Objectives: This prospective observational study was performed to investigate if the hand position used for external chest compressions is in an optimal position for compressing the ventricles during standard cardiopulmonary resuscitation (CPR).Methods: Transesophageal echocardiography (TEE) was performed during standard CPR in 34 patients with nontraumatic cardiac arrest (24 males, mean ± standard deviation [SD] age = 56 ± 12 years). On the recorded image of TEE, an area of maximal compression (AMC) was identified, and the degree of compression at the AMC and the left ventricular stroke volume was calculated.Results: A significant narrowing of the left ventricular outflow tract (LVOT) or the aorta was noted in all patients, with the degree of compression at the AMC ranging from 19% to 83% (mean ± SD = 49 ± 19%). The AMC was found at the aorta in 20 patients (59%) and at the LVOT in 14 patients (41%). A significant narrowing of more than 50% of the diameter at the end of the relaxation phase occurred in 15 patients (44%). On linear regression, the left ventricular stroke volume was correlated with the location of the AMC (R 2 = 0.165, p = 0.017). Conclusions:The outflow of the left ventricle is affected during standard CPR, resulting in varying degrees of narrowing in the LVOT and ⁄ or the aortic root.ACADEMIC EMERGENCY MEDICINE 2009; 16:928-933 ª

song j.‐e., chang s.‐b., park s.‐m., kim s. & nam c.m. (2010) Empirical test of an explanatory theory of postpartum fatigue in Korea. Journal of Advanced Nursing 66(12), 2627–2639. Abstract Aim.  This paper is a report of a study designed to test an explanatory theory of postpartum fatigue. Background.  Postpartum fatigue is influenced by various factors and affects a mother’s performance. A full understanding of postpartum fatigue is very important for developing effective nursing strategies to reduce postpartum fatigue and enhance mothers’ performance. Methods.  Healthy postpartum women were recruited from five medical centers and one midwifery office in urban area in Korea (n = 291) by convenience sampling. Data were collected at 4‐ to 8‐week follow‐up visits after childbirth in 2006, using a self‐report questionnaire. The proposed fatigue theory incorporated postpartum fatigue, postpartum depression, sleep quality, childcare stress, unsatisfactory feeding, social support, infant difficulty and satisfaction with Sanhujori, the Korean traditional postpartum care provided for 3 weeks following delivery by non‐professional caregivers. Structural equation modelling was used to test the explanatory theory of postpartum fatigue. Results.  The modified fatigue theory showed good fit and high compatibility with the empirical data. In the final explanatory theory, postpartum depression and sleep quality directly affected postpartum fatigue, while childcare stress and the cultural phenomenon of Sanhujori had indirect effects on postpartum fatigue, via postpartum depression and sleep quality respectively. Conclusion.  These findings suggest the potential role of comprehensive nursing focused on decreasing postpartum depression and improving sleep quality as a way to decrease postpartum fatigue. Also, nursing strategies for decreasing childcare stress and enhancing Sanhujori satisfaction may be helpful in reducing postpartum fatigue in Korean mothers.

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