The nationwide impact of COVID-19 on life support courses. A retrospective evaluation by Resuscitation Council UK.

Aim: To determine the impact of the COVID-19 pandemic on Resuscitation Council UK Advanced Life Support (ALS) and Immediate Life Support (ILS) course numbers and outcomes. Methods: We conducted a before-after study using course data from the Resuscitation Council UK Learning Management System between January 2018 and December 2021, using 23 March 2020 as the cut-off between pre- and post-pandemic periods. Demographics and outcomes were analysed using chi-squared tests and regression models. Results: There were 90,265 ALS participants (51,464 pre-; 38,801 post-) and 368,140 ILS participants (225,628 pre-; 142,512 post-). There was a sharp decline in participants on ALS/ILS courses due to COVID-19. ALS participant numbers rebounded to exceed pre-pandemic levels, whereas ILS numbers recovered to a lesser degree with increased uptake of e-learning versions. Mean ALS course participants reduced from 20.0 to 14.8 post-pandemic (P < 0.001).Post-pandemic there were small but statistically significant decreases in ALS Cardiac Arrest Simulation Test pass rates (from 82.1 % to 80.1 % (OR = 0.90, 95 % CI = 0.86-0.94, P < 0.001)), ALS MCQ score (from 86.6 % to 86.0 % (mean difference = -0.35, 95 % CI -0.44 to -0.26, P < 0.001)), and overall ALS course results (from 95.2 %to 94.7 %, OR = 0.92, CI = 0.85-0.99, P = 0.023). ILS course outcomes were similar post-pandemic (from 99.4 % to 99.4 %, P = 0.037). Conclusion: COVID-19 caused a sharp decline in the number of participants on ALS/ILS courses and an accelerated uptake of e-learning versions, with the average ALS course size reducing significantly. The small reduction in performance on ALS courses requires further research to clarify the contributing factors.

Feedback in advanced life support: A quality improvement initiative.

AIM: To identify participant, course characteristics and centre factors associated with participant satisfaction and ALS outcomes. METHODS: 17,690 participants enrolled on ALS courses between 1st December 2017 and 30th November 2018. Participant, course and centre characteristics were explored in relation to course learning outcomes and participant experience. Learning outcomes were assessed through a post-course MCQ score and technical and non-technical skills through a cardiac arrest simulation test (CAS-Test). Successful completion of knowledge and skill-based assessments led to overall course success. Participant feedback was collected on a post-course questionnaire. Multivariable analyses identified variables associated with course outcomes and feedback. Adjusted funnel plots compared inter-course centre outcomes. RESULTS: Mean post-course MCQ score was 86.7% (SD = 6.7). First attempt CAS-Test pass rate was 82.6% and overall course pass rate 94.4%. Participant characteristics explained the majority of variation between course centres. Characteristics associated with knowledge, skill and course outcomes were age, prior experience, pre-course MCQ score, course type, ethnicity, place of work, profession and seniority. Feedback scores were predicted by course type, pre-course MCQ, ethnicity, profession and seniority. CONCLUSION: This is the first study to identify variables associated with both ALS feedback scores and assessment outcomes. It has demonstrated that both course outcomes and participant experience are similar across a large number of course centres. Identifying the demographic traits of participants who may struggle with ALS, may enable bespoke support from an earlier stage. Analysis of feedback scores and outcomes enables ongoing appraisal and targeted improvement of the Resuscitation Council UK ALS course.

e-Learning in Advanced Life Support-What factors influence assessment outcome?

AIM: To establish variables which are associated with favourable Advanced Life Support (ALS) course assessment outcomes, maximising learning effect. METHOD: Between 1 January 2013 and 30 June 2014, 8218 individuals participated in a Resuscitation Council (UK) e-learning Advanced Life Support (e-ALS) course. Participants completed 5-8h of online e-learning prior to attending a one day face-to-face course. e-Learning access data were collected through the Learning Management System (LMS). All participants were assessed by a multiple choice questionnaire (MCQ) before and after the face-to-face aspect alongside a practical cardiac arrest simulation (CAS-Test). Participant demographics and assessment outcomes were analysed. RESULTS: The mean post e-learning MCQ score was 83.7 (SD 7.3) and the mean post-course MCQ score was 87.7 (SD 7.9). The first attempt CAS-Test pass rate was 84.6% and overall pass rate 96.6%. Participants with previous ALS experience, ILS experience, or who were a core member of the resuscitation team performed better in the post-course MCQ, CAS-Test and overall assessment. Median time spent on the e-learning was 5.2h (IQR 3.7-7.1). There was a large range in the degree of access to e-learning content. Increased time spent accessing e-learning had no effect on the overall result (OR 0.98, P=0.367) on simulated learning outcome. CONCLUSION: Clinical experience through membership of cardiac arrest teams and previous ILS or ALS training were independent predictors of performance on the ALS course whilst time spent accessing e-learning materials did not affect course outcomes. This supports the blended approach to e-ALS which allows participants to tailor their e-learning experience to their specific needs.

E-learning in advanced life support--an evaluation by the Resuscitation Council (UK).

AIM: To descriptively analyse the outcomes following the national roll out of an e-Learning advanced life support course (e-ALS) compared to a conventional 2-day ALS course (c-ALS). METHOD: Between 1st January 2013 and 30th June 2014, 27,170 candidates attended one of the 1350 Resuscitation Council (UK) ALS courses across the UK. 18,952 candidates were enrolled on a c-ALS course and 8218 on an e-ALS course. Candidates participating in the e-ALS course completed 6-8h of online e-Learning prior to attending the 1 day modified face-to-face course. Candidates participating in the c-ALS course undertook the Resuscitation Council (UK) 2-day face-to-face course. All candidates were assessed by a pre- and post-course MCQ and a practical cardiac arrest simulation (CAS-test). Demographic data were collected in addition to assessment outcomes. RESULTS: Candidates on the e-ALS course had higher scores on the pre-course MCQ (83.7%, SD 7.3) compared to those on the c-ALS course (81.3%, SD 8.2, P<0.001). Similarly, they had slightly higher scores on the post-course MCQ (e-ALS 87.9%, SD 6.4 vs. c-ALS 87.4%, SD 6.5; P<0.001). The first attempt CAS-test pass rate on the e-ALS course was higher than the pass rate on the c-ALS course (84.6% vs. 83.6%; P=0.035). The overall pass rate was 96.6% on both the e-ALS and c-ALS courses (P=0.776). CONCLUSION: The e-ALS course demonstrates equivalence to traditional face-to-face learning in equipping candidates with ALS skills when compared to the c-ALS course. Value is added when considering benefits such as increased candidate autonomy, cost-effectiveness, decreased instructor burden and improved standardisation of course material. Further dissemination of the e-ALS course should be encouraged.

Influence of acid washing on the surface morphology of ionomer glasses and handling properties of glass ionomer cements.

Acid washing is known to influence the handling properties of ionomer glasses used in glass ionomer cements due to the production of an ion depleted-zone on the surface of the glass particles. The influence of acid washing on the particle size distribution and surface area of four glasses was examined by scanning electron microscopy (SEM), particle size analysis (PSA) and accelerated surface area porosimetry (ASAP) and the working and setting times of cements, produced from the glasses, correlated to changes in surface morphology. A linear relationship was found between the specific surface area of acid-washed SiO(2)-Al(2)O(3)-XF(2)-P(2)O(5) glasses (X being either calcium or strontium) and their cement working and setting times. These changes directly correlated with increases in the mesopore volume. However, the influence of acid washing on the surface morphology was also found to be glass composition-dependent with the addition of sodium into the glass network resulting in no significant change in the surface area or mesopore volume despite changes in the working and setting time. Through examination of the influence of acid washing and glass composition on the specific surface area improvements in the control of the working and setting times of glass ionomer cements may be achieved.

The influence of capsule geometry and cement formulation on the apparent viscosity of dental cements.

OBJECTIVES: This work examines the influence of specific aspects of capsule design and cement formulation on the handling properties of the extruded glass polyalkenoate cement (GPC) pastes. METHODS: A commercial metal reinforced GPC, HiDense, and experimental GPCs were extruded using a tensometer at loads and rates maintained within end-user limits and the apparent viscosity of the cement paste was determined by applying Poiseuille's law. The influence of the extrusion procedure (mixing time and ram speed), capillary geometry (length and diameter) and cement composition (powder: liquid (P:L) ratio, tartaric acid content and poly(acrylic acid) molar mass) on the apparent viscosity of the cement paste was evaluated. RESULTS: The examined GPCs behaved as non-Newtonian, pseudoplastic materials and exhibited a yield stress. Variation of the geometry of the capsule capillary resulted in the apparent viscosity of HiDense increasing by 7% as the length increased from 5 to 15mm whilst halving the capillary diameter from 2 to 1mm resulted in a 63% decrease in the apparent viscosity and a 600% increase in the extrusion load. The apparent viscosity of the experimental GPCs was increased by an increase in the P:L ratio and, in general, by the PAA molar mass, whilst the concentration-dependent effect of (+)-tartaric acid (TAA) indicates a working time dependence on TAA content. CONCLUSIONS: Using this approach optimisation of the rheological properties can be achieved by manipulation of the capsule design and cement formulation due to the dependency of the apparent viscosity on the capillary diameter, TAA content, P:L ratio and poly(acrylic acid) molar mass.