BackgroundAdvanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve.MethodsA single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS) Instructor.A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups) if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents.The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks.Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE). The checklist items were based on International Liaison Committee on Resuscitation (ILCOR) guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness.The results were analysed using Exact methods, chi-squared and t-test.ResultsA total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98%) of students from the expert-led group achieved a Pass compared to 72/74 (97%) from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001) that the expert-led group was 20% better than the peer-led group.There were no safety incidents, and High Pass grades were achieved by 64 (49%) of students: 33/58 (57%) from the expert-led group, 31/74 (42%) from the peer-led group. Exact statistics showed that the difference of 15% meant that it was possible that the expert-led teaching was 20% better at generating students with High Passes.ConclusionsThe key elements of advanced cardiac resuscitation can be safely and effectively taught to medical students in small groups by peer-instructors who have undergone basic medical education training.

The prevalence of coronary disease is high in patients with atrial myxomas yet routine angiography is not performed. Moreover, some tumors have angiographically detectable neovascularity, which can alter surgical planning. We report two cases that support our recommendation for performing coronary angiography in all cases diagnosed with cardiac myxomas.

No abstract

Cardiopulmonary bypass provides excellent circulatory support for profound hypothermia and allows rapid core rewarming. The femoro-femoral approach is the preferred method for this scenario.

Stimulation of growth hormone by oral clonidine. We don't have the ideal test wich permit us know the pituitary reserve of GH.We studied the effect of the clonidine in 1 6 healthy children whose ages were from 6-15 years old and in 3 with hypopituitarism. The dose used was of 0.005 mgfkg given orally.We obtained blood samples to measure the GH (in the normal children samples were also taken for glucose in ten of them, and for insulin, TSH and prolactin in all of them) at 0, 4 0 , 6 0 , 90, 1 2 0 , and 1 4 0 min.At the same time and at the 1 8 0 min. the blood-pressure was measured. In the healthy one we obtained and increaae of the plasvtic levels of GH of 2.51 SM) and T t o g e t h e r w i t h body w e i g h t were examined. I n t h e C A -t r e a t e d a n i m a f s body w e i g h t and i t s v e l o c i t y were suppressed. When CA was withdrawn a t d i f f e r e n t phases o f m a t u r a t i o n , catch-up growth was c b s e r v e d a t a l l t i m e -p o i n t s e x c e p t age day 80. The C A -t r e a t e d a n i m a l s showed m u l t i p l e e f f e c t s on t h e i r hormonal l e v e l s : FSH b e i n g i n c r e a s e d a t a l l t i m e -p o i n t s , LH i n c r e m e n t a f t e r day 30 t h e n i nc r e a s i n g and DHA i n c r e a s i n g a f t e r day 30. I n c o n t r a s t t o t h e findirgs i n humans, t h e a n t i g o n a d o t r o p i c e f f e c to f CA seen i n p r e p u b e r t a l a n i m a l s was l a t e r overcome by a n t i a n d r z g e n i c e f f e c t . M. ROGER. M. BROYER;: K. S C H .).From Nap 1978 u r l t i l Febl-uary 1980, 758,571 newbozns were screened, r e p r e s e n t i n g a screrrilng r a t e of approxiaately 90% of a l l i.nfun-ts born i n I s r a e l . During t h i s pried 49 p r inlsrj c e o n a t a l hypothyroi8 i n f a n t s were d e t e c t e d , an incidence of 1:$300. "!ere A-abs and 31 were of Jewish 0r.ig-i n. There was no sex riifference. During t h e uanie period 45 PBG-d. neonates were d s t e c t e d (1:3500), t h e h i g h e s t i n c i d e n :~ reported u n t i l cow. 22 were kca't)s arid 2: of Jewish orie;in. The sex r a t i o K:F was 8 I;o 1 sllrgesting an x-linked .in:?eritsnce. 1 2 of t t c T B G~~ wzre from two adjacent Arab irillages. 11) one of t h e s e v i l l a g e s with a pop111ati.on of 4000 ve oturt e d a t o t s 1 popallat5 cn screening progran. I n 2 of t h e extended faml.11.e~ ("Heuula"), where intermnrriege i s a custom, we already found 7 komozygote females who a r e TBG d e f i c i e n t . Thus, co.:~sanguinity i n t h e s e Arab f a m i l i e s might be t h e c a m e o l t h e high i n c idome of T5S-d iti t h e A.?ab population a r~d explain t h e very high incidence of T9G-d i.n I s r a e l .