Significant acceleration of emergency response using smartphone geolocation data and a worldwide emergency call support system

Importance

When patients are disorientated or experience language barriers, it is impossible to activate the emergency response system. In these cases, the delay for receiving appropriate help can extend to several hours.

Objectives

A worldwide emergency call support system (ECSS), including geolocation of modern smartphones (GPS, WLAN and LBS), was established referring to E911 and eCall systems. The system was tested for relevance in quickly forwarding abroad emergency calls to emergency medical services (EMS).

Design

To verify that geolocation data from smartphones are exact enough to be used for emergency cases, the accuracy of GPS (global positioning system), Wi-Fi (wireless LAN network) and LBS (location based system) was tested in eleven different countries and compared to actual location. The main objective was analyzed by simulation of emergencies in different countries. The time delay in receiving help in unsuccessful emergency call cases by using the worldwide emergency call support system (ECSS) was measured.

Results

GPS is the gold standard to locate patients with an average accuracy of 2.0 ± 3.3 m. Wi-Fi can be used within buildings with an accuracy of 7.0 ± 24.1 m. Using ECSS, the emergency call leads to a successful activation of EMS in 22.8 ± 10.8 min (Median 21 min). The use of a simple app with one button to touch did never cause any delay.

Conclusions and relevance

The worldwide emergency call support system (ECSS) significantly improves the emergency response in cases of disorientated patients or language barriers. Under circumstances without ECSS, help can be delayed by 2 or more hours and might have relevant lifesaving effects. This is the first time that Wi-Fi geolocation could prove to be a useful improvement in emergencies to enhance GPS, especially within or close to buildings.

[Legal medicine specialists within the framework of acute care : Analysis of legal medicine consultations in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt]

BACKGROUND

In acute medical care, there are patients who have been injured by the influence of others. The aim of this study was to analyze all cases which were presented to the Institute for Legal Medicine of the University Halle (Saale). The cases where analyzed in relation to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt.

MATERIALS AND METHODS

The consultations of the Institute for Legal Medicine Halle-Wittenberg for 2012-2015 were evaluated with regard to the age and gender distribution, the reasons for the consultation and time until the request for consultations. These cases were statistically compared to the victims' statistics of the state office of criminal investigation in Saxony-Anhalt 2014-2015.

RESULTS

A total of 536 cases (55.6% male and 44.4% female patients) were evaluated. In all, 62.1% of patients were under 18 years of age; 43.5% of all consultations were requested by pediatric (surgery) clinics. The most common reasons for consultation were sexual child abuse or violence against children (50.7%). Compared to the victims' statistics, significantly more children were examined by legal medicine specialists than could have been expected (p < 0.001). In adult patients, the most common causes for consultation were acts of violence (20.4%) and domestic violence (10.1%). Among adults, significantly more women and fewer men were presented than expected (p = 0.001).

CONCLUSION

There were only a small number of consultations of legal medicine specialists in relation to the victims' statistics. Most of them were children and women. The temporal latency between the act of violence and the consultations was one day and more. The latency and the renunciation of the consultation of the legal medicine specialists can lead to loss of evidence.

Für Chirurgie begeistern – Einflüsse der Famulatur aus Sicht Studierender auf eine spätere Fachpräferenz

Hintergrund/Zielsetzung In den chirurgischen Fächern ist seit Jahren ein Nachwuchsmangel festzustellen. Wegen des abnehmenden Interesses an Chirurgie bereits im Studium empfehlen die Fachgesellschaften u. a. eine Stärkung der Betreuung während der praktischen Phasen des Medizinstudiums zur Steigerung der Attraktivität des Fachbereichs. Innerhalb der curricularen Praxisphasen des Medizinstudiums nimmt die Famulatur als erste ärztliche Tätigkeit eine besondere Stellung ein. Ziel dieser Studie war es, Bedeutung und Einflüsse von Famulaturerfahrungen für die Fachpräferenz einer Wunschdisziplin bei Famulierenden zu untersuchen.

Methoden Es wurden Humanmedizinstudierende der Otto-von-Guericke-Universität Magdeburg zu 4 verschiedenen Zeitpunkten im klinischen Studienabschnitt (n total = 373) über ihre Auswahlkriterien der Famulaturfächer und zu ihren Famulatureindrücken befragt. Hierzu wurden Fragen zu 5 Themenblöcken anhand einer 5-stufigen „Likert-Skala“ von 1 bis 5 (trifft „außerordentlich“ bis „gar nicht“ zu) eingeschätzt. Die Ergebnisse wurden statistisch analysiert.

Ergebnisse Die Famulatur hat eine erhebliche Bedeutung für die frühe Laufbahn eines Studierenden. Medizinstudierende nutzen die Famulatur, um gezielt Fächer, die für ihre spätere Weiterbildung infrage kommen, kennenzulernen. Eigene und besonders auch fremde Einschätzungen und Erfahrungen einer Klinik oder von Ausbildern beeinflussen die Entscheidung zu Famulaturfach und -ort. Famulaturvorbereitende Lehrformate können diesen Effekt verstärken. Aus Sicht der befragten Studierenden sollten sich Inhalte der Famulatur an Gelehrtes und Gelerntes des Studiums anschließen. Studierende erwarten Einblick und praktische, bereichsübergreifende, auch interdisziplinär geprägte Mitarbeit in einem Famulaturfach. Aus studentischer Sicht beeinflussen die Famulaturerfahrungen in den chirurgischen Fächern im Gegensatz zu den nicht chirurgischen Erfahrungen eine Weiterbildungspräferenz für operative Fächer und sind somit ein relevanter Prädiktor.

Schlussfolgerung Lehre im Spannungsfeld der Famulatur ist als wichtige Komponente für die Orientierung zu einer chirurgischen Laufbahn wirksam. Unterstützende fachspezifische Lehre zur Famulatur kann durch Verbesserung des Praktikumserlebens zu einer zusätzlichen Verstärkung dieses fachpräferenzbildenden Effekts einer Famulatur beitragen. Positive Famulaturerfahrungen werden von Studierenden attraktivitätssteigernd für das Fach wahrgenommen und können so ein Interesse an einer chirurgischen Tätigkeit bereits im Studium stärken.

Air Repatriation With a Medium-sized Pneumothorax Without Thoracic Tube: A Special Case of a Repatriation Accompanied by an Experienced Surgeon

We report on the repatriation of a 28-year old female from Germany, who was involved in a serious bus accident and was transported to the nearest hospital in Oruro, Bolivia. CT scans and x-rays performed in this hospital demonstrated a complete pneumothorax right. Thorax drainage was inserted, which was removed after 5 days. Since the hospital refused to acknowledge the presence of a residual middle-sized pneumothorax on the repatriation day and did not want to insert another tube, the decision was made to repatriate the patient on commercial flight back home to Germany without a thoracic tube.

Conveying practical clinical skills with the help of teaching associates-a randomised trial with focus on the long term learning retention

BACKGROUND

Ensuring that all medical students achieve adequate clinical skills remains a challenge, yet the correct performance of clinical skills is critical for all fields of medicine. This study analyzes the influence of receiving feedback by teaching associates in the context of achieving and maintaining a level of expertise in complex head and skull examination.

METHODS

All third year students at a German university who completed the obligatory surgical skills lab training and surgical clerkship participated in this study. The students were randomized into two groups.

CONTROL GROUP

lessons by an instructor and peer-based practical skills training. Intervention group: training by teaching associates who are examined as simulation patients and provided direct feedback on student performance. Their competency in short- and long-term competence (directly after intervention and at 4 months after the training) of head and skull examination was measured. Statistical analyses were performed using SPSS Statistics version 19 (IBM, Armonk, USA). Parametric and non-parametric test methods were applied. As a measurement of correlation, Pearson correlations and correlations via Kendall's-Tau-b were calculated and Cohen's d effect size was calculated.

RESULTS

A total of 181 students were included (90 intervention, 91 control). Out of those 181 students 81 agreed to be videotaped (32 in the control group and 49 in the TA group) and examined at time point 1. At both time points, the intervention group performed the examination significantly better (time point 1, p = <.001; time point 2 (rater 1 p = .009, rater 2 p = .015), than the control group. The effect size (Cohens d) was up to 1.422.

CONCLUSIONS

The use of teaching associates for teaching complex practical skills is effective for short- and long-term retention. We anticipate the method could be easily translated to nearly every patient-based clinical skill, particularly with regards to a competence-based education of future doctors.

Structured evaluation and need-based restructuring of the cranio-maxillofacial surgery module within surgical clerkship

BACKGROUND

Evaluations are important for teaching courses and contribute to educational quality assurance. CMF surgery provides a module in the skills-lab week in preparation for surgical clerkship. Even though the CMF module receives positive evaluations, the students report deviating content. Subsequently, exams skills were often not mastered correctly. The aim of this study is to gather the contents taught within the course and to revise the module accordingly.

METHODS

A structured evaluation sheet was used to evaluate the CMF modules. The detailed time frame used, teaching methods integrated, and learning objectives taught were documented. Based on the results, the module was restructured and re-evaluated twice.

RESULTS

There were substantial fluctuations among the taught learning objectives in the first evaluation (21%-47% of the objectives were totally covered). The deployed time (160.50 ± 32.55 min) for the module was much shorter than scheduled (210 min). After restructuring, more learning objectives were totally covered (44%-100%), which corresponds to a significant gain (p = .024). The deployed teaching time for the modules was used more efficiently (183.65 ± 21.10 min/p = .005), and the additional time (51.89 ± 21.23 min vs. 37.55 ± 16.06 min before/p = .011) was used mainly for practical exercises.

CONCLUSION

Structured evaluations are a meaningful tool for gaining valuable insights regarding the contents and quality of teaching courses and pinpointing potential for improvement. Key factors for the improvement of an educational module are the definition of learning goals within the context of a transparent and structured module.

Mapping Equivalence of German Emergency Department Medical Record Concepts with SNOMED CT After Implementation with HL7 CDA

INTRODUCTION

The German Emergency Department Medical Record (GEDMR) was created by medical domain experts and healthcare providers providing a dataset as well as a form. The trauma module of GEDMR was syntactically standardized using HL7 CDA and semantically standardized using different terminologies including SNOMED CT, LOINC and proprietary coding systems. This study depicts the mapping accuracy with aforementioned syntactical and semantical standards in general and especially the content coverage of SNOMED CT.

METHODS

The specification of GEDMR (V2015.1) concepts with eHealth-standards HL7-CDA, LOINC, SNOMED CT was analyzed. A content coverage assessment was made using the ISO TR 12300 rating scheme, following descriptive analysis.

RESULTS

The trauma module of GEDMR contains 489 concepts, with 202 concepts expressed via HL7 CDA structure. It is possible to code 89 % of the remaining concepts via SNOMED CT. 79 % provide an advanced level of semantic interoperability, as they represent the source information either lexically or as an approved synonym.

DISCUSSION

The terminology binding problem is relevant when combining different standards for syntactic and semantic interoperability with best practice documents and reference specifications providing guidance. A national license and extension for SNOMED CT in Germany as well as an ongoing effort in contributing to the International Version of SNOMED CT would be necessary to gain full coverage for concepts in German Emergency Medicine and to leverage the associated standardization process.

Disseminating a Standard for Medical Records in Emergency Departments Among Different Software Vendors Using HL7 CDA

A standardized medical record for the emergency department (GEDMR) was released in Germany, but only sparsely and randomly implemented by emergency department (ED) electronic health record (EHR) vendors. A reason for this may be a lacking common language between the medical and the Health Information Technology (HIT) domain. HL7 clinical document architecture (CDA) may leverage this communication gap. This paper reports on the effects of a professional medical association record standard on EHR vendors and the German ED-EHR market. Standard records and data standards are developed and published by different institutions either on governmental, healthcare agency or medical association level. There are some standard records, especially by US cardiology associations, transformed into HL7 C-CDA. GEDMR was modeled as HL7 CDA with the use of interoperable terminologies like LOINC and SNOMED CT. Being part of an emergency department data registry development project, local deployment at 15 project hospitals receiving sufficient funding was performed. Two major ED-EHR vendors adapted GEDMR within their product including CDA export. 106,868 CDAs were produced in six hospitals until now. Four local implementations with four different ED-EHRs were developed, producing 42,256 CDAs. Five additional vendors are adapting or developing an ED-EHR. The GEDMR-CDA implementation guide with funding for implementation in project hospitals had a significant impact on the German ED-EHR market. Within two years after release, a broadening and increasingly self-enforcing support by German ED-EHR vendors is notable.

[Consideration of guidelines, recommendations and quality indicators for treatment of stroke in the dataset "Emergency Department" of DIVI]

BACKGROUND

The dataset "Emergency Department" of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) has been developed during several expert meetings. Its goal is an all-encompassing documentation of the early clinical treatment of patients in emergency departments. Using the example of the index disease acute ischemic stroke (stroke), the aim was to analyze how far this approach has been fulfilled.

MATERIAL AND METHODS

In this study German, European and US American guidelines were used to analyze the extent of coverage of the datasets on current emergency department guidelines and recommendations from professional societies. In addition, it was examined whether the dataset includes recommended quality indicators (QI) for quality management (QM) and in a third step it was examined to what extent national provisions for billing are included. In each case a differentiation was made whether the respective rationale was primary, i.e. directly apparent or whether it was merely secondarily depicted by expertise. In the evaluation an additional differentiation was made between the level of recommendations and further quality relevant criteria.

RESULTS

The modular design of the emergency department dataset comprising 676 data fields is briefly described. A total of 401 individual fields, divided into basic documentation, monitoring and specific neurological documentation of the treatment of stroke patients were considered. For 247 data fields a rationale was found. Partially overlapping, 78.9 % of 214 medical recommendations in 3 guidelines and 85.8 % of the 106 identified quality indicators were primarily covered. Of the 67 requirements for billing of performance of services, 55.5 % are primarily part of the emergency department dataset. Through appropriate expertise and documentation by a board certified neurologist, the results can be improved to almost 100 %.

CONCLUSION

The index disease stroke illustrates that the emergency department dataset of the DIVI covers medical guidelines, especially 100 % of the German guidelines with a grade of recommendation. All necessary information to document the specialized stroke treatment procedure in the German diagnosis-related groups (DRG) system is also covered. The dataset is also suitable as a documentation tool of quality management, for example, to participate in the registry of the German Stroke Society (ADSR). Best results are obtained if the dataset is applied by a physician specialized in the treatment of patients with stroke (e.g. board certified neurologist). Finally the results show that changes in medical guidelines and recommendations for quality management as well as billing-relevant content should be implemented in the development of datasets for documentation to avoid duplicate documentation.

[Patients with Acute, Non-Traumatic Abdominal Pain in German Emergency Departments: A Prospective Monocentric Observation Study]

Background: Up to 11 % of patients in an Emergency Department (ED) present with non-traumatic acute abdominal pain. Based on this presenting symptom, this study aimed to analyse how residents (surgery, internal medicine, anaesthesiology and other fields) working in an ED during their second and third year of education treat these patients. Material and Methods: We performed a prospective, monocentric observation study in an ED in accordance with the STROBE recommendations, following the recommendations from the Ethics Committee of the University of Ulm (application no. 335/12) and the Declaration of Helsinki. The hospital's data protection officer approved the study. During a 12-month period (Dec. 2012 to Dec. 2013), a random sample of patients with non-traumatic abdominal pain was obtained in the ED of a major German acute care hospital by an independent observer, who was not part of the ED team. In addition to demographic data, the study focused on analysing processes and patient care (including medical history taking and physical examinations). In addition, subgroups were defined (clinical background of the treating physician, severity pursuant to the Manchester Triage Score [MTS]). Results: 143 patients met the inclusion criteria. The clinical background of the physician had no influence on the reviewed processes such as medical history taking, initial examinations, the request of consultative examinations or diagnostic procedures. Patients triaged as "urgent" were treated significantly earlier than patients triaged as "non-urgent" (time to first physician contact 26 ± 24 vs. 46 ± 34 min, p < 0.001). However, the overall time spent in the ED was equal (210 ± 79 vs. 220 ± 114 min, p = 0.555). Yet the initially estimated urgency was correlated with the need for hospitalisation (share: 57 %). Conclusion: The overall compliance with standards of care was high. The clinical background (surgery, internal medicine, anaesthesiology, other fields) of the physician in charge of initial treatment had no influence on the reviewed processes.

Perspectives of patients about bioabsorbable internal fixation for maxillofacial fractures

PURPOSE

Resorbable/bioabsorbable internal fixation provides effective treatment for maxillofacial fractures and avoids the need for metal hardware removal. We evaluated the initial knowledge, attitudes, subjective demand, and treatment satisfaction of patients concerning bioabsorbable osteofixation for maxillofacial trauma.

MATERIALS AND METHODS

From May 2007 to October 2009, there were 71 patients (63 males and 8 females; mean age: 35 ± 15 years) included in this prospective study. The patients completed preoperative and postoperative (4-6 weeks and 1 year) questionnaires.

RESULTS

After receiving information, 70 patients (99%) preferred resorbable/bioabsorbable bone fixation, usually because they preferred to avoid a second operation to remove metal hardware (67 patients [94%]). The higher cost of resorbable/bioabsorbable bone fixation was believed and justified by 41 patients (58%) and not justified by 30 patients (42%). No adverse events were reported by 27 of 34 patients (79%) at 4-6 weeks and by 14 of 21 patients (67%) at 1 year after surgery. Most patients were very satisfied with the outcome of surgery.

CONCLUSION

Patients who have maxillofacial trauma have a high frequency of preference and high satisfaction with resorbable/bioabsorbable than metal osteofixation. Literature review showed increased activity in research and publication worldwide about resorbable bone fixation, suggesting that there may be increased patient demand for resorbable bone fixation in the future.

[Materials/Biomaterials in Clinical Practice - a Short Review and Current Trends]

Biomaterials play a major role in interventional medicine and surgery. However, the development of biomaterials is still in its early phases in spite of the huge progress made within the last decades. On the one hand, this is because our knowledge of the molecular and cellular processes associated with biomaterials is still increasing exponentially. On the other hand, a wide variety of advanced materials with highly interesting properties is being developed currently. This review provides a short introduction into the variety of materials in use as well as their application in interventional medicine and surgery. Also the importance of biomaterials for tissue engineering in the field of regenerative medicine and the functionalisation of biomaterials, including sterilisation methods are discussed. For the future, an even broader interdisciplinary scientific collaboration is necessary in order to develop novel biomaterials and facilitate their translation into clinical practice.

[Physician Shortage: How to Prevent Generation Y From Staying Away - Results of a Nationwide Survey]

BACKGROUND

Medical students' attitudes and expectations about their future working life are changing. To hire the best talents from Generation Y, hospitals must pay attention to these factors to make working in patient care more attractive. However, little detailed knowledge about the professional and career expectations of today's medical students is available to date.

METHOD

In a nationwide online survey, a total of 9079 medical students from all German medical faculties returned the questionnaire. Twenty-one questions related to future career choices and work satisfaction, followed by 21 questions dealing with reasons for not working in patient care.

RESULTS

Factor analysis yielded five factors: work-life balance, career, professional needs, working atmosphere, and prestige. A correlation analysis between these factors and respondents' socio-demographic data revealed significant correlations with sex, specialty choice, and marital/parental status. A correlation analysis with "reasons for not working in patient care" revealed that work-life balance, career, professional needs, and working atmosphere had high priority for both sexes.

DISCUSSION

It is crucial to collect data on the work satisfaction of Generation Y, whose members are motivated and willing to perform in today's highly demanding work environment. However, sex-dependent/independent expectations must be met to make the medical profession more attractive, to overcome the Germany-wide shortage of physicians, and to attract young doctors to the hospitals.