Scientific Conferences to Keep in Mind
Scientific Council of Cardiovascular Nursing
Our council promotes excellence in nursing care for patients and their families, ranging from primary prevention to the care of the critically ill, integrates cardiovascular nursing research into the American Heart Association's (AHA's) national research program, and works to advance evidence-based practice by disseminating knowledge generated by all types of research. Our council also collaborates with other AHA scientific councils, cosponsors professional educational conferences, participates in writing scientific papers, and sponsors summer research scholarships for students in various healthcare disciplines.
Advanced Practice Corner: Hands-Only Cardiopulmonary Resuscitation
A summary from the AHA Science Advisory: Michael R. Sayre, Robert A. Berg, Diana M. Cave, Richard L. Page, Jerald Potts, and Roger D. White, "Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out-of-Hospital Sudden Cardiac Arrest: A Science Advisory for the Public" from the AHA Emergency Cardiovascular Care (ECC) Committee (Circulation, April 2008; 117:2162-2167).
Although bystander cardiopulmonary resuscitation (CPR) can more than double survival from cardiac arrest, the reported prevalence of bystander CPR remains low in most cities, about 27% to 33%. Reducing barriers to bystander action can be expected to substantially improve cardiac arrest survival rates. Bystanders who witness the sudden collapse of an adult should activate the emergency medical services (EMS) system and provide high-quality chest compressions by pushing hard and fast in the middle of the victim's chest, with minimal interruptions. This recommendation is based on evaluation of recent scientific studies and consensus of the AHA ECC Committee.
This science advisory is published to amend and clarify the "2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)" for bystanders who witness an adult out-of-hospital sudden cardiac arrest.
Recommendations and Call to Action
All victims of cardiac arrest should receive, at a minimum, high-quality chest compressions (ie, chest compressions of adequate rate and depth with minimal interruptions). To support that goal and save more lives, the AHA ECC Committee recommends the following:
* When an adult suddenly collapses, trained or untrained bystanders should, at a minimum, activate their community emergency medical response system (eg, call 911) and provide high-quality chest compressions by pushing hard and fast in the center of the chest, minimizing interruptions (class I).
* If a bystander is not trained in CPR, then the bystander should provide hands-only CPR (class IIa). The rescuer should continue hands-only CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over care of the victim.
* If a bystander was previously trained in CPR and is confident in his/her ability to provide rescue breaths with minimal interruptions in chest compressions, then the bystander should provide either conventional CPR using a 30:2 compression-to-ventilation ratio (class IIa) or hands-only CPR (class IIa). The rescuer should continue CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over care of the victim.
* If the bystander was previously trained in CPR but is not confident in his/her ability to provide conventional CPR, including high-quality chest compressions (ie, compressions of adequate rate and depth with minimal interruptions) with rescue breaths, then the bystander should give hands-only CPR (class IIa). The rescuer should continue hands-only CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over the care of the victim.
Classes are defined as the following:
Class I-A therapeutic option that is usually indicated, always acceptable, and considered useful and effective.
Class IIa-A therapeutic option for which the weight of evidence is in favor of its usefulness and efficacy.
Research Corner: Propensity Scores
A summary from: Ralph B. D'Agostino Jr, "Propensity Scores in Cardiovascular Research" (Circulation. 2007;115:2340-2343).
Propensity scores are applied when researchers want to make a casual inference when comparing exposures. For example, in epidemiological studies or nonrandomized research studies, pretreatment covariates vary among the treatment groups. Such differences can cause biased estimates of the treatment effects. Rosenbaum and Rubin (1983) introduced propensity scores as an alternative method for estimating treatment effects with nonrandomized research. The "propensity score for an individual, defined as the conditional probability of being treated given the individual's covariates, can be used to balance the covariates in the two groups and thus reduce this bias." If we have a binary treatment and an outcome, with pretreatment covariates, the propensity score is the conditional probability of treatment given the pretreatment covariates. This statistic is typically estimated by logistic regression, where the binary treatment variable is the outcome and the pretreatment covariates are the predictors in the model. Propensity score modeling helps researchers obtain the best estimated probability of the treatment assignment.
Briefly, 3 strategies are applied to propensity scores: (1) matching: controlled subjects "matched" with the treated subjects on pretreatment covariates that need to be controlled are selected; (2) stratification: with identified strata based on background characteristics, treated and control subjects in the same strata are compared directly; and (3) regression adjustment: the impact of the pretreatment covariates are adjusted to best estimate the treatment effect. Although propensity scores are often used in statistical analyses, researchers benefit the most when propensity scores are incorporated into the early design stages of research studies.
American Heart Association Funding
The AHA offers many different types of research funding opportunities, and the Cardiovascular Nursing (CVN) Council encourages our members to apply. Submission dates vary from affiliate to affiliate, so make sure you check your specific affiliate. Here is a summary of specific types of programs available from AHA. CVN nurse scientists should pay particular attention to the Scientist Development Grant as a way toward advancing their research independence. Visit the AHA site for specifics regarding affiliate and national funding programs. Each affiliate may differ slightly so make sure you find your correct affiliate for funding opportunities.
National:http://www.americanheart.org/downloadable/heart/1194636165666National_Final_with
Affiliate:http://www.americanheart.org/presenter.jhtml?identifier=3014871
Consider Becoming a Fellow in American Heart Association
Fellows are an identifiable, knowledgeable group of cardiovascular leaders with specialized expertise who may be called upon to develop scientific and position papers and to address issues beyond the scope of the council. Visit our Web page to see specific criteria. Even if you are not quite ready to apply for this next year, review the criteria so you can earn this honor (http://www.americanheart.org/presenter.jhtml?identifier=3004210).