Improvement of Nurse Competence in Puskesmas In Handling Emergency Response to Cardiac arrest case for Reduce Mortality Rate In Pre Hospital Order Through Training   Pulmonary Heart Resuscitation In Pangandaran District

There are many cardiac arrest events in the community that can not be saved because they do not get the right and quick action due to the ignorance and the inability of the nurses of the puskesmas to provide emergency response to cardiac pulmonary resuscitation. Cardiopulmonary resuscitation (CPR) is the main action in cardiac arrest and stop breath, which can increase life expectation. Goal to be achieved in the implementation of this program is increased ability of nurse puskesmas in performing action of heart resuscitation of lung. The specific targets of the activities are the increased ability of health center nurses on the ability to perform cardiopulmonary resuscitation with the latest guidelines and the implementation of a structured training program on pulmonary cardiac resuscitation at community health center nurses on an ongoing basis. Solutions offered to overcome the problem is the training of Lung Heart Resuscitation (RJP) to nurses Puskesmas. Training activities conducted for one day include pre-test evaluation, material exposure, rjp skills training and post training evacuation. The result showed that there was significant difference between attitude value and perceived behavioral control between before and after training, whereas there was no difference of subjective norm value between before and after training. Training on updating and increasing the competence of cardiopulmonary resuscitation should be done regularly and periodically. Routine and periodic training needs to be done to improve nursing services, especially cardiovascular emergency

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Abstract 138: A Before and After Study of Active Compression Decompression Cardiopulmonary Resuscitation With the Impedance Threshold Device in a Large Urban Pre-Hospital System

Circulation ◽

10.1161/circ.138.suppl_2.138 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Johanna C Moore ◽

Michael Grahl ◽

Tracy Marko ◽

Ariel Blythe-Reske ◽

Amber Lage ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Response Time ◽

First Responders ◽

The United States ◽

Threshold Device ◽

Before And After ◽

Mechanical Cpr ◽

Impedance Threshold Device ◽

Before And After Study

Introduction: Active Compression Decompression cardiopulmonary resuscitation with an impedance threshold device (ACD+ITD CPR) is available for use in the United States. However, little is known regarding integration of this CPR system into a large urban prehospital system with short response times, routine use of mechanical CPR and ITD, and transport of patients to cardiac arrest centers. This is an ongoing before and after study of the implementation of ACD+ITD CPR in non-traumatic cardiac arrest cases 6 months pre and post protocol change. Hypothesis: Neurologically intact rates of survival, defined by Cerebral Performance Category (CPC) score of 1 or 2, would be higher post protocol. Methods: Basic life support first responders (n = 420) and paramedics (n = 207) underwent training including didactic and hands-on sessions to learn ACD+ITD CPR. The protocol included ACD+ITD CPR initially, with the option to transition to mechanical CPR at 15 minutes. Demographics, response time, CPR duration, initial rhythm, signs of perfusion during CPR, and return of spontaneous circulation (ROSC) were recorded prospectively by first responders. Chart review was performed to determine survival to hospital admission and CPC score at discharge. Results: Training occurred October 2016 to March 2017, with protocol change on May 1, 2017. Cases from November 2016-April 2017 (n = 136) and May 2017-November 2017 (n= 103) were reviewed. Complete data were available for 128 subjects pre-protocol change (94%) and 96 subjects (94%) post. Age, gender, response time, rhythm, total CPR time, and rates of bystander CPR and witnessed arrest were similar between groups. Post protocol change, 87% (89/102) received ACD+ITD CPR with median ACD+ITD CPR time of 15 minutes (range 2-300). Pre-protocol, 6/128 (4.7%) subjects survived with CPC score 1 or 2, versus 8/96 (13.5%) subjects post (difference 8.8%, 95% CI 1%-17%). ROSC rates were similar (pre: 54/127, 42.5% post: 44/93, 47%, difference 4.8%, 95% CI -8% - 18%) Conclusions: The change in protocol was straightforward with a high rate of adherence of the system for the recommended duration of therapy. Results are suggestive of a higher rate of neurological survival with the routine use of ACD+ITD CPR in a small cardiac arrest patient population.

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Effectiveness of Mechanical Chest Compression Devices over Manual Cardiopulmonary Resuscitation: A Systematic Review with Meta-analysis and Trial Sequential Analysis

Western Journal of Emergency Medicine ◽

10.5811/westjem.2021.3.50932 ◽

2021 ◽

Vol 22 (4) ◽

pp. 810-819

Author(s):

Mack Sheraton ◽

John Columbus ◽

Salim Surani ◽

Ravinder Chopra ◽

Rahul Kashyap

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Relative Effectiveness ◽

Sufficient Evidence ◽

Mechanical Compression ◽

Mechanical Chest Compression ◽

Significant Difference ◽

Bystander Cpr ◽

Meta Regression

Introduction: Our goal was to systematically review contemporary literature comparing the relative effectiveness of two mechanical compression devices (LUCAS and AutoPulse) to manual compression for achieving return of spontaneous circulation (ROSC) in patients undergoing cardiopulmonary resuscitation (CPR) after an out-of-hospital cardiac arrest (OHCA). Methods: We searched medical databases systematically for randomized controlled trials (RCT) and observational studies published between January 1, 2000–October 1, 2020 that compared mechanical chest compression (using any device) with manual chest compression following OHCA. We only included studies in the English language that reported ROSC outcomes in adult patients in non-trauma settings to conduct random-effects metanalysis and trial sequence analysis (TSA). Multivariate meta-regression was performed using preselected covariates to account for heterogeneity. We assessed for risk of biases in randomization, allocation sequence concealment, blinding, incomplete outcome data, and selective outcome reporting. Results: A total of 15 studies (n = 18474), including six RCTs, two cluster RCTs, five retrospective case-control, and two phased prospective cohort studies, were pooled for analysis. The pooled estimates’ summary effect did not indicate a significant difference (Mantel-Haenszel odds ratio = 1.16, 95% confidence interval, 0.97 to 1.39, P = 0.11, I2 = 0.83) between mechanical and manual compressions during CPR for ROSC. The TSA showed firm evidence supporting the lack of improvement in ROSC using mechanical compression devices. The Z-curves successfully crossed the TSA futility boundary for ROSC, indicating sufficient evidence to draw firm conclusions regarding these outcomes. Multivariate meta-regression demonstrated that 100% of the between-study variation could be explained by differences in average age, the proportion of females, cardiac arrests with shockable rhythms, witnessed cardiac arrest, bystander CPR, and the average time for emergency medical services (EMS) arrival in the study samples, with the latter three attaining statistical significance. Conclusion: Mechanical compression devices for resuscitation in cardiac arrests are not associated with improved rates of ROSC. Their use may be more beneficial in non-ideal situations such as lack of bystander CPR, unwitnessed arrest, and delayed EMS response times. Studies done to date have enough power to render further studies on this comparison futile.

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From physical to digital: what drives generation Z for mobile commerce adoption?

Journal of Asia Business Studies ◽

10.1108/jabs-05-2020-0207 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Deepti Verma ◽

Vaibhav Tripathi ◽

Ajai Pratap Singh

Keyword(s):

Gender Differences ◽

Behavioral Intention ◽

Behavioral Control ◽

Mobile Commerce ◽

Survey Method ◽

Perceived Behavioral Control ◽

Content Type ◽

Intention To Adopt ◽

Generation Z ◽

Significant Difference

Purpose This study aims to identify factors affecting generation Z as the early adopters of mobile commerce (m-commerce). The research seeks to explore their behavioral intention to adopt m-commerce in India with consideration of gender differences while providing empirical validation for the theory of planned behavior (TPB). Design/methodology/approach In this study, a modified TPB model has been used to explain generation Z’s intention to adopt m-commerce. The proposed model was tested using a survey method with a sample of 245 students from a private university in Northern India. Subgroup analysis was performed to find gender differences in the process of adopting m-commerce. Findings All three independent constructs have a positive influence on the behavioral intention of generation Z to adopt m-commerce. Further, the male subgroup has a lower beta value for attitude and higher beta value for subjective norm in comparison to the female subgroup. For perceived behavioral control, no significant difference in beta value across gender could be established. Practical implications A better understanding of generation Z behavioral intentions will be of great use to telecom companies, marketers and electronic commerce companies to formulate strategies to expedite the use of m-commerce. As gender plays an important role in attitude and subjective norms, companies are advised to target their communication tactics in accordance to gender. Originality/value To the best of the authors’ knowledge, this study is one of the first to test TPB and generation Z association in the context of m-commerce adoption in India. Data regarding the difference between the two genders has also shed light on the uniqueness of the context.

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Abstract 312: The Impact of Sedation on Quantitative Electroencephalogram Trends and Neurological Outcomes in a Mouse Model of Cardiac Arrest and Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.142.suppl_4.312 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Takamitsu Ikeda ◽

Yusuke Miyazaki ◽

Eizo Marutani ◽

Fumito Ichinose

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Function ◽

Temperature Management ◽

Vehicle Group ◽

Altered Level ◽

Eeg Activity ◽

Neurological Outcomes ◽

Significant Difference ◽

The Impact

Introduction: The majority of patients resuscitated from cardiac arrest (CA) present in coma or with an altered level of consciousness. Although most CA survivors are sedated during targeted temperature management, the effects of sedation on post-arrest outcomes remain to be determined. Hypothesis: Sedation after CA improves neurological outcomes by modulating cerebral electrical activity and metabolism. Methods: Ten to 14 days after implantation of EEG transmitters, adult male C57BL/6J mice were subjected to CA and cardiopulmonary resuscitation (CPR). After return of spontaneous circulation (ROSC), mice received intravenous infusion of propofol, dexmedetomidine (DEX), or normal saline (vehicle) for 2 hours. Body temperature was maintained at 37°C, and was subsequently lowered to 33°C. Cerebral blood flow (CBF) was measured for 4 hours following ROSC. To quantify time-dependent EEG changes, we calculated the sum of the Delta, Theta, and Alpha band power in consecutive 12-hour intervals after ROSC (D 0-12 and D 12-24 , T 0-12 and T 12-24 , and A 0-12 and A 12-24 , respectively). Because the increase in fast EEG activity over time may reflect neurological recovery after CA, we compared the ratios of D 12-24 to D 0-12 , of T 12-24 to T 0-12 , and of A 12-24 to A 0-12 among groups. Results: As compared with vehicle-treated mice, propofol- or DEX-treated mice exhibited improved survival rate and neurological function after CA, though no difference was found between propofol- and DEX-treated mice. In the vehicle group, CBF was higher than the baseline after ROSC, while the increase in CBF was attenuated in the propofol and DEX group. The values of A 12-24 /A 0-12 and T 12-24 /T 0-12 were significantly higher in propofol- and DEX-treated mice than in vehicle-treated mice ( P = 0.017 and P = 0.004, respectively, propofol vs vehicle; P = 0.038 and P = 0.002, respectively, DEX vs vehicle), but there was no significant difference in D 12-24 /D 0-12 among groups. In all post-arrest mice, both A 12-24 /A 0-12 and T 12-24 /T 0-12 were positively correlated with better neurological function at 24 and 48 hours after CA. Conclusions: Post-arrest sedation was associated with a reduction in CBF and a greater recovery of fast EEG activity after CA, and improved neurological outcomes and survival in mice.

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A comparative study on decision and documentation of refraining from resuscitation in two medical home care units in Sweden

BMC Palliative Care ◽

10.1186/s12904-019-0472-z ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Bogdan Sterpu ◽

Pia Lindman ◽

Linda Björkhem-Bergman

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Home Care ◽

Medical Home ◽

Medical Records ◽

Terminally Ill ◽

Time Of Death ◽

Next Of Kin ◽

Significant Difference ◽

Palliative Phase

Abstract Background A decision to refrain from cardiopulmonary resuscitation (CPR) in the case of cardiac arrest is recommended in terminally ill patients to avoid unnecessary suffering at time of death. The aim of this study was to describe the frequency of decisions and documentation of “do not attempt cardiopulmonary resuscitation” (DNACPR) in two Medical Home Care Units in Stockholm. Unit A had written guidelines about how to document CPR-decisions in the medical records, including a requirement for a decision to be taken (CPR: yes/no) while Unit B had no such requirement. Method The medical records for all patients in palliative phase of their disease at the two Units were reviewed. Data was collected on documentation of decisions about CPR (yes/no), DNACPR-decisions and documentation regarding whether the patient or next-of-kin had been informed about the DNACPR-decision. Results In the two Units, 316 and 219 patients in palliative phase were identified. In Unit A 100% of the patients had a CPR-decision (yes/no) compared to 79% in Unit B (p < 0.001). There was no statistically significant difference in DNACPR-decisions between the two Units, 43 and 37%. Documentation about informing the patient regarding the decision was significantly higher in Unit A, 53% compared to 14% at Unit B (p < 0.001). Documentation about informing the next-of-kin was also significantly higher at Unit A; 42% compared to 6% at Unit B (p < 0.001). Conclusion Less than 50% of patients in palliative phase had a decision of DNACPR in two Medical Home Care Units in Stockholm. The presence of written guidelines and a requirement for a CPR-decision did not increase the frequency of DNACPR-decisions but was associated with a higher frequency of documentation of decisions and of information given to both the patients and the next-of-kin.

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Impact of Dispatcher-Assisted Bystander Cardiopulmonary Resuscitation with Out-of-Hospital Cardiac Arrest: A Systemic Review and Meta-Analysis

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20000588 ◽

2020 ◽

Vol 35 (4) ◽

pp. 372-381

Author(s):

Junhong Wang ◽

Hua Zhang ◽

Zongxuan Zhao ◽

Kaifeng Wen ◽

Yaoke Xu ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Meta Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Significant Difference ◽

Bystander Cardiopulmonary Resuscitation ◽

The Impact ◽

Hospital Cardiac Arrest

AbstractObjective:This systemic review and meta-analysis was conducted to explore the impact of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) on bystander cardiopulmonary resuscitation (BCPR) probability, survival, and neurological outcomes with out-of-hospital cardiac arrest (OHCA).Methods:Electronically searching of PubMed, Embase, and Cochrane Library, along with manual retrieval, were done for clinical trials about the impact of DA-BCPR which were published from the date of inception to December 2018. The literature was screened according to inclusion and exclusion criteria, the baseline information, and interested outcomes were extracted. Two reviewers assessed the methodological quality of the included studies. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated by STATA version 13.1.Results:In 13 studies, 235,550 patients were enrolled. Compared with no dispatcher instruction, DA-BCPR tended to be effective in improving BCPR rate (I2 = 98.2%; OR = 5.84; 95% CI, 4.58-7.46; P <.01), return of spontaneous circulation (ROSC) before admission (I2 = 36.0%; OR = 1.17; 95% CI, 1.06-1.29; P <.01), discharge or 30-day survival rate (I2 = 47.7%; OR = 1.25; 95% CI, 1.06-1.46; P <.01), and good neurological outcome (I2 = 30.9%; OR = 1.24; 95% CI, 1.04-1.48; P = .01). However, no significant difference in hospital admission was found (I2 = 29.0%; OR = 1.09; 95% CI, 0.91-1.30; P = .36).Conclusion:This review shows DA-BPCR plays a positive role for OHCA as a critical section in the life chain. It is effective in improving the probability of BCPR, survival, ROSC before admission, and neurological outcome.

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Implementation of the Format for the Nursing Problem Oriented Record (Por) Performance in Investment Health Center in Ternate City 2018

KnE Life Sciences ◽

10.18502/kls.v4i15.5759 ◽

2019 ◽

Author(s):

Amira . ◽

Muhlisa . ◽

Tri Johan

Keyword(s):

Health Center ◽

Nursing Care ◽

Statistical Tests ◽

Sampling Technique ◽

Control Group ◽

P Value ◽

Nursing Documentation ◽

Significant Difference ◽

Before And After ◽

Quasi Experimental

Completeness of nursing documentation is one of the quality indicators of nursing care. Based on the nursing practice law no. 38 article 37, nurses in carrying out Nursing Practices are obliged to document Nursing Care in accordance with the standards. Documentation in Inpatient PKM consisting of Siko, Jambula, and Sulamadaha PKM itself, based on the observations of researchers found several obstacles, namely, the lack of nurses given the large number of PKM programs that must be run, varying levels of education so documentation has a different understanding, this also supported by the lack of education and training related to temporary nursing care documentation relating to the Nursing Process and Documentation experiencing some recent changes. The purpose of this study was to determine the effect of applying the nursing documentation format for the model Problem-Oriented Record (POR) on the performance of nurses in the Inpatient Health Center in Ternate City. The design of this study is quasi-experimental, namely, pre and post-test without control group. The population is nurses with 41 people in PKM Inpatient who are in Ternate City. Samples were taken by total sampling technique and analyzed using statistical tests t-test, Anova, and correlation. The results of the study found a significant difference between the performance of nurses before and after the application of the documentation format for nursing care in the POR model (p-value: 0,0005 α: 0.05) while the characteristics of respondents included age, sex, marital status, length of work and education had no effect on performance.

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Effect of educational program based on theory of planned behavior on osteoporosis preventive behaviors: a randomized clinical trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04861-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Nasim Pakyar ◽

Sarieh Poortaghi ◽

Shahzad Pashaeypoor ◽

Farshad Sharifi

Keyword(s):

Primary Care ◽

Theory Of Planned Behavior ◽

Planned Behavior ◽

Behavioral Intention ◽

Educational Program ◽

Behavioral Control ◽

Subjective Norms ◽

Perceived Behavioral Control ◽

Preventive Behaviors ◽

Significant Difference

Abstract Background The prevalence of chronic diseases is increasing worldwide. Implementing educational programs is an important step in prevention of chronic diseases in the community setting. This study was conducted to assess the effect of educational program based on the Theory of Planned Behavior (TPB) on the osteoporosis preventive behaviors in middle-aged individuals. Methods A randomized clinical trial was conducted on 64 middle-aged individuals presenting to primary care centers. A researcher-made questionnaire developed according to “a guide for compiling and analyzing the questionnaire based on TPB” was used for data collection. Random block sampling was applied to assign participants to control and intervention groups after ensuring the validity and reliability. An educational program on osteoporosis prevention was conducted in six educational sessions based on the TPB constructs for the intervention group in primary care centers. Control group received routine education about lifestyle changes including osteoporosis by primary care centers. Eight weeks after the intervention, the questionnaires were completed again and the data were analyzed using the SPSS V16 software. Results Independent t-test found no significant difference in the mean score of knowledge, osteoporosis preventive behavior, attitude, subjective norms, perceived behavioral control and behavioral intention between intervention and control groups before intervention (p > 0.05). After the intervention, however, a significant difference was found in the mean score of knowledge, attitude, subjective norms, perceived behavioral control and behavioral intention between the cases in intervention and control groups (P < 0.05). In addition, based on repeated measurement ANOVA, the intervention had a significant effect on knowledge, preventive behaviors, attitude, subjective norms, perceived behavioral control, and behavioral intention (P < 0.05). Conclusions The results of the present study showed that implementation of an educational intervention based on the Theory of Planned Behavior significantly increased the knowledge along with all constructs of TPB in osteoporosis preventive behaviors. Trial registration This study was registered in the Iranian Registry of Clinical Trials IRCT2017081735647N2 (11/10/2017).

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The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1294.2829 ◽

2016 ◽

Vol 24 (0) ◽

Author(s):

Renata Maria de Oliveira Botelho ◽

Cássia Regina Vancini Campanharo ◽

Maria Carolina Barbosa Teixeira Lopes ◽

Meiry Fernanda Pinto Okuno ◽

Aécio Flávio Teixeira de Góis ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Survival Rates ◽

Spontaneous Circulation ◽

University Hospital ◽

Control Group ◽

Case Group ◽

Chi Square ◽

Significant Difference ◽

Service Data

ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51) received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. Results: ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017) or the occurrence of death (p=0.8112). Conclusion: the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC.

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