20 results on '"Graham, CA"'
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2. P-6 Cardiopulmonary resuscitation training for new medical graduates
- Author
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Scollon, D, primary and Graham, CA, additional
- Published
- 1996
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3. What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population?
- Author
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Rotheray KR, Cheung PS, Cheung CS, Wai AK, Chan DY, Rainer TH, and Graham CA
- Published
- 2012
4. Validation of the APLS age-based vital signs reference ranges in a Chinese population.
- Author
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Chan SS, Cattermole GN, Leung PY, Mak PS, Graham CA, and Rainer TH
- Published
- 2011
5. Performance of automated external defibrillators under conditions of in-flight turbulence.
- Author
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Hung KKC, Graham CA, Chan LK, Poon WK, Rainer TH, and Cocks RA
- Subjects
- Aerospace Medicine methods, Aircraft, Humans, Manikins, Materials Testing methods, Research Design, Defibrillators adverse effects, Defibrillators standards, Electric Countershock methods, Electric Countershock standards, Ventricular Fibrillation prevention & control
- Abstract
Introduction: Modern automated external defibrillators (AEDs) are designed to prevent shock delivery when excessive motion produces rhythm disturbances mimicking ventricular fibrillation (VF). This has been reported as a safety issue in airline operations, where turbulent motion is commonplace. We aimed to evaluate whether all seven AEDs can deliver shock appropriately in a flight simulator under turbulent conditions., Methods: The study was performed in a Boeing 747-400 full motion flight simulator in Hong Kong. An advanced life support manikin and arrhythmia generator were used to produce sinus rhythm (SR), asystole, and five amplitudes of VF, with a programmed change to SR in the event of an effective shock being delivered. All rhythms were tested at rest (no turbulence) and at four levels of motion (ground taxi vibration, and mild, moderate and severe in-flight turbulence). Success was defined as: 1. effective shock being delivered where the rhythm was VF successfully converted to SR; 2. no inappropriate shock being delivered for asystole or SR., Results: Five AEDs produced acceptable results at all levels of turbulence. Another was satisfactory for VF except at very fine amplitudes. One model was deemed unsatisfactory for in-flight use as its motion detector inhibited shocks at all levels of turbulence., Conclusion: Some AEDs designed primarily for ground use may not perform well under turbulent in-flight conditions. AEDs for possible in-flight or other non-terrestrial use should be fully evaluated by manufacturers or end-users before introduction to service., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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6. ViEWS in the emergency department.
- Author
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Cattermole GN, Graham CA, and Rainer TH
- Subjects
- Female, Humans, Male, Acute Disease, Hospitalization statistics & numerical data, Length of Stay statistics & numerical data, Severity of Illness Index
- Published
- 2014
- Full Text
- View/download PDF
7. Early risk stratification of patients with major trauma requiring massive blood transfusion.
- Author
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Rainer TH, Ho AM, Yeung JH, Cheung NK, Wong RS, Tang N, Ng SK, Wong GK, Lai PB, and Graham CA
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- Adult, Female, Hemorrhage etiology, Humans, Injury Severity Score, Male, Middle Aged, Retrospective Studies, Risk Assessment, Severity of Illness Index, Wounds and Injuries complications, Blood Transfusion methods, Hemorrhage therapy
- Abstract
Background: There is limited evidence to guide the recognition of patients with massive, uncontrolled hemorrhage who require initiation of a massive transfusion (MT) protocol., Objective: To risk stratify patients with major trauma and to predict need for MT., Designs: Retrospective analysis of an administrative trauma database of major trauma patients. A REGIONAL TRAUMA CENTRE: A regional trauma centres in Hong Kong., Patients: Patients with Injury Severity Score ≥ 9 and age ≥ 12 years were included. Burn patients, patients with known severe anemia and renal failure, or died within 24h were excluded., Main Outcome Measures: Delivery of ≥ 10 units of packed red blood cells (RBC) within 24h., Results: Between 01/01/2001 and 30/06/2009, 1891 patients met the inclusion criteria. 92 patients required ≥ 10 units RBC within 24h. Seven variables which were easy to be measured in the ED and significantly predicted the need for MT are heart rate ≥ 120/min; systolic blood pressure ≤ 90 mm Hg; Glasgow coma scale ≤ 8; displaced pelvic fracture; CT scan or FAST positive for fluid; base deficit >5 mmol/L; hemoglobin ≤ 7 g/dL; and hemoglobin 7.1-10 g/dL. At a cut off of ≥ 6, the overall correct classification for predicting need for MT was 96.9%, with a sensitivity of 31.5% and specificity of 99.7%, and an incidence of MT of 82.9%. The area under the curve was 0.889., Conclusion: A prediction rule for determining an increased likelihood for the need for massive transfusion has been derived. This needs validation in an independent data set., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
8. Mid-arm circumference can be used to estimate children's weights.
- Author
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Cattermole GN, Leung PY, Mak PS, Graham CA, and Rainer TH
- Subjects
- Child, Child, Preschool, Female, Humans, Infant, Male, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Anthropometry methods, Arm anatomy & histology, Body Weight
- Abstract
Introduction: Accurate measurement of children's weight is rarely possible in paediatric resuscitation, and rapid estimates are made to ensure appropriate drug and fluid doses and equipment selection. Weight is commonly estimated from formulae based on children's age, or from their height using the Broselow tape. Foot-length and mid-arm circumference have also been suggested as the basis of weight-estimation formulae., Objectives: To determine which of age, height, foot-length or mid-arm circumference had the strongest relationship with weight in healthy children, to derive a simple weight-estimation formula from the strongest correlate, and to compare its performance with existing weight-estimation tools., Methods: This was a population-based prospective observational study of Hong Kong Chinese children aged 1-11 years old last birthday. Weight was measured to the nearest 0.2 kg; height, foot-length and mid-arm circumference to the nearest 0.1 cm. Multiple regression analysis was used to determine the strongest independent relationships with weight, and linear regression analysis derived a weight-estimation formula. Accuracy and precision of this formula were compared with standard age-based and height-based weight-estimation methods., Results: Mid-arm circumference had the strongest relationship with weight, and this relationship grew stronger with age. The formula, weight [kg]=(mid-arm circumference [cm]-10) x 3, was at least as accurate and precise as the Broselow method and outperformed the age-based rule in school-age children, but was inadequate in pre-school children., Conclusion: This weight-estimation formula based on mid-arm circumference is reliable for use in school-age children, and an arm-tape could be considered as an alternative to the Broselow tape in this population., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2010
- Full Text
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9. Derivation of a prognostic score for identifying critically ill patients in an emergency department resuscitation room.
- Author
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Cattermole GN, Mak SK, Liow CH, Ho MF, Hung KY, Keung KM, Li HM, Graham CA, and Rainer TH
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- Adolescent, Adult, Aged, Aged, 80 and over, Cardiopulmonary Resuscitation mortality, Female, Follow-Up Studies, Hong Kong epidemiology, Humans, Male, Middle Aged, Prospective Studies, ROC Curve, Survival Rate trends, Young Adult, Cardiopulmonary Resuscitation statistics & numerical data, Critical Illness epidemiology, Intensive Care Units
- Abstract
Introduction: Several prognostic scores exist for critically ill patients, including APACHE II, Revised Trauma Score (RTS), Rapid Emergency Medicine Score (REMS) and Modified Early Warning Score (MEWS). However, there is no widely used score specifically designed to predict the likelihood of early intensive care unit (ICU) admission or death in undifferentiated emergency department (ED) resuscitation room patients. We aimed to derive such a score and compare it with other similar scores., Methods: This was a single centre study of consecutive adult resuscitation room patients over one month. Physiological and blood test variables were compared according to the composite primary outcome: admission to ICU or death within 7 days of attendance. Multivariate logistic regression was used to derive a prediction score which was compared with other scores using ROC (receiver operating characteristic) analysis., Results: 330 patients were included in the study, of whom 77 were admitted to ICU or died within 7 days. A prediction score was derived using the following parameters: systolic blood pressure; Glasgow coma score; blood glucose; bicarbonate; white cell count; and a history of metastates. This score significantly out-performed APACHE II, RTS, REMS and MEWS with an area under the ROC curve of 0.909 (95% CI 0.872-0.938)., Conclusion: The Prince of Wales Emergency Department Score (PEDS) is a new prognostic score to predict the likelihood of early ICU admission or death in undifferentiated resuscitation room patients. Further studies are needed to validate and refine this potentially useful tool.
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- 2009
- Full Text
- View/download PDF
10. EMS systems in China.
- Author
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Hung KK, Cheung CS, Rainer TH, and Graham CA
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- China, Humans, Delivery of Health Care organization & administration, Emergency Medical Services organization & administration, Regional Medical Programs organization & administration
- Abstract
The prehospital emergency service is the initial part of the Emergency Medical Service System (EMSS) in China, and is the de facto overall emergency medical service for China. As the EMSS in China continues to undergo rapid development, it faces the challenge of providing rapid response times with adequate coverage for this highly populated country. The recent Sichuan earthquake on 12 May 2008 tested the ability of the EMSS response. This article focuses on the prehospital emergency service of the EMSS and discusses the strengths and weaknesses of the current system.
- Published
- 2009
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- View/download PDF
11. EMS systems in Hong Kong.
- Author
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Graham CA, Cheung CS, and Rainer TH
- Subjects
- Ambulances statistics & numerical data, Emergency Medicine education, Hong Kong, Humans, Delivery of Health Care organization & administration, Emergency Medical Services organization & administration, Regional Medical Programs organization & administration
- Abstract
Emergency medical services (EMS) in Hong Kong, now a Special Administrative Region of the People's Republic of China, have a distinguished history spanning more than 50 years. This paper outlines the history and the development of the Hong Kong EMS, with a particular focus on the ambulance service, the design of the system and the training of its staff.
- Published
- 2009
- Full Text
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12. Timing of tracheal intubation in traumatic cardiac tamponade: a word of caution.
- Author
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Ho AM, Graham CA, Ng CS, Yeung JH, Dion PW, Critchley LA, and Karmakar MK
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- Algorithms, Blood Pressure, Cardiac Tamponade etiology, Heart Valve Prosthesis, Humans, Male, Middle Aged, Pericardiocentesis, Wounds, Stab complications, Cardiac Tamponade therapy, Intubation, Intratracheal methods, Positive-Pressure Respiration
- Abstract
Airway, breathing, and circulation are top priorities in any resuscitation. However, in cardiac tamponade, the decision to intubate the trachea and initiate positive pressure ventilation (PPV) should only be taken after consideration of the deleterious haemodynamic effects of positive intrathoracic pressure. We suggest that the threshold for intubation and PPV should be raised in tamponade and that intubation and PPV should, if possible, be timed so that relief of tamponade can immediately follow. In the trauma setting, emergency thoracotomy is the best approach. When intubation is unavoidable because of very low oxygen saturation or cardiac arrest, high ventilatory pressures should be avoided.
- Published
- 2009
- Full Text
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13. Evaluation of the performance of a modified Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system for critically ill patients in emergency departments in Hong Kong.
- Author
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Man SY, Chan KM, Wong FY, Wong KY, Yim CL, Mak PS, Kam CW, Lau CC, Lau FL, Graham CA, and Rainer TH
- Subjects
- Adult, Aged, Aged, 80 and over, Analysis of Variance, Female, Hong Kong epidemiology, Humans, Logistic Models, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, ROC Curve, Reproducibility of Results, Survival Rate, APACHE, Critical Illness, Emergency Service, Hospital organization & administration, Hospital Mortality, Resuscitation statistics & numerical data
- Abstract
Introduction: Numerous prognostic predictive models have been developed for critically ill patients, many of which are primarily designed for use in intensive care units. The objective of this study was to evaluate the accuracy of a modified Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system in predicting the mortality for critically ill patients managed in emergency department (ED) resuscitation rooms in Hong Kong., Method: A multi-centre, prospective study was conducted for patients managed in the resuscitation rooms of the EDs of four major hospitals, including one university teaching hospital. The primary outcome measure was 14 day all-cause mortality and the secondary outcome measure was the length of stay in hospital., Results: Of 867 patients recruited between 4 and 30 April 2004, 106 (12.2%) patients died. The modified APACHE II score was found to be significantly higher in non-survivors compared to survivors (mean+/-S.D.: 21.2+/-7.7 versus 14.4+/-7.1, p<0.001). The area under the curve for modified APACHE II in predicting mortality was 0.743 (95% CI, 0.696-0.790)., Conclusion: The modified APACHE II score is only a moderate predictor of mortality for critically ill patients managed in the resuscitation rooms of EDs in Hong Kong. A more ED specific scoring method is required.
- Published
- 2007
- Full Text
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14. Do trauma teams make a difference? A single centre registry study.
- Author
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Rainer TH, Cheung NK, Yeung JH, and Graham CA
- Subjects
- Adult, Aged, Female, Guideline Adherence, Hong Kong, Hospital Records, Humans, Male, Prospective Studies, Wounds and Injuries therapy, Patient Care Team statistics & numerical data, Trauma Centers standards, Wounds and Injuries mortality
- Abstract
Objective: To evaluate the association between trauma team activation according to well-established protocols and patient survival., Methods: Single centre, registry study of data collected prospectively from trauma patients (who were treated in a trauma resuscitation room, who died or who were admitted to ICU) of a tertiary referral trauma centre Emergency Department (ED) in Hong Kong. A 10-point protocol was used to activate rapid trauma team response to the ED. The main outcome measures were mortality, need for ICU care, or operation within 6h of injury., Results: Between 1 January 2001 and 31 December 2005, 2539 consecutive trauma patients were included in our trauma registry, of which 674 patients (mean age 43 years, S.D. 22; 71% male; 94% blunt trauma) met trauma call criteria. Four hundred and eighty two (72%) correctly triggered a trauma call, and 192 (28%) were not called ('undercall'). Patients were less likely to have a trauma call despite meeting criteria if they were aged over 64 years, had sustained a fall, had a respiratory rate <10 or >29 per minute, a systolic blood pressure between 60 and 89 mm Hg, or a GCS of 9-13. In a sub-group of moderately poor probability of survival (probability of survival, P(s), 0.5-0.75), the odds ratio for mortality in the undercall group compared with the trauma call group was 7.6 (95% CI, 1.1-33.0)., Conclusions: In our institution, undercalls account for 28% of patients who meet trauma call criteria and in patients with moderately poor probability of survival undercall is associated with decreased survival. Although trauma team activation does not guarantee better survival, better compliance with trauma team activation protocols optimises processes of care and may translate into improved survival.
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- 2007
- Full Text
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15. Mortality after trauma intubation without drugs in Scottish emergency departments.
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Graham CA, Wares GM, and Munro PT
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- Age Distribution, Cohort Studies, Databases, Factual, Drug Utilization, Humans, Intubation, Intratracheal statistics & numerical data, Male, Retrospective Studies, Scotland, Sex Distribution, Emergency Service, Hospital statistics & numerical data, Emergency Treatment methods, Intubation, Intratracheal mortality, Wounds and Injuries therapy
- Abstract
Background: Trauma patients who are intubated without anaesthetic drugs in the pre-hospital phase of care have universally poor outcomes. This study aimed to determine the mortality of trauma patients intubated without drugs in emergency departments in Scotland., Methods: This retrospective cohort study used the prospective Scottish Trauma Audit Group (STAG) database to identify how many patients were intubated and how many required drugs for intubation between 1 January 1999 and 31 December 2002. The mortality of those intubated with drugs and without drugs was determined from the database., Results: 24,756 patients were included in the STAG database. There were 1469 intubations: 1287 with drugs and 182 without drugs. 92.5% of all intubations were for blunt trauma. There was no difference in the proportion of males or median age between groups. Median GCS was 8 (E1M5V2) in the drugs group and 3 (E1M1V1) in the no drugs group (p<0.001). Median ISS was higher in those intubated without drugs (33 versus 25, p<0.001). Median RTS and probability of survival were lower in those intubated without drugs (both p<0.001). Mortality was higher in those intubated without drugs (91.2% versus 29.4%, p<0.001). Sixteen patients, intubated without drugs, survived. These patients had a higher median respiratory rate (9 versus 0, p=0.013) and higher median systolic blood pressure (80 mmHg versus 0 mmHg, p=0.041) than non-survivors., Conclusion: Trauma patients in Scottish emergency departments who are intubated without drugs have high mortality rates. Outcomes are not universally fatal and aggressive resuscitation efforts may be of benefit to a small number of such patients.
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- 2006
- Full Text
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16. CPR for children: one hand or two?
- Author
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Stevenson AG, McGowan J, Evans AL, and Graham CA
- Subjects
- Adult, Child, Child, Preschool, Cross-Over Studies, Female, Humans, Infant, Male, Manikins, Task Performance and Analysis, Cardiopulmonary Resuscitation methods, Pediatrics methods
- Abstract
Aims: Current guidelines for chest compressions in CPR advocate a one handed technique in children (1-8 years old) and a two handed technique in adults (>8 years old). No previous study has examined whether these two techniques generate different compression pressures. This study assesses the relative difference in intrathoracic compression pressures generated by one- and two handed chest compression techniques in a paediatric manikin., Methods: Randomised crossover design. Subjects performed both types of chest compressions on an adapted paediatric resuscitation manikin connected to a pressure transducer and personal computer. Ethical approval was granted., Results: A 30 volunteer subjects (9 male, 21 female) participated in the study. Their mean age was 30.8 years (S.D. 8.6), and mean weight was 70.5 kg (S.D. 12.8). The mean compression pressure was 86.6 mmHg (S.D. 13.68) for two handed and 75.1 mmHg (S.D. 12.02) for one handed (P < 0.001, paired t-test). The average peak compression pressure was 133.5 mmHg (S.D. 26.36) for two handed and 116.8 mmHg (S.D. 21.48) for one handed (P = 0.001, paired t-test); 29 found the two handed technique easier to perform., Conclusion: Two handed chest compression CPR seems to be easier to perform on a paediatric resuscitation manikin and produces significantly higher mean and peak pressures. Further work is needed to determine the comparative effects on children and which technique produces better clinical outcomes.
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- 2005
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17. Evaluation of a new method for the carotid pulse check in cardiopulmonary resuscitation.
- Author
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Graham CA and Lewis NF
- Subjects
- Adult, Carotid Arteries, Evaluation Studies as Topic, Humans, Palpation, Cardiopulmonary Resuscitation methods, Pulse methods
- Abstract
Background: The ability to determine the presence or absence of a central pulse remains a key skill in cardiopulmonary resuscitation (CPR) for healthcare providers, despite studies showing that they perform this poorly. The aim of this study was to evaluate a modified technique for palpation of the carotid pulse., Methods: Sixty seven undergraduate dental students were taught the standard method of carotid pulse detection during a basic life support session and were also taught a modified method. Each student was asked to palpate the carotid pulse of a volunteer in two positions (neck neutral and neck extended) with the volunteer on the floor and on a trolley. The time taken to identify the pulse was measured and the scenarios compared., Results: The time to detect the carotid pulse was reduced in three of the four scenarios (floor, neck extended P=0.0053, trolley neck neutral P=0.0070, trolley neck extended P=0.0024). The final scenario (floor, neck neutral) showed no improvement (P=0.36)., Conclusion: The new method of carotid pulse palpation results in a more rapid determination of the carotid pulse when it is present in all positions except with the neck neutral on the floor. This will only be clinically significant if trauma is suspected.
- Published
- 2002
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18. A scoring system for the assessment of basic life support ability.
- Author
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Graham CA and Lewis NF
- Subjects
- Adult, Humans, Students, Dental, Cardiopulmonary Resuscitation education, Educational Measurement
- Abstract
Introduction: There are no current validated scoring systems for the assessment of adult single rescuer basic life support (BLS) ability. A system was proposed and prospectively validated., Methods: The system was tested firstly on 12 skilled BLS providers (all instructors). It was then further evaluated on 75 undergraduate dental students, who were assessed before and after a standard training session on adult BLS., Results: All 12 skilled persons passed the test according to the system. The system successfully showed a positive training effect in the dental students. It correctly identified those who 'passed' after training, i.e. those were capable of providing effective BLS (71/75, 94.7%). It also correctly identified those who were not considered competent (4/71, 5.3%)., Conclusion: This is a simple, effective, objective system for assessment of basic life support. It is easily adaptable for the 1998 Guidelines on BLS.
- Published
- 2000
- Full Text
- View/download PDF
19. Appointment of a Resuscitation Training Officer is associated with improved survival from in-hospital ventricular fibrillation/ventricular tachycardia cardiac arrest.
- Author
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McGowan J, Graham CA, and Gordon MW
- Subjects
- Evaluation Studies as Topic, Female, Heart Arrest therapy, Humans, Male, Prospective Studies, Survival Analysis, Survival Rate, Tachycardia, Ventricular therapy, United Kingdom epidemiology, Ventricular Fibrillation therapy, Workforce, Cardiopulmonary Resuscitation education, Emergency Medicine education, Emergency Medicine organization & administration, Heart Arrest mortality, Inservice Training organization & administration, Outcome Assessment, Health Care, Tachycardia, Ventricular mortality, Ventricular Fibrillation mortality
- Abstract
Objective: To determine if the appointment of a Resuscitation Training Officer improves survival to discharge from in-hospital ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest., Design: A 22-month prospective study., Setting: A 1100-bed teaching hospital., Subjects: All inpatients suffering ventricular fibrillation or ventricular tachycardia cardiorespiratory arrests., Interventions: Appointment of a Resuscitation Training Officer at start of study, who introduced coordinated resuscitation training for all staff., Main Outcome: Survival to discharge., Result: Improvement in survival to discharge of 20-75% (P<0.03, Spearman Rank Correlation test)., Conclusion: Appointment of a Resuscitation Training Officer is associated with improved survival to discharge in ventricular fibrillation and ventricular tachycardia in-hospital cardiac arrest.
- Published
- 1999
- Full Text
- View/download PDF
20. Cardiopulmonary resuscitation training for UK undergraduate dental students.
- Author
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Graham CA and Scollon D
- Subjects
- Data Collection, Humans, Schools, Dental, Students, Dental, United Kingdom, Cardiopulmonary Resuscitation education, Education, Dental
- Abstract
Cardiopulmonary resuscitation (CPR) is a vital skill which must be mastered by all health care professionals. The General Dental Council recommends that it is taught to all UK dental undergraduates. This study was done to elicit how many schools teach aspects of Basic and Advanced Life Support to their students, how often and whether they assess their students. All UK schools teach Basic Life Support (BLS) at least once, but a lower proportion assess their students formally and only three schools teach BLS in each year of the course. Only 64% (9/14) of respondents thought their students received enough training to be able to cope with the initial stages of an emergency on their own. Thus, although the level of BLS training is probably acceptable at present, further improvement of CPR training in UK Dental Schools is advisable.
- Published
- 1996
- Full Text
- View/download PDF
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