Original
Assessment of knowledge and skills in using an Automated External Defibrillator (AED) by university students. A quasi-experimental study
Evaluación del conocimiento y de las habilidades para el uso de un Desfibrilador Externo Automatizado (DEA) por estudiantes universitarios. Un diseño cuasiexperimental
S. Basanta Camiñoa, R. Navarro Patóna,
, M. Freire Telladob, R. Barcala Furelosc, M.P. Pavón Prietob, M. Fernández Lópezb, M.A. Neira Pájarod
Corresponding author
a Facultad de Formación del Profesorado, Universidad de Santiago de Compostela, Lugo, Spain
b Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Lugo, Centro de Salud de Fingoy, Lugo, Spain
c Facultad de Ciencias de la Educación y del Deporte, Universidad de Vigo, Campus A Xunqueira, Pontevedra, Spain
d Fundación Pública Urgencias Sanitarias 061, Base 061 Foz, Foz, Lugo, Spain
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"apellidos" => "Fernández López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "M.A." "apellidos" => "Neira Pájaro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Facultad de Formación del Profesorado, Universidad de Santiago de Compostela, Lugo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Emergencias Médicas de la Fundación Pública Urgencias Sanitarias 061, Base 061 Lugo, Centro de Salud de Fingoy, Lugo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Facultad de Ciencias de la Educación y del Deporte, Universidad de Vigo, Campus A Xunqueira, Pontevedra, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Fundación Pública Urgencias Sanitarias 061, Base 061 Foz, Foz, Lugo, Spain" "etiqueta" => "d" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación del conocimiento y de las habilidades para el uso de un Desfibrilador Externo Automatizado (DEA) por estudiantes universitarios. Un diseño cuasiexperimental" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2088 "Ancho" => 1428 "Tamanyo" => 187971 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Study flowchart.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Out-hospital cardiac arrest (OHCA) is an important health problem associated to cardiovascular disease, due to its high incidence and mortality.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1–3</span></a> A study conducted in 37 European countries found the annual incidence of OHCA attended by the emergency medical services to be 38 cases per 100,000 inhabitants.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a> However, the on-site management of such cases is ineffective, since it is typically applied late, despite scientific evidence that early basic cardiopulmonary resuscitation performed by witnesses of the event can result in a three- to four-fold increase in the patient chances for survival.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a> Thus, early basic life support (BLS) maneuvering is necessary in order to improve the prognosis of OHCA – including immediate defibrillation if available, since it forms part of the third link in the patient chain of survival.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> Early defibrillation and public access to automated external defibrillators (AEDs) have been shown to increase the chances for survival to 74%.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6–10</span></a> When carried out in the first 3–5<span class="elsevierStyleHsp" style=""></span>min after collapse, survival rates of up to 50–70% have been reported,<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11–13</span></a> provided the previous steps—i.e., recognition of cardiac arrest (CA), activation of the emergency system and start of CPR maneuvering—have been correctly executed. In this regard, the chances for survival decrease between 7 and 10% for every minute of delay.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">On the other hand, insufficient awareness and capacitation on the part of the general population in dealing with OHCA,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">15</span></a> and the lack of training in how to deal with an emergency, have suggested the need to incorporate instruction on the use of an AED to the protocolized educational setting in order to palliate this situation. Knowing how to apply BLS techniques means knowing how to save lives.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a> In this regard, we can speak of a strategy for population-based access to public defibrillators, with the implementation of different programs—some of which have already been tested in practice.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">8,17,18</span></a> It has been shown that the first individuals to intervene (usually laypersons)<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">19,20</span></a> can safely use a defibrillator, regardless of whether they have received basic training in its use or not.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The present study aims to analyze the use and time taken by university students to apply a discharge with the AED, since it is considered that a good setting in which to start the chain of training in BLS techniques (including the handling of AEDs) would be the teacher training schools. In effect, once these university students become teaching professionals, they will be the individuals in closest contact with the children of the future, and thus may contribute to transmit this kind of knowledge in schools over the long term, providing instruction for as many people as possible. Furthermore, according to the observations of previous studies, both laypersons and children can use an AED without training.<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">21,22</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study is therefore to analyze knowledge and skills referred to the use of the AED among a population of students of the University of Santiago de Compostela (Spain), without prior training or experience with BLS, and centered on their capacity to administer defibrillation with an AED—measuring the time taken to apply the discharge in three different scenarios: initially, without previous training; after a brief visual and theoretical explanation lasting less than one minute; and 6<span class="elsevierStyleHsp" style=""></span>months after such training activities.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">A repeated measures, quasi-experimental design with a control group was used. The study was carried out in abidance with the ethical-regulatory principles of the Declaration of Helsinki (1964 and posterior updates), and approval was moreover obtained from the Bioethics Committee of the University of Santiago de Compostela. The participants in turn received a detailed explanation of the study objectives and protocol, the voluntary nature of participation, and the confidentiality of the responses and data. Verbal consent to participation was considered mandatory. The student intervention consisted of the following:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">(1)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Conceptual evaluation based on a questionnaire exploring knowledge of the AED (P-K); prior training in how to use the device (P-T); and its real use on some occasion (P-U).<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">21,22</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">(2)</span><p id="par0035" class="elsevierStylePara elsevierViewall">After administration of the questionnaire, a clinical simulation of OHCA was carried out. The participants received access to an AED stored in its box alongside a Resusci Anne mannequin (Laerdal). From the moment in which the participants picked up the AED, we measured the time taken in fitting the device and delivering an effective discharge following the acoustic and visual instructions of the AED. This procedure was carried out on an individualized basis while one of the members of the research team applied continuous massage to the mannequin in order to produce a more realistic simulation.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">(3)</span><p id="par0040" class="elsevierStylePara elsevierViewall">The time taken by the students in delivering an electric discharge was measured with a chronometer on three occasions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>):<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Initially, upon receiving the defibrillator. The students were simply instructed to apply the device to the mannequin simulating OHCA, while one of the investigators simulated the application of continuous massage to the unconscious patient (T0).</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Following a brief individualized visual and theoretical explanation lasting no more than 60<span class="elsevierStyleHsp" style=""></span>s, after which the students repeated the same operation as above (T1).</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Six months after first use of the defibrillator. In this case, the aim of the third application of the AED was to assess the long-term retention of the knowledge gained by the students (T2).</p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">The training provided between T0 and T1 involved a theoretical explanation of the steps to be followed in placing the AED and in delivering a discharge where required, following the recommendations of the American Heart Association (AHA)<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> and the European Resuscitation Council (ERC).<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> Practical simulation with the device was also explained: (1) turn on the device; (2) place the electrodes on the bare chest of the patient; (3) connect the electrodes to the device; and (4) press the discharge button when prompted to do so. The information was provided verbally and in practical form by one of the investigators.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In all cases, correct discharge was defined by placement of the electrode patches without the plastic covers onto the naked chest of the mannequin, likewise in accordance with the recommendations of the AHA<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> and the ERC.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> The time taken was recorded from the moment in which the AED was picked up until the discharge button was pressed.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Sample</span><p id="par0075" class="elsevierStylePara elsevierViewall">The experimental group consisted of a non-randomized sample of 129 subjects: 89<span class="elsevierStyleHsp" style=""></span>women (69%) and 40 men (31%). All were students of the University of Santiago de Compostela (Spain), and informed consent to participation was obtained in all cases. The subjects were asked about their previous experience, training and use of the AED. Those individuals who had received previous training or had used the AED before were excluded from the study.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The control sample was selected on a convenience basis from among those individuals that gave informed consent to participation, and comprised 20 emergency healthcare technicians.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Instruments</span><p id="par0085" class="elsevierStylePara elsevierViewall">An individualized questionnaire was used to assess previous knowledge of AED among the university students, previous training in the use of the device, and previous use of the defibrillator on some occasion. The items of the questionnaire were of a dichotomic nature (Yes/No).</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the simulations, we used a Resusci Anne mannequin and an AED Trainer 2 (both from Laerdal).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Study variables</span><p id="par0095" class="elsevierStylePara elsevierViewall">The independent variables analyzed were subject age and gender, while the dependent variables were the times taken to deliver an effective discharge in three different moments: in the absence of previous knowledge (T0); after a brief explanation (T1); and 6 months (T2) after the first recording (T0). We also considered the variables “improvement effect”, defined as the absolute difference between T1 and T0, and the “degree of forgetfulness effect”, defined as the absolute difference between T1 and T2.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Statistical analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">All the data were processed using the SPSS version 20 statistical package for MS Windows (SPSS Inc., IBM, USA). The data were reported with measures of central tendency (mean) and dispersion (standard deviation [SD]), with the corresponding 95% confidence interval (95%CI). The Kolmogorov–Smirnov test was used to assess normal distribution of the data. Repeated measures analysis of variance (ANOVA) with Bonferroni correction was used for the analysis of discharge time in each test, while the Pearson chi-squared test was applied for exploring group differences referred to age and gender.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">The analysis of the results obtained in relation to university student knowledge of the use of the AED is described below.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Of the 129 students included in the study, 71.3% did not know what an AED is (P-K); 100% claimed to have received no prior training (P-T); and 100% had never used the device before (P-U) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">A total of 28.7% of the university students had heard about AEDs, but had not received training or used the device before.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The results referred to the mean time (in seconds) taken by the students in applying a discharge with the AED were: T0<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>67.7 (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15.6) s; T1<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>44.2 (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6.3) s; T2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>45.9 (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5.8)<span class="elsevierStyleHsp" style=""></span>s. The mean time taken in applying a discharge among the emergency healthcare technicians was 51.9 (SD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9.7)<span class="elsevierStyleHsp" style=""></span>s.</p><p id="par0125" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results of the repeated measures analysis of the mean times to defibrillation among the university students in the different moments of the study. Within-subject contrast testing revealed significant interaction between the time taken to deliver a discharge and the moment in which the time was recorded (T0, T1 and T2) – 66.5% of the variance of the study being explained by interaction of the factors <span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">(1,128)</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>253.79 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001; Eta<span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.665). This means that there were statistically significant differences among the three time measurements, i.e., the observed differences were not attributable to chance. A decrease of 23.4<span class="elsevierStyleHsp" style=""></span>s in mean defibrillation time was observed after having received training (“improvement effect”) (34.6%). The defibrillation time in turn increased an average of 1.6<span class="elsevierStyleHsp" style=""></span>s as measured after 6 months (T2) (3.7%) (“degree of forgetfulness effect”), but was still shorter than the mean time recorded at T0.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">The variable “improvement effect” was not influenced by either gender (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.540) or age (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.124) – T0 being the only variable conditioning the decrease in time registries (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.004). Likewise, neither gender (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.637) nor age (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.272) exerted an influence upon the variable “degree of forgetfulness effect”.</p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the results of the bivariate comparative analysis of the mean defibrillation times of the university students in the different moments of the study.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">After the brief basic training provided, the time taken in delivering a discharge was seen to decrease 34.6%. Six months after the training received, the time was found to have increased an average of 1.6<span class="elsevierStyleHsp" style=""></span>s.</p><p id="par0145" class="elsevierStylePara elsevierViewall">On the other hand, regarding the results of the multivariate analysis of the mean defibrillation times of the university students in the different moments of the study, compared with the times recorded in the control group (emergency healthcare technicians), between-subject contrast testing revealed <span class="elsevierStyleItalic">F</span> (time 1)<span class="elsevierStyleInf">(1,148)</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19.08 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001); <span class="elsevierStyleItalic">F</span> (time 2)<span class="elsevierStyleInf">(1,148)</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>21.71 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) and <span class="elsevierStyleItalic">F</span> (time 3)<span class="elsevierStyleInf">(1,148)</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15.04 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). This means that there were statistically significant differences among the three time measurements, i.e., the observed differences were not attributable to chance – time 1 being understood as (T0us and T0eht); time 2 as (T1us and T0eht), and time 3 as (T2us and T0eht).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">The present study shows the capacity of laypersons (university students) both without and with brief training to use an AED, compared with a group of trained staff. The findings confirm that defibrillation performed by first intervening individuals using a public access ARD is a feasible and effective strategy, in concordance with the observations in other settings, such as Japan, where excellent results were recorded in real interventions.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> Indeed, even 9-year-old children are able to understand the importance of CPR performed by witnesses, and can learn to apply BLS measures and retain the knowledge gained.<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">26,27</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The data obtained show that skill in using the AED after a brief (no more than 60<span class="elsevierStyleHsp" style=""></span>s) explanation of how the device is employed and handled is noticeably greater than when the AED is used without any type of training. Specifically, the time required was found to decrease by 34.6%. This result is also 7.7<span class="elsevierStyleHsp" style=""></span>s better than that obtained by the trained staff (emergency healthcare technicians). The explanation for this could be that most BLS training courses involve teamwork by two individuals: a first technician starts continuous cardiac massage, while the other member of the team is in charge of telephone activation of the emergency service switchboard and fitting of the AED. In this context, the technicians are more thoroughly trained in such aspects and in the quality of cardiac massage—with less emphasis being placed on immediate rapidity of execution.</p><p id="par0160" class="elsevierStylePara elsevierViewall">On the other hand, the response time barely increased among the layperson sample after 6 months (−3.7%), and remained significantly better than the time taken in the absence of any previous training (about 23.4<span class="elsevierStyleHsp" style=""></span>s). It therefore can be concluded that there is good retention of the skills gained, and in contrast to the situation in the case of thoracic compression maneuvers,<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> no reinforcement training would be needed in under 6 months, since the time taken to deliver the discharge was seen to increase very little.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">This 22-s difference in skill retention cannot be attributed to biological aspects of the participants, since their ages were similar, and moreover studies are available corresponding to individuals of younger age in which long-term retention was found to be similar.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a> Based on the results obtained, it is seen that skills in using an AED are easily gained and retained, independently of the age of the individual.</p><p id="par0170" class="elsevierStylePara elsevierViewall">If laypersons were able to make use of a defibrillator several minutes before the arrival of professional help, the survival rates could be improved to about 49–75%.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a> This is of great importance, since an early defibrillation program has a better chance for success if the time elapsed from CA to defibrillation is under 12<span class="elsevierStyleHsp" style=""></span>min.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">On the basis of the results obtained, and as reflected by the European Resuscitation Council (ERC), AEDs can be regarded as safe and effective when used by both laypersons and medical staff.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> The Spanish Cardiopulmonary Resuscitation Council considers liberalization of the non-negligent use of AEDs by untrained non-sanitary staff (citizens in general) to be adequate when done with the intention of helping a CA victim.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">The results obtained in this investigation support the recommendations of the Spanish Cardiopulmonary Resuscitation Council,<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a> the ERC<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> and the AHA,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a> since university students—as a sample of general citizens without training in the use of defibrillators—can apply a discharge with the AED if necessary.</p><p id="par0185" class="elsevierStylePara elsevierViewall">All this would reinforce implementation of the strategy proposed in 1992 by the AHA,<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a> whereby placing the AED in the hands of a great number of people capable of using the device could represent the key intervention for increasing the chances of survival among patients with OHCA. The generalized effectiveness and safety demonstrated by the AED make it acceptable for effective handling by non-professionals,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> in conjunction with the necessary recommendations and instructions received from the urgencies and emergencies coordination centers by telephone.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">In the context of training in BLS, the recognition of OHCA, activation of the emergencies system and the start of basic CPR maneuvering are crucial elements, followed by the use of the AED (if available) as the third link in the chain of survival. However, it must be mentioned that mere use of the AED alone is not enough: correct execution of the previous steps is equally important.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> For this reason, citizen training in BLS is essential, even when the programs used for this purpose are very brief, as demonstrated in the present study.</p><p id="par0195" class="elsevierStylePara elsevierViewall">These contents should be incorporated to the training of future teachers, with a view to reaching as much of the population as possible. In this regard, teachers are regarded as targets for training since they in turn can become future instructors in their own classroom settings,<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">33,34</span></a> transmitting this knowledge to the children in the morning, with the aim of achieving the goal of the ERC,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> i.e., to ensure that defibrillation with the AED occurs between 3 and 5<span class="elsevierStyleHsp" style=""></span>min after patient collapse, though the adoption of programs contemplating public access to devices of this kind.</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Limitations</span><p id="par0200" class="elsevierStylePara elsevierViewall">Due to ethical reasons, this study has not been carried out in the real-life setting. Instead, we simulated OHCA with a mannequin and a training AED. On the other hand, it is not clear whether the study design (an investigator performing continuous massage) may have influenced the electrode application times.</p><p id="par0205" class="elsevierStylePara elsevierViewall">It was not the aim of our study to assess AED safety of use (defibrillation errors), and the errors in placing the patches on recording of the initial times periods were not documented. We likewise did not measure the time taken in removing the patient clothing, and have not evaluated the quality of basic CPR performed by the investigators.</p><p id="par0210" class="elsevierStylePara elsevierViewall">The sample consisted of university students, and in this regard we do not know whether the assimilation of knowledge may have been faster in these individuals due to their particular academic characteristics.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">Consensus is still lacking regarding the timelines for a training program in AED, though our study could be a starting point for implementing public access to early defibrillation, since the AED is easy to handle. The university students, as laypersons without training, were able to perform defibrillation without prior instruction.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Training is simple, and should be carried out in the context of the university education of teacher training school students, as possible future teachers of children who in turn can receive the necessary knowledge and offer better chances for survival among people who suffer OHCA.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Funding</span><p id="par0225" class="elsevierStylePara elsevierViewall">No funding was received for this investigation or preparation of the article.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Authorship</span><p id="par0230" class="elsevierStylePara elsevierViewall">All the authors have participated in all parts of the investigation and in preparation of the manuscript (study conception and design, data acquisition, data analysis and interpretation, drafting of the manuscript, critical review of the intellectual content, and definitive approval of the manuscript).</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflicts of interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres851055" "titulo" => "Abstract" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Scope" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Main variables of interest" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec845684" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres851056" "titulo" => "Resumen" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Participantes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables de interés principales" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec845685" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Sample" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Instruments" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Study variables" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Authorship" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 12 => array:2 [ "identificador" => "xack285458" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-05-04" "fechaAceptado" => "2016-07-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec845684" "palabras" => array:3 [ 0 => "Laypersons" 1 => "Automated external defibrillator" 2 => "First responder" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec845685" "palabras" => array:3 [ 0 => "Personal lego" 1 => "Desfibrilador externo automatizado" 2 => "Primer interviniente" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate layperson (university student) ability to use an automated external defibrillator (AED).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A repeated measures quasi-experimental study with non-probabilistic sampling and a control group was carried out.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Scope</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Teacher training degree students at the University of Santiago de Compostela (Spain).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participants</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The sample consisted of 129 subjects (69% women and 31% men), between 19 and 47 years of age (mean 23.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.7 years). As inclusion criterion, the subjects were required to have no previous knowledge of AED.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Times to apply defibrillation with an AED to a mannequin were recorded untrained (T0), after a theoretical and practice explanation lasting less than one minute (T1), and 6 months after the training process (T2).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Main variables of interest</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The primary endpoint was the time taken to deliver a defibrillation discharge. The “improvement effect” variable was defined by the absolute time difference between T1 and T0, while the “degree of forgetfulness effect” variable was defined as the absolute difference between T1 and T2.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The mean times were T0<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>67.7<span class="elsevierStyleHsp" style=""></span>s; T1<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>44.2<span class="elsevierStyleHsp" style=""></span>s; T2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>45.9<span class="elsevierStyleHsp" style=""></span>s. The time to apply defibrillation was reduced after explanation training (T1<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>T0) (−23.4<span class="elsevierStyleHsp" style=""></span>s; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). T2 proved shorter than T0 (−21.8<span class="elsevierStyleHsp" style=""></span>s; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) but longer than T1 (1.6<span class="elsevierStyleHsp" style=""></span>s; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002). The improvement effect was significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), in the same way as the degree of forgetfulness (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Easy handling of AED was demonstrated, since untrained people were able to deliver a discharge. Defibrillation time was reduced after brief training. This time barely increased after 6 months.</p></span>" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Scope" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Main variables of interest" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evaluar la capacidad del personal lego (estudiantes universitarios) para usar un desfibrilador externo automatizado (DEA).</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Diseño</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudio cuasiexperimental de medidas repetidas de muestreo no probabilístico con grupo control.</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Ámbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Estudiantes de formación de profesorado de la Universidad de Santiago de Compostela.</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participantes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La muestra estuvo compuesta por 129 sujetos, 69% mujeres y 31% hombres, de entre 19 y 47 años (media 23,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,7), cuyo criterio de inclusión fue el no tener conocimientos previos sobre DEA.</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se tomaron los tiempos empleados en aplicar una descarga sobre un maniquí con DEA sin formación (T0); tras una explicación teórico-práctica inferior a 1 minuto (T1) y tras 6 meses del proceso formativo (T2).</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de interés principales</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La variable de resultado principal fue el tiempo empleado en aplicar una descarga. Se definió la variable «efecto de mejora» mediante la diferencia absoluta de tiempo entre T1 y T0, y la variable «efecto de grado de olvido» como la diferencia absoluta entre T1 y T2.</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Las medias de tiempos fueron: T0<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>67,7<span class="elsevierStyleHsp" style=""></span>s; T1<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>44,2<span class="elsevierStyleHsp" style=""></span>s; T2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>45,9<span class="elsevierStyleHsp" style=""></span>s. Se redujo el tiempo para realizar una descarga tras la explicación formativa (T1<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>T0) (−23,4<span class="elsevierStyleHsp" style=""></span>s; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001). El T2 es inferior a T0 (−21,8<span class="elsevierStyleHsp" style=""></span>s; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), pero mayor que T1 (1,6<span class="elsevierStyleHsp" style=""></span>s; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002). El efecto de mejora fue significativo (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), al igual que el grado de olvido (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002).</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se demostró el fácil manejo del DEA, ya que personas sin formación fueron capaces de aplicar una descarga. El tiempo de administración de descarga se redujo tras una pequeña formación. Este tiempo apenas aumentó pasados 6 meses.</p></span>" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Participantes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables de interés principales" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Basanta Camiño S, Navarro Patón R, Freire Tellado M, Barcala Furelos R, Pavón Prieto MP, Fernández López M, et al. Evaluación del conocimiento y de las habilidades para el uso de un Desfibrilador Externo Automatizado (DEA) por estudiantes universitarios. Un diseño cuasiexperimental. Med Intensiva. 2017;41:270–276.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2088 "Ancho" => 1428 "Tamanyo" => 187971 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Study flowchart.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">P-K: question on knowledge of the automated external defibrillator; P-T: question on training in the use of the automated external defibrillator; P-U: question on use of the automated external defibrillator.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Question \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes, n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No, n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total, n (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">P-K \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (28.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (71.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">P-T \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">P-U \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1436637.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Results of the study questionnaire.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">SD: standard deviation; No.: number of subjects; T0: collection of data without training; T1: collection of data after training for 60<span class="elsevierStyleHsp" style=""></span>s; T2: collection of data 6 months after training.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Men</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Women</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time (s) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1436636.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Descriptive statistics of the variable time with respect to gender and total.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">T0: without training; T1: after training; T2: 6 months after training.</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">The numbers in boldface indicate the observed significant differences.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Men</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">women</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time (s) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference of means \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper and lower limit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference of means \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper and lower limit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference of means \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper and lower limit \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T0-T1</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><span class="elsevierStyleBold">24.7</span></td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><0.001</td><td class="td" title="table-entry " align="char" valign="top">31.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><span class="elsevierStyleBold">22.8</span></td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><0.001</td><td class="td" title="table-entry " align="char" valign="top">26.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><span class="elsevierStyleBold">23.4</span></td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><0.001</td><td class="td" title="table-entry " align="char" valign="top">26.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T1-T2</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top">−1.3</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top">0.760</td><td class="td" title="table-entry " align="char" valign="top">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><span class="elsevierStyleBold">−1.8</span></td><td class="td" title="table-entry " rowspan="2" align="char" valign="top">0.001</td><td class="td" title="table-entry " align="char" valign="top">−0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><span class="elsevierStyleBold">−1.6</span></td><td class="td" title="table-entry " rowspan="2" align="char" valign="top">0.002</td><td class="td" title="table-entry " align="char" valign="top">−0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">−4.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">T0-T2</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><span class="elsevierStyleBold">23.4</span></td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><0.001</td><td class="td" title="table-entry " align="char" valign="top">30.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><span class="elsevierStyleBold">21.0</span></td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><0.001</td><td class="td" title="table-entry " align="char" valign="top">24.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><span class="elsevierStyleBold">21.8</span></td><td class="td" title="table-entry " rowspan="2" align="char" valign="top"><0.001</td><td class="td" title="table-entry " align="char" valign="top">25.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1436635.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Paired comparisons of the variable time.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:34 [ 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 5 | 7 |
| 2024 October | 61 | 43 | 104 |
| 2024 September | 115 | 45 | 160 |
| 2024 August | 137 | 58 | 195 |
| 2024 July | 83 | 32 | 115 |
| 2024 June | 120 | 44 | 164 |
| 2024 May | 86 | 45 | 131 |
| 2024 April | 108 | 32 | 140 |
| 2024 March | 120 | 37 | 157 |
| 2024 February | 91 | 38 | 129 |
| 2024 January | 143 | 46 | 189 |
| 2023 December | 97 | 39 | 136 |
| 2023 November | 117 | 71 | 188 |
| 2023 October | 101 | 48 | 149 |
| 2023 September | 125 | 49 | 174 |
| 2023 August | 78 | 33 | 111 |
| 2023 July | 80 | 37 | 117 |
| 2023 June | 77 | 15 | 92 |
| 2023 May | 102 | 40 | 142 |
| 2023 April | 111 | 29 | 140 |
| 2023 March | 155 | 50 | 205 |
| 2023 February | 101 | 28 | 129 |
| 2023 January | 144 | 28 | 172 |
| 2022 December | 103 | 49 | 152 |
| 2022 November | 111 | 59 | 170 |
| 2022 October | 139 | 59 | 198 |
| 2022 September | 117 | 38 | 155 |
| 2022 August | 120 | 55 | 175 |
| 2022 July | 89 | 58 | 147 |
| 2022 June | 85 | 35 | 120 |
| 2022 May | 111 | 38 | 149 |
| 2022 April | 154 | 61 | 215 |
| 2022 March | 112 | 63 | 175 |
| 2022 February | 116 | 54 | 170 |
| 2022 January | 92 | 41 | 133 |
| 2021 December | 93 | 65 | 158 |
| 2021 November | 103 | 50 | 153 |
| 2021 October | 92 | 83 | 175 |
| 2021 September | 71 | 45 | 116 |
| 2021 August | 112 | 62 | 174 |
| 2021 July | 41 | 37 | 78 |
| 2021 June | 56 | 27 | 83 |
| 2021 May | 138 | 58 | 196 |
| 2021 April | 258 | 83 | 341 |
| 2021 March | 137 | 75 | 212 |
| 2021 February | 137 | 26 | 163 |
| 2021 January | 150 | 45 | 195 |
| 2020 December | 108 | 43 | 151 |
| 2020 November | 82 | 37 | 119 |
| 2020 October | 97 | 50 | 147 |
| 2020 September | 100 | 28 | 128 |
| 2020 August | 47 | 25 | 72 |
| 2020 July | 58 | 33 | 91 |
| 2020 June | 66 | 25 | 91 |
| 2020 May | 94 | 22 | 116 |
| 2020 April | 104 | 23 | 127 |
| 2020 March | 74 | 18 | 92 |
| 2020 February | 226 | 34 | 260 |
| 2020 January | 108 | 48 | 156 |
| 2019 December | 133 | 48 | 181 |
| 2019 November | 101 | 34 | 135 |
| 2019 October | 246 | 42 | 288 |
| 2019 September | 132 | 49 | 181 |
| 2019 August | 129 | 41 | 170 |
| 2019 July | 101 | 33 | 134 |
| 2019 June | 91 | 32 | 123 |
| 2019 May | 139 | 49 | 188 |
| 2019 April | 113 | 30 | 143 |
| 2019 March | 70 | 37 | 107 |
| 2019 February | 47 | 28 | 75 |
| 2019 January | 52 | 33 | 85 |
| 2018 December | 132 | 47 | 179 |
| 2018 November | 316 | 33 | 349 |
| 2018 October | 215 | 24 | 239 |
| 2018 September | 92 | 8 | 100 |
| 2018 August | 49 | 9 | 58 |
| 2018 July | 38 | 7 | 45 |
| 2018 June | 35 | 8 | 43 |
| 2018 May | 34 | 10 | 44 |
| 2018 April | 57 | 20 | 77 |
| 2018 March | 46 | 9 | 55 |
| 2018 February | 27 | 12 | 39 |
| 2018 January | 38 | 21 | 59 |
| 2017 December | 28 | 14 | 42 |
| 2017 November | 53 | 17 | 70 |
| 2017 October | 41 | 0 | 41 |
| 2017 September | 7 | 0 | 7 |
| 2017 July | 3 | 2 | 5 |
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