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December 4, 2015

Large Study Compares Two CPR Methods Used By EMS

Emergency medical technicians perform CPR

In a study published online Nov. 9 in the New England Journal of Medicine, researchers found that cardiopulmonary resuscitation (CPR) administered by emergency medical services (EMS) providers following sudden cardiac arrest that combines chest compressions with interruptions for ventilation resulted in longer survival times and shorter hospital stays than CPR that uses continuous chest compressions. Although compressions with pauses for ventilation lead to more hospital-free days within 30 days of the cardiac arrest, both methods achieved similar overall survival to hospital discharge, the study noted.

The compressions with interruptions consisted of 30 compressions then pauses for two ventilations. The continuous chest compressions consisted of 100 compressions per minute with simultaneous ventilations at 10 per minute. In both groups, EMS providers gave ventilations using a bag and mask.

The study, funded in part by NHLBI, is the largest of its kind to date to evaluate CPR practices among firefighters and paramedics and suggests the importance of ventilation in CPR by EMS providers, the investigators say.

“Current CPR guidelines permit use of either continuous chest compressions or interrupted chest compressions with ventilations by EMS providers,” said principal author Dr. Graham Nichol of the University of Washington-Harborview Center for Prehospital Emergency Care in Seattle. “Our trial shows that both types of CPR achieve good outcomes, but that compressions with pauses for ventilations appears to be a bit better.”

10 Percent of U.S. Adults Have Drug Use Disorder at Some Point in Their Lives

A survey of American adults revealed that drug use disorder is common, co-occurs with a range of mental health disorders and often goes untreated. The study, funded by NIAAA, found that about 4 percent of Americans met the criteria for drug use disorder in the past year and about 10 percent have had drug use disorder at some time in their lives.

“Based on these findings, more than 23 million adults in the United States have struggled with problematic drug use,” said NIAAA director Dr. George Koob. “Given these numbers, and other recent findings about the prevalence and under-treatment of alcohol use disorder in the U.S., it is vitally important that we continue our efforts to understand the underlying causes of drug and alcohol addiction, their relationship to other psychiatric conditions and the most effective forms of treatment.”

A diagnosis of drug use disorder is based on a list of symptoms including craving, withdrawal, lack of control and negative effects on personal and professional responsibilities. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no longer uses the terms abuse and dependence. Instead, DSM-5 uses a single disorder rated by severity (mild, moderate and severe) depending on the number of symptoms met. Individuals must meet at least two of 11 symptoms to be diagnosed with a drug use disorder.

Lucentis Found Effective for Diabetic Retinopathy

A clinical trial funded by NEI has found that the drug ranibizumab (Lucentis) is highly effective in treating proliferative diabetic retinopathy (PDR). The trial, conducted by the Diabetic Retinopathy Clinical Research (DRCR) Network, compared Lucentis with a type of laser therapy called panretinal or scatter photocoagulation, which has remained the gold standard for PDR since the mid-1970s. The findings demonstrate the first major therapy advance in nearly 40 years.

“These latest results from the DRCR Network provide crucial evidence for a safe and effective alternative to laser therapy against proliferative diabetic retinopathy,” said NEI director Dr. Paul Sieving. Results were published online Nov. 16 in the Journal of the American Medical Association.

Treating abnormal retinal blood vessels with laser therapy became the standard treatment for PDR after NEI announced results of the Diabetic Retinopathy Study in 1976. Although laser therapy effectively preserves central vision, it can damage night and side vision; so, researchers have sought therapies that work as well or better than laser but without such side effects.

A complication of diabetes, diabetic retinopathy can damage blood vessels in the light-sensitive retina in the back of the eye. As the disease worsens, blood vessels may swell, become distorted and lose their ability to function properly. About 7.7 million U.S. residents have diabetic retinopathy, a leading cause of blindness among working-age Americans. Among these, about 1.5 percent have PDR.

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