Search

Only 30% of survivors from out-of-hospital cardiac arrest receive basic life support (BLS) before the arrival of emergency personnel. This is also due to reluctance to perform BLS, especially mouth-to-mouth ventilation without barrier devices in victims who are unknown to the rescuer (either layperson or healthcare provider).To evaluate the incidence of reluctance to perform mouth-to-mouth ventilation without barrier devices and its consequences in a simulated BLS scenario proposed by a questionnaire to healthcare providers of critical area in a public general hospital.Answers were collected from 128 of 165 (77.5%) interviewed healthcare providers. Physicians were 46 of 128 (35.9%), professional nurses were 78 of 128 (60.9%) and 4 of 128 (3.2%) were other health workers devoted to patient assistance. Seventy-five of 128 (58.6 %) were reluctant to perform mouth-to-mouth ventilation without barrier devices; 68 of 75 (90.6%) would perform BLS only by chest compression. Compared with non-reluctant providers, they would have been available to perform assisted ventilation by non-validated alternative methods (54.2 vs 18.8% respectively, p0.001). Seven of 75 (9.6%, no physician among them) would perform no BLS at all. The most significant predictors of reluctance were age40 years (p = 0.07) and previous attendance of BLS-BLSD courses (p = 0.07).Reluctance to perform mouth-to-mouth ventilation without barrier devices is frequent and may reduce the number of potential BLS providers. Because of the concern about disease transmission between victim and rescuer, rescuers with a duty to respond such as healthcare providers should follow precautions including the use of barrier device also outside their workplace. When barrier devices are unavailable first responders should consider chest compression alone instead of not performing any BLS maneuvers. BLS training should help give a greater emphasis on this topics.

Chronic heart failure is a major health problem for prevalence, morbidity and costs; heart failure management programs may prevent hospital admissions, improve clinical status and reduce medical costs.A care program for chronic heart failure patients was activated by the Cardiology Department, based on a nurse-monitored outpatient clinic, ran in cooperation with cardiologists, who were responsible for optimal pharmacological treatment. Nurses provided patient education, monitoring of clinical status and symptoms and verified adherence to pharmacologic and dietary therapy. To assess the impact of the program on hospitalization rate, functional status and quality of life we compared: 1) hospital admission rate for heart failure in the 6 months before and the 6 months after referral; 2) Minnesota Living with Heart Failure Questionnaire (MLHFQ) score and NYHA functional class at referral time and after 6 months. A cost-based analysis was performed to compare the two periods.Between January 1999 and November 2000, 107 patients were followed up for at least 6 months. Hospitalization declined by 70% (57 admissions in the 6 months before referral, 17 in the 6 months afterwards, p = 0.0001). Functional status improved after 6 months: 41 patients were in NYHA class III-IV at referral time, 26 after 6 months. The mean total score of MLHFQ was reduced from 33.9 to 28.7 (p = 0.005). The average cost of the program was estimated to be [symbol: see text] 218 (Itl 423,000) per patient in 6 months. The savings in overall cost of care was [symbol: see text] 615 (Itl 1,192,000) per patient in 6 months.A management program based on a nurse-monitored outpatient clinic can reduce hospitalization rate, improve functional status and quality of life and decrease medical costs for chronic heart failure patient's care.