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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2017 | Original research

The effect of a national web course “Help-Brain-Heart” as a supplemental learning tool before CPR training: a cluster randomised trial

Authors: Anette Nord, Leif Svensson, Andreas Claesson, Johan Herlitz, Håkan Hult, Susanne Kreitz-Sandberg, Lennart Nilsson

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2017

Abstract

Background

The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation.

Methods

Classes with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention). Data were collected (practical test and a questionnaire) directly after training and at 6 months. CPR skills were evaluated using a modified Cardiff test (12–48 points). Knowledge on stroke symptoms (0–7 points), AMI symptoms (0–9 points) and lifestyle factors (0–6 points), and willingness to act were assessed by the questionnaire. The primary endpoint was CPR skills at 6 months. CPR skills directly after training, willingness to act and theoretical knowledge were secondary endpoints. Training and measurements were performed from December 2013 to October 2014.

Results

Four hundred and thirty-two students were included in the analysis of practical skills and self-reported confidence. The mean score for CPR skills was 34 points after training (control, standard deviation [SD] 4.4; intervention, SD 4.0; not significant [NS]); and 32 points at 6 months for controls (SD 3.9) and 33 points for intervention (SD 4.2; NS). At 6 months, 73% (control) versus 80% (intervention; P = 0.05) stated they would do compressions and ventilation if a friend had a cardiac arrest, whereas 31% versus 34% (NS) would perform both if the victim was a stranger. One thousand, two hundred and thirty-two students were included in the analysis of theoretical knowledge; the mean scores at 6 months for the control and intervention groups were 2.8 (SD 1.6) and 3.2 (SD 1.4) points (P < 0.001) for stroke symptoms, 2.6 (SD 2.0) and 2.9 (SD 1.9) points (P = 0.008) for AMI symptoms and 3.2 (SD 1.2) and 3.4 (SD 1.0) points (P < 0.001) for lifestyle factors, respectively.

Discussion

Use of online learning platforms is a fast growing technology that increases the flexibility of learning in terms of location, time and is available before and after practical training.

Conclusions

A web course before CPR training did not influence practical CPR skills or willingness to act, but improved the students’ theoretical knowledge of AMI, stroke and lifestyle factors.

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Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, et al. European resuscitation council guidelines for resuscitation 2015 section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015;95:81–99. doi:10.1016/j.resuscitation.2015.07.015.CrossRefPubMed

Muller D, Agrawal R, Arntz HR. How sudden is sudden cardiac death? Circulation. 2006;114:1146–50. doi:10.1161/CIRCULATIONAHA.106.616318.CrossRefPubMed

Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg M, Nordberg P, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015;372:2307–15. doi:10.1056/NEJMoa1405796.5.CrossRefPubMed

Holmberg M, Holmberg S, Herlitz J. Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation. 2000;47:59–70. doi:10.1016/S0300-9572(00)00199-4.CrossRefPubMed

Means B, Toyama Y, Murphy R, Bakia M, Jones K. Evaluation of evidence based practices in online learning - a meta-analysis and review of online learning studies. Washington, DC: Center for Technology in Learning, US Department of Education; 2010.

Baller S, Dutta S, Lanvin B. The Global Information Technology Report 2016. Innovating in the digital economy. Geneva: World Economic Forum and INSEAD. http://www3.weforum.org/docs/GITR2016/GITR_2016_full%20report_final.pdf. Accessed 29 May 2017.

Davidsson P, Findahl O. Svenskarna och internet 2016. Version 1.1. Stockholm; 2016 (in Swedish). https://www.iis.se/docs/Svenskarna_och_internet_2016.pdf. Accessed 29 May 2017

Reder S, Cummings P, Quan L. Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students. Resuscitation. 2006;69:443–53. doi:10.1016/j.resuscitation.2005.08.020.CrossRefPubMed

Brannon TS, White LA, Kilcrease JN, Richard LS, Spillers JG, Phelps CL. Use of instructional video to prepare parents for learning infant cardiopulmonary resuscitation. Proc (Bayl Univ Med Cent). 2009;22:133–7.

10.

European Resuscitation Council online CoSy course system. https://cosy.erc.edu/landing. Accessed 21 May 2017.

11.

Böttiger BW, Van Aken H. Kids save lives - training school children in cardiopulmonary resuscitation worldwide. Resuscitation. 2015;94:A5–7. doi:10.1016/j.resuscitation.2015.07.005.CrossRefPubMed

12.

Cave DM, Aufderheide TP, Beeson J, Ellison A, Hazinski MF, Hiratzka LF. Importance and implementation of training in cardiopulmonary resuscitation and automated external defibrillation in schools. Circulation. 2011;123:691–706. doi:10.1161/CIR.0b013e31820b5328.CrossRefPubMed

13.

Bohn A, Lukas RP, Breckwoldt J, Böttiger BV, Van Aken H. Kids save lives’: why schoolchildren should train in cardiopulmonary resuscitation. Curr Opin Crit Care. 2015;21:220–5. doi:10.1097/MCC.0000000000000204.CrossRefPubMed

14.

Greif R, Lockeyb AS, Conaghanc P, Lippert A, De Vries W, Monsieurs KG, et al. European resuscitation council guidelines for resuscitation 2015 section 10. Education and implementation of resuscitation. Resuscitation. 2015;95:288–301. doi: 10.1016/j.resuscitation.2015.07.032.CrossRefPubMed

15.

The web course Help-Brain-Heart. http://www.hjalphjarnahjarta.se. Accessed 21 May 2017.

16.

Swedish National Agency for Education. Swedish curriculum for the compulsory school, preschool class and the recreation centre, 2011. http://www.skolverket.se/publikationer?id=2687. Accessed 21 May 2017.

17.

Donner A, Klar N. Design and analysis of cluster randomization trials in health research. London: Arnold Publishing; 2000.

18.

Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castren M, et al. European resuscitation council guidelines for resuscitation 2010 section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2010;81:1277–92. doi:10.1016/j.resuscitation.2010.08.009.CrossRefPubMed

19.

Nord A, Svensson L, Hult H, Kreitz-Sandberg S, Nilsson L. Effect of mobile application-based versus DVD-based CPR training on students’ practical CPR skills and willingness to act: a cluster randomised study. BMJ Open. 2016;6:e010717. doi:10.1136/bmjopen-2015-010717.CrossRefPubMedPubMedCentral

20.

Whitfield RH, Newcombe RG, Woollard M. Reliability of the Cardiff test of basic life support and automated external defibrillation version 3.1. Resuscitation. 2003;59:291–314. doi: 10.1016/S0300-9572(03)00246-6.CrossRefPubMed

21.

Nielsen AM, Isbye DL, Lippert FK, Rasmussen LS. Distributing personal resuscitation manikins in an untrained population: how well are basic life support skills acquired? Emerg Med J. 2012;29:587–91. doi:10.1136/emermed-2011-200098.CrossRefPubMed

22.

Henriksson C. Coronary heart disease and early decision making, from symptoms to seeking care. Studies with focus on pre-hospital delay in acute myocardial infarction patients. Uppsala: Uppsala University, Department of Medical Sciences, Akademiska sjukhuset; 2011.

23.

Nord A, Hult H, Kreitz-Sandberg S, Herlitz J, Svensson L, Nilsson L. Effect of two additional interventions, test and reflection, added to standard cardiopulmonary resuscitation training on seventh grade students’ practical skills and willingness to act: a cluster randomised trial. BMJ Open. 2017;7:e014230. doi:10.1136/bmjopen-2016-014230.CrossRefPubMed

24.

Nord A. CPR training in 7th grade. Instructor-led or DVD-based, which teaching method is most effective? Linköping University; master 2013:03. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-117856. Accessed 21 May 2017.

25.

Killip S, Mahfoud Z, Pearce K. What is an intracluster correlation coefficient? Crucial concepts for primary care researchers. Ann Fam Med. 2004;2:204–8. doi:10.1370/afm.141.CrossRefPubMedPubMedCentral

26.

Creutzfeldt J, Hedman L, Felländer-Tsai L. Effects of pre-training using serious game technology on CPR performance – an exploratory quasi-experimental transfer study. Scand J Trauma Resusc Emerg Med. 2012;20:79. doi:10.1186/1757-7241-20-79.CrossRefPubMedPubMedCentral

27.

Perkins GD, Fullerton JN, Davis-Gomez N, Davies RP, Baldock C, Stevens H, et al. The effect of pre-course e-learning prior to advanced life support training: a randomised controlled trial. Resuscitation. 2010;81:877–81. doi:10.1016/j.resuscitation.2010.03.019.CrossRefPubMed

28.

Rehberg R, Diaz GL, Middlemas D. Classroom versus computer-based CPR training: a comparison of effectiveness of two instructional methods. Athl Train Educ J. 2009;4:98–103.

29.

Hattie J. Visible learning: a synthesis of over 800 meta-analyses relating to achievement. London: Routledge; 2008.

30.

Olsson T, Wisher RA. The effectiveness of web-based instruction: an initial inquiry. International Review of Research in Open and Distributed Learning. 2002;3 doi:10.19173/irrodl.v3i2.103.

31.

Plant N, Taylor K. How best to teach CPR to schoolchildren: a systematic review. Resuscitation. 2013;84:415–21. doi:10.1016/j.resuscitation.2012.12.008.CrossRefPubMed

32.

Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52:1–26.CrossRefPubMed

33.

Kanstad BK, Nilsen SA, Fredriksen K. CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway. Resuscitation. 2011;82:1053–9. doi:10.1016/j.resuscitation.2011.03.033.CrossRefPubMed

34.

Omi W, Taniguchi T, Kaburaki T, Okajima M, Takamura M, Noda T, et al. The attitudes of Japanese high school students toward cardiopulmonary resuscitation. Resuscitation. 2008;78:340–5. doi:10.1016/j.resuscitation.2008.03.233.CrossRefPubMed

35.

Immordino-Yang MH, Damasio A. We feel, therefore we learn: the relevance of affective and social neuroscience to education. Mind Brain Educ. 2007;1:3–10. doi:10.1111/j.1751-228X.2007.00004.x.CrossRef

36.

Arntz HR, Bossaert LL, Danchin N, Nikolaou NI. European resuscitation council guidelines for resuscitation 2010 section 5. Initial management of acute coronary syndromes. Resuscitation. 2010;81:1353–63. doi:10.1016/j.resuscitation.2010.08.016.CrossRefPubMed

37.

Mosley I, Nicol M, Donnan G, Thrift AG, Dewey HM. What is stroke symptom knowledge? Int J Stroke. 2014;9:48–52. doi:10.1111/ijs.12024.CrossRefPubMed

38.

Barber PA, Zhang J, Demchuk AM, Hill MD, Buchan AM. Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology. 2001;56:1015–20.CrossRefPubMed

39.

Thylen I, Ericsson M, Ängerud KH, Isaksson RM, Sederholm LS. First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study. BMJ Open. 2015;5:e007059. doi:10.1136/bmjopen-2014-007059.CrossRefPubMedPubMedCentral

40.

Nordanstig A, Jood K, Rosengren L. Public stroke awareness and intent to call 112 in Sweden. Acta Neurol Scand. 2014;130:400–4. doi:10.1111/ane.12293.CrossRefPubMed

41.

Henriksson C, Larsson M, Arnetz J, Herlitz J, Karlsson J-E, Svensson L, et al. Knowledge about acute myocardial infarction (AMI) and attitudes to medical care seeking - a comparison between patients and the general public. Open J Nurs. 2012;2:372–8. doi:10.4236/ojn.2012.24055.CrossRef

42.

Bohn A, Van Aken HK, Möllhoff T, Wienzek H, Kimmeyer P, Wild E, et al. Teaching resuscitation in schools: annual tuition by trained teachers is effective starting at age 10. A four-year prospective cohort study. Resuscitation. 2012;83:619–25. doi:10.1016/j.resuscitation.2012.01.020.CrossRefPubMed

43.

Aaberg AM, Larsen CE, Rasmussen BS, Hansen CM, Larsen JM. Basic life support knowledge, self-reported skills and fears in Danish high school students and effect of a single 45-min training session run by junior doctors; a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2014;22:24. doi:10.1186/1757-7241-22-24.CrossRefPubMedPubMedCentral

44.

Mohammadyari S, Singh H. Understanding the effect of e-learning on individual performance: the role of digital literacy. Comput Educ. 2015;82:11–25. doi:10.1016/j.compedu.2014.10.025.CrossRef

Title: The effect of a national web course “Help-Brain-Heart” as a supplemental learning tool before CPR training: a cluster randomised trial
Authors: Anette Nord
Leif Svensson
Andreas Claesson
Johan Herlitz
Håkan Hult
Susanne Kreitz-Sandberg
Lennart Nilsson
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2017
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-017-0439-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The effect of a national web course “Help-Brain-Heart” as a supplemental learning tool before CPR training: a cluster randomised trial

Abstract

Background

Methods

Results

Discussion

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Discussion

Conclusions

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