Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation.

INTRODUCTION: Bystander cardiopulmonary resuscitation (B-CPR) is associated with improved out-of hospital cardiac arrest survival. Community-level interventions including dispatcher-assisted CPR (DA-CPR) and myResponder were implemented to increase B-CPR. We sought to assess whether these interventions increased B-CPR. METHODS: The Singapore out-of-hospital cardiac arrest registry captured cases that occurred between 2010 and 2017. Outcomes occurring in 3 time periods (Baseline, DA-CPR, and DA-CPR plus myResponder) were compared. Segmented regression of time-series data was conducted to investigate our intervention impact on the temporal changes in B-CPR. RESULTS: A total of 13,829 out-of-hospital cardiac arrest cases were included from April 2010 to December 2017. Higher B-CPR rates (24.8% versus 50.8% vs 64.4%) were observed across the 3 time periods. B-CPR rates showed an increasing but plateauing trend. DA-CPR implementation was significantly associated with an increased B-CPR (level odds ratio [OR] 2.26, 95% confidence interval [CI] 1.79-2.88; trend OR 1.03, 95% CI 1.01-1.04), while no positive change was detected with myResponder (level OR 0.95, 95% CI 0.82-1.11; trend OR 0.99, 95% CI 0.98-1.00). CONCLUSION: B-CPR rates in Singapore have been increasing alongside the implementation of community-level interventions such as DA-CPR and myResponder. DA-CPR was associated with improved odds of receiving B-CPR over time while the impact of myResponder was less clear.

myResponder Smartphone Application to Crowdsource Basic Life Support for Out-of-Hospital Cardiac Arrest: The Singapore Experience.

OBJECTIVE: The Singapore myResponder is a novel smartphone application developed by the Singapore Civil Defence Force (SCDF) that notifies volunteer first responders of a suspected out-of-hospital cardiac arrest (OHCA) case and locations of Automated External Defibrillators (AED) in the vicinity so that they can assist with resuscitation. We aimed to examine the performance of this application, challenges encountered, and future directions. Methods: We analyzed data from the myResponder app since its launch from April 2015 to July 2019. The number of installations, registered community first responders, suspected OHCA cases, notifications sent by the app, percentage of responders who accepted activation and arrived at scene were reviewed. A subgroup of taxi driving responders (within a 1.5-kilometer response radius) carrying an AED under a subsequent pilot program was also analyzed. Results: By July 2019, 46,689 responders were registered in the myResponder app. There were a total of 19,189 cases created for suspected OHCA, with a median of 358 cases per month (IQR 330-430), in which 10,073 responders accepted activation from myResponder and 4,955 arrived on-scene. A total of 135,599 notifications were sent for these cases, with a median of 7.1 notifications per case (IQR 4.3-8.7). In 2019, the percentages of responders who accepted notification and arrived on scene were 45.8% and 24.1%, respectively. 43% (1110/2581) of responders arrived before EMS crew. Conclusion: The myResponder mobile application is a feasible smart technology solution to improve community response to OHCA, and to increase bystander CPR and AED use. Future directions include increasing the number of active responders, improving response rates, app performance, and better data capture for quality improvement.

Letrozole versus testosterone. a single-center pilot study of HIV-infected men who have sex with men on highly active anti-retroviral therapy (HAART) with hypoactive sexual desire disorder and raised estradiol levels.

INTRODUCTION: Since the advent of Highly Active Anti-Retroviral Therapy (HAART), men with HIV experience good quality of life and expect to have normal sexual function. However, it appears that men infected with HIV commonly complain of sexual problems. There is evidence that men on HAART develop low sexual desire that is associated with raised estradiol levels. It has been postulated that abnormal metabolism seen in this group of men increases the aromatization of testosterone to estradiol. We hypothesized that letrozole, an aromatase inhibitor that inhibits the conversion of testosterone to estradiol, would be beneficial in these men. AIM: The aim of this study was to compare the effects of testosterone vs. an aromatase inhibitor, letrazole, in HIV-infected men with raised estradiol and low sexual desire. METHODS: Thirteen men who have sex with men on HAART with low sexual desire as well as raised estradiol levels (>120 pmol/L) were randomly allocated to receive either parenteral testosterone (Sustanon 250 intramuscular injection) (N = 6) or letrozole 2.5 mg orally daily (N = 7) for 6 weeks. MAIN OUTCOME MEASURES: Sex steroid hormone assays, sex hormone-binding globulin, virological, hematological, and biochemical parameters were measured before and after treatment. Each subject was given the Spector Sexual Desire Inventory and the Depression/Anxiety Stress Scale before and immediately after treatment. Subjects were also asked to estimate the number of actual sexual acts before and after treatment. Results. Inventory data showed a rise in dyadic desire in both treatment arms. Mean actual sexual acts rose from 0.33 to 1.5 in the testosterone group and from 0.43 to 1.29 for the letrozole group. Luteinizing hormone increased in seven of seven men on letrozole. Serum testosterone increased in seven of seven men on letrozole. There were no adverse events from either medication. CONCLUSION: Letrozole may be useful in the management of men on HAART who have low sexual desire.