Life Support Research Articles

Embracing Large Language Models for Adult Life Support Learning.

Background It is recognisedthat large language models (LLMs) may aid medical education by supporting the understanding of explanations behind answers to multiple choice questions. This study aimed to evaluate the efficacy of LLM chatbots ChatGPT and Bard in answering an Intermediate Life Support pre-course multiple choice question (MCQs) test developed by the Resuscitation Council UK focused on managing deteriorating patients and identifying causes and treating cardiac arrest. We assessed the accuracy of responses and quality of explanations to evaluate the utility of the chatbots. Methods The performance of the AI chatbots ChatGPT-3.5 and Bard were assessed on their ability to choose the correct answer and provide clear comprehensive explanations in answering MCQs developed by the Resuscitation Council UK for their Intermediate Life Support Course. Ten MCQs were tested with a total score of 40, with one point scored for each accurate response to each statement a-d. In a separate scoring, questions were scored out of 1 if all sub-statements a-d were correct, to give a total score out of 10 for the test. The explanations provided by the AI chatbots were evaluated by three qualified physicians as per a rating scale from 0-3 for each overall question and median rater scores calculated and compared. The Fleiss multi-rater kappa (κ) was used to determine the score agreement among the three raters. Results When scoring each overall question to give a total score out of 10, Bard outperformed ChatGPT although the difference was not significant (p=0.37). Furthermore, there was no statistically significant difference in the performance of ChatGPT compared to Bard when scoring each sub-question separately to give a total score out of 40 (p=0.26). The qualities of explanations were similar for both LLMs. Importantly, despite answering certain questions incorrectly, both AI chatbots provided some useful correct information in their explanations of the answers to these questions. The Fleiss multi-rater kappa was 0.899 (p<0.001) for ChatGPT and 0.801 (p<0.001) for Bard. Conclusions The performances of both Bard and ChatGPT were similar in answering the MCQs with similar scores achieved. Notably, despite having access to data across the web, neither of the LLMs answered all questions accurately. This suggests that there is still learning required of AI models in medical education.

Narratives of health-promoting experiences by older husbands and wives providing care to their home-dwelling spouses receiving home-care services in Norway

BackgroundIn today’s healthcare systems, older family caregivers who care for their spouses at home are indispensable providers of healthcare. However, many of these caregivers are at risk of becoming ill themselves. To prevent this and to guide the development of targeted healthcare services, home-care personnel need knowledge on how to promote the health of older family caregivers. The purpose of this study was to understand the health-promoting experiences of older family caregivers who care for their home-dwelling spouses receiving home-care services.MethodsThe experiences of older family caregivers were explored using a narrative design that involved narrative interviews and a narrative thematic and structural analytical approach. The sample consisted of four husbands and six wives aged 79–91 years. In the analysis, two storylines of narratives were constructed: one by husbands and one by wives.FindingsIn the husbands’ narrative, continuation of everyday life and social support in everyday life were highlighted as being health-promoting. In the wives’ narrative, the importance of having time for oneself and being seen, heard and included by the home-care personnel were emphasized as promoting their health. The husbands’ narrative contained stories of the past and the present, while the wives’ narrative mainly comprised stories of the present.ConclusionThis study has provided insights into the narratives of older husbands and wives acting as family caregivers regarding what promotes their health caring for their spouses at home. Their stories show variations in care style, coping style and experiences of the caregiver burden. These findings suggest that home-care services should consider providing customized health-promoting services to older family caregivers who are providing care to their home-dwelling spouses receiving home-care services. Given the sample size of only ten participants, further qualitative and quantitative research is needed.

Motor pool selectivity of neuromuscular degeneration in type I spinal muscular atrophy is conserved between human and mouse.

Spinal muscular atrophy (SMA) is caused by low levels of the survival motor neuron (SMN) protein. Even though SMN is ubiquitously expressed, the disease selectively affects motor neurons, leading to progressive muscle weakness. Even among motor neurons, certain motor units appear more clinically resistant to SMA. To quantitatively survey selective resistance, we studied extensive neuromuscular autopsies of Type I SMA patients and age-matched controls. We found highly divergent degrees of degeneration of neighboring motor units, even within individual cranial nerves or a single anatomical area such as the neck. Examination of a Type I SMA patient maintained on life support for 17years found that most muscles were atrophied, but the diaphragm was strikingly preserved. Nevertheless, some resistant human muscles with preserved morphology displayed nearly complete conversion to slow Type I myofibers. Remarkably, a similar pattern of selective resistance was observed in the SMNΔ7 mouse model. Overall, differential motor unit vulnerability in human Type I SMA suggests the existence of potent, motor unit-specific disease modifiers. Mechanisms that confer selective resistance to SMA may represent therapeutic targets independent of the SMN protein, particularly in patients with neuromuscular weakness refractory to current treatments.

Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities.

To facilitate the implementation of controlled donation after circulatory death (cDCD) programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation (ECMO) team (Spokes), some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion (NRP) implantation in the setting of a cDCD pathway. While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization, regarding composition, responsibilities and training programs, no clear, widely accepted indications are to date available for NRP teams. Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs, there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway. Thus, in the present manuscript we summarized the characteristics of an ECMO mobile team, highlighting similarities and differences with the NRP mobile team. We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program, especially for those centers who are starting the program. Differences were identified between the mobile ECMO team and NRP mobile team. The common essential feature for both mobile teams is high skills and experience to reduce complications and, in the case of cDCD, to reduce the total warm ischemic time. Dedicated training programs should be developed for the launch of de novo NRP teams.

Using Relational Biology with Loop Analysis to Study the North Atlantic Biological Carbon Pump in a ‘Hybrid’ Non-Algorithmic Manner

Biologists, philosophers, and mathematicians building upon Robert Rosen’s non-algorithmic theories of life using Relational Biology and Category Theory have continued to develop his theory and modeling approaches. There has been general agreement that the impredicative, self-referential, and complex nature of living systems negates an algorithmic approach. Rosen’s main goal was to answer, “What is Life?”. Many believe he provided the best but minimum answer using a cellular, metabolism–repair or (M, R)-system as a category-theoretic model. It has been challenging, however, to incorporate his theory to develop a fully non-algorithmic methodology that retains the essence of his thinking while creating more operational models of living systems that can be used to explore other facets of life and answer different questions. Living systems do more than the minimum in the real world beyond the confines of definition alone. For example, ecologists ask how living systems inherently mitigate existential risk from climate change and biodiversity loss through their complex self-organization. Loop Analysis, a signed graph technique, is discussed as a hybrid algorithmic/non-algorithmic methodology in Relational Biology. This methodology can be used at the ecosystem level with standard non-algorithmic field data as per McAllister’s description of the algorithmic incompressibility of empirical data of this type. An example is described showing how the North Atlantic Carbon Pump, an important planetary life support system, is situated in the plankton community and functions as a mutualistic ecosystem chimera. It captures carbon from the atmosphere as an extended (M, R)-system and processes it until it is sequestered in the marine sediments. This is an important process to alleviate climate change in magnitude equal to or larger than the sequestration of carbon on land with forests. It is suggested that the ecosystem level should replace the cellular and organismic levels as the main system unit in biology and evolution since all life exists and evolves with full functional potential in ecosystem networks and not laboratory test tubes. The plankton ecosystem is the largest after the total biosphere and consists of evolutionary links and relationships that have existed for eons of time. If there was ever a genuine robust, highly self-organized ecosystem, it would be planktonic. Severing the links in these thermodynamically open networks by focusing on lower levels of the biological hierarchy loses the critical organization of how life exists on this planet. There is no theory to regain this crucial ‘omitted’ ecological relational causality at the cell or organismal levels. At the end of the paper, some future directions are outlined.

Thoughts of older adults living in an isolated community on a remote island while continuing to live in familiar surroundings

Objective This study clarified the thoughts of older adults living in an isolated community on a remote island while continuing to live in familiar surroundings. Additionally, suggestions for health policies were obtained.Methods Island B, a remote island in Prefecture A, is isolated and surrounded by the sea. It has a population of 138 people and an aging rate of 48.6% (R2). We conducted semi-structured interviews with seven older adults living on Island B and qualitatively and inductively analyzed the contents, which consisted of (1) thoughts about living in one's own home in a familiar community; (2) nursing, medical, and preventive care as well as social and human resources that could help support one's life; and (3) continuing to live on the island. Codes, subcategories, and categories were generated based on verbatim transcripts of the interviews.Results The average age of the study participants was 76.9 years. The daily life independence level for older adults with disabilities was J1-2. They thought that "their life on the island was easygoing and enjoyable" but also that "the strong ties among the islanders may become a hindrance." They expressed that "life on the island is founded on mutual support" and the availability of life support services allows them to "live a comfortable life on the island." Additionally, because of the insulation provided by the sea, "connections outside of the island were regarded as minimally essential." Regarding life on the island in the future, they stated that "they cannot do anything about the island's decay," "life on the island will become critical due to the scarcity of living resources," "life on the island will not be possible under any circumstances in the future," and "they need to accept that they will not be able to die on the island as they would like to." Regarding continuing to live on the island, they believed that "self-help efforts are essential to preserve independence" and "a resolute spirit is necessary when facing your last days."Conclusion The results of the study highlight the importance of providing support for physical fitness activities to maintain links with the world off the island, providing opportunities to promote mutual assistance among older islanders, strengthening the medical system using ICT, and encouraging islanders to regularly discuss with their distant family members how they would like to spend the final days of their lives.

The evidence supporting AHA guidelines on adult cardiopulmonary resuscitation (CPR).

Guidelines for the management of cardiac arrest play a crucial role in guiding clinical decisions and care. We examined the strength and quality of evidence underlying these recommendations in order to elucidate strengths and gaps in knowledge. Using the 2020 American Heart Association (AHA) Guidelines for Adult CPR, we subdivided all recommendations into advanced life support (ALS), basic life support (BLS), and recovery after cardiac arrest, as well as a more granular categorization by topic (i.e. the intervention or evaluation recommended). The Class of Recommendation (COR) and Level of Evidence (LOE) for each were reviewed. Additionally, we reviewed the 2023 guidelines to ensure the inclusion of the most recent updates. We noted 254 recommendations, of which 181 were ALS, 69 were BLS, and 4 were recovery after resuscitation. In total, only 2 (1%) had the most robust evidence (LOE A), while 23% were at LOE B-NR (Non-Randomized), 15% at LOE B-R (Randomized), 50% at LOE C-LD (Limited Data), and 12% relied on expert opinion LOE C-EO (Expert Opinion). Despite the strength of ALS recommendations (Class 1, 2a, or 2b), none had LOE A. In BLS, no recommendations were supported by LOE A. For BLS, 7% of recommendations had LOE C (C-LD or C-EO). The evidence for specific BLS topics, such as airway management, was notably low. Among ALS topics, neurological prognostication had relatively stronger evidence. Only 26 out of the 81 COR 1 recommendations (32%) were supported by LOE A or B, indicating a strong discrepancy between the strength of recommendation and the underlying evidence in cardiac arrest guidelines. The findings underscore a pressing need for more rigorous research, particularly randomized trials.

The Ethical Paradox of Informed Consent in HPV Vaccination: Examining the Legal Boundaries and Ethical Considerations of Parental Consent, Public Health, and Individual Rights

Background and Objective: Effective communication is crucial in medical procedures, and informed consent is a key example of this. However, informed consent may face unique circumstances, such as in life support situations or government health programs. The Human Papillomavirus (HPV) vaccination, as part of a government initiative, raises the question of whether informed consent is still required. The study aims to explore whether informed consent is still necessary for the HPV vaccination and to analyze the legal implications if a citizen refuses to receive the vaccine. Patients have the right to refuse medical actions, making it essential to understand the legal consequences of rejecting the HPV vaccination. Methods: This study adopts a normative juridical approach with an analytic descriptive specification. Secondary data was gathered from primary, secondary, and tertiary legal sources through literature reviews, document studies, and archival research. The collected data was then analyzed qualitatively and presented in a descriptive format. Results: The study found that there are exceptions to the requirement for informed consent for vaccinations included in government programs. Specifically, informed consent is not necessary for individuals within the target age group of the government’s HPV vaccination program. In Indonesia, this program targets girls aged 9 to 14. Additionally, there are currently no legal penalties for individuals who refuse the HPV vaccination. Conclusion: Informed consent is not required for individuals within the targeted age group of the government’s HPV vaccination program in Indonesia. Furthermore, there are no legal penalties for rejecting the vaccination.

Direct Contact Membrane Distillation of Hydroponic Solutions for Recycling of Phosphate and Potassium

A critical issue facing extraterrestrial expansion has always been long-term life support capabilities. The large energy requirements to move even small amounts of material from Earth necessitate the ability to reuse and recycle as much as possible, particularly waste. The weight of food supplies eventually starts to limit the length of the expedition. Hydroponic growth systems offer the ability to grow plants, and with them, a miniature ecosystem. This offers the ability to repurpose both carbon dioxide and waste salts such as ammonia and other compounds, such as those found in urine. A major issue facing hydroponic systems is the need to provide a stable water-based nutrient stream. Direct contact membrane distillation (DCMD) was tested for viability as a method of re-concentrating and stabilizing the nutrient-rich water stream. Polytetrafluoroethylene (PTFE)- and polyvinylidene (PVDF)-based polymer hydrophobic membranes were used to separate solutes from water. The DCMD method was tested with the feed stream operating at temperatures of 50 °C, 65 °C, and 80 °C. The results were analyzed using UV-Visible spectroscopy to determine concentrations. The benefits and limitations of the PTFE and PVDF membranes in DCMD were compared. The larger-pore PTFE membranes concentrated solutions effectively at 80 °C, while the PVDF membranes removed more water at lower temperatures, but permitted detectable phosphate ion leakage. Adjusting temperature and flow rates can help maintain stable ion and water transfer, benefiting hydroponic systems in achieving reliable nutrient levels.

An experimental study to evaluate the effectiveness of lecture cum demonstration on knowledge and practice on basic life support among lay person

: Basic Life Support (BLS) refers to a set of emergency procedures that assist individuals experiencing cardiac arrest, respiratory distress, or airway obstruction. Cardiopulmonary resuscitation (CPR) and other BLS techniques serve as crucial interventions that can save lives in critical situations. Effective training in BLS can empower laypersons to act decisively and appropriately during emergencies. To shed light on the effectiveness of a comprehensive BLS training program, incorporating lectures and practical demonstration, in empowering layperson to respond effectively to cardiac arrest situation.: To assess the knowledge of lay person regarding basic life support, To assess the practice of lay person regarding basic life support, to evaluate the effectiveness of demonstration on basic life support, to find out the association between the knowledge and practice of lay person regarding basic life support with their selected demographic variables. A quantitative research approach was employed in this study, utilizing a true experimental (one group pre-test and post-test) research design. A convenient sampling technique was used to select 60 participants for the study. Data were collected using structured questionnaires to assess knowledge and practice checklists to evaluate practical skills. Descriptive and inferential statistical methods were applied for data analysis.: The pre-test and post-test assessments revealed a significant improvement in the participants’ knowledge and practice of BLS after the training. The mean knowledge score in the pre-test was 5.75 ± 1.85 (27.38 ± 8.83%), while the mean score in the post-test increased to 12.48 ± 2.03 (59.44 ± 9.70%). The mean practice score was 11.46 ± 3.03 (40.95 ± 10.85%) in the post-test.The evaluation of the training method, which incorporated both lectures and demonstrations, showed statistically significant improvement in both knowledge and practice scores. The paired ‘t’ test for overall knowledge scores yielded a calculated value of 16.87, which exceeded the tabulated value of 2.00 (with 59 degrees of freedom), confirming the effectiveness of the intervention.: The study demonstrated that the lecture and demonstration-based training significantly improved the knowledge and practical application of Basic Life Support techniques among laypersons. As a result, the null hypothesis (H0) was rejected, and the research hypothesis (H1) was accepted.

Fire Protection Systems, Life-Saving Facilities, and Fire Management in Depok City in 2020: A Case Study

Introduction: Hospital fire can result in greater casualties, injuries to patients or staff, and loss of property and equipment compared to fires in other types of building. This is attributed to the presence of a large number of vulnerable individuals, including those who are ill, disabled, pregnant, children, elderly, immunocompromised, on life support, or incapable of moving independently. This study aims to assess the implementation of the fire protection system, life-saving facilities, and fire management in Hospital X. Methods: This was a quantitative study on active fire protection system facilities, passive protection system facilities, live-saving facilities, and fire management as the subjects. Data were collected through observation, interviews, and document review, as well as a checklist and then analyzed by comparing the actual conditions with applicable standards and regulations. The final result was presented as the percentage compliance level and categorization according to the criteria established by the Research and Development Agency of the Public Works Department. Results: The active fire protection system presented a standard fulfillment rate of 53%, categorizing it as poor. The passive fire protection systems similarly demonstrated a poor fulfillment rate at 42%, while the life-saving facilities achieved a 66.7% fulfillment rate, placing them in the quite good category. Additionally, fire management attained an 81% fulfillment level, which falls under the good category. Conclusion: Hospital X has a good fire prevention approach with a standard fulfillment level of 60%.

Perceptions and Experiences of Exercise Snacks Among Middle-Aged and Older Adults: A Systematic Review and Meta-Synthesis.

Physical inactivity in middle-aged and older adults is a major health problem. Exercise snacks are an emerging form of physical activity characterized by shorter single bouts of high-intensity exercise spread out repeatedly throughout the day which can provide more exercise opportunities for middle-aged and older adults. To summarize perceptions and experiences of exercise snacks among middle-aged and older adults, and explore the barriers and facilitators of promoting exercise snacks. We followed the PRISMA and systematically searched five databases from the earliest to May 2024. The Critical Appraisal Skills Program tool is used to quality assess and the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) is used to guide thematic synthesis. Fourteen categories from nine studies were summarized, and 277 findings were identified. Three synthesized findings were: capability of middle-aged and older adults (including health-related exercise disorders, learning and mastery skills, and health literacy), opportunities for exercise snacks (including flexible and free, easy and quick, integration into life, social and family support, and application of mobile health technology), and motivation of exercise snacks (including pleasurable experiences, gaining physical and mental benefits, effective reminders, incentives and feedback, personalized needs, and self-efficacy). Exercise snacks are a promising approach， however, they need to be continuously optimized. Our results can provide evidence for designing and optimizing exercise snack programs. Medical workers should assist middle-aged and older adults in developing appropriate exercise snack strategies. PROSPERO (CRD42024544089).

Intervention measures to improve the filter life of continuous renal replacement therapy in critically ill patients-A systematic review.

Continuous renal replacement therapy (CRRT) is a method of blood purification, which is widely used in the treatment of critical diseases as a means of multiple organ function protection and life support therapy. However, because of the serious condition of ICU (intensive care unit) patients, CRRT needs to be carried out continuously, but the treatment is interrupted ahead of time as a result of various conditions, which not only affects the treatment effect but also increases the patient cost. To evaluate intervention measures to improve the filter life of CRRT in critically ill patients, and also to identify which interventions are considered 'promising interventions'. This is a systematic review. Seven databases were searched using terms related to the concepts of 'continuous renal replacement therapy' and 'filter life', from the establishment of the database to 31 December 2023. The quality of the methodology included in the study was assessed using standard evaluation tools developed by the Effective Public Health Practice Project (EPHPP), and pre-established criteria were used to identify 'promising interventions'. A total of 28 studies were included, of which 7 were rated 'strong' in terms of design and methodological quality, and the others were 'medium'. The most commonly identified interventions to extend the life of CRRT filters include the use of sodium citrate anticoagulation, the choice of CVVHD or CVVHDF or pre-diluted CVVH for CRRT and the use of personalized sodium citrate anticoagulant regimens to reduce the incidence of filter clotting. The intervention measures of 14 studies were statistically significant, while the other 14 studies were not statistically significant. Interventions in nine studies were identified as 'promising interventions' because they were published within 10 years, with a medium or strong methodological quality rating, significant positive results and a strong evidence base. In the promising interventions study, citrate anticoagulation and CVVHD or CVVHDF models were recommended to significantly prolong filter life. However, more high-quality studies are needed to identify interventions that can prolong the life of CRRT filters in critically ill patients, thereby supplementing the literature in this field. The existing studies lack blinding and have limited quality. Future studies should be carried out with the goal of 'best evidence', and the interventions should be more universal and clinically practical. This study uses the method of systematic review to scientifically and rigorously provide some suggestions for extending the life of CRRT filters in critically ill patients, such as 'By implementing personalized citrate anticoagulation protocols, the incidence of CRRT filter life shortening due to coagulation can be reduced', which can reduce the cost of patients and improve the quality of treatment to a certain extent in clinical practice.

Basic Life Support (BLS) Knowledge Among the Ha’il Region Population, Saudi Arabia: A Cross-Sectional Study

Basic Life Support (BLS) Knowledge Among the Ha’il Region Population, Saudi Arabia: A Cross-Sectional Study

Research on the Effect Mechanism of Career-Specific Parental Support Promoting Meaning in Life of Chinese Higher Vocational College Students

Adolescent students’ meaning in life is an important topic of research in positive psychology and educational psychology. Meaning in life is of outstanding value to the whole career development of Chinese higher vocational college students (CHVCS), and parental behaviors have a profound impact on CHVCS’ meaning in life. In order to explore the mechanism of the role of career-specific parental support in promoting CHVCS’ meaning in life from the perspective of career, this study was based on career construction theory (CCT) and investigated 2498 CHVCS. The results showed that (1) career-specific parental support could directly and positively influence meaning in life; (2) core self-evaluations, career exploration, and career adaptability individually played a partially mediating effect in the relationship between career-specific parental support and meaning in life; (3) “core self-evaluations + career exploration”, “core self-evaluations + career adaptability”, “career exploration + career adaptability”, and “core self-evaluations + career exploration + career adaptability” play a partial chain mediating effect in the relationship between career-specific parental support and meaning in life. This study contributes to meaning in life in CHVCS, enriches career-related research based on CCT, and has important implications for career counseling from a construct perspective.

ASSESSMENT OF KNOWLEDGE AND ATTITUDE BASIC LIFE SUPPORT (BLS) AMONG ARTS AND SCIENCE STUDENTS IN TIRUVALLUR

Introduction: Basic Life Support (BLS) is a critical set of emergency procedures designed to sustain life in individuals experiencing cardiac arrest or other life-threatening conditions. This study aims to aimed to assessment of knowledge and attitude basic life support (bls) among arts and science students in Tiruvallur.Methods: The study employed a descriptive cross-sectional design with 50 students selected via convenience sampling. Inclusion criteria included students aged 17+, enrolled in selected colleges, and willing to participate, excluding those with prior BLS training.Results: The results show that 60% of students had poor knowledge of Basic Life Support (BLS), 30% had average knowledge, and only 10% had a good understanding. In terms of attitudes, 40% held a negative view, 40% were neutral, and 20% had a positive attitude towards BLS. This suggests a general lack of BLS knowledge and a prevalent neutral or negative attitude among students.Conclusions: The study concluded that most Arts and Science students in Tiruvallur had limited knowledge of Basic Life Support (BLS), with poor to average understanding and primarily neutral or negative attitudestowards BLS. Future research should focus on developing and evaluating the effectiveness of BLS training programs tailored to the unique needs of non-medical students, ensuring that they are equipped with the skills necessary to respond effectively in emergencies.

Differences in the Usability of Fully Automated External Defibrillators between Medical and Nonmedical Professionals.

Objective Early defibrillation is crucial for improving the survival rates of patients with shockable cardiac arrest (OHCA). Automated external defibrillators (AEDs) are essential in basic life support (BLS), yet their usage in out-of-hospital cardiac arrests remains around 10%. There are two types of AEDs: semi-automatic (s-AED) and fully automatic (f-AED), with the latter automatically delivering a shock if indicated. Although f-AEDs were introduced in Japan in 2021, they have not yet been widely adopted. The present study investigated whether or not the ease of use and preferences for these AED types differ between healthcare professionals and laypersons. Methods BLS courses, including training on both AED types, were conducted between 2021 and 2022 at our institution. The participants were divided into medical and non-medical professional groups, and a survey was administered. Results A total of 443 participants were included, with 47 medical professionals and 396 non-medical professionals. Notably, 401 participants were new to f-AED lectures. The medical professional group had more prior experience with AED training courses than non-medical professionals and showed a preference for s-AEDs, whereas the non-medical professional group showed no significant preference. Although a subset of participants expressed hesitation in pressing the shock button on the s-AEDs, no statistically significant difference was observed between the groups. Conclusion This study suggests that preferences for AED types may vary between medical and non-medical professional groups, with some reluctance in using s-AEDs. Although no significant differences in hesitation were found between the groups, f-AEDs may reduce hesitation and potentially improve AED effectiveness during cardiopulmonary resuscitation.

Nurses' Knowledge and Skills After Use of an Augmented Reality App for Advanced Cardiac Life Support Training: Randomized Controlled Trial.

Advanced cardiac life support (ACLS) skills are essential for nurses. During the COVID-19 pandemic, augmented reality (AR) technologies were incorporated into medical education to increase learning motivation and accessibility. This study aims to determine whether AR for educational applications can significantly improve crash cart learning, learning motivation, cognitive load, and system usability. It focused on a subgroup of nurses with less than 2 years of experience. This randomized controlled trial study was conducted in a medical center in southern Taiwan. An ACLS cart training course was developed using AR technologies in the first stage. Additionally, the efficacy of the developed ACLS training course was evaluated. The AR group used a crash cart learning system developed with AR technology, while the control group received traditional lecture-based instruction. Both groups were evaluated immediately after the course. Performance was assessed through learning outcomes related to overall ACLS and crash cart use. The Instructional Materials Motivation Survey, System Usability Scale, and Cognitive Load Theory Questionnaire were also used to assess secondary outcomes in the AR group. Subgroup analyses were performed for nurses with less than 2 years of experience. All 102 nurses completed the course, with 43 nurses in the AR group and 59 nurses in the control group. The AR group outperformed the control group regarding overall ACLS outcomes and crash cart learning outcomes (P=.002; P=.01). The improvement rate was the largest for new staff regardless of the overall learning effect and the crash cart effect. Subgroup analysis revealed that nurses with less than 2 years of experience in the AR group showed more significant improvements in both overall learning (P<.001) and crash cart outcomes (P<.001) compared to their counterparts in the control group. For nurses with more than 2 years of experience, no significant differences were found between the AR and control groups in posttraining learning outcomes for the crash cart (P=.32). The AR group demonstrated high scores for motivation (Instructional Materials Motivation Survey mean score 141.65, SD 19.25) and system usability (System Usability Scale mean score 90.47, SD 11.91), as well as a low score for cognitive load (Cognitive Load Theory Questionnaire mean score 15.42, SD 5.76). AR-based learning significantly improves ACLS knowledge and skills, especially for nurses with less experience, compared to traditional methods. The high usability and motivational benefits of AR suggest its potential for broader applications in nursing education. ClinicalTrials.gov NCT06057285; https://clinicaltrials.gov/ct2/show/NCT06057285.

An assessment of long-term complications following prehospital intraosseous access: A nationwide study

BackgroundThe guidelines for Advanced Life Support issued by the European Resuscitation Council recommend considering drug delivery through intraosseous access if intravenous access to the vascular bed is not feasible or unsuccessful. Emergency prehospital intraosseous cannulation may theoretically lead to an increased risk of long-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome. Such complications have previously been reported in case reports or small sample case series. We systematically investigated long-term complications potentially associated with intraosseous cannulation using validated Danish health registries. MethodsData sources were the nationwide electronic Prehospital Patient Record system, the Danish National Patient Registry, and the Danish Civil Personal Registry. We investigated all patients who were subjected to prehospital intraosseous cannulation in Denmark from January 2016 through December 2019. During a follow-up period of 180 days from the index date we extracted information concerning mortality status and potential long-term complications defined as osteomyelitis, osteonecrosis, or compartment syndrome from the day of prehospital intraosseous cannulation. ResultsOf the 5,387 patients receiving intraosseous access, 375 were unidentified and lost to follow-up. Of the 5012 remaining patients, 4,775 were adults, and 237 were children. No children and “less than five” adults had long-term complications. No osteonecrosis, osteomyelitis or compartment syndrome appeared later than 175 days after an intraosseous cannulation. ConclusionsLong-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome following prehospital intraosseous cannulation and drug delivery occurred in less than 0.1% of the cases. Our findings indicate that prehospital intraosseous cannulation may be safe across age groups.

Return on Investment With Health Care Simulation.

Delivering simulation across a health system can engage the entire workforce by moving beyond traditional educational delivery and focusing on broader organizational needs specific to a particular organization. The commonly known use of simulation as a form of life support education has progressed to include fully immersive simulation experiences focusing on team-based communication, leadership, fellowship, and clinical care. It continues beyond this point with the inclusion of patient safety strategies, root cause analysis investigation, leadership, and management training, and recently, it has included environments that catalyze innovation in complex healthcare systems. The focus on pure fiscal elements of simulation-based approaches does not give a health system the accurate nontangible benefits simulation can provide, and importantly, acknowledging that each location has differing needs is essential when considering what investment should be made and where. A small community hospital will have vastly different needs from specialty hospitals that deliver specialist care. It must also be understood that every simulation center, to some extent, will always be unique, as it should. The commonly quoted statement "when you have seen one simulation center, you have seen one simulation center" really does reflect the reality of this established and rapidly growing specialty. In this article, we reflect on the traditional use of simulation and discuss some wider uses that may engage a wider audience and, importantly, provide a greater return on investment for your facility, making the case for investment more reasonable and impactful to each part of a busy health system.