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P111: Introduction of an ECPR protocol to paramedics in Atlantic Canada; a pilot knowledge translation project
- C. Rouse, J. Mekwan, P. Atkinson, J. Fraser, J. Gould, D. Rollo, J. Middleton, T. Pishe, M. Howlett, J. Legare, S. Chanyi, M. Tutschka, A. Hassan, S. Lutchmedial
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S104
- Print publication:
- May 2019
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Introduction: There is currently no protocol for the initiation of extra corporeal cardiopulmonary resuscitation (ECPR) in out of hospital cardiac arrest (OHCA) in Atlantic Canada. Advanced care paramedics (ACPs) perform advanced cardiac life support in the prehospital setting often completing the entire resuscitation on-scene. Implementation of ECPR will present a novel intervention that is only available at the receiving hospital, altering how ACPs manage selected patients. Our objective is to determine if an educational program can improve paramedic identification of ECPR candidates. Methods: An educational program was delivered to paramedics including a short seminar and pocket card coupled with simulations of OHCA cases. A before and after study design using a case-based survey was employed. Paramedics were scored on their ability to correctly identify OHCA patients who met the inclusion criteria for our ECPR protocol. Scores before and after the education delivery were compared using a two tailed t-test. A 6-month follow-up is planned to assess knowledge retention. Qualitative data was also collected from paramedics during simulation to help identify potential barriers to implementation of our protocol in the prehospital setting. Results: Nine advanced care paramedics participated in our educational program. Mean score pre-education was 9.7/16 (61.1%) compared to 14/16 (87.5%) after education delivery. The mean difference between groups was 4.22 (CI = 2.65-5.80, p = 0.0003). There was a significant improvement in the paramedics’ ability to correctly identify ECPR candidates after completing our educational program. Conclusion: Paramedic training through a didactic session coupled with a pocket card and simulation appears to be a feasible method of knowledge translation. 6-month retention data will help ensure knowledge retention is achieved. If successful, this pilot will be expanded to train all paramedics in our prehospital system as we seek to implement an ECPR protocol at our centre.
A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study
- A. M. Ashman, C. E. Collins, L. Weatherall, L. J. Brown, M. E. Rollo, D. Clausen, C. C. Blackwell, K. G. Pringle, J. Attia, R. Smith, E. R. Lumbers, K. M. Rae
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- Journal:
- Journal of Developmental Origins of Health and Disease / Volume 7 / Issue 4 / August 2016
- Published online by Cambridge University Press:
- 15 April 2016, pp. 357-368
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Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the child’s first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5–43.2, n=110), median birth weight was 3180 g (910–5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.
A model of growth, pregnancy and lactation in the red deer
- I. VETHARANIAM, D. R. STEVENS, G. W. ASHER, S. J. R. WOODWARD, J. A. ARCHER, M. D. ROLLO
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- Journal:
- The Journal of Agricultural Science / Volume 147 / Issue 3 / June 2009
- Published online by Cambridge University Press:
- 03 March 2009, pp. 253-272
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A model of the growth, pregnancy and lactation of red deer was developed for incorporation into a whole-farm systems model in order to improve the understanding of venison supply systems. The model estimates the level of metabolic demand for a deer, which depends on the maximum capacity of its tissues to use energy. A function that takes account of satiation signals and rumen capacity is used to convert the metabolic demand into an estimate of the deer's forage intake demand, which can be used as an input into a foraging model. The actual energy intake of the deer is subsequently used to predict live weight (LW), body condition score, foetal growth and gestation length in pregnant hinds, and milk yield in lactating hinds. In order to make these predictions, the model requires inputs that include values for mean daily temperature, mean daily wind speed, day length and season, as well as pasture quality. Values for model parameters were obtained from the literature, rather than by fitting to data, and model predictions were then compared with measurements obtained in independent trials.
In simulations, the model predicted that 152-day-old stags and hinds, weighing, respectively, 44 and 48 kg, would grow to, respectively, 106 and 90 kg when 517 days old, compared with trial results of, respectively, 103 and 84 kg. Predictions for the weight of pregnant hinds, gestation length and calf birth weight compared well with an experiment for hinds on a high plane of nutrition but poorly for hinds on medium and low planes. Weekly predictions of hind LWs for days 132–230 of pregnancy had respective residual means of 0·08, 6·2 and 8·5 kg, and respective residual standard deviations of 1·33, 4·6 and 5·2 kg for the high, medium and low nutritional planes. Predicted gestation length for high, medium and low planes of nutrition were, respectively, 231·5, 238·0 and 242·0 days compared with experimental values of, respectively, 231·3, 234·7 and 239·2 days, while predicted birth weights were, respectively, 8·5, 8·3 and 8·9 kg compared with measured values of, respectively, 8·4, 9·5 and 9·3 kg. Predicted calf growth from birth to 14 weeks agreed well with data (residual mean and standard deviation being 0·04 and 1·15 kg, respectively).
The existing software structure of the whole-farm model dictated that the deer model use the Euler method with a fixed, daily time step. Therefore, the model was constructed using difference (rather than differential) equations and used a traditional, energy-balance method for predicting growth. This empirical approach tacitly imposed a standard body composition and standard metabolic rate for adults, with values corresponding to well-fed deer. This does not cater for variation in body composition and metabolic activity, and in retrospect, caused the model to perform poorly for the medium and low nutritional regimes.