normality with the Kolmogorov-Smirnov test and analyzed using non-parametric tests. Statistical significance of the differences in knowledge before and after intervention were calculated with chi-square statistics and effect sizes r are reported. Differences between genders, grades and previous attendance to BLS courses were compared using Mann – Whitney U test. The effect size was calculated from the Z score and reported as r value. Results After educometric analysis, questions were adjusted to meet the requirements of satisfactory functioning difficulty and discriminating indices (values between 0,40 and 0,60, and above 0,20, respectively). Only one question had to be eliminated due to inadequate difficulty and discriminating index (0,99 and 0,02, respectively). Measurement invariance across gender (p < 0,001), school grade (p < 0,001), and attendance to previous courses (p = 0,303) was assured. Conclusions A test for accurate and reliable measurement of knowledge of BLS and AED among schoolchildren was developed and validated. According to the findings it can now reliably be used to assess baseline knowledge and potential improvement in knowledge after a course on BLS and AED. Standardized data gathered with a validated tool can now be presented at legislative levels to promote BLS and AED courses implementation in school curricula.

Effectiveness of Interactive Videodisc Instruction for the Continuing Education of Paramedics

1994 ◽  
Vol 9 (3) ◽  
pp. 165-171 ◽  
Author(s):  
Michael Heller ◽  
Walt A. Stoy ◽  
Larry J. Shuman ◽  
Harvey Wolfe ◽  
Chalice A. Zavada
Keyword(s):  
Computer Analysis ◽  
Life Support ◽  
Advanced Life Support ◽  
Interactive Videodisc ◽  
Chi Square ◽  
Group Score ◽  
Subject Areas ◽  
Student’S T ◽  
Mean Compliance ◽  
Student’S T Test

AbstractObjectives:To evaluate the effectiveness of interactive videodisc (IVD) instruction of paramedics through the use of computer analysis of trip sheets.Design/Setting:Prospective, controlled, in an urban 9-1-1, paramedic, emergency medical services (EMS) system with total call volume of 62,000/year; 15,000 advanced life support (ALS).Interventions:All 150 paramedics in the system received eight hours of IVD instruction covering five subject areas: 1) airway; 2) head/cervical trauma; 3) chest; 4) shock; and 5) cardiac arrest. Trip sheets from 9,943 runs in the pre-IVD period were subjected to computer analysis, and a compliance score was generated using previously developed algorithms that assigned a weight to each omission and commission. After a nine-month IVD training period, 4,303 cases were collected and analyzed in the post-IVD period. Statistical analyses were made using “Student's“ t-test and Chi-square with alpha set at 0.05.Exclusions:Only those records of adult patients who fit one of the five protocols were eligible for computer analysis. Of the 9,943 cases in the pre-IVD group, 480 (4.8%) were excluded, all due to inadequate data recording by the paramedics. A statistically similar portion, 233 (5.4%) of the 4,303 post-IVD instruction cases were excluded (p = .15).Results:Overall the mean compliance score of the pre-IVD group was 0.65 ±0.19 (±SD). The post-IVD group score was 0.65 ±0.19 (p = 0.99). Analysis of scores for each algorithm also showed no significant differences. This study had an observed power of .94 to detect a difference in compliance as small as 0.030.Conclusion:Eight hours of IVD instruction did not result in improved paramedic performance as judged by computer analysis of trip sheets.

Utilization of Warning Lights and Siren Based on Hospital Time-Critical Interventions

2010 ◽  
Vol 25 (4) ◽  
pp. 335-339 ◽  
Author(s):  
Andreia Marques-Baptista ◽  
Pamela Ohman-Strickland ◽  
Kimberly T. Baldino ◽  
Michael Prasto ◽  
Mark A. Merlin
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Time Of Day ◽  
Average Difference ◽  
Transport Time ◽  
Day Of The Week ◽  
Medical Transport ◽  
Critical Patients ◽  
Time Critical ◽  
Warning Lights

AbstractObjective:The objective of this study was to evaluate the time saved by usage of lights and siren (L&S) during emergency medical transport and measure the total number of time-critical hospital interventions gained by this time difference.Methods:A retrospective study was performed of all advanced life support (ALS) transports using lights and siren to this university emergency department during a three-week period. Consecutive times were measured for 112 transports and compared with measured transport times for a personal vehicle traveling the same day of the week and time of day without lights and siren. The time-critical hospital interventions are defined as procedures or treatments that could not be performed in the prehospital setting requiring a physician. The project assessed whether the patients received the hospital interventions within the average time saved using lights and siren transport.Results:The average difference in time with versus without L&S was -2.62 minutes (95% CI: -2.60− -2.63, paired t-test p <0.0001). The average transport time with L&S was 14.5 ±7.9 minutes (min) (1 standard deviation/minute (min), range = 1–36 min.). The average transport time without L&S was 17.1 ±8.3 min (range = 1−40 min). Of the 112 charts evaluated, five patients (4.5%) received time-critical hospital interventions. No patients received time-critical interventions within the time saved by utilizing lights and siren. Longer distances did not result in time saved with lights and siren.Conclusions:Limiting lights and siren use to the patients requiring hospital interventions will decrease the risks of injury and death, while adding the benefit of time saved in these critical patients.

scholarly journals Relationship between Body Mass Index and Gender with Asthma

2021 ◽  
Vol 9 (2) ◽  
pp. 115
Author(s):  
Dewi Puji Ayuningrum ◽  
Risna Nur Fajariyah ◽  
Randy Novirsa ◽  
Erni Astutik
Keyword(s):  
Body Mass Index ◽  
Logistic Regression ◽  
Body Mass ◽  
Life Support ◽  
Statistical Significance ◽  
Secondary Data ◽  
The Other ◽  
Chi Square ◽  
Cross Sectional ◽  
And Gender

Background: Asthma is ranked 16th among the leading causes of years lived with disability (YLD) and ranks 28th among the causes of global burden of disease (GBD). Various potential factors can cause asthma, which include body mass index (BMI) and gender. Purpose: This research aimed to determine the relationship between BMI and gender in people living with asthma in Indonesia. Methods: This research employed secondary data obtained from the Indonesian family life support (IFLS) 5th edition. This research used an observational analysis technique with a cross-sectional approach. The number of respondents in this research were 30,713. In this study, the BMI category was based on WHO’s classification for Asians. Data was analyzed using logistic regression tests and chi square. Statistical significance was set at a value of p<0.05. Results: As many as 17,175 respondents had a normal BMI range (56.92%), out of which the majority were women—16,001 respondents (52.10%). After controlling the other variables, statistical test results with logistic regression indicated that male respondents had 1.23 times the odds of experiencing asthma compared to females (adjusted odds ratio (AOR)=1.23; 95% confidence interval (CI), 1.04–1.44; p=0.02). Again, after controlling the other variables, underweight respondents had 1.31 times the odds of experiencing asthma compared to respondents who had a normal BMI (AOR=1.31; 95%CI=1.07–1.59; p=0.01). Conclusion: A relationship between gender and the category of people who were underweight after determining their BMI could be established. Health counseling can be provided to help improve the respiratory conditions of these individuals.

Abstract 15507: CPR Education in Middle School Students During Physical Education Class

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kae Watanabe ◽  
Dalia Lopez-Colon ◽  
Jonathan J Shuster ◽  
Joseph Philip
Keyword(s):  
Middle School ◽  
Physical Education ◽  
Life Support ◽  
Low Cost ◽  
Statistical Significance ◽  
Randomized Study ◽  
The United States ◽  
School Students ◽  
Knowledge And Skills ◽  
Significant Difference

Introduction: AHA advocates for CPR education as a required element of the secondary school curriculum. Unfortunately, many states have not adopted CPR education as part of their standard curriculum. Our aim was to investigate a low-cost, and time effective method to educate students on Basic life Support (BLS) during a physical education (PE) class, including evaluation of the use of re-education. Hypothesis: We hypothesize that a 45 minute BLS class during PE class is sufficient to provide with CPR and AED knowledge and skills. Methods: This is a prospective, randomized study. The study included forty one 8 th grade students in an Alachua County Middle School in Gainesville, Florida. Education was performed by an AHA-certified provider during a 45 minute PE class. Education was limited to chest compressions and the usage of an Automatic External Defibrillator (AED). Students were randomized into two groups; one group received repeat education at two months post-initial education, while the second group did not. Students had a skills and knowledge test administered pre- and post-education, given after initial education and repeated two and four months later to assess retention. Total scores were compared between pre- and post- education, as well as between groups. Results: There was a significant difference in CPR skills and knowledge when comparing pre- and post-education results for all time-points (p<0.001). When assessing retention, no significant difference in mean total scores was observed between the initial post-education as compared to two and four months (p>0.1). Mean total scores compared between groups showed no statistical significance of re-education. However, a statistical significance was noted for AED usage in the repeat education group. Conclusions: Our study indicates significant increase in CPR knowledge and skills following a one-time 45 minute session. Repeat education may be useful as a yearly event, but would need further investigation. If schools across the United States invested one 45-60 minute period a year for each school year, this would ensure widespread CPR knowledge with minimal cost and loss of school time.

Abstract 398: A New Paradigm in Resuscitation Education: “Does Frequency Matter?”

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Kathleen Ward ◽  
David Rivera
Keyword(s):  
Training Program ◽  
Self Efficacy ◽  
Life Support ◽  
Statistical Significance ◽  
P Value ◽  
Nurse Training ◽  
New Paradigm ◽  
Chi Square ◽  
Convenience Sample ◽  
Intervention Unit

Introduction: Survival of in-house cardiac arrests (IHCA) is dependent upon high quality cardiopulmonary resuscitation (CPR). While current BLS and ACLS training occur biannually, studies demonstrate that skills and knowledge diminish over time. Although Self Efficacy (SE) correlates with CPR skills and knowledge, one’s SE can be strengthened through mastery experiences. The RQI training program increases the frequency of training. This study questioned Resuscitation Quality Improvement (RQI), a new quarterly training program, and its influence on self-efficacy and skill decay Methods: The study used a quantitative, quasi-experimental design with a convenience sample derived from 3 medical-surgical (MS) units. Registered nurses (RNs) completed the Basic Resuscitation Skills Self-Efficacy Scale (BRS-SES) survey. Two units were enrolled in traditional life support training, an intervention unit completed the RQI program. Performance data was obtained from program mannequins. Data analysis used Chi-square statistic and ANOVA; p-value 0.05 determined statistical significance. Data sets were inclusive of BRS-SES and performance reports from RQI. Results: SE increased on the intervention unit baseline to 1 year (1512.4±226 to 1600±164, p=0.068); SE improved for safe use of automated external defibrillator (AED)/Defibrillator (627.2±91 to 661.8±71, p=0.034); CPR Skill (350±52 to 374.6±65, p=0.117); recognition (535.2±91 to 563.6±55, p=0.173). RNs < 40 years of age demonstrated an increased SE compared to their peers. Performance was measured by average attempts to pass (ATTP) and mean score with the RQI: compression (2.3 to 1, 79 to 95.4); ventilation (1.6 to 1, 81.1 to 94.9). Conclusions: The RQI training program was associated with increased SE and decreased skill decay. Age appears to influence the degree of success in nurse training using this new methodology. Data suggests an association between RQI and clinical outcomes. Multi-site studies are recommended for future study.

Abstract 19: Prehospital Identification of Acute Ischemic Stroke is Associated With Faster and More Frequent Thrombolysis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Christopher T Richards ◽  
Heidi Sucharew ◽  
Brett M Kissela ◽  
Dawn Kleindorfer ◽  
Kathleen S Alwell ◽  
...  
Keyword(s):  
Large Population ◽  
Geographical Area ◽  
The United States ◽  
Population Based ◽  
Stroke Patients ◽  
Chi Square ◽  
Stroke Study ◽  
Large Geographical Area ◽  
Suspected Stroke ◽  
To Receive

Background: Functional outcomes are improved when AIS patients receive faster treatment. The first medical contact for many AIS patients is with emergency medical services (EMS) providers. We hypothesize that AIS treatment is faster when EMS providers suspect stroke. Methods: We performed a retrospective analysis of the Greater Cincinnati/Northern Kentucky Stroke Study, a comprehensive study of stroke patients in a large geographical area with 1.3 million inhabitants whose demographics are representative of the United States. We compared AIS patients age ≥18 years transported by EMS in 2015 with an EMS impression of “stroke” or “weakness/numbness” to those with other EMS impressions. Primary outcome was thrombolysis rate, and secondary outcomes were times from EMS scene arrival to ED arrival, CT, and treatment and times from ED arrival to CT and treatment. Chi-square and Mann-Whitney U-tests were used to compare treatment rates and times, respectively. Logistic regression (for rates) and median regression (for times) adjusted for NIHSS, GCS, age, sex, race, and prior stroke history. Results: Among 2,486 confirmed AIS patients from 1/1/2015-12/31/2015, 868 were transported by EMS, including 595 (69%) with EMS suspected stroke. Compared to EMS non-suspected strokes, patients with EMS suspected stroke patients were more likely to receive thrombolysis (18% vs 8%; OR 2.67, 95% CI 1.63-4.47) and had faster prehospital transport (30 vs 32 min, p=0.02), ED arrival to CT (27 vs 46 min, p<0.01) and thrombolysis (64 vs 83 min, p=0.03), and EMS scene arrival to thrombolysis (91 vs 118 min, p=0.03) and EVT (164 vs 250 min, p=0.03). Findings were maintained in the adjusted models except for EMS arrival to EVT (Table). Conclusions: In a large population-based study, EMS stroke identification is associated with a higher rate of and faster thrombolysis. Efforts to increase accuracy of EMS stroke identification is likely to have significant clinical impact by shortening treatment times.

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