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L Niemi-Murola

Publications and source records attributed to L Niemi-Murola.

8 recordsLinked to original sources
PubMed2006

Assessment of CPR-D skills of nurses in Göteborg, Sweden and Espoo, Finland: teaching leadership makes a difference.

INTRODUCTION: Construction of an effective in-hospital resuscitation programme is challenging. To document and analyse resuscitation skills assessment must provide reliable data. Benchmarking with a hospital having documented excellent results of in-hospital resuscitation is beneficial. The purpose of this study was to assess the resuscitation skills to facilitate construction of an educational programme. MATERIALS AND METHODS: Nurses working in a university hospital Jorvi, Espoo (n=110), Finland and Sahlgrenska University Hospital, Göteborg (n=40), Sweden were compared. The nurses were trained in the same way in both hospitals except for the defining and teaching of leadership applied in Sahlgrenska. Jorvi nurses are not trained to be, nor do they act as, leaders in a resuscitation situation. Their cardiopulmonary resuscitation (CPR) skills using an automated external defibrillator (AED) were assessed using Objective Structured Clinical Examination (OSCE) which was build up as a case of cardiac arrest with ventricular fibrillation (VF) as the initial rhythm. The subjects were tested in pairs, each pair alone. Group-working skills were registered. RESULTS: All Sahlgrenska nurses, but only 49% of Jorvi nurses, were able to defibrillate. Seventy percent of the nurses working in the Sahlgrenska hospital (mean score 35/49) and 27% of the nurses in Jorvi (mean score 26/49) would have passed the OSCE test. Statistically significant differences were found in activating the alarm (P<0.001), activating the AED without delay (P<0.01), setting the lower defibrillation electrode correctly (P<0.001) and using the correct resuscitation technique (P<0.05). The group-working skills of Sahlgrenska nurses were also significantly better than those of Jorvi nurses. CONCLUSIONS: Assessment of CPR-D skills gave valuable information for further education in both hospitals. Defining and teaching leadership seems to improve resuscitation performance.

Cardiopulmonary Resuscitation↗
PubMed2006

Teaching basic life support to nurses.

BACKGROUND AND OBJECTIVE: Every member of healthcare personnel should be able to perform basic life support including defibrillation (CPR-D). The biggest cost of implementation is training and these costs need to be reduced. The purpose of this randomized study was to evaluate the applicability of distance learning as a method to teach CPR-D. METHODS: Nurses (n = 56) working in a geriatric hospital were randomized into three groups. The first group was given the Internet-based CPR-D course and the second was given a traditional, small-group CPR-D course. A third group without specific training in CPR-D served as a control group. An objective structured clinical examination (OSCE) was performed 2 weeks after the courses with a manikin patient having a cardiac arrest. RESULTS: The median score of all participants was 31/49 (range 21-38). The reliability of the checklist was adequate (Cronbach alpha 0.77). Nurses receiving traditional CPR-D performed better than those receiving the Internet-based course (median score 34 vs. 28, P < 0.05) and the control group (median score 34 vs. 26, P < 0.0001). Nurses receiving Internet-based course performed similarly as the control group (median score 28 vs. 26, ns). CONCLUSIONS: Distance learning cannot substitute for traditional small-group learning.

Education, Distance↗
PubMed2006

Comparison of airway management with the intubating laryngeal mask, laryngeal tube and CobraPLA by paramedical students in anaesthetized patients.

BACKGROUND: Because of the importance of airway management in emergency care, alternative methods with shorter learning curves for inexperienced personnel have been looked for as a substitute for endotracheal intubation (ETI). METHODS: We compared the success of insertion, oxygenation and ventilation of the intubating laryngeal mask (ILMA), laryngeal tube (LT) and CobraPLA (COB) in anaesthetized patients when used by paramedical students. After informed consent, 96 patients were monitored and anaesthetized for general surgery without the use of a muscle relaxant. After the induction of anaesthesia, 32 paramedical students inserted the ILMA, LT or COB in a random order and ventilated the patient for a 60-s period. The number of insertion attempts, the time needed for insertion, and oxygenation and ventilation parameters were recorded. The students gave a subjective evaluation of the airway devices after the test. RESULTS: Twenty-four of the 32 students (75%) successfully inserted ILMA at the first attempt, compared with 14 of 32 (44%) for LT and seven of 32 (22%) for COB (P<0.001, ILMA vs. COB). One student failed to insert ILMA after all three attempts, compared with seven of 32 (21%) using LT and seven of 32 (21%) using COB (P=not significant). Oxygenation and ventilation parameters did not differ between the groups after successful insertion. CONCLUSION: Clinically inexperienced paramedical students can successfully use ILMA in anaesthetized patients. Further investigations are warranted to study whether ILMA or LT can replace ETI in emergency airway management when used by inexperienced medical or paramedical staff.

Anesthesia, General↗
PubMed2005

The outcome of pain related undergraduate teaching in Finnish medical faculties.

Little is known about how other than cancer pain related issues are represented in medical education. A standardised questionnaire was mailed to all medical students who graduated from the five Finnish medical schools in 2001. A total of 387 students received the questionnaire and 41% responded. The students had to evaluate the quantity and the quality of pain teaching. The availability and the participation in the advanced courses or research in pain medicine were asked. The students reported how the IASP curriculum on pain had been covered during the studies. Two clinical cases were presented for diagnosis and treatment. In addition to integrated pain teaching, specific pain education was received by 27% of the students. The departments of anaesthesiology were reported as the major deliverers of teaching of pain. The overall ratings of the pain-related teaching of the faculties varied from 3.4 to 4.6 on a scale of 10. Anatomy, biochemistry, physiology and pharmacology of pain were covered well. The definitions of pain, pain research, sociological issues, paediatric, geriatric and mentally retarded patients' pain were taught most poorly. Only 34% of the students had been offered advanced studies and 15% had been offered research projects in pain medicine. The lack of teaching about the concept of a multidisciplinary pain clinic was recognised by almost all students. The clinical problems were excellently solved. In conclusion, the IASP curriculum is well covered in the present programmes in the Finnish medical faculties. However, the quality and the methods of teaching still need improvement.

Curriculum↗
PubMed2005

Feasibility of electromyography (sEMG) in measuring muscular activity during spinal anaesthesia in patients undergoing knee arthroplasty.

BACKGROUND: Bromage scale (0-3) is used to measure the degree of motor block during spinal anaesthesia. However, an estimation of motor block is difficult during surgery. The purpose of this study was to evaluate the feasibility of surface EMG describing spontaneous muscular activity in the lower extremities during spinal anaesthesia. METHODS: In part I of the study, 13 patients undergoing day case surgery were studied. They received 10 mg hyperbaric bupivacaine at interspace L3-4. EMG, sensory and muscular block were measured at 5-min intervals during the first 30 min and then every 15 min until the patient was able to flex the knee. In part II of the study, 16 patients undergoing knee arthroplasty received 10 mg bupivacaine through spinal catheter at interspace L3-4 (Group CSA). An additional bolus of 2.5 mg was administered using EMG-guidance, if needed. Another group, 15 patients, received a single bolus of bupivacaine (15-20 mg) at L3-4 (Group Bolus). EMG, muscular and sensory block were monitored as described above. The epidural catheter was used as rescue. RESULTS: Part I: EMG compared to modified Bromage scale showed a significant correlation (P < 0.01, Spearman rank correlation). Part II: The amount of bupivacaine was significantly reduced with EMG guidance when compared with the single bolus group (14.0 mg vs. 17.0 mg) (P < 0.05 Mann-Whitney U). Motor block started to recover before the sensory block in 7/15 CSA patients vs. 1/15 Bolus patient. CONCLUSION: Stable maximal sensory block does not necessarily correlate with adequate motor block in patients receiving spinal anaesthesia induced with small bolus doses. In spite of electrical noise, EMG-guided administration of spinal anaesthesia significantly reduced the amount of bupivacaine compared to the hospital routine. Further studies are needed to develop the method.

Adult↗
PubMed2004

Teaching public access defibrillation to lay volunteers--a professional health care provider is not a more effective instructor than a trained lay person.

BACKGROUND: Survival improves in witnessed out-of-hospital cardiac arrest if the victim receives bystander-initiated cardiopulmonary resuscitation and rapid defibrillation (BLS/AED). The European Resuscitation Council has a simple programme to teach these life-saving skills that require no previous experience of automated external defibrillators (AEDs). To be able to implement the use of AEDs widely, many instructors are needed, and therefore, lay persons may also be used as trainers. The purpose of this randomized study was to compare lay volunteers trained by a lay person with those trained by a health care professional using the Objective Structured Clinical Examination (OSCE). METHODS: Eight instructors, including four lay persons and four health care professionals, were given a basic course and an instructor course in CPR-D by the same instructor. All newly trained instructors trained 38 lay volunteers (19 pairs) who had no previous training in the use of a defibrillator. The lay volunteers performed the OSCE 2-3 weeks after the course. The OSCE comprised two scenarios with a manikin: the first, a patient in cardiac arrest with ventricular fibrillation, and the second, an imminent cardiac arrest with asystole as the initial rhythm. The same OSCE was performed by a group of lay first aiders practicing every 2 weeks who served as the control group. RESULTS: No statistical difference was present between the two groups of lay volunteers in the OSCE. All were able to use the AED and follow instructions. They identified patients with ventricular fibrillation and cardiac arrest, but had difficulties identifying cases with imminent cardiac arrest. The control group of trained first aiders performed significantly more effectively than the newly trained lay persons. CONCLUSIONS: No significant benefit exists in the trainer being a health care professional, but thorough training and subsequent rehearsing of the skills learned are crucial.

Cardiopulmonary Resuscitation↗
PubMed2003

Preliminary experience of combined peri- and retrobulbar block in surgery for penetrating eye injuries.

BACKGROUND AND OBJECTIVE: Regional anaesthesia has not been recommended as an anaesthetic method for penetrating eye injuries because it is suspected to aggravate the injury already present. After having successfully managed the treatment of a penetrating eye injury under combined peri- and retrobulbar block in an ASA IV patient, it was decided to evaluate this anaesthetic method further in the treatment of such emergency cases. METHODS: Twenty adult patients with penetrating eye injuries with a maximum wound length of 8 mm extending up to 4 mm posteriorly from the limbus were operated on under combined peri- and retrobulbar anaesthesia. Eighteen patients receiving general anaesthesia served as controls. RESULTS: The mean (range) volume injected for a satisfactory peribulbar retrobulbar block was 7.4 (6.5-8.0) mL, six patients needed an additional retrobulbar injection before surgery (2.9, range 2-4, mL). All patients receiving regional anaesthesia were satisfied with the anaesthetic method and the surgeons considered the surgical conditions as good. No problems relating to local anaesthesia were observed or reported by any of the patients. CONCLUSIONS: In the hands of an experienced anaesthesiologist and under certain conditions, regional anaesthesia appears to be suitable for adult patients having penetrating eye injuries.

Adolescent↗