Emotional Impact of Cardiopulmonary Resuscitation Training on High School Students.

BACKGROUND: The American Heart Association (AHA) has implemented several programs to educate the public about cardiopulmonary resuscitation (CPR). A common issue in bystander CPR is the fear of hurting the victim. As a result, the victim may not receive CPR in time. The purpose of this study was to measure the emotional impact of CPR training on high school students using two approved AHA courses. METHODS: A total of 60 students participated in this study. These students had a mean age of 15.4 ± 1.2 years old and were selected from a high school in Southern California. Subjects were divided into two groups, Basic Life Support (BLS) (n1 = 31) and Hands-Only™ CPR (n2 = 29). Emotional impacts were assessed by having each subject answer a questionnaire based on given scenarios before and after their training session. RESULTS: There was a significant difference in both groups when comparing positive-emotion scores before and after the training (BLS: 30.3 ± 6.0 vs. 34.5 ± 6.7, p < 0.001; Hands-Only 27.9 ± 5.0 vs. 32.1 ± 6.5, p < 0.001). In addition, both groups showed significant reductions in negative-emotion scores (BLS: 29.2 ± 6.7 vs. 23.7 ± 6.5, p < 0.001 and Hands-Only: 26.8 ± 6.1vs. 24.8 ± 7.7, p = 0.05). CONCLUSION: Our results indicate that the AHA programs have positive effects on students' emotional response. We recommend that future studies include an in-depth study design that probes the complexity of students' emotions after completing an AHA session.

Diverse Inhaler Devices: A Big Challenge for Health-Care Professionals.

BACKGROUND: The current variety of medication inhaler devices can be confusing to patients due to the many different delivery systems. Many health-care professionals who prescribe these devices may not be educated properly about the administration techniques for different inhalers. The objectives of this study were to evaluate various health-care providers' knowledge of specific inhaler devices and to assess their ability to retain this knowledge for a minimum period of 3 months. METHODS: This was a prospective study that included 4 different health-care professional groups (physicians, respiratory therapists, registered nurses, and pharmacists). All subjects underwent baseline written and practical tests. A checklist was developed for the practicum test for each inhaler on the correct delivery method. The written examination tested knowledge of 4 different inhaler techniques with true or false questions. Then subjects watched an instructional video that demonstrated the correct method of delivery for each device. Last, subjects were retested on the practicum and written tests after a minimum lapse of 3 months. RESULTS: The distribution of written and practical scores at baseline and postintervention was approximately normal (P > .05). The baseline written scores were significantly different across groups (P = .002). The mean written score of respiratory therapists was significantly higher than those of registered nurses and physicians (P = .02 and .01, respectively). Similarly, the baseline practical scores were significantly different across groups (P < .001). The mean practical score of respiratory therapists was significantly higher compared with those of registered nurses and physicians (P = .002 and P < .001, respectively). CONCLUSIONS: We found a suboptimal number of medical professionals who have the proper knowledge base and technical skill to teach different inhaler device techniques. In order to increase the simplicity and effectiveness of delivering inhaler medication, we hope that the industry will provide more uniformity for future inhaler devices.

Does hyperbaric oxygen therapy have the potential to improve salivary gland function in irradiated head and neck cancer patients?

Following radiotherapy, many patients with osteoradionecrosis suffer from xerostomia, thereby decreasing their quality of life. Patients can develop problems with speech, eating, increased dental caries, dysphagia, fractured dentition, chronic refractory osteomyelitis and osteoradionecrosis. Symptoms associated with salivary gland dysfunction can be severe enough that patients terminate the course of their radiotherapy prematurely due to the decrease in their quality of life. Currently, the only treatments available to patients are palliative. A definitive treatment has yet to be discovered. Head and neck cancers, which comprise 5% of overall cancer treatments, rank 8th most expensive to treat in the United States today. Hyperbaric oxygen is being considered for the therapy of radiated salivary glands because it has been shown to stimulate capillary angiogenesis and fibroplasia in radiation treated tissues. It has been hypothesized that salivary acinar cells undergo apoptosis following radiation therapy. The purpose of this paper is to discuss the mechanisms of salivary gland injury and evaluate whether hyperbaric oxygen therapy improves salivary gland function in patients who develop xerostomia and osteoradionecrosis following head and neck radiation.

The pacific chapter annual meeting of the undersea & hyperbaric medical society.

The following is the summary report on the UHMS Pacific Chapter Annual Meeting held in Long Beach in October 2010. The conference provided the latest updates on scientific, technical and organizational aspects of Hyperbaric and Diving Medicine. Invited speakers gave series of lectures dealing with current standards of clinical practice and presenting the results of laboratory investigations with particular emphasis on mechanisms of hyperbaric oxygen therapy. Scientific sessions were accompanied by vendor exhibits and social events.

The combined effect of a three-channel electrode delivery system with local heat on the healing of chronic wounds.

BACKGROUND: Historically, electrical stimulation (ES) has been used as a treatment for wound care. However, some studies show wounds healing with ES, whereas others do not. Part of the difficulty can be resolved by using heat to help dilate blood vessels, but an inherent problem with ES is uneven currents across the wound due to the use of only two electrodes. Therefore, we designed and tested a multi-electrode ES device in combination with local warming of the wound in non-healing chronic ulcers. STUDY DESIGN: Eighteen subjects (mean +/- SD age, 35.7 +/- 21.3 years) with chronic ulcers (no healing for 26.1 +/- 24.6 months) received ES treatment three times a week for 4 weeks. A heat lamp was used before and during ES to keep the wound and area surrounding the wound warm (37 degrees C). ES was applied for 30 min with biphasic sine wave stimulation at a frequency of 30 Hz, pulse width of 250 micros, and current of about 20 mA. Skin blood flow (BF) in and around the wound was measured with a laser Doppler imager. Wound size was measured prior to each treatment. RESULTS: Over the 1-month period, the mean wound area significantly decreased by 43.4 +/- 44.5% (P < 0.05), and wound volume decreased by 57.0 +/- 27.9% (P < 0.05). Skin BF significantly increased after application of ES and local heat (P < 0.05). The skin BF response decreased as time progressed and the wound healed. CONCLUSIONS: Thus, in this pilot study, application of a three-channel ES system in combination with local heat is effective in the healing of non-healing chronic wounds. Future studies should examine a larger population with variables such as treatment duration, number of days, or length of treatment to optimize the effect of ES on healing of non-healing chronic wounds.

 prediction of wound healing outcome using skin perfusion pressure and transcutaneous oximetry: a single-center experience in 100 patients.

Chronic lower extremity wounds are challenging and typically occur in patients with complicating conditions such as diabetes and peripheral vascular disease. Noninvasive modalities developed to assess wound healing potential, such as transcutaneous oximetry (TcPO2), present problems including lengthy test time, variable results, and anatomical limitations. Skin perfusion pressure (SPP) testing appears to be a timely, objective, and reliable alternative. This prospective, single center, comparative study evaluated TcPO2 and SPP test results in 100 patients with chronic extremity wounds to determine their accuracy and usefulness in predicting wound healing potential. Concomitant baseline SPP and TcPO2 were measured and used as predictors of successful wound healing. A threshold of < 30 mmHg was selected as the cutoff below which the test was considered significantly abnormal and indicative of a wound that was unlikely to heal. Follow-up evaluations were conducted for 12 months or until healing, whichever occurred first. The study was evenly balanced for gender distribution and the mean age of the population was 63.4 years (range 19-94). Wounds were secondary to underlying diabetic, arterial, or venous conditions. SPP alone successfully predicted wound outcome in 87% of the cohort compared to TcPO2 at a rate of 64% (P < 0.0002). Furthermore, skin perfusion pressure was more sensitive in its ability to predict wound healing relative to TcPO2 (90% versus 66%; P <0.0001). SPP with values ≥ 30 mmHg is a useful positive independent predictor of wound healing potential. The continued use and investigation of SPP as a reliable and objective measurement tool in wound assessment protocols and other microperfusion assessments are recommended.

The thermal effect on the blood flow response to electrical stimulation.

BACKGROUND: Wounds, especially in the elderly, can be life threatening. One modality which allegedly increases blood flow (BF) as an aid to heal chronic wounds is electrical stimulation. This technique applies electrical current (ES) across wounds. However, while many studies show positive findings, others do not. The purpose of this investigation was to investigate some of this inconsistency in results by determining the effect of environmental temperature on the circulation of the skin which may negate the effects of electrical stimulation in a clinical setting. MATERIAL/METHODS: Ten people with no wounds, controls (C), and 12 people with wounds (W) were examined in a thermally neutral or cool room (20 degrees C) and a warm room (34 degrees C) to observe the effect of reducing sympathetic vasoconstrictor activity on the response to 5 and 15 mA sine wave biphasic ES delivered by 2x2 cm surface electrodes. RESULTS: C and W subjects showed a greater BF in the skin in a warm room. In group C, after 30 minutes of stimulation at a current of 15 milliamps, BF increased significantly (p<0.05) but by an average of only 4 flux in the cool room. In the warm environment, BF increased significantly (p<0.01) by 19.3+/-7 flux and increased further during the 60 minute recovery phase. In the W group, BF during ES increased much more during stimulation in a warm room compared to a cool room. CONCLUSIONS: The results show that local vasoconstriction due to exposure to a warm global temperature greatly increases the response of the skin the ES.

Mechanisms of hyperbaric oxygen and neuroprotection in stroke.

Cerebral vascular diseases, such as neonatal encephalopathy and focal or global cerebral ischemia, all result in reduction of blood flow to the affected regions, and cause hypoxia-ischemia, disorder of energy metabolism, activation of pathogenic cascades, and eventual cell death. Due to a narrow therapeutic window for neuroprotection, few effective therapies are available, and prognosis for patients with these neurological injuries remains poor. Hyperbaric oxygen (HBO) has been used as a primary or adjunctive therapy over the last 50 years with controversial results, both in experimental and clinical studies. In addition, the mechanisms of HBO on neuroprotection remain elusive. Early applications of HBO within a therapeutic window of 3-6h or delayed but repeated administration of HBO can either salvage injured neuronal tissues or promote neurobehavioral functional recovery. This review explores the discrepancies between experimental and clinical observations of HBO, focusing on its therapeutic window in brain injuries, and discusses the potential mechanisms of HBO neuroprotection.

A dual closed-loop control system for mechanical ventilation.

OBJECTIVE: Closed-loop mechanical ventilation has the potential to provide more effective ventilatory support to patients with less complexity than conventional ventilation. The purpose of this study was to investigate the effectiveness of an automatic technique for mechanical ventilation. METHODS: Two closed-loop control systems for mechanical ventilation are combined in this study. In one of the control systems several physiological data are used to automatically adjust the frequency and tidal volume of breaths of a patient. This method, which is patented under US Patent number 4986268, uses the criterion of minimal respiratory work rate to provide the patient with a natural pattern of breathing. The inputs to the system include data representing CO2 and O2 levels of the patient as well as respiratory compliance and airway resistance. The I:E ratio is adjusted on the basis of the respiratory time constant to allow for effective emptying of the lungs in expiration and to avoid intrinsic positive end expiratory pressure (PEEP). This system is combined with another closed-loop control system for automatic adjustment of the inspired fraction of oxygen of the patient. This controller uses the feedback of arterial oxygen saturation of the patient and combines a rapid stepwise control procedure with a proportional-integral-derivative (PID) control algorithm to automatically adjust the oxygen concentration in the patient's inspired gas. The dual closed-loop control system has been examined by using mechanical lung studies, computer simulations and animal experiments. RESULTS: In the mechanical lung studies, the ventilation controller adjusted the breathing frequency and tidal volume in a clinically appropriate manner in response to changes in respiratory mechanics. The results of computer simulations and animal studies under induced disturbances showed that blood gases were returned to the normal physiologic range in less than 25 s by the control system. In the animal experiments understeady-state conditions, the maximum standard deviations of arterial oxygen saturation and the end-tidal partial pressure of CO2 were +/- 1.76% and +/- 1.78 mmHg, respectively. CONCLUSION: The controller maintained the arterial blood gases within normal limits under steady-state conditions and the transient response of the system was robust under various disturbances. The results of the study have showed that the proposed dual closed-loop technique has effectively controlled mechanical ventilation under different test conditions.

Closed-loop control if the inspired fraction of oxygen in mechanical ventilation.

OBJECTIVE: Supplemental oxygen treatment of patients on mechanical ventilation is crucial in maintaining the patients' oxygen levels in the normal range. The purpose of this study was to evaluate the effectiveness of a closed-loop controller for automatic adjustment of the fraction of inspired oxygen, FIO2. More specifically, the aim of the study was to assess the robustness of the controller in correcting hypoxemia as well as its effectiveness in prevention of hyperoxemia and oxygen toxicity. METHODS: The microprocessor-based feedback control system combines a rapid control algorithm with a proportional-integral-derivative (PID) control procedure to automatically adjust FIO2. The system is designed to prevent hypoxemia by applying a stepwise control procedure in response to rapid declines in arterial oxygen saturation while fine-tuning FIO2 and avoiding hyperoxemia by resuming to the PID control procedure when appropriate. The system includes a sophisticated safeguard unit which is designed to communicate any oxygenation problems or measurement artifacts to the medical personnel while keeping FIO2 at a safe and sufficiently high level. The control system has been tested by using computer simulations as well as animal studies. RESULTS: In response to different disturbances, the arterial oxygen saturation returned to the normal safe range within less than 20 seconds, thereby avoiding any untoward effects of hypoxemia. Under steady state conditions, the variations in arterial oxygen saturation were kept within +/- 3% of the mean value. The controller corrected hypoxemia within seconds while preventing hyperoxemia, rejecting artifacts, and minimizing exposure to high concentrations of oxygen. CONCLUSION: The results of the study attest to the reliability of the proposed closed-loop control scheme for automatic adjustment of FIO2. Further evaluation of the controller will require testing the effectiveness of the system on different patient groups.