Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.

OBJECTIVE: In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. METHODS: This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. RESULTS: During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. CONCLUSIONS: This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery rate and false positive are similar to those found in previous studies. We found our results satisfying the given short time frame of this study. Our results demonstrate that it is possible to improve the quality of emergency services at moderate or even no additional costs and this should be of interest to all EMS that do not presently benefit from using T-CPR procedures. EMS that currently do not offer T-CPR should consider implementing this technique as soon as possible, and we expect our experience may provide answers to those planning to incorporate T-CPR in their daily practice.

Pääministeri J. Virolainen 7/12 1964

Kirje

Opetusministeri J. Virolainen 13/4 1969

Kirje 13.4.1969

Dr J. Virolainen 17.8.1958

Kirje

Serum procalcitonin as a marker of post-cardiac arrest syndrome and long-term neurological recovery, but not of early-onset infections, in comatose post-anoxic patients treated with therapeutic hypothermia.

OBJECTIVE: To examine the relationship of early serum procalcitonin (PCT) levels with the severity of post-cardiac arrest syndrome (PCAS), long-term neurological recovery and the risk of early-onset infections in patients with coma after cardiac arrest (CA) treated with therapeutic hypothermia (TH). METHODS: A prospective cohort of adult comatose CA patients treated with TH (33°C, for 24h) admitted to the medical/surgical intensive care unit, Lausanne University Hospital, was studied. Serum PCT was measured early after CA, at two time-points (days 1 and 2). The SOFA score was used to quantify the severity of PCAS. Diagnosis of early-onset infections (within the first 7 days of ICU stay) was made after review of clinical, radiological and microbiological data. Neurological recovery at 3 months was assessed with Cerebral Performance Categories (CPC), and was dichotomized as favorable (CPC 1-2) vs. unfavorable (CPC 3-5). RESULTS: From December 2009 to April 2012, 100 patients (median age 64 [interquartile range 55-73] years, median time from collapse to ROSC 20 [11-30]min) were studied. Peak PCT correlated with SOFA score at day 1 (Spearman's R=0.44, p<0.0001) and was associated with neurological recovery at 3 months (peak PCT 1.08 [0.35-4.45]ng/ml in patients with CPC 1-2 vs. 3.07 [0.89-9.99] ng/ml in those with CPC 3-5, p=0.01). Peak PCT did not differ significantly between patients with early-onset vs. no infections (2.14 [0.49-6.74] vs. 1.53 [0.46-5.38]ng/ml, p=0.49). CONCLUSIONS: Early elevations of serum PCT levels correlate with the severity of PCAS and are associated with worse neurological recovery after CA and TH. In contrast, elevated serum PCT did not correlate with early-onset infections in this setting.

Statistical Brief on the Agricultural Research of Cape Verde

The primary purpose of this brief is to provide various statistical and institutional details on the development and current status of the public agricultural research system in Cape Verde. This information has been collected and presented in a systematic way in order to inform and thereby improve research policy formulation with regard to the Cape Verdean NARS. Most importantly, these data are assembled and reported in a way that makes them directly comparable with the data presented in the other country briefs in this series. And because institutions take time to develop and there are often considerable lags in the agricultural research process, it is necessary for many analytical and policy purposes to have access to longer-run series of data. NARSs vary markedly in their institutional structure and these institutional aspects can have a substantial and direct effect on their research performance. To provide a basis for analysis and cross-country, over-time comparisons, the various research agencies in a country have been grouped into five general categories; government, semi-public, private, academic, and supranational. A description of these categories is provided in table 1.

Statistical Brief on the Agricultural Research of Cape Verde

The primary purpose of this brief is to provide various statistical and institutional details on the development and current status of the public agricultural research system in Cape Verde. This information has been collected and presented in a systematic way in order to inform and thereby improve research policy formulation with regard to the Cape Verdean NARS. Most importantly, these data are assembled and reported in a way that makes them directly comparable with the data presented in the other country briefs in this series. And because institutions take time to develop and there are often considerable lags in the agricultural research process, it is necessary for many analytical and policy purposes to have access to longer-run series of data. NARSs vary markedly in their institutional structure and these institutional aspects can have a substantial and direct effect on their research performance. To provide a basis for analysis and cross-country, over-time comparisons, the various research agencies in a country have been grouped into five general categories; government, semi-public, private, academic, and supranational. A description of these categories is provided in table 1.

Agrarförbundets ordförande 1958 generaldirektör V. J. Sukselainen

Kirje

A situação em Cabo Verde nos finais do século XVI

Os problemas de defesa da cidade da Ribeira Grande, única povoação no século XVI com alguma relevância no arquipélago de Cabo Verde, eram relatados desde os meados desse século, mas levaram muito tempo a conhecer o interesse da corte de Lisboa. Em 1542, já Jorge Vaz escrevia a D. João III referindo que “a cidade e porto está sem nenhuma resistência, que só uma nau avante dela, certo a porá por terra e a porão a saque (…) o porto tem grande necessidade de artilharia e munições”. O material começou a chegar entre 1556 e 1558, então um falcão e 6 berços, 4 quintais 4 arráteis de pólvora, 58 espingardas e demais munições. Nos anos seguintes ainda chegariam 35 arcabuzes aparelhados, mais 8 berços, 3 meios-berços, 2 esperas e diversas câmaras para falcões e berços, para além de 40 lanças, ou piques, 841 pelouros de espera e falcão e mais pólvora.

As Ordens Religiosas em Cabo Verde

As Ordens Religiosas, como a dos Franciscanos, acompanharam logo os primeiros povoadores, no sentido de fornecerem os primeiros serviços religiosos e catequizarem as comunidades locais. Já havia a ideia inicial de formação de um clero local, que mais facilmente chegasse às comunidades africanas, logo pelos homens do infante D. Henrique, por 1444 e, depois, por D. João II, chegando a Santa Sé, por breve pontifício de 12 de Junho de 1518, a dar faculdades ao capelão-mor do monarca português para promover ordens sacras aos índios e africanos. Nos finais do século XVI, em 1584, já se refere na Guiné um jalofo, o padre João Pinto, seguindo-se depois outros, por certo formados em Lisboa, ou nos núcleos das ordens religiosas locais, o mesmo devendo ter acontecido em Cabo Verde e bem mais cedo.

Estimación de la fecundidad parcial de la caballa (scomber japonicus peruanus) a inicios de otoño 1998. Crucero BIC Humboldt 9803-05 de Tumbes a Tacna

Se estimó la fecundidad parcial de la caballa, Scomber japonicus peruanus en 28.978 huevos con una desviación estándar de 1529. El rango fluctuó entre 7.603 y 53.921 huevos por bache de desove. La distribución de tallas estuvo comprendida entre 24 y 31 cm de longitud a la horquilla. Las muestras fueron tomadas de 6 lances, siendo el tamaño de muestra de 42 individuos.

Estudo da Prevalência de Perturbações depressivas nos pacientes da consulta externa

Este trabalho de investigação tem como objectivo o estudo da prevalência das perturbações depressivas nos pacientes da consulta externa do H.A.N. – extensão Trindade, de 2004-2008. A amostra do estudo é constituída por 1499 sujeitos, sendo 317 com perturbações afectivas (34.4 %) do sexo masculino e (65.6%) do sexo feminino). A metodologia utilizada é do tipo prospectivo, em que o objectivo deste estudo é caracterizar um grupo: por sexo, idade, nível de escolaridade, profissão, etc., e neste sentido aproxima-se das pesquisas exploratórias visto que pode se dar uma fundamentação teórica, envolvendo pesquisas bibliográficas, com base nos livros, pesquisas de Internet, artigos científicos. A análise de dados foi efectuada através do programa SPSS (Statistical package for the social science base 15.0 for Windows Evaluation (version, 2008) Verificamos uma prevalência de perturbações afectivas de 21%, mais acentuada no sexo feminino (65.6%), com muitas perturbações comórbidas sobretudo relacionadas com o abuso de substâncias tóxicas. Essas comorbilidades têm maior expressão entre os sujeitos do sexo masculino. Verificamos ainda, uma tendência crescente de diagnóstico dessas perturbações ao longo dos cinco anos estudos. Entre as perturbações depressivas destaca-se o episódio depressivo com uma prevalência de 91.4%