By Marie Ellis
Amyotrophic lateral sclerosis - also known as Lou Gehrig's disease - is a condition that gradually attacks nerve cells that control our voluntary movement, leading to paralysis and death. In the US, a reported 30,000 individuals are living with the disease, but now, scientists have identified a fault in protein formation, which could be the origin of this condition.
The researchers, from the University of Wisconsin-Madison, have published their study on amyotrophic lateral sclerosis (ALS) in the journal Cell Stem Cell.
According to the Centers for Disease Control and Prevention (CDC), nobody knows for sure why ALS occurs, and there is currently no cure.
The researchers of this latest study, led by Su-Chun Zhang, senior author and neuroscientist at UW-Madison, say previously, a genetic mutation was discovered in a small group of patients with ALS, prompting scientists to transfer that gene to animals for drug treatment testing.
However, this approach has not yet worked. As such, Zhang and his team decided to study diseased human cells - called motor neurons - in lab dishes. These motor neurons are what direct muscles to contract, and Zhang explains this is where failures occur in ALS.
Discovery centers on faulty proteins inside motor neurons
Zhang was the first scientist to ever grow motor neurons from human embryonic stem cells around 10 years ago, and he has recently been transforming skin cells into induced pluripotent stem (iPS) cells, which are then transformed into motor neurons.
He explains that the iPS cells can be used as models for disease since they have many of the same characteristics as their donor cells.
"With iPS, you can take a cell from any patient, and grow up motor neurons that have ALS," Zhang explains. "That offers a new way to look at the basic disease pathology."
For their latest study, the researchers have focused on proteins that erect a transport structure - called a neurofilament - inside the motor neurons.
They say the neurofilament moves chemicals and cellular parts - including neurotransmitters - to far sides of the nerve cell.
Zhang explains that the motor neurons, for example, that control foot muscles are around 3 ft long, so they need to be moved a whole yard from the cell body to the spot where they can signal the muscles.
As such, one of the first signs of ALS in a patient who lacks this connection is paralysis of the feet and legs.
'Findings have implications for other neurodegenerative disorders'
Before now, scientists have understood that with ALS, so-called tangles - misshapen protein - along the nerve's paths block the route along the nerve fibers, which eventually results in the nerve fiber malfunctioning and dying.
The team's recent discovery, however, has to do with the source of these tangles, which lies in a shortage of one of three proteins in the neurofilament.
Zhang explains that the neurofilament plays both a structural and a functional role:
"Like the studs, joists and rafters of a house, the neurofilament is the backbone of the cell, but it's constantly changing. These proteins need to be shipped from the cell body, where they are produced, to the most distant part, and then be shipped back for recycling.
If the proteins cannot form correctly and be transported easily, they form tangles that cause a cascade of problems."
He says their discovery is that the origin of ALS is "misregulation of one step in the production of the neurofilament."
Additionally, he notes that similar tangles crop up with Alzheimer's and Parkinson's diseases: "We got really excited at the idea that when you study ALS, you may be looking at the root of many neurodegenerative disorders."
Zhang and his team also observed that this misregulation happens very early, which is why it is highly likely that what they found is the origin ALS.
"Nobody knew this before, but we think if you can target this early step in pathology, you can potentially rescue the nerve cell," he says.
And as if this discovery is not exciting enough, the team also found a way to rescue the neural cells in the lab dishes, and when they "edited" the gene that orchestrates formation of the blundered protein, they found that the cells suddenly looked normal.
They report that they are currently testing a wide range of potential drugs, which brings hope to the domain of ALS research.
The CDC have a National ALS Registry, where patients with the condition can complete brief risk-factor surveys to help scientists defeat ALS.
By Steven Reinberg
A brain abnormality may be responsible for more than 40 percent of deaths from sudden infant death syndrome (SIDS), a new study suggests.
The abnormality is in the hippocampus, a part of the brain that influences breathing, heart rate and body temperature. This abnormality may disrupt the brain's control of breathing and heart rate during sleep or during brief waking that happens during the night, the researchers report.
"This abnormality could put infants at risk for SIDS," said lead researcher Dr. Hannah Kinney, a professor of pathology at Harvard Medical School in Boston.
Kinney can't say for sure that this abnormality is a cause of SIDS. "We don't know at this stage. This is the first observation of this abnormality," she said. "It's just an observation at this point."
Before this brain abnormality can be called a cause of SIDS, Kinney said, they have to find out what causes this abnormality and determine if it alone can cause SIDS.
For the study, Kinney's team examined sections of the hippocampus from 153 infants who died suddenly and unexpectedly between 1991 and 2012. The deaths were classified as unexplained -- which includes SIDS -- or from a known cause, such as infection, accident, murder or lack of oxygen.
Kinney's group found that 41.2 percent of infants who died for an unexplained reason compared with 7.7 percent of those whose death was explainable had an abnormality in the part of the hippocampus known as the dentate gyrus.
Among the 86 infants whose death was classified as SIDS, 43 percent had this abnormality, the researchers added.
This change in the dentate gyrus suggests there was a problem in development at some point late in the life of the fetus or in the months after birth, Kinney said.
Kinney added that this abnormality has only been seen under the microscope after death, so a child cannot be tested for the abnormality.
"There are no signs or symptoms that predict SIDS or warn families that this problem is there or that SIDS is going to occur," she said.
The report was published online Nov. 24 in the journal Acta Neuropathologica.
"Until we understand more about this abnormality, parents should follow the safe sleep recommendations of the American Academy of Pediatrics," Kinney said.
The recommendation is to place an infant alone in a crib on the back without toys or pillows as bolsters. "The same messages we have always had are still applicable," she said.
SIDS is the leading cause of death of infants younger than 1 year of age in the United States, the researchers said.
Dr. Sayed Naqvi, a pediatric neurologist at Miami Children's Hospital, noted that this brain abnormality has been found in epilepsy, but this is the first time it has been linked to SIDS.
"This needs to be confirmed and more research done to say this is a cause of SIDS," he said.
Marian Willinger, a special assistant for SIDS at U.S. National Institute of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a statement, "The new finding adds to a growing body of evidence that brain abnormalities may underlie many cases of SIDS."
"The hope is that research efforts in this area eventually will provide the means to identify vulnerable infants so that we'll be able to reduce their risk for SIDS," she added.
The number of emergency department visits in the United States rose from about 130 million in 2010 to a record 136 million in 2011, according to the U.S. Centers for Disease Control and Prevention.
The findings also showed that fewer people were going to ERs with non-urgent medical needs: 96 percent of patients were identified as needing medical care within two hours of arriving at the ER. In 2010, that number was 92 percent, according to the research.
Sixty percent of patients arrived at the ER after normal business hours (after 5 p.m. on weekdays). One-third of visits were for patients on either end of the age spectrum -- younger than 15 or older than 65, the researchers found.
Almost 30 percent of visits were for injuries. The highest injury rates were among patients 75 and older, the study noted.
"The report also finds that there are large numbers of admitted patients who wait long times for inpatient beds," Dr. Michael Gerardi, president of the American College of Emergency Physicians (ACEP), said in an ACEP news release.
"Nearly two-thirds of patients waited two or more hours for beds in 2011, and nearly three-quarters of hospitals continued to board patients, even when the emergency department was critically overloaded. Hospitals must move admitted patients out of the emergency department faster to make room for the increasing number of people coming," he said.
It's believed that there will be about 140 million ER visits in 2014, according to the ACEP.
"The growth in patient demand aligns with what emergency physicians have been seeing and predicting: demand is going to increase," Gerardi said.
"Given that our nation's population is aging, and emergency departments have a critical role as the front line of responding to disasters and infectious disease outbreaks in America, such as what we saw with Ebola, we need to prepare for increased numbers of patients," he added.
Despite increasing use of ERs, most hospitals had not expanded their ERs as of 2011 and had no plans to expand them in the following two years, according to Gerardi.
"Emergency departments are essential to every community and must have adequate resources," he said. "They continue to be under severe stress and face soaring demands, despite the efficiency of caring for more than 136 million of the sickest patients each year using only 4 percent of the nation's health care dollar. This report is more evidence that we are going to need more resources, not less, in the future."
The current measles vaccine - administered by an injection - is effective and safe, but experts say coverage could be made better by a vaccine that is easier to administer and transport. Now, a measles vaccine consisting of dry powder that is delivered with a puff of air has proven safe in early human trials and effective in previous animal trials.
Though many people living in the US consider measlesto be a thing of the past - thanks, in large part, to widespread vaccination efforts - the disease has made a comeback in recent years.
In fact, 2014 has so far seen a record number of measles cases in the US, with 603 confirmed cases reported to the Centers for Disease Control and Prevention's (CDC) National Center for Immunization and Respiratory Diseases (NCIRD) between January 1st and October 31st.
The organization says this is the highest number of cases since measles elimination was confirmed in the US in 2000.
Measles is spread by droplets or direct contact with the nose or throat secretions of people who are infected, but it can also be spread through the air or by objects containing nose and throat secretions.
According to the World Health Organization (WHO), measles is "one of the most readily transmitted communicable diseases and probably the best known and most deadly of all childhood rash/fever illnesses."
In 2013, the disease killed 145,700 people worldwide - most of whom were children - despite an already existing effective injectable vaccine.
"Delivering vaccines in the conventional way, with needle injections, poses some serious challenges, especially in resource-poor parts of the world," says Prof. Robert Sievers, author of the latest study from the University of Colorado Boulder's Department of Chemistry and Biochemistry.
New vaccine safe, with evidence of positive immune response
To improve the delivery of the vaccine, Prof. Sievers and his colleagues created a dry delivery technique - that involves an inhalable, dry powder - in order to circumvent the need for injections and liquid storage, and to avoid risk of vaccine contamination.
In previous work, he and his team showed that their vaccine protected rhesus macaques and cotton rats from measles infection, and they also demonstrated that their dry vaccines can be safely stored for 6 months to 4 years at room temperature or in refrigerators kept at 36-46° F (2-8°C).
But their latest study heralds the success of the first phase 1 clinical trial for their vaccine in humans. "Out of an abundance of caution," says Prof. Sievers, "we test first in people who have already had the disease, or been injected earlier by needles with liquid vaccines."
As such, they enrolled 60 adult males aged 18-45 years who were already seropositive for the measles antibody. In the clinical trial, the researchers tested delivery of the powder using two devices and compared those two groups with a group that received the typical injection.
Results showed that the men from all three groups responded similarly and displayed no clinically relevant side effects. What is more, there was also evidence of a positive immune response to vaccination from the powder.
Any adverse events were recorded with diary cards for 28 days after the vaccination, and researchers followed the participants for 180 days post-vaccination to watch for any long-term adverse events. Additionally, the team measured measles antibodies 7 days before vaccination and 21 and 77 days after vaccination.
Commenting on their new dry vaccine, Prof. Sievers says:
"You don't need to worry about needles; you don't need to worry about reconstituting vaccines with clean water; you don't need to worry about disposal of sharps waste or other vaccine wastage issues; and dry delivery is cheaper."
Vaccine trials in humans are ongoing
Though their trial demonstrated that their powder vaccine is safe, because the men were already immune to measles, it could not compare effectiveness of the vaccines.
"It is very good news that we encountered no problems," says Prof. Sievers, "and now we can move on."
He and his team plan to continue their research through phase 2 and 3 trials in people who are not yet immune to measles, including women and children.
The research was funded by a $20 million grant from the Foundation for the National Institutes of Health, with support from the Bill and Melinda Gates Foundation. It should be noted that the authors of the paper include researchers from the Serum Institute of India, Ltd. - the largest manufacturer of childhood vaccines used in developing countries.
Additionally, Prof. Sievers is president and CEO of Aktiv-Dry, LLC, a Colorado-based company that provides dry powder solutions for the vaccine, pharmaceutical and biotechnology industries.
By Carly Dell
In the Future of Nursing report published by the Institute of Medicine, it is recommended that health care facilities throughout the United States increase the proportion of nurses with a BSN to 80 percent and double the number of nurses with a DNP by the year 2020. Research shows that nurses who are prepared at baccalaureate and graduate degree levels are linked to lower readmission rates, shorter lengths of patient stay, and lower mortality rates in health care facilities.
What does the job market look like for RNs who are looking to advance their careers?
We tackle this question in our latest infographic, “Career Paths for RNs,” where we look in-depth at the three higher education paths RNs can choose from to advance their careers — Bachelor of Science in Nursing, Master of Science in Nursing, and Doctor of Nursing Practice.
For each career path, we outline the various in-demand specialties, salaries, and job outlook.
In the wake of media focus on the trials and bravery of nurses in the context of the Ebola crisis, leaders in the fields of nursing and clinical ethics have released an unprecedented report on the ethical issues facing the profession, as the American Nursing Association prepares to release a revised Code of Ethics in 2015.
The report captures the discussion at the first National Nursing Ethics Summit, held at Johns Hopkins University in August. Fifty leaders in nursing and ethics gathered to discuss a broad range of timely issues and develop guidance. The report, A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit, is available in full online at www.bioethicsinstitute.org/nursing-ethics-summit-report. It covers issues including weighing personal risk with professional responsibilities and moral courage to expose deficiencies in care, among other topics.
An executive summary of the report is available at: http://www.bioethicsinstitute.org/wp-content/uploads/2014/09/Executive_summary.pdf
"This blueprint was in development before the Ebola epidemic really hit the media and certainly before the first U.S. infections, which have since reinforced the critical need for our nation's healthcare culture to more strongly support ethical principles that enable effective ethical nursing practice," says Cynda Hylton Rushton, PhD, RN, FAAN, the Bunting Professor of Clinical Ethics at the Johns Hopkins School of Nursing and Berman Institute of Bioethics, and lead organizer of the summit.
The report makes both overarching and specific recommendations in four key areas: Clinical Practice, Nursing Education, Nursing Research, and Nursing Policy. Among the specific recommendations are:
- Clinical Practice: Create tools and guidelines for achieving ethical work environments, evaluate their use in practice, and make the results easily accessible.
- Education: Develop recommendations for preparing faculty to teach ethics effectively
- Nursing Research: Develop metrics that enable ethics research projects to identify common outcomes, including improvements in the quality of care, clinical outcomes, costs, and impacts on staff and the work environment
- Policy: Develop measurement criteria and an evaluation component that could be used to assess workplace culture and moral distress
What does this blueprint mean for nurses on the front line?
"It's our hope this will serve as a blueprint for cultural change that will more fully support nurses in their daily practice and ultimately improve how healthcare is administered -- for patients, their families and nurses," says Rushton. "We want to start a movement within nursing and our healthcare system to address the ethical challenges embedded in all settings where nurses work."
On the report's website, nurses and the public can learn more about ethical challenges and proposed solutions, share personal stories, and endorse the vision of the report by signing a pledge.
"This is only a beginning," says Marion Broom, PhD, RN, FAAN, Dean and Vice Chancellor for Nursing Affairs at Duke University and Associate Vice President for Academic Affairs for Nursing at Duke University Health System. "The next phase is to have these national nursing organizations and partners move the conversation and recommendations forward to their respective constituencies and garner feedback and buy-in. Transformative change will come through innovative clinical practice, education, advocacy and policy."
At the time of publication, the vision statement of the report has been endorsed by the nation's largest nursing organizations, representing more than 700,000 nurses:
- American Academy of Nursing
- American Association of Critical-Care Nurses
- American Nurses Association
- American Association of Colleges of Nursing
- American Organization of Nurse Executives
- Association of Women's Health, Obstetric and Neonatal Nurses
- The Center for Practical Bioethics
- National League for Nursing
- National Student Nurses' Association
- Oncology Nursing Society
- Sigma Theta Tau International
Use of "antibiograms" in skilled nursing facilities could improve antibiotic effectiveness and help address problems with antibiotic resistance that are becoming a national crisis, researchers conclude in a new study.
Antibiograms are tools that aid health care practitioners in prescribing antibiotics in local populations, such as a hospital, nursing home or the community. They are based on information from microbiology laboratory tests and provide information on how likely a certain antibiotic is to effectively treat a particular infection.
The recent research, published by researchers from Oregon State University in Infection Control and Hospital Epidemiology, pointed out that 85 percent of antibiotic prescriptions in the skilled nursing facility residents who were studied were made "empirically," or without culture data to help determine what drug, if any, would be effective.
Of those prescriptions, 65 percent were found to be inappropriate, in that they were unlikely to effectively treat the target infection.
By contrast, use of antibiograms in one facility improved appropriate prescribing by 40 percent, although due to small sample sizes the improvement was not statistically significant.
"When we're only prescribing an appropriate antibiotic 35 percent of the time, that's clearly a problem," said Jon Furuno, lead author on the study and an associate professor in the Oregon State University/Oregon Health & Science University College of Pharmacy.
"Wider use of antibiograms won't solve this problem, but in combination with other approaches, such as better dose and therapy monitoring, and limiting use of certain drugs, we should be able to be more effective," Furuno said.
"And it's essential we do more to address the issues of antibiotic resistance," he said. "We're not keeping up with this problem. Pretty soon, there won't be anything left in the medical cabinet that works for certain infections."
In September, President Obama called antibiotic resistant infections "a serious threat to public health and the economy," and outlined a new national initiative to address the issue. The Centers for Disease Control and Prevention has concluded that the problem is associated with an additional 23,000 deaths and 2 million illnesses each year in the U.S., as well as up to $55 billion in direct health care costs and lost productivity.
Antibiograms may literally be pocket-sized documents that outline which antibiotics in a local setting are most likely to be effective. They are often used in hospitals but less so in other health care settings, researchers say. There are opportunities to increase their use in nursing homes but also in large medical clinics and other local health care facilities for outpatient treatment. The recent study was based on analysis of 839 resident and patient records from skilled nursing and acute care facilities.
"Antibiograms help support appropriate and prudent antibiotic use," said Jessina McGregor, also an associate professor in the OSU/OHSU College of Pharmacy, and lead author on another recent publication on evaluating antimicrobial programs.
"Improved antimicrobial prescriptions can help save lives, but they also benefit more than just an individual patient," McGregor said. "The judicious use of antibiotics helps everyone in a community by slowing the spread of drug-resistant genes. It's an issue that each person should be aware of and consider."
Multi-drug resistant organisms, such as methicillin-resistant Staphylococcus aureus, or MRSA, and other bacterial attacks that are being called "superinfections" have become a major issue.
Improved antibiotic treatment using a range of tactics, researchers say, could ultimately reduce morbidity, save money and lives, and improve patients' quality of life.
By George Putic
Each year, about one million babies throughout the world die of complications due to premature birth. Many of them could have been saved if given access to an incubator. But this expensive device is sorely lacking in developing countries. A young British researcher says he has found a solution -- a low-cost inflatable incubator.
Doctors say many expectant mothers in developing countries give birth prematurely, especially in refugee camps, largely because of poor diet and unhealthy living conditions.
Premature birth is the biggest killer of children worldwide. Because these tiny babies are born before their lungs are fully developed, they are more susceptible to often deadly infections. But they could survive if placed in an incubator, where they would continue to develop in the closed chamber and warm, controlled environment.
However with a price tag of around $50,000, incubators are out of reach even for some hospitals.
Design engineering student James Roberts, 23, of Britain says his $400 inflatable incubator may help solve this problem.
“It's basically an insulated piece of air, so it's like the difference between double and single glazing, so it's easier to keep the inside at a stable heat environment, heat temperature," he said.
The inflated incubator is collapsible and when folded resembles an ordinary travel bag.
It is powered through a regular electrical line, but Roberts said he has found a solution in case there is a power outage, which often happens in refugee camps.
“I thought 'why not car batteries?' There's loads of cars out there, they're pretty readily available. So you can plug this into a car battery. It will run for 24 hours and then when the mains [regular electrical line] comes back on, the mains can then charge this battery, and then that can run the incubator," he said.
Roberts' won the $47,000 James Dyson Award earlier this year for his incubator design. He said the project is still in the development phase, but the prize money will help him start a company for the mass manufacturing of inflatable incubators.
By Melissa Wirkus
“HIT has been shown to help some patients, but it has also been shown to perhaps provide some complications in care, or less than adequate care, when messages are not received, when messages are interrupted or when messages are routed to the inappropriate person,” explained Milisa Manojlovich, PhD, RN, CCRN, associate professor at the University of Michigan School of Nursing (UMSN) and member of U-M’s Institute for Healthcare Policy and Innovation.
Manojlovich will serve as the primary investigator on a new $1.6 million grant from the federal Agency for Healthcare Research and Quality (AHRQ) that will focus on health IT’s effects on nurse–physician communication. Manojlovich and her co-investigators will look at how communication technologies make it easier or harder for doctors and nurses to communicate with each other. They hope their research will identify the optimal way to support effective communication while fostering improved and positive interdisciplinary team-based care.
Until the research is completed, Manojlovich offers some simple procedures clinicians can begin to adopt right now to help alleviate common problems with digital communication:
1. Use multiple forms of technology
Just like there is more than one way to treat a cold, there is more than one way to communicate electronically. Utilizing multiple forms of technology to communicate important information, or sometimes even reverting back to the “old-fashioned” ways of making a phone call or talking in person, can help ensure the receipt of a message in an environment that is often inundated.
“One of the things we are going to investigate is this idea of matching the message to the medium,” Manojlovich said. “So depending on the message that you want to send, you will identify what is the best medium to send that message.”
Using the current Ebola situation in Texas as an example, Manojlovich explained that using multiple forms of technology as a back-up to solely documenting the information in the EHR system could have mitigated the breakdown in communication that occurred. “Although the clinician did her job by entering the information into the EHR, she maybe should have texted or emailed the physician with the information or found someone to talk to in person about the situation. What we are trying to do with this study is see if there is another way that messages like this could have been transmitted better.”
2. Include the whole message
Reducing fragmented messages and increasing the aggregation of key data and information in communications may be one of the most critical pieces to improving communication between nurses and physicians. Manojlovich has been passionate about nurse–physician communication throughout her career and has conducted several previous studies on communication technologies.
“What we’ve noticed, for example, is that nurses will sometimes use the same form of communication over and over again. In one of the studies we actually watched a nurse page the same physician three times with the same question within an hour period.”
The physician did not answer any of the messages, and Manojlovich concluded it was because the pages were missing critical components of information related to the patient’s care plan. Increasing the frequency of communications can be beneficial, but only if the entire message and all important facets of information are relayed.
“If you do what you’ve always done, you’re going to get what you’ve always gotten. If you don’t alter or change the communication technology you are using, you are going to get the same results,” she added.
3. Incorporate a team-based approach
“At a really high level the problem is that a lot of these computer and electronic health record technologies are built with individuals in mind,” Manojlovich said. “When you talk about care process and team processes, that requires more interaction than the technologies are currently able to give us. The computer technologies are designed for individual use, but health care is based on the interaction of many different disciplines.”
Infusing this collaborative mindset into the “siloed” technology realm will undoubtedly help to improve the communication problems between providers and clinicians at all levels and all practice settings--which is especially important in today’s environment of co-morbidities and coordinating care.
Nurses play a critical role in improving communication as frontline care providers. “Nurses are the 24-hour surveillance system for hospitalized patients. It is our job to do that monitoring and surveillance and to let physicians know when something comes up.”
“I believe that for quality patient care, a patient needs input from all disciplines; from doctors, nurses, pharmacists, nutritionists--everyone,” Manojlovich said. “We are being trained separately and each discipline has a different knowledge base, and these differences make it difficult for us to understand each other. Developing mutual understanding is really important because when we have that mutual understanding I think outcomes are better and it can be argued that the quality of care is better when you have everyone providing input.”
By Maureen Salamon
Talking bystanders through CPR methods for a cardiac emergency during a 911 call can significantly boost survival rates, a new study suggests.
State researchers in Arizona examined the aggressive use of so-called pre-arrival telephone CPR guidelines -- step-by-step dispatcher instructions on administering cardiopulmonary resuscitation before trained rescuers arrive -- and found that it bumped survival of cardiac arrest patients from about 8 percent to more than 11 percent.
Cardiac arrest occurs when the heart's normal rhythm abruptly stops, and the organ can no longer pump blood and oxygen to the body. It can be triggered by a heart attack, but the two conditions are different.
Lead researcher Dr. Ben Bobrow said the type of focused intervention studied in his home state -- not only training telephone dispatchers but measuring bystander CPR outcomes and circling back to 911 centers with feedback -- is not done uniformly on a national basis, despite American Heart Association (AHA) guidelines.
But he hopes the results of his study, scheduled to be presented Saturday at the AHA meeting in Chicago, will promote that ideal.
"We believe strongly that this may be the best, and most efficient, way to improve survival rates across the country," said Bobrow, the medical director of the Bureau of EMS and Trauma System for the Arizona Department of Health Services. "Cardiac arrest is one of the leading causes of death, and as a country, despite tons of efforts ... this has not improved."
About 359,000 people in the United States suffered sudden cardiac arrest outside of a hospital setting in 2013, and more than 90 percent of them died, according to the AHA.
The heart association also has reported that 70 percent of Americans feel helpless to act during a cardiac arrest emergency because they don't know CPR or their training had lapsed.
Bobrow and his colleagues analyzed more than 4,000 audio recordings from 911 calls over three years from eight Arizona dispatch centers. That information, paired with emergency medical services (EMS) and hospital outcome data, showed that providing telephone CPR instructions prompted a jump in the number of bystanders implementing CPR, from 44 percent to 62 percent.
With the guidelines in place, the average amount of time elapsing between a bystander's call to 911 and the first chest compression in CPR dropped by 23 seconds, to 155 seconds.
"This research shows . . . that even the simplest of interventions, like having someone on the other end of a phone guide you [in CPR], can result in a remarkable difference of outcome," said Dr. Vinay Nadkarni, a spokesperson for the AHA, who wasn't involved in the study.
"That change is possible with a cellphone and our own two hands," added Nadkarni, an associate professor of anesthesiology and critical care at the University of Pennsylvania School of Medicine. "It's within our grasp."
Nadkarni said that Bobrow and his team had done an "excellent job" in helping 911 dispatchers in Arizona use certain phrases to prompt quick action among bystanders who witness a cardiac arrest.
For example, before the intervention, dispatchers typically asked 911 callers if anyone was available to perform CPR, or if they would be willing to. After the Web-based and live training, the revised script emphasized the importance of dispatchers directing callers to start CPR, saying something like, "You need to do chest compressions and I'm going to help you. Let's start."
With the apparent success of this approach, Bobrow said he and his team have asked the U.S. Centers for Disease Control and Prevention to consider implementing it on a national scale. Funding for such a program is needed, he said.
"It would be an incredibly inexpensive intervention for how many lives it would save," he said. "We estimate conservatively that it would save several thousand lives per year. It's not complicated stuff . . . and the beauty of the 911 system is that it already exists."
Research presented at scientific conferences typically has not been peer-reviewed or published and results are considered preliminary.