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PubMed1989

Calibration of [14C]plastic standards for quantitative autoradiography of [125I]labeled ligands with Amersham Hyperfilm beta-max.

The densitometric response of Hyperfilm beta-max (HFBM) to [14C]plastic standards was calibrated to tissue-equivalent concentrations of [125I]. Plastic sections with standard concentrations of [125I] and [14C] were apposed to HFBM for 1, 3, 5, and 9 days, with liver and muscle slices (20 microns thick) labeled with [125I]insulin. The relative optical densities (ROD = log 10 [1/gray level x 256(-1)] produced by [125I]- and [14C]plastic standards were converted to equivalent tissue [125I] concentrations (dpm/mm2). The response of HFBM to the [125I]- and [14C]plastic standards was similar (P less than 0.001). Standard curves of tissue [125I] (dpm/mm2) vs plastic [14C] (microCi/g) concentrations fit second order polynomials (r2 = 0.995-0.999). The results show that [14C]plastic standards are valid for measuring [125I] radioactivity in tissue slices by autoradiography with HFBM.

Animals↗
PubMed1989

A proposed standard data file format for hyperthermia treatments.

One of the most critical areas of research essential to improve the clinical use of hyperthermia in cancer therapy is the determination and evaluation of temperature during therapy. In order to improve the dissemination of newly developed thermometry measurement and analysis programs and facilitate the transport of hyperthermia data files between computers for both intra- and inter- institutional use, we propose a standard file format, the Hyperthermia Data Standard (HDS), which can be used for all hyperthermia data. This data file consists of segments of which nine have been defined. The first is an initial /VERSION segment which identifies the file standard. This is followed by eight major segments: 2) a /IDENT segment which contains file and patient identification information; 3) a /TEXT segment containing additional miscellaneous documentation; 4) a /TUMOR segment which provides tumor and treatment site information; 5) a /HSETUP segment which contains treatment setup information; 6) a /FORMAT segment which defines the data segment structure; 7) a /DATA segment containing the actual thermometry data; 8) a /FOLLOWUP segment for documenting patient response; and 9) an /ANALYSIS segment containing summary information. All segments begin and end with a specified delimiter and, except for the first two (/VERSION and /IDENT), may be repeated more than once. For ease in debugging and verifying adherence to the standard, all information in the file is encoded in printable ASCII characters. All segments consist solely of records containing KEYWORDS and KEYWORD VALUES which identify specified information. Certain KEYWORDS are standard, i.e., having specified names and information formats as defined in this document. The /DATA segment consists of ASCII encoded chronological treatment thermometry and other data whose format and structure is identified in the /FORMAT segment. The /ANALYSIS segment provides the flexibility to store the results of any analysis program along with the actual data file for ease of data management. This thermometry data file standard is designed to provide both flexibility and extendability for all possible forms of hyperthermia treatment data. Furthermore, it is designed to provide a simple format which may be easily read by higher level languages. This document is intended for commercial manufacturers and others who are writing programs to document clinical hyperthermia treatments with the intention that they either use this format for their data storage or provide a means to convert their data into this format.(ABSTRACT TRUNCATED AT 400 WORDS)

Body Temperature↗
PubMed1992

Standardization in the determination of red blood cell polyamines by high-performance liquid chromatography.

The choice of the standardization method in the high-performance liquid chromatographic determination of dansyl polyamines (spermidine and spermine) in red blood cell extracts is discussed. 1,6-Hexanediamine, commonly used as an internal standard, is unsuitable for the quantification of spermidine and spermine in red blood cells because their percentage recoveries are significantly different (100% for 1,6-hexanediamine, and 70% for spermidine and spermine). The external standard method and the standard addition method are better suited. The procedure for the preparation of the standard mixture before dansylation has an influence on the values of red blood cell polyamines. Two procedures are compared and the corresponding percentages of variation were found to be high for spermidine and spermine. Thus the procedure in which the standard is treated in a strictly similar way as the red blood cells is certainly the most appropriate one for the quantification.

Chromatography, High Pressure Liquid↗
PubMed2005

Estimating and comparing diagnostic tests' accuracy when the gold standard is not binary.

RATIONALE AND OBJECTIVES: Investigators often need to assess the accuracies of diagnostic tests when the gold standard is not binary-scale. The objective of this article is to describe nonparametric estimators of diagnostic test accuracy when the gold standard is continuous, ordinal, and nominal scale. MATERIALS AND METHODS: A nonparametric method of estimating and comparing the area under receiver operating characteristic (ROC) curves, proposed by DeLong et al, is extended to situations in which the gold standard is not binary. Two examples illustrate the methods. RESULTS: Measures of diagnostic test accuracy, their variance, and tests for comparing two diagnostic tests' accuracies in paired designs are presented for situations in which the gold standard is continuous, ordinal, and nominal scale. These summary measures of diagnostic test accuracy are analogous in form and interpretation to the area under the ROC curve. CONCLUSION: Dichotomizing the outcomes of a gold standard so that traditional ROC methods can be applied can lead to bias. The methods described here are useful for assessing and comparing summary test accuracy when the gold standard is not binary scale. They have limitations similar to other summary indices.

Diagnostic Imaging↗
PubMed2006

Retention of pediatric bag-mask ventilation efficacy skill by inexperienced medical student resuscitators using standard bag-mask ventilation masks, pocket masks, and blob masks.

OBJECTIVE: To measure the ventilation efficacy with three single-sized mask types on infant and child manikin models. METHODS: Medical students were recruited as study subjects inasmuch as they are inexperienced resuscitators. They were taught proper bag-mask ventilation (BMV) according to the American Heart Association guidelines on an infant and a child manikin. Subjects completed a BMV attempt successfully using the adult standard mask (to simulate the uncertainty of mask selection), pocket mask, and blob mask. Each attempt consisted of 5 ventilations assessed by chest rise of the manikin. Study subjects were asked which mask was easiest to use. Four to six weeks later, subjects repeated the procedure with no instructions (to simulate an emergency BMV encounter without immediate pre-encounter teaching). RESULTS: Forty-six volunteer subjects were studied. During the first attempt, subjects preferred the standard and blob masks over the pocket mask. For the second attempt, the blob mask was preferred over the standard mask, and few liked the pocket mask. Using the standard, blob, and pocket masks on the child manikin, 39, 42, and 20 subjects, respectively, were able to achieve adequate ventilation. Using the standard, blob, and pocket masks on the infant manikin, 45, 45, and 11 subjects, respectively, were able to achieve adequate ventilation. CONCLUSIONS: Both the standard and blob masks are more effective than the pocket mask at achieving adequate ventilation on infant and child manikins in this group of inexperienced medical student resuscitators, who most often preferred the blob mask.

Adult↗
PubMed2006

Size of corneal topographic effective optical zone: comparison of standard and customized myopic laser in situ keratomileusis.

PURPOSE: To investigate the corneal topographic effective optical zone (EOZ) in eyes after wavefront-guided myopic laser in situ keratomileusis (LASIK) and to compare them with the EOZ after standard LASIK. DESIGN: Retrospective, case-control study. METHODS: We evaluated the corneal topographic maps of 41 eyes of 25 consecutive patients who had CustomVue LASIK (CV LASIK) and 41 eyes of 23 patients who had standard LASIK with correction up to -7 diopters using the VISX Star S4 laser (VISX Inc, Santa Clara, California, USA). On the refractive map of the Humphrey Topography System, we defined the EOZ as the area outlined by a change of corneal power of 0.5 diopters from the power at the center of the pupil. We analyzed the differences in EOZs of the two ablation patterns and the correlation between EOZ and magnitude of refractive correction. RESULTS: The mean postoperative EOZs were 17.9 +/- 3.7 mm(2) and 11.4 +/- 3.4 mm(2) after CV and standard LASIK, representing 60% and 40% of the laser-programmed optical zones, respectively (both P < .0001). There was no correlation between the postoperative EOZs and the magnitude of refractive correction for both ablations (all P > .05). In eyes with spherical correction (cylinder < or =0.25 diopters), CV LASIK increased the preoperative EOZ by 3.8 +/- 5.6 mm(2) (P = .018), whereas standard LASIK decreased EOZ by 4.5 +/- 5.2 mm(2) (P = .005). CONCLUSION: CV LASIK created larger corneal topographic EOZs than standard ablation. In eyes with spherical correction, the preoperative EOZ was expanded by CV LASIK and reduced by standard LASIK.

Adult↗
PubMed2005

The impact of manipulating personal standards on eating attitudes and behaviour.

The relationship between perfectionism and eating disorders is well established and is of theoretical interest. This study used an experimental design to test the hypothesis that manipulating personal standards, a central feature of perfectionism, would influence eating attitudes and behaviour. Forty-one healthy women were randomly assigned either to a high personal standards condition (n = 18) or to a low personal standards condition for 24 h (n = 23). Measures of personal standards, perfectionism, and eating attitudes and behaviour were taken before and after the experimental manipulation. The manipulation was successful. After the manipulation, participants in the high personal standards condition ate fewer high calorie foods, made more attempts to restrict the overall amount of food eaten, and had significantly more regret after eating than those in the low personal standards condition. Other variables remained unchanged. It is concluded that experimental analyses can be of value in elucidating causal connections between perfectionism and eating attitudes and behaviour.

Adult↗
PubMed2006

When ambiguity hurts: social standards moderate self-appraisals in generalized social phobia.

Thirty-nine individuals with generalized social phobia (social anxiety disorder) and 39 nonclinical controls performed a public speech after receiving cues about social standards. Using a novel video manipulation paradigm, one third of participants received cues indicating that standards for performance were high, one third received cues that standards were low, and the remaining third were given no explicit information about expected standards (i.e., standards were ambiguous). Individuals with social phobia performed objectively worse than controls in all conditions, but rated their performance as being worse only in the high and ambiguous standards conditions. These results suggest that in social phobia, negative self-perception is context-dependent. Implications for the cognitive model and treatment are discussed.

Adolescent↗
PubMed2006

Should a standard be defined for the Positive Predictive Value (PPV) of recall in the UK NHS Breast Screening Programme?

The UK NHSBSP defines standards for both cancer detection rate and recall rate for assessment but has not explicitly set a defined standard for positive predictive value (PPV) of recall. However, as PPV is defined as the percentage of women who are recalled and have a final diagnosis of cancer, a standard for PPV is an implicit consequence of the standards for cancer detection rate and recall rate. The standards are defined in terms of a lower level of acceptability known as the 'minimum standard' and a higher level of acceptability referred to as the 'target'. The target can be shown to be a PPV of more than 5.1% for prevalent screens and more than 8.4% for incident screens. This paper will explore the role of PPV as a performance measure and show how making moderate increases in PPV for programmes with the lowest PPVs could lead to major improvements in the overall efficiency of the programme.

Breast Neoplasms↗
PubMed2006

Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats.

BACKGROUND: Recent studies have shown excellent clinical results using eccentric squat training on a 25 degrees decline board to treat patellar tendinopathy. It remains unknown why therapeutic management of patellar tendinopathy using decline eccentric squats offer superior clinical efficacy compared to standard horizontal eccentric squats. This study aimed to compare electromyography activity, patellar tendon strain and joint angle kinematics during standard and decline eccentric squats. METHODS: Thirteen subjects performed unilateral eccentric squats on flat-and a 25 degrees decline surface. During the squats, electromyography activity was obtained in eight representative muscles. Also, ankle, knee and hip joint goniometry was obtained. Additionally, patellar tendon strain was measured in vivo using ultrasonography as subjects maintained a unilateral isometric 90 degrees knee angle squat position on either flat or 25 degrees decline surface. FINDINGS: Patellar tendon strain was significantly greater (P<0.05) during the squat position on the decline surface compared to the standard surface. The stop angles of the ankle and hip joints were significantly smaller during the decline compared to the standard squats (P<0.001, P<0.05). Normalized mean electromyography amplitudes of the knee extensor muscles were significantly greater during the decline compared to the standard squats (P<0.05). Hamstring and calf muscle mean electromyography did not differ, respectively, between standard and decline squats. INTERPRETATION: The use of a 25 degrees decline board increases the load and the strain of the patellar tendon during unilateral eccentric squats. This finding likely explains previous reports of superior clinical efficacy of decline eccentric squats in the rehabilitative management of patellar tendinopathy.

Adult↗
PubMed2005

Tibial somatosensory evoked potential intraoperative monitoring: recommendations based on signal to noise ratio analysis of popliteal fossa, optimized P37, standard P37, and P31 potentials.

OBJECTIVE: To compare the intraoperative signal-to-noise ratio (SNR), reproducibility and rapidity of popliteal fossa (PF), optimized P37, standard P37 and P31 potentials. METHODS: Raw sweeps and 11 averages doubling sweep number from 2 to 2048 were compared in 37 patients undergoing scoliosis surgery. Optimized (highest amplitude or SNR) P37 derivations were Cz-CPc (22), CPz-CPc (27), Pz-CPc (7), iCPi-CPc (8), CPi-CPc (1), Cz-Pz (2) or Pz-FPz (3), and in two patients with non-decussation, Cz-CPi (1) or CPz-CPi (3). Standard P37 and P31 derivations were CPz-FPz and FPz-C5S. Signal amplitude was measured in 2048-sweep averages; peak noise was measured in raw sweeps and +/- averages; SNR was amplitude/noise. Visual superimposability and < 20-30% amplitude variation determined reproducibility. Sweeps to reproducibility determined rapidity. RESULTS: The SNR order was PF >> optimized P37 > standard P37 > P31. Mean optimized P37 SNR advantages over the standard P37 and P31 were 2.1:1 and 4.9:1. SNR had powerful non-linear correlations to reproducibility and rapidity. Median sweeps to reproducibility were PF: 2, optimized P37: 128, standard P37: 512 and P31: 1024. EEG noise was greatest in FPz derivations. Burst-suppression increased scalp potential SNR and rapidity. CONCLUSIONS: Optimized P37 and PF recordings are most rapidly reproducible due to superior SNRs and are recommended. FPz should be avoided. Burst-suppression may be desirable. SIGNIFICANCE: CPz-FPz and FPz-C5S should no longer be standard.

Adolescent↗
PubMed2004

Gold standard medical therapy for glaucoma: defining the criteria identifying measures for an evidence-based analysis.

BACKGROUND: Over the past decade, several new medical therapies have become available for the treatment of primary open-angle glaucoma (POAG). A systematic evidence-based approach for identifying an optimal therapeutic agent is lacking. OBJECTIVES: The aims of this review were to critically evaluate published treatment recommendations for POAG and, based on a systematic review of the literature, to develop criteria that would define a "gold standard" medical therapy that reflects new treatment advances and established therapeutic goals. METHODS: A MEDLINE search spanning the years 1966 to 2002 and using the search terms gold standard, drug of choice, agent of choice, benchmark, ophthalmology, eye, and glaucoma was conducted and the results reviewed by a panel of 15 experts in the field of glaucoma. Published treatment recommendations for POAG were discussed. Criteria, anchored to medical evidence, for distinguishing a standard of medical therapy for POAG were defined. RESULTS: The terms connoting a gold standard therapy were found in only 258 of approximately 368,000 ophthalmology-related citations and 53 of almost 23,000 glaucoma citations, validating the need to define therapeutic standards. The lack of recommendations for the use of new classes of ocular hypotensive agents was acknowledged. Criteria identified to evaluate intraocular pressure (IOP)-lowering agents as gold standards included the following: efficacy in reducing IOP consistently over a 24-hour period to a level that will preserve the visual field and protect the optic nerve without inducing tachyphylaxis and tolerance, paucity of local and systemic adverse effects, promotion of patient compliance, and applicability in diverse patient populations. CONCLUSIONS: These criteria should be employed as measures for evidence-based analyses to evaluate available and future IOP-lowering medical therapies for POAG. The conceptual framework presented may be applicable to other therapeutic areas.

Adrenergic beta-Antagonists↗
PubMed2006

Comparison of carbon-impregnated and standard ePTFE prostheses in extra-anatomical anterior tibial artery bypass: a prospective randomized multicenter study.

OBJECTIVES: The aim of this study was to find out whether carbon impregnated ePTFE vascular grafts have better long-term patency or limb salvage rates than Standard ePTFE vascular grafts in crural revascularization in patients with chronic critical ischemia. DESIGN: Prospective randomized multicenter trial. Study endpoints were 36 months follow-up, major amputation or death. MATERIALS: We used 6mm carbon ePTFE (Carboflo) and 6mm standard ePTFE vascular grafts (both C.R. BARD Inc./IMPRA). METHODS: From June 1995 to November 1998, 283 patients were randomly assigned either to carbon (C) (n=140) or to standard (St) ePTFE (n=143) vascular grafts at 19 centres. A standard protocol was used with lateral extra-anatomic course of the graft to the anterior tibial artery and of a distal vein patch or cuff. More than 90% of the patients had rest pain or gangrene. RESULTS: Two hundred and sixty-five (C=130; St=135) patients could be analysed in the intention-to-treat (ITT) group. Primary patency, secondary patency and limb salvage rates after 36 months were 33, 43 and 67% in the carbon- and 30, 38 and 58% in the standard PTFE group, respectively, (log-rank test: p=0.20, 0.12 and 0.16). Additional analyses were made per protocol (PP) and as-treated (AT). The retrospective power of the study was calculated as 79 and 83%. CONCLUSION: The ITT, PP and AT analysis, showed no statistically significant advantage of the carbon ePTFE vascular graft in terms of patency or limb salvage over the standard ePTFE vascular graft at 36 months.

Adult↗
PubMed2004

Developing evidence-based interdisciplinary care standards and implications for improving patient safety.

AIM: Establish an organizational infrastructure to foster the delivery of quality clinical care through the development of interdisciplinary patient care standards that are evidenced-based and consistent throughout IHC. DESIGN: Develop a process for document development, review, and approval that includes best evidence from research and input from clinical experts. RESULTS: After six years of development, the electronic reference InfoBase (a searchable online reference manual which provides easy access to standards for clinical practice throughout the organization) contains over 700 interdisciplinary patient care standards (e.g., protocols, procedures, standards of care) and over 1000 "information chunks" (e.g., assessments, instructions, scales, tables, graphics) that support consistency in care delivery. All documents have been written, based on the best evidence available from research and reviewed by a group of clinicians at IHC facilities and approved for use throughout the company. An example of how standardization of interdisciplinary standards can improve patient safety in the area of falls is also included.

Accidental Falls↗
PubMed2004

A prospective randomized clinical trial comparing 2.0-mm locking plates to 2.0-mm standard plates in treatment of mandible fractures.

PURPOSE: The purpose of this study was to compare standard 2.0-mm monocortical plates to 2.0-mm locking plates in the treatment of mandible fractures. PATIENTS AND METHODS: A prospective randomized clinical trial was conducted at Harborview Medical Center in Seattle, WA, from January 1, 2002, to February 1, 2003, to compare 2.0-mm locking plates to 2.0-mm standard plates in treating consecutive mandible fractures. Patients were randomly assigned to receive locking 2.0-mm plates (group A) or nonlocking 2.0-mm plates (group B). Complications were divided into major and minor categories. Each complication was analyzed according to which plate was used and where the fracture occurred. The number of days from injury to operation, average age, gender, American Society of Anesthesiologists (ASA) classification,compliance, and social habits were all reviewed. RESULTS: Ninety patients with 122 fractures met the inclusion criteria. Sixty-four fracture sites were treated with locking plates and 58 with standard plates. A total of 6 complications occurred: 2 occurred at the angle, 3 at the parasymphysis, and 1 at the body. Three complications occurred in the locking group and 3 in the standard group with complication rates equaling 4.6% and 5.2%, respectively. When comparing the overall complication rates according to plates used, the Fisher exact test showed no statistically significant difference between the locking and standard plates (P = .90). The 95% confidence interval for the odds ratio is from 0.1 to 7. CONCLUSION: Mandible fractures treated with 2.0-mm locking plates and standard 2.0-mm plates present similar short-term complication rates.

Adolescent↗
PubMed2006

Clinical results of Hancock II versus Hancock Standard at long-term follow-up.

OBJECTIVE: We performed a multi-institutional study to compare the long-term structural valve deterioration of isolated Hancock Standard versus Hancock II bioprostheses. METHODS: From 1983 to 2002, 714 Hancock Standard and 1293 Hancock II bioprostheses were implanted at hospitals of the Venetian territory (Padova, Treviso, and Venice). Follow-up on January 1, 2003, included 14,749 patient-years with a median of 12 years and was 96% complete: 115 Hancock Standard and 53 Hancock II bioprostheses were at risk at 15 years. The 2 series were nonconcomitant, and many covariates differed (Table 1). Survival was analyzed with Cox analysis, and durability was analyzed with Weibull analysis. Balancing analysis with the logistic propensity score model was performed. RESULTS: Perioperative mortality was 6% in Hancock II and 12% in Hancock Standard operations. The overall unadjusted 15-year survival was identical (39.7% +/- 2.3% vs 39.9% +/- 2.4%, respectively), but age-adjusted survival at 15 years was 46% versus 25% (P < .001). Late survival was unrelated to the prosthetic model, whereas it was adversely affected by older age, previous operations, aortic regurgitation, male sex, higher New York Heart Association class, atrial fibrillation, and coronary artery bypass grafting. In Hancock II patients aged 65 years and older, the cumulative hazard of structural valve deterioration at 15 years was 6%, versus 17.5% in Hancock Standard patients. In younger patients, it was 18% and 37%, respectively. Analysis of 541 propensity-balanced patients showed a hazard ratio of the Hancock Standard prosthesis of 2 and a risk reduction of older age of approximately 10% every 10 years. CONCLUSION: After balancing risk factors and calibrating age effects, Hancock II propensity-matched bioprostheses showed similar survival but definitely increased durability.

Adult↗
PubMed2006

It is likely that the risk of cardiovascular events from pharmaceuticals as COX-2 inhibitors can be reduced significantly by standard pharmaceutical and lifestyle preventative measures.

Based on the principles of the altered homeostatic theory, a case will be made that the risk of cardiovascular (CV) events from pharmaceuticals as COX-2 inhibitors (coxibs) and sympatho-mimetic drugs can be reduced significantly by using standard pharmaceutical and lifestyle preventative measures as statins, exercise, a proper diet, and weight and stress reduction. The standard method of preventing CV events from coxibs, the prototypical pharmaceuticals which induce CV events, is not overly helpful; this method is based essentially on limitation of coxibs to low risk individuals, and to low dose and short term usage. Use of standard preventative measures apparently had not been considered because coxib-induced CV events are regarded as "special" as they are attributed to thromboxane. "Regular" CV events are attributed basically to dyslipidemia, and standard preventative measures are designed to improve dyslipidemia; therefore, it probably has been assumed that standard therapy for "regular" CV events would not be applicable to coxib-induced infarctions. In contrast, the altered homeostatic theory treats pharmaceuticals which induce CV events as "regular" risk factors which induce "regular" CV events. Therefore, "regular" preventative measures as exercise and statins should reduce the incidence of pharmaceutical-induced CV events. The critical issue is the mechanism of CV events. Thrombosis is the accepted and vasoconstriction (spasm of resistance vessels) is a proposed mechanism for CV events, and thrombosis and/or vasoconstriction (thrombosis/vasoconstriction) is regarded as the direct mechanism of CV events. Multiple and diverse "regular" risk factors express thrombosis/vasoconstriction, and multiple and diverse pharmaceutical and lifestyle preventative measures express anti-thrombosis/vasodilation. Risk and preventative factors are considered to operate in a dynamic balance; dominance of thrombosis/vasoconstriction favors development of CV events, and dominance of anti-thrombosis/vasodilation favors prevention of CV events. Thromboxane, and thus coxibs, and sympatho-mimetic drugs also express thrombosis/vasoconstriction; it is this expression which makes pharmaceuticals "regular" risk factors which induce "regular" CV events. It is assumed that all pharmaceuticals which induce CV events express thrombosis/vasoconstriction; thrombosis/vasoconstriction is the obvious mechanism for CV events from any source, and expression of thrombosis/vasoconstriction by multiple and diverse "regular" risk factors is supportive. Just as standard pharmaceutical and lifestyle preventative agent significantly reduce the risk of "regular" CV events, such measures should significantly reduce the risk of pharmaceuticals which favor CV events; protection is effected by shifting the overall balance between thrombosis/vasoconstriction and anti-thrombosis/vasodilation beneficially towards dominance of anti-thrombosis/vasodilation.

Cardiovascular Diseases↗
PubMed2004

A comparison between over-the-head and standard cardiopulmonary resuscitation.

BACKGROUND: Standard cardiopulmonary resuscitation (CPR) is performed by kneeling adjacent to the side of the casualty. In certain circumstances it may be difficult or impossible to perform CPR in this position, for example in confined spaces such as a narrow corridor, aircraft or train gangway. The aim of this study was to investigate the technique of over-the-head CPR (OTH CPR), where the CPR provider kneels above the casualty and performs chest compressions OTH of the casualty. METHODS: Twenty volunteers were randomised to a cross over trial where they performed standard and OTH CPR at a 7-day interval. Compression and ventilation variables were recorded on the Laerdal Resusci Annie VAM system. RESULTS: Chest compression depth and ventilation volume declined over time (0-3 min P < 0.001). There was no difference in compression rate, depth, duty cycle or ventilation rate, inflation rate and ventilation volume between techniques. Hand position was incorrect more frequently in the standard compared to the OTH group (incorrect compressions 300 versus 76, respectively, P < 0.001) due principally to a greater proportion of low positioned compressions in the standard CPR group. CONCLUSION: OTH CPR appears equally effective as standard CPR with some marginal advantages in correct hand placement. We suggest that in situations where it is not possible to perform standard CPR, OTH CPR may be considered as a suitable alternative.

Analysis of Variance↗