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Background Advanced 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. Methods A 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. Results A 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. Conclusions The 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.

This article traces the history of evidence-based practice (EBP), outlines current issues and reviews the literature on the key concepts, features and outcomes. The author then establishes a set of principles to guide EBP in health care.

Purpose Cystic fibrosis (CF), caused by pathogenic variants in the CF transmembrane conductance regulator ( CFTR ), affects multiple organs including the exocrine pancreas, which is a causal contributor to cystic fibrosis–related diabetes (CFRD). Untreated CFRD causes increased CF-related mortality whereas early detection can improve outcomes. Methods Using genetic and easily accessible clinical measures available at birth, we constructed a CFRD prediction model using the Canadian CF Gene Modifier Study (CGS; n  = 1,958) and validated it in the French CF Gene Modifier Study (FGMS; n  = 1,003). We investigated genetic variants shown to associate with CF disease severity across multiple organs in genome-wide association studies. Results The strongest predictors included sex, CFTR severity score, and several genetic variants including one annotated to PRSS1 , which encodes cationic trypsinogen. The final model defined in the CGS shows excellent agreement when validated on the FGMS, and the risk classifier shows slightly better performance at predicting CFRD risk later in life in both studies. Conclusion We demonstrated clinical utility by comparing CFRD prevalence rates between the top 10% of individuals with the highest risk and the bottom 10% with the lowest risk. A web-based application was developed to provide practitioners with patient-specific CFRD risk to guide CFRD monitoring and treatment.

This article explores the compatibility of evidence-based practice with nursing. The generation of relevant research evidence in nursing and determining best evidence are discussed. The article concludes that different forms of research, other than randomised controlled trials, are valid and in many cases more applicable to nursing practice, and that nurses need to determine what constitutes relevant and best evidence for the profession.

Drawing on Althusserian notions of ideology and Bourdieu’s understanding of bodily hexis, A Body of Text seeks to reframe Physical Culture as an artifact worthy of serious study, more complex and less reactionary than its beefcake-and-sentiment reputation might suggest. This dissertation addresses the story of Physical Culture magazine from three different perspectives, reading the magazine through lenses of media history, medical history and social context, in order to understand the ways in which class operated on and through the body. In contrast to nearly every other publication in the early twentieth century, Physical Culture suggested that class mobility was possible, and that success would naturally follow improvement of body and health. Whereas the idea of “fitness” in the eugenics movement very clearly indicated an essential condition, consequent to the quality of the germline, Physical Culture initiated the idea that fitness was obtainable—and commodifiable—through diet, exercise and “lifestyle.” Much of this argument is constructed by contrasting Physical Culture with Hygeia, the health magazine created by the American Medical Association for a lay audience, and by contrasting Physical Culture impresario Bernarr Macfadden with his counterpart at the AMA, Morris Fishbein. Whereas Macfadden’s story has been told, Fishbein’s story has yet to be the subject of a responsible biography. First gestures in that direction open the door to further work on Fishbein as a subject, and to deeper studies of the relationship between medicine, marketing and modern consumerism. Far from suggesting that Macfadden is ipso facto a liberatory force or a sophisticated theorist, the likeliest explanation for the complex, unstable and evolving constructions of body politics in Physical Culture are twofold: first, coming himself from “unfit” germlines, Macfadden needs to enrich contemporary thinking about the body to make sense of (and room for) his own success; second, and more importantly: you can’t sell a bloodline.

Background Advanced 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. Methods A 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. Results A 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. Conclusions The 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.

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