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BACKGROUND Basic life support (BLS) education is essential for improving bystander cardiopulmonary resuscitation (CPR) rates, but the imparting of such education faces obstacles during the outbreak of emerging infectious diseases, such as COVID-19. When face-to-face teaching is limited, distance learning—blended learning (BL) or an online-only model—is encouraged. However, evidence regarding the effect of online-only CPR training is scarce, and comparative studies on classroom-based BL (CBL) are lacking. While other strategies have recommended self-directed learning and deliberate practice to enhance CPR education, no previous studies have incorporated all of these instructional methods into a BLS course. OBJECTIVE This study aimed to demonstrate a novel BLS training model—remote practice BL (RBL)—and compare its educational outcomes with those of the conventional CBL model. METHODS A static-group comparison study was conducted. It included RBL and CBL courses that shared the same paradigm, comprising online lectures, a deliberate practice session with Little Anne quality CPR (QCPR) manikin feedback, and a final assessment session. In the main intervention, the RBL group was required to perform distant self-directed deliberate practice and complete the final assessment via an online video conference. Manikin-rated CPR scores were measured as the primary outcome; the number of retakes of the final examination was the secondary outcome. RESULTS A total of 52 and 104 participants from the RBL and CBL groups, respectively, were eligible for data analysis. A comparison of the 2 groups revealed that there were more women in the RBL group than the CBL group (36/52, 69.2% vs 51/104, 49%, respectively; P=.02). After adjustment, there were no significant differences in scores for QCPR release (96.9 vs 96.4, respectively; P=.61), QCPR depth (99.2 vs 99.5, respectively; P=.27), or QCPR rate (94.9 vs 95.5, respectively; P=.83). The RBL group spent more days practicing before the final assessment (12.4 vs 8.9 days, respectively; PP CONCLUSIONS We developed a remote practice BL–based method for online-only distant BLS CPR training. In terms of CPR performance, using remote self-directed deliberate practice was not inferior to the conventional classroom-based instructor-led method, although it tended to take more time to achieve the same effect. CLINICALTRIAL Not applicable.

Stretchers are commonly used for transporting cardiac arrest patients, but their use may be limited in confined spaces, like elevators. Use of transfer sheet as an alternative has not been explored. We aimed to compare manual chest compression quality between these two methods.

Background Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on bystander cardiopulmonary resuscitation (BCPR) for fear of transmission while breaking social distancing rules. The latest guidelines recommend hands-only cardiopulmonary resuscitation (CPR) and facemask use. However, public willingness in this setup remains unknown. Methods A cross-sectional, unrestricted volunteer Internet survey was conducted to assess individuals’ attitudes and behaviors toward performing BCPR, pre-existing CPR training, occupational identity, age group, and gender. The raking method for weights and a regression analysis for the predictors of willingness were performed. Results Among 1,347 eligible respondents, 822 (61%) had negative attitudes toward performing BCPR. Healthcare providers (HCPs) and those with pre-existing CPR training had fewer negative attitudes (p < 0.001); HCPs and those with pre-existing CPR training and unchanged attitude showed more positive behaviors toward BCPR (p < 0.001). Further, 9.7% of the respondents would absolutely refuse to perform BCPR. In contrast, 16.9% would perform BCPR directly despite the outbreak. Approximately 9.9% would perform it if they were instructed, 23.5%, if they wore facemasks, and 40.1%, if they were to perform hands-only CPR. Interestingly, among the 822 respondents with negative attitudes, over 85% still tended to perform BCPR in the abovementioned situations. The weighted analysis showed similar results. The adjusted predictors for lower negative attitudes toward BCPR were younger age, being a man, and being an HCP; those for more positive behaviors were younger age and being an HCP. Conclusions Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on attitudes and behaviors toward BCPR. Younger individuals, men, HCPs, and those with pre-existing CPR training tended to show fewer negative attitudes and behaviors. Meanwhile, most individuals with negative attitudes still expressed positive behaviors under safer measures such as facemask protection, hands-only CPR, and available dispatch instructions.

This study examined HIV-related health risk behaviors–unprotected anal intercourse, alcohol intoxication, and drug use–and their association with stigma in a sample of transgender women. We conducted a cross-sectional survey of 191 transgender women recruited through purposive sampling in San Francisco, CA. Unprotected anal intercourse, alcohol intoxication, and illicit drug use were significantly intercorrelated, suggesting the presence of a “syndemic” among these HIV-related behavioral health risks. In multivariable analyses controlling for sociodemographic and individual health characteristics, stigma was independently associated with greater levels of unprotected anal intercourse, illicit drug use, and a composite index of the 3 risk behaviors. Findings highlight a need for interventions to address stigma and the social context of unprotected sex, alcohol intoxication, and drug use, which may contribute to HIV risk among transgender women.

Previous research indicates elevated risk for psychological distress in sexual and gender minority populations, and some research suggests that stigma contributes to elevated psychological distress among members of these groups. This study examined the hypothesis that exposure to transgender-related stigma (TRS) is associated with both higher levels of depression and anxiety among transgender women.We analyzed data from a diverse sample of 191 adult transgender women living or working in the San Francisco Bay area who were recruited using purposive sampling methods to participate in a cross-sectional survey, which included measures of stigmatization, depression, and anxiety.Higher levels of exposure to TRS were independently associated with higher levels of depression (β=0.31, P.001) and anxiety (β=39, P.001), adjusting for self-reported health and sociodemographic co-variates. Associations between stigmatization, depression, and anxiety were not moderated by participants' age or race/ethnicity.Findings suggest a need for counseling interventions to address the role of stigmatization as a factor potentially contributing to psychological distress among transgender women. This research further highlights the need to develop a stronger evidence base on effective counseling approaches to improve the mental health of transgender women.

Objectives: The outcome of patients after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. Extracorporeal membrane oxygenation has been proposed to assist CPR (ECPR) in OHCA. This study was to investigate the effects and characteristics of ECPR for adult non-traumatic (ANT) OHCA versus Non-ECPR on a community-wide basis. Methods: A prospective four-year observational database collected from a community-wide OHCA web registry in an urban EMS (emergency medical services) was studied. The EMS ambulance teams were capable with advanced airway, intravenous (iv) fluid skills, basic and advanced life support and automated external defibrillator techniques. Outcomes included survival and cerebral performance category scale (CPC) at discharge. ANT OHCA with and without ECPR in emergency were compared by regression analysis including factors of patient, pre-hospital and hospital characteristics and outcomes. Results: Comparing OHCA receiving ECPR (n=79) to those without (n=959), ECPR group were younger (median age 56 vs 78 p Conclusions: In current emergency practice for ANT OHCA, ECPR tended to apply to patients of younger age, men, witnessed arrest, BCPR, and initially shockable rhythms regardless of positive ROSC upon hospital arrival, that can independently lead to higher survival and good neurological outcome compared to non-ECPR.

Background: The resuscitation guidelines indicate pre-arrival dispatcher-assisted telephone CPR (DATCPR) instructions and measurement to increase the proportion of bystander CPR (BCPR), however the impact of those guidelines on survival is not well known. Objective: To describe the impact of a comprehensive bundle of DATCPR on BCPR and survival from OHCA in a horizontal computerized-aided dispatch (CAD) system. Methods: A centralize CAD system in a metropolitan EMS is studied. Routinely in system the time from call to ambulance dispatch should be within 60 seconds. The audio recordings of confirmed OHCAs were reviewed using a standardized format linked with EMS and hospital process and outcome data. The proportions of BCPR and survival six months after implementation (P1) of a bundle that included guideline-based protocol changes, staff training, computerized audit, feedback to providers and leadership rebuilt are compared with that of the same month period in the prior year as control group (P0), using regression analysis for statistics. Results: There were 1437 OHCAs [665 P0, 772 P1; 64% male, median age 62 (IQR: 47-74)](Table 1). The rate of BCPR went from 20.6% in P0 to 35.0% in P1 (p Conclusions: The implementation of a comprehensive bundle of DATCPR in a metropolitan horizontal dispatch system was associated with significant improvements in the rates of BCPR and good neurologic outcome after OHCA.

between patients treated with ALS and BLS. Main outcome measures were functional status at 1 month after OHCA (good status defined as cerebral performance category 1 or 2, and poor as 3 or 4). Results: Of the eligible 158,991 patients, 148,230 (93.2%) were received ALS and 10,761 (6.8%) were received BLS. The propensityscore matching process selected 10,736 patients each from ALS and BLS group. Compared with BLS group, ALS group incurred a higher rate of return of spontaneous circulation before hospital arrival (8.6% vs. 6.2%) and poor functional status (3.4% vs. 2.5%), a similar survival rate (5.1% vs. 5.3%), and a lower rate of good functional status (1.7%vs. 2.8%). Inmultivariable logistic regression, ALS was associated with decreased odds of good functional status (odds ratio [OR] 0.56, 95% CI 0.42–0.74) and increased odds of poor functional status (OR 1.25, 95% CI 1.03–1.50). Adrenaline administration was also associated with decreased odds of good functional status (OR 0.41, 95% CI 0.25–0.67), meanwhile, no association was observedbetweenadvancedairway insertionand functional status. Conclusions: Among adult patients with OHCA in Japan, ALS was negatively associated with good functional status and increased the chance of poor functional survival compared with BLS.