Sex differences in anxiety and hesitation toward bystander CPR and AED / 体力科学

Women who suffer out-of-hospital cardiac arrest receive cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) less frequently than that of men. Understanding the public perception on the necessity of the occurrence of life-saving disparities for fair intervention application to individuals with injuries and sickness is needed. The participants were undergraduate students of the university. Anxiety and irritability towards bystander CPR and AED operations were investigated. The participants of the analysis were 368 individuals (153 men and 215 women), of which 80.4% of men and 95.8% of women had anxiety about life-saving procedures. Regarding AED operation, 90 (58.8%) men and 74 (34.4%) women hesitated on removing clothing from a woman with injury or sickness. The reasons on women with injury and illness were less likely to be suitable with AEDs involved anxiety about life-saving procedures, litigation issues, and posting and spreading on social networking sites (SNS). Particularly, if men intervened with women with wounds, the main limitations were the risk of the act developing into a lawsuit and gaze of others, namely SNS. Bystander anxiety towards life-saving procedures was found to be strongly expressed by women. It also became evident that early recognition of cardiac arrest was not performed for patients with injuries 20–30% of the time. Training specifically for women with wounds and sickness may reduce sex differences in bystander CPR and AED application.

Assessment of Awareness and Attitudes Regarding Automated External ‎Defibrillators (AED) In Sports Facilities in Jeddah, Saudi Arabia

Background: Sudden cardiac death (SCD) is a leading cause of death in young athletes. Most of those events occur during exercise and insports facilities. We sought to assess awareness and attitudes towards automated external defibrillators (AED) in sports facilities in Jeddah,Saudi Arabia. Methods: The survey included 293 individuals who attend 18 different sports facilities in Jeddah, Saudi Arabia to estimatethe overall knowledge level of CPR and AED usage and determine general attitudes toward intervening in the setting of sudden cardiacarrest (SCA). We included adult participants who were 18 years of age or older. After explaining the aim of our study, each participant wasconsented to participate in the survey. The survey included 33 questions to assess demographic characteristics, knowledge, and skills ofCPR, confidence to perform CPR and to use AED. Results: A total of 293 candidates completed the questionnaire. Mean age was 28.33 ±8.22 years. Only 19 candidates who worked in sports facilities agreed to participate in our survey, of those only 10 participants hadprevious CPR training but only 8 (42.1%) had the self-confidence to do CPR and use AED. Of individuals who participated in the survey,110 (37%) of them indicated that they were more likely to intervene in an SCA after receiving the proper training. 140 (47.7%) participantsof our cohort were reluctant to perform CPR because they were anxious about harming the arrested patient. 108 (36%) of our cohort couldexplain the purpose of using AED. Unfortunately, 101 (34.5%) of our sample did not know the number of Red Crescent for emergency calls.73 (53.7%) of the total 136 participants who received CPR training before stated that they are able to use AED. Our survey showed that264 (90.1%) wished to receive BLS training course if it was announced in order to qualify them for performing CPR and applying AED.Conclusion: Our survey showed insufficient knowledge in all aspects of CPR skills and inadequate knowledge of AED and its purpose ofuse in sports facilities in Jeddah. We recommend initiating an effective national public campaign to increase the public awareness of theimportance of CPR and AED performance using different pathways for education through media and new legislations.

Exploration and application of automatic ele ctrothermal digestion instrument——a new pretreatment technology for detection of arsenic in urine samples / 中华地方病学杂志

Objective To explore the application of new pretreatment technology of automatic electrothermal digestion instrument in the detection of arsenic in urine samples,in order to achieve rapid,convenient and accurate detection results.Methods Using wet digestion,an advanced sample preparation and digestion method (referred to as new pretreatment technology) was established by hydride generation-atomic fluorescence spectrometry (HG-AFS).Wet digestion:took 1.0 ml urine samples and put them into 10.0 ml corked scale digestive tubes,and added 0.20 ml sulfuric acid,0.30 ml nitric acid and 0.50 ml hydrogen peroxide into the tubes successively.Shook solution and put them at AED-IV automatic electrothermal digestion instrument with 160 ℃ for half an hour,then heated up to 200 ℃ for 1 hour.It needed to be continually heated up to 260 ℃ and dissolved the solution until colorless transparent or light yellow.When the liquid level calm,and uniform reflux appeared,which meant the digestion finished,and then measured by atomic fluorescence photometer.At the same time,the new pretreatment technology was compared with the current standard (WS/T 474-2015) method,and the standard curve and linear range were calculated,as well as the detection line,precision and accuracy of the sample measurement.Results The new pretreatment technology could digest 60 samples per sample,which was superior to the current standard methods (20 samples)and reduced the amount of reagent used.There was no statistically significant difference between the two methods (P ＞ 0.05).In the linear range of 0-100 μg/L,the correlation coefficient (r) ＞0.999 3,the detection limit of the method was 0.066 μg/L,and the relative standard deviation (RSD) ＜ 5％.Conclusions The new pretreatment technology is fast,efficient,environmentally friendly,economical,highly automated.The experimental result error is in a controllable range.It can be used for digestion of arsenic content in urine of different concentrations and has high applicability.

Exploration and application of automatic electrothermal digestion instrument —— a new pretreatment technology for detection of arsenic in urine samples / 中华地方病学杂志

Objective@#To explore the application of new pretreatment technology of automatic electrothermal digestion instrument in the detection of arsenic in urine samples, in order to achieve rapid, convenient and accurate detection results.@*Methods@#Using wet digestion, an advanced sample preparation and digestion method (referred to as new pretreatment technology) was established by hydride generation-atomic fluorescence spectrometry (HG-AFS). Wet digestion: took 1.0 ml urine samples and put them into 10.0 ml corked scale digestive tubes, and added 0.20 ml sulfuric acid, 0.30 ml nitric acid and 0.50 ml hydrogen peroxide into the tubes successively. Shook solution and put them at AED-IV automatic electrothermal digestion instrument with 160 ℃ for half an hour, then heated up to 200 ℃ for 1 hour. It needed to be continually heated up to 260 ℃ and dissolved the solution until colorless transparent or light yellow. When the liquid level calm, and uniform reflux appeared, which meant the digestion finished, and then measured by atomic fluorescence photometer. At the same time, the new pretreatment technology was compared with the current standard (WS/T 474-2015) method, and the standard curve and linear range were calculated, as well as the detection line, precision and accuracy of the sample measurement.@*Results@#The new pretreatment technology could digest 60 samples per sample, which was superior to the current standard methods (20 samples) and reduced the amount of reagent used. There was no statistically significant difference between the two methods (P > 0.05). In the linear range of 0-100 μg/L, the correlation coefficient (r) > 0.999 3, the detection limit of the method was 0.066 μg/L, and the relative standard deviation (RSD) < 5%.@*Conclusions@#The new pretreatment technology is fast, efficient, environmentally friendly, economical, highly automated. The experimental result error is in a controllable range. It can be used for digestion of arsenic content in urine of different concentrations and has high applicability.

Knowledge and attitudes of Singapore schoolchildren learning cardiopulmonary resuscitation and automated external defibrillator skills

<p><b>INTRODUCTION</b>Victims of out-of-hospital cardiac arrests require timely cardiopulmonary resuscitation (CPR) and early defibrillation. Callers to emergency medical services are asked to provide dispatcher-guided responses until an ambulance arrives. Knowing what to expect in such circumstances should reduce both delay and confusion.</p><p><b>METHODS</b>This study was conducted among schoolchildren aged 11-17 years using ten-item pre- and post-training surveys. We aimed to observe any knowledge and attitude shifts regarding CPR and automated external defibrillator (AED) use subsequent to the training.</p><p><b>RESULTS</b>A total of 1,196 students across five schools completed the pre- and post-training surveys. Survey questions tested basic CPR knowledge and attitudes towards CPR and AED use. The overall response rate was 80.8% and 81.5% in the pre- and post-training surveys, respectively. There was a statistically significant improvement in the students' CPR knowledge. The number of students who selected all the correct answers for the knowledge-based questions in the post-training survey increased by 64.7% (95% confidence interval 61.9%-67.5%; p < 0.001). There was also an improvement in their willingness to administer CPR (likely/very likely to administer CPR pre-training vs. post-training: 13.0% vs. 71.0%; p < 0.001) and use AED (likely/very likely to administer AED pre-training vs. post-training: 11.7% vs. 78.0%; p < 0.001) after training.</p><p><b>CONCLUSION</b>The training programme imparted new information and skills, and improved attitudes towards providing CPR and using AED. However, some concerns persisted about hurting the victim while performing CPR.</p>

Phenytoin toxicity presenting with acute visual loss and acute delirium, a case report

@#Phenytoin is a widely prescribed antiepileptic agent for both focal and generalized seizure. We report a case of a 20-year-old man with focal epilepsy presented with acute bilateral visual loss, and delirium. His random phenytoin serum concentration on admission was 43.6 mg/L, well above the recommended therapeutic range of 10-20 mg/L. Extensive investigations have ruled out other vascular or demyelinating causes. His visual symptoms completely resolved after discontinuing phenytoin for 84 hours. This case shows that acute phenytoin toxicity can result in reversible visual failure.

Design of Multifunctional Automated External Defibrillator Based on STM32 / 中国医疗器械杂志

This paper presents a design of multifunctional portable automated external defibrillator based on STM32F103VC SCM. The defibrillator mainly realizes the defibrillation and ECG analysis function, and according to the clinical actual need, increases information storage and transmission function, query of local records, the function of synchronous LCD display and voice prompt in the defibrillation process. The device uses the defibrillating electrodes to measure body resistance, ECG and so on. We detailedly researched and achieved the discharge module of biphasic defibrillation apparatus based on the damping of two order discharge circuit, and finished the real-time LCD display and voice prompt modules of defibrillation information based on the control of PIC24FJ256DA210 chip.

A Questionnaire Survey of Perceptions of Basic Life Support (BLS) among Radiological Technologists: Radiological Technologists Often Encounter Patients with Cardiopulmonary Arrest during Diagnostic Imaging Examinations.

Aim: The present study aims to investigate the perceptions of basic life support (BLS), motivations for learning BLS and self-evaluations of the ability to practice BLS skills in radiological technologists clinically working in Mie prefecture, Japan. Methods: A cross-sectional questionnaire survey was conducted on 489 radiological technologists (RTs) living in Mie prefecture, Japan, from August to December 2014. The responded questionnaire was collected from 158 RTs (recovery rate: 32%) with written informed consent. Results: Almost one third of the RTs (32.3%) had encountered cardiopulmonary arrest during a radiological examination. The percentage of those who ‘understood’ the purpose and method of BLS reached 71.5%. Approximately half of the respondents considered the ability to practice BLS ‘practicable’, while the remaining half considered it to be ‘difficult’. All RTs knew of the term ‘AED’, and 98.7% ‘understood’ the purpose of AEDs and how to handle them. Similarly, 92.4% of them responded that they were ‘practicable’ to use AEDs. Although sixty percent of RTs had undertaken a BLS training course, only three quarters of them considered themselves ‘practicable’ BLS and 65.6% had no confidence in their BLS skills. Moreover, 39.2% of RTs had not undertaken a BLS training course, and only 9.7% responded ‘practicable’ for practice of BLS among those with training course experience. None of RTs who had not undertaken a BLS training course answered ‘fully confident’ and 95.2% had no or little confidence in their BLS skills. Conclusion: In this study, it is considered that many RTs understand the purpose and handling of AEDs and have the ability to use an AED. The majority of the RTs participating in a BLS training course are ‘practicable’ to practice BLS, though they felt ‘little confidence’ about their BLS skill level. In contrast, the majority of RTs with no experience of attending a BLS training course were not able to practice BLS. Therefore, a BLS training course is very crucial for obtaining the ability to practice BLS, although there is a necessity to improve the content of BLS training course.

Effect of Argemone mexicana (L.) against lithium-pilocarpine induced status epilepticus and oxidative stress in wistar rats.

Argemone mexicana (L.) has a role in the treatment of epileptic disorders in Indian traditional system of medicine. We studied its effect on induced status epilepticus (SE) and oxidative stress in rats. SE was induced in male albino rats by administration of pilocarpine (30 mg/kg, ip) 24 h after injection of lithium chloride (3 mEq/kg, ip). Different doses of the ethanol extract of A. mexicana were administered orally 1 h before the injection of pilocarpine. The severity of SE was observed and recorded every 15 min for 90 min and thereafter at every 30 min for another 90 min, using the Racine scoring system. In vivo lipid peroxidation of rat brain tissue was measured utilizing thiobarbiturate-reactive substances. Both in vitro free radical nitric oxide and 2,2-diphenyl-1-picryl hydrazyl scavenging activities of the extract were also determined. The SE severity was significantly reduced following oral administration of the extract at 250, 500 and 1000 mg/kg doses. None of the animals from groups 3 to 5 (with A. mexicana extract) have exhibited forelimb clonus of stage 4 seizure. The extract also exhibited both in vivo and in vitro antioxidant activities.

Scale and scope economies in Mexican private medical units / Economías de escala y alcance en unidades médicas privadas en México

Objective. To evaluate technical efficiency and potential presence of scale and scope economies in Mexican private medical units (PMU) that will improve management decisions. Materials and methods. We used data envelopment analysis methods with inputs and outputs for 2 105 Mexican PMU published in 2010 by the Instituto Nacional de Estadística y Geografía from the "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)" questionnaire. Results. The application of the models used in the paper found that there is a marginal presence of economies of scale and scope in Mexican PMU. Conclusions. PMU in Mexico must focus to deliver their services on a diversified structure to achieve technical efficiency.

Objetivo. Evaluar la eficiencia técnica y la presencia de potenciales economías de escala y alcance en unidades médicas privadas (UMP) mexicanas, de forma que sea posible establecer planes para la mejora de su gestión. Material y métodos. Se utilizó el método de Análisis Envolvente de Datos con información de insumos y productos para 2 105 UMP del año 2010 publicada por el Instituto Nacional de Estadística y Geografía a través del cuestionario denominado "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)". Resultados. La aplicación de los modelos encuentra una presencia marginal de economías de escala y alcance en las UMP mexicanas. Conclusiones. La operación de las UMP en México debe enfocarse a prestar servicios bajo un modelo diversificado para alcanzar mejores niveles de eficiencia técnica.

Accuracy of the Automatic External Defibrillator on an Electric Mattress: Simulation Study

PURPOSE: The accuracy of the automated external defibrillator (AED) is susceptible to environmental factors such as vibration, motion artifacts, and electromagnetic interference (EMI). The purpose of this study was to evaluate whether the EMI produced by an electric mattress can affect the performance of AEDs. METHODS: Four commercially available AEDs were evaluated under four ECG rhythm settings (normal sinus rhythm, asystole, ventricular fibrillation, and ventricular tachycardia) with or without an electric mattress. The sensitivity, specificity, positive predictable value, negative predictable value, and accuracy of AEDs were calculated to differentiate shockable from nonshockable rhythms. Times required to interpret the ECGs were checked with and without an electric mattress. RESULTS: A total of 320 tests were recorded, and each AED was tested a total of 80 times. Depending on the AED model used on an electric mattress, sensitivity ranged from 55% to 90% with a specificity of 100%, and accuracy ranged from 77.5% to 95%. For some AEDs, sensitivity was reduced compared to the control. Although there was no significant difference in times required to interpret ECG signals with or without an electric mattress, some AEDs detected a relatively small interference as motion artifacts when an electric mattress was used. All recorded ECG rhythms on an electric mattress showed baseline artifacts and these artifacts lessened with increasing distance from an electric mattress. CONCLUSION: This study suggests that an electric mattress could affect the shockable rhythm performance of some AEDs. Electromagnetic interference generated by an electric mattress could interfere with the ability of some commercial AEDs to correctly interpret stimulated ECG rhythms and provide appropriate defibrillation.

Accuracy of the Automatic External Defibrillator on an Electric Mattress: Simulation Study

PURPOSE: The accuracy of the automated external defibrillator (AED) is susceptible to environmental factors such as vibration, motion artifacts, and electromagnetic interference (EMI). The purpose of this study was to evaluate whether the EMI produced by an electric mattress can affect the performance of AEDs. METHODS: Four commercially available AEDs were evaluated under four ECG rhythm settings (normal sinus rhythm, asystole, ventricular fibrillation, and ventricular tachycardia) with or without an electric mattress. The sensitivity, specificity, positive predictable value, negative predictable value, and accuracy of AEDs were calculated to differentiate shockable from nonshockable rhythms. Times required to interpret the ECGs were checked with and without an electric mattress. RESULTS: A total of 320 tests were recorded, and each AED was tested a total of 80 times. Depending on the AED model used on an electric mattress, sensitivity ranged from 55% to 90% with a specificity of 100%, and accuracy ranged from 77.5% to 95%. For some AEDs, sensitivity was reduced compared to the control. Although there was no significant difference in times required to interpret ECG signals with or without an electric mattress, some AEDs detected a relatively small interference as motion artifacts when an electric mattress was used. All recorded ECG rhythms on an electric mattress showed baseline artifacts and these artifacts lessened with increasing distance from an electric mattress. CONCLUSION: This study suggests that an electric mattress could affect the shockable rhythm performance of some AEDs. Electromagnetic interference generated by an electric mattress could interfere with the ability of some commercial AEDs to correctly interpret stimulated ECG rhythms and provide appropriate defibrillation.

Lamotrigine Induced Severe Cutaneous Reaction.

Antiepileptic drugs are used commonly by physicians, neurologist and neurosurgeons in Nepal. Lamotrigine is an effective antiepileptic drug used as an add-on and monotherapy for a variety of seizure types in both adults and children. Rashes due to AED including SJS and hypersensitivity syndrome leading to hospitalization occur in approximately 0.33% of adults and 0.8% in children. Reactions due to LTG alone occur in around 5.7% of cases. We report probably the first case of this reaction in a 12-year old girl with a brief discussion on its etiology and management.

Surgical Coronary Revascularization in a Patient Resuscitated from Out-Of-Hospital Cardiac Arrest / 日本心臓血管外科学会雑誌

We report a 77-year-old man treated successfully surgical coronary revascularization following out-of-hospital cardiac arrest. The patient suddenly suffered from loss of consciousness with cardiopulmonary arrest on June 3, 2007. His wife quickly started cardiac massage and a bystander called an ambulance. Using an automated external defibrillator, paramedics performed defibrillation, which started his heart beating again in 30 min. He was then transferred by ambulance to the emergency room in our hospital. Severe coronary artery disease (left main disease and three-vessel disease) was diagnosed on June 11 after treatment for congestive heart failure and confirmation of good consciousness. Thereafter, urgent on-pump beating coronary artery bypass grafting was performed. On the 45th post operative day, the patient was discharged to home with an acceptable level of daily life activity. To the best of our knowledge, this is the fifth such case report in the Japanese literature.

Difference and Correlation between Seizure Numbers during the First Year and the Second Year of Antiepileptic Drug Treatnent in Temporal Lobe Epilepsy with Mesial Temporal Sclerosis / 대한간질학회지

PURPOSE: Determination of medical intractability is primarily essential for planning a surgical treatment of epolepsy. Questions regarding intractability include the optimum duration of adequate antiepileptic drug (AED) treatment and the tolerable seizure frequency. Unfortunately, thereis no established guideline for determination of medical intractability in terms of the duration or the tolerability of AED resistance. In temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS), a Well-Known surgically remediable epileptic syndrome, the inverstigation of relationship between short-term and long-term AED response may help us finding a way to solve the above questions. METHODS: From 2 epilepsy centers, 86 patients with TLE demonstrating MTS on MRI were evaluated. All of them were on AED treatment for at least 2 years. We investigated seizure free rate for 1st 1 year, for next 1 year and that for two years. We compared seizure number of 1st 1 year with that of 2nd 1 year and analyzed corrdlation coefficiency between seizure numbers of the two periods. Paired-t-test and Pearson correlation test were performed for statistical analysis. RESULTS: Two year terminal remission rate was 3.5%. Remission rate for the 1st 1 year was 4.7% Whereas in the 2nd 1 year it rose to 16.3%. Mean seizure number of 1st one year was 34.9 and that of next one year was 27.0. Mean paired differences between seizure numbers of the two periods was 7.95(95% dcnfidence interval:1.82-14.09) Which was statistically significant(p=0.012). Pearson correlation coefficiendy was 0.815 between seizure numbers fo the two periods. CONCLUSION: In TLE with MTS, seizure free outcome was very poor. However, seizurw-free rate rose and seizure number declined as AED treatment duration was prolonged for 2 years. Weizure munber of 1st year may predict that of 2nd year. To establish an appropriate index time for considering medical intractability, further studies on longer-term outcone by AED treatment duration was porlonged for 2 years. Seizure munber of 1st year further studies on longer-term outcome by AED treatment should be recommended in addition to studies on adequate tolerability of AED resistance.

Side Effects of Antiepileptic Drug in Children

PURPOSE: The purpose of this study is to estimate the side effects of antiepileptic drug(AED) in children. METHODS: Subjects were 267 children who had received AED for at least 1 month during January 1995 to July 1998. We reviewed their sex, age at start of seizure onset, age at medication, class and number of AED, developmental delay, type and cause of seizure according to the presence of side effect. We analyzed data using Student's t-test and X2-test. RESULTS: Side effects were observed in 61 of 267(22.8%) patients. There were no significant differences in their characteristics according to the presence of side effect. There were 112 episodes of complications in 61 patients. In decreasing order, CNS(38.4%) > digestive(25.9%) > hematologic(22.3%) > skin and connective tissue(7.1%) > others(6.3%). There were 12 episodes in 11 patients who should have been taken off AED due to drug eruption, drowsiness, nausea and so on. Side effects were observed in 16 of 123(6.0%) patients in monotherapy compared with 45 of 144(16.8%) patients in polytherapy, which showed significantly fewer side effects in monotherapy(P<0.05). In monotherapy, mean age at seizure onset and medication start were older(4.63+/-3.83, 5.85+/-3.86 years, respectively) than in polytherapy(2.69+/-3.06, 3.69+/-3.58 years, respectively) (P<0.05). CONCLUSION: In the data, CNS is the most common side effect(43 episodes, 38.4%) and there were significantly fewer side effects in monotherapy compared with polytherapy. Accordingly, we concluded that monotherapy is preferred over polytherapy in reducing the side effects of AED.

The side effects of antiepileptic drugs in epileptic children treated with monotherapy

The goal of therapy of epileptic children is to control of seizures with minimal side effects of antiepileptic drug (AED). The relationship between side effects, serum levels and doses of AED were examined prospectively in 72 epileptic children who received monotherapy with phenobarbital, phenytoin, valproate, or carbamazepine for 6 to 26 months. Our results were as follows: 1) Side effects were observed in 59.7% of all patients; in decreasing order, behavioral (41.6%)>digestive (25.0%)>others (22.2%)>neurologic (11.1%). 2) The most common side effects in children treated with phenobarbital (PB) was behavioral (54.2%); these included hyperactivity, drowsiness, sleeping in decreasing order and there was significant relationship between drowsiness and serum level of PB(P<0.05). 3) Common side effects in patients receing carbamazepine (CBZ) were behavioral (52.0%) and digestive (52.2%); behavioral disorders included drowsiness and sleeping which showed significance with dosage of CBZ (P<0.01), digestive disorders were abdominal pain which showed significance, with dosage of CBZ (P<0.05) and weight gain. Other side effects were dizziness, headache, diplopia, tremor pallor, durg eruption, alopecia, aggravated acne etc. 4) The most common side effect in children treated with valproate (VPA) was pallor which showed significance with dosage of VPA (P<0.05). Abdominal pain had<0.05 significance with serum level of VPA, and Other side effects were anemia and weight gain. 5) In 83.3% of all patients, they had no side effects or could tolerate mild side effects. But in 12.5% of patients, the side effects disappeared when dosages were reduced, and AED had to be withdrawn in only 4.2% of patients.