Deconstructing programmatic assessment.

We describe programmatic assessment and the problems it might solve in relation to assessment and learning, identify some models implemented internationally, and then outline what we believe are programmatic assessment's key components and what these components might achieve. We then outline some issues around implementation, which include blueprinting, data collection, decision making, staff support, and evaluation. Rather than adopting an all-or-nothing approach, we suggest that elements of programmatic assessment can be gradually introduced into traditional assessment systems.

Do different mattresses affect the quality of cardiopulmonary resuscitation?

OBJECTIVE: To determine the effect of different mattresses on cardiopulmonary resuscitation performance and establish whether emergency deflation of an inflatable mattress improves the quality of resuscitation. DESIGN AND SETTING: Randomised controlled cross-over trial performed in a general ICU PARTICIPANTS: Critical care staff from a general ICU. INTERVENTIONS: Cardiopulmonary resuscitation on a manikin on the floor or on a bed with a standard foam mattress and inflated and deflated pressure redistributing mattresses. Maximal compression force was measured at different bed heights. MEASUREMENTS AND RESULTS: Compression depth, duty cycle and rate and percentage correct expired air ventilation were recorded on a manikin. Compression depth was significantly lower on the foam (35.2 mm), inflated (37.2 mm) and deflated mattress (39.1 mm) than the floor (44.2 mm). There were no clinically important differences in duty cycle or compression rate. The quality of ventilation was poor on all surfaces. Maximal compression force declined as bed height increased. CONCLUSIONS: Resuscitation performance is adversely affected when performed on a bed (irrespective of mattress type) compared to the floor. There were no differences between the inflated and deflated mattresses, although the deflation process did not adversely affect performance. This study does not support the routine deflation of an inflated mattress during resuscitation and questions the potential benefits from using a backboard. The finding that bed height affects maximal compression forces, challenges the recommendation that cardiopulmonary resuscitation be performed with the bed at middle-thigh level and requires further investigation.