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Obtaining valid parental informed consent for pediatric procedures in the emergency department (ED) is challenging. We compared a video-assisted informed consent intervention with conventional discussion to inform parents about pediatric procedural sedation in the ED. We conducted a prospective randomized controlled trial using a convenience sample including the parents of children in the ED in whom procedural sedation for facial laceration was recommended. The video group watched an informational video. Conventional group participants received information from physicians during conventional discussion. The primary outcome was knowledge improvement of the video intervention compared with conventional discussion. The secondary outcome was parental satisfaction. Video and conventional groups comprised 32 and 30 participants, respectively. Mean knowledge scores of parents after intervention [±standard deviation] were higher in the video group (91.67 ± 12.70) than in the conventional group (73.33 ± 19.86). Knowledge score differences were significantly bigger in the video group (coefficient: 18.931, 95% confidence interval: 11.146–26.716). Video group participants reported greater satisfaction than conventional group participants. Parents’ comprehension of and satisfaction with the informed consent process for pediatric procedural sedation may be improved with the use of an educational video. Standardized approaches should be developed by healthcare institutions to better educate parents, facilitate treatment decisions, and boost satisfaction in the ED.

Nanowire (NW) structure is superior at defining the direction of device due to its one-dimension feature. In this work, the p-n ZnO NWs were successfully synthesized, and were able to vertically grow on Ta2O5 substrate. Thus, the well-performed Au/p-n ZnO NWs/Ta2O5/Au one-diode one-memoristor device was fabricated. The p-n ZnO NWs not only exhibited excellent rectifying behavior, but also played the role of oxygen storing during filaments formation. Therefore, the low-leakage device aimed to build high-density crossbar arrays which was required for accelerating the combination of 5 G with AI in near future applications.

Background Obtaining valid parental informed consent for pediatric procedures in the emergency department (ED) is challenging. This study compared a video-assisted informed consent intervention with conventional consent discussion to inform parents about pediatric procedural sedation in the ED. Methods A video-assisted informed consent intervention was developed to explain the process, benefits, risks, and alternatives of pediatric procedural sedation. A prospective randomized controlled trial was conducted with a convenience sample of parents of children recommended for procedural sedation for facial laceration in the ED. Intervention group participants watched the video. Control group participants received information from physicians during conventional discussion. Participants completed pre- and post-education knowledge tests and rated their satisfaction with the informed consent process. The primary outcome was efficacy of the video intervention compared with conventional discussion. Secondary outcomes were parental satisfaction and consent refusal. A covariate-controlled multivariable regression model was used to analyze between-group differences in knowledge and satisfaction. Results There were 32 participants in the intervention group and 30 in the control group. Mean knowledge scores were higher in the intervention group (91.67 ± [standard deviation] 12.70) than in the control group (73.33 ± 19.86). The intervention group showed significantly greater knowledge score differences (coefficient: 18.931, 95% confidence interval: 11.146–26.716). Intervention group participants showed greater satisfaction than control group participants. Conclusions Video-assisted informed consent was superior to conventional discussion for informing parents during an ED informed consent process. Video-assisted informed consent may improve parents’ understanding of pediatric procedural sedation and satisfaction with the informed consent process in the ED. Institutions should develop structured methods and strategies to better inform parents, facilitate treatment decisions, and improve parent satisfaction in the ED. Trial registration: The ClinicalTrials.gov Identifier is NCT01850329. Registered 9 May, 2013 - Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/study/NCT01850329

Nanowire (NW) structure is superior at defining the direction of device due to its one-dimension feature. In this work, the p-n ZnO NWs were successfully synthesized, and were able to vertically grow on Ta2O5 substrate. Thus, the well-performed Au/ p-n ZnO NWs/ Ta2O5/ Au one-diode one-memoristor device was fabricated. The p-n ZnO NWs not only exhibited excellent rectifying behavior, but also played the role of oxygen storing during filaments formation. Therefore, the low-leakage device aimed to build high-density crossbar arrays which was required for accelerating the combination of 5G with AI in near future applications.

In this paper, we introduce a 10 Gbps digital baseband transceiver with 1V supply voltage, 16-QAM, 3/4 code rate single carrier mode using 28 nm CMOS process to do the implementation. In millimeter wave communications, well-defined standard, IEEE 802.11ad is referenced for our system design and simulation. We target at modified chip rate 2.5 GHz with 4 times parallelism hardware at clock rate 625 MHz. The overall transceiver architecture design with hardware implementation considerations will be proposed. With the smart shared memory allocation, we can reduce 31% of the total amount. According to the referenced specifications, we achieve the required bit error rate 3 × 10−7 before SNR 18.5 dB. After the system algorithm design, we implement the hardware with the core area 2.92 mm2 with measured power 1.8 Watt for baseband transceiver chip. The performance of energy per bit is 0.023 nJ and 0.211 nJ per bit for Tx and Rx, including ADC/DAC.

Appendix 2. Methodological quality checklist. (DOCX 13 kb)

Appendix 1. Data extraction form. (DOCX 15 kb)

In cognitive radio networks (CRNs), access to unused portions of the licensed spectrum by secondary users renders the system vulnerable to malicious attack. A number of channel hopping schemes with anti-jamming capability have been proposed; however, existing solutions require the pre-sharing of access information or cannot guarantee rendezvous success. Furthermore, existing channel hopping schemes with anti-jamming capability do not consider variations in the traffic loads of different nodes. In this study, we developed a novel anti-jamming scheme, which allows for the dynamic adjustment of the sending/receiving ratio to maximize the throughput of an SU node. The proposed Load Awareness Anti-jamming channel hopping scheme is based on extended Langford pairing. The proposed scheme guarantees rendezvous for any pair of nodes, and was shown in simulations to outperform Sec-CH and Tri-CH in terms of throughput and TTR.

In cognitive radio networks (CRNs), secondary users (SUs) are vulnerable to malicious attacks because an SU node's opportunistic access cannot be protected from adversaries. How to design a channel hopping scheme to protect SU nodes from jamming attacks is thus an important issue in CRNs. Existing anti-jamming channel hopping schemes have some limitations: Some require SU nodes to exchange secrets in advance; some require an SU node to be either a receiver or a sender, and some are not flexible enough. Another issue for existing anti-jamming channel hopping schemes is that they do not consider different nodes may have different traffic loads. In this paper, we propose an anti-jamming channel hopping protocol, Load Awareness Anti-jamming channel hopping (LAA) scheme. Nodes running LAA are able to change their channel hopping sequences based on their sending and receiving traffic. Simulation results verify that LAA outperforms existing anti-jamming schemes.

Background We investigated whether, in the emergency department (ED), educational video-assisted informed consent is superior to the conventional consent process, to inform trauma patients undergoing surgery about the procedure, benefits, risks, alternatives, and postoperative care. Methods We conducted a prospective randomized controlled trial, with superiority study design. All trauma patients scheduled to receive trauma-related debridement surgery in the ED of Kaohsiung Medical University Hospital were included. Patients were assigned to one of two education protocols. Participants in the intervention group watched an educational video illustrating informed consent information, whereas those in the control group read an informed consent document. The primary outcome was knowledge scores and the secondary outcome was assessment of patient satisfaction. A multivariable regression model, with predefined covariates, was used to analyze differences in knowledge scores and patient satisfaction levels between the groups. Results A total of 142 patients were enrolled, with 70 and 72 assigned to the intervention and control groups, respectively. Mean knowledge scores were higher in the intervention (72.57 ± 16.21 (SD)) than in the control (61.67 ± 18.39) group. By multivariate analysis, the intervention group had significantly greater differences in knowledge scores (coefficient: 7.646, 95% CI: 3.381–11.911). Age, injury severity score, and baseline knowledge score significantly affected the differences in knowledge scores. Significant improvements were observed in patients’ perception of statements addressing comprehension of the information provided, helpfulness of the supplied information for decision making, and satisfaction with the informed consent process. Multivariate analysis showed significant correlations between video education and patient satisfaction. Conclusions Both the educational approach and severity of injury may have an impact on patient understanding during the informed consent process in an emergency environment. Video-assisted informed consent may improve the understanding of surgery and satisfaction with the informed consent process for trauma patients in the ED. Institutions should develop structured methods and other strategies to better inform trauma patients, facilitate treatment decisions, and improve patient satisfaction. Trial registration The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12910-018-0264-7) contains supplementary material, which is available to authorized users.

Table S1. Comparisons of satisfaction between control and intervention subgroups. (DOCX 29 kb)

Appendix. Knowledge measurement questionnaire. (DOCX 15 kb)

For wide-ranging applications in nanoscale electronic devices, durable and reproducible p-type nanostructures are essential. In this work, simple ZnO nanowire (NW) p–n homojunctions were grown using a two-step hydrothermal synthesis method. P2O5 served as a doping source to obtain p-type ZnO NWs. The morphology of the ZnO NW arrays was examined using field emission scanning electron microscopy. The high-resolution transmission electron microscopy (HRTEM) image indicated that the ZnO NW p–n homojunction is single-crystalline with a ⟨0001⟩ growth direction. The distribution of P element was analyzed using energy-dispersive spectroscopy. The dynamic growth observation was conducted using liquid in situ TEM to investigate the ZnO nucleation and growth mechanism. We divided the ZnO nanocrystal precipitation into three processes. Whether two adjacent particles grow stably or not was found to be related to the distance. Moreover, the temperature-dependent photoluminescence spectra revealed that two extra emissio...

Background Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. Methods A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. Results The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department (ED) were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Conclusions Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. Trial registration The ClinicalTrials.gov Identifier is NCT01338480 . The date of registration was April 18, 2011 (retrospectively registered).

In this paper, a pseudo minimum mean square error (P-MMSE) frequency domain equalizer (FDE) is proposed to combat deep fading channel for single carrier (SC) modulation under IEEE 802.11ad and IEEE 802.15.3c standard. This FDE has resistance like MMSE to deep fading channel and maintain low complexity like zero-forcing (ZF) equalizer. In order to calculate bit error rate (BER) performance, the proposed P-MMSE integrating with our previous dual-mode baseband receiver [1] to do simulation. P-MMSE FDE can provide about 1dB improvement for 16QAM and 5 dB improvement for QPSK and BPSK when BER at 10−-2 in serious deep fading channel. Besides, it enhances the BER floor from 4 × 10−-3 to 10−-3 in 16-QAM Moreover, P-MMSE FDE maintains the same complexity as ZF FDE.

Study objective Missed injuries sustain an important issue concerning patient safety and quality of care. The purpose of this study is to examine the effect of surgeon commitment to trauma care on missed injuries. We hypothesised that surgeons committed to the trauma service has less missed injuries than surgeons not committed to the trauma service would have. Methods By retrospective analysis of 976 adult patients admitted to the trauma intensive care unit (ICU) at an urban, university-based trauma centre. Missed injuries were compared between two groups; in group 1 the patients were evaluated and treated by the surgeons who were committed to the trauma service and in group 2 the patients were evaluated and treated by surgeons practicing mainly in other specialties. Results Patients had significantly lower rates of missed major or life-threatening injuries when treated by group 1 surgeons. Logistic regression model revealed significant factors associated with missed major or life-threatening injuries including ISS and groups in which patients were treated by different group surgeons. Conclusions Physicians will perform better when they are trained and interested in a specific area than those not trained, or even not having any particular interest in that specific area. Surgeons committed to the trauma service had less missed injuries in severely injured patients, and it is vital to improve patient safety and quality of care for trauma patients. Staff training and education for assessing severely injured patients and creating an open culture with detection and reduction of the potential for error are important and effective strategies in decreasing missed injuries and improving patient safety.

Chronic kidney disease (CKD) has become a burden of health care globally. However, data on epidemiology, clinical features, and outcomes of urinary tract infection (UTI) in this population are scarce. This study aims to retrospectively review such data. Materials and methods: A retrospective cohort study was conducted from 1 January 2005 to 31 December 2011 in patients with CKD requiring hospitalization. Patients who had upper and lower UTIs were compared for demography and clinical data. Logistic regression was used to assess which variables were associated with upper UTI. Results: A total of 276 bacteriuria patients were admitted to our ward with upper and lower UTIs. The average ages of the upper and lower UTI patients were 59.21 ± 16.54 and 71.18 ± 14.77 years, respectively. The results of logistic regression analysis showed that age (OR 0.946, P < 0.001), female sex (OR 4.695, P < 0.001), and renal stones (OR 8.232, P < 0.001) were independently associated with upper UTI. Conclusion: This study shows that patients with CKD and UTIs were elderly, and that females were prone to have more bacteriuria and upper UTIs than males. In addition, patients who had renal stones were more prone to have upper UTI than other bacteriuria patients. Aggressive treatment of renal stones should be considered in these patients.

This paper is intended to demonstrate the effect of the high refractive index of an intermediary zinc oxide (ZnO) layer to improving the full width at half maximum (FWHM) of the surface plasmon resonance (SPR) reflectance curve. This case is an asymmetric dielectric structure (ADS) of low-loss surface plasmon resonance (LLSPR). The ADS-LLSPR chip is particularly interesting for two surface plasmons (SPs) mode of external and internal on a gold (Au) interface. These SPs have different energy fields, which enables separation of the surface and bulk refractive index changes. We optimize ZnO and Au thin films thicknesses through analytical comparisons with conventional SPR structures. Upon exposure to ethanol, the ADS-LLSPR chip showed a 2-times decrease in the FWHM and a 4.5-times larger shift in intensity interrogation. The ADS-LLSPR chip exhibits a widely linearity range, high accuracy and high sensitivity. This characteristic of the ADS-LLSPR chip is the basis for early diagnosis crucial in DNA-based viruses.

It is not unusual that narcotics-dependent patients fulfill their medical requirements in the emergency department (ED). The behavior of these patients varies, and their manifestations and predictors are still not fully studied. We performed this retrospective study by prospectively collecting data on patients with suspected drug dependence who were undiagnosed at first and then treated for some kind of reported pain at the ED. Patients who were confirmed to have narcotics dependence were compared with control patients in a ratio of 1:3 matching for age, gender, disease, and clinical diagnoses. From January 2006 to October 2009, 26 of 223 patients treated for pain were found to be drug dependent (12 males and 14 females). The average dose of narcotics used was higher than the control group [3.23 ± 1.14 vs. 1.12 ± 0.36, p

Copper–zinc–indium–sulfide (Cu–Zn–In–S) semiconductor films are deposited onto fluorine-doped-tin-oxide-coated glass substrates using one-step electrodeposition. The effect of the [Zn]/[Cu + Zn] molar ratio in the solution bath on the structural, optical, and electrical properties of samples is investigated. X-ray diffraction patterns reveal that the samples are the quaternary Cu–In–Zn–S phase with a small amount of ZnS impurity. The thicknesses and direct band gaps of the samples, determined from surface profile measurements and transmittance and reflectance spectra, are in the ranges of 0.68–2.09 μm and 1.43–3.03 eV, respectively. The flat-band potentials of the samples obtained from Mott–Schottky measurements are the range of −1.03 to −1.44 V vs. an Ag/AgCl reference electrode. All samples are n-type semiconductors with a carrier density of 8.4 × 10 15 to 2.0 × 10 14 cm −3 and a mobility of 96–263 cm 2 V −1 s −1 . The samples with the Cu:Zn:In:S molar ratio of 1:1.08:2.16:5.20 had a maximum photo-enhanced current density of 1.50 mA cm −2 at an applied bias of −0.25 V vs. an Ag/AgCl electrode in contact with an electrolyte containing Na 2 S and K 2 SO 3 under illumination. The results show that Cu–Zn–In–S films can be obtained using one-step electrodeposition for photoelectrochemical applications.

Objective Vagal maneuvers can cause a bradycardiac response with a reciprocal increase in parasympathetic outflow and reduction of sympathetic tone. Heart rate variability (HRV) analysis is useful in the evaluation of the autonomic nervous system. The present study investigated the magnitude of heart rate (HR) reduction and autonomic response in healthy young adults following three vagal maneuvers: carotid sinus massage (CSM), the cold face test (CFT), and the Valsalva maneuver (VM). Materials and Methods A prospective study was conducted in 50 healthy volunteers between 21 and 35 years old who completed CSM, the CFT, and the VM in random order. Before and after each test, the RR intervals were recorded by electrocardiography for 5 min to analyze variability in the time and frequency domains, and to monitor changes in the HR, blood pressure (BP), and body temperature (BT). Results After each test, HR, BP, and BT significantly decreased compared with values at rest (all p values p = 0.001, p = 0.009, and p = 0.009, respectively). Although not all of these changes were statistically significant, increased power of the normalized low-frequency component (LF%), decreased power of the normalized high-frequency component (HF%), and an increased LF/HF ratio suggested relative sympathetic enhancement. Only the VM had significant effects on sympathovagal balance in the LF%, HF%, and LF/HF ( p = 0.006, p = 0.004, and p = 0.006, respectively). Conclusion Of the three maneuvers, CSM had the greatest effects on HR reduction, while only the VM had significant effects on sympathovagal modulation. Although accurate assessment of vagal activity was not available from spectral analysis of HRV, the increases in VAR, LF%, and LF/HF, and decrease in HF% observed in this study suggest that increases in cardiac autonomic activities and sympathetic dominance occur as compensatory responses to HR reduction in a 5-min window following vagal maneuvers. More research is required to determine whether CSM is a superior initial nonpharmacologic treatment for supraventricular tachyarrhythmia in a young population if there are no contraindications.

Background Cervical collar brace protection of the cervical spine at the scene of the incident is the first priority for emergency medical technicians treating patients who have sustained trauma. However, there is still controversy between over- or underprotection. The objective of this study was to survey the cervical spine injury of lightweight motorcycle accident victims and further evaluate the neck collar protection policy. Materials and Methods We retrospectively reviewed patients who sustained lightweight motorcycle injuries, assumed to have been at a low velocity, with incidence of cervical spine damage, from a single medical center's trauma registration from 2008 to 2009. Patients were divided into 2 groups: those who were immobilized by cervical collar brace and those who were not. Results Of the 8633 motorcycle crash victims, 63 patients had cervical spine injury. The average of the injury severity score in these patients was 14.31 ± 8.25. There was no significant correlation of cervical spine injury between the patients who had had the neck collar applied and those who had not ( χ 2 , P = .896). The length of stay in intensive care unit was longer in the patients who had the neck collar applied, but the total hospital length of stay was not statistically different to the patients who did not have the neck collar applied. Conclusion The incidence of cervical spinal injuries in the urban area lightweight motorcyclists is very low. Prehospital protocol for application of a cervical collar brace to people who have sustained a lightweight motorcycle accident in the urban area should be revised to avoid unnecessary restraint and possible complications.

Web services are being adopted as a viable means of accessing Web-based applications. Web services are not only used to exchange information between enterprises but also to help software developers provide value-added services for various demands. Web service compositions are synthesised by researchers from elementary Web services, offering the opportunity for service providers and application developers to create value-added services. However, a problem exists in the current distribution process of Web service compositions: the general analysis and selection of services can be overly complex and are completed manually. Therefore, there is a need to manage composite Web services automatically. But the research related to ranking candidate services and selection of optimisation strategies is sparse. Yet, few have been published that consider the constraints of non-functional properties. In this article, a systemic but autonomous composition process has been proposed. This study proposes an evolutionary approach that applies the characteristics of the object-oriented concept of Web services and the genetic algorithm to effectively manage and optimise the Web service composition. It is capable of escaping not only from local optima due to a population-based approach, but also from unbiased nature, which enables it to perform well in a situation with little domain knowledge. In this article, the related literature is reviewed. Then, the Web service composition model incorporated with a genetic algorithm is proposed. Finally, a practical implementation is illustrated and shows a good result in terms of solution quality.

ObjectiveDizziness after minor head injury (mHI) is common. In some eastern countries, it is treated with 7% sodium bicarbonate solution (SB). This prospective study evaluated the clinical efficacy of SB compared with normal saline (NS).Material and methodsFrom April 2009 to April 2010, we performed a prospective observational study on 228 patients (68% female, 32% male) with acute dizziness after mHI. At the emergency physician’s discretion, intravenous SB (1 mL/kg) in NS (250 mL) or NS (250 mL) was administered to 166 patients and 62 patients, respectively, as empiric antidizziness therapy. Outcome measures were severity of dizziness and treatment response, which were measured by a visual analog scale. Various characteristics were compared between treatment groups. Any continued dizziness of the patients during follow-up was also compared with their pre-injury condition, such as prior psychiatric disorders and the presence of vertigo.ResultsThe SB group had their visual analog scale scores reduced by 25.4% compared with 24.6% in the NS group. Both groups showed a statistically significant reduction in dizziness (p

Background: In motorcycle accidents, especially in an urban area with lightweight motorcycles, the belly of the motorcyclist is not protected, and this makes this type of trauma a cause of blunt hepatic injuries. This study investigated the effect and safety of using nonoperative management and selective early angioembolization to treat patients with blunt liver injuries as a result of motorcycle accident. Methods: This was a retrospective study of the hepatic injuries sustained by motorcyclists involved in traffic accidents. We collected patient demographic information, the severity of total injuries, grade of liver injury, associated concomitant injuries, management scheme, and outcome of patients from 2006 to 2007. These patients were treated nonoperatively with selective early angioembolization and close monitoring in our intensive care unit (ICU). Results: We reviewed the cases of 266 patients sustaining blunt abdominal injuries. Thirty-four patients (12.78%) had hepatic injuries. All survived with no obvious morbidity, and no further invasive procedures were performed after admission to ICU. There was no significant association between grade of injury and ICU length of stay (P = .073), but there was a significant association between grade and in-patient length of stay on our regular ward (P = .001). Conclusion: Most patients with hepatic injury caused by motorcycle accidents can be treated safely by nonoperative management. Early selective angioembolization improved the success of nonoperative management of blunt liver injury without other surgical intervention. Routine follow-up with computed axial tomography scans and endoscopic retrograde cholangiopancreatography may not be necessary because complications associated with hepatic injuries were rare.

Blunt abdominal contusion is common in children, but isolated injury with gallbladder hematoma is rarely observed. Examining children can be difficult because they may not cooperate or understand procedures, and therefore, radiography is helpful for diagnosis. However, there are still limitations in applying radiographic examinations in diagnosing intra-abdominal injuries, especially in children with peritoneal signs or an unstable hemodynamic status. In these circumstances, invasive intervention with laparoscopy should be applied for further evaluation. We report here a 6-year-old girl with blunt abdominal trauma in whom hepatobiliary injury was noted on computed tomography and magnetic resonance imaging. Because the patient was unconscious, had unstable vital signs, and the radiographic study was ambiguous, peritonitis could not be excluded. A laparoscopy was then performed and isolated gallbladder hematoma was diagnosed. The patient was discharged after laparoscopic intervention and orthopedic fixation.

ObjectiveHead nurses in a hospital setting work to maintain the quality of nursing care and ensure that staff nursing skills are up-to-date. Although cardiopulmonary resuscitation (CFR) is most often performed by physicians in a hospital, nurses play crucial assistance roles, including the administration of medication, record-keeping, obtaining intravenous access, and helping with intubation. Patient outcome is therefore related to nurses' skill level in CFR. We hypothesized that the more senior head nurses would be more skillful at assisting with CFR.Materials and MethodsWe conducted an observational study of 55 head nurses, who were asked to perform a 4-minute simulation in which they assisted with CFR using a resuscitation manikin. We collected demographic data, including age and years since becoming a nurse and becoming a head nurse, together with a stress score, which assessed the stress felt by the nurses while taking the test. These measures were analyzed along with the accuracy of the nurses' skills while performing CFR.ResultsTwenty-two skills were evaluated, with each skill graded as either a pass or fail. Only 30/55 (54.5%) of the head nurses passed all 22 skills. There was a significant difference in the numbers of skills with a pass rating (p = 0.043) in relation to the units where the head nurses were employed. Their performance also showed a strong negative correlation with age (p = 0.001), work experience (p = 0.028), and time since becoming head nurse (p