Liaison Committee Research Articles

Navigating the liminal space: Enhancing film teaching through anonymous feedback, digital collages, and advocacy

This reflective piece focuses on the strategies of designing seminars that foster inclusivity and belonging, mainly when teaching in a liminal space as a Graduate Teaching Assistant (GTA). It requires a commitment to understanding diverse student needs, including A-level subjects, learning difficulties, neurodiversity, LGBTQIA+ identities, ethnicity, socio-economic backgrounds, and more. Alongside the module convenor’s guidance and departmental procedures, a GTA’s identity and expertise play a crucial role in shaping the classroom atmosphere. My interdisciplinary PhD research, which focuses on co-creating films with participants facing mental health challenges, informs my view of students as co-creators. As a Staff-Student Liaison Committee (SSLC) representative, I am dedicated to upholding students’ dignity, autonomy, and contributions to the university and society while aiming to provide them with the ethical understanding needed to navigate complex 21st-century challenges. After each seminar, I value anonymous student feedback to tailor my content, listening to their needs and questions, and incorporating audiovisual and interactive material to promote participation, especially among quieter students. With this piece, by sharing my lived experiences as a GTA, I intend to contribute to a collective knowledge base and foster dialogue and collaboration among my peers.

2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. In the United States, drowning is the leading cause of death in children 1 to 4 years of age and second leading cause of death due to unintentional injury in those aged 5 to 14 years. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest due to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Academy of Pediatrics and the American Heart Association. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Academy of Pediatrics and the American Heart Association. The writing group used these reviews to update its recommendations aimed at resuscitation from cardiac arrest following drowning in children.

2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. The World Health Organization estimates that there are ≈236 000 deaths due to drowning worldwide each year. Significant efforts have focused on creating systems to prevent drowning, but an average of 4000 fatal and 8000 nonfatal drownings still occur annually in the United States—likely an underestimate. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest attributable to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, a boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Heart Association and the American Academy of Pediatrics. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Heart Association and American Academy of Pediatrics. The writing group used these reviews to update its recommendations aimed at resuscitation of cardiac arrest following drowning in adults and children.

Comparing Scoring Consistency of Large Language Models with Faculty for Formative Assessments in Medical Education.

The Liaison Committee on Medical Education requires that medical students receive individualized feedback on their self-directed learning skills. Pre-clinical students are asked to complete multiple spaced critical appraisal assignments. However, the individual feedback requires significant faculty time. As large language models (LLMs) can score and generate feedback, we explored their use in grading formative assessments through validity and feasibility lenses. To explore the consistency and feasibility of using an LLM to assess and provide feedback for formative assessments in undergraduate medical education. This was a cross-sectional study of pre-clinical students' critical appraisal assignments at University of Illinois College of Medicine (UICOM) during the 2022-2023 academic year. An initial sample of ten assignments was used to develop a prompt. For each student entry, the de-identified assignment and prompt were provided to ChatGPT 3.5, and its scoring was compared to the existing faculty grade. Differences in scoring of individual items between ChatGPT and faculty were assessed. Scoring consistency using inter-rater reliability (IRR) was calculated as percent exact agreement. Chi-squared test was used to determine if there were significant differences in scores. Psychometric characteristics including internal-consistency reliability, area under precision-recall curve (AUCPR), and cost were studied. In this cross-sectional study, 111 pre-clinical students' faculty graded assignments were compared with that of ChatGPT and the scoring of individual items was comparable. The overall agreement between ChatGPT and faculty was 67% (OR = 2.53, P < 0.001); mean AUCPR was 0.69 (range 0.61-0.76). Internal-consistency reliability of ChatGPT was 0.64 and its use resulted in a fivefold reduction in faculty time, and potential savings of 150 faculty hours. This study of psychometric characteristics of ChatGPT demonstrates the potential role for LLMs to assist faculty in assessing and providing feedback for formative assignments.

Interactive Serious Game to Teach Basic Life Support Among Schoolchildren in Brazil: Design and Rationale.

Cardiovascular diseases are leading causes of death and morbidity worldwide. CPR and early defibrillation significantly enhance survival rates. Serious Games (SG) improve learning through entertainment. Current strategies target Cardiopulmonary resuscitation for communities and schoolchildren, but none have been validated for children in low-to-middle-income settings. The SG Children Save Hearts, developed in Brazil, teaches the five resuscitation steps according to International Liaison Committee on Resuscitation 2020 guidelines and requires formal usability assessment. The study aimed to evaluate the usability of SG Children Save Hearts among IT and healthcare professionals using the System Usability Scale (SUS). The usability test was conducted in August 2022 in the university's IT department. The game was developed targeting schoolchildren aged 7 to 17. Categorical variables as absolute and relative frequencies, while continuous variables were presented as median with interquartile range (IQR). Normality was assessed using the Shapiro-Wilk test. Comparisons between IT and healthcare professionals were made using the independent t-test for normal distributions or the Mann-Whitney U test for non-normal distributions. We included 17 volunteers with a mean age of 22 years (IQR 20-26). All participants played the game and completed a 10-question survey on its usability using a Likert-type scale. The final grade was converted to a 0 to 100 scale, with a grade above 70 considered acceptable for a minimum viable product. The mean SUS score was 75 (IQR 72.5-87.5). Healthcare professionals gave higher grades to all five domains compared to IT professionals. The average time spent playing the game was 3.2 minutes. Novel technologies have shown promising results for CPR teaching using active teaching methods, but face challenges in developing countries, such as language barriers, device acquisition, cultural differences, and technical support. To our knowledge, this is the first SG developed in portuguese for brazilian schoolchidren. Despite some usability issues, the SG Children Save Hearts is considered adequate for teaching CPR to schoolchildren in Brazil.

Construction and psychometric validation in Spanish schoolchildren of a knowledge questionnaire on basic life support and Automated External Defibrillator (ConocES-BLS/AED) in Spain

The 60 % of cardiac arrests happen in the out-of-hospital setting. In 2023, the International Liaison Committee on Resuscitation issued a statement entitled “Children save lives”, recommending the teaching of basic life support to children from the age of 12. However, we have not identified validated instruments that assess the level of knowledge of schoolchildren about BLS and AED. Objective: Construction and psychometric validation of a questionnaire to assess knowledge on Basic Life Support (BLS) and Automated External Defibrillator (AED) in primary to secondary school children. Method: Cross-sectional descriptive study of validation of the questionnaire consisting of several phases: construction of the questionnaire on knowledge on BLS and AED (ConocES-BLS/AED), content validation, pilot test and psychometric validation. Results: The ConocES-SVB/AED questionnaire was constructed, content validation was carried out by 14 experts, the pilot test carried out on 105 students reported good reliability (0.84), and finally with the psychometric validation a questionnaire composed of 12 items was obtained and psychometrically validated using the Item Response Theory in a final sample of 182 participants. Adequate fit values and acceptable reliability (0.65) were obtained, demonstrating its usefulness to accurately measure the level of knowledge about SVB/AED maneuvers in schoolchildren. Conclusions: The created and validated questionnaire provides educators with a fundamental resource to identify areas of lack of knowledge, improve and design effective educational interventions for schoolchildren on SVB/AED maneuvers.

CPR Memory and Skill Degradation Among Non-Allied Healthcare Professionals

Cardiopulmonary Resuscitation is defined by the Mayo Clinic as a lifesaving technique that is useful in many emergencies, such as a heart attack, stroke, choking, or drowning, in which someone’s breathing and heartbeat have stopped.Under the guidelines put forth by the International Liaison Committee on Resuscitation (ILCOR) and the Emergency Cardiovascular Care Organization (ECC), the American Red Cross and American Heart Association currently require that an individual’s CPR certification be renewed every two years. However, data has suggested that non-allied healthcare providers, such as school-based personnel, may require more regular training to maintain required CPR proficiency levels. Four hundred non-allied healthcare professionals from a school district in central Georgia were CPR-certified under the American Heart Association (AHA) Heart-Saver curriculum. Participants included 153 males and 247 females from elementary, middle, and high school settings. Participants included administrators, teachers, coaches, and staff. Two tenured college professors from the School of Health and Human Performance were responsible for teaching and certifying study participants. Each of these professors possessed a minimum of five years of CPR certification experience with the American Heart Association. Course sizes were limited to 12-15 participants. All CPR certification courses were implemented under standardized, controlled circumstances. Following the initial certification, twenty-five percent of participants were randomly selected to be reassessed at either three, six, nine, or twelve months, respectively, to determine memory and skill degradation rates and patterns. Degradation of declarative and procedural knowledge was observed during subsequent retest sessions at each of the three-, six-, nine-, and twelve-month marks. Scores depreciated approximately 10% each three-month retesting period, to 88%, 79%, 69%, and 57%, respectively. Data suggest that after six months, participants failed to meet the AHA standards for demonstrating acceptable declarative and procedural knowledge related to CPR implementation. Due to the observed degradation in both declarative and procedural knowledge, it is apparent that a more periodic training and recertification process in CPR is required for school-based personnel. A more consistent and periodic approach to preparing school-based first responders may prove beneficial in maintaining CPR proficiency rates, which very well could save lives.

Newborn face mask ventilation training using a standardised intervention and respiratory function monitor: a before and after manikin study

ObjectiveThe International Liaison Committee on Resuscitation has recommended improvements in training for neonatal resuscitation, highlighting the potential role of respiratory function monitors (RFMs). Our objective was to determine whether a...

How Internal Medicine Clerkship Directors Are Using Entrustable Professional Activities: A National Survey Study.

In the present assessment environment in undergraduate medical education at U.S. medical schools, the prevalence and implementation of Entrustable Professional Activities (EPAs) in internal medicine (IM) clerkships are not well understood. To describe the prevalence and approach to EPA use in U.S. IM clerkships. Cross-sectional, nationally representative survey of core IM clerkship directors. One-hundred forty IM clerkship directors at Liaison Committee on Medical Education-accredited U.S./U.S. territory-based allopathic medical schools with membership in the Clerkship Directors in Internal Medicine (CDIM) as of December 2022. Use of EPAs in IM core clerkships, including use for grading, types of EPAs, use of supportive measures for assessment, and current validity frameworks. The survey response was 80% (112/140); two additional respondents completed the section on EPA use (n = 114). Approximately half of respondents (47%) reported their IM clerkship used EPAs. Among schools accredited after 1977, a higher percentage was associated with having incorporated EPAs (p = 0.03). The Association of American Medical Colleges Core EPAs for Entering Residency (CEPAER) was the most common framework used by Clerkship Directors (CDs) for developing EPAs (55%). Most CDs (56%) used EPAs for both formative and summative assessments, and approximately half of CDs (48%) used EPAs for a portion of the final grade determination. CDs who used EPAs were no more likely to report efforts to ensure the validity of assessment, the use of faculty development, or that written assessments were a valid measure of students' performance compared to those who did not use EPAs. Although EPAs have experienced substantial uptake in the IM clerkship and contribute to formative and summative assessment of learners, their use does not appear to be associated with enhanced efforts to obtain validity information.

Insights from coronial recommendations for preventing natural deaths in sport and recreation in Québec, Canada.

This descriptive retrospective study analyzed coronial recommendations for natural deaths in sport and recreation from January 2006 to December 2019 using data from the Bureau du coroner du Québec. Reports with recommendations were analyzed by sex, age group, cause of death, context, and activity. The nature of recommendations was assessed using a public health-based model. Thematic analysis was conducted following a four-phase approach in which themes developed were emphasized and further connected with existing literature. Reports involving individuals aged 18-24 and reports related to ice hockey were significantly more likely to contain recommendations. Reports related to individuals ≥45 years old, or related to cycling or hunting had higher death frequencies, but relatively low recommendation rates. Most recommendations aligned with the public health-based model but specifying implementation time frames was rare (11.7%). Nearly 60% of coroner's recommendations focused on automated external defibrillator implementation, delivery and training. Mitigation of sudden cardiac arrest risk for individuals ≥45 years old, timely treatment of life-threatening arrhythmias especially for activity practiced in remote regions and specifying implementation time frames were identified as improvement areas. The multi-faceted approach to enhancing public access defibrillation developed by the International Liaison Committee on Resuscitation in 2022 addresses recurrent themes covered by coroners and holds the potential to inform evidence-based decision making.

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: 2024 Update of the Utstein Out-of-Hospital Cardiac Arrest Registry Template.

The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains-system, dispatch, patient, process, and outcomes-were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest.

Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein Out-of-Hospital Cardiac Arrest Registry template

The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains—system, dispatch, patient, process, and outcomes—were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest.

Complexities of autonomy in military medical ethics: A brief report.

The first Fallen Surgeons Military Educational Symposium was convened in conjunction with the the American Association for the Surgery of Trauma (AAST) 23 meeting, under the guidance of the AAST Military Liaison Committee. The daylong session included a 1.5-hour segment on military medical ethics in combat and its unique challenges. Medical ethical issues arise frequently within the military across a range of varied circumstances, from the day-to-day operations of stateside forces to the complexities of deployed troops in theaters of conflict. Given the scope of these circumstances, preparation and advanced planning are the key to addressing and resolving the ethical issues that occur. The goal of this session was to present illustrative cases, not to prescribe solutions, and to make the attendees aware of some of the challenges they may encounter when deployed.

Tailored Basic Life Support Training for Specific Layperson Populations-A Scoping Review.

Background: Basic life support (BLS) is a life-saving link in the out-of-hospital cardiac arrest chain of survival. Most members of the public are capable of providing BLS but are more likely to do so confidently and effectively if they undertake BLS training. Lay members of the public comprise diverse and specific populations and may benefit from tailored BLS training. Data on this topic are scarce, and it is completely unknown if there are any benefits arising from tailored courses or for whom course adaptations should be developed. Methods: The primary objective of this scoping review was to identify and describe differences in patient, clinical, and educational outcomes when comparing tailored versus standard BLS courses for specific layperson populations. This review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation. Results: A primary search identified 1307 studies and after title, abstract, and full-text screening, we included eight publications reporting on tailored courses for specific populations. There were no studies reporting direct comparisons between tailored and standardized training. Seven (88%) studies investigated courses tailored for individuals with a disability, and only one study covered another specific population group (refugees). Overall, the quality of evidence was low as the studies did not compare tailored vs. non-tailored approaches or consisted of observational or pre-post-designed investigations. Conclusions: Tailored BLS education for specific populations is likely feasible and can include such groups into the pool of potential bystander resuscitation providers. Research into comparing tailored vs. standard courses, their cost-to-benefit ratio, how to best adapt courses, and how to involve members of the respective communities should be conducted. Additionally, tailored courses for first responders with and without a duty to respond could be explored.

Improving Outcomes After Post–Cardiac Arrest Brain Injury: A Scientific Statement From the International Liaison Committee on Resuscitation

This scientific statement presents a conceptual framework for the pathophysiology of post–cardiac arrest brain injury, explores reasons for previous failure to translate preclinical data to clinical practice, and outlines potential paths forward. Post–cardiac arrest brain injury is characterized by 4 distinct but overlapping phases: ischemic depolarization, reperfusion repolarization, dysregulation, and recovery and repair. Previous research has been challenging because of the limitations of laboratory models; heterogeneity in the patient populations enrolled; overoptimistic estimation of treatment effects leading to suboptimal sample sizes; timing and route of intervention delivery; limited or absent evidence that the intervention has engaged the mechanistic target; and heterogeneity in postresuscitation care, prognostication, and withdrawal of life-sustaining treatments. Future trials must tailor their interventions to the subset of patients most likely to benefit and deliver this intervention at the appropriate time, through the appropriate route, and at the appropriate dose. The complexity of post–cardiac arrest brain injury suggests that monotherapies are unlikely to be as successful as multimodal neuroprotective therapies. Biomarkers should be developed to identify patients with the targeted mechanism of injury, to quantify its severity, and to measure the response to therapy. Studies need to be adequately powered to detect effect sizes that are realistic and meaningful to patients, their families, and clinicians. Study designs should be optimized to accelerate the evaluation of the most promising interventions. Multidisciplinary and international collaboration will be essential to realize the goal of developing effective therapies for post–cardiac arrest brain injury.

Barriers to USMLE Step-1 accommodations: Students with Type 1 Diabetes.

Students who earn their medical doctorate (MD) in the U.S. must pass the United States Medical Licensing Exam (USMLE) Step-1. The application process for students with disabilities who seek Step-1 accommodations can be arduous, barrier-ridden, and can impose a significant burden that may have long-lasting effects. We sought to understand the experiences of medical students with Type-1 Diabetes (T1D) who applied for Step-1 accommodations. A Qualtrics survey was administered to students enrolled in Liaison Committee on Medical Education (LCME)-accredited MD programs who disclosed having a primary diagnosis of T1D. Basic counts and qualitative inductive analyses were conducted. Of the 21 surveys sent, 16 (76.2%) participants responded. Of the 16 respondents, 11 (68.8%) applied for USMLE Step-1 accommodations, whereas 5 (31.2%) did not. Of the 11 who applied for accommodations, 7 (63.6%) received the accommodations requested, while 4 (36.4%) did not. Of those who received the accommodations requested, 5/7 (71.4%) experienced at least one diabetes-related barrier on exam day. Of those who did not apply for Step-1 accommodations, 4/5 (80%) participants reported experiencing at least one diabetes-related barrier on exam day. Overall, 11/16 (68.8%) students experienced barriers on exam day with or without accommodations. Qualitative analysis revealed themes among participants about their experience with the process: frustration, anger, stress, and some areas of general satisfaction. This study reports the perceptions of students with T1D about barriers and inequities in the Step-1 accommodations application process. Students with and without accommodations encountered T1D-related obstacles on test day.

U.S. Medical School Participation in Nationally Funded Biomedical Research: A New Accounting of NIH Award Dollars.

To better understand the amount of National Institutes of Health (NIH) funding received by U.S. medical schools with Liaison Committee on Medical Education-accredited medical education programs, the Association of American Medical Colleges (AAMC) developed a new methodology that crosswalks faculty NIH grants with medical schools and their affiliated organizations (e.g., teaching hospitals). This approach offers a more comprehensive and methodologically transparent accounting of NIH extramural funding to academic medicine than existing processes.The AAMC Crosswalk utilized publicly available grants data from the NIH and resources unique to the AAMC, such as the Faculty Roster and Council of Teaching Hospitals and Health Systems records. Using a multi-step algorithm, the AAMC Crosswalk linked individual faculty with NIH grants, their organizations, and partner medical schools, aggregated at the level of the medical school and its affiliated organizations for fiscal year (FY) 2017-2021.The AAMC Crosswalk attributed on average $3.7 billion more per year in NIH funding to U.S. medical schools, representing a 24% increase compared to the NIH and Blue Ridge Institute for Medical Research (BRIMR) methodologies. In FY 2021, the AAMC Crosswalk attributed 60% of NIH funding to U.S. medical schools compared with 47% by NIH and 50% by BRIMR. An exploration of limitations showed no medical school affiliations were missed by the AAMC Crosswalk among 90 randomly sampled organizations, and medical school affiliations for 30 randomly sampled principal investigator faculty members were attributed correctly.These findings indicate that academic medicine's contribution to biomedical research may be greater than historically reported. Systematically accounting for grants awarded to faculty across medical schools and their affiliated organizations provides a more comprehensive understanding of NIH funding to U.S. medical schools. The AAMC Crosswalk provides a new tool to better estimate the true investment and role of academic medicine in advancing biomedical research.

Recognition and Awareness of Sepsis by First-Aid Providers in Adults With Suspected Infection: A Scoping Review.

Sepsis accounts for a significant proportion of preventable deaths worldwide and early treatment has been found to be a mainstay of decreasing mortality. Early identification of sepsis in the first-aid setting is critical as this results in a shorter time to hospital presentation and management with antibiotics and initial resuscitation. Our aim was to explore the existing literature related to either sepsis recognition or awareness of sepsis by first-aid providers who are evaluating an adult suspected of an acute infection. Our scoping review was performed as part of the International Liaison Committee on Resuscitation's (ILCOR) continuous evidence evaluation process to update the 2024 ILCOR Consensus on Science with Treatment Recommendations. We searched Embase, Medline, and Cochrane databases from their inception to January 17, 2023, with updated searches performed on November 21, 2023, and December 2, 2023. The gray literature search was conducted on August 29, 2023.The population included adults presenting with an acute illness exhibiting signs and symptoms of a severe infection.Outcomes included sepsis recognition or awareness of sepsis by a lay first-aid provider. After reviewing 4380 potential sources, four reviews (three systematic reviews and one scoping review), 11 observational studies, and 27 websites met the inclusion criteria. No study directly addressed our PICOST (Population, Intervention, Comparator, Outcomes, Study Design, and Timeframe) question as none were performed in the first-aid setting. Three systematic reviews and nine observational studies that assessed the ability of early warning scores to detect sepsis and predict adverse outcomes secondary to sepsis had inconsistent results, but many found the screening tools to be useful. One scoping review and one observational study found public knowledge and awareness of sepsis to be variable and dependent upon healthcare employment, location, education level, ethnicity, sex, and age. Signs and symptoms associated with sepsis as listed by gray literature sources fell primarily under nine general categories as a means of educating the public on sepsis recognition. Although this scoping review did not identify any studies that directly addressed our outcomes, it highlights the need for future research to better understand the recognition of sepsis in first-aid settings.

Cardiovascular disease risk factors and infertility: multivariable analyses and one-sample Mendelian randomization analyses in the Trøndelag Health Study.

Are cardiovascular disease (CVD) risk factors causally associated with higher risk of infertility among women and men? We found evidence to support a causal relationship between smoking initiation and history of infertility in women. Several CVD risk factors are associated with history of infertility. Previous studies using Mendelian randomization (MR) further support a causal relationship between BMI and infertility in women. We used data from the Trøndelag Health Study (HUNT) in Norway, a prospective population-based cohort study, including 26811 women and 15598 men participating in three survey collections in 1995-1997 (HUNT2), 2006-2008 (HUNT3), and 2017-2019 (HUNT4). Our outcome was women's self-reported history of infertility, defined as ever having tried to conceive for 12 months or more or having used ART. We assigned the history of infertility reported by women to their male partners; therefore, the measure of infertility was on the couple level. We used both conventional multivariable analyses and one-sample MR analyses to evaluate the association between female and male CVD risk factors (including BMI, blood pressure, lipid profile measurements, and smoking behaviours) and history of infertility in women and men, separately. A total of 4702 women (18%) and 2508 men (16%) were classified with a history of infertility. We found a higher risk of infertility among female smokers compared to non-smokers in both multivariable and MR analyses (odds ratio (OR) in multivariable analysis, 1.20; 95% CI, 1.12-1.28; OR in MR analysis, 1.13; CI, 1.02-1.26), and potentially for higher BMI (OR in multivariable analysis, 1.13; CI, 1.09-1.18; OR in MR analysis, 1.11, CI, 0.92-1.34). In multivariable analysis in women, we also found evidence of associations between triglyceride levels, high-density lipoprotein cholesterol, lifetime smoking index, and smoking intensity with higher risk of infertility. However, these results were not consistent in MR analyses. We found no robust or consistent associations between male CVD risk factors and infertility. Our main limitation was that the CVD risk factors measured might not adequately capture the relevant time periods for when couples were trying to conceive. Additionally, we did not have information on causes of infertility in either women or men. Women with infertility could have a worse CVD risk factor profile and thus public health interventions aimed at reducing the impact of some CVD risk factors, such as smoking and BMI, could reduce the burden of infertility. However, additional MR studies of the relationship between CVD risk factors and infertility with a larger sample size would be of value. The study was supported by a grant from the European Research Council under the European Union's Horizon 2020 research and innovation program (grant agreements no. 947684). This research was also supported by the Research Council of Norway through its Centres of Excellence funding scheme (project no. 262700) and partly funded by the Research Council of Norway, project: Women's fertility-an essential component of health and well-being (project no. 320656). D.A.L. and A.F. work in a unit that is supported by the University of Bristol and the UK Medical Research Council (MC_UU_00011/6). D.A.L.'s contribution to the article is supported by the European Research Council (101021566), the British Heart Foundation (CH/F/20/90003 and AA/18/7/34219). S.B.'s contribution to the article is supported by the Wellcome Trust (225790/Z/22/Z). B.M.B. is funded by The Liaison Committee for education, research and innovation in Central Norway; and the Joint Research Committee between St. Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU. The genotyping in HUNT was financed by the National Institute of Health (NIH); University of Michigan; The Research Council of Norway; The Liaison Committee for education, research and innovation in Central Norway; and the Joint Research Committee between St. Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU. None of the funding organizations influenced the study design, reporting, or interpretation of results. The views expressed in the present article are those of the authors and not necessarily any acknowledged funding organization. D.A.L. reports grants from Medtronic Ltd and Roche Diagnostics outside the submitted work. The other authors have no conflicts of interest. N/A.

ILCOR pediatric life support recommendations translation to constituent council guidelines: An emphasis on similarities and differences

The International Liaison Committee on Resuscitation (ILCOR) performs rigorous scientific evidence evaluation and publishes Consensus on Science with Treatment Recommendations. These evidence-based recommendations are incorporated by ILCOR constituent resuscitation councils to inform regional guidelines, and further translated into training approaches and materials and implemented by laypersons and healthcare providers in- and out-of-hospital. There is variation in council guidelines as a result of the weak strength of evidence and interpretation. In this manuscript, we highlight ten important similarities and differences in regional council pediatric resuscitation guidelines, and further emphasize three differences that identify key knowledge gaps and opportunity for “natural experiments.”