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2.
Resuscitation ; 153: 45-55, 2020 08.
Article in English | MEDLINE | ID: mdl-32525022

ABSTRACT

Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person's presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.


Subject(s)
Coronavirus Infections/complications , Heart Arrest/etiology , Heart Arrest/therapy , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Cardiopulmonary Resuscitation/standards , Europe , Humans , Pandemics , Personal Protective Equipment/supply & distribution , Risk Assessment , SARS-CoV-2 , Societies, Medical
3.
Resuscitation ; 136: 78-84, 2019 03.
Article in English | MEDLINE | ID: mdl-30572073

ABSTRACT

OBJECTIVE: There is international variation in the rates of bystander cardiopulmonary resuscitation (CPR). 'Bystander CPR' is defined in the Utstein definitions, however, differences in interpretation may contribute to the variation reported. The aim of this cross-sectional survey was to understand how the term 'bystander CPR' is interpreted in Emergency Medical Service (EMS) across Europe, and to contribute to a better definition of 'bystander' for future reference. METHODS: During analysis of the EuReCa ONE study, uncertainty about the definition of a 'bystander' emerged. Sixty scenarios were developed, addressing the interpretation of 'bystander CPR'. An electronic version of the survey was sent to 27 EuReCa National Coordinators, who distributed it to EMS representatives in their countries. Results were descriptively analysed. RESULTS: 362 questionnaires were received from 23 countries. In scenarios where a layperson arrived on scene by chance and provided CPR, up to 95% of the participants agreed that 'bystander CPR' had been performed. In scenarios that included community response systems, firefighters and/or police personnel, the percentage of agreement that 'bystander CPR' had been performed ranged widely from 16% to 91%. Even in scenarios that explicitly matched examples provided in the Utstein template there was disagreement on the definition. CONCLUSION: In this survey, the interpretation of 'bystander CPR' varied, particularly when community response systems including laypersons, firefighters, and/or police personnel were involved. It is suggested that the definition of 'bystander CPR' should be revised to reflect changes in treatment of OHCA, and that CPR before arrival of EMS is more accurately described.


Subject(s)
Cardiopulmonary Resuscitation/methods , Out-of-Hospital Cardiac Arrest/therapy , Terminology as Topic , Cross-Sectional Studies , Emergency Medical Services , Europe , Female , Humans , Male , Surveys and Questionnaires
5.
Med Teach ; 33(7): e382-7, 2011.
Article in English | MEDLINE | ID: mdl-21696272

ABSTRACT

BACKGROUND: It is often assumed that the way teachers approach their teaching is determined by the way they think about learning. This study explores how teachers of an undergraduate medical programme (UMP) think about learning, how they approach teaching and whether their conceptions of learning relate to their teaching approaches. METHODS: Quantitative data of academic teachers involved in the undergraduate programme in medicine were collected and analysed. We used a questionnaire designed to measure teachers' conceptions of their own learning (COL) and of student learning as well as teachers' approaches to teaching (AT). RESULTS: Teachers of the medical undergraduate programme hold a variety of COL, of how students learn and their AT. No significant correlations were found between teachers' conceptions of learning and their AT. CONCLUSIONS: Although UMP teachers' ideas on learning and teaching are very diverse, some of their conceptions are interrelated. Teachers' ideas on their own learning is sometimes - but not always - related to how they think about student learning. But most importantly, the way UMP teachers think about learning is not automatically converted into the way they approach teaching.


Subject(s)
Faculty, Medical , Schools, Medical , Teaching , Humans , Netherlands , Surveys and Questionnaires
6.
Resuscitation ; 82(8): 989-94, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21507548

ABSTRACT

BACKGROUND: Knowledge about the epidemiology of cardiac arrest in Europe is inadequate. AIM: To describe the first attempt to build up a Common European Registry of out-of-hospital cardiac arrest, called EuReCa. METHODS: After approaching key persons in participating countries of the European Resuscitation Council, five countries or areas within countries (Belgium, Germany, Andalusia, North Holland, Sweden) agreed to participate. A standardized questionnaire including 28 items, that identified various aspects of resuscitation, was developed to explore the nature of the regional/national registries. This comprises inclusion criteria, data sources, and core data, as well as technical details of the structure of the databases. RESULTS: The participating registers represent a population of 35 million inhabitants in Europe. During 2008, 12,446 cardiac arrests were recorded. The structure as well as the level of complexity varied markedly between the 5 regional/national registries. The incidence of attempted resuscitation ranged between registers from 17 to 53 per 100,000 inhabitants each year whilst the number of patients admitted to hospital alive ranged from 5 to 18 per 100,000 inhabitants each year. Bystander CPR varied 3-fold from 20% to 60%. CONCLUSION: Five countries agreed to participate in an attempt to build up a common European Registry for out-of-hospital cardiac arrest. These regional/national registries show a marked difference in terms of structure and complexity. A marked variation was found between countries in the number of reported resuscitation attempts, the number of patients brought to hospital alive, and the proportion that received bystander CPR. At present, we are unable to explain the reason for the variability but our first findings could be a 'wake-up-call' for building up a high quality registry that could provide answers to this and other key questions in relation to the management of out-of-hospital cardiac arrest.


Subject(s)
Cardiopulmonary Resuscitation/standards , Emergency Medical Services/standards , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Registries , Europe/epidemiology , Humans , Surveys and Questionnaires
8.
Med Teach ; 31(3): e64-8, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19089721

ABSTRACT

BACKGROUND: Changing a curriculum raises the question whether the results, new curriculum student outcomes, are different from old curriculum student outcomes. AIMS: To see whether different curricula produce different outcomes, we compared test and questionnaire results of two cohorts. We wanted to know if there is a difference on knowledge and skills test results, and on the number of times students practiced their skills during their final internships. METHOD: We used two validated test instruments: the Dutch Progress Test (PT) and the Objective Structured Clinical Examination (OSCE). For reporting their skills practice, we asked students of both cohorts to fill out a basic skills questionnaire. RESULTS: We found no significant difference between both cohorts on the results of their knowledge test and their report on skills practice. On the OSCE, students from the new curriculum cohort scored significantly higher than old curriculum students. CONCLUSION: Curriculum change can lead to improvements in graduating students' outcome results.


Subject(s)
Curriculum/standards , Education, Medical/standards , Educational Measurement/methods , Program Evaluation , Adult , Female , Humans , Male
9.
Educ Health (Abingdon) ; 20(3): 125, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18080964

ABSTRACT

CONTEXT: The necessity of learning skills through "integrated skills training" at an undergraduate level has been supported by several studies. The University of Antwerp implemented undergraduate skills training in its renewed curriculum in 1998, after it was demonstrated that Flemish students did not master their medical skills as well as Dutch students who received "integrated skills training" as part of their undergraduate medical course. AIM: The aim of this study was to compare the skill outcome levels of two different student populations: students who had been trained in basic clinical skills mainly through clinical internships in year 7 with students who had learned these skills through an integrated longitudinal programme in a special learning environment in years 1-5 prior to their internship experience. STUDY SAMPLE: Students of the traditional curriculum learned skills through a 75 hour programme in years 4 and 5, through plenary sessions followed by a 12 month period of internships during which skills could be further practiced. We tested this group right after completion of their internships. Students from the renewed curriculum followed a 200 hour intensive small group skills training programme offered in years 1-5. This group was tested before starting their internships. RESULTS: On global OSCE-scores, renewed curriculum students had significantly higher overall scores (p<0.001) and they scored significantly higher at 6 of 15 stations. There was no significant difference at 8 stations, while traditional curriculum students scored better at station 1. DISCUSSION: 5 years and 200 hours of integrated undergraduate skills training is more effective as a method of learning basic clinical skills, compared to learning these skills through 75 hours of traditional skill training and reinforcement of these skills in 12 month clinical internships, when measured by means of an OSCE.


Subject(s)
Clinical Competence , Curriculum , Education, Medical, Undergraduate/methods , Problem-Based Learning/methods , Belgium , Clinical Competence/standards , Cohort Studies , Humans , Internship and Residency , Models, Educational , Time Factors
10.
Clin Microbiol Infect ; 12(1): 56-62, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16460547

ABSTRACT

This study evaluated retrospectively the efficacy of treatment with cefepime vs. a carbapenem, in combination with amikacin or ciprofloxacin, for seriously-ill patients infected with ESBL-producing Enterobacter aerogenes who were admitted to an intensive care unit. Forty-four episodes of infection were investigated in 43 patients: 21 treated with cefepime; 23 with a carbapenem. The two treatment groups did not differ statistically in terms of age, APACHE II scores, and infection sites, but the average duration of antibiotic exposure was significantly shorter in the cefepime group (8.5 days vs. 11.4 days; p 0.04). Clinical improvement was seen in 62% of patients receiving cefepime vs. 70% of patients receiving a carbapenem (p 0.59). Bacteriological eradication was achieved in 14% of patients receiving cefepime vs. 22% of patients receiving a carbapenem (p 0.76). The 30-day mortality rates related to infection were 33% in the cefepime group and 26% in the carbapenem group (p 0.44). Thus, outcome parameters did not differ significantly between the two groups. Nevertheless, a statistically significant increase in failure to eradicate ESBL-producing E. aerogenes was observed as the MICs of cefepime rose (p 0.017). Pulsed-field gel electrophoresis revealed three distinct clones, but one predominant clone harbouring the bla(TEM-24) gene was associated with most (42/44) of the episodes of infection. It was concluded that cefepime may be an alternative agent for therapy of severe infections caused by TEM-24 ESBL-producing E. aerogenes, although further studies are required to confirm these observations.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Bacterial Proteins/biosynthesis , Cephalosporins/administration & dosage , Critical Illness , Enterobacter aerogenes/enzymology , Enterobacteriaceae Infections/drug therapy , Intensive Care Units , beta-Lactamases/biosynthesis , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Carbapenems/administration & dosage , Carbapenems/therapeutic use , Cefepime , Cephalosporins/therapeutic use , Cross Infection/drug therapy , Cross Infection/microbiology , Drug Therapy, Combination , Enterobacter aerogenes/drug effects , Enterobacteriaceae Infections/microbiology , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Retrospective Studies , Treatment Outcome
13.
Stud Health Technol Inform ; 103: 315-26, 2004.
Article in English | MEDLINE | ID: mdl-15747936

ABSTRACT

This paper reports the results of the first of the two systems developed by JUST, a collaborative project supported by the European Union under the Information Society Technologies (IST) Programme. The most innovative content of the project has been the design and development of a complementary training course for non-professional health emergency operators, which supports the traditional learning phase, and which purports to improve the retention capability of the trainees. This was achieved with the use of advanced information technology techniques, which provide adequate support and can help to overcome the present weaknesses of the existing training mechanisms.


Subject(s)
CD-I , Emergency Treatment , Internet , Teaching/methods , Volunteers/education , Adolescent , Adult , Clinical Competence , Computer Simulation , Emergency Medical Technicians/education , Female , Humans , Male , Middle Aged
14.
Rev Med Brux ; 25(6): 497-505, 2004 Dec.
Article in French | MEDLINE | ID: mdl-15688888

ABSTRACT

Acute arrhythmia is a condition covering a wide variety of rhythm disturbances. The aim of the article is to give practical recommendations for the approach and the treatment of the patient presenting with an acute arrhythmia. We discuss bradycardia and tachycardia. Tachycardias are divided into the small QRS complex tachycardias and the wide QRS complex tachycardias. Another important distinction with immediate therapeutic consequences is that between the hemodynamic stable and unstable patient. Flowcharts with diagnostic means and therapeutic schemes are added and a table with practical considerations for electrical cardioversion.


Subject(s)
Arrhythmias, Cardiac/therapy , Acute Disease , Arrhythmias, Cardiac/physiopathology , Bradycardia/physiopathology , Bradycardia/therapy , Decision Trees , Humans , Tachycardia/physiopathology , Tachycardia/therapy
19.
Rev Med Liege ; 57(6): 400-4, 2002 Jun.
Article in French | MEDLINE | ID: mdl-12180035

ABSTRACT

The Belgium Interdisciplinary Working group on Acute Cardiology, including cardiologists, intensivists and urgentists was formed to provide consensus regarding the management of acute chest pain in the prehospital and the early hospital phase. General recommendations and critical pathways are proposed to improve the treatment of the patients with acute coronary syndromes.


Subject(s)
Algorithms , Angina, Unstable/diagnosis , Chest Pain/etiology , Myocardial Infarction/diagnosis , Practice Guidelines as Topic , Acute Disease , Angina, Unstable/complications , Angina, Unstable/therapy , Diagnosis, Differential , Humans , Myocardial Infarction/complications , Myocardial Infarction/therapy
20.
Rev Med Brux ; 23(2): 71-7, 2002 Apr.
Article in French | MEDLINE | ID: mdl-12056060

ABSTRACT

The Belgium Interdisciplinary Working Group on Acute Cardiology (BIWAC), including cardiologists, intensivists and urgentists was formed to give consensus regarding the management of acute chest pain in the prehospital and the early hospital phases. General recommendations and critical pathways are proposed to improve the treatment of the patients with acute coronary syndromes.


Subject(s)
Chest Pain/therapy , Acute Disease , Chest Pain/etiology , Humans
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