1. Resusc Plus. 2023 Sep 9;16:100467. doi: 10.1016/j.resplu.2023.100467.

eCollection 2023 Dec.

Basic life support training for people with disabilities. A scoping review.

Berlanga-Macías C(1)(2), Barcala-Furelos R(3), Méndez-Seijo N(3), Peixoto-Pino

L(4)(5), Martínez-Isasi S(5)(6)(7).

Author information:
(1)Social and Health Care Research Center, University of Castilla-La Mancha,
Cuenca, Spain.
(2)Faculty of Nursing, University of Castilla-La Mancha, Albacete, Spain.
(3)REMOSS Research Group, Facultade de CC, da Educación e do Deporte,
Universidade de Vigo, Pontevedra, Spain.
(4)Faculty of Education Sciences. Universidade de Santiago de Compostela,
Santiago de Compostela, Spain.
(5)CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and
Medicine Department, Universidade de Santiago de Compostela, Santiago de
Compostela, Spain.
(6)Simulation and Intensive Care Unit of Santiago (SICRUS) Reseach Group, Health
Research Institute of Santiago, University Hospital of Santiago de
Compostela-CHUS, Santiago de Compostela, Spain.
(7)Faculty of nursing. University of Santiago de Compostela, Santiago de
Compostela, Spain.

BACKGROUND: The integration of populations with various types of disabilities

into basic life support (BLS) training programs could contribute to a potential
increase in trained laypersons with BLS knowledge and, consequently, in survival
rates. The objective of this study was to analyze the distinct educational
methods which exist today on BLS for people with some type of specific
disability, and to evaluate their impact on the quality of BLS maneuvers.
METHODS: A scoping review in which the different training strategies in BLS for
people with distinctive disabilities were analyzed was carried out. Previous
studies were sought and researched in MEDLINE, EMBASE, and the Cochrane Library
from the beginning up to 4 August 2023.
RESULTS: A total of 14 studies were thoroughly analyzed. The BLS training
strategies for people with disabilities were classified according to the
following criteria: objective (training, content validation or analysis of
learning barriers), target population (visual, hearing, physical disabilities or
Down syndrome), training resources (training with/without adaptation), contents
(BLS and use of the automated external defibrillator) and evaluation instrument
(i.e., the simulation test and knowledge questionnaire). The variety of BLS
training programs for such population is limited. Likewise, people with
different disabilities are able to effectively learn BLS maneuvers, although
with mixed results, mainly in those regarding the CPR quality.
CONCLUSION: People with visual, hearing disabilities or Down syndrome are able
to effectively learn BLS maneuvers.

© 2023 The Authors.

DOI: 10.1016/j.resplu.2023.100467
PMCID: PMC10497786
PMID: 37711683

Conflict of interest statement: The authors declare that they have no known
competing financial interests or personal relationships that could have appeared
to influence the work reported in this paper.
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T(949), Kanneganti TD(950), Kanno H(951), Kanthasamy AG(952), Kantorow M(206),
Kaparakis-Liaskos M(953), Kapuy O(954), Karantza V(955), Karim MR(956), Karmakar
P(957), Kaser A(958), Kaushik S(395), Kawula T(959), Kaynar AM(960)(961), Ke
PY(962), Ke ZJ(963), Kehrl JH(964), Keller KE(965), Kemper JK(966), Kenworthy
AK(967), Kepp O(968), Kern A(969), Kesari S(970), Kessel D(971), Ketteler
R(972), Kettelhut Ido C(707), Khambu B(973), Khan MM(974), Khandelwal VK(975),
Khare S(701), Kiang JG(976), Kiger AA(977), Kihara A(978), Kim AL(979), Kim
CH(980), Kim DR(981), Kim DH(982), Kim EK(364), Kim HY(983), Kim HR(984), Kim
JS(985), Kim JH(986)(987), Kim JC(988), Kim JH(986)(987), Kim KW(989), Kim
MD(990), Kim MM(991), Kim PK(992), Kim SW(993), Kim SY(994), Kim YS(995), Kim
Y(996), Kimchi A(70), Kimmelman AC(997), Kimura T(482), King JS(998), Kirkegaard
K(169), Kirkin V(999), Kirshenbaum LA(1000), Kishi S(1001), Kitajima Y(1002),
Kitamoto K(1003), Kitaoka Y(1004), Kitazato K(1005), Kley RA(1006), Klimecki
WT(325), Klinkenberg M(87), Klucken J(1007), Knævelsrud H(1008), Knecht E(1009),
Knuppertz L(758), Ko JL(1010), Kobayashi S(1011), Koch JC(1012),
Koechlin-Ramonatxo C(1013), Koenig U(1014), Koh YH(1015), Köhler K(1016),
Kohlwein SD(260), Koike M(1017), Komatsu M(1018), Kominami E(1019), Kong
D(1020), Kong HJ(1021), Konstantakou EG(1022), Kopp BT(1023), Korcsmaros
T(1024), Korhonen L(1025), Korolchuk VI(265), Koshkina NV(914), Kou Y(477),
Koukourakis MI(1026), Koumenis C(1027), Kovács AL(924), Kovács T(166), Kovacs
WJ(1028), Koya D(1029), Kraft C(1030), Krainc D(1031), Kramer H(1032),
Kravic-Stevovic T(1033), Krek W(1034), Kretz-Remy C(1035)(1036), Krick R(1037),
Krishnamurthy M(1038), Kriston-Vizi J(972), Kroemer G(1039)(1040)(1041)(1042),
Kruer MC(1043), Kruger R(1044), Ktistakis NT(1045), Kuchitsu K(1046), Kuhn
C(623), Kumar AP(1047), Kumar A(1), Kumar A(1048), Kumar D(1049), Kumar D(293),
Kumar R(1050), Kumar S(1051), Kundu M(1052), Kung HJ(1053)(1054), Kuno A(1055),
Kuo SH(233), Kuret J(1056), Kurz T(1057), Kwok T(1058)(1059), Kwon TK(1060),
Kwon YT(1061), Kyrmizi I(289), La Spada AR(1062)(1063), Lafont F(1064), Lahm
T(1065), Lakkaraju A(1066), Lam T(1067), Lamark T(1068), Lancel S(533),
Landowski TH(1069), Lane DJ(98), Lane JD(1070), Lanzi C(268), Lapaquette
P(1071), Lapierre LR(1072), Laporte J(1073), Laukkarinen J(1074), Laurie
GW(1075), Lavandero S(351)(1076), Lavie L(1077), LaVoie MJ(1078), Law BY(1079),
Law HK(1080), Law KB(992), Layfield R(1081), Lazo PA(1082)(1083), Le Cam
L(1084)(1085)(1086), Le Roch KG(1087), Le Stunff H(1088)(1089), Leardkamolkarn
V(1090), Lecuit M(1091), Lee BH(1092), Lee CH(1093), Lee EF(575)(576)(577), Lee
GM(1094), Lee HJ(1095), Lee H(1096), Lee JK(343), Lee J(1097), Lee JH(185), Lee
JH(1098), Lee M(1099), Lee MS(1100), Lee PJ(1101), Lee SW(721), Lee SJ(1102),
Lee SJ(1103), Lee SY(1104), Lee SH(1105), Lee SS(468)(1106), Lee SJ(1107), Lee
S(1108), Lee YR(1109), Lee YJ(579), Lee YH(1110), Leeuwenburgh C(1111), Lefort
S(1112), Legouis R(1089), Lei J(1113), Lei QY(1114), Leib DA(1115), Leibowitz
G(1116), Lekli I(1117), Lemaire SD(1118), Lemasters JJ(1119), Lemberg MK(1120),
Lemoine A(1121), Leng S(1122), Lenz G(603), Lenzi P(465), Lerman LO(1123),
Lettieri Barbato D(68), Leu JI(1124), Leung HY(1125)(1126), Levine B(1127)(514),
Lewis PA(1128)(1129), Lezoualc'h F(1130), Li C(1131), Li F(1132), Li FJ(779), Li
J(1133), Li K(1134), Li L(350), Li M(1135), Li M(1136), Li Q(1137), Li R(1138),
Li S(1139), Li W(1140), Li W(1141), Li X(1142), Li Y(1143), Lian J(780), Liang
C(926), Liang Q(1011), Liao Y(1144), Liberal J(430), Liberski PP(1145), Lie
P(901), Lieberman AP(1146), Lim HJ(1147), Lim KL(1148)(1149), Lim K(1150), Lima
RT(1151)(1152)(1153), Lin CS(1154)(1155), Lin CF(1156), Lin F(1157), Lin
F(1158), Lin FC(1159), Lin K(1160), Lin KH(342), Lin PH(1161), Lin T(1162), Lin
WW(1163), Lin YS(294), Lin Y(1164), Linden R(1165), Lindholm D(1166), Lindqvist
LM(1167), Lingor P(1168), Linkermann A(1169), Liotta LA(1170), Lipinski
MM(1171), Lira VA(1172), Lisanti MP(1173), Liton PB(1174), Liu B(1175), Liu
C(1176), Liu CF(1177), Liu F(1178), Liu HJ(1179), Liu J(1180), Liu JJ(1181), Liu
JL(1182), Liu K(1183), Liu L(1184), Liu L(1079), Liu Q(1185), Liu RY(1186), Liu
S(1187), Liu S(1188), Liu W(1189), Liu XD(1190), Liu X(1191), Liu XH(1159), Liu
X(1192), Liu X(1)(2), Liu X(903)(904), Liu Y(514), Liu Y(324), Liu Z(1193), Liu
Z(1194), Liuzzi JP(1195), Lizard G(1196), Ljujic M(257), Lodhi IJ(1197), Logue
SE(257), Lokeshwar BL(1198), Long YC(1199), Lonial S(1200), Loos B(526),
López-Otín C(591), López-Vicario C(384), Lorente M(453), Lorenzi PL(1201)(1202),
Lõrincz P(924), Los M(1203), Lotze MT(1204), Lovat PE(1205), Lu B(1206), Lu
B(1207), Lu J(1208), Lu Q(1209), Lu SM(1210), Lu S(1211), Lu Y(1212), Luciano
F(1213), Luckhart S(1214), Lucocq JM(1215), Ludovico P(1216)(1217), Lugea
A(1218), Lukacs NW(1146), Lum JJ(1219), Lund AH(621), Luo H(1220), Luo J(305),
Luo S(1221), Luparello C(17), Lyons T(629), Ma J(1161), Ma Y(1222), Ma Y(895),
Ma Z(1223), Machado J(707), Machado-Santelli GM(1224), Macian F(1225), MacIntosh
GC(1226), MacKeigan JP(1227), Macleod KF(1228), MacMicking JD(1229),
MacMillan-Crow LA(1230), Madeo F(260), Madesh M(1231), Madrigal-Matute J(395),
Maeda A(1232), Maeda T(1233), Maegawa G(1234), Maellaro E(472), Maes H(18),
Magariños M(1235), Maiese K(1236), Maiti TK(1237), Maiuri L(1238), Maiuri
MC(1239), Maki CG(528), Malli R(1240), Malorni W(683)(684), Maloyan A(1241),
Mami-Chouaib F(366), Man N(1242)(1243), Mancias JD(1244), Mandelkow EM(1245),
Mandell MA(482), Manfredi AA(279), Manié SN(1246), Manzoni C(1247)(1248), Mao
K(1249), Mao Z(1250), Mao ZW(1251), Marambaud P(1252), Marconi AM(91), Marelja
Z(1253), Marfe G(1254), Margeta M(467), Margittai E(1255), Mari M(1256), Mariani
FV(1257), Marin C(1258), Marinelli S(1259), Mariño G(1260), Markovic I(1261),
Marquez R(1262), Martelli AM(1263), Martens S(1030), Martin KR(1227), Martin
SJ(1264), Martin S(1265), Martin-Acebes MA(1266), Martín-Sanz P(1267),
Martinand-Mari C(699), Martinet W(463), Martinez J(1268), Martinez-Lopez
N(1269), Martinez-Outschoorn U(1270), Martínez-Velázquez M(1271),
Martinez-Vicente M(1272), Martins WK(1273), Mashima H(1274), Mastrianni
JA(1275), Matarese G(1276)(1277), Matarrese P(1278), Mateo R(169), Matoba
S(1279), Matsumoto N(1280), Matsushita T(1281), Matsuura A(873), Matsuzawa
T(1282), Mattson MP(1283), Matus S(1284)(795)(1285), Maugeri N(1286), Mauvezin
C(1287), Mayer A(1288), Maysinger D(1289), Mazzolini GD(1290), McBrayer MK(901),
McCall K(1291), McCormick C(1292), McInerney GM(1293), McIver SC(207), McKenna
S(1294), McMahon JJ(1295), McNeish IA(1126), Mechta-Grigoriou F(1296), Medema
JP(1297), Medina DL(221), Megyeri K(1298), Mehrpour M(188), Mehta JL(502), Mei
Y(1299), Meier UC(527), Meijer AJ(1300), Meléndez A(1301), Melino G(1302)(1303),
Melino S(1304), de Melo EJ(1305), Mena MA(1306), Meneghini MD(1307), Menendez
JA(1308), Menezes R(1309)(1310), Meng L(1210), Meng LH(1311), Meng S(1312),
Menghini R(587), Menko AS(1313), Menna-Barreto RF(1314), Menon MB(639),
Meraz-Ríos MA(1315), Merla G(637), Merlini L(1316), Merlot AM(98), Meryk
A(1317), Meschini S(399), Meyer JN(155), Mi MT(1318), Miao CY(1176), Micale
L(637), Michaeli S(1319), Michiels C(77), Migliaccio AR(1320), Mihailidou
AS(1321)(1322), Mijaljica D(486), Mikoshiba K(757), Milan E(278)(279),
Miller-Fleming L(1323), Mills GB(1324), Mills IG(1325)(1326)(1327), Minakaki
G(1007), Minassian BA(1328), Ming XF(1329), Minibayeva F(1330), Minina EA(197),
Mintern JD(1331), Minucci S(1332), Miranda-Vizuete A(1333), Mitchell CH(1334),
Miyamoto S(1335), Miyazawa K(4), Mizushima N(1336), Mnich K(257), Mograbi
B(144), Mohseni S(936), Moita LF(1337), Molinari M(443), Molinari M(1338)(1339),
Møller AB(1340), Mollereau B(1341), Mollinedo F(1342), Mongillo M(1343), Monick
MM(1344), Montagnaro S(379), Montell C(1345)(1346), Moore DJ(1347), Moore
MN(1348), Mora-Rodriguez R(1349), Moreira PI(1350), Morel E(188), Morelli
MB(254), Moreno S(1351), Morgan MJ(130), Moris A(1352), Moriyasu Y(1353),
Morrison JL(1354), Morrison LA(1355), Morselli E(1356), Moscat J(1357), Moseley
PL(510), Mostowy S(1358), Motori E(727), Mottet D(1359), Mottram JC(1360),
Moussa CE(1361), Mpakou VE(1362), Mukhtar H(1363), Mulcahy Levy JM(1364), Muller
S(1365), Muñoz-Moreno R(40), Muñoz-Pinedo C(1366), Münz C(1367), Murphy
ME(1368), Murray JT(1369), Murthy A(1370), Mysorekar IU(128), Nabi IR(913),
Nabissi M(1371), Nader GA(285), Nagahara Y(1372), Nagai Y(1373), Nagata K(1374),
Nagelkerke A(1375), Nagy P(924), Naidu SR(1376), Nair S(1377), Nakano H(1378),
Nakatogawa H(1379), Nanjundan M(1380), Napolitano G(221), Naqvi NI(477),
Nardacci R(63), Narendra DP(1381), Narita M(1382), Nascimbeni AC(188), Natarajan
R(1383), Navegantes LC(1384), Nawrocki ST(1385), Nazarko TY(1386), Nazarko
VY(1387), Neill T(857), Neri LM(1388), Netea MG(916), Netea-Maier RT(1389),
Neves BM(1390), Ney PA(1391), Nezis IP(1392), Nguyen HT(442), Nguyen HP(1393),
Nicot AS(1073), Nilsen H(1394)(1395), Nilsson P(1396)(1397), Nishimura M(1398),
Nishino I(1399), Niso-Santano M(630), Niu H(1400), Nixon RA(1401), Njar
VC(1402), Noda T(1403), Noegel AA(1404), Nolte EM(919), Norberg E(285), Norga
KK(1405), Noureini SK(1406), Notomi S(1407), Notterpek L(1408), Nowikovsky
K(1409), Nukina N(1410), Nürnberger T(747), O'Donnell VB(1411), O'Donovan
T(1294), O'Dwyer PJ(1412), Oehme I(1413), Oeste CL(1414), Ogawa M(1415),
Ogretmen B(1416), Ogura Y(1417), Oh YJ(1418), Ohmuraya M(1419), Ohshima T(1420),
Ojha R(1421), Okamoto K(1422), Okazaki T(1423), Oliver FJ(1424), Ollinger
K(936), Olsson S(1425), Orban DP(1)(2), Ordonez P(245), Orhon I(188), Orosz
L(1298), O'Rourke EJ(1426), Orozco H(1427)(1428), Ortega AL(1429), Ortona
E(1430), Osellame LD(486), Oshima J(1431), Oshima S(1432), Osiewacz HD(758),
Otomo T(1433), Otsu K(1434), Ou JH(926), Outeiro TF(1435), Ouyang DY(783),
Ouyang H(1436), Overholtzer M(1437), Ozbun MA(1438), Ozdinler PH(1439), Ozpolat
B(123), Pacelli C(1440), Paganetti P(1441), Page G(1442), Pages G(696), Pagnini
U(379), Pajak B(900)(1443), Pak SC(1444), Pakos-Zebrucka K(257), Pakpour
N(1214), Palková Z(1445), Palladino F(1446), Pallauf K(840), Pallet N(1447),
Palmieri M(512), Paludan SR(1448), Palumbo C(1449), Palumbo S(398), Pampliega
O(74), Pan H(1450), Pan W(1451), Panaretakis T(212), Pandey A(459)(460),
Pantazopoulou A(195), Papackova Z(1452), Papademetrio DL(1453), Papassideri
I(1454), Papini A(1455), Parajuli N(1230), Pardo J(1456), Parekh VV(1457),
Parenti G(112), Park JI(1458), Park J(1459), Park OK(1460), Parker R(1461),
Parlato R(1462)(1463), Parys JB(230), Parzych KR(1)(2), Pasquet JM(1464),
Pasquier B(1465), Pasumarthi KB(1466), Patschan D(1467), Patterson C(1468),
Pattingre S(1469)(1470), Pattison S(1471), Pause A(1472), Pavenstädt H(1473),
Pavone F(1259), Pedrozo Z(1474), Peña FJ(1475), Peñalva MA(195), Pende M(1476),
Peng J(1477), Penna F(413), Penninger JM(1478), Pensalfini A(901), Pepe S(1479),
Pereira GJ(1480), Pereira PC(1481), Pérez-de la Cruz V(1482), Pérez-Pérez
ME(428), Pérez-Rodríguez D(595), Pérez-Sala D(1414), Perier C(1483), Perl
A(1484), Perlmutter DH(1485), Perrotta I(1486), Pervaiz S(1487)(1488)(1149),
Pesonen M(1489), Pessin JE(1269), Peters GJ(693), Petersen M(1490), Petrache
I(930), Petrof BJ(1491), Petrovski G(1492)(1493)(1494), Phang JM(1495),
Piacentini M(68), Pierdominici M(1430), Pierre P(665)(666)(667)(1496),
Pierrefite-Carle V(1497), Pietrocola F(202)(203)(204)(205), Pimentel-Muiños
FX(176), Pinar M(195), Pineda B(1498), Pinkas-Kramarski R(1499), Pinti M(854),
Pinton P(1388), Piperdi B(1500), Piret JM(1501), Platanias LC(1502)(1503),
Platta HW(1504), Plowey ED(1505), Pöggeler S(1506), Poirot M(1507), Polčic
P(1508), Poletti A(1509), Poon AH(1510), Popelka H(2), Popova B(201), Poprawa
I(1511), Poulose SM(1512), Poulton J(1513), Powers SK(12), Powers T(1514),
Pozuelo-Rubio M(1515), Prak K(972), Prange R(1516), Prescott M(486), Priault
M(1517), Prince S(1518), Proia RL(1519), Proikas-Cezanne T(1520), Prokisch
H(161), Promponas VJ(1521), Przyklenk K(1522), Puertollano R(1523), Pugazhenthi
S(1524), Puglielli L(1525), Pujol A(1526)(1527)(1528), Puyal J(1529)(385), Pyeon
D(1530), Qi X(1531), Qian WB(1532), Qin ZH(1533), Qiu Y(1534), Qu Z(477),
Quadrilatero J(1535), Quinn F(1536), Raben N(1537), Rabinowich H(1538), Radogna
F(280), Ragusa MJ(1539), Rahmani M(1540), Raina K(15), Ramanadham S(1541),
Ramesh R(1542), Rami A(1543), Randall-Demllo S(565), Randow F(154)(1544), Rao
H(1545), Rao VA(1546), Rasmussen BB(1547), Rasse TM(1548), Ratovitski EA(1549),
Rautou PE(1550)(1551)(1552)(1553), Ray SK(1554), Razani B(1555)(1556), Reed
BH(1557), Reggiori F(1256), Rehm M(1558), Reichert AS(1559), Rein T(664), Reiner
DJ(1560), Reits E(1561), Ren J(1377), Ren X(1562), Renna M(1563), Reusch
JE(1564)(1565), Revuelta JL(1566), Reyes L(1567), Rezaie AR(1568), Richards
RI(1569), Richardson DR(98), Richetta C(1352), Riehle MA(1570), Rihn BH(1571),
Rikihisa Y(1572), Riley BE(1573), Rimbach G(840), Rippo MR(1574), Ritis K(942),
Rizzi F(1575), Rizzo E(1576), Roach PJ(513), Robbins J(1577), Roberge M(1578),
Roca G(1579), Roccheri MC(17), Rocha S(1580), Rodrigues CMP(1581), Rodríguez
CI(1582), de Cordoba SR(1583), Rodriguez-Muela N(195), Roelofs J(1104), Rogov
VV(509), Rohn TT(1584), Rohrer B(1585), Romanelli D(1586), Romani L(1587),
Romano PS(1588), Roncero MI(409), Rosa JL(1589), Rosello A(1590), Rosen
KV(1591)(1592), Rosenstiel P(1593), Rost-Roszkowska M(1511), Roth KA(1594), Roué
G(1595), Rouis M(1596), Rouschop KM(931), Ruan DT(1597), Ruano D(1598),
Rubinsztein DC(1599), Rucker EB 3rd(1600), Rudich A(1601), Rudolf E(1602),
Rudolf R(1603), Ruegg MA(269), Ruiz-Roldan C(409), Ruparelia AA(222), Rusmini
P(1509), Russ DW(1604), Russo GL(1605), Russo G(689), Russo R(1606), Rusten
TE(883)(884), Ryabovol V(1607), Ryan KM(1125), Ryter SW(1608), Sabatini
DM(1609), Sacher M(1610)(1611), Sachse C(1612), Sack MN(1613), Sadoshima
J(1614), Saftig P(444), Sagi-Eisenberg R(1615), Sahni S(98), Saikumar P(1616),
Saito T(1617), Saitoh T(1618), Sakakura K(1619), Sakoh-Nakatogawa M(1620),
Sakuraba Y(1621), Salazar-Roa M(1622), Salomoni P(1623), Saluja AK(1624),
Salvaterra PM(1625), Salvioli R(1626), Samali A(257), Sanchez AM(1627),
Sánchez-Alcázar JA(1628), Sanchez-Prieto R(1629), Sandri M(1343), Sanjuan
MA(1630), Santaguida S(53), Santambrogio L(1631), Santoni G(1632), Dos Santos
CN(1309)(1310), Saran S(1633), Sardiello M(1634), Sargent G(992), Sarkar P(901),
Sarkar S(1635), Sarrias MR(1636), Sarwal MM(1637), Sasakawa C(1638), Sasaki
M(1639), Sass M(924), Sato K(1640), Sato M(1641), Satriano J(1642), Savaraj
N(1643), Saveljeva S(1644), Schaefer L(1645), Schaible UE(1646), Scharl M(1647),
Schatzl HM(1648), Schekman R(670), Scheper W(1649)(1650)(1651), Schiavi
A(1652)(1653), Schipper HM(1654)(1655), Schmeisser H(1656), Schmidt J(1657),
Schmitz I(1658)(1659), Schneider BE(1646), Schneider EM(1660), Schneider JL(74),
Schon EA(979), Schönenberger MJ(1661), Schönthal AH(1662), Schorderet
DF(417)(418), Schröder B(444), Schuck S(1663), Schulze RJ(1664), Schwarten
M(1665), Schwarz TL(1666), Sciarretta S(615)(1614)(1667), Scotto K(1668),
Scovassi AI(1669), Screaton RA(1670), Screen M(1671), Seca H(1151)(1672)(1153),
Sedej S(1673), Segatori L(1674)(119), Segev N(1387), Seglen PO(1675),
Seguí-Simarro JM(1676), Segura-Aguilar J(1677), Seki E(1678), Sell C(1679),
Seiliez I(1680), Semenkovich CF(1681), Semenza GL(1682), Sen U(1683), Serra
AL(1684), Serrano-Puebla A(195), Sesaki H(1549), Setoguchi T(1685), Settembre
C(1686), Shacka JJ(1594), Shajahan-Haq AN(1687), Shapiro IM(1688), Sharma
S(1689), She H(350), Shen CK(1690), Shen CC(1691), Shen HM(1149), Shen S(1692),
Shen W(1693), Sheng R(1694), Sheng X(1695), Sheng ZH(1696), Shepherd TG(1697),
Shi J(1698)(1699), Shi Q(1700), Shi Q(1701), Shi Y(345), Shibutani S(1702),
Shibuya K(1703), Shidoji Y(1704), Shieh JJ(1705), Shih CM(1706), Shimada
Y(1707), Shimizu S(1708), Shin DW(1709), Shinohara ML(784), Shintani M(1710),
Shintani T(1711), Shioi T(1712), Shirabe K(1713), Shiri-Sverdlov R(1714),
Shirihai O(1715), Shore GC(1716), Shu CW(1717), Shukla D(1718), Sibirny
AA(1719)(1720), Sica V(202)(203)(204)(205), Sigurdson CJ(1721), Sigurdsson
EM(1722), Sijwali PS(1723), Sikorska B(1145), Silveira WA(1384), Silvente-Poirot
S(1507), Silverman GA(1444), Simak J(1724), Simmet T(1725), Simon AK(1726),
Simon HU(1727), Simone C(1728), Simons M(1253), Simonsen A(175), Singh R(240),
Singh SV(1729), Singh SK(1421), Sinha D(1730), Sinha S(1731), Sinicrope
FA(1732), Sirko A(1733), Sirohi K(1734), Sishi BJ(526), Sittler A(1735), Siu
PM(1080), Sivridis E(1736), Skwarska A(1737), Slack R(1738), Slaninová I(1739),
Slavov N(1740), Smaili SS(1480), Smalley KS(1741), Smith DR(1742), Soenen
SJ(1743), Soleimanpour SA(1744), Solhaug A(1745), Somasundaram K(1746), Son
JH(1747), Sonawane A(1748), Song C(1749), Song F(1750), Song HK(1460), Song
JX(1135), Song W(1751), Soo KY(1752), Sood AK(1753)(1754), Soong TW(1755),
Soontornniyomkij V(1756), Sorice M(381), Sotgia F(1757), Soto-Pantoja DR(1758),
Sotthibundhu A(1759), Sousa MJ(1760), Spaink HP(1761), Span PN(1762), Spang
A(1763), Sparks JD(1764), Speck PG(1765), Spector SA(1766), Spies CD(1767),
Springer W(602), Clair DS(1768), Stacchiotti A(1769), Staels B(1770), Stang
MT(1771), Starczynowski DT(1772), Starokadomskyy P(1076), Steegborn C(1773),
Steele JW(1774), Stefanis L(1775), Steffan J(1776), Stellrecht CM(123), Stenmark
H(1777), Stepkowski TM(1778), Stern ST(1779), Stevens C(1780), Stockwell
BR(1781)(1782), Stoka V(1783), Storchova Z(1784), Stork B(1785), Stratoulias
V(569), Stravopodis DJ(1454)(1022), Strnad P(1786), Strohecker AM(1787), Ström
AL(1788), Stromhaug P(1789), Stulik J(1790), Su YX(1791), Su Z(1792), Subauste
CS(1793), Subramaniam S(1794), Sue CM(1795), Suh SW(1796), Sui X(1450), Sukseree
S(548), Sulzer D(233), Sun FL(1797), Sun J(1798), Sun J(1799), Sun SY(1800), Sun
Y(1801), Sun Y(1802), Sun Y(501), Sundaramoorthy V(84), Sung J(1803), Suzuki
H(1804), Suzuki K(1805), Suzuki N(1806), Suzuki T(1807), Suzuki YJ(1808),
Swanson MS(1809), Swanton C(1810), Swärd K(1811), Swarup G(1734), Sweeney
ST(557), Sylvester PW(1812), Szatmari Z(924), Szegezdi E(257), Szlosarek
PW(1813), Taegtmeyer H(1067), Tafani M(381), Taillebourg E(1814), Tait SW(1125),
Takacs-Vellai K(1815), Takahashi Y(1816), Takáts S(924), Takemura G(1817),
Takigawa N(1818), Talbot NJ(1819), Tamagno E(1820), Tamburini J(1821), Tan
CP(1251), Tan L(1822), Tan ML(1823)(1824), Tan M(1825), Tan YJ(1826)(1827),
Tanaka K(1828), Tanaka M(1829), Tang D(947), Tang D(1830), Tang G(233), Tanida
I(1831), Tanji K(1832), Tannous BA(1833), Tapia JA(1475), Tasset-Cuevas I(74),
Tatar M(106), Tavassoly I(1834), Tavernarakis N(1835)(1836)(1837), Taylor
A(1838), Taylor GS(1839), Taylor GA(784)(1840)(393)(1841), Taylor JP(1842),
Taylor MJ(1843), Tchetina EV(1844), Tee AR(1845), Teixeira-Clerc F(1846)(1847),
Telang S(339), Tencomnao T(1848), Teng BB(1849), Teng RJ(1850), Terro F(1851),
Tettamanti G(1586), Theiss AL(1852), Theron AE(919), Thomas KJ(1853), Thomé
MP(603), Thomes PG(515), Thorburn A(130), Thorner J(845), Thum T(1854), Thumm
M(1037), Thurston TL(1855), Tian L(1139), Till A(1856)(1857), Ting
JP(1858)(1859), Titorenko VI(1860), Toker L(1861), Toldo S(1862), Tooze
SA(1863), Topisirovic I(1864)(1655), Torgersen ML(1865)(1866)(1867),
Torosantucci L(674), Torriglia A(968), Torrisi MR(145), Tournier C(1868), Towns
R(1869), Trajkovic V(1870), Travassos LH(1871), Triola G(1872), Tripathi
DN(1873), Trisciuoglio D(1874), Troncoso R(1875)(1876), Trougakos IP(1022),
Truttmann AC(1529), Tsai KJ(1877), Tschan MP(1878), Tseng YH(342), Tsukuba
T(1879), Tsung A(1880), Tsvetkov AS(1881), Tu S(1882), Tuan HY(824), Tucci
M(1883), Tumbarello DA(1884), Turk B(1783), Turk V(1783), Turner RF(1885),
Tveita AA(1886), Tyagi SC(1887), Ubukata M(1888), Uchiyama Y(1831), Udelnow
A(1889), Ueno T(1890), Umekawa M(1891), Umemiya-Shirafuji R(1892), Underwood
BR(1893), Ungermann C(1894), Ureshino RP(1480), Ushioda R(1895), Uversky
VN(1896), Uzcátegui NL(1897), Vaccari T(1898), Vaccaro MI(1899), Váchová
L(1900), Vakifahmetoglu-Norberg H(285), Valdor R(1901), Valente EM(1902),
Vallette F(1903), Valverde AM(1904), Van den Berghe G(742), Van Den Bosch
L(1905), van den Brink GR(1906), van der Goot FG(1339), van der Klei IJ(1907),
van der Laan LJ(1908), van Doorn WG(1909), van Egmond M(1910), van Golen
KL(1911)(1912)(1913), Van Kaer L(1914), van Lookeren Campagne M(1915),
Vandenabeele P(1916), Vandenberghe W(1917)(1918), Vanhorebeek I(742),
Varela-Nieto I(1919), Vasconcelos MH(1151)(1672)(1153), Vasko R(1920), Vavvas
DG(1407), Vega-Naredo I(1921), Velasco G(453), Velentzas AD(1022), Velentzas
PD(102), Vellai T(166), Vellenga E(1922), Vendelbo MH(1923), Venkatachalam
K(1924), Ventura N(1925)(1652), Ventura S(1926), Veras PS(1927), Verdier
M(1928), Vertessy BG(1929), Viale A(1930), Vidal M(1931), Vieira HL(1932),
Vierstra RD(1132), Vigneswaran N(1933), Vij N(1934), Vila M(1935)(1936)(1937),
Villar M(462), Villar VH(541), Villarroya J(74), Vindis C(1938), Viola G(1939),
Viscomi MT(443), Vitale G(1940), Vogl DT(1412), Voitsekhovskaja OV(1941), von
Haefen C(1767), von Schwarzenberg K(1942), Voth DE(1943), Vouret-Craviari
V(1944), Vuori K(493), Vyas JM(1945), Waeber C(1946), Walker CL(1184), Walker
MJ(1947), Walter J(1948), Wan L(1949)(1950), Wan X(1951), Wang B(1952), Wang
C(128), Wang CY(1953), Wang C(1954), Wang C(435), Wang C(1955), Wang D(1956),
Wang F(1957), Wang F(1958), Wang G(1959), Wang HJ(1960), Wang H(1961), Wang
HG(1962), Wang H(1963), Wang HD(1964), Wang J(1965), Wang J(1966), Wang M(872),
Wang MQ(1967), Wang PY(1968), Wang P(332), Wang RC(1969), Wang S(1970), Wang
TF(1690), Wang X(1971), Wang XJ(1972), Wang XW(1973), Wang X(1974), Wang
X(1975), Wang Y(324), Wang Y(1976), Wang Y(1977), Wang YJ(1978), Wang Y(1245),
Wang Y(1979), Wang YT(1980), Wang Y(992), Wang ZN(1981), Wappner P(1982), Ward
C(1635), Ward DM(1983), Warnes G(1984), Watada H(632), Watanabe Y(1985), Watase
K(1986), Weaver TE(1987), Weekes CD(1988), Wei J(1989), Weide T(1990), Weihl
CC(1991), Weindl G(1992), Weis SN(1993), Wen L(1243), Wen X(1)(2), Wen
Y(1753)(1754), Westermann B(177), Weyand CM(1994), White AR(1995), White
E(1996), Whitton JL(34), Whitworth AJ(1997), Wiels J(1998), Wild F(1603),
Wildenberg ME(1906), Wileman T(1999), Wilkinson DS(493), Wilkinson S(2000),
Willbold D(1665)(2001), Williams C(2002)(1907), Williams K(701), Williamson
PR(2003), Winklhofer KF(2004), Witkin SS(2005), Wohlgemuth SE(2006), Wollert
T(2007), Wolvetang EJ(2008), Wong E(2009), Wong GW(2010), Wong RW(2011), Wong
VK(1079), Woodcock EA(2012), Wright KL(2013), Wu C(2014), Wu D(2015), Wu
GS(2016), Wu J(2017), Wu J(2018), Wu M(2019), Wu M(2020), Wu S(241), Wu
WK(2021), Wu Y(439), Wu Z(2022), Xavier CP(1151)(1153), Xavier RJ(2023), Xia
GX(1958), Xia T(2024), Xia W(2025)(657), Xia Y(746), Xiao H(2026), Xiao J(2027),
Xiao S(2028), Xiao W(2029), Xie CM(2030), Xie Z(2031), Xie Z(2032), Xilouri
M(2033), Xiong Y(1329), Xu C(2034), Xu C(832), Xu F(2035), Xu H(1), Xu H(2036),
Xu J(2037), Xu J(2038), Xu J(310)(311), Xu L(1262), Xu X(1732), Xu Y(769), Xu
Y(2039), Xu ZX(2040), Xu Z(1)(2), Xue Y(1193), Yamada T(2041), Yamamoto A(2042),
Yamanaka K(2043), Yamashina S(2044), Yamashiro S(2045), Yan B(2046), Yan
B(2047), Yan X(2048), Yan Z(2049), Yanagi Y(2050), Yang DS(2051), Yang JM(2052),
Yang L(2053), Yang M(251), Yang PM(2054), Yang P(2055), Yang Q(2056), Yang
W(2057), Yang WY(306), Yang X(2058), Yang Y(2059), Yang Y(2060), Yang Z(2061),
Yang Z(2062), Yao MC(1690), Yao PJ(2063), Yao X(2064), Yao Z(2065), Yao Z(1)(2),
Yasui LS(2066), Ye M(2067), Yedvobnick B(2068), Yeganeh B(2069), Yeh ES(2070),
Yeyati PL(2071), Yi F(2072), Yi L(1318), Yin XM(973), Yip CK(2073), Yoo
YM(2074), Yoo YH(983), Yoon SY(2075), Yoshida K(2076), Yoshimori T(2077), Young
KH(2078), Yu H(2079), Yu JJ(790), Yu JT(1822), Yu J(2080), Yu L(2081), Yu
WH(2082), Yu XF(2083), Yu Z(2084), Yuan J(769), Yuan ZM(2085), Yue BY(2086), Yue
J(1212), Yue Z(2087), Zacks DN(2088), Zacksenhaus E(2089), Zaffaroni N(268),
Zaglia T(1343), Zakeri Z(2090), Zecchini V(625), Zeng J(2091), Zeng M(2092),
Zeng Q(1826), Zervos AS(2093), Zhang DD(325), Zhang F(2094), Zhang G(2095),
Zhang GC(2096), Zhang H(2097), Zhang H(2098), Zhang H(2099), Zhang
H(2100)(2101), Zhang J(2067), Zhang J(2102), Zhang J(2103), Zhang J(1594), Zhang
JP(1134), Zhang L(2079), Zhang L(2104), Zhang L(2105), Zhang L(2106), Zhang
MY(2107), Zhang X(332), Zhang XD(2108), Zhang Y(2109), Zhang Y(566), Zhang
Y(2110), Zhang Y(1377)(2111), Zhang Y(1243), Zhao M(2112), Zhao WL(2113), Zhao
X(832), Zhao YG(2114), Zhao Y(2115), Zhao Y(1802), Zhao YX(1952), Zhao Z(2116),
Zhao ZJ(1542), Zheng D(2117), Zheng XL(2118), Zheng X(2119), Zhivotovsky
B(2120)(2121), Zhong Q(2122)(514), Zhou GZ(2123), Zhou G(2124), Zhou H(2125),
Zhou SF(2126), Zhou XJ(2099)(2127)(2128), Zhu H(2129), Zhu H(1161), Zhu
WG(2115), Zhu W(1210), Zhu XF(2130), Zhu Y(1966), Zhuang SM(2131), Zhuang
X(896), Ziparo E(190), Zois CE(771), Zoladek T(1733), Zong WX(877), Zorzano
A(2132)(2133)(2134), Zughaier SM(2135).

Author information:
(1)boc University of Michigan , Department of Molecular , Cellular, and
Developmental Biology , Ann Arbor , MI , USA.
(2)bog University of Michigan, Life Sciences Institute , Ann Arbor , MI , USA.
(3)afh National Institute on Aging, National Institutes of Health, Biomedical
Research Center, RNA Regulation Section, Laboratory of Genetics , Baltimore , MD
, USA.
(4)auo Tokyo Medical University , Department of Biochemistry , Tokyo , Japan.
(5)bot University of Minnesota , Department of Lab Medicine and Pathology ,
Minneapolis , MN , USA.
(6)pi Hebrew University of Jerusalem, Faculty of Agriculture, Food, and
Environment, Biochemistry and Food Science , Rehovot , Israel.
(7)adi MRC Harwell, Mammalian Genetics Unit , Oxfordshire , UK.
(8)bqf University of Occupational and Environmental Health School of Medicine ,
Department of Neurology , Fukuoka , Japan.
(9)ble University of Iowa , Department of Internal Medicine , Iowa City , IA ,
USA.
(10)be Beatson Institute for Cancer Research, University of Glasgow , Glasgow ,
UK.
(11)bxe University of Toronto, Molecular Structure and Function, Research
Institute, Hospital for Sick Children , Toronto, ON , Canada.
(12)bjm University of Florida , Department of Applied Physiology and Kinesiology
, Gainesville , FL , USA.
(13)zx Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center ,
Torrance , CA.
(14)bo Ben-Gurion University of the Negev and Mental Health Center , Department
of Clinical Biochemistry and Pharmacology and Psychiatry Research Unit ,
Beer-Sheva , Israel.
(15)bia University of Colorado Denver, Skaggs School of Pharmacy and
Pharmaceutical Sciences , Department of Pharmaceutical Sciences , Aurora , CO ,
USA.
(16)bgc University of California San Francisco , Department of Neurological
Surgery , San Francisco , CA , USA.
(17)brf University of Palermo , Dipartimento di Scienze e Tecnologie Biologiche
, Chimiche e Farmaceutiche (STEBICEF) , Palermo , Italy.
(18)yn KU Leuven, Laboratory for Cell Death Research and Therapy , Department of
Cellular and Molecular Medicine , Campus Gasthuisberg , Leuven , Belgium.
(19)bwj University of Texas, Medical Branch , Department of Pathology ,
Galveston , TX , USA.
(20)add Icahn School of Medicine at Mount Sinai , Department of Otolaryngology ,
Tisch Cancer Institute at Mount Sinai , New York , NY , USA.
(21)adf Icahn School of Medicine at Mount Sinai, Division of Hematology and
Oncology , Department of Medicine , New York , NY , USA.
(22)ck Broad Institute of MIT and Harvard , Cambridge , MA , USA.
(23)pf Harvard University , Department of Statistics , Cambridge , MA , USA.
(24)azx Université Paris Diderot, Sorbonne Paris Cité, Centre Epigénétique et
Destin Cellulaire, UMR 7216, Centre National de la Recherche Scientifique CNRS ,
Paris , France.
(25)byh University of Vienna , Department of Chromosome Biology , Max F. Perutz
Laboratories , Vienna , Austria.
(26)ape Sidra Medical and Research Centre , Doha , Qatar.
(27)bap University College Dublin, School of Chemical and Bioprocess Engineering
, Dublin , Ireland.
(28)awt Universidad de Oviedo , Departamento de Biología Funcional , Oviedo ,
Spain.
(29)my Georgetown University, Lombardi Comprehensive Cancer Center , Departments
of Oncology and Pathology , Washington, DC , USA.
(30)uo IRCCS-Istituto di Ricerche Farmacologiche Mario Negri , Department of
Neuroscience , Milan , Italy.
(31)sw Institut Pasteur , Department of Immunology , Paris , France.
(32)dx Centro de Biologia Molecular "Severo Ochoa" (UAM/CSIC), Centro de
Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)
, Madrid , Spain.
(33)art Technische Universität München, II. Medizinische Klinik, Klinikum rechts
der Isar , Munich , Germany.
(34)atb The Scripps Research Institute , Department of Immunology and Microbial
Science , La Jolla , CA , USA.
(35)xr KERBASQUE, Basque Foundation for Sciences , Bilbao , Spain.
(36)ahd Neurogenomiks , Neurosciences Department , Faculty of Medicine and
Odontology, University of Basque , Leioa , Spain.
(37)gx Cleveland Clinic , Department of Cancer Biology , Cleveland , OH , USA.
(38)td Institute of Biomedical Investigation (INIBIC), Aging, Inflamation and
Regenerative Medicine , Coruña , Spain.
(39)atp Thomas Jefferson University , Department of Biochemistry and Molecular
Biology , Philadelphia , PA , USA.
(40)tx Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria
(INIA) , Departamento de Biotecnología , Madrid , Spain.
(41)afp National Institutes of Health, National Heart, Lung, and Blood Institute
, Bethesda , MD , USA.
(42)ati The Wistar Institute , Philadelphia , PA , USA.
(43)beo University of Buenos Aires, Institute of Biochemistry and Biophysics,
School of Pharmacy and Biochemistry , Buenos Aires , Argentina.
(44)baq University College London , Department of Clinical Neurosciences ,
London , UK.
(45)dc CEA/DSV/12;BM, INSERM U1169, Gene Therapy for Neurodegenerative Diseases
, Fontenay-aux-Roses Cedex , France.
(46)agb National Research Council (CNR), Institute of Translational Pharmacology
(IFT) , Rome , Italy.
(47)ait Osaka University Graduate School of Dentistry , Department of Preventive
Dentistry , Osaka , Japan.
(48)bgt University of Camerino, School of Biosciences and Veterinary Medicine ,
Camerino , Italy.
(49)bdb University of Barcelona, School of Medicine, Campus Bellvitge ,
Hospitalet del Llobregat , Spain.
(50)acb Medical Research Council (MRC), Toxicology Unit , Leicester , UK.
(51)aih Ohio State University , Department of Microbial Infection and Immunity ,
Columbus , OH , USA.
(52)cbi Wayne State University, School of Medicine , Department of Pathology ,
Karmanos Cancer Institute , Detroit , MI , USA.
(53)aax Massachusetts Institute of Technology, Koch Institute for Integrative
Cancer Research , Cambridge , MA , USA.
(54)bgd University of California San Francisco , Department of Neurology , San
Francisco , CA , USA.
(55)ke Emory University, School of Medicine, Division of Digestive Diseases ,
Atlanta , GA , USA.
(56)f Aarhus University , Department of Molecular Biology and Genetics , Aarhus
, Denmark.
(57)cay Washington University in St. Louis, School of Medicine , Department of
Ophthalmology and Visual Sciences , St. Louis , MO , USA.
(58)blz University of Leicester , Department of Cancer Studies , Leicester , UK.
(59)sh INSERM UMR1037, Centre de Recherches en Cancérologie de Toulouse ,
Toulouse , France.
(60)byy University of Zaragoza , Department of Biochemistry and Molecular and
Cell Biology , Faculty of Sciences , Zaragoza , Spain.
(61)bf Beckman Research Institute, City of Hope , Department of Molecular
Pharmacology , Duarte , CA , USA.
(62)nx Griffith University, Menzies Health Institute Queensland , Australia.
(63)aez National Institute for Infectious Diseases "L. Spallanzani" IRCCS , Rome
, Italy.
(64)afz Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg,
Germany.
(65)bpw University of Niigata , Department of Neurosurgery , Brain Research
Institute , Niigata , Japan.
(66)bye University of Valencia , Department of Pharmacology , Valencia , Spain.
(67)ber University of Calabria , Department of Pharmacy , Health and Nutritional
Sciences , Arcavacata di Rende (Cosenza) , Italy.
(68)btd University of Rome "Tor Vergata" , Department of Biology , Rome , Italy.
(69)kf Emory University, School of Medicine , Emory Vaccine Center and
Department of Microbiology and Immunology , Atlanta , GA , USA.
(70)cbr Weizmann Institute of Science , Department of Molecular Genetics ,
Rehovot , Israel.
(71)qn IATA-CSIC, Institute of Agrochemistry and Food Technology , Paterna
(Valencia) , Spain.
(72)vs Jikei University School of Medicine, Divison of Respiratory Disease ,
Department of Internal Medicine , Tokyo , Japan.
(73)bdp University of Bern, Division of Pediatric Hematology/Oncology ,
Department of Clinical Research , Bern , Switzerland.
(74)z Albert Einstein College of Medicine , Department of Developmental and
Molecular Biology , Institute for Aging Studies , Bronx , NY , USA.
(75)auc Tohoku University, Graduate School of Life Sciences, Sendai , Miyagi ,
Japan.
(76)bvf University of Sunderland , Department of Pharmacy , Health and
Wellbeing, Faculty of Applied Sciences , Sunderland , UK.
(77)bpe University of Namur, Laboratory of Biochemistry and Cell Biology (URBC),
Namur Research Institute for Life Sciences (NARILIS) , Namur , Belgium.
(78)ccn York College/The City University of New York , Department of Biology ,
Jamaica , NY , USA.
(79)yy Kyoto University, Graduate School of Medicine, Medical Innocation Center
(TMK project) , Kyoto , Japan.
(80)buz University of Southern California, Keck School of Medicine, Neurology
and Pathology , Los Angeles , CA , USA.
(81)bsu University of Quebec at Trois-Rivieres , Department of Biology and
Medicine , Trois-Rivieres, Quebec , Canada.
(82)adn Nagasaki University Graduate School of Biomedical Sciences , Department
of Molecular Microbiology and Immunology , Nagasaki , Japan.
(83)ne Georgia Regents University, Medical College of Georgia , Augusta , GA ,
USA.
(84)aak Macquarie University , Department of Biomedical Sciences , Faculty of
Medicine and Health Sciences , Sydney , NSW , Australia.
(85)aqm Stanford University, School of Medicine, Departments of Radiation
Oncology and Genetics , Stanford , CA , USA.
(86)bps University of Nice, INSERM U1065, C3M , Nice , France.
(87)no Goethe University Medical School, Experimental Neurology , Frankfurt am
Main , Germany.
(88)bnk University of Maryland, School of Medicine , Department of Pharmacology
, Baltimore , MD , USA.
(89)bxp University of Turin , Department of Clinical and Biological Sciences ,
Turin , TO , Italy.
(90)amo San Paolo Hospital Medical School, Unit of Obstetrics and Gynecology ,
Milano , Italy.
(91)bom University of Milan , Department of Health Sciences , Milan , Italy.
(92)mz Georgetown University, Lombardi Comprehensive Cancer Center , Washington,
DC , USA.
(93)arv Tel Aviv University , Department of Human Molecular Genetics and
Biochemistry , Sackler School of Medicine , Tel Aviv , Israel.
(94)bxj University of Toyama, Division of Natural Drug Discovery, Institute of
Natural Medicine , Toyama , Japan.
(95)on Hampton University , Department of Pharmaceutical Sciences , School of
Pharmacy , Hampton , VA , USA.
(96)uv Istituto Giannina Gaslini, UOC Medical Genetics , Genova , Italy.
(97)ab Albert Einstein College of Medicine , Department of Molecular
Pharmacology , Bronx , NY , USA.
(98)bvi University of Sydney , Department of Pathology and Bosch Institute ,
Sydney, New South Wales , Australia.
(99)za Kyungpook National University , Department of Physiology , School of
Medicine , Jung-gu, Daegu , Korea.
(100)os Hanyang University, College of Pharmacy , Ansan , Korea.
(101)cck Yonsei University, College of Medicine, Severance Biomedical Science
Institute , Seoul , Korea.
(102)bnm University of Massachusetts, Medical School , Department of Molecular ,
Cell and Cancer Biology , Worcester , MA , USA.
(103)q Ajou University, College of Pharmacy , Gyeonggido , Korea.
(104)azp Université Montpellier 2, Institut des Sciences de l'Evolution - UMR
CNRS 5554 , Montpellier, Languedoc-Roussillon , France.
(105)b A. Mickiewicz University, Department of General Botany, Institute of
Experimental Biology, Faculty of Biology , Poznań , Poland.
(106)cl Brown University , Department of Ecology and Evolutionary Biology ,
Providence , RI , USA.
(107)yq Kunming University of Science and Technology, Medical School , Kunmimg,
Yunnan , China.
(108)aqo State Key Laboratory of Kidney Diseases, National Clinical Research
Center for Kidney Diseases , Department of Nephrology , Chinese PLA General
Hospital, Chinese PLA Institute of Nephrology , Beijing , China.
(109)agz INCI, CNRS UPR3212, Institut des Neurosciences Cellulaires and
Intégratives , Strasbourg , France.
(110)re Indian Institute of Science , Department of Microbiology and Cell
Biology , Bangalore , India.
(111)bxz University of Urbino "Carlo Bo" , Department of Biomolecular Sciences ,
Urbino , Italy.
(112)ld Federico II University, Telethon Institute of Genetics and Medicine
(TIGEM) , Department of Medical and Translational Sciences , Naples , Italy.
(113)bmu University of Malta , Department of Physiology and Biochemistry ,
Faculty of Medicine and Surgery , Msida , Malta.
(114)ie CSIR, Indian Institute of Chemical Technology, Biomaterials Group ,
Hyderabad , India.
(115)anl Semmelweis University , Department of Medical Chemistry , Molecular
Biology and Pathobiochemistry , Budapest , Hungary.
(116)ccc Xuzhou Medical College , Department of Pathology , Xuzhou, Jiangsu ,
China.
(117)azk Université du Québec à Montréal , Département des Sciences Biologiques
and Centre de Recherche BioMed , Montréal, Québec , Canada.
(118)qy IMIM-Hospital del Mar CIBERES, Pompeu Fabra University, Barcelona
Biomedical Research Park , Respiratory Medicine Department , Lung Cancer and
Muscle Research Group , Barcelona , Spain.
(119)ali Rice University , Department of BioSciences , Houston , TX , USA.
(120)hn Columbia University , Department of Medicine , New York , NY , USA.
(121)ud Iowa State University , Department of Genetics , Development and Cell
Biology , Ames , IA , USA.
(122)anf Scientific Institute IRCCS Eugenio Medea, Laboratory of Molecular
Biology , Bosisio Parini, Lecco , Italy.
(123)avy University of Texas, MD Anderson Cancer Center , Department of
Experimental Therapeutics , Houston , TX , USA.
(124)bqd University of North Texas Health Science Center , Department of
Molecular and Medical Genetics , Fort Worth , TX , USA.
(125)bhr University of Coimbra , Coimbra , Portugal.
(126)ayj Université Catholique de Louvain (UCL), Institut des Sciences de la Vie
, Louvain-la-Neuve , Belgium.
(127)akh Polytechnic University of Marche , Department of Clinical Science ,
Faculty of Medicine , Ancona , Italy.
(128)cbe Washington University, School of Medicine, Departments of Obstetrics
and Gynecology, and Pathology and Immunology , St. Louis , MO , USA.
(129)buk University of South Carolina Upstate , Department of Biology , Division
of Natural Sciences and Engineering , Spartanburg, SC.
(130)bih University of Colorado, School of Medicine , Department of Pharmacology
, Aurora , CO , USA.
(131)bgs University of Cambridge, Division of Virology , Department of Pathology
, Cambridge , UK.
(132)azh Université de Sherbrooke , Department of Anatomy and Cell Biology ,
Faculty of Medicine and Health Sciences , Sherbrooke, QC , Canada.
(133)av Atlanta Department of Veterans Affairs Medical Center , Decatur , GA.
(134)kh Emory University, Division of Endocrinology, Metabolism, and Lipids ,
Department of Medicine , Atlanta , GA , USA.
(135)lx Friedrich-Alexander-University Erlangen-Nürnberg , Department of
Medicine 1 , Erlangen , Germany.
(136)bii University of Colorado, School of Medicine, Division of Infectious
Diseases , Aurora , CO , USA.
(137)abu McMaster University , Department of Biology , Hamilton, Ontario ,
Canada.
(138)ko Ernst-Moritz-Arndt University, Institute of Pharmacy , Greifswald ,
Germany.
(139)aqq State University of New York, College of Nanoscale Science and
Engineering , Albany , NY , USA.
(140)bbo University Medical Center of the Johannes Gutenberg-University,
Institute for Pathobiochemistry , Mainz , Germany.
(141)acc Medical School Goethe University, Institute of Biochemistry II ,
Frankfurt , Germany.
(142)op Hannover Medical School , Department for Clinical Immunology and
Rheumotology , Hannover , Germany.
(143)bjo University of Florida , Department of Surgery , Gainesville , FL , USA.
(144)rv INSERM U1081, CNRS UMR7284, Institute of Research on Cancer and Ageing
of Nice (IRCAN) , Nice , France.
(145)ana Sapienza University of Rome , Department of Clinical and Molecular
Medicine , Rome , Italy.
(146)sc INSERM U862, Neurocentre Magendie , Bordeaux , France.
(147)aad Luxembourg Institute of Health and Centre Hospitalier de Luxembourg ,
Luxembourg.
(148)aku Queen Mary University of London, Blizard Institute, Centre for Cell
Biology and Cutaneous Research , London , UK.
(149)baw University Hospital Cologne, CECAD Research Center , Cologne , Germany.
(150)bck University of Amsterdam, Laboratory of Experimental Virology, Center
for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC) ,
Amsterdam , The Netherlands.
(151)aal Magna Graecia University , Department of Health Sciences , Catanzaro ,
Italy.
(152)azb Université de Montréal , Department of Medicine , Montréal, Quebec ,
Canada.
(153)bth University of Rome "Tor Vergata" , Department of Experimental Medicine
and Surgery , Rome , Italy.
(154)adk MRC Laboratory of Molecular Biology , Cambridge , UK.
(155)jl Duke University, Nicholas School of the Environment , Durham , NC , USA.
(156)ayy Université de Montpellier, DIMNP, UMR 5235, CNRS , Montpellier ,
France.
(157)brh University of Parma , Department of Biomedicine , Biotechnology and
Translational Research , Parma , Italy.
(158)aic Northwestern University, Division of Hematology/Oncology , Chicago , IL
, USA.
(159)akk Post Graduate Institute of Medical Education and Research (PGIMER) ,
Department of Biophysics , Chandigarh , India.
(160)aff National Institute of Technology Rourkela , Department of Life Science
, Rourkela, Odisha , India.
(161)aro Technical University Munich, Institute of Human Genetics , Munich,
Bavaria , Germany.
(162)sz Institute for Integrative Biology of the Cell, Université Paris-Saclay ,
Gif-sur-Yvette , France.
(163)azz Université Paris-Est Créteil , Créteil , France.
(164)bac Université Paris-Sud, CEA, CNRS , Paris , France.
(165)hb CNRS UM, Centre d'études d'agents Pathogènes et Biotechnologies pour la
Santé , Montpellier , France.
(166)kl Eötvös Loránd University , Department of Genetics , Budapest , Hungary.
(167)axn Universidade Federal de São Paulo (UNIFESP) , Departamento de
Farmacologia , Escola Paulista de Medicina , São Paulo, SP , Brazil.
(168)ml Genentech Inc. , Department of Neuroscience , South San Francisco , CA ,
USA.
(169)aqj Stanford University , Department of Microbiology and Immunology ,
Stanford , CA , USA.
(170)apt Sorbonne Universités, UPMC Univ Paris 06, INSERM UMRS974, CNRS FRE
3617, Center for Research in Myology , Paris , France.
(171)avj UCL Cancer Institute , London , UK.
(172)afk National Institutes of Health, Cell Biology Section, Neurogenetics
Branch, National Institute of Neurological Disorders and Stroke , Bethesda , MD
, USA.
(173)asm The Feinstein Institute for Medical Research, Laboratory of
Developmental Erythropoiesis , Manhasset , NY.
(174)ben University of Buenos Aires, IDEHU-CONICET, Faculty of Pharmacy and
Biochemistry , Buenos Aires , Argentina.
(175)bqr University of Oslo, Institute of Basic Medical Sciences , Oslo ,
Norway.
(176)aww Universidad de Salamanca, Campus Unamuno, Instituto de Biologia
Molecular y Celular del Cancer (IBMCC), Centro de Investigacion del Cancer ,
Salamanca , Spain.
(177)bdh University of Bayreuth, Cell Biology , Bayreuth , Germany.
(178)bbs University Medical Centre Utrecht , Laboratory of Translational
Immunology and Department of Pediatric Immunology , Utrecht , The Netherlands.
(179)bro University of Pennsylvania , Department of Biochemistry , SDM ,
Philadelphia , PA , USA.
(180)jz Emory University , Department of Cell Biology , Atlanta , GA , USA.
(181)ka Emory University , Department of Hematology and Medical Oncology ,
Atlanta , GA , USA.
(182)cai INSPE, Institute of Experimental Neurology, Division of Neuroscience ,
San Raffaele Scientific Institute, Milan , Italy.
(183)zq Linköping University, Experimental Pathology , Department of Clinical
and Experimental Medicine , Faculty of Health Sciences , Linköping , Sweden.
(184)brc University of Padova , Department of Molecular Medicine , Padova ,
Italy.
(185)ahm New York University , Department of Psychiatry , New York NY ; and
Center for Dementia Research, Nathan S. Kline Institute , Orangeburg , NY , USA.
(186)wj Johns Hopkins, Bloomberg School of Public Health , Department of
Biochemistry and Molecular Biology and Johns Hopkins Malaria Research Institute
, Baltimore , MD , USA.
(187)axh Universidade de Santiago de Compostela , Departamento Farmacoloxía ,
Facultade de Veterinaria , Lugo , Spain.
(188)azw Université Paris Descartes-Sorbonne Paris Cité, Institut Necker
Enfants-Malades (INEM), INSERM U1151-CNRS UMR 8253 , Paris , France.
(189)bba University Hospital La Coruña , Microbiology Department , La Coruña ,
Spain.
(190)amx Sapienza University of Rome, DAHFMO-Section of Histology , Rome ,
Italy.
(191)aye Université Bordeaux Segalen, Institut de Biochimie et Génétique
Cellulaires, CNRS UMR 5095 , Bordeaux , France.
(192)buc University of Sherbrooke, Faculté de Médecine et des Sciences de la
Santé , Department of Medicine/Gastroenterology Division , Sherbrooke, Québec ,
Canada.
(193)rm Indiana University School of Medicine , Department of Ophthalmology ,
Indianapolis , IN , USA.
(194)bvb University of Southern California, The Saban Research Institute,
Developmental Neuroscience Program, Children's Hospital Los Angeles , Los
Angeles , CA , USA.
(195)ec Centro de Investigaciones Biológicas (CSIC) , Department of Cellular and
Molecular Biology , Madrid , Spain.
(196)ays Université de Franche-Comté, UFR Sciences et Techniques, Laboratoire de
Biochimie , Besançon , France.
(197)aqw Swedish University of Agricultural Sciences and Linnean Center for
Plant Biology, Department of Chemistry and Biotechnology, Uppsala BioCenter,
Uppsala, Sweden.
(198)nj German Cancer Research Center (DKFZ), Systems Biology of Cell Death
Mechanisms , Heidelberg , Germany.
(199)ra Imperial College London, National Heart and Lung Institute , London ,
UK.
(200)bxu University of Udine , Dipartimento di Scienze Mediche e Biologiche ,
Udine , Italy.
(201)mo Georg-August-Universität Göttingen , Department of Molecular
Microbiology and Genetics , Institute of Microbiology and Genetics , Göttingen ,
Germany.
(202)km Centre de Recherche des Cordeliers, Equipe 11 labellisée par la Ligue
Nationale contre le Cancer , Paris , France.
(203)oc Gustave Roussy Cancer Campus , Villejuif , France.
(204)sn INSERM, U1138 , Paris , France.
(205)azv Université Paris Descartes/Paris V , Paris , France.
(206)lj Florida Atlantic University, Schmidt College of Medicine , Department of
Biomedical Sciences , Boca Raton , FL , USA.
(207)byt University of Wisconsin, School of Medicine and Public Health ,
Department of Cell and Regenerative Biology , Carbone Cancer Center , Madison ,
WI , USA.
(208)bvo University of Tennessee Health Science Center , Department of
Physiology , Memphis , TN , USA.
(209)dt UMR 1324 INRA, 6265 CNRS, Université de Bourgogne Franche-Comté, Centre
des Sciences du Goût et de l'Alimentation, Dijon , France.
(210)brb University of Padova , Department of Biology , Padova , Italy.
(211)axk Universidade de São Paulo, Instituto do Cancer do Estado de São Paulo,
Faculdade de Medicina , São Paulo, SP , Brazil.
(212)xg Karolinska Institute, Cancer Center Karolinska , Department of
Oncology-Pathology , Stockholm , Sweden.
(213)bsz University of Rochester Medical Center , Department of Anesthesiology ,
Rochester , NY , USA.
(214)mn Genentech Inc., Immunology and Infectious Diseases , South San Francisco
, CA , USA.
(215)rl Indiana University School of Medicine , Department of Microbiology and
Immunology , Indianapolis , IN , USA.
(216)rr INRA, UMR 1019 Nutrition Humaine , Centre de Clermont Theix, Saint Genès
Champanelle , France.
(217)aym Université Clermont 1, UFR Médecine, UMR1019 Nutrition Humaine ,
Clermont-Ferrand , France.
(218)btu University of São Paulo, School of Physical Education and Sport,
Cellular and Molecular Exercise Physiology Laboratory , São Paulo , Brazil.
(219)qd Hospital for Sick Children, Toronto , ON , Canada.
(220)lc Federico II University , Department of Translational Medicine , Naples ,
Italy.
(221)asa Telethon Institute of Genetics and Medicine (TIGEM) , Pozzuoli, Naples
, Italy.
(222)ada Monash University, School of Biological Sciences , Melbourne , Victoria
, Australia.
(223)bpi University of Nebraska Medical Center , Omaha , NE , USA.
(224)bqy University of Oxford, Acute Stroke Programme, Radcliffe Department of
Medicine , Oxford , UK.
(225)amh Sabanci University, Molecular Biology, Genetics and Bioengineering
Program , Istanbul , Turkey.
(226)dn Centre Antoine Lacassagne , Nice , France.
(227)sk INSERM, U1081-UMR CNRS 7284 , Nice , France.
(228)bpu University of Nice-Sophia Antipolis, Institute for Research on Cancer
and Aging of Nice (IRCAN) , Nice , France.
(229)bpx University of North Carolina , Department of Genetics , Chapel Hill ,
NC , USA.
(230)yo KU Leuven, Laboratory of Molecular and Cellular Signaling , Department
of Cellular and Molecular Medicine , Leuven , Belgium.
(231)bdn University of Belgrade, School of Medicine, Institute of Histology and
Embryology , Belgrade , Serbia.
(232)azd Université de Montréal, Faculty of Pharmacy , Montréal, Québec ,
Canada.
(233)hh Columbia University Medical Center , Department of Neurology , New York
, NY , USA.
(234)hi Columbia University Medical Center , Department of Pathology and Cell
Biology , New York , NY , USA.
(235)boh University of Michigan, Molecular and Behavioral Neuroscience Institute
, Departments of Computational Medicine and Bioinformatics , Psychiatry, and
Human Genetics , Ann Arbor , MI , USA.
(236)bdq University of Bern, Institute of Biochemistry and Molecular Medicine ,
Bern , Switzerland.
(237)bxk University of Trento, The Microsoft Research, Centre for Computational
and Systems Biology (COSBI) , Rovereto , TN , Italy.
(238)ahl New York University School of Medicine, Skirball Institute , Department
of Microbiology , New York , NY , USA.
(239)dh Center of Experimental Medicine, Institute for Clinical and Experimental
Medicine , Prague , Czech Republic.
(240)x Albert Einstein College of Medicine , Bronx , NY , USA.
(241)cbs Wenzhou Medical University, School of Optometry and Ophthalmology and
Eye Hospital , Wenzhou, Zhejiang , China.
(242)amd Rutgers University, The State University of New Jersey , Department of
Cell Biology and Neuroscience , Piscataway , NJ , USA.
(243)ayq Université de Bordeaux, UMR 5095, CNRS, Institut de Biochimie et
génétique Cellulaires , Bordeaux , France.
(244)bmj University of London , RVC Department of Comparative Biomedical
Sciences , UCL Consortium for Mitochondrial Research , London , UK.
(245)bfq University of California San Diego , Department of Pediatrics , La
Jolla , CA , USA.
(246)ava Trinity College Dublin, Smurfit Institute of Genetics , Dublin ,
Ireland.
(247)uj IRCCS Santa Lucia Foundation , Department of Experimental Neurosciences
, Rome , Italy.
(248)bpa University of Montpellier, UMR 866, Dynamique Musculaire et Métabolisme
, Montpellier , France.
(249)bxg University of Toronto/Lunenfeld-Tanenbaum Research Institute, Mount
Sinai Hospital , Department of Obstetrics and Gynecology , Toronto, Ontario ,
Canada.
(250)un IRCCS-Istituto di Ricerche Farmacologiche Mario Negri , Department of
Molecular Biochemistry and Pharmacology , Milan , Italy.
(251)dl Central South University , Department of Pediatrics , Xiangya Hospital ,
Changsha, Hunan , China.
(252)bkr University of Idaho, Plant, Soil, and Entomological Sciences , Moscow ,
ID , USA.
(253)ank Second University of Naples , Department of Biochemistry , Biophysics
and General Pathology , Naples , Italy.
(254)anc Sapienza University of Rome , Department of Molecular Medicine , Rome ,
Italy.
(255)bhs University of Coimbra, Faculty of Medicine, Center for Neuroscience and
Cell Biology , Coimbra , Portugal.
(256)gz Cleveland Clinic, Taussig Cancer Institute , Cleveland , OH , USA.
(257)agp National University of Ireland, Apoptosis Research Centre , Galway ,
Ireland.
(258)cw Case Western Reserve University, Molecular Biology and Microbiology ,
Cleveland , OH , USA.
(259)avs Umeå University , Department of Medical Biochemistry and Biophysics ,
Umeå , Sweden.
(260)bke University of Graz, Institute of Molecular Biosciences, BioTechMed Graz
, Graz , Austria.
(261)kz Federal University of Rio de Janeiro, Insititute of Microbiology ,
Department of Immunology , Rio de Janeiro , Brazil.
(262)aki Polytechnic University of Marche , Department of Life and Environmental
Sciences , Ancona , Italy.
(263)axr Universita' degli Studi di Modena e Reggio Emilia , Dipartimento di
Scienze Biomediche , Metaboliche e Neuroscienze , Modena , Italy.
(264)dp Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068,
CNRS UMR 7258, Aix-Marseille Université , Institut Paoli-Calmette, Parc
Scientifique et Technologique de Luminy, Marseille , France.
(265)ahp Newcastle University, Campus for Ageing and Vitality, Institute for
Cell and Molecular Biosciences and Institute for Ageing , Newcastle upon Tyne ,
UK.
(266)axx Universitat Autònoma de Barcelona , Department of Cell Biology ,
Physiology and Immunology, Institut de Neurociències , Barcelona , Spain.
(267)apx Spanish Council for Scientific Research, Institute for Advanced
Chemistry of Catalonia , Department of Biomedicinal Chemistry , Barcelona ,
Spain.
(268)ll Fondazione IRCCS Istituto Nazionale dei Tumori , Department of
Experimental Oncology and Molecular Medicine , Milan , Italy.
(269)bdf University of Basel , Biozentrum, Basel, BS , Switzerland.
(270)hf Colonia Ciudad Universitaria , Neurodevelopment and Physiology
Department , Neuroscience Division, Instituto de Fisiologia Celular, UNAM ,
Mexico , DF , Mexico.
(271)bru University of Pisa, Interdepartmental Research Centre on Biology and
Pathology of Aging , Pisa , Italy.
(272)is Danish Cancer Society Research Center , Unit of Cell Stress and Survival
(CSS) , Copenhagen , Denmark.
(273)ui IRCCS Santa Lucia Foundation , Rome , Italy.
(274)btl University of Rome "Tor Vergata" , Department of Biology, Rome , Italy.
(275)qq Icahn School of Medicine at Mount Sinai , Department of Pharmacology and
Systems Therapeutics , New York , NY , USA.
(276)gq CIBERNED, ISCIII, Unidad Asociada Neurodeath , Madrid , Spain.
(277)awg Universidad de Castilla-La Mancha , Albacete , Spain.
(278)axw Università Vita-Salute San Raffaele , Milan , Italy.
(279)caj San Raffaele Scientific Institute , Milan , Italy.
(280)qb Hôpital Kirchberg, Laboratoire de Biologie Moléculaire et Cellulaire du
Cancer , Luxembourg.
(281)bxt University of Tuscia , Department for Innovation in Biological ,
Agro-food and Forest Systems (DIBAF) , Viterbo , Italy.
(282)bdv University of Bologna , Dipartimento di Scienze Biomediche e
Neuromotorie , Bologna , Italy.
(283)byz University of Zürich , Department of Radiation Oncology , Zurich ,
Switzerland.
(284)ge Chonbuk National University , Department of Pharmacology , Medical
School , Chonbuk , Korea.
(285)xj Karolinska Institute , Department of Physiology and Pharmacology ,
Stockholm , Sweden.
(286)xb Kaohsiung Medical University Hospital , Department of Pathology ,
Kaohsiung City , Taiwan.
(287)xd Kaohsiung Medical University, Faculty of Medicine , Department of
Pathology , Kaohsiung City , Taiwan.
(288)bet University of Calcutta , Department of Biotechnology , Dr.B.C. Guha
Centre for Genetic Engineering and Biotechnology , Kolkata , WB , India.
(289)bio University of Crete, School of Medicine , Department of Infectious
Diseases , Heraklion, Crete , Greece.
(290)aqx Strathclyde Institute of Pharmacy and Biomedical Sciences , Glasgow ,
UK.
(291)fy Chinese University of Hong Kong , Department of Anaesthesia and
Intensive Care , Shatin, NT, Hong Kong.
(292)alo Roswell Park Cancer Institute , Department of Pharmacology and
Therapeutics , Buffalo , NY , USA.
(293)ub International Center for Genetic Engineering and Biotechnology,
Immunology Group , New Delhi , India.
(294)ael National Cheng Kung University , Department of Microbiology and
Immunology , College of Medicine , Tainan , Taiwan.
(295)bko University of Hong Kong, Laboratory of Neurodegenerative Diseases ,
School of Biomedical Sciences , LKS Faculty of Medicine , Hong Kong , China.
(296)mg Geisel School of Medicine at Dartmouth , Department of Biochemistry ,
Hanover , NH , USA.
(297)bcd University of Alabama at Birmingham, Division of Molecular and Cellular
Pathology , Department of Pathology , Birmingham , AL , USA.
(298)bul University of South Carolina, Environmental Health and Disease
Laboratory , Department of Environmental Health Sciences , Columbia , SC , USA.
(299)tg Institute of Life Sciences , Bhubaneshwar , Odisa , India.
(300)bj Beijing Institute of Pharmacology and Toxicology, State Key Laboratory
of Toxicology and Medical Countermeasures , Beijing , China.
(301)avo UCL Institute of Ophthalmology , London , UK.
(302)bpo University of New South Wales, Inflammation and Infection Research
Centre, School of Medical Sciences , Sydney, NSW , Australia.
(303)ari Taichung Veterans General Hospital , Department of Medical Research ,
Taichung City , Taiwan.
(304)vz Jinshan Hospital of Fudan University , Department of Urology , Shanghai
, China.
(305)bll University of Kentucky, College of Medicine , Department of
Pharmacology and Nutritional Sciences , Lexington , KY , USA.
(306)i Academia Sinica, Institute of Biological Chemistry , Taipei , Taiwan.
(307)aol Shanghai Jiao Tong University, School of Medicine, Key Laboratory of
Cell Differentiation and Apoptosis of Chinese Ministry of Education , Shanghai ,
China.
(308)aok Shanghai Jiao Tong University, School of Medicine , Department of
Pharmacology and Chemical Biology , Shanghai , China.
(309)bff University of California Irvine , Department of Neurosurgery , Irvine ,
CA , USA.
(310)nf Georgia Regents University, Medical College of Georgia , Department of
Cellular Biology and Anatomy , Augusta , GA , USA.
(311)ng Georgia Regents University, Medical College of Georgia , Department of
Medicine , Augusta , GA , USA.
(312)io Dalian Medical University , Department of Food Nutrition and Safety ,
Dalian , China.
(313)cbx Wuhan University, College of Life Science, State Key Laboratory of
Virology , Wuhan, Hubei , China.
(314)blj University of Kansas Medical Center , Department of Pharmacology ,
Toxicology and Therapeutics , Kansas City , KS , USA.
(315)fp Chinese Academy of Sciences, Institute of Zoology , Beijing , China.
(316)eh Chang Gung University, College of Medicine , Department of Neurology ,
Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan.
(317)lm Food and Drug Administration (FDA), Division of Biochemical Toxicology,
National Center for Toxicological Research (NCTR) , Jefferson , AR , USA.
(318)j Academia Sinica, Institute of Biomedical Sciences , Taipei , Taiwan.
(319)ccs Zhejiang University , Department of Food Science and Nutrition ,
Hangzhou , China.
(320)aew National Ilan University , Department of Biotechnology and Animal
Science , Yilan City , Taiwan.
(321)akq Qilu Hospital of Shandong University, Cardiology , Jinan, Shandong ,
China.
(322)apu South China Normal University, College of Biophotonics , Guangdong ,
China.
(323)arm Tamkang University , Department of Chemistry , Tamsui, New Taipei City
, Taiwan.
(324)avb Tsinghua University, School of Life Sciences , Beijing , China.
(325)bcq University of Arizona , Department of Pharmacology and Toxicology ,
College of Pharmacy , Tucson , AZ , USA.
(326)ajq Peking University , Department of Immunology , Beijing , China.
(327)ajs Peking University, Health Science Center, Center for Human Disease
Genomics , Beijing , China.
(328)cdc Zhengzhou University Affiliated Cancer Hospital , Zhengzhou , China.
(329)aaj Mackay Memorial Hospital , Department of Radiation Oncology , Taipei ,
Taiwan.
(330)ara Sun Yat-Sen University, Key Laboratory of Gene Engineering of the
Ministry of Education, School of Life Science , Guangzhou , China.
(331)atl Third Military Medical University , Department of Neurosurgery ,
Southwest Hospital , Shapingba District, Chongqing , China.
(332)ma Fudan University, Cancer Center , Department of Integrative Oncology ,
Shanghai , China.
(333)ccq Zhejiang University, Deparment of Pharmacology, College of
Pharmaceutical Sciences , Hangzhou, Zhejiang , China.
(334)bml University of Louisville , Department of Biochemistry and Molecular
Genetics , Louisville , KY , USA.
(335)gb Chinese University of Hong Kong, School of Biomedical Sciences, Faculty
of Medicine , Shatin, NT, Hong Kong.
(336)bnl University of Maryland, School of Medicine, Institute of Human Virology
, Baltimore , MD , USA.
(337)aeh National Cancer Center, Division of Cancer Biology, Research Institute
, Gyeonggi , Korea.
(338)brp University of Pennsylvania , Department of Microbiology , Philadelphia
, PA , USA.
(339)bmm University of Louisville , Department of Medicine (Hem-Onc) ,
Louisville , KY , USA.
(340)aek National Cheng Kung University, College of Medicine , Department of
Pharmacology and Institute of Basic Medical Sciences , Tainan , Taiwan.
(341)azg Université de Rennes-1, Oncogenesis, stress, Signaling" (OSS), ERL 440
INSERM, Centre de Lutte Contre le Cancer Eugene Marquis , Rennes , France.
(342)ej Chang Gung University , Department of Biochemistry , College of Medicine
, Taoyuan , Taiwan.
(343)yf Korea University , Department of Life Science and Biotechnology , Seoul
, Korea.
(344)kv European Institute of Oncology (IEO) , Department of Experimental
Oncology , Milan , Italy.
(345)ajv Pennsylvania State University, College of Medicine , Department of
Cellular and Molecular Physiology , Hershey , PA , USA.
(346)ia Consiglio Nazionale delle Ricerche, Core Research Laboratory , Siena ,
Italy.
(347)uu Istituto di Fisiologia Clinica , Siena , Italy.
(348)ve Istituto Toscano Tumori , Siena , Italy.
(349)afc National Institute of Gastoenterology, Laboratory of Experimental
Immunopathology , Castellana Grotte (BA) , Italy.
(350)kd Emory University, School of Medicine , Department of Pharmacology ,
Atlanta , GA , USA.
(351)awk Universidad de Chile, Advanced Center for Chronic Diseases (ACCDiS) ,
Santiago , Chile.
(352)agt National University of Singapore , Department of Pharmacy , Singapore.
(353)yz Kyung Hee University, Graduate School of East-West Medical Science ,
Seoul , Korea.
(354)xz Konkuk University , Department of Animal Biotechnology , Seoul , Korea.
(355)akt Queen Elizabeth Hospital , Department of Clinical Oncology , Kowloon,
Hong Kong.
(356)da Catholic University of Korea, College of Pharmacy , Bucheon , Korea.
(357)anx Seoul St. Mary's Hospital , Department of Internal Medicine , Seoul,
Korea.
(358)cbo Weill Cornell Medical College , New York , NY , USA.
(359)nw Graduate School of Hallym University , Chuncheon, Kangwon-do , Korea.
(360)oj Hallym University , Department of Biomedical Gerontology , Chuncheon,
Kangwon-do, Korea; and Anyang, Gyeonggi-do , Korea.
(361)zi Laboratory of Cellular Aging and Neurodegeneration, Ilsong Institute of
Life Science, Anyang , Gyeonggi-do , Korea.
(362)bhc University of Chicago , Department of Pathology , Chicago , IL , USA.
(363)cbm Weill Cornell Medical College, Division of Nephrology and Hypertension,
Joan and Sanford I . Weill Department of Medicine , New York , NY , USA.
(364)ccj Yonsei University, College of Medicine, Corneal Dystrophy Research
Institute ; and Department of Ophthalmology , Seoul , Korea.
(365)ov Harbor-UCLA Medical Center and Los Angeles Biomedical Research
Institute, Division of Medical Genetics , Department of Pediatrics , Torrance ,
CA , USA.
(366)oe Gustave Roussy Institute , Villejuif , France.
(367)bhn University of Cincinnati , Cincinnati , OH , USA.
(368)bvl University of Tartu , Department of Pharmacology , Tartu , Estonia.
(369)aep National Chung Hsing University, Graduate Institute of Biomedical
Sciences , Taichung , Taiwan.
(370)abb Max Planck Institute of Biophysical Chemistry , Department of Molecular
Cell Biology , Göttingen , Germany.
(371)bsj University of Pittsburgh, School of Medicine , Department of Pathology
and Center for Neuroscience , Pittsburgh , PA , USA.
(372)aeu National Health Research Institutes, Immunology Research Center ,
Miaoli , Taiwan.
(373)yg Korea University, Department of Biotechnology, College of Life Sciences
and Biotechnology , Seoul , Korea.
(374)yb Konkuk University School of Medicine , Department of Ophthalmology ,
Seoul , Korea.
(375)akp Pusan National University , Department of Biological Sciences , Busan ,
Korea.
(376)asx The Institute of Cancer Research, Cancer Research UK Cancer Imaging
Centre, Division of Radiotherapy and Imaging , Sutton, Surrey , UK.
(377)r Ajou University, School of Medicine , Department of Microbiology ,
Gyeonggi-do , Korea.
(378)it Danish Cancer Society Research Center, Unit of Cell Stress and Survival
, Copenhagen , Denmark.
(379)bpg University of Naples Federico II , Department of Veterinary Medicine
and Animal Production , Naples , Italy.
(380)ahb Nencki Institute of Experimental Biology, Neurobiology Center,
Laboratory of Molecular Neurobiology , Warsaw , Poland.
(381)anb Sapienza University of Rome , Department of Experimental Medicine ,
Rome , Italy.
(382)bmd KU Leuven-University of Leuven, Center for Human Genetics; VIB Center
for the Biology of Disease , Leuven , Belgium.
(383)bmh University of Liverpool, Cellular and Molecular Physiology, Institute
of Translational Medicine , Liverpool , UK.
(384)bda University of Barcelona , Department of Biochemistry and Molecular
Genetics , Hospital Clínic, IDIBAPS-CIBERehd , Barcelona , Spain.
(385)blw University of Lausanne , Department of Fundamental Neurosciences ,
Faculty of Biology and Medicine , Lausanne , Switzerland.
(386)mw Georgetown University Medical Center , Department of Oncology ,
Washington, DC , USA.
(387)ane Scientific Institute IRCCS Eugenio Medea , Bosisio Parini , Italy.
(388)bat University Hospital "Luigi Sacco", Università di Milano, Unit of
Clinical Pharmacology, National Research Council-Institute of Neuroscience ,
Department of Biomedical and Clinical Sciences "Luigi Sacco" , Milano , Italy.
(389)bpm University of New Mexico , Department of Pathology and Cancer Research
and Treatment Center , Albuquerque , NM , USA.
(390)azn Universite Libre de Bruxelles, ULB Center for Diabetes Research ,
Brussels , Belgium.
(391)vb Istituto Superiore di Sanità , Department of Infectious , Parasitic and
Immunomediated Diseases , Rome , Italy.
(392)bdc University of Bari 'Aldo Moro' , Department of Basic Medical Sciences ,
Neurosciences and Organs of Senses , Bari , Italy.
(393)jk Duke University, Medical Center , Department of Molecular Genetics and
Microbiology , Durham , NC , USA.
(394)bfy University of California San Diego, Moores Cancer Center , La Jolla ,
CA , USA.
(395)y Albert Einstein College of Medicine , Department of Developmental and
Molecular Biology , Bronx , NY , USA.
(396)ds Centre for Research in Agricultural Genomics (CSIC-IRTA-UAB-UB) ,
Bellaterra , Catalonia , Spain.
(397)sv Institut Pasteur, CNRS, URA2578, Unité Macrophages et Développement de
l'Immunité , Département de Biologie du Développement et des Cellules Souches ,
Paris , France.
(398)bri University of Pavia , Department of Biology and Biotechnology , Pavia ,
Italy.
(399)vf Italian National Institute of Health , Department of Technology and
Health, Rome , Italy.
(400)cas Wake Forest University , Department of Surgery , Hypertension and
Vascular Research Center, Wake Forest Comprehensive Cancer Center ,
Winston-Salem , NC , USA.
(401)bve University of Strathclyde, Strathclyde Institute of Pharmacy and
Biomedical Sciences , Glasgow , UK.
(402)cav Washington State University Vancouver, School of Molecular Biosciences
, Vancouver , WA , USA.
(403)wc Johns Hopkins University, Bloomberg School of Public Health, Malaria
Research Institute , Department of Molecular Microbiology and Immunology ,
Baltimore , MD , USA.
(404)bai University "Magna Graecia" of Catanzaro , Department of Health Sciences
, Catanzaro , Italy.
(405)rq INMI-IRCCS "L. Spallanzani" , Rome , Italy.
(406)bhf University of Chile, Advanced Center for Chronic Diseases (ACCDiS),
Division of Cardiovascular Diseases, Faculty of Medicine , Santiago , Chile.
(407)iq Danish Cancer Society Research Center, Cell Death and Metabolism Unit,
Center for Autophagy, Recycling and Disease , Copenhagen , Denmark.
(408)bua University of Sevilla, Instituto de Biomedicina de Sevilla (IBIS) ,
Oral Medicine Department , Sevilla , Spain.
(409)awo Universidad de Córdoba, Campus de Excelencia Agroalimentario (ceiA3),
Departamento de Genética , Córdoba , Spain.
(410)sm INSERM, U1127, CNRS, UMR 7225 , Paris , France.
(411)apq Sorbonne Universités, UMR S1127 , Paris , France.
(412)boy University of Modena and Reggio Emilia, School of Medicine , Department
of Surgery , Medicine, Dentistry and Morphological Sciences , Modena , Italy.
(413)bxq University of Turin , Department of Clinical and Biological Sciences ,
Unit of Experimental Medicine and Clinical Pathology , Turin , Italy.
(414)bfj University of California Los Angeles, Larry Hillblom Islet Research
Center, David Geffen School of Medicine , Los Angeles , CA , USA.
(415)aas Massachusetts General Hospital and Harvard Medical School, Center for
Human Genetic Research and Department of Neurology , Boston , MA , USA.
(416)ajj Oviedo University, Morphology and Cellular Biology Department , Oviedo
, Spain.
(417)ut IRO, Institute for Research in Ophthalmology , Sion , Switzerland.
(418)blx University of Lausanne , Department of Ophthalmology , Lausanne ,
Switzerland.
(419)axa Universidad de Valparaíso, Instituto de Biología, Facultad de Ciencias
, Valparaíso , Chile.
(420)ama Rutgers University , Department of Cell Biology and Neuroscience ,
Piscataway , NJ , USA.
(421)ach Medical University of South Carolina, Biochemistry and Molecular
Biology , Charleston , SC , USA.
(422)bgb University of California San Francisco , Department of Microbiology and
Immunology , San Francisco , CA , USA.
(423)bbw University of Aberdeen, Division of Applied Medicine , Aberdeen , UK.
(424)brz University of Pittsburgh , Department of Microbiology and Molecular
Genetics , Pittsburgh , PA , USA.
(425)buu University of Southampton, Cancer Sciences , Southampton , UK.
(426)blo University of Kentucky , Department of Pharmacology and Nutritional
Sciences , Lexington , KY , USA.
(427)bxs University of Turin , Turin , Italy.
(428)awz Universidad de Sevilla, Instituto de Bioquímica Vegetal y Fotosíntesis,
CSIC , Sevilla , Spain.
(429)ul IRCCS, "C. Mondino" National Neurological Institute, Experimental
Neurobiology Lab , Pavia , Italy.
(430)bhp University of Coimbra, Center for Neuroscience and Cell Biology and
Faculty of Pharmacy , Coimbra , Portugal.
(431)awc Universidad Autonoma de Madrid, Departamento de Biologia Molecular ,
Madrid , Spain.
(432)bui University of South Carolina School of Medicine , Department of Cell
Biology and Anatomy , Columbia , SC , USA.
(433)aky Queen Mary University of London, Centre for Haemato-Oncology, Barts
Cancer Institute , London , UK.
(434)aa Albert Einstein College of Medicine , Department of Medicine , Bronx ,
NY , USA.
(435)bhl University of Cincinnati College of Medicine , Department of Cancer
Biology , Cincinnati , OH , USA.
(436)can University of Nevada School of Medicine, Department of Pharmacology,
Reno, NV, USA.
(437)baz University Hospital Jena , Department of General , Visceral and
Vascular Surgery, Experimental Transplantation Surgery , Jena , Germany.
(438)adt Nanjing Medical University, Center for Kidney Disease, 2nd Affiliated
Hospital , Jiangsu , China.
(439)asq The First Affiliated Hospital of Harbin Medical University, Key
Laboratory of Hepatosplenic Surgery , Department of General Surgery , Harbin ,
China.
(440)cae Virginia Commonwealth University, Massey Cancer Center , Department of
Medicine , Richmond , VA , USA.
(441)bvp University of Texas at Austin, College of Pharmacy, Division of
Medicinal Chemistry , Austin , TX , USA.
(442)ayn Université d'Auvergne, M2iSH "Microbes, Intestine, Inflammation,
Susceptibility of the Host", UMR 1071 INSERM, Centre Biomédical de Recherche et
Valorisation, Faculté de Médecine , Clermont-Ferrand , France.
(443)uk IRCCS Santa Lucia Foundation , Rome , Italy.
(444)gf Christian Albrechts University, Institut für Biochemie , Kiel , Germany.
(445)ajn Paris Diderot University, Sorbonne Paris Cité, INSERM, CNRS , Paris ,
France.
(446)bcc University of Alabama at Birmingham , Department of Pathology , Center
for Free Radical Biology , Birmingham , AL , USA.
(447)gw Cleveland Clinic , Cleveland , OH , USA.
(448)gt Cincinnati Children's Hospital Medical Center, Division of Oncology ,
Cincinnati , OH , USA.
(449)avf Tulane University Health Sciences Center , Department of Pathology and
Laboratory Medicine , New Orleans , LA , USA.
(450)ih Curtin University, School of Pharmacy , Bentley , Australia.
(451)h Alberystwyth University, Institute of Biological, Environmental and Rural
Sciences , Penglais , Aberystwyth , Wales , UK.
(452)bgz University of Cape Town, Redox Laboratory , Department of Human Biology
, Cape Town , South Africa.
(453)hs Complutense University, Instituto de Investigaciones Sanitarias San
Carlos (IdISSC) , Department of Biochemistry and Molecular Biology I , School of
Biology , Madrid , Spain.
(454)bno University of Massachusetts, Medical School, Howard Hughes Medical
Institute , Worcester , MA , USA.
(455)wf Johns Hopkins University, School of Medicine , Departments of Neurology
, Neuroscience and Pharmacology and Molecular Sciences ; Neuroregeneration
Program, Institute for Cell Engineering , Baltimore , MD , USA.
(456)wh Johns Hopkins University, School of Medicine, Neuroregeneration and Stem
Cell Programs, Institute for Cell Engineering , Department of Neurology ,
Department of Physiology , Baltimore , MD , USA.
(457)btz University of Sevilla , Department of Cell Biology , Sevilla , Spain.
(458)rb Imperial College London, Neurogenetics Group, Division of Brain Sciences
, London , UK.
(459)asj Texas A&M University , Department of Microbial Pathogenesis and
Immunology , Texas A&M Health Science Center , Bryan , TX , USA.
(460)asl Texas A&M University, The Norman Borlaug Center , College Station , TX
, USA.
(461)ee Centro de Pesquisas Aggeu Magalhães/FIOCRUZ-PE , Departamento de
Microbiologia , Recife , PE , Brazil.
(462)ami SaBio, Instituto de Investigación en Recursos Cinegéticos
IREC-CSIC-UCLM-JCCM , Ciudad Real , Spain.
(463)bcm University of Antwerp, Laboratory of Physiopharmacology, Wilrijk ,
Antwerp , Belgium.
(464)all Rio de Janeiro Federal University, Instituto de Biofísica Carlos Chagas
Filho , Rio de Janeiro , Brazil.
(465)brt University of Pisa , Department of Translational Research and New
Technologies in Medicine and Surgery , Pisa , Italy.
(466)ir Danish Cancer Society Research Center, Cell Stress and Survival Unit ,
Copenhagen , Denmark.
(467)bgi University of California San Francisco, School of Medicine , Department
of Pathology , San Francisco , CA , USA.
(468)kq ETH Zurich, Institute of Biochemistry , Zurich , Switzerland.
(469)yk KU Leuven , Department of Abdominal Transplant Surgery , Leuven ,
Belgium.
(470)bbh University Hospitals Leuven , Department of Microbiology and Immunology
, Laboratory of Abdominal Transplantation , Leuven , Belgium.
(471)ayp Université de Bordeaux, Institut des Maladies Neurodégénératives, CNRS
UMR 5293 , Bordeaux , France.
(472)bud University of Siena , Department of Molecular and Developmental
Medicine , Siena , Italy.
(473)amc Rutgers University, New Jersey Medical School , Department of Cell
Biology and Molecular Medicine , Newark , NJ , USA.
(474)ayr Université de Franche-Comté, UFR Sciences et Techniques EA3922/SFR IBCT
FED 4234, Estrogènes, Expression Génique et Pathologies du Système Nerveux
Central , Besançon , France.
(475)bns University of Melbourne , Department of Physiology , Parkville ,
Australia.
(476)ayk Université Catholique de Louvain (UCL), Institute of Neuroscience ,
Louvain-la-Neuve , Belgium.
(477)asb Temasek Life Sciences Laboratory , Singapore.
(478)bjr University of Freiburg , Department of Dermatology , Medical Center,
Center for Biological Systems Analysis (ZBSA) , Freiburg , Germany.
(479)blt University of La Réunion, CYROI, IRG Immunopathology and Infection
Research Grouping , Reunion , France.
(480)bzw Virginia Commonwealth University , Department of Biochemistry and
Molecular Biology , Richmond , VA , USA.
(481)bpz University of North Carolina, Lineberger Comprehensive Cancer Center ,
Chapel Hill , NC , USA.
(482)bpn University of New Mexico, Health Sciences Center , Department of
Molecular Genetics and Microbiology , Albuquerque , NM , USA.
(483)kt ETH Zürich, LFW D 18.1 , Zürich , Switzerland.
(484)bad Université Paris-Sud, INSERM 1030, Gustave Roussy Cancer Campus , Paris
, France.
(485)asi Texas A&M University , Department of Biochemistry and Biophysics ,
College Station , TX , USA.
(486)acx Monash University, Clayton Campus , Department of Biochemistry and
Molecular Biology , Melbourne , Victoria , Australia.
(487)btj University of Rome "Tor Vergata" , Department of System Medicine , Rome
, Italy.
(488)amz Sapienza University of Rome , Department of Biochemical Sciences "A.
Rossi Fanelli" , Rome , Italy.
(489)ew Children's Hospital , Department of Neurology , Boston , MA , USA.
(490)cbb Washington University, School of Medicine , Department of Developmental
Biology , St. Louis , MO , USA.
(491)awl Universidad de Chile, Facultad de Ciencias Químicas y Farmacéuticas ,
Santos Dumont , Santiago de Chile.
(492)bcg University of Alcala , Department of System Biology , Biochemistry and
Molecular Biology Unit, School of Medicine , Madrid , Spain.
(493)amt Sanford Burnham Prebys Medical Discovery Institute , La Jolla , CA ,
USA.
(494)awa Universidad Autónoma de Madrid, Centro de Biología Molecular Severo
Ochoa, CIBERER , Madrid , Spain.
(495)bup University of South Florida, Byrd Alzheimer's Institute , Tampa , FL ,
USA.
(496)bln University of Kentucky , Department of Molecular and Cellular
Biochemistry , Lexington , KY , USA.
(497)anu Seoul National University , College of Pharmacy , Seoul , Korea.
(498)biz University of Edinburgh, Easter Bush, The Roslin Insitute , Midlothian
, UK.
(499)nq Goethe University School of Medicine, Institute of Biochemistry II and
Buchmann Institute for Molecular Life Sciences , Frankfurt am Main , Germany.
(500)bfc University of California Davis , Department of Plant Biology and the
Genome Center , College of Biological Sciences , Davis , CA , USA.
(501)aov Shanghai Veterinary Research Institute , Shanghai , China.
(502)bcr University of Arkansas for Medical Sciences , Department of Cardiology
, Little Rock , AR , USA.
(503)btn University of Salento , Department of Biological and Environmental
Science and Technology , Lecce , Italy.
(504)bjc University of Erlangen-Nuremberg , Department of Internal Medicine 3 ,
Erlangen , Germany.
(505)cbg Washington University, School of Medicine, John Cochran VA Medical
Center, Center for Cardiovascular Research , St. Louis , MO , USA.
(506)ayo Université de Bordeaux, INSERM U916, Institut Bergonié , Bordeaux cedex
, France.
(507)aeb NAS of Ukraine , Department of Molecular Genetics and Biotechnology ,
Institute of Cell Biology , Lviv , Ukraine.
(508)bgx University of Canterbury, Biomolecular Interaction Centre, School of
Biological Sciences , Christchurch , New Zealand.
(509)np Goethe University of Frankfurt, Institute of Biophysical Chemistry ,
Frankfurt am Main , Germany.
(510)bpl University of New Mexico , Department of Internal Medicine ,
Albuquerque , NM , USA.
(511)bae Université Paris-Sud, Institut Gustave Roussy, CNRS UMR 8126 ,
Villejuif , France.
(512)byg University of Verona , Department of Neurological, Biomedical and
Movement Sciences , Verona , Italy.
(513)rj Indiana University School of Medicine , Department of Biochemistry and
Molecular Biology , Indianapolis , IN , USA.
(514)bvr University of Texas , Southwestern Medical Center, Department of
Internal Medicine , Center for Autophagy Research, Dallas , TX , USA.
(515)bph University of Nebraska Medical Center , Department of Internal Medicine
, Omaha , NE , USA.
(516)bzj VA Nebraska-Western Iowa Health Care System , Omaha , NE , USA.
(517)amm San Diego State University , Department of Biology and Center for
Microbial Sciences , San Diego , CA , USA.
(518)bah University "G. dAnnunzio" , Department of Medical , Oral and
Biotechnological Sciences , Chieti , Italy.
(519)cax Washington University in St. Louis, School of Medicine , Department of
Internal Medicine , St. Louis , MO , USA.
(520)by Bogomoletz Institute of Physiology, National Academy of Sciences Ukraine
, General and Molecular Pathophysiology Department , Kiev , Ukraine.
(521)bcu University of Arkansas, Center of Excellence for Poultry Science ,
Fayetteville , AR , USA.
(522)arx Tel Aviv University, Oncogenetic Laboratory, Meir Medical Center, Kfar
Saba and Sackler Faculty of Medicine , Tel Aviv , Israel.
(523)bi Beijing Anzhen Hospital, Capital Medical University, Beijing Institute
of Heart, Lung, and Blood Vessel Diseases , Beijing , China.
(524)afb National Institute of Biological Sciences , Beijing , China.
(525)me Fujian Provincial Hospital, Department of Urology , Fuzhou , China.
(526)aqr Stellenbosch University , Department of Physiological Sciences ,
Stellenbosch , South Africa.
(527)akw Queen Mary University of London, Blizard Institute , Department of
Neuroscience and Trauma , London , UK.
(528)alx Rush University Medical Center , Department of Anatomy and Cell Biology
, Chicago , IL , USA.
(529)aim Ohio State University, DHLRI , Department of Medicine , Columbus , OH ,
USA.
(530)rg Indian Institute of Technology Guwahati , Department of Biosciences and
Bioengineering , Guwahati , Assam , India.
(531)bas University College London, UCL Consortium for Mitochondrial Research
and Department of Cell and Developmental Biology , London , UK.
(532)bbd University Hospital of Lausanne, Service and Central Laboratory of
Hematology , Lausanne , Switzerland.
(533)bbk University Lille, INSERM, CHU Lille, Institut Pasteur de Lille, U1011,
EGID , Lille , France.
(534)si INSERM UMRS 1166, Unité de Recherche sur les Maladies Cardiovasculaires,
du Métabolisme et de la Nutrition , Paris , France.
(535)lu Freiburg University, Center for Biological Systems Analysis (ZBSA), Core
Facility Proteomics , Freiburg , Germany.
(536)bnz University of Michigan , Department of Cell and Developmental Biology ,
Ann Arbor , MI , USA.
(537)ct Cardiff University, Institute of Cancer and Genetics , Cardiff , Wales,
UK.
(538)bji University of Florida, College of Medicine , Department of Anatomy and
Cell Biology , Gainesville , FL , USA.
(539)ry INSERM U1118, Mécanismes Centraux et Périphétiques de la
Neurodégénérescence , Strasbourg , France.
(540)azi Université de Strasbourg, Faculté de Médecine, UMRS 1118 , Strasbourg ,
France.
(541)se INSERM U916, Université de Bordeaux, Institut Européen de Chimie et
Biologie , Pessac , France.
(542)abt McGill University, Montreal Neurological Institute , Montreal, QC ,
Canada.
(543)ayg Université Bordeaux, CNRS, Institut de Biochimie et Génétique
Cellulaires, UMR 5095 , Bordeaux , France.
(544)bzk VA Pittsburgh Health System, University of Pittsburgh Medical Center ,
Pittsburgh , PA , USA.
(545)cd Brandeis University , Department of Biology , Waltham , MA , USA.
(546)alw Ruprecht-Karls-University Heidelberg, Division of Pediatric Neurology ,
Department of Pediatrics , Heidelberg University Hospital , Heidelberg ,
Germany.
(547)st Institut Pasteur, CNRS URA2582 , Cell Biology and Infection Department ,
Membrane Traffic and Cell Division Lab , Paris , France.
(548)acn Medical University of Vienna , Department of Dermatology , Vienna ,
Austria.
(549)bhy University of Colorado Denver , Boulder , CO , USA.
(550)bfe University of California Irvine , Department of Developmental and Cell
Biology , Irvine , CA , USA.
(551)bhx University of Cologne, Medical Faculty, Center for Biochemistry ,
Cologne , Germany.
(552)cbq Weizmann Institute of Science , Department of Chemical Biology ,
Rehovot , Israel.
(553)bb Baylor College of Medicine , Department of Medicine , Houston , TX ,
USA.
(554)ajz Laboratory of Translational Oncology and Experimental Cancer
Therapeutics, Department of Hematology/Oncology and Molecular Therapeutics
Program, Fox Chase Cancer Center, Philadelphia, PA, USA.
(555)aaf Luxembourg Institute of Health, Department of Oncology, Luxembourg City
, Luxembourg.
(556)cbp Weizmann Institute of Science , Department of Biological Chemistry ,
Rehovot , Israel.
(557)byx University of York , Department of Biology , Heslington, York , UK.
(558)brj University of Pavia , Department of Health Sciences , Pavia , Italy.
(559)bxf University of Toronto, Sunnybrook Research Institute, Sunnybrook Health
Sciences Centre , Toronto, Ontario , Canada.
(560)bqs University of Oslo, Oslo University Hospital, Centre for Molecular
Medicine Norway, Nordic EMBL Partnership , Oslo , Norway.
(561)arp Technion-Israel Institute of Technology, The Rappaport Faculty of
Medicine and Research Institute , Department of Biochemistry , Haifa , Israel.
(562)ajf Oslo University Hospital, Institute for Microbiology , Oslo , Norway.
(563)alu Ruhr University Bochum, Medical Faculty, System Biochemistry , Bochum ,
Germany.
(564)zk Latvian Biomedical Research and Study Centre , Riga , Latvia.
(565)bvn University of Tasmania, School of Health Sciences , Launceston ,
Tasmania.
(566)bkp University of Houston, College of Pharmacy, Pharmacological and
Pharmaceutical Sciences , Houston , TX , USA.
(567)bmi University of Ljubljana, Institute of Cell Biology, Faculty of Medicine
, Ljubljana , Slovenia.
(568)co C.S.I.C./U.A.M., Instituto de Investigaciones Biomédicas Alberto Sols ,
Madrid , Spain.
(569)bkj University of Helsinki , Department of Biosciences , Helsinki ,
Finland.
(570)bka University of Glasgow, Institute of Infection, Immunity and
Inflammation , Glasgow , UK.
(571)bhu University of Cologne , Department of Dermatology , Cologne , Germany.
(572)amy Sapienza University of Rome , DAHFMO-Section of Anatomy , Rome , Italy.
(573)um IRCCS, Istituto Dermopatico dell'Immacolata , Rome , Italy.
(574)bvc University of Southern Denmark, Villum Center for Bioanalytical
Sciences , Department of Biochemistry and Molecular Biology , Odense , Denmark.
(575)zc Olivia Newton-John Cancer Research Institute , Melbourne , Victoria ,
Australia.
(576)ze La Trobe University , Department of Chemistry and Physics , Melbourne ,
Victoria , Australia.
(577)zf La Trobe University, School of Cancer Medicine , Melbourne , Victoria ,
Australia.
(578)fk Chinese Academy of Sciences, Division of Physical Biology and Bioimaging
Center, Shanghai Synchrotron Radiation Facility, Shanghai Institute of Applied
Physics , Shanghai , China.
(579)bsc University of Pittsburgh , Department of Surgery , Pittsburgh , PA ,
USA.
(580)bne University of Maryland, School of Medicine, Center for Biomedical
Engineering and Technology , Department of Physiology , Baltimore , MD , USA.
(581)xu King's College London , Department of Basic and Clinical Neuroscience ,
IoPPN , London , UK.
(582)bdz University of Brescia , Department of Molecular and Translational
Medicine , Brescia , Italy.
(583)ayw Université de Lyon, INSERM, U 1111, Centre International de Recherche
en Infectiologie (CIRI), Ecole Normale Supérieure de Lyon, CNRS, UMR 5308 , Lyon
, France.
(584)rs INRA, UMR866 Dynamique Musculaire et Métabolisme , Montpellier , France.
(585)aza Université de Montpellier , Montpellier , France.
(586)agq National University of Ireland, Pharmacology and Therapeutics , Galway
, Ireland.
(587)btk University of Rome "Tor Vergata" , Department of Systems Medicine ,
Rome , Italy.
(588)ads Nanchang University, Institute of Life Science , Nanchang , China.
(589)afl National Institutes of Health, Experimental Transplantation and
Immunology Branch, National Cancer Institute , Bethesda , MD , USA.
(590)bkn University of Hong Kong , Hong Kong , China.
(591)awu Universidad de Oviedo, Instituto Universitario de Oncología ,
Departamento de Bioquímica y Biología Molecular , Oviedo , Spain.
(592)aws Universidad de Navarra, Centro de Investigacion Medica Aplicada ,
Pamplona , Spain.
(593)tr Instituto de Investigaciones Biomedicas de Barcelona, CSIC-IDIBAPS and
Centro de Investigacion en Red en enfermedades hepáticas y digestivas, CIBEREHD,
ISCIII , Barcelona , Spain.
(594)bva University of Southern California, Research ALPD and Cirrhosis Center,
Keck School of Medicine , Los Angeles , CA , USA.
(595)awr Universidad de León, Área de Biología Celular, Instituto de Biomedicina
, León , Spain.
(596)abh Mayo Clinic, Schulze Center for Novel Therapeutics, Division of
Oncology Research , Department of Oncology , Rochester , MN , USA.
(597)ayi Université Catholique de Louvain (UCL), Institut de Recherche
Expérimentale et Clinique (IREC) , Brussels , Belgium.
(598)uh IRCCS San Raffaele Pisana, Laboratory of Skeletal Muscle Development and
Metabolism , Rome , Italy.
(599)bgw University of Campinas , Department of Biochemistry and Tissue Biology
, Campinas, São Paulo , Brazil.
(600)biq University of Debrecen , Debrecen , Hungary.
(601)amn San Diego State University , Department of Biology , San Diego , CA ,
USA.
(602)abe Mayo Clinic , Department of Neuroscience , Jacksonville , FL , USA.
(603)axc Universidad Federal do Rio Grande do Sul (UFRGS) , Department of
Biophysics and Center of Biotechnology , Porto Alegre , Brazil.
(604)bto University of Salento , Department of Biological and Environmental
Sciences and Technologies (DiSTeBA) , Lecce , Italy.
(605)aqs Stephen A. Wynn Institute for Vision Research , Iowa City , IA , USA.
(606)blg University of Iowa , Department of Ophthalmology and Visual Sciences ,
Iowa City , IA , USA.
(607)bgh University of California San Francisco, Departments of Neurology and
Physiology ; Gladstone Institute of Neurological Disease , San Francisco , CA ,
USA.
(608)ss Istituto Zooprofilattico Sperimentale del Mezzogiorno, Department of
Chemistry, Portici (Naples), Italy.
(609)cab Virginia Commonwealth University, Institute of Molecular Medicine,
Massey Cancer Center, Virginia Commonwealth University, School of Medicine ,
Department of Human and Molecular Genetics , Richmond , VA , USA.
(610)aln Rockefeller University , New York , NY , USA.
(611)az Babraham Institute, Signalling Program , Cambridge , UK.
(612)bgn University of Cambridge, Cambridge Institute for Medical Research ,
Cambridge , UK.
(613)axs Università del Piemonte Orientale "A. Avogadro" , Dipartimento di
Scienze della Salute , Novara , Italy.
(614)abs McGill University, McGill Parkinson Program , Department of Neurology
and Neurosurgery , Montreal, QC , Canada.
(615)ug IRCCS Neuromed , Pozzilli, IS , Italy.
(616)bal University Clinic Heidelberg , Department of Experimental Surgery ,
Heidelberg , Germany.
(617)bpj University of Nebraska-Lincoln, Redox Biology Center and School of
Veterinary Medicine and Biomedical Sciences , Lincoln , NE , USA.
(618)do Centre de Recherche du CHU de Québec, Faculty of Pharmacy , Québec ,
Canada.
(619)azm Université Laval, Neurosciences Axis , Québec , Canada.
(620)sq Institut de Cancérologie de Lorraine , Vandoeuvre-Lès-Nancy Cedex ,
France.
(621)bij University of Copenhagen, Biotech Research and Innovative Center (BRIC)
, Copenhagen , Denmark.
(622)aft National Institutes of Health, NIAID, Laboratory of Systems Biology ,
Bethesda , MD , USA.
(623)blq University of Kiel , Department of Cardiology , Kiel , Germany.
(624)ayv Université de Lyon, Faculty of Medicine , Saint Etienne , France.
(625)adh MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre
, Cambridge , UK.
(626)adg Icahn School of Medicine at Mount Sinai, Division of Liver Diseases ,
New York , NY , USA.
(627)qf Houston Methodist Research Institute, Genomic Medicine Program , Houston
, TX , USA.
(628)bkq University of Houston , Department of Biology and Biochemistry , Center
for Nuclear Receptors and Cell Signaling , Houston , TX , USA.
(629)ala Queen's University of Belfast, Centre for Experimental Medicine ,
Belfast , UK.
(630)awq Universidad de Extremadura, Centro de Investigación Biomédica en Red
sobre Enfermedades Neurodegenerativas (CIBERNED) , Departamento de Bioquímica y
Biología Molecular y Genética , Facultad de Enfermería y Terapia Ocupacional ,
Cáceres , Spain.
(631)bwd University of Texas, MD Anderson Cancer Center , Department of
Neuro-Oncology , Houston , TX , USA.
(632)wn Juntendo University, Graduate School of Medicine , Department of
Metabolism and Endocrinology , Tokyo , Japan.
(633)afe National Institute of Neuroscience, National Center of Neurology and
Psychiatry , Department of Degenerative Neurological Diseases , Tokyo , Japan.
(634)as Asahikawa Medical University, Division of Gastroenterology and
Hematology/Oncology , Department of Medicine , Hokkaido , Japan.
(635)aty Tohoku University , Department of Developmental Biology and
Neurosciences , Graduate School of Life Sciences, Sendai , Miyagi , Japan.
(636)ns Goethe University, Institute for Experimental Cancer Research in
Pediatrics , Frankfurt , Germany.
(637)uf IRCCS Casa Sollievo della Sofferenza, Medical Genetics Unit , San
Giovanni Rotondo (FG) , Italy.
(638)acg Medical University of Silesia , Department of Pharmacology , Katowice ,
Poland.
(639)oq Hannover Medical School , Department of Biochemistry , Hannover ,
Germany.
(640)ayl Université Catholique de Louvain (UCL), Laboratory of Cell Physiology ,
Brussels , Belgium.
(641)cau Warsaw University of Life Sciences (SGGW) , Department of Physiological
Sciences , Faculty of Veterinary Medicine , Warsaw , Poland.
(642)u Al Jalila Foundation Research Centre , Dubai , UAE.
(643)avi UAE University, Cell Signaling Laboratory , Department of Biochemistry
, College of Medicine and Health Sciences , Al Ain, Abu Dhabi , UAE.
(644)ath The Weizmann Institute of Science , Department of Plant Sciences ,
Rehovot , Israel.
(645)hr Complejo Hospitalario Universitario de Albacete, Unidad de
Neuropsicofarmacología , Albacete , Spain.
(646)bbn University Medical Center Hamburg-Eppendorf, Institute of
Neuropathology , Hamburg , Germany.
(647)app Sorbonne Universités, CNRS, UPMC, Univ Paris 06, UMR 7622, IBPS , Paris
, France.
(648)bja University of Edinburgh, Edinburgh Cancer Research Centre , Edinburgh ,
UK.
(649)qr Icahn School of Medicine at Mount Sinai , Departments of Neurology and
Psychiatry , Center for Cognitive Health, Mount Sinai Alzheimer's Disease
Research Center , New York , NY , USA.
(650)vj James J. Peters VA Medical Center , Bronx , NY , USA.
(651)bfh University of California Irvine , Irvine , CA , USA.
(652)bbx University of Adelaide, Alzheimer's Disease Genetics Laboratory ,
Adelaide , Australia.
(653)biv University of Dundee, MRC Protein Phosphorylation and Ubiquitylation
Unit, School of Life Sciences , Dundee , UK.
(654)bjv University of Geneva, School of Medicine , Department of Pathology and
Immunology , Geneva , Switzerland.
(655)bnn University of Massachusetts, Medical School , Department of Neurology ,
Worcester , MA , USA.
(656)ass The Fourth Military Medical University, School of Basic Medical
Sciences , Department of Physiology , Xi'an , China.
(657)aoq Shanghai Jiao Tong University, State Key Laboratory of Oncogenes and
Related Genes, Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital,
School of Medicine , Shanghai , China.
(658)tn Instituto de Biología Molecular y Celular de Rosario (IBR-CONICET) ,
Rosario , Argentina.
(659)ae Albert Einstein College of Medicine, Departments of Medicine
(Endocrinology) and Molecular Pharmacology , Bronx , NY , USA.
(660)tv Instituto de Investigaciones Biomédicas de Barcelona IIBB-CSIC , Liver
Unit, Hospital Clinic de Barcelona-IDIBAPS and CIBEREHD, Barcelona , Spain.
(661)bmb University of Leuven, Campus Gasthuisberg , Department of Cellular and
Molecular Medicine , Laboratory for Cell Death Research and Therapy , Leuven ,
Belgium.
(662)ak All India Institute of Medical Sciences , Department of Gastroenterology
, New Delhi , India.
(663)awb Universidad Autónoma de Madrid, Centro Nacional de Biotecnología
(CNB-CSIC), Centro de Biología Molecular Severo Ochoa, Departamento de Biología
Molecular , Madrid , Spain.
(664)abc Max Planck Institute of Psychiatry, Translational Research in
Psychiatry , Munich , Germany.
(665)p Aix-Marseille Université, U2M, Centre d'Immunologie de Marseille-Luminy ,
Marseille , France.
(666)hd CNRS, UMR 7280 , Marseille , France.
(667)sl INSERM, U1104 , Marseille , France.
(668)dq Centre de Recherche en Cancérologie de Nantes-Angers, CNRS UMR6299,
INSERM U892 , Nantes , France.
(669)ad Albert Einstein College of Medicine, Departments of Biochemistry and of
Medicine , Bronx , NY , USA.
(670)bex University of California Berkeley, Howard Hughes Medical Institute ,
Department of Molecular and Cell Biology , Berkeley , CA , USA.
(671)lf First Hospital of Jilin University , Department of Neurosurgery ,
Changchun , China.
(672)aoj Shanghai Jiao Tong University, School of Medicine , Department of
Biochemistry and Molecular Biology , Shanghai , China.
(673)aem National Cheng Kung University , Department of Pharmacology , Tainan ,
Taiwan.
(674)if CSS-Mendel Institute, Neurogenetics Unit , Rome , Italy.
(675)axt Università del Piemonte Orientale , Novara , Italy.
(676)ox Harvard Medical School , Boston , MA , USA.
(677)du Centre National de la Recherche Scientifique, Institut de Biologie
Moléculaire des Plantes, Unité Propre de Recherche , Strasbourg , France.
(678)bgf University of California San Francisco , Department of Pharmaceutical
Chemistry , San Francisco , CA , USA.
(679)caf Virginia Commonwealth University, Massey Cancer Center , Richmond , VA
, USA.
(680)bmz University of Manitoba , Department of Human Anatomy and Cell Science ,
Winnipeg, Manitoba , Canada.
(681)o Aix-Marseille Université, CNRS UMR 7278, IRD198, INSERM U1095, Medicine
Faculty , Marseille , France.
(682)al All India Institute of Medical Sciences , Department of Physiology , New
Delhi , India.
(683)vd Istituto Superiore di Sanità , Rome , Italy.
(684)amp San Raffaele Institute, Dept. of Therapeutic Research and Medicine
Evaluation , Sulmona, L'Aquila , Italy.
(685)iv Democritus University of Thrace , Department of Pathology ,
Alexandroupolis , Greece.
(686)bqw University of Ottawa , Department of Cellular and Molecular Medicine ,
Ottawa, Ontario , Canada.
(687)box University of Modena and Reggio Emilia , Department of Surgery ,
Medicine, Dentistry and Morphological Sciences , Modena , Italy.
(688)bmy University of Manitoba, CancerCare Manitoba, Manitoba Institute of Cell
Biology , Departments of Biochemistry and Medical Genetics and Immunology ,
Winnipeg, Manitoba , Canada.
(689)asc Temple University, Sbarro Institute for Cancer Research and Molecular
Medicine, Center for Biotechnology, College of Science and Technology ,
Philadelphia , PA , USA.
(690)btb University of Siena, Department of Medicine, Surgery & Neuroscience,
Siena, Italy.
(691)bma University of Leicester , Department of Genetics , Leicester , UK.
(692)ux Cancer Pharmacology Lab, AIRC Start-Up Unit, University of Pisa , Pisa ,
Italy.
(693)cak VU University Medical Center , Department of Medical Oncology ,
Amsterdam , The Netherlands.
(694)bxa University of Toronto , Department of Laboratory Medicine and
Pathobiology , Toronto, Ontario , Canada.
(695)rw Centre Scientifique de Monaco, Biomedical Department, Monaco,
Principality of Monaco.
(696)rx University of Nice Sophia Antipolis, Institute of Research on Cancer and
Ageing of Nice, CNRS UMR 7284/INSERM U1081 , Nice , France.
(697)awm Universidad de Chile, Facultad de Ciencias , Departamento de Biología ,
Centro de Regulación del Genoma , Santiago , Chile.
(698)bej University of British Columbia , Department of Urological Sciences ,
Vancouver, BC , Canada.
(699)bpb University of Montpellier, UMR 5554 , Montpellier , France.
(700)bjw University of Georgia, College of Veterinary Medicine , Department of
Biosciences and Diagnostic Imaging , Athens , GA , USA.
(701)bzh US Food and Drug Administration, National Center for Toxicology
Research, Division of Microbiology , Jefferson , AR , USA.
(702)axi Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de
São Paulo (FCFRP, USP) , São Paulo , Brazil.
(703)afa National Institute for Infectious Diseases , Department of Epidemiology
and Preclinical Research , Translational Research Unit , Rome , Italy.
(704)ahi New York Medical College , Department of Medicine, Pharmacology, and
Physiology , Valhalla , NY , USA.
(705)bfb University of California Davis , Department of Neurobiology ,
Physiology, and Behavior , Davis , CA , USA.
(706)bry University of Pittsburgh , Department of Critical Care Medicine ,
Center for Critical Care Nephrology, Clinical Research Investigation and Systems
Modeling of Acute Illness (CRISMA) Center , Pittsburgh , PA , USA.
(707)bts University of São Paulo, Ribeirão Preto Medical School , Department of
Biochemistry and Immunology , Ribeirão Preto, São Paulo , Brazil.
(708)jx Ege University, Faculty of Science , Department of Biology , Bornova ,
Izmir , Turkey.
(709)ady Nankai University, College of Life Sciences , Tianjin , China.
(710)ur IRCM, INSERM, U896, Institut de Recherche en Cancérologie de Montpellier
, Montpellier , France.
(711)avz Universidad Austral de Chile , Department of Physiology , Valdivia ,
Chile.
(712)brm University of Pennsylvania, Center for Cell and Molecular Therapy, The
Children Hospital of Philadelphia , Department of Neurology , Perelman School of
Medicine , Philadelphia , PA , USA.
(713)go CIBER de Enfermedades Raras (CIBERER) , Valencia , Spain.
(714)akm Program in Rare and Genetic Diseases, Centro de Investigación Príncipe
Felipe (CIPF), IBV/CSIC Associated Unit at CIPF , Valencia , Spain.
(715)bcf University of Alberta , Department of Biochemistry , Edmonton, Alberta
, Canada.
(716)bya University of Utah School of Medicine , Department of Biochemistry ,
Salt Lake City , UT , USA.
(717)avw Uniformed Services University of the Health Sciences , Department of
Anesthesiology , Bethesda , MD , USA.
(718)bwz University of Toronto , Department of Cell and Systems Biology ,
Toronto, Ontario , Canada.
(719)ci British Columbia Cancer Agency , Genome Sciences Centre , Vancouver, BC
, Canada.
(720)apf Simon Fraser University, Department of Molecular Biology and
Biochemistry , Burnaby, BC , Canada.
(721)aat Massachusetts General Hospital and Harvard Medical School, Cutaneous
Biology Research Center , Charlestown , MA.
(722)yw Kyoto University , Department of Botany , Kyoto , Japan.
(723)hx Consejo Superior de Investigaciones Científicas (CSIC), Instituto de
Bioquímica Vegetal y Fotosíntesis , Sevilla , Spain.
(724)dd Cedars-Sinai Heart Institute, Barbra Streisand Women's Heart Center ,
Los Angeles , CA , USA.
(725)arz Tel Aviv University, Sackler Faculty of Medicine , Tel Aviv , Israel.
(726)n Aix Marseille Université, CNRS, IBDM, UMR 7288 , Campus de Luminy,
Marseille , France.
(727)aay Max Planck Institute for Biology of Ageing , Cologne , Germany.
(728)bzz Virginia Commonwealth University , Department of Internal Medicine ,
Richmond , VA , USA.
(729)blu University of L'Aquila , Department of Biotechnological and Applied
Clinical Sciences , Division of Radiotherapy and Radiobiology , L'Aquila ,
Italy.
(730)aqe St. Jude Children's Research Hospital , Memphis , TN , USA.
(731)beb University of Bristol, School of Cellular and Molecular Medicine ,
Bristol , UK.
(732)alq Royal Military College, Chemistry and Chemical Engineering, Kingston ,
ON , Canada.
(733)uw Istituto Italiano di Tecnologia , Department of Drug Discovery and
Development , Laboratory of Molecular Medicine , Genoa , Italy.
(734)azj Université de Strasbourg/CNRS UPR3572, Immunopathologie et Chimie
Thérapeutique, IBMC , Strasbourg , France.
(735)blc University of Iowa, Children's Hospital , Iowa City , IA , USA.
(736)ams Sanford Burnham Medical Research Institute, Cell Death and Survival
Networks Program , La Jolla , CA , USA.
(737)acm Medical University of Vienna , Department of Dermatology , CD Lab -
Skin Aging , Vienna , Austria.
(738)nl German Institute of Human Nutrition , Department of Molecular Toxicology
, Nuthetal , Germany.
(739)bfr University of California San Diego , Department of Pharmacology and
Moores Cancer Center , La Jolla , CA , USA.
(740)awe Universidad Complutense, School of Pharmacy , Madrid , Spain; and CIBER
de Diabetes y Enfermedades Metab olicas Asociadas (CIBERDEM), Instituto de Salud
Carlos III, Madrid, Spain.
(741)gy Cleveland Clinic , Department of Cellular and Molecular Medicine ,
Cleveland , OH , USA.
(742)yj KU Leuven , Clinical Division and Laboratory of Intensive Care Medicine
, Department Cellular and Molecular Medicine , Leuven , Belgium.
(743)aus Tongji University School of Medicine , Department of Gastroenterology ,
Shanghai Tenth People's Hospital , Shanghai , China.
(744)avp UCLA David Geffen School of Medicine, Brain Research Institute , Los
Angeles , CA , USA.
(745)vr Jiangsu University, School of Pharmacy , Zhenjiang, Jiangsu , China.
(746)atf The Third Affiliated Hospital of Guangzhou Medical University ,
Department of Clinical Laboratory Medicine , Guangzhou, Guangdong , China.
(747)bxn University of Tübingen, Center for Plant Molecular Biology (ZMBP) ,
Department of Plant Biochemistry , Tübingen , Germany.
(748)bga University of California San Diego, Skaggs School of Pharmacy and
Pharmaceutical Sciences , La Jolla , CA , USA.
(749)lt The Francis Crick Institute, Mill Hill Laboratory , London , UK.
(750)nv Graduate School of Cancer Science and Policy , Department of System
Cancer Science , Goyang , Korea.
(751)bdx University of Bonn, Institute for Cell Biology , Bonn , Germany.
(752)auf Tokai University School of Medicine , Department of Molecular Life
Sciences , Kanagawa , Japan.
(753)bp Bernhard Nocht Institute for Tropical Medicine , Hamburg , Germany.
(754)gr Cincinnati Children's Hospital Medical Center, Division of Clinical
Pharmacology , Cincinnati , OH , USA.
(755)bna University of Manitoba , Department of Physiology and Pathophysiology ,
Winnipeg, Manitoba , Canada.
(756)ni German Cancer Research Center (DKFZ), Lysosomal Systems Biology ,
Heidelberg , Germany.
(757)alj RIKEN Brain Science Institute, Laboratory for Developmental
Neurobiology , Saitama , Japan.
(758)nt Goethe University, Institute for Molecular Biosciences, Molecular
Developmental Biology , Frankfurt , Hesse , Germany.
(759)aix Osaka University , Department of Genetics , Graduate School of Medicine
, Osaka , Japan.
(760)bpf University of Namur, Research Unit in Molecular Physiology (URPhyM) ,
Namur , Belgium.
(761)aor University of Sharjah, College of Medicine, United Arab Emirates.
(762)bqz University of Oxford, CRUK/MRC Oxford Institute for Radiation Oncology
, Oxford , UK.
(763)ccx Zhejiang University, Institute of Pharmacology, Toxicology and
Biochemical Pharmaceutics , Hangzhou , China.
(764)cda Zhejiang University, Sir Run Run Shaw Hospital, College of Medicine ,
Hangzhou, Zhejiang , China.
(765)wk Johns Hopkins, School of Medicine, Wilmer Eye Institute , Baltimore , MD
, USA.
(766)afw National Institutes of Health, NIDDK, LCMB , Bethesda , MD , USA.
(767)bqg University of Occupational and Environmental Health , Third Department
of Internal Medicine , Kitakyushu , Japan.
(768)bdj University of Belgrade, Institute for Biological Research "Sinisa
Stankovic" , Belgrade , Serbia.
(769)pb Harvard Medical School , Department of Cell Biology , Boston , MA , USA.
(770)xs King Saud University, College of Science , Department of Zoology ,
Riyadh , Saudi Arabia.
(771)ajk Oxford University, Department of Oncology , Weatherall Institute of
Molecular Medicine, John Radcliffe Hospital, Molecular Oncology Laboratories ,
Oxford , UK.
(772)acw Monash University, Centre for Inflammatory Diseases, Lupus Research
Laboratory , Clayton , Victoria , Australia.
(773)bju University of Geneva , Department of Cellular Physiology and Metabolism
, Geneva , Switzerland.
(774)bay University Hospital Freiburg , Department of Medicine II , Freiburg ,
Germany.
(775)wt Kagoshima University, Graduate School of Medical and Dental Sciences,
Division of Human Pathology , Department of Oncology , Course of Advanced
Therapeutics , Kagoshima , Japan.
(776)mt George Washington University , Department of Anatomy and Regenerative
Biology , Washington, DC , USA.
(777)mu George Washington University, Flow Cytometry Core Facility , Washington,
DC , USA.
(778)aia Northwestern University , Department of Cell and Molecular Biology ,
Feinberg School of Medicine , Chicago , IL , USA.
(779)ags National University of Singapore , Department of Biological Sciences ,
Singapore.
(780)atk Third Military Medical University , Department of Biochemistry and
Molecular Biology , Chongqing , China.
(781)apd Sichuan University, West China Hospital, State Key Labortary of
Biotherapy , Sichuan , China.
(782)vv Jinan University, Anti-stress and Health Center, College of Pharmacy ,
Guangzhou , China.
(783)vw Jinan University , Department of Immunobiology , College of Life Science
and Technology , Guangzhou , China.
(784)ji Duke University, Medical Center , Department of Immunology , Durham , NC
, USA.
(785)bhb University of Chicago , Department of Medicine , Section of Dermatology
, Chicago , IL , USA.
(786)atg The Walter and Eliza Hall Institute of Medical Research, Development
and Cancer Division , Parkville , VIC , Australia.
(787)afx National Institutes of Health, Rocky Mountain Laboratories, NIAID,
Coxiella Pathogenesis Section , Hamilton , MT , USA.
(788)bkb University of Glasgow, Wolfson Wohl Cancer Research Centre, MVLS,
Institute of Cancer Sciences , Glasgow , UK.
(789)bqt University of Osnabrueck, Division of Microbiology , Osnabrueck ,
Germany.
(790)cg Brigham and Women's Hospital, Harvard Medical School , Boston , MA ,
USA.
(791)caw Washington State University, School of Molecular Biosciences , Pullman
, WA , USA.
(792)aij Ohio State University , Department of Molecular Genetics , Columbus ,
OH , USA.
(793)axj Universidade de São Paulo , Departamento de Parasitología , Instituto
de Ciências Biomédicas , São Paulo , Brazil.
(794)lg FISABIO, Hospital Dr. Peset , Valencia , Spain.
(795)bge FONDAP Center for Geroscience, Brain Health and Metabolism, Santiago,
Chile.
(796)bhj University of Chile, Institute of Biomedical Sciences, Center for
Molecular Studies of the Cell, Program of Cellular, Molecular Biology and
Biomedical Neuroscience Institute, Faculty of Medicine , Santiago , Chile.
(797)bwn University of Texas, Southwestern Medical Center , Dallas , TX , USA.
(798)auv Tottori University, Research Center for Bioscience and Technology ,
Yonago , Japan.
(799)hw Consejo Superior de Investigaciones Científicas (CSIC), Institute of
Parasitology and Biomedicine López-Neyra , Granada , Spain.
(800)bmn University of Louisville , Department of Medicine , Institute of
Molecular Cardiology, Diabetes and Obesity Center , Louisville , KY , USA.
(801)bwr University of Texas, Southwestern Medical Center, Medicine and
Molecular Biology , Dallas , TX.
(802)nb Georgia Regents University , Department of Neurology , Augusta , GA ,
USA.
(803)nc Georgia Regents University , Department of Orthopaedic Surgery , Augusta
, GA , USA.
(804)nd Georgia Regents University, Institute for Regenerative and Reparative
Medicine , Augusta , GA , USA.
(805)xm Kawasaki Medical School , Department of Hepatology and Pancreatology ,
Kurashiki, Okayama , Japan.
(806)arh Swedish University of Agricultural Sciences and Linnean Center for
Plant Biology , Department of Plant Biology , Uppsala BioCenter , Uppsala ,
Sweden.
(807)bpt University of Nice-Sophia Antipolis, INSERM U1081, CNRS 7284, Faculty
of Medicine , Nice , France.
(808)nk German Center for Neurodegenerative Diseases (DZNE) , Munich , Germany.
(809)ars Technische Universität München , Department of Neurology , Munich ,
Germany.
(810)w Albert Einstein Cancer Center , New York , NY , USA.
(811)ccg Yeshiva University , New York , NY , USA.
(812)rp Inje University , Department of Rehabilitation Science, College of
Biomedical Science & Engineering, u-Healthcare & Anti-aging Research Center
(u-HARC), Gimhae , Korea.
(813)cco York University, School of Kinesiology and Health Science , Toronto,
Ontario , Canada.
(814)cam VU University Medical Center , Department of Pathology , Amsterdam ,
The Netherlands.
(815)bhv University of Cologne, Institute for Genetics, CECAD Research Center ,
Cologne , Germany.
(816)blk University of Kaohsiung Medical University , Department of Physiology ,
Faculty of Medicine, College of Medicine , Kaohsiung , Taiwan.
(817)ek Chang Gung University , Department of Biomedical Sciences , College of
Medicine , Taoyuan , Taiwan.
(818)agk National Taiwan University, Institute of Molecular Medicine, College of
Medicine , Taipei , Taiwan.
(819)ao Anhui University of Science and Technology , Department of Immunology
and Medical Inspection , Huainan , Anhui , China.
(820)bku University of Illinois at Chicago, Departments of Anesthesiology and
Pharmacology , Chicago , IL , USA.
(821)akn Providence Portland Medical Center, Earle A. Chiles Research Institute
, Portland , OR , USA.
(822)fa China Agricultural University , Department of Nutrition and Food Safety
, Beijing , China.
(823)bwo University of Texas, Southwestern Medical Center , Department of
Internal Medicine , Center for Mineral Metabolism and Clinical Research , Dallas
, TX , USA.
(824)agm National Tsing Hua University , Department of Chemical Engineering ,
Hsinchu , Taiwan.
(825)fg Chinese Academy of Medical Sciences and Peking Union Medical College,
Molecular Immunology and Cancer Pharmacology Group, State Key Laboratory of
Bioactive Substance and Function of Natural Medicines, Institute of Materia
Medica , Beijing , China.
(826)boi University of Michigan, Neurosurgery , Ann Arbor , MI , USA.
(827)apc Sichuan University, State Key Laboratory of Biotherapy/Collaborative
Innovation Center of Biotherapy; West China Hospital , Chengdu , China.
(828)em Chang Jung Christian University , Department of Bioscience Technology ,
Tainan , Taiwan.
(829)agi National Taiwan University , Department of Urology , College of
Medicine , Taipei , Taiwan.
(830)el Chang Gung University, Molecular Regulation and Bioinformatics
Laboratory , Department of Parasitology , Taoyuan , Taiwan.
(831)zy Louisiana State University Health Sciences Center , Department of
Biochemistry and Molecular Biology , Shreveport , LA , USA.
(832)aoo Shanghai Jiao Tong University, School of Medicine, Shanghai Institute
of Immunology , Shanghai , China.
(833)agg National Taiwan University , Department of Life Science , Taipei ,
Taiwan.
(834)aom Shanghai Jiao Tong University, School of Medicine, Renji Hospital ,
Shanghai , China.
(835)qp Icahn School of Medicine at Mount Sinai , Department of Neuroscience ,
New York , NY , USA.
(836)v Albany Medical College, Center for Neuropharmacology and Neuroscience ,
Albany , NY , USA.
(837)ai Albert Ludwigs University, Renal Division , Freiburg , Germany.
(838)bx BIOSS Centre for Biological Signalling Studies , Freiburg , Germany.
(839)bbl University Medical Center Freiburg , Freiburg , Germany.
(840)bls University of Kiel, Institute of Human Nutrition and Food Science ,
Kiel , Germany.
(841)ant Seoul National University , Department of Biological Sciences , Seoul ,
Korea.
(842)bkk University of Helsinki , Department of Physiology , Faculty of Medicine
, Helsinki , Finland.
(843)blh University of Jyväskylä , Department of Biology of Physical Activity ,
Jyväskylä , Finland.
(844)gk Chungnam National University, School of Medicine , Department of
Pharmacology , Daejeon , Korea.
(845)bew University of California Berkeley , Department of Molecular and Cell
Biology , Berkeley , CA , USA.
(846)apz St. Anna Kinderkrebsforschung, Children's Cancer Research Institute,
Immunological Diagnostics , Vienna, Austria.
(847)abk McGill University , Department of Critical Care , Montreal, Quebec ,
Canada.
(848)abp McGill University, Health Centre , Department of Medicine , Montreal,
Quebec , Canada.
(849)afr National Institutes of Health, National Institute of Environmental
Health Sciences, Clinical Research Program , Research Triangle Park , NC , USA.
(850)at Asan Medical Center, Asan Institute for Life Sciences , Seoul , Korea.
(851)aoy Shin Kong Wu Ho-Su Memorial Hospital , Department of Urology , Taipei ,
Taiwan.
(852)aur Tokyo Women's Medical University , Department of Endocrinology and
Hypertension , Tokyo , Japan.
(853)wl Juntendo University , Department of Research for Parkinson's Disease ,
Tokyo , Japan.
(854)bow University of Modena and Reggio Emilia , Department of Life Sciences ,
Modena , Italy.
(855)ar Asahi University, School of Dentistry , Department of Oral Microbiology
, Division of Oral Infections and Health Sciences , Mizuho , Gifu , Japan.
(856)btp University of Salerno , Department of Pharmacy , Fisciano, Salerno ,
Italy.
(857)atq Thomas Jefferson University , Department of Pathology , Anatomy and
Cell Biology , Philadelphia , PA , USA.
(858)py The Hong Kong University of Science and Technology, Clear Water Bay ,
Kowloon, Hong Kong.
(859)pc Harvard Medical School, Laboratory of Comparative Immunology, Center for
the Study of Inflammatory Bowel Disease, Massachusetts General Hospital Research
Institute , Boston , MA , USA.
(860)ed Centro de Investigaciones en Bioquímica Clínica e Inmunología
(CIBICI-CONICET), Universidad Nacional de Córdoba , Departamento de Bioquímica
Clínica , Facultad de Ciencias Químicas , Córdoba , Argentina.
(861)aiu Osaka University Graduate School of Medicine , Department of Nephrology
, Osaka , Japan.
(862)baj University Belgrade, School of Medicine , Belgrade , Serbia.
(863)ev Children's Hospital of Philadelphia, Research Institute , Philadelphia ,
PA , USA.
(864)akd Perelman School of Medicine at the University of Pennsylvania ,
Departments of Pediatrics and Systems Pharmacology and Translational
Therapeutics , Philadelphia , PA , USA.
(865)bsn University of Pittsburgh, Vascular Medicine Institute , Pittsburgh , PA
, USA.
(866)th Institute of Microbial Technology (IMTECH), Cell Biology and Immunology
Division , Chandigarh , India.
(867)aub Tohoku University, Graduate School of Agricultural Sciences , Sendai ,
Japan.
(868)xp Keio University, Graduate School of Pharmaceutical Sciences , Department
of Biochemistry , Tokyo , Japan.
(869)air Oregon State University , Department of Pharmaceutical Sciences ,
College of Pharmacy , Corvallis , OR , USA.
(870)adq Nagoya University School of Medicine , Nagoya , Japan.
(871)aru Technische Universität München, Plant Systems Biology , Freising ,
Germany.
(872)jm Duke-NUS Graduate Medical School, Cancer and Stem Cell Biology Program ,
Singapore.
(873)et Chiba University , Department of Nanobiology , Chiba , Japan.
(874)bzx Virginia Commonwealth University , Department of Human and Molecular
Genetics , Richmond , VA , USA.
(875)dy Centro de Biologia Molecular "Severo Ochoa" (UAM/CSIC), Consejo Superior
de Investigaciones Científicas, Universidad Autónoma de Madrid , Department of
Cell Biology and Immunology , Madrid , Spain.
(876)amk Saitama Medical University, Saitama Medical Center , Department of
General Thoracic Surgery , Saitama , Japan.
(877)aqu Stony Brook University , Department of Molecular Genetics and
Microbiology , Stony Brook , NY , USA.
(878)bkc University of Göttingen, Department of Geobiology , Göttingen ,
Germany.
(879)bni University of Maryland, School of Medicine , Department of Microbiology
and Immunology , Baltimore , MD , USA.
(880)aj All India Institute of Medical Sciences , Department of Anatomy , New
Delhi , India.
(881)avl UCL Institute of Child Health and Great Ormond Street Hospital for
Children NHS Foundation Trust , London , UK.
(882)bvt University of Texas, Health Science Center at Houston , Department of
Pathology and Laboratory Medicine , Houston , TX , USA.
(883)aje Oslo University Hospital , Department of Molecular Cell Biology ,
Institute for Cancer Research , Oslo , Norway.
(884)bqk University of Oslo, Centre for Cancer Biomedicine , Oslo , Norway.
(885)aef National Brain Research Centre , Manesar, Gurgaon , India.
(886)xo Keimyung University, School of Medicine, Division of Gastroenterology
and Hepatology , Department of Internal Medicine , Daegu , Korea.
(887)bib University of Colorado, Denver ; and Denver VAMC , Denver , CO , USA.
(888)aae Luxembourg Institute of Health, Laboratory of Experimental
Hemato-Oncology , Department of Oncology , Luxembourg City , Luxembourg.
(889)ep Charité - Universitätsmedizin Berlin , Department of Neuropathology ,
Campus Charité Mitte , Berlin , Germany.
(890)anp Seoul National University College of Medicine , Department of
Physiology and Biomedical Sciences , Seoul , Korea.
(891)e Aarhus University , Department of Clinical Medicine , Aarhus , Denmark.
(892)gi Chungbuk National University, College of Veterinary Medicine , Cheongju,
Chungbuk , Korea.
(893)li Florida Atlantic University , Department of Biological Sciences ,
Jupiter , FL , USA.
(894)mb Cancer Institute, Fudan University Shanghai Cancer Center ,
Collaborative Innovation Center of Cancer Medicine, Department of Oncology ,
Shanghai Medical College , Fudan University, Shanghai , China.
(895)asp The First Affiliated Hospital of Harbin Medical University , Department
of General Surgery , Harbin, Heilongjiang Province , China.
(896)gd Chinese University of Hong Kong, School of Life Science, Centre for Cell
and Developmental Biology and State Key Laboratory of Agrobiotechnology , Sha
Tin, Hong Kong.
(897)adu Nanjing Medical University , Department of Neurology , Nanjing First
Hospital , Nanjing , China.
(898)bek University of British Columbia, Medical Genetics, and BC Cancer Agency,
Terry Fox Laboratory , Vancouver, BC , Canada.
(899)fu Chinese Academy of Sciences, State Key Laboratory of Mycology, Institute
of Microbiology , Beijing , China.
(900)adb Mossakowski Medical Research Centre, Polish Academy of Sciences,
Electron Microscopy Platform , Warsaw , Poland.
(901)dg Center for Dementia Research, Nathan S. Kline Institute , Orangeburg ,
NY , USA.
(902)ahn New York University , Department of Psychiatry , New York , NY , USA.
(903)lw Freshwater Aquaculture Collaborative Innovation Center of Hubei Province
, Wuhan , China.
(904)qj Huazhong Agricultural University , Department of Aquatic Animal Medicine
, College of Fisheries , Wuhan , China.
(905)awv Universidad de Salamanca, Campus Miguel de Unamuno , Departamento de
Microbiología y Genética , Salamanca , Spain.
(906)cct Zhejiang University , Hangzhou , China.
(907)bpr University of Newcastle, School of Medicine and Public Health ,
Callaghan, NSW , Australia.
(908)amf Rutgers University-Robert Wood Johnson Medical School , Pharmacology
Department , Piscataway , NJ , USA.
(909)but University of South Florida , Department of Pharmaceutical Sciences ,
College of Pharmacy, Byrd Alzheimer's Institute , Tampa , FL , USA.
(910)gl Chungnam National University, School of Medicine, Infection Signaling
Network Research Center , Daejeon , Korea.
(911)bxm University of Tromsø - The Arctic University of Norway, Molecular
Cancer Research Group, Institute of Medical Biology , Tromsø , Norway.
(912)brw University of Pittsburgh Cancer Institute , Pittsburgh , PA , USA.
(913)bee University of British Columbia , Department of Cellular and
Physiological Sciences , Vancouver, BC , Canada.
(914)bwf University of Texas, MD Anderson Cancer Center , Houston , TX , USA.
(915)te Institute of Cancer Research, Divisions of Molecular Pathology and
Cancer Therapeutics , London , UK.
(916)alc Radboud University Nijmegen Medical Center , Department of Internal
Medicine , Nijmegen , The Netherlands.
(917)awh Universidad de Castilla-La Mancha, Facultad de Medicina , Departamento
Ciencias Medicas , Albacete , Spain.
(918)bjk University of Florida , Department of Aging and Geriatric Research ,
Gainesville , FL , USA.
(919)bst University of Pretoria , Department of Physiology , Pretoria, Gauteng ,
South Africa.
(920)mc Fudan University , Department of Biosynthesis , Key Laboratory of Smart
Drug Delivery, Ministry of Education, School of Pharmacy , Shanghai , China.
(921)aqv Stony Brook University , Department of Pathology , Stony Brook , NY ,
USA.
(922)agf National Taiwan University , Department of Life Science , Institute of
Molecular and Cellular Biology , Taipei , Taiwan.
(923)bci University of Amsterdam , Department of Cellbiology and Histology ,
Academic Medical Center , Amsterdam , The Netherlands.
(924)kj Eötvös Loránd University , Department of Anatomy , Cell and
Developmental Biology , Budapest , Hungary.
(925)anr Seoul National University Hospital , Department of Internal Medicine ,
Seoul , Korea.
(926)bux University of Southern California, Keck School of Medicine , Department
of Molecular Microbiology and Immunology , Los Angeles , CA , USA.
(927)kx Evelina's Children Hospital, Guy's and St. Thomas' Hospital NHS
Foundation Trust , Department of Paediatric Neurology , Neuromuscular Service ,
London , UK.
(928)xv King's College, Randall Division of Cell and Molecular Biophysics,
Muscle Signalling Section , London , UK.
(929)ri Indiana University School of Medicine, Biochemistry and Molecular
Biology , Denver , CO , USA.
(930)afy National Jewish Health , Denver , CO , USA.
(931)aag Maastricht University, Maastricht Radiation Oncology (MaastRO) Lab,
GROW - School for Oncology and Developmental Biology , Maastricht , The
Netherlands.
(932)bpp University of New South Wales, School of Biotechnology and Biomolecular
Sciences , Sydney, NSW , Australia.
(933)biy University of Eastern Finland, Kuopio University Hospital , Department
of Ophthalmology , Kuopio , Finland.
(934)bvm University of Tartu, Institute of Biomedicine and Translational
Medicine , Tartu , Estonia.
(935)avt UMR 1280 , Nantes , France.
(936)zo Linköping University , Department of Clinical and Experimental Medicine
, Linköping , Sweden.
(937)boj University of Michigan, Ophthalmology and Visual Sciences, Kellogg Eye
Center , Ann Arbor , MI , USA.
(938)bgj University of California San Francisco, UCSF Diabetes Center ,
Department of Cell and Tissue Biology , San Francisco , CA , USA.
(939)oh Hadassah Hebrew University Medical Center , Department of Neurology ,
Jerusalem , Israel.
(940)auw Translational Health Science and Technology Institute, Vaccine and
Infectious Disease Research Centre , Faridabad , India.
(941)aey National Institute for Basic Biology, Sokendai , Okazaki , Japan.
(942)iw Democritus University of Thrace, Laboratory of Molecular Hematology ,
Alexandroupolis , Greece.
(943)xk Karolinska Institute, Institute of Environmental Medicine , Stockholm ,
Sweden.
(944)bcx University of Groningen, Department of Cell Biology, Groningen, The
Netherlands.
(945)oy Harvard Medical School, Brigham and Women's Hospital , Department of
Genetics , Division of Genetics , Boston , MA , USA.
(946)qg Howard Hughes Medical Institute , Boston , MA , USA.
(947)bsb University of Pittsburgh , Department of Surgery , Hillman Cancer
Center , Pittsburgh , PA , USA.
(948)oi Hallym University , Department of Anatomy and Neurobiology , College of
Medicine , Kangwon-Do , Korea.
(949)ahs Niigata University Graduate School of Medical and Dental Sciences,
Laboratory of Biosignaling , Niigata , Japan.
(950)aqb St. Jude Children's Research Hospital , Department of Immunology ,
Memphis , TN , USA.
(951)aue Tohoku University School of Medicine , Department of Orthopaedic
Surgery , Miyagi , Japan.
(952)uc Iowa State University , Department of Biomedical Science , Iowa Center
for Advanced Neurotoxiclogy , Ames , IA , USA.
(953)ql Hudson Institute of Medical Research, Centre for Innate Immunity and
Infectious Diseases, Clayton , Melbourne , Victoria , Australia.
(954)jb Department of Medical Chemistry , Molecular Biology and
Pathobiochemistry , Budapest , Hungary.
(955)act Merck Research Laboratories , Rahway , NJ , USA.
(956)bou University of Minnesota , Department of Neuroscience , Minneapolis , MN
, USA.
(957)vi Jadavpur University, Life Science and Biotechnology, Kolkata , West
Bengal , India.
(958)bgl University of Cambridge, Addenbrooke's Hospital , Department of
Medicine , Cambridge , UK.
(959)bqb University of North Carolina, Microbiology and Immunology , Chapel Hill
, NC , USA.
(960)bsg University of Pittsburgh, School of Medicine , Department of
Anesthesiology , Pittsburgh , PA , USA.
(961)bsh University of Pittsburgh, School of Medicine , Department of Critical
Care Medicine , Pittsburgh , PA , USA.
(962)ei Chang Gung University , Department of Biochemistry and Molecular Biology
and Graduate Institute of Biomedical Sciences , College of Medicine , Taoyuan
County , Taiwan.
(963)aou Shanghai University of Traditional Chinese Medicine , Department of
Biochemistry , Shanghai , China.
(964)afn National Institutes of Health, Laboratory of Immunoregulation, National
Institute of Allergy and Infectious Diseases , Bethesda , MD , USA.
(965)aip Oregon Health and Science University, Casey Eye Institute , Portland ,
OR , USA.
(966)bky University of Illinois at Urbana-Champaign , Department of Molecular
and Integrative Physiology , Urbana , IL , USA.
(967)bzs Vanderbilt University, School of Medicine , Department of Molecular
Physiology and Biophysics , Nashville , TN , USA.
(968)rz INSERM U1138 , Paris , France.
(969)aby Medical Center of the Johannes Gutenberg University , Mainz , Germany.
(970)wb John Wayne Cancer Institute , Department of Neurosciences , Santa Monica
, CA , USA.
(971)cbk Wayne State University, School of Medicine , Detroit , MI , USA.
(972)bar University College London, MRC Laboratory for Molecular Cell Biology ,
London , UK.
(973)rn Indiana University School of Medicine , Department of Pathology and
Laboratory Medicine , Indianapolis , IN , USA.
(974)xf Karlsruhe Institute of Technology, Institute of Toxicology and Genetics
, Karlsruhe , Germany.
(975)bzv Venus Medicine Research Center (VMRC) , Baddi , Himachal Pradesh ,
India.
(976)avx Uniformed Services University of the Health Sciences, Radiation
Combined Injury Program, Armed Forces Radiobiology Research Institute , Bethesda
, MD , USA.
(977)bfu University of California San Diego, Division of Biological Sciences ,
La Jolla , CA , USA.
(978)pu Hokkaido University, Faculty of Pharmaceutical Sciences , Sapporo ,
Japan.
(979)hj Columbia University Medical Center , New York , NY , USA.
(980)yd Korea Cancer Center Hospital , Department of Internal Medicine , Seoul ,
Korea.
(981)of Gyeongsang National University School of Medicine , Department of
Biochemistry and Convergence Medical Science and Institute of Health Sciences ,
JinJu , Korea.
(982)bor University of Minnesota , Department of Biochemistry , Molecular
Biology and Biophysics , Minneapolis , MN , USA.
(983)jc Dong-A University, College of Medicine and Mitochondria Hub Regulation
Center , Department of Anatomy and Cell Biology , Busan , Korea.
(984)cbw Wonkwang University , Department of Dental Pharmacology , School of
Dentistry , Chonbuk , Korea.
(985)bjp University of Florida , Gainesville , FL , USA.
(986)ann Seoul National University College of Medicine , Department of Advanced
Education for Clinician-Scientists (AECS) , Seoul , Korea.
(987)ano Seoul National University College of Medicine , Department of
Ophthalmology , Seoul , Korea.
(988)bxx University of Ulsan College of Medicine, Asan Medical Center ,
Department of Surgery , Seoul , Korea.
(989)bzq Vanderbilt University Medical Center , Department of Pediatric Surgery
, Nashville , TN , USA.
(990)bnu University of Miami, Miller School of Medicine , Department of
Molecular and Cellular Pharmacology , Miami , FL , USA.
(991)jd Dong-Eui University , Department of Chemistry , Busan , Korea.
(992)bxd University of Toronto, Hospital for Sick Children , Toronto, Ontario ,
Canada.
(993)bxw University of Ulsan College of Medicine, Asan Medical Center ,
Department of Biochemistry and Molecular Biology , Seoul , Korea.
(994)aeg National Cancer Center, Cancer Cell and Molecular Biology Branch,
Division of Cancer Biology, Research Institute , Goyang , Korea.
(995)ok Hallym University , Department of Microbiology , College of Medicine ,
Chuncheon, Gangwon , Korea.
(996)bce University of Alabama , Department of Chemical and Biological
Engineering , Tuscaloosa , AL , USA.
(997)oz Harvard Medical School, Dana Farber Cancer Institute , Boston , MA ,
USA.
(998)bub University of Sheffield , Department of Biomedical Sciences , Sheffield
, UK.
(999)acs Merck KGaA, RandD Merck Serono , Darmstadt , Germany.
(1000)bnb University of Manitoba, Institute of Cardiovascular Sciences, College
of Medicine, Faculty of Health Sciences , Winnipeg, Manitoba , Canada.
(1001)atc The Scripps Research Institute , Department of Metabolism and Aging ,
Jupiter , FL , USA.
(1002)aua Tohoku University, Division of Biomedical Engineering for Health and
Welfare , Sendai , Japan.
(1003)bww University of Tokyo , Department of Biotechnology , Tokyo , Japan.
(1004)aqg St. Marianna University School of Medicine , Department of
Ophthalmology , Kawasaki, Kanagawa , Japan.
(1005)ado Nagasaki University , Department of Molecular Microbiology and
Immunology , Graduate School of Biomedical Sciences , Nagasaki , Japan.
(1006)alv Ruhr University Bochum, University Hospital Bergmannsheil , Department
of Neurology , Heimer Institute for Muscle Research , Bochum , Germany.
(1007)bax University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg (FAU) , Erlangen , Germany.
(1008)aze Université de Montréal, Institute for Research in Immunology and
Cancer , Montréal, Québec , Canada.
(1009)ea Centro de Investigación Príncipe Felipe , Valencia , Spain.
(1010)gm Chung-Shan Medical University, Institute of Medicine , Taichung ,
Taiwan.
(1011)ahh New York Institute of Technology , Department of Biomedical Sciences ,
College of Osteopathic Medicine , Old Westbury , NY , USA.
(1012)bbt University Medicine Göttingen , Department of Neurology , Göttingen ,
Germany.
(1013)boz University of Montpellier, INRA, UMR 866, Dynamique Musculaire et
Métabolisme , Montpellier , France.
(1014)cbu Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1,
Institute of Experimental Musculoskeletal Medicine , Münster , Germany.
(1015)ol Hallym University, Ilsong Institute of Life Science , Chuncheon ,
Korea.
(1016)ks ETH Zurich, Institute of Molecular Systems Biology , Zurich ,
Switzerland.
(1017)wm Juntendo University, Graduate School of Medicine , Department of Cell
Biology and Neuroscience , Tokyo , Japan.
(1018)aht Niigata University, School of Medicine , Department of Biochemistry ,
Niigata , Japan.
(1019)ws Juntendo University , Tokyo , Japan.
(1020)atw Tianjin Medical University, School of Pharmaceutical Sciences ,
Tianjin , China.
(1021)aes National Fisheries Research and Development Institute (NFRDI) , Busan
, Korea.
(1022)bcv University of Athens , Department of Cell Biology and Biophysics ,
Faculty of Biology , Athens , Greece.
(1023)agy Nationwide Children's Hospital, Center for Microbial Pathogenesis ,
Columbus , OH , USA.
(1024)asu The Genome Analysis Centre (TGAC), Institute of Food Research, Gut
Health and Food Safety Programme , Norwich , UK.
(1025)pp Helsinki University, Central Hospital, Medical Faculty, Division of
Child Psychiatry , Helsinki , Finland.
(1026)iy Democritus University of Thrace, School of Medicine , Alexandroupolis ,
Greece.
(1027)brk University of Pennsylvania Perelman School of Medicine , Department of
Radiation Oncology , Philadelphia , PA , USA.
(1028)kp ETH Zurich , Department of Biology , Institute of Molecular Health
Sciences , Zurich , Switzerland.
(1029)wx Kanazawa Medical University, Diabetology and Endocrinology , Ishikawa ,
Japan.
(1030)byi University of Vienna, Max F. Perutz Laboratories , Vienna , Austria.
(1031)aid Northwestern University, Feinberg School of Medicine , Department of
Neurology , Chicago , IL , USA.
(1032)bwq University of Texas, Southwestern Medical Center , Department of
Neuroscience , Dallas , TX.
(1033)bdk University of Belgrade, Institute of Histology and Embryology, School
of Medicine , Belgrade , Serbia.
(1034)kr ETH Zurich, Institute of Molecular Health Sciences , Zurich ,
Switzerland.
(1035)he CNRS, UMR 5534 , Villeurbanne , France.
(1036)ayu Université de Lyon, Lyon France; and Centre de Génétique et de
Physiologie Moléculaire et Cellulaire, Université Lyon 1, Villeurbanne , France.
(1037)mr Georg-August-University Göttingen, Institute of Cellular Biochemistry ,
Göttingen , Germany.
(1038)bwy University of Toledo , Department of Biological Sciences , Toledo , OH
, USA.
(1039)od Gustave Roussy Comprehensive Cancer Center , Villejuif , France.
(1040)qa Hôpital Européen Georges Pompidou, AP-HP , Paris , France.
(1041)sj INSERM, Cordeliers Research Cancer , Paris , France.
(1042)azr Université Paris Descartes, Apoptosis, Cancer and Immunity Laboratory,
Team 11, Equipe Labellisée Ligue contre le Cancer and Cell Biology and
Metabolomics Platforms , Paris , France.
(1043)bco University of Arizona College of Medicine, Barrow Neurological
Institute, Phoenix Children's Hospital , Department of Child Health , Phoenix ,
AZ , USA.
(1044)bms University of Luxembourg, Luxembourg Center for Systems Biomedicine ,
Luxembourg.
(1045)ay Babraham Institute , Cambridge , UK.
(1046)auq Tokyo University of Science , Department of Applied Biological Science
and Imaging Frontier Center , Noda, Chiba , Japan.
(1047)bvy University of Texas, Health Science Center at San Antonio , Department
of Urology , San Antonio , TX , USA.
(1048)bmq University of Louisville, School of Medicine , Department of
Anatomical Sciences and Neurobiology , Louisville , KY , USA.
(1049)bwt University of the District of Columbia, Cancer Research Laboratory ,
Washington, DC , USA.
(1050)lo George Washington University, Department of Biochemistry and Molecular
Medicine, Washington, DC , USA.
(1051)bug University of South Australia and SA Pathology, Centre for Cancer
Biology, Adelaide , SA , Australia.
(1052)aqc St. Jude Children's Research Hospital , Department of Pathology ,
Memphis , TN , USA.
(1053)aet National Health Research Institutes , Institute of Molecular and
Genomic Medicine, Miaoli , Taiwan.
(1054)bey University of California Davis, Cancer Center , Davis , CA , USA.
(1055)and Sapporo Medical University School of Medicine , Department of
Pharmacology , Sapporo , Japan.
(1056)aii Ohio State University , Department of Molecular and Cellular
Biochemistry , Columbus , OH , USA.
(1057)zp Linköping University , Department of Medical and Health Sciences ,
Linköping , Sweden.
(1058)acy Monash University , Department of Biochemistry and Molecular Biology ,
Victoria , Australia.
(1059)acz Monash University , Department of Microbiology , Victoria , Australia.
(1060)xn Keimyung University , Daegu , Korea.
(1061)anw Seoul National University, Protein Metabolism Medical Research Center
and Department of Biomedical Sciences , College of Medicine , Seoul , Korea.
(1062)amr Sanford Consortium for Regenerative Medicine , La Jolla , CA , USA.
(1063)bft University of California San Diego, Departments of Cellular and
Molecular Medicine, Neurosciences, and Pediatrics, Division of Biological
Sciences Institute for Genomic Medicine , La Jolla , CA , USA.
(1064)su Center for Infection and Immunity of Lille, Institut Pasteur de Lille,
CNRS, INSERM, Lille Regional University Hospital Centre, Lille University ,
Lille , France.
(1065)ro Indiana University School of Medicine, Richard L. Roudebush VA Medical
Center, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine ,
Indianapolis , IN , USA.
(1066)bys University of Wisconsin , Department of Ophthalmology and Visual
Sciences , McPherson Eye Research Institute , Madison , WI , USA.
(1067)bwl University of Texas, Medical School at Houston, Division of
Cardiovascular Medicine , Department of Medicine , Houston , TX , USA.
(1068)bxl University of Tromsø - The Arctic University of Norway , Department of
Medical Biology , Tromsø , Norway.
(1069)bcn University of Arizona Cancer Center , Department of Medicine , Tucson
, AZ , USA.
(1070)bea University of Bristol, School of Biochemistry , Bristol , UK.
(1071)ayh Université Bourgogne Franche-Comté, Agrosup Dijon, UMR PAM, Équipe
Vin, Aliment, Microbiologie, Stress , Dijon , France.
(1072)cm Brown University , Department of Molecular Biology , Cell Biology and
Biochemistry , Providence , RI , USA.
(1073)sg INSERM U964, CNRS UMR7104, Université de Strasbourg , Department of
Translational Medecine , Institut de Génétique et de Biologie Moléculaire et
Cellulaire (IGBMC) , Illkirch , France.
(1074)arn Tampere University Hospital , Department of Gastroenterology and
Alimentary Tract Surgery , Tampere , Finland.
(1075)byk University of Virginia , Department of Cell Biology , Charlottesville
, VA , USA.
(1076)bwp University of Texas, Southwestern Medical Center , Department of
Internal Medicine , Dallas , TX.
(1077)arq Technion-Israel Institute of Technology, Unit of Anatomy and Cell
Biology, The Ruth and Bruce Rappaport Faculty of Medicine , Haifa , Israel.
(1078)cf Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases
, Department of Neurology , Harvard Medical School , Boston , MA , USA.
(1079)aai Macau University of Science and Technology, State Key Laboratory of
Quality Research in Chinese Medicine , Macau , China.
(1080)px Hong Kong Polytechnic University , Department of Health Technology and
Informatics , Faculty of Health and Social Sciences , Kowloon, Hong Kong.
(1081)bqe University of Nottingham, School of Life Sciences , Nottingham , UK.
(1082)hz Consejo Superior de Investigaciones Científicas (CSIC), Universidad de
Salamanca, Experimental Therapeutics and Translational Oncology Program,
Instituto de Biología Molecular y Celular del Cáncer , Salamanca , Spain.
(1083)to Instituto de Investigación Biomédica de Salamanca (IBSAL) , Hospital
Universitario de Salamanca, Salamanca , Spain.
(1084)qu ICM, Institut de Recherche en Cancérologie de Montpellier , Montpellier
, France.
(1085)sd INSERM U896 , Montpellier , France.
(1086)sr Institut du Cancer de Montpellier , Montpellier , France.
(1087)bfk University of California Riverside , Department of Cell Biology and
Neuroscience , Riverside , CA , USA.
(1088)azy Université Paris Diderot, Unité Biologie Fonctionnelle et Adaptative -
CNRS UMR 8251 , Paris , France.
(1089)bab Université Paris-Sud, CEA, CNRS, Institute for Integrative Biology of
the Cell , Gif-sur-Yvette Cedex , France.
(1090)aam Mahidol University , Department of Anatomy , Faculty of Science ,
Bangkok , Thailand.
(1091)sx Institut Pasteur, INSERM, Biology of Infection Unit , Paris , France.
(1092)ans Seoul National University, College of Pharmacy and Research Institute
of Pharmaceutical Science , Seoul , Korea.
(1093)fb China Medical University , Department of Microbiology , Taichung ,
Taiwan.
(1094)wv KAIST , Department of Biological Sciences , Daejon , Korea.
(1095)yc Konkuk University, School of Medicine , Department of Anatomy , Seoul ,
Korea.
(1096)age National Taiwan University , Department of Life Science and Center for
Biotechnology , Taipei , Taiwan.
(1097)bfm University of California San Diego , Department of Medicine , La Jolla
, CA , USA.
(1098)bob University of Michigan , Department of Molecular and Integrative
Physiology , Ann Arbor , MI , USA.
(1099)rd Incheon National University, Division of Life Siences , Incheon ,
Korea.
(1100)arf Yonsei University College of Medicine, Severans Biomedical Science
Institute and Department of Internal Medicine , Seoul , Korea.
(1101)cce Yale University School of Medicine, Section of Pulmonary, Critical
Care and Sleep Medicine , New Haven , CT , USA.
(1102)anq Seoul National University College of Medicine, Neuroscience Research
Institute , Department of Medicine , Seoul , Korea.
(1103)aev National Health Research Institutes, Institute of Biotechnology and
Pharmaceutical Research , Miaoli County , Taiwan.
(1104)xa Kansas State University, Division of Biology , Manhattan , KS , USA.
(1105)db Catholic University of Korea , Seoul , Korea.
(1106)ku ETH Zurich, ScopeM (Scientific Center for Optical and Electron
Microscopy) , Zurich , Switzerland.
(1107)ye Korea University , Department of Biotechnology , BK21-PLUS Graduate
School of Life Sciences and Biotechnology , Seoul , Korea.
(1108)jf Duke University , Department of Medicine , Human Vaccine Institute ,
Durham , NC , USA.
(1109)es Ditmanson Medical Foundation Chia-Yi Christian Hospital, Center for
Translational Medicine , Chiayi City , Taiwan.
(1110)afo National Institutes of Health, National Cancer Institute, Urologic
Oncology Branch , Bethesda , MD , USA.
(1111)bjq University of Florida, Institute on Aging , Gainesville , FL , USA.
(1112)cj British Columbia Cancer Agency, Terry Fox Laboratory , Vancouver, BC ,
Canada.
(1113)avd Tsinghua University, Zhou Pei-Yuan Center for Applied Mathematics ,
Beijing , China.
(1114)ly Fudan University Shanghai Medical College , Department of Biochemistry
and Molecular Biology , School of Basic Medical Sciences, Institute of
Biomedical Sciences , Shanghai , China.
(1115)mh Geisel School of Medicine at Dartmouth , Department of Microbiology and
Immunology , Lebanon , NH , USA.
(1116)og Hadassah Hebrew University Medical Center, Endocrinology and Metabolism
Service , Department of Medicine , Jerusalem , Israel.
(1117)bir University of Debrecen, Faculty of Pharmacy , Department of
Pharmacology , Debrecen , Hungary.
(1118)dv Centre National de la Recherche Scientifique, Sorbonne Universités UPMC
Univ Paris 06, UMR 8226, Laboratoire de Biologie Moléculaire et Cellulaire des
Eucaryotes, Institut de Biologie Physico-Chimique , Paris , France.
(1119)acl Medical University of South Carolina, Departments of Drug Discovery
and Biomedical Sciences , and Biochemistry and Molecular Biology , Charleston ,
SC , USA.
(1120)bkg University of Heidelberg, Center for Molecular Biology , Heidelberg ,
Germany.
(1121)qc Hôpital Paul Brousse - Hôpitaux Universitaires Paris-Sud, Biochimie et
Oncogénétique , Villejuif , France.
(1122)ny Guangzhou Medical University , Department of Human Anatomy , School of
Basic Science , Guangzhou, Guangdong , China.
(1123)abf Mayo Clinic, Division of Nephrology and Hypertension , Rochester , MN
, USA.
(1124)akc Perelman School of Medicine at the University of Pennsylvania ,
Department of Genetics , Philadelphia , PA , USA.
(1125)bjy University of Glasgow, Cancer Research UK Beatson Institute , Glasgow
, UK.
(1126)bjz University of Glasgow, Institute of Cancer Sciences , Glasgow , UK.
(1127)qh Howard Hughes Medical Institute , Dallas , TX.
(1128)avm UCL Institute of Neurology , Department of Molecular Neuroscience ,
London , UK.
(1129)bsy University of Reading, School of Pharmacy, Whiteknights , Reading ,
UK.
(1130)bzd University Paul Sabatier, INSERM U1048 , Toulouse , France.
(1131)bmp University of Louisville, James Graham Brown Cancer Center ,
Department of Medicine , Department of Pharmacology and Toxicology , Louisville
, KY , USA.
(1132)byq Washington University in St Louis, Department of Biology, St. Louis,
MO , USA.
(1133)bzr Vanderbilt University , Department of Neurology , Nashville , TN ,
USA.
(1134)fe Chinese Academy of Medical Sciences and Peking Union Medical College,
Institute of Medicinal Biotechnology , Beijing , China.
(1135)pw Hong Kong Baptist University, School of Chinese Medicine , Kowloon
Tong, Hong Kong.
(1136)aqz Sun Yat-Sen University , Department of Pharmacology and Toxicology ,
School of Pharmaceutical Sciences , Guangzhou , China.
(1137)fj Chinese Academy of Sciences, Division of Medical Physics, Institute of
Modern Physics , Lanzhou, Gansu Province , China.
(1138)abl McGill University , Department of Neuroscience , Montreal Neurological
Institute , Montreal, QC , Canada.
(1139)fq Chinese Academy of Sciences, Key Laboratory of Developmental and
Evolutionary Biology, Institute of Plant Physiology and Ecology, Shanghai
Institutes for Biological Sciences , Shanghai , China.
(1140)cq Capital Medical University, Center for Medical Genetics, Beijing
Children's Hospital , Beijing , China.
(1141)fv Chinese Academy of Sciences, State Key Laboratory of Stem Cell and
Reproductive Biology, Institute of Zoology , Beijing , China.
(1142)jr East China Normal University , Shanghai , China.
(1143)ang Second Hospital of Lanzhou University, Key Laboratory of Digestive
System Tumors , Gansu , China.
(1144)apv Southern Medical University , Department of Cardiology , Nanfang
Hospital , Guangzhou , China.
(1145)acf Medical University of Lodz , Department of Molecular Pathology and
Neuropathology , Lodz , Poland.
(1146)bnx University of Michigan Medical School , Department of Pathology , Ann
Arbor , MI , USA.
(1147)ya Konkuk University , Department of Veterinary Medicine , Seoul , Korea.
(1148)aga National Neuroscience Institute , Singapore.
(1149)agv National University of Singapore , Department of Physiology , Yong Loo
Lin School of Medicine , Singapore.
(1150)gj Chungnam National University, School of Medicine , Department of
Biochemistry , Infection Signaling Network Research Center, Cancer Research
Institute , Daejeon , Korea.
(1151)bsp University of Porto, Cancer Drug Resistance Group, IPATIMUP -
Institute of Molecular Pathology and Immunology , Porto , Portugal.
(1152)bsr University of Porto , Department of Pathology and Oncology , Faculty
of Medicine , Porto , Portugal.
(1153)bss University of Porto, i3S-Instituto de Investigação e Inovação em Saúde
, Porto , Portugal.
(1154)xc Kaohsiung Medical University , Graduate Institute of Medicine ,
Kaohsiung , Taiwan.
(1155)agd National Sun Yat-Sen University, Department of Biological Sciences ,
Kaohsiung , Taiwan.
(1156)ark Taipei Medical University , Department of Microbiology and Immunology
, Institute of Medical Sciences , Taipei , Taiwan.
(1157)apn Soochow University, School of Pharmaceutical Science , Department of
Pharmacology , Laboratory of Aging and Nervous Diseases , Su Zhou, Jiangsu
Province , China.
(1158)hk Columbia University, College of Physicians and Surgeons , Department of
Pediatrics , New York , NY , USA.
(1159)ccu Zhejiang University, Institute of Agriculture and Biotechnology ,
Hangzhou , China.
(1160)mm Genentech Inc. , Department of Translational Oncology , South San
Francisco , CA , USA.
(1161)aik Ohio State University , Department of Surgery , Davis Heart and Lung
Research Institute , Columbus , OH , USA.
(1162)cby Xiamen University, School of Life Sciences , Fujian , China.
(1163)agh National Taiwan University , Department of Pharmacology , College of
Medicine , Taipei , Taiwan.
(1164)aaa Lovelace Respiratory Research Institute, Molecular Biology and Lung
Cancer Program , Albuquerque , NM , USA.
(1165)avq UFRJ, Instituto de Biofisica Carlos Chagas Filho , Rio de Janeiro ,
Brazil.
(1166)bki University of Helsinki, Biomedicum , Helsinki , Finland.
(1167)bnq Cell Signalling and Cell Death Division, and University of Melbourne,
Walter and Eliza Hall Institute of Medical Research , Department of Medical
Biology , Parkville , Victoria , Australia.
(1168)bkd University of Göttingen , Department of Neurology , Göttingen ,
Germany.
(1169)gg Christian-Albrechts-University of Kiel , Department of Nephrology and
Hypertension , Kiel , Germany.
(1170)ms George Mason University , Manassas , VA , USA.
(1171)bng University of Maryland, School of Medicine , Department of
Anesthesiology , Baltimore , MD , USA.
(1172)bld University of Iowa , Department of Health and Human Physiology , Iowa
City , IA , USA.
(1173)bmv University of Manchester, Breakthrough Breast Cancer Research Unit,
Manchester Centre for Cellular Metabolism , UK.
(1174)jh Duke University , Department of Ophthalmology , Durham , NC , USA.
(1175)apb Sichuan University, State Key Laboratory of Biotherapy/Collaborative
Innovation Center of Biotherapy, West China Hospital , Chengdu , China.
(1176)ani Second Military Medical University , Department of Pharmacology ,
Shanghai , China.
(1177)apk Soochow University , Department of Neurology , Second Affiliated
Hospital of Soochow University and Institute of Neuroscience , Suzhou , China.
(1178)bok University of Michigan, School of Dentistry , Department of Biologic
and Materials Sciences , Ann Arbor , MI , USA.
(1179)aeq National Chung Hsing University, Institute of Molecular Biology ,
Taichung , Taiwan.
(1180)ex China Academy of Chinese Medical Sciences, Institute of Basic Medical
Sciences of Xiyuan Hospital , Beijing , China.
(1181)bfw University of California San Diego, Division of Biological Sciences,
Section of Molecular Biology , La Jolla , CA , USA.
(1182)ef Chang Gung Memorial Hospital , Department of Pathology , Chiayi ,
Taiwan.
(1183)apa Sichuan University, Key Laboratory of Bio-Resources and
Eco-Environment of Ministry of Education, College of Life Science , Chengdu,
Sichuan , China.
(1184)asf Texas A&M Health Science Center, Institute of Biosciences and
Technology , Houston , TX , USA.
(1185)ip Dalian Medical University, Institute of Cancer Stem Cell , Dalian ,
China.
(1186)aso The First Affiliated Hospital of Anhui Medical University , Department
of Pulmonary , Anhui Geriatric Institute , Anhui , China.
(1187)ate The Second Hospital Affiliated to Guangzhou Medical University,
Guangzhou Institute of Cardiovascular Disease , Guangzhou, Guangdong Province ,
China.
(1188)apw Southern Medical University, School of Pharmaceutical Sciences,
Guangzhou , Guangdong , China.
(1189)ccz Zhejiang University, School of Medicine , Department of Biochemistry ,
Hangzhou, Zhejiang , China.
(1190)bwb University of Texas, MD Anderson Cancer Center , Department of
Genitourinary Medical Oncology , Houston , TX , USA.
(1191)aob Shandong University, School of Life Sciences , Jinan , China.
(1192)adv Nanjing University School of Medicine, Jinling Hospital , Department
of Neurology , Nanjing , China.
(1193)qk Huazhong University of Science and Technology , Department of
Biomedical Engineering , College of Life Science and Technology , Wuhan, Hubei ,
China.
(1194)atv Tianjin Medical University , Department of Immunology , Tianjin Key
Laboratory of Medical Epigenetics , Tianjin , China.
(1195)lk Florida International University , Department of Dietetics and
Nutrition , Miami , FL , USA.
(1196)bak University Bourgogne Franche Comté, EA 7270/INSERM , Dijon , France.
(1197)cbf Washington University, School of Medicine, Division of Endocrinology,
Metabolism and Lipid Research , Department of Medicine , St. Louis , MO , USA.
(1198)na Georgia Regents University, Cancer Center , Department of Medicine ,
Augusta , GA , USA.
(1199)agw National University of Singapore, Yong Loo Lin School of Medicine ,
Department of Biochemistry , Singapore.
(1200)ki Emory University, Winship Cancer Institute , Department of Hematology
and Medical Oncology , Atlanta , GA , USA.
(1201)bwa University of Texas, MD Anderson Cancer Center , Department of
Bioinformatics and Computational Biology , Houston , TX , USA.
(1202)bwg University of Texas, MD Anderson Cancer Center, The Proteomics and
Metabolomics Core Facility , Houston , TX , USA.
(1203)zn Medical University of Silesia, ENT Department, School of Medicine,
Katowice, Poland.
(1204)bsd University of Pittsburgh , Department of Surgery , University of
Pittsburgh Cancer Institute , Pittsburgh , PA , USA.
(1205)ahq Newcastle University, The Medical School, Institute of Cellular
Medicine , Newcastle upon Tyne , UK.
(1206)bsi University of Pittsburgh, School of Medicine , Department of
Immunology , Pittsburgh , PA , USA.
(1207)ato Thomas Jefferson University Hospitals , Department of Radiation
Oncology , Philadelphia , PA , USA.
(1208)bmt University of Macau, State Key Lab of Quality Research in Chinese
Medicine, Institute of Chinese Medical Sciences , Macao , China.
(1209)am Alpert Medical School of Brown University, Vascular Research
Laboratory, Providence Veterans Affairs Medical Center , Department of Medicine
, Providence , RI , USA.
(1210)cca Xi'an Jiaotong University Health Science Center , Department of
Biochemistry and Molecular Biology , School of Basic Medical Sciences , Shaanxi
, China.
(1211)ake Pfizer Inc., Drug Safety Research and Development , San Diego , CA ,
USA.
(1212)gu City University of Hong Kong , Department of Biomedical Sciences ,
Kowloon Tong, Hong Kong , China.
(1213)ru INSERM U1065, C3M, Team 2 , Nice , France.
(1214)bez University of California Davis , Department of Medical Microbiology
and Immunology , School of Medicine , Davis , CA , USA.
(1215)bvd University of St Andrews, School of Medicine , St Andrews, Fife , UK.
(1216)boo Life and Health Sciences Research Institute (ICVS), School of Health
Sciences, University of Minho, Braga, Portugal.
(1217)boq ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães,
Portugal.
(1218)df Cedars-Sinai Medical Center, VAGLAHS-UCLA, Pancreatic Research Group ,
Los Angeles , CA , USA.
(1219)aux Trev and Joyce Deeley Research Centre; and University of Victoria, BC
Cancer Agency; and Department of Biochemistry and Microbiology , Victoria, BC ,
Canada.
(1220)beg University of British Columbia , Department of Pathology and
Laboratory Medicine , James Hogg Research Centre , Vancouver, BC , Canada.
(1221)akf Plymouth University, Peninsula School of Medicine and Dentistry ,
Plymouth , UK.
(1222)aoi Shanghai Jiao Tong University, School of Medicine, Center for
Reproductive Medicine, Renji Hospital , Shanghai , China.
(1223)atu Tianjin Medical University , Department of Biochemistry and Molecular
Biology , School of Basic Medical Sciences, Tianjin Key Laboratory of Medical
Epigenetics , Tianjin , China.
(1224)btr University of São Paulo, Institute of Biomedical Science , Department
of Cell and Developmental Biology , São Paulo, SP , Brazil.
(1225)ac Albert Einstein College of Medicine , Department of Pathology , Bronx ,
NY , USA.
(1226)ue Iowa State University, Roy J. Carver Department of Biochemistry,
Biophysics, and Molecular Biology , Ames , IA , USA.
(1227)bzo Van Andel Research Institute, Laboratory of Systems Biology , Grand
Rapids , MI , USA.
(1228)bhe University of Chicago , The Ben May Department for Cancer Research ,
Chicago , IL , USA.
(1229)ccd Yale University School of Medicine , Department of Microbial
Pathogenesis and Howard Hughes Medical Institute , New Haven , CT , USA.
(1230)bct University of Arkansas for Medical Sciences , Department of
Pharmacology/Toxicology , Little Rock , AR , USA.
(1231)asd Temple University, School of Medicine , Department of Biochemistry ;
and Center for Translational Medicine , Philadelphia , PA , USA.
(1232)cv Case Western Reserve University , Department of Ophthalmology and
Visual Sciences , Cleveland , OH , USA.
(1233)bwx University of Tokyo, Institute of Molecular and Cellular Biosciences ,
Tokyo , Japan.
(1234)bjn University of Florida , Department of Pediatrics/Genetics and
Metabolism , Gainesville , FL , USA.
(1235)awd Universidad Autónoma de Madrid , Departamento de Biología , Madrid ,
Spain.
(1236)bnp University of Medicine and Dentistry of New Jersey, Cellular and
Molecular Signaling , Newark , NJ , USA.
(1237)rh Indian Institute of Technology Kharagpur , Department of Biotechnology
, Kharagpur , India.
(1238)cah San Raffaele Scientific Institute, European Institute for Research in
Cystic Fibrosis , Milan , Italy.
(1239)avv UMRS 1138, Centre de Recherche des Cordeliers , Paris , France.
(1240)ace Medical University of Graz, Institute of Molecular Biology and
Biochemistry, Centre of Molecular Medicine , Graz , Austria.
(1241)aiq Oregon Health and Science University, Knight Cardiovascular Institute
, Portland , OR , USA.
(1242)bnv University of Miami, Miller School of Medicine, Sylvester
Comprehensive Cancer Center , Miami , FL , USA.
(1243)btv University of Science and Technology of China , Anhui , China.
(1244)pa Harvard Medical School, Dana Farber Cancer Institute and Beth Israel
Deaconess Medical Center , Department of Radiation Oncology , Boston , MA , USA.
(1245)jp DZNE, German Center for Neurodegenerative Diseases, and CAESAR Research
Center , Bonn , Germany.
(1246)avu UMR CNRS 5286, INSERM 1052, Cancer Research Center of Lyon , Lyon ,
France.
(1247)avn UCL Institute of Neurology , London , UK.
(1248)bsx University of Reading, School of Pharmacy , Reading , UK.
(1249)aau Massachusetts General Hospital and Harvard Medical School , Department
of Molecular Biology ; Department of Genetics , Boston , MA , USA.
(1250)kc Emory University, School of Medicine , Department of Pharmacology and
Neurology , Atlanta , GA , USA.
(1251)arb Sun Yat-Sen University, School of Chemistry and Chemical Engineering ,
Guangzhou , China.
(1252)asn The Feinstein Institute for Medical Research, North Shore LIJ Health
System, Litwin-Zucker Research Center for the Study of Alzheimer's Disease , New
York , NY , USA.
(1253)ajm Paris Descartes University-Sorbonne Paris Cité, Imagine Institute ,
Paris , France.
(1254)anj Second University of Naples , Department of Biochemistry and
Biophysics , Naples , Italy.
(1255)anm Semmelweis University, Institute of Human Physiology and Clinical
Experimental Research , Budapest , Hungary.
(1256)bbp University Medical Center Utrecht , Department of Cell Biology ,
Groningen , The Netherlands.
(1257)buy University of Southern California, Keck School of Medicine, Eli and
Edythe Broad CIRM Center for Regenerative Medicine and Stem Cell Research ,
Department of Cell and Neurobiology , Los Angeles , CA , USA.
(1258)uq IRCE, Institut d'Investigacions Biomèdiques August Pi i Sunyer
(IDIBAPS) , Barcelona , Spain.
(1259)ha CNR, Institute of Cell Biology and Neurobiology and IRCCS Santa Lucia
Foundation , Rome , Italy.
(1260)bqx University of Oviedo , Department of Animal Physiology , Faculty of
Medicine, Campus del Cristo , Oviedo , Spain.
(1261)bdl University of Belgrade, Institute of Medical and Clinical
Biochemistry, Faculty of Medicine , Belgrade , Serbia.
(1262)bli University of Kansas and University of Kansas Cancer Center ,
Departments of Molecular Biosciences and Radiation Oncology , Lawrence , KS ,
USA.
(1263)bdu University of Bologna , Department of Biomedical and Neuromotor
Sciences , Bologna , Italy.
(1264)auy Trinity College Dublin , Department of Genetics , The Smurfit
Institute , Dublin , Ireland.
(1265)yl KU Leuven , Department of Cellular and Molecular Medicine , Leuven ,
Belgium.
(1266)dz Centro de Biologia Molecular "Severo Ochoa" (UAM/CSIC) , Department of
Virology and Microbiology , Madrid , Spain.
(1267)tp Instituto de Investigaciones Biomédicas Alberto Sols, CSIC/UAM, Centro
de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
(CIBERehd) , Madrid , Spain.
(1268)bbj National Institute of Environmental Health Sciences, Immunity,
Inflammation, and Disease Laboratory, Research Triangle Park, NC, USA.
(1269)af Albert Einstein College of Medicine, Departments of Medicine and
Molecular Pharmacology , Bronx , NY , USA.
(1270)ats Thomas Jefferson University , Philadelphia , PA , USA.
(1271)eb Centro de Investigación y Asistencia en Tecnología y Diseño del Estado
de Jalisco, AC, Unidad de Biotecnología Médica y Farmacéutica , Guadalajara ,
Jalisco , México.
(1272)bzm Vall d'Hebron Research Institute-CIBERNED, Neurodegenerative Diseases
Research Group , Barcelona , Spain.
(1273)amw São Paulo University , Biochemistry Department ; and Santo Amaro
University, Life Sciences , São Paulo , Brazil.
(1274)t Akita University, Graduate School of Medicine , Akita , Japan.
(1275)bhd University of Chicago, Pritzker School of Medicine , Department of
Neurology , Chicago , IL , USA.
(1276)up IRCCS-MultiMedica , Milan , Italy.
(1277)axu Università di Salerno , Dipartimento di Medicina e Chirurgia ,
Baronissi, Salerno , Italy.
(1278)vc Istituto Superiore di Sanità , Department of Therapeutic Research and
Medicine , Evaluation Section of Cell Aging, Degeneration and Gender Medicine ,
Rome , Italy.
(1279)ys Kyoto Prefectural University of Medicine , Department of Cardiovascular
Medicine , Graduate School of Medical Science , Kyoto , Japan.
(1280)cch Yokohama City University Graduate School of Medicine , Department of
Human Genetics , Yokohama , Japan.
(1281)xx Kobe University, Graduate School of Medicine , Department of
Orthopaedic Surgery , Hyogo , Japan.
(1282)ais Osaka Prefecture University, Graduate School of Life and Environmental
Science , Osaka , Japan.
(1283)afg National Institute on Aging, Intramural Research Program, Laboratory
of Neurosciences , Baltimore , MD , USA.
(1284)ahf Neurounion Biomedical Foundation , Santiago , Chile.
(1285)bhh University of Chile, Biomedical Neuroscience Institute , Santiago ,
Chile.
(1286)cag Vita-Salute San Raffaele University, San Raffaele Scientific
Institute, Autoimmunity and Vascular Inflammation Unit , Milan , Italy.
(1287)bos University of Minnesota , Department of Genetics , Cell Biology and
Development , Minneapolis , MN , USA.
(1288)blv University of Lausanne , Department of Biochemistry , Epalinges ,
Switzerland.
(1289)abm McGill University , Department of Pharmacology and Therapeutics ,
Montreal, Quebec , Canada.
(1290)aw Austral University-CONICET, Gene and Cell Therapy Laboratory , Pilar ,
Buenos Aires , Argentina.
(1291)cb Boston University , Department of Biology , Boston , MA , USA.
(1292)ij Dalhousie University , Department of Microbiology and Immunology ,
Halifax, Nova Scotia , Canada.
(1293)xi Karolinska Institute , Department of Microbiology , Tumor and Cell
Biology , Stockholm , Sweden.
(1294)ban University College Cork, Cork Cancer Research Centre, BioSciences
Institute, Co. Cork , Ireland.
(1295)jg Duke University , Department of Molecular Genetics and Microbiology ,
Durham , NC , USA.
(1296)sb INSERM U830, Stress and Cancer Laboratory, Institut Curie , Paris ,
France.
(1297)bch University of Amsterdam, Academic Medical Center, Laboratory of
Experimental Oncology and Radiobiology , Amsterdam, North Holland , The
Netherlands.
(1298)bvj University of Szeged , Department of Medical Microbiology and
Immunobiology , Szeged, Csongrád , Hungary.
(1299)btw University of Science and Technology of China, CAS Key Laboratory of
Innate Immunity and Chronic Disease, School of Lifesciences , Hefei, Anhui ,
China.
(1300)bcj University of Amsterdam , Department of Medical Biochemistry ,
Academic Medical Center , Amsterdam , The Netherlands.
(1301)gv City University of New York , Department of Biology , Queens College
and The Graduate Center , Flushing , NY , USA.
(1302)adm MRC Toxicology Unit , Leicester , UK.
(1303)bti University of Rome "Tor Vergata" , Department of Surgery and
Experimental Medicine , Rome , Italy.
(1304)btf University of Rome "Tor Vergata" , Department of Chemistry , Rome ,
Italy.
(1305)axl Universidade Estadual do Norte Fluminense Darcy Ribeiro, Centro de
Biociencias e Biotecnologia, Lab Biologia Celular e Tecidual, Setor de
Toxicologia Celular, Campos dos Goytacazes , Rio de Janeiro , Brazil.
(1306)qe Hospital Universitario Ramón y Cajal, CIBERNED , Neurobiology
Department , Madrid , Spain.
(1307)bxb University of Toronto , Department of Molecular Genetics , Toronto,
Ontario , Canada.
(1308)nn Girona Biomedical Research Institute (IDIBGI), Catalan Institute of
Oncology (ICO) , Catalonia , Spain.
(1309)qo iBET, Instituto de Biologia Experimental e Tecnológica , Oeiras ,
Portugal.
(1310)tt Instituto de Tecnologia Química e Biológica António Xavier,
Universidade Nova de Lisboa , Oeiras , Portugal.
(1311)aod Shanghai Institute of Materia Medica, Division of Antitumor
Pharmacology , Shanghai , China.
(1312)im Dalian Medical University, Cancer Center, Institute of Cancer Stem Cell
, Dalian, Liaoning Province , China.
(1313)atr Thomas Jefferson University , Department of Pathology, Anatomy, and
Cell Biology , Sydney Kimmel Medical College , Philadelphia , PA , USA.
(1314)ua Instituto Oswaldo Cruz, FIOCRUZ, Laboratório de Biologia Celular , Rio
de Janeiro , Brazil.
(1315)di Center of Investigation and Advanced Studies, Cinvestav-IPN , Mexico
City , Mexico.
(1316)uy Istituto Ortopedico Rizzoli IOR-IRCCS, Laboratory of Musculoskeletal
Cell Biology , Bologna , Italy.
(1317)bla University of Innsbruck, Institute for Biomedical Aging Research ,
Innsbruck , Austria.
(1318)atn Third Military Medical University, Research Center for Nutrition and
Food Safety, Institute of Military Preventive Medicine , Chongqing , China.
(1319)bt Biochimie et Physiologie Moléculaire des Plantes, UMR5004
CNRS/INRA/UM2/SupAgro, Institut de Biologie Intégrative des Plantes ,
Montpellier , France.
(1320)adc Icahn School of Medicine at Mount Sinai , Department of Medicine , New
York , NY , USA.
(1321)alr Royal North Shore Hospital, Cardiovascular and Hormonal Research
Laboratory, Royal North Shore Hospital and Kolling Institute, Sydney , NSW ,
Australia.
(1322)bvg University of Sydney , Department of Cardiology , Sydney, NSW ,
Australia.
(1323)bgp University of Cambridge , Department of BIochemistry , Cambridge , UK.
(1324)bwe University of Texas, MD Anderson Cancer Center , Department of Systems
Biology , Houston , TX , USA.
(1325)ajg University of Oslo and Oslo University Hospital, Prostate Cancer
Research Group, Centre for Molecular Medicine (Norway) , Oslo , Norway.
(1326)bqn University of Oslo , Department of Molecular Oncology , Department of
Urology , Oslo , Norway.
(1327)bqq Centre for Cancer Research and Cell Biology, Queen's University
Belfast, Lisburn Road, Belfast, UK.
(1328)asw The Hospital for Sick Children , Department of Paediatrics , Toronto,
Ontario , Canada.
(1329)bjt University of Fribourg , Department of Medicine , Division of
Physiology , Fribourg , Switzerland.
(1330)aly Russian Academy of Sciences, Kazan Institute of Biochemistry and
Biophysics , Kazan, Tatarstan , Russia.
(1331)bs Bio21 Molecular Science and Biotechnology Institute , Department of
Biochemistry and Molecular Biology , Parkville , Victoria , Australia.
(1332)bol University of Milan , Department of Experimental Oncology , European
Institute of Oncology and Department of Biosciences , Milan , Italy.
(1333)awx Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del
Rocío, Consejo Superior de Investigaciones Científicas, Universidad de Sevilla ,
Sevilla , Spain.
(1334)brn University of Pennsylvania , Department of Anatomy and Cell Biology ,
Philadelphia , PA , USA.
(1335)bfs University of California San Diego , Department of Pharmacology , La
Jolla , CA , USA.
(1336)bwv University of Tokyo , Department of Biochemistry and Molecular Biology
, Graduate School and Faculty of Medicine , Tokyo , Japan.
(1337)tu Instituto Gulbenkian de Ciência , Oeiras , Portugal.
(1338)jt Institute for Research in Biomedicine, Bellinzona, Switzerland,
Università Svizzera italiana, Lugano , Switzerland.
(1339)ju Ecole Polytechnique Federale de Lausanne, Global Health Institute,
School of Life Sciences , Lausanne , Switzerland.
(1340)g Aarhus University, Medical Research Laboratory, Institute for Clinical
Medicine , Aarhus , Denmark.
(1341)ayx Université de Lyon, UMR 5239 CNRS, Laboratory of Molecular Biology of
the Cell, Ecole Normale Supérieure de Lyon , Lyon , France.
(1342)hy Consejo Superior de Investigaciones Científicas (CSIC), Universidad de
Salamanca, Campus Miguel de Unamuno, Instituto de Biología Molecular y Celular
del Cáncer, Centro de Investigación del Cáncer , Salamanca , Spain.
(1343)bre University of Padova, Venetian Institute of Molecular Medicine ,
Department of Biomedical Science , Padova , Italy.
(1344)blf University of Iowa , Department of Medicine , Iowa City , IA , USA.
(1345)ahe Neuroscience Research Institute , Santa Barbara , CA , USA.
(1346)bgk University of California Santa Barbara , Department of Molecular ,
Cellular, and Developmental Biology , Santa Barbara , CA , USA.
(1347)bzn Van Andel Institute, Center for Neurodegenerative Science , Grand
Rapids , MI , USA.
(1348)bjd University of Exeter Medical School, European Centre for Environment
and Human Health (ECEHH), Truro , Cornwall , UK.
(1349)awp Universidad de Costa Rica, CIET , San José , Costa Rica.
(1350)bho University of Coimbra, CNC - Center for Neuroscience and Cell Biology
and Faculty of Medicine , Coimbra , Portugal.
(1351)bzf University Roma Tre , Department of Science , LIME, Rome , Italy.
(1352)aps Sorbonne Universités, UPMC Univ Paris 06, INSERM U1135, CNRS ERL 8255,
Center for Immunology and Microbial Infections - CIMI-Paris , Paris , France.
(1353)aml Saitama University, Graduate School of Science and Engineering ,
Saitama , Japan.
(1354)buh University of South Australia, Early Origins of Adult Health Research
Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health
Research, Adelaide , SA , Australia.
(1355)amj Saint Louis University School of Medicine , Department of Molecular
Microbiology and Immunology , St. Louis , MO , USA.
(1356)akj Pontificia Universidad Católica de Chile , Physiology Department ,
Santiago , Chile.
(1357)amq Sanford Burnham Prebys NCI-Cancer Center, Cell Death and Survival
Networks Program , La Jolla , CA , USA.
(1358)rc Imperial College London, Section of Microbiology, MRC Centre for
Molecular Bacteriology and Infection , London , UK.
(1359)bme University of Liege , GIGA-Signal Transduction Department , Protein
Signalisation and Interaction Laboratory , Liège , Belgium.
(1360)byw University of York, Centre for Immunology and Infection , Department
of Biology , Hull York Medical School , York , UK.
(1361)mv Georgetown University Medical Center , Department of Neuroscience ,
Washington, DC , USA.
(1362)bcw University of Athens, Medical School , Second Department of Internal
Medicine and Research Institute , Attikon University General Hospital , Athens ,
Greece.
(1363)byp University of Wisconsin , Department of Dermatology , Madison , WI ,
USA.
(1364)bic University of Colorado , Department of Pediatrics , Center for Cancer
and Blood Disorders , Aurora , CO , USA.
(1365)hc CNRS, Immunopathology and Therapeutic Chemistry, Institut de Biologie
Moléculaire et Cellulaire , Strasbourg , France.
(1366)bl Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Cell
Death Regulation Group , Barcelona , Spain.
(1367)bzb University of Zurich, Institute of Experimental Immunology , Zurich ,
Switzerland.
(1368)atj The Wistar Institute, Program in Molecular and Cellular Oncogenesis ,
Philadelphia , PA , USA.
(1369)auz Trinity College Dublin, School of Biochemistry and Immunology, Trinity
Biomedical Sciences Institute , Dublin , Ireland.
(1370)mj Genentech Inc. , Department of Cancer Immunology , South San Francisco
, CA , USA.
(1371)bgu University of Camerino, School of Pharmacy , Camerino , Italy.
(1372)aui Tokyo Denki University, Division of Life Science and Engineering ,
Hatoyama, Hiki-gun, Saitama , Japan.
(1373)aei National Center of Neurology and Psychiatry , Department of
Degenerative Neurological Diseases , Kodaira, Tokyo , Japan.
(1374)yu Kyoto Sangyo University , Department of Life Sciences , Kyoto , Japan.
(1375)ale Radboud University, Institute for Molecules and Materials , Department
of Molecular Materials , Nijmegen , The Netherlands.
(1376)rk Indiana University School of Medicine , Department of Dermatology ,
Indianapolis , IN , USA.
(1377)byv University of Wyoming, School of Pharmacy, College of Health Sciences
, Laramie , WY , USA.
(1378)atx Toho University, School of Medicine , Department of Biochemistry ,
Tokyo , Japan.
(1379)auk Tokyo Institute of Technology, Graduate School of Bioscience and
Biotechnology , Tokyo , Japan.
(1380)buq University of South Florida , Department of Cell Biology ,
Microbiology, and Molecular Biology , Tampa , FL , USA.
(1381)pd Harvard Medical School, Neurology Residency Program, Brigham and
Women's Hospital and Massachusetts General Hospital , Boston , MA , USA.
(1382)bgo University of Cambridge, Cancer Research UK Cambridge Institute, Li Ka
Shing Centre , Cambridge , UK.
(1383)bzy Virginia Commonwealth University , Department of Internal Medicine ,
Division of Pulmonary Disease and Critical Care Medicine , Richmond , VA , USA.
(1384)btt University of São Paulo, Ribeirão Preto Medical School , Department of
Physiology , Ribeirão Preto, São Paulo , Brazil.
(1385)bvv University of Texas, Health Science Center at San Antonio, CTRC
Institute for Drug Development , San Antonio , TX , USA.
(1386)bfv University of California San Diego, Division of Biological Sciences,
Section of Molecular Biology , La Jolla, CA , USA.
(1387)bkw University of Illinois at Chicago, Deprtment of Biochemistry and
Molecular Genetics , Chicago , IL , USA.
(1388)bjg University of Ferrara , Department of Morphology , Surgery and
Experimental Medicine , Ferrara , Italy.
(1389)alb Radboud University Nijmegen Medical Center , Department of Internal
Medicine , Division of Endocrinology , Nijmegen , The Netherlands.
(1390)bcz University of Aveiro/QOPNA , Department of Chemistry , Aveiro ,
Portugal.
(1391)ahg New York Blood Center, Lindsley F. Kimball Research Institute , New
York , NY , USA.
(1392)byl University of Warwick, Life Sciences , Coventry , UK.
(1393)bxo University of Tübingen, Institute of Medical Genetics and Applied
Genomics , Tübingen , Germany.
(1394)s Akershus University Hospital , Oslo , Norway.
(1395)bqo University of Oslo , Department of Clinical Molecular Biology , Oslo ,
Norway.
(1396)xh Karolinska Institute, Center for Alzheimer Research , Department of
Neurobiology , Care Sciences and Society, Division for Neurogeriatrics ,
Huddinge , Sweden.
(1397)zh Laboratory for Proteolytic Neuroscience, RIKEN Brain Science Institute,
Wako , Saitama , Japan.
(1398)aex National Institute for Basic Biology , Department of Cell Biology ,
Okazaki , Japan.
(1399)aej National Center of Neurology and Psychiatry , Department of
Neuromuscular Research , National Institute of Neuroscience , Tokyo , Japan.
(1400)apl Soochow University , Department of Pathogenic Biology , Suzhou,
Jiangsu , China.
(1401)aho New York University, Nathan Kline Institute , Orangeburg , NY , USA.
(1402)bnh University of Maryland, School of Medicine , Department of Chemistry ,
Baltimore , MD , USA.
(1403)aiy Osaka University, Graduate School of Dentistry , Osaka , Japan.
(1404)bhw University of Cologne, Institute of Biochemistry I, Medical Faculty ,
Koeln , Germany.
(1405)bcl University of Antwerp , Department of Paediatric Oncology , Antwerp ,
Belgium.
(1406)bly Hakim Sabzevari University, Department of Biology, Faculty of Basic
Sciences, Sabzevar, Iran.
(1407)pe Harvard Medical School, Ophthalmology , Boston , MA , USA.
(1408)bjj University of Florida, College of Medicine , Department of
Neuroscience , Gainesville , FL , USA.
(1409)aco Medical University of Vienna, Internal Medicine I , Vienna , Austria.
(1410)wo Juntendo University, Graduate School of Medicine , Department of
Neuroscience for Neurodegenerative Disorders , Tokyo , Japan.
(1411)cu Cardiff University, Systems Immunity Research Institute , Cardiff ,
Wales, UK.
(1412)brl University of Pennsylvania, Abramson Cancer Center , Philadelphia , PA
, USA.
(1413)nh German Cancer Research Center (DKFZ), Clinical Cooperation Unit (CCU)
Pediatric Oncology , Heidelberg , Germany.
(1414)hv Consejo Superior de Investigaciones Científicas (CSIC), Centro de
Investigaciones Biológicas , Madrid , Spain.
(1415)afd National Institute of Infectious Diseases , Department of Bacteriology
I , Tokyo , Japan.
(1416)aci Medical University of South Carolina , Department of Biochemistry and
Molecular Biology , Hollings Cancer Center , Charleston , SC , USA.
(1417)aqh St. Marianna University School of Medicine , Department of Physiology
, Kanagawa , Japan.
(1418)cci Yonsei University, College of Life Science and Biotechnology ,
Department of Systems Biology , Seoul , Korea.
(1419)yp Kumamoto University, Institute of Resource Development and Analysis ,
Kumamoto , Japan.
(1420)aug Tokushima Bunri University, Faculty of Pharmaceutical Sciences at
Kagawa Campus, Sanuki City , Kagawa , Japan.
(1421)akl Post Graduate Institute of Medical Education and Research (PGIMER) ,
Department of Urology , Chandigarh , India.
(1422)aiz Osaka University, Graduate School of Frontier Biosciences , Osaka ,
Japan.
(1423)ww Kanazawa Medical University , Department of Medicine , Ishikawa ,
Japan.
(1424)ts Instituto de Parasitología y Biomedicina López Neyra (IPBLN), CSIC ,
Granada , Spain.
(1425)bil University of Copenhagen , Department of Plant and Environmental
Sciences , Section for Genetics and Microbiology , Copenhagen , Denmark.
(1426)bws University of Virginia, Departments of Biology and Cell Biology,
Charlottesville, VA, USA.
(1427)byc University of Valencia , Departamento de Bioquimica y Biologia
Molecular , IATA-CSIC , Valencia , Spain.
(1428)byd University of Valencia , Departamento de Biotecnología , IATA-CSIC ,
Valencia , Spain.
(1429)byf University of Valencia , Department of Physiology , Burjassot,
Valencia , Spain.
(1430)uz Istituto Superiore di Sanità , Department of Cell Biology and
Neurosciences , Rome , Italy.
(1431)bym University of Washington , Department of Pathology , Seattle , WA.
(1432)aum Tokyo Medical and Dental University , Department of Gastroenterology
and Hepatology , Tokyo , Japan.
(1433)aiv Osaka University Graduate School of Medicine , Department of
Pediatrics , Osaka , Japan.
(1434)xt King's College London, Cardiovascular Division , London , UK.
(1435)bbr University Medical Centre Göttingen , Department of Neurodegeneration
and Restorative Research , Göttingen , Germany.
(1436)bsf University of Pittsburgh, School of Dental Medicine , Department of
Endodontics , Pittsburgh , PA , USA.
(1437)acr Memorial Sloan Kettering Cancer Center , New York , NY , USA.
(1438)bpk University of New Mexico, Comprehensive Cancer Center , Department of
Molecular Genetics and Microbiology , Albuquerque , NM , USA.
(1439)aib Northwestern University , Department of Neurology , Feinberg School of
Medicine , Chicago , IL , USA.
(1440)azc Université de Montréal , Department of Pharmacology , Faculty of
Medicine , Montreal, QC , Canada.
(1441)zg Laboratory for Biomedical Neurosciences NSI/EOC, Neurodegeneration
Group , Torricella-Taverne , Switzerland.
(1442)bso University of Poitiers, EA3808 Molecular Targets and Therapeutics in
Alzheimer's Disease , Poitiers , France.
(1443)cat Warsaw University of Life Sciences - SGGW, Faculty of Veterinary
Medicine , Department of Physiological Sciences , Warsaw , Poland.
(1444)bsk University of Pittsburgh, School of Medicine , Department of
Pediatrics , Pittsburgh , PA , USA.
(1445)er Charles University in Prague, Faculty of Science , Department of
Genetics and Microbiology , Prague , Czech Republic.
(1446)azo Université Lyon, Ecole Normale Supérieure de Lyon , Lyon , France.
(1447)sa INSERM U1147 , Paris , France.
(1448)d Aarhus University, Department of Biomedicine , Aarhus , Denmark.
(1449)btg University of Rome "Tor Vergata" , Department of Clinical Sciences and
Translational Medicine , Rome , Italy.
(1450)cdb Zhejiang University, Sir Run Run Shaw Hospital , Department of Medical
Oncology , Hangzhou, Zhejiang , China.
(1451)agl Department of Cardiology, Nanhai Hospital Affiliated to Southern
Medical University, Foshan, Guangdong Province, China.
(1452)sy Institute for Clinical and Experimental Medicine, Centre for
Experimental Medicine , Department of Metabolism and Diabetes , Prague , Czech
Republic.
(1453)awf Universidad de Buenos Aires, Inmunología, Facultad de Farmacia y
Bioquímica , Buenos Aires , Argentina.
(1454)aee National and Kapodistrian University of Athens , Department of Cell
Biology and Biophysics , Faculty of Biology , Athens , Greece.
(1455)bjh University of Florence , Department of Biology , Florence , Italy.
(1456)axb IIS Aragon, Universidad de Zaragoza/Araid, Centro de Investigación
Biomédica de Aragón , Zaragoza , Spain.
(1457)bzu Vanderbilt University, School of Medicine, Pathology Microbiology and
Immunology , Nashville , TN , USA.
(1458)abz Medical College of Wisconsin , Department of Biochemistry , Milwaukee
, WI , USA.
(1459)ccm Yonsei University, Division of Biological Science and Technology ,
Wonju , Korea.
(1460)yh Korea University, Division of Life Sciences , Seoul , Korea.
(1461)bid University of Colorado, HHMI , Department of Chemistry and
Biochemistry , Aurora , CO , USA.
(1462)bkh University of Heidelberg, Institute of Anatomy and Cell Biology ,
Heidelberg , Germany.
(1463)bxv University of Ulm, Institute of Applied Physiology , Ulm , Germany.
(1464)ayf Université Bordeaux Segalen, U1035 INSERM, Hématopoïèse Leucémique et
Cibles Thérapeutiques , Bordeaux , France.
(1465)amv Sanofi , Vitry Sur Seine , France.
(1466)il Dalhousie University , Department of Pharmacology , Halifax, Nova
Scotia , Canada.
(1467)bbc University Hospital of Göttingen , Department of Nephrology and
Rheumatology , Göttingen , Germany.
(1468)ahr New York-Presbyterian Hospital/Weill-Cornell Medical Center , New York
, NY , USA.
(1469)us IRCM, Institut de Recherche en Cancérologie de Montpellier ,
Montpellier , France.
(1470)ayz Université de Montpellier, Institut régional du Cancer de Montpellier,
INSERM, U 1194 , Montpellier , France.
(1471)bum University of South Dakota, Division of Basic Biomedical Sciences ,
Vermillion , SD , USA.
(1472)abn McGill University , Goodman Cancer Research Centre and Department of
Biochemistry , Montreal, Quebec , Canada.
(1473)bbb University Hospital Muenster Albert-Schweitzer-Campus, Internal
Medicine D , Department of Nephrology , Hypertension and Rheumatology , Münster
, Germany.
(1474)bhg P Catholic University of Chile, Advanced Center for Chronic Diseases
(ACCDiS), Faculty of Medicine , Santiago , Chile.
(1475)bjf University of Extremadura , Department of Medicine , Faculty of
Veterinary Medicine , Cáceres , Spain.
(1476)azt Université Paris Descartes, Institut Necker-Enfants Malades, INSERM,
U1151 , Paris , France.
(1477)dj College of Science, Central China Normal University , Wuhan , China.
(1478)tj Institute of Molecular Biotechnology of the Austrian Academy of
Sciences (IMBA) , Vienna , Austria.
(1479)bnt Murdoch Childrens Research Institute, University of Melbourne ,
Department of Paediatrics , Royal Children's Hospital , Melbourne , Victoria ,
Australia.
(1480)lb Federal University of São Paulo , Department of Pharmacology , Paulista
School of Medicine , São Paulo , Brazil.
(1481)bht University of Coimbra, IBILI, Faculty of Medicine , Coimbra ,
Portugal.
(1482)ty Instituto Nacional de Neurología y Neurocirugía, Neurochemistry Unit ,
Mexico City , Mexico.
(1483)bzl Vall d'Hebron Research Institute, Neurodegenerative Diseases Lab ,
Barcelona , Spain.
(1484)aqp State University of New York, College of Medicine , Departments of
Medicine , Microbiology and Immunology, Biochemistry and Molecular Biology ,
Syracuse , NY , USA.
(1485)bse University of Pittsburgh , Pittsburgh , PA , USA.
(1486)beq University of Calabria , Department of Biology , Ecology and Earth
Science, Laboratory of Electron Microscopy , Cosenza , Italy.
(1487)ig Curtin University, School of Biomedical Sciences , Perth , Australia.
(1488)ago National University Cancer Institute, National University Health
System , Singapore.
(1489)bix University of Eastern Finland, Faculty of Health Science, School of
Pharmacy/Toxicology , Kuopio , Finland.
(1490)bik University of Copenhagen , Department of Biology , Copenhagen ,
Denmark.
(1491)abo McGill University, Health Centre Research Institute, Meakins Christie
Laboratories , Montreal, Quebec , Canada.
(1492)aja Oslo University Hospital, Center for Eye Research , Oslo , Norway.
(1493)bqp University of Oslo , Department of Ophthalmology , Oslo , Norway.
(1494)bvk University of Szeged , Department of Ophthalmology , Faculty of
Medicine , Szeged , Hungary.
(1495)aha NCI/CCR, Basic Research Laboratory , Frederick , MD , USA.
(1496)bcy University of Aveiro, Institute for Research in Biomedicine - iBiMED,
Aveiro Health Sciences Program , Aveiro , Portugal.
(1497)azq Université Nice Sophia Antipolis, UMR E-4320TIRO-MATOs CEA/iBEB,
Faculté de Médecine , Nice , France.
(1498)tz Instituto Nacional de Neurología y Neurocirugía, Neuroimmunology and
Neuro-Oncology Unit , Mexico City , Mexico.
(1499)arw Tel Aviv University , Department of Neurobiology , Tel-Aviv , Israel.
(1500)ah Albert Einstein College of Medicine, Montefiore Medical Center , Bronx
, NY , USA.
(1501)bel University of British Columbia, Michael Smith Laboratories ,
Department of Chemical and Biological Engineering , Vancouver, BC , Canada.
(1502)vl Jesse Brown VA Medical Center , Department of Medicine , Chicago , IL ,
USA.
(1503)aie Northwestern University, Robert H. Lurie Comprehensive Cancer Center ,
Chicago , IL , USA.
(1504)als Ruhr University Bochum, Biochemie Intrazellulärer Transportprozesse ,
Bochum , Germany.
(1505)aql Stanford University, School of Medicine , Department of Pathology ,
Stanford , CA , USA.
(1506)mp Georg-August-Universität Göttingen, Institute of Microbiology and
Genetics , Department of Genetics of Eukaryotic Microorganisms , Göttingen ,
Germany.
(1507)bxh University of Toulouse, INSERM UMR 1037, Cancer Research Center of
Toulouse , Toulouse , France.
(1508)hq Comenius University in Bratislava , Department of Biochemistry ,
Faculty of Natural Sciences , Bratislava , Slovak Republic.
(1509)axq Universita' degli Studi di Milano , Dipartimento di Scienze
Farmacologiche e Biomolecolari , Milan , Italy.
(1510)abq McGill University, Health Centre Research Institute, Meakins-Christie
Laboratories , Montreal, Quebec, Canada.
(1511)bue University of Silesia , Department of Animal Histology and Embryology
, Katowice , Poland.
(1512)bzi USDA-Human Nutrition Research Center on Aging at Tufts University ,
Department of Neuroscience and Aging , Boston , MA , USA.
(1513)bra University of Oxford , Nuffield Department of Obstetrics and
Gynaecology , Oxford , UK.
(1514)bfa University of California Davis , Department of Molecular and Cellular
Biology , Davis , CA , USA.
(1515)dw Centro Andaluz de Biología Molecular y Medicina Regenerativa, Consejo
Superior de Investigaciones Científicas , Sevilla , Spain.
(1516)wa Johannes Gutenberg University Mainz, University Medical Center ,
Department of Medical Microbiology and Hygiene , Mainz , Germany.
(1517)ayd Université Bordeaux Ségalen, Institut de Biochimie et de Génétique
Cellulaires, CNRS, UMR 5095 , Bordeaux , France.
(1518)bgy University of Cape Town , Department of Human Biology , Cape Town,
Western Province , South Africa.
(1519)afv National Institutes of Health, NIDDK, Genetics of Development and
Disease Branch , Bethesda , MD , USA.
(1520)js Eberhard Karls University Tübingen, Interfaculty Institute of Cell
Biology , Tübingen , Germany.
(1521)bip University of Cyprus , Department of Biological Sciences ,
Bioinformatics Research Laboratory , Nicosia , Cyprus.
(1522)cbh Wayne State University, School of Medicine, Cardiovascular Research
Institute , Detroit , MI , USA.
(1523)afj National Institutes of Health, Cell Biology and Physiology Center,
National Heart, Lung, and Blood Institute , Bethesda , MD , USA.
(1524)bie University of Colorado, School of Medicine, Anschutz Medical Campus ,
Aurora , CO , USA.
(1525)byr University of Wisconsin , Department of Medicine , Madison , WI , USA.
(1526)bm Bellvitge Biomedical Research Institute (IDIBELL), Neurometabolic
Diseases Laboratory , Barcelona , Spain.
(1527)gp CIBERER Spanish Network for Rare Diseases , Madrid , Spain.
(1528)qv ICREA Catalan Institution for Research and Advanced Studies , Catalonia
, Spain.
(1529)bav University Hospital Center, University of Lausanne, Clinic of
Neonatology , Department of Pediatrics and Pediatric Surgery , Lausanne ,
Switzerland.
(1530)big University of Colorado, School of Medicine , Department of Immunology
and Microbiology , Aurora , CO , USA.
(1531)cx Case Western Reserve University, School of Medicine , Department of
Physiology and Biophysics , Cleveland , OH , USA.
(1532)ccv Zhejiang University, Institute of Hematology, First Affiliated
Hospital, College of Medicine , Hangzhou , China.
(1533)apo Soochow University, School of Pharmaceutical Science , Department of
Pharmacology , Suzhou , China.
(1534)aqd St. Jude Children's Research Hospital , Department of Structural
Biology , Memphis , TN , USA.
(1535)byo University of Waterloo , Department of Kinesiology , Waterloo, Ontario
, Canada.
(1536)bjx University of Georgia , Department of Infectious Diseases , Athens ,
GA , USA.
(1537)afu National Institutes of Health, NIAMS, Laboratory of Muscle Stem Cells
and Gene Regulation , Bethesda , MD , USA.
(1538)bsa University of Pittsburgh , Department of Pathology , Pittsburgh , PA ,
USA.
(1539)iu Dartmouth College , Department of Chemistry , Hanover , NH , USA.
(1540)cad Virginia Commonwealth University, Massey Cancer Center , Department of
Internal Medicine , Richmond , VA , USA.
(1541)bbz University of Alabama at Birmingham , Department of Cell ,
Developmental, and Integrative Biology (CDIB), Comprehensive Diabetes Center
(UCDC) , Birmingham , AL , USA.
(1542)bqi University of Oklahoma Health Sciences Center , Department of
Pathology , Oklahoma City , OK , USA.
(1543)bam University Clinics, Institute of Cellular and Molecular Anatomy
(Anatomie 3) , Frankfurt , Germany.
(1544)bgr University of Cambridge , Department of Medicine , Addenbrooke's
Hospital , Cambridge , UK.
(1545)bvw University of Texas, Health Science Center at San Antonio , Department
of Molecular Medicine , San Antonio , TX , USA.
(1546)avh U.S. Food and Drug Administration, Center for Drug Evaluation and
Research , Silver Spring , MD , USA.
(1547)bwi University of Texas, Medical Branch , Department of Nutrition and
Metabolism , Galveston , TX , USA.
(1548)pj Heidelberg University, Deutsches Krebsforschungszentrum, Proteostasis
in Neurodegenerative Disease (B180), CHS Research Group at CellNetworks ,
Heidelberg , Germany.
(1549)wd Johns Hopkins University, School of Medicine , Baltimore , MD , USA.
(1550)pz Hôpital Beaujon , Paris , France.
(1551)so INSERM, U970 , Paris , France.
(1552)ajl Paris Cardiovascular Research Center - PARCC , Clichy , France.
(1553)azu Université Paris Descartes , Paris , France.
(1554)buj University of South Carolina School of Medicine , Department of
Pathology , Microbiology, and Immunology , Columbia , SC , USA.
(1555)cba Washington University, School of Medicine, Cardiovascular Division ,
Department of Medicine , St. Louis , MO , USA.
(1556)cbd Washington University, School of Medicine , Department of Pathology
and Immunology , St. Louis , MO , USA.
(1557)byn University of Waterloo , Department of Biology , Waterloo, Ontario ,
Canada.
(1558)alp Royal College of Surgeons in Ireland , Department of Physiology and
Medical Physics , Dublin , Ireland.
(1559)ayc Universitätsklinikum Düsseldorf, Institute for Biochemistry and
Molecular Biology I , Düsseldorf , Germany.
(1560)ask Texas A&M University, Texas A&M Health Science Center, College of
Medicine, Institute of Biosciences and Technology , Houston , TX , USA.
(1561)m Academic Medical Center, University of Amsterdam , Department of Cell
Biology and Histology , Amsterdam , The Netherlands.
(1562)ajx Pennsylvania State University, College of Medicine , Department of
Pharmacology , Hershey , PA , USA.
(1563)bgq University of Cambridge , Department of Medical Genetics , Cambridge
Institute for Medical Research , Cambridge , UK.
(1564)iz Denver VAMC , Denver , CO , USA.
(1565)bif University of Colorado, School of Medicine , Aurora , CO , USA.
(1566)axp Universidal de Salamanca, Campus Miguel de Unamuno , Departamento de
Microbiologia y Genetica , Salamanca , Spain.
(1567)byu University of Wisconsin, School of Veterinary Medicine , Department of
Pathobiological Sciences , Madison , WI , USA.
(1568)aqf St. Louis University School of Medicine , Department of Biochemistry
and Molecular Biology , St. Louis , MO , USA.
(1569)bby University of Adelaide , Department of Genetics and Evolution , School
of Biological Sciences , Adelaide , SA , Australia.
(1570)bcp University of Arizona , Department of Entomology , Tucson , AZ , USA.
(1571)zw Lorraine University, CITHéFOR EA3452, Faculté de Pharmacie , Nancy ,
France.
(1572)ail Ohio State University , Department of Veterinary Biosciences , College
of Veterinary Medicine , Columbus , OH , USA.
(1573)amu Sangamo Biosciences , Richmond , CA , USA.
(1574)axv Università Politecnica delle Marche , Department of Clinical and
Molecular Sciences , Ancona , Italy.
(1575)brg University of Parma , Department of Biomedical , Biotechnological and
Translational Sciences , Parma , Italy.
(1576)axm Universidade Federal de Minas Gerais, UFMG , Departamento de
Morfologia , Instituto de Ciências Biológicas , Belo Horizonte , Minas Gerais ,
Brazil.
(1577)bhm University of Cincinnati, Cincinnati Children's Hospital , Cincinnati
, OH , USA.
(1578)bec University of British Columbia , Department of Biochemistry and
Molecular Biology , Vancouver, BC Canada.
(1579)arr Technische Universität Braunschweig, Biozentrum , Braunschweig ,
Germany.
(1580)biu University of Dundee, Centre for Gene Regulation and Expression,
College of Life Sciences , UK.
(1581)axg Universidade de Lisboa, Research Institute for Medicines
(iMed.ULisboa), Faculty of Pharmacy , Lisboa , Portugal.
(1582)ib BioCruces Health Research Institute, Cruces University Hospital, Stem
Cells and Cell Therapy Laboratory , Barakaldo , Spain.
(1583)ja Department of Cellular and Molecular Medicine , Center for Biological
Research and Center for Biomedical Network Research on Rare Diseases , Madrid ,
Spain.
(1584)bz Boise State University , Department of Biological Sciences, Boise , ID
, USA.
(1585)ack Medical University of South Carolina , Department of Ophthalmology ,
Charleston , SC , USA.
(1586)blb University of Insubria , Department of Biotechnology and Life Sciences
, Varese , Italy.
(1587)brs University of Perugia , Department of Experimental Medicine , Perugia
, Italy.
(1588)axd Universidad Nacional de Cuyo (FCM-UNCUYO), Instituto de Histologia y
Embriologia (IHEM-CONICET), Facultad de Ciencias Medicas , Mendoza , Argentina.
(1589)aya Universitat de Barcelona, L'Hospitalet de Llobregat , Departament de
Ciències Fisiol∫giques II , Campus de Bellvitge, Institut d'Investigació
Biomèdica de Bellvitge (IDIBELL) , Barcelona , Spain.
(1590)ako Public Health England, Health Protection Services, Modelling and
Economics Unit, Colindale , London , UK.
(1591)ii Dalhousie University, Biochemistry and Molecular Biology , Halifax, NS
, Canada.
(1592)ik Dalhousie University , Department of Pediatrics , Halifax, Nova Scotia
, Canada.
(1593)blr University of Kiel, Institute of Clinical Molecular Biology , Kiel ,
Germany.
(1594)bcb University of Alabama at Birmingham , Department of Pathology ,
Birmingham , AL , USA.
(1595)sp Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) ,
Hemato-oncology Department , Barcelona , Spain.
(1596)bze University Pierre et Marie Curie, UMR8256/INSERM U-1164, Biological
Adaptation and Ageing (B2A) , Paris , France.
(1597)bq Beth Israel Deaconess Medical Center, Medical Genetics , Boston , MA ,
USA.
(1598)awy Universidad de Sevilla, Instituto de Biomedicina de Sevilla , Sevilla
, Spain.
(1599)bgm University of Cambridge, Cambridge Institute for Medical Research,
Addenbrooke's Hospital , Department of Medical Genetics , Cambridge , UK.
(1600)blm University of Kentucky , Department of Biology , Lexington , KY , USA.
(1601)bn Ben-Gurion University , Department of Clinical Biochemistry and the
National Institute of Biotechnology in the Negev , Beer-Sheva , Israel.
(1602)eq Charles University in Prague, Faculty of Medicine in Hradec Kralove ,
Department of Medical Biology and Genetics , Hradec Kralove , Czech Republic.
(1603)aaq Mannheim University of Applied Sciences, Institute of Molecular and
Cell Biology , Mannheim , Germany.
(1604)aio Ohio University, Division of Physical Therapy , Athens , OH , USA.
(1605)agc National Research Council, Institute of Food Sciences , Avellino ,
Italy.
(1606)bes University of Calabria , Department of Pharmacy , Health and
Nutritional Sciences, Section of Preclinical and Translational Pharmacology ,
Rende (Cosenza) , Italy.
(1607)tc Institute of Biochemistry and Biophysics , Kazan , Russia.
(1608)cbn Weill Cornell Medical College , Joan and Sanford I. Weill Department
of Medicine , New York , NY , USA.
(1609)cbv Whitehead Institute, HHMI and Massachusetts Institute of Technology ,
Cambridge , MA , USA.
(1610)hu Concordia University , Department of Biology , Montreal , Canada.
(1611)abi McGill University , Department of Anatomy and Cell Biology , Montreal
, Canada.
(1612)kw European Molecular Biology Laboratory (EMBL), Structural and
Computational Biology Unit , Heidelberg , Germany.
(1613)afi National Institutes of Health, Cardiovascular Branch, NHLB , Bethesda
, MD , USA.
(1614)alz Rutgers New Jersey Medical School , Department of Cell Biology and
Molecular Medicine , Newark , NJ , USA.
(1615)ary Tel Aviv University, Sackler Faculty of Medicine , Department of Cell
and Developmental Biology , Tel Aviv , Israel.
(1616)bvx University of Texas, Health Science Center at San Antonio , Department
of Pathology , San Antonio , TX , USA.
(1617)ahv Nippon Medical School , Department of Cardiovascular Medicine , Tokyo
, Japan.
(1618)auh Tokushima University, Division of Molecular Genetics, Institute for
Enzyme Research , Tokushima , Japan.
(1619)nz Gunma University Graduate School of Medicine , Department of
Otolaryngology-Head and Neck Surgery , Gunma , Japan.
(1620)auj Tokyo Institute of Technology, Frontier Research Center , Yokohama ,
Japan.
(1621)anv Seoul National University , Department of Plant Science , Seoul ,
Korea.
(1622)apy Spanish National Cancer Research Centre (CNIO), Cell Division and
Cancer Group , Madrid , Spain.
(1623)avk UCL Cancer Institute, Samantha Dickson Brain Cancer Unit , London ,
UK.
(1624)bov University of Minnesota , Department of Surgery , Minneapolis , MN ,
USA.
(1625)bg Beckman Research Institute, City of Hope , Department of Neuroscience ,
Irell and Manella Graduate School of Biological Science , Duarte , CA , USA.
(1626)va Istituto Superiore di Sanità , Department of Haematology , Oncology and
Molecular Medicine , Rome , Italy.
(1627)brr Laboratoire Européen Performance Santé Altitude, EA 4604, University
of Perpignan Via Domitia , Font-Romeu , France.
(1628)axe Universidad Pablo de Olavide, Centro Andaluz de Biología del
Desarrollo (CABD), Consejo Superior de Investigaciones Científicas-Junta de
Andalucía , Sevilla , Spain.
(1629)awi Universidad de Castilla-La Mancha, Laboratorio de Oncología Molecular,
Centro Regional de Investigaciones Biomédicas , Albacete , Spain.
(1630)acp MedImmune, Respiratory, Inflammation and Autoimmunity Research
Department , Gaithersburg , MD , USA.
(1631)ag Albert Einstein College of Medicine, Departments of Pathology,
Microbiology and Immunology , New York , NY , USA.
(1632)bgv University of Camerino, School of Pharmacy, Section of Experimental
Medicine , Camerino, MC , Italy.
(1633)vk Jawaharlal Nehru University, School of Life Sciences , New Delhi ,
India.
(1634)bc Baylor College of Medicine , Department of Molecular and Human Genetics
, Houston , TX , USA.
(1635)bds University of Birmingham, Institute of Biomedical Research, Institute
of Cancer and Genomic Sciences, College of Medical and Dental Sciences ,
Edgbaston, Birmingham , UK.
(1636)ph Health Research Institute Germans Trias i Pujol , Badalona , Spain.
(1637)bgg University of California San Francisco , Department of Surgery , San
Francisco , CA , USA.
(1638)eu Chiba University, Medical Mycology Research Center , Chiba , Japan.
(1639)wy Kanazawa University Graduate School of Medical Sciences , Department of
Human Pathology , Kanazawa , Japan.
(1640)ob Gunma University, Laboratory of Molecular Traffic, Institute for
Moleclualr and Cellular Regulation , Gunma , Japan.
(1641)oa Gunma University, Laboratory of Molecular Membrane Biology, Institute
for Moleclualr and Cellular Regulation , Gunma , Japan.
(1642)bfn University of California San Diego , Department of Medicine , San
Diego , CA , USA.
(1643)acu Miami VA Healthcare System and University of Miami Miller School of
Medicine, Oncology/Hematology , Miami , FL , USA.
(1644)cp Cambridge University , Department of Medicine , Cambridge , UK.
(1645)nr Goethe University, Institue of Pharmacology and Toxicology , Frankfurt
am Main , Germany.
(1646)alg Research Center Borstel , Borstel , Germany.
(1647)bbg University Hospital Zürich, Division of Gastroenterology and Hepatolog
, Zürich , Switzerland.
(1648)bev University of Calgary, Faculty of Veterinary Medicine , Calgary, AB ,
Canada.
(1649)cao VU University, Medical Center , Academic Medical Center, Department of
Clinical Genetics and Alzheimer Center , Amsterdam , Netherlands.
(1650)cap Department of Genome Analysis , Amsterdam , Netherlands.
(1651)caq VU University, Departments of Functional Genomics and Molecular and
Cellular Neuroscience, Center for Neurogenomics and Cognitive Research ,
Amsterdam , Netherlands.
(1652)vg IUF-Leibniz Research Institute for Environmental Medicine , Duesseldorf
, Germany.
(1653)bte University of Rome "Tor Vergata" , Department of Biomedicine and
Prevention , Rome , Italy.
(1654)vn Jewish General Hospital , Department of Neurology and Neurosurgery ,
Department of Medicine , Montreal, Quebec , Canada.
(1655)abr McGill University, Lady Davis Institute for Medical Research ,
Montreal, Quebec , Canada.
(1656)afq National Institutes of Health, National Institute of Allergy and
Infectious Disease, Cytokine Biology Section , Bethesda , MD , USA.
(1657)bbq University Medical Centre Göttingen , Clinic for Neurology and
Department of Neuroimmunology , Göttingen , Germany.
(1658)po Systems-oriented Immunology and Inflammation Research, Helmholtz Centre
for Infection Research , Braunschweig , Germany.
(1659)aji Otto-von-Guericke-University Magdeburg, Institute of Molecular and
Clinical Immunology , Magdeburg , Germany.
(1660)bbf University Hospital Ulm, Sektion Experimentelle Anaestesiologie , Ulm
, Germany.
(1661)bzc University of Zürich, Institute of Physiology , Zürich , Switzerland.
(1662)buw University of Southern California , Department of Molecular
Microbiology and Immunology , Keck School of Medicine , Los Angeles , CA , USA.
(1663)pk Heidelberg University, Zentrum für Molekulare Biologie der Universität
Heidelberg (ZMBH) , Heidelberg , Germany.
(1664)abd Mayo Clinic , Department of Biochemistry , Rochester , MN , USA.
(1665)ln Forschungszentrum Juelich, ICS-6/Structural Biochemistry , Juelich ,
Germany.
(1666)ca Boston Children's Hospital, F.M. Kirby Neuroscience Center , Boston ,
MA , USA.
(1667)btc University of Rome "Sapienza" , Department of Medical-Surgical
Sciences and Biotechnologies , Latina , Italy.
(1668)amg Rutgers University-Robert Wood Johnson Medical School, Rutgers Cancer
Institute of New Jersey , Piscataway , NJ , USA.
(1669)tk Institute of Molecular Genetics, National Research Council , Pavia ,
Italy.
(1670)arg Sunnybrook Research Institute; and University of Toronto , Department
of Biochemistry , Toronto, Ontario , Canada.
(1671)pq Helsinki University , Department of Medical Genetics , Helsinki ,
Finland.
(1672)bsq University of Porto , Department of Biological Sciences , Faculty of
Pharmacy , Porto , Portugal.
(1673)acd Medical University of Graz, Division of Cardiology , Graz , Austria.
(1674)alh Rice University, Chemical and Biomolecular Engineering , Houston , TX
, USA.
(1675)bql University of Oslo, Centre for Molecular Medicine Norway (NCMM) , Oslo
, Norway.
(1676)ayb Universitat Politècnica de València, COMAV Institute , Valencia ,
Spain.
(1677)bhi University of Chile, Faculty of Medicine, ICBM, Molecular and Clinical
Pharmacology , Santiago , Chile.
(1678)de Cedars-Sinai Medical Center , Department of Medicine , Los Angeles , CA
, USA.
(1679)je Drexel University, College of Medicine , Department of Pathology ,
Philadelphia , PA , USA.
(1680)rt INRA, UR1067, Nutrion Métabolisme Aquaculture , St-Pée-sur-Nivelle ,
France.
(1681)caz Washington University , Department of Medicine , St. Louis , MO , USA.
(1682)wg Johns Hopkins University, School of Medicine, Institute for Cell
Engineering and McKusick-Nathans Institute of Genetic Medicine , Baltimore , MD
, USA.
(1683)bmo University of Louisville , Department of Physiology , Louisville , KY
, USA.
(1684)bza University of Zurich, Epidemiology, Biostatistics and Prevention
Institute , Zurich , Switzerland.
(1685)wu Kagoshima University, The Near-Future Locomoter Organ Medicine Creation
Course, Graduate School of Medical and Dental Sciences , Kagoshima , Japan.
(1686)jn Dulbecco Telethon Institute and Telethon Institute of Genetics and
Medicine (TIGEM) , Naples , Italy.
(1687)zs Lombardi Comprehensive Cancer Center, Georgetown University Medical
Center , Department of Oncology , Washington, DC , USA.
(1688)att Thomas Jefferson University, Sidney Kimmel Medical College ,
Philadelphia , PA , USA.
(1689)bnc University of Maryland , Department of Nutrition and Food Science ,
College Park , MD , USA.
(1690)k Academia Sinica, Institute of Molecular Biology , Taipei , Taiwan.
(1691)qm Hungkuang University , Department of Physical Therapy , Taichung ,
Taiwan.
(1692)agr National University of Ireland, Regenerative Medicine Institute ,
Galway , Ireland.
(1693)aon Shanghai Jiao Tong University, School of Medicine, Shanghai Institute
of Hypertension , Shanghai , China.
(1694)apm Soochow University, School of Pharmaceutical Science , Department of
Pharmacology and Laboratory of Aging and Nervous Diseases , Suzhou , China.
(1695)cr Capital Normal University , Beijing , China.
(1696)ahu NINDS, National Institutes of Health, Synaptic Function Section ,
Bethesda , MD , USA.
(1697)cbt Western University , Department of Obstetrics and Gynaecology ,
London, ON , Canada.
(1698)aqi St. Paul's Hospital, Centre for Heart Lung Innovation , Vancouver, BC
, Canada.
(1699)beh University of British Columbia , Department of Pathology and
Laboratory Medicine , Vancouver, BC , Canada.
(1700)bzg US Food and Drug Administration, National Center for Toxicological
Research, Division of Systems Biology , Jefferson , AR , USA.
(1701)btx University of Science and Technology of China, School of Life
Sciences, and Hefei National Laboratory for Physical Sciences at Microscale ,
Hefei, Anhui , China.
(1702)ccf Yamaguchi University, Joint Faculty of Veterinary Medicine, Laboratory
of Veterinary Hygiene , Yamaguchi , Japan.
(1703)aea NARO Institute of Floricultural Science , Tsukuba , Japan.
(1704)bpd University of Nagasaki, Molecular and Cellular Biology, Graduate
School of Human Health Science , Nagasaki , Japan.
(1705)aer National Chung-Hsing University, Institute of Biomedical Sciences,
College of Life Sciences , Taichung , Taiwan.
(1706)arj Taipei Medical University , Department of Biochemistry , College of
Medicine , Taipei City , Taiwan.
(1707)vt Jikei University School of Medicine, Research Center for Medical
Sciences, Division of Gene Therapy , Tokyo , Japan.
(1708)aun Tokyo Medical and Dental University, Medical Research Institute,
Pathological Cell Biology , Tokyo , Japan.
(1709)an Amorepacific Corporation RandD Center, Bioscience Research Institute ,
Gyeonggi , Korea.
(1710)xw Kobe University, Graduate School of Health Sciences, Laboratory of
Pathology, Division of Medical Biophysics , Hyogo , Japan.
(1711)aud Tohoku University, Laboratory of Bioindustrial Genomics, Graduate
School of Agricultural Science , Miyagi , Japan.
(1712)yx Kyoto University , Department of Cardiovascular Medicine , Kyoto ,
Japan.
(1713)zb Kyushu University , Department of Surgery and Science , Fukuoka ,
Japan.
(1714)aah Maastricht University, Medical Centre, NUTRIM , Department of
Molecular Genetics , Maastricht , The Netherlands.
(1715)cc Boston University , Department of Medicine , Boston , MA , USA.
(1716)abj McGill University , Department of Biochemistry , Montreal, Quebec ,
Canada.
(1717)xe Kaohsiung Veterans General Hospital , Department of Medical Education
and Research , Kaohsiung , Taiwan.
(1718)bkv University of Illinois at Chicago, Departments of Ophthalmology and
Microbiology and Immunology , Chicago , IL , USA.
(1719)aed National Academy of Sciences of Ukraine , Department of Biotechnology
and Microbiology , Lviv , Ukraine.
(1720)btm University of Rzeszow, Institute of Cell Biology , Rzeszow , Poland.
(1721)bfo University of California San Diego , Department of Pathology , La
Jolla , CA , USA.
(1722)ahk New York University School of Medicine, Departments of Neuroscience
and Physiology, and Psychiatry , New York , NY , USA.
(1723)id CSIR - Centre for Cellular and Molecular Biology , Hyderabad , India.
(1724)avg U.S. Food and Drug Administration, Center for Biologics Evaluation and
Research , Silver Spring , MD , USA.
(1725)avr Ulm University, Institute of Pharmacology of Natural Compounds and
Clinical Pharmacology , Ulm , Germany.
(1726)adj MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine
and BRC Translational Immunology Lab, NDM , Oxford , UK.
(1727)bdr University of Bern, Institute of Pharmacology , Bern , Switzerland.
(1728)bde University of Bari 'Aldo Moro', Division of Medical Genetics, DIMO,
School of Medicine , Bari , Italy.
(1729)brv University of Pittsburgh Cancer Institute, Hillman Cancer Center
Research Pavilion , Pittsburgh , PA , USA.
(1730)wi Johns Hopkins University, School of Medicine, Wilmer Eye Institute ,
Baltimore , MD , USA.
(1731)ahw North Dakota State University , Department of Chemistry and
Biochemistry , Fargo , ND , USA.
(1732)abg Mayo Clinic , Rochester , MN , USA.
(1733)akg Polish Academy of Sciences, Institute of Biochemistry and Biophysics ,
Warsaw , Poland.
(1734)dr Centre for Cellular and Molecular Biology, Council of Scientific and
Industrial Research , Hyderabad , India.
(1735)apr Sorbonne Universités, University Pierre and Marie Curie, Paris 6,
Brain and Spine Institute, INSERM U1127, CNRS UMR722 , Paris , France.
(1736)ix Democritus University of Thrace, Medical School , Department of
Pathology , Alexandroupolis , Greece.
(1737)mf Gdansk University of Technology , Department of Pharmaceutical
Technology and Biochemistry , Gdansk , Poland.
(1738)bqv University of Ottawa , Department of Cellular and Molecular Medicine ,
Faculty of Medicine , Ottawa, Ontario , Canada.
(1739)aar Masaryk University , Department of Biology , Faculty of Medicine ,
Brno , Czech Republic.
(1740)ahy Northeastern University , Department of Bioengineering , Boston , MA ,
USA.
(1741)acv Moffitt Cancer Center , Department of Tumor Biology , Tampa , FL ,
USA.
(1742)aao Mahidol University, Salaya Campus, Institute of Molecular Biosciences
, Nakorn Pathom , Thailand.
(1743)ym KU Leuven , Department of Imaging and Pathology , Leuven , Belgium.
(1744)bnw University of Michigan Medical School , Department of Internal
Medicine , Ann Arbor , MI , USA.
(1745)aif Norwegian Veterinary Institute , Oslo , Norway.
(1746)rf Indian Institute of Science, Microbiology and Cell Biology , Bangalore
, India.
(1747)ky Ewha W. University, Brain and Cognitive Sciences/Pharmacy , Seoul ,
Korea.
(1748)qx IIT University, School of Biotechnology , Orissa , India.
(1749)ap Applied Genetic Technologies Corporation , Alachua , FL , USA.
(1750)anz Shandong University , Department of Toxicology , Jinan, Shandong ,
China.
(1751)vm Jewish General Hospital, Bloomfield Centre for Research in Aging, Lady
Davis Institute for Medical Research , Montreal, Quebec , Canada.
(1752)zd La Trobe University , Department of Biochemistry and Genetics , La
Trobe Institute for Molecular Science , Melbourne , Victoria , Australia.
(1753)abv MD Anderson Cancer Center , Department of Cancer Biology , Houston ,
TX , USA.
(1754)abx MD Anderson Cancer Center , Department of Gynecologic Oncology and
Reproductive Medicine , Houston , TX , USA.
(1755)agu National University of Singapore , Department of Physiology ,
Singapore.
(1756)bfz University of California San Diego, School of Medicine , Department of
Psychiatry , La Jolla , CA , USA.
(1757)bmx University of Manchester, Institute of Cancer Sciences, Faculty of
Medical and Human Sciences , Manchester , UK.
(1758)car Wake Forest University , Department of Surgery and Cancer Biology ,
Winston-Salem , NC , USA.
(1759)aan Chulabhorn International College of Medicine, Thammasat University,
Pathum Thani, Thailand.
(1760)bop University of Minho, Molecular and Environmental Biology Centre
(CBMA)/Department of Biology , Braga , Portugal.
(1761)zl Leiden University, Institute of Biology , Leiden , The Netherlands.
(1762)ald Radboud University Nijmegen Medical Center , Department of Radiation
Oncology , Nijmegen , The Netherlands.
(1763)bdg University of Basel , Biozentrum, Basel , Switzerland.
(1764)bta University of Rochester Medical Center , Department of Pathology and
Laboratory Medicine , Rochester , NY , USA.
(1765)lh Flinders University, School of Biological Sciences, Bedford Park ,
South Australia , Australia.
(1766)bfp University of California San Diego , Department of Pediatrics ,
Division of Infectious Diseases , La Jolla , CA , USA.
(1767)eo Charité - Universitätsmedizin Berlin , Department of Anesthesiology and
Intensive Care Medicine , Campus Charité Mitte and Campus Virchow-Klinikum ,
Berlin , Germany.
(1768)blp University of Kentucky , Department of Toxicology and Cancer Biology,
Lexington , KY , USA.
(1769)ce Brescia University , Department of Clinical and Experimental Sciences ,
Brescia , Italy.
(1770)bmf University of Lille, INSERM UMR1011, Institut Pasteur de Lille, EGID ,
Lille , France.
(1771)bsm University of Pittsburgh, School of Medicine , Department of Surgery ,
Division of Endocrine Surgery , Pittsburgh , PA , USA.
(1772)gs Cincinnati Children's Hospital Medical Center, Division of Experimental
Hematology and Cancer Biology , Cincinnati , OH , USA.
(1773)bdi University of Bayreuth , Department of Biochemistry , Bayreuth ,
Germany.
(1774)bfl University of California San Diego , Department of Cellular and
Molecular Medicine , La Jolla , CA , USA.
(1775)bv Biomedical Research Foundation of the Academy of Athens, Laboratory of
Neurodegenerative Diseases , Athens , Attiki , Greece.
(1776)bfg University of California Irvine , Department of Psychiatry and Human
Behavior , Irvine , CA , USA.
(1777)ajd Oslo University Hospital , Department of Biochemistry , Institute for
Cancer Research , Oslo , Norway.
(1778)tm Institute of Nuclear Chemistry and Technology, Centre for Radiobiology
and Biological Dosimetry , Dorodna , Poland.
(1779)zm Leidos Biomedical Research, Inc., Frederick National Laboratory for
Cancer Research, Nanotechnology Characterization Lab, Cancer Research Technology
Program , Frederick , MD , USA.
(1780)jv Edinburgh Napier University, School of Life, Sport and Social Sciences
, Edinburgh , UK.
(1781)hl Columbia University , Department of Biological Sciences , New York , NY
, USA.
(1782)hm Columbia University , Department of Chemistry , New York , NY , USA.
(1783)vh J. Stefan Institute , Department of Biochemistry and Molecular and
Structural Biology , Ljubljana , Slovenia.
(1784)aaz Max Planck Institute of Biochemistry, Group Maintenance of Genome
Stability , Martinsried , Germany.
(1785)pn Heinrich-Heine-University, Institute of Molecular Medicine , Düsseldorf
, Germany.
(1786)bau University Hospital Aachen , IZKF and Department of Internal Medicine
III , Aachen , Germany.
(1787)ain Ohio State University, The James Comprehensive Cancer Center .
Department of Molecular Virology , Immunology and Medical Genetics and
Department of Surgery , Division of Surgical Oncology , Columbus , OH , USA.
(1788)aqt Stockholm University , Department of Neurochemistry , Stockholm ,
Sweden.
(1789)br Binghamton University, State University of New York , Binghamton , NY ,
USA.
(1790)tl Institute of Molecular Pathology and Biology, FMHS UO , Hradec Kralove
, Czech Republic.
(1791)bkm University of Hong Kong, Division of Oral and Maxillofacial Surgery,
Faculty of Dentistry , Hong Kong.
(1792)vq Jiangsu University , Department of Immunology , Zhenjiang, Jiangsu ,
China.
(1793)cy Case Western Reserve University, School of Medicine, Division of
Infectious Diseases and HIV Medicine , Department of Medicine , Cleveland , OH ,
USA.
(1794)atd The Scripps Research Institute , Department of Neuroscience , Jupiter
, FL , USA.
(1795)bvh University of Sydney , Department of Neurogenetics , Kolling Institute
, St Leonards, NSW , Australia.
(1796)om Hallym University, School of Medicine , Department of Physiology ,
Chuncheon , Korea.
(1797)aut Tongji University, School of Life Science and Technology , Shanghai ,
China.
(1798)bwh University of Texas, Medical Branch , Department of Microbiology and
Immunology , Galveston , TX , USA.
(1799)bkx University of Illinois at Chicago, Division of Gastroenterology and
Hepatology , Department of Medicine , Chicago , IL , USA.
(1800)kg Emory University, School of Medicine, Winship Cancer Institute ,
Atlanta , GA , USA.
(1801)adx Nanjing University, School of Life Sciences, State Key Laboratory of
Pharmaceutical Biotechnology , Nanjing, Jiangsu , China.
(1802)bof University of Michigan , Department of Radiation Oncology , Division
of Radiation and Cancer Biology , Ann Arbor , MI , USA.
(1803)ga Chinese University of Hong Kong, Institute of Digestive Diseases ,
Shatin, Hong Kong.
(1804)xq Keio University, School of Medicine , Medical Education Center , Tokyo
, Japan.
(1805)bwu University of Tokyo, Bioimaging Center, Graduate School of Frontier
Sciences , Chiba , Japan.
(1806)atz Tohoku University , Department of Neurology , Sendai , Japan.
(1807)alk RIKEN Global Research Cluster, Glycometabolome Team, Systems
Glycobiology Research Group , Saitama , Japan.
(1808)mx Georgetown University , Department of Pharmacology and Physiology ,
Washington, DC , USA.
(1809)boa University of Michigan , Department of Microbiology and Immunology ,
Ann Arbor , MI , USA.
(1810)zv University College London Cancer Institute , London , UK.
(1811)aac Lund University, Biomedical Centre , Department of Experimental
Medical Science , Lund , Sweden.
(1812)bmk University of Louisiana at Monroe, School of Pharmacy , Monroe , LA ,
USA.
(1813)akv Queen Mary University of London, Barts Cancer Institute, Center for
Molecular Oncology , London , UK.
(1814)azl Université Grenoble-Alpes, CEA-DSV-iRTSV-BGE-GenandChem, INSERM, U1038
, Grenoble , France.
(1815)kk Eötvös Loránd University , Department of Biological Anthropology ,
Budapest , Hungary.
(1816)aka Pennsylvania State University, College of Medicine , Hershey Cancer
Institute and Department of Pediatrics , Hershey , PA , USA.
(1817)aq Asahi University , Department of Internal Medicine , Gifu , Japan.
(1818)xl Kawasaki Medical School , Department of General Internal Medicine 4 ,
Okayama , Japan.
(1819)bje University of Exeter, School of Biosciences , Exeter , UK.
(1820)bxr University of Turin, Neuroscience Institute Cavalieri Ottolenghi ,
Turin , Italy.
(1821)azs Université Paris Descartes, Institut Cochin, Faculté de Médecine
Sorbonne Paris Cité , Paris , France.
(1822)aks Qingdao University , Department of Neurology , Qingdao Municipal
Hospital, School of Medicine , Qingdao, Shandong Province , China.
(1823)aap Malaysian Institute of Pharmaceuticals and Nutraceuticals , Pulau
Pinang , Malaysia.
(1824)bag Universiti Sains Malaysia, Advanced Medical and Dental Institute,
Ministry of Science, Technology and Innovation , Pulau Pinang , Malaysia.
(1825)buf University of South Alabama, Mitchell Cancer Institute , Mobile , AL ,
USA.
(1826)a A*STAR (Agency for Science, Technology and Research), Institute of
Molecular and Cell Biology , Singapore.
(1827)agx National University of Singapore, Department of Microbiology and
Immunology, Yong Loo Lin School of Medicine, National University Health System
(NUHS) , Singapore.
(1828)aup Tokyo Metropolitan Institute of Medical Science, Laboratory of Protein
Metabolism , Tokyo , Japan.
(1829)yr Kyoto Prefectural University of Medicine , Department of Basic
Geriatrics , Kyoto , Japan.
(1830)fw Chinese Academy of Sciences, State Key Laboratory of Plant Cell and
Chromosome Engineering, Institute of Genetics and Developmental Biology ,
Beijing , China.
(1831)wq Juntendo University, School of Medicine , Department of Cell Biology
and Neuroscience , Tokyo , Japan.
(1832)ps Hirosaki University Graduate School of Medicine , Hirosaki , Japan.
(1833)aav Massachusetts General Hospital and Harvard Medical School,
Experimental Therapeutics and Molecular Imaging Laboratory, Neuroscience Center
, Charlestown , MA , USA.
(1834)ade Icahn School of Medicine at Mount Sinai , Department of Pharmacology
and Systems Therapeutics , New York , NY , USA.
(1835)lp Foundation for Research and Technology - Hellas , Heraklion, Crete ,
Greece.
(1836)bim University of Crete , Department of Basic Sciences , Faculty of
Medicine , Heraklion, Crete , Greece.
(1837)bin University of Crete, Institute of Molecular Biology and Biotechnology
, Heraklion, Crete , Greece.
(1838)ave Tufts University, USDA Human Nutrition Research Center on Aging ,
Boston , MA , USA.
(1839)bdt University of Birmingham, Institute of Immunology and Immunotherapy ,
Birmingham, West Midlands , UK.
(1840)jj Duke University, Medical Center , Department of Medicine , Durham , NC
, USA.
(1841)jo Durham VA Medical Center, GRECC , Durham , NC , USA.
(1842)aqa Howard Hughes Medical Institute, St. Jude Children's Research
Hospital, Cell and Molecular Biology , Memphis , TN , USA.
(1843)zr Liverpool School of Tropical Medicine , Department of Parasitology ,
Liverpool, Merseyside , UK.
(1844)aec Nasonova Research Institute of Rheumatology, Immunology and Molecular
Biology Laboratory , Moscow , Russia.
(1845)cs Cardiff University, Heath Park, Institute of Cancer and Genetics ,
Cardiff , Wales , UK.
(1846)sf INSERM U955, Faculté de Médecine de Créteil, UMR-S955 , Créteil ,
France.
(1847)baa Université Paris-Est, Institut Mondor de Recherche Biomédicale , Paris
, France.
(1848)gh Chulalongkorn University , Department of Clinical Chemistry , Faculty
of Allied Health Sciences , Bangkok , Thailand.
(1849)bvs University of Texas, Health Science Center at Houston, Center for
Human Genetics, Institute of Molecular Medicine , Houston , TX , USA.
(1850)aca Medical College of Wisconsin , Department of Pediatrics , Milwaukee ,
WI , USA.
(1851)bmg University of Limoges , Department of Histology and Cell Biology ,
Limoges , France.
(1852)bd Baylor University Medical Center , Department of Internal Medicine ,
Division of Gastroenterology, Baylor Research Institute , Dallas , TX.
(1853)hg Colorado Mesa University , Department of Biological Sciences , Grand
Junction , CO , USA.
(1854)or Hannover Medical School, Institute of Molecular and Translational
Therapeutic Strategies (IMTTS) , Hannover , Germany.
(1855)qz Imperial College London, MRC Centre for Molecular Bacteriology and
Infection , London , UK.
(1856)bdy University of Bonn, Institute of Reconstructive Neurobiology , Bonn ,
Germany.
(1857)bfx University of California San Diego, San Diego Center for Systems
Biology , La Jolla , CA , USA.
(1858)bpy University of North Carolina , Department of Microbiology-Immunology ,
Chapel Hill , NC , USA.
(1859)bqa University of North Carolina, Lineberger Comprehensive Cancer Center,
Institute of Inflammatory Diseases, Center for Translational Immunology , Chapel
Hill , NC , USA.
(1860)ht Concordia University , Biology Department , Montreal, Quebec , Canada.
(1861)bei University of British Columbia , Department of Psychiatry , Vancouver,
BC , Canada.
(1862)cac Virginia Commonwealth University, Internal Medicine, VCU Pauley Heart
Center , Richmond , VA , USA.
(1863)zu London Research Institute, Cancer Research UK , London , UK.
(1864)vo Jewish General Hospital , Department of Oncology , Montreal, Quebec ,
Canada.
(1865)ajb Oslo University Hospital, Centre for Cancer Biomedicine , Oslo ,
Norway.
(1866)asy The Norwegian Radium Hospital, Faculty of Medicine , Oslo , Norway.
(1867)bqm University of Oslo , Department of Biochemistry , Institute for Cancer
Research , Oslo , Norway.
(1868)bmw University of Manchester, Faculty of Life Sciences , Manchester , UK.
(1869)bny University of Michigan , Ann Arbor , MI , USA.
(1870)bdm University of Belgrade, School of Medicine , Belgrade , Serbia.
(1871)la Federal University of Rio de Janeiro, Institute of Biophysics Carlos
Chagas Filho, Laboratory of Immunoreceptors and Signaling , Rio de Janeiro ,
Brazil.
(1872)tb Institute of Advanced Chemistry of Catalonia, Spanish Research Council
(IQAC-CSIC) , Department of Biomedicinal Chemistry , Barcelona , Spain.
(1873)asg Texas A&M University Health Science Center, Center for Translational
Cancer Research, Institute of Bioscience and Technology , Houston , TX , USA.
(1874)alf Regina Elena National Cancer Institute, Experimental Chemotherapy
Laboratory , Rome , Italy.
(1875)awj Universidad de Chile, Advanced Center for Chronic Diseases (ACCDiS),
Facultad de Ciencias Químicas y Farmacéuticas , Santiago , Chile.
(1876)awn Universidad de Chile, Instituto de Nutrición y Tecnología de los
Alimentos (INTA) , Santiago , Chile.
(1877)aen National Cheng Kung University, Institute of Clinical Medicine ,
Tainan , Taiwan.
(1878)bdo University of Bern, Division of Experimental Pathology, Institute of
Pathology , Bern , Switzerland.
(1879)adp Nagasaki University, Division of Dental Pharmacology, Graduate School
of Biomedical Sciences , Nagasaki , Japan.
(1880)brx University of Pittsburgh Medical Center , Department of Surgery ,
Pittsburgh , PA , USA.
(1881)bwk University of Texas, Medical School at Houston , Department of
Neurobiology and Anatomy , Houston , TX , USA.
(1882)aos Shanghai Jiao Tong University, School of Medicine, Renji Hospital ,
Shanghai , China.
(1883)bdd University of Bari 'Aldo Moro' , Department of Biomedical Sciences and
Clinical Oncology , Bari , Italy.
(1884)buv University of Southampton, Centre for Biological Sciences, Highfield
Campus , Southampton , UK.
(1885)bem University of British Columbia, Michael Smith Laboratories ,
Vancouver, British Columbia , Canada.
(1886)ajc Oslo University Hospital, Centre for Immune Regulation , Oslo ,
Norway.
(1887)bmr University of Louisville, School of Medicine , Department of
Physiology and Biophysics , Louisville , KY , USA.
(1888)pv Hokkaido University, Research Faculty of Agriculture , Sapporo , Japan.
(1889)ajh Otto-von-Guericke-University Magdeburg , Department of General ,
Visceral and Vascular Surgery , Magdeburg , Germany.
(1890)wp Juntendo University, Graduate School of Medicine, Laboratory of
Proteomics and Biomolecular Science , Tokyo , Japan.
(1891)alm Ritsumeikan University , Department of Biotechnology , Shiga , Japan.
(1892)aig Obihiro University of Agriculture and Veterinary Medicine, National
Research Center for Protozoan Diseases , Obihiro, Hokkaido , Japan.
(1893)bh Beechcroft, Fulbourn Hospital , Cambridge , UK.
(1894)bqu University of Osnabrueck, Fachbereich Biologie/Chemie , Osnabrueck ,
Germany.
(1895)yv Kyoto Sangyo University , Department of Molecular Biosciences , Faculty
of Life Sciences , Kyoto , Japan.
(1896)bur University of South Florida , Department of Molecular Medicine , Tampa
, FL , USA.
(1897)dm Central University of Venezuela, Institute for Anatomy , Caracas ,
Venezuela.
(1898)qw IFOM - The FIRC Institute of Molecular Oncology , Milan , Italy.
(1899)bep University of Buenos Aires, National Council for Scientific and
Technical Research (CONICET), Institute for Biochemistry and Molecular Medicine
, Department of Pathophysiology , School of Pharmacy and Biochemistry , Buenos
Aires , Argentina.
(1900)ti Institute of Microbiology ASCR, v.v.i. , Prague , Czech Republic.
(1901)bpc University of Murcia-IMIB Virgen de la Arrixaca Hospital, Human
Anatomy and Psycobiology Department, Cell Therapy and Hematopoietic
Transplantation Unit , Murcia , Spain.
(1902)btq University of Salerno, Section of Neurosciences , Department of
Medicine and Surgery , Salerno , Italy.
(1903)azf Université de Nantes, CRCNA, UMRINSERM 892/CNRS 6299 , Nantes ,
France.
(1904)tq Instituto de Investigaciones Biomédicas Alberto Sols, CSIC/UAM , Madrid
, Spain.
(1905)yi KU Leuven and VIB, Vesalius Research Center, Laboratory of Neurobiology
, Leuven , Belgium.
(1906)l Academic Medical Center , Department of Gastroenterology and Hepatology
, Amsterdam , The Netherlands.
(1907)bkf University of Groningen, Molecular Cell Biology , Groningen , The
Netherlands.
(1908)kn Erasmus MC-University Medical Center Rotterdam , Department of Surgery
, Rotterdam , The Netherlands.
(1909)bfd University of California Davis, Mann Laboratory , Department of Plant
Sciences , Davis , CA , USA.
(1910)cal VU University Medical Center , Department of Molecular Cell Biology
and Immunology , Amsterdam , The Netherlands.
(1911)asv The Helen F. Graham Cancer Center , Newark , DE , USA.
(1912)bis University of Delaware , Department of Biological Sciences , Newark ,
DE , USA.
(1913)bit University of Delaware, The Center for Translational Cancer Research ,
Newark , DE , USA.
(1914)bzt Vanderbilt University, School of Medicine , Department of Pathology ,
Microbiology and Immunology , Nashville , TN , USA.
(1915)mk Genentech Inc. , Department of Immunology , South San Francisco , CA ,
USA.
(1916)nm Ghent University , Department of Biomedical Molecular Biology ,
Inflammation Research Center, VIB, Methusalem Program , Gent , Belgium.
(1917)bbi University Hospitals Leuven , Department of Neurology , Leuven ,
Belgium.
(1918)bmc University of Leuven , Department of Neurosciences , Leuven , Belgium.
(1919)ic CSIC-UAM and CIBERER, Institute for Biomedical Research "Alberto Sols"
, Madrid , Spain.
(1920)mq Georg-August-University Göttingen , Department of Nephrology and
Rheumatology , Göttingen , Germany.
(1921)bhq University of Coimbra, CNC-Center for Neuroscience and Cell Biology ,
Cantanhede , Portugal.
(1922)bbm University Medical Center Groningen, University of Groningen ,
Department of Hematology , Groningen , The Netherlands.
(1923)c Aarhus University Hospital, Department of Nuclear Medicine and PET
Center , Aarhus , Denmark.
(1924)bvz University of Texas, Health Sciences Center-Houston (UTHSC) ,
Department of Integrative Biology and Pharmacology , Houston , TX , USA.
(1925)pl Heinrich Heine University, Institute of Clinical Chemistry and
Laboratory Diagnostic, Medical Faculty , Duesseldorf , Germany.
(1926)axy Universitat Autònoma de Barcelona, Institut de Biotecnologia i
Biomedicina and Departament de Bioquímica i Biologia Molecular , Bellaterra
(Barcelona) , Spain.
(1927)nu Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, FIOCRUZ-BA,
Laboratory of Pathology and Biointervention , Salvador, BA , Brazil.
(1928)ayt Université de Limoges, EA 3842, LHCP, Faculté de Médecine , Limoges ,
France.
(1929)cn Budapest University of Technology and Economics, Institute of
Enzymology, RCNC , HAS and Department of Applied Biotechnology , Budapest ,
Hungary.
(1930)abw MD Anderson Cancer Center , Department of Genomic Medicine , Houston ,
TX , USA.
(1931)bbv University Montpellier, UMR5235 , Montpellier , France.
(1932)axo Universidade Nova de Lisboa, CEDOC, NOVA Medical School , Lisboa ,
Portugal.
(1933)bvu University of Texas, Health Science Center at Houston, School of
Dentistry , Houston , TX , USA.
(1934)dk Central Michigan University, College of Medicine , Mt. Pleasant , MI ,
USA.
(1935)ax Autonomous University of Barcelona (UAB) , Department of Biochemistry
and Molecular Biology , Barcelona , Spain.
(1936)cz Catalan Institution for Research and Advanced Studies (ICREA) ,
Barcelona , Spain.
(1937)ahc Neurodegenerative Diseases Research Group, Vall d'Hebron Research
Institute-CIBERNED , Barcelona , Spain.
(1938)bxi University of Toulouse, INSERM UMR 1048 , Toulouse , France.
(1939)brd University of Padova , Department of Woman's and Child's Health ,
Laboratory of Oncohematology , Padova , Italy.
(1940)bon University of Milan, Istituto Auxologico Italiano , Department of
Clinical Sciences and Community Health , Milan , Italy.
(1941)xy Komarov Botanical Institute RAS, Plant Ecological Physiology Laboratory
, Saint Petersburg , Russian Federation.
(1942)aab Ludwig-Maximilians-University Munich , Department of Pharmacy , Munich
, Germany.
(1943)bcs University of Arkansas for Medical Sciences , Department of
Microbiology and Immunology , Little Rock , AR , USA.
(1944)bpv University of Nice-Sophia Antipolis, IRCAN , Nice , France.
(1945)aaw Massachusetts General Hospital, Division of Infectious Disease ,
Boston , MA , USA.
(1946)bao University College Cork, School of Pharmacy , Department of
Pharmacology and Therapeutics , Cork , Ireland.
(1947)bsv University of Queensland, Australian Infectious Diseases Research
Centre and School of Chemistry and Molecular Biosciences , Brisbane , Queensland
, Australia.
(1948)bdw University of Bonn , Department of Neurology , Bonn , Germany.
(1949)au Asia University , Department of Biotechnology , Taichung , Taiwan.
(1950)fc China Medical University, School of Chinese Medicine , Taichung ,
Taiwan.
(1951)api Sixth Affiliated Hospital of Sun Yat-Sen University, Gastrointestinal
Institute , Department of Radiation Oncology , Guangzhou, Guangdong , China.
(1952)akr Qilu Hospital of Shandong University , Department of Traditional
Chinese Medicine , Jinan , China.
(1953)eg Chang Gung University, Chang Gung Memorial Hospital , Department of
Cardiology , Internal Medicine , Taoyuan , Taiwan.
(1954)fo Chinese Academy of Sciences, Institute of Plant Physiology and Ecology,
Shanghai Institutes for Biological Sciences , Shanghai , China.
(1955)jq East China Normal University, School of Life Science , Shanghai ,
China.
(1956)ot Harbin Medical University, College of Bioinformatics Science and
Technology , Harbin, Heilongjiang , China.
(1957)ase Texas A&M Health Science Center, Center for Cancer and Stem Cell
Biology, Institute of Biosciences and Technology , Houston , TX , USA.
(1958)fn Chinese Academy of Sciences, Institute of Microbiology , Beijing ,
China.
(1959)apj Soochow University, College of Pharmaceutical Sciences , Jiangsu ,
China.
(1960)aot Shanghai Medical School of Fudan University , Department of Anatomy ,
Histology and Embryology , Shanghai , China.
(1961)ahx North Shore University Hospital , Department of Emergency Medicine ,
Manhasset , NY , USA.
(1962)ajw Pennsylvania State University, College of Medicine , Department of
Pediatrics , Hershey , PA , USA.
(1963)bun University of South Dakota, Sanford School of Medicine, Division of
Basic Biomedical Sciences , Vermillion , SD , USA.
(1964)agn National Tsing Hua University, Institute of Biotechnology, Institute
of Systems Neuroscience , and Department of Life Science , HsinChu City ,
Taiwan.
(1965)bbu University Montpellier 1, INSERM U1051 , Montpellier , France.
(1966)ey China Agricultural University, College of Animal Science and
Technology, State Key Laboratory of Animal Nutrition , Beijing , China.
(1967)lr Fourth Military Medical University , Department of Oral Anatomy and
Physiology and TMD , College of Stomatology , Xi'an , China.
(1968)agj National Taiwan University, Graduate Institute of Brain and Mind
Sciences, College of Medicine , Taipei , Taiwan.
(1969)bwm University of Texas, Southwestern Medical Center at Dallas ,
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(1970)fi Chinese Academy of Sciences, CAS Key Laboratory of Infection and
Immunity, Institute of Biophysics , Beijing , China.
(1971)aph Sir Runrun Shaw Hospital, Medical School of Zhejiang University ,
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(1972)ccp Zhejiang Cancer Hospital , Department of Medical Oncology , Hangzhou ,
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(1973)ccw Zhejiang University, Institute of Insect Science , Hangzhou , China.
(1974)ch Brigham and Women's Hospital, Harvard Medical School , Department of
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(1975)buo University of South Dakota , Vermillion , SD , USA.
(1976)akb Pennsylvania State University , Department of Biochemistry and
Molecular Biology , Center for Eukaryotic Gene Regulation , University Park , PA
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(1977)bk Beijing Jishuitan Hospital , Department of Molecular Orthopedics ,
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(1978)aeo National Cheng Kung University, Medical College , Department of
Environmental and Occupational Health , Tainan , Taiwan.
(1979)bkl University of Hong Kong , Department of Pharmacology and Pharmacy ,
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(1980)bef University of British Columbia , Department of Medicine and Brain
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(1981)en Changzheng Hospital, The Second Military Medical University ,
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(1982)tw Instituto Leloir , Buenos Aires , Argentina.
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(1984)akx Queen Mary University of London, Blizard Institute, Flow Cytometry
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(1985)yt Kyoto Prefectural University of Medicine , Department of Basic
Geriatrics, Kyoto , Japan.
(1986)aul Tokyo Medical and Dental University, Center for Brain Integration
Research, Bunkyo , Tokyo , Japan.
(1987)bhk University of Cincinnati College of Medicine, Cincinnati Children's
Research Foundation and Department of Pediatrics , Cincinnati , OH , USA.
(1988)bhz University of Colorado Denver, Division of Medical Oncology ,
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(1989)adw Nanjing University, Jiangsu Key Laboratory of Molecular Medicine,
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(1990)bbe University Hospital of Muenster , Department of Internal Medicine D ,
Molecular Nephrology , Muenster , Germany.
(1991)cbc Washington University, School of Medicine , Department of Neurology ,
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(1992)lv Freie Universität Berlin, Institute of Pharmacy (Pharmacology and
Toxicology) , Berlin , Germany.
(1993)axf Universidade de Brasília , Departamento de Biologia Celular ,
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(1994)aqn Stanford University, School of Medicine , Stanford , CA , USA.
(1995)bnr University of Melbourne , Department of Pathology , Parkville ,
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(1996)ame Rutgers University, The State University of New Jersey, Rutgers Cancer
Institute of New Jersey , New Brunswick , NJ , USA.
(1997)adl MRC Mitochondrial Biology Unit , Cambridge , UK.
(1998)baf Université Paris-Sud, Université Paris-Saclay, UMR 8126CNRS, Institut
Gustave Roussy , Villejuif , France.
(1999)biw University of East Anglia, Norwich Medical School , Norfolk , UK.
(2000)bjb University of Edinburgh, Edinburgh Cancer Research UK Centre, MRC
Institute of Genetics and Molecular Medicine , Edinburgh , UK.
(2001)pm Heinrich-Heine-University , Institut für Physikalische Biologie,
Duesseldorf , Germany.
(2002)bw Biomolecular Sciences and Biotechnology Institute (GBB) , Groningen ,
The Netherlands.
(2003)afm National Institutes of Health, Laboratory of Clinical Infectious
Diseases, National Institute of Allergy and Infectious Diseases , Bethesda , MD
, USA.
(2004)alt Ruhr University Bochum , Department of Molecular Cell Biology ,
Institute of Biochemistry and Pathobiochemistry , Bochum , Germany.
(2005)cbl Weill Cornell Medical College , Department of Obstetrics and
Gynecology , New York , NY , USA.
(2006)bjl University of Florida , Department of Animal Sciences , IFAS/College
of Agriculture and Life Science , Gainesville , FL , USA.
(2007)aba Max Planck Institute of Biochemistry, Molecular Membrane and Organelle
Biology , Martinsried , Germany.
(2008)bsw University of Queensland, Australian Institute for Bioengineering and
Nanotechnology (AIBN) , Brisbane , Australia.
(2009)adz Nanyang Technological University, School of Biological Sciences ,
Singapore.
(2010)we Johns Hopkins University, School of Medicine , Department of Physiology
and Center for Metabolism and Obesity Research , Baltimore , MD , USA.
(2011)wz Kanazawa University, Cell-bionomics Unit and Laboratory of Molecular
and Cellular Biology , Department of Biology , Faculty of Natural Systems,
Institute of Science and Engineering , Ishikawa , Japan.
(2012)ba Baker IDI Heart and Diabetes Institute, Molecular Cardiology Laboratory
, Melbourne , Australia.
(2013)zj Lancaster University, Faculty of Health and Medicine, Division of
Biomedical and Life Sciences , Lancaster , UK.
(2014)zz Louisiana State University Health Sciences Center, Neuroscience Center
of Excellence , New Orleans , LA , USA.
(2015)qt Icahn School of Medicine at Mount Sinai , New York , NY , USA.
(2016)cbj Wayne State University, School of Medicine , Departments of Oncology
and Pathology , Detroit , MI , USA.
(2017)lz Fudan University Shanghai Medical College, Key Laboratory of Molecular
Virology , Shanghai , China.
(2018)bnf University of Maryland, School of Medicine , Department of
Anesthesiology and Center for Shock , Trauma and Anesthesiology Research (STAR),
National Study Center for Trauma and EMS , Baltimore , MD , USA.
(2019)bty University of Science and Technology of China, School of Life Sciences
, Hefei, Anhui , China.
(2020)bqc University of North Dakota , Department of Biomedical Sciences ,
School of Medicine and Health Sciences , Grand Forks , ND , USA.
(2021)fx Chinese University of Hong Kong , Department of Anaesthesia and
Intensive Care , Hong Kong.
(2022)ez China Agricultural University , Department of Animal Nutrition and Feed
Science , Beijing , China.
(2023)ow Harvard Medical School and Broad Institute , Boston , MA , USA.
(2024)bfi University of California Los Angeles , Department of Medicine , Los
Angeles , CA , USA.
(2025)aog Shanghai Jiao Tong University, School of Biomedical Engineering and
Med-X Research Institute , Shanghai , China.
(2026)aoz Sichuan University, Aging Research Group, State Key Lab for
Biotherapy, West China Hospital , Chengdu , China.
(2027)anh Second Military Medical University , Department of Cardiothoracic
Surgery , Changzheng Hospital , Shanghai , China.
(2028)ard Sun Yat-Sen University, State Key Laboratory of Biocontrol, School of
Life Sciences , Guangzhou , China.
(2029)fm Chinese Academy of Sciences, Institute of Hydrobiology , Wuhan, Hubei ,
China.
(2030)boe University of Michigan , Department of Radiation Oncology , Ann Arbor
, MI , USA.
(2031)aoh Shanghai Jiao Tong University, School of Life Sciences and
Biotechnology , Shanghai , China.
(2032)bqj University of Oklahoma, Health Sciences Center, Section of Molecular
Medicine , Department of Medicine , Oklahoma City , OK , USA.
(2033)bu Biomedical Research Foundation of the Academy of Athens, Center of
Clinical, Experimental Surgery and Translational Research , Athens , Greece.
(2034)gc Chinese University of Hong Kong, School of Chinese Medicine, Faculty of
Medicine , Shatin, NT, Hong Kong.
(2035)md Fudan University , Department of Neurosugery , Shanghai , China.
(2036)ou Harbin Medical University , Department of Immunology , Heilongjiang
Provincial Key Laboratory for Infection and Immunity , Harbin , China.
(2037)bqh University of Oklahoma Health Sciences Center , Department of Medicine
, Oklahoma City , OK , USA.
(2038)aox Shantou University Medical College , Department of Biochemistry and
Molecular Biology , Shantou , China.
(2039)vu Jilin Medical University, Medical Research Laboratory , Jilin City,
Jilin Province , China.
(2040)bca University of Alabama at Birmingham , Department of Medicine ,
Division of Hematology and Oncology, Comprehensive Cancer Center , Birmingham ,
AL , USA.
(2041)pt Hokkaido University Graduate School of Medicine , Department of
Obstetrics and Gynecology , Sapporo , Hokkaido , Japan.
(2042)ho Columbia University , Department of Neurology , New York , NY , USA.
(2043)adr Nagoya University, Research Institute of Environmental Medicine,
Nagoya , Aichi , Japan.
(2044)wr Juntendo University, School of Medicine , Department of
Gastroenterology , Tokyo , Japan.
(2045)amb Rutgers University, Molecular Biology and Biochemistry , Piscataway ,
NJ , USA.
(2046)aoa Shandong University, School of Chemistry and Chemical Engineering,
Jinan , Shandong , China.
(2047)vy Jining Medical University, Shandong Provincial Sino-US Cooperation
Research Center for Translational Medicine , Shandong , China.
(2048)qi Huazhong Agricultural University, College of Animal Sciences and
Technology, Wuhan , Hubei , China.
(2049)byj University of Virginia , Charlottesville , VA , USA.
(2050)apg Singapore Eye Research Institute, Singapore National Eye Center ,
Singapore.
(2051)ahj New York University Langone Medical Center, Nathan Kline Institute for
Psychiatric Research , Orangeburg , NY , USA.
(2052)ajy Pennsylvania State University, College of Medicine , Department of
Pharmacology , Pennsylvania State University Hershey Cancer Institute , Hershey
, PA , USA.
(2053)asr The Fourth Military Medical University, Institute of Orthopaedics,
Xijing Hospital , Xi'an, Shanxi , China.
(2054)arl Taipei Medical University, Graduate Institute of Cancer Biology and
Drug Discovery, College of Medical Science and Technology , Taipei , Taiwan.
(2055)bnj University of Maryland, School of Medicine , Department of Obstetrics
, Gynecology and Reproductive Sciences , Baltimore , MD , USA.
(2056)ast The Fourth Military Medical University , Xi'an , China.
(2057)mi Geisinger Clinic, Weis Center for Research , Danville , PA , USA.
(2058)vx Jinan University, Medical College, Division of Histology and Embryology
, Guangzhou, Guangdong , China.
(2059)oo Hangzhou Normal University , Department of Pharmacology , School of
Medicine , Hangzhou , China.
(2060)aof Shanghai Jiao Tong University , Department of Endocrinology and
Metabolism , Affiliated Sixth People's Hospital, Shanghai Diabetes Institute,
Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for
Diabetes , Shanghai , China.
(2061)aqk Stanford University , Department of Radiation Oncology , Stanford , CA
, USA.
(2062)bjs University of Fribourg , Department of Medicine , Division of
Physiology, Faculty of Science , Fribourg , Switzerland.
(2063)afs National Institutes of Health, National Institute on Aging, Biomedical
Research Center, Laboratory of Neurosciences , Baltimore , MD , USA.
(2064)in Dalian Medical University , Department of Environmental and
Occupational Hygiene , Dalian , China.
(2065)fr Chinese Academy of Sciences, Shenzhen Institutes of Advanced Technology
, Guangdong , China.
(2066)ahz Northern Illinois University , Department of Biological Sciences ,
DeKalb , IL , USA.
(2067)lq Fourth Military Medical University , Department of Biochemistry and
Molecular Biology , Xi'an , China.
(2068)jy Emory University , Department of Biology , Atlanta , GA , USA.
(2069)bxc University of Toronto, Hospital for Sick Children Research Institute ,
Department of Physiology and Experimental Medicine , Toronto , Canada.
(2070)acj Medical University of South Carolina , Department of Cell and
Molecular Pharmacology and Experimental Therapeutics , Charleston , SC , USA.
(2071)jw Edinburgh University, MRC Human Genetics Unit , Edinburgh , UK.
(2072)aoc Shandong University, School of Medicine , Department of Pharmacology ,
Jinan, Shandong Province , China.
(2073)bed University of British Columbia , Department of Biochemistry and
Molecular Biology , Vancouver, British Columbia , Canada.
(2074)ccl Yonsei University , Department of Biomedical Engineering , College of
Health Science , Seoul , Korea.
(2075)bxy University of Ulsan College of Medicine , Department of Brain Science
, Seoul , Korea.
(2076)acq Meiji University , Department of Life Sciences , Kanagawa , Japan.
(2077)aiw Osaka University , Department of Genetics , Graduate School of
Medicine, Laboratory of Intracellular Membrane Dynamics, Graduate School of
Frontier Biosciences , Osaka , Japan.
(2078)bwc University of Texas, MD Anderson Cancer Center , Department of
Hematopathology , Houston , TX , USA.
(2079)vp Jiangsu Institute of Nuclear Medicine , Wuxi, Jiangsu , China.
(2080)fz Chinese University of Hong Kong, Institute of Digestive Diseases ,
Department of Medicine and Therapeutics , State Key Laboratory of Digestive
Disease , Hong Kong.
(2081)avc Tsinghua University, State Key Laboratory of Biomembrane and Membrane
Biotechnology, Tsinghua University-Peking University Joint Center for Life
Sciences, School of Life Science , Beijing , China.
(2082)hp Columbia University, Taub Institute for Alzheimer's Disease Research ,
Department of Pathology and Cell Biology , New York , NY , USA.
(2083)le First Hospital of Jilin University , Changchun, Jilin , China.
(2084)atm Third Military Medical University , Department of Occupational Health
, Chongqing , China.
(2085)pg Harvard University, School of Public Health , Department of Genetics
and Complex Diseases , Boston , MA , USA.
(2086)bks University of Illinois at Chicago, College of Medicine , Department of
Ophthalmology and Visual Sciences , Chicago , IL , USA.
(2087)qs Icahn School of Medicine at Mount Sinai, Friedman Brain Institute , New
York , NY , USA.
(2088)bod University of Michigan , Department of Ophthalmology and Visual
Sciences , Ann Arbor , MI , USA.
(2089)auu Toronto General Research Institute - University Health Network,
Division of Advanced Diagnostics , Toronto, Ontario , Canada.
(2090)akz Queens College of the City University of New York , Department of
Biology , Flushing , NY , USA.
(2091)aqy Sun Yat-Sen University , Department of Neurology and Stroke Center ,
The First Affiliated Hospital , Guangzhou , China.
(2092)ata The People's Hospital of Hainan Province, Medical Care Center, Haikou
, Hainan , China.
(2093)bha University of Central Florida College of Medicine, Burnett School of
Biomedical Sciences , Orlando , FL , USA.
(2094)bzp Vancouver Prostate Centre , Vancouver, BC , Canada.
(2095)asz The People's Hospital of Guangxi Zhuang Autonomous Region , Department
of Gastroenterology , Nanning , Guangxi , China.
(2096)bkz University of Illinois at Urbana-Champaign, Institute for Genomic
Biology , Urbana , IL , USA.
(2097)aow Shantou University Medical College, Cancer Research Center, Shantou ,
Guangdong , China.
(2098)fl Chinese Academy of Sciences, Institute of Biophysics, State Key
Laboratory of Biomacromolecules , Beijing , China.
(2099)ajp Peking University First Hospital, Renal Division , Beijing , China.
(2100)fd Chinese Academy of Medical Sciences and Peking Union Medical College ,
Department of Physiology , Institute of Basic Medical Sciences , Beijing ,
China.
(2101)ajo Peking University First Hospital , Department of Internal Medicine ,
Beijing , China.
(2102)ls Fourth Military Medical University , Department of Pulmonary Medicine ,
Xijing Hospital , Xi'an, Shaanxi Province , China.
(2103)ash Texas A&M University Health Science Center, Center for Translational
Cancer Research, Institute of Biosciences and Technology , Houston , TX , USA.
(2104)brq University of Pennsylvania , Department of Obstetrics and Gynecology ;
Perelman School of Medicine , Philadelphia , PA , USA.
(2105)bsl University of Pittsburgh, School of Medicine , Department of
Pharmacology and Chemical Biology , Pittsburgh , PA , USA.
(2106)ccy Zhejiang University, Life Sciences Institute , Zhejiang , China.
(2107)fs Chinese Academy of Sciences, South China Botanical Garden , Guangzhou ,
China.
(2108)bpq University of Newcastle, School of Biomedical Sciences and Pharmacy ,
Newcastle, NSW , Australia.
(2109)any Shandong Agricultural University, State Key Laboratory of Crop Science
, Tai'an , China.
(2110)bnd University of Maryland , Department of Veterinary Medicine , College
Park , MD , USA.
(2111)ccb Xijing Hospital, The Fourth Military Medical University , Xi'an ,
China.
(2112)cbz Xi'an Jiaotong University Health Center , Department of Pharmacology ,
Xi'an, Shaanxi , China.
(2113)aop Shanghai Jiao Tong University, School of Medicine, State Key
Laboratory of Medical Genomics; Shanghai Institute of Hematology; Shanghai Rui
Jin Hospital , Shanghai , China.
(2114)ft Chinese Academy of Sciences, State Key Laboratory of Biomacromolecules,
Institute of Biophysics , Beijing , China.
(2115)ajt Peking University, Health Science Center , Department of Biochemistry
and Molecular Biology , Beijing , China.
(2116)ff Chinese Academy of Medical Sciences and Peking Union Medical College,
MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen
Biology , Beijing , China.
(2117)fh Chinese Academy of Medical Sciences and Peking Union Medical College,
National Laboratory of Medical Molecular Biology, Institute of Basic Medical
Sciences , Beijing , China.
(2118)beu University of Calgary , Department of Biochemistry and Molecular
Biology , Libin Cardiovascular Institute of Alberta , Calgary, AB , Canada.
(2119)ccr Zhejiang University , Department of Biomedical Engineering , Qiushi
Academy for Advanced Studies , Hangzhou , China.
(2120)tf Institute of Environmental Medicine, Division of Toxicology, Karolinska
Institute , Stockholm , Sweden.
(2121)zt Lomonosov Moscow State University, Faculty of Basic Medicine , Moscow ,
Russia.
(2122)bvq University of Texas , Department of Biochemistry , Dallas , TX , USA.
(2123)pr Henan University of Technology, College of Bioengineering , Zhengzhou,
Henan Province , China.
(2124)bkt University of Illinois at Chicago, College of Medicine , Department of
Pediatrics , Chicago , IL , USA.
(2125)caa Virginia Commonwealth University , Department of Microbiology and
Immunology , Richmond , VA , USA.
(2126)bus University of South Florida , Department of Pharmaceutical Science ,
Tampa , FL , USA.
(2127)ajr Peking University , Department of Medicine , Beijing , China.
(2128)aju Peking University, Institute of Nephrology, Key Laboratory of Renal
Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease
Prevention and Treatment, Ministry of Education , Beijing , China.
(2129)aoe Shanghai Jiao Tong University, Bio-X Institutes , Shanghai , China.
(2130)are Sun Yat-Sen University, State Key Laboratory of Oncology in South
China, Cancer Center , Guangzhou , China.
(2131)arc Sun Yat-Sen University, School of Life Sciences , Guangzhou , China.
(2132)gn CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM),
Instituto de Salud Carlos III , Barcelona , Spain.
(2133)ta Institute for Research in Biomedicine (IRB Barcelona) , The Barcelona
Institute of Science and Technology, Barcelona , Spain.
(2134)axz Universitat de Barcelona , Departament de Bioquímica i Biologia
Molecular , Facultat de Biologia , Barcelona , Spain.
(2135)kb Emory University, School of Medicine , Department of Microbiology and
Immunology , Atlanta , GA , USA.

Erratum in
Autophagy. 2016;12(2):443. doi: 10.1080/15548627.2016.1147886.. Selliez,
Iban [corrected to Seiliez, Iban].

DOI: 10.1080/15548627.2015.1100356
PMCID: PMC4835977
PMID: 26799652 [Indexed for MEDLINE]

3. Br J Nurs. 2024 May 9;33(9):411-417. doi: 10.12968/bjon.2024.33.9.411.

Basic life support training: Is student confidence enhanced by advanced levels

of simulation?

Rushton M(1), Pilkington R(2).

Author information:
(1)Head of Adult Nursing, School of Health and Society, University of Salford.
(2)Lecturer in Adult Nursing, School of Health and Society, University of
Salford.

BACKGROUND: Basic life support (BLS) is a mandatory skill for nurses. The
confidence of the BLS provider should be enhanced by regular training.
Traditionally, BLS training has used low-fidelity manikins, but more recent
studies have suggested the use of high-fidelity manikins and alternative levels
of simulation such as virtual reality.
METHODS: A quasi-experimental study including 125 nursing students. Data on
confidence levels in various elements of BLS were collected using pre-validated
questionnaires and analysed using SPSSv23.
RESULTS: The study revealed that high-fidelity simulation had a significant
impact on the BLS learner's confidence levels.
CONCLUSION: The study identified the importance of high-fidelity simulation in
BLS training in preparing students for clinical practice. This highlights the
need for further exploration of simulation technologies, such as virtual
reality, to enable students to gain the knowledge, skills, confidence and
competence required to enable safe and effective practice.

DOI: 10.12968/bjon.2024.33.9.411
PMID: 38722006 [Indexed for MEDLINE]

4. Int J Environ Res Public Health. 2021 Feb 3;18(4):1409. doi:

10.3390/ijerph18041409.

Effects of a Clinical Simulation Course about Basic Life Support on

Undergraduate Nursing Students' Learning.

Requena-Mullor MDM(1), Alarcón-Rodríguez R(1), Ventura-Miranda MI(1),

García-González J(2).

Author information:
(1)Department of Nursing, Physiotherapy and Medicine, Faculty of Health
Sciences, University of Almería, 04120 Almería, Spain.
(2)Department of Nursing, Faculty of Health and Social Sciences, Campus de
Lorca, University of Murcia, 30800 Murcia, Spain.

Training in basic life support (BLS) using clinical simulation improves

compression rates and the development of cardiopulmonary resuscitation (CPR)
skills. This study analyzed the learning outcomes of undergraduate nursing
students taking a BLS clinical simulation course. A total of 479 nursing
students participated. A pre-test and post-test were carried out to evaluate
theoretical knowledge of BLS through questions about anatomical physiology,
cardiac arrest, the chain of survival, and CPR. A checklist was used in the
simulation to evaluate practical skills of basic CPR. The learning outcomes
showed statistically significant differences in the total score of the pre-test
and after completing the BLS clinical simulation course (pre-test: 12.61 (2.30),
post-test: 15.60 (2.06), p < 0.001). A significant increase in the mean scores
was observed after completing the course in each of the four parts of the
assessment protocol (p < 0.001). The increase in scores in the cardiac arrest
and CPR sections were relevant (Rosenthal's r: -0.72). The students who had
prior knowledge of BLS scored higher on both the pre-test and the post-test. The
BLS simulation course was an effective method of teaching and learning BLS
skills.

DOI: 10.3390/ijerph18041409
PMCID: PMC7913518
PMID: 33546328 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.

5. CJEM. 2022 Jun;24(4):408-418. doi: 10.1007/s43678-022-00291-3. Epub 2022 Apr 19.

Early or late booster for basic life support skill for laypeople: a
simulation-based randomized controlled trial.
Boet S(1)(2)(3)(4)(5)(6), Waldolf R(7)(8)(9), Bould C(10), Lam S(11), Burns
JK(11), Moffett S(10), McBride G(10), Ramsay T(11), Bould MD(7)(11)(12).

Author information:
(1)Department of Anesthesiology and Pain Medicine, The Ottawa Hospital,
University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M2, Canada. sboet@toh.ca.
(2)Department of Innovation in Medical Education, University of Ottawa, Ottawa,
ON, Canada. sboet@toh.ca.
(3)Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa,
ON, Canada. sboet@toh.ca.
(4)Institut du Savoir Montfort, Ottawa, ON, Canada. sboet@toh.ca.
(5)Faculty of Medicine, Francophone Affairs, University of Ottawa, Ottawa, ON,
Canada. sboet@toh.ca.
(6)Faculty of Education, University of Ottawa, Ottawa, ON, Canada. sboet@toh.ca.
(7)Department of Innovation in Medical Education, University of Ottawa, Ottawa,
ON, Canada.
(8)Institut du Savoir Montfort, Ottawa, ON, Canada.
(9)Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.
(10)Department of Anesthesiology and Pain Medicine, The Ottawa Hospital,
University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M2, Canada.
(11)Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa,
ON, Canada.
(12)Department of Anesthesiology, The Children's Hospital of Eastern Ontario,
University of Ottawa, Ottawa, ON, Canada.

PURPOSE: Retention of skills and knowledge has been shown to be poor after
resuscitation training. The effect of a "booster" is controversial and may
depend on its timing. We compared the effectiveness of an early versus late
booster session after Basic Life Support (BLS) training for skill retention at
4 months.
METHODS: We performed a single-blind randomized controlled trial in a simulation
environment. Eligible participants were adult laypeople with no BLS training or
practice in the 6 months prior to the study. We provided participants with
formal BLS training followed by an immediate BLS skills post-test. We then
randomized participants to one of three groups: control, early booster, or late
booster. Based on their group allocation, participants attended a brief BLS
refresher at either 3 weeks after training (early booster), at 2 months after
training (late booster), or not at all (control). All participants underwent a
BLS skills retention test at 4 months. We measured BLS skill performance
according to the Heart and Stroke Foundation's skills testing checklist for
adult CPR and the use of an automated external defibrillator.
RESULTS: A total of 80 laypeople were included in the analysis (control group,
n = 28; early booster group, n = 23; late booster group, n = 29). The late
booster group achieved better skill retention (mean difference in checklist
score at retention compared to the immediate post-test = - 0.8 points out of 15,
[95% CI - 1.7, 0.2], P = 0.10) compared to the early booster (- 1.3, [- 2.6,
0.0], P = 0.046) and control group (- 3.2, [- 4.7, - 1.8], P < 0.001).
CONCLUSION: A late booster session improves BLS skill retention at 4 months in
laypeople.
TRIAL REGISTRATION NUMBER: NCT02998723.

Publisher: RéSUMé: OBJECTIF: Il a été démontré que la rétention des compétences

et des connaissances est faible après une formation en réanimation. L'effet d'un
"booster" est controversé et peut dépendre de son moment. Nous avons comparé
l'efficacité d'une session de rappel précoce ou tardive après la formation Basic
Life Support (BLS) pour le maintien des compétences après quatre mois. MéTHODES:
Nous avons réalisé un essai contrôlé randomisé en simple aveugle dans un
environnement de simulation. Les participants éligibles étaient des laïcs
adultes n'ayant pas suivi de formation ou pratiqué le BLS dans les 6 mois
précédant l'étude. Nous avons fourni aux participants une formation BLS formelle
suivie d'un post-test immédiat sur les compétences BLS. Nous avons ensuite
randomisé les participants dans l'un des trois groupes suivants: groupe témoin,
rappel précoce ou rappel tardif. En fonction de leur répartition dans le groupe,
les participants ont assisté à un bref rappel de BLS soit 3 semaines après la
formation (rappel précoce), soit 2 mois après la formation (rappel tardif), soit
pas du tout (groupe témoin). Tous les participants ont été soumis à un test de
maintien des compétences BLS après quatre mois. Nous avons mesuré la performance
des compétences BLS selon la liste de contrôle des compétences de la Fondation
des maladies du cœur pour la RCP chez l'adulte et l'utilisation d'un
défibrillateur externe automatisé. RéSULTATS: Au total, 80 profanes ont été
inclus dans l'analyse (groupe témoin, n = 28; groupe de rappel précoce, n = 23;
groupe de rappel tardif, n = 29). Le groupe de rappel tardif a obtenu un
meilleur maintien des compétences (différence moyenne du score de la liste de
contrôle au moment du maintien par rapport au post-test immédiat = -0,8 points
sur 15, [IC 95% -1,7, 0,2], P = 0,10) par rapport au groupe de rappel précoce
(-1,3, [-2,6, 0,0], P = 0,046) et au groupe témoin (-3,2, [-4,7, -1,8],
P < 0,001). CONCLUSION: Une session de rappel tardive améliore la rétention des
compétences BLS à 4 mois chez les profanes.

© 2022. The Author(s), under exclusive licence to Canadian Association of

Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence
(ACMU).

DOI: 10.1007/s43678-022-00291-3
PMID: 35438450 [Indexed for MEDLINE]

6. J Sch Nurs. 2019 Aug;35(4):262-267. doi: 10.1177/1059840517753879. Epub 2018 Jan

23.

Effectiveness of Basic Life Support Training for Middle School Students.

Aloush S(1), Tubaishat A(2), ALBashtawy M(3), Suliman M(3), Alrimawi I(4), Al
Sabah A(5), Banikhaled Y(6).

Author information:
(1)1 Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
(2)2 Faculty of Nursing, Adult Health Nursing, Al al-Bayt University, Mafraq,
Jordan.
(3)3 Community and Mental Health Department, Princess Salma Faculty of Nursing,
Al al-Bayt University, Mafraq, Jordan.
(4)4 School of Nursing, Stratford University, USA.
(5)5 Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
(6)6 Ministry of Education, Amman, Jordan.

Bystander cardiopulmonary resuscitation improves survival after out-of-hospital

cardiac arrest. This study aimed to assess the effectiveness of a basic life
support (BLS) educational course given to 110 middle school children, using a
pretest posttest design. In the pretest, students were asked to demonstrate BLS
on a manikin to simulate a real-life scenario. After the pretest, a BLS training
course of two sessions was provided, followed by posttest on the same manikin.
Students were assessed using an observational sheet based on the American Heart
Association's BLS guidelines. In the pretest, students showed significant
weakness in the majority of guidelines. In the posttest, they demonstrated
significant improvement in their BLS skills. BLS training in the middle school
was effective, considering the lack of previous skills. It is recommended that
BLS education be compulsory in the school setting.
DOI: 10.1177/1059840517753879
PMID: 29361872 [Indexed for MEDLINE]

7. Int J Environ Res Public Health. 2021 Oct 13;18(20):10724. doi:

10.3390/ijerph182010724.

Performing Simulated Basic Life Support without Seeing: Blind vs. Blindfolded
People.

Martínez-Isasi S(1)(2)(3), Jorge-Soto C(1)(2), Barcala-Furelos R(1)(3)(4),

Abelairas-Gómez C(1)(3)(4), Carballo-Fazanes A(1)(2), Fernández-Méndez F(1)(5),
Gómez-González C(1), Nadkarni VM(6)(7), Rodríguez-Núñez A(1)(2)(3)(4)(8).

Author information:
(1)CLINURSID Research Group, University of Santiago de Compostela, 15782
Santiago de Compostela, Spain.
(2)Faculty of Nursing, University of Santiago de Compostela, 15782 Santiago de
Compostela, Spain.
(3)Life Support and Simulation Research Group, Health Research Institute of
Santiago (IDIS), 15706 Santiago de Compostela, Spain.
(4)REMOSS Research Group, Faculty of Education and Sports Science, University of
Vigo, 36005 Pontevedra, Spain.
(5)University College of Nursing, University of Vigo, 36004 Pontevedra, Spain.
(6)Department of Anesthesiology and Critical Care Medicine, Children's Hospital
of Philadelphia, University of Pennsylvania Perelman School of Medicine,
Philadelphia, PA 3400, USA.
(7)Department of Pediatrics, Children's Hospital of Philadelphia, University of
Pennsylvania Pereman School of Medicine, Philadelphia, PA 3400, USA.
(8)Pediatric Intensive Care Unit, University Clinical Hospital of Santiago de
Compostela, 15706 Santiago de Comopostela, Spain.

Previous pilot experience has shown the ability of visually impaired and blind
people (BP) to learn basic life support (BLS), but no studies have compared
their abilities with blindfolded people (BFP) after participating in the same
instructor-led, real-time feedback training. Twenty-nine BP and 30 BFP
participated in this quasi-experimental trial. Training consisted of a 1 h
theoretical and practical training session with an additional 30 min afterwards,
led by nurses with prior experience in BLS training of various collectives.
Quantitative quality of chest compressions (CC), AED use and BLS sequence were
evaluated by means of a simulation scenario. BP's median time to start CC was
less than 35 s. Global and specific components of CC quality were similar
between groups, except for compression rate (BFP: 123.4 + 15.2 vs. BP: 110.8 +
15.3 CC/min; p = 0.002). Mean compression depth was below the recommended target
in both groups, and optimal CC depth was achieved by 27.6% of blind and 23.3% of
blindfolded people (p = 0.288). Time to discharge was significantly longer in
BFP than BP (86.0 + 24.9 vs. 66.0 + 27.0 s; p = 0.004). Thus, after an adapted
and short training program, blind people were revealed to have abilities
comparable to those of blindfolded people in learning and performing the BLS
sequence and CC.

DOI: 10.3390/ijerph182010724
PMCID: PMC8536197
PMID: 34682471 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.

8. J Clin Med. 2024 Jul 10;13(14):4032. doi: 10.3390/jcm13144032.

Tailored Basic Life Support Training for Specific Layperson Populations-A

Scoping Review.

Schnaubelt S(1)(2)(3)(4), Veigl C(1)(2), Snijders E(3), Abelairas Gómez C(5)(6),

Neymayer M(1)(2), Anderson N(7), Nabecker S(8), Greif R(9)(10); International
Liaison Committee on Resuscitation Education, Implementation and Teams Task
Force.

Author information:
(1)Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna,
Austria.
(2)PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria.
(3)Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem,
Belgium.
(4)Emergency Medical Service Vienna, 1030 Vienna, Austria.
(5)Faculty of Education Sciences and CLINURSID Research Group, Universidade de
Santiago de Compostela, 15705 Santiago de Compostela, Spain.
(6)Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group,
Health Research Institute of Santiago, University Hospital of Santiago de
Compostela-CHUS, 15706 Santiago de Compostela, Spain.
(7)Faculty of Medical and Health Sciences, University of Auckland, Auckland
1023, New Zealand.
(8)Department of Anesthesiology and Pain Management, Mount Sinai Hospital,
Toronto, ON M5G 1X5, Canada.
(9)Faculty of Medicine, University of Bern, 3012 Bern, Switzerland.
(10)School of Medicine, Sigmund Freud University Vienna, 1020 Vienna, Austria.

Background: Basic life support (BLS) is a life-saving link in the

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

DOI: 10.3390/jcm13144032
PMCID: PMC11277549
PMID: 39064072
Conflict of interest statement: This scoping review was part of the ILCOR
continuous evidence evaluation process, which is guided by a rigorous conflict
of interest policy (see www.ilcor.org). Sebastian Schnaubelt is an ILCOR EIT
Task Force member, ERC Advanced Life Support Science and Education Committee
member, and Vice Chair of the Austrian Resuscitation Council. Christoph Veigl is
a Young ERC committee member. Cristian Abelairas-Gomez is an ILCOR EIT Task
Force member and ERC Basic Life Support Science and Education Committee member.
Natalie Anderson is an ILCOR EIT Task Force member. Sabine Nabecker is an ILCOR
EIT Task Force member and ERC Instructor Educator Support Science and Education
Committee member. Robert Greif is the ERC Director of ILCOR and Guidelines, and
Chair of the ILCOR EIT Task Force Education. Apart from partly being the authors
of the studies included in this scoping review, none of the other authors
declare conflicts of interest.

9. Front Med (Lausanne). 2022 May 12;9:825823. doi: 10.3389/fmed.2022.825823.

eCollection 2022.

Innovative Tele-Instruction Approach Impacts Basic Life Support Performance: A

Non-inferiority Trial.

Schauwinhold MT(1)(2), Schmidt M(1)(2), Rudolph JW(3)(4), Klasen M(1)(2),

Lambert SI(1)(2), Krusch A(1)(2), Vogt L(1)(2), Sopka S(1)(2).

Author information:
(1)AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty,
RWTH Aachen University, Aachen, Germany.
(2)Department of Anaesthesiology, University Hospital RWTH Aachen, Medical
Faculty, RWTH Aachen University, Aachen, Germany.
(3)Center for Medical Simulation, Boston, MA, United States.
(4)Department of Anaesthesiology, Critical Care and Pain Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States.

BACKGROUND: Sustaining Basic Life Support (BLS) training during the COVID-19
pandemic bears substantial challenges. The limited availability of highly
qualified instructors and tight economic conditions complicates the delivery of
these life-saving trainings. Consequently, innovative and resource-efficient
approaches are needed to minimize or eliminate contagion while maintaining high
training standards and managing learner anxiety related to infection risk.
METHODS: In a non-inferiority trial 346 first-year medical, dentistry, and
physiotherapy students underwent BLS training at AIXTRA-Competence Center for
Training and Patient Safety at the University Hospital RWTH Aachen. Our
objectives were (1) to examine whether peer feedback BLS training supported by
tele-instructors matches the learning performance of standard instructor-guided
BLS training for laypersons; and (2) to minimize infection risk during BLS
training. Therefore, in a parallel group design, we compared arm (1) Standard
Instructor Feedback (SIF) BLS training (Historical control group of 2019) with
arm (2) a Tele-Instructor Supported Peer-Feedback (TPF) BLS training
(Intervention group of 2020). Both study arms were based on Peyton's 4-step
approach. Before and after each training session, objective data for BLS
performance (compression depth and rate) were recorded using a resuscitation
manikin. We also assessed overall BLS performance via standardized instructor
evaluation and student self-reports of confidence via questionnaire.
Non-inferiority margins for the outcome parameters and sample size calculation
were based on previous studies with SIF. Two-sided 95% confidence intervals were
employed to determine significance of non-inferiority.
RESULTS: The results confirmed non-inferiority of TPF to SIF for all tested
outcome parameters. A follow-up after 2 weeks found no confirmed COVID-19
infections among the participants.
CONCLUSION: Tele-instructor supported peer feedback is a powerful alternative to
in-person instructor feedback on BLS skills during a pandemic, where infection
risk needs to be minimized while maximizing the quality of BLS skill learning.
TRIAL REGISTRATION:
https://www.drks.de/drks_web/navigate.do?
navigationId=trial.HTML&TRIAL_ID=DRKS00025199,
Trial ID: DRKS00025199.

Copyright © 2022 Schauwinhold, Schmidt, Rudolph, Klasen, Lambert, Krusch, Vogt

and Sopka.

DOI: 10.3389/fmed.2022.825823
PMCID: PMC9134732
PMID: 35646961

Conflict of interest statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.

10. J Educ Health Promot. 2023 Jun 30;12:218. doi: 10.4103/jehp.jehp_1045_22.

eCollection 2023.

Teaching basic life support for medical students: Assessment of learning and
knowledge retention.

Silva NLC(1), de Melo MDCB(2), Liu PMF(3), Campos JPR(4), Arruda MA(5).

Author information:
(1)Specialist in Health Systems and Services Management, Secretary of State for
Health of Minas Gerais, Brazil.
(2)Department of Pediatrics, Member of Health Technology Center and Telehealth
Center, Coordinator of Simulation Center, Faculty of Medicine at Universidade
Federal de Minas Gerais, Brazil.
(3)Department of Pediatrics, Subcoordinator of Simulation Center, Faculty of
Medicine, Universidade Federal de Minas Gerais, Brazil.
(4)Palliative Care Specialist, Hospital Felício Rocho, Minas Gerais State,
Brazil.
(5)General Practitioner, General Practitioner Health Center of the City Hall of
Belo Horizonte, Minas Gerais State, Brazil.

BACKGROUND: Education mediated by simulation is a widely used method for

teaching basic life support (BLS). The American Heart Association recommends
protocols based on scientific evidence to reduce sequelae and mortality. We
aimed to assess learning and retention of knowledge of BLS in students of the
first semester of the medical course using teaching methods of dialogic
expository class (group 1), expository and demonstrative class (group 2), and
the two previous methodologies associated with simulated practice (group 3), and
after 3 months, memory retention.
MATERIALS AND METHODS: This was an experimental, prospective, randomized study.
Participants were assessed in terms of performance in theoretical and simulated
practical tests, satisfaction with training (Likert scale), and knowledge
retention.
RESULTS: The practical test results were analyzed by two experienced observers.
Students had 20% progression in knowledge and 80% retention of knowledge after 3
months of exposure comparing the theoretical pre- and posttest. The students in
group 3 performed better than the others (P = 0.007) in the posttest. With the
simulated practice, the knowledge acquired was maintained after 3 months with a
mean performance of 90%, but in the test of the infant age group, there was a
loss of learning retention by 10%. There was no difference of the results
between the two evaluators (P < 0.001). The training was positively assessed by
the participants.
CONCLUSION: The use of different methodologies promoted knowledge progression,
with emphasis on simulated practice. Learning retention was maintained after 3
months. In order to teach BLS to infants, it may be necessary to improve
teaching techniques.

Copyright: © 2023 Journal of Education and Health Promotion.

DOI: 10.4103/jehp.jehp_1045_22
PMCID: PMC10402818
PMID: 37546014

Conflict of interest statement: There are no conflicts of interest.

11. BMC Nurs. 2023 Oct 20;22(1):398. doi: 10.1186/s12912-023-01552-x.

The effect of a simulation-based training program in basic life support on the

knowledge of Palestinian nurses: a quasi-experimental study in governmental
hospitals.

Fahajan Y(1), Emad OJ(2), Albelbeisi AH(3)(4), Albelbeisi A(5), Shnena YA(6),
Khader A(1), Kakemam E(7).

Author information:
(1)General Directorate of Nursing, Ministry of Health, Gaza, Palestine.
(2)General Directorate of Mental Health, Ministry of Health, Gaza, Palestine.
(3)Medical Services Directorate, Gaza Strip, Palestine.
(4)College of Health Professions, Israa University, Gaza, Palestine.
(5)Health Research Unit, Ministry of Health, Gaza, Palestine.
(6)Faculty of Nursing, Midwifery Department, Islamic University of Gaza, Gaza,
Palestine.
(7)Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz
University of Medical Sciences, Tabriz, Iran. edriskakemam@gmail.com.

BACKGROUND: Basic Life Support (BLS) plays an important role in increasing the
survival rate of hospitalized heart attack patients. There are no previous
studies on the effect of BLS training among Palestinian nurses. This study aimed
to evaluate the effect of simulation-based BLS training program on nurses'
knowledge Palestinian nurses at governmental hospitals.
METHODS: A quasi-experimental, pre & post-test design was used. 700 nurses were
recruited proportionally using a simple random sampling method among 2980 nurses
from 13 public hospitals in the Gaza Strip. This study was conducted from June
to August 2022. A practical BLS test consisting of 10 multiple-choice questions
according to American Heart Association guidelines (2020) was collected and
sociodemographic characteristics. SPSS software, version 24 was used for the
statistical analysis. Descriptive statistics and weighted mean were used. T-Test
and One-way analysis of variance (ANOVA) were applied to determine differences
in means among groups.
RESULTS: Most of the participating nurses (55.7%) were male, while (44.3%) were
female. The majority of nurses (84.4%) are under 40 years of age. The weighted
mean scores in the pre-test ranged from 52.2 to 75.1% and the mean scores was
(6.16 ± 1.97). After applying conventional BLS training, the weighted mean
scores ranged from 85.6 to 97.3% and the mean scores was (9.19 ± 1.04). The
study revealed that the nurses' knowledge increased after applying
simulation-based training program. The mean of knowledge scores was
statistically significant between the pre and post-test on the basis of the
current work hospital (P-value < 0.001).
CONCLUSION: This study affords significant evidence of the positive effects of
the BLS training program in improving nurses' knowledge; we recommend advanced
BLS training for all healthcare providers, doctors, and nurses working in
hospitals and healthcare centers. Nursing managers can implement systematic
strategies to enhance nurses' knowledge and practice in BLS to target
low-scoring Governorates.

© 2023. BioMed Central Ltd., part of Springer Nature.

DOI: 10.1186/s12912-023-01552-x
PMCID: PMC10588256
PMID: 37864224

Conflict of interest statement: The authors declare no competing interests.

12. Clin Exp Emerg Med. 2020 Dec;7(4):245-249. doi: 10.15441/ceem.19.095. Epub 2020
Dec 31.

Outcome of basic life support training among primary school students in

Southeast Asia.

Suwanpairoj C(1), Wongsombut T(1), Maisawat K(1), Torod N(1), Jaengkrajan A(1),
Sritharo N(1), Atthapreyangkul N(1)(2), Wittayachamnankul B(1)(2).

Author information:
(1)Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
(2)Department of Emergency Medicine, Chiang Mai University, Chiang Mai,
Thailand.

OBJECTIVE: This study aimed to evaluate how BLS courses affect primary school
students' knowledge, attitudes, and life support skills; investigate how medical
students' knowledge and competence in teaching BLS can improve by serving as
instructors.
METHODS: This experimental study was conducted in a rural primary school.
First-year medical students conducted a BLS course for grade 4 and 5 primary
school students with a 6-7:1 ratio of trainees-to-trainer. All trainers had
completed a BLS course before the course. This 3.5-hour simulation-based course
covered chest compressions and automated external defibrillator use. The pre-
and post-course assessments included multiple choice questions toward BLS,
practical skills test, and attitude test. For medical students, evaluation was
conducted by attitude test, both pre- and post-teaching.
RESULTS: The mean pre- and post-test scores increased from 5.74±0.10 to
9.43±0.13 (P<0.01). The increase in the scores was the same for both the
students and the teachers (3.05±0.60 vs. 3.68±0.16, P=0.33). After the course,
more than 90% of the students could perform all the procedures involved in BLS
and automated external defibrillation. Medical students showed an improved
understanding of CPR and confidence in performing and teaching CPR (both,
P<0.01).
CONCLUSION: Primary school students can learn how to perform BLS through
simulation-based learning. Simulation-based training can improve their attitude
and provide them with knowledge and crucial skill sets, improving their
confidence in performing BLS. Furthermore, teachers' attitudes and confidence
toward CPR improved after teaching CPR.

DOI: 10.15441/ceem.19.095
PMCID: PMC7808835
PMID: 33440101

Conflict of interest statement: No potential conflict of interest relevant to

this article was reported.

13. Resuscitation. 2018 May;126:147-153. doi: 10.1016/j.resuscitation.2018.02.031.

Epub 2018 Mar 6.

Self-learning basic life support: A randomised controlled trial on learning

conditions.

Pedersen TH(1), Kasper N(2), Roman H(3), Egloff M(2), Marx D(2), Abegglen S(4),
Greif R(5).

Author information:
(1)Department of Anaesthesiology and Pain Therapy, Bern University Hospital,
University of Bern, Bern, Switzerland. Electronic address:
tinaheidipedersen@yahoo.dk.
(2)Department of Anaesthesiology and Pain Therapy, Bern University Hospital,
University of Bern, Bern, Switzerland.
(3)Bern Institute of Primary Care (BIHAM), University of Bern, Bern,
Switzerland.
(4)University of Bern, Institute of Psychology, Clinical Psychology and
Psychotherapy, University of Bern, Bern, Switzerland.
(5)Department of Anaesthesiology and Pain Therapy, Bern University Hospital,
University of Bern, Bern, Switzerland; ERC Research NET, Niel, Belgium.

AIM OF THE STUDY: To investigate whether pure self-learning without instructor

support, resulted in the same BLS-competencies as facilitator-led learning, when
using the same commercially available video BLS teaching kit.
METHODS: First-year medical students were randomised to either BLS self-learning
without supervision or facilitator-led BLS-teaching. Both groups used the
MiniAnne kit (Laerdal Medical, Stavanger, Norway) in the students' local
language. Directly after the teaching and three months later, all participants
were tested on their BLS-competencies in a simulated scenario, using the Resusci
Anne SkillReporter™ (Laerdal Medical, Stavanger, Norway). The primary outcome
was percentage of correct cardiac compressions three months after the teaching.
Secondary outcomes were all other BLS parameters recorded by the SkillReporter
and parameters from a BLS-competence rating form.
RESULTS: 240 students were assessed at baseline and 152 students participated in
the 3-month follow-up. For our primary outcome, the percentage of correct
compressions, we found a median of 48% (interquartile range (IQR) 10-83) for
facilitator-led learning vs. 42% (IQR 14-81) for self-learning (p = 0.770)
directly after the teaching. In the 3-month follow-up, the rate of correct
compressions dropped to 28% (IQR 6-59) for facilitator-led learning (p = 0.043)
and did not change significantly in the self-learning group (47% (IQR 12-78),
p = 0.729).
CONCLUSIONS: Self-learning is not inferior to facilitator-led learning in the
short term. Self-learning resulted in a better retention of BLS-skills three
months after training compared to facilitator-led training.

Copyright © 2018 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2018.02.031
PMID: 29522830 [Indexed for MEDLINE]

14. Int J Environ Res Public Health. 2023 Feb 24;20(5):4095. doi:
10.3390/ijerph20054095.

Efficacy of Virtual Reality Simulation in Teaching Basic Life Support and Its
Retention at 6 Months.

Castillo J(1), Rodríguez-Higueras E(1), Belmonte R(1), Rodríguez C(1), López

A(1), Gallart A(1).

Author information:
(1)Departament Infermeria, Universitat Internacional de Catalunya (UIC), Sant
Cugat del Vallès, 08195 Barcelona, Spain.

Educational efficiency is the predetermining factor for increasing the survival

rate of patients with cardiac arrest. Virtual reality (VR) simulation could help
to improve the skills of those undergoing basic life support-automated external
defibrillation (BLS-AED) training. Our purpose was to evaluate whether BLS-AED
with virtual reality improves the skills and satisfaction of students enrolled
in in-person training after completing the course and their retention of those
skills 6 months later. This was an experimental study of first-year university
students from a school of health sciences. We compared traditional training
(control group-CG) with virtual reality simulation (experimental group-EG). The
students were evaluated using a simulated case with three validated instruments
after the completion of training and at 6 months. A total of 241 students
participated in the study. After the training period, there were no
statistically significant differences in knowledge evaluation or in practical
skills when assessed using a feedback mannequin. Statistically significant
results on defibrillation were poorer in the EG evaluated by the instructor.
Retention at 6 months decreased significantly in both groups. The results of the
teaching methodology using VR were similar to those obtained through traditional
methodology: there was an increase in skills after training, and their retention
decreased over time. Defibrillation results were better after traditional
learning.

DOI: 10.3390/ijerph20054095
PMCID: PMC10001443
PMID: 36901106 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.

15. Emerg Med J. 2022 May;39(5):357-362. doi: 10.1136/emermed-2021-211774. Epub

2021
Aug 16.

Commencing one-handed chest compressions while activating emergency medical

system using a handheld mobile device in lone-rescuer basic life support: a
randomised cross-over simulation study.

Park SO(#)(1), Shin DH(#)(2), Kim C(3), Lee YH(4)(5).

Author information:
(1)Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of
Korea.
(2)Emergency Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
(3)Department of Preventive Medicine, Pusan National University School of
Medicine, Busan, Republic of Korea.
(4)Emergency Medicine, Soonchunhyang University Hospital Bucheon, Bucheon,
Republic of Korea zerohwani@gmail.com.
(5)Emergency Medicine, Sacred Heart Hospital, Hallym University School of
Medicine, Anyang, Republic of Korea.
(#)Contributed equally

INTRODUCTION: In conventional basic life support (c-BLS), a lone rescuer is

recommended to start chest compressions (CCs) after activating the emergency
medical system. To initiate earlier CCs in lone-rescuer BLS, we designed a
modified BLS (m-BLS) sequence in which the lone rescuer commences one-handed CCs
while calling for help using a handheld cellular phone with the other free hand.
This study aimed to compare the quality of BLS between c-BLS and m-BLS.
METHODS: This was a simulation study performed with a randomised cross-over
controlled trial design. A total of 108 university students were finally
enrolled. After training for both c-BLS and m-BLS, participants performed a
3-minute c-BLS or m-BLS on a manikin with a SkillReporter at random cross-over
order. The paired mean difference with SE between c-BLS and m-BLS was assessed
using paired t-test.
RESULTS: The m-BLS had reduced lag time before the initiation of CCs (with a
mean estimated paired difference (SE) of -35.0 (90.4) s) (p<0.001). For CC, a
significant increase in compression fraction and a higher number of CCs with
correct depth were observed in m-BLS (with a mean estimated paired difference
(SE) of 16.2% (0.6) and 26.9% (3.3), respectively) (all p<0.001). However, no
significant paired difference was observed in the hand position, compression
rate and interruption time. For ventilation, the mean tidal volumes did not
differ. However, the number of breaths with correct tidal volume was higher in
m-BLS than in c-BLS.
CONCLUSION: In simulated lone-rescuer BLS, the m-BLS could deliver significantly
earlier CCs than the c-BLS while maintaining high-quality cardiopulmonary
resuscitation.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and
permissions. Published by BMJ.

DOI: 10.1136/emermed-2021-211774
PMID: 34400404 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.

16. IEEE J Transl Eng Health Med. 2022 Feb 16;10:4900507. doi:
10.1109/JTEHM.2022.3152365. eCollection 2022.

Development of an Extended Reality Simulator for Basic Life Support Training.

Lee DK(1)(2), Choi H(3), Jheon S(4), Jo YH(1)(2), Im CW(1), Il SY(5).

Author information:
(1)Department of Emergency MedicineSeoul National University Bundang Hospital
Seongnam 13620 Republic of Korea.
(2)Department of Emergency MedicineSeoul National University College of Medicine
Seoul 03080 Republic of Korea.
(3)TETRASIGNUM Corporation Seoul 05839 Republic of Korea.
(4)Department of Thoracic and Cardiovascular SurgerySeoul National University
Bundang Hospital, Seoul National University College of Medicine Seoul 03080
Republic of Korea.
(5)THIRTEENTH FLOOR Corporation Seoul 06798 Republic of Korea.

OBJECTIVE: Extended Reality (XR) is a simultaneous combination of the virtual

and real world. This paper presents the details of the framework and development
methods for an XR basic life support (XR-BLS) simulator, as well as the results
of an expert usability survey.
METHODS: The XR-BLS simulator was created by employing a half-torso manikin in a
virtual reality environment and using BLS education data that is in line with
the 2020 American Heart Association guidelines. A head-mounted display (HMD) and
hand-tracking device were used to perform chest compressions and ventilation and
to enable the use of an automated external defibrillator in a virtual
environment. A usability study of the XR-BLS simulator through an expert survey
was also conducted. The survey consisted of a total of 8 items: 3, 2, and 2
questions about the ease of use of XR-BLS, delivery of training, and artificial
intelligence (AI) instructor in the simulator, respectively.
RESULTS: The XR simulator was developed, and the expert survey showed that it
was easy to use, the BLS training was well delivered, and the interaction with
the AI instructor was clear and understandable.
DISCUSSION/CONCLUSION: The XR-BLS simulator is useful as it can conduct BLS
education without requiring instructors and trainees to gather.

DOI: 10.1109/JTEHM.2022.3152365
PMCID: PMC9342859
PMID: 35937462 [Indexed for MEDLINE]

17. Fujita Med J. 2023 Feb;9(1):22-29. doi: 10.20407/fmj.2021-008. Epub 2022 May
25.

Relationships between cognitive appraisal and roles/personality traits in basic

life support.

Nakamura T(1), Nakamura S(2), Kageura N(2), Kondo A(2), Hotta Y(2), Oda C(2).

Author information:
(1)Department of Intensive Care Unit, Fujita Health University Hospital,
Toyoake, Aichi, Japan.
(2)Faculty of Nursing, Fujita Health University, School of Health Sciences,
Toyoake, Aichi, Japan.

OBJECTIVE: To examine the relationship between the cognitive assessment of

stress (cognitive appraisal) caused in a scenario requiring basic life support
(BLS) and the roles during BLS/personality traits in nursing students.
METHODS: We conducted an anonymous self-administered questionnaire survey for
264 freshman and senior nursing students. The study period was one month from
June 2019. The questionnaire included characteristics, roles (active involvement
group/passive involvement group/no involvement group), Cognitive Appraisal
Rating Scale (CARS), and Maudsley Personality Inventory (MPI). We only included
data for female students (107 people) in the analysis because very little data
is available for male students. The Mann-Whitney test was used for the
comparison between two groups and the Kruskal-Wallis test was used for the
comparison between three groups. The significance level was set at p<0.05.
RESULTS: The total number of responses was 133 (50.4%), and the number of valid
responses was 107 (40.5%). As a result of analyzing the relationship between the
role and the CARS subscale, the controllability of the active and passive
involvement groups was significantly lower than that of the no involvement group
(p=0.046). Also, the analysis of the relationship between the grade and the CARS
subscale showed that the controllability was significantly lower in freshmen
than seniors (p=0.020).
CONCLUSION: This study showed the relationship between controllability and
cognitive appraisal of stress in the simulation scenario of BLS. Therefore, it
was suggested that support for improving controllability is necessary as a
preventive measure to reduce the stress associated with BLS.

DOI: 10.20407/fmj.2021-008
PMCID: PMC9923453
PMID: 36789124

18. Nurse Educ Today. 2015 Sep;35(9):999-1003. doi: 10.1016/j.nedt.2015.03.017.

Epub
2015 Apr 16.

Impact of simulation training on Jordanian nurses' performance of basic life

support skills: A pilot study.

Toubasi S(1), Alosta MR(2), Darawad MW(3), Demeh W(4).

Author information:
(1)Faculty of Nursing, The University of Jordan, Amman 11942, Jordan. Electronic
address: samar_sami2002@yahoo.com.
(2)Specialty Hospital Amman, Jordan. Electronic address: Mro1984@yahoo.com.
(3)Faculty of Nursing, The University of Jordan, Amman 11942, Jordan. Electronic
address: m.darawad@ju.edu.jo.
(4)Faculty of Nursing, The University of Jordan, Amman 11942, Jordan; Al-Farabi
College for Dentistry and Nursing, Al-Farabi College, Riyadh 11514, Saudi
Arabia. Electronic address: w.demeh@ju.edu.jo.

BACKGROUND: Providing efficient basic life support (BLS) training is crucial for
practicing nurses who provide direct patient care. Nevertheless, data addressing
the impact of BLS courses on the skills and performance of Jordanian nurses are
scarce. This study aimed to assess the effectiveness of a BLS simulation
training on Jordanian nurses' skill improvement in cardiopulmonary
resuscitation.
METHODS: A prospective quasi-experimental, single group pretest-posttest design
was used to study the effect of BLS simulation; using a 9-item checklist; on the
spot training; American Heart Association, on a group of Jordanian nurses. A
pre-test was conducted following a CPR scenario to test the skills using 9-item
checklist extrapolated from the American Heart Association guidelines. After
debriefing, an interactive on spot training was provided. Later, participants
undertook an unscheduled post-test after four weeks that included the same nine
items.
RESULTS: Thirty registered nurses with a mean clinical experience of 6.1years
participated in the study. Comparing pre-test (M=4.6, SD=2.9, range=0 to 9) with
post-test results (M=7.5, SD=1.7, range=4 to 9) showed an overall improvement in
skills and BLS scores after the simulation training program (t=7.4, df=29,
p<0.0001).
CONCLUSIONS: BLS simulation training sessions are associated with significant
improvement in skills and performance among Jordanian nurses. A refreshment BLS
training session for nurses is highly recommended to guarantee nurses'
preparedness in actual CPR scenarios.

Copyright © 2015 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.nedt.2015.03.017
PMID: 25935665 [Indexed for MEDLINE]

19. PLoS One. 2021 Jul 22;16(7):e0254923. doi: 10.1371/journal.pone.0254923.

eCollection 2021.

Peer video feedback builds basic life support skills: A randomized controlled
non-inferiority trial.
Sopka S(1)(2), Hahn F(1), Vogt L(1)(2), Pears KH(1), Rossaint R(2), Rudolph
J(3), Klasen M(1).

Author information:
(1)Medical Faculty, AIXTRA-Competency Center for Training and Patient Safety,
RWTH Aachen University, Aachen, Germany.
(2)Medical Faculty, Department of Anaesthesiology, University Hospital Aachen,
RWTH Aachen University, Aachen, Germany.
(3)Center for Medical Simulation, Boston, MA, United States of America.

INTRODUCTION: Training Basic Life Support saves lives. However, current BLS
training approaches are time-consuming and costly. Alternative cost-efficient
and effective training methods are highly needed. The present study evaluated
whether a video-feedback supported peer-guided Basic Life Support training
approach achieves similar practical performance as a standard instructor-guided
training in laypersons.
METHODS: In a randomized controlled non-inferiority trial, 288 first-year
medical students were randomized to two study arms with different Basic Life
Support training methods: 1) Standard Instructor Feedback (SIF) or 2) a Peer
Video Feedback (PVF). Outcome parameters were objective data for Basic Life
Support performance (compression depth and rate) from a resuscitation manikin
with recording software as well as overall Basic Life Support performance and
subjective confidence. Non-inferiority margins (Δ) for these outcome parameters
and sample size calculation were based on previous studies with Standard
Instructor Feedback. Two-sided 95% confidence intervals were employed to
determine significance of non-inferiority.
RESULTS: Results confirmed non-inferiority of Peer Video Feedback to Standard
Instructor Feedback for compression depth (proportion difference PVF-SIF = 2.9%;
95% CI: -8.2% to 14.1%; Δ = -19%), overall Basic Life Support performance
(proportion difference PVF-SIF = 6.7%; 95% CI: 0.0% to 14.3%; Δ = -27%) and
subjective confidence for CPR performance (proportion difference PVF-SIF =
-0.01; 95% CI: -0.18-0.17; Δ = -0.5) and emergency situations (proportion
difference PVF-SIF = -0.02; 95% CI: -0.21-0.18; Δ = -0.5). Results for
compression rate were inconclusive.
DISCUSSION: Peer Video Feedback achieves comparable results as standard
instructor-based training methods. It is an easy-to-apply and cost-efficient
alternative to standard Basic Life Support training methods. To improve
performance with respect to compression rate, additional implementation of a
metronome is recommended.

DOI: 10.1371/journal.pone.0254923
PMCID: PMC8297748
PMID: 34293034 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing

interests exist.

20. Curr Opin Crit Care. 2022 Jun 1;28(3):270-275. doi:

10.1097/MCC.0000000000000932. Epub 2022 Mar 9.

The future of resuscitation education.

Bray JE(1), Greif R(2), Morley P(3).

Author information:
(1)Department of Epidemiology and Preventive Medicine, Monash University,
Victoria, Australia; and Curting University, Perth, Australia.
(2)Bern University Hospital, University of Bern, Bern Switzerland; and School of
Medicine, Sigmund Freud University Vienna, Vienna, Austria.
(3)University of Melbourne, Royal Melbourne Hospital, Victoria, Australia.

PURPOSE OF REVIEW: The purpose of this review is to provide an update for

critical care clinicians and providers on the recent developments in patient and
healthcare professional (HCP) resuscitation education.
RECENT FINDINGS: The family members of patients at high-risk of cardiac arrest
need to be provided with access to basic life support (BLS) training. Many
low-cost methods are now available to provide BLS training beyond attending a
traditional BLS instructor-led cardiopulmonary resuscitation (CPR) class.
Hybrid-blended learning formats provide new opportunities to receive
individualized CPR-training in a flexible and convenient format. HCPs'
participation in accredited advanced life support courses improves patient
outcomes. Monitoring HCPs exposure to resuscitation and supplementing with
frequent simulation is recommended. Training should include human factors and
nontechnical skills. Volunteering for first responder programs when off-duty
provides a great opportunity for HCP's to improve out-of-hospital cardiac arrest
survival and increase exposure to resuscitation.
SUMMARY: Frequent resuscitation education and training is critical to improving
cardiac arrest patient outcomes. Recent evidence shows the effectiveness of
technological developments to improve access to training and outcomes.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/MCC.0000000000000932
PMID: 35653247 [Indexed for MEDLINE]

21. Pediatrics. 2021 Oct;148(4):e2021051408. doi: 10.1542/peds.2021-051408. Epub

2021 Sep 13.

Teaching Basic Life Support to 5- to 8-Year-Old Children: A Cluster Randomized

Trial.

Varela-Casal C(1), Abelairas-Gómez C(2)(3)(4), Otero-Agra M(1), Barcala-Furelos

R(1)(5)(4), Rodríguez-Núñez A(5)(4)(6), Greif R(7)(8).

Author information:
(1)REMOSS Research Group, Faculty of Education and Sport Sciences, University of
Vigo, Vigo, Spain.
(2)CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and
Medicine Department cristianabelairasgomez@gmail.com.
(3)Faculty of Education Sciences, Universidade de Santiago de Compostela,
Santiago, Spain.
(4)Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group,
Health Research Institute of Santiago.
(5)CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and
Medicine Department.
(6)PICU, University Hospital of Santiago de Compostela-CHUS, Santiago de
Compostela, Spain.
(7)Department of Anaesthesiology and Pain Medicine, Bern University Hospital,
University of Bern, Bern, Switzerland.
(8)School of Medicine, Sigmund Freud University Vienna, Vienna, Austria.

OBJECTIVE: We aimed to compare traditional basic life support (BLS) education

with specific and innovative educative didactic material that has been
previously designed and validated.
METHODS: Fifteen classes of schoolchildren aged 5 to 8 years (n = 237) were
randomly assigned to 4 groups in which different didactic and complementary
materials were used: (1) the Rescube tool with a cuddly toy (n = 61), (2) the
Endless Book tool with a cuddly toy (n = 74), (3) traditional teaching with a
cuddly toy (n = 46), and (4) traditional teaching with a manikin (n = 55). The
BLS sequence was assessed at baseline (T0). After that, children took part in a
one-hour theory and practice session in their assigned training modality. BLS
sequence was assessed again within one week (T1) and after one month (T2).
RESULTS: The 4 modalities were successful in improving children's skills when
comparing T0 with both T1 and T2 (P < .05). At T2, more schoolchildren
remembered the complete BLS sequence after using the Rescube (75%) compared with
the number of schoolchildren who remember the complete BLS sequence after using
the Endless Book (53%), a manikin (42%), or a cuddly toy (13%) (P < .05). A
higher proportion of participants who used the Rescube correctly performed all
the BLS steps analyzed compared with those who used only the manikin or a cuddly
toy during the learning phase. The Endless Book was also more effective except
for learning to check consciousness and breathing.
CONCLUSION: Better BLS learning and knowledge retention outcomes were achieved
by using our specific and adapted didactic materials (Rescube and Endless Book).
These new educational tools have the potential to substantially support BLS
school education programs.

Copyright © 2021 by the American Academy of Pediatrics.

DOI: 10.1542/peds.2021-051408
PMID: 34518314 [Indexed for MEDLINE]

Conflict of interest statement: POTENTIAL CONFLICT OF INTEREST: The authors have

indicated they have no potential conflicts of interest to disclose.

22. Int J Med Educ. 2017 Aug 25;8:309-313. doi: 10.5116/ijme.5985.cbce.

The effects of an online basic life support course on undergraduate nursing

students' learning.

Tobase L(1), Peres HHC(2), Gianotto-Oliveira R(3), Smith N(4), Polastri TF(5),
Timerman S(5).

Author information:
(1)Personnel Management, Mobile Emergency Care Service, Sao Paulo, Brazil.
(2)Department of Professional Counseling, School of Nursing, University of Sao
Paulo, Sao Paulo, Brazil.
(3)Department of Emergency Medicine, Campinas State University (UNICAMP),
Campinas, Brazil.
(4)Heart Sarver Center, University of Arizona College of Medicine, Tucson, USA.
(5)Laboratory of Cardiovascular Emergencies Training, Heart Institute (InCor),
Clinicals Hospital of the Sao Paulo University, Sao Paulo, Brazil.

OBJECTIVES: To describe learning outcomes of undergraduate nursing students

following an online basic life support course (BLS).
METHODS: An online BLS course was developed and administered to 94 nursing
students. Pre- and post-tests were used to assess theoretical learning.
Checklist simulations and feedback devices were used to assess the
cardiopulmonary resuscitation (CPR) skills of the 62 students who completed the
course.
RESULTS: A paired t-test revealed a significant increase in learning [pre-test
(6.4 ± 1.61), post-test (9.3 ± 0.82), p < 0.001]. The increase in the average
grade after taking the online course was significant (p<0.001). No learning
differences (p=0.475) had been observed between 1st and 2nd year (9.20 ± 1.60),
and between 3rd and 4th year (9.67 ± 0.61) students. A CPR simulation was
performed after completing the course: students checked for a response (90%),
exposed the chest (98%), checked for breathing (97%), called emergency services
(76%), requested for a defibrillator (92%), checked for a pulse (77%),
positioned their hands properly (87%), performed 30 compressions/cycle (95%),
performed compressions of at least 5 cm depth (89%), released the chest (90%),
applied two breaths (97%), used the automated external defibrillator (97%), and
positioned the pads (100%).
CONCLUSIONS: The online course was an effective method for teaching and learning
key BLS skills wherein students were able to accurately apply BLS procedures
during the CPR simulation. This short-term online training, which likely
improves learning and self-efficacy in BLS providers, can be used for the
continuing education of health professionals.

DOI: 10.5116/ijme.5985.cbce
PMCID: PMC5699862
PMID: 28850944 [Indexed for MEDLINE]

23. Cardiol J. 2019;26(5):536-542. doi: 10.5603/CJ.a2018.0073. Epub 2018 Jul 16.

Schoolteachers as candidates to be basic life support trainers: A simulation

trial.

Jorge-Soto C(1)(2), Abilleira-González M(3), Otero-Agra M(4), Barcala-Furelos

R(1)(3), Abelairas-Gómez C(1)(5), Szarpak Ł(6), Rodríguez-Núñez A(1)(2)(7)(8).

Author information:
(1)CLINURSID Research Group. University of Santiago de Compostela, Santiago de
Compostela, Spain.
(2)School of Nursing, University of Santiago de Compostela, Santiago de
Compostela, Spain.
(3)Faculty of Physical Activity and Sport Sciences. University of Vigo, Vigo,
Spain.
(4)School of Nursing. University of Vigo, Vigo, Spain.
(5)Faculty of Educational Sciences. University of Santiago de Compostela,
Santiago de Compostela, Spain.
(6)Lazarski University, Warsaw, Poland. lukasz.szarpak@gmail.com.
(7)Paediatric Emergency and Critical Care Division, Clinical University
Hospital, University of Santiago de Compostela, Spain, Santiago de Compostela,
Spain.
(8)Institute of Research of Santiago (IDIS) and SAMID Network, Santiago de
Compostela , Spain.

BACKGROUND: The aim was to assess future schoolteachers' basic life support
(BLS) knowledge and willingness to include this content in school lessons. The
aim was also to determine the learning effect of a brief BLS hands-on training
session, supported by real-time feedback.
METHODS: A convenience sample of 98 University students of Educational Sciences
and Sports were recruited. The training program consisted of brief theoretical
and hands-on interactive sessions with a 2/10 instructor/participants ratio.
Knowledge and willingness was assessed by means of a survey. Chest compressions
(CC) and ventilation quality were registered in 47 cases during 1 min
cardiopulmonary resuscitation (CPR) tests.
RESULTS: Fifty-eight percent of subjects declared to know how to perform CPR,
62% knew the correct chest compression/ventilation ratio but only one in four
knew the CC quality standards. Eighty-eight percent knew what an automated
external defibrillator (AED) was; willingness to use the device improved from
70% to 98% after training. Almost half of CCs were performed atan adequate rate.
Men performed deeper compressions than women (56.1 ± 4.03 mm vs. 52.17 ± 5.51
mm, p = 0.007), but in both cases the mean value was within recommendations.
Full chest recoil was better in women (72.2 ± 32.8% vs. 45.4 ± 32.9%, p =
0.009). All CCs were delivered with correct hand positions.
CONCLUSIONS: Brief hands-on training supported by real-time feedback of CPR
quality helps future schoolteachers improve their knowledge, self-confidence and
CPR skills. BLS training should be implemented in University curricula for
schoolteachers in order to promote their engagement in effective BLS training of
schoolchildren.

DOI: 10.5603/CJ.a2018.0073
PMCID: PMC8084407
PMID: 30009374 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: None declare

24. JMIR Serious Games. 2020 Nov 25;8(4):e24166. doi: 10.2196/24166.

Comparing Basic Life Support Serious Gaming Scores With Hands-on Training
Platform Performance Scores: Pilot Simulation Study for Basic Life Support
Training.

Aksoy ME(#)(1).

Author information:
(1)Acibadem Mehmet Ali Aydınlar University, Department Biomedical Device
Technology, CASE (Center of Advanced Simulation and Education), Istanbul,
Turkey.
(#)Contributed equally

BACKGROUND: Serious games enrich simulation-based health care trainings and

improve knowledge, skills, and self-confidence of learners while entertaining
them.
OBJECTIVE: A platform which can combine performance data from a basic life
support (BLS) serious game app and hands-on data based on the same scoring
system is not available in the market. The aim of this study was to create such
a platform and investigate whether performance evaluation of BLS trainings would
be more objective compared to conventional Objective Structured Clinical
Examination (OSCE) examinations if these evaluations were carried out with the
platform which combines OSCE scoring criteria with sensor data retrieved from
the simulator's sensors.
METHODS: Participants were 25 volunteers (11 men [44.0%] and 14 [56.0] women)
among Acıbadem Mehmet Ali Aydınlar University students without prior knowledge
of the BLS protocol. A serious game module has been created for teaching
learners the European Resuscitation Council Basic Life Support 2015 protocol. A
second module called the hands-on module was designed for educators. This module
includes a checklist used for BLS OSCE examinations and can retrieve sensor data
such as compression depth, compression frequency, and ventilation volume from
the manikin (CPR Lilly; 3B Scientific GmbH) via Bluetooth. Data retrieved from
the sensors of the manikin enable educators to evaluate learners in a more
objective way. Performance data retrieved from the serious gaming module have
been combined with the results of the hands-on module. Data acquired from the
hands-on module have also been compared with the results of conventional OSCE
scores of the participants, which were obtained by watching the videos of the
same trainings.
RESULTS: Participants were considered successful in the game if they scored
80/100 or above. Overall, participants scored 80 or above in an average of 1.4
(SD 0.65) trials. The average BLS serious game score was 88.3/100 (SD 5.17) and
hands-on average score was 70.7/100 (SD 17.3), whereas the OSCE average score
was 84.4/100 (SD 12.9). There was no statistically significant correlation
between success on trials (score ≥80/100), serious game, hands-on training app,
and OSCE scores (Spearman rho test, P>.05). The mean BLS serious game score of
the participants was 88.3/100 (SD 5.17), whereas their mean hands-on training
app score was 70.7/100 (SD 17.3) and OSCE score was 84.4/100 (SD 12.9).
CONCLUSIONS: Although scoring criteria for OSCE and hands-on training app were
identical, OSCE scores were 17% higher than hands-on training app scores. After
analyzing the difference of scores between hands-on training app and OSCE, it
has been revealed that these differences originate from scoring parameters such
as compression depth, compression frequency, and ventilation volume. These data
suggest that evaluation of BLS trainings would be more objective if these
evaluations were carried out with the modality, which combines visual OSCE
scoring criteria with sensor data retrieved from the simulator's sensors.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04533893;
https://clinicaltrials.gov/ct2/show/NCT04533893.

©Mehmet Emin Aksoy. Originally published in JMIR Serious Games

(http://games.jmir.org), 25.11.2020.

DOI: 10.2196/24166
PMCID: PMC7725648
PMID: 33237035

Conflict of interest statement: Conflicts of Interest: None declared.

25. Resusc Plus. 2024 Dec 19;21:100824. doi: 10.1016/j.resplu.2024.100824.

eCollection 2025 Jan.

Teaching high quality paediatric basic life support to laypeople: The

development and evaluation of a virtual simulation game.

Boggs S(1)(2), McNally JD(1)(3), O'Hearn K(3), Del Bel M(3), Armstrong J(3),
Newhook D(3), Lobos AT(1)(3).

Author information:
(1)Department of Paediatrics, Division of Paediatric Critical Care, CHEO, 401
Smyth Rd, Ottawa, Ontario K1H 8L1, Canada.
(2)Department of Paediatrics, Division of Paediatric Critical Care, McMaster
University, 1280 Main Street West, HSC 3E20, Hamilton, Ontario L8S 4K1, Canada.
(3)CHEO Research Institute, 401 Smyth Road, Ottawa K1H 8L1, Canada.

BACKGROUND: Self-directed training has been recognized as a reasonable

alternative to traditional instructor-led formats to teach laypeople Basic Life
Support (BLS). Virtual tools can facilitate high-quality self-directed
resuscitation education; however, their role in teaching paediatric BLS remains
unclear due to limited empiric evaluation and suboptimal design of existing
tools.
AIM: We describe the development and evaluation of a virtual simulation game
(VSG) designed to teach high-quality paediatric BLS using a self-directed,
online format with integrated deliberate practice and feedback.
METHODS: We conducted a pilot prospective single-arm cohort study examining the
VSG's impact on laypeople's paediatric BLS self-efficacy, attitudes, and
knowledge as well as learner reactions. Data was collected using online surveys
immediately after VSG completion and was analysed using descriptive statistics.
RESULTS: Fifty-five participants (median age 32 years, 76% female, 11% active
certification in paediatric BLS) evaluated the VSG. Participants reported high
self-efficacy, willingness to perform paediatric BLS, and high perceived
knowledge after VSG completion. Fifty (91%) achieved a passing score (≥13/15) on
the paediatric BLS knowledge assessment. Learner reactions were favourable with
98% of participants agreeing that VSG educational content was clear and helpful.
Mean System Usability Scale score was 81.1 (standard deviation 12.6) with a Net
Promoter Score of 32 indicating high levels of usability and likelihood to
recommend to others.
CONCLUSIONS: The VSG was well-received by laypeople with positive effects
observed on paediatric BLS self-efficacy, attitudes, and knowledge. Future
studies should examine the impact of VSGs on skill performance through
standalone or blended learning approaches.

© 2024 The Author(s).

DOI: 10.1016/j.resplu.2024.100824
PMCID: PMC11728990
PMID: 39807286

Conflict of interest statement: The authors declare that they have no known
competing financial interests or personal relationships that could have appeared
to influence the work reported in this paper.

26. Front Med (Lausanne). 2023 Jan 6;9:1025449. doi: 10.3389/fmed.2022.1025449.

eCollection 2022.

Indications for hand and glove disinfection in Advanced Cardiovascular Life

Support: A manikin simulation study.

Bushuven S(1)(2)(3), Bansbach J(3), Bentele M(4)(5), Bentele S(4)(5)(6), Gerber

B(4), Reinoso-Schiller N(7), Scheithauer S(7).

Author information:
(1)Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk
Gailingen, Health Care Association District of Constance, Gailingen, Germany.
(2)Institute for Medical Education, University Hospital, LMU Munich, Munich,
Germany.
(3)Department of Anesthesiology and Critical Care, Medical Center - University
of Freiburg, Freiburg, Germany.
(4)Institute for Anaesthesiology, Intensive Care, Emergency Medicine and Pain
Therapy, Hegau Bodensee Hospital, Singen, Germany.
(5)Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany.
(6)Department of Emergency Medicine, University-Hospital Augsburg, University of
Augsburg, Augsburg, Germany.
(7)Department of Infection Control and Infectious Diseases, University Medical
Center Göttingen (UMG), Georg-August University Göttingen, Göttingen, Germany.

BACKGROUND AND AIM: There are no investigations on hand hygiene during

cardiopulmonary resuscitation (CPR), even though these patients are at high risk
for healthcare-associated infections. We aimed to evaluate the number of
indicated hand hygiene per CPR case in general and the fraction that could be
accomplished without delay for other life-saving techniques through standardized
observations.
MATERIALS AND METHODS: In 2022, we conducted Advanced Cardiovascular Life
Support (ACLS) courses over 4 days, practicing 33 ACLS case vignettes with
standard measurements of chest compression fractions and hand hygiene
indications. A total of nine healthcare workers (six nurses and three
physicians) participated.
RESULTS: A total of 33 training scenarios resulted in 613 indications for hand
disinfection. Of these, 150 (24%) occurred before patient contact and 310 (51%)
before aseptic activities. In 282 out of 310 (91%) indications, which have the
highest impact on patient safety, the medication administrator was responsible;
in 28 out of 310 (9%) indications, the airway manager was responsible. Depending
on the scenario and assuming 15 s to be sufficient for alcoholic disinfection,
56-100% (mean 84.1%, SD ± 13.1%) of all indications could have been accomplished
without delaying patient resuscitation. Percentages were lower for 30-s of
exposure time.
CONCLUSION: To the best of our knowledge, this is the first study investigating
the feasibility of hand hygiene in a manikin CPR study. Even if the feasibility
is overestimated due to the study setup, the fundamental conclusion is that a
relevant part of the WHO indications for hand disinfection can be implemented
without compromising quality in acute care, thus increasing the overall quality
of patient care.

Copyright © 2023 Bushuven, Bansbach, Bentele, Bentele, Gerber, Reinoso-Schiller

and Scheithauer.

DOI: 10.3389/fmed.2022.1025449
PMCID: PMC9853186
PMID: 36687411

Conflict of interest statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.

27. Australas Emerg Care. 2023 Dec;26(4):303-307. doi: 10.1016/j.auec.2023.03.003.

Epub 2023 Mar 22.

Factors associated with willingness to perform basic life support in the

community setting in Yogyakarta, Indonesia.

Kusumawati HI(1), Sutono(2), Alim S(2), Achmad BF(2), Putri AF(3).

Author information:
(1)Department of Nursing, Faculty of Medicine, Public Health and Nursing,
Universitas Gadjah Mada, Indonesia. Electronic address:
happy.i.kusumawati@ugm.ac.id.
(2)Department of Nursing, Faculty of Medicine, Public Health and Nursing,
Universitas Gadjah Mada, Indonesia.
(3)Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

BACKGROUND: Cardiac arrest is one of the fatal medical emergencies which need to
be treated immediately. Poor survival rates in the community settings are common
because of limited and ineffective bystander basic life support (BLS). This
study aimed to identify factors that are associated with the willingness to
perform BLS in communities in Yogyakarta, Indonesia METHODS: A descriptive study
was conducted with a cross-sectional design. Participants (n = 251) were
enrolled from the general population consisting of teachers, security personnel,
and police officers recruited through cluster random sampling. Data were
gathered using both digital or printed questionnaires. Ordinal logistic
regression with adjusted odds ratio (AOR) was used to analyze the association
between BLS predictors and willingness to perform BLS.
RESULTS: Most participants were willing to perform BLS for all genders (55.55%).
The inability to perform BLS and fear of causing harm were the main barriers to
performing BLS accounting for 61.35% and 43.82%, respectively. Compared to other
independent predictors, ages 40-59 were found to be the highest predictors of
willingness to perform BLS (AOR:1.44) followed by experience of seeing real or
simulation of the emergency case (AOR:1.38) CONCLUSIONS: More than half of the
respondents were eager to perform BLS although some barriers were also found.
This study provides some understanding of the predictor factors associated with
BLS performance and shows respondents with some training or experience were more
likely to perform BLS. The results inform policymakers to develop a strategic
plan for increasing willingness to apply BLS in the community. WC:250.

Copyright © 2023 College of Emergency Nursing Australasia. Published by Elsevier

Ltd. All rights reserved.

DOI: 10.1016/j.auec.2023.03.003
PMID: 36964023 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of Interest No competing interests

declared.

28. Simul Healthc. 2018 Feb;13(1):27-32. doi: 10.1097/SIH.0000000000000286.

Comparison of Cardiopulmonary Resuscitation Quality Between Standard Versus

Telephone-Basic Life Support Training Program in Middle-Aged and Elderly
Housewives: A Randomized Simulation Study.

Kim TH(1), Lee YJ, Lee EJ, Ro YS, Lee K, Lee H, Jang DB, Song KJ, Shin SD,
Myklebust H, Birkenes TS.

Author information:
(1)From the Department of Emergency Medicine (T.H.K.), Seoul Metropolitan
Government Seoul National University Boramae Medical Center, Seoul National
University College of Medicine, Seoul; Department of Emergency Medicine
(Y.J.L.), Inha University Hospital, Incheon; Department of Emergency Medicine
(E.J.L.), Korea University Anam Hospital; Laboratory of Emergency Medical
Services (Y.S.R., H.L., D.B.J.), Seoul National University Hospital Biomedical
Research Institute; Department of Emergency Medicine (K.W.L.), Inje University
College of Medicine and Seoul Paik Hospital; Department of Emergency Medicine
(K.J.S., S.D.S.), Seoul National University College of Medicine, Seoul, Korea;
and Laerdal Medical (H.M., T.S.B.), Stavanger, Norway.

INTRODUCTION: For cardiac arrests witnessed at home, the witness is usually a

middle-aged or older housewife. We compared the quality of cardiopulmonary
resuscitation (CPR) performance of bystanders trained with the newly developed
telephone-basic life support (T-BLS) program and those trained with standard BLS
(S-BLS) training programs.
METHODS: Twenty-four middle-aged and older housewives without previous CPR
education were enrolled and randomized into two groups of BLS training programs.
The T-BLS training program included concepts and current instruction protocols
for telephone-assisted CPR, whereas the S-BLS training program provided training
for BLS. After each training course, the participants simulated CPR and were
assisted by a dispatcher via telephone. Cardiopulmonary resuscitation quality
was measured and recorded using a mannequin simulator. The primary outcome was
total no-flow time (>1.5 seconds without chest compression) during simulation.
RESULTS: Among 24 participants, two (8.3%) who experienced mechanical failure of
simulation mannequin and one (4.2%) who violated simulation protocols were
excluded at initial simulation, and two (8.3%) refused follow-up after 6 months.
The median (interquartile range) total no-flow time during initial simulation
was 79.6 (66.4-96.9) seconds for the T-BLS training group and 147.6
(122.5-184.0) seconds for the S-BLS training group (P < 0.01). Median cumulative
interruption time and median number of interruption events during BLS at initial
simulation and 6-month follow-up simulation were significantly shorter in the
T-BLS than in the S-BLS group (1.0 vs. 9.5, P < 0.01, and 1.0 vs. 10.5, P =
0.02, respectively).
CONCLUSIONS: Participants trained with the T-BLS training program showed shorter
no-flow time and fewer interruptions during bystander CPR simulation assisted by
a dispatcher.

DOI: 10.1097/SIH.0000000000000286
PMID: 29369963 [Indexed for MEDLINE]

29. BMC Emerg Med. 2024 Sep 27;24(1):176. doi: 10.1186/s12873-024-01092-w.

Redesign of a virtual reality basic life support module for medical training - a
feasibility study.

Wiltvank IL(1), Besselaar LM(2), van Goor H(2), Tan ECTH(2).

Author information:
(1)Department of Surgery, Radboudumc, Nijmegen, The Netherlands.
iris.wiltvank@radboudumc.nl.
(2)Department of Surgery, Radboudumc, Nijmegen, The Netherlands.

BACKGROUND: Healthcare providers, including medical students, should maintain

their basic life support (BLS) skills and be able to perform BLS in case of
cardiac arrest. Research shows that the use of virtual reality (VR) has
advantages such as improved accessibility, practice with lifelike situations,
and real-time feedback during individual training sessions. A VR BLS module
incorporating these advantages, called Virtual Life Support, has been developed
especially for the medical domain. Virtual Life Support was collaboratively
developed by software developers and stakeholders within the field of medical
education. For this study, we explored whether the first version of this module
capitalised on the advantages of VR and aimed to develop an understanding of
barriers to feasibility of use.
METHODS: This study was conducted to assess the feasibility of employing Virtual
Life Support for medical training and pinpoint potential obstacles. Four groups
of stakeholders were included through purposive sampling: physicians, BLS
instructors, educational experts, and medical students. Participants performed
BLS on a BLS mannequin while using Virtual Life Support and were interviewed
directly afterwards using semi-structured questions. The data was coded and
analysed using thematic analysis.
RESULTS: Thematic saturation was reached after seventeen interviews were
conducted. The codes were categorised into four themes: introduction, content,
applicability, and acceptability/tolerability. Sixteen barriers for the use of
Virtual Life Support were found and subsequently categorised into must-have
(restraining function, i.e. necessary to address) and nice to have features
(non-essential elements to consider addressing).
CONCLUSION: The study offers valuable insights into redesigning Virtual Life
Support for Basic Life Support training, specifically tailored for medical
students and healthcare providers, using a primarily qualitative approach. The
findings suggest that the benefits of virtual reality, such as enhanced realism
and immersive learning, can be effectively integrated into a single training
module. Further development and validation of VR BLS modules, such as the one
evaluated in this study, have the potential to revolutionise BLS training. This
could significantly improve both the quality of skills and the accessibility of
training, ultimately enhancing preparedness for real-life emergency scenarios.

© 2024. The Author(s).

DOI: 10.1186/s12873-024-01092-w
PMCID: PMC11438090
PMID: 39333990 [Indexed for MEDLINE]
Conflict of interest statement: The authors declare no competing interests.

30. Nurs Rep. 2023 Feb 21;13(1):297-306. doi: 10.3390/nursrep13010028.

Self-Confidence, Satisfaction, and Knowledge of Nursing Students with Training

in Basic Life Support in Pregnant Women: A Cross-Sectional Study.

Peinado-Molina RA(1), Martínez-Vázquez S(1), Paulano-Martínez JF(2),

Hernández-Martínez A(3), Martínez-Galiano JM(1)(4).

Author information:
(1)Department of Nursing, University of Jaen, 23071 Jaen, Spain.
(2)Hospital of Jaén, 23006 Jaen, Spain.
(3)Department of Nursing, Faculty of Nursing of Ciudad Real, The University of
Castilla-La Mancha, 02008 Ciudad Real, Spain.
(4)Consortium for Biomedical Research in Epidemiology and Public Health
(CIBERESP), 28029 Madrid, Spain.

BACKGROUND: A flipped classroom integrating clinical simulation has been shown

to be effective for basic life support (BLS) competencies in nursing students.
Cardiopulmonary arrests (CPAs) in pregnant women have a low incidence but high
morbidity and mortality. Current trends show an increasing incidence; however,
most official university nursing training curricula do not include specific
training modules for BLS in pregnant women. This study aims to know the
satisfaction and self-confidence of nursing students with respect to a training
intervention regarding in BLS in pregnant women. Additionally, it aims to assess
the adequacy of this intervention for acquiring the necessary knowledge on the
subject.
METHODS: A cross-sectional study was conducted at the University of Jaen in
2022. Data were collected on sociodemographic factors, previous contact with the
topic, and topic knowledge in addition to the use of an SCLS questionnaire to
measure satisfaction. Participants took the BLS training (a flipped classroom
integrating clinical simulation on this topic) before answering the
questionnaire.
RESULTS: A total of 136 students participated. The mean score on the BLS
questionnaire was 9.10 out of 10 (SD = 1.01). The mean score for the SCLS
questionnaire for females was 62.36 (SD = 7.70) and 56.23 (SD = 16.94) for the
male group. Age showed a statistically significant association with SCLS score:
the score decreased with an increase in age (p < 0.001).
CONCLUSIONS: The flipped classroom, integrating simulation for BLS in pregnant
women, improves self-confidence, satisfaction, and knowledge on the topic.

DOI: 10.3390/nursrep13010028
PMCID: PMC10057892
PMID: 36976680

Conflict of interest statement: The authors declare no conflict of interest.

31. J Emerg Med. 2014 May;46(5):695-700. doi: 10.1016/j.jemermed.2013.08.055. Epub

2013 Oct 22.

Perceptions of basic, advanced, and pediatric life support training in a United

States medical school.

Pillow MT(1), Stader D(2), Nguyen M(3), Cao D(2), McArthur R(4), Hoxhaj S(5).
Author information:
(1)Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas;
Simulation Program, Baylor College of Medicine, Houston, Texas.
(2)Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North
Carolina.
(3)Department of Emergency Medicine, New York Presbyterian, New York, New York.
(4)Department of Emergency Medicine, Beth Israel Deaconess, New York, New York.
(5)Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas.

BACKGROUND: Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and
Pediatric Advanced Life Support (PALS) are integral parts of emergency
resuscitative care. Although this training is usually reserved for residents,
introducing the training in the medical student curriculum may enhance
acquisition and retention of these skills.
OBJECTIVES: We developed a survey to characterize the perceptions and needs of
graduating medical students regarding BLS, ACLS, and PALS training.
METHODS: This was a study of graduating 4th-year medical students at a U.S.
medical school. The students were surveyed prior to participating in an ACLS
course in March of their final year.
RESULTS: Of 152 students, 109 (71.7%) completed the survey; 48.6% of students
entered medical school without any prior training and 47.7% started clinics
without training; 83.4% of students reported witnessing an average of 3.0
in-hospital cardiac arrests during training (range of 0-20). Overall, students
rated their preparedness 2.0 (SD 1.0) for adult resuscitations and 1.7 (SD 0.9)
for pediatric resuscitations on a 1-5 Likert scale, with 1 being unprepared. A
total of 36.8% of students avoided participating in resuscitations due to lack
of training; 98.2%, 91.7%, and 64.2% of students believe that BLS, ACLS, and
PALS, respectively, should be included in the medical student curriculum.
CONCLUSIONS: As per previous studies that have examined this topic, students
feel unprepared to respond to cardiac arrests and resuscitations. They feel that
training is needed in their curriculum and would possibly enhance perceived
comfort levels and willingness to participate in resuscitations.

Copyright © 2014 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jemermed.2013.08.055
PMID: 24161229 [Indexed for MEDLINE]

32. JNMA J Nepal Med Assoc. 2018 Jul-Aug;56(212):774-780. doi: 10.31729/jnma.3645.

An Experience of Video Based Training on Basic Life Support.

Shrestha R(1), Shrestha A(2), Batajoo KH(3), Thapa R(4), Acharya S(2),
Bajracharya S(2), Singh S(5).

Author information:
(1)Department of General Practice and Emergency Medicine, Kathmandu University
School of Medical Sciences, Dhulikhel, Kavre, Nepal.
(2)Department of General Practice and Emergency Medicine, Patan Academy of
Health Sciences, Patan, Nepal.
(3)Department of General Practice and Emergency Medicine, KIST Medical College
and Teaching Hospital, Imadol, Nepal.
(4)Department of General Practice and Emergency Medicine, Kathmandu Medical
college and Teaching Hospital, Nepal.
(5)Department of Emergency Medicine, Nepal Mediciti Hospital, Kathmandu, Nepal.

INTRODUCTION: Basic life support is foundation to save lives. In contrast to the

developed countries, there is still no national standard BLS training module in
Nepal. Basic life support training is being provided by various institutions but
lack in consistency and coordination. The Nepal basic life support Course is the
video based training in Nepali language with reference to recent advances which
was intended for all health care personnel of Nepal in urban as well as rural
setting. We aimed to describe the features of this video based training module
in local language, to analyse the differences of knowledge before and after the
training and to find out the participants perception and satisfaction with this
course.
METHODS: This is a descriptive cross-sectional study based on data of trainings
conducted over the study period. Ethical approval was taken. The post-test score
was recorded and compared with the occupational using ANOVA. On the spot and
delayed feedbacks from the participants were collected voluntarily and
summarized.
RESULTS: Total of 576 participants (435 clinical doctors, 92 nurses/paramedics,
18 non-clinical doctors and 41 intern doctors) successfully completed the
training. The difference in post test scores (mean = 12.9±1.8) among the
different occupational background was not significant (P=0.159). The feedbacks
from the participants were mostly positive and encouraging.
CONCLUSIONS: The knowledge of basic life support improved significantly
irrespective of the occupation of the participants. A universal, nationwide
video based training module in Nepali language should be developed focusing all
health care personnel of urban as well rural Nepal.

DOI: 10.31729/jnma.3645
PMCID: PMC8827550
PMID: 30387468 [Indexed for MEDLINE]

Conflict of interest statement: None.

33. Belitung Nurs J. 2024 Jun 28;10(3):261-271. doi: 10.33546/bnj.3328. eCollection

2024.

Enriching nursing knowledge and practice in Jordanian government hospitals

through basic life support simulation training: A randomized controlled trial.

Abu-Wardeh Y(1)(2), Ahmad WMAW(3), Che Hamzah MSS(4), Najjar YW(5), Hassan
II(1).

Author information:
(1)School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150
Kubang Kerian, Kelantan, Malaysia.
(2)Nursing Department, Prince Faisal Hospital, Ministry of Health, AMMAN,
Jordan.
(3)Department of Biostatistics, School of Dental Sciences, Health Campus,
Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
(4)Department of Emergency Medicine, School of Medical Science, Health Campus,
Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
(5)Zarqa University College, Al-Balqa Applied University, Zarqa, Jordan.

BACKGROUND: Healthcare providers must possess the necessary knowledge and skills
to perform effective cardiopulmonary resuscitation (CPR). In the event of
cardiopulmonary arrest, basic life support (BLS) is the initial step in the
life-saving process before the advanced CPR team arrives. BLS simulation
training using manikins has become an essential teaching methodology in nursing
education, enhancing newly employed nurses' knowledge and skills and empowering
them to provide adequate resuscitation.
OBJECTIVE: This study aimed to evaluate the potential effect of BLS simulation
training on knowledge and practice scores among newly employed nurses in
Jordanian government hospitals.
METHODS: A total of 102 newly employed nurses were randomly assigned to two
groups: the control group (n = 51) received standard training, and the
experimental group (n = 51) received one full day of BLS simulation training.
The training program used the American Heart Association (AHA)-BLS-2020
guidelines and integrated theoretical models such as Miller's Pyramid and Kolb's
Cycle. Both groups were homogeneous in inclusion characteristics and pretest
results. Knowledge and practice scores were assessed using 23 multiple-choice
questions (MCQs). Data were analyzed using one-way repeated measures ANOVA.
RESULTS: The results indicated significant differences in knowledge scores, F(2,
182) = 58.514, p <0.001, and practice scores, F(2, 182) = 20.134, p <0.001,
between the control and experimental groups at all measurement times: pretest,
posttest 1, and posttest 2. Moreover, Cohen's d reflected the effectiveness of
BLS simulation training as an educational module, showing a large effect
(Cohen's d = 1.568) on participants' knowledge levels and a medium effect
(Cohen's d = 0.749) on participants' practice levels.
CONCLUSION: The study concludes that BLS simulation training using the
AHA-BLS-2020 guidelines and integrating theoretical models such as Miller's
Pyramid and Kolb's Cycle significantly improves knowledge and practice scores
among newly employed nurses, proving highly effective in enhancing their
competencies in performing CPR. Implementing BLS simulation training in nursing
education programs can significantly elevate the proficiency of newly employed
nurses, ultimately improving patient outcomes during cardiopulmonary arrest
situations. This training approach should be integrated into standard nursing
curricula to ensure nurses are well-prepared for real-life emergencies.
TRIAL REGISTRY NUMBER: NCT06001879.

© The Author(s) 2024.

DOI: 10.33546/bnj.3328
PMCID: PMC11211748
PMID: 38947304

Conflict of interest statement: The authors declared that they have no known
competing financial interests or personal relationships that could have appeared
to influence the work reported in this paper.

34. Int J Environ Res Public Health. 2019 Nov 28;16(23):4771. doi:
10.3390/ijerph16234771.

Basic Life-Support Learning in Undergraduate Students of Sports Sciences:

Efficacy of 150 Minutes of Training and Retention after Eight Months.

Aranda-García S(1)(2), Herrera-Pedroviejo E(3)(4), Abelairas-Gómez C(5)(6)(7).

Author information:
(1)GRAFIS Research group, Institut Nacional d'Educació Física de Catalunya
(INEFC), Universitat de Barcelona (UB), 08038 Barcelona, Spain.
(2)Health and Applied Sciences Department, Institut Nacional d'Educació Física
de Catalunya (INEFC), Universitat de Barcelona (UB), 08038 Barcelona, Spain.
(3)Physiotherapy Department, Faculty of Medicine and Health Sciences,
Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain.
(4)Blanquerna School of Health Sciences-Ramon Llull University, 08025 Barcelona,
Spain.
(5)CLINURSID Research Group, Universidade de Santiago de Compostela, 15782
Santiago de Compostela, Spain.
(6)Faculty of Education Sciences, Universidade de Santiago de Compostela, 15782
Santiago de Compostela, Spain.
(7)Institute of Health Research of Santiago (IDIS), Santiago de Compostela,
15706 Santiago de Compostela, Spain.

Several professional groups, which are not health professionals, are more likely
to witness situations requiring basic life support (BLS) due to the nature of
their job. The aim of this study was to assess BLS learning after 150 min of
training in undergraduate students of sports science and their retention after
eight months. Participants trained on BLS (150-min session: 30 theory, 120
practice). After training (T1) and after 8 months (T2), we evaluated their
performance of the BLS sequence and two minutes of cardiopulmonary resuscitation
(CPR). At T1, the 23 participants presented a mean score of 72.5 ± 21.0% in the
quality of the CPRs (compressions: 78.6 ± 25.9%, ventilation: 69.9 ± 30.1%).
More than 90% of the participants acted correctly in each step of the BLS
sequence. At T2, although the overall quality of the CPR performed did not
decrease, significant decreases were observed for: correct hand position (T1:
98.2 ± 8.8, T2: 77.2 ± 39.7%), compression depth (T1: 51.4 ± 7.9, T2: 56.0 ± 5.7
mm), and compression rate. They worsened opening the airway and checking for
breathing. In conclusions, participants learned BLS and good-quality CPR after
the 150-min training session. At eight months they had good retention of the BLS
sequence and CPR skills. Training on airway management and the position of the
hands during CPR should be reinforced.

DOI: 10.3390/ijerph16234771
PMCID: PMC6926514
PMID: 31795163 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.

35. Prehosp Emerg Care. 2017 May-Jun;21(3):362-377. doi:

10.1080/10903127.2016.1258096. Epub 2017 Jan 6.

Retention of Basic Life Support in Laypeople: Mastery Learning vs. Time-based

Education.

Boet S, Bould MD, Pigford AA, Rössler B, Nambyiah P, Li Q, Bunting A, Schebesta

K.

OBJECTIVE: To compare the effectiveness of a mastery learning (ML) versus a

time-based (TB) BLS course for the acquisition and retention of BLS knowledge
and skills in laypeople.
METHODS: After ethics approval, laypeople were randomized to a ML or TB BLS
course based on the American Heart Association (AHA) Heartsaver course. In the
ML group, subjects practiced and received feedback at six BLS stations until
they reached a pre-determined level of performance. The TB group received a
standard AHA six-station BLS course. All participants took the standard
in-course BLS skills test at the end of their course. BLS skills and knowledge
were tested using a high-fidelity scenario and knowledge questionnaire upon
course completion (immediate post-test) and after four months (retention test).
Video recorded scenarios were assessed by two blinded, independent raters using
the AHA skills checklist.
RESULTS: Forty-three subjects were included in analysis (23ML;20TB). For primary
outcome, subjects' performance did not change after four months, regardless of
the teaching modality (TB from (median[IQR]) 8.0[6.125;8.375] to 8.5[5.625;9.0]
vs. ML from 8.0[7.0;9.0] to 7.0[6.0;8.0], p = 0.12 for test phase, p = 0.21 for
interaction between effect of teaching modality and test phase). For secondary
outcomes, subjects acquired knowledge between pre- and immediate post-tests (p <
0.005), and partially retained the acquired knowledge up to four months (p <
0.005) despite a decrease between immediate post-test and retention test (p =
0.009), irrespectively of the group (p = 0.59) (TB from 63.3[48.3;73.3] to
93.3[81.7;100.0] and then 93.3[81.7;93.3] vs. ML from 60.0[46.7;66.7] to
93.3[80.0;100.0] and then 80.0[73.3;93.3]). Regardless of the group after
4 months, chest compression depth improved (TB from 39.0[35.0;46.0] to
48.5[40.25;58.0] vs. ML from 40.0[37.0;47.0] to 45.0[37.0;52.0]; p = 0.012), but
not the rate (TB from 118.0[114.0;125.0] to 120.5[113.0;129.5] vs. ML from
119.0[113.0;130.0] to 123.0[102.0;132.0]; p = 0.70). All subjects passed the
in-course BLS skills test. Pass/fail rates were poor in both groups at both the
simulated immediate post-test (ML = 1/22;TB = 0/20; p = 0.35) and retention test
(ML pass/fail = 1/22, TB pass/fail = 0/20; p = 0.35). The ML course was slightly
longer than the TB course (108[94;117] min vs. 95[89;102] min; p = 0.003).
CONCLUSIONS: There was no major benefit of a ML compared to a TB BLS course for
the acquisition and four-month retention of knowledge or skills among laypeople.

DOI: 10.1080/10903127.2016.1258096
PMID: 28059603 [Indexed for MEDLINE]

36. Cureus. 2024 Jun 19;16(6):e62719. doi: 10.7759/cureus.62719. eCollection 2024

Jun.

Use of High-Fidelity Simulation as an Adjunct to Basic Life Support Training To

Promote Team-Based Resuscitation Skills: A Mixed-Methods Pilot Study.

Berger DJ(1), Lum L(2), Shercliffe R(2), Sinz E(3).

Author information:
(1)Emergency & Internal Medicine, Virginia Commonwealth University Health
System, Richmond, USA.
(2)Resuscitation Sciences Training Center, Penn State Health Milton S. Hershey
Medical Center, Hershey, USA.
(3)Anesthesiology and Critical Care, West Virginia University, Morgantown, USA.

Introduction The 2020 American Heart Association's (AHA) Basic Life Support
(BLS) curriculum focuses on cardiac arrest resuscitation with one or two
rescuers, providing only limited opportunities to develop higher-level skills
such as leadership, communication, and debriefing. This mixed-methods pilot
study evaluated whether supplementing the traditional Heartcode BLS course with
a high-fidelity teamwork simulation session improved mastery of these
higher-level skills. Methods Twenty-four first-year medical students completed
the pilot training during sessions offered in February and May of 2023. The
program included the traditional AHA Heartcode BLS course, which ranges from two
to four hours, and includes both online and in-person skills components. This
was followed by a 90-minute high-fidelity simulation session consisting of two
simulated resuscitations separated by a student-led plus/delta debriefing.
Facilitators then debriefed the entire activity. Students completed an anonymous
online survey that used a 0-10 slider scale to attribute their perceived
proficiency for specific skills to the initial BLS course or the teamwork
simulations and provided qualitative feedback. Results Twenty-one students
(87.5%) completed the follow-up survey. Students credited their proficiency in
technical skills (e.g., "Chest Compressions") to both sessions equally, but
proficiency in higher-level skills, such as leadership, communication, and
teamwork, was predominantly credited to the simulation. Additionally, students
reported that the teamwork simulation promoted realism and increased
self-efficacy. Conclusion Team-based resuscitation simulations using
high-fidelity equipment augmented the AHA BLS course by promoting perceived
competence in team dynamics domains and increasing students' self-efficacy for
participating in real hospital-based resuscitations. Studies with larger sample
sizes and objective data should be performed, and the use of similar
resuscitation simulations or the development of a formal team-based BLS
certification course should be considered.

Copyright © 2024, Berger et al.

DOI: 10.7759/cureus.62719
PMCID: PMC11259406
PMID: 39036194

Conflict of interest statement: Human subjects: Consent was obtained or waived

by all participants in this study. Pennsylvania State University Institutional
Review Board issued approval STUDY00022019. Animal subjects: All authors have
confirmed that this study did not involve animal subjects or tissue. Conflicts
of interest: In compliance with the ICMJE uniform disclosure form, all authors
declare the following: Payment/services info: The project described was
supported by the National Center for Advancing Translational Sciences, National
Institutes of Health, through Grant UL1 TR002014 and Grant UL1 TR00045. The
content is solely the responsibility of the authors and does not necessarily
represent the official views of the NIH. The use of the Penn State College of
Medicine Clinical Simulation Center & Resuscitation Science Training Center
equipment, staff, and space was provided free of charge for this project. Gift
cards were self-funded by the authors. Financial relationships: Elizabeth Sinz
declare(s) personal fees and Travel from Sinz Healthcare Education Solutions,
LLC. Sinz Healthcare Education Solutions, LLC is owned by Elizabeth Sinz to
facilitate her work for the American Heart Association as an editor, updating
educational materials when the guidelines are updated. Other relationships: All
authors have declared that there are no other relationships or activities that
could appear to have influenced the submitted work.

37. J Clin Diagn Res. 2016 Jul;10(7):OC33-7. doi: 10.7860/JCDR/2016/19221.8197.

Epub
2016 Jul 1.

Quality of Basic Life Support - A Comparison between Medical Students and

Paramedics.

Körber MI(1), Köhler T(1), Weiss V(2), Pfister R(1), Michels G(1).

Author information:
(1)Department III of Internal Medicine, University of Cologne , Heart Center,
Germany .
(2)Institute of Medical Statistics, Informatics and Epidemiology, University of
Cologne , Cologne, Germany .

INTRODUCTION: Poor survival rates after cardiac arrest can partly be explained
by poor basic life support skills in medical professionals.
AIM: This study aimed to assess quality of basic life support in medical
students and paramedics.
MATERIALS AND METHODS: We conducted a prospective observational study with 100
early medical students (group A), 100 late medical students (group B) and 100
paramedics (group C), performing a 20-minute basic life support simulation in
teams of two. Average frequency and absolute number of chest compressions per
minute (mean (±SD)), chest decompression (millimetres of compression remaining,
mean (±SD)), hands-off-time (seconds/minute, mean (±SD)), frequency of switching
positions between ventilation and chest compression (per 20 minutes) and rate of
sufficient compressions (depth ≥50mm) were assessed as quality parameters of
CPR.
RESULTS: In groups A, B and C the rates of sufficiently deep chest compressions
were 56%, 42% and 52%, respectively, without significant differences. Male
gender and real-life CPR experience were significantly associated with deeper
chest compression. Frequency and number of chest compressions were within
recommended goals in at least 96% of all groups. Remaining chest compressions
were 6 mm (±2), 6 mm (±2) and 5 mm (±2) with a significant difference between
group A and C (p=0.017). Hands-off times were 6s/min (±1), 5s/min (±1) and
4s/min (±1), which was significantly different across all three groups.
CONCLUSION: Overall, paramedics tended to show better quality of CPR compared to
medical students. Though, chest compression depth as an important quality
characteristic of CPR was insufficient in almost 50% of participants, even in
well trained paramedics. Therefore, we suggest that an effort should be made to
find better ways to educate health care professionals in BLS.

DOI: 10.7860/JCDR/2016/19221.8197
PMCID: PMC5020289
PMID: 27630885

38. Resuscitation. 2019 Nov;144:33-39. doi: 10.1016/j.resuscitation.2019.08.040.

Epub 2019 Sep 7.

Basic life support training using shared mental models improves team performance
of first responders on normal wards: A randomised controlled simulation trial.

Beck S(1), Doehn C(2), Funk H(1), Kosan J(1), Issleib M(1), Daubmann A(3),
Zöllner C(1), Kubitz JC(1).

Author information:
(1)Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf,
Martini-Str. 52, 20246 Hamburg, Germany.
(2)Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf,
Martini-Str. 52, 20246 Hamburg, Germany. Electronic address: c.doehn@uke.de.
(3)Department of Medical Biometry and Epidemiology, University Medical Center
Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany.

INTRODUCTION: Survival of in-hospital cardiac arrest (IHCA) depends on fast and

effective action of the first responding team. Not only technical skills, but
professional teamwork is required. Observational studies and theoretical models
suggest that shared mental models of members improve teamwork. This study
investigated if a training on shared mental models, improves team performance in
simulated in-hospital cardiac arrest.
METHODS: On the background of an introduction of mandatory Basic Life Support
(BLS) training for clinical staff a randomized controlled trial was performed to
compare two training methods. Staff from clinical departments was randomised to
receive either a conventional instructor led training (control group) or an
interventional training (intervention group). The interventional training was
based on self-directed learning of the group in order to develop shared mental
models. Primary outcome were mean scores of the team assessment scale (TAS) and
the hands-off time. Secondary outcome were mean scores for quality of BLS.
RESULTS: Performance of 75 teams of the interventional and 66 of the control
group was analysed. The hands-off time was significantly lower in the
interventional group (5.42% vs. 8.85%, p = 0.029). Scores of the TAS and the
overall BLS score were high and not significantly different between the groups.
Hands-off time correlated significantly negative with all TAS items.
CONCLUSION: BLS training for clinical staff which creates shared mental models
reduces hands-off time in a simulated cardiac arrest scenario. Training methods
establishing shared mental models of team members can be considered for
effective team trainings without adding additional training time.
Copyright © 2019 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2019.08.040
PMID: 31505232 [Indexed for MEDLINE]

39. Scand J Trauma Resusc Emerg Med. 2015 Jun 21;23:48. doi:
10.1186/s13049-015-0123-1.

Quality of basic life support when using different commercially available public
access defibrillators.

Müller MP(1), Poenicke C(2), Kurth M(3), Richter T(4), Koch T(5), Eisold C(6),
Pfältzer A(7), Heller AR(8).

Author information:
(1)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital, Technische Universität Dresden, Dresden, Germany.
mpmueller.web@gmail.com.
(2)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital, Technische Universität Dresden, Dresden, Germany.
Cynthia.poenicke@uniklinikum-dresden.de.
(3)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital, Technische Universität Dresden, Dresden, Germany. maxi.eli@gmx.de.
(4)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital, Technische Universität Dresden, Dresden, Germany.
torsten.richter@uniklinikum-dresden.de.
(5)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital, Technische Universität Dresden, Dresden, Germany.
thea.koch@uniklinikum-dresden.de.
(6)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital, Technische Universität Dresden, Dresden, Germany.
carolin.eisold@uniklinikum-dresden.de.
(7)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital, Technische Universität Dresden, Dresden, Germany.
pfaeltzer@uniklinikum-dresden.de.
(8)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital, Technische Universität Dresden, Dresden, Germany.
axel.heller@uniklinikum-dresden.de.

BACKGROUND: Basic life support (BLS) guidelines focus on chest compressions with
a minimal no-flow fraction (NFF), early defibrillation, and a short perishock
pause. By using an automated external defibrillator (AED) lay persons are guided
through the process of attaching electrodes and initiating defibrillation. It is
unclear, however, to what extent the voice instructions given by the AED might
influence the quality of initial resuscitation.
METHODS: Using a patient simulator, 8 different commercially available AEDs were
evaluated within two different BLS scenarios (ventricular fibrillation vs.
asystole). A BLS certified instructor acted according to the current European
Resuscitation Council 2010 Guidelines and followed all of the AED voice prompts.
In a second set of scenarios, the rescuer anticipated the appropriate actions
and started already before the AED stopped speaking. A BLS scenario without AED
served as the control. All scenarios were run three times.
RESULTS: The time until the first chest compression was 25 ± 2 seconds without
the AED and ranged from 50 ± 3 to 148 ± 13 seconds with the AED depending on the
model used. The NFF was .26 ± .01 without the AED and between .37 ± .01 and
.72 ± .01 when an AED was used. The perishock pause ranged from 12 ± 0 to 46 ± 0
seconds. The optimized sequence of actions reduced the NFF, which ranged now
from .32 ± .01 to .41 ± .01, and the perishock pause ranging from 1 ± 1 to
19 ± 1 seconds.
CONCLUSIONS: Voice prompts given by commercially available AED merely meet the
requirements of current evidence in basic life support. Furthermore, there is a
significant difference between devices with regard to time until the first chest
compression, perishock pause, no-flow fraction and other objective measures of
the quality of BLS. However, the BLS quality may be improved with optimized
handling of the AED. Thus, rescuers should be trained on the respective AED
devices, and manufacturers should expend more effort in improving user guidance
to shorten the NFF and perishock pause.

DOI: 10.1186/s13049-015-0123-1
PMCID: PMC4475613
PMID: 26094032 [Indexed for MEDLINE]

40. J Gen Fam Med. 2022 Apr 19;23(4):289-290. doi: 10.1002/jgf2.538. eCollection
2022 Jul.

Combined online and offline basic life support workshop with infection
prevention and control for COVID-19.

Ikeda A(1), Tochino Y(2), Nishihata T(1), Oku S(3), Shuto T(2).

Author information:
(1)Osaka City University School of Medicine Osaka Japan.
(2)Department of Medical Education and General Practice, Osaka City University
Graduate School of Medicine Osaka Japan.
(3)Skills Simulation Center Osaka City University Hospital Osaka Japan.

The coronavirus disease 2019 outbreak has made it difficult to hold face-to-face
BLS training sessions at university. Even in this limited situation, the
effective use of combined online video course and offline training can
contribute to gaining participants' confidence in conducting BLS and improving
mindset than before.

© 2022 The Authors. Journal of General and Family Medicine published by John
Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.

DOI: 10.1002/jgf2.538
PMCID: PMC9110984
PMID: 35600906

Conflict of interest statement: None.

41. Medicine (Baltimore). 2021 Apr 2;100(13):e24819. doi:

10.1097/MD.0000000000024819.

Basic life support training programme in schools by school nurses: How long and
how often to train?

Martínez-Isasi S(1), García-Suárez M(2), De La Peña Rodríguez MA(3),

Gómez-Salgado J(4)(5), Fernández N(6), Méndez-Martínez C(2), Leon-Castelao E(7),
Clemente-Vivancos A(7)(8), Fernández-García D(9).

Author information:
(1)Life Support and Medical Simulation Research Group, Health Research Institute
of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; CLINURSID
Research Group. Faculty of Nursing, University of Santiago de Compostela,
Santiago de Compostela.
(2)Servicio de Anestesia y Reanimación, Complejo Asistencial Universitario de
León (CAULE), Gerencia Regional de Salud de Castilla y León (SACYL), Leon.
(3)Primary Care Board Management. Guayaba Health Center, Madrid Health Service,
Madrid.
(4)Department of Sociology, Faculty of Labour Sciences, Social Work and Public
Health, University of Huelva, Huelva.
(5)Safety and Health Postgraduate Programme, Universidad Espíritu Santo,
Guayaquil, Ecuador.
(6)Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED),
University of Leon, Leon.
(7)Clinical Simulation Lab, School of Medicine and Healthcare Sciences,
University of Barcelona.
(8)Escola Superior de Enfermeria Mar (ESIMar), Universitat Pompeu Fabra,
Barcelona.
(9)Unidad de Radiología Vascular Intervencionista, Complejo Asistencial
Universitario de León (CAULE), Gerencia Regional de Salud de Castilla y León
(SACYL), Leon, Spain.

BACKGROUND: Cardiopulmonary resuscitation (CPR) training in schools, despite

being legislated in Spain, is not established as such within the subjects that
children are taught in schools.
OBJECTIVE: to evaluate the acquisition of CPR skills by 11-year-old children
after a brief theoretical-practical teaching programme taught by nurses at
school.
METHODS: 62 students were assessed in a quasi-experimental study on 2 cohorts
(51.4% of the sample in control group [CG]). In total, 2 sessions were given, a
theoretical one, and a practical training for skill development in children, in
which the CG performed the CPR in 2-minute cycles and the intervention group in
1-minute cycles. The anthropometric variables recorded were weight and height,
and the variables compression quality and ventilation quality were recorded
using the Laerdal ResusciAnne manikin with Personal Computer/Wireless
SkillReport.
RESULTS: The assessment showed better results, in terms of BLS sequence
performance and use of automated external defibrillator, in the CG and after
training, except for the evaluation of the 10-second breathing assessment
technique. The quality of chest compressions was better in the CG after
training, as was the quality of the ventilations. There were no major
differences in CPR quality after training and 4 months after the 1-minute and
2-minute training cycles.
CONCLUSIONS: 11-year-old children do not perform quality chest compressions or
ventilations but, considering their age, they are able to perform a BLS sequence
correctly.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000024819
PMCID: PMC8021366
PMID: 33787576 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to

disclose .

42. J Med Internet Res. 2020 May 12;22(5):e14910. doi: 10.2196/14910.

Augmented Reality Learning Environment for Basic Life Support and Defibrillation
Training: Usability Study.
Ingrassia PL(1), Mormando G(2), Giudici E(3), Strada F(4), Carfagna F(1),
Lamberti F(4), Bottino A(4).

Author information:
(1)SIMNOVA - Centro di Simulazione in Medicina e Professioni Sanitarie,
Università del Piemonte Orientale, Novara, Italy.
(2)Department of Medicine, Università di Padova, Padova, Italy.
(3)School of Medicine, Università Piemonte Orientale, Novara, Italy.
(4)Department of Control and Computer Engineering, Politecnico di Torino,
Torino, Italy.

BACKGROUND: Basic life support (BLS) is crucial in the emergency response

system, as sudden cardiac arrest is still a major cause of death worldwide.
Unfortunately, only a minority of victims receive cardiopulmonary resuscitation
(CPR) from bystanders. In this context, training could be helpful to save more
lives, and technology-enhanced BLS simulation is one possible solution.
OBJECTIVE: The aim of this study is to assess the feasibility and acceptability
of our augmented reality (AR) prototype as a tool for BLS training.
METHODS: Holo-BLSD is an AR self-instruction training system, in which a
standard CPR manikin is "augmented" with an interactive virtual environment that
reproduces realistic scenarios. Learners can use natural gestures, body
movements, and spoken commands to perform their tasks, with virtual 3D objects
anchored to the manikin and the environment. During the experience, users were
trained to use the device while being guided through an emergency simulation
and, at the end, were asked to complete a survey to assess the feasibility and
acceptability of the proposed tool (5-point Likert scale; 1=Strongly Disagree,
5=Strongly Agree).
RESULTS: The system was rated easy to use (mean 4.00, SD 0.94), and the trainees
stated that most people would learn to use it very quickly (mean 4.00, SD 0.89).
Voice (mean 4.48, SD 0.87), gaze (mean 4.12, SD 0.97), and gesture interaction
(mean 3.84, SD 1.14) were judged positively, although some hand gesture
recognition errors reduced the feeling of having the right level of control over
the system (mean 3.40, SD 1.04).
CONCLUSIONS: We found the Holo-BLSD system to be a feasible and acceptable tool
for AR BLS training.

©Pier Luigi Ingrassia, Giulia Mormando, Eleonora Giudici, Francesco Strada,

Fabio Carfagna, Fabrizio Lamberti, Andrea Bottino. Originally published in the
Journal of Medical Internet Research (http://www.jmir.org), 12.05.2020.

DOI: 10.2196/14910
PMCID: PMC7251481
PMID: 32396128 [Indexed for MEDLINE]

Conflict of interest statement: Conflicts of Interest: None declared.

43. Afr J Emerg Med. 2021 Sep;11(3):366-371. doi: 10.1016/j.afjem.2021.03.014. Epub

2021 Jul 22.

Impact of structured basic life-support course on nurses' cardiopulmonary

resuscitation knowledge and skills: Experience of a paediatric department in
low-resource country.

Umuhoza C(1)(2), Chen L(3), Unyuzumutima J(2), McCall N(3).

Author information:
(1)Paediatrics, University of Rwanda, Kigali City, Rwanda.
(2)Paediatrics, Centre Hospitalier Universitaire de Kigali (CHUK), Kigali City,
Rwanda.
(3)Paediatrics, Yale University, New Haven, CT, United States of America.

INTRODUCTION: The study aimed to assess the impact of a modified paediatric

basic life support (BLS) training on paediatric nurses' knowledge and skills in
the main tertiary level public hospital in Rwanda.
METHODS: A prospective, before-and-after educational intervention study was
performed. Nurses working in the paediatric department at Centre Hospitalier
Universitaire de Kigali (CHUK) were enrolled after consenting to the study. A
modified BLS training was administered using didactic lectures, videos, case
discussions, and simulations. Knowledge and skills were assessed before,
immediately and six months after the training, using the American Heart
Association (AHA) multiple-choice questions test and simulation scenarios.
Ethical approval from the hospital's investigational review board was obtained
before the start of the study.
RESULTS: Fifty-seven nurses working in paediatric department were included in
the study, most with advanced nursing degrees. At baseline, only 3.5% scored
above 80% on the knowledge test and none were able to perform high-quality
one-rescuer CPR. Knowledge and high-quality one-rescuer CPR skills improved
significantly immediately after the training, with 63.2% scoring above 80% and
63.2% capable of performing high-quality one-rescuer CPR (p < 0.01). Six months
later, only 45.6% scored above 80% and 15.8% were capable of performing
high-quality one-rescuer CPR (p < 0.01). Some skills, such as delivering breaths
using bag-mask device, showed better retention.
CONCLUSION: In the paediatric department of the main public tertiary care
hospital in Rwanda, nurses' baseline knowledge and skills in providing BLS was
poor but can increase with focused BLS training. Due to the decline in knowledge
and skills over six months, the use of debriefing and focused trainings
following resuscitation events and improved implementation of yearly
departmental refresher courses are recommended.

© 2018 Published by Elsevier Ltd. CC BY 4.0.

DOI: 10.1016/j.afjem.2021.03.014
PMCID: PMC8327485
PMID: 34367898

Conflict of interest statement: The principal investigator is also employed by

CHUK. The authors declared no further conflict of interest.

44. Resuscitation. 2016 Nov;108:1-7. doi: 10.1016/j.resuscitation.2016.08.020. Epub

2016 Aug 27.

Teaching school children basic life support improves teaching and basic life
support skills of medical students: A randomised, controlled trial.

Beck S(1), Meier-Klages V(2), Michaelis M(2), Sehner S(3), Harendza S(4),
Zöllner C(2), Kubitz JC(2).

Author information:
(1)Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf,
Martini-Str. 52, 20246 Hamburg, Germany. Electronic address: st.beck@uke.de.
(2)Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf,
Martini-Str. 52, 20246 Hamburg, Germany.
(3)Department of Medical Biometry and Epidemiology, University Medical Center
Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany.
(4)III. Medical Clinic and Polyclinic, University Medical Center
Hamburg-Eppendorf, Martini-Str. 52, 20246 Hamburg, Germany.
BACKGROUND: The "kids save lives" joint-statement highlights the effectiveness
of training all school children worldwide in cardiopulmonary resuscitation (CPR)
to improve survival after cardiac arrest. The personnel requirement to implement
this statement is high. Until now, no randomised controlled trial investigated
if medical students benefit from their engagement in the BLS-education of school
children regarding their later roles as physicians. The objective of the present
study is to evaluate if medical students improve their teaching behaviour and
CPR-skills by teaching school children in basic life support.
METHODS: The study is a randomised, single blind, controlled trial carried out
with medical students during their final year. In total, 80 participants were
allocated alternately to either the intervention or the control group. The
intervention group participated in a CPR-instructor-course consisting of a
4h-preparatory seminar and a teaching-session in BLS for school children. The
primary endpoints were effectiveness of teaching in an objective teaching
examination and pass-rates in a simulated BLS-scenario.
RESULTS: The 28 students who completed the CPR-instructor-course had
significantly higher scores for effective teaching in five of eight dimensions
and passed the BLS-assessment significantly more often than the 25 students of
the control group (Odds Ratio (OR): 10.0; 95%-CI: 1.9-54.0; p=0.007).
CONCLUSIONS: Active teaching of BLS improves teaching behaviour and
resuscitation skills of students. Teaching school children in BLS may prepare
medical students for their future role as a clinical teacher and support the
implementation of the "kids save lives" statement on training all school
children worldwide in BLS at the same time.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2016.08.020
PMID: 27576085 [Indexed for MEDLINE]

45. J Dent Educ. 2023 Oct;87(10):1458-1468. doi: 10.1002/jdd.13303. Epub 2023 Jul
3.

The effect of game-based learning on basic life support skills training for
undergraduate dental students.

Akaltan KF(1), Önder C(2), Vural Ç(3), Orhan K(4), Akdoğan N(5), Atakan C(6).

Author information:
(1)Department of Prosthodontics, Faculty of Dentistry, Ankara University,
Ankara, Turkey.
(2)Department of Periodontology, Faculty of Dentistry, Ankara University,
Ankara, Turkey.
(3)Department of Oral and Maxillofacial Surgery, Anesthesiology, Faculty of
Dentistry, Ankara University, Ankara, Turkey.
(4)Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara
University, Ankara, Turkey.
(5)Aesthetic and Computerized Dentistry Research Clinic, Faculty of Dentistry,
Ankara University, Ankara, Turkey.
(6)Department of Statistics, Faculty of Science, Ankara University, Ankara,
Turkey.

OBJECTIVES: The aim of this study was to investigate the impact of serious game
training on the performance of undergraduate dental students during basic life
support (BLS) training.
METHODS: Students at the Ankara University Faculty of Dentistry were divided
into two groups at random: Serious Game (SG) (n = 46) and Traditional (Tr)
(n = 45). Students completed the BLS pre-test following their lecture-based
training. The SG set of students practiced until they achieved an 85 on the BLS
Platform, after which they completed the BLS post-test. All students practiced
cardiopulmonary resuscitation (CPR) on a manikin with the instructor's guidance,
and then they independently applied CPR by using the model training component.
The module evaluation scale was then used to determine each student's grade.
Finally, the students provided input on surveys regarding technology perceptions
of SG training, serious gaming, and hands-on training.
RESULTS: In the SG group, the BLS post-test scores were significantly higher
than the pre-test results (p = 0.00). In the SG and Tr groups, there was no
statistically significant difference in the overall hands-on training scores
(p = 0.11). Students in both groups evaluated the hands-on training on the
manikin favorably and with high levels of participation.
CONCLUSIONS: The SG-based training platform for BLS training has enhanced the
BLS performance of undergraduate dental students in terms of knowledge and
skill. It has been shown that digital learners have a beneficial impact on
game-based learning outcomes; it is advised to use SGs and develop new games for
various learning objectives.

© 2023 The Authors. Journal of Dental Education published by Wiley Periodicals

LLC on behalf of American Dental Education Association.

DOI: 10.1002/jdd.13303
PMID: 37400112

46. Curr Pharm Teach Learn. 2018 Jun;10(6):744-749. doi:

10.1016/j.cptl.2018.03.006.
Epub 2018 Apr 7.

Performance and retention of basic life support skills improve with a peer-led
training program.

Priftanji D(1), Cawley MJ(2), Finn LA(3), Hollands JM(4), Morel DW(5),
Siemianowski LA(6), Bingham AL(7).

Author information:
(1)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy University of the Sciences, Philadelphia, PA, United States.
Electronic address: dpriftanji@mail.usciences.edu.
(2)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy University of the Sciences, Philadelphia, PA, United States.
Electronic address: m.cawley@usciences.edu.
(3)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy University of the Sciences, Philadelphia, PA, United States.
Electronic address: l.finn@usciences.edu.
(4)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy University of the Sciences, Philadelphia, PA, United States.
Electronic address: j.hollands@usciences.edu.
(5)Associate Dean for Academic Affairs and Assessment, South College School of
Pharmacy, 400 Goody's Lane, Knoxville, TN, United States. Electronic address:
dmorel@southcollegetn.edu.
(6)Department of Pharmacy, Hospital of the University of Pennsylvania, 3400
Spruce Street- Ground Rhoads, Philadelphia, PA, United States. Electronic
address: Laura.siemianowski@uphs.upenn.edu.
(7)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy University of the Sciences, Philadelphia, PA, United States.
Electronic address: a.bingham@usciences.edu.
BACKGROUND AND PURPOSE: Pharmacy students' performance and retention of Basic
Life Support (BLS) skills were evaluated 120 days after completion of a peer-led
BLS training program.
EDUCATIONAL ACTIVITY AND SETTING: This was a single-center, parallel group,
observational study. Doctor of pharmacy (PharmD) students in their third
professional year completed a peer-led BLS training program (n = 148) and
participated in a high-fidelity mannequin simulation activity 120 days later.
Students were randomly assigned to rapid response teams (n = 24) of five to six
members and the American Heart Association's standardized form for BLS
assessment was used to assess BLS skills performance. The performance of skills
was compared to that of students two years prior to the implementation of the
peer-led BLS program.
FINDINGS AND DISCUSSION: Students who received peer-led BLS training
demonstrated retention of BLS skills 120 days after the BLS training program.
The teams also displayed significant improvement of the skills evaluated when
compared to student teams prior to implementation of the peer-led training
(n = 22). Improvement was demonstrated for assessment of responsiveness (96% vs.
41%, p < 0.001), assessment for breathing (100% vs. 32%, p < 0.001), assessment
for pulse (96% vs. 36%, p < 0.001), and administration of appropriate
ventilation (100% vs. 32%, p < 0.001). Numerical superiority was exhibited for
high-quality cardiopulmonary resuscitation (CPR) initiation by teams who
received peer-led training (100% vs. 86%, p = 0.101).
SUMMARY: Students who received peer-led BLS training demonstrated significant
improvement in BLS skills performance and retention 120 days after the training
program. Data suggests that peer-led BLS training can improve student BLS skills
performance and retention.

Copyright © 2018 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.cptl.2018.03.006
PMID: 30025775 [Indexed for MEDLINE]

47. Trials. 2021 Dec 20;22(1):946. doi: 10.1186/s13063-021-05908-z.

Comparison of extended reality and conventional methods of basic life support

training: protocol for a multinational, pragmatic, noninferiority, randomised
clinical trial (XR BLS trial).

Lee DK(#)(1)(2), Im CW(#)(1), Jo YH(3)(4), Chang T(5), Song JL(5), Luu C(5),
Mackinnon R(6), Pillai S(7), Lee CN(8), Jheon S(9), Ahn S(10), Won SH(10).

Author information:
(1)Department of Emergency Medicine, Seoul National University Bundang Hospital,
13620, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic of
Korea.
(2)Department of Emergency Medicine, Seoul National University College of
Medicine, Seoul, Republic of Korea.
(3)Department of Emergency Medicine, Seoul National University Bundang Hospital,
13620, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic of
Korea. drakejo@snubh.org.
(4)Department of Emergency Medicine, Seoul National University College of
Medicine, Seoul, Republic of Korea. drakejo@snubh.org.
(5)Division of Emergency and Transport Medicine, Department of Pediatrics,
Children's Hospital Los Angeles, Keck School of Medicine, University of Southern
California, Los Angeles, USA.
(6)Department of Anaesthesia, Royal Manchester Children's Hospital, Manchester,
UK.
(7)Centre for Healthcare Simulation, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore, Singapore.
(8)Department of Surgery, Yong Loo Lin School of Medicine, National University
of Singapore, Singapore, Singapore.
(9)Department of Thoracic and Cardiovascular Surgery, Seoul National University
Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic
of Korea.
(10)Division of Statistics, Medical Research Collaborating Centre, Seoul
National University Bundang Hospital, Seongnam, Republic of Korea.
(#)Contributed equally

BACKGROUND: Conventional cardiopulmonary resuscitation (CPR) training for the

general public involves the use of a manikin and a training video, which has
limitations related to a lack of realism and immersion. To overcome these
limitations, virtual reality and extended reality technologies are being used in
the field of medical education. The aim of this study is to explore the efficacy
and safety of extended reality (XR)-based basic life support (BLS) training.
METHODS: This study is a prospective, multinational, multicentre, randomised
controlled study. Four institutions in 4 countries will participate in the
study. A total of 154 participants will be randomly assigned to either the XR
group or the conventional group stratified by institution and sex (1:1 ratio).
Each participant who is allocated to either group will be sent to a separate
room to receive training with an XR BLS module or conventional CPR training
video. All participants will perform a test on a CPR manikin after the training.
The primary outcome will be mean compression depth. The secondary outcome will
be overall BLS performance, including compression rate, correct hand position,
compression, and full release and hands-off time.
DISCUSSION: Using virtual reality (VR) to establish a virtual educational
environment can give trainees a sense of realism. In the XR environment, which
combines the virtual world with the real world, trainees can more effectively
learn various skills. This trial will provide evidence of the usefulness of XR
in CPR education.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04736888. Registered on 29 January
2021.

© 2021. The Author(s).

DOI: 10.1186/s13063-021-05908-z
PMCID: PMC8687636
PMID: 34930418 [Indexed for MEDLINE]

Conflict of interest statement: You Hwan Jo and Sanghoon Jheon hold unlisted
shares of Tetra Signum, Inc. They will not obtain access to the study data and
will not participate in data analysis.

48. Resuscitation. 2015 Apr;89:70-4. doi: 10.1016/j.resuscitation.2015.01.010. Epub

2015 Jan 28.

A multiple linear regression analysis of factors affecting the simulated Basic

Life Support (BLS) performance with Automated External Defibrillator (AED) in
Flemish lifeguards.

Iserbyt P(1), Schouppe G(2), Charlier N(3).

Author information:
(1)KU Leuven, Physical Activity, Sports & Health Research Group, Tervuursevest
101, B-3001 Leuven, Belgium. Electronic address:
Peter.iserbyt@faber.kuleuven.be.
(2)KU Leuven, Physical Activity, Sports & Health Research Group, Tervuursevest
101, B-3001 Leuven, Belgium.
(3)KU Leuven, Specific Teacher Training Programme in Health Sciences,
Tervuursevest 101, B-3001 Leuven, Belgium.

BACKGROUND: Research investigating lifeguards' performance of Basic Life Support

(BLS) with Automated External Defibrillator (AED) is limited.
AIM: Assessing simulated BLS/AED performance in Flemish lifeguards and
identifying factors affecting this performance.
METHODS: Six hundred and sixteen (217 female and 399 male) certified Flemish
lifeguards (aged 16-71 years) performed BLS with an AED on a Laerdal ResusciAnne
manikin simulating an adult victim of drowning. Stepwise multiple linear
regression analysis was conducted with BLS/AED performance as outcome variable
and demographic data as explanatory variables.
RESULTS: Mean BLS/AED performance for all lifeguards was 66.5%. Compression rate
and depth adhered closely to ERC 2010 guidelines. Ventilation volume and flow
rate exceeded the guidelines. A significant regression model, F(6, 415)=25.61,
p<.001, ES=.38, explained 27% of the variance in BLS performance (R2=.27).
Significant predictors were age (beta=-.31, p<.001), years of certification
(beta=-.41, p<.001), time on duty per year (beta=-.25, p<.001), practising BLS
skills (beta=.11, p=.011), and being a professional lifeguard (beta=-.13,
p=.029). 71% of lifeguards reported not practising BLS/AED.
DISCUSSION: Being young, recently certified, few days of employment per year,
practising BLS skills and not being a professional lifeguard are factors
associated with higher BLS/AED performance.
CONCLUSION: Measures should be taken to prevent BLS/AED performances from
decaying with age and longer certification. Refresher courses could include a
formal skills test and lifeguards should be encouraged to practise their BLS/AED
skills.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2015.01.010
PMID: 25636894 [Indexed for MEDLINE]

49. Pediatr Int. 2017 Mar;59(3):352-356. doi: 10.1111/ped.13155. Epub 2016 Nov 21.

Quality of basic life support education and automated external defibrillator

setting in schools in Ishikawa, Japan.

Takamura A(1)(2)(3)(4), Ito S(5), Maruyama K(5), Ryo Y(5), Saito M(5), Fujimura
S(5), Ishiura Y(3), Hori A(1).

Author information:
(1)Department of Medical Education, Kanazawa Medical University, Uchinada,
Japan.
(2)Department of Community Medicine, Kanazawa Medical University, Uchinada,
Japan.
(3)Clinical Simulation Centre, Kanazawa Medical University, Uchinada, Japan.
(4)Department of Family Medicine, Mie University Graduate School of Medicine,
Tsu, Japan.
(5)Faculty of Medicine, Kanazawa Medical University, Uchinada, Japan.

BACKGROUND: Automated external defibrillators (AED) have been installed in

schools in Japan since 2004, and the government strongly recommends teaching
basic life support (BLS). We therefore examined the quality of BLS education and
AED installation in schools.
METHODS: We conducted a prefecture-wide questionnaire survey of all primary and
junior high schools in 2016, to assess BLS education and AED installation
against the recommendations of the Japan Circulation Society. The results were
analyzed using descriptive statistics and chi-squared test.
RESULTS: In total, 195 schools out of 315 (62%) responded, of which 38% have
introduced BLS education for children. BLS training was held in a smaller
proportion of primary schools (18%) than junior high schools (86%). More than
90% of primary school staff had undergone BLS training in the previous 2 years.
The most common locations of AED were the gymnasium (32%) followed by entrance
hall (28%), staffroom (25%), and infirmary (12%). The reasons given for location
were that it was obvious (34%), convenient for staff (32%), could be used out of
hours (17%), and the most likely location for a heart attack (15%).
Approximately 18% of schools reported that it takes >5 min to reach the AED from
the furthest point.
CONCLUSION: BLS training, AED location, and understanding of both are not
sufficient to save children's lives efficiently. Authorities should make
recommendations about the correct number of AED, and their location, and provide
more information to improve the quality of BLS training in schools.

© 2016 Japan Pediatric Society.

DOI: 10.1111/ped.13155
PMID: 27589486 [Indexed for MEDLINE]

50. Resuscitation. 2017 May;114:127-132. doi: 10.1016/j.resuscitation.2017.03.014.

Epub 2017 Mar 18.

Integration of in-hospital cardiac arrest contextual curriculum into a basic

life support course: a randomized, controlled simulation study.

Hunt EA(1), Duval-Arnould JM(2), Chime NO(3), Jones K(4), Rosen M(3),
Hollingsworth M(5), Aksamit D(6), Twilley M(6), Camacho C(7), Nogee DP(8), Jung
J(9), Nelson-McMillan K(10), Shilkofski N(10), Perretta JS(11).

Author information:
(1)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland,
USA; Department of Pediatrics, Baltimore, Maryland, USA; Division of Health
Sciences Informatics, Baltimore, Maryland, USA; Johns Hopkins Medicine
Simulation Center, Baltimore, Maryland, USA. Electronic address: ehunt@jhmi.edu.
(2)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland,
USA; Division of Health Sciences Informatics, Baltimore, Maryland, USA; Johns
Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
(3)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland,
USA.
(4)Stanford University School of Medicine, Palo Alto, California, USA;
Department of Anesthesiology, Perioperative and Pain Medicine, New York, USA.
(5)Montefiore Einstein Center for Innovation in Simulation, Bronx, New York,
USA.
(6)Johns Hopkins Hospital, Baltimore, Maryland, USA.
(7)Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
(8)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
(9)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns
Hopkins Medicine Simulation Center, Baltimore, Maryland, USA; Department of
Emergency Medicine, Baltimore, Maryland, USA.
(10)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland,
USA; Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins Medicine
Simulation Center, Baltimore, Maryland, USA.
(11)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland,
USA; Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.

OBJECTIVE: The objective was to compare resuscitation performance on simulated

in-hospital cardiac arrests after traditional American Heart Association (AHA)
Healthcare Provider Basic Life Support course (TradBLS) versus revised course
including in-hospital skills (HospBLS).
DESIGN: This study is a prospective, randomized, controlled curriculum
evaluation.
SETTING: Johns Hopkins Medicine Simulation Center.
SUBJECTS: One hundred twenty-two first year medical students were divided into
fifty-nine teams.
INTERVENTION: HospBLS course of identical length, containing additional content
contextual to hospital environments, taught utilizing Rapid Cycle Deliberate
Practice (RCDP).
MEASUREMENTS: The primary outcome measure during simulated cardiac arrest
scenarios was chest compression fraction (CCF) and secondary outcome measures
included metrics of high quality resuscitation.
MAIN RESULTS: Out-of-hospital cardiac arrest HospBLS teams had larger CCF: [69%
(65-74) vs. 58% (53-62), p<0.001] and were faster than TradBLS at initiating
compressions: [median (IQR): 9s (7-12) vs. 22s (17.5-30.5), p<0.001].
In-hospital cardiac arrest HospBLS teams had larger CCF: [73% (68-75) vs. 50%
(43-54), p<0.001] and were faster to initiate compressions: [10s (6-11) vs. 36s
(27-63), p<0.001]. All teams utilized the hospital AED to defibrillate within
180s per AHA guidelines [HospBLS: 122s (103-149) vs. TradBLS: 139s (117-172),
p=0.09]. HospBLS teams performed more hospital-specific maneuvers to optimize
compressions, i.e. utilized: CPR button to flatten bed: [7/30 (23%) vs. 0/29
(0%), p=0.006], backboard: [21/30 (70%) vs. 5/29 (17%), p<0.001], stepstool:
[28/30 (93%) vs. 8/29 (28%), p<0.001], lowered bedrails: [28/30 (93%) vs. 10/29
(34%), p<0.001], connected oxygen appropriately: [26/30 (87%) vs. 1/29 (3%),
p<0.001] and used oral airway and/or two-person bagging when traditional
bag-mask-ventilation unsuccessful: [30/30 (100%) vs. 0/29 (0%), p<0.001].
CONCLUSION: A hospital focused BLS course utilizing RCDP was associated with
improved performance on hospital-specific quality measures compared with the
traditional AHA course.

Copyright © 2017. Published by Elsevier B.V.

DOI: 10.1016/j.resuscitation.2017.03.014
PMID: 28323084 [Indexed for MEDLINE]

51. Eur J Emerg Med. 2018 Feb;25(1):18-24. doi: 10.1097/MEJ.0000000000000410.

Teaching basic life support with an automated external defibrillator using the
two-stage or the four-stage teaching technique.

Bjørnshave K(1)(2), Krogh LQ(1), Hansen SB(1)(3), Nebsbjerg MA(1), Thim T(4)(5),
Løfgren B(1)(5)(6).

Author information:
(1)Research Center for Emergency Medicine.
(2)Departments of Emergency.
(3)Respiratory Diseases and Allergy.
(4)Cardiology, Aarhus University Hospital.
(5)Institute of Clinical Medicine, Aarhus University, Aarhus.
(6)Department of Internal Medicine, Regional Hospital of Randers, Randers,
Denmark.

INTRODUCTION: Laypersons often hesitate to perform basic life support (BLS) and
use an automated external defibrillator (AED) because of self-perceived lack of
knowledge and skills. Training may reduce the barrier to intervene. Reduced
training time and costs may allow training of more laypersons. The aim of this
study was to compare BLS/AED skills' acquisition and self-evaluated BLS/AED
skills after instructor-led training with a two-stage versus a four-stage
teaching technique.
METHODS: Laypersons were randomized to either two-stage or four-stage teaching
technique courses. Immediately after training, the participants were tested in a
simulated cardiac arrest scenario to assess their BLS/AED skills. Skills were
assessed using the European Resuscitation Council BLS/AED assessment form. The
primary endpoint was passing the test (17 of 17 skills adequately performed). A
prespecified noninferiority margin of 20% was used.
RESULTS: The two-stage teaching technique (n=72, pass rate 57%) was noninferior
to the four-stage technique (n=70, pass rate 59%), with a difference in pass
rates of -2%; 95% confidence interval: -18 to 15%. Neither were there
significant differences between the two-stage and four-stage groups in the chest
compression rate (114±12 vs. 115±14/min), chest compression depth (47±9 vs.
48±9 mm) and number of sufficient rescue breaths between compression cycles
(1.7±0.5 vs. 1.6±0.7). In both groups, all participants believed that their
training had improved their skills.
CONCLUSION: Teaching laypersons BLS/AED using the two-stage teaching technique
was noninferior to the four-stage teaching technique, although the pass rate was
-2% (95% confidence interval: -18 to 15%) lower with the two-stage teaching
technique.

DOI: 10.1097/MEJ.0000000000000410
PMID: 27203452 [Indexed for MEDLINE]

52. ScientificWorldJournal. 2021 Jan 29;2021:4878305. doi: 10.1155/2021/4878305.

eCollection 2021.

Awareness of Secondary School Students regarding Basic Life Support in Abha

City, Southern Saudi Arabia: A Cross-Sectional Survey.

Almojarthe B(1), Alqahtani S(2), AlGouzi B(2), Alluhayb W(2), Asiri N(2).

Author information:
(1)Family Medicine Department at King Khalid University, Abha, Saudi Arabia.
(2)King Khalid University, College of Medicine, Abha, Saudi Arabia.

BACKGROUND: Basic life support (BLS) is a level of medical care that is used for
individuals with life-threatening illnesses or injuries until they can be given
full medical care at a hospital. It can be provided by trained medical
personnel, including emergency medical technicians and paramedics, and by
qualified bystanders. Vital areas of adult BLS include immediate identification
of sudden cardiac arrest and activation of the emergency response system, early
performance of high-quality cardiopulmonary resuscitation (CPR), and rapid
defibrillation, when appropriate.
AIM: To assess the awareness of secondary school students regarding BLS in Abha
City, Saudi Arabia. Methodology. A descriptive cross-sectional survey was
conducted targeting all accessible secondary school students in Abha City during
the academic years 2018-2019. After explaining the objectives and importance of
the research topic, all students in the three grades were invited to complete
the study questionnaire. The questionnaire was developed by the researchers
after reviewing the literature for related topics and consulting an expert for
any additions or modifications.
RESULTS: The study included 761 students with ages ranging from 15 to 20 years
and a mean age of 17 ± 1 years old. Male students accounted for 53.6% of the
participants, and 96.7% of the participants were Saudi. Exactly 31% of the
students had had a BLS training course, among which 79.2% had had training that
lasted for only one day. Regarding awareness, 65% of the students had heard
about BLS, and 44% knew about CPR. Exactly 52% of the students indicated that
they should call the ER if there was a case with fainting. A total of 45.3% of
the students reported that airway checking was the first step in CPR, and 16.7%
reported that the chest compression to oral breathing ratio should be 30 to 2.
Conclusions and Recommendations. In conclusion, the study revealed that poor
awareness regarding BLS was present among the students. The researchers
concluded that less than one-third of the students had BLS training. BLS should
be taught, theoretically and practically (with simulations), to middle and high
school students as BLS involves relatively simple concepts and methods.

Copyright © 2021 Bandar Almojarthe et al.

DOI: 10.1155/2021/4878305
PMCID: PMC7868155
PMID: 33603571 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflicts
of interest.

53. Scand J Trauma Resusc Emerg Med. 2012 Apr 14;20:31. doi:
10.1186/1757-7241-20-31.

Basic life support skills of high school students before and after
cardiopulmonary resuscitation training: a longitudinal investigation.

Meissner TM(1), Kloppe C, Hanefeld C.

Author information:
(1)Medizinische Klinik III, St, Elisabeth-Hospital, Bleichstr, 15, 44787 Bochum,
Germany. theresa.meissner@rub.de

BACKGROUND: Immediate bystander cardiopulmonary resuscitation (CPR)

significantly improves survival after a sudden cardiopulmonary collapse. This
study assessed the basic life support (BLS) knowledge and performance of high
school students before and after CPR training.
METHODS: This study included 132 teenagers (mean age 14.6 ± 1.4 years). Students
completed a two-hour training course that provided theoretical background on
sudden cardiac death (SCD) and a hands-on CPR tutorial. They were asked to
perform BLS on a manikin to simulate an SCD scenario before the training.
Afterwards, participants encountered the same scenario and completed a
questionnaire for self-assessment of their pre- and post-training confidence.
Four months later, we assessed the knowledge retention rate of the participants
with a BLS performance score.
RESULTS: Before the training, 29.5% of students performed chest compressions as
compared to 99.2% post-training (P < 0.05). At the four-month follow-up, 99% of
students still performed correct chest compressions. The overall improvement,
assessed by the BLS performance score, was also statistically significant
(median of 4 and 10 pre- and post-training, respectively, P < 0.05). After the
training, 99.2% stated that they felt confident about performing CPR, as
compared to 26.9% (P < 0.05) before the training.
CONCLUSIONS: BLS training in high school seems highly effective considering the
minimal amount of previous knowledge the students possess. We observed
significant improvement and a good retention rate four months after training.
Increasing the number of trained students may minimize the reluctance to conduct
bystander CPR and increase the number of positive outcomes after sudden
cardiopulmonary collapse.

DOI: 10.1186/1757-7241-20-31
PMCID: PMC3353161
PMID: 22502917 [Indexed for MEDLINE]

54. BMC Med Educ. 2014 Sep 6;14:185. doi: 10.1186/1472-6920-14-185.

Basic life support is effectively taught in groups of three, five and eight
medical students: a prospective, randomized study.

Mahling M, Münch A, Schenk S, Volkert S, Rein A, Teichner U, Piontek P, Haffner

L, Heine D, Manger A, Reutershan J, Rosenberger P, Herrmann-Werner A(1), Zipfel
S, Celebi N.

Author information:
(1)Department of Internal Medicine VI, Psychosomatic Medicine, University
Hospital of Tübingen, Osianderstraße 5, Tübingen 72076, Germany.
Anne.Herrmann-Werner@med.uni-tuebingen.de.

BACKGROUND: Resuscitation is a life-saving measure usually instructed in

simulation sessions. Small-group teaching is effective. However, feasible group
sizes for resuscitation classes are unknown. We investigated the impact of
different group sizes on the outcome of resuscitation training.
METHODS: Medical students (n = 74) were randomized to courses with three, five
or eight participants per tutor. The course duration was adjusted according to
the group size, so that there was a time slot of 6 minutes hands-on time for
every student. All participants performed an objective structured clinical
examination before and after training. The teaching sessions were videotaped and
resuscitation quality was scored using a checklist while we measured the chest
compression parameters with a manikin. In addition, we recorded hands-on-time,
questions to the tutor and unrelated conversation.
RESULTS: Results are displayed as median (IQR). Checklist pass rates and scores
were comparable between the groups of three, five and eight students per tutor
in the post-test (93%, 100% and 100%). Groups of eight students asked fewer
questions (0.5 (0.0 - 1.0) vs. 3.0 (2.0 - 4.0), p < .001), had less hands-on
time (2:16 min (1:15 - 4:55 min) vs. 4:07 min (2:54 - 5:52 min), p = .02),
conducted more unrelated conversations (17.0 ± 5.1 and 2.9 ± 1.7, p < 0.001) and
had lower self-assessments than groups of three students per tutor (7.0 (6.1 -
9.0) and 8.2 (7.2 - 9.0), p = .03).
CONCLUSIONS: Resuscitation checklist scores and pass rates after training were
comparable in groups of three, five or eight medical students, although smaller
groups had advantages in teaching interventions and hands-on time. Our results
suggest that teaching BLS skills is effective in groups up to eight medical
students, but smaller groups yielded more intense teaching conditions, which
might be crucial for more complex skills or less advanced students.

DOI: 10.1186/1472-6920-14-185
PMCID: PMC4168208
PMID: 25194168 [Indexed for MEDLINE]

55. J Vet Emerg Crit Care (San Antonio). 2025 Jan-Feb;35(1):9-18. doi:
10.1111/vec.13445. Epub 2025 Jan 20.
An exploratory study on the effect of rescuer team size on basic and advanced
life support technical skills in a high-fidelity simulation of canine
cardiopulmonary arrest.

Hoehne SN(1), Cary JA(1), Bailey LN(1), Davidow EB(1), Martin LG(1), DeJong
TL(2).

Author information:
(1)Department of Veterinary Clinical Sciences, College of Veterinary Medicine,
Washington State University, Pullman, Washington, USA.
(2)Center for Interdisciplinary Statistical Education and Research, Washington
State University, Pullman, Washington, USA.

OBJECTIVE: To evaluate the effect of rescuer team size on objective skill

measures of basic life support (BLS) and advanced life support (ALS) using
high-fidelity canine CPR simulation.
DESIGN: Prospective, experimental study.
SETTING: Veterinary clinical simulation center.
SUBJECTS: Forty-eight Reassessment Campaign on Veterinary Resuscitation
CPR-certified veterinary students.
MEASUREMENTS AND MAIN RESULTS: Five groups of participants each conducted 3 CPR
simulations in configurations of 4, 6, and 8 rescuers. Simulations represented a
shock patient declining into asystole, followed by ventricular fibrillation and
return of spontaneous circulation. Resuscitation efforts were video-recorded to
evaluate BLS and ALS tasks. Mean (±SD) was derived and data were compared among
team sizes using ANOVA and Tukey's post hoc analysis. Significance was set at
P < 0.05. Among teams of 4, 6, and 8 rescuers, time to first chest compression
(13 s [±6], 9 s [±2], 8 s [±4]; P = 0.24) and positive-pressure breath (101 s
[±37], 56 s [±15], 67 s [±24]; P = 0.05) were not significantly different. Chest
compression (100/min [±5], 108/min [±6], 107/min [±6]; P = 0.12) and ventilatory
rates (9/min [±1], respectively, P = 0.52) were not significantly different.
Time without chest compressions/total length of CPR was not significantly
different (72 s [±16], 61 s [±16], 54 s [±8]; P = 0.15). Capnography and ECG
monitoring were used by all teams. Time to first vasopressor administration was
significantly different among team sizes (268 s [±70], 164 s [±65], 174 s [±34];
P = 0.04), with vasopressors being most quickly administered by teams of 6
rescuers. Time to electrical defibrillation was not significantly different
(486 s [±45], 424 s [±22], 488 s [±181]; P = 0.57). Incorrect ALS interventions
occurred in 60%, 0%, and 40% of CPR events in 4, 6, and 8 rescuer teams,
respectively.
CONCLUSIONS: Although the achievement of BLS tasks was comparable in teams of 4
rescuers, teams of 6 rescuers may be preferable based on differences in the rate
of guideline-incompliant treatments and ALS task efficiency. Teams of 8 rescuers
were neither more efficient nor more accurate at conducting BLS and ALS tasks.

© 2025 The Author(s). Journal of Veterinary Emergency and Critical Care

published by Wiley Periodicals LLC on behalf of Veterinary Emergency and
Critical Care Society.

DOI: 10.1111/vec.13445
PMCID: PMC11831585
PMID: 39831450 [Indexed for MEDLINE]

Conflict of interest statement: S.N.H. is a member of the RECOVER initiative

research committee, the RECOVER CPR registry data quality manager, and a
certified RECOVER CPR instructor. The RECOVER Initiative is a not‐for‐profit
organization, the author's services are being provided on a volunteer basis, and
the author will not receive any financial renumeration arising from the
publication of this study. The authors declare no other conflicts of interest.
56. BMC Med Educ. 2024 May 9;24(1):488. doi: 10.1186/s12909-024-05490-3.

The effect of scenario-based training versus video training on nurse anesthesia

students' basic life support knowledge and skill of cardiopulmonary
resuscitation: a quasi-experimental comparative study.

Saidkhani V(1), Albooghobeish M(1), Rahimpour Z(2), Haghighizadeh MH(3).

Author information:
(1)Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran.
(2)Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran.
zrahimpour0558@gmail.com.
(3)Department of Biostatistics and Epidemiology, School of Health, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran.

BACKGROUND: Performing CPR (Cardiopulmonary Resuscitation) is an extremely

intricate skill whose success depends largely on the level of knowledge and
skill of Anesthesiology students. Therefore, this research was conducted to
compare the effect of the scenario-based training method as opposed to video
training method on nurse anesthesia students' BLS (Basic Life Support) knowledge
and skills.
METHODS: This randomized quasi-experimental study involved 45 nurse anesthesia
students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran in
2022-2023. The practical room of the university formed the research environment.
The participants were randomly divided into three groups of scenario-based
training, video training, and control. Data were collected by a knowledge
questionnaire and a BLS skill assessment checklist before and after the
intervention.
RESULTS: There was a significant difference between the students' scores of BLS
knowledge and skill before and after the educational intervention in both SG
(scenario group) (p < 0.001) and VG (video group) (p = 0.008) (p < 0.001).
However, no significant difference was observed in this regard in the CG
(control group) (p = 0.37) (p = 0.16). Also, the mean scores of BLS knowledge
and skills in the SG were higher than those in the VG (p < 0.001).
CONCLUSION: Given the beneficial impact of scenario-based education on fostering
active participation, critical thinking, utilization of intellectual abilities,
and learner creativity, it appears that this approach holds an advantage over
video training, particularly when it comes to teaching crucial subjects like
Basic Life Support.

© 2024. The Author(s).

DOI: 10.1186/s12909-024-05490-3
PMCID: PMC11080119
PMID: 38724939 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.

57. J Intensive Care. 2014 Apr 24;2(1):28. doi: 10.1186/2052-0492-2-28. eCollection

2014.

Basic life support training for single rescuers efficiently augments their
willingness to make early emergency calls with no available help: a cross-over
questionnaire survey.
Hirose K(1), Enami M(1), Matsubara H(1), Kamikura T(1), Takei Y(2), Inaba H(1).

Author information:
(1)Department of Emergency Medical Science, Kanazawa University Graduate School
of Medicine, 13-1 Takaramachi, Kanazawa, 920-8641 Japan.
(2)Department of Medical Science and Technology, Hiroshima International
University, Hiroshima, Japan.

BACKGROUND: The aim of this study was to investigate effects of basic life
support (BLS) training on willingness of single rescuers to make emergency calls
during out-of-hospital cardiac arrests (OHCAs) with no available help from
others.
METHODS: A cross-over questionnaire survey was conducted with two
questionnaires. Questionnaires were administered before and after two BLS
courses in fire departments. One questionnaire included two scenarios which
simulate OHCAs occurring in situations where help from other rescuers is
available (Scenario-M) and not available (Scenario-S). The conventional BLS
course was designed for multiple rescuers (Course-M), and the other was designed
for single rescuers (Course-S).
RESULTS: Of 2,312 respondents, 2,218 (95.9%) answered all questions and were
included in the analysis. Although both Course-M and Course-S significantly
augmented willingness to make early emergency calls not only in Scenario-M but
also in Scenario-S, the willingness for Scenario-M after training course was
significantly higher in respondents of Course-S than in those of Course-M (odds
ratio 1.706, 95% confidential interval 1.301-2.237). Multiple logistic
regression analysis for Scenario-M disclosed that post training (adjusted odds
ratio 11.6, 95% confidence interval 7.84-18.0), age (0.99, 0.98-0.99), male
gender (1.77, 1.39-2.24), prior BLS experience of at least three times (1.46,
1.25-2.59), and time passed since most recent training during 3 years or less
(1.80, 1.25-2.59) were independently associated with willingness to make early
emergency calls and that type of BLS course was not independently associated
with willingness. Therefore, both Course-M and Course-S similarly augmented
willingness in Scenario-M. However, in multiple logistic regression analyses for
Scenario-S, Course-S was independently associated with willingness to make early
emergency calls in Scenario-S (1.26, 1.00-1.57), indicating that Course-S more
efficiently augmented willingness. Moreover, post training (2.30, 1.86-2.83) and
male gender (1.26, 1.02-1.57) were other independent factors associated with
willingness in Scenario-S.
CONCLUSIONS: BLS courses designed for single rescuers with no help available
from others are likely to augment willingness to make early emergency calls more
efficiently than conventional BLS courses designed for multiple rescuers.

DOI: 10.1186/2052-0492-2-28
PMCID: PMC4267597
PMID: 25520840

58. Simul Healthc. 2019 Oct;14(5):281-286. doi: 10.1097/SIH.0000000000000386.

Certified Basic Life Support Instructors Identify Improper Cardiopulmonary

Resuscitation Skills Poorly: Instructor Assessments Versus Resuscitation Manikin
Data.

Hansen C(1), Bang C, Stærk M, Krogh K, Løfgren B.

Author information:
(1)From the Research Center for Emergency Medicine, Aarhus University Hospital,
Aarhus (C.H., C.B., M.S., B.L.); Department of Internal Medicine, Randers
Regional Hospital, Randers (C.H., C.B., M.S., B.L.), and Clinical Research Unit,
Randers Regional Hospital, Randers (C.H., C.B., M.S.); Department of Anesthesia
and Intensive Care, Aarhus University Hospital (K.K.); Centre for Health
Sciences Education, Aarhus University, Aarhus, (K.K.), Department of Clinical
Medicine, Aarhus University, Aarhus (B.L.), and Department of Cardiology, Aarhus
University Hospital, Aarhus, Denmark (B.L.).

INTRODUCTION: During basic life support (BLS) training, instructors assess

learners' cardiopulmonary resuscitation (CPR) skills and correct errors to
ensure high-quality performance. This study aimed to investigate certified BLS
instructors' assessments of CPR skills.
METHODS: Data were collected at BLS courses for medical students at Aarhus
University, Aarhus, Denmark. Two certified BLS instructors evaluated each
learner with a cardiac arrest test scenario, where learners demonstrated CPR on
a resuscitation manikin for 3.5 minutes. Instructors' assessments were compared
with manikin data as reference for correct performance. The first 3 CPR cycles
were analyzed. Correct chest compressions were defined as 2 or more of 3 CPR
cycles with 30 ± 2 chest compressions, 50 to 60 mm depth, and 100 to 120 min
rate. Correct rescue breaths were defined as 50% or more efficient breaths with
visible, but not excessive manikin chest inflation (for instructors) or 500 to
600mL air (manikin data).
RESULTS: Overall, 90 CPR assessments were performed by 16 instructor pairs.
Instructors passed 81 (90%) learners, whereas manikin pass rate was 2%.
Instructors identified correct chest compressions with a sensitivity of 0.96
[95% confidence interval (CI) = 0.79-1) and a specificity of 0.05 (95% CI =
0.01-0.14), as well as correct rescue breaths with a sensitivity of 1 (95% CI =
0.40-1) and a specificity of 0.07 (95% CI = 0.03-0.15). Instructors mistakenly
failed 1 learner with adequate chest compression depth, while passing 53 (59%)
learners with improper depth. Moreover, 80 (89%) improper rescue breath
performances were not identified.
CONCLUSIONS: Certified BLS instructors assess CPR skills poorly. Particularly,
improper chest compression depth and rescue breaths are not identified.

DOI: 10.1097/SIH.0000000000000386
PMID: 31490866 [Indexed for MEDLINE]

59. Simul Healthc. 2019 Dec;14(6):372-377. doi: 10.1097/SIH.0000000000000391.

Learning Impacts of Pretraining Video-Assisted Debriefing With Simulated Errors

or Trainees' Errors in Medical Students in Basic Life Support Training: A
Randomized Controlled Trial.

Li Q(1), Lin J, Fang LQ, Ma EL, Liang P, Shi TW, Xiao H, Liu J.

Author information:
(1)From the Department of Anesthesiology, West China Hospital of Sichuan
University, Chengdu, Sichuan, People's Republic of China.

BACKGROUND: Previous studies demonstrated that pretraining video-assisted

debriefing (VAD) with trainees' errors (TE) videotaped in a skills pretest
improved skill learning of basic life support (BLS). However, conducting a
pretest and preparing TE video examples is resource intensive. Exposing
individual trainee's errors to peers might be a threat to learners'
psychological safety. We hypothesized pretraining VAD with simulated errors (SE,
performed by actors) might have the same beneficial effect on skills learning as
pretraining VAD with TE, but avoid drawbacks of TE.
METHODS: Three hundred twenty-two third-year medical students were randomized
into 3 groups (the control [C], TE, SE). A videotaped BLS skills pretest was
conducted in 3 groups. Then, group C received traditional training with
concurrent feedback. Video-assisted debriefing with TE in the pretest or SE was
delivered in groups TE or SE, respectively, followed by BLS training without any
feedback. Basic life support skills were retested 1 week later (posttest).
Students completed a survey to express their preference to TE or SE for VAD in
the future.
RESULTS: Higher BLS skills scores were observed in groups TE (85.7 ± 7.0) and SE
(86.8 ± 7.5) in the posttest, compared with group C (68.7 ± 13.3, P < 0.001). No
skills difference was observed between group TE and SE in the posttest. More
trainees (65.8%) preferred SE for VAD.
CONCLUSIONS: Pretraining VAD with SE had an equivalent beneficial effect as VAD
with TE on BLS skills learning in medical students. More trainees preferred SE
for VAD with regard to psychological safety.

DOI: 10.1097/SIH.0000000000000391
PMID: 31652180 [Indexed for MEDLINE]

60. Pediatr Rep. 2024 Jul 30;16(3):631-643. doi: 10.3390/pediatric16030053.

Attitudes and Skills in Basic Life Support after Two Types of Training:
Traditional vs. Gamification, of Compulsory Secondary Education Students: A
Simulation Study.

Rodríguez-García A(1)(2), Ruiz-García G(3), Navarro-Patón R(4), Mecías-Calvo

M(4).

Author information:
(1)Departamento de Salud, Universidad Internacional Iberoamericana, Campeche
24560, Mexico.
(2)Faculty of Health Sciences, Universidad Europea del Atlántico, 39011
Santander, Spain.
(3)Institute of Secondary Education José del Campo, 39849 Ampuero, Spain.
(4)Faculty of Teacher Training, Universidade de Santiago de Compostela, 27001
Lugo, Spain.

It is recommended to implement the teaching of Basic Life Support (BLS) in

schools; however, studies on the best training method are limited and have been
a priority in recent years. The objective of this study was to analyze the
attitudes and practical skills learned during BLS training using a gamified
proposal. A comparative study was carried out, consisting of Compulsory
Secondary Education students [control group (CG; classical teaching) and
experimental group (EG; gamified proposal)]. The instruments used were the CPR
and AED action sequence observation sheet, data from the Laerdal Resusci Anne
manikin and AED and Attitude Questionnaire towards Basic Life Support and the
Use of the Automated External Defibrillator. Sixty-eight students (33 girls)
with a mean age of 13.91 ± 0.70 years were recruited. Results were significantly
better in the EG (n = 37) [i.e., breathing control (p = 0.037); call to
emergency services (p = 0.049); mean compression depth (p = 0.001);
self-confidence (p = 0.006); intention to perform BLS and AED (p = 0.002)]; and
significantly better in the CG (n = 31) [Total percentage of CPR (p < 0.001);
percentage of correct compression (p < 0.001); time to apply effective shock
with AED (p < 0.001); demotivation (p = 0.005). We can conclude that the group
that was trained with the training method through the gamified proposal presents
better intentions and attitudes to act in the event of cardiac arrest than those
of the classic method. This training method allows for similar results in terms
of CPR and AED skills to classical teaching, so it should be taken into account
as a method for teaching BLS to secondary education students.
DOI: 10.3390/pediatric16030053
PMCID: PMC11348261
PMID: 39189287

Conflict of interest statement: The authors declare no conflicts of interest.

61. BMJ Open. 2021 Nov 30;11(11):e052478. doi: 10.1136/bmjopen-2021-052478.

Training frequency for educating schoolchildren in basic life support: very

brief 4-month rolling-refreshers versus annual retraining-a 2-year prospective
longitudinal trial.

Abelairas-Gómez C(1)(2)(3), Martinez-Isasi S(4)(3)(5), Barcala-Furelos R(6)(7),

Varela-Casal C(6)(7), Carballo-Fazanes A(1)(3)(5), Pichel-López M(6), Fernández
Méndez F(6), Otero-Agra M(6), Sanchez Santos L(8), Rodriguez-Nuñez
A(1)(3)(5)(9).

Author information:
(1)Simulation and Intensive Care Unit of Santiago (SICRUS), Health Research
Institute of Santiago, University Hospital of Santiago de Compostela- CHUS,
Santiago Compostela, Spain.
(2)Faculty of Education Sciences, Universidade de Santiago de Compostela, Spain,
Santiago Compostela, Spain.
(3)CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and
Medicine Department, University of Santiago de Compostela, Santiago de
Compostela, Spain.
(4)Simulation and Intensive Care Unit of Santiago (SICRUS), Health Research
Institute of Santiago, University Hospital of Santiago de Compostela- CHUS,
Santiago Compostela, Spain smtzisasi@gmail.com.
(5)Faculty of Nursing, Universidade de Santiago de Compostela, Santiago
Compostela, Spain.
(6)REMOSS Research Group, Faculty of Education and Sport Sciences, University of
Vigo, Vigo, Spain.
(7)Faculty of Education and Sport Sciences, Universidad de Vigo, Vigo, Spain.
(8)Pediatric, Health area of Santiago de Compostela-Barbanza, Santiago de
Compostela, Spain.
(9)Pediatric Intensive Care Unit, University Hospital of Santiago de
Compostela-CHUS, Santiago de Compostela, Spain.

OBJECTIVE: To compare the effectiveness of 4-month rolling-refreshers and annual

retraining in basic life support (BLS) on a sample of schoolchildren.
DESIGN: Prospective longitudinal trial.
SETTING AND PARTICIPANTS: Four hundred and seventy-two schoolchildren (8-12
years old).
INTERVENTIONS: Schoolchildren were instructed in BLS and then split into the
following three groups: control group (CG), standard group (SG) and
rolling-refresher group (RRG). Their BLS skills were assessed within 1 week (T1)
and 2 years later (T2). Moreover, CG did not receive any additional training; SG
received one 50 min retraining session 1 year later; RRG participated in very
brief (5 min) rolling-refreshers that were carried out every 4 months.
PRIMARY AND SECONDARY OUTCOMES: Hands-on skills of BLS sequence and
cardiopulmonary resuscitation.
RESULTS: BLS sequence performance was similar in all groups at T1, but SG and
RRG followed the steps of the protocol in more proportion than CG at T2. When
compared at T2, RRG showed higher proficiency than SG in checking safety,
checking response, opening the airway and alerting emergency medical services.
In addition, although the mean resuscitation quality was low in all groups, RRG
participants reached a higher percentage of global quality cardiopulmonary
resuscitation (CG: 16.4±24.1; SG: 25.3±28.8; RRG: 29.9%±29.4%), with a higher
percentage of correct chest compressions by depth (CG: 3.9±11.8; SG: 10.8±22.7;
RRG: 15.5±26.1 mm).
CONCLUSIONS: In 8-to-12-year-old schoolchildren, although annual 50 min
retraining sessions help to maintain BLS performance, 4-month very brief
rolling-refreshers were shown to be even more effective. Thus, we recommend
implementing baseline BLS training at schools, with subsequently brief
rolling-refreshers.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No

commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2021-052478
PMCID: PMC8634240
PMID: 34848519 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.

62. BMC Emerg Med. 2020 Jan 30;20(1):8. doi: 10.1186/s12873-020-0304-8.

To strengthen self-confidence as a step in improving prehospital youth laymen

basic life support.

Abelsson A(1), Odestrand P(2), Nygårdh A(2).

Author information:
(1)Jönköping University, School of Health Sciences, PO Box 1026, 551 11,
Jönköping, Sweden. anna.abelsson@ju.se.
(2)Jönköping University, School of Health Sciences, PO Box 1026, 551 11,
Jönköping, Sweden.

BACKGROUND: A rapid emergency care intervention can prevent the cardiac arrest
from resulting in death. In order for Cardio Pulmonary Resuscitation (CPR) to
have any real significance for the survival of the patient, it requires an
educational effort educating the large masses of people of whom the youth is an
important part. The aim of this study was to investigate the effect of a
two-hour education intervention for youth regarding their self-confidence in
performing Adult Basic Life Support (BLS).
METHODS: A quantitative approach where data consist of a pre- and post-rating of
seven statements by 50 participants during an intervention by means of BLS
theoretical and practical education.
RESULTS: The two-hour training resulted in a significant improvement in the
participants' self-confidence in identifying a cardiac arrest (pre 51, post 90),
to perform compressions (pre 65, post 91) and ventilations (pre 64, post 86) and
use a defibrillator (pre 61, post 81). In addition, to have the self-confidence
to be able to perform, and to actually perform, first aid to a person suffering
from a traumatic event was significantly improved (pre 54, post 89).
CONCLUSION: By providing youth with short education sessions in CPR, their
self-confidence can be improved. This can lead to an increased will and ability
to identify a cardiac arrest and to begin compressions and ventilations. This
also includes having the confidence using a defibrillator. Short education
sessions in first aid can also lead to increased self-confidence, resulting in
young people considering themselves able to perform first aid to a person
suffering from a traumatic event. This, in turn, results in young people
perceiveing themselves as willing to commence an intervention during a traumatic
event. In summary, when the youth believe in their own knowledge, they will dare
to intervene.
DOI: 10.1186/s12873-020-0304-8
PMCID: PMC6993316
PMID: 32000691 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing
interests.

63. Curriculum Development in Medical Simulation.

Ladkany D(1), Pastorino A(2).

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025

Jan–.
2023 May 1.

Author information:
(1)Georgetown University Hospital/MedStar
(2)OhioHealth Doctors Hospital, OU HCOM

Simulation training, initially developed in the 18th century, has become a

mainstay of medical education. The medical profession strives to provide safe
and high-quality care to patients. Both evidence-based medicine and procedural
competency are important in attaining this goal. Simulation, which spans from
procedural training to case-based scenarios and beyond, has been implemented for
all levels of learners. While Cardiopulmonary Resuscitation (CPR) and Basic Life
Support (BLS) training are some of the most common simulation scenarios people
will encounter, simulation training can be much more advanced, complex, and
interprofessional. Simulation activities do not occur in isolation. Appropriate
pre-simulation education is necessary, and it should occur in conjunction with
adequate debriefing. Therefore, the development of a robust curriculum using
simulation must be deliberate to ensure that it is a valuable experience for all
participants.

Copyright © 2025, StatPearls Publishing LLC.

PMID: 32119378

Conflict of interest statement: Disclosure: Diana Ladkany declares no relevant

financial relationships with ineligible companies. Disclosure: Alyssa Pastorino
declares no relevant financial relationships with ineligible companies.

64. Resuscitation. 2020 Nov;156:125-136. doi: 10.1016/j.resuscitation.2020.08.120.

Epub 2020 Sep 1.

The Copenhagen Tool a research tool for evaluation of basic life support
educational interventions.

Jensen TW(1), Lockey A(2), Perkins GD(3), Granholm A(4), Eberhard KE(5),
Hasselager A(6), Møller TP(5), Ersbøll AK(7), Folke F(8), Lippert A(6),
Østergaard D(6), Handley AJ(9), Chamberlain D(10), Lippert F(11).

Author information:
(1)Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej
5, 2750 Copenhagen, Denmark; Danish Resuscitation Council, c/o Emergency Medical
Services, Telegrafvej 5, 2750 Copenhagen, Denmark. Electronic address:
theo.walther.jensen.01@regionh.dk.
(2)Emergency Department, Calderdale Royal Hospital, Halifax, United Kingdom.
(3)Warwick Trials Unit, University of Warwick, Coventry, CV4 7AL, United
Kingdom.
(4)Department of Intensive Care, Copenhagen University Hospital -
Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
(5)Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej
5, 2750 Copenhagen, Denmark; Copenhagen Academy for Medical Education and
Simulation, Capital Region of Denmark, University of Copenhagen, Copenhagen,
Denmark.
(6)Copenhagen Academy for Medical Education and Simulation, Capital Region of
Denmark, University of Copenhagen, Copenhagen, Denmark.
(7)National Institute of Public Health, University of Southern Denmark,
Studiestræde 6, DK-1455 Copenhagen, Denmark.
(8)Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej
5, 2750 Copenhagen, Denmark.
(9)Hadstock, Cambridge, UK.
(10)Brighton & Sussex Medical School, University of Sussex, Brighton, East
Sussex, United Kingdom.
(11)Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej
5, 2750 Copenhagen, Denmark; Danish Resuscitation Council, c/o Emergency Medical
Services, Telegrafvej 5, 2750 Copenhagen, Denmark.

INTRODUCTION: Over the past decades, major changes have been made in basic life
support (BLS) guidelines and manikin technology. The aim of this study was to
develop a BLS evaluation tool based on international expert consensus and
contemporary validation to enable more valid comparison of research on BLS
educational interventions.
METHODS: A modern method for collecting validation evidence based on Messick's
framework was used. The framework consists of five domains of evidence: content,
response process, internal structure, relations with other variables, and
consequences. The research tool was developed by collecting content evidence
based on international consensus from an expert panel; a modified Delphi process
decided items essential for the tool. Agreement was defined as identical ratings
by 70% of the experts.
RESULTS: The expert panel established consensus on a three-levelled score
depending on expected response level: laypersons, first responders, and health
care personnel. Three Delphi rounds with 13 experts resulted in 16 "essential"
items for laypersons, 21 for first responders, and 22 for health care personnel.
This, together with a checklist for planning and reporting educational
interventional studies within BLS, serves as an example to be used for
researchers.
CONCLUSIONS: An expert panel agreed on a three-levelled score to assess BLS
skills and the included items. Expert panel consensus concluded that the tool
serves its purpose and can act to guide improved research comparison on BLS
educational interventions.

Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2020.08.120
PMID: 32889023 [Indexed for MEDLINE]

65. Resuscitation. 2023 Nov;192:109973. doi: 10.1016/j.resuscitation.2023.109973.

Epub 2023 Sep 18.

Virtual Reality, Augmented Reality, Augmented Virtuality, or Mixed Reality in

cardiopulmonary resuscitation: Which Extended Reality am I using for teaching
adult basic life support?

Fijačko N(1), Metličar Š(2), Kleesiek J(3), Egger J(4), Chang TP(5).
Author information:
(1)University of Maribor, Faculty of Health Sciences, Maribor, Slovenia; ERC
Research Net, Niels, Belgium; Maribor University Medical Centre, Maribor,
Slovenia. Electronic address: nino.fijacko@um.si.
(2)University of Maribor, Faculty of Health Sciences, Maribor, Slovenia; Medical
Dispatch Centre Maribor, University Clinical Centre Ljubljana, Ljubljana,
Slovenia.
(3)Institute for Artificial Intelligence in Medicine, Essen University Hospital,
Essen, Germany; Cancer Research Center Cologne Essen, University Medicine Essen,
Essen, Germany; Department of Physics, TU Dortmund University, Dortmund,
Germany; German Cancer Consortium, Essen, Germany.
(4)Institute for Artificial Intelligence in Medicine, Essen University Hospital,
Essen, Germany; Cancer Research Center Cologne Essen, University Medicine Essen,
Essen, Germany; Center for Virtual and Extended Reality in Medicine, Essen
University Hospital, Essen, Germany.
(5)Children's Hospital Los Angeles, Las Madrinas Simulation Center, Los Angeles,
CA, USA.

DOI: 10.1016/j.resuscitation.2023.109973
PMID: 37730097 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors

declare the following financial interests/personal relationships which may be
considered as potential competing interests: Nino Fijačko is an ERC BLS Science
and Education Committee and ILCOR Task Force Education Implementation and Team
member. Todd P. Chang is an American Heart Association Emergency Cardiovascular
Care Committee member. Špela Metličar, Jan Egger, Jens Kleesiek declare no
conflict of interest.

66. Scand J Trauma Resusc Emerg Med. 2012 May 8;20:34. doi: 10.1186/1757-7241-20-
34.

Basic life support and automated external defibrillator skills among ambulance
personnel: a manikin study performed in a rural low-volume ambulance setting.

Nielsen AM(1), Isbye DL, Lippert FK, Rasmussen LS.

Author information:
(1)Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen
University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
mnielsen.anne@gmail.com

BACKGROUND: Ambulance personnel play an essential role in the 'Chain of

Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a
rural Danish island and in this study we assessed the cardiopulmonary
resuscitation performance of ambulance personnel on that island.
METHODS: The Basic Life Support (BLS) and Automated External Defibrillator (AED)
skills of the ambulance personnel were tested in a simulated cardiac arrest.
Points were given according to a scoring sheet. One sample t test was used to
analyze the deviation from optimal care according to the 2005 guidelines. After
each assessment, individual feedback was given.
RESULTS: On 3 consecutive days, we assessed the individual EMS teams responding
to OHCA on the island. Overall, 70% of the maximal points were achieved. The
hands-off ratio was 40%. Correct compression/ventilation ratio (30:2) was used
by 80%. A mean compression depth of 40-50 mm was achieved by 55% and the mean
compression depth was 42 mm (SD 7 mm). The mean compression rate was 123 per min
(SD 15/min). The mean tidal volume was 746 ml (SD 221 ml). Only the mean tidal
volume deviated significantly from the recommended (p = 0.01). During the rhythm
analysis, 65% did not perform any visual or verbal safety check.
CONCLUSION: The EMS providers achieved 70% of the maximal points. Tidal volumes
were larger than recommended when mask ventilation was applied. Chest
compression depth was optimally performed by 55% of the staff. Defibrillation
safety checks were not performed in 65% of EMS providers.

DOI: 10.1186/1757-7241-20-34
PMCID: PMC3430550
PMID: 22569089 [Indexed for MEDLINE]

67. Resuscitation. 2013 Sep;84(9):1274-8. doi: 10.1016/j.resuscitation.2013.04.017.

Epub 2013 May 9.

Pre-training evaluation and feedback improved skills retention of basic life

support in medical students.

Li Q(1), Zhou RH, Liu J, Lin J, Ma EL, Liang P, Shi TW, Fang LQ, Xiao H.

Author information:
(1)Department of Anesthesiology, West China Hospital of Sichuan University,
Chengdu, Sichuan 610041, PR China.

BACKGROUND: Pre-training evaluation and feedback have been shown to improve

medical students' skills acquisition of basic life support (BLS) immediately
following training. The impact of such training on BLS skills retention is
unknown. This study was conducted to investigate effects of pre-training
evaluation and feedback on BLS skills retention in medical students.
METHODS: Three hundred and thirty 3rd year medical students were randomized to
two groups, the control group (C group) and pre-training evaluation and feedback
group (EF group). Each group was subdivided into four subgroups according to the
time of retention-test (at 1-, 3-, 6-, 12-month following the initial training).
After a 45-min BLS lecture, BLS skills were assessed (pre-training evaluation)
in both groups before training. Following this, the C group received 45 min
training. 15 min of group feedback corresponding to students' performance in
pre-training evaluation was given only in the EF group that was followed by 30
min of BLS training. BLS skills were assessed immediately after training
(post-test) and at follow up (retention-test).
RESULTS: No skills difference was observed between the two groups in
pre-training evaluation. Better skills acquisition was observed in the EF group
(85.3 ± 7.3 vs. 68.1 ± 12.2 in C group) at post-test (p<0.001). In all
retention-test, better skills retention was observed in each EF subgroup,
compared with its paired C subgroup.
CONCLUSIONS: Pre-training evaluation and feedback improved skills retention in
the EF group for 12 months after the initial training, compared with the control
group.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2013.04.017
PMID: 23665155 [Indexed for MEDLINE]

68. Curr Pharm Teach Learn. 2020 Aug;12(8):975-980. doi:

10.1016/j.cptl.2020.04.002.
Epub 2020 May 14.

Advanced cardiac life support certification for student pharmacists improves

simulated patient survival.

Bingham AL(1), Kavelak HL(2), Hollands JM(3), Finn LA(4), Delic JJ(5), Schroeder
N(6), Cawley MJ(6).

Author information:
(1)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy, University of the Sciences, 600 S. 43rd Street,
Philadelphia, PA 19104, United States. Electronic address:
a.bingham@usciences.edu.
(2)Department of Pharmacy, St. Luke's University Health Network, 801 Ostrum
Street, Bethlehem, PA 18015, United States. Electronic address:
haley.kavelak@sluhn.org.
(3)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy, University of the Sciences, 600 S. 43rd Street,
Philadelphia, PA 19104, United States. Electronic address:
j.hollands@usciences.edu.
(4)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy, University of the Sciences, 600 S. 43rd Street,
Philadelphia, PA 19104, United States. Electronic address: l.finn@usciences.edu.
(5)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy, University of the Sciences, 600 S. 43rd Street,
Philadelphia, PA 19104, United States. Electronic address:
j.delic@usciences.edu.
(6)Department of Pharmacy Practice and Pharmacy Administration, Philadelphia
College of Pharmacy, University of the Sciences, 600 S. 43rd Street,
Philadelphia, PA 19104, United States.

BACKGROUND AND PURPOSE: Basic life support (BLS) and advanced cardiac life
support (ACLS) skills performance, as well as simulated patient survival, were
compared for student pharmacist teams with and without at least one member with
American Heart Association (AHA) ACLS certification.
EDUCATIONAL ACTIVITY AND SETTING: Doctor of pharmacy students in their third
professional year completed a high-fidelity mannequin simulation. Within the
previous year, 30 of 184 students (16%) completed ACLS certification. Rapid
response teams (n = 31) of five to six members were formed through random
student assignment. Two AHA instructors recorded and assessed performance using
a checklist adapted from the AHA's standardized forms for BLS and ACLS
assessment. Teams with and without ACLS certified members were compared for
skills performance and simulated patient survival (i.e. correct performance of
all BLS and ACLS skills).
FINDINGS: Teams with ACLS certified members (n = 21) were superior to teams
without certified members (n = 10) for correct performance of all observed BLS
and ACLS skills, including pulse assessment and medication selection for
cardiovascular support. For teams who had ACLS certified members, simulated
patient survival was 86% higher. The study groups did not differ in their
ability to calculate a correct vasopressor infusion rate if warranted.
SUMMARY: BLS and ACLS skills performance were improved by AHA ACLS
certification. Additionally, simulated patient survival was improved for teams
with students who had at least one ACLS certified member.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.cptl.2020.04.002
PMID: 32565000 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest None.

69. Nurse Educ Pract. 2025 Feb;83:104292. doi: 10.1016/j.nepr.2025.104292. Epub
2025
Feb 8.

The effect of hot and cold debriefing on basic life support competence and
reflection in undergraduate nursing students: A qualitative study.

Alanezi FZ(1), Morrison CF(2), Wagner R(3), Kelcey B(4), Miller E(5).

Author information:
(1)University of Cincinnati, College of Nursing, 3110 Vine St, Cincinnati, OH
45221, United States. Electronic address: Nur.fahd@hotmail.com.
(2)University of Cincinnati, College of Nursing, 3110 Vine St, Cincinnati, OH
45221, United States. Electronic address: morriscf@ucmail.uc.edu.
(3)University of Cincinnati, College of Nursing, 3110 Vine St, Cincinnati, OH
45221, United States. Electronic address: wagnerrr@ucmail.uc.edu.
(4)University of Cincinnati, CECH Educational Studies, 2610 University Circle,
Cincinnati, OH 45221, United States. Electronic address: kelceybn@ucmail.uc.edu.
(5)University of Cincinnati, College of Nursing, 3110 Vine St, Cincinnati, OH
45221, United States. Electronic address: millerel@ucmail.uc.edu.

AIM: To explore the experiences of undergraduate nursing students regarding hot

and cold debriefing styles following Basic Life Support (BLS) training.
BACKGROUND: Debriefing plays a vital role in nursing education, especially in
simulation-based experiences. Debriefing is defined as a two-directional,
"formal, collaborative, reflective process within the simulation learning
activity". According to the literature, "hot" debriefings take place within
minutes to hours after the simulation, while "cold" debriefings can happen
within days to weeks. There is insufficient evidence to determine the most
effective debriefing methods for undergraduate nursing students.
DESIGN: A qualitative descriptive study was conducted to understand students'
perceptions of hot and cold debriefing styles.
METHODS: Data were collected through two focus group interviews with 12
undergraduate nursing students. Participants were randomly assigned to hot
debriefing (n = 22) or cold debriefing (n = 22), with six students from each
group participating in the focus groups.
RESULTS: Five main categories emerged from students' perceptions related to
simulation and debriefing experiences: Simulation Experience, Debriefing
Experience, Reflection, Debriefing Impact on Learning and Feedback for
Educators.
CONCLUSIONS: It is suggested that incorporating simulation followed by
debriefing into the nursing curriculum, particularly for teaching BLS, can be
highly beneficial. The study highlights the importance of debriefing in
simulation-based education and provides recommendations for enhancing debriefing
strategies to enhance nursing skills and knowledge.

Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.

DOI: 10.1016/j.nepr.2025.104292
PMID: 39947056 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors

declare that they have no known competing financial interests or personal
relationships that could have appeared to influence the work reported in this
paper.

70. PLoS One. 2019 Jul 11;14(7):e0219341. doi: 10.1371/journal.pone.0219341.

eCollection 2019.
Effectiveness of web-based education in addition to basic life support learning
activities: A cluster randomised controlled trial.

Bylow H(1), Karlsson T(2), Lepp M(3)(4)(5), Claesson A(6), Lindqvist J(7),
Herlitz J(1)(7)(8).

Author information:
(1)Department of Molecular and Clinical Medicine, Institute of Medicine,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
(2)Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University
of Gothenburg, Gothenburg, Sweden.
(3)Institute of Health and Care Sciences, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden.
(4)Østfold University College, Halden, Norway.
(5)School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
(6)Department of Medicine, Centre for Resuscitation Science, Karolinska
Institute, Stockholm, Sweden.
(7)Centre of Registers Västra Götaland, Gothenburg, Sweden.
(8)Prehospen-Centre of Prehospital Research; Faculty of Caring Science, Work
Life and Social Welfare; University of Borås, Borås, Sweden.

BACKGROUND: Effective education in basic life support (BLS) may improve the
early initiation of high-quality cardiopulmonary resuscitation and automated
external defibrillation (CPR-AED).
AIM: To compare the learning outcome in terms of practical skills and knowledge
of BLS after participating in learning activities related to BLS, with and
without web-based education in cardiovascular diseases (CVD).
METHODS: Laymen (n = 2,623) were cluster randomised to either BLS education or
to web-based education in CVD before BLS training. The participants were
assessed by a questionnaire for theoretical knowledge and then by a simulated
scenario for practical skills. The total score for practical skills in BLS six
months after training was the primary outcome. The total score for practical
skills directly after training, separate variables and self-assessed knowledge,
confidence and willingness, directly and six months after training, were the
secondary outcomes.
RESULTS: BLS with web-based education was more effective than BLS without
web-based education and obtained a statistically significant higher total score
for practical skills at six months (mean 58.8, SD 5.0 vs mean 58.0, SD 5.0; p =
0.03) and directly after training (mean 59.6, SD 4.8 vs mean 58.7, SD 4.9; p =
0.004).
CONCLUSION: A web-based education in CVD in addition to BLS training enhanced
the learning outcome with a statistically significant higher total score for
performed practical skills in BLS as compared to BLS training alone. However, in
terms of the outcomes, the differences were minor, and the clinical relevance of
our findings has a limited practical impact.

DOI: 10.1371/journal.pone.0219341
PMCID: PMC6622500
PMID: 31295275 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing

interests exist.

71. Data Brief. 2020 Dec 31;34:106679. doi: 10.1016/j.dib.2020.106679. eCollection

2021 Feb.

Data concerning the Copenhagen tool: A research tool for evaluation of basic
life Support educational interventions.

Jensen TW(1)(2), Lockey A(3), Perkins GD(4), Granholm A(5), Eberhard KE(1)(6),
Hasselager A(6), Møller TP(1)(6), Ersbøll AK(7), Folke F(1), Lippert A(6),
Østergaard D(6), Handley AJ(8), Chamberlain D(9), Lippert F(1)(2).

Author information:
(1)Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej
5, 2750 Copenhagen, Denmark.
(2)Danish Resuscitation Council, c/o Emergency Medical Services, Telegrafvej 5,
2750 Copenhagen, Denmark.
(3)Emergency Department, Calderdale Royal Hospital, Halifax, United Kingdom.
(4)Warwick Trials Unit, University of Warwick, Coventry, CV4 7AL, United
Kingdom.
(5)Department of Intensive Care, Copenhagen University Hospital -
Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
(6)Copenhagen Academy for Medical Education and Simulation, Capital Region of
Denmark, University of Copenhagen, Copenhagen, Denmark.
(7)National Institute of Public Health, University of Southern Denmark,
Studiestræde 6, DK-1455 Copenhagen K, Denmark.
(8)Hadstock, Cambridge, UK.
(9)Brighton & Sussex Medical School, University of Sussex, Brighton, East
Sussex, United Kingdom.

The data presented in this article are supplementary data related to the
research article entitled "The Copenhagen Tool: A research tool for evaluation
of BLS educational interventions" (Jensen et al., 2019). We present the
following supplementary materials and data: 1) a standardized scenario used to
introduce the test for gathering data on internal structure and additional
response process; 2) test sheets used for rating test participant via video
recordings; 3) interview-guide for collecting additional response process data;
4) items deemed relevant but not essential for laypersons, first responders and
health personnel in the modified Delphi consensus process; 5) inter-rater
reliability values for raters using the essential items of the tool to evaluate
test participants via video recordings; 6) main themes from coding interviews
with raters; 7) comparison of rater results and manikin software output.

© 2021 The Authors.

DOI: 10.1016/j.dib.2020.106679
PMCID: PMC7811037
PMID: 33490323

Conflict of interest statement: The authors declare no competing interests.

72. Med Sci Educ. 2023 Feb 18;33(2):395-400. doi: 10.1007/s40670-023-01746-7.

eCollection 2023 Apr.

Comparison Between Self-Deliberate Practice and Directed Learning Training

Methods for Basic Life Support Knowledge and High-Quality Cardiopulmonary
Resuscitation Skill Retention in Second-Year Medical Students 3 and 6 Months
After Training.

Sianipar IR(1)(2), Tantri AR(1)(3), Muktiarti D(1)(4), Dwijayanti A(1)(5),

Manggala SK(3), Muliyah E(1).

Author information:
(1)Simulation-Based Medical Education and Research Center (SIMUBEAR), Indonesian
Medical Education and Research Institute (IMERI), Faculty of Medicine,
Universitas Indonesia, Education Tower, 8 - 9th Floor, Jl. Salemba Raya No. 6,
10430 Jakarta, Indonesia.
(2)Department of Medical Physiology and Biophysics, Faculty of Medicine,
Universitas Indonesia, Jl. Salemba Raya No. 6, Jakarta, 10430 Indonesia.
(3)Department of Anesthesiology and Intensive Care, Faculty of Medicine,
Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Diponegoro No. 71,
Jakarta, 10430 Indonesia.
(4)Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto
Mangunkusumo Hospital, Jl. Diponegoro No. 71, Jakarta, 10430 Indonesia.
(5)Department of Medical Pharmacy, Faculty of Medicine, Universitas Indonesia,
Jl. Salemba Raya No. 6, Jakarta, 10430 Indonesia.

BACKGROUND: Cardiopulmonary resuscitation (CPR) requires well-trained medical

personnel. Multiple learning methods can be done for CPR skills training. This
study aimed to compare self-deliberate practice (SDP) method and directed
learning (DL) method to improve basic life support (BLS) knowledge and CPR skill
performance in medical students.
METHODS: This is an experimental, single-blind, randomized controlled trial
study of 40 medical students from February to July 2019. Forty subjects were
randomly assigned into SDP and DL groups through a voluntary sampling method.
Both groups attended a 1-day course and then practiced once a month for
3 months. The DL group had practice sessions with assigned tutors, while the SDP
group had to practice by themselves. Examination of BLS knowledge and CPR
performance quality (compression depth, rate, and performance score) was
collected before and after course lecture, after a skills training, 3 and
6 months after training.
RESULTS: Subject characteristics of both groups were comparable. Significant
knowledge and skill improvement were found in the DL group and the SDP group
when compared to their knowledge and skill before training. There were no
significant differences between both groups in BLS knowledge and CPR performance
quality in all examination periods.
CONCLUSION: Both SDP and DL teaching methods show significant improvement and
excellent retention in BLS knowledge and high-quality CPR performance. These two
learning methods are both feasible and bring positive results for students.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material
available at 10.1007/s40670-023-01746-7.

© The Author(s) under exclusive licence to International Association of Medical

Science Educators 2023. Springer Nature or its licensor (e.g. a society or other
partner) holds exclusive rights to this article under a publishing agreement
with the author(s) or other rightsholder(s); author self-archiving of the
accepted manuscript version of this article is solely governed by the terms of
such publishing agreement and applicable law.

DOI: 10.1007/s40670-023-01746-7
PMCID: PMC10226953
PMID: 37261012

Conflict of interest statement: Conflict of InterestThe authors declare no

competing interests.

73. BMC Med Educ. 2023 Jan 23;23(1):50. doi: 10.1186/s12909-023-04029-2.

Use of virtual reality compared to the role-playing methodology in basic life

support training: a two-arm pilot community-based randomised trial.

Figols Pedrosa M(1), Barra Perez A(2), Vidal-Alaball J(3)(4)(5)(6),

Miro-Catalina Q(7)(8), Forcada Arcarons A(1).

Author information:
(1)Gerència Territorial de La Catalunya Central, Institut Català de la Salut,
Sant Fruitós de Bages, Spain.
(2)Servei d'Atenció Primària Bages-Berguedà-Moianès, Institut Català de la
Salut, Manresa, Spain.
(3)Gerència Territorial de La Catalunya Central, Institut Català de la Salut,
Sant Fruitós de Bages, Spain. jvidal.cc.ics@gencat.cat.
(4)Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut
Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina
(IDIAPJGol), Sant Fruitós del Bages, Spain. jvidal.cc.ics@gencat.cat.
(5)Health Promotion in Rural Areas Research Group, Gerencia Territorial de la
Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.
jvidal.cc.ics@gencat.cat.
(6)Faculty of Medicine, University of Vic-Central University of Catalonia, Vic,
Spain. jvidal.cc.ics@gencat.cat.
(7)Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut
Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina
(IDIAPJGol), Sant Fruitós del Bages, Spain.
(8)Health Promotion in Rural Areas Research Group, Gerencia Territorial de la
Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain.

INTRODUCTION: Virtual reality (VR) is a technology that allows us to replace our

real environment with one created with digital media. This technology is
increasingly used in the training of healthcare professionals, and previous
studies show that the involvement and motivation of students who participate in
activities that use VR increases compared to those who undergo training with the
traditional methodology. The main aim of the study is to evaluate the learning
curve of the students using a VR environment, to evaluate the satisfaction with
the training activity and the cost, and to compare them with training that uses
role-playing methodology.
METHODOLOGY: Two-arm community-based randomised trial. The control arm will base
the training on the usual role-playing methodology. The second arm or
intervention arm will base the Basic Life Support (BLS) training on a VR
programme.
RESULTS: Statistically significant differences are observed in the percentage of
correct answers in favour of the group that used VR as a learning methodology in
the test taken at the end of the course. These differences disappear when
comparing the results of the test performed at six months. The satisfaction
rating of the role-playing training activity has a score of 9.37 out of a total
of 10 and satisfaction with the VR methodology has a score of 9.72. The cost
analysis shows that the cost of training a student by role-playing is 32.5 euros
and, if trained by VR, it is 41.6 euros.
CONCLUSIONS: VR is a tool that allows the consolidation of a greater amount of
knowledge in the short term and can be used for situations such as pandemics,
where traditional formats are not available. In relation to student satisfaction
with the training activity, the rating in both groups is very high and the
differences are minimal. The results will be directly applicable to the decision
making of BLS training in Central Catalonia in relation to the scheduling of
training activities that use the VR methodology in an uncertain environment.

© 2023. The Author(s).

DOI: 10.1186/s12909-023-04029-2
PMCID: PMC9869298
PMID: 36690993 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing
interests.

74. Med Teach. 2011;33(10):e549-55. doi: 10.3109/0142159X.2011.600360.

Pre-training evaluation and feedback improve medical students' skills in basic

life support.

Li Q(1), Ma EL, Liu J, Fang LQ, Xia T.

Author information:
(1)West China Hospital of Sichuan University, Chengdu, Sichuan 610041, PR China.

BACKGROUND: Evaluation and feedback are two factors that could influence
simulation-based medical education and the time when they were delivered
contributes their different effects.
AIM: To investigate the impact of pre-training evaluation and feedback on
medical students' performance in basic life support (BLS).
METHODS: Forty 3rd-year undergraduate medical students were randomly divided
into two groups, C group (the control) and pre-training evaluation and feedback
group (E&F group), each of 20. After BLS theoretical lecture, the C group
received 45 min BLS training and the E&F group was individually evaluated
(video-taped) in a mock cardiac arrest (pre-training evaluation). Fifteen
minutes of group feedback related with the students' BLS performance in
pre-training evaluation was given in the E&F group, followed by a 30-min BLS
training. After BLS training, both groups were evaluated with one-rescuer BLS
skills in a 3-min mock cardiac arrest scenario (post-training evaluation). The
score from the post-training evaluation was converted to a percentage and was
compared between the two groups.
RESULTS: The score from the post-training evaluation was higher in the E&F group
(82.9 ± 3.2% vs. 63.9 ± 13.4% in C group).
CONCLUSIONS: In undergraduate medical students without previous BLS training,
pre-training evaluation and feedback improve their performance in followed BLS
training.

DOI: 10.3109/0142159X.2011.600360
PMID: 21942491 [Indexed for MEDLINE]

75. Am J Emerg Med. 2013 Aug;31(8):1248-50. doi: 10.1016/j.ajem.2013.02.047. Epub

2013 Jun 14.

Verification of changes in the time taken to initiate chest compressions

according to modified basic life support guidelines.

Sekiguchi H(1), Kondo Y, Kukita I.

Author information:
(1)Intensive Care Unit, Tomishiro Central Hospital, Okinawa, Japan.
qqp54x429@gaea.ocn.ne.jp

OBJECTIVE: The 2010 American Heart Association (AHA) for Cardiopulmonary

Resuscitation and Emergency Cardiovascular Care Science has changed the basic
life support (BLS) sequence from "A-B-C" to "C-A-B." The AHA explained that this
change may shorten the initiation time for chest compressions. In this study,
the 2010 AHA guidelines for BLS (2010-BLS) were studied through a simulation
program and practiced on a manikin. The time saved in initiating initial chest
compressions was calculated, and the significance of the new guidelines was
evaluated.
METHODS: Forty health care providers who had undergone both the BLS guidelines
of 2005 (2005-BLS) and the 2010-BLS programs were targeted in this study. The
following items were measured: time spent on rescue breathing, including setting
up of ventilation equipment; time taken to initiate chest compressions; and time
taken to initiate chest compressions without performance of rescue breathing
because of the lack of ventilation equipment.
RESULTS: The time taken to initiate chest compressions was 36.0 ± 4.1 seconds
when 2005-BLS was followed and 15.4 ± 3.0 seconds when 2010-BLS was followed (P
< .001). Furthermore, chest compressions were initiated earlier when 2010-BLS
was followed (15.4 ± 3.0 seconds) than when 2005-BLS was followed without the
performance of rescue breathing (19.8 ± 2.7 seconds; P < .001). The mean time
spent on setting up ventilation equipment and performing rescue breathing was
15.9 ± 3.8 seconds, indicating considerable time variations among individuals.
CONCLUSION: Chest compressions were initiated earlier by health care providers
who were re-educated according to the 2010 AHA guidelines.

Copyright © 2013 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ajem.2013.02.047
PMID: 23769851 [Indexed for MEDLINE]

76. Front Public Health. 2018 Jan 29;6:4. doi: 10.3389/fpubh.2018.00004.

eCollection
2018.

Implementation of a Sustainable Training System for Emergency in Vietnam.

Kang S(1), Seo H(2), Ho BD(3), Nguyen PTA(3).

Author information:
(1)Department of Nursing, Cheju Halla University, Jeju City, South Korea.
(2)Halla-Stony Brook Emergency Medicine Education Center, Cheju Halla
University, Jeju City, South Korea.
(3)Hue University of Medicine and Pharmacy, Hue, Vietnam.

PURPOSE: This study analyzed the project outcomes to share lessons regarding the
development of an emergency medicine education system in Vietnam.
METHODS: Retrospective evaluation was implemented using project outcome
indicators.
RESULTS: A total of 13 training courses were administered, with the
collaboration of international experts in Korea and Vietnam. A total of 23 kinds
of emergency medicine education equipment were purchased, and a basic life
support (BLS) and two advanced cardiac life support labs were remodeled to
provide appropriate simulation training. Throughout the 2 years of the project,
nine Vietnamese BLS instructors were approved by the Korea Association of
Cardiopulmonary Resuscitation under American Heart Association. Results of
evaluation by Korean international development experts were based on five
criteria, provided by the Development Assistance Committee of the Organization
for Economic Co-operation and Development, were excellent. Success factors were
identified as partnership, ownership, commitment, government support, and global
networking.
CONCLUSION: Project indicators were all accomplished and received an excellent
evaluation by external experts. For sustainable success, healthcare policy and
legal regulation to promote high quality and safe service to the Vietnamese
people are recommended.

DOI: 10.3389/fpubh.2018.00004
PMCID: PMC5797645
PMID: 29441344

77. Biomed Res Int. 2016;2016:2420568. doi: 10.1155/2016/2420568. Epub 2016 Jul 27.

The Effect of the Duration of Basic Life Support Training on the Learners'
Cardiopulmonary and Automated External Defibrillator Skills.

Lee JH(1), Cho Y(1), Kang KH(1), Cho GC(1), Song KJ(2), Lee CH(3).

Author information:
(1)Department of Emergency Medicine, Hallym University School of Medicine, Seoul
24252, Republic of Korea.
(2)Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul 06351, Republic of Korea.
(3)Department of Emergency Medical Service, Namseoul University, Cheonan,
Chungnam 331-707, Republic of Korea.

Background. Basic life support (BLS) training with hands-on practice can improve
performance during simulated cardiac arrest, although the optimal duration for
BLS training is unknown. This study aimed to assess the effectiveness of various
BLS training durations for acquiring cardiopulmonary resuscitation (CPR) and
automated external defibrillator (AED) skills. Methods. We randomised 485 South
Korean nonmedical college students into four levels of BLS training: level 1
(40 min), level 2 (80 min), level 3 (120 min), and level 4 (180 min). Before and
after each level, the participants completed questionnaires regarding their
willingness to perform CPR and use AEDs, and their psychomotor skills for CPR
and AED use were assessed using a manikin with Skill-Reporter™ software.
Results. There were no significant differences between levels 1 and 2, although
levels 3 and 4 exhibited significant differences in the proportion of overall
adequate chest compressions (p < 0.001) and average chest compression depth (p =
0.003). All levels exhibited a greater posttest willingness to perform CPR and
use AEDs (all, p < 0.001). Conclusions. Brief BLS training provided a moderate
level of skill for performing CPR and using AEDs. However, high-quality skills
for CPR required longer and hands-on training, particularly hands-on training
with AEDs.

DOI: 10.1155/2016/2420568
PMCID: PMC4978818
PMID: 27529066 [Indexed for MEDLINE]

78. J Med Life. 2010 Oct-Dec;3(4):465-7.

Importance of basic life support training for first and second year medical
students--a personal statement.

Tipa RO(1), Bobirnac G.

Author information:
(1)Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
tipa.raluca@yahoo.com

INTRODUCTION: Current studies show that there is a significant lack of knowledge

regarding the typical signs and risk factors associated with serious medical
conditions among medical students and laypersons. Basic life support consists of
a number of medical procedures provided to patients with life threatening
conditions of the body that cause pain or dysfunction to the person.
FURTHER DEVELOPMENTS: In spite of the fact that this programme is not included
in the curricula, students might receive this information from various persons,
even though these persons are not specialized in the domain of giving first aid.
Learning medicine without placing patients at an increased risk of complications
is of utmost importance in the medical profession. High-fidelity patient
simulators can potentially achieve this, and, therefore they are increasingly
used in the training of medical students. Recent studies regarding simulation
training show that the simulation-based intervention offers a positively
evaluated possibility to enhance students' skills in recognizing and handling
emergencies improving the ability to manage medical emergencies.
CONCLUSION: Understanding BLS courses and more than that, practicing these
techniques is by far the most challenging task confronting first aid. Taking
everything into consideration, we believe that an adequate education in first
aid and basic life support should be considered an essential aspect of the
medical curriculum.

PMCID: PMC3019063
PMID: 21254750 [Indexed for MEDLINE]

79. Scand J Trauma Resusc Emerg Med. 2018 Jan 29;26(1):10. doi:
10.1186/s13049-018-0479-0.

Sensemaking in the formation of basic life support teams - a proof-of-concept,

qualitative study of simulated in-hospital cardiac arrests.

Hallas P(1)(2), Lauridsen J(3), Brabrand M(4)(5).

Author information:
(1)Institute of Regional Health Research, University of Southern Denmark,
Finsensgade 35, 6700, Esbjerg, DK, Denmark. hallas@rocketmail.com.
(2)Department of Emergency Medicine, Zealand University Hospital, Lykkebækvej 1,
4600, Køge, DK, Denmark. hallas@rocketmail.com.
(3)Department of Anaesthesiology and Intensive Care, Svendborg Hospital, Baagøes
Allé 15, 5700, Svendborg, DK, Denmark.
(4)Institute of Regional Health Research, University of Southern Denmark,
Finsensgade 35, 6700, Esbjerg, DK, Denmark.
(5)Department of Emergency Medicine, Hospital of South West Jutland, Finsensgade
35, 6700, Esbjerg, DK, Denmark.

BACKGROUND: The formation of critical care teams is a complex process where team
members need to get a shared understanding of a serious situation. No previous
studies have focused on how this shared understanding is achieved during the
formation of cardiac arrest teams. "Sensemaking" is a concept well known in
organizational studies. It refers to the collaborative effort among members in a
dialogue to create meaning in an ambiguous situation, often by using subtle
variations in the sentences in the dialogue. Sentences with high degrees of
"sensemaking" activity can be thematized as "co-orientation", "re-presentation"
and/or "subordination" (among others). We sought to establish if elements of
"sensemaking" occur in the formation of in-hospital cardiac arrest teams.
METHODS: Videos of ten simulations of unannounced in-hospital cardiac arrests
treated by basic life support (BLS) providers. We transcribed all verbal
communication from the moment the first responder stepped into the room until
the moment external chest compression were initiated (verbatim transcription).
Transcriptions were then analyzed with a focus on identifying three elements of
sensemaking: Co-orientation, Re-presentation and Sub-ordination.
RESULTS: Sensemaking elements could be identified in seven of ten scenarios as
part of team formation. Co-orientation was the element that was used most
consistently, occurring in all of the eight scenarios that included sensemaking
efforts.
CONCLUSIONS: Sensemaking is an element in the communication in some cardiac
arrest teams. It is possible that the active moderation of sensemaking should be
considered a non-technical skill in cardiac arrest teams.

DOI: 10.1186/s13049-018-0479-0
PMCID: PMC5789685
PMID: 29378616 [Indexed for MEDLINE]

Conflict of interest statement: ETHICS APPROVAL AND CONSENT TO PARTICIPATE:

Participants had consented to participation and the project was approved by the
Danish Data Protection Agency. CONSENT FOR PUBLICATION: No relevant. COMPETING
INTERESTS: The authors declare that they have no competing interests.
PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.

80. Medicine (Baltimore). 2023 Jan 27;102(4):e32736. doi:

10.1097/MD.0000000000032736.

Efficiency of virtual reality for cardiopulmonary resuscitation training of

adult laypersons: A systematic review.

Alcázar Artero PM(1)(2), Pardo Rios M(1)(2), Greif R(3)(4), Ocampo Cervantes
AB(1), Gijón-Nogueron G(5), Barcala-Furelos R(6), Aranda-García S(7), Ramos
Petersen L(5).

Author information:
(1)UCAM Universidad Católica de Murcia, Murcia, España.
(2)Gerencia de Urgencias y Emergencias 061 de la Región de Murcia, Murcia,
España.
(3)Department of Anaesthesiology and Pain Medicine, Bern University Hospital,
Inselspital, Bern, Switzerland.
(4)School of Medicine, Sigmund Freud Private University Vienna, Vienna, Austria.
(5)Department of Nursing and Podiatry, Faculty of Health Sciences, University of
Malaga, Spain.
(6)Faculty of Education and Sports Sciences, University of Vigo, Pontevedra,
Spain.
(7)GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya
(INEFC), Universitat de Barcelona, Barcelona, Spain.

BACKGROUND: Virtual reality (VR) is an interesting and promising way to teach

cardiopulmonary resuscitation (CPR) to adult laypersons as its high immersive
characteristics could improve the level of skills and acquired knowledge in
learning basic life support (BLS).
METHODS: This systematic review assesses current literature about BLS training
with VR and its possible effect on CPR-quality parameters, self-efficacy,
perceived learning, and learners' satisfaction and short and long-term patients'
outcome. We screened the Cochrane Library, PubMed, CINAHL, MEDLINE Ovid, Web of
Science, and Scopus databases and included only clinical trials and
quasi-experimental studies published from inception to October 1, 2021, which
analyzed adult laypersons' BLS training with the use of VR. Primary outcomes
were CPR parameters (chest compression rate and depth, Automated External
Defibrillator use). Secondary outcomes were self-efficacy, perceived learning
and learners satisfaction, and patients' outcomes (survival and good neurologic
status). The risk of bias of included study was assessed using the Cochrane
Handbook for Systematic Reviews of Interventions tool to evaluate randomized
control trials and the transparent reporting of evaluations with nonrandomized
designs checklist for nonrandomized studies.
RESULTS: After full article screening, 6 studies were included in the systematic
review (731 participants) published between 2017 and 2021. Because of the
heterogeneity of the studies, we focused on describing the studies rather than
meta-analysis. The assessment of the quality of evidence revealed overall a very
low quality. Training with VR significantly improved the rate and depth of chest
compressions in 4 out of 6 articles. VR was described as an efficient teaching
method, exerting a positive effect on self-efficacy, perception of confidence,
and competence in 2 articles.
CONCLUSION: VR in BLS training improves manual skills and self-efficacy of adult
laypersons and may be a good teaching method in a blended learning CPR training
strategy. VR may add another way to divide complex parts of resuscitation
training into easier individual skills. However, the conclusion of this review
suggests that VR may improve the quality of the chest compressions as compared
to instructor-led face-to-face BLS training.

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

DOI: 10.1097/MD.0000000000032736
PMCID: PMC9875948
PMID: 36705392 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to

disclose.

81. Am J Perinatol. 2023 Oct;40(13):1425-1430. doi: 10.1055/a-1614-8538. Epub 2023

Sep 18.

A Survey of Academic Neonatologists on Neonatal Electrical Cardioversion and

Defibrillation.

Panchangam C(1), Rodriguez C(2), Dyke Ii PC(1), Ohler A(3), Vachharajani A(4).

Author information:
(1)Division of Pediatric Cardiology, Department of Child Health, University of
Missouri, Columbia, Missouri.
(2)Department of Pediatrics, University of Colorado, Aurora, Colorado.
(3)Department of Child Health, University of Missouri, Columbia, Missouri.
(4)Division of Neonatology, Department of Child Health, University of Missouri,
Columbia, Missouri.

OBJECTIVE: This study aimed to assess neonatologists' experience and comfort

with neonatal electrical cardioversion or defibrillation (EC-D).
STUDY DESIGN: Electronic surveys were distributed to academic neonatologists
affiliated with 12 Midwest academic hospitals. Neonatologists were asked about
their residency training; years since completing residency; current
certification/competency training in the Basic Life Support (BLS), Pediatric
Advanced Life Support (PALS), Advanced Cardiovascular Life Support (ACLS), and
Neonatal Resuscitation Program (NRP); experiences with EC-D; availability of a
pediatric cardiologist; and their comfort levels with such procedures. Standard
statistical tests evaluated comfort with EC-D.
RESULTS: Seventy-two out of 180 neonatologists responded to the survey (response
rate = 40%). Of them, 98.6% (71), 54.2% (39), and 37.5% (27) maintained current
NRP, BLS, and PALS trainings, respectively. Also, 73.6% (n = 53) reported having
performed neonatal EC-D. Of those, 50.9% (n = 27) indicated feeling slightly to
very uncomfortable performing EC-D. We report a lack of BLS certification being
associated with a lack of comfort (odds ratio [OR]: 0.269, 95% confidence
interval [CI]: [0.071, 0.936]), and a positive association between a pediatric
cardiologist being present and being uncomfortable (OR: 3.722, 95% CI: [1.069,
14.059]). Those reporting greater volume and more recent experience with EC-D
report more comfort.
CONCLUSION: Of neonatologists who performed EC-D, half of them reported being
uncomfortable. BLS certification and experience are positively associated with
comfort in performing EC-D. Simulations to increase training in EC-D should be
offered regularly to academic neonatologists.
KEY POINTS: · Most neonatologists have performed EC-D, but many feel
uncomfortable with performing EC-D.. · Many do not maintain current
certification in BLS, PALS, or ACLS.. · Simulation training in EC-D will
increase comfort with EC-D..

Thieme. All rights reserved.

DOI: 10.1055/a-1614-8538
PMID: 34448175 [Indexed for MEDLINE]

Conflict of interest statement: None declared.

82. Resuscitation. 2014 Jul;85(7):874-8. doi: 10.1016/j.resuscitation.2014.03.046.

Epub 2014 Mar 28.

Effects of a mandatory basic life support training programme on the no-flow

fraction during in-hospital cardiac resuscitation: an observational study.

Müller MP(1), Richter T(2), Papkalla N(2), Poenicke C(2), Herkner C(3), Osmers
A(2), Brenner S(2), Koch T(3), Schwanebeck U(4), Heller AR(3).

Author information:
(1)ResQer (Resuscitation - Quality in Education and Research), Department of
Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav
Carus, TU Dresden, Dresden, Germany; Interdisciplinary Medical Simulation Centre
(ISIMED), University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
Electronic address: mpmueller.web@gmail.com.
(2)ResQer (Resuscitation - Quality in Education and Research), Department of
Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav
Carus, TU Dresden, Dresden, Germany; Interdisciplinary Medical Simulation Centre
(ISIMED), University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
(3)ResQer (Resuscitation - Quality in Education and Research), Department of
Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav
Carus, TU Dresden, Dresden, Germany.
(4)Coordination Centre for Clinical Trials, University Hospital Carl Gustav
Carus, TU Dresden, Dresden, Germany.

AIM OF THE STUDY: Many hospitals have basic life support (BLS) training
programmes, but the effects on the quality of chest compressions are unclear.
This study aimed to evaluate the no-flow fraction (NFF) during BLS provided by
standard care nursing teams over a five-year observation period during which
annual participation in the BLS training was mandatory.
METHODS: All healthcare professionals working at Dresden University Hospital
were instructed in BLS and automated external defibrillator (AED) use according
to the current European Resuscitation Council guidelines on an annual basis.
After each cardiac arrest occurring on a standard care ward, AED data were
analyzed. The time without chest compressions during the period without
spontaneous circulation (i.e., the no-flow fraction) was calculated using
thoracic impedance data.
RESULTS: For each year of the study period (2008-2012), a total of 1454, 1466,
1487, 1432, and 1388 health care professionals, respectively, participated in
the training. The median no-flow fraction decreased significantly from 0.55
[0.42; 0.57] (median [25‰; 75‰]) in 2008 to 0.3 [0.28; 0.35] in 2012. Following
revision of the BLS curriculum after publication of the 2010 guidelines, cardiac
arrest was associated with a higher proportion of patients achieving ROSC (72%
vs. 48%, P=0.025) but not a higher survival rate to hospital discharge (35% vs.
19%, P=0.073).
CONCLUSION: The NFF during in-hospital cardiac resuscitation decreased after
establishment of a mandatory annual BLS training for healthcare professionals.
Following publication of the 2010 guidelines, more patients achieved ROSC after
in-hospital cardiac arrest.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2014.03.046
PMID: 24686020 [Indexed for MEDLINE]

83. Eur J Pediatr. 2023 Dec;182(12):5483-5491. doi: 10.1007/s00431-023-05202-x.

Epub
2023 Sep 30.

School children brief training to save foreign body airway obstruction.

Martínez-Isasi S(1)(2)(3)(4), Carballo-Fazanes A(5)(6)(7)(8), Jorge-Soto

C(1)(2)(3), Otero-Agra M(9)(10), Fernández-Méndez F(1)(9)(10), Barcala-Furelos
R(9), Izquierdo V(2)(4), García-Martínez M(11), Rodríguez-Núñez
A(1)(2)(3)(4)(12).

Author information:
(1)CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and
Medicine Department, Universidade de Santiago de Compostela, Santiago de
Compostela, Spain.
(2)Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the
Health Research Institute of Santiago de Compostela (IDIS), Santiago de
Compostela, Spain.
(3)Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII,
S/N, 15782, Santiago de Compostela, Spain.
(4)Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of
Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III,
RD21/0012/0025, Madrid, Spain.
(5)CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and
Medicine Department, Universidade de Santiago de Compostela, Santiago de
Compostela, Spain. aida.carballo.fazanes@usc.es.
(6)Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the
Health Research Institute of Santiago de Compostela (IDIS), Santiago de
Compostela, Spain. aida.carballo.fazanes@usc.es.
(7)Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII,
S/N, 15782, Santiago de Compostela, Spain. aida.carballo.fazanes@usc.es.
(8)Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of
Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III,
RD21/0012/0025, Madrid, Spain. aida.carballo.fazanes@usc.es.
(9)REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade
de Vigo, Pontevedra, Spain.
(10)Escuela de Enfermería de Pontevedra, Universidade de Vigo, Pontevedra,
Spain.
(11)Lucus Augusti Universitary Hospital, Lugo, Spain.
(12)Pediatric Critical, Intermediate and Palliative Care Section, Pediatric
Area, Santiago de Compostela's University Clinic Hospital, Santiago de
Compostela, Spain.

Foreign body airway obstruction (FBAO) is a relatively common emergency and a

potential cause of sudden death both in children and older people; bystander
immediate action will determine the victim's outcome. Although many school
children's basic life support (BLS) training programs have been implemented in
recent years, references to specific training on FBAO are lacking. Therefore,
the aim was to assess FBAO-solving knowledge acquisition in 10-13-year-old
school children. A quasi-experimental non-controlled simulation study was
carried out on 564 ten-to-thirteen-year-old children from 5 schools in Galicia
(Spain). Participants received a 60-min training led by their physical education
teachers (5 min theory, 15 min demonstration by the teacher, and 30 min hands-on
training) on how to help to solve an FBAO event. After the training session, the
school children's skills were assessed in a standardized adult's progressive
FBAO simulation scenario. The assessment was carried out by proficient
researchers utilizing a comprehensive checklist specifically designed to address
the variables involved in resolving a FBAO event according with current
international guidelines. The assessment of school children's acquired knowledge
during the simulated mild FBAO revealed that 62.2% of participants successfully
identified the event and promptly encouraged the simulated patient to cough
actively. When the obstruction progressed, its severity was recognized by 86.2%
and back blows were administered, followed by abdominal thrusts by 90.4%. When
the simulated victim became unconscious, 77.1% of children identified the
situation and immediately called the emergency medical service and 81.1%
initiated chest compressions. No significant differences in performance were
detected according to participants' age. Conclusion: A brief focused training
contributes to prepare 10-13-year-old school children to perform the recommended
FBAO steps in a standardized simulated patient. We consider that FBAO should be
included in BLS training programs for school children. What is Known: • Kids
Save Lives strategy states that school children should learn basic life support
(BLS) skills because of their potential role as first responders. • This BLS
training does not include content for resolving a foreign body airway
obstruction (FBAO). What is New: • Following a 60-min theoretical-practical
training led by physical education teachers, 10-13-year-old school children are
able to solve a simulated FBAO situation. • The inclusion of FBAO content in BLS
training in schools should be considered.

© 2023. The Author(s).

DOI: 10.1007/s00431-023-05202-x
PMCID: PMC10746610
PMID: 37777603 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.

84. Front Neurosci. 2019 Dec 12;13:1336. doi: 10.3389/fnins.2019.01336. eCollection

2019.

Performance Monitoring via Functional Near Infrared Spectroscopy for Virtual

Reality Based Basic Life Support Training.

Aksoy E(1)(2), Izzetoglu K(3), Baysoy E(1), Agrali A(1), Kitapcioglu D(2),
Onaral B(3).

Author information:
(1)Department of Biomedical Device Technology, Acıbadem Mehmet Ali Aydınlar
University, Istanbul, Turkey.
(2)Center of Advanced Simulation and Education, Acıbadem Mehmet Ali Aydınlar
University, Istanbul, Turkey.
(3)School of Biomedical Engineering, Science and Health Systems, Drexel
University, Philadelphia, PA, United States.
The use of serious game tools in training of medical professions is steadily
growing. However, there is a lack of reliable performance assessment methods to
evaluate learner's outcome. The aim of this study is to determine whether
functional near infrared spectroscopy (fNIRS) can be used as an additional tool
for assessing the learning outcome of virtual reality (VR) based learning
modules. The hypothesis is that together with an improvement in learning outcome
there would be a decrease in the participants' cerebral oxygenation levels
measured from the prefrontal cortex (PFC) region and an increase of
participants' serious gaming results. To test this hypothesis, the subjects were
recruited and divided into four groups with different combinations of prior
virtual reality experience and prior Basic Life Support (BLS) knowledge levels.
A VR based serious gaming module for teaching BLS and 16-Channel fNIRS system
were used to collect data from the participants. Results of the participants'
scores acquired from the serious gaming module were compared with fNIRS measures
on the initial and final training sessions. Kruskal Wallis test was run to
determine any significant statistical difference between the groups and
Mann-Whitney U test was utilized to obtain pairwise comparisons. BLS training
scores of the participants acquired from VR based serious game's the learning
management system and fNIRS measurements revealed decrease in use of resources
from the PFC, but increase in behavioral performance. Importantly, brain-based
measures can provide an additional quantitative metric for trainee's expertise
development and can assist the medical simulation instructors.

Copyright © 2019 Aksoy, Izzetoglu, Baysoy, Agrali, Kitapcioglu and Onaral.

DOI: 10.3389/fnins.2019.01336
PMCID: PMC6920174
PMID: 31920503

85. Med Klin Intensivmed Notfmed. 2016 Sep;111(6):493-500. doi:

10.1007/s00063-015-0088-x. Epub 2015 Sep 15.

Effect of the laryngeal tube on the no-flow-time in a simulated two rescuer

basic life support setting with inexperienced users.

[Article in English]

Schröder J(1), Bucher M(2), Meyer O(3).

Author information:
(1)Department of Medicine III, University Hospital of the
Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120,
Halle/Saale, Germany. jochen.schroeder@uk-halle.de.
(2)Department of Anesthesiology, University Hospital of the
Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120,
Halle/Saale, Germany.
(3)Institute for Emergency Medicine and Management in Medicine-INM, Klinikum der
Universität München, Schillerstr. 53, 80336, Munich, Germany.

INTRODUCTION: Intubation with a laryngeal tube (LT) is a recommended alternative

to endotracheal intubation during advanced life support (ALS). LT insertion is
easy; therefore, it may also be an alternative to bag-mask ventilation (BMV) for
untrained personnel performing basic life support (BLS). Data from manikin
studies support the influence of LT on no-flow-time (NFT) during ALS.
METHODS: We performed a prospective, randomized manikin study using a
two-rescuer model to compare the effects of ventilation using a LT and BMV on
NFT during BLS. Participants were trained in BMV and were inexperienced in the
use of a LT.
RESULTS: There was no significant difference in total NFT with the use of a LT
and BMV (LT: mean 83.1 ± 37.3 s; BMV: mean 78.7 ± 24.5 s; p = 0.313), but we
found significant differences in the progression of the scenario: in the
BLS-scenario, the proportion of time spent performing chest compressions was
higher when BMV was used compared to when a LT was used. The quality of chest
compressions and the ventilation rate did not differ significantly between the
two groups. The mean tidal volume and mean minute volume were significantly
larger with the use of a LT compared with the use of BMV.
CONCLUSIONS: In conclusion, in a two-rescuer BLS scenario, NFT is longer with
the use of a LT (without prior training) than with the use of BMV (with prior
training). The probable reasons for this result are higher tidal volumes with
the use of a LT leading to longer interruptions without chest compressions.

DOI: 10.1007/s00063-015-0088-x
PMID: 26374339 [Indexed for MEDLINE]

86. Eur J Emerg Med. 2008 Aug;15(4):224-5. doi: 10.1097/MEJ.0b013e3282f08d5f.

Can effective basic life support be taught to untrained individuals during a

cardiac arrest?

Dare L(1), Davies P, Benger J, Llewellyn T.

Author information:
(1)SpR Emergency Medicine, Frenchay Hospital, North Bristol NHS Trust, Bristol,
UK. leilah.dare@blueyonder.co.uk

OBJECTIVE: The objective of this study was to determine whether a trained

rescuer could teach untrained bystanders to perform basic life support (BLS)
during a simulated cardiac arrest.
METHOD: Volunteers were recruited from hospital ancillary staff and relatives of
patients attending an emergency department. None had previous formal training in
BLS. They were asked to perform BLS without instruction on a Laerdal 'Resusi
Annie'. An instructor then gave training whilst performing BLS. When volunteers
felt competent they performed BLS on their own. A penalty score was used to
assess their performance.
RESULTS: Fifty-one volunteers completed the study (32 female, 19 male) mean age
was 39 years (range 18-67 years). All the 51 volunteers showed an improvement in
their penalty score after instruction. The score improved from 86.9 (SD=13.8) to
38.2 (SD=11.8). This decline was statistically significant (paired-sample
t-test, P<0.0001).
CONCLUSION: Untrained individuals showed an improvement in BLS skills when
taught during a cardiac arrest.

DOI: 10.1097/MEJ.0b013e3282f08d5f
PMID: 19078820 [Indexed for MEDLINE]

87. Resuscitation. 2016 Sep;106:37-41. doi: 10.1016/j.resuscitation.2016.06.007.

Epub 2016 Jun 26.

Automated external defibrillation skills by naive schoolchildren.

Jorge-Soto C(1), Abelairas-Gómez C(2), Barcala-Furelos R(3), Garrido-Viñas A(4),

Navarro-Patón R(5), Muiño-Piñeiro M(6), Díaz-Pereira MP(7), Rodríguez-Núñez
A(8).
Author information:
(1)School of Nursing, University of Santiago de Compostela, Santiago de
Compostela, Spain; CLINURSID Research Group, University of Santiago de
Compostela, Spain.
(2)CLINURSID Research Group, University of Santiago de Compostela, Spain;
University School of Health Sciences, European Atlantic University, Santander,
Spain.
(3)CLINURSID Research Group, University of Santiago de Compostela, Spain;
University School of Education and Sport Sciences, University of Vigo,
Pontevedra, Spain.
(4)School of Nursing, University of Santiago de Compostela, Santiago de
Compostela, Spain.
(5)University School of Teacher Training, University of Santiago de Compostela,
Lugo, Spain.
(6)University School of Sport Sciences and Physical Education, University of A
Coruña, A Coruña, Spain.
(7)University School of Educational Sciences, University of Vigo, Ourense,
Spain.
(8)School of Nursing, University of Santiago de Compostela, Santiago de
Compostela, Spain; CLINURSID Research Group, University of Santiago de
Compostela, Spain; Paediatric Emergency and Critical Care Division, Hospital
Clínico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela,
Spain; Institute of Research of Santiago (IDIS) and SAMID-II Network, Spain.
Electronic address: Antonio.Rodriguez.Nunez@sergas.es.

AIM: Early defibrillation should achieve the highest survival rates when applied
within the first minutes after the collapse. Public access defibrillation
programs have increased the population awareness of the importance of
defibrillation. Schoolchildren should be trained in basic life support (BLS)
skills and some countries have included BLS in their school syllabus. However,
little is known of the current knowledge and ability of schoolchildren to use an
automated external defibrillator (AED).
METHODS: A multicentric descriptive study, 1295 children from 6 to 16 years of
age without previous BLS or AED training. Subjects performed a simulation with
an AED and a manikin with no training or feedback and were evaluated by means of
a checklist.
RESULTS: A total of 258 participants (19.9%) were able to simulate an effective
and safe defibrillation in less than 3min and 52 (20.1% of this group) performed
it successfully. A significant correlation between objective and age group was
observed (G=0.172) (p<0.001). The average time to deliver a shock was
83.3±26.4s; that time decreased significantly with age [6 YO (108.3±40.4) vs. 16
YO (64.7±18.6)s] (p<0.001).
CONCLUSIONS: Around 20% of schoolchildren without prior training are able to use
an AED correctly in less than 3min following the device's acoustic and visual
instructions. However, only one-fifth of those who showed success managed to
complete the procedure satisfactorily. These facts should be considered in order
to provide a more accurate definition and effective implementation of BLS/AED
teaching and training at schools.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2016.06.007
PMID: 27353288 [Indexed for MEDLINE]

88. Taehan Kanho Hakhoe Chi. 2005 Oct;35(6):1081-90. doi:

10.4040/jkan.2005.35.6.1081.

[Evaluation of a self-efficacy-based basic life support program for high-risk

patients' family caregivers].

[Article in Korean]

Kang K(1), Lee I.

Author information:
(1)Department of Emergency Medical Technology, Gachongil College and Graduate
School of Nursing, Gachon Medical School, Incheon, Korea. blskang@unitel.co.kr

PURPOSE: The purpose of this study was to evaluate a Self-efficacy-based Basic

Life Support (SEBLS) program for high-risk patients' family caregivers on
cardiac arrest. The SEBLS program was constructed on the basis of Bandura's
self-efficacy resources as well as the International Liaison Committee on
Resuscitation's "2000 Guidelines for CPR and ECC".
METHOD: The effect of the SEBLS program on emergency response self-efficacy and
emergency response behavior such as BLS (Basic Life Support) knowledge and BLS
skill performance was measured by a simulated control group pretest-posttest
design. Study subjects were38 high-risk patients' family caregivers (20
experimental subjects and 18 control subjects) whose family patients were
admitted to a general hospital in Incheon, Korea.
RESULT: 1. Emergency response self-efficacy was significantly higher in the
experimental subjects who participated in the SEBLS program than in the control
subjects. (t=8.3102, p=0.0001). 2. For emergency response behavior, BLS
knowledge (t=5.6941, p=0.0001) and BLS skill performance (t=27.8281, p=0.0001)
was significantly higher in experimental subjects than in control subjects.
CONCLUSION: A SEBLS program can increase emergency response self-efficacy and
emergency response behavior, and could be an effective intervention for
high-risk patient's family caregivers. Long-term additional studies are needed
to determine the lasting effects of the program.

DOI: 10.4040/jkan.2005.35.6.1081
PMID: 16288151 [Indexed for MEDLINE]

89. Children (Basel). 2022 Nov 15;9(11):1751. doi: 10.3390/children9111751.

Feasibility of Mouth-to-Mouth Ventilation through FPP2 Respirator in BLS

Training during COVID-19 Pandemic (MOVERESP Study): Simulation-Based Study.

Kosinová M(1)(2), Štourač P(1)(2), Prokopová T(1)(3), Vafková T(1)(4), Vafek

V(1)(2), Barvík D(1)(3), Skříšovská T(1)(2), Dvořáček J(1)(3), Djakow
J(1)(2)(5), Klučka J(1)(2), Jarkovský J(6), Plevka P(7).

Author information:
(1)Department of Simulation Medicine, Faculty of Medicine, Masaryk University,
Kamenice 5, 625 00 Brno, Czech Republic.
(2)Department of Paediatric Anaesthesiology and Intensive Care Medicine,
University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská
20, 625 00 Brno, Czech Republic.
(3)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00
Brno, Czech Republic.
(4)Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute,
Faculty of Medicine, Masaryk University, Žlutý kopec 534/7, 656 53 Brno, Czech
Republic.
(5)Paediatric Intensive Care Unit, NH Hospital Inc., 268 01 Hořovice, Czech
Republic.
(6)Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk
University, Kamenice 126/3, 625 00 Brno, Czech Republic.
(7)Central European Institute of Technology, Masaryk University, Kamenice 753/5,
625 00 Brno, Czech Republic.

BACKGROUND: Due to the COVID-19 pandemic, Basic Life Support (BLS) training has
been limited to compression-only or bag-mask ventilation. The most breathable
nanofiber respirators carry the technical possibility for inflation of the
mannequin. The aim of this study was to assess the efficacy of mouth-to-mouth
breathing through a FFP2 respirator during BLS.
METHODS: In the cross-over simulation-based study, the medical students
performed BLS using a breathable nanofiber respirator for 2 min on three
mannequins. The quantitative and qualitative efficacy of mouth-to-mouth
ventilation through the respirator in BLS training was analyzed. The primary aim
was the effectivity of mouth-to-mouth ventilation through a breathable
respirator. The secondary aims were mean pause, longest pause, success in
achieving the optimal breath volume, technique of ventilation, and incidence of
adverse events.
RESULTS: In 104 students, effective breath was reached in 951 of 981 (96.9%)
attempts in Adult BLS mannequin (Prestan), 822 of 906 (90.7%) in Resusci Anne,
and 1777 of 1857 (95.7%) in Resusci Baby. In Resusci Anne and Resusci Baby,
28.9%/15.9% of visible chest rises were evaluated as low-, 33.0%/44.0% as
optimal-, and 28.8%/35.8% as high-volume breaths.
CONCLUSIONS: Mouth-to-mouth ventilation through a breathable respirator had an
effectivity greater than 90%.

DOI: 10.3390/children9111751
PMCID: PMC9688859
PMID: 36421199

Conflict of interest statement: The authors declare no conflict of interest.

90. Arch Dis Child. 2019 Aug;104(8):793-801. doi: 10.1136/archdischild-2018-316576.

Epub 2019 Jun 4.

Can real-time feedback improve the simulated infant cardiopulmonary

resuscitation performance of basic life support and lay rescuers?

Kandasamy J(1), Theobald PS(1), Maconochie IK(2), Jones MD(1).

Author information:
(1)Biomedical Engineering Research Group, Cardiff University, Cardiff, UK.
(2)Paediatric Emergency Department, Imperial College Hospital NHS Healthcare
Trust, London, UK.

BACKGROUND: Performing high-quality chest compressions during cardiopulmonary

resuscitation (CPR) requires achieving of a target depth, release force, rate
and duty cycle.
OBJECTIVE: This study evaluates whether 'real time' feedback could improve
infant CPR performance in basic life support-trained (BLS) and lay rescuers. It
also investigates whether delivering rescue breaths hinders performing
high-quality chest compressions. Also, this study reports raw data from the two
methods used to calculate duty cycle performance.
METHODOLOGY: BLS (n=28) and lay (n=38) rescuers were randomly allocated to
respective 'feedback' or 'no-feedback' groups, to perform two-thumb chest
compressions on an instrumented infant manikin. Chest compression performance
was then investigated across three compression algorithms (compression only;
five rescue breaths then compression only; five rescue breaths then 15:2
compressions). Two different routes to calculate duty cycle were also
investigated, due to conflicting instruction in the literature.
RESULTS: No-feedback BLS and lay groups demonstrated <3% compliance against each
performance target. The feedback rescuers produced 20-fold and 10-fold increases
in BLS and lay cohorts, respectively, achieving all targets concurrently in
>60% and >25% of all chest compressions, across all three algorithms. Performing
rescue breaths did not impede chest compression quality.
CONCLUSIONS: A feedback system has great potential to improve infant CPR
performance, especially in cohorts that have an underlying understanding of the
technique. The addition of rescue breaths-a potential distraction-did not
negatively influence chest compression quality. Duty cycle performance depended
on the calculation method, meaning there is an urgent requirement to agree a
single measure.

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and
permissions. Published by BMJ.

DOI: 10.1136/archdischild-2018-316576
PMID: 31164375 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.

91. Anesth Analg. 2005 Jul;101(1):200-5, table of contents. doi:

10.1213/01.ANE.0000154305.70984.6B.

Over-the-head cardiopulmonary resuscitation improves efficacy in basic life

support performed by professional medical personnel with a single rescuer: a
simulation study.

Hüpfl M(1), Duma A, Uray T, Maier C, Fiegl N, Bogner N, Nagele P.

Author information:
(1)Department of Anesthesia and General Intensive Care, Medical University
Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.

Comment in
Anesth Analg. 2006 Aug;103(2):498; author reply 498-9. doi:
10.1213/01.ANE.0000227073.07034.D1.

Two-rescuer cardiopulmonary resuscitation (CPR) is considered the best method

for professional basic life support (BLS). However, in many prehospital cardiac
arrest situations, one rescuer has to begin CPR alone while the other performs
additional tasks. In theory, over-the-head CPR is a suitable alternative in this
situation, with the added benefit of allowing the single rescuer to use a
self-inflating bag for ventilation. In this trial, we compared standard
single-rescuer CPR with over-the-head CPR in manikins. We planned this study
using a crossover study design where each participant administered both CPR
techniques in a randomized order. Ventilation and chest compression data were
collected with analysis software during a 2-min CPR test for each technique.
Sixty-seven emergency medical technician students participated in this trial.
Over-the-head CPR allowed for superior ventilation compared to standard CPR
(number of correct ventilations: 330 of 760 versus 279 of 779; P = 0.002). The
quality of delivered chest compressions did not differ between the two groups
(correct chest compressions: 4293 of 6304 versus 4313 of 6395; P = 0.44). In
conclusion, our study has shown that over-the-head CPR may be an effective
alternative BLS technique when a single professional rescuer has to perform CPR,
likely offering superior ventilation and comparable chest compression quality
compared with standard BLS.
DOI: 10.1213/01.ANE.0000154305.70984.6B
PMID: 15976232 [Indexed for MEDLINE]

92. Eur J Emerg Med. 2009 Dec;16(6):336-8. doi: 10.1097/MEJ.0b013e32832d048b.

First aid and basic life support training for first year medical students.

Altintaş KH(1), Yildiz AN, Aslan D, Ozvariş SB, Bilir N.

Author information:
(1)Department of Public Health, Faculty of Medicine, Hacettepe University,
Ankara, Turkey. hakana@hacettepe.edu.tr

We developed 24 and 12-h programs for first aid and basic life support (FA-BLS)
training for first-year medical students and evaluated the opinions of both the
trainers and trainees on the effectiveness of the programs. The trainees were
the first-year students of academic years 2000-2001 (316 students) and 2001-2002
(366 students). The evaluations of the participants were collected from short
questionnaires created specifically for the study. For the 24-h training
program, most of the students stated that FA-BLS sessions met their expectations
(85.9%) and they were satisfied with the training (91.1%). Of the participants,
75.6% stated that they could apply FA confidently in real situations simulating
the topics they learned in the FA-BLS sessions. For the 12-h training program,
84.4% of the students felt themselves competent in FA-BLS applications. The
trainers considered both of the programs as effective.

DOI: 10.1097/MEJ.0b013e32832d048b
PMID: 19491692 [Indexed for MEDLINE]

93. Resuscitation. 2005 Oct;67(1):45-50. doi: 10.1016/j.resuscitation.2005.04.012.

Improved basic life support performance by ward nurses using the CAREvent Public
Access Resuscitator (PAR) in a simulated setting.

Monsieurs KG(1), De Regge M, Vogels C, Calle PA.

Author information:
(1)Emergency Department, Ghent University Hospital, De Pintelaan 185, B-9000
Ghent, Belgium. koen.monsieurs@ugent.be

INTRODUCTION: The CAREvent Public Access Resuscitator (PAR, O-Two Medical

Technologies, Ontario, Canada) is a new oxygen-driven device alternating two
ventilations with 15 prompts for chest compressions. The PAR is designed for use
with a standard resuscitation face mask and is equipped with mask leakage and
obstruction alarms. The purpose of this study was to assess the quality of basic
life support (BLS) by hospital nurses and to evaluate if BLS with the PAR is
better than BLS using the mouth-to-mask technique.
METHODS: The study group consisted of 352 nurses from Ghent University Hospital
working outside the critical care and emergency departments. BLS skills were
measured using a Laerdal Skillreporter manikin (Laerdal, Norway) connected to a
Laerdal PC Skillreporting system. To assess base line skills, 200 nurses were
tested without previous notice in single rescuer BLS using a pocket mask (PM,
Laerdal, Norway) or a bag-valve mask device (Laerdal, Norway) over a period of 2
min. A separate consecutive sample of 152 nurses was randomised to the PM or PAR
groups after a standard BLS refresher course. The PAR group received a short
period of training in PAR use. Immediately after training, both groups performed
the 2 min single rescuer BLS test.
RESULTS: Unprepared nurses achieved only 26 compressions and 3 ventilations/min.
Immediately after training, nurses using the PAR delivered 54 compressions/min
as opposed to 35 for the PM group (p<0.0001). PAR users ventilated six times/min
compared to five times for PM users (p<0.0001).
CONCLUSION: Immediately after training, the use of the PAR improved BLS
performance by ward nurses significantly, bringing the number of ventilations
and compressions per minute close to the theoretical maximum achievable within
the current guidelines. Retention tests after 6 and 12 months will show if the
effect is sustained.

DOI: 10.1016/j.resuscitation.2005.04.012
PMID: 16129540 [Indexed for MEDLINE]

94. Resuscitation. 2022 Nov;180:45-51. doi: 10.1016/j.resuscitation.2022.09.006.

Epub 2022 Sep 19.

Cost-effectiveness analysis of termination-of-resuscitation rules for patients

with out-of-hospital cardiac arrest.

Shibahashi K(1), Konishi T(2), Ohbe H(2), Yasunaga H(2).

Author information:
(1)Department of Clinical Epidemiology and Health Economics, School of Public
Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan;
Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15,
Kotobashi, Sumida-ku, Tokyo 1308575, Japan. Electronic address:
Shibahashi-tky@umin.ac.jp.
(2)Department of Clinical Epidemiology and Health Economics, School of Public
Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.

AIM: To evaluate the cost-effectiveness of practices with and without

termination-of-resuscitation (TOR) rules for out-of-hospital cardiac arrest
(OHCA), using an analytic model based on a nationwide population-based registry
in Japan.
METHODS: A combined model using a decision tree and Markov model was developed
to compare costs and treatment effectiveness of three scenarios: basic life
support (BLS) TOR rules (BLS-rule scenario), advanced life support (ALS) TOR
rules (ALS-rule scenario), and no TOR rules (No-rule scenario). A nationwide
population-based OHCA registry from January 1 to December 31, 2019 and published
data were used. Analyses were performed from healthcare payers' perspectives.
Life-time incremental cost-effectiveness ratio (ICER) was determined by the
difference in cost between two scenarios, divided by the difference in quality
adjusted life year (QALY).
RESULTS: The OHCA registry included 126,271 patients (57.3% men; median age,
80 years). The BLS-rule scenario yielded lower cost and less QALY than the
ALS-rule scenario and No-rule scenario. With reference to the BLS-rule scenario,
the ICERs for the ALS-rule scenario and No-rule scenario were 81,000 and 98,762
USD per QALY, respectively. The BLS-rule scenario was cost-effective in 100% of
simulations at the willingness-to-pay threshold in Japan (5 million JPY = 45,455
USD). The willingness-to-pay threshold higher than 80,000 and 204,000 USD were
required for the ALS-rule scenario and No-rule scenarios, respectively, to be
cost-effective.
CONCLUSION: No-rule scenario was not cost-effective compared with BLS-rule
scenario within acceptable willingness-to-pay thresholds. Further research on
health economics of TOR rules is warranted to support constructive discussion on
implementing TOR rules.

Copyright © 2022 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2022.09.006
PMID: 36176229

95. Resuscitation. 1998 Oct-Nov;39(1-2):47-50. doi: 10.1016/s0300-9572(98)00114-2.

Successful automatic external defibrillator operation by people trained only in

basic life support in a simulated cardiac arrest situation.

Domanovits H(1), Meron G, Sterz F, Kofler J, Oschatz E, Holzer M, Müllner M,

Laggner AN.

Author information:
(1)Department of Emergency Medicine, University of Vienna Medical School,
Austria.

Comment in
Circulation. 2000 Nov 14;102(20):E166. doi: 10.1161/01.cir.102.20.e166.

OBJECTIVE: To show whether in an in-hospital cardiac arrest, early

defibrillation can also be performed by hospital staff trained only in basic
life support.
BACKGROUND: The International Liaison Committee on Resuscitation (ILCOR)
endorses the concept that in many settings non-medical individuals should be
allowed and encouraged to use defibrillators.
METHODS: Five different groups of hospital staff were evaluated whether they
were able to correctly operate an automatic external defibrillator in a
simulated sudden cardiac arrest situation without any prior instruction. The
participants were assigned either to the 'basic life support-trained' group
(BLS, n = 40, or to the 'advanced life support-trained' group (ALS, n = 40).
RESULTS: All persons of the 'only BLS-trained' group delivered the three
sequential ('stacked') shocks with the automatic external defibrillator when
persistent ventricular fibrillation was simulated. The 'ALS-trained' persons
successfully delivered the three shocks with the automatic external
defibrillator in 98% of the cases. When this group used a conventional
defibrillator, only 88% were able to deliver the three shocks, however they were
able to do it significantly more quickly.
CONCLUSION: Using an automatic defibrillator without any prior instruction, even
persons trained only in BLS were able to deliver three sequential shocks in a
simulated persistent ventricular fibrillation cardiac arrest.

DOI: 10.1016/s0300-9572(98)00114-2
PMID: 9918447 [Indexed for MEDLINE]

96. PeerJ. 2022 Nov 15;10:e14345. doi: 10.7717/peerj.14345. eCollection 2022.

Initial implementation of the resuscitation quality improvement program in

emergency department of a teaching hospital in China.

Jiang H(#)(1), Zong L(#)(1), Li F(1), Gao J(1), Zhu H(1), Shi D(1), Liu J(1).

Author information:
(1)Emergency Department, State Key Laboratory of Complex Severe and Rare
Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical
Science and Peking Union Medical College, Beijing, China.
(#)Contributed equally
BACKGROUND: Cardiopulmonary resuscitation (CPR) skills may decay over time after
conventional instructor-led BLS training. The Resuscitation Quality Improvement®
(RQI®) program, unlike a conventional basic life support (BLS) course, is
implemented through mastery learning and low-dose, high-frequency training
strategies to improve CPR competence. We facilitated the RQI program to compare
the performance of novices vs those with previous BLS training experience before
RQI implementation and to obtain their confidence and attitude of the RQI
program.
METHODS: A single-center observational study was conducted from May 9, 2021 to
June 25, 2021 in an emergency department of a tertiary hospital. The performance
assessment data of both trainees with a previous training experience in
conventional BLS course (BLS group) and the novice ones with no prior experience
with any BLS training (Non-BLS group) was collected by RQI cart and other
outcome variables were rated by online questionnaire. Outcome measurements
included chest compression and ventilation in both adult-sized and infant-sized
manikins.
RESULTS: A total of 149 participants were enrolled. Among them, 103 participants
were in BLS group and 46 participants in Non-BLS group. Post RQI training, all
the trainees achieved a passing score of 75 or more, and obtained an improvement
in CPR performance. The number of attempts to pass RQI for compression and
ventilation practice was lower in the BLS group in both adult and infant
training sessions (P < 0.05). Although the BLS group had a poor baseline, it had
fewer trials and the same learning outcomes, and the BLS group had better
self-confidence. Trainees were well adapted to the innovative training modality,
and satisfaction among all of the participants was high. Only the respondents
for non-instructor led training, the satisfaction was low in both groups (72.8%
in BLS group vs 65.2% in No-BLS group, strongly agreed).
CONCLUSION: Among novices, RQI can provide excellent CPR core skills
performance. But for those who had previous BLS training experience, it was able
to enhance the efficiency of the skills training with less time consumption.
Most trainees obtained good confidence and satisfaction with RQI program, which
might be an option for the broad prevalence of BLS training in China.

© 2022 Jiang et al.

DOI: 10.7717/peerj.14345
PMCID: PMC9673765
PMID: 36405021 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing
interests.

97. Anaesthesist. 2016 Mar;65(3):183-9. doi: 10.1007/s00101-016-0140-0. Epub 2016

Feb 17.

Effect of using a laryngeal tube on the no-flow time in a simulated,

single-rescuer, basic life support setting with inexperienced users.

Meyer O(1), Bucher M(2), Schröder J(3).

Author information:
(1)Institute for Emergency Medicine and Management in Medicine - INM, Klinikum
der Universität München, Schillerstr. 53, 80336, Munich, Germany.
(2)Department of Anesthesiology, University Hospital of the
Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120,
Halle/Saale, Germany.
(3)Department of Medicine III, University Hospital of the
Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120,
Halle/Saale, Germany. jochen.schroeder@uk-halle.de.

BACKGROUND: The laryngeal tube (LT) is a recommended alternative to endotracheal

intubation during advanced life support (ALS). Its insertion is relatively
simple; therefore, it may also serve as an alternative to bag mask ventilation
(BMV) for untrained personnel performing basic life support (BLS). Data support
the influence of LT on the no-flow time (NFT) compared with BMV during ALS in
manikin studies.
METHODS: We performed a manikin study to investigate the effect of using the LT
for ventilation instead of BMV on the NFT during BLS in a prospective,
randomized, single-rescuer study. All 209 participants were trained in BMV, but
were inexperienced in using LT; each participant performed BLS during a 4-min
time period.
RESULTS: No significant difference in total NFT (LT: mean 81.1 ± 22.7 s; BMV:
mean 83.2 ± 13.1 s, p = 0.414) was found; however, significant differences in
the later periods of the scenario were identified. While ventilating with the
LT, the proportion of chest compressions increased significantly from 67.2 to
73.2%, whereas the proportion of chest compressions increased only marginally
when performing BMV. The quality of the chest compressions and the associated
ventilation rate did not differ significantly. The mean tidal volume and mean
minute volume were significantly lower when performing BMV.
CONCLUSIONS: The NFT was significantly shorter in the later periods in a
single-rescuer, cardiac arrest scenario when using an LT without previous
training compared with BMV with previous training. A possible explanation for
this result may be the complexity and workload of alternating tasks (e.g., time
loss when reclining the head and positioning the mask for each ventilation
during BMV).

DOI: 10.1007/s00101-016-0140-0
PMID: 26886383 [Indexed for MEDLINE]

98. Br J Gen Pract. 2020 Jun;70(suppl 1):bjgp20X711425. doi: 10.3399/bjgp20X711425.

In situ deteriorating patient simulation in general practice.

Lawrence J(1), Eastwick-Field P(2), Maloney A(3), Higham H(3).

Author information:
(1)Brighton and Sussex Medical School.
(2)Health Education Thames Valley.
(3)Health Education England Thames Valley.

BACKGROUND: GP practices have limited access to medical emergency training and

basic life support is often taught out of context as a skills-based event.
AIM: To develop and evaluate a whole team integrated simulation-based education,
to enhance learning, change behaviours and provide safer care.
METHOD: Phase 1: 10 practices piloted a 3-hour programme delivering 40 minutes
BLS and AED skills and 2-hour deteriorating patient simulation. Three scenarios
where developed: adult chest pain, child anaphylaxis and baby bronchiolitis. An
adult simulation patient and relative were used and a child and baby manikin.
Two facilitators trained in coaching and debriefing used the 3D debriefing
model. Phase 2: 12 new practices undertook identical training derived from Phase
1, with pre- and post-course questionnaires. Teams were scored on: team working,
communication, early recognition and systematic approach. The team developed
action plans derived from their learning to inform future response. Ten of the
12 practices from Phase 2 received an emergency drill within 6 months of the
original session. Three to four members of the whole team integrated training,
attended the drill, but were unaware of the nature of the scenario before.
Scoring was repeated and action plans were revisited to determine behaviour
changes.
RESULTS: Every emergency drill demonstrated improved scoring in skills and
behaviour.
CONCLUSION: A combination of: in situ GP simulation, appropriately qualified
facilitators in simulation and debriefing, and action plans developed by the
whole team suggests safer care for patients experiencing a medical emergency.

© British Journal of General Practice 2020.

DOI: 10.3399/bjgp20X711425
PMID: 32554667

99. Mil Med. 2022 May 3;187(5-6):e764-e769. doi: 10.1093/milmed/usab198.

Simulation-Based Training Program to Improve Cardiopulmonary Resuscitation and

Teamwork Skills for the Urgent Care Clinic Staff.

Laco RB(1), Stuart WP(2).

Author information:
(1)Emergency Services Flight, 374th Medical Group, Yokota Air Base, APO, AP
96328, Japan.
(2)Adult Health Nursing, University of South Alabama College of Nursing, Mobile,
AL 36688-0002, USA.

INTRODUCTION: Lack of high-quality cardiopulmonary resuscitation (CPR) and

effective team communication during cardiovascular emergencies could lead to
poor patient outcomes and adverse events. Studies have shown that CPR
psychomotor skills declined 3 months and plateaued up to 6 months after the
completion of CPR training. The Urgent Care Clinic (UCC) interprofessional staff
did not receive consistent training on CPR and teamwork skills beyond what was
received from the biannual American Red Cross (ARC) Basic Life Support (BLS)
training and semiannual Resuscitative Care Function mock cardiac arrest. Most
participants took their last CPR training for more than 6 months (n = 12, 67%),
between 3 and 6 months (n = 2, 11%), and within the last 3 months before the
pre-intervention period (n = 4, 22%). The purpose of the project was to form an
interprofessional team to lead the development and implementation of a theory-
and evidence-based simulation-based training program to improve CPR and teamwork
skills while enhancing patient safety and emergency medical readiness in the
hospital and UCC.
MATERIALS AND METHODS: The quality improvement project utilized an
interprofessional in situ simulation-based training to improve participants' CPR
and teamwork skills. The UCC physicians, nurses, and medical technicians
completed a CPR and teamwork simulation-based training with a high-fidelity
mannequin, pre-simulation preparation, briefing, and debriefing. The project
collected pre-intervention and post-intervention data for CPR competence and
teamwork perceptions. A paired t-test was used to assess differences in
participant CPR skills and Team Strategies to Enhance Performance and Patient
Safety Teamwork Perceptions Questionnaire responses before and after the
simulation-based training intervention. The 59th Medical Wing and the University
of South Alabama Institutional Review Boards approved the quality improvement
project.
RESULTS: A total of 18 participants completed the ARC BLS and Team Strategies to
Enhance Performance and Patient Safety simulation-based training. Most
participants were medical technicians (n = 8, 44%), followed by physicians
(n = 5, 28%) and (n = 5, 28%) nurses. There was a statistical significance in
participants' ARC BLS scores, with a pre-simulation mean score of 45.42 and a
post-simulation mean score of 89.21 (P = .000, 95% CI = 36.89-50.68). For Team
Strategies to Enhance Performance and Patient Safety teamwork perceptions, there
was a statistically significant increase in the participants' teamwork
perception levels, with a pre-simulation mean score of 4.61 and a
post-simulation mean score of 4.86 (P = .000, 95% CI = 0.20-0.31).
CONCLUSIONS: Our results demonstrated that the participants' ARC BLS scores and
UCC's team perceptions have increased after in situ simulation-based training.
We did not assess the ideal time for re-training. We recommend a 3- to 6-month
post-training assessment to determine the optimal time for a CPR and teamwork
refresher training. A high-fidelity simulation-based program with trained
facilitators that assess the healthcare providers' CPR and teamwork skills could
enhance the delivery of high-quality CPR and execution of effective teamwork
skills in their workplace.

Published by Oxford University Press on behalf of the Association of Military

Surgeons of the United States 2021. This work is written by (a) US Government
employee(s) and is in the public domain in the US.

DOI: 10.1093/milmed/usab198
PMID: 34050365 [Indexed for MEDLINE]

100. Am J Emerg Med. 2016 Mar;34(3):381-5. doi: 10.1016/j.ajem.2015.11.003. Epub

2015
Nov 4.

Randomized trial of the chest compressions effectiveness comparing 3 feedback

CPR devices and standard basic life support by nurses.

Truszewski Z(1), Szarpak L(2), Kurowski A(3), Evrin T(4), Zasko P(3), Bogdanski
L(3), Czyzewski L(5).

Author information:
(1)Department of Emergency Medicine, Medical University of Warsaw, Warsaw,
Poland.
(2)Department of Emergency Medicine, Medical University of Warsaw, Warsaw,
Poland. Electronic address: lukasz.szarpak@gmail.com.
(3)Department of Anesthesiology, Cardinal Wyszynski National Institute of
Cardiology, Warsaw, Poland.
(4)Department of Emergency Medicine, UFuK University Medical Faculty, Dr Ridvan
Ege Education and Research Hospital, Ankara, Turkey.
(5)Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw,
Poland.

BACKGROUND: Out-of-hospital cardiac arrest is a leading cause of mortality and

serious neurological morbidity in Europe. We aim to investigate the effect of 3
cardiopulmonary resuscitation (CPR) feedback devices on effectiveness of chest
compression during CPR.
METHODS: This was prospective, randomized, crossover, controlled trial.
Following a brief didactic session, 140 volunteer nurses inexperienced with
feedback CPR devices attempted chest compression on a manikin using 3 CPR
feedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support
(BLS) without feedback.
RESULTS: Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed
differences in the effectiveness of chest compression (compressions with correct
pressure point, correct depth, and sufficient decompression), which are,
respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs
45.6 vs 39.6 mm); and compression rate (129.4 vs 110.2 vs 101.5 vs 103.5
min(-1)).
CONCLUSIONS: During the simulated resuscitation scenario, only TrueCPR
significantly affected the increased effectiveness compression compared with
standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirm the
results in clinical practice.

Copyright © 2015 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ajem.2015.11.003
PMID: 26612703 [Indexed for MEDLINE]

101. GMS J Med Educ. 2021 Nov 15;38(7):Doc116. doi: 10.3205/zma001512. eCollection
2021.

Basic resuscitation skills of medical students - a monocenter randomized

simulation trial.

Bülow C(1), Krispin SK(1), Lehmanski F(1), Spalding G(2)(3), Haase-Fielitz

A(4)(3)(5), Butter C(4)(3), Nübel J(4)(3).

Author information:
(1)Medizinische Hochschule Brandenburg (MHB), Neuruppin, Germany.
(2)Immanuel Klinikum Bernau, Herzzentrum Brandenburg, Zentrale Notaufnahme,
Bernau bei Berlin, Germany.
(3)Medizinische Hochschule Brandenburg (MHB), Hochschulklinikum, Neuruppin,
Germany.
(4)Immanuel Klinikum Bernau, Herzzentrum Brandenburg, Abteilung for Kardiologie,
Bernau bei Berlin, Germany.
(5)Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Institut für
Sozialmedizin und Gesundheitssystemforschung, Magdeburg, Germany.

Objective: The aim of this study was to evaluate resuscitation skills, defined
as recognition of resuscitation situations and performance of Basic Life Support
(BLS) in students at the Brandenburg Model Medical School (BMM). Methods:
Participating students (n=102) were randomized to different simulation
scenarios: unconscious person with physiological breathing (15/min), gasping
(<10/min) and apnea (resuscitation dummy AmbuMan® Wireless with electronic
recording). Primary endpoint was the proportion of students with correct
decision for or against resuscitation. Secondary endpoint was resuscitation
quality, self-assessment, and prior resuscitation experience. The latter two
were assessed by questionnaire prior to the simulated situation. Results:
Overall, there was a high risk for incorrectly omitted or incorrectly performed
resuscitation (OR 3.4 [95% CI 1.4-8.1] p=0.005. The highest probability of error
occurred in the unconsciousness and gasping groups. 22.3% of all performed
resuscitations where at the same time indicated and reached the European
Resuscitation Council recommendations for compression frequency, pressure depth
and where as well = 90% relieved. A particularly large discrepancy emerged
between participants' self-assessment of being prepared for a resuscitation
situation by medical school and their actual documented resuscitation
competence. Conclusion: The present data indicate significant uncertainty among
students in recognizing a resuscitation situation. Even in curricula with a high
proportion of practice and a high degree of students with completed vocational
training in health care, resuscitation competence is poor.

Publisher: Zielsetzung: Ziel der Untersuchung war die Analyse der

Reanimationskompetenz definiert als Indikationserkennung und Durchführung des
Basic Life Support (BLS) von Studierenden des Brandenburger Modellstudiengangs
Medizin (BMM). Methodik: Die teilnehmenden Studierenden (n=102) wurden zu
unterschiedlichen Simulationsszenarien randomisiert: bewusstlose Person mit
physiologischer Atmung (15/min), Schnappatmung (<10/min) und Apnoe
(Reanimationsdummy AmbuMan® Wireless mit elektronischer Aufzeichnung). Primärer
Endpunkt war der Anteil an Studierenden mit korrekter Entscheidung für oder
gegen eine Reanimation. Sekundärer Endpunkt war die Reanimationsgüte,
Selbsteinschätzung und Reanimationsvorerfahrung. Letztere beiden wurden vor
Studienbeginn durch einen Fragebogen erfasst.Ergebnisse: Insgesamt bestand ein
hohes Risiko für eine falsch unterlassene oder fälschlicherweise durchgeführte
Reanimation (OR 3,4 [95% KI 1,4-8,1] p=0,005. Die größte
Irrtumswahrscheinlichkeit ergab sich bei Bewußtlosigkeit und Schnappatmung.
22,3% aller indizierten und durchgeführten Reanimationen erreichten die vom
European Resuscitation Council empfohlene Kompressionsfrequenz, Drucktiefe sowie
90% Kompressionsentlastung. Eine besonders große Diskrepanz ergab sich zwischen
der Selbsteinschätzung der Teilnehmenden, durch die universitäre Lehre auf eine
Reanimationssituation vorbereitet zu sein und ihrer tatsächlich dokumentierten
Reanimationskompetenz.Schlussfolgerung: Die vorliegenden Daten weisen auf
deutliche Unsicherheit der Studierenden beim Erkennen einer
Reanimationssituation hin. Selbst in Curricula mit hohem Praxisanteil und hohem
Grad an Studierenden mit medizinischer Berufsausbildung ist die
Reanimationskompetenz mangelhaft.

Copyright © 2021 Bülow et al.

DOI: 10.3205/zma001512
PMCID: PMC8675384
PMID: 34957321 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing
interests.

102. Resuscitation. 2021 Aug;165:77-82. doi: 10.1016/j.resuscitation.2021.05.034.

Epub 2021 Jun 6.

The effective group size for teaching cardiopulmonary resuscitation skills - A

randomized controlled simulation trial.

Nabecker S(1), Huwendiek S(2), Theiler L(3), Huber M(4), Petrowski K(5), Greif
R(6).

Author information:
(1)Department of Anaesthesiology and Pain Medicine, Bern University Hospital,
University of Bern, Bern, Switzerland; Department of Anesthesia and Pain
Management, Sinai Health System, University of Toronto, Toronto, Canada; ERC
ResearchNET. Electronic address: sabine.nabecker@insel.ch.
(2)Department for Assessment and Evaluation, Institute for Medical Education,
University of Bern, Bern, Switzerland.
(3)Department of Anaesthesia, Kantonsspital Aarau, Aarau, Switzerland.
(4)Department of Anaesthesiology and Pain Medicine, Bern University Hospital,
University of Bern, Bern, Switzerland; Statistical Unit, Department of
Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern,
Bern, Switzerland.
(5)Department for Medical Psychology and Medical Sociology, University Medical
Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.
(6)Department of Anaesthesiology and Pain Medicine, Bern University Hospital,
University of Bern, Bern, Switzerland; ERC ResearchNET; School of Medicine,
Sigmund Freud University Vienna, Vienna, Austria.

AIM OF THE STUDY: The ideal group size for effective teaching of cardiopulmonary
resuscitation is currently under debate. The upper limit is reached when
instructors are unable to correct participants' errors during skills practice.
This simulation study aimed to define this limit during cardiopulmonary
resuscitation teaching.
METHODS: Medical students acting as simulated Basic Life Support course
participants were instructed to make three different pre-defined Basic Life
Support quality errors (e.g., chest compression too fast) in 7 min. Basic Life
Support instructors were randomized to groups of 3-10 participants. Instructors
were asked to observe the Basic Life Support skills and to correct performance
errors. Primary outcome was the maximum group size at which the percentage of
correctly identified participants' errors drops below 80%.
RESULTS: Sixty-four instructors participated, eight for each group size. Their
average age was 41 ± 9 years and 33% were female, with a median [25th
percentile; 75th percentile] teaching experience of 6 [2;11] years. Instructors
had taught 3 [1;5] cardiopulmonary resuscitation courses in the year before the
study. A logistic binominal regression model showed that the predicted mean
percentage of correctly identified participants' errors dropped below 80% for
group sizes larger than six.
CONCLUSION: This randomized controlled simulation trial reveals decreased
ability of instructors to detect Basic Life Support performance errors with
increased group size. The maximum group size enabling Basic Life Support
instructors to correct more than 80% of errors is six. We therefore recommend a
maximum instructor-to-participant ratio of 1:6 for cardiopulmonary resuscitation
courses.

Copyright © 2021 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2021.05.034
PMID: 34107336 [Indexed for MEDLINE]

103. Mil Med. 2022 Mar 28;187(3-4):351-359. doi: 10.1093/milmed/usab229.

Effects of Left Ventricular Versus Traditional Chest Compressions in a Traumatic

Pulseless Electrical Activity Model.

Anderson KL(1), Evans JC(2), Castaneda MG(3), Boudreau SM(3), Maddry JK(4),
Morgan JD(2).

Author information:
(1)Department of Emergency Medicine, Stanford University School of Medicine,
Palo Alto, CA 94304, USA.
(2)Department of Emergency Medicine, San Antonio Military Medical Center, Fort
Sam Houston, TX 78234, USA.
(3)Wilford Hall Ambulatory Surgical Center, CREST Research Program, Lackland
AFB, TX 78236, USA.
(4)United States Army Institute of Surgical Research, Fort Sam Houston, TX
78234, USA.

BACKGROUND: Prehospital cardiopulmonary resuscitation has commonly been

considered ineffective in traumatic cardiopulmonary arrest because traditional
chest compressions do not produce substantial cardiac output. However, recent
evidence suggests that chest compressions located over the left ventricle (LV)
produce greater hemodynamics when compared to traditional compressions. We
hypothesized that chest compressions located directly over the LV would result
in an increase in return of spontaneous circulation (ROSC) and hemodynamic
variables, when compared to traditional chest compressions, in a swine model of
traumatic pulseless electrical activity (PEA).
METHODS: Transthoracic echocardiography was used to mark the location of the
aortic root (traditional compressions) and the center of the LV on animals
(n = 34) that were randomized to receive chest compressions in one of the two
locations. Animals were hemorrhaged to mean arterial pressure <20 to simulate
traumatic PEA. After 5 minutes of PEA, basic life support (BLS) with mechanical
cardiopulmonary resuscitation was initiated and performed for 10 minutes
followed by advanced life support for an additional 10 minutes. Hemodynamic
variables were averaged over the final 2 minutes of BLS and advanced life
support periods.
RESULTS: Six of the LV group (35%) achieved ROSC compared to eight of the
traditional group (47%) (P = .73). There was an increase in aortic systolic
blood pressure (P < .01), right atrial systolic blood pressure (P < .01), and
right atrial diastolic blood pressure (P = .02) at the end of BLS in the LV
group compared to the traditional group.
CONCLUSIONS: In our swine model of traumatic PEA, chest compressions performed
directly over the LV improved blood pressures during BLS but not ROSC.

© The Association of Military Surgeons of the United States 2021. All rights
reserved. For permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/milmed/usab229
PMID: 34143215 [Indexed for MEDLINE]

104. J Perianesth Nurs. 2023 Jun;38(3):404-407. doi: 10.1016/j.jopan.2022.08.008.

Epub 2022 Dec 29.

Time-to-Task in Interval Simulated Cardiopulmonary Resuscitation Training: A

Method for Maintaining Resuscitation Skills.

Peverini A(1), Lawson G(2), Petsas-Blodgett N(3), Oermann MH(4), Tola DH(3).

Author information:
(1)Premier Surgery Center, Sarasota, FL. Electronic address:
anthonypeverini@gmail.com.
(2)Premier Surgery Center, Sarasota, FL.
(3)Duke University, Durham, NC.
(4)Duke University School of Nursing, Durham, NC.

PURPOSE: The literature supports interval simulation training as a means of

improving nurses' cardiopulmonary resuscitation (CPR) skills. The aim of this
project was to improve the time-to-task skills in single-rescuer basic life
support (BLS) in an outpatient surgery center through interval simulation
training.
DESIGN: Quality Improvement project.
METHODS: Twenty-nine nursing staff were included in this pretest/post-test
within subjects interventional design quality improvement project. A 2-minute
pretest cardiac arrest simulation was performed in the outpatient surgery center
where time-to-task and quality of CPR data were collected. The pretest was
followed by a lecture and CPR training. Three months later, the simulation was
post-tested in an identical scenario with measures of time-to-task and quality
of CPR.
FINDINGS: The mean times for code bell activation and initiation of CPR
decreased significantly following the interval simulation training (P < .05). A
clinically significant decrease was seen in the mean time-to-task placement of a
backboard on code team arrival.
CONCLUSIONS: Interval simulation training is an effective means of maintaining
CPR skills in the outpatient surgery center setting.

Copyright © 2022 American Society of PeriAnesthesia Nurses. Published by

Elsevier Inc. All rights reserved.
DOI: 10.1016/j.jopan.2022.08.008
PMID: 36585289 [Indexed for MEDLINE]

105. Resuscitation. 2004 Apr;61(1):41-7. doi: 10.1016/j.resuscitation.2003.12.014.

Trials of teaching methods in basic life support (4): comparison of simulated

CPR performance at unannounced home testing after conventional or staged
training.

Smith A(1), Colquhoun M, Woollard M, Handley AJ, Kern KB, Chamberlain D.

Author information:
(1)The Pre-hospital Emergency Research Unit, The University of Wales College of
Medicine, Cardiff, UK.

This study compares the retention of basic life support (BLS) skills after 6 and
12 months by lay persons trained either in a conventional manner, or using a
staged approach. Three classes, each of 2h, were offered to volunteers over a
period of 4 months. For the conventional group, the second and third classes
consisted of review of skills. Those in the staged group were first taught chest
compression alone; chest compression with ventilation in a ratio of 50:5 was
introduced at the second class; full standard CPR was taught at the third class.
A total of 495 volunteers entered the study, 262 being randomly allocated to
conventional training, and 233 to staged training. More of those who received
staged training attended a second (78 volunteers) and third class (41
volunteers), compared with those who received conventional training (36 and 17,
respectively). The objective of this study, however, was to compare the
strategies of the different training methods. A total of 291 volunteers (167
conventional and 124 staged training) were available for unannounced home
testing of full conventional CPR 6 months after initial training, and 260
volunteers (135 conventional and 125 staged training) were tested at 12 months.
At 6 months, those taught by the staged method were significantly better at time
to first compression (P < 0.0001), compression rate (P = 0.024), and hand
position (P = 0.0001). At 12 months, those taught by the staged method were
significantly better at shouting for help (P = 0.005), time to first compression
(P < 0.0001), and compression depth (P = 0.003). Those taught conventionally
were significantly better at checking for a carotid pulse at both 6 and 12
months (P < 0.0001). These results suggest that training lay persons in basic
life support skills using a staged approach leads to overall better skill
retention at 6 and 12 months, and has other advantages including a greater
willingness to re-attend follow-up classes.

DOI: 10.1016/j.resuscitation.2003.12.014
PMID: 15081180 [Indexed for MEDLINE]

106. Extrem Physiol Med. 2013 Apr 1;2(1):11. doi: 10.1186/2046-7648-2-11.

A comparison between the 2010 and 2005 basic life support guidelines during
simulated hypogravity and microgravity.

Russomano T(1), Baers JH, Velho R, Cardoso RB, Ashcroft A, Rehnberg L, Gehrke
RD, Dias MK, Baptista RR.

Author information:
(1)Microgravity Centre, School of Engineering, PUCRS, Porto Alegre 90619-900,
Brazil. trussomano@hotmail.com.
BACKGROUND: Current 2010 terrestrial (1Gz) CPR guidelines have been advocated by
space agencies for hypogravity and microgravity environments, but may not be
feasible. The aims of this study were to (1) evaluate rescuer performance over
1.5 min of external chest compressions (ECCs) during simulated Martian
hypogravity (0.38Gz) and microgravity (μG) in relation to 1Gz and rest baseline
and (2) compare the physiological costs of conducting ECCs in accordance with
the 2010 and 2005 CPR guidelines.
METHODS: Thirty healthy male volunteers, ranging from 17 to 30 years, performed
four sets of 30 ECCs for 1.5 min using the 2010 and 2005 ECC guidelines during
1Gz, 0.38Gz and μG simulations (Evetts-Russomano (ER) method), achieved by the
use of a body suspension device. ECC depth and rate, range of elbow flexion,
post-ECC heart rate (HR), minute ventilation (VE), peak oxygen consumption
(VO2peak) and rate of perceived exertion (RPE) were measured.
RESULTS: All volunteers completed the study. Mean ECC rate was achieved for all
gravitational conditions, but true depth during simulated microgravity was not
sufficient for the 2005 (28.5 ± 7.0 mm) and 2010 (32.9 ± 8.7 mm) guidelines,
even with a mean range of elbow flexion of 15°. HR, VE and VO2peak increased to
an average of 136 ± 22 bpm, 37.5 ± 10.3 L·min-1, 20.5 ± 7.6 mL·kg-1·min-1 for
0.38Gz and 161 ± 19 bpm, 58.1 ± 15.0 L·min-1, 24.1 ± 5.6 mL·kg-1·min-1 for μG
from a baseline of 84 ± 15 bpm, 11.4 ± 5.9 L·min-1, 3.2 ± 1.1 mL·kg-1·min-1,
respectively. RPE was the only variable to increase with the 2010 guidelines.
CONCLUSION: No additional physiological cost using the 2010 basic life support
(BLS) guidelines was needed for healthy males performing ECCs for 1.5 min,
independent of gravitational environment. This cost, however, increased for each
condition tested when the two guidelines were compared. Effective ECCs were not
achievable for both guidelines in simulated μG using the ER BLS method. This
suggests that future implementation of an ER BLS in a simulated μG instruction
programme as well as upper arm strength training is required to perform
effective BLS in space.

DOI: 10.1186/2046-7648-2-11
PMCID: PMC3710155
PMID: 23849595

107. Cardiol J. 2021;28(3):439-445. doi: 10.5603/CJ.a2019.0092. Epub 2019 Sep 30.

How should we teach cardiopulmonary resuscitation? Randomized multi-center

study.

Katipoglu B(1), Madziala MA(2), Evrin T(1), Gawlowski P(3), Szarpak A(4),
Dabrowska A(5), Bialka S(6), Ladny JR(7), Szarpak L(8), Konert A(4), Smereka
J(3).

Author information:
(1)Department of Emergency Medicine, Ufuk University Medical Faculty, Dr Ridvan
Ege Education and Research Hospital, Ankara, Turkey., Turkey.
(2)Medical Simulation Center, Lazarski University, Swieradowska 43 Str, 02-662
Warsaw, Poland. rat.poz@wp.pl.
(3)Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw,
Poland.
(4)Lazarski University, Warsaw, Poland.
(5)Department of Rescue Medical Service, Poznan University of Medical Sciences,
Poznan.
(6)Department of Anaesthesiology and Intensive Care, Medical University of
Silesia, Katowice, Poland.
(7)Department of Emergency Medicine and Disaster, Medical University Bialystok,
Bialystok, Poland.
(8)Medical Simulation Center, Lazarski University, Swieradowska 43 Str, 02-662
Warsaw, Poland.

BACKGROUND: A 2017 update of the resuscitation guideline indicated the use of

cardiopulmonary resuscitation (CPR) feedback devices as a resuscitation teaching
method. The aim of the study was to compare the influence of two techniques of
CPR teaching on the quality of resuscitation performed by medical students.
METHODS: The study was designed as a prospective, randomized, simulation study
and involved 115 first year students of medicine. The participants underwent a
basic life support (BLS) course based on the American Heart Association
guidelines, with the first group (experimental group) performing chest
compressions to observe, in real-time, chest compression parameters indicated by
software included in the simulator, and the second group (control group)
performing compressions without this possibility. After a 10-minute
resuscitation, the participants had a 30-minute break and then a 2-minute cycle
of CPR. One month after the training, study participants performed CPR, without
the possibility of observing real-time measurements regarding quality of chest
compression.
RESULTS: One month after the training, depth of chest compressions in the
experimental and control group was 50 mm (IQR 46-54) vs. 39 mm (IQR 35-42; p =
0.001), compression rate 116 CPM (IQR 102-125) vs. 124 CPM (IQR 116-134; p =
0.034), chest relaxation 86% (IQR 68-89) vs. 74% (IQR 47-80; p = 0.031)
respectively.
CONCLUSIONS: Observing real-time chest compression quality parameters during BLS
training may improve the quality of chest compression one month after the
training including correct hand positioning, compressions depth and rate
compliance.

DOI: 10.5603/CJ.a2019.0092
PMCID: PMC8169195
PMID: 31565794 [Indexed for MEDLINE]

Conflict of interest statement: Conflict of interest: None declared

108. Telemed J E Health. 2019 Nov;25(11):1108-1114. doi: 10.1089/tmj.2018.0173.

Epub
2019 Feb 1.

Rubrum Coelis: The Contribution of Real-Time Telementoring in Acute Trauma

Scenarios-A Randomized Controlled Trial.

Netzer I(1), Kirkpatrick AW(2)(3), Nissan M(1), McKee JL(3)(4), McBeth P(2)(3),
Dobron A(1), Glassberg E(1)(5).

Author information:
(1)Israel Defense Forces Medical Corps, Tel Hashomer, Israel.
(2)Departments of Surgery and Critical Care Medicine, University of Calgary,
Calgary, Canada.
(3)Canadian Forces Medical Services, Ottawa, Canada.
(4)Innovative Trauma Care, Edmonton, Canada.
(5)Bar-Ilan University Faculty of Medicine, Safed, Israel.

Background: Most deaths in military trauma occur soon after wounding, and demand
immediate on scene interventions. Although hemorrhage predominates as the cause
of potentially preventable death, airway obstruction and tension pneumothorax
are also frequent. First responders caring for casualties in operational
settings often have limited clinical experience.Introduction: We hypothesized
that communications technologies allowing for real-time communications with a
senior medically experienced provider might assist in the efficacy of first
responding to catastrophic trauma.Methods: Thirty-three basic life saving (BLS)
medics were randomized into two groups: either receiving telementoring support
(TMS, n = 17) or no telementoring support (NTMS, n = 16) during the diagnosis
and resuscitation of a simulated critical battlefield casualty. In addition to
basic life support, all medics were required to perform a procedure needle
thoracentesis (not performed by BLS medics in Israel) for the first time. TMS
was performed by physicians through an internet link. Performance was assessed
during the simulation and later on review of videos.Results: The TMS group was
significantly more successful in diagnosing (82.35% vs. 56.25%, p = 0.003) and
treating pneumothorax (52.94% vs. 37.5%, p = 0.035). However, needle
thoracentesis time was slightly longer for the TMS group versus the NTMS group
(1:24 ± 1:00 vs. 0:49 ± 0:21 minu, respectively (p = 0.016). Complete treatment
time was 12:56 ± 2:58 min for the TMS group, versus 9:33 ± 3:17 min for the NTMS
group (p = 0.003).Conclusions: Remote telementoring of basic life support
performed by military medics significantly improved the medics' ability to
perform an unfamiliar lifesaving procedure at the cost of prolonging time needed
to provide care. Future studies must refine the indications and
contraindications for using telemedical support.

DOI: 10.1089/tmj.2018.0173
PMID: 30707651 [Indexed for MEDLINE]

109. Int J Environ Res Public Health. 2021 Apr 7;18(8):3885. doi:
10.3390/ijerph18083885.

Importance of Immediate Electronic-Based Feedback to Enhance Feedback for

First-Time CPR Trainees.

Misztal-Okońska P(1), Goniewicz K(2), Goniewicz M(1), Ranse J(3)(4), Hertelendy

AJ(5)(6)(7), Gray L(8)(9), Carlström E(10)(11)(12), Løwe Sørensen J(12),
Khorram-Manesh A(13)(14).

Author information:
(1)Department of Emergency Medicine, Medical University of Lublin, 20-059
Lublin, Poland.
(2)Department of Aviation Security, Military University of Aviation, 08-521
Dęblin, Poland.
(3)School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4215,
Australia.
(4)Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD 4215,
Australia.
(5)Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth
Israel Deaconess Medical Centre, Boston, MA 02215, USA.
(6)Department of Emergency Medicine, Harvard Medical School, Boston, MA 02215,
USA.
(7)Department of Information Systems and Business Analytics, College of
Business, Florida International University, Miami, FL 33119, USA.
(8)Department of Primary Health Care and General Practice, University of Otago,
Wellington 6242, New Zealand.
(9)Joint Centre for Disaster Research, Massey University, Wellington 6021, New
Zealand.
(10)Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska
University Hospital, 413 45 Gothenburg, Sweden.
(11)Institute of Health and Care Sciences, Sahlgrenska Academy, University of
Gothenburg, 405 30 Gothenburg, Sweden.
(12)USN School of Business, University of South-Eastern Norway, 3616 Kongsberg,
Norway.
(13)Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy,
Gothenburg University, 413 45 Gothenburg, Sweden.
(14)Department of Development and Research, Armed Forces Center for Defense
Medicine, 426 76 Gothenburg, Västra Frölunda, Sweden.

Sudden cardiac arrest is one of the leading causes of death globally. The
recommended clinical management in out-of-hospital cardiac arrest cases is the
immediate initiation of high-quality cardiopulmonary resuscitation (CPR).
Training mannequins should be combined with technology that provides students
with detailed immediate feedback on the quality of CPR performance. This study
aimed to verify the impacts of the type of feedback (basic or detailed) the
responders receive from the device while learning CPR and how it influences the
quality of their performance and the motivation to improve their skills. The
study was conducted at the Medical University of Lublin among 694
multi-professional health students during first aid classes on basic life
support (BLS). The students first practiced on an adult mannequin with a basic
control panel; afterward, the same mannequin was connected to a laptop, ensuring
a detailed record of the performed activities through a projector. Next, the
participants expressed their subjective opinion on how the feedback provided
during the classes, basic vs. detailed, motivated them to improve the quality of
their CPR performance. Additionally, during the classes, the instructor
conducted an extended observation of students' work and behavior. In the
students' opinion, the CPR training with detailed feedback devices provided
motivation for learning and improving CPR proficiency than that with a basic
control panel. Furthermore, the comments given from devices seemed to be more
acceptable to the students, who did not see any bias in the device's evaluation
compared to that of the instructor. Detailed device feedback motivates student
health practitioners to learn and improve the overall quality of CPR. The use of
mannequins that provide detailed feedback during BLS courses can improve
survival in out-of-hospital cardiac arrest.

DOI: 10.3390/ijerph18083885
PMCID: PMC8067975
PMID: 33917203 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.

110. Clin Teach. 2018 Feb;15(1):38-43. doi: 10.1111/tct.12623. Epub 2017 Mar 16.

Trainees at a resuscitation: a dual liability.

Stewart NH(1), Tanksley A(2), Edelson DP(3), Arora VM(2).

Author information:
(1)Department of Pulmonary, Critical Care and Sleep Medicine, Creighton
University School of Medicine, Omaha, Nebraska, USA.
(2)Department of General Medicine, University of Chicago, Illinois, USA.
(3)Department of Hospital Medicine, University of Chicago, Illinois, USA.

BACKGROUND: During basic life support (BLS) training, medical students receive
little instruction on their role during a resuscitation attempt. Research is
sparse regarding trainee perceptions of the resuscitation team. This study
sought to describe trainee experiences and perceptions of resuscitation teams.
METHODS: Clinical third-year medical students (MS3s) and incoming interns
(PGY1s) reported on survey items addressing prior BLS education, knowledge of
BLS, and the student's perceptions and experiences during a resuscitation
attempt.
RESULTS: Of the 61 third-year medical students surveyed, 72 per cent responded.
Over half (51%) of third-year medical students reported feeling confident with
their compressions, yet few knew the correct rate of compressions (16%). Nearly
three-quarters of the third-year medical students participated in a
resuscitation (74%), but only 16 per cent considered themselves an essential
member of the resuscitation team. Moreover, almost half (45%) felt awkward
during a resuscitation attempt, and nearly one-third (29%) felt marginalised. To
contextualise our data, incoming interns were surveyed during their orientation
week and 81 per cent responded: one-third (35%) considered themselves essential
to the team, over half (64%) felt awkward and nearly one-third (32%) felt
marginalised. In addition, many do not understand their role on the
resuscitation team: 37 per cent of third-year students versus 57 per cent of
incoming interns.
DISCUSSION: Although most students participated in a resuscitation attempt, many
students do not understand their role, few felt included on the team and
numerous students felt awkward or marginalised. Explicit role training and
expanding resuscitation simulation to include the student may increase
confidence levels, improving patient care. Medical students receive little
instruction on their role during a resuscitation attempt.

© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical
Education.

DOI: 10.1111/tct.12623
PMID: 28300340 [Indexed for MEDLINE]

111. Am J Emerg Med. 2023 Sep;71:163-168. doi: 10.1016/j.ajem.2023.06.035. Epub

2023
Jun 28.

Dispatcher-assisted BLS for lay bystanders: A pilot study comparing video

streaming via smart glasses and telephone instructions.

Aranda-García S(1), Barrio-Cortes J(2), Fernández-Méndez F(3), Otero-Agra M(4),

Darné M(5), Herrera-Pedroviejo E(6), Barcala-Furelos R(7), Rodríguez-Núñez A(8).

Author information:
(1)GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya
(INEFC), Universitat de Barcelona (UB), Barcelona, Spain; CLINURSID Research
Group, School of Nursing, University of Santiago de Compostela, Santiago de
Compostela, Spain; Faculty of Health, University Camilo José Cela, Madrid,
Spain.
(2)Faculty of Health, University Camilo José Cela, Madrid, Spain; Foundation for
Biosanitary Research and Innovation in Primary Care, Madrid, Spain.
(3)CLINURSID Research Group, School of Nursing, University of Santiago de
Compostela, Santiago de Compostela, Spain; REMOSS Research Group, Faculty of
Education and Sport Sciences, University of Vigo, Pontevedra, Spain; School of
Nursing from Pontevedra, Universidade de Vigo, Pontevedra, Spain; Life Support
and Medical Simulation Research Group (SICRUS), Health Research Institute of
Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
(4)REMOSS Research Group, Faculty of Education and Sport Sciences, University of
Vigo, Pontevedra, Spain; School of Nursing from Pontevedra, Universidade de
Vigo, Pontevedra, Spain. Electronic address: marotero@uvigo.es.
(5)GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya
(INEFC), Universitat de Barcelona (UB), Barcelona, Spain.
(6)Blanquerna School of Health Sciences, Ramon Llull University, Barcelona,
Spain.
(7)CLINURSID Research Group, School of Nursing, University of Santiago de
Compostela, Santiago de Compostela, Spain; REMOSS Research Group, Faculty of
Education and Sport Sciences, University of Vigo, Pontevedra, Spain.
(8)CLINURSID Research Group, School of Nursing, University of Santiago de
Compostela, Santiago de Compostela, Spain; Life Support and Medical Simulation
Research Group (SICRUS), Health Research Institute of Santiago de Compostela
(IDIS), Santiago de Compostela, Spain; Paediatric Critical, Intermediate and
Palliative Care Section, Santiago de Compostela's University Hospital, Santiago
de Compostela, Spain; Primary Care Interventions to Prevent Maternal and Child
Chronic Diseases of Perinatal and Developmental Origin (RICORS), RD21/0012/0025,
Instituto de Salud Carlos III, Madrid, Spain.

OBJECTIVE: To determine whether dispatcher assistance via smart glasses improves

bystander basic life support (BLS) performance compared with standard telephone
assistance in a simulated out-of-hospital cardiac arrest (OHCA) scenario.
METHODS: Pilot study in which 28 lay people randomly assigned to a smart
glasses-video assistance (SG-VA) intervention group or a smartphone-audio
assistance (SP-AA) control group received dispatcher guidance from a dispatcher
to provide BLS in an OHCA simulation. SG-VA rescuers received assistance via a
video call with smart glasses (Vuzix, Blade) connected to a wireless network,
while SP-AA rescuers received instructions over a smartphone with the speaker
function activated. BLS protocol steps, quality of chest compressions, and
performance times were compared.
RESULTS: Nine of the 14 SG-VA rescuers correctly completed the BLS protocol
compared with none of the SP-AA rescuers (p = 0.01). A significantly higher
number of SG-VA rescuers successfully opened the airway (13 vs. 5, p = 0.002),
checked breathing (13 vs. 8, p = 0.03), correctly positioned the automatic
external defibrillator pads (14 vs.6, p = 0.001), and warned bystanders to stay
clear before delivering the shock (12 vs. 0, p < 0.001). No significant
differences were observed for performance times or chest compression quality.
The mean compression rate was 104 compressions per minute in the SG-VA group and
98 compressions per minute in the SP-AA group (p = 0.46); mean depth of
compression was 4.5 cm and 4.4 cm (p = 0.49), respectively.
CONCLUSIONS: Smart glasses could significantly improve dispatcher-assisted
bystander performance in an OHCA event. Their potential in real-life situations
should be evaluated.

Copyright © 2023. Published by Elsevier Inc.

DOI: 10.1016/j.ajem.2023.06.035
PMID: 37418840 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of Competing Interest The authors

declare that they have no known competing financial interests or personal
relationships that could have appeared to influence the work reported in this
paper.

112. Aten Primaria. 2010 Jan;42(1):7-13. doi: 10.1016/j.aprim.2009.03.006. Epub

2009
Aug 5.

[Test to measure basic life support and defibrillation skills in primary care
doctors and nurses].

[Article in Spanish]

Casabella Abril B(1), Lacasta Tintorer D, Clusa Gironella T, Perelló Bratescu A,

García Ortega MA, Albiach Pla A, Larrea Tárrega S.

Author information:
(1)CAP Drassanes. Equipo de Atención Primaria Raval Sud (SAP Litoral-Institut
Català de la Salut), Spain.

Erratum in
Aten Primaria. 2010 Dec;42(12):631-2.

Comment in
Aten Primaria. 2010 Jan;42(1):13-4. doi: 10.1016/j.aprim.2009.10.003.

OBJECTIVE: To prepare and validate a tool to measure Basic Life Support (BLS)
and semi-automatic defibrillator (SAD) skills adapted for use by health
professionals in Primary Care Teams (PCT). To propose an updated version and
demonstrate self-sufficiency of the team to use it in a training evaluation.
DESIGN: Validation of measurement tools. Study of reliability with repeated
measurements after a training course.
SETTING: Drassanes Primary Care Centre. Raval Sud Basic Health Area. Barcelona.
Spain.
PARTICIPANTS: A total of 37 voluntary resuscitators (all doctors/nurses),
professional camera, medical controller, computerised mannequin, 6 evaluators.
INTERVENTIONS: Test preparation methodology. Cardiff Model 3.1.
IMPLEMENTATION: 2 filmed series (professional+domestic), of 26-25 "station type"
simulations, separated by 1 month. A training workshop between series.
Retrospective evaluation of DVD recordings (5 evaluators). 2nd series scored
again at 3 weeks with a blind and random order filmed version.
VARIABLES: performances classified from worse to best execution. Psychometric
analysis: Validity (content/apparent). Test-retest reliability, between-observer
and sensitivity to change.
RESULTS: Compared to the Cardiff test (46 items) our 83 item test contained
38(46%) new, 34(41%) modified and 11(13%) similar. Between-evaluator
reliability, excellent/good in 51/62 items analysed; Within-evaluator and
between-filming reliability, excellent/good in all except 1 item; the test score
doubled after the training course. A version of the test according to BLS-SAD
recommendations is proposed.
CONCLUSIONS: On there not being useful tools available for Primary Care doctors
and nurses, one has been prepared with adequate psychometric guarantees and
proven self-sufficient evaluation. We propose the immediate application of the
updated version for training evaluation purposes.

OBJETIVO: Elaborar y validar un instrumento para medir aptitudes en soporte

vital básico (SVB) y desfibrilación semiautomática (DSA) adaptado a los
profesionales sanitarios de equipos de atención primaria. Proponer una versión
actualizada y demostrar autosuficiencia del equipo para utilizarlo en evaluación
formativa.
DISEÑO: Validación de instrumentos de medida. Estudio de fiabilidad con medidas
repetidas tras intervención formativa.
EMPLAZAMIENTO: Centro de atención primaria Drassanes. Área Básica de Salud Raval
Sud.
PARTICIPANTES: Treinta y siete rescatadores voluntarios (total entre médicos y
enfermeras), cámara profesional, médico controlador, maniquí informatizado, 6
evaluadores.
INTERVENCIONES: Metodología de elaboración de test. Modelo Cardiff versión 3.1
(que se encuentra en internet). Ejecución: 2 series filmadas (una profesional y
otra doméstica), de 26 a 25 simulaciones “tipo estación”, separadas por un mes.
Taller formativo entre series. Evaluación retrospectiva de grabaciones DVD (6
evaluadores). Segunda serie nuevamente puntuada a las 3 semanas con ciego de
versión filmada y orden aleatorizado.
MEDICIONES PRINCIPALES: Variables: actuaciones categorizadas de peor a mejor
ejecución. Análisis psicométrico: validez (contenido/aparente). Fiabilidad
test-retest, intraobservador y sensibilidad al cambio.
RESULTADOS: Respecto al test de Cardiff (46 ítems), este test de 83 ítems
contiene 38 (46%) nuevos, 34 (41%) modificados y 11 (13%) similares. La
fiabilidad entre evaluadores fue excelente/buena en 51 de 62 ítems analizados;
fiabilidad intraevaluador y entre filmaciones excelente/buena en todos los
ítems, menos en uno; la prueba dobló la puntuación tras intervención formativa.
Se propone una versión del test según las recomendaciones actuales en SVB y DSA.
CONCLUSIONES: Al no disponer de instrumentos útiles para los médicos y
enfermeras de atención primaria se ha elaborado uno con suficientes garantías
psicométricas y se ha probado autosuficiencia evaluativa. Se propone
aplicabilidad inmediata de la versión actualizada con fines de evaluación
formativa.

Copyright (c) 2008 Elsevier España, S.L. All rights reserved.

DOI: 10.1016/j.aprim.2009.03.006
PMCID: PMC7022135
PMID: 19660840 [Indexed for MEDLINE]

113. Resuscitation. 2012 Feb;83(2):219-26. doi:

10.1016/j.resuscitation.2011.08.024.
Epub 2011 Sep 14.

Influence of pre-course assessment using an emotionally activating stimulus with

feedback: a pilot study in teaching Basic Life Support.

Beckers SK(1), Biermann H, Sopka S, Skorning M, Brokmann JC, Heussen N, Rossaint

R, Younker J.

Author information:
(1)Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen
University, Germany. sbeckers@ukaachen.de

BACKGROUND: Cardiopulmonary resuscitation (CPR) mastery continues to challenge

medical professionals. The purpose of this study was to determine if an
emotional stimulus in combination with peer or expert feedback during pre-course
assessment effects future performance in a single rescuer simulated cardiac
arrest.
METHODS: First-year medical students (n=218) without previous medical knowledge
were randomly assigned to one of the study groups and asked to take part in a
pre-course assessment: Group 1: after applying an emotionally activating
stimulus an expert (instructor) gave feedback on CPR performance (Ex). Group 2:
after applying the same stimulus feedback was provided by a peer from the same
group (Pe); Group 3: standard without feedback (S). Following pre-course
assessment, all subjects received a standardized BLS-course, were tested after 1
week and 6 months later using single-rescuer-scenario, and were surveyed using
standardized questionnaires (6-point-likert-scales: 1=completely agree,
6=completely disagree).
RESULTS: Participants exposed to stimulus demonstrated superior performance
concerning compression depth after 6 months independent of feedback-method (Ex:
65.85% [p=0.0003]; Pe: 57.50% [p=0.0076] vs. 21.43%). The expert- more than the
peer-group was emotionally more activated in initial testing, Ex: 3.26 ± 1.35 [p
≤ 0.0001]; Pe: 3.73 ± 1.53 [p=0.0319]; S: 4.25 ± 1.37) and more inspired to
think about CPR (Ex: 2.03 ± 1.37 [p=0.0119]; Pe: 2.07 ± 1.14 [p=0.0204]; S: 2.60
± 1.55). After 6 months this activation effect was still detectable in the
expert-group (p=0.0114).
CONCLUSIONS: The emotional stimulus approach to BLS-training seems to impact the
ability to provide adequate compression depth up to 6 months after training.
Furthermore, pre-course assessment helped to keep the participants involved
beyond initial training.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2011.08.024
PMID: 21924220 [Indexed for MEDLINE]

114. Front Pediatr. 2022 May 24;10:867304. doi: 10.3389/fped.2022.867304.

eCollection
2022.

Provider Visual Attention Correlates With the Quality of Pediatric

Resuscitation: An Observational Eye-Tracking Study.

Gröpel P(1), Wagner M(2), Bibl K(2), Schwarz H(2), Eibensteiner F(3), Berger
A(2), Cardona FS(2).

Author information:
(1)Division of Sport Psychology, Department of Sport Sciences, Centre for Sport
Science and University Sports, University of Vienna, Vienna, Austria.
(2)Division of Neonatology, Pediatric Intensive Care and Neuropediatrics,
Department of Pediatrics, Comprehensive Center for Pediatrics, Medical
University of Vienna, Vienna, Austria.
(3)Department of Emergency Medicine, Medical University of Vienna, Vienna,
Austria.

BACKGROUND: Eye-tracking devices are an innovative tool to understand providers'

attention during stressful medical tasks. The knowledge about what gaze
behaviors improve (or harm) the quality of clinical care can substantially
improve medical training. The aim of this study is to identify gaze behaviors
that are related to the quality of pediatric resuscitation.
METHODS: Forty students and healthcare providers performed a simulated pediatric
life support scenario, consisting of a chest compression task and a ventilation
task, while wearing eye-tracking glasses. Skill Reporter software measured chest
compression (CC) quality and Neo Training software measured ventilation quality.
Main eye-tracking parameters were ratio [the number of participants who attended
a certain area of interest (AOI)], dwell time (total amount of time a
participant attended an AOI), the number of revisits (how often a participant
returned his gaze to an AOI), and the number of transitions between AOIs.
RESULTS: The most salient AOIs were infant chest and ventilation mask (ratio =
100%). During CC task, 41% of participants also focused on ventilation bag and
59% on study nurse. During ventilation task, the ratio was 61% for ventilation
bag and 36% for study nurse. Percentage of correct CC rate was positively
correlated with dwell time on infant chest (p = 0.044), while the overall CC
quality was negatively correlated with dwelling outside of pre-defined
task-relevant AOIs (p = 0.018). Furthermore, more dwell time on infant chest
predicted lower leakage (p = 0.042). The number of transitions between AOIs was
unrelated to CC parameters, but correlated negatively with mask leak during
ventilations (p = 0.014). Participants with high leakage shifted their gaze more
often between ventilation bag, ventilation mask, and task-irrelevant
environment.
CONCLUSION: Infant chest and ventilation mask are the most salient AOIs in
pediatric basic life support. Especially the infant chest AOI gives beneficial
information for the resuscitation provider. In contrast, attention to
task-irrelevant environment and frequent gaze shifts seem to harm the quality of
care.

Copyright © 2022 Gröpel, Wagner, Bibl, Schwarz, Eibensteiner, Berger and

Cardona.

DOI: 10.3389/fped.2022.867304
PMCID: PMC9171025
PMID: 35685920

Conflict of interest statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.

115. Resuscitation. 2019 Jan;134:110-121. doi: 10.1016/j.resuscitation.2018.10.029.

Epub 2018 Oct 29.

A nationwide investigation of CPR courses, books, and skill retention.

Jensen TW(1), Møller TP(2), Viereck S(2), Roland Hansen J(3), Pedersen TE(4),
Ersbøll AK(5), Lassen JF(6), Folke F(2), Østergaard D(7), Lippert F(8).

Author information:
(1)Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej
5, 2750 Copenhagen, Denmark; Copenhagen Academy for Medical Education and
Simulation, Capital Region of Denmark, University of Copenhagen, Copenhagen,
Denmark. Electronic address: theo.walther.jensen.01@regionh.dk.
(2)Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej
5, 2750 Copenhagen, Denmark.
(3)Danish Resuscitation Council, c/o Emergency Medical Services, Telegrafvej 5,
2750 Copenhagen, Denmark.
(4)Danish First Aid Council, c/o Dansk Folkehjælp, Brovejen 4, 4800 Nykøbing
Falster, Denmark.
(5)National Institute of Public Health, University of Southern Denmark,
Studiestræde 6, DK-1455 Copenhagen K, Denmark.
(6)Danish Resuscitation Council, c/o Emergency Medical Services, Telegrafvej 5,
2750 Copenhagen, Denmark; Department of Cardiology, The Heart Centre,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
(7)Copenhagen Academy for Medical Education and Simulation, Capital Region of
Denmark, University of Copenhagen, Copenhagen, Denmark.
(8)Emergency Medical Services Copenhagen, University of Copenhagen, Telegrafvej
5, 2750 Copenhagen, Denmark; Danish Resuscitation Council, c/o Emergency Medical
Services, Telegrafvej 5, 2750 Copenhagen, Denmark.

INTRODUCTION: Survival from Out-of-Hospital Cardiac Arrest is highly associated

with bystander cardiopulmonary resuscitation. The quality of bystander CPR is
influenced by citizens attending Basic Life Support (BLS) courses and the
quality of these courses. The purpose of the study was to investigate content,
quality and compliance with the European Resuscitation Council (ERC) guidelines
in national Danish BLS courses and the skill retention.
METHODS: Books from 16 different course providers were analyzed for compliance
with guidelines using the principle of mutually exclusive and collectively
exhaustive questioning. Observation of 56 BLS courses were conducted using an
evaluation sheet, with a five-point Likert scale including theoretical,
technical, and non-technical skills. BLS skills of participants were assessed
with a follow-up test 4-6 months after a course using a modified Cardiff Test.
RESULTS: Analysis of the books, showed compliance with ERC guidelines of 69% on
the examined items. Courses using ERC educational structure and having maximum
six participants per instructor were associated with high quality in the course
observations and a better follow-up test. Especially, the use of automated
external defibrillator showed significant odds ratio (OR) of 21.8 (95% CI
4.1-114.7) to 31.3 (95% CI 3.7-265.1) of achieving high quality on courses with
similar results in the follow-up test.
CONCLUSION: National BLS courses had significant variation in the content of
books, and compliance to ERC guidelines during courses and in skills retention
4-6 months after the courses. This study can be used to further improve and
standardize BLS courses.

Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2018.10.029
PMID: 30385384 [Indexed for MEDLINE]

116. Int Emerg Nurs. 2021 Jan;54:100951. doi: 10.1016/j.ienj.2020.100951. Epub 2020
Dec 9.

The inefficiency of ventilation in basic resuscitation. Should we improve

mouth-to-mouth ventilation training of nursing students?

Pujalte-Jesús MJ(1), Leal-Costa C(2), Díaz Agea JL(3).

Author information:
(1)Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Murcia,
Spain. Electronic address: mjpujalte@ucam.edu.
(2)Faculty of Nursing, University of Murcia, Spain. Electronic address:
cleal@um.es.
(3)Faculty of Nursing, Official Masters in Emergency and Special Care Nursing,
Catholic University of Murcia, Spain. Electronic address: jluis@ucam.edu.

OBJECTIVE: To analyse the differences in the quality of the basic

cardiopulmonary resuscitation (CPR) between the algorithms of compressions with
rescue ventilation (CPR [30:2]) and chest compressions only (CPR [C/O]). In
addition, the specific objective was to study the effectiveness of the physical
manoeuvre of mouth-to-mouth ventilations performed by nursing students after the
completion of a simulation training program in Basic Life Support (BLS)
standardized in the study plan approved for the Nursing Degree at a Spanish
university.
RESEARCH METHODOLOGY: analytical, quasi-experimental, cross-sectional study with
clinical simulation of 114 students enrolled in the third year of the Nursing
Degree.
RESULTS: the mean depth of chest compressions was 47.6 mm (SD 9.5) for CPR
[30:2] and 45 mm (SD 8.8) when CPR [C/O] was performed (t = 5.39, p < 0.0001,
CI95% 1.69-3.65). The compressions with complete chest re-expansion were 106 (SD
55) for CPR [30:2] and 138 (SD 85) for CPR [C/O] [t = -4.75, p < 0.0001, CI95%
-44.6 - (-18.4)]. Of the participants, 28.1% correctly ventilated with the
head-tilt/chin-lift manoeuvre (Fisher: p < 0.0001).
CONCLUSIONS: As a whole, CPR with only chest compressions offers great
advantages with respect to standard CPR, minimizing interruptions in
compressions, maintaining coronary and cerebral perfusion and thus increasing
the likelihood of return of spontaneous circulation. The problem of rescuers
fatigue could be reduced with a greater number of relays between rescuers. We
believe that is important to improve the acquisition of competencies in the
management of the airway and the ventilation devices (such as the bag-valve
mask).

Copyright © 2020 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ienj.2020.100951
PMID: 33310433 [Indexed for MEDLINE]
117. BMC Med Educ. 2022 Jun 22;22(1):483. doi: 10.1186/s12909-022-03533-1.

Virtual reality as a teaching method for resuscitation training in undergraduate

first year medical students during COVID-19 pandemic: a randomised controlled
trial.

Moll-Khosrawi P(1), Falb A(2), Pinnschmidt H(3), Zöllner C(2), Issleib M(2).

Author information:
(1)Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf,
Martinistr. 52, 20246, Hamburg, Germany. pmollkho@icloud.com.
(2)Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf,
Martinistr. 52, 20246, Hamburg, Germany.
(3)Center for Experimental Medicine, Institute of Medical Biometry and
Epidemiology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52,
20246, Hamburg, Germany.

BACKGROUND: Virtual reality (VR) is a computer-generated simulation technique

which yields plenty of benefits and its application in medical education is
growing. This study explored the effectiveness of a VR Basic Life Support (BLS)
training compared to a web-based training during the COVID-19 pandemic, in which
face-to-face trainings were disrupted or reduced.
METHODS: This randomised, double-blinded, controlled study, enrolled 1st year
medical students. The control group took part in web-based BLS training, the
intervention group received an additional individual VR BLS training. The
primary endpoint was the no-flow time-an indicator for the quality of BLS-,
assessed during a structural clinical examination, in which also the overall
quality of BLS (secondary outcome) was rated. The tertiary outcome was the
learning gain of the undergraduates, assessed with a comparative self-assessment
(CSA).
RESULTS: Data from 88 undergraduates (n = 46 intervention- and n = 42 control
group) were analysed. The intervention group had a significant lower no-flow
time (p = .009) with a difference between the two groups of 28% (95%-CI
[8%;43%]). The overall BLS performance of the intervention group was also
significantly better than the control group with a mean difference of 15.44
points (95%-CI [21.049.83]), p < .001. In the CSA the undergraduates of the
intervention group reported a significant higher learning gain.
CONCLUSION: VR proved to be effective in enhancing process quality of BLS,
therefore, the integration of VR into resuscitation trainings should be
considered. Further research needs to explore which combination of instructional
designs leads to deliberate practice and mastery learning of BLS.

© 2022. The Author(s).

DOI: 10.1186/s12909-022-03533-1
PMCID: PMC9214467
PMID: 35733135 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing
interests.

118. Resusc Plus. 2022 Nov 2;12:100323. doi: 10.1016/j.resplu.2022.100323.

eCollection 2022 Dec.

Is the AED as intuitive as we think? Potential relevance of "The Sound of

Silence" during AED use.
Abelairas-Gómez C(1)(2)(3), Carballo-Fazanes A(1)(2), Chang TP(4)(5), Fijačko
N(6)(3), Rodríguez-Núñez A(1)(2)(7).

Author information:
(1)CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and
Medicine Department, Universidade de Santiago de Compostela, Spain.
(2)SICRUS Research Group, Health Research Institute of Santiago, University
Hospital of Santiago de Compostela-CHUS, Spain.
(3)ERC Research Net, Niels, Belgium.
(4)Division of Emergency Medicine & Transport & Las Madrinas Simulation Center,
Children's Hospital Los Angeles, Los Angeles, CA, USA.
(5)Keck School of Medicine, University of Southern California, Los Angeles, CA,
USA.
(6)University of Maribor, Faculty of Health Sciences, Maribor, Slovenia.
(7)Pediatric Intensive Care Unit, University Hospital of Santiago de
Compostela-CHUS, Spain.

DOI: 10.1016/j.resplu.2022.100323
PMCID: PMC9640343
PMID: 36386767

Conflict of interest statement: Cristian Abelairas-Gómez and Nino Fijačko are

members of the ERC BLS Science and Education Committee and mentees of ILCOR Task
Force Education Implementation and Team..

119. Resuscitation. 2015 Jan;86:1-5. doi: 10.1016/j.resuscitation.2014.10.007. Epub

2014 Oct 18.

A novel approach to life support training using "action-linked phrases".

Hunt EA(1), Cruz-Eng H(2), Bradshaw JH(3), Hodge M(4), Bortner T(5), Mulvey
CL(6), McMillan KN(7), Galvan H(5), Duval-Arnould JM(8), Jones K(9), Shilkofski
NA(10), Rodgers DL(5), Sinz EH(11).

Author information:
(1)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns
Hopkins University School of Medicine Department of Anesthesiology and Critical
Care Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of
Medicine Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins
University School of Medicine Division of Health Sciences Informatics,
Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation Center, Baltimore,
Maryland, USA.
(2)Penn State Hershey Medical Center Department of Anesthesiology, Hershey,
Pennsylvania, USA.
(3)Uniformed Services of the Health Sciences, Bethesda, Maryland, USA.
(4)Penn State University College of Medicine, Hershey, Pennsylvania, USA.
(5)Penn State Hershey Clinical Simulation Center, Hershey, Pennsylvania, USA.
(6)Penn State Hershey Medical Center Department of Anesthesiology, Hershey,
Pennsylvania, USA; Penn State Hershey Clinical Simulation Center, Hershey,
Pennsylvania, USA.
(7)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns
Hopkins University School of Medicine Department of Anesthesiology and Critical
Care Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of
Medicine Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins
Medicine Simulation Center, Baltimore, Maryland, USA.
(8)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns
Hopkins University School of Medicine Department of Anesthesiology and Critical
Care Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of
Medicine Division of Health Sciences Informatics, Baltimore, Maryland, USA;
Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
(9)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns
Hopkins University School of Medicine Department of Anesthesiology and Critical
Care Medicine, Baltimore, Maryland, USA; Johns Hopkins Medicine Simulation
Center, Baltimore, Maryland, USA.
(10)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns
Hopkins University School of Medicine Department of Anesthesiology and Critical
Care Medicine, Baltimore, Maryland, USA; Johns Hopkins University School of
Medicine Department of Pediatrics, Baltimore, Maryland, USA; Johns Hopkins
Medicine Simulation Center, Baltimore, Maryland, USA; Perdana University
Graduate School of Medicine, Kuala Lumpur, Malaysia.
(11)Penn State Hershey Medical Center Department of Anesthesiology, Hershey,
Pennsylvania, USA; Penn State University College of Medicine, Hershey,
Pennsylvania, USA; Penn State Hershey Clinical Simulation Center, Hershey,
Pennsylvania, USA; Penn State Hershey Medical Center Department of Neurosurgery,
Hershey, Pennsylvania, USA. Electronic address: esinz@psu.edu.

BACKGROUND: Observations of cardiopulmonary arrests (CPAs) reveal concerning

patterns when clinicians identify a problem, (e.g. loss of pulse) but do not
immediately initiate appropriate therapy (e.g. compressions) resulting in delays
in life saving therapy.
METHODS: We hypothesized that when individuals utilized specific, short,
easy-to-state action phrases stating an observation followed by an associated
intervention, there would be a higher likelihood that appropriate action would
immediately occur. Phase I: A retrospective analysis of residents in simulated
CPAs measured what proportion verbalized "There's no pulse", statements and/or
actions that followed and whether "Action-Linked Phrases" were associated with
faster initiation of compressions. Phase II: Two prospective, quasi-experimental
studies evaluated if teaching three Action-Linked Phrases for Basic Life Support
(BLS) courses or six Action-Linked Phrases for Advanced Cardiovascular Life
Support (ACLS) courses was associated with increased use of these phrases.
RESULTS: Phase I: 62% (42/68) of residents verbalized "there's no pulse" during
initial assessment of a pulseless patient, and only 16/42 (38%) followed that by
stating "start compressions". Residents verbalizing this Action-Linked Phrase
started compressions sooner than others: (30s [IQR:19-42] vs. 150 [IQR:51-242],
p < 0.001). Phase II: In BLS courses, the three Action-Linked Phrases were used
more frequently in the intervention group: (226/270 [84%] vs. 14/195 [7%]; p <
0.001). In ACLS courses, the six Action-Linked Phrases were uttered more often
in the intervention group: (43% [157/368] vs. 23% [46/201], p < 0.001).
CONCLUSIONS: Action-Linked Phrases innately used by residents in simulated CPAs
were associated with faster initiation of compressions. Action-Linked Phrases
were verbalized more frequently if taught as part of a regular BLS or ACLS
course. This simple, easy to teach, and easy to implement technique holds
promise for impacting cardiac arrest teams' performance of key actions.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2014.10.007
PMID: 25457379 [Indexed for MEDLINE]

120. Int J Environ Res Public Health. 2022 Apr 26;19(9):5257. doi:
10.3390/ijerph19095257.

AvaLife-A New Multi-Disciplinary Approach Supported by Accident and Field Test

Data to Optimize Survival Chances in Rescue and First Aid of Avalanche Patients.

Genswein M(1), Macias D(2), McIntosh S(3), Reiweger I(4), Hetland A(5), Paal
P(6).

Author information:
(1)MountainSafety.info, 7260 Davos, Switzerland.
(2)Department of Emergency Medicine, University of New Mexico, International
Mountain Medicine Center, Albuquerque, NM 87131, USA.
(3)Department of Emergency Medicine, University of Utah Health, AirMed, Salt
Lake City, UT 84132, USA.
(4)Institute of Mountain Risk Engineering, University of Natural Resources and
Life Sciences, 1190 Vienna, Austria.
(5)CARE Center for Avalanche Research and Education, UiT The Arctic University
of Norway, 9010 Tromsø, Norway.
(6)Department of Anesthesiology and Intensive Care Medicine, St. John of God
Hospital, Paracelsus Medical University, 5010 Salzburg, Austria.

Snow sports in the backcountry have seen a steep increase in popularity, and
therefore preparedness for efficient companion and organized rescue is
important. While technical rescue skills are widely taught, there is a lack of
knowledge regarding first aid for avalanche patients. The stressful and
time-critical situation for first responders requires a rule-based decision
support tool. AvaLife has been designed from scratch, applying mathematical and
statistical approaches including Monte Carlo simulations. New analysis of
retrospective data and large prospective field test datasets were used to
develop evidence-based algorithms exclusively for the avalanche rescue
environment. AvaLife differs from other algorithms as it is not just a
general-purpose CPR algorithm which has been slightly adapted for the avalanche
patient. The sequence of actions, inclusion of the ≥150 cm burial depth triage
criterion, advice to limit CPR duration for normothermic patients to 6 min in
case of multiple burials and shortage of resources, criteria for using recovered
subjects as a resource in the ongoing rescue, the adapted definition of
"injuries incompatible with life", reasoning behind the utmost importance of
rescue breaths, as well as the updated BLS-iCPR algorithm make AvaLife useful in
single and multiple burial rescue. AvaLife is available as a companion rescue
basic life support (BLS) version for the recreational user and an advanced
companion and organized rescue BLS version for guides, ski patrols and mountain
rescuers. AvaLife allows seamless interoperability with advanced life support
(ALS) qualified medical personnel arriving on site.

DOI: 10.3390/ijerph19095257
PMCID: PMC9104102
PMID: 35564653 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no conflict of interest.

121. Scand J Trauma Resusc Emerg Med. 2021 Feb 1;29(1):27. doi:
10.1186/s13049-021-00836-y.

Virtual reality as a teaching method for resuscitation training in undergraduate

first year medical students: a randomized controlled trial.

Issleib M(#)(1), Kromer A(#)(2), Pinnschmidt HO(3), Süss-Havemann C(2), Kubitz

JC(2)(4).

Author information:
(1)Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf,
Martini-Str. 52, 20246, Hamburg, Germany. missleib@uke.de.
(2)Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf,
Martini-Str. 52, 20246, Hamburg, Germany.
(3)Department of Medical Biometry and Epidemiology, University Medical Center
Hamburg-Eppendorf, Martini-Str. 52, 20246, Hamburg, Germany.
(4)Department of Anaesthesiology and Intensive Care Medicine, Paracelsus Medical
University Nuremberg, Breslauer Straße 201, 90471, Nuremberg, Germany.
(#)Contributed equally

BACKGROUND: Virtual reality is an innovative technology for medical education

associated with high empirical realism. Therefore, this study compares a
conventional cardiopulmonary resuscitation (CPR) training with a Virtual Reality
(VR) training aiming to demonstrate: (a) non-inferiority of the VR intervention
in respect of no flow time and (b) superiority in respect of subjective learning
gain.
METHODS: In this controlled randomized study first year, undergraduate students
were allocated in the intervention group and the control group. Fifty-six
participants were randomized to the intervention group and 104 participants to
the control group. The intervention group received an individual 35-min VR Basic
Life Support (BLS) course and a basic skill training. The control group took
part in a "classic" BLS-course with a seminar and a basic skill training. The
groups were compared in respect of no flow time in a final 3-min BLS examination
(primary outcome) and their learning gain (secondary outcome) assessed with a
comparative self-assessment (CSA) using a questionnaire at the beginning and the
end of the course. Data analysis was performed with a general linear fixed
effects model.
RESULTS: The no flow time was significantly shorter in the control group (Mean
values: control group 82 s vs. intervention group 93 s; p = 0.000). In the CSA
participants of the intervention group had a higher learning gain in 6 out of 11
items of the questionnaire (p < 0.05).
CONCLUSION: A "classic" BLS-course with a seminar and training seems superior to
VR in teaching technical skills. However, overall learning gain was higher with
VR. Future BLS course-formats should consider the integration of VR technique
into the classic CPR training or vice versa, to use the advantage of both
teaching techniques.

DOI: 10.1186/s13049-021-00836-y
PMCID: PMC7851931
PMID: 33526042 [Indexed for MEDLINE]

Conflict of interest statement: All authors declare that they have no conflicts
of Interest.

122. Scand J Trauma Resusc Emerg Med. 2020 Nov 2;28(1):108. doi:
10.1186/s13049-020-00793-y.

Cardiopulmonary resuscitation (CPR) during spaceflight - a guideline for CPR in

microgravity from the German Society of Aerospace Medicine (DGLRM) and the
European Society of Aerospace Medicine Space Medicine Group (ESAM-SMG).

Hinkelbein J(1)(2)(3), Kerkhoff S(4)(5)(6), Adler C(7)(8), Ahlbäck A(6)(9),

Braunecker S(6)(10), Burgard D(11), Cirillo F(12), De Robertis E(13), Glaser
E(4)(6)(14), Haidl TK(15), Hodkinson P(6)(16), Iovino IZ(12), Jansen S(17),
Johnson KVL(6)(18), Jünger S(19), Komorowski M(6)(20), Leary M(21), Mackaill
C(6)(22), Nagrebetsky A(23), Neuhaus C(4)(6)(24), Rehnberg L(25), Romano GM(26),
Russomano T(27), Schmitz J(4)(5)(6), Spelten O(28), Starck C(6)(29), Thierry
S(6)(30)(31)(32), Velho R(33), Warnecke T(34).

Author information:
(1)German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.
jochen.hinkelbein@gmail.com.
(2)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital of Cologne, 50937, Cologne, Germany. jochen.hinkelbein@gmail.com.
(3)Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne,
Germany. jochen.hinkelbein@gmail.com.
(4)German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.
(5)Department of Anaesthesiology and Intensive Care Medicine, University
Hospital of Cologne, 50937, Cologne, Germany.
(6)Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne,
Germany.
(7)Department of Internal Medicine III, Heart Centre of the University of
Cologne, Cologne, Germany.
(8)Fire Department City of Cologne, Institute for Security Science and Rescue
Technology, Cologne, Germany.
(9)Department of Anaesthesia and Intensive Care, Örebro University Hospital,
Örebro, Sweden.
(10)Department of Anesthesiology, University of Florida College of Medicine,
Jacksonville, FL, USA.
(11)Department of Cardiology and Angiology, Heart Center Duisburg, Evangelisches
Klinikum Niederrhein, Duisburg, Germany.
(12)Department of Anaesthesia and Intensive Care, Santa Maria delle Grazie
Hospital, Pozzuoli, Naples, Italy.
(13)Division of Anaesthesia, Analgesia, and Intensive Care, Department of
Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.
(14), Gerbrunn, Germany.
(15)Department of Psychiatry and Psychotherapy, Faculty of Medicine and
University Hospital Cologne, University of Cologne, 50937, Cologne, Germany.
(16)Aerospace Medicine, Centre of Human and Applied Physiological Sciences,
King's College, London, UK.
(17)Department of Otorhinolaryngology, Head and Neck Surgery, University of
Cologne, 50937, Cologne, Germany.
(18)University of Perugia-Terni, Perugia-Terni, Italy.
(19)Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health
(CERES), University of Cologne and University Hospital of Cologne, Cologne,
Germany.
(20)Department of Surgery and Cancer, Faculty of Medicine, Imperial College
London, Exhibition road, London, SW7 2AZ, UK.
(21)School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
(22)Accident and Emergency Department, Queen Elizabeth University Hospital,
Glasgow, Scotland.
(23)Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, USA.
(24)Department of Anesthesiology, Heidelberg University Hospital, Heidelberg,
Germany.
(25)University Hospital Southampton NHS Foundation Trust, Anaesthetic
Department, Southampton, UK.
(26)Anesthesia and Postoperative Intensive Care Unit, AORN Cardarelli, Naples,
Italy.
(27)Centre of Human and Applied Physiological Sciences, Kings College London,
London, UK.
(28)Department of Anaesthesiology and Intensive Care Medicine, Schön Klinik
Düsseldorf, Am Heerdter Krankenhaus 2, 40549, Düsseldorf, Germany.
(29)Anesthesiology Department, Brest University Hospital, Brest, France.
(30)Anesthesiology Department, Bretagne Sud General Hospital, Lorient, France.
(31)Medical and Maritime Simulation Center, Lorient, France.
(32)Laboratory of Psychology, Cognition, Communication and Behavior, University
of Bretagne Sud, Vannes, France.
(33)Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation,
University Hospitals Birmingham, Heart of England NHS Foundation Trust,
Birmingham, UK.
(34)University Department for Anesthesia, Intensive and Emergency Medicine and
Pain Management, Hospital Oldenburg, Oldenburg, Germany.

BACKGROUND: With the "Artemis"-mission mankind will return to the Moon by 2024.
Prolonged periods in space will not only present physical and psychological
challenges to the astronauts, but also pose risks concerning the medical
treatment capabilities of the crew. So far, no guideline exists for the
treatment of severe medical emergencies in microgravity. We, as a international
group of researchers related to the field of aerospace medicine and critical
care, took on the challenge and developed a an evidence-based guideline for the
arguably most severe medical emergency - cardiac arrest.
METHODS: After the creation of said international group, PICO questions
regarding the topic cardiopulmonary resuscitation in microgravity were developed
to guide the systematic literature research. Afterwards a precise search
strategy was compiled which was then applied to "MEDLINE". Four thousand one
hundred sixty-five findings were retrieved and consecutively screened by at
least 2 reviewers. This led to 88 original publications that were acquired in
full-text version and then critically appraised using the GRADE methodology.
Those studies formed to basis for the guideline recommendations that were
designed by at least 2 experts on the given field. Afterwards those
recommendations were subject to a consensus finding process according to the
DELPHI-methodology.
RESULTS: We recommend a differentiated approach to CPR in microgravity with a
division into basic life support (BLS) and advanced life support (ALS) similar
to the Earth-based guidelines. In immediate BLS, the chest compression method of
choice is the Evetts-Russomano method (ER), whereas in an ALS scenario, with the
patient being restrained on the Crew Medical Restraint System, the handstand
method (HS) should be applied. Airway management should only be performed if at
least two rescuers are present and the patient has been restrained. A
supraglottic airway device should be used for airway management where crew
members untrained in tracheal intubation (TI) are involved.
DISCUSSION: CPR in microgravity is feasible and should be applied according to
the Earth-based guidelines of the AHA/ERC in relation to fundamental statements,
like urgent recognition and action, focus on high-quality chest compressions,
compression depth and compression-ventilation ratio. However, the special
circumstances presented by microgravity and spaceflight must be considered
concerning central points such as rescuer position and methods for the
performance of chest compressions, airway management and defibrillation.

DOI: 10.1186/s13049-020-00793-y
PMCID: PMC7607644
PMID: 33138865 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing
interests.

123. J Surg Res. 2020 Oct;254:64-74. doi: 10.1016/j.jss.2020.03.026. Epub 2020 May
15.

The Effect of Chest Compression Location and Occlusion of the Aorta in a

Traumatic Arrest Model.

Anderson KL(1), Morgan JD(2), Castaneda MG(3), Boudreau SM(3), Araña AA(4), Kohn
MA(5), Bebarta VS(6).

Author information:
(1)Department of Emergency Medicine, Stanford University School of Medicine,
Palo Alto, California. Electronic address: kentona@stanford.edu.
(2)San Antonio Military Medical Center, Fort Sam Houston, Texas.
(3)CREST Research Program, Wilford Hall Ambulatory Surgical Center, Lackland
AFB, Bexar County, Texas.
(4)United States Army Institute of Surgical Research, Fort Sam Houston, Texas.
(5)Department of Emergency Medicine, Stanford University School of Medicine,
Palo Alto, California.
(6)Department of Emergency Medicine, University of Colorado School of Medicine,
Aurora, Colorado.

BACKGROUND: Recent evidence demonstrates that closed chest compressions directly

over the left ventricle (LV) in a traumatic cardiac arrest (TCA) model improve
hemodynamics and return of spontaneous circulation (ROSC) when compared with
traditional compressions. Resuscitative endovascular balloon occlusion of the
aorta (REBOA) also improves hemodynamics and controls hemorrhage in TCA. We
hypothesized that chest compressions located over the LV would result in
improved hemodynamics and ROSC in a swine model of TCA using REBOA.
MATERIALS AND METHODS: Transthoracic echo was used to mark the location of the
aortic root (traditional location) and the center of the LV on animals (n = 26),
which were randomized to receive chest compressions in one of the two locations.
After hemorrhage, ventricular fibrillation was induced to simulate TCA. After a
period of 10 min of ventricular fibrillation, basic life support (BLS) with
mechanical cardiopulmonary resuscitation was initiated and performed for 10 min
followed by advanced life support for an additional 10 min. REBOA balloons were
inflated at 6 min into BLS. Hemodynamic variables were averaged during the final
2 min of the BLS and advanced life support periods. Survival was compared
between this REBOA cohort and a control group without REBOA (no-REBOA cohort)
(n = 26).
RESULTS: There was no significant difference in ROSC between the two REBOA
groups (P = 0.24). Survival was higher with REBOA group versus no-REBOA group
(P = 0.02).
CONCLUSIONS: There was no difference in ROSC between LV and traditional
compressions when REBOA was used in this swine model of TCA. REBOA conferred a
survival benefit regardless of compression location.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jss.2020.03.026
PMID: 32417498 [Indexed for MEDLINE]

124. Resuscitation. 2008 Apr;77(1):95-100. doi:

10.1016/j.resuscitation.2007.11.009.
Epub 2008 Jan 18.

Quality of chest compressions during 10min of single-rescuer basic life support

with different compression: ventilation ratios in a manikin model.

Bjørshol CA(1), Søreide E, Torsteinbø TH, Lexow K, Nilsen OB, Sunde K.

Author information:
(1)Department of Anaesthesia and Intensive Care, Division of Acute Care
Medicine, Stavanger University Hospital, Stavanger, Norway. bjco@sus.no

INTRODUCTION: Good quality basic life support (BLS) improves outcome during
cardiac arrest. As fatigue may reduce BLS performance over time we wanted to
examine the quality of chest compressions in a single-rescuer scenario during
prolonged BLS with different compression:ventilation ratios (C:V ratios).
MATERIAL AND METHODS: Professional paramedics were asked to perform
single-rescuer BLS with C:V ratios of 15:2, 30:2 and 50:2 for 10 min each in
random order. A Laerdal Medical Resusci Anne Simulator with PC Skillreporting
System was used for BLS quality analysis. Total number of chest compressions,
compression depth and compression rate were measured and the differences between
the C:V ratios were analysed with repeated measures ANOVA. For analysis of
fatigue, chest compression variables for each 2-min period were analysed and
compared with the first 2-min period using repeated measures ANOVA.
RESULTS: Altogether 50 paramedics completed the study. The mean number of chest
compressions increased significantly from 604 to 770 and 862 with C:V ratios of
15:2, 30:2 and 50:2, respectively. Chest compression rate was significantly
higher with C:V ratio of 15:2 compared to 30:2 and 50:2 but was above 100 per
minute for all three ratios. However, the mean chest compression depth did not
change significantly between the different C:V ratios. The number of chest
compressions did not change significantly with time for any of the three C:V
ratios. Compression depth did decline after the first 2-min period for 30:2 and
50:2 as did compression rate for all three ratios. However all were above the
guideline limits for the entire test period.
CONCLUSION: Increasing the C:V ratio increases the number of chest compressions
during 10 min of BLS. Compression depth and compression rate were within
guideline recommendations for all three ratios. We found no decline in chest
compression quality below guideline recommendations during 10 min of BLS with
any of the three different C:V ratios.

DOI: 10.1016/j.resuscitation.2007.11.009
PMID: 18207627 [Indexed for MEDLINE]

125. Emerg Med J. 2010 Oct;27(10):734-8. doi: 10.1136/emj.2009.074518.

Simulation training improves ability to manage medical emergencies.

Ruesseler M(1), Weinlich M, Müller MP, Byhahn C, Marzi I, Walcher F.

Author information:
(1)Department of Trauma Surgery, J.W. Goethe University Hospital,
Theodor-Stern-Kai 7, Frankfurt 60590, Germany. miri@mruesseler.de

Republished in
Postgrad Med J. 2012 Jun;88(1040):312-6. doi: 10.1136/pgmj-2009-074518rep.

OBJECTIVE: In the case of an emergency, fast and structured patient management

is crucial for a patient's outcome. Every physician and graduate medical student
should possess basic knowledge of emergency care and the skills to manage common
emergencies. This study determines the effect of a simulation-based curriculum
in emergency medicine on students' abilities to manage emergency situations.
METHODS: A controlled, blinded educational trial of 44 final-year medical
students was carried out at Frankfurt Medical School; 22 students completed the
former curriculum as the control group and 22 the new curriculum as the
intervention group. The intervention consists of simulation-based training with
theoretical and simulation-based training sessions in realistic encounters based
on the Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and
adapted Advanced Trauma Life Support (ATLS) training. Further common emergencies
were integrated corresponding to the course objectives. All students faced a
performance-based assessment in a 10 station Objective Structured Clinical
Examination (OSCE) using checklist rating within a maximum of 4 months after
completion of the intervention.
RESULTS: The intervention group performed significantly better at all of the 10
OSCE stations in the checklist rating (p<0.0001 to p=0.016).
CONCLUSIONS: The simulation-based intervention offers a positively evaluated
possibility to enhance students' skills in recognising and handling emergencies.
Additional studies are required to measure the long-term retention of the
acquired skills, as well as the effect of training in healthcare professionals.

DOI: 10.1136/emj.2009.074518
PMID: 20852280 [Indexed for MEDLINE]

126. Resuscitation. 2014 Apr;85(4):560-6. doi: 10.1016/j.resuscitation.2013.10.028.

Epub 2013 Nov 8.

Comparing three CPR feedback devices and standard BLS in a single rescuer
scenario: a randomised simulation study.

Zapletal B(1), Greif R(2), Stumpf D(3), Nierscher FJ(4), Frantal S(5), Haugk
M(6), Ruetzler K(7), Schlimp C(8), Fischer H(9).

Author information:
(1)Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical
University Vienna, Austria.
(2)Department of Anaesthesiology and Pain Therapy, University Hospital Bern and
University of Bern, Switzerland.
(3)Department of Family Medicine, Hospital of the Sisters of Charity Linz,
Austria.
(4)Department of Anaesthesia, General Intensive Care and Pain Medicine, Division
of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical
University Vienna, Austria.
(5)Centre for Medical Statistics, Informatics and Intelligent Systems, Medical
University Vienna, Austria.
(6)Department of Emergency Medicine, Medical University Vienna, Austria.
(7)Institute of Anaesthesiology, University Hospital Zürich, Zürich,
Switzerland; Department of Anaesthesia, General Intensive Care and Pain
Medicine, Medical University Vienna, Austria.
(8)Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA
Research Centre, Vienna, Austria.
(9)Department of Anaesthesia, General Intensive Care and Pain Control, Division
of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical
University Vienna, Austria. Electronic address: henrik.fischer@utanet.at.

BACKGROUND: Efficiently performed basic life support (BLS) after cardiac arrest
is proven to be effective. However, cardiopulmonary resuscitation (CPR) is
strenuous and rescuers' performance declines rapidly over time. Audio-visual
feedback devices reporting CPR quality may prevent this decline. We aimed to
investigate the effect of various CPR feedback devices on CPR quality.
METHODS: In this open, prospective, randomised, controlled trial we compared
three CPR feedback devices (PocketCPR, CPRmeter, iPhone app PocketCPR) with
standard BLS without feedback in a simulated scenario. 240 trained medical
students performed single rescuer BLS on a manikin for 8min. Effective
compression (compressions with correct depth, pressure point and sufficient
decompression) as well as compression rate, flow time fraction and ventilation
parameters were compared between the four groups.
RESULTS: Study participants using the PocketCPR performed 17±19% effective
compressions compared to 32±28% with CPRmeter, 25±27% with the iPhone app
PocketCPR, and 35±30% applying standard BLS (PocketCPR vs. CPRmeter p=0.007,
PocketCPR vs. standard BLS p=0.001, others: ns). PocketCPR and CPRmeter
prevented a decline in effective compression over time, but overall performance
in the PocketCPR group was considerably inferior to standard BLS. Compression
depth and rate were within the range recommended in the guidelines in all
groups.
CONCLUSION: While we found differences between the investigated CPR feedback
devices, overall BLS quality was suboptimal in all groups. Surprisingly,
effective compression was not improved by any CPR feedback device compared to
standard BLS. All feedback devices caused substantial delay in starting CPR,
which may worsen outcome.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2013.10.028
PMID: 24215730 [Indexed for MEDLINE]

127. Resusc Plus. 2023 Oct 20;16:100487. doi: 10.1016/j.resplu.2023.100487.

eCollection 2023 Dec.

Comparison of instructor-led compression-only cardiopulmonary resuscitation and

automated external defibrillator training for secondary school students: A
multicenter noninferiority randomized trial.

Yeung CY(1), So KY(1), Cheung HHT(2), Hou PY(2), Ko HF(1)(2), Lee A(2); Hong
Kong CO-CPRAED Instructors and Assessors Group.

Author information:
(1)Accident and Emergency Department, Queen Elizabeth Hospital, Kowloon, Hong
Kong Special Administrative Region.
(2)Department of Anaesthesia and Intensive Care, The Chinese University of Hong
Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special
Administrative Region.

BACKGROUND: Many barriers exist to the wider and sustainable implementation of

basic life support (BLS) training in secondary schools. Whether trained teacher
instructors are not worse than healthcare instructors by 20% (noninferiority
margin) of simulated BLS skills for secondary school students is unclear.
METHODS: We conducted a two-armed, parallel, noninferiority, blinded, randomized
controlled trial at four secondary schools in Hong Kong after teachers had
undergone BLS training. Students were randomized to either the trained teacher
or healthcare instructor group for the 2-hour compression-only cardiopulmonary
resuscitation and automated external defibrillator (CO-CPRAED) course. The
assessors for the students' BLS skill performance six months after the CO-CPRAED
course were blinded.
RESULTS: Of the 33 trained teachers, 13 (39.4%) volunteered to be instructors
for the CO-CPRAED course. Three hundred and eleven students (median age:
15 years, 67% males) were randomized to either the teacher (n = 161) or
healthcare (n = 150) instructor group. The BLS skill performance passing rate
(%) at six months was high in both instructor groups (teacher: 88% versus
healthcare: 91%; mean difference: -3%, 95% CI: -11% to 5%; P = 0.22). The
students' knowledge levels remained high (>90%) and were similar between
instructor groups at six months (P = 0.91). The teachers' willingness to teach
BLS to students was mildly positive. However, the students were extremely
positive towards learning and performing BLS.
CONCLUSIONS: A brief 2-hour CO-CPRAED intervention by trained teachers was
noninferior to healthcare instructors and it was associated with students' very
positive attitudes towards CPR, and retention of knowledge and BLS skills.

© 2023 The Author(s).

DOI: 10.1016/j.resplu.2023.100487
PMCID: PMC10598683
PMID: 37886710
Conflict of interest statement: The authors declare the following financial
interests/personal relationships which may be considered as potential competing
interests: ‘CYY is a lecturer at the Hong Kong Red Cross. All other authors
declare no conflicts of interest’.

128. Indian J Pediatr. 2018 Mar;85(3):184-188. doi: 10.1007/s12098-017-2473-3. Epub

2017 Nov 20.

Utility of Low Fidelity Manikins for Learning High Quality Chest Compressions.

Girish M(1), Rawekar A(2), Jose S(3), Chaudhari U(4), Nanoti G(4).

Author information:
(1)Department of Pediatrics, NKP Salve Institute of Medical Sciences, Nagpur,
Maharashtra, India. meenakshimgirish@gmail.com.
(2)Department of Physiology, JNMC, DMIMS, Sawangi, Maharashtra, India.
(3)Nursing Department, NKP Salve Institute of Medical Sciences, Nagpur,
Maharashtra, India.
(4)Department of Pediatrics, NKP Salve Institute of Medical Sciences, Nagpur,
Maharashtra, India.

Comment in
Indian J Pediatr. 2018 Mar;85(3):168-169. doi: 10.1007/s12098-017-2573-0.

OBJECTIVES: Primarily, to measure the adequacy of chest compression depth after

training on low fidelity manikins and secondarily to assess the comparative
experience of the learners on high fidelity and low fidelity simulators.
METHODS: An observational cohort study in which seventy-two first year
postgraduate students underwent a Basic Life Support (BLS) workshop conducted by
AHA accredited BLS trainers and they were then required to perform on a high
fidelity manikin to objectively record the quality of their performance.
RESULTS: There were 34 (47.22%) male and 38 (52.77%) female participants. CPR
skills, as judged by checklist of sequential actions and visual inspection
during the BLS training on low fidelity simulators (LFS) were correctly
performed by majority (95.89%) participants. However, none of the participants
could achieve the recommended depth for high quality chest compressions. The
participants' perception of degree of realism and their practical experience on
both the types of manikins were similar.
CONCLUSIONS: Low fidelity manikins are useful for training CPR in sequential
manner but fail to impart quality of chest compressions as per AHA
recommendations.

DOI: 10.1007/s12098-017-2473-3
PMID: 29152687 [Indexed for MEDLINE]

129. J Surg Res. 2021 Feb;258:88-99. doi: 10.1016/j.jss.2020.08.052. Epub 2020 Sep
28.

The Effect of Chest Compression Location and Aortic Perfusion in a Traumatic

Arrest Model.

Barringer BJ(1), Castaneda MG(2), Rall J(2), Maddry JK(3), Anderson KL(4).

Author information:
(1)Department of Emergency Medicine, Joint Base Elmendorf-Richardson, Elmendorf
AFB, Alaska.
(2)CREST Research Program, Wilford Hall Ambulatory Surgical Center, Lackland
AFB, Texas.
(3)United States Air Force En-route Care Research Center, United States Army
Institute of Surgical Research/59th MDW/ST, San Antonio, Texas.
(4)Department of Emergency Medicine, Stanford University School of Medicine,
Palo Alto, California. Electronic address: kentona@stanford.edu.

BACKGROUND: Recent evidence demonstrates that closed chest compressions directly

over the left ventricle (LV) in a traumatic cardiac arrest (TCA) model improve
hemodynamics and return of spontaneous circulation (ROSC) when compared to
traditional compressions. Selective aortic arch perfusion (SAAP) also improves
hemodynamics and controls hemorrhage in TCA. We hypothesized that chest
compressions located over the LV would result in improved hemodynamics and ROSC
in a swine model of TCA using SAAP.
MATERIALS AND METHODS: Transthoracic echo was used to mark the location of the
aortic root (Traditional location) and the center of the LV on animals (n = 24),
which were randomized to receive chest compressions in one of the two locations.
After hemorrhage, ventricular fibrillation (VF) was induced to simulate TCA.
After a period of 10 min of VF, basic life support (BLS) with mechanical CPR was
initiated and performed for 10 min, followed by advanced life support (ALS) for
an additional 10 min. SAAP balloons were inflated at min 6 of BLS. Hemodynamic
variables were averaged over the final 2 min of the BLS and ALS periods.
Survival was compared between this SAAP cohort and a control group without SAAP
(No-SAAP) (n = 26).
RESULTS: There was no significant difference in ROSC between the two SAAP groups
(P = 0.67). There was no ROSC difference between SAAP and No-SAAP (P = 0.74).
CONCLUSIONS: There was no difference in ROSC between LV and Traditional
compressions when SAAP was used in this swine model of TCA. SAAP did not confer
a survival benefit compared to historical controls.

Copyright © 2020 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jss.2020.08.052
PMID: 33002666 [Indexed for MEDLINE]

130. Prehosp Disaster Med. 2018 Dec;33(6):621-626. doi: 10.1017/S1049023X18001024.

Epub 2018 Nov 13.

Needs Assessment for Simulation Training for Prehospital Providers in Botswana.

Glomb NW(1), Kosoko AA(2), Doughty CB(3), Rus MC(3), Shah MI(3), Cox M(4),
Galapi C(5), Parkes PS(6), Kumar S(7), Laba B(5).

Author information:
(1)1University of California,San Francisco/Benioff Children's
Hospital,Department of Emergency Medicine,San Francisco,CaliforniaUSA.
(2)2University of Texas Health Sciences Center at Houston,McGovern School of
Medicine,Department of Emergency Medicine,Houston,TexasUSA.
(3)3Baylor College of Medicine/Texas Children's Hospital,Department of
Pediatrics,Section of Emergency Medicine,Houston,Texas,USA.
(4)4University of Botswana/Princess Marina Hospital,Department of Emergency
Medicine,Gaborone,Botswana.
(5)5Emergency Medical Services,Botswana Ministry of Health and
Wellness,Gaborone,Botswana.
(6)6Baylor College of Medicine/Texas Children's Hospital,Baylor School of
Medicine,Houston,TexasUSA.
(7)7Baylor College of Medicine/Texas Children's Hospital,Department of
Pediatrics,Center for Research Innovation and Scholarship,Houston,TexasUSA.
BACKGROUND: In June 2012, the Botswana Ministry of Health and Wellness (MOHW;
Gaborone, Botswana) initiated a national Emergency Medical Services (EMS) system
in response to significant morbidity and mortality associated with prehospital
emergencies. The MOHW requested external expertise to train its developing
workforce. Simulation-based training was planned to equip these health care
providers with clinical knowledge, procedural skills, and communication
techniques.
OBJECTIVE: The objective of this study was to assess the educational needs of
the pioneer Botswana MOHW EMS providers based on retrospective EMS logbook
review and EMS provider feedback to guide development of a novel educational
curriculum.
METHODS: Data were abstracted from a representative sample of the Gaborone,
Botswana MOHW EMS response log from 2013-2014 and were quantified into the five
most common call types for both adults and children. Informal focus groups with
health professionals and EMS staff, as well as surveys, were used to rank common
response call types and self-perceived educational needs.
RESULTS: Based on 1,506 calls, the most common adult response calls were for
obstetric emergencies, altered mental status, gastrointestinal/abdominal pain,
trauma, gynecological emergencies, and cardiovascular and respiratory
distress-related emergencies. The most common pediatric response calls were for
respiratory distress, gastrointestinal complaints/dehydration, trauma and
musculoskeletal injuries, newborn delivery, seizures, and toxic
ingestion/exposure. The EMS providers identified these same chief complaints as
priorities for training using the qualitative approach. A locally relevant,
simulation-based curriculum for the Botswana MOHW EMS system was developed and
implemented based on these data.
CONCLUSIONS: Trauma, respiratory distress, gastrointestinal complaints, and
puerperal/perinatal emergencies were common conditions for all age groups. Other
age-specific conditions were also identified as educational needs based on
epidemiologic data and provider feedback. This needs assessment may be useful
when designing locally relevant EMS curricula in other low-income and
middle-income countries. GlombNW, KosokoAA, DoughtyCB, RusMC, ShahMI, CoxM,
GalapiC, ParkesPS, KumarS, LabaB. Needs assessment for simulation training for
prehospital providers in Botswana. Prehosp Disaster Med. 2018;33(6):621-626.

DOI: 10.1017/S1049023X18001024
PMID: 30419999 [Indexed for MEDLINE]

131. Resusc Plus. 2021 May 14;6:100123. doi: 10.1016/j.resplu.2021.100123.

eCollection 2021 Jun.

Bystander performance using the 2010 vs 2015 ERC guidelines: A post-hoc analysis
of two randomised simulation trials.

Nguyen DT(1)(2), Lauridsen KG(1)(2)(3)(4), Krogh K(1)(5), Løfgren B(1)(3)(6).

Author information:
(1)Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus,
Denmark.
(2)Clinical Research Unit, Randers Regional Hospital, Randers, Denmark.
(3)Department of Medicine, Randers Regional Hospital, Randers, Denmark.
(4)Center for Simulation, Advanced Education, and Innovation, Children's
Hospital of Philadelphia, USA.
(5)Department of Anaesthesiology and Intensive Care, Viborg Regional Hospital,
Denmark.
(6)Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.

BACKGROUND: The European Resuscitation Council (ERC) basic life support (BLS)
2015 guidelines were simplified compared to the 2010 guidelines. We aimed to
compare BLS/automated external defibrillator (AED) skill performance and skill
retention following training with the 2010 or 2015 BLS/AED guidelines.
METHODS: Post-hoc analysis of two randomised simulation trials including
videorecordings of laypersons skill-tested after ERC BLS/AED training using
either the 2010 (n = 70) or 2015 (n = 70) BLS guidelines. Outcomes: (a) correct
sequence of the BLS/AED algorithm, (b) correct sequence of the BLS/AED algorithm
with all skills performed correctly, and (c) time to EMS call, first chest
compression and shock delivery immediately after training and three months
later. Groups were compared using multivariate logistic regression.
RESULTS: Mean age (±standard deviation) was 40 (±11) vs. 44 (±11) years and 70%
vs. 50% were females for the 2010 and 2015 groups, respectively. Correct
sequence of the BLS/AED algorithm for the 2010 vs. 2015 group was 84% vs. 91%,
P = 0.08 immediately after training and 16% vs. 41%, adjusted odds ratio (aOR):
5.6 (95% CI: 2.3-14.0, P < 0.001) after three months. Correct sequence with all
skills performed correctly was 56% vs. 47%, P = 0.31 immediately after training
and 5% vs. 16%, aOR: 4.8 (95% CI: 1.2-19.2), P = 0.03 after three months. Time
to EMS call was shorter in the 2015 group immediately after training (P = 0.008)
but all other time points did not differ.
CONCLUSION: The simplified 2015 BLS guidelines was associated with better
adherence to the sequence of the BLS/AED algorithm when compared to the 2010 BLS
guidelines three months after training in a simulated cardiac arrest scenario,
without significantly improving skill performance immediately after training.

© 2021 The Authors.

DOI: 10.1016/j.resplu.2021.100123
PMCID: PMC8244366
PMID: 34223381

132. Resusc Plus. 2023 May 8;14:100393. doi: 10.1016/j.resplu.2023.100393.

eCollection 2023 Jun.

An effort to reduce chest compression pauses during automated external

defibrillator use among laypeople: A randomized partially blinded controlled
trial.

Abelairas-Gómez C(1)(2)(3), Carballo-Fazanes A(2)(4)(3), Martínez-Isasi

S(2)(4)(3), López-García S(5), Rodríguez-Núñez A(2)(4)(3)(6).

Author information:
(1)Faculty of Education Sciences, Universidade de Santiago de Compostela
Santiago de Compostela, Spain.
(2)CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and
Medicine Department, Universidade de Santiago de Compostela, Spain.
(3)Simulation and Intensive Care Unit of Santiago (SICRUS) Reseach Group, Health
Research Institute of Santiago, University Hospital of Santiago de
Compostela-CHUS, Santiago de Compostela, Spain SICRUS Research Group, Spain.
(4)Faculty of Nursing, Universidade de Santiago de Compostela Santiago de
Compostela, Spain.
(5)Faculty of Education, Pontifical University of Salamanca, Salamanca, Spain.
(6)Pediatric Intensive Care Unit, University Hospital of Santiago de
Compostela-CHUS Spain.

AIM: To implement small methodological changes in basic life support (BLS)

training to reduce unnecessary pauses during automated external defibrillator
(AED) use.
METHODS: One hundred and two university students with no BLS knowledge were
randomly allocated into three groups (control and 2 experimental groups). Both
experimental groups received a two-hour BLS training. While the contents were
identical in both groups, in one of them the reduction of no-flow time was
focused on (focused no-flow group). The control group did not receive any
training. Finally, all of them were evaluated in the same out-of-hospital
cardiac arrest simulated scenario. The primary endpoint was the compression
fraction.
RESULTS: Results from 78 participants were analysed (control group: 19;
traditional group: 30; focused no-flow group: 29). The focused no-flow group
achieved higher percentages of compression fraction (median: 56.0, interquartile
rank (IQR): 53.5-58.5) than the traditional group (44.0, IQR: 42.0-47.0) and
control group (52.0, IQR: 43.0-58.0) in the complete scenario. Participants from
the control group performed compression-only cardiopulmonary resuscitation
(CPR), while the other groups performed compression-ventilation CPR. CPR
fraction was calculated, showing the fraction of time in which the participants
were performing resuscitation manoeuvres. In this case, the focused no-flow
group reached higher percentages of CPR fraction (77.6, IQR: 74.4-82.4) than the
traditional group (61.9, IQR: 59.3-68.1) and the control group (52.0, IQR:
43.0-58.0).
CONCLUSIONS: Laypeople having automated external defibrillation training focused
on acting in anticipation of the AED prompts contributed to a reduction in chest
compression pauses during an OHCA simulated scenario.

© 2023 The Author(s).

DOI: 10.1016/j.resplu.2023.100393
PMCID: PMC10189509
PMID: 37207261

Conflict of interest statement: The authors declare the following financial

interests/personal relationships which may be considered as potential competing
interests: Cristian Abelairas-Gómez is member of the ERC BLS Science and
Education Committee and member of the Education, Implementation and Teams ILCOR
Task Force. Antonio Rodríguez-Núñez is member of the Pediatric Life Support
ILCOR Task Force.

133. Resusc Plus. 2021 Jan 30;5:100082. doi: 10.1016/j.resplu.2021.100082.

eCollection 2021 Mar.

Higher resuscitation guideline adherence in paramedics with use of real-time

ventilation feedback during simulated out-of-hospital cardiac arrest: A
randomised controlled trial.

Lyngby RM(1)(2), Clark L(3), Kjoelbye JS(1), Oelrich RM(1), Silver A(3),
Christensen HC(1), Barfod C(1), Lippert F(1), Nikoletou D(2), Quinn T(2), Folke
F(1)(4).

Author information:
(1)Copenhagen Emergency Medical Services, Copenhagen, Denmark.
(2)Kingston University and St. Georges, University of London, London, United
Kingdom.
(3)ZOLL Medical Corporation, Chelmsford, MA, USA.
(4)Herlev Gentofte University Hospital, Copenhagen, Denmark.

Erratum in
Resusc Plus. 2021 Mar 10;6:100106. doi: 10.1016/j.resplu.2021.100106.

OBJECTIVES: To investigate whether real-time ventilation feedback would improve

provider adherence to ventilation guidelines.
DESIGN: Non-blinded randomised controlled simulation trial.
SETTING: One Emergency Medical Service trust in Copenhagen.
PARTICIPANTS: 32 ambulance crews consisting of 64 on-duty basic or advanced life
support paramedics from Copenhagen Emergency Medical Service.
INTERVENTION: Participant exposure to real-time ventilation feedback during
simulated out-of-hospital cardiac arrest.
MAIN OUTCOME MEASURES: The primary outcome was ventilation quality, defined as
ventilation guideline-adherence to ventilation rate (8-10 bpm) and tidal volume
(500-600 ml) delivered simultaneously.
RESULTS: The intervention group performed ventilations in adherence with
ventilation guideline recommendations for 75.3% (Interquartile range (IQR)
66.2%-82.9%) of delivered ventilations, compared to 22.1% (IQR 0%-44.0%)
provided by the control group. When controlling for participant covariates,
adherence to ventilation guidelines was 44.7% higher in participants receiving
ventilation feedback. Analysed separately, the intervention group performed a
ventilation guideline-compliant rate in 97.4% (IQR 97.1%-100%) of delivered
ventilations, versus 66.7% (IQR 40.9%-77.9%) for the control group. For tidal
volume compliance, the intervention group reached 77.5% (IQR 64.9%-83.8%) of
ventilations within target compared to 53.4% (IQR 8.4%-66.7%) delivered by the
control group.
CONCLUSIONS: Real-time ventilation feedback increased guideline compliance for
both ventilation rate and tidal volume (combined and as individual parameters)
in a simulated OHCA setting. Real-time feedback has the potential to improve
manual ventilation quality and may allow providers to avoid harmful
hyperventilation.

© 2021 The Authors.

DOI: 10.1016/j.resplu.2021.100082
PMCID: PMC8244327
PMID: 34223348

134. J Paediatr Child Health. 2012 Jun;48(6):529-33. doi:

10.1111/j.1440-1754.2011.02250.x. Epub 2011 Nov 23.

Paediatric resuscitation training: is e-learning the answer? A before and after

pilot study.

O'Leary FM(1).

Author information:
(1)Emergency Department of The Children's Hospital at Westmead, New South Wales,
Australia. fentono@chw.edu.au

AIM: To determine whether an e-learning resuscitation programme was able to

improve the knowledge and competence of doctors and nurses in providing
cardiopulmonary resuscitation to children in a simulated cardiac arrest.
METHOD: A prospective before and after pilot study comprising of a simulated
paediatric resuscitation before and after participants undertook an e-learning
programme. Participants were emergency department doctors and new graduate
nurses from The Children's Hospital at Westmead, Australia. Primary outcome
measures were the ability to perform successful basic life support (BLS) and
advanced life support (ALS) according to published guidelines. Secondary outcome
measures were the individual steps in performing the overall resuscitation and
subjective feedback from participants.
RESULTS: Fifty-six clinicians were enrolled in the study (29 doctors and 27
nurses). Thirty-seven were re-tested (25 doctors and 12 nurses). The mean time
between tests was 49 days (17 standard deviation). The e-learning module led to
an improvement in participants' ability to perform BLS by 51% (P < 0.001) and
ALS by 57% (P= 0.001) overall resulting in an overall competence of 89% (BLS)
and 65% (ALS). There were also significant improvements in time to rhythm
recognition (P= 0.006), time to first defibrillation (P= 0.009) and
participants' self-reported knowledge and confidence in BLS and ALS (P < 0.001).
CONCLUSIONS: E-learning does improve both the knowledge and competence of
doctors and nurses in providing cardiopulmonary resuscitation to children in the
simulation environment.

© 2011 The Author. Journal of Paediatrics and Child Health © 2011 Paediatrics
and Child Health Division (Royal Australasian College of Physicians).

DOI: 10.1111/j.1440-1754.2011.02250.x
PMID: 22107149 [Indexed for MEDLINE]

135. Resuscitation. 2019 Oct;143:50-56. doi: 10.1016/j.resuscitation.2019.07.030.

Epub 2019 Aug 4.

Association of diastolic blood pressure with survival during paediatric

cardiopulmonary resuscitation.

O'Brien CE(1), Santos PT(1), Reyes M(1), Adams S(1), Hopkins CD(1), Kulikowicz
E(1), Hamrick JL(2), Hamrick JT(2), Lee JK(1), Kudchadkar SR(3), Hunt EA(4),
Koehler RC(1), Shaffner DH(5).

Author information:
(1)Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University
School of Medicine, 1800 Orleans Street, Bloomberg Children's Center Suite 6302,
Baltimore, MD 21287 United States.
(2)Department of Anesthesiology, Rady Children's Hospital, 3020 Children's Way,
San Diego, CA 92123 United States.
(3)Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University
School of Medicine, 1800 Orleans Street, Bloomberg Children's Center Suite 6302,
Baltimore, MD 21287 United States; Department of Pediatrics, Johns Hopkins
University School of Medicine, 1800 Orleans Street, Bloomberg Children's Center
Suite 6302, Baltimore, MD 21287 United States; Department of Physical Medicine
and Rehabilitation, Johns Hopkins University School of Medicine, 600 N Wolfe St,
Baltimore, MD 21287 United States.
(4)Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University
School of Medicine, 1800 Orleans Street, Bloomberg Children's Center Suite 6302,
Baltimore, MD 21287 United States; Department of Pediatrics, Johns Hopkins
University School of Medicine, 1800 Orleans Street, Bloomberg Children's Center
Suite 6302, Baltimore, MD 21287 United States; Division of Health Sciences
Informatics, Johns Hopkins University School of Medicine, 2024 East Monument St.
S 1-200, Baltimore, MD 21205 United States.
(5)Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University
School of Medicine, 1800 Orleans Street, Bloomberg Children's Center Suite 6302,
Baltimore, MD 21287 United States. Electronic address: dshaffn1@jhmi.edu.

Comment in
Resuscitation. 2019 Dec;145:208-209. doi:
10.1016/j.resuscitation.2019.09.036.
Resuscitation. 2019 Dec;145:210-211. doi:
10.1016/j.resuscitation.2019.10.010.

AIM: To examine the relationship between survival and diastolic blood pressure
(DBP) throughout resuscitation from paediatric asphyxial cardiac arrest.
METHODS: Retrospective, secondary analysis of 200 swine resuscitations. Swine
underwent asphyxial cardiac arrest and were resuscitated with predefined periods
of basic and advanced life support (BLS and ALS, respectively). DBP was recorded
every 30 s. Survival was defined as 20-min sustained return of spontaneous
circulation (ROSC).
RESULTS: During BLS, DBP peaked between 1-3 min and was greater in survivors
(20.0 [11.3, 33.3] mmHg) than in non-survivors (5.0 [1.0, 10.0] mmHg;
p < 0.001). After this transient increase, the DBP in survivors progressively
decreased but remained greater than that of non-survivors after 10 min of
resuscitation (9.0 [6.0, 13.8] versus 3.0 [1.0, 6.8] mmHg; p < 0.001). During
ALS, the magnitude of DBP change after the first adrenaline (epinephrine)
administration was greater in survivors (22.0 [16.5, 36.5] mmHg) than in
non-survivors (6.0 [2.0, 11.0] mmHg; p < 0.001). Survival rate was greater when
DBP improved by ≥26 mmHg after the first dose of adrenaline (20/21; 95%) than
when DBP improved by ≤10 mmHg (1/99; 1%). The magnitude of DBP change after the
first adrenaline administration correlated with the timetoROSC (r = -0.54;
p < 0.001).
CONCLUSIONS: Survival after asphyxial cardiac arrest is associated with a higher
DBP throughout resuscitation, but the difference between survivors and
non-survivors was reduced after prolonged BLS. During ALS, response to
adrenaline administration correlates with survival and time to ROSC. If
confirmed clinically, these findings may be useful for titrating adrenaline
during resuscitation and prognosticating likelihood of ROSC. Institutional
Protocol Numbers: SW14M223 and SW17M101.

Copyright © 2019 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2019.07.030
PMCID: PMC6769417
PMID: 31390531 [Indexed for MEDLINE]

Conflict of interest statement: CONFLICT OF INTEREST STATEMENT We wish to draw

the attention of the Editor to the following facts which may be considered as
potential conflicts of interest. Dr. Hunt has served as a consultant for Zoll
Medical Corporation, which has supplied honoraria and travel expenses for
speaking engagements. Dr. Hunt and colleagues have been awarded patents for
developing several educational simulation technologies for which Zoll Medical
Corporation has a non-exclusive license with the potential for royalties. The
remaining authors have disclosed that they do not have any potential conflicts
of interest. We confirm that the manuscript has been read and approved by all
named authors and that there are no other persons who satisfied the criteria for
authorship but are not listed. We further confirm that the order of authors
listed in the manuscript has been approved by all of us. We confirm that we have
given due consideration to the protection of intellectual property associated
with this work and that there are no impediments to publication, including the
timing of publication, with respect to intellectual property. In so doing we
confirm that we have followed the regulations of our institutions concerning
intellectual property. We further confirm that any aspect of the work covered in
this manuscript that has involved either experimental animals or human patients
has been conducted with the ethical approval of all relevant bodies and that
such approvals are acknowledged within the manuscript. We understand that the
Corresponding Author is the sole contact for the Editorial process (including
Editorial Manager and direct communications with the office). He is responsible
for communicating with the other authors about progress, submissions of
revisions and final approval of proofs. We confirm that we have provided a
current, correct email address which is accessible by the Corresponding Author.

136. Anesth Analg. 2016 Feb;122(2):490-6. doi: 10.1213/ANE.0000000000001049.

The Impact of Monitoring on the Initiation of Cardiopulmonary Resuscitation in
Children: Friend or Foe?

Hörner E(1), Schebesta K, Hüpfl M, Kimberger O, Rössler B.

Author information:
(1)From the *Medical Simulation and Emergency Management Research Group,
Department of Anesthesia, Critical Care and Pain Medicine, Medical University of
Vienna, Austria; and †Department of Anesthesia, Critical Care and Pain Medicine,
Medical University of Vienna, Austria.

BACKGROUND: The immediate initiation and high quality of basic life support
(BLS) are pivotal to improving patient outcome after cardiac arrest. Although
cardiorespiratory monitoring could shorten the time to recognize the onset of
cardiac arrest, little is known about how monitoring and the misinterpretation
of monitor readings could impair the initiation of BLS. In this study, we
assessed the speed of initiation and quality of BLS in simulated monitored and
nonmonitored pediatric cardiac arrest.
METHODS: Sixty residents frequently involved in the care of critically ill
children were randomly assigned to either the intervention (monitoring) group or
the control (nonmonitoring) group. Participants of both groups performed BLS in
1 of 2 clinically identical, unwitnessed simulated cardiac arrest scenarios.
Although in 1 scenario cardiorespiratory monitoring (i.e., electrocardiogram)
was attached, the other scenario reflected a nonmonitored cardiac arrest. Time
to first chest compression was chosen as the primary outcome variable. Adherence
to resuscitation guidelines and subjective performance ratings were secondary
outcome variables.
RESULTS: Participants in the monitoring group initiated chest compressions
significantly later than those in the nonmonitoring group (91 ± 36 vs 71 ± 26
seconds, hazard ratio, 0.26; 95% confidence interval, 0.14-0.49, P < 0.001). Six
members of the monitoring group did not start chest compression within 5
minutes. Furthermore, adherence to the guidelines was better in the
nonmonitoring group. Participants who were previously involved in BLS training
did not show better performance.
CONCLUSIONS: The presence of cardiorespiratory monitoring significantly delayed
or even prevented the initiation of chest compressions and impaired the quality
of BLS in simulated pediatric cardiac arrest. Based on these data, specific
training should be conducted for exposed personnel.

DOI: 10.1213/ANE.0000000000001049
PMID: 26554459 [Indexed for MEDLINE]

137. Med Sci Educ. 2020 Aug 26;30(4):1729-1730. doi: 10.1007/s40670-020-01071-3.

eCollection 2020 Dec.

Integrating First Responder Hands-on Training into Medical School Curricula-a

Perspective from Medical Students.

Nelson T(1), Engberg A(1), Smalheer M(2), Murphy B(2), Csank J(2),
Rowland-Seymour A(1), Noeller T(1)(2).

Author information:
(1)Case Western Reserve University School of Medicine, Cleveland, OH USA.
(2)MetroHealth Simulation Center, Cleveland, OH USA.

An investigation of the effectiveness of an emergency-responder-based program

entitled "First Five Minutes" in teaching medical students the necessary
assessments and procedures upon arrival to a medical crisis situation in a
timely and cost-effective manner. The "First Five" includes scene safety,
primary/secondary survey, airway management, basic life support
(BLS)/cardiopulmonary resuscitation (CPR), and hemorrhage control.

© International Association of Medical Science Educators 2020.

DOI: 10.1007/s40670-020-01071-3
PMCID: PMC8368970
PMID: 34457836

Conflict of interest statement: Conflict of InterestThe authors declare that

there is no conflict of interest.

138. BMC Med Educ. 2017 Sep 12;17(1):161. doi: 10.1186/s12909-017-1005-1.

Paediatric cardiopulmonary resuscitation training program in Latin-America: the

RIBEPCI experience.

López-Herce J(1)(2)(3), Matamoros MM(4), Moya L(5), Almonte E(6), Coronel D(7),
Urbano J(8)(9), Carrillo Á(8)(10)(9); Red de Estudio Iberoamericano de estudio
de la parada cardiorrespiratoria en la infancia (RIBEPCI); Del Castillo J(11),
Mencía S(11), Moral R(11), Ordoñez F(4), Sánchez C(4), Lagos L(4), Johnson
M(12), Mendoza O(12), Rodriguez S(12).

Author information:
(1)Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital,
Paediatrics Department, Faculty of Medicine, Complutense University, Madrid, Dr
Castelo 47, 28009, Madrid, Spain. pielvi@hotmail.com.
(2)Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain.
pielvi@hotmail.com.
(3)Mother-Child and Developmental Health Network (Red SAMID), Subdirección
General de Evaluación y Fomento de la Investigación y el Fondo Europeo de
Desarrollo Regional (FEDER) referencia Instituto de Salud Carlos III
RD12/0026/0001, Madrid, Spain. pielvi@hotmail.com.
(4)Hospital Escuela, Tegucigalpa, Honduras.
(5)Hospital General San Juan de Dios, Ciudad de Guatemala, Guatemala.
(6)Hospital General Plaza de la Salud, Santo Domingo, Dominican Republic.
(7)Centro Nacional para la Salud de la Infancia y la Adolescencia, México,
Distrito Federal, Mexico.
(8)Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital,
Paediatrics Department, Faculty of Medicine, Complutense University, Madrid, Dr
Castelo 47, 28009, Madrid, Spain.
(9)Mother-Child and Developmental Health Network (Red SAMID), Subdirección
General de Evaluación y Fomento de la Investigación y el Fondo Europeo de
Desarrollo Regional (FEDER) referencia Instituto de Salud Carlos III
RD12/0026/0001, Madrid, Spain.
(10)Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain.
(11)Hospital General Universitario Gregorio Marañón, Madrid, Spain.
(12)Hospital del Niño, Ciudad de Panamá, Panamá.

BACKGROUND: To describe the design and to present the results of a paediatric

and neonatal cardiopulmonary resuscitation (CPR) training program adapted to
Latin-America.
METHODS: A paediatric CPR coordinated training project was set up in several
Latin-American countries with the instructional and scientific support of the
Spanish Group for Paediatric and Neonatal CPR. The program was divided into four
phases: CPR training and preparation of instructors; training for instructors;
supervised teaching; and independent teaching. Instructors from each country
participated in the development of the next group in the following country.
Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and
Paediatric Advanced (ALS) courses were organized in each country adapted to
local characteristics.
RESULTS: Five Paediatric Resuscitation groups were created sequentially in
Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6
instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29
Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804
students) were given. At the end of the program all five groups are autonomous
and organize their own instructor courses.
CONCLUSIONS: Training of autonomous Paediatric CPR groups with the collaboration
and scientific assessment of an expert group is a good model program to develop
Paediatric CPR training in low- and middle income countries. Participation of
groups of different countries in the educational activities is an important
method to establish a cooperation network.

DOI: 10.1186/s12909-017-1005-1
PMCID: PMC5596484
PMID: 28899383 [Indexed for MEDLINE]

Conflict of interest statement: ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The

study did not include data of patients. All students agree with the study
maintaining the anonymity. The study was approved by the ethics committee of all
institutions that participated in the study. (Gregorio Marañón Hospital, Madrid,
Spain; Hospital Escuela, Tegucigalpa, Honduras; Hospital General San Juan de
Dios, Ciudad de Guatemala, Guatemala; Hospital General Plaza de la Salud. Santo
Domingo, Republica Dominicana and Centro Nacional para la Salud de la Infancia y
la Adolescencia. México Distrito Federal, México). CONSENT FOR PUBLICATION: Not
applicable. COMPETING INTERESTS: The authors declare that they have no competing
interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.

139. Front Public Health. 2023 Mar 21;11:1124270. doi: 10.3389/fpubh.2023.1124270.

eCollection 2023.

Effectiveness of video self-instruction training on cardiopulmonary

resuscitation retention of knowledge and skills among nurses in north-western
Nigeria.

Saidu A(1)(2), Lee K(1), Ismail I(3)(4), Arulogun O(5), Lim PY(6).

Author information:
(1)Department of Nursing, Faculty of Medicine and Health Sciences, Universiti
Putra Malaysia, Serdang, Selangor, Malaysia.
(2)Federal University Birnin-Kebbi, Birnin Kebbi, Kebbi, Nigeria.
(3)Department of Medicine, Faculty of Medicine and Health Sciences, Universiti
Putra Malaysia, Serdang, Selangor, Malaysia.
(4)RESQ Stroke Emergency Unit, Hospital Sultan Abdul Aziz Shah, Universiti Putra
Malaysia, Serdang, Malaysia.
(5)Department of Health Promotion and Education, Faculty of Public Health,
College of Medicine, University of Ibadan, Ibadan, Nigeria.
(6)Department of Community Health, Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia, Serdang, Selangor, Malaysia.

BACKGROUND: Adaptable cardiopulmonary resuscitation/basic life support (CPR/BLS)

training are required to reduce cardiac arrest mortality globally, especially
among nurses. Thus, this study aims to compared CPR knowledge and skills
retention level between instructor-led (control group) and video
self-instruction training (intervention group) among nurses in northwestern
Nigeria.
METHODS: A two-arm randomized controlled trial study using double blinding
method was conducted with 150 nurses from two referral hospitals. Stratified
simple random method was used to choose eligible nurses. For video
self-instruction training (intervention group), participants learnt the CPR
training via computer in a simulation lab for 7 days, in their own available
time whereas for instructor-led training (control group), a 1-day program was
conducted by AHA certified instructors. A generalized estimated equation model
was used for statistical analysis.
RESULTS: Generalized Estimated Equation showed that there were no significant
differences between the intervention group (p = 0.055) and control group (p =
0.121) for both CPR knowledge and skills levels respectively, whereas higher
probability of having good knowledge and skills in a post-test, one month and
three-month follow-up compared to baseline respectively, adjusted with
covariates (p < 0.05). Participants had a lower probability of having good
skills at 6-month follow-up compared to baseline, adjusted with covariates (p =
0.003).
CONCLUSION: This study showed no significant differences between the two
training methods, hence video self-instruction training is suggested can train
more nurses in a less cost-effective manner to maximize resource utilization and
quality nursing care. It is suggested to be used to improve knowledge and skills
among nurses to ensure cardiac arrest patients receive excellent resuscitation
care.

Copyright © 2023 Saidu, Lee, Ismail, Arulogun and Lim.

DOI: 10.3389/fpubh.2023.1124270
PMCID: PMC10070802
PMID: 37026136 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.

140. Resuscitation. 2008 Jul;78(1):59-65. doi: 10.1016/j.resuscitation.2008.02.007.

Epub 2008 Apr 10.

Evaluation of staff's retention of ACLS and BLS skills.

Smith KK(1), Gilcreast D, Pierce K.

Author information:
(1)US Army ISR/Burn Center Consultant OTSG, Critical Care Nursing US Army,
Institute of Surgical Research, Fort Sam Houston, San Antonio, TX 78234, USA.
kimberly.k.smith@amedd.army.mil

OBJECTIVES/PURPOSE: To test registered nurses' abilities to retain basic or

advanced life support psychomotor skills and theoretical knowledge.
DESIGN: A repeated-measures, quasi-experimental design was used.
METHODS: Written and performance tests (initial, post-training, and final
testing) used scenarios requiring performance of advanced cardiac life support
(ACLS) or basic life support (BLS) skills. Final testing was by random
assignment to 3, 6, 9, or 12 months.
SAMPLE: A convenience sample (n=133) was used.
INSTRUMENTATION: American Heart Association 2000 ACLS and BLS evaluation tools
were used in a simulated testing environment.
FINDINGS: Findings show nurses retain theoretical knowledge but performance
skills degrade quickly. ACLS skills degrade faster than BLS skills with 63%
passing BLS at 3 months and 58% at 12 months. Only 30% of participants passed
ACLS skills at 3 months and 14% at 12 months. These findings are similar to the
results of other investigators in over a decade of research.
CONCLUSIONS: Study results showed a decline in skills retention with nurses
unable to perform ACLS and BLS skills to standard for the entire certification
period. The need for more frequent refresher training is needed. No formal
research at this institution indicates skill degradation adversely affected
patient outcomes. Further research on ACLS and BLS course content, design,
management, and execution is needed.

DOI: 10.1016/j.resuscitation.2008.02.007
PMID: 18406037 [Indexed for MEDLINE]

141. Postgrad Med J. 2012 Jun;88(1040):312-6. doi: 10.1136/pgmj-2009-074518rep.

Republished: Simulation training improves ability to manage medical emergencies.

Ruesseler M(1), Weinlich M, Müller MP, Byhahn C, Marzi I, Walcher F.

Author information:
(1)Department of Trauma Surgery, J.W. Goethe University Hospital,
Theodor-Stern-Kai 7, Frankfurt 60590, Germany. miri@mruesseler.de

Republished from
Emerg Med J. 2010 Oct;27(10):734-8. doi: 10.1136/emj.2009.074518.

OBJECTIVE: In the case of an emergency, fast and structured patient management

is crucial for a patient's outcome. Every physician and graduate medical student
should possess basic knowledge of emergency care and the skills to manage common
emergencies. This study determines the effect of a simulation-based curriculum
in emergency medicine on students' abilities to manage emergency situations.
METHODS: A controlled, blinded educational trial of 44 final-year medical
students was carried out at Frankfurt Medical School; 22 students completed the
former curriculum as the control group and 22 the new curriculum as the
intervention group. The intervention consists of simulation-based training with
theoretical and simulation-based training sessions in realistic encounters based
on the Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and
adapted Advanced Trauma Life Support (ATLS) training. Further common emergencies
were integrated corresponding to the course objectives. All students faced a
performance-based assessment in a 10 station Objective Structured Clinical
Examination (OSCE) using checklist rating within a maximum of 4 months after
completion of the intervention.
RESULTS: The intervention group performed significantly better at all of the 10
OSCE stations in the checklist rating (p<0.0001 to p=0.016).
CONCLUSIONS: The simulation-based intervention offers a positively evaluated
possibility to enhance students' skills in recognising and handling emergencies.
Additional studies are required to measure the long-term retention of the
acquired skills, as well as the effect of training in healthcare professionals.

DOI: 10.1136/pgmj-2009-074518rep
PMID: 22586148

142. Lancet. 1981 Sep 26;2(8248):679-81. doi: 10.1016/s0140-6736(81)91008-4.

Cardiopulmonary resuscitation by medical and surgical house-officers.

Lowenstein SR, Hansbrough JF, Libby LS, Hill DM, Mountain RD, Scoggin CH.

In teaching hospitals the responsibility for cardiopulmonary resuscitation

usually rests with the house-staff, yet most house-officers receive no formal
training in life support. The life-support skills of 45 medical and surgical
house-officers in a university teaching hospital were tested by means of
simulated cardiac arrests. House-officers were graded on the basis of a
performance checklist derived from the standards of the American Heart
Association. No house-officer received a pass score in basic life support (BLS).
Only 29% could properly compress and ventilate the mannequin. In advanced
cardiac life support (ACLS) only one-third could intubate in 35 s or less; only
31%, 40%, and 33% could manage ventricular fibrillation, asystole, and complete
heart block, respectively. Some house-officers were unable to operate the
defibrillator or assemble resuscitation equipment. Many house-officers displayed
helplessness and anxiety during the simulations; fourteen (40%) were prompted to
register for additional advanced life-support courses. The performance of
medical and surgical house-officers was equal. House-officers who had received
prior life-support training performed better in BLS (p less than 0.001) but not
in ACLS. It was concluded that (a) most medical and surgical house-officers are
not reasonably proficient in BLS and ACLS, and (b) cardiac arrest simulation is
a motivating exercise which permits analysis of each house-officer's
life-support skills. House-officers should have more training and practice in
life support, or they should not have primary responsibility for cardiopulmonary
resuscitations.

DOI: 10.1016/s0140-6736(81)91008-4
PMID: 6116054 [Indexed for MEDLINE]

143. Rev Esc Enferm USP. 2016 Nov-Dec;50(6):990-997. doi:

10.1590/S0080-623420160000700016.

Development of a virtual learning environment for cardiorespiratory arrest

training.

[Article in English, Portuguese]

Silva AC(1), Bernardes A(1), Évora YD(1), Dalri MC(1), Silva AR(2), Sampaio
CS(1).

Author information:
(1)Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão
Preto, SP, Brazil.
(2)Valpamed Emergências Médicas, Ribeirão Preto, SP, Brazil.

OBJECTIVE: To develop a Virtual Learning Environment (VLE) aiming at the

training of nursing team workers and emergency vehicle drivers in Basic Life
Support (BLS) to attend Cardiorespiratory arrest, and to evaluate the quality of
its contents among specialists in the area of Emergency and Urgent care.
METHOD: Applied research of technological development. The methodology used was
based on the Instructional Design Model (ADDIE), which structures the
teaching-learning planning in different stages (analysis, design, development,
implementation and evaluation). The VLE was composed of texts elaborated from
bibliographic research, links, edited video from a simulation scenario in the
laboratory and questions to evaluate the fixation of the content, organized in
modules.
RESULTS: After its development, it was evaluated as adequate to satisfy the
needs of the target public, by eight expert judges, which was made available for
electronic access.
CONCLUSION: The VLE has potential as a tool for training and qualification in
BLS, as it can be easily integrated with other pedagogical approaches and
strategies with active methodologies.
OBJETIVO: Desenvolver um Ambiente Virtual de Aprendizagem (AVA) visando à
capacitação de trabalhadores da equipe de enfermagem e condutores de veículo de
emergência em Suporte Básico de Vida (SBV) no atendimento à Parada
Cardiorrespiratória, e avaliar a qualidade do seu conteúdo junto a especialistas
na área de Urgência e Emergência.
MÉTODO: Pesquisa aplicada, de produção tecnológica. A metodologia utilizada foi
baseada no Modelo de Design Instrucional (ADDIE), que estrutura o planejamento
de ensino-aprendizagem em estágios distintos (analysis, design, development,
implementation and evaluation). O AVA foi composto por textos elaborados a
partir de pesquisa bibliográfica, links, vídeo construído a partir de um cenário
de simulação em laboratório e questões para avaliar a fixação do conteúdo,
organizados em módulos.
RESULTADOS: Após a sua construção, foi avaliado como adequado para satisfazer às
necessidades do público-alvo, por oito juízes especialistas, sendo
disponibilizado para acesso eletrônico.
CONCLUSÃO: O AVA tem potencial como ferramenta para formação e capacitação em
SBV porser facilmente integrado a outras abordagens pedagógicas e estratégias
com metodologias ativas.

DOI: 10.1590/S0080-623420160000700016
PMID: 28198965 [Indexed for MEDLINE]

144. Simul Healthc. 2019 Dec;14(6):366-371. doi: 10.1097/SIH.0000000000000388.

Evaluating Best Methods for Crisis Resource Management Education: Didactic

Teaching or Noncontextual Active Learning.

Saravana-Bawan BB(1), Fulton C, Riley B, Katulka J, King S, Paton-Gay D, Widder

S.

Author information:
(1)From the University of Alberta (B.B.S.-B., B.R., J.K., S.K., D.P.-G., S.W.),
Edmonton, Alberta, Canada; and Community Hospital (C.F.), Grand Junction CO.

INTRODUCTION: Health care training traditionally focuses on medical knowledge;

however, this is not the only component of successful patient management.
Nontechnical skills, such as crisis resource management (CRM), have significant
impact on patient care. This study examines whether there is a difference in CRM
skills taught by traditional lecture in comparison with low-fidelity simulation
consisting of noncontextual learning through team problem-solving activities.
METHODS: Two groups of multidisciplinary preclinical students were taught CRM
through lecture or noncontextual active learning. Both groups were given a
cardiopulmonary resuscitation simulation and clinical performance assessed by
basic life support (BLS) checklist and CRM skills by Ottawa Global Rating Scale.
The groups were reassessed at 4 months. A third group, who received no CRM
education, served as a control group.
RESULTS: The mean BLS scores after CRM education were 18.9 and 24.9 with mean
Ottawa Global Rating Scale (GRS) scores of 22.4 and 29.1 in the didactic
teaching and noncontextual groups, respectively. The difference between
intervention groups was significant for BLS (P = 0.02) and Ottawa GRS (P = 0.03)
score. At 4-month follow-up, there was no statistically significant difference
in BLS (P = 1.0) or Ottawa GRS score (P = 0.55) between intervention groups. In
comparison with the control group, there was a marginally significant difference
in Ottawa GRS score (P = 0.06) at 4-month follow-up.
CONCLUSIONS: Noncontextual active learning of CRM using low-fidelity simulation
results in improved CRM performance in comparison with didactic teaching. The
benefits of CRM education do not seem to be sustained after one education
session, suggesting the need for continued education and practice of skills to
improve retention.

DOI: 10.1097/SIH.0000000000000388
PMID: 31490864 [Indexed for MEDLINE]

145. Intern Emerg Med. 2023 Aug;18(5):1551-1559. doi: 10.1007/s11739-023-03251-6.

Epub 2023 Apr 4.

Are smart glasses feasible for dispatch prehospital assistance during on-boat
cardiac arrest? A pilot simulation study with fishermen.

Barcala-Furelos R(1)(2), Aranda-García S(3)(4), Otero-Agra M(1)(5),

Fernández-Méndez F(1)(2)(6)(5), Alonso-Calvete A(1)(7), Martínez-Isasi
S(2)(6)(8), Greif R(9)(10), Rodríguez-Núñez A(2)(6)(8)(11).

Author information:
(1)REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade
de Vigo, Pontevedra, Spain.
(2)CLINURSID Research Group, School of Nursing, Universidade de Santiago de
Compostela, Santiago de Compostela, Spain.
(3)CLINURSID Research Group, School of Nursing, Universidade de Santiago de
Compostela, Santiago de Compostela, Spain. silvia.aranda@rai.usc.es.
(4)GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya
(INEFC), Universitat de Barcelona, Av. De l'Estadi 22, 08038, Barcelona, Spain.
silvia.aranda@rai.usc.es.
(5)School of Nursing from Pontevedra, Universidade de Vigo, Pontevedra, Spain.
(6)Life Support and Medical Simulation Research Group (SICRUS), Health Research
Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
(7)Faculty of Physiotherapy, Universidade de Vigo, Pontevedra, Spain.
(8)Faculty of Nursing, Universidade de Santiago de Compostela, Santiago de
Compostela, Spain.
(9)University of Bern, Bern, Switzerland.
(10)School of Medicine, Sigmund Freud University Vienna, Vienna, Austria.
(11)Paediatric Critical, Intermediate and Palliative Care Section, Santiago de
Compostela's University Hospital, Santiago de Compostela, Spain.

The aim of the study was to explore feasibility of basic life support (BLS)
guided through smart glasses (SGs) when assisting fishermen bystanders. Twelve
participants assisted a simulated out-of-hospital cardiac arrest on a fishing
boat assisted by the dispatcher through the SGs. The SGs were connected to make
video calls. Feasibility was assessed whether or not they needed help from the
dispatcher. BLS-AED steps, time to first shock/compression, and CPR's quality
(hands-only) during 2 consecutive minutes (1st minute without dispatcher
feedback, 2nd with dispatcher feedback) were analyzed. Reliability was analyzed
by comparing the assessment of variables performed by the dispatcher through SGs
with those registered by an on-scene instructor. Assistance through SGs was
needed in 72% of the BLS steps, which enabled all participants to perform the
ABC approach and use AED correctly. Feasibility was proven that dispatcher's
feedback through SGs helped to improve bystanders' performance, as after
dispatcher gave feedback via SGs, only 3% of skills were incorrect. Comparison
of on-scene instructor vs. SGs assessment by dispatcher differ in 8% of the
analyzed skills: greatest difference in the "incorrect hand position during CPR"
(on-scene: 33% vs. dispatcher: 0%). When comparing the 1st minute with 2nd
minute, there were only significant differences in the percentage of
compressions with correct depth (1st:48 ± 42%, 2nd:70 ± 31, p = 0.02). Using SGs
in aquatic settings is feasible and improves BLS. CPR quality markers were
similar with and without SG. These devices have great potential for
communication between dispatchers and laypersons but need more development to be
used in real emergencies.

© 2023. The Author(s).

DOI: 10.1007/s11739-023-03251-6
PMCID: PMC10412669
PMID: 37014496 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare they have no conflict of

interest to declare regarding this article.

146. Resuscitation. 2007 Dec;75(3):491-8. doi: 10.1016/j.resuscitation.2007.05.014.

Epub 2007 Jul 12.

A web-based micro-simulation program for self-learning BLS skills and the use of
an AED. Can laypeople train themselves without a manikin?

de Vries W(1), Handley AJ.

Author information:
(1)Department of Education and Development, Doczero, Rondweg 29, NL-5406 NK
Uden, The Netherlands. vriesw@xs4all.nl

AIM: Various methods, including self-instruction, have been used to try to

improve the acquisition of basic life support skills. This is a preliminary
report of the effectiveness of a web-based self-training program for BLS and the
use of an AED.
METHODS: Sixteen volunteers completed on-line training in their own time over a
period of 8 weeks. The program included theory, scenario training and
self-testing, but without practice on a manikin, or any instructor input. The
volunteers were assessed, without prior warning, in a scenario setting. A
recording manikin, expert assessors and video recording were used with a
modified version of the Cardiff Test.
RESULTS: All 16 volunteers performed the assessed skills in the use of an AED
correctly. Most of the skills of BLS assessed were performed well. Chest
compression depth and rate were performed less well (59% and 67% of
participants, respectively, performed correctly). Opening the airway and lung
inflation were performed poorly (38% and 13% of participants performed
correctly), as was checking for safety (19% participants performed correctly).
There was no significant correlation between the time a participant spent
on-line and the quality of performance. Only 5 of the volunteers had ever
attended a BLS course or used a resuscitation manikin before the assessment;
their performance scores were not significantly better than those of the other
11 volunteers.
CONCLUSION: These results suggest that it may be possible to train people in BLS
and AED skills using a micro-simulation web-based interactive program but
without any practice on a manikin. This seems to be particularly the case for
the use of an AED, where performance achieved a uniformly high standard.

DOI: 10.1016/j.resuscitation.2007.05.014
PMID: 17629390 [Indexed for MEDLINE]

147. Scand J Trauma Resusc Emerg Med. 2024 Jun 4;32(1):50. doi:
10.1186/s13049-024-01226-w.

Online training to improve BLS performance with dispatcher assistance? Results

of a cluster-randomised controlled simulation trial.

Bathe J(1), Daubmann A(2), Doehn C(1), Napp A(1), Raudies M(3), Beck S(4).

Author information:
(1)Centre of Anaesthesiology and Intensive Care Medicine, Hamburg-Eppendorf
University Medical Centre, Hamburg, Germany.
(2)Department of Medical Biometry and Epidemiology, Hamburg-Eppendorf University
Medical Centre, Hamburg, Germany.
(3)Hamburg Fire Brigade, Hamburg, Germany.
(4)Centre of Anaesthesiology and Intensive Care Medicine, Hamburg-Eppendorf
University Medical Centre, Hamburg, Germany. st.beck@uke.de.

BACKGROUND: The prognosis for patients improves significantly with effective

cardiopulmonary resuscitation (CPR) performed by bystanders. Current research
indicates that individuals who receive CPR from trained bystanders have a
greater likelihood of survival compared to those who receive dispatcher-assisted
CPR from untrained laypersons. This cluster-randomised controlled trial assessed
the impact of a 30-min online training session prior to a simulated cardiac
arrest situation with dispatcher-assisted CPR (DA-CPR) on enhancing Basic Life
Support (BLS) performance.
METHODS: This study was performed in 2018 in Hamburg, Germany. The primary
outcome was the practical BLS skills of high school students in simulated
out-of-hospital cardiac arrest scenarios with dispatcher assistance. The
intervention group participants underwent a 30-min online BLS training session,
while the control group did not receive an intervention. It was hypothesized
that the average practical BLS scores of the intervention group would be 1.5
points higher than those of the control group.
RESULTS: BLS assessments of 286 students of 16 different classes were analysed.
The estimated mean BLS score in the intervention group was 7.60 points (95% CI:
6.76 to 8.44) compared to 6.81 (95% CI: 5.97 to 7.65) in the control group
adjusted for BLS training and class. Therefore, the estimated mean difference
between the groups was 0.79 (95% CI: -0.40 to 1.97) and not significantly
different (p-value: 0.176). Based on a logistic regression analysis the
intervention had only a significant effect on the chance to pass the item
"vertically above the chest" (OR = 4.99; 95% CI: 1.46 to 17.12) adjusted for BLS
training and class.
CONCLUSION: Prior online training exhibits beneficial impacts on the BLS
performance of bystanders during DA-CPR. To maximise the effect size, online
training should be incorporated into a set of interventions that are mutually
complementary and specifically designed for the target participants.
TRIAL REGISTRATION: DRKS00033531 . "Kann online Training Laien darauf
vorbereiten Reanimationsmaßnahmen unter Anleitung der Leitstelle adäquat
durchzuführen? " Registered on January 29, 2024.

© 2024. The Author(s).

DOI: 10.1186/s13049-024-01226-w
PMCID: PMC11149242
PMID: 38835039 [Indexed for MEDLINE]

Conflict of interest statement: None.

148. Eur Arch Paediatr Dent. 2018 Jun;19(3):133-138. doi: 10.1007/s40368-018-0338-

8.
Epub 2018 May 10.

Evaluation of knowledge of students in paediatric dentistry concerning

cardiopulmonary resuscitation skills in children.

De Mauro LM(1), Oliveira LB(2), Bergamaschi CC(3), Ramacciato JC(4), Motta

RHL(4).

Author information:
(1)Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
(2)Division of Pediatric Dentistry, Faculdade São Leopoldo Mandic, São Leopoldo
Mandic School of Dentistry, Rua José Rocha Junqueira, 13, Campinas, SP,
13045-755, Brazil. lubutini@uol.com.br.
(3)Department of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba,
São Paulo, Brazil.
(4)Division of Pharmacology, Anesthesiology, and Therapeutics, Faculdade São
Leopoldo Mandic, Campinas, SP, Brazil.

AIM: The study evaluated the theoretical knowledge and practical ability of
students in paediatric dentistry concerning basic life support (BLS) and
cardiopulmonary resuscitation (CPR) in children and babies.
METHODS: Seventy paediatric dentistry students answered a questionnaire and also
performed a simulation of the manoeuvres of BLS and CPR on baby and child
manikins.
RESULTS: The results showed that 41 (58%) students had never received BLS
training. When questioned about the correct ratio of compression and ventilation
during CPR, most students answered incorrectly. For the CPR of babies in the
presence of a first responder only 19 (27.1%) answered correctly (30 × 2), and
for babies with two rescuers, 23 (32.8%) answered correctly (15 × 2); in
relation to the correct rhythm of chest compressions, 38 (54.4%) answered
incorrectly; when asked if they felt prepared to deal with a medical emergency
in their dental surgeries, only 12 (17.1%) stated "yes". In the practice
evaluation, 51 (73%) students who had been assessed in CPR manoeuvres for
children and 55 (78%) in the manoeuvres for babies scored inadequately.
CONCLUSIONS: The evaluated students did not have adequate knowledge about CPR in
children and babies.

DOI: 10.1007/s40368-018-0338-8
PMID: 29750427 [Indexed for MEDLINE]

149. Porto Biomed J. 2018 Jul 3;3(1):e8. doi: 10.1016/j.pbj.0000000000000008.

eCollection 2018 Aug.

Evaluation of skills acquisition using a new low-cost tool for CPR

self-training.

Sá-Couto C(1)(2)(3)(4), Ferreira AM(2)(5)(4), Almeida D(4), Nicolau A(1)(2)(6),

Vieira-Marques P(2)(5)(4).

Author information:
(1)Biomedical Simulation Center.
(2)Center for Health Technology and Services Research (CINTESIS).
(3)Department of Public Health and Forensic Sciences, and Medical Education.
(4)Faculty of Medicine of University of Porto.
(5)Informatics Service.
(6)Faculty of Engineering of University of Porto, Porto, Portugal.

BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) remains essential

to improve the outcome of patients in sudden cardiorespiratory arrest. Feedback
on performance is a crucial component of the learning processes associated with
simulation and has been shown to improve CPR quality during simulated cardiac
arrest on mannequins. This study aims to evaluate skills acquisition using a new
low-cost feedback device for CPR self-training when compared to standard
training methods.
METHODS: Thirty-nine pregraduated medical and biomedical engineering students
were recruited for a longitudinal double-blinded randomized control study. For
training Basic Life Support skills, the control group used a standard
task-trainer and received feedback from an instructor. The intervention group
used the same standard task-trainer, instrumented with the CPR Personal Trainer
that provided automated performance feedback (with no instructor) on
compression-related parameters. Students' knowledge and skills were assessed
before and after training, through a theoretical knowledge test and 2 minutes of
CPR practical performance.
RESULTS: The theoretical tests showed an improvement both in the intervention
and in the control group. For each compression-related parameters (hands
position, recoil, rate, and depth), significant increase in scores is observed,
between the pre- and the post-test, in both groups. The intervention and control
groups presented identical mean differences for the total score (0.72 vs 0.72),
with no statistical difference (P = 0.754).
CONCLUSIONS: The proposed tool proved to be effective in the acquisition of
compression-related skills, with similar outcomes as the traditional
instructor-based method, corroborating the hypothesis that a low-cost tool with
feedback for CPR self-training can provide an alternative or a complementary
extension to traditional training methods. The system can also be considered
cost-efficient as it reduces the permanent presence of an instructor for the
chest compressions training, promoting regular training outside formal training
courses.

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf
of PBJ-Associação Porto Biomedical/Porto Biomedical Society. All rights
reserved.

DOI: 10.1016/j.pbj.0000000000000008
PMCID: PMC6726303
PMID: 31595234

Conflict of interest statement: Sponsorships or competing interests that may be

relevant to content are disclosed at the end of this article.The authors declare
no conflicts of interest.

150. Med Teach. 2024 Nov 13:1-8. doi: 10.1080/0142159X.2024.2427735. Online ahead
of
print.

The importance of combined use of spacing and testing effects for complex skills
training: A quasi-experimental study.

Soares RV(1), Pedrosa RBDS(2), Sandars J(3), Cecilio-Fernandes D(1)(4).

Author information:
(1)School of Medical Sciences, University of Campinas, Campinas, Brazil.
(2)School of Nursing, University of Campinas, Campinas, Brazil.
(3)Health Research Institute, Edge Hill University, Ormskirk, UK.
(4)Institute of Medical Education Research Rotterdam, Erasmus MC University
Medical Centre Rotterdam, Rotterdam, The Netherlands.
INTRODUCTION: A major challenge is retention of complex clinical skills. Spacing
training and testing have been demonstrated to increase knowledge and skill
retention but the combination has not been previously investigated in complex
clinical skills. The aim of our study was to compare the effectiveness of
combined spacing and testing for Basic Life Support (BLS) and Advance Life
Support (ALS) simulation training in one group (intervention group), with
combined spacing and testing, and another group (control) that received
simulation training in a single-session simulation training without testing.
METHODS: A quasi-experimental study.
RESULTS: Thirteen nursing students were in the intervention group and 18 in the
control group. After three months, there was no significant reduction in
retention of BLS knowledge (p > 0.05) or BLS skills (p < 0.05) in the
intervention group, but there was a significant reduction in both (p < 0.05) in
the control group. We found no significant reduction in retention of ALS
knowledge in the control group (p > 0.05), but there was a significant reduction
in the intervention group (p < 0.05). There was no significant decay of ALS
skills in both groups (p < 0.05).
DISCUSSION: This is the first study to demonstrate that combined spacing and
testing could be highly effective for complex skills simulation training to
increase retention after three months.

DOI: 10.1080/0142159X.2024.2427735
PMID: 39535960

151. Scand J Trauma Resusc Emerg Med. 2016 May 13;24:70. doi:
10.1186/s13049-016-0265-9.

Short structured feedback training is equivalent to a mechanical feedback device

in two-rescuer BLS: a randomised simulation study.

Pavo N(1), Goliasch G(1), Nierscher FJ(2), Stumpf D(3), Haugk M(4), Breckwoldt
J(5), Ruetzler K(6), Greif R(7), Fischer H(8).

Author information:
(1)Department of Cardiology, Medical University of Vienna, Vienna, Austria.
(2)Department of Anaesthesia, General Intensive Care and Pain Control, AUVA
Lorenz Böhler Trauma Hospital, Vienna, Austria.
(3)Hospital of the Sisters of Charity Linz, Linz, Austria.
(4)Department of Emergency Medicine, Medical University of Vienna, Vienna,
Austria.
(5)Faculty of Medicine, University of Zurich, Zurich, Switzerland.
(6)Institute of Anaesthesiology, University and University Hospital Zurich,
Zurich, Switzerland.
(7)Department of Anaesthesiology and Pain Therapy, University Hospital Bern and
University of Bern, Inselspital, 3010, Bern, Switzerland. Robert.Greif@insel.ch.
(8)Federal Ministry of the Interior and Sigmund Freud University Vienna, Vienna,
Austria.

BACKGROUND: Resuscitation guidelines encourage the use of cardiopulmonary

resuscitation (CPR) feedback devices implying better outcomes after sudden
cardiac arrest. Whether effective continuous feedback could also be given
verbally by a second rescuer ("human feedback") has not been investigated yet.
We, therefore, compared the effect of human feedback to a CPR feedback device.
METHODS: In an open, prospective, randomised, controlled trial, we compared CPR
performance of three groups of medical students in a two-rescuer scenario. Group
"sCPR" was taught standard BLS without continuous feedback, serving as control.
Group "mfCPR" was taught BLS with mechanical audio-visual feedback (HeartStart
MRx with Q-CPR-Technology™). Group "hfCPR" was taught standard BLS with human
feedback. Afterwards, 326 medical students performed two-rescuer BLS on a
manikin for 8 min. CPR quality parameters, such as "effective compression ratio"
(ECR: compressions with correct hand position, depth and complete decompression
multiplied by flow-time fraction), and other compression, ventilation and
time-related parameters were assessed for all groups.
RESULTS: ECR was comparable between the hfCPR and the mfCPR group (0.33 vs.
0.35, p = 0.435). The hfCPR group needed less time until starting chest
compressions (2 vs. 8 s, p < 0.001) and showed fewer incorrect decompressions
(26 vs. 33 %, p = 0.044). On the other hand, absolute hands-off time was higher
in the hfCPR group (67 vs. 60 s, p = 0.021).
CONCLUSIONS: The quality of CPR with human feedback or by using a mechanical
audio-visual feedback device was similar. Further studies should investigate
whether extended human feedback training could further increase CPR quality at
comparable costs for training.

DOI: 10.1186/s13049-016-0265-9
PMCID: PMC4866361
PMID: 27177424 [Indexed for MEDLINE]

152. Simul Healthc. 2018 Dec;13(6):376-386. doi: 10.1097/SIH.0000000000000339.

Comparative Analysis of Emergency Medical Service Provider Workload During

Simulated Out-of-Hospital Cardiac Arrest Resuscitation Using Standard Versus
Experimental Protocols and Equipment.

Asselin N(1), Choi B, Pettit CC, Dannecker M, Machan JT, Merck DL, Merck LH,
Suner S, Williams KA, Baird J, Jay GD, Kobayashi L.

Author information:
(1)From the Department of Emergency Medicine (N.A., B.C., L.H.M., S.S., K.A.W.,
J.B., L.K., G.D.J.), Alpert Medical School of Brown University, Providence, RI;
Emergency Department (C.C.P.), Tobey Hospital, Wareham, MA; Lifespan Medical
Simulation Center (M.D.); Biostatistics Core (J.T.M.), Rhode Island Hospital;
Departments of Diagnostic Imaging (D.L.M., L.H.M.) and Neurosurgery (L.H.M.),
Alpert Medical School of Brown University; and School of Engineering (G.D.J.),
Brown University, Providence, RI.

INTRODUCTION: Protocolized automation of critical, labor-intensive tasks for

out-of-hospital cardiac arrest (OHCA) resuscitation may decrease Emergency
Medical Services (EMS) provider workload. A simulation-based assessment method
incorporating objective and self-reported metrics was developed and used to
quantify workloads associated with standard and experimental approaches to OHCA
resuscitation.
METHODS: Emergency Medical Services-Basic (EMT-B) and advanced life support
(ALS) providers were randomized into two-provider mixed-level teams and fitted
with heart rate (HR) monitors for continuous HR and energy expenditure (EE)
monitoring. Subjects' resting salivary α-amylase (sAA) levels were measured
along with Borg perceived exertion scores and multidimensional workload
assessments (NASA-TLX). Each team engaged in the following three OHCA
simulations: (1) baseline simulation in standard BLS/ALS roles; (2) repeat
simulation in standard roles; and then (3) repeat simulation in reversed roles,
ie, EMT-B provider performing ALS tasks. Control teams operated with standard
state protocols and equipment; experimental teams used resuscitation-automating
devices and accompanying goal-directed algorithmic protocol for simulations 2
and 3. Investigators video-recorded resuscitations and analyzed subjects'
percent attained of maximal age-predicted HR (%mHR), EE, sAA, Borg, and NASA-TLX
measurements.
RESULTS: Ten control and ten experimental teams completed the study (20
EMT-Basic; 1 EMT-Intermediate, 8 EMT-Cardiac, 11 EMT-Paramedic). Median %mHR,
EE, sAA, Borg, and NASA-TLX scores did not differ between groups at rest.
Overall multivariate analyses of variance did not detect significant
differences; univariate analyses of variance for changes in %mHR, Borg, and
NASA-TLX from resting state detected significant differences across simulations
(workload reductions in experimental groups for simulations 2 and 3).
CONCLUSIONS: A simulation-based OHCA resuscitation performance and workload
assessment method compared protocolized automation-assisted resuscitation with
standard response. During exploratory application of the assessment method,
subjects using the experimental approach appeared to experience reduced levels
of physical exertion and perceived workload than control subjects.

DOI: 10.1097/SIH.0000000000000339
PMID: 30407958 [Indexed for MEDLINE]

153. Scand J Trauma Resusc Emerg Med. 2020 Sep 10;28(1):91. doi:
10.1186/s13049-020-00785-y.

Consistency and variability in human performance during simulate infant CPR: a

reliability study.

Almeida D(1)(2), Clark C(3), Jones M(4), McConnell P(5), Williams J(6).

Author information:
(1)Faculty of Health and Social Sciences, Bournemouth University, R604, Royal
London House, Christchurch Road, Bournemouth, BH1 3LT, England.
almeidad@bournemouth.ac.uk.
(2)Department of Anesthesiology, Main Theatres, Royal Bournemouth and
Christchurch Hospitals, Castle Lane East, Bournemouth, BH7 7DW, England.
almeidad@bournemouth.ac.uk.
(3)Faculty of Health and Social Sciences, Bournemouth University, R612, Royal
London House, Christchurch Road, Bournemouth, BH1 3LT, England.
(4)Cardiff School of Engineering, Cardiff University, Cardiff, CF23 3AA, Wales.
(5)Resuscitation Services, Heart Club, Royal Bournemouth Hospital, Castle Lane
East, Bournemouth, BH7 7DW, England.
(6)Faculty of Health and Social Sciences, Bournemouth University, R611, Royal
London House, Christchurch Road, Bournemouth, BH1 3LT, England.

BACKGROUND: Positive outcomes from infant cardiac arrest depend on the effective
delivery of resuscitation techniques, including good quality infant
cardiopulmonary resuscitation (iCPR) However, it has been established that iCPR
skills decay within weeks or months after training. It is not known if the
change in performance should be considered true change or inconsistent
performance. The aim of this study was to investigate consistency and
variability in human performance during iCPR.
METHODS: An experimental, prospective, observational study conducted within a
university setting with 27 healthcare students (mean (SD) age 32.6 (11.6) years,
74.1% female). On completion of paediatric basic life support (BLS) training,
participants performed three trials of 2-min iCPR on a modified infant manikin
on two occasions (immediately after training and after 1 week), where
performance data were captured. Main outcome measures were within-day and
between-day repeated measures reliability estimates, determined using Intraclass
Correlation Coefficients (ICCs), Standard Error of Measurement (SEM) and Minimal
Detectable Change (MDC95%) for chest compression rate, chest compression depth,
residual leaning and duty cycle along with the conversion of these into quality
indices according to international guidelines.
RESULTS: A high degree of reliability was found for within-day and between-day
for each variable with good to excellent ICCs and narrow confidence intervals.
SEM values were low, demonstrating excellent consistency in repeated
performance. Within-day MDC values were low for chest compression depth and
chest compression rate (6 and 9%) and higher for duty cycle (15%) and residual
leaning (22%). Between-day MDC values were low for chest compression depth and
chest compression rate (3 and 7%) and higher for duty cycle (21%) and residual
leaning (22%). Reliability reduced when metrics were transformed in quality
indices.
CONCLUSION: iCPR skills are highly repeatable and consistent, demonstrating that
changes in performance after training can be considered skill decay. However,
when the metrics are transformed in quality indices, large changes are required
to be confident of real change.

DOI: 10.1186/s13049-020-00785-y
PMCID: PMC7488154
PMID: 32912284 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no competing
interests.

154. Jt Comm J Qual Patient Saf. 2019 Dec;45(12):789-797. doi:

10.1016/j.jcjq.2019.08.010. Epub 2019 Oct 18.

Implementation of a Low-Dose, High-Frequency Cardiac Resuscitation Quality

Improvement Program in a Community Hospital.

Dudzik LR(1), Heard DG(2), Griffin RE(3), Vercellino M(4), Hunt A(5), Cates
A(6), Rebholz M(7).

Author information:
(1)College of Nursing and Health Sciences, Lewis University, Romeoville,
Illinois; AHA Instructor and Get With The Guidelines(Ⓡ)-Resuscitation Data
Abstractor, Edward Hospital, Naperville, Illinois. Electronic address:
lornardudzik@lewisu.edu.
(2)American Heart Association, Dallas.
(3)Strategic Research and Innovation, RQI Partners, LLC, Dallas.
(4)Clinical Education, Edward Hospital and Health Services, Naperville.
(5)Simulation and Training, Edward-Elmhurst Health, Naperville.
(6)RQI Partners, LLC, Chicago.
(7)Illinois Valley Community Hospital, Peru, Illinois.

BACKGROUND: In 2015 the American Heart Association launched the Resuscitation

Quality ImprovementⓇ (RQIⓇ) Program to address the urgent need to improve
in-hospital cardiac arrest survival through a novel competency-based model for
health care provider (HCP) cardiopulmonary resuscitation (CPR) training. This
innovation differs from the traditional Basic Life Support (BLS) training model
by providing self-directed, low-dose, high-frequency CPR skill activities with
the objectives of skills mastery and retention. A program implementation study
was conducted at the first hospital in the state of Illinois to adopt RQI in
2016.
METHODS: The study was designed to evaluate implementation of the RQI program,
CPR performance during RQI simulation sessions, and participant impressions at a
community hospital. Quantitative data were evaluated based on psychomotor
compression and ventilation performance. Quantitative and qualitative data were
evaluated based on a perceptual CPR confidence and program satisfaction survey.
RESULTS: Statistical analysis demonstrates significant improvement in HCPs'
quarterly psychomotor CPR skill performance over a one-year period in first
compression score, and first and highest ventilation score per quarterly
session. The number of attempts to pass the ventilation skill session decreased
between the first and fourth quarter. Survey results of HCPs' program
perceptions 30 months post-RQI implementation indicate satisfaction with the RQI
program and an increase in CPR skill confidence.
CONCLUSION: Findings demonstrate that the RQI program for ongoing verification
of BLS skill and knowledge provides improvements in HCPs' CPR psychomotor
competence and confidence/satisfaction using an efficient and sustainable method
at a community hospital.

Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jcjq.2019.08.010
PMID: 31630977 [Indexed for MEDLINE]

155. CJEM. 2021 Mar;23(2):180-184. doi: 10.1007/s43678-020-00038-y. Epub 2021 Jan

4.

Efficacy and cost-feasibility of the Timely Chest Compression Training (T-CCT):

a contextualized cardiopulmonary resuscitation training for personal support
workers participating during in-hospital cardiac arrests.

Vincelette C(1)(2), Sokoloff C(3)(4)(5), Nadon N(3), Desaulniers P(4), Carrier

FM(6)(7).

Author information:
(1)Faculty of Medicine and Health Sciences, School of Nursing, Université de
Sherbrooke, Sherbrooke, Canada. Christian.Vincelette@usherbrooke.ca.
(2)Learning and Simulation Center, CHUM Academy, Montréal, Canada.
Christian.Vincelette@usherbrooke.ca.
(3)Learning and Simulation Center, CHUM Academy, Montréal, Canada.
(4)Department of Emergency Medicine, CHUM, Montréal, Canada.
(5)Critical Care Division, Department of Medicine, CHUM, Montréal, Canada.
(6)Critical Care Division, Department of Anesthesiology and Department of
Medicine, CHUM, Montréal, Canada.
(7)Centre de Recherche du Centre Hospitalier de l'Université de Montréal
(CRCHUM), Montréal, Canada.

OBJECTIVES: The Timely Chest Compression Training (T-CCT) was created to promote
more frequent training in chest compressions for personal support workers. This
study aims to assess the efficacy of the T-CCT on the chest compression
performance and to examine costs related to this intervention.
METHODS: A prospective single group, before-after study was conducted at a
university-affiliated hospital. The T-CCT is adapted for support workers and
lasts 20 min during working hours. Guided by peer trainers, live feedback
devices and mannikins, the T-CCT targets chest compression training. Using an
algorithm, chest compression performance scores were gathered before and after
the intervention.
RESULTS: Of 875 employed support workers, 573 were trained in 5 days. Prior to
the intervention, the median performance score was 72%. Participants
significantly improved after the intervention (p < 0.001) and the median of the
differences was 32% (95% CI 28.5-36.0). Support workers in critical care units
and those with an active basic life support (BLS) certification performed better
at baseline and were less inclined to have large changes in performance scores
after the intervention. When compared to basic life support training, the T-CCT
is over three times less expensive.
CONCLUSIONS: The T-CCT was an effective and low-cost initiative that allowed to
train a large group of support workers in a short amount of time. Since they are
actively involved in resuscitation efforts in Quebec (Canada), it may promote
the delivery of high-quality compressions during in-hospital cardiac arrests.
Our inquiry can incite and guide other organizations in the implementation of
similar interventions.

Publisher: RéSUMé: OBJECTIFS: Le Timely Chest Compression Training (T-CCT) a été

créé pour promouvoir une formation plus fréquente en compressions thoraciques
pour les préposés aux bénéficiaires. Cette étude vise à évaluer l'efficacité du
T-CCT sur la performance en compressions thoraciques et à examiner les coûts
liés à cette intervention. MéTHODES: Une étude prospective avant-après avec un
seul groupe a été menée dans un hôpital universitaire. Le T-CCT est adapté aux
préposés aux bénéficiaires et dure 20 min pendant les heures de travail. Guidé
par des pairs formateurs, des appareils de rétroaction en direct et des
mannequins, le T-CCT cible l'entraînement des compression thoraciques. À l'aide
d'un algorithme, les scores de performance en compression thoraciques ont été
recueillis avant et après l'intervention. RéSULTATS: Sur les 875 préposés aux
bénéficiaires employés, 573 ont été formés en cinq jours. Avant l'intervention,
le score de performance médian était de 72 %. Les participants se sont nettement
améliorés après l’intervention (p < 0.001) et la médiane des différences était
de 32 % (IC à 95 %, 28.5−36.0). Les préposés aux bénéficiaires dans les unités
de soins intensifs et ceux avec une formation de réanimation cardiorespiratoire
de base (BLS) active ont obtenu de meilleurs résultats au départ et étaient
moins enclins à avoir de grands changements dans leurs scores de performance
après l'intervention. Comparé à la formation BLS, le T-CCT est trois fois moins
cher. CONCLUSIONS: Le T-CCT était une initiative efficace et peu coûteuse qui a
permis la formation d'un grand groupe de préposés aux bénéficiaires en peu de
temps. Étant donné qu’ils sont activement impliqués dans les efforts de
réanimation au Québec (Canada), cela pourrait favoriser la réalisation de
compressions de grande qualité pendant les arrêts cardiorespiratoires en milieu
hospitalier. Notre démarche pourra inciter et guider d'autres organisations dans
la mise en œuvre d'interventions similaires.

DOI: 10.1007/s43678-020-00038-y
PMID: 33709352 [Indexed for MEDLINE]

156. BMC Nurs. 2021 Nov 15;20(1):229. doi: 10.1186/s12912-021-00744-7.

Effectiveness of applying clinical simulation scenarios and integrating

information technology in medical-surgical nursing and critical nursing courses.

Tseng LP(1)(2), Hou TH(2), Huang LP(3), Ou YK(4).

Author information:
(1)Department of Management Center, Sisters of our Lady of China Catholic
Medical Foundation, St. Martin De Porres Hospital, Chiayi City, 60069, Taiwan.
(2)Department of Industrial Engineering and Management, National Yunlin
University of Science and Technology, Yunlin, 640301, Taiwan.
(3)Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences
and Management, Chiayi, 60077, Taiwan.
(4)Department of Creative Product Design, Southern Taiwan University of Science
and Technology, No. 1, Nan-Tai Street, Yungkang Dist, Tainan City, 71005,
Taiwan. ouyk@stust.edu.tw.

BACKGROUND: To determine the impact of combining clinical simulation scenario

training and Information Technology Integrated Instruction (ITII) on the
teaching of nursing skills.
METHODS: 120 4th-year students in a nursing program who were enrolled in medical
and surgical nursing courses. 61 received innovative instruction (experimental
group) and 59 received conventional instruction (control group). The ADDIE
model, systematic method of course development that includes analysis, design,
development, implementation, and evaluation,was used to build simulation
teaching and clinical scenarios and to create and modify objective structure
clinical examination (OSCE) scenario checklists for acute myocardial infarction
(AMI) care, basic life support and operation of automated external defibrillator
(BLS), and subdural hemorrhage (SDH) care. The modified OSCE checklists were
assessed for reliability, consistency, and validity. The innovative training
included flipped classrooms, clinical simulation scenarios, ITII and blended
learning formats.
RESULTS: The reliability and validity of the OSCE checklists developed in this
study were acceptable and comparable or higher than checklists in past studies
and could be utilized as an OSCE performance tool. Students in innovative
instruction obtained significantly better OSCE performance, lab scores and
improvements from the previous year's grades. Significant differences were found
in situational awareness (SA). No strong correlations were found between OSCE
scores and clinical internship scores, and no significant differences were found
between the groups in overall clinical internship performance.
CONCLUSIONS: Innovative instruction showed better performance than conventional
methods in summative evaluation of knowledge components, OSCE formative
evaluation and clinical nursing internship scores, as well as improved
situational awareness in nursing students.

© 2021. The Author(s).

DOI: 10.1186/s12912-021-00744-7
PMCID: PMC8591873
PMID: 34781931

157. Am J Robot Surg. 2015 Dec;2(1):9-15. doi: 10.1166/ajrs.2015.1022.

Strategically Leapfrogging Education in Prehospital Trauma Management:

Four-Tiered Training Protocols.

Abraham R(1), Vyas D(1), Narayan M(2), Vyas A(3).

Author information:
(1)Surgery, College of Human Medicine, Michigan State University, Lansing, MI
48912, USA.
(2)Trauma and Critical Care, J. Crowley Shock Trauma, University of Maryland,
Baltimore, MD 21201, USA.
(3)Pediatrics and Human Development, College of Human Medicine, Michigan State
University, East Lansing, MI 48824, USA.

Trauma-related injury in fast developing countries are linked to 90% of

international mortality rates, which can be greatly reduced by improvements in
often non-existent or non-centralized emergency medical systems
(EMS)-particularly in the pre-hospital care phase. Traditional trauma training
protocols-such as Advanced Trauma Life Support (ATLS), International Trauma Life
Support (ITLS), and Basic Life Support (BLS)-have failed to produce an effective
pre-hospital ground force of medical first responders. To overcome these
barriers, we propose a new four-tiered set of trauma training protocols: Massive
Open Online Course (MOOC) Trauma Training, Acute Trauma Training (ATT), Broad
Trauma Training (BTT), and Cardiac and Trauma Training (CTT). These standards
are specifically differentiated to accommodate the educational and socioeconomic
diversity found in fast developing settings, where each free course is taught in
native, lay language while ensuring the education standards are maintained by
fully incorporating high-fidelity simulation, video-recorded debriefing, and
retraining. The innovative pedagogy of this trauma education program utilizes
MOOC for global scalability and a "train-the-trainer" approach for exponential
growth-both components help fast developing countries reach a critical mass of
first responders needed for the base of an evolving EMS.

DOI: 10.1166/ajrs.2015.1022
PMCID: PMC4941789
PMID: 27419222

158. Resuscitation. 2021 Mar;160:79-83. doi: 10.1016/j.resuscitation.2021.01.021.

Epub 2021 Jan 30.

The use of personal protection equipment does not impair the quality of
cardiopulmonary resuscitation: A prospective triple-cross over randomised
controlled non-inferiority trial.

Kienbacher CL(1), Grafeneder J(1), Tscherny K(1), Krammel M(2), Fuhrmann V(1),
Niederer M(1), Neudorfsky S(3), Herbich K(3), Schreiber W(4), Herkner H(5), Roth
D(1).

Author information:
(1)Department of Emergency Medicine, Medical University of Vienna, Währinger
Gürtel 18-20, 1090 Vienna, Austria.
(2)Emergency Medical Services Vienna, Radetzkystraße 1, 1030 Vienna, Austria;
PULS-Austrian Cardiac Arrest Awareness Association, Lichtentaler Gasse 4/1/R03,
1090 Vienna, Austria.
(3)Emergency Medical Services Vienna, Radetzkystraße 1, 1030 Vienna, Austria.
(4)Department of Emergency Medicine, Medical University of Vienna, Währinger
Gürtel 18-20, 1090 Vienna, Austria; PULS-Austrian Cardiac Arrest Awareness
Association, Lichtentaler Gasse 4/1/R03, 1090 Vienna, Austria.
(5)Department of Emergency Medicine, Medical University of Vienna, Währinger
Gürtel 18-20, 1090 Vienna, Austria. Electronic address:
harald.herkner@meduniwien.ac.at.

AIM: Prior studies suggest that the use of personal protective equipment might
impair the quality of critical care. We investigated the influence of personal
protective equipment on out-of-hospital cardiopulmonary resuscitation.
METHODS: Randomised controlled non-inferiority triple-crossover study.
Forty-eight emergency medical service providers, randomized into teams of two,
performed 12 min of basic life support (BLS) on a manikin after climbing 3
flights of stairs. Three scenarios were completed in a randomised order: Without
personal protective equipment, with personal protective equipment including a
filtering face piece (FFP) 2 mask with valve, and with personal protective
equipment including an FFP2 mask without valve. The primary outcome was mean
depth of chest compressions with a pre-defined non-inferiority margin of 3.5 mm.
Secondary outcomes included other measurements of CPR quality, providers'
subjective exhaustion levels, and providers' vital signs, including end-tidal
CO2.
RESULTS: Differences regarding the primary outcome were well below the
pre-defined non-inferiority margins for both control vs. personal protective
equipment without valve (absolute difference 1 mm, 95% CI [-1, 2]) and control
vs. personal protective equipment with valve (absolute difference 1 mm, [-0.2,
2]). This was also true for secondary outcomes regarding quality of chest
compressions and providers' vital signs including etCO2. Subjective physical
strain after BLS was higher in the personal protective equipment groups (Borg 4
(SD 3) without valve, 4 (SD 2) with valve) than in the control group (Borg 3 (SD
2)).
CONCLUSION: PPE including masks with and without expiration valve is safe for
use without concerns regarding the impairment of CPR quality.
Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2021.01.021
PMID: 33524489 [Indexed for MEDLINE]

159. Int J Emerg Med. 2020 Jun 11;13(1):31. doi: 10.1186/s12245-020-00287-9.

The effect of 10-min dispatch-assisted cardiopulmonary resuscitation training: a

randomized simulation pilot study.

Fukushima H(1), Asai H(2), Seki T(3), Takano K(2), Bolstad F(4).

Author information:
(1)Department of Emergency and Critical Care Medicine, Nara Medical University,
Shijo-cho 840, Kashihara City, Nara, 634-8522, Japan. hidetakarina@gmail.com.
(2)Department of Emergency and Critical Care Medicine, Nara Medical University,
Shijo-cho 840, Kashihara City, Nara, 634-8522, Japan.
(3)Department of Emergency, Nara Prefecture General Medical Center,
Shichijo-Nishimachi 2-897-5, Nara City, 630-8581, Japan.
(4)Clinical English, Nara Medical University, Shijo-cho 840, Kashihara City,
Nara, 634-8522, Japan.

BACKGROUND: Immediate bystander cardiopulmonary resuscitation (CPR) is essential

for survival from sudden cardiac arrest (CA). Current CPR guidelines recommend
that dispatchers assist lay rescuers performing CPR (dispatch-assisted CPR
(DACPR)), which can double the frequency of bystander CPR. Laypersons, however,
are not familiar with receiving CPR instructions from dispatchers. DACPR
training can be beneficial for lay rescuers, but this has not yet been
validated. The aim of this study was to determine the effectiveness of simple
DACPR training for lay rescuers.
METHODS: We conducted a DACPR simulation pilot study. Participants who were
non-health care professionals with no CPR training within 1 year prior to this
study were recruited from Nara Medical University Hospital. The participants
were randomly assigned to one of the two 90-min adult basic life support (BLS)
training course groups: DACPR group (standard adult BLS training plus an
additional 10-min DACPR training) or Standard group (standard adult BLS training
only). In the DACPR group, participants practiced DACPR through role-playing of
a dispatcher and an emergency caller. Six months after the training, all
subjects were asked to perform a 2-min CPR simulation under instructions given
by off-duty dispatchers.
RESULTS: Out of the 66 participants, 59 completed the simulation (30 from the
DACPR group and 29 from the Standard group). The CPR quality was similar between
the two groups. However, the median time interval between call receipt and the
first dispatch-assisted compression was faster in the DACPR group (108 s vs 129
s, p = 0.042).
CONCLUSIONS: This brief DACPR training in addition to standard CPR training can
result in a modest improvement in the time to initiate CPR. Future studies are
now required to examine the effect of DACPR training on survival of sudden CA.

DOI: 10.1186/s12245-020-00287-9
PMCID: PMC7291724
PMID: 32527221

Conflict of interest statement: There are no competing interests to declare in

this study.

160. Resuscitation. 2023 Dec;193:109995. doi: 10.1016/j.resuscitation.2023.109995.

Epub 2023 Oct 7.

Improving EMS response times for out-of-hospital cardiac arrest in urban areas
using drone-like vertical take-off and landing air ambulances: An international,
simulation-based cohort study.

Heidet M(1), Benjamin Leung KH(2), Bougouin W(3), Alam R(2), Frattini B(4),
Liang D(5), Jost D(6), Canon V(7), Deakin J(8), Hubert H(7), Christenson J(9),
Vivien B(10), Chan T(2), Cariou A(11), Dumas F(12), Jouven X(13), Marijon E(13),
Bennington S(14), Travers S(4), Souihi S(15), Mermet E(16), Freyssenge J(17),
Arrouy L(18), Lecarpentier E(14), Derkenne C(19), Grunau B(9).

Author information:
(1)Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor
University Hospital, Créteil, France; Université Paris-Est Créteil (UPEC),
CIR/TincNet (EA-3956), Créteil, France. Electronic address:
matthieu.heidet@aphp.fr.
(2)Department of Mechanical and Industrial Engineering University of Toronto,
Toronto, Canada.
(3)Université de Paris, INSERM U970, Paris Cardiovascular Research Center
(PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death
Expertise Center, Paris, France; Medical Intensive Care Unit, Ramsay Générale de
Santé, Hôpital Privé Jacques Cartier, Massy, France.
(4)Paris Fire Brigade (BSPP), Paris, France.
(5)Department of Emergency Medicine, University of Calgary, Calgary, Canada.
(6)Paris Fire Brigade (BSPP), Paris, France; Paris Sudden Death Expertise
Center, Paris, France.
(7)University de Lille, METRICS, France.
(8)BCEHS, Vancouver, Canada.
(9)Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, Canada;
Department of Emergency Medicine, St Paul's Hospital and University of British
Columbia, Vancouver, Canada.
(10)AP-HP, SAMU 75, Necker University Hospital, Paris, France.
(11)Paris Sudden Death Expertise Center, Paris, France; AP-HP, Medical Intensive
Care Unit, Cochin University Hospital, Paris, France.
(12)Université de Paris, INSERM U970, Paris Cardiovascular Research Center
(PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death
Expertise Center, Paris, France; AP-HP, Emergency Department, Cochin-Hotel-Dieu
University Hospital, Paris, France.
(13)Université de Paris, INSERM U970, Paris Cardiovascular Research Center
(PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death
Expertise Center, Paris, France; AP-HP, Cardiology Department, European Georges
Pompidou University Hospital, Paris, France.
(14)Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor
University Hospital, Créteil, France.
(15)Université Paris-Est Créteil (UPEC), CIR/TincNet (EA-3956), Créteil, France.
(16)Centre National pour la Recherche scientifique (CNRS), TSE-R, UMR 5314,
Toulouse, France; Toulouse School of Economics (TSE), Toulouse, France.
(17)Université Claude Bernard Lyon 1, INSERME U1290, Research on Healthcare
Performance (RESHAPE), Lyon, France; Urgences-ARA Network, ARS Auvergne
Rhône-Alpes, Lyon, France.
(18)AP-HP, Emergency Department, Paris Ile-de-France Ouest University Hospitals,
Ambroise Paré University Hospital, Boulogne-Billancourt, France.
(19)Medical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques
Cartier, Massy, France.

BACKGROUND: Advances in vertical take-off and landing (VTOL) technologies may

enable drone-like crewed air ambulances to rapidly respond to out-of-hospital
cardiac arrest (OHCA) in urban areas. We estimated the impact of incorporating
VTOL air ambulances on OHCA response intervals in two large urban centres in
France and Canada.
METHODS: We included adult OHCAs occurring between Jan. 2017-Dec. 2018 within
Greater Paris in France and Metro Vancouver in Canada. Both regions utilize
tiered OHCA response with basic (BLS)- and advanced life support (ALS)-capable
units. We simulated incorporating 1-2 ALS-capable VTOL air ambulances dedicated
to OHCA response in each study region, and computed time intervals from call
reception by emergency medical services (EMS) to arrival of the: (1) first ALS
unit ("call-to-ALS arrival interval"); and (2) first EMS unit ("call-to-first
EMS arrival interval").
RESULTS: There were 6,217 OHCAs included during the study period (3,760 in
Greater Paris and 2,457 in Metro Vancouver). Historical median call-to-ALS
arrival intervals were 21 min [IQR 16-29] in Greater Paris and 12 min [IQR 9-17]
in Metro Vancouver, while median call-to-first EMS arrival intervals were 11 min
[IQR 8-14] and 7 min [IQR 5-8] respectively. Incorporating 1-2 VTOL air
ambulances improved median call-to-ALS arrival intervals to 7-9 min and
call-to-first EMS arrival intervals to 6-8 min in both study regions (all
P < 0.001).
CONCLUSION: VTOL air ambulances dedicated to OHCA response may improve EMS
response intervals, with substantial improvements in ALS response metrics.

Copyright © 2023 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2023.109995
PMID: 37813148 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors

declare the following financial interests/personal relationships which may be
considered as potential competing interests: [Prof. Alain Cariou is a member of
the Resuscitation’s editorial board. All authors declare no conflict of interest
with any of the two VTOL companies cited in this work (Urban Aero or
Volocopter).].

161. J Perianesth Nurs. 2014 Oct;29(5):385-96. doi: 10.1016/j.jopan.2013.10.004.

A cross-sectional survey study of nurses' self-assessed competencies in

obstetric and surgical postanesthesia care units.

Greenfield ML, O'Brien DD, Kofflin SK, Mhyre JM.

PURPOSE: The purpose of this study was to identify priorities to guide

development of an obstetric PACU continuing education curriculum.
DESIGN: A cross-sectional, survey design was used.
METHODS: A total of 54 obstetric nurses and 68 perianesthesia Phase I nurses at
an academic, tertiary care center completed online surveys for self-assessment
of recent education, competency, and encounters with 14 topics related to
postanesthesia nursing (eg, basic life support [BLS], advanced cardiac life
support [ACLS], neonatal resuscitation, and the American Society of
Perianesthesia Nurses' standards).
FINDINGS: Obstetric nurses reported low encounters, competency, and recent
training in all study topics except oxygen administration, phlebotomy, BLS, and
neonatal resuscitation. Perianesthesia Phase I nurses indicated high encounters,
competency, and recent training for all topics except for ACLS and malignant
hyperthermia. All nurses indicated the need for arranging debriefing sessions
after life-threatening situations.
CONCLUSION: Results suggest that obstetric-postanesthesia care unit (PACU)
nursing should focus on continuing education curriculum development, whereas
main surgical-PACU emphasis should be on skills assessment. Future research
should be directed to knowledge- (didactics) and skills- (simulation)
educational programs, including maintenance and assessment of skills unique to
obstetric-PACU care.

Copyright © 2014 American Society of PeriAnesthesia Nurses. Published by

Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jopan.2013.10.004
PMID: 25261142 [Indexed for MEDLINE]

162. PLoS One. 2020 Feb 13;15(2):e0228702. doi: 10.1371/journal.pone.0228702.

eCollection 2020.

Providing the best chest compression quality: Standard CPR versus chest
compressions only in a bystander resuscitation model.

Rössler B(1)(2), Goschin J(1), Maleczek M(1)(3), Piringer F(3), Thell R(3),
Mittlböck M(4), Schebesta K(1)(2).

Author information:
(1)Medical Simulation and Emergency Management Research Group, University
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical
University of Vienna, Vienna, Austria.
(2)Academic Simulation Center Vienna, Medical University of Vienna and Vienna
Hospital Association, Vienna, Austria.
(3)St. John Ambulance, Vienna, Austria.
(4)Center for Medical Statistics, Informatics, and Intelligent Systems, Medical
University of Vienna, Medical University of Vienna, Vienna, Austria.

AIM OF THE STUDY: Bystander-initiated basic life support (BLS) for the treatment
of prehospital cardiac arrest increases survival but is frequently not performed
due to fear and a lack of knowledge. A simple flowchart can improve motivation
and the quality of performance. Furthermore, guidelines do recommend a chest
compression (CC)-only algorithm for dispatcher-assisted bystander resuscitation,
which may lead to increased fatigue and a loss of compression depth.
Consequently, we wanted to test the hypothesis that CCs are more correctly
delivered in a flowchart-assisted standard resuscitation algorithm than in a
CC-only algorithm.
METHODS: With the use of a manikin model, 84 laypersons were randomized to
perform either flowchart-assisted standard resuscitation or CC-only
resuscitation for 5min. The primary outcome was the total number of CCs.
RESULTS: The total number of correct CCs did not significantly differ between
the CC-only group and the standard group (63 [±81] vs. 79 [±86]; p = 0.394; 95%
CI of difference: 21-53). The total hand-off time was significantly lower in the
CC-only group than in the standard BLS group. The relative number of correct CCs
(the fraction of the total number of CCs achieving 5-6cm) and the level of
exhaustion after BLS did not significantly differ between the groups.
CONCLUSION: Standard BLS did not lead to an increase in correctly delivered CCs
compared to CC-only resuscitation and exhibited significantly more hand-off
time. The low rate of CCs in both groups indicates the need for an increased
focus on performance during BLS training.

DOI: 10.1371/journal.pone.0228702
PMCID: PMC7017996
PMID: 32053634 [Indexed for MEDLINE]

Conflict of interest statement: The authors have declared that no competing

interests exist.
163. Prehosp Emerg Care. 2010 Apr-Jun;14(2):229-34. doi: 10.3109/10903120903572293.

Effect of crew size on objective measures of resuscitation for out-of-hospital

cardiac arrest.

Martin-Gill C(1), Guyette FX, Rittenberger JC.

Author information:
(1)Department of Emergency Medicine, University of Pittsburgh, Pittsburgh,
Pennsylvania 15261, USA.

BACKGROUND: There is no consensus among emergency medical services (EMS) systems

as to the optimal numbers and training of EMS providers who respond to the scene
of prehospital cardiac arrests. Increased numbers of providers may improve the
performance of cardiopulmonary resuscitation (CPR), but this has not been
studied as part of a comprehensive resuscitation scenario.
OBJECTIVE: To compare different all-paramedic crew size configurations on
objective measures of patient resuscitation using a high-fidelity human
simulator.
METHODS: We compared two-, three-, and four-person all-paramedic crew
configurations in the effectiveness and timeliness of performing basic life
support (BLS) and advanced life support (ALS) skills during the first 8 minutes
of a simulated cardiac arrest scenario. Crews were compared to determine
differences in no-flow fraction (NFF) as a measure of effectiveness of CPR and
time to defibrillation, endotracheal intubation, establishment of intravenous
access, and medication administration.
RESULTS: There was no significant difference in mean NFF among the two-, three-,
and four-provider crew configurations (0.32, 0.26, and 0.27, respectively; p =
0.105). More three- and four-person groups completed ALS procedures during the
scenario, but there was no significant difference in time to performance of BLS
or ALS procedures among the crew size configurations for completed procedures.
There was a trend toward lower time to intubation with increasing group size,
though this was not significant using a Bonferroni-corrected p-value of 0.01
(379, 316, and 263 seconds, respectively; p = 0.018).
CONCLUSION: This study found no significant difference in effectiveness of CPR
or in time to performance of BLS or ALS procedures among crew size
configurations, though there was a trend toward decreased time to intubation
with increased crew size. Effectiveness of CPR may be hindered by distractions
related to the performance of ALS procedures with increasing group size,
particularly with an all-paramedic provider model. We suggest a renewed emphasis
on the provision of effective CPR by designated providers independent of any ALS
interventions being performed.

DOI: 10.3109/10903120903572293
PMCID: PMC2902150
PMID: 20128704 [Indexed for MEDLINE]

164. Adv Simul (Lond). 2021 Apr 21;6(1):14. doi: 10.1186/s41077-021-00168-y.

The assessment of a manikin-based low-dose, high-frequency cardiac resuscitation

quality improvement program in early UK adopter hospitals.

Kuyt K(1), Mullen M(1), Fullwood C(2)(3), Chang TP(4), Fenwick J(5), Withey
V(6), McIntosh R(7), Herz N(8), MacKinnon RJ(9).

Author information:
(1)Department of Research & Innovation, Manchester University NHS Foundation
Trust, Manchester, UK.
(2)Medical Statistics Group, Manchester University NHS Foundation Trust,
Manchester, UK.
(3)Centre for Biostatistics, University of Manchester, Manchester, UK.
(4)Division of Emergency Medicine and Transport, Children's Hospital of Los
Angeles, Los Angeles, USA.
(5)Resuscitation Service, Basildon University Hospital, Mid and South Essex NHS
Foundation Trust, Southend-on-Sea, UK.
(6)Spire Cheshire Hospital, Warrington, UK.
(7)Department of Resuscitation, Borders General Hospital, Borders NHS, Selkirk,
UK.
(8)British Heart Foundation, London, UK.
(9)Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital,
Manchester University NHS Foundation Trust, Manchester, UK.
ralph.mackinnon@mft.nhs.uk.

BACKGROUND: Adult and paediatric basic life support (BLS) training are often
conducted via group training with an accredited instructor every 24 months.
Multiple studies have demonstrated a decline in the quality of cardio-pulmonary
resuscitation (CPR) performed as soon as 3-month post-training. The
'Resuscitation Quality Improvement' (RQI) programme is a quarterly low-dose,
high-frequency training, based around the use of manikins connected to a cart
providing real-time and summative feedback. We aimed to evaluate the effects of
the RQI Programme on CPR psychomotor skills in UK hospitals that had adopted
this as a method of BLS training, and establish whether this program leads to
increased compliance in CPR training.
METHODS: The study took place across three adopter sites and one control site.
Participants completed a baseline assessment without live feedback. Following
this, participants at the adopter sites followed the RQI curriculum for adult
CPR, or adult and infant CPR. The curriculum was split into quarterly training
blocks, and live feedback was given on technique during the training session via
the RQI cart. After following the curriculum for 12/24 months, participants
completed a second assessment without live feedback.
RESULTS: At the adopter sites, there was a significant improvement in the
overall score between baseline and assessment for infant ventilations (N = 167,
p < 0.001), adult ventilations (n = 129, p < 0.001), infant compressions (n =
163, p < 0.001) adult compressions (n = 205, p < 0.001), and adult CPR (n = 249,
p < 0.001). There was no significant improvement in the overall score for infant
CPR (n = 206, p = 0.08). Data from the control site demonstrated a statistically
significant improvement in mean score for adult CPR (n = 22, p = 0.02), but not
for adult compressions (N = 18, p = 0.39) or ventilations (n = 17, p = 0.08). No
statistically significant difference in improvement of mean scores was found
between the grouped adopter sites and the control site. The effect of the
duration of the RQI curriculum on CPR performance appeared to be minimal in this
data set. Compliance with the RQI curriculum varied by site, one site maintained
hospital compliance at 90% over a 1 year period, however compliance reduced over
time at all sites.
CONCLUSIONS: This data demonstrated an increased adherence with guidelines for
high-quality CPR post-training with the RQI cart, for all adult and most infant
measures, but not infant CPR. However, the relationship between a formalised
quarterly RQI curriculum and improvements in resuscitation skills is not clear.
It is also unclear whether the RQI approach is superior to the current
classroom-based BLS training for CPR skill acquisition in the UK. Further
research is required to establish how to optimally implement the RQI system in
the UK and how to optimally improve hospital wide compliance with CPR training
to improve the outcomes of in-hospital cardiac arrests.

DOI: 10.1186/s41077-021-00168-y
PMCID: PMC8058602
PMID: 33883025

Conflict of interest statement: This work was in part funded Laerdal Medical.
These funds covered the salary of study staff for time spent working on the
study. NH is substantively employed by the British Heart Foundation.

165. Prehosp Disaster Med. 2019 Apr;34(2):220-223. doi: 10.1017/S1049023X19000098.

Epub 2019 Apr 10.

A Cross-Over Trial Comparing Conventional to Compression-Adjusted Ventilations

with Metronome-Guided Compressions.

Nikolla DA(1), Kramer BJ(2), Carlson JN(1).

Author information:
(1)1.Department of Emergency Medicine, Allegheny Health Network,Saint Vincent
Hospital,Erie, PennsylvaniaUSA.
(2)2.Department of Emergency Medicine,Meadville Medical Center,Meadville,
PennsylvaniaUSA.

INTRODUCTION: Hyperventilation during cardiopulmonary resuscitation (CPR)

negatively affects cardiopulmonary physiology. Compression-adjusted ventilations
(CAVs) may allow providers to deliver ventilation rates more consistently than
conventional ventilations (CVs). This study sought to compare ventilation rates
between these two methods during simulated cardiac arrest.Null Hypothesis:That
CAV will not result in different rates than CV in simulated CPR with
metronome-guided compressions.
METHODS: Volunteer Basic Life Support (BLS)-trained providers delivered
bag-valve-mask (BVM) ventilations during simulated CPR with metronome-guided
compressions at 100 beats/minute. For the first 4-minute interval, volunteers
delivered CV. Volunteers were then instructed on how to perform CAV by
delivering one breath, counting 12 compressions, and then delivering a
subsequent breath. They then performed CAV for the second 4-minute interval.
Ventilation rates were manually recorded. Minute-by-minute ventilation rates
were compared between the techniques.
RESULTS: A total of 23 volunteers were enrolled with a median age of 36 years
old and with a median of 14 years of experience. Median ventilation rates were
consistently higher in the CV group versus the CAV group across all 1-minute
segments: 13 vs 9, 12 vs 8, 12 vs 8, and 12 vs 8 for minutes one through four,
respectively (P 10 breaths per minute) occurred 64% of the time intervals with
CV versus one percent with CAV (P &lt;.01). The proportion of time which
hyperventilation occurred was also consistently higher in the CV group versus
the CAV group across all 1-minute segments: 78% vs 4%, 61% vs 0%, 57% vs 0%, and
61% vs 0% for minutes one through four, respectively (P &lt;.01, all).
CONCLUSIONS: In this simulated model of cardiac arrest, CAV had more accurate
ventilation rates and fewer episodes of hyperventilation compared with
CV.Nikolla DA, Kramer BJ, Carlson JN. A cross-over trial comparing conventional
to compression-adjusted ventilations with metronome-guided compressions. Prehosp
Disaster Med. 2019;34(2):220-223.

DOI: 10.1017/S1049023X19000098
PMID: 30968816 [Indexed for MEDLINE]

166. Prehosp Emerg Care. 2021 May-Jun;25(3):377-387. doi:

10.1080/10903127.2020.1757181. Epub 2020 May 13.
Verbal Motivation vs. Digital Real-Time Feedback during Cardiopulmonary
Resuscitation: Comparing Bystander CPR Quality in a Randomized and Controlled
Manikin Study of Simulated Cardiac Arrest.

Plata C, Nowack M, Loeser J, Drinhaus H, Steinhauser S, Hinkelbein J, Wetsch WA,

Böttiger BW, Spelten O(1)(2)(3)(4).

Author information:
(1)Faculty of Medicine and University Hospital of Cologne, Department of
Anesthesiology and Intensive Care Medicine, University of Cologne, Cologne,
Germany (CP, MN, HD, JH, WAW, BWB).
(2)Faculty of Medicine and University Hospital of Cologne, Centre of Palliative
Medicine, University of Cologne, Cologne, Germany (JL).
(3)Faculty of Medicine, Institute of Medical Statistics and Computational
Biology, University of Cologne, Cologne, Germany (SS).
(4)Department of Anesthesiology and Intensive Care Medicine, Schön Klinik
Düsseldorf, Düsseldorf, Germany (OS).

The use of smartphone applications increases bystander CPR quality as well as

the use of telephone CPR protocols. The present prospective, randomized,
controlled manikin trial analyses the effects of a smartphone application
(PocketCPR©) on CPR quality in a bystander CPR scenario compared to a
dispatcher-assisted telephone CPR with the additional use of a metronome and
verbal motivation. Methods: 150 laypersons were included to perform 8-minute CPR
on a manikin. Volunteers were randomly assigned to one of three groups: (1)
dispatcher-assisted telephone CPR (telephone-group), (2) dispatcher-assisted
telephone CPR combined with the smartphone-application (telephone + app-group)
and (3) dispatcher-assisted telephone CPR with additional verbal motivation
("push harder, release completely," every 20 seconds, starting after 60 seconds)
and a metronome with 100 min-1 (telephone + motivation-group). Results: Median
compression depth did not differ significantly between the study groups
(p = 0.051). However, in the post hoc analysis median compression depth in the
telephone + motivation-group was significantly elevated compared to the
telephone + app-group (59 mm [IQR 47-67 mm] vs. 51 mm [IQR 46-57 mm];
p = 0.025). The median number of superficial compressions was significantly
reduced in the telephone + motivation-group compared to the
telephone + app-group (70 [IQR 3-362] vs. 349 [IQR 88-538]; p = 0.004), but not
compared to the telephone-group (91 [IQR 4-449]; p = 0.707). In contrast to the
other study groups, median compression depth of the telephone + motivation-group
increased over time. Chest compressions with correct depth were found
significantly more often in the telephone + app-group compared to the other
study groups (p = 0.011). Median compression rate in the telephone + app-group
was significantly elevated (108 min-1 [IQR 96-119 min-1]) compared to the
telephone-group (78 min-1 [IQR 56-106 min-1]; p < 0.001) and the
telephone + motivation-group (99 min-1 [IQR 91-101 min-1]; p < 0.001).
Conclusions: The use of a smartphone application as well as verbal motivation by
a dispatcher during telephone CPR leads to higher CPR quality levels compared to
standard telephone CPR. Thereby, the use of the smartphone application mainly
shows an increase in compression rate, while increased compression rate with
simultaneously increased compression depth was only apparent in the telephone +
motivation-group.

DOI: 10.1080/10903127.2020.1757181
PMID: 32301644 [Indexed for MEDLINE]

167. Resuscitation. 2010 Apr;81(4):453-6. doi: 10.1016/j.resuscitation.2009.12.018.

Epub 2010 Feb 1.
Written evaluation is not a predictor for skills performance in an Advanced
Cardiovascular Life Support course.

Rodgers DL(1), Bhanji F, McKee BR.

Author information:
(1)Center for Simulation, Advanced Education, and Innovation, The Children's
Hospital of Philadelphia, Philadelphia, PA 19104, USA. rodgersd@email.chop.edu

OBJECTIVE: Both a written cognitive knowledge evaluation and a practical

evaluation that tests psychomotor skills, cognitive knowledge, and affective
behaviors such as leadership and team skills are required for successful
completion of American Heart Association (AHA) Advanced Cardiovascular Life
Support (ACLS) course. The 2005 International Liaison Committee on Resuscitation
(ILCOR) Consensus on Science and Treatment Recommendations noted that in Basic
Life Support (BLS) there is little to no correlation between written and
practical skills. The current study was conducted to determine if there is a
correlation between written and practical evaluations in an ACLS course.
METHODS: 34 senior nursing students from four nursing programs participated in
two separate ACLS classes, completing both the written and practical
evaluations. Immediately following the courses, all participants served as team
leader for a video recorded simulated cardiac arrest event. A panel of expert
ACLS instructors who did not participate as instructors in the courses reviewed
each video and independently scored team leaders' performances.
RESULTS: Spearman's rho correlation coefficient between the written test scores
and practical skills performance was 0.194 (2-tailed significance=0.272).
CONCLUSION: The ACLS written evaluation was not a predictor of participant
skills in managing a simulated cardiac arrest event immediately following an
ACLS course. The single case simulations used in ACLS skills evaluation test a
narrow portion of ACLS content while written evaluation tests can more
practically test a broader spectrum of content. Both work in concert to define
participant knowledge and neither should be used exclusively to determine
participant competence.

Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2009.12.018
PMID: 20117875 [Indexed for MEDLINE]

168. Pediatr Emerg Care. 2024 Dec 9. doi: 10.1097/PEC.0000000000003316. Online

ahead
of print.

Children and Restraints Study in Emergency Ambulance Transport-Cardiopulmonary

Resuscitation (CARSEAT-CPR): An Observational Cohort Study of a Simulated
Pediatric Cardiac Arrest.

Cochran-Caggiano N(1), Tse W(2), Swinburne C(3), Lang N(4), Till S(5), Donovan
S(6), Woodson MCC(7), Dailey MW(6).

Author information:
(1)From the Division of EMS, Department of Emergency Medicine, Yale School of
Medicine, New Haven, CT.
(2)Childrens Hospital Oakland, Oakland, CA.
(3)Northern Light Emergency Care, Eastern Maine Medical Center, Bangor, ME.
(4)Department of Emergency Medicine, University of Vermont, Burlington, VT.
(5)Albany Medical College, Albany, NY.
(6)Department of Emergency Medicine, Albany Medical Center Albany, NY.
(7)University of Illinois at Urbana-Champaign, Champaign, IL; Albany Medical
College, Albany, NY.

OBJECTIVES: To compare the ability to perform basic life support (BLS) skills on
children and infants in a moving ambulance whether or not they are properly
secured to the stretcher.
METHODS: Emergency Medicine Services provider ability to perform BLS skills was
measured in moving ambulances on a closed course using an analog for child and
infant cardiac arrest. Data were compared for child and infant manikins secured
to the stretcher via different methods in simulated patient resuscitations
performed by 24 participants.
RESULTS: We found that there was no significant difference in mean rate (P =
0.104), depth (P = 0.21), or chest compression fraction (P = 0.92) between tests
on restrained and unrestrained pediatric manikins. For infants, there was a 4-mm
difference in compression depth (P = 0.0018). The clinical significance of this
difference is not readily apparent. Infant tests did not show a difference in
compression rate (P = 0.35) or compression fraction (P = 0.26). Across all
tests, the rate and depth of compressions were adequate, but compression
fraction was not adequate in the infant simulations. There were no differences
in ventilations between restrained and unrestrained simulations (child P = 0.15;
infant P = 0.13) but both were less than the American Heart Association
recommendation.
CONCLUSIONS: In this simulation study, it was found that there was no
significant difference noted in BLS adequacy between unrestrained pediatric
patients and those restrained with commercial devices. Overall, the ability to
perform appropriate BLS on children was equivocal and our simulations suggested
BLS could not be adequately performed on infants regardless of restraint
type/status.

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

DOI: 10.1097/PEC.0000000000003316
PMID: 39642211

Conflict of interest statement: Disclosures: The authors declare no conflict of

interest.

169. Sangyo Eiseigaku Zasshi. 2016 Jul 29;58(4):118-29. doi:

10.1539/sangyoeisei.B15018. Epub 2016 Jun 13.

[Evaluation of an emergency treatment training program for occupational health

nurses].

[Article in Japanese]

Matsuda Y(1), Negishi M, Otani K, Arakida M, Higashi T.

Author information:
(1)Department of Nursing, International University of Health and Welfare School
of Health Sciences at Odawara.

OBJECTIVES: The purpose of this study was to evaluate the appropriateness and
usefulness of the first aid training program developed for occupational health
nurses (OHNs) to improve their basic skills of first aid treatment.
METHODS: This was a case-control study. The subjects were 69 nurses who were
stationed in workplaces in Japan (intervention group: n=35; waiting-list control
group: n=34). The training program was developed using the method of
instructional design (ID) and composed of basic life support (BLS) training,
basic first aid training, and simulation training. This study was conducted from
April to August 2012. The training was evaluated using the Kirkpatrick model of
training evaluation: level 1 (reaction), level 2 (learning), level 3 (behavior),
and level 4 (results; this level was omitted). For level 1, the training
contents were evaluated on a visual analog scale (VAS) of 0 to 10 points on the
basis of whether the programs' contents were interesting, understandable, and
applicable in the workplace. For level 2, a knowledge test (15 true/false
questions) was used. For level 3, the practical application of activities
relating to the emergency system was evaluated.
RESULTS: There were no significant differences in the attributes and
characteristics of the subjects of the workplaces between the intervention and
the waiting-list control groups. The score for reaction (level 1) were 8.5-9.7
points. In the knowledge test (level 2), there was no significant difference in
the score before training between the intervention (11.0 points) and the
waiting-list control groups (11.1 points). However, the score three months later
showed a significant difference between the intervention (12.5 points) and the
waiting-list control groups (11.0 points). The score after training was
significantly higher than the score before the training that the intervention
group received. For evaluation of behavior (level 3) three months later, the
ratios of implementation of management and review of necessary items, review of
task, and discussion with OHNs on emergency systems were significantly high in
the intervention group.
CONCLUSIONS: The evaluation of the first aid training programs for OHNs in this
study showed high satisfaction of the participants and indicated improved
knowledge and contributions to the waiting-list control group. We consider the
contents of the program as appropriate.

DOI: 10.1539/sangyoeisei.B15018
PMID: 27302831 [Indexed for MEDLINE]

170. Int J Environ Res Public Health. 2021 Apr 30;18(9):4834. doi:
10.3390/ijerph18094834.

Comparative Analysis of the Effectiveness of Performing Advanced Resuscitation

Procedures Undertaken by Two- and Three- Person Basic Medical Rescue Teams in
Adults under Simulated Conditions.

Krzyżanowski K(1), Ślęzak D(1), Dąbrowski S(1), Żuratyński P(1),

Mędrzycka-Dąbrowska W(2), Buca P(3), Jastrzębski P(4), Robakowska M(5).

Author information:
(1)Department of Medical Rescue, Faculty of Health Sciences with the Institute
of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7,
80-211 Gdańsk, Poland.
(2)Department of Anaesthesiology and Intensive Care Nursing, Institute of
Nursing and Midwifery, Faculty of Health Sciences with the Institute of Maritime
and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk,
Poland.
(3)Division of Hyperbaric Medicine & Maritime Rescue-National Centre for
Hyperbaric Medicine, Institute of Maritime and Tropical Medicine, Faculty of
Health Sciences with the Institute of Maritime and Tropical Medicine, Medical
University of Gdańsk, Powstania Styczniowego 9b, 81-519 Gdynia, Poland.
(4)Department of Emergency Medicine, Faculty of Health Science, University of
Warmia and Mazury, Żołnierska 18, 10-561 Olsztyn, Poland.
(5)Division of Public Health and Social Medicine, Faculty of Health Sciences
with the Institute of Maritime and Tropical Medicine, Medical University of
Gdańsk, Tuwima 15, 80-210 Gdańsk, Poland.
(1) Objective: Paramedics as a profession are a pillar of the State Medical
Rescue system. The basic difference between a specialist and a basic team is the
composition of members. The aim of the study was to benchmark the effectiveness
of performing advanced resuscitation procedures undertaken by two- and
three-person basic emergency medical teams in adults under simulated conditions.
(2) Design: The research was observational. 200 two- and three-people basic
emergency medical teams were analyzed during advanced resuscitation procedures,
ALS (Advanced Life Support) in adults under simulated conditions. (3) Method:
The study was carried out among professionally active and certified paramedics.
It lasted over two years. The study took place under simulated conditions using
prepared scenarios. (4) Results: In total, 463 people took part in the study.
The analysis of the survey results indicates that the efficiency of three-person
teams is superior to the activities performed by two-person teams. Three-person
teams were quicker to perform rescue actions than two-person teams. The
two-person teams were much quicker to assess the condition of victims than the
three-person teams. The three-person teams were more likely to check an open
airway. The three-person teams were more efficient in assessing the heart rhythm
and current condition of victims. It was demonstrated that three-person teams
were more effective during electrotherapy. The analysis demonstrated that
three-person teams were significantly faster and more efficient in chest
compressions. Three-person teams were less likely to use emergency airway
techniques than two-person teams. The results indicate that three-person teams
administered the first dose of adrenaline significantly faster than two-person
teams. For the "call for help", the three-person teams were found to be more
effective. (5) Conclusion: Paramedics in three-person teams work more
effectively, make a proper assessment of heart rhythm and monitor when taking
advanced actions. The quality of ventilation and BLS in both groups studied is
insufficient. Numerous errors have been observed in two-person teams during
pharmacotherapy.

DOI: 10.3390/ijerph18094834
PMCID: PMC8124675
PMID: 33946551 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare that they have no conflict
of interest.

171. Resuscitation. 2009 Jan;80(1):104-8. doi: 10.1016/j.resuscitation.2008.09.015.

Epub 2008 Nov 6.

Reduced hands-off-time and time to first shock in CPR according to the ERC
Guidelines 2005.

Roessler B(1), Fleischhackl R, Losert H, Arrich J, Mittlboeck M, Domanovits H,

Hoerauf K.

Author information:
(1)Medical University of Vienna, Department of Anaesthesia and General Intensive
Care, Vienna, Austria.

BACKGROUND AND AIM: Chest compressions and early defibrillation are crucial in
cardiopulmonary resuscitation (CPR). The Guidelines 2005 brought major changes
to the basic life support and automated external defibrillator (BLS-AED)
algorithm. We compared the European Resuscitation Council's Guidelines 2000
(group '00) and 2005 (group '05) on hands-off-time (HOT) and time to first shock
(TTFS) in an experimental model.
METHODS: In a randomised, cross-over design, volunteers were assessed in
performing BLS-AED over a period of 5min on a manikin in a simulated ventricular
fibrillation cardiac arrest situation. Ten minutes of standardised teaching and
10min of training including corrective feedback were allocated for each of the
guidelines before evaluation. HOT was chosen as the primary and TTFS as the
secondary outcome parameter.
RESULTS: Forty participants were enrolled; one participant dropped out after
group allocation. During the 5-min evaluation period of adult BLS-AED, HOT was
significantly (p<0.001) longer in group '00 [273+/-3s (mean+/-standard error)]
than in group '05 (188+/-3s). The TTFS was significantly (p<0.001) longer in
group '00 (91+/-3s) than in group '05 (71+/-3s).
CONCLUSION: In this manikin setting, HOT and TTFS improved with BLS-AED
performed according to Guidelines 2005.

DOI: 10.1016/j.resuscitation.2008.09.015
PMID: 18992984 [Indexed for MEDLINE]

172. Acad Emerg Med. 2018 Dec;25(12):1396-1408. doi: 10.1111/acem.13564. Epub 2018
Oct 25.

Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty

Emergency Departments: A Prospective, In Situ, Simulation-based Study.

Auerbach M(1), Brown L(2), Whitfill T(1), Baird J(2), Abulebda K(3), Bhatnagar
A(1), Lutfi R(3), Gawel M(1), Walsh B(4), Tay KY(5), Lavoie M(5), Nadkarni V(6),
Dudas R(7), Kessler D(8), Katznelson J(9), Ganghadaran S(10), Hamilton MF(11).

Author information:
(1)Department of Pediatrics and Emergency Medicine, Yale University School of
Medicine, New Haven, CT.
(2)Department of Emergency Medicine, Alpert School of Medicine at Brown
University, Providence, RI.
(3)Department of Pediatrics, Division of Critical Care, Indiana University
School of Medicine, Riley Hospital for Children at Indiana University Health,
Indianapolis, IN.
(4)Department of Pediatrics, Division of Pediatric Emergency Medicine, Boston
University, Boston, MA.
(5)Department of Pediatrics, Division of Pediatric Emergency Medicine,
University of Pennsylvania Perelman School of Medicine, The Children's Hospital
of Philadelphia, Philadelphia, PA.
(6)Department of Anesthesiology and Critical Care Medicine, University of
Pennsylvania Perelman School of Medicine, The Children's Hospital of
Philadelphia, Philadelphia, PA.
(7)Department of Pediatrics, Division of General Pediatrics and Adolescent
Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
(8)Department of Pediatrics, Columbia University Irving Medical Center, New
York, NY.
(9)Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD.
(10)Department of Critical Care Medicine and Pediatrics, Children's Hospital at
Montefiore, Bronx, NY.
(11)Department of Critical Care Medicine and Pediatrics, Children's Hospital of
Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.

BACKGROUND AND OBJECTIVES: Pediatric out-of-hospital cardiac arrest survival

outcomes are dismal (<10%). Care that is provided in adherence to established
guidelines has been associated with improved survival. Lower mortality rates
have been reported in higher-volume hospitals, teaching hospitals, and trauma
centers. The primary objective of this article was to explore the relationship
of hospital characteristics, such as annual pediatric patient volume, to
adherence to pediatric cardiac arrest guidelines during an in situ simulation.
Secondary objectives included comparing adherence to other team, provider, and
system factors.
METHODS: This prospective, multicenter, observational study evaluated
interprofessional teams in their native emergency department (ED) resuscitation
bays caring for a simulated 5-year-old child presenting in cardiac arrest. The
primary outcome, adherence to the American Heart Association pediatric
guidelines, was assessed using a 14-item tool including three component domains:
basic life support (BLS), pulseless electrical activity (PEA), and ventricular
fibrillation (VF). Provider, team, and hospital-level data were collected as
independent data. EDs were evaluated in four pediatric volume groups
(low < 1,800/year; medium 1,800-4,999; medium-high 5,000-9,999; high > 10,000).
Cardiac arrest adherence and domains were evaluated by pediatric patient volume
and other team and hospital-level characteristics, and path analyses were
performed to evaluate the contribution of patient volume, systems readiness, and
teamwork on BLS, PEA, and VF adherence.
RESULTS: A total of 101 teams from a spectrum of 50 EDs participated including
nine low pediatric volume (<1,800/year), 36 medium volume (1,800-4,999/year), 24
medium-high (5,000-9,999/year), and 32 high volume (≥10000/year). The median
total adherence score was 57.1 (interquartile range = 50.0-78.6). This was not
significantly different across the four volume groups. The highest level of
adherence for BLS and PEA domains was noted in the medium-high-volume sites,
while no difference was noted for the VF domain. The lowest level of BLS
adherence was noted in the lowest-volume EDs. Improved adherence was not
directly associated with higher pediatric readiness survey (PRS) score provider
experience, simulation teamwork performance, or more providers with Pediatric
Advanced Life Support (PALS) training. EDs in teaching hospitals with a trauma
center designation that served only children demonstrated higher adherence
compared to nonteaching hospitals (64.3 vs 57.1), nontrauma centers (64.3 vs.
57.1), and mixed pediatric and adult departments (67.9 vs. 57.1), respectively.
The overall effect sizes for total cardiac adherence score are ED type γ = 0.47
and pediatric volume (low and medium vs. medium-high and high) γ = 0.41. A
series of path analyses models was conducted that indicated that overall
pediatric ED volume predicted significantly better guideline adherence, but the
effect of volume on performance was only mediated by the PRS for the VF domain.
CONCLUSIONS: This study demonstrated variable adherence to pediatric cardiac
arrest guidelines across a spectrum of EDs. Overall adherence was not associated
with ED pediatric volume. Medium-high-volume EDs demonstrated the highest levels
of adherence for BLS and PEA. Lower-volume EDs were noted to have lower
adherence to BLS guidelines. Improved adherence was not directly associated with
higher PRS score provider experience, simulation teamwork performance, or more
providers with PALS training. This study demonstrates that current approaches
optimizing the care of children in cardiac arrest in the ED (provider training,
teamwork training, environmental preparation) are insufficient.

© 2018 by the Society for Academic Emergency Medicine.

DOI: 10.1111/acem.13564
PMID: 30194902 [Indexed for MEDLINE]

173. Simul Healthc. 2013 Aug;8(4):242-52. doi: 10.1097/SIH.0b013e31828e716d.

Simulation intervention with manikin-based objective metrics improves CPR

instructor chest compression performance skills without improvement in chest
compression assessment skills.

Al-Rasheed RS(1), Devine J, Dunbar-Viveiros JA, Jones MS, Dannecker M, Machan

JT, Jay GD, Kobayashi L.
Author information:
(1)Department of Emergency Medicine, Brown University. dr.rocky20@gmail.com

INTRODUCTION: Cardiopulmonary resuscitation (CPR) instructor/coordinator

(CPR-I/C) adherence to published guidelines during resuscitation and learner
assessment for basic life support (BLS)/CPR skills has not been experimentally
studied. Investigators sought to (1) determine the quality of CPR-I/C chest
compression and the accuracy of CPR-I/C chest compression assessment, and (2)
improve CPR-I/C compression and assessment skills through cardiac arrest
simulations with objective in-scenario performance feedback.
METHODS: Thirty CPR-I/Cs (median, 20 years [range, 4-40 years] of BLS provider
experience; 6 years [range 1-40 years] of BLS instructor experience) were
randomized to control or experimental group. Each subject performed compressions
during a 2-minute simulation, then reviewed 6 videos of simulated CPR
performances (featuring prespecified chest compression parameters) for scoring
as "pass" or "needs remediation." Subjects participated in a second simulation
with or without real-time manikin compression feedback, then reviewed 6
additional videos. Primary outcome variables were the proportion of subjects
with more than 80% (American Heart Association regional criteria) or more than
23 of 30 (ie, 77%; American Heart Association instructor manual criteria)
correct compressions and subjects' accuracy of "pass"/"needs remediation"
assessment for videos. The secondary outcome variable was correlation between
subjects' correctness of chest compressions and their assessment accuracy for
simulated CPR compression performance.
RESULTS: All CPR-I/C subjects compressed suboptimally at baseline; real-time
manikin feedback improved the proportion of subjects with more than 77% correct
compressions to 0.53 (P < 0.01). Video review data revealed persistently low
CPR-I/C assessment accuracy. Correlation between subjects' correctness of
compressions and their assessment accuracy remained poor regardless of
interventions.
CONCLUSIONS: Real-time compression feedback during simulation improved CPR-I/C's
chest compression performance skills without comparable improvement in chest
compression assessment skills.

DOI: 10.1097/SIH.0b013e31828e716d
PMID: 23842118 [Indexed for MEDLINE]

174. Resuscitation. 2018 Sep;130:6-12. doi: 10.1016/j.resuscitation.2018.06.025.

Epub
2018 Jun 23.

Improving CPR quality with distributed practice and real-time feedback in

pediatric healthcare providers - A randomized controlled trial.

Lin Y(1), Cheng A(2), Grant VJ(3), Currie GR(4), Hecker KG(5).

Author information:
(1)KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital,
Department of Community Health Sciences, University of Calgary, 2888 Shaganappi
Trail NW, Calgary, Alberta, T3B 6A8, Canada. Electronic address:
yiqlin@ucalgary.ca.
(2)University of Calgary, KidSIM-ASPIRE Research Program, Section of Emergency
Medicine, Department of Pediatrics, Alberta Children's Hospital, 2888 Shaganappi
Trail NW, Calgary, Alberta, T3B 6A8, Canada. Electronic address: chenger@me.com.
(3)University of Calgary, KidSIM-ASPIRE Research Program, Section of Emergency
Medicine, Department of Pediatrics, Alberta Children's Hospital, 2888 Shaganappi
Trail NW, Calgary, Alberta, T3B 6A8, Canada. Electronic address:
vincent.grant@ahs.ca.
(4)University of Calgary, Department of Community Health Sciences, Department of
Pediatrics, University of Calgary, HRIC Building, 3280 Hospital Drive NW,
Calgary, Alberta, T3N 4Z6, Canada. Electronic address: currie@ucalgary.ca.
(5)University of Calgary, Department of Veterinary Clinic and Diagnostic
Sciences, Department of Community Health Sciences, University of Calgary, 3280
Hospital Drive NW, Calgary, Alberta, T2N 4A6, Canada. Electronic address:
kghecker@ucalgary.ca.

OBJECTIVES: Guideline compliant CPR is associated with improved survival for

patients with cardiac arrest. Conventional Basic Life Support (BLS) training
results in suboptimal CPR competency and skill retention. We aimed to compare
the effectiveness of distributed CPR training with real-time feedback to
conventional BLS training for CPR skills in pediatric healthcare providers.
METHODS: Healthcare providers were randomized into receiving annual BLS training
(control) or distributed training with real-time feedback (intervention). The
intervention group was asked to practice CPR for 2 min on mannequins while
receiving real-time CPR feedback, at least once per month. Control group
participants were not asked to practice CPR during the study period. Excellent
CPR was defined as 90% guideline-compliance for depth, rate and recoil of chest
compressions. CPR performance of participants was assessed (on infant and
adult-sized mannequins) every 3 months for a duration of 12 months. CPR
performance was compared between the 2 groups.
RESULTS: A total of 87 healthcare providers were included in the analyses
(control n = 41, intervention n = 46). Baseline assessment showed no significant
difference in CPR performance across the 2 groups. The intervention group has a
significantly greater proportion of participants with excellent CPR compared
with the control group on an adult sized mannequin (14.6% vs. 54.3%, p < 0.001)
and infant-sized mannequin (19.5% vs. 71.7%, p < 0.001) at the end of the study.
In the intervention group, all CPR metrics except infant depth were improved and
retained over the course of the study.
CONCLUSION: Distributed CPR training with real-time feedback improves the
compliance of AHA guidelines of quality of CPR.

Copyright © 2018 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.resuscitation.2018.06.025
PMID: 29944894 [Indexed for MEDLINE]

175. BMJ Open. 2020 Oct 21;10(10):e040469. doi: 10.1136/bmjopen-2020-040469.

Brief compression-only cardiopulmonary resuscitation and automated external

defibrillator course for secondary school students: a multischool feasibility
study.

So KY(1), Ko HF(1)(2), Tsui CSY(3), Yeung CY(1), Chu YC(1), Lai VKW(2)(4), Lee
A(5).

Author information:
(1)Accident and Emergency Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
SAR, China.
(2)Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin,
Hong Kong SAR, China.
(3)Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, Hong Kong
SAR, China.
(4)Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of
Higher Education, Tseung Kwan O, Hong Kong SAR, China.
(5)Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin,
Hong Kong SAR, China annalee@cuhk.edu.hk.

OBJECTIVES: This study assessed the feasibility and preliminary efficacy of a

2-hour compression-only cardiopulmonary resuscitation and automated external
defibrillator (CO-CPRAED) course in secondary school students.
DESIGN: Prospective pre-post feasibility study.
SETTING AND PARTICIPANTS: 128 students (12-15 years old) without prior basic
life support (BLS) training at four secondary schools in Hong Kong. All students
were followed up at 3 months after training.
INTERVENTIONS: Emergency medicine-trained nurse and physicians taught the 2-hour
CO-CPRAED course using the American Heart Association 'CPR in School Training
Kit' programme. Students were trained in groups up to 40 students/session, with
an instructor to student ratio not exceeding 1:10. To practise hands-on
compressions, the manikin to student ratio was 1:1. For a simulated cardiac
arrest, the manikin and AED to student ratio was 1:10.
PRIMARY AND SECONDARY OUTCOMES: CPR and AED knowledge, attitude statements
towards bystander CPR and AED, quality of BLS performance skills during training
and at 3 months.
RESULTS: Some students (46%) knew how deep to push on an adult chest when doing
CO-CPR before training. The course was associated with an increase in knowledge
score (pretraining 55%, post-training 93%; adjusted mean difference (MD) 38%,
95% CI 33% to 43%; p<0.001). Most students (68%) thought that CPR education in
senior secondary school was essential before training. The students had a very
positive attitude towards CPR; no change in the mean (SD) attitude score out of
30 over time (pretraining 27.2 (2.5), post-training 27.6 (2.7); adjusted MD 0.5,
95% CI -0.1 to 1.0; p=0.132). Most students were competent in performing BLS
immediately after training (77%) and at 3 months (83%) (adjusted MD 6%, 95% CI
-4% to 15%; p=0.268).
CONCLUSIONS: The results demonstrate the feasibility of scaling up the number of
secondary schools trained in a brief CO-CPRAED course within the local school
curriculum.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No

commercial re-use. See rights and permissions. Published by BMJ.

DOI: 10.1136/bmjopen-2020-040469
PMCID: PMC7580074
PMID: 33087377 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: CYY is a lecturer at the

Hong Kong Red Cross.

176. Med Teach. 2015 Apr;37(4):374-8. doi: 10.3109/0142159X.2014.956056. Epub 2014

Sep 4.

May student examiners be reasonable substitute examiners for faculty in an

undergraduate OSCE on medical emergencies?

Iblher P(1), Zupanic M, Karsten J, Brauer K.

Author information:
(1)University of Luebeck Medical School , Germany .

Comment in
Med Teach. 2015 Apr;37(4):404. doi: 10.3109/0142159X.2015.1009428.
Med Teach. 2016;38(2):212. doi: 10.3109/0142159X.2015.1056127.
Med Teach. 2016;38(2):212-3. doi: 10.3109/0142159X.2015.1072266.
OBJECTIVES: To compare the effect of student examiners (SE) to that of faculty
examiners (FE) on examinee performance in an OSCE as well as on post-assessment
evaluation in the area of emergency medicine management.
METHODS: An OSCE test-format (seven stations: Advanced Cardiac Life Support
(ACLS), Basic Life Support (BLS), Trauma-Management (TM), Pediatric-Emergencies
(PE), Acute-Coronary-Syndrome (ACS), Airway-Management (AM), and
Obstetrical-Emergencies (OE)) was administered to 207 medical students in their
third year of training after they had received didactics in emergency medicine
management. Participants were randomly assigned to one of the two simultaneously
run tracks: either with SE (n = 110) or with FE (n = 98). Students were asked to
rate each OSCE station and to provide their overall OSCE perception by means of
a standardized questionnaire. The independent samples t-test was used and effect
sizes were calculated (Cohens d).
RESULTS: Students achieved significantly higher scores for the OSCE stations
"TM", "AM", and "OE" as well as "overall OSCE score" in the SE track, whereas
the station score for "PE" was significantly higher for students in the FE
track. Mostly small effect sizes were reported. In the post-assessment
evaluation portion of the study, students gave significant higher ratings for
the ACS station and "overall OSCE evaluation" in the FE track; also with small
effect sizes.
CONCLUSION: It seems quite admissible and justified to encourage medical
students to officiate as examiners in undergraduate emergency medicine OSCE
formative testing, but not necessarily in summative assessment evaluations.

DOI: 10.3109/0142159X.2014.956056
PMID: 25186850 [Indexed for MEDLINE]

177. Resusc Plus. 2024 Aug 1;19:100731. doi: 10.1016/j.resplu.2024.100731.

eCollection 2024 Sep.

Kids Save Lives - The kids' and teachers' view: How school children and
schoolteachers would alter a BLS course designed by specialists.

Andreotti C(1), Kolbe M(2), Capon-Sieber V(3), Spahn DR(1), Breckwoldt J(1).

Author information:
(1)University Hospital Zurich, Institute of Anesthesiology, Switzerland.
(2)Simulation Center, University Hospital Zurich, Switzerland.
(3)Institute of Education, Dept. for Research on Learning, Instruction, and
Didactics, University of Zurich, Switzerland.

BACKGROUND: Training schoolchildren in basic life support ('Kids-Save-Lives'

training) is widely believed to improve outcomes from out-of-hospital cardiac
arrest. Numerous programmes have been launched, but to our knowledge, neither
children nor schoolteachers have been directly involved in designing these
courses. This is unfortunate, as it is well-known that children (as the target
goup of training) learn differently from adults. We therefore sought to explore
the view of schoolchildren and their teachers on the design of a
'Kids-Save-Lives' course.
METHODS: We designed a state-of-the-art, 90-min BLS training and delivered it to
all 13 classes of a secondary community school (children aged 12-16). Directly
after each training, we performed Video-Stimulated Recall (VSR) with 2 children
and 2 schoolteachers. For VSR, we presented video sequences from defined
sections of the training and related semi-structured questions to these
sections. The interviews were audio-recorded, transcribed, and analysed using
qualitative content analysis.
RESULTS: Twenty-four children and 24 teachers participated in the VSR. The
overall satisfaction with the training was very high. Participants especially
appreciated the brief theoretical introduction using a video, the high practical
involvement, and the final scenario. Children suggested the program could be
improved by better linking the video to the children's world, increasing
excitement and action, and limiting the group size in the final scenario.
Teachers suggested incorporating more theoretical background, using terms and
language more consistently, and better integrating the program into the school
curriculum.
CONCLUSIONS: Although very satisfied with a state-of-the-art 'Kids-Save-Lives'
training, children and teachers made important suggestions for improvement.

© 2024 The Authors.

DOI: 10.1016/j.resplu.2024.100731
PMCID: PMC11345691
PMID: 39188894

Conflict of interest statement: The authors declare that they have no known
competing financial interests or personal relationships that could have appeared
to influence the work reported in this paper.

178. Resuscitation. 2013 Jul;84(7):982-6. doi: 10.1016/j.resuscitation.2013.01.001.

Epub 2013 Jan 7.

Can a flowchart improve the quality of bystander cardiopulmonary resuscitation?

Rössler B(1), Ziegler M, Hüpfl M, Fleischhackl R, Krychtiuk KA, Schebesta K.

Author information:
(1)Medical Simulation and Emergency Management Research Group, Department of
Anaesthesia, General Intensive Care and Pain Management, Medical University of
Vienna, Austria. bernhard.roessler@meduniwien.ac.at

BACKGROUND: Since the introduction of basic life support in the 1950s, on-going
efforts have been made to improve the quality of bystander cardiopulmonary
resuscitation (CPR). Even though bystander-CPR can increase the chance of
survival almost fourfold, the rates of bystander initiated CPR have remained low
and rarely exceed 20%. Lack of confidence and fear of committing mistakes are
reasons why helpers refrain from initiating CPR. The authors tested the
hypothesis that quality and confidence of bystander-CPR can be increased by
supplying lay helpers with a basic life support flowchart when commencing CPR,
in a simulated resuscitation model.
MATERIALS AND METHODS: After giving written informed consent, 83 medically
untrained laypersons were randomised to perform basic life support for 300s with
or without a supportive flowchart. The primary outcome parameter was hands-off
time (HOT). Furthermore, the participants' confidence in their actions on a
10-point Likert-like scale and time-to-chest compressions were assessed.
RESULTS: Overall HOT was 147±30 s (flowchart) vs. 169±55 s (non-flowchart),
p=0.024. Time to chest compressions was significantly longer in the flowchart
group (60±24 s vs. 23±18 s, p<0.0001). Participants in the flowchart group were
significantly more confident when performing BLS than the non-flowchart
counterparts (7±2 vs. 5±2, p=0.0009).
CONCLUSIONS: A chart provided at the beginning of resuscitation attempts
improves quality of CPR significantly by decreasing HOT and increasing the
participants' confidence when performing CPR. As reducing HOT is associated with
improved outcome and positively impacting the helpers' confidence is one of the
main obstacles to initiate CPR for lay helpers, charts could be utilised as
simple measure to improve outcome in cardiopulmonary arrest.
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2013.01.001
PMID: 23306815 [Indexed for MEDLINE]

179. Eur J Obstet Gynecol Reprod Biol. 2017 Sep;216:98-103. doi:

10.1016/j.ejogrb.2017.07.019. Epub 2017 Jul 16.

Coronary perfusion pressure and compression quality in maternal cardiopulmonary

resuscitation in supine and left-lateral tilt positions: A prospective,
crossover study using mannequins and swine models.

Dohi S(1), Ichizuka K(2), Matsuoka R(3), Seo K(2), Nagatsuka M(2), Sekizawa
A(3).

Author information:
(1)Department of Obstetrics and Gynecology, Showa University Northern Yokohama
Hospital, Kanagawa, Japan. Electronic address: satoshi.dohi1018@gmail.com.
(2)Department of Obstetrics and Gynecology, Showa University Northern Yokohama
Hospital, Kanagawa, Japan.
(3)Department of Obstetrics and Gynecology, Showa University School of Medicine,
Tokyo, Japan.

OBJECTIVE: The risk of maternal and fetal mortality is high if cardiopulmonary

arrest occurs during pregnancy. To assess the best position for maternal
cardiopulmonary resuscitation (CPR), a prospective randomized crossover study
was undertaken, involving basic life support mannequin-based simulation (BLS-MS)
and a swine model of pulseless electrical activity (an unstable cardiac state)
incorporating a fetal mannequin (PEA-FM).
STUDY DESIGN: The BLS-MS (performed by certified rescuers) served to evaluate
the quality of chest compressions in 30° left lateral tilt (LLT) and supine
positions. Based on a 5-point scale, each rescuer subjectively graded their
experience. The PEA-FM model was used to compare coronary perfusion pressure
readings during CPR in supine, supine with left uterine displacement, 30° LLT,
and 30° right lateral tilt positions. Compression rate and correctness of hand
position, compression depth, and recoil were measures of compression quality
(BLS-MS).
RESULTS: Compared with LLT position, supine position enabled correct hand
position (rate: 0.99 vs 0.88; p<0.05) and compression depth (rate: 0.76 vs 0.36;
p<0.001) significantly more often. Moreover, BLS-MS rescuers found chest
compressions significantly easier to perform with the mannequin in supine (vs
LLT) position (difficulty score: 1.75 vs 3.95; p<0.001). In the PEA-FM study
arm, supine position with left uterine displacement and right lateral tilt
positions had the highest and lowest recorded coronary perfusion pressure
readings, respectively.
CONCLUSION: Supine position with left uterine displacement is optimal for
maternal CPR.

Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.ejogrb.2017.07.019
PMID: 28743074 [Indexed for MEDLINE]

180. GMS J Med Educ. 2016 Aug 15;33(4):Doc60. doi: 10.3205/zma001059. eCollection
2016.

Peyton's 4-Steps-Approach in comparison: Medium-term effects on learning

external chest compression - a pilot study.

Münster T(1), Stosch C(1), Hindrichs N(1), Franklin J(2), Matthes J(3).

Author information:
(1)University of Cologne, Cologne interprofessional SkillsLab and Simulation
Centre (KISS), Cologne, Germany.
(2)University of Cologne, Institute of Medical Statistics, Informatics and
Epidemiology (IMSIE), Cologne, Germany.
(3)University of Cologne, Department of Pharmacology, Cologne, Germany.

INTRODUCTION: The external chest compression is a very important skill required

to maintain a minimum of circulation during cardiac arrest until further medical
procedures can be taken. Peyton's 4-Steps-Approach is one method of skill
training, the four steps being: Demonstration, Deconstruction, Comprehension and
Execution. Based on CPR skill training, this method is widely, allegedly
predominantly used, although there are insufficient studies on Peyton's
4-Steps-Approach for skill training in CPR in comparison with other methods of
skill training. In our study, we compared the medium- term effects on learning
external chest compression with a CPR training device in three different groups:
PEY (Peyton's 4-Steps-Approach), PMOD (Peyton's 4-Steps-Approach without Step 3)
and STDM, the standard model, according to the widely spread method "see one, do
one" (this is equal to Peyton's step 1 and 3).
MATERIAL AND METHODS: This prospective and randomised pilot study took place
during the summer semester of 2009 at the SkillsLab and Simulation Centre of the
University of Cologne (Kölner interprofessionelles Skills Lab und
Simulationszentrum - KISS). The subjects were medical students (2(nd) and 3(rd)
semester). They volunteered for the study and were randomised in three parallel
groups, each receiving one of the teaching methods mentioned above. One week and
5/6 months after the intervention, an objective, structured single assessment
was taken. Compression rate, compression depth, correct compressions, and the
sum of correct checklist items were recorded. Additionally, we compared
cumulative percentages between the groups based on the correct implementation of
the resuscitation guidelines during that time.
RESULTS: The examined sample consisted of 134 subjects (68% female; age 22±4;
PEY: n=62; PMOD: n=31; STDM: n=41). There was no difference between the groups
concerning age, gender, pre-existing experience in CPR or time of last CPR
course. The only significant difference between the groups was the mean
compression rate (bpm): Group 1 (PEY) with 99±17 bpm, Group 2 (PMOD) with 101±16
bpm and Group 3 (STDM) with 90±16 bpm (p=0,007 for Group 3 vs. Group 1 and Group
3 vs. Group 2, Mann-Whitney- U-Test). We observed no significant differences
between the groups after the second assessment.
CONCLUSION: Our study showed that there are no essential differences in external
chest compression during CPR performed by medical students dependent on the
teaching method (Peyton vs. "Non-Peyton") implemented with regard to the
medium-term effects. The absence of benefits could possibly be due to the
simplicity of external chest compression.

Publisher: Einführung: Die extrakorporale Herzdruckmassage ist eine wichtige

Fertigkeit, um ein Minimum der Organdurchblutung bei Patienten/-innen mit
Herz-Kreislauf-Stillstand zu gewährleisten, bis weitere medizinische Hilfe
geleistet werden kann. Eine Methode um diese Fertigkeit zu vermitteln ist der
Ansatz nach Peyton. Dieser besteht aus 4 Schritten: Demonstration,
Dekonstruktion, Verständnis und Durchführung. Bezogen auf die kardiopulmonale
Reanimation wird eine Überlegenheit dieser Methode gegenüber Anderen angenommen,
ist jedoch bisher durch Studien nicht ausreichend gesichert. In unserer Studie
haben wir den mittelfristigen Lernerfolg durch die 4-Schritt-Methode nach Peyton
(„PEY“) mit dem der Modifikation „PMOD“ (4-Schritt-Methode ohne Schritt 3) und
dem „STDM“ (Standardmodell, entsprechend der weit verbreiteten Methode „See one
Do one“, entspricht der 4-Schritt-Methode ohne Schritt 1 und 3,) anhand von
Parametern der Durchführung einer Herzdruckmassage am Modell verglichen.Material
und Methoden: Die prospektiv, randomisierte Pilotstudie wurde im Sommersemester
2009 im Kölner Interprofessionellen SkillsLab und Simulationszentrum (KISS) an
der Universität zu Köln durchgeführt. Die Probanden (Studierende der
Humanmedizin des zweiten und dritten Fachsemesters) nahmen freiwillig an der
Studie teil. Die Studierenden wurden in drei parallele Studiengruppen
randomisiert, die nach jeweils einer der oben genannten Methoden unterrichtet
wurden. Eine Woche sowie fünf bzw. sechs Monate nach Intervention wurden die
Probanden in einer objektivierten strukturierten Einzel-Überprüfung bzgl. ihrer
Reanimationsfertigkeiten geprüft. Die Ergebnisse der Gruppen wurden hinsichtlich
der Parameter Kompressionsfrequenz, Kompressionstiefe, Anteil richtiger
Kompressionen sowie Anzahl in einer Checkliste erreichter Items verglichen.
Verglichen wurden außerdem Häufigkeitsverteilungen bezogen auf das Umsetzen oder
Verfehlen damals geltender Leitlinienempfehlungen zur kardiopulmonalen
Reanimation.Ergebnisse: Die untersuchte Stichprobe umfasste 134 Probanden (68%
weiblich; Alter: 22±4 Jahre; PEY: n=62; PMOD: n=31; STDM: n=41). Es bestand kein
Unterschied zwischen den Gruppen bzgl. Alter, Geschlechterverteilung,
Vorerfahrung oder zeitlichem Abstand zu einem vorherigen (Reanimations-) Kurs.
Nur bei einem Endpunkt fand sich ein statistisch signifikanter Unterschied: Die
mittlere Kompressionsfrequenz in der ersten Prüfung lag in Gruppe 1 (PEY) bei
99±17/Minute, in Gruppe 2 (PMOD) bei 101±16/Minute und in Gruppe 3 (STDM) bei
90±16/Minute (p=0,007 für Gruppe 3 vs. Gruppe 1 sowie Gruppe 3 vs. Gruppe 2 im
Mann-Whitney-U-Test). Keiner der untersuchten Parameter unterschied sich
zwischen den drei untersuchten Gruppen 5 bzw. 6 Monate nach Durchführung des
Kurses.Schlussfolgerung: Unsere Studie liefert keinen Hinweis auf wesentliche
Unterschiede bei der Durchführung einer Herzdruckmassage durch Studierende im
Rahmen der kardiopulmonalen Reanimation am Modell in Abhängigkeit von der
Unterrichtsmethode (Peyton vs. „Non-Peyton“) bezogen auf den mittelfristigen
Überprüfungszeitraum. Möglicherweise ist die Herzdruckmassage als Fertigkeit
nicht komplex genug, um von der Vermittlung nach Peyton zu profitieren.

DOI: 10.3205/zma001059
PMCID: PMC5003127
PMID: 27579360 [Indexed for MEDLINE]

181. J Clin Med. 2024 Oct 5;13(19):5933. doi: 10.3390/jcm13195933.

Effectiveness of Adult Chest Compressions during Resuscitation Performed by

Children Aged 10-14 Years under Simulated Conditions.

Leszczyński PK(1)(2), Ciołek W(1), Cudna J(1), Ilczak T(3)(2).

Author information:
(1)Department of Medical and Health Sciences, University of Siedlce, 08-110
Siedlce, Poland.
(2)European Pre-Hospital Research Network, Nottingham NG11 8NS, UK.
(3)Department of Emergency Medicine, Faculty of Health Sciences, University of
Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland.

Introduction: Numerous educational programs recommend implementing the teaching

principles of BLS from an early age. The aim of this study was to evaluate
selected parameters of the quality of resuscitation performed by children aged
10-14 years during simulated circulatory arrest in an adult. Materials and
Methods: The project involved four stages, culminating in students performing
thoracic compressions on an adult simulator for 2 min. A digital analysis of the
quality, depth, relaxation and rate of compressions allowed us to formulate
results and conclusions. The authors' proprietary questionnaire form allowed for
the correlation of criteria such as age, gender, body mass and past experience
in first aid training of the participant. Results: A total of 149 girls and 130
boys were studied. The mean age was 12 years (SD ± 1.41). A directly
proportional increase in body mass with participant age was observed (p <
0.000). Children as young as 10 years old achieved only 24.13% quality, while
those at the age of 14 demonstrated a more than doubled value (67.61%). The
minimum depth of chest compressions recommended for an adult (5-6 cm) was not
reached in any age group. Girls from all grades achieved a mean quality of
44.69% (SD ± 32.57), while boys achieved a score of 60.23% (SD ± 31.74). On the
other hand, in the case of evaluating thoracic relaxation, a significantly
better result was achieved by girls compared to boys (66.14% vs. 56.78%;
rho-Spearman test for p = 0.011). Conclusions: Age, sex and body mass play
important roles in the quality of resuscitation provided by children. None of
the age groups studied achieved the minimum mean depth during adult thoracic
compressions under simulated conditions. It is recommended to modify
school-based BLS classes to better match the exercises to students'
predispositions.

DOI: 10.3390/jcm13195933
PMCID: PMC11477497
PMID: 39407993

Conflict of interest statement: The authors declare no conflict of interest.

182. BMJ Open. 2018 Feb 22;8(2):e017705. doi: 10.1136/bmjopen-2017-017705.

Comparison of a newly established emotional stimulus approach to a classical

assessment-driven approach in BLS training: a randomised controlled trial.

Kuckuck K(1), Schröder H(1), Rossaint R(1), Stieger L(2), Beckers SK(1)(2),
Sopka S(1)(2).

Author information:
(1)Department of Anaesthesiology, University Hospital RWTH Aachen University,
Aachen, Germany.
(2)AIXTRA-Aachen Interdisciplinary Training Centre for Medical Education,
University Hospital RWTH Aachen University, Aachen, Germany.

OBJECTIVE: The study objective was to implement two strategies (short emotional
stimulus vs announced practical assessment) in the teaching of resuscitation
skills in order to evaluate whether one led to superior outcomes.
SETTING: This study is an educational intervention provided in one German
academic university hospital.
PARTICIPANTS: First-yearmedical students (n=271) during the first3 weeks of
their studies.
INTERVENTIONS: Participants were randomly assigned to one of two groups
following a sequence of random numbers: the emotional stimulus group (EG) and
the assessment group (AG). In the EG, the intervention included watching an
emotionally stimulating video prior to the Basic Life Support (BLS) course. In
the AG, a practical assessment of the BLS algorithm was announced and tested
within a 2 min simulated cardiac arrest scenario. After the baseline testing, a
standardised BLS course was provided. Evaluation points were defined 1 week and
6 months after.
PRIMARY OUTCOME MEASURES: Compression depth (CD) and compression rate (CR) were
recorded as the primary endpoints for BLS quality.
RESULTS: Within the study, 137 participants were allocated to the EG and 134 to
the AG. 104 participants from EG and 120 from AG were analysed1 week after the
intervention, where they reached comparable chest-compression performance
without significant differences (CR P=0.49; CD P=0.28). The chest-compression
performance improved significantly for the EG (P<0.01) and the AG (P<0.01) while
adhering to the current resuscitation guidelines criteria for CD and CR.
CONCLUSIONS: There was no statistical difference between both groups' practical
chest-compression-performance. Nevertheless, the 2 min video sequence used in
the EG with its low production effort and costs, compared with the expensive
assessment approach, provides broad opportunities for applicability in BLS
training.

© Article author(s) (or their employer(s) unless otherwise stated in the text of
the article) 2018. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.

DOI: 10.1136/bmjopen-2017-017705
PMCID: PMC5855479
PMID: 29472255 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.

183. Acad Emerg Med. 2012 Nov;19(11):1242-7. doi: 10.1111/acem.12008.

Single rescuer exertion using a mechanical resuscitation device: a randomized

controlled simulation study.

Fischer H(1), Zapletal B, Neuhold S, Rützler K, Fleck T, Frantal S, Theiler L,

Stumpf D, Havel C, Greif R.

Author information:
(1)Department of Anesthesia, General Intensive Care and Pain Control, Division
of Cardiothoracic and Vascular Anesthesia and Intensive Care, Vienna, Austria.

OBJECTIVES: The goal of this experimental study was to investigate rescuer

exertion when using "Animax," a manually operated hand-powered mechanical
resuscitation device (MRD) for cardiopulmonary resuscitation (CPR), compared to
standard basic life support (BLS).
METHODS: This was a prospective, open, randomized, crossover simulation study.
After being trained, 80 medical students with substantial knowledge in BLS
performed one-rescuer CPR using either the MRD or the standard BLS for 12-minute
intervals in random order. The main outcome parameter was the heart rate
pressure product (RPP) as an index of cardiac work. Secondary outcome parameters
were physical exhaustion quantified by the Borg scale (measurement of perceived
exertion), Nine Hole Peg Test (NHPT; measurement of fine motor skills), and
capillary lactate concentration during testing.
RESULTS: While no significant difference could be found for the RPP, a
significantly increased mean heart rate during the final minute of standard BLS
compared to the MRD was found (139 ± 22 beats/min vs. 135 ± 26 beats/min, p =
0.027). By contrast, subjective exertion using the MRD was rated significantly
higher on the Borg scale (15.1 ± 2.4 vs. 14.6 ± 2.6, p = 0.027). Mean serum
lactate concentration was significantly higher when the MRD was used compared to
standard BLS (3.4 ± 1.5 mmol/L vs. 2.1 ± 1.3 mmol/L, p ≤ 0.001).
CONCLUSIONS: Use of the MRD leads to a RPP of the rescuers comparable to
standard BLS. These findings suggest that there is no clinically relevant
reduction of exertion if this MRD is used by a single rescuer. If this kind of
MRD is used for CPR, frequent changeovers with a second rescuer should be
considered as the guidelines suggest for standard CPR.

© 2012 by the Society for Academic Emergency Medicine.

DOI: 10.1111/acem.12008
PMID: 23167854 [Indexed for MEDLINE]

184. Indian J Crit Care Med. 2020 Jun;24(6):409-413. doi:

10.5005/jp-journals-10071-23457.

Influence of Physical Activity of the Rescuer on Chest Compression Duration and

its Effects on Hemodynamics and Fatigue Levels of the Rescuer: A
Simulation-based Study.

Nayak VR(1), Babu A(1), Unnikrishnan R(1), Babu AS(2), Krishna HM(3).

Author information:
(1)Department of Respiratory Therapy, Manipal College of Health Professions,
Manipal Academy of Higher Education, Manipal, Karnataka, India.
(2)Department of Physiotherapy, Manipal College of Health Professions, Manipal
Academy of Higher Education, Manipal, Karnataka, India.
(3)Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of
Higher Education, Manipal, Karnataka, India.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is a lifesaving skill performed

during the cardiac arrest. Various factors of rescuer affect CPR quality, and
rescuers physical fitness is one among the important factors needs to be
explored for improved CPR quality. This study aimed to assess the physical
activity (PA) levels of the health care providers (HCPs) who were trained in
basic life support (BLS) and its relationship on chest compression duration,
hemodynamic parameters, and fatigue levels of the rescuers.
MATERIALS AND METHODS: A single-center, cross-sectional study was conducted on
48 HCPs who were trained in BLS within one year. Eligible participants were
contacted by email, and the responders' level of PA was determined using the
global physical activity questionnaire (GPAQ). The participants were recruited
for chest compression-only cardiac arrest scenarios. Each subject performed
continuous chest compression on the manikin until they perceived maximum
fatigue. Heart rate (HR), blood pressure (BP), oxygen saturation (SpO2), and
fatigue level were assessed at baseline, immediately after and following two
minutes of cessation of chest compressions. The total duration of chest
compression was also documented.
RESULTS: Most participants (24, 50%) reported high levels of PA while 22
(45.83%) and 2 (4.17%) reported moderate and low intensity of PA, respectively.
The mean age of the 35 participants was 26.08 ± 4.60 years. The mean duration of
chest compressions was 193.25 seconds with higher times reported for those with
high PA when compared to those with moderate PA (p = 0.017). Similar findings
were also observed for fatigue.
CONCLUSION: Rescuers who reported high PA had lower levels of fatigue and could
perform longer duration of chest compressions.
HOW TO CITE THIS ARTICLE: Nayak VR, Babu A, Unnikrishnan R, Babu AS, Krishna HM.
Influence of Physical Activity of the Rescuer on Chest Compression Duration and
its Effects on Hemodynamics and Fatigue Levels of the Rescuer: a
Simulation-based Study. Indian J Crit Care Med 2020;24(6):409-413.

Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.

DOI: 10.5005/jp-journals-10071-23457
PMCID: PMC7435083
PMID: 32863632

Conflict of interest statement: Source of support: Nil Conflict of interest:

None
185. Resuscitation. 2011 Apr;82(4):459-63. doi:
10.1016/j.resuscitation.2010.12.004.
Epub 2011 Jan 22.

Quality of resuscitation: flight attendants in an airplane simulator use a new

mechanical resuscitation device--a randomized simulation study.

Fischer H(1), Neuhold S, Hochbrugger E, Steinlechner B, Koinig H, Milosevic L,

Havel C, Frantal S, Greif R.

Author information:
(1)Department of Anaesthesia, General Intensive Care and Pain Control, Division
of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical
University Vienna, Austria.

Comment in
Resuscitation. 2011 Aug;82(8):1112. doi:
10.1016/j.resuscitation.2011.03.036.

PURPOSE: Cardiopulmonary resuscitation (CPR) during flight is challenging and

has to be sustained for long periods. In this setting a
mechanical-resuscitation-device (MRD) might improve performance. In this study
we compared the quality of resuscitation of trained flight attendants practicing
either standard basic life support (BLS) or using a MRD in a cabin-simulator.
METHODS: Prospective, open, randomized and crossover simulation study. Study
participants, competent in standard BLS were trained to use the MRD to deliver
both chest compressions and ventilation. 39 teams of two rescuers resuscitated a
manikin for 12 min in random order, standard BLS or mechanically assisted
resuscitation. Primary outcome was "absolute hands-off time" (sum of all periods
during which no hand was placed on the chest minus ventilation time). Various
parameters describing the quality of chest compression and ventilation were
analysed as secondary outcome parameters.
RESULTS: Use of the MRD led to significantly less "absolute hands-off time"
(164±33 s vs. 205±42 s, p<0.001). The quality of chest compression was
comparable among groups, except for a higher compression rate in the standard
BLS group (123±14 min(-1) vs. 95±11 min(-1), p<0.001). Tidal volume was higher
in the standard BLS group (0.48±0.14 l vs. 0.34±0.13 l, p<0.001), but we
registered fewer gastric inflations in the MRD group (0.4±0.3% vs. 16.6±16.9%,
p<0.001).
CONCLUSION: Using the MRD resulted in significantly less "absolute hands-off
time", but less effective ventilation. The translation of higher chest
compression rate into better outcome, as shown in other studies previously, has
to be investigated in another human outcome study.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2010.12.004
PMID: 21257251 [Indexed for MEDLINE]

186. Resuscitation. 2010 Mar;81(3):348-52. doi:

10.1016/j.resuscitation.2009.11.020.
Epub 2010 Jan 13.

Distribution of pre-course BLS/AED manuals does not influence skill acquisition

and retention in lay rescuers: a randomised study.
Papadimitriou L(1), Xanthos T, Bassiakou E, Stroumpoulis K, Barouxis D,
Iacovidou N.

Author information:
(1)Department of Experimental Surgery and Surgical Research, University of
Athens, Medical School, 15B Agiou Thoma Street, 11527 Athens, Greece.
theodorosxanthos@yahoo.com

AIM: The present study aims to investigate whether the distribution of the Basic
Life Support and Automated External Defibrillation (BLS/AED) manual, 4 weeks
prior to the course, has an effect on skill acquisition, theoretical knowledge
and skill retention, compared with courses where manuals were not distributed.
METHODS: A total of 303 laypeople were included in the present study. The
courses were randomised with sealed envelopes in 12 courses, where manuals were
distributed to participants (group A) and in 12 courses, where manuals were not
distributed to participants (group B). The participants were formally evaluated
at the end of the course, and at 1, 3 and 6 months after each course. The
evaluation procedure was the same at all time intervals and consisted of two
distinct parts: a written test and a simulated cardiac arrest scenario.
RESULTS: No significant difference was observed between the two groups in skill
acquisition at the time of initial training. Furthermore, there was no
significant difference between the groups in performing BLS/AED skills at 1, 3
and 6 months after initial training. Theoretical knowledge in either group at
the specified time intervals did not exhibit any significant difference.
Significant deterioration of skills was observed in both groups between initial
training and at 1 month after the course, as well as between the first and third
month after the course.
CONCLUSION: The present study shows that distribution of BLS/AED manuals 1 month
prior to the course has no effect on theoretical knowledge, skill acquisition
and skill retention in laypeople.

Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2009.11.020
PMID: 20074843 [Indexed for MEDLINE]

187. Medicine (Baltimore). 2018 Oct;97(40):e12673. doi:

10.1097/MD.0000000000012673.

Bystander cardiopulmonary resuscitation training in primary and secondary school

children in China and the impact of neighborhood socioeconomic status: A
prospective controlled trial.

Li H(1), Shen X(1)(2), Xu X(3), Wang Y(1), Chu L(1), Zhao J(4), Wang Y(1), Wang
H(5), Xie G(1), Cheng B(1), Ye H(1), Sun Y(1), Fang X(1).

Author information:
(1)Department of Anesthesiology, The First Affiliated Hospital, School of
Medicine, Zhejiang University, Hangzhou.
(2)Department of Anesthesiology, Jiaxing First Hospital of Zhejiang Province,
Jiaxing.
(3)Department of Anesthesiology, Lihuili Hospital, Ningbo Medical center,
Ningbo.
(4)Department of Anesthesiology, The Children's Hospital, Zhejiang University
School of Medicine, Hangzhou, Zhejiang.
(5)Department of Anesthesiology, Sir Run Run Shaw Hospital Affiliated to Medical
College of Zhejiang University, Hangzhou, China.
BACKGROUND: The World Health Organization (WHO) has endorsed school bystander
cardiopulmonary resuscitation (CPR) training programs. But related researches in
China are limited. Therefore, we conducted this study to assess bystander CPR
training in school children in China and the impact of neighborhood
socio-economic status (SES) on.
METHODS: A total of 1,093 students from seven schools in Zhejiang province
participated in this study. Theoretical and practical bystander CPR training
were conducted in instructor-led classes. Students completed a 10-statement
questionnaire before and after training, and then underwent a skills assessment
during a simulated basic life support (BLS) scenario. Subgroup analyses were
stratified according to neighborhood SES.
RESULTS: Before training, most students (72.83%) had a strong desire to learn
bystander CPR and share with others. After training, bystander CPR theory was
significantly improved (P < .01), and 92.64% students reached an 85-100%
performance rate in a simulated BLS scenario. Students from low-SES
neighborhoods had less pre-training knowledge of bystander CPR (P < .01).
However, their performance was similar with students from higher-SES
neighborhoods on the post-training questionnaire and the skills assessment, and
better among students aged 13-14 years.
CONCLUSION: School children in China have a poor pre-training knowledge of
bystander CPR. However, with training, there was a significant improvement in
the basic theory and skills of CPR. Bystander CPR training efforts should be
targeted to Chinese primary and secondary school children, especially in low-SES
neighborhoods.

DOI: 10.1097/MD.0000000000012673
PMCID: PMC6200495
PMID: 30290654 [Indexed for MEDLINE]

Conflict of interest statement: The authors have no conflicts of interest to

disclose.

188. Respir Care. 1994 Jul;39(7):725-9.

Simulated pediatric cardiopulmonary resuscitation: initial events and response

times of a hospital arrest team.

Palmisano JM(1), Akingbola OA, Moler FW, Custer JR.

Author information:
(1)CS Mott Children's Hospital, Ann Arbor, MI 48109.

BACKGROUND: Cardiopulmonary resuscitation (CPR) training programs exist to

enhance knowledge and skills retention. However, they do not ensure that
effective CPR will be performed by trainees or resuscitation teams. One aspect
of CPR effectiveness is the ability of the team to respond to an emergency call
in a timely manner.
METHODS: We prospectively evaluated the time required for team members to
respond to an emergency call and to initiate definitive treatment in our
pediatric facility. The medical staff who responded had no prior knowledge of
the simulated cardiac arrest (SCA) events. All events were recorded on
audio-cassette tape to determine the sequence of events and response time of
arrest team members. SCA scenarios represented examples of cardiac, hematologic,
renal, respiratory, and pharmacologic pathophysiology. All participants were
instructed to respond as though the SCA were an actual emergency.
RESULTS: From December 1991 to January 1993, 37 SCAs were evaluated.
Documentation began after a concise arrest scenario had been presented to a
designated nursing representative who was to be the first rescuer on the scene.
The rescuer first assessed the patient's condition, activated the cardiac arrest
system (median elapsed time, MET, 0.50 minutes), and then initiated
single-person CPR (MET 0.58 minutes). Administration of oxygen occurred at an
MET of 2.25 minutes. The first member of the arrest team to respond was the
pediatric resident (MET 3.17 minutes) followed by the respiratory therapist (MET
3.20 minutes), an ICU nurse (MET 3.58 minutes), a pharmacist (MET 3.42 minutes),
and anesthesiology personnel (MET 4.70 minutes).
DISCUSSION: The use of SCAs (termed "Mega Code") serves as an extension of Basic
Life Support and Advanced Cardiac Life Support education and provides a valuable
learning experience and quality assurance tool. Limitations that might influence
patient outcome during an actual in-hospital arrest have led to refinements in
our cardiac arrest procedures. Of particular note was the delay in oxygen
administration, which may be linked to its omission from the 1986 and 1992
American Heart Association Basic Life Support Guidelines.
CONCLUSION: We believe that BLS education for hospital employees should include
and emphasize oxygen delivery for resuscitation.

PMID: 10146053 [Indexed for MEDLINE]

189. Emerg Med J. 2015 Mar;32(3):189-94. doi: 10.1136/emermed-2013-202867. Epub

2013
Nov 15.

Exploration of the impact of a voice activated decision support system (VADSS)

with video on resuscitation performance by lay rescuers during simulated
cardiopulmonary arrest.

Hunt EA(1), Heine M(2), Shilkofski NS(3), Bradshaw JH(4), Nelson-McMillan K(5),
Duval-Arnould J(6), Elfenbein R(7).

Author information:
(1)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland,
USA Department of Pediatrics, Baltimore, Maryland, USA Division of Health
Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore,
Maryland, USA Johns Hopkins Medicine Simulation Center, Baltimore, Maryland,
USA.
(2)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
(3)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland,
USA Department of Pediatrics, Baltimore, Maryland, USA Johns Hopkins Medicine
Simulation Center, Baltimore, Maryland, USA Perdana University Graduate School
of Medicine, Kuala Lumpur, Malaysia.
(4)Division of Health Sciences Informatics, Johns Hopkins University School of
Medicine, Baltimore, Maryland, USA Uniformed Services of the Health Sciences,
Bethesda, Maryland, USA.
(5)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland,
USA Department of Pediatrics, Baltimore, Maryland, USA Johns Hopkins Medicine
Simulation Center, Baltimore, Maryland, USA.
(6)Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Division of Health Sciences Informatics, Johns Hopkins University School of
Medicine, Baltimore, Maryland, USA Johns Hopkins Medicine Simulation Center,
Baltimore, Maryland, USA.
(7)Southern Maryland Hospital Center, Clinton, Maryland, USA l St. Mary's
Hospital, Leonardtown, Maryland, USA.

AIM: To assess whether access to a voice activated decision support system

(VADSS) containing video clips demonstrating resuscitation manoeuvres was
associated with increased compliance with American Heart Association Basic Life
Support (AHA BLS) guidelines.
METHODS: This was a prospective, randomised controlled trial. Subjects with no
recent clinical experience were randomised to the VADSS or control group and
participated in a 5-min simulated out-of-hospital cardiopulmonary arrest with
another 'bystander'. Data on performance for predefined outcome measures based
on the AHA BLS guidelines were abstracted from videos and the simulator log.
RESULTS: 31 subjects were enrolled (VADSS 16 vs control 15), with no significant
differences in baseline characteristics. Study subjects in the VADSS were more
likely to direct the bystander to: (1) perform compressions to ventilations at
the correct ratio of 30:2 (VADSS 15/16 (94%) vs control 4/15 (27%), p=<0.001)
and (2) insist the bystander switch compressor versus ventilator roles after
2 min (VADSS 12/16 (75%) vs control 2/15 (13%), p=0.001). The VADSS group took
longer to initiate chest compressions than the control group: VADSS 159.5
(±53) s versus control 78.2 (±20) s, p<0.001. Mean no-flow fractions were very
high in both groups: VADSS 72.2% (±0.1) versus control 75.4 (±8.0), p=0.35.
CONCLUSIONS: The use of an audio and video assisted decision support system
during a simulated out-of-hospital cardiopulmonary arrest prompted lay rescuers
to follow cardiopulmonary resuscitation (CPR) guidelines but was also associated
with an unacceptable delay to starting chest compressions. Future studies should
explore: (1) if video is synergistic to audio prompts, (2) how mobile
technologies may be leveraged to spread CPR decision support and (3) usability
testing to avoid unintended consequences.

Published by the BMJ Publishing Group Limited. For permission to use (where not
already granted under a licence) please go to
http://group.bmj.com/group/rights-licensing/permissions.

DOI: 10.1136/emermed-2013-202867
PMID: 24243484 [Indexed for MEDLINE]

190. Resuscitation. 2011 Jul;82(7):913-9. doi: 10.1016/j.resuscitation.2011.02.026.

Epub 2011 Mar 27.

A manually powered mechanical resuscitation device used by a single rescuer: a

randomised controlled manikin study.

Fischer H(1), Neuhold S, Zapletal B, Hochbrugger E, Koinig H, Steinlechner B,

Frantal S, Stumpf D, Greif R.

Author information:
(1)Department of Anaesthesia, General Intensive Care and Pain Medicine, Division
of Cardio-Thoracic-Vascular Surgical Anaesthesia and Intensive Care Medicine,
Medical University Vienna, Austria. henrik.fischer@meduniwien.ac.at

PURPOSE: The goal of this randomized, open, controlled crossover manikin study
was to compare the performance of "Animax", a manually operated hand-powered
mechanical resuscitation device (MRD) to standard single rescuer basic life
support (BLS).
METHODS: Following training, 80 medical students performed either standard BLS
or used an MRD for 12 min in random order. We compared the quality of chest
compressions (effective compressions, compression depth and rate, absolute
hands-off time, hand position, decompression), and of ventilation including the
number of gastric inflations. An effective compression was defined as a
compression performed with correct depth, hand position and decompression.
RESULTS: The use of the MRD resulted in a significantly higher number of
effective compressions compared to standard BLS (67 ± 34 vs. 41 ± 34%, p<0.001).
In a comparison with standard BLS, the use of the MRD resulted in less absolute
hands-off time (264 ± 57 vs. 79 ± 40 s, p<0.001) and in a higher minute-volume
(1.86 ± 0.7 vs. 1.62 ± 0.7 l, p=0.020). However, ventilation volumes were below
the 2005 ERC guidelines for both methods. Gastric inflations occurred only in 0
± 0.1% with the MRD compared to 3 ± 7% during standard BLS (p<0.001).
CONCLUSION: Single rescuer cardio-pulmonary resuscitation with the manually
operated MRD was superior to standard BLS regarding chest compressions in this
simulation study. The MRD delivered a higher minute-volume but did not achieve
the recommended minimal volume. Further clinical studies are needed to test the
MRD's safety and efficacy in patients.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2011.02.026
PMID: 21444144 [Indexed for MEDLINE]

191. Zhonghua Yi Xue Za Zhi. 2010 Mar 9;90(9):614-7.

[Investigation and analysis of status in simulation education of anesthesiology

of China].

[Article in Chinese]

Wang TL(1), Xue JX, Xiao W, Wu XM.

Author information:
(1)Department of Anesthesiology, Xuanwu Hospital, Capital Medical University,
Beijing 100053, China.

OBJECTIVE: To investigate the status of simulation education of anesthesiology

in China.
METHODS: Five hundreds questionnaires were mailed to chairmen of department of
anesthesiology in teaching hospitals in 29 provinces and autonomous regions in
China. The retrieved questionnaires and data were processed and analyzed with
statistics.
RESULTS: Sixty one questionnaires were retrieved, and retrieved rate is 12.2%.
The result indicated that the theory and knowledge of anesthesiology was adopted
for the training of medical students and residents in 2% teaching hospitals,
theory and knowledge of anesthesiology combined with problem-based learning
discussion in 52% teaching hospitals, theory and knowledge of anesthesiology
combined with problem-based learning discussion and simulation training in 46%
teaching hospitals. The order of simulation devices possessed was as follows:
Basic Life Support (BLS) (79.6%), training model for clinical anesthesia
techniques (53.1%) and Advances Life Support (ALS) (51.0%). There were only six
teaching hospitals utilized Human Patient Simulator for anesthesia training. The
result of evaluation of simulation education showed that 91.2% anesthesiologists
recognized it as applicable, 90.1% anesthesiologists recognized it as medical
ethic requirement and 86.0% anesthesiologists recognized it as partly close to
clinical situation. The degree of cognition of anesthesiologists to simulation
education was ordered as follows: manipulation correcting ability (92.6%),
procedure controllability (87.0%), training adjustability (76.0%) and patients
safety (68.5%).
CONCLUSION: The simulation education of anesthesiology in China is still in the
preliminary period. The executive departments of education should enhance
supports to the simulation education in both hard ware and in soft ware.

PMID: 20450785 [Indexed for MEDLINE]

192. Acad Emerg Med. 2008 Feb;15(2):183-9. doi: 10.1111/j.1553-2712.2008.00026.x.

Comparison of 15:1, 15:2, and 30:2 compression-to-ventilation ratios for

cardiopulmonary resuscitation in a canine model of a simulated, witnessed
cardiac arrest.

Hwang SO(1), Kim SH, Kim H, Jang YS, Zhao PG, Lee KH, Choi HJ, Shin TY.

Author information:
(1)Wonju College of Medicine, Yonsei University, Wonju, Kangwondo, Republic of
Korea. shwang@yonsei.ac.kr

OBJECTIVES: This experimental study compared the effect of

compression-to-ventilation (CV) ratios of 15:1, 15:2, and 30:2 on hemodynamics
and resuscitation outcome in a canine model of a simulated, witnessed
ventricular fibrillation (VF) cardiac arrest.
METHODS: Thirty healthy dogs, irrespective of species (mean +/- SD, 19.2 +/- 2.2
kg), were used in this study. A VF arrest was induced. The dogs received
cardiopulmonary resuscitation (CPR) and were divided into three groups based on
the applied CV ratios of 15:1, 15:2, and 30:2. After 1 minute of untreated VF, 4
minutes of basic life support (BLS) was performed. At the end of the 4 minutes,
the dogs were defibrillated with an automatic external defibrillator (AED) and
advanced cardiac life support (ACLS) efforts were continued for 10 minutes or
until restoration of spontaneous circulation (ROSC) was attained, whichever came
first.
RESULTS: None of the hemodynamic parameters, and arterial oxygen profiles was
significantly different between the three groups during BLS- and ACLS-CPR. Eight
dogs (80%) from each group achieved ROSC during BLS and ACLS. The survival rate
was not different between the three groups. In the 15:1 and 30:2 groups, the
number of compressions delivered over 1 minute were significantly greater than
in the 15:2 group (73.1 +/- 8.1 and 69.0 +/- 6.9 to 56.3 +/- 6.8; p < 0.01). The
time for ventilation during which compressions were stopped at each minute was
significantly lower in the 15:1 and 30:2 groups than in the 15:2 group (15.4 +/-
3.9 and 17.1 +/- 2.7 to 25.2 +/- 2.6 sec/min; p < 0.01).
CONCLUSIONS: In a canine model of witnessed VF using a simulated scenario, CPR
with three CV ratios, 15:1, 15:2, and 30:2, did not result in any differences in
hemodynamics, arterial oxygen profiles, and resuscitation outcome among the
three groups. CPR with a CV ratio of 15:1 provided comparable chest compressions
and shorter pauses for ventilation between each cycle compared to a CV ratio of
30:2.

DOI: 10.1111/j.1553-2712.2008.00026.x
PMID: 18275449 [Indexed for MEDLINE]

193. Scand J Trauma Resusc Emerg Med. 2012 Feb 28;20:16. doi:
10.1186/1757-7241-20-16.

Effect of feedback on delaying deterioration in quality of compressions during 2

minutes of continuous chest compressions: a randomized manikin study
investigating performance with and without feedback.

Lyngeraa TS(1), Hjortrup PB, Wulff NB, Aagaard T, Lippert A.

Author information:
(1)Danish Institute for Medical Simulation, Copenhagen University Hospital,
Herlev Hospital, Copenhagen, Denmark. tlyngeraa@gmail.com
BACKGROUND: Good quality basic life support (BLS) improves outcome following
cardiac arrest. As BLS performance deteriorates over time we performed a
parallel group, superiority study to investigate the effect of feedback on
quality of chest compression with the hypothesis that feedback delays
deterioration of quality of compressions.
METHODS: Participants attending a national one-day conference on cardiac arrest
and CPR in Denmark were randomized to perform single-rescuer BLS with (n = 26)
or without verbal and visual feedback (n = 28) on a manikin using a ZOLL AED
plus. Data were analyzed using Rescuenet Code Review. Blinding of participants
was not possible, but allocation concealment was performed. Primary outcome was
the proportion of delivered compressions within target depth compared over a
2-minute period within the groups and between the groups. Secondary outcome was
the proportion of delivered compressions within target rate compared over a
2-minute period within the groups and between the groups. Performance variables
for 30-second intervals were analyzed and compared.
RESULTS: 24 (92%) and 23 (82%) had CPR experience in the group with and without
feedback respectively. 14 (54%) were CPR instructors in the feedback group and
18 (64%) in the group without feedback. Data from 26 and 28 participants were
analyzed respectively. Although median values for proportion of delivered
compressions within target depth were higher in the feedback group (0-30 s:
54.0%; 30-60 s: 88.0%; 60-90 s: 72.6%; 90-120 s: 87.0%), no significant
difference was found when compared to without feedback (0-30 s: 19.6%; 30-60 s:
33.1%; 60-90 s: 44.5%; 90-120 s: 32.7%) and no significant deteriorations over
time were found within the groups. In the feedback group a significant
improvement was found in the proportion of delivered compressions below target
depth when the subsequent intervals were compared to the first 30 seconds (0-30
s: 3.9%; 30-60 s: 0.0%; 60-90 s: 0.0%; 90-120 s: 0.0%). Significant differences
were not found in secondary outcome and in other performance variables between
the groups and over time
CONCLUSIONS: Quality of CPR was maintained during 2 minutes of continuous
compressions regardless of feedback in a group of trained rescuers.

DOI: 10.1186/1757-7241-20-16
PMCID: PMC3310737
PMID: 22373499 [Indexed for MEDLINE]

194. Resusc Plus. 2024 Apr 17;18:100631. doi: 10.1016/j.resplu.2024.100631.

eCollection 2024 Jun.

Do laypersons need App-linked real-time feedback devices for effective

resuscitation? - Results of a prospective, randomised simulation trial.

Wingen S(1)(2)(3), Großfeld N(4)(5), Adams NB(1)(6), Streit A(6), Stock J(5),
Böttiger BW(1)(2)(6), Wetsch WA(1)(2)(6).

Author information:
(1)University of Cologne, Medical Faculty and University Hospital Cologne,
Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62,
50937 Cologne, Germany.
(2)German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany.
(3)FOM University of Applied Sciences, Agrippinawerft 4, 50678 Cologne, Germany.
(4)University of Applied Science Stralsund, Faculty of Electrical Engineering
and Computer Science, Zur Schwedenschanze 15, 18435 Stralsund, Germany.
(5)L2R GmbH, Cliev 4, 51515 Kürten, Germany.
(6)University of Cologne, Medical Faculty, Albertus-Magnus-Platz, 50923 Cologne,
Germany.

BACKGROUND: App-linked real-time feedback-devices for cardiopulmonary

resuscitation (CPR) aim to improve laypersons' resuscitation quality.
Resuscitation guidelines recommend these technologies in training settings. This
is the first study comparing resuscitation quality of all App-linked
feedback-devices currently on market.
METHODS: A prospective randomised simulation study was performed. After
standardised instructions, participants performed 2-minutes compression-only CPR
on a manikin without feedback (baseline). Afterwards, participants performed
4 × 2 min CPR with four different feedback devices in randomised order
(CorPatch® Trainer, CPRBAND AIO Training, SimCPR®ProTrainer, Relay Response™)
(intervention). CPR metrics (chest compression depth (CD), chest compression
rate (CR), percentage of correct CD/CR (%), correct hand position, correct chest
recoil, and technical preparation-time) were assessed. Devices data were
compared to the baseline group using Wilcoxon testing with IBM SPSS (primary
outcome). Differences between devices were analysed with ANOVA testing
(secondary outcome). Normally distributed data were described as mean ± standard
deviation (SD) and non-normally distributed data as Median [Interquartile range
(IQR). CPR self-confidence was measured by means of questionnaire before and
after feedback devices' use. Comparison was performed by students t-test.
RESULTS: Forty participants were involved. SimCPR®ProTrainer was the only
device, which resulted in guideline-compliant chest compressions
(Mean ± SD:5.37 ± 0.76) with improved chest compression depth (p < 0.001), and
percentage of correct chest compression depth (p < 0.001) compared to unassisted
CPR (baseline). CorPatch® Trainer as the only device with audio-visual recoil
instructions resulted in improved chest recoil (Mean ± SD:72.25 ± 24.89)
compared to baseline (Mean ± SD:49.00 ± 42.20; p < 0.01), while the other three
devices resulted in significantly lower chest recoil rates (CPRBAND AIO
Training: 37.03 ± 39.90; p < 0.01, SimCPR®ProTrainer: Mean ± SD:39.88 ± 36.50;
p = 0.03, Relay Response™: Mean ± SD:36.88 ± 37.73; p = 0.02). CPR quality when
using the different feedback devices differ in chest compression depth
(p = 0.02), chest compression rate (p < 0.001), percentage of correct chest
compression depth/rate (p = 0.03/p = 0.04), and technical preparation-time
(p < 0.001). Feedback-devices' use increased participant's CPR self-confidence
(p < 0.001).
CONCLUSION: Although, CPR feedback devices show improved CPR performance in
layperson in some metrics, none of the tested CPR feedback devices supported
layperson in overall adequate CPR performance. More and better technical
functionality is necessary, to fully utilise the potential of CPR feedback
devices and to prevent a worsening of CPR performance when layperson use this
technology.

© 2024 The Author(s).

DOI: 10.1016/j.resplu.2024.100631
PMCID: PMC11043874
PMID: 38666255

Conflict of interest statement: The authors declare the following financial

interests/personal relationships which may be considered as potential competing
interests: ‘Sabine Wingen is executive personal assistant of the executive board
of the German Resuscitation Council (GRC) and receive fees for lectures and
consulting from FOM Hochschule für Oekonomie & Management and L2R GmbH. Nele
Großfeld works for the L2R GmbH. Jan Stock is Head of the L2R GmbH and Project
Manager at the Hans Peter Esser GmbH. Bernd W. Böttiger is treasurer of the
European Resuscitation Council (ERC), Founder of the ERC Research NET, Chairman
of the German Resuscitation Council (GRC), Member of the „Advanced Life Support
(ALS) Task Force of the International Liaison Committee on Resuscitation
(ILCOR), Member of the Executive Committee of the German Interdisciplinary
Association for Intensive Care and Emergency Medicine (DIVI), Founder of the
“Deutsche Stiftung Wiederbelebung”, Federal Medical Advisor of the German Red
Cross (DRK), Member of the Advisory Board of the “Deutsche Herzstiftung”,
Co-Editor of “Resuscitation”, Editor of the Journal “Notfall + Rettungsmedizin”,
Co-Editor of the Brazilian Journal of Anesthesiology. He received fees for
lectures from the following companies: Forum für medizinische Fortbildung
(FomF), ZOLL Medical Deutschland GmbH, C.R. Bard GmbH, Becton Dickinson GmbH.
Wolfgang A. Wetsch, Niels-Benjamin Adams, and Antonia Streit have no conflicts
of interest.’.

195. Int J Med Inform. 2003 Dec;72(1-3):57-72. doi: 10.1016/j.ijmedinf.2003.08.003.

Modeling an emergency medical services system using computer simulation.

Su S(1), Shih CL.

Author information:
(1)Institute of Health Care Organization Administration, School of Public
Health, National Taiwan University, No. 1, Sec. 1, Jen Ai Road, Rm. 1512, 100,
ROC, Taipei, Taiwan. susyi@ha.mc.ntu.edu.tw

STUDY OBJECTIVES: In the emergency medical services (EMS) system, appropriate

prehospital care can substantially decrease casualty mortality and morbidity.
This study designed a simulation model, evaluated the existing EMS system, and
suggested improvements.
METHODS: The study focused on 23 networked EMS hospitals affiliated with 36
emergency response units (subgroups) to perform two-tier rescues (advanced life
support [ALS] in addition to basic life support [BLS] services) in Taipei,
Taiwan. Using the existing EMS model as a base, this research constructed a
computer simulation model and explored several model alternatives to achieve the
study's objectives. The virtual models varied with staffing level, number of
assigned emergency network hospitals, and various two-tier rescue probabilities.
RESULTS: Increasing the staffing to two teams for Hospital 22 lessened the call
waiting probability (delay between rescue call and ambulance dispatch) by 50%,
even if the dispatch rate of the two-tier rescue increased from the empirical 2%
to a simulated 10 and 20%. Changing the two-tier rescue pattern so each EMS
subgroup cooperated with two specific, preassigned network hospitals lowered the
probability of patients having to wait for rescue dispatch to under 1%.
CONCLUSION: The following alternatives provided the greatest combination of
effectiveness, quality patient care, and cost-efficiency: (1) because of its
unique location, increase Hospital 22's staffing level to two ALS teams. (2)
Establish a specific rescue protocol for the two-tier system that preassigns two
network hospitals to each of the 36 EMS subgroups along with a prearranged
calling sequence. If implemented, this will improve EMS performance, streamline
the system, reduce randomness, and enhance efficiency.

DOI: 10.1016/j.ijmedinf.2003.08.003
PMID: 14644307 [Indexed for MEDLINE]

196. Resuscitation. 2002 Sep;54(3):259-64. doi: 10.1016/s0300-9572(02)00147-8.

Effectiveness of ventilation-compression ratios 1:5 and 2:15 in simulated single

rescuer paediatric resuscitation.

Dorph E(1), Wik L, Steen PA.

Author information:
(1)Norwegian Air Ambulance, N-1441, Drøbak, Norway. elizabeth@nakos.org
Current guidelines for paediatric basic life support (BLS) recommend a
ventilation-compression ratio of 1:5 during child resuscitation compared with
2:15 for adults, based on the consensus that ventilation is more important in
paediatric than in adult BLS. We hypothesized that the ratio 2:15 would provide
the same minute ventilation as 1:5 during single-rescuer paediatric BLS due to
the reduced time required to change between ventilations and compressions.
Fourteen lay rescuers were trained with both ratios and thereafter performed
single rescuer BLS for approximately 4 min with each of the two ratios in random
order on a child-sized manikin with a built-in respiratory monitor. Quality of
chest compressions was assessed by measurement of the rate, depth and position.
There were no significant differences in tidal volumes or minute ventilation
between the ratios. Nearly all chest compressions were within acceptable limits
for depth and place with both methods, but the mean number of chest compressions
per minute was 48+/-15% greater with ratio 2:15. In conclusion, there was no
difference in ventilation, but nearly one and a half times as many compressions
with a ratio of 2:15 than 1:5 for lay rescuers during single rescuer paediatric
CPR. In order to simplify CPR training for laypersons, we recommend a 2:15 ratio
for both single- and two-person, adult and paediatric layperson BLS.

DOI: 10.1016/s0300-9572(02)00147-8
PMID: 12204459 [Indexed for MEDLINE]

197. J Am Coll Emerg Physicians Open. 2024 Jan 21;5(1):e13100. doi:

10.1002/emp2.13100. eCollection 2024 Feb.

Early intranasal medication administration in out-of-hospital cardiac arrest:

Two randomized simulation trials.

Dowker SR(1), Downey ML(1), Majhail NK(1), Scott IG(1), Mathisson J(1), Rizk
D(1), Trumpower B(2), Yake D(1), Williams M(1), Coulter-Thompson EI(1)(3), Brent
CM(4), Smith GC(4), Swor R(5)(6), Berger DA(5)(6), Rooney DM(1), Neumar
RW(4)(7), Friedman CP(1), Cooke JM(1)(8), Missel AL(1).

Author information:
(1)Department of Learning Health Sciences University of Michigan Medical School
Ann Arbor Michigan USA.
(2)Department of Internal Medicine Division of Cardiovascular Medicine
University of Michigan Medical School, 2139 Cardiovascular Center Ann Arbor
Michigan USA.
(3)Center for Bioethics and Social Sciences in Medicine, University of Michigan
Ann Arbor Michigan USA.
(4)Department of Emergency Medicine University of Michigan Medical School Ann
Arbor Michigan USA.
(5)Department of Emergency Medicine Corewell East William Beaumont University
Hospital Royal Oak Michigan USA.
(6)Department of Emergency Medicine Oakland University William Beaumont School
of Medicine Rochester Michigan USA.
(7)Max Harry Weil Institute for Critical Care Research and Innovation,
University of Michigan Ann Arbor Michigan USA.
(8)Department of Family Medicine University of Michigan Medical School Ann Arbor
Michigan USA.

OBJECTIVE: Intranasal medications have been proposed as adjuncts to

out-of-hospital cardiac arrest (OHCA) care. We sought to quantify the effects of
intranasal medication administration (INMA) in OHCA workflows.
METHODS: We conducted separate randomized OHCA simulation trials with lay
rescuers (LRs) and first responders (FRs). Participants were randomized to
groups performing hands-only cardiopulmonary resuscitation (CPR)/automated
external defibrillator with or without INMA during the second analysis phase.
Time to compression following the second shock (CPR2) was the primary outcome
and compression quality (chest compression rate (CCR) and fraction (CCF)) was
the secondary outcome. We fit linear regression models adjusted for CPR training
in the LR group and service years in the FR group.
RESULTS: Among LRs, INMA was associated with a significant increase in CPR2
(mean diff. 44.1 s, 95% CI: 14.9, 73.3), which persisted after adjustment
(p = 0.005). We observed a significant decrease in CCR (INMA 95.1 compressions
per min (cpm) vs control 104.2 cpm, mean diff. -9.1 cpm, 95% CI -16.6, -1.6) and
CCF (INMA 62.4% vs control 69.8%, mean diff. -7.5%, 95% CI -12.0, -2.9). Among
FRs, we found no significant CPR2 delays (mean diff. -2.1 s, 95% CI -15.9,
11.7), which persisted after adjustment (p = 0.704), or difference in quality
(CCR INMA 115.5 cpm vs control 120.8 cpm, mean diff. -5.3 cpm, 95% CI -12.6,
2.0; CCF INMA 79.6% vs control 81.2% mean diff. -1.6%, 95% CI -7.4, 4.3%).
CONCLUSIONS: INMA in LR resuscitation was associated with diminished
resuscitation performance. INMA by FR did not impede key times or quality.

© 2024 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of
American College of Emergency Physicians.

DOI: 10.1002/emp2.13100
PMCID: PMC10800291
PMID: 38260004

Conflict of interest statement: Mr. Dowker reports grant‐funding from the

National Institutes of Health (grant R01‐HL137964), travel support from National
Association of EMS Physicians (NAEMSP)/GMR Foundation, and concurrent employment
as a firefighter/EMT with the Green Oak Charter Township Fire Department a
licensed nontransporting Basic Life Support (BLS) agency in Michigan. Ms.
Majhail and Ms. Scott report employment, during one or more phases of the study,
with Emergent Health Partners, a licensed transporting Advanced Life Support
(ALS) agency that serves as a regional provider of BLS/ALS medical transport and
911 dispatched emergency response in southern Michigan. Dr. Brent reports a
leadership position for the Washtenaw/Livingston Medical Control Authority, she
is an Air Medical Physician Association Board Member, NAEMSP Air Medical
Committee Vice Chair, NAEMSP Council of EMS Fellowship Directors Vice Chair, and
grant funding CMB Toyota Grant on Prehospital Medical Drones, and travel support
from Air Medical Physician Association. Dr. Smith reports effort as associate
medical director for the Washtenaw/Livingston Medical Control Authority, a
regional EMS oversight body. Dr. Berger reports grant funding from AHRQ R01
HS025411‐02BCBSM Foundation, Dr. Neumar reports the following grant support
National Institutes of Health: K12HL133304, R01HL133129, R34HL130738 ‐
Institution; Laerdal Foundation‐Institution, and he is SaveMiHeart President and
Board Chair, ILCOR cochair. All other authors report no relevant interests.

198. Prehosp Emerg Care. 2001 Apr-Jun;5(2):174-80. doi: 10.1080/10903120190940092.

Emergency medical services telephone referral program: an alternative approach

to nonurgent 911 calls.

Smith WR(1), Culley L, Plorde M, Murray JA, Hearne T, Goldberg P, Eisenberg M.

Author information:
(1)University of Washington School of Medicine, Seattle, USA.

OBJECTIVE: To examine the effects of transferring nonurgent 911 calls to a

telephone consulting nurse. It was hypothesized that the telephone referral
program would result in fewer basic life support (BLS) responses with no adverse
patient outcome or decrease in patient satisfaction.
METHODS: A two-phased prospective study was conducted in an urban and rural
setting with a population of 650,000. During phase I, a BLS unit was dispatched
on all calls and a nurse intervention was simulated. During phase II, no BLS
unit was dispatched for calls meeting study criteria. Callers were transferred
to the nurse, and consulting nurse protocols were used to direct care. Data were
collected from dispatch, BLS, nurse, and hospital records and patient
self-assessment.
RESULTS: During phase I, 38 callers were transferred to the consulting nurse
with no nurse intervention. During phase II, 133 cases were transferred to the
nurse line. There were no adverse outcomes detected. The nurse recommended home
care for 31%, physician referral for 24%, referral back to 911 for 17%,
community resource for 11%, and other referral for 17%. Nurses contacted 85
patients for telephone follow-up. Ninety-four percent of the patients reported
feeling better, 6% felt the same, and none felt worse. Patients were satisfied
with the outcome in 96% of the cases.
CONCLUSION: Transferring 911 calls to a nurse line resulted in fewer BLS
responses and no adverse patient outcomes, while maintaining high patient
satisfaction. Dispatch criteria correctly identified cases with minimal medical
needs. A high percentage of the patients reported feeling better after the
intervention. This study has major implications for communities interested in
efficient use of emergency medical services resources.

DOI: 10.1080/10903120190940092
PMID: 11339729 [Indexed for MEDLINE]

199. Resuscitation. 2011 Jul;82(7):902-7. doi: 10.1016/j.resuscitation.2011.02.023.

Epub 2011 Mar 31.

Effects and limitations of an AED with audiovisual feedback for cardiopulmonary

resuscitation: a randomized manikin study.

Fischer H(1), Gruber J, Neuhold S, Frantal S, Hochbrugger E, Herkner H, Schöchl

H, Steinlechner B, Greif R.

Author information:
(1)Division of Cardio-Thoracic-Vascular Surgical Anaesthesia and Intensive Care
Medicine¸ Department of Anaesthesia, General Intensive Care and Pain Medicine,
Medical University, Waehringer Gürtel 18-20, 1090 Vienna, Austria.

Comment in
Resuscitation. 2012 Jan;83(1):e9. doi: 10.1016/j.resuscitation.2011.08.028.

PURPOSE: Correctly performed basic life support (BLS) and early defibrillation
are the most effective measures to treat sudden cardiac arrest. Audiovisual
feedback improves BLS. Automated external defibrillators (AED) with feedback
technology may play an important role in improving CPR quality. The aim of this
simulation study was to investigate if an AED with audiovisual feedback improves
CPR parameters during standard BLS performed by trained laypersons.
METHODS: With ethics committee approval and informed consent, 68 teams (2 flight
attendants each) performed 12 min of standard CPR with the AED's audiovisual
feedback mechanism enabled or disabled. We recorded CPR quality parameters
during resuscitation on a manikin in this open, prospective, randomized
controlled trial. Between the feedback and control-group we measured differences
in compression depth and rate as main outcome parameters and effective
compressions, correct hand position, and incomplete decompression as secondary
outcome parameters. An effective compression was defined as a compression with
correct depth, hand position, and decompression.
RESULTS: The feedback-group delivered compression rates closest to the
recommended guidelines (101 ± 9 vs. 109 ± 15/min, p=0.009), more effective
compressions (20 ± 18 vs. 5 ± 6%, p<0.001), more compressions with correct hand
position (96 ± 13 vs. 88 ± 16%, p<0.001), and less leaning (21 ± 31 vs. 77 ±
33%, p<0.001). However, only the control-group adhered to the recommended
compression depth (44 ± 7 mm vs. 39 ± 6, p=0.003).
CONCLUSION: Use of an AED's audiovisual feedback system improved some
CPR-quality parameters, thus confirming findings of earlier studies with the
notable exception of decreased compression depth, which is a key parameter that
might be linked to reduced cardiac output.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

DOI: 10.1016/j.resuscitation.2011.02.023
PMID: 21454006 [Indexed for MEDLINE]

200. Resuscitation. 2005 Apr;65(1):45-8. doi: 10.1016/j.resuscitation.2004.10.010.

Differences in time to defibrillation and intubation between two different

ventilation/compression ratios in simulated cardiac arrest.

Kill C(1), Giesel M, Eberhart L, Geldner G, Wulf H.

Author information:
(1)Department of Anaesthesiology and Critical Care, Philipps-University, D-35033
Marburg, Germany. killc@mailer.uni-marburg.de

OBJECTIVE: During basic life support (BLS) by a two-rescuer-team early

defibrillation and ALS procedures should be performed without interruptions of
the BLS-ventilation/compression sequence. The objective of this study was to
determine the impact of a ventilation/compression ratio of 5:50 versus 2:15 on
the time intervals "Start BLS to first shock" and "Start BLS to intubation".
METHODS: Using a random cross over design 40 experienced paramedics performed a
standard BLS/ALS-algorithm according to ILCOR guidelines in a manikin model with
ventricular fibrillation (resusci skillreporter anne, Laerdal, Norway)
performing both the 2:15 and the 5:50 ventilation/compression ratio. BLS was
started with bag/valve/mask ventilation, a semi-automatic defibrillator (corpuls
08/16S) was connected with the manikin, ECG-analysis and three shocks were
performed and the tracheal intubation was prepared. Ventilation/compression
sequence was only interrupted during ECG-analysis and defibrillation. Expiratory
volumes and number of compressions were measured. Variables were compared using
paired Students t-test. In addition paramedics were interviewed about work-flow
and emotional stress during the tests.
RESULTS: The time interval "Start BLS to first shock" was 78 s (2:15-group)
versus 63 s (5:50-group), p<0.0001, the time interval "Start BLS to intubation"
was 183 s (2:15-group) versus 150 s (5:50-group), p<0.0001, mean ventilation
volumes per minute were 4490 ml (2:15-group) versus 4370 ml (5:50-group), p>0.1,
mean number of compressions were 65 min-1. (2:15-group) versus 68 min-1
(5:50-group), p>0.1. The work-flow and emotional stress was appraised by the
paramedics to be significantly superior in the 5:50 ratio (p<0.0001).
CONCLUSIONS: The ventilation/compression ratio of 5:50 compared with 2:15 during
BLS with an unsecured airway reduces the time until the first defibrillation and
tracheal intubation was performed without changes in ventilation volume and
compressions per minute. The Paramedics stated that the 5:50 ratio improved the
work-flow and reduced the emotional stress.

DOI: 10.1016/j.resuscitation.2004.10.010
PMID: 15797274 [Indexed for MEDLINE]