A response to 'A rationale for staged teaching of basic life support'.
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Cardiopulmonary Resuscitation↗
Biomedical subjects
R T Brennan
Publications and source records attributed to R T Brennan.
Cardiopulmonary resuscitation performance of subjects over forty is better following half-hour video self-instruction compared to traditional four-hour classroom training.
Cardiopulmonary resuscitation (CPR) training is not well targeted to family members of individuals at highest risk of cardiac arrest. Participants in traditional CPR classes (TRAD) average 31 years of age, while family members of cardiac patients average 55 years. Video self-instruction (VSI) can reach older individuals and others who do not participate in TRAD classes. VSI is a combination of a 34-min videotape and an inexpensive manikin intended for use in the home, where three-quarters of all out-of-hospital cardiac arrests occur. We exposed 202 subjects 40 years of age and older (mean age 59.4 years, S.D. = 10.9) to either TRAD or VSI, and tested them individually immediately following training rising validated methods including measurement by means of a Laerdal-Skillmeter manikin. According to American Heart Association (AHA) criteria, VSI subjects performed an average of 20.8% of all compressions and 25.1% of all ventilations correctly, compared with 3.4% of compressions and 1.7% of ventilations by TRAD subjects (P < 0.0001). VSI subjects performed an average of 10.1 of the total 14 CPR assessment and sequence skills correctly, compared with an average of 4.7 for TRAD (P < 0.0001). On a measure of overall performance, 62.7% of the VSI subjects were rated 'competent' or better (i.e. capable of performing CPR that 'would probably be effective'), compared to 6.1% of TRAD subjects (P < 0.0001). Only 17.8% of VSI subjects were rated as 'not competent' (i.e. unable to obtain a combination of any chest rise and any compression of the sternum) compared with 69.1% of TRAD subjects. VSI provides an effective, convenient, and inexpensive means of training persons over 40 years of age that achieves skill performance superior to TRAD.
Adult↗
Video self-instruction for cardiopulmonary resuscitation.
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Black or African American↗
Fit as a mediator of the relationship between work hours and burnout.
The authors studied number of hours worked and estimated its relationship to burnout in a nonrandom sample of 141 married physicians. It was hypothesized that this relationship is mediated by a process called fit, conceptualized as the extent to which workers realize the various components of their work-family strategies. Results of structural equation modeling supported the mediation hypothesis. Employees whose work hours are more or fewer than they and their partner prefer and whose work hours are distributed differently than they and their partner prefer will be more disengaged, distracted, and alienated at work than will their counterparts who are working their preferred schedules. Thus, the relationship between number of hours worked and burnout depends on the extent to which work schedules meet the needs of the worker, her or his partner, and their children, if any.
Adaptation, Psychological↗
Layperson CPR.
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Cardiopulmonary Resuscitation↗
Randomized, controlled trial of video self-instruction versus traditional CPR training.
STUDY OBJECTIVE: We conducted a prospective, randomized, controlled trial to test the hypothesis that a 34-minute video self-instruction (VSI) training program for adult CPR would yield comparable or better CPR performance than the current community standard, the American Heart Association Heartsaver course. METHODS: Incoming freshman medical students were randomly assigned to VSI or the Heartsaver CPR course. Two to 6 months after training, we tested subjects to determine their ability to perform CPR in a simulated cardiac arrest setting. Blinded observers used explicit criteria to assess our primary outcome, CPR performance skill. In addition, we assessed secondary outcomes including sequential performance of individual skills, ventilation and chest compression characteristics, and written tests of CPR-related knowledge and attitudes. RESULTS: VSI trainees displayed superior overall performance compared with traditional trainees. Twenty of 47 traditional trainees (43%) were judged not competent in their performance of CPR, compared with only 8 of 42 VSI trainees (19%; absolute difference, 24%; 95% confidence interval, 5% to 42%). CONCLUSION: In a group of incoming freshman medical students, we found that a half-hour of VSI resulted in superior overall CPR performance compared with that in traditional trainees. If validated by further research, VSI may provide a simple, quick, and inexpensive alternative to traditional CPR instruction for health care workers and, perhaps, the general population.
Adult↗
Are we training the right people yet? A survey of participants in public cardiopulmonary resuscitation classes.
It has long been argued that cardiopulmonary resuscitation (CPR) training should be targeted at those most likely to be on the scene when a cardiac arrest occurs. Since cardiac arrest occurs in the home about three-quarters of the time, the persons most likely to be on hand are family members. We surveyed 244 participants in public (i.e. not offered in a workplace) CPR classes to determine the make up of the population. In contrast to the family members of cardiac patients, who average 55 years of age, CPR class participants are young (mean 30.8 years). The majority (66.8%) of participants are in their twenties and thirties; only 6.6% are aged 50 or older. A minority (18.5%) indicate living with someone at high risk for a heart attack. In at least one respect, CPR class participants do resemble family members of cardiac patients, they are overwhelmingly (69.4%) female. Even in public classes, the majority (78.5%) of persons taking CPR are fulfilling a job requirement. Most (62.0%) have had prior CPR training; about half (49.2%) have had recent (i.e. within three years) training. Targeting of CPR training to the individuals most likely to be at the scene of a cardiac arrest has long been advocated, but the reality is that training does not reach the right people. More research is needed to determine how better to reach these persons.
Adolescent↗
Skill mastery in public CPR classes.
Effectiveness of CPR performance on a manikin was evaluated immediately after training in public CPR classes by trained independent observers using validated measures and procedures. An instrumented manikin was used to assess critical skills thought to be related to survival following out-of-hospital cardiac arrest (compressions and ventilations), applying standards of the American Heart Association. The 226 subjects were enrolled in CPR classes offered to the public by the American Red Cross and the American Heart Association. Fifty percent of subjects performed 2% or fewer compressions correctly (the most common error being insufficient depth), and 50% performed 10% or fewer of ventilations correctly (the most common error being insufficient volume). Sixty-five percent failed to achieve a compression rate of 80 to 100/min. Forty-five percent of subjects failed to open the airway prior to a breathing check, 50% failed to adequately assess breathing, and 53% did not perform an adequate pulse check. Nearly half of all subjects made at least four errors in assessment and sequencing of skills. According to published criteria, trainee performance of CPR is poor. Failure in critical skills may contribute to poor survival rate following out-of-hospital cardiac arrest. CPR training programs must be developed with attention to learner outcomes.
Cardiopulmonary Resuscitation↗
A reappraisal of mouth-to-mouth ventilation during initiated cardiopulmonary resuscitation.
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Cardiopulmonary Resuscitation↗
Layperson CPR.
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American Heart Association↗
Does child care involvement increase or decrease distress among dual-earner couples?
This study addressed how parents' relative involvement in child care is related to marital-role quality and psychological distress. These relationships were examined in a random sample of 133 mothers and fathers in dual-earner couples. Regression analyses employing hierarchical linear modeling techniques indicated that the more fathers participated in child care relative to their wives, the lower the father's distress. For mothers, the effect of child care involvement was complex: Although there were psychological benefits to spending proportionally more time involved in child care (lowered distress), these benefits were offset by a decrease in marital-role quality, which in turn increased distress. These findings indicate that the relation between child care involvement and the psychological health of both women and men in dual-earner couples is intertwined and complex.
Adult↗
Change in job conditions and change in psychological distress within couples: a study of crossover effects.
In a random sample of 242 full-time employed men and women in dual-earner couples (N = 484), this study estimated the relations between (a) his experiences on the job over time and her distress over time and (b) her experiences on the job over time and his distress over time. In addition, we explored whether the crossover effects were due primarily to experiences with particular job conditions, and whether there were gender differences in the magnitude of these associations. The participants were interviewed 3 times over a 2-year period. After taking into account the relationship between each partner's own job conditions over time and her or his own psychological distress, there were significant associations between both the time-varying and the stable components of each partner's job conditions on the other partner's distress. The findings are discussed within the context of the need to expand the models used to study the job stress-illness relation to include longitudinal and within-couple crossover effects.
Adult↗
The psychological effects of work experiences and disagreements about gender role beliefs in dual-earner couples: a longitudinal study.
Using an economically diverse random sample of 300 full-time employed men and women in dual-earner couples from two communities in the Northeast, we estimated the relation between the direction and magnitude of disagreement about gender role ideology (GRI) within couples and psychological distress. We conceptualized GRI within couples as both the couple mean or stable gender-role ideology (the "couple ideology") and as each partner's deviation from the other partner's score. Moreover, for each partner, we estimated the relation between both the stable (i.e., mean) component and the change (i.e., time-varying) component of GRI and distress. Finally, for each partner we estimated the moderating effect of GRI on the relation between job-role quality and distress. Findings are: (a) the more egalitarian the husband's average GRI is relative to his wife's, the less distressed he is; (b) if over time a wife's GRI becomes less egalitarian relative to her husband's, then her distress will be more affected by changes in her job-role quality; (c) for husbands, as the couple's average GRI becomes more egalitarian over time, the effect of job-role quality on distress is lessened; and (d) for a man in a couple with a more egalitarian stable GRI, the effects of change in job-role quality on distress are less pronounced than for a man in a couple with a less egalitarian stable GRI. Results are discussed in terms of new conceptions of GRI revealing the dynamic interaction of within-couples' gender-role ideologies.
Adult↗
Negative affectivity: how serious a threat to self-report studies of psychological distress?
Serious questions have been raised about the common practice of relying on self-report measures to assess the relation between subjective role experiences on the one hand and both mental and physical health symptoms on the other. Such self-report measures may reflect a common underlying dimension of negative affectivity (NA), thereby leading to spurious results. In this article, we present findings from analyses in which we estimate, using a hierarchical linear model, the relation between subjective experiences in job and marital roles and self-reports of symptoms of psychological distress after controlling for NA in a sample of 300 full-time employed men and women in married couples. Results demonstrate (a) that NA can account for a great deal of the variation in self-reported psychological distress, as much as half in the case of the men in the sample; (b) that estimates of the relations between a self-reported predictor of social-role quality (e.g., marital-role quality, job-role quality) may be biased by failure to include NA as a predictor of self-reported psychological distress; (c) that the degree of bias in these estimates is dependent on the nature of the predictor, and (d) that the role of NA as a confounder does not appear to be dependent on gender.
Adult↗
CPR training without an instructor: development and evaluation of a video self-instructional system for effective performance of cardiopulmonary resuscitation.
Traditional classroom-based instruction of cardiopulmonary resuscitation (CPR) has failed to achieve desired rates of bystander CPR. Video self-instruction (VSI) is a more accessible alternative to traditional classroom instruction (TRAD), and it achieves better CPR skill performance. VSI employs a 34-min training tape and an inexpensive manikin. VSI combines simplified and reordered content focusing on the delivery of one-rescuer CPR with the 'practice-as-you-watch' approach of an exercise video. Performance of CPR skills immediately following VSI was compared to performance immediately following TRAD using an instrumented manikin, a valid and reliable skill checklist, and an overall competency rating. Compared with TRAD subjects, VSI subjects performed more compressions correctly (P < 0.001), more ventilations correctly (P < 0.001), and more assessment and sequence skills correctly (P < 0.001). TRAD subjects delivered twice as many compressions that were too shallow, and underinflated the lungs twice as often. VSI subjects were rated 'competent' or better 80.0% of the time, compared with TRAD subjects, who achieved this rating only 45.1% of the time (P < 0.001). TRAD subjects were rated to be 'not competent' in performing CPR nearly 10 times more often than VSI subjects (P < 0.001). Subjects 40 years of age and older performed better after VSI than after TRAD. Superior skill performance among subjects exposed to VSI persisted 60 days following training. VSI has the potential to reach individuals unlikely to participate in TRAD classes because of its greater convenience, lower cost, and training in about 0.50 h compared with 3-4 h for TRAD classes.
Adult↗
A reliable and valid method for evaluating cardiopulmonary resuscitation training outcomes.
In order to compare the quality of CPR performance after various training methods, training outcome assessment must provide meaningful data and do it in a way that is reliable. Few studies have provided details of their assessment procedures, and even fewer report on whether the measures to evaluate performance are reliable (yielding information consistently over multiple trials), or valid (measuring the outcome intended). Few studies have attempted to replicate assessment methods used by other authors. Conventional skill sheets have not been shown to assess compressions and ventilations reliably and validly. When using an instrumented manikin, skill checklists can be simplified by eliminating qualitative assessment of compressions and ventilations. Using a sample of 171 CPR trainees rated by trained evaluators, we provide details of agreement between two evaluators and use an established statistic (Cronbach's alpha) to assess the reliability of a 14-item simplified CPR checklist. The level of agreement between two raters was high (Pearson product-moment correlation = 0.87) as was the reliability estimate obtained by Cronbach's alpha (0.89). As criterion-related evidence of the validity of the CPR checklist to assess CPR performance, a correlation with a five-point subjective overall rating of CPR was estimated (Spearman correlation = 0.92). We urge standardized reporting of CPR training outcomes in order to achieve comparability across studies.
Adult↗
A peer-training model for instruction of basic cardiac life support.
This study evaluates a peer-training model for cardiopulmonary resuscitation (CPR) instruction for laypersons. Forty-one Norwegian factory employees were trained in CPR and given instructor training. These first trainees then trained 311 co-workers. These employees then trained 873 family members and associates at home. The reference group consists of employees in a Massachusetts commercial hotel trained in seven American Red Cross (ARC): Adult CPR classes. The Norwegian home trainees learned CPR using a cardboard training manikin and were trained by Norwegian factory employees who had learned CPR from co-workers. Trainees were evaluated using skill sheets and a Laerdal Skillmeter manikin. The performance of the Norwegians trained at home by peers did not differ from that of the ARC: Adult CPR trainees in six skills of the initial sequence of CPR. The home trainees outperformed the ARC: Adult CPR trainees in the proportion of compressions delivered correctly (P = 0.032) and ventilations delivered correctly (P = 0.015). Peer training may provide CPR instruction comparable to training in CPR classes at lower cost and with potential to reach new population segments.
Analysis of Variance↗
Skill mastery in cardiopulmonary resuscitation training classes.
The authors evaluated skill levels of trainees (n = 48) who were taught cardiopulmonary resuscitation (CPR) in "American Red Cross: Adult CPR" classes offered at a work site. The evaluation used a validated skill checklist and a Laerdal Skillmeter mannequin to assess trainee competence. Only 1 in 10 of the trainees could correctly perform all 12 CPR skills assessed by the skill checklist. Fewer than 12% of all compressions met published standards, and fewer than 25% of the ventilations met the standards as evaluated by the Skillmeter mannequin. All trainees felt confident they could use their CPR skills in an actual emergency; 64% were "very confident." Videotape recordings of the practice sessions showed that instructors overlooked many errors in CPR performance and that trainees provided little corrective feedback to one another. The role of instructors in assisting CPR skill practice and in evaluating skill mastery is questioned.
Adult↗