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Kabwama SN, Wanyenze RK, Razaz N, Ssenkusu JM, Alfvén T, Lindgren H. How interventions to maintain services during the COVID-19 pandemic strengthened systems for delivery of maternal and child health services: a case-study of Wakiso District, Uganda. Glob Health Action 2024; 17:2314345. [PMID: 38381458 PMCID: PMC10883101 DOI: 10.1080/16549716.2024.2314345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Health systems are resilient if they absorb, adapt, and transform in response to shocks. Although absorptive and adaptive capacities have been demonstrated during the COVID-19 response, little has been documented about their transformability and strengthened service delivery systems. We aimed to describe improvements in maternal and child health service delivery as a result of investments during the COVID-19 response. METHODS This was a descriptive case study conducted in Wakiso District in central Uganda. It included 21 nurses and midwives as key informants and 32 mothers in three focus group discussions. Data were collected using an interview guide following the Systems Engineering Initiative for Patient Safety theoretical framework for service delivery. RESULTS Maternal and child health service delivery during the pandemic involved service provision without changes, service delivery with temporary changes and outcomes, and service delivery that resulted into sustained changes and outcomes. Temporary changes included patient schedule adjustments, community service delivery and negative outcomes such as increased workload and stigma against health workers. Sustained changes that strengthened service delivery included new infrastructure and supplies such as ambulances and equipment, new roles involving infection prevention and control, increased role of community health workers and outcomes such as improved workplace safety and teamwork. CONCLUSIONS In spite of the negative impact the COVID-19 pandemic had on health systems, it created the impetus to invest in system improvements. Investments such as new facility infrastructure and emergency medical services were leveraged to improve maternal and child health services delivery. The inter-departmental collaboration during the response to the COVID-19 pandemic resulted into an improved intra-hospital environment for other service delivery. However, there is a need to evaluate lessons beyond health facilities and whether these learnings are deliberately integrated into service delivery. Future responses should also address the psychological and physical impacts suffered by health workers to maintain service delivery.
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Affiliation(s)
- Steven Ndugwa Kabwama
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Neda Razaz
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - John M. Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Paediatric Public Health Department, Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden
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Brune C, Agerholm J, Burström B, Liljas A. Experience of moral distress among doctors at emergency departments in Stockholm during the Covid-19 pandemic: a qualitative interview study. Int J Qual Stud Health Well-being 2024; 19:2300151. [PMID: 38258523 PMCID: PMC10810614 DOI: 10.1080/17482631.2023.2300151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE The COVID-19 pandemic and consequent strain on healthcare globally shed light on the concept of moral distress among healthcare workers, albeit to a smaller extent among doctors at emergency departments. This study aimed to examine moral distress as perceived by medical doctors working at emergency departments in Stockholm during the pandemic, with the purpose of investigating causes of moral distress and methods to manage moral distress. METHODS Semi-structured interviews were conducted with twelve doctors working at two emergency departments. A questionnaire was developed based on previous research and the interviews were analysed qualitatively through thematic analysis. RESULTS The themes "The factors that precipitated moral distress", "Experience of workplace support" and "Coping strategies" as well as seven subthemes and 15 codes were identified. The informants reported on various situations with different causes of moral distress. Common causes were resource depletion, such as hospital bed shortages, and following stricter triage criteria. Informants reported varying ways of managing moral distress. CONCLUSIONS Informants experienced moral distress when faced with challenges such as resource depletion, rules and regulations, and colleagues' decisions. The informants who chose to seek support received it from their workplace, which helped them cope with their experiences. Some informants chose to not seek support.
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Affiliation(s)
- Clara Brune
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ann Liljas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Xia YM, Guan YQ, Liang JF, Wu WD. TAK-242 improves sepsis-associated acute kidney injury in rats by inhibiting the TLR4/NF-κB signaling pathway. Ren Fail 2024; 46:2313176. [PMID: 38482886 PMCID: PMC10877656 DOI: 10.1080/0886022x.2024.2313176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/27/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE This study was designed to observe the effect of toll-like receptor 4 (TLR4)/nuclear factor kappa-B (NF-κB) pathway activity on sepsis-associated acute kidney injury (SA-AKI), thereby providing new considerations for the prevention and treatment of SA-AKI. METHODS The rats were divided into Sham, cecal ligation and puncture (CLP), CLP + vehicle, and CLP + TAK-242 groups. Except the Sham group, a model of CLP-induced sepsis was established in other groups. After 24 h, the indicators related to kidney injury in blood samples were detected. The pathological changes in the kidneys were observed by hematoxylin-eosin staining, and tubular damage was scored. Oxidative stress-related factors, mitochondrial dysfunction-related indicators in each group were measured; the levels of inflammatory factors in serum and kidney tissue of rats were examined. Finally, the expression of proteins related to the TLR4/NF-κB signaling pathway was observed by western blot. RESULTS Compared with the CLP + vehicle and CLP + TAK-242 groups, the CLP + TAK-242 group reduced blood urea nitrogen (BUN), creatinine (Cr), cystatin-C (Cys-C), reactive oxygen species (ROS), malondialdehyde (MDA), and inflammatory factors levels (p < 0.01), as well as increased superoxide dismutase (SOD) activity of CLP rats (p < 0.01). Additionally, TAK-242 treatment improved the condition of CLP rats that had glomerular and tubular injuries and mitochondrial disorders (p < 0.01). Further mechanism research revealed that TAK-242 can inhibit the TLR4/NF-κB signaling pathway activated by CLP (p < 0.01). Above indicators after TAK-242 treatment were close to those of the Sham group. CONCLUSION TAK-242 can improve oxidative stress, mitochondrial dysfunction, and inflammatory response by inhibiting the activity of TLR4/NF-κB signaling pathway, thereby preventing rats from SA-AKI.
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Affiliation(s)
- Yan-mei Xia
- Department of Critical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PRChina
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PRChina
| | - Yu-qian Guan
- Department of Critical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PRChina
| | - Ji-fang Liang
- Department of Critical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PRChina
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PRChina
| | - Wei-dong Wu
- Department of Critical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, PRChina
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PRChina
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Kalanlar B, Akkaya G. Nursing student's experiences of Role-Play Scenario-Based Disaster Triage (START) training: A qualitative research. NURSE EDUCATION TODAY 2024; 141:106307. [PMID: 39002414 DOI: 10.1016/j.nedt.2024.106307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/06/2024] [Accepted: 07/09/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Disasters can overwhelm healthcare systems, making effective triage a crucial skill for nurses. Role-Play Scenario-Based Disaster Triage Training offers a promising approach to prepare nursing students for these situations. Understanding students' experiences with this training method can inform its development and effectiveness in fostering disaster preparedness. However, little is known about this training experience of nursing students. In particular, by examining the challenges faced by students, the emotional distress they experience and their achievements, it will provide guidance for the development of education programs in a more comprehensive and student-oriented manner. AIM The aim of this study is to elucidate the experiences of nursing students regarding Role-Play Scenario-Based Disaster Triage Training. DESIGN AND METHODS A qualitative approach was employed to comprehend participating students' experiences. Face-to-face and online semi-structured interviews were conducted with 17 students using an interview guide, and the interactions were recorded for subsequent analysis. Thematic analysis was employed to develop themes. RESULTS The study results emphasize the challenges experienced by students during triage training, their gains and the support they need to cope with the challenges they experience. Data were organized around four main themes: "Challenges of the triage process" with subthemes such as "Thinking of the actual earthquake moment" and "Ethical dilemmas"; "Emotional turmoil" with subthemes including "Anxiety" and "Fear and Helplessness"; "Achievements" with subthemes such as "Increase in knowledge and skills" and "The importance of the nurse"; and "Suggestions" with subthemes including "Continuous education" and "Mandatory course". CONCLUSIONS The findings of the study provide new insights into the experiences of nursing students during the disaster triage process. The results may contribute to the improvement of future training programs by identifying the challenges and needs faced by nursing students after disaster triage education.
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Affiliation(s)
- Bilge Kalanlar
- Department of Public Health Nursing, Hacettepe University Faculty of Nursing Ankara, Turkey.
| | - Gülnur Akkaya
- Department of Nursing, Health Science Faculty Çanakkale Onsekiz Mart University, Turkey
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Gorlicki J, Masip J, Gil V, Llorens P, Jacob J, Alquézar-Arbé A, Domingo Baldrich E, Fortuny MJ, Romero M, Esquivias MA, Moyano García R, Gómez García Y, Noceda J, Rodríguez P, Aguirre A, López-Díez MP, Mir M, Serrano L, Fuentes de Frutos M, Curtelín D, Freund Y, Miró Ò. Effect of early initiation of noninvasive ventilation in patients transported by emergency medical service for acute heart failure. Eur J Emerg Med 2024; 31:339-346. [PMID: 38847652 DOI: 10.1097/mej.0000000000001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
BACKGROUND While the indication for noninvasive ventilation (NIV) in severely hypoxemic patients with acute heart failure (AHF) is often indicated and may improve clinical course, the benefit of early initiation before patient arrival to the emergency department (ED) remains unknown. OBJECTIVE This study aimed to assess the impact of early initiation of NIV during emergency medical service (EMS) transportation on outcomes in patients with AHF. DESIGN A secondary retrospective analysis of the EAHFE (Epidemiology of AHF in EDs) registry. SETTING Fifty-three Spanish EDs. PARTICIPANTS Patients with AHF transported by EMS physician-staffed ambulances who were treated with NIV at any time during of their emergency care were included and categorized into two groups based on the place of NIV initiation: prehospital (EMS group) or ED (ED group). OUTCOME MEASURES Primary outcome was the composite of in-hospital mortality and 30-day postdischarge death, readmission to hospital or return visit to the ED due to AHF. Secondary outcomes included 30-day all-cause mortality after the index event (ED admission) and the different component of the composite primary endpoint considered individually. Multivariate logistic regressions were employed for analysis. RESULTS Out of 2406 patients transported by EMS, 487 received NIV (EMS group: 31%; EMS group: 69%). Mean age was 79 years, 48% were women. The EMS group, characterized by younger age, more coronary artery disease, and less atrial fibrillation, received more prehospital treatments. The adjusted odds ratio (aOR) for composite endpoint was 0.66 (95% CI: 0.42-1.05). The aOR for secondary endpoints were 0.74 (95% CI: 0.38-1.45) for in-hospital mortality, 0.74 (95% CI: 0.40-1.37) for 30-day mortality, 0.70 (95% CI: 0.41-1.21) for 30-day postdischarge ED reconsultation, 0.80 (95% CI: 0.44-1.44) for 30-day postdischarge rehospitalization, and 0.72 (95% CI: 0.25-2.04) for 30-day postdischarge death. CONCLUSION In this ancillary analysis, prehospital initiation of NIV in patients with AHF was not associated with a significant reduction in short-term outcomes. The large confidence intervals, however, may preclude significant conclusion, and all point estimates consistently pointed toward a potential benefit from early NIV initiation.
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Affiliation(s)
- Judith Gorlicki
- Emergency Department, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny
- INSERM UMR-S 942, France
| | | | - Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, Catalonia
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante
| | - Javier Jacob
- Emergency Department. Hospital Universitario de Bellvitge, Barcelona
| | | | | | | | - Marta Romero
- Emergency Department, Hospital de Móstoles, Madrid
| | | | | | | | - José Noceda
- Emergency Department, Hospital Universitario Clínico de Valencia, València
| | | | | | | | - María Mir
- Emergency Department, Hospital Infanta Leonor, Madrid
| | - Leticia Serrano
- Emergency Department. Hospital Universitario y Politécnico La Fe, València
| | | | - David Curtelín
- Emergency Department, Hospital Clínic, IDIBAPS, Catalonia
| | - Yonathan Freund
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Òscar Miró
- University of Barcelona, Barcelona
- Emergency Department, Hospital Clínic, IDIBAPS, Catalonia
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Bijl I, Vianen NJ, Van Lieshout EMM, Beekers CHJ, Van Der Waarden NWPL, Pekbay B, Maissan IM, Verhofstad MHJ, Van Vledder MG. Emergency reflex action drill for traumatic cardiac arrest in a simulated pre-hospital setting; a one-group pre-post intervention study. Intensive Crit Care Nurs 2024; 84:103731. [PMID: 38823272 DOI: 10.1016/j.iccn.2024.103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/06/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Emergency Reflex Action Drills (ERADs) are meant to decrease stress-associated cognitive demand in high urgency situations. The aim of this study was to develop and test an ERAD for witnessed traumatic cardiac arrest (TCA), an event in which potentially reversible causes need to be systematically addressed and treated in a short period of time. We hypothesize that this ERAD (the TCA-Drill) helps ground Emergency Medical Services (EMS) nurses in overcoming performance decline during this specific high-pressure situation. METHODS This was a prospective, experimental one-group pre-post intervention study. Ground EMS nurses participated in a session of four simulated scenarios, with an in-between educational session to teach the TCA-Drill. Scenarios were video recorded, after which adherence and time differences were analyzed. Self-confidence on clinical practice was measured before and after the scenarios. RESULTS Twelve ground EMS nurses participated in this study. Overall median time to address reversible causes of TCA decreased significantly using the TCA-Drill (132 vs. 110 s; p = 0.030) compared with the conventional ALS strategy. More specifically, participants adhering to the TCA-Drill showed a significantly lower time needed for hemorrhage control (58 vs. 37 s; p = 0.012). Eight of 12 (67 %) ground EMS nurses performed the ERAD without protocol deviations. Reported self-confidence significantly increased on 11 of the 13 surveyed items. CONCLUSIONS The use of an ERAD for TCA (the TCA-Drill) significantly reduces the time to address reversible causes for TCA without delaying chest compressions in a simulated environment and can be easily taught to ground EMS nurses and increases self-confidence. IMPLICATIONS FOR CLINICAL PRACTICE The use of an ERAD for TCA (the TCA-Drill can significantly reduce the time to address reversible causes for TCA without delaying chest compression. This drill can be easily taught to ground EMS nurses and increases their self-confidence in addressing TCA-patients.
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Affiliation(s)
- Irene Bijl
- Nursing Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Niek J Vianen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Christian H J Beekers
- Regional Ambulance Care Provider, Brabant Midden West Noord, 's Hertogenbosch, The Netherlands
| | | | - Begüm Pekbay
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Iscander M Maissan
- Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Mark G Van Vledder
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands.
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Cui Y, He W, Wang Z, Yang H, Zheng M, Li Y. Reduced estrogenic risks of a sunscreen additive: Theoretical design and evaluation of functionally improved salicylates. JOURNAL OF HAZARDOUS MATERIALS 2024; 477:135371. [PMID: 39084014 DOI: 10.1016/j.jhazmat.2024.135371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/17/2024] [Accepted: 07/27/2024] [Indexed: 08/02/2024]
Abstract
Salicylic esters (SEs), the widely used ultraviolet (UV) absorbers in sunscreen products, have been found to have health risks such as skin sensitization and estrogenic effects. This study aims to design SE substitutes that maintain high UV absorbance while reducing estrogenicity. Using molecular docking and Gaussian09 software for initial assessments and further application of a combination of two-dimensional and three-dimensional quantitative structure-activity relationships (2D-QSAR and 3D-QSAR, respectively) models, we designed 73 substitutes. The best-performing molecules, ethylhexyl salicylate (EHS)-5 and EHS-15, significantly reduced estrogenicity (44.54 % and 17.60 %, respectively) and enhanced UV absorbance (249.56 % and 46.94 %, respectively). Through screening for human health risks, we found that EHS-5 and EHS-15 were free from skin sensitivity and eye irritation and exhibited reduced skin permeability compared with EHS. Furthermore, the photolysis and synthetic pathways of EHS-5 and EHS-15 were deduced, demonstrating their good photodegradability and potential synthesizability. In addition, we analyzed the mechanisms underlying the changes in estrogenic effects and UV absorption properties. We identified covalent hydrogen bond basicity and acidity Propgen value for atomic molecular properties and the highest occupied molecular orbital eigenvalue as the main factors affecting the estrogenic effect and UV absorbance of SEs, respectively. This study focuses on the design and screening of SEs, exhibiting enhanced functionality, reduced health risks, and synthetic feasibility.
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Affiliation(s)
- Yuhan Cui
- College of Environmental Science and Engineering, North China Electric Power University, Beijing 102206, China.
| | - Wei He
- College of Environmental Science and Engineering, North China Electric Power University, Beijing 102206, China.
| | - Zhonghe Wang
- College of Environmental Science and Engineering, North China Electric Power University, Beijing 102206, China.
| | - Hao Yang
- College of Environmental Science and Engineering, North China Electric Power University, Beijing 102206, China.
| | - Maosheng Zheng
- College of Environmental Science and Engineering, North China Electric Power University, Beijing 102206, China.
| | - Yu Li
- College of Environmental Science and Engineering, North China Electric Power University, Beijing 102206, China.
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Hilly JJ, Singh KR, Jagals P, Mani FS, Turagabeci A, Ashworth M, Mataki M, Morawska L, Knibbs LD, Stuetz RM, Dansie AP. Review of scientific research on air quality and environmental health risk and impact for PICTS. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 942:173628. [PMID: 38848924 DOI: 10.1016/j.scitotenv.2024.173628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/03/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024]
Abstract
Air quality (AQ) significantly impacts human health, influenced by both natural phenomena and human activities. In 2021, heightened awareness of AQ's health impacts prompted the revision of the World Health Organization (WHO) guidelines, advocating for stricter pollution standards. However, research on AQ has predominantly focused on high-income countries and densely populated cities, neglecting low- and middle-income countries, particularly Pacific Island Countries, Territories, and States (PICTS). This systematic review compiles existing peer-reviewed literature on AQ research in PICTS to assess the current state of knowledge and emphasize the need for further investigation. A systematic literature search yielded 40 papers from databases including Web of Science, Scopus, and Embase. Among the 26 PICTS, only 6 (Hawai'i, Fiji, Papua New Guinea, New Caledonia, Republic of Marshall Islands, and Pacific) have been subject to AQ-related research, with 4 considering the World Health Organization (WHO) parameters and 26 addressing non-WHO parameters. Analysis reveals AQ parameters often exceed 2021 WHO guidelines for PM2.5, PM10, SO2, and CO, raising concerns among regional governments. Studies primarily focused on urban, agricultural, rural, and open ocean areas, with 15 based on primary data and 14 on both primary and secondary sources. Research interests and funding sources dictated the methods used, with a predominant focus on environmental risks over social, economic, and technological impacts. Although some papers addressed health implications, further efforts are needed in this area. This review underscores the urgent need for ongoing AQ monitoring efforts in PICTS to generate spatially and temporally comparable data. By presenting the current state of AQ knowledge, this work lays the foundation for coordinated regional monitoring and informs national policy development.
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Affiliation(s)
- J J Hilly
- School of Civil and Environmental Engineering, University of New South Wales, Australia; Environmental Health Division, Solomon Islands Ministry of Health and Medical Services, Solomon Islands.
| | - K R Singh
- School of Earth Sciences and Environmental Engineering, Gwangju Institute of Science and Technology, Republic of Korea
| | - P Jagals
- Children's Health and Environmental Program, The University of Queensland, Australia
| | - F S Mani
- School of Agriculture, Geography, Environment, Ocean and Natural Sciences, The University of the South Pacific, Suva, Fiji
| | - A Turagabeci
- College of Medicine, Nursing & Health science, Fiji National University, Fiji
| | - M Ashworth
- Institute of Environmental Science and Research Limited (ESR), Christchurch Science Centre, 27 Creyke Road, Ilam, Christchurch 8041, New Zealand
| | - M Mataki
- Solomon Islands Ministry of Environment, Climate Change, Disaster Management and Meteorology, Solomon Islands
| | - L Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Australia
| | - L D Knibbs
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - R M Stuetz
- School of Civil and Environmental Engineering, University of New South Wales, Australia
| | - A P Dansie
- School of Civil and Environmental Engineering, University of New South Wales, Australia
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Jarosławski J, Burzyński J, Kryczka K, Michalak A, Warda W, Zieliński K, Fendler W, Chobot A. Impact of anthropometric factors on chest compression depth during CPR provided by children aged 11-14 in a community-wide study. Resusc Plus 2024; 19:100708. [PMID: 39100391 PMCID: PMC11294725 DOI: 10.1016/j.resplu.2024.100708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 08/06/2024] Open
Abstract
Objective To assess the depth of chest compressions (CC) provided by schoolchildren and their relation with providers's anthropometric characteristics. Methods We organized 1-hour hands-on training sessions for 11-14y.o. in volunteering schools. After training, willing subjects performed 2 min of recorded continuous CCs by means of Laerdal Resusci Anne® with CPRMeter2®, with visual feedback. Compression pace was given by metronome; instructors supervised the correct body position. Collected data included age, sex, as well as measured body weight and height. Results We analyzed records from N = 702 children (mean age: 12.76 ± 1.02 years, 379 (51.63%) boys) out of 761 participating in the study. Their mean median compression depth (MCD) was 46.70 ± 7.74 mm, which was below minimal effective CC depth advised by current guidelines (50 mm). This corresponded to low mean fraction of CCs ≥ 50 mm (CCF ≥ 50 mm, 42.86 ± 33.67%), and only 42.88% of children achieving at least 50% of compressions ≥ 50 mm. Boys had significantly higher mean MCD and CCF ≥ 50 mm than girls (MCD: 49.34 ± 7.05 mm vs 45.97 ± 8.07 mm, p < 0.0001; CCF ≥ 50 mm: 50.23 ± 32.90% vs 40.40 ± 34.97%, p < 0.0001). Age differentiated children who achieved at least 50% of compressions ≥50 mm from those who did not with AUC of 0.69 (for cut-off of 12.1 years: 85% sensitivity, 41% specificity), whereas weight offered an improved prediction (AUC 0.74; for cut-off 44.8 kg: 77.4% sensitivity, 61.1% specificity). Conclusions Sex, age and anthropometric factors are significant CC quality factors. Children with higher body weight are more likely to deliver CCF50%≥50 mm. Among the studied population, children ≥12 years old provided more effective chest compressions.
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Affiliation(s)
- Jarosław Jarosławski
- Student Association of Pediatrics and Critical Care, Department of Pediatrics, Institute of Medical Sciences, University of Opole, Al. W.Witosa 26, 45-052 Opole, Poland
| | - Jacek Burzyński
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Ul. Mazowiecka 15, 92-215Lodz, Poland
| | - Krzysztof Kryczka
- Student Association of Pediatrics and Critical Care, Department of Pediatrics, Institute of Medical Sciences, University of Opole, Al. W.Witosa 26, 45-052 Opole, Poland
| | - Arkadiusz Michalak
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Ul. Mazowiecka 15, 92-215Lodz, Poland
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Ul. Sporna 36/50, 91-738 Lodz Poland
| | - Wiktor Warda
- Student Association of Pediatrics and Critical Care, Department of Pediatrics, Institute of Medical Sciences, University of Opole, Al. W.Witosa 26, 45-052 Opole, Poland
| | - Krzysztof Zieliński
- Student Association of Pediatrics and Critical Care, Department of Pediatrics, Institute of Medical Sciences, University of Opole, Al. W.Witosa 26, 45-052 Opole, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Ul. Mazowiecka 15, 92-215Lodz, Poland
| | - Agata Chobot
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Al. W.Witosa 26, 45-052 Opole, Poland
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Godoy DA, Rubiano AM, Aguilera S, Jibaja M, Videtta W, Rovegno M, Paranhos J, Paranhos E, de Amorim RLO, Castro Monteiro da Silva Filho R, Paiva W, Flecha J, Faleiro RM, Almanza D, Rodriguez E, Carrizosa J, Hawryluk GWJ, Rabinstein AA. Moderate Traumatic Brain Injury in Adult Population: The Latin American Brain Injury Consortium Consensus for Definition and Categorization. Neurosurgery 2024; 95:e57-e70. [PMID: 38529956 DOI: 10.1227/neu.0000000000002912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/30/2024] [Indexed: 03/27/2024] Open
Abstract
Moderate traumatic brain injury (TBI) is a diagnosis that describes diverse patients with heterogeneity of primary injuries. Defined by a Glasgow Coma Scale between 9 and 12, this category includes patients who may neurologically worsen and require increasing intensive care resources and/or emergency neurosurgery. Despite the unique characteristics of these patients, there have not been specific guidelines published before this effort to support decision-making in these patients. A Delphi consensus group from the Latin American Brain Injury Consortium was established to generate recommendations related to the definition and categorization of moderate TBI. Before an in-person meeting, a systematic review of the literature was performed identifying evidence relevant to planned topics. Blinded voting assessed support for each recommendation. A priori the threshold for consensus was set at 80% agreement. Nine PICOT questions were generated by the panel, including definition, categorization, grouping, and diagnosis of moderate TBI. Here, we report the results of our work including relevant consensus statements and discussion for each question. Moderate TBI is an entity for which there is little published evidence available supporting definition, diagnosis, and management. Recommendations based on experts' opinion were informed by available evidence and aim to refine the definition and categorization of moderate TBI. Further studies evaluating the impact of these recommendations will be required.
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Affiliation(s)
| | - Andres M Rubiano
- Universidad El Bosque, Bogota , Colombia
- MEDITECH Foundation, Cali , Colombia
| | - Sergio Aguilera
- Department Neurosurgery, Herminda Martín Hospital, Chillan , Chile
| | - Manuel Jibaja
- School of Medicine, San Francisco University, Quito , Ecuador
- Intensive Care Unit, Eugenio Espejo Hospital, Quito , Ecuador
| | - Walter Videtta
- Intensive Care Unit, Hospital Posadas, Buenos Aires , Argentina
| | - Maximiliano Rovegno
- Department Critical Care, Pontificia Universidad Católica de Chile, Santiago , Chile
| | - Jorge Paranhos
- Department of Neurosurgery and Critical Care, Santa Casa da Misericordia, Sao Joao del Rei , Minas Gerais , Brazil
| | - Eduardo Paranhos
- Intensive Care Unit, HEMORIO and Santa Barbara Hospitals, Rio de Janeiro , Brazil
| | | | | | - Wellingson Paiva
- Experimental Surgery Laboratory and Division of Neurological Surgery, University of São Paulo Medical School, Sao Paulo , Brazil
| | - Jorge Flecha
- Intensive Care Unit, Trauma Hospital, Asuncion , Paraguay
- Social Security Institute Central Hospital, Asuncion , Paraguay
| | - Rodrigo Moreira Faleiro
- Department of Neurosurgery, João XXIII Hospital and Felício Rocho Hospital, Faculdade de Ciencias Médicas de MG, Belo Horizonte , Brazil
| | - David Almanza
- Critical and Intensive Care Medicine Department, University Hospital, Fundación Santa Fe de Bogotá, Bogotá , Colombia
- Universidad del Rosario, School of Medicine and Health Sciences, Bogotá , Colombia
| | - Eliana Rodriguez
- Critical and Intensive Care Medicine Department, University Hospital, Fundación Santa Fe de Bogotá, Bogotá , Colombia
- Universidad del Rosario, School of Medicine and Health Sciences, Bogotá , Colombia
| | - Jorge Carrizosa
- Universidad del Rosario, School of Medicine and Health Sciences, Bogotá , Colombia
- Neurointensive Care Unit, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá , Colombia
| | - Gregory W J Hawryluk
- Cleveland Clinic Akron General Hospital, Neurological Institute, Akron , Ohio , USA
| | - Alejandro A Rabinstein
- Neurocritical Care and Hospital Neurology Division, Mayo Clinic, Rochester , Minnesota , USA
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Uddin H, Hasan MK, Cuartas-Alvarez T, Castro-Delgado R. Effects of mass casualty incidents on anxiety, depression, and post-traumatic stress disorder among doctors and nurses: a systematic review. Public Health 2024; 234:132-142. [PMID: 39002283 DOI: 10.1016/j.puhe.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVES Doctors and nurses suffer different mental health conditions following traumatic incidents. We systematically synthesized existing evidence on the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) and their associated risk factors among doctors and nurses following mass casualty incidents (MCIs). STUDY DESIGN Systematic review. METHODS Seven databases were searched (2010-2022) with peer-reviewed articles in English using the predefined keywords. Two reviewers screened the titles, abstracts, and full texts using the eligibility criteria and extracted data independently. We used the National Institutes of Health Quality Assessment Tools (NIH-QAT) and the Critical Appraisal Skills Programme checklist (CASP) to measure the quality appraisal of the included studies. RESULTS A total of 5170 articles were retrieved, and 2512 articles were assessed by title and abstract (53 were eligible for full-text review). Finally, we included 19 studies. Most were assessed as of fair quality with a considerable risk of bias. PTSD was the highest-reported mental health condition. Nurses reported higher mental conditions, particularly PTSD. Two sets of risk factors (personal and workplace) are associated with anxiety, depression, and PTSD were found. CONCLUSIONS MCIs have a significant impact on the mental health outcomes of emergency health workers. Preventive measures should be designed considering the high-risk group, personal, and organizational risk factors of mental health outcomes.
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Affiliation(s)
- H Uddin
- Department of Medicine, University of Oviedo, Oviedo 33006, Spain; Department of Global Public Health, Karolinska Institutet, Solna 17177, Sweden; Department of Sociology, East West University, Dhaka 1212, Bangladesh; South Asian Institute for Social Transformation (SAIST), Dhaka 1205, Bangladesh.
| | - M K Hasan
- Institute of Disaster Management and Vulnerability Studies, University of Dhaka, Dhaka 1000, Bangladesh; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - T Cuartas-Alvarez
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo 33001, Spain; RINVEMER-SEMES (Research Network on Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain
| | - R Castro-Delgado
- Department of Medicine, University of Oviedo, Oviedo 33006, Spain; Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo 33001, Spain; RINVEMER-SEMES (Research Network on Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain.
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12
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Crapis C, Chang KYJ, Villeneuve M. A cross-sectional survey of Australian service providers' emergency preparedness capabilities. Disabil Rehabil 2024; 46:4276-4286. [PMID: 37855373 DOI: 10.1080/09638288.2023.2270916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Emergency and disaster management planning is an emerging role with limited practical guidance on how it should be implemented by community, disability, health and rehabilitation service providers. This study examined the emergency preparedness of service providers and how they viewed their role and contributions to disaster risk reduction, including their capacity and willingness to facilitate preparedness planning with their clients. MATERIALS AND METHODS A questionnaire was developed and administered nationally. Descriptive statistics, multivariate regression analyses, and thematic analysis of open-ended questions provide insight on the knowledge, tools and training needs of service providers to contribute to preparedness of themselves and the people they support. RESULTS Facilitating emergency preparedness with people with disability was strongly associated with a high level of mental preparedness, household preparedness scores, and completion of Person-Centred Emergency Preparedness (P-CEP) training. Perceived lack of funding, insufficient tools, and exclusion of emergency planning from job descriptions were negatively associated with facilitating emergency preparedness with clients. CONCLUSIONS Study findings lay the groundwork for development of the role and capabilities of individual service providers including the need to equip disability, health and rehabilitation service providers with training and tools to prepare themselves and the people they support for emergencies.
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Affiliation(s)
- Carla Crapis
- D18 Susan Wakil Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kuo-Yi Jade Chang
- Centre for Disability Research and Policy, The University of Sydney, Sydney, Australia
| | - Michelle Villeneuve
- D18 Susan Wakil Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Disability Research and Policy, The University of Sydney, Sydney, Australia
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Bicakcioglu M, Gok A, Cicek IB, Dogan Z, Ozer AB. Mortality predictors in earthquake victims admitted to intensive care unit in Kahramanmaraş earthquakes. Injury 2024; 55:111632. [PMID: 38852033 DOI: 10.1016/j.injury.2024.111632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 05/03/2024] [Accepted: 05/25/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The purpose of this study is to report the data for patients followed-up in our intensive care unit due to the 6th February 2023, earthquake in Kahramanmaraş, Türkiye, and to investigate parameters affecting mortality. METHODS The demographic characteristics of patients followed-up in intensive care due to trauma following the earthquake, the treatments administered, developing complications, lengths of stay in the hospital and intensive care, and laboratory data were scanned retrospectively and recorded. These data were then compared between the surviving and non-surviving patients. RESULTS Twenty-six patients, 13 (50 %) male, were followed-up in our intensive care, 24 (92 %) due to being buried under earthquake debris, and 2 (8 %) due to falling from heights. Increased Sequential Organ Failure Assessment (SOFA) (p = 0.027), higher initial serum potassium (p = 0.043), higher initial serum phosphorus (p = 0.035), higher initial and peak serum magnesium (p = 0.004 and p = 0.001), lower initial and peak bicarbonate (p = 0.021 and p = 0.012) and higher initial and peak serum base deficit values (p = 0.012 and p = 0.009) were associated with mortality. In the subgroup with crush injuries, higher initial and peak serum potassium (p = 0.001 and p = 0.025), higher initial and peak serum magnesium (p = 0.005 and p = 0.004), lower initial and peak bicarbonate (p = 0.019 and p = 0.021) and higher initial and peak serum base deficit values (p = 0.017 and p = 0.025) were associated with mortality. Multiorgan dysfunction failure developed in nine patients, sepsis in seven, dissemine intravascular coagulation in four, and acute respiratory distress syndrome in two. Fasciotomy was performed on 2 (8 %) patients and amputation on 8 (31 %). Extremity injuries were most frequently observed. 10 (38.5 %) of the 12 (46 %) patients developing acute kidney injury required renal replacement therapy. 7 (27 %) patients died during follow-up. In logistic regression analysis, higher SOFA scores, lower initial bicarbonate and BE levels, higher serum initial potassium and magnesium levels were a risk factor for mortality. Higher SOFA scores, lower initial bicarbonate and base deficit and higher initial phosphorus values affected mortality in patients with crush syndrome. CONCLUSION Not only increased SOFA, serum potassium, serum phosphorus, and serum magnesium, but also decreased bicarbonate, and base deficit were associated with mortality in earthquake victims with crush syndrome in ICU.
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Affiliation(s)
- Murat Bicakcioglu
- İnönü University Medical Faculty Anesthesiology Department, Intensive Care Unit, Turkey
| | - Abdullah Gok
- İnönü University Medical Faculty Anesthesiology Department, Intensive Care Unit, Turkey
| | - Ipek Balikci Cicek
- İnönü University Medical Faculty Biostatistics and Medical Informatics Department, Turkey
| | - Zafer Dogan
- İnönü University Medical Faculty Anesthesiology Department, Intensive Care Unit, Turkey
| | - Ayse B Ozer
- İnönü University Medical Faculty Anesthesiology Department, Intensive Care Unit, Turkey.
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Schnaubelt S, Monsieurs KG, Fijacko N, Veigl C, Al-Hilali Z, Atiq H, Bigham BL, Eastwood K, Ko YC, Matsuyama T, Athieno Odakha J, Olaussen A, Greif R. International facets of the 'chain of survival' for out-of-hospital and in-hospital cardiac arrest - A scoping review. Resusc Plus 2024; 19:100689. [PMID: 38988609 PMCID: PMC11234005 DOI: 10.1016/j.resplu.2024.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 07/12/2024] Open
Abstract
Background The "chain of survival" was first systematically addressed in 1991, and its sequence still forms the cornerstone of current resuscitation guidelines. The term "chain of survival" is widely used around the world in literature, education, and awareness campaigns, but growing heterogeneity in the components of the chain has led to confusion. It is unclear which of these emerging chains is most suitable, or if adaptations are needed in particular contexts to depict key actions of resuscitation in the 21st century. This scoping review provides an overview of the variety of chains of survival described. Objectives To identify published facets of the chain of survival, to assess views and strategies about adapting the chain, and to identify reports on how the chain of survival affects teaching, implementation, or patient outcomes. Methods eligibility criteria and sources of evidence A scoping review as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR) was conducted. MEDLINE(R) ALL (Ovid), Embase (Ovid), APA PsycINFO (Ovid), CINAHL (Ebscohost), ERIC (Ebscohost), Web of Science (Clarivate), Scopus (Elsevier), and Cochrane Library (Wiley Online) were searched. All publications in all languages describing chains of survival were eligible, without time restrictions. Due to the heterogeneity and publication types of the relevant studies, we did not pursue a systematic review or meta-analysis. Results A primary search yielded 1713 studies and after screening we included 43 publications. Modified versions of the chain of survival for specific contexts were found (e.g., in-hospital cardiac arrest or paediatric resuscitation). There were also numerous versions with minor adaptations of the existing chain. Three publications suggested an impact of the use of the chain of survival on patient outcomes. No educational or implementation outcomes were reported. Conclusion There is a vast heterogeneity of chain of survival concepts published. Future research is warranted, especially into the concept's importance concerning educational, implementation, and clinical outcomes.
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Affiliation(s)
- Sebastian Schnaubelt
- Dpt. of Emergency Medicine, Medical University of Vienna, Austria
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Dpt. of Emergency Medicine, Antwerp University Hospital, and University of Antwerp, Belgium
| | - Koenraad G Monsieurs
- Dpt. of Emergency Medicine, Antwerp University Hospital, and University of Antwerp, Belgium
| | - Nino Fijacko
- University of Maribor, Faculty of Health Sciences, and Maribor University Medical Centre, Maribor, Slovenia
| | - Christoph Veigl
- Dpt. of Emergency Medicine, Medical University of Vienna, Austria
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | | | - Huba Atiq
- Dpt. of Anaesthesiology, Centre of Excellence for Trauma & Emergency, The Aga Khan University Hospital, Karachi, Pakistan
| | - Blair L Bigham
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Kathryn Eastwood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ying-Chih Ko
- Section of Emergency Medicine, Dpt. of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Tasuku Matsuyama
- Dpt. of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Justine Athieno Odakha
- Dpt. of Emergency Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander Olaussen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Alfred Health Emergency Service, Melbourne, Victoria, Australia
| | - Robert Greif
- University of Bern, Bern, Switzerland
- Department of Surgical Sciences, University of Turin, Turin, Italy
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15
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Cuevas M, Frank M, Haacke W, Lüdke T. [Prehospital care of anaphylactic reactions by the air rescue and ground-based emergency services Dresden : An analysis of treatment and outcome]. HNO 2024; 72:611-618. [PMID: 38592478 PMCID: PMC11339158 DOI: 10.1007/s00106-024-01457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Anaphylaxis can lead to a life-threatening situation. Therefore, rapid diagnosis and emergency treatment is indicated. Immediate treatment with intramuscular adrenaline (or intravascularly with sufficient medical expertise) in anaphylaxis with cardiovascular and/or respiratory symptoms is recommended by various guidelines. Previous studies have shown that anaphylaxis is often not treated according to guidelines and that adrenaline in particular is rarely administered. OBJECTIVE The aim of the study was to investigate the data on emergency treatment and outcomes of patients with anaphylaxis by the air rescue and ground-based emergency services Dresden. Moreover, the results of the air- and ground-based services were compared. The focus was on administration of adrenaline and outcomes. MATERIALS AND METHODS Data from the ground-based emergency service Dresden (from 2012 to 2016) and the air rescue service Dresden (from 2008 to 2015) related to anaphylactic reactions were analyzed retrospectively. The severity of the anaphylaxis, the emergency medication administered, further monitoring, and outcomes were analyzed. RESULTS Data from 152 adults/29 children were analyzed for air rescue and 1131 adults/223 children for the ground-based emergency service. Adults with grade II-IV anaphylaxis received adrenaline in 19% (air rescue) and 7% (ground rescue) of cases. Children with grade II-IV anaphylaxis received adrenaline in 7% (air rescue) and 8% (ground rescue) of cases. Immediate drug therapy led to an improvement in general condition in 96-98% (air rescue) and 72-77% (ground-based emergency service) of cases. A significant correlation was found between the administration of adrenaline and the improvement in outcome in the ground-based emergency cohort. CONCLUSION Guideline-compliant first-line therapy with adrenaline was not performed in the majority of the cases analyzed in this study. The significant effect of adrenaline on outcome demonstrated in this study emphases the need to improve the emergency treatment of anaphylactic reactions.
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Affiliation(s)
- Mandy Cuevas
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
- Praxis für Hals‑, Nasen‑, Ohrenheilkunde und Allergologie, Freital, Deutschland
| | - Mark Frank
- Zentrale interdisziplinäre Notaufnahme, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Deutschland
- DRF Stiftung Luftrettung gAG, Filderstadt, Deutschland
- Wissenschaftlicher Arbeitskreis der DRF Stiftung Luftrettung gemeinnützige AG, Filderstadt, Deutschland
| | - Wladimir Haacke
- Brand- und Katastrophenschutzamt Dresden, Feuerwehr und Rettungsdienst, Dresden, Deutschland
| | - Theresa Lüdke
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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Grøntved S, Jørgine Kirkeby M, Paaske Johnsen S, Mainz J, Brink Valentin J, Mohr Jensen C. Towards reliable forecasting of healthcare capacity needs: A scoping review and evidence mapping. Int J Med Inform 2024; 189:105527. [PMID: 38901268 DOI: 10.1016/j.ijmedinf.2024.105527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/31/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the critical importance of robust healthcare capacity planning and preparedness for emerging crises. However, healthcare systems must also adapt to more gradual temporal changes in disease prevalence and demographic composition over time. To support proactive healthcare planning, statistical capacity forecasting models can provide valuable information to healthcare planners. This systematic literature review and evidence mapping aims to identify and describe studies that have used statistical forecasting models to estimate healthcare capacity needs within hospital settings. METHOD Studies were identified in the databases MEDLINE and Embase and screened for relevance before items were defined and extracted within the following categories: forecast methodology, measure of capacity, forecast horizon, healthcare setting, target diagnosis, validation methods, and implementation. RESULTS 84 studies were selected, all focusing on various capacity outcomes, including number of hospital beds/ patients, staffing, and length of stay. The selected studies employed different analytical models grouped in six items; discrete event simulation (N = 13, 15 %), generalized linear models (N = 21, 25 %), rate multiplication (N = 15, 18 %), compartmental models (N = 14, 17 %), time series analysis (N = 22, 26 %), and machine learning not otherwise categorizable (N = 12, 14 %). The review further provides insights into disease areas with infectious diseases (N = 24, 29 %) and cancer (N = 12, 14 %) being predominant, though several studies forecasted healthcare capacity needs in general (N = 24, 29 %). Only about half of the models were validated using either temporal validation (N = 39, 46 %), cross-validation (N = 2, 2 %) or/and geographical validation (N = 4, 5 %). CONCLUSION The forecasting models' applicability can serve as a resource for healthcare stakeholders involved in designing future healthcare capacity estimation. The lack of routine performance validation of the used algorithms is concerning. There is very little information on implementation and follow-up validation of capacity planning models.
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Affiliation(s)
- Simon Grøntved
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Mette Jørgine Kirkeby
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Aalborg University Hospital - Research, Education and Innovation, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Aalborg University Hospital - Research, Education and Innovation, Aalborg, Denmark
| | - Jan Mainz
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Brink Valentin
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christina Mohr Jensen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark; Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
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Prothero LS, Strudwick T, Foster T, Lake AK, Boyle A, Clark A, Williams J, Rayman G, Dhatariya K. Ambulance clinician use of capillary blood ketone meters to improve emergency hyperglycaemia care: A stepped-wedged controlled, mixed-methods feasibility study. Diabet Med 2024; 41:e15372. [PMID: 38853420 DOI: 10.1111/dme.15372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Abstract
AIM To determine whether it was feasible, safe and acceptable for ambulance clinicians to use capillary blood ketone meters for 'high-risk' diabetic ketoacidosis (DKA) recognition and fluid initiation, to inform the need for a full-powered, multi-centre trial. METHODS Adopting a stepped-wedge controlled design, participants with hyperglycaemia (capillary blood glucose >11.0 mmol/L) or diabetes and unwell were recruited. 'High-risk' DKA intervention participants (capillary blood ketones ≥3.0 mmol/L) received paramedic-led fluid therapy. Participant demographic and clinical data were collated from ambulance and hospital care records. Twenty ambulance and Emergency Department clinicians were interviewed to understand their hyperglycaemia and DKA care experiences. RESULTS In this study, 388 participants were recruited (Control: n = 203; Intervention: n = 185). Most presented with hyperglycaemia, and incidence of type 1 and type 2 diabetes was 18.5% and 74.3%, respectively. Ketone meter use facilitated 'high-risk' DKA identification (control: 2.5%, n = 5; intervention: 6.5%, n = 12) and was associated with improved hospital pre-alerting. Ambulance clinicians appeared to have a high index of suspicion for hospital-diagnosed DKA participants. One third (33.3%; n = 3) of Control and almost half (45.5%; n = 5) of Intervention DKA participants received pre-hospital fluid therapy. Key interview themes included clinical assessment, ambulance DKA fluid therapy, clinical handovers; decision support tool; hospital DKA management; barriers to hospital DKA care. CONCLUSIONS Ambulance capillary blood ketone meter use was deemed feasible, safe and acceptable. Opportunities for improved clinical decision making, support and safety-netting, as well as in-hospital DKA care, were recognised. As participant recruitment was below progression threshold, it is recommended that future-related research considers alternative trial designs. CLINICALTRIALS gov: NCT04940897.
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Affiliation(s)
| | - Thomas Strudwick
- East of England Ambulance Service NHS Trust, Barton Mills, Suffolk, UK
| | - Theresa Foster
- East of England Ambulance Service NHS Trust, Barton Mills, Suffolk, UK
| | - Andrea Kathleen Lake
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Adrian Boyle
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Julia Williams
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Gerry Rayman
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, Suffolk, UK
| | - Ketan Dhatariya
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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18
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Mani ZA, Kuhn L, Plummer V. Core competencies of emergency nurses for the armed conflict context: Experiences from the field. Int Nurs Rev 2024; 71:670-679. [PMID: 37953625 DOI: 10.1111/inr.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Armed conflicts are usually associated with high mortality and morbidity rates, with unpredictable workload, injuries and illnesses. Identifying emergency nurses' views of the core competencies required to enable them to work effectively in hospitals in areas of armed conflict is critical. It is important to inform the requisite standards of care and facilitate the translation of knowledge into safe, quality care. AIM The aim of this study was to identify emergency nurses' perceptions of core competencies necessary to work in hospitals in the context of armed conflict. METHOD A descriptive qualitative phase of a mixed-method study using semi-structured interviews with participants was conducted from June to July 2019. The COREQ guideline for reporting qualitative research was followed. FINDINGS A sample of 15 participants was interviewed. The participant perceptions provided a different perspective of core competencies required for emergency nurses in the context of armed conflict, culminating in four main areas: (i) personal preparedness , (ii) leadership, (iii) communication and (iv) assessment and intervention. CONCLUSION This study identified emergency nurses' perceptions of their core competencies. Personal preparedness, leadership, communication, assessment and intervention were identified as contributing to calmness of character, confidence in care and cultural awareness for care in this setting and were essential for them to work effectively when managing victims of armed conflict in emergency departments. IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY The findings of this study are important and novel because the researchers sought the perspectives of emergency nurses who have experience in receiving patients from armed conflict firsthand. The findings will inform policymakers in those settings regarding standard of care, education and drills for hospital nurses in optimizing armed conflict care response outcomes.
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Affiliation(s)
- Zakaria A Mani
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- College of Nursing, Jazan University, Jazan, Saudi Arabia
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- Monash Health, Clayton, Australia
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, Frankston, Australia
- Federation University Australia, Ballarat, Australia
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Middlemiss L. What are the political and ethical challenges that health professionals face in providing care to undocumented migrants? How should they respond to these challenges? Med Confl Surviv 2024; 40:285-294. [PMID: 39148464 DOI: 10.1080/13623699.2024.2382826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
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Freyer O, Wiest IC, Kather JN, Gilbert S. A future role for health applications of large language models depends on regulators enforcing safety standards. Lancet Digit Health 2024; 6:e662-e672. [PMID: 39179311 DOI: 10.1016/s2589-7500(24)00124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/17/2024] [Accepted: 06/06/2024] [Indexed: 08/26/2024]
Abstract
Among the rapid integration of artificial intelligence in clinical settings, large language models (LLMs), such as Generative Pre-trained Transformer-4, have emerged as multifaceted tools that have potential for health-care delivery, diagnosis, and patient care. However, deployment of LLMs raises substantial regulatory and safety concerns. Due to their high output variability, poor inherent explainability, and the risk of so-called AI hallucinations, LLM-based health-care applications that serve a medical purpose face regulatory challenges for approval as medical devices under US and EU laws, including the recently passed EU Artificial Intelligence Act. Despite unaddressed risks for patients, including misdiagnosis and unverified medical advice, such applications are available on the market. The regulatory ambiguity surrounding these tools creates an urgent need for frameworks that accommodate their unique capabilities and limitations. Alongside the development of these frameworks, existing regulations should be enforced. If regulators fear enforcing the regulations in a market dominated by supply or development by large technology companies, the consequences of layperson harm will force belated action, damaging the potentiality of LLM-based applications for layperson medical advice.
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Affiliation(s)
- Oscar Freyer
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | - Isabella Catharina Wiest
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany; Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jakob Nikolas Kather
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany; Department of Medicine, University Hospital Dresden, Dresden, Germany; Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephen Gilbert
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany.
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Braybrook PJ, Tohira H, Brink D, Finn J, Buzzacott PL. Epidemiology and Severity of Medical Events for Mountain Bikers and Hikers Transported by Ambulance in Western Australia, 2015 to 2020. Wilderness Environ Med 2024; 35:257-265. [PMID: 38634125 DOI: 10.1177/10806032241245966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Outdoor activities offer physical and mental health benefits. However, incidents can occur requiring ambulance transport to hospital. This study aimed to describe the epidemiology and severity of traumatic and medical incidents for mountain bikers and hikers transported by ambulance within Western Australia. METHODS This was a retrospective cohort study of ambulance-transported mountain bikers and hikers within Western Australia from 2015 to 2020. Data were extracted from ambulance electronic patient care records. Multivariable analyses were undertaken to identify variables associated with higher patient severity based on the National Early Warning Score 2 (NEWS2). RESULTS A total of 610 patients required ambulance transport to hospital while mountain biking (n=329; 54%) or hiking (n = 281; 46%). Median age of mountain bikers and hikers was 38 (24-48) y and 49 (32-63) y, respectively. Paramedics reported a fracture in 92 (28%) mountain bikers and 78 (28%) hikers. The predominant injury locations for mountain bikers were upper limbs and for hikers, lower limbs. Cases were trauma related in 92% of mountain bikers and 55% of hikers. A significant association (P<0.001) between the etiology of the ambulance callout and patient severity was found. In trauma etiology cases, the frequency of medium-risk+ NEWS2 severity was 21.4%. In medical cases, the frequency of medium-risk+ severity was 40.8%. CONCLUSION Both mountain bikers and hikers experienced incidents requiring ambulance transport to hospital. Incidents of a medical etiology had a higher clinical risk, as determined by the NEWS2 scores, regardless of activity being undertaken.
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Affiliation(s)
- Paul J Braybrook
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
- St John Western Australia, Belmont, WA, Australia
| | - Hideo Tohira
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
- Discipline of Emergency Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Deon Brink
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
- St John Western Australia, Belmont, WA, Australia
| | - Judith Finn
- Discipline of Emergency Medicine, Medical School, University of Western Australia, Perth, WA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter L Buzzacott
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
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Dewan M, Schachna E, Eastwood K, Perkins G, Bray J. The optimal surface for delivery of CPR: An updated systematic review and meta-analysis. Resusc Plus 2024; 19:100718. [PMID: 39149224 PMCID: PMC11325767 DOI: 10.1016/j.resplu.2024.100718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 08/17/2024] Open
Abstract
Aim To determine the effect of CPR delivery surface (e.g. firm mattress, floor, backboard) on patient outcomes and CPR delivery. Methods We searched MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials for studies published since 2019 that evaluated the effect of CPR delivery surface in adults and children on patient outcomes and CPR depth (PROSPERO CRD42023467583). We included manikin studies due to a lack of human studies. We identified pre-2019 studies from the 2020 ILCOR evaluation of this topic. Two reviewers independently screened titles/abstracts and full-text papers, extracted data and assessed risk of bias. Evidence certainty for each outcome was evaluated using GRADE methodology. Where appropriate, we pooled data in a meta-analysis, using a random-effects model. Results Database searches identified 489 citations. We included six studies published since 2019. We analysed these studies together with the eleven studies included in the previous ILCOR review. All included studies were manikin randomised controlled trials. Certainty of evidence was low. Interventions including placing the patient on the floor or the use of backboard had minimal impact on achieving greater compression depth. Meta-analyses of floor versus firm hospital mattress or firm home mattress found a mean difference of 5.36 mm (95% CI -1.59 to 12.32) and 2.11 mm (95% CI -3.23 to 7.45) respectively. Conclusion The use of a backboard led to a small 2 mm increase in chest compression depth in meta-analysis of multiple mannikin trials. Use of a firm mattress or transitioning to the floor did not affect chest compression depth.
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Affiliation(s)
- Maya Dewan
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ethan Schachna
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Curtin School of Nursing, Curtin University, Perth, Australia
| | - Kathryn Eastwood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gavin Perkins
- MERIT and Enhanced Care Team, West Midlands Ambulance Service NHS University Foundation Trust, Oldbury, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Curtin School of Nursing, Curtin University, Perth, Australia
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Thilakasiri K, Wijegunawardana P, de Silva S, Fernando S, De Silva SL. "1990 Suwa Seriya" the national pre-hospital care ambulance service of Sri Lanka; a narrative review describing the EMS system with special emphasis on Out of Hospital Cardiac Arrest (OHCA) in Sri Lanka. Resusc Plus 2024; 19:100649. [PMID: 38827272 PMCID: PMC11143911 DOI: 10.1016/j.resplu.2024.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Background Sri Lanka is a leading nation in healthcare provision in the South Asia. Notably, it recorded amongst the lowest maternal and neonatal mortality rates in the region. However a significant deficit in improving all-cause mortality rates was the absence of a cohesive system of pre-hospital care. Method This narrative review delves into the evolution of Sri Lanka's Emergency Medical Services (EMS) system over the past decade. It examines the historical context, challenges encountered, and the transformative role of the "1990 Suwa Seriya" ambulance service on all causes of morbidity and mortality rates including out-of-hospital cardiac arrest (OHCA). Results The review elucidates the path from no organised pre-hospital system in 2015 to a comprehensive free to public, pre-hospital care emergency ambulance service that effectively serves 22 million people nationa-wide in 6 short years. Collaborations with emergency medicine, novel approaches to training and credentialing, as well as evolving research initiatives illustrate an approach to be emulated in countries with emerging pre-hospital systems. 1990 Suwa Seriya's response during the COVID-19 pandemic and its implications on public perception are discussed in conjunction with efforts to limit morbidity and mortality from OHCA. Conclusion In conclusion, the article underscores 1990 Suwa Seriya's dedication to continuous improvement and its potential as a model for bolstering emergency healthcare. By addressing challenges, fostering collaborations, and adapting to crises like the COVID-19 pandemic, 1990 Suwa Seriya exemplifies a pathway towards elevating pre-hospital care standards in lower-middle-income countries (LMICs).
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Affiliation(s)
- Kaushila Thilakasiri
- Ministry of Health, Sri Lanka
- Oxford University Hospitals NHS Trust, United Kingdom
| | | | | | - Sanj Fernando
- Liverpool Hospital, Sydney, Australia
- NSW State, NSW Ambulance, Australia
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Barik AK, Gupta A, Mohanty CR, Radhakrishnan RV, Satapathy A. Response to "Fixed dose ketamine for prehospital management of hyperactive delirium with severe agitation". Am J Emerg Med 2024; 83:132-133. [PMID: 38866624 DOI: 10.1016/j.ajem.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Affiliation(s)
- Amiya Kumar Barik
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anju Gupta
- Department of Anesthesia, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, India.
| | | | - Ananya Satapathy
- Department of Anaesthesiology and critical care, All India Institute of Medical Sciences, Bhubaneswar, India
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Mansouri F, Nia MT, Villar R, Cornish SM, Giesbrecht GG. Upper- vs. Whole-Body Cooling During Exercise with Thermal Protective Clothing in the Heat. Aerosp Med Hum Perform 2024; 95:659-666. [PMID: 39169487 DOI: 10.3357/amhp.6434.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
INTRODUCTION: Firefighters operating in hot environments face challenges from protective garments that restrict heat dissipation, resulting in increased core temperature, thermal discomfort, and performance decline. Cooling vests represent a viable solution. The study aim was to compare effectiveness of the same amount of cooling power to the upper body (UB) or whole body (WB) in alleviating thermoregulatory and physiological stress, enhancing cognitive function, and reducing ratings of thermal discomfort and exertion, during 60 min of exercise in a hot environment (40°C, 40% relative humidity) while wearing firefighter turnout gear.METHODS: Eight healthy individuals (27.5 ± 3 y) participated in three conditions with either no cooling (Control) or active cooling with a liquid perfused shirt (UB cooling), or with a liquid perfused shirt and pants (WB cooling). In each trial, subjects performed three sets of 15 min of stepping (20 steps ⋅ min-1) and 5 min of rest.RESULTS: Both cooling strategies were beneficial compared to having no cooling at all. Subjects could only complete two exercise bouts during Control, but they completed all three bouts with active cooling. WB cooling provided an advantage over UB cooling for core and skin temperature, and thermal comfort and sensation. The advantage in minimizing the increase in core temperature was only evident during the third exercise bout.DISCUSSION: Active cooling is advantageous under these conditions. WB cooling provided some benefits vs UB cooling during heavy intensity exercise; however, it is uncertain whether these benefits would be observed during light-to-moderate exercise, which more likely reflects an actual firefighting scenario.Mansouri F, Talebian Nia M, Villar R, Cornish SM, Giesbrecht GG. Upper- vs. whole-body cooling during exercise with thermal protective clothing in the heat. Aerosp Med Hum Perform. 2024; 95(9):659-666.
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Werner K, Stassen W, Theron E, Wallis LA, Lin TK. Patient Preferences for Out-of-Hospital Cardiac Arrest Care in South Africa: A Discrete Choice Experiment. Value Health Reg Issues 2024; 43:101006. [PMID: 38857557 PMCID: PMC11349466 DOI: 10.1016/j.vhri.2024.101006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 03/27/2024] [Accepted: 05/01/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE This study examined the trade-offs low-resource setting community members were willing to make in regard to out-of-hospital cardiac arrest care using a discrete choice experiment survey. METHODS We administered a discrete choice experiment survey to a sample of community members 18 years or older across South Africa between April and May 2022. Participants were presented with 18 paired choice tasks comprised of 5 attributes (distance to closest adequate facility, provider of care, response time, chances of survival, and transport cost) and a range of 3 to 5 levels. We used mixed logit models to evaluate respondents' preferences for selected attributes. RESULTS Analyses were based on 2228 responses and 40 104 choice tasks. Patients valued care with the shortest response time, delivered by the highest qualified individuals, which placed them within the shortest distance of an adequate facility, gave them the highest chance of survival, and costed the least. In addition, patients preferred care delivered by their family members over care delivered by the lay public. The highest mean willingness-to-pay for increased survival is 11 699 South African rand (ZAR), followed by distance to health facility (8108 ZAR), and response time (5678 ZAR), and the lowest for increasing specialization of provider (1287 ZAR). CONCLUSIONS In low-resource settings, it may align with patients' preference to include targeted resuscitation training for family members of individuals with high-risk for cardiac arrest as a part of out-of-hospital cardiac arrest intervention strategies.
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Affiliation(s)
- Kalin Werner
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA; Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa.
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Elzarie Theron
- Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Tracy K Lin
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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Malmin NP, Nostrand EV. Comparison of Laws that Impact Volunteer Response in Three Disaster-Prone Southeastern States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:E247-E254. [PMID: 38865600 DOI: 10.1097/phh.0000000000001965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVE As natural disasters become more frequent and severe, the ability of impacted states to rapidly scale up their capacity to respond and facilitate recovery through volunteers is ever more crucial. However, the legal landscape that may facilitate or hamper augmentation through volunteers has yet to be fully explored. DESIGN This study utilized policy surveillance methodology to code relevant laws identified in searches using the Emergency Law Inventory database and Westlaw. SETTING We assessed laws in three natural disaster-prone states: North Carolina, South Carolina, and Georgia. MAIN OUTCOME MEASURES We assessed the presence of liability protection, license reciprocity, and scope of practice laws for health care volunteers. RESULTS Of the three assessed legal domains, liability protection for health care volunteers across all states contained the most robust language. Liability protections apply unless the health care volunteers act with reckless disregard, willful misconduct, or gross negligence. However, nuance exists based on which organizations (state vs charitable) volunteers are affiliated with to qualify for coverage. License reciprocity for out-of-state specific health care professions entering the impacted states was available across all three states. However, only Georgia enacted federal model legislation that provides additional flexibility regarding credentialing and liability protections. Lastly, very few laws addressed the scope of practice in impacted states. CONCLUSIONS Comparisons of laws that impact the ability of health care volunteers to respond and recover from disasters are scarce. More research needs to be performed to better understand the laws that impact volunteers in emergencies, particularly as the public health system is overtasked when providing services to impacted communities.
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Affiliation(s)
- Natasha Prudent Malmin
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia (Dr Malmin); and Department of Health Service Administration and Policy, Temple University College of Public Health, Philadelphia, Pennsylvania (Dr Nostrand)
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Skaltsis J, Sackett A, Ellis KA, Cohen SA. Learner Perception of Disaster Simulation Modalities: A Pilot Study. Nurse Educ 2024; 49:E275-E279. [PMID: 38330393 DOI: 10.1097/nne.0000000000001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Both simulation and tabletop exercises are used in disaster training, but the efficacy of one approach versus the other is lacking. PURPOSE This pilot study explored the satisfaction, confidence, and perception of effectiveness among nursing students regarding 2 disaster preparedness training methods: simulation and tabletop exercises. METHODS A comparative quasi-experimental design assessed the effectiveness of 2 simulation experiences. Validated effectiveness and confidence survey tools were completed by 126 self-selected senior prelicensure baccalaureate nursing students after the completion of simulation experiences. RESULTS Tabletop exercises may be more effective to build confidence and understand pathophysiology. Full-scale simulations may be more effective in facilitating participant expression of feelings and providing a constructive evaluation of the simulation. CONCLUSIONS Variability among facilitators may have impacted the results of this pilot project. Further research is needed to enhance understanding of the effectiveness of tabletop and full-scale simulations for disaster preparedness in nursing education.
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Affiliation(s)
- Jessica Skaltsis
- Simulation Education Coordinator, Acting Undergraduate Program Coordinator (Ms Skaltsis), and Associate Professor (Dr Cohen), Clinical Assistant Professor, College of Nursing (Drs Sackett and Ellis), and Associate Professor (Dr Cohen), Department of Health Studies, University of Rhode Island, Kingston, Rhode Island
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Wilkinson-Stokes M, Tew M, Yap CYL, Crellin D, Gerdtz M. The Economic Impact of Community Paramedics Within Emergency Medical Services: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:665-684. [PMID: 39017994 PMCID: PMC11339145 DOI: 10.1007/s40258-024-00902-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Globally, emergency medical services (EMSs) report that their demand is dominated by non-emergency (such as urgent and primary care) requests. Appropriately managing these is a major challenge for EMSs, with one mechanism employed being specialist community paramedics. This review guides policy by evaluating the economic impact of specialist community paramedic models from a healthcare system perspective. METHODS A multidisciplinary team (health economics, emergency care, paramedicine, nursing) was formed, and a protocol registered on PROSPERO (CRD42023397840) and published open access. Eligible studies included experimental and analytical observational study designs of economic evaluation outcomes of patients requesting EMSs via an emergency telephone line ('000', '111', '999', '911' or equivalent) responded to by specialist community paramedics, compared to patients attended by usual care (i.e. standard paramedics). A three-stage systematic search was performed, including Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Two independent reviewers extracted and verified 51 unique characteristics from 11 studies, costs were inflated and converted, and outcomes were synthesised with comparisons by model, population, education and reliability of findings. RESULTS Eleven studies (n = 7136 intervention group) met the criteria. These included one cost-utility analysis (measuring both costs and consequences), four costing studies (measuring cost only) and six cohort studies (measuring consequences only). Quality was measured using Joanna Briggs Institute tools, and was moderate for ten studies, and low for one. Models included autonomous paramedics (six studies, n = 4132 intervention), physician oversight (three studies, n = 932 intervention) and/or special populations (five studies, n = 3004 intervention). Twenty-one outcomes were reported. Models unanimously reduced emergency department (ED) transportation by 14-78% (higher quality studies reduced emergency department transportation by 50-54%, n = 2639 intervention, p < 0.001), and costs were reduced by AU$338-1227 per attendance in four studies (n = 2962). One study performed an economic evaluation (n = 1549), finding both that the costs were reduced by AU$454 per attendance (although not statistically significant), and consequently that the intervention dominated with a > 95% chance of the model being cost effective at the UK incremental cost-effectiveness ratio threshold. CONCLUSIONS Community paramedic roles within EMSs reduced ED transportation by approximately half. However, the rate was highly variable owing to structural (such as local policies) and stochastic (such as the patient's medical condition) factors. As models unanimously reduced ED transportation-a major contributor to costs-they in turn lead to net healthcare system savings, provided there is sufficient demand to outweigh model costs and generate net savings. However, all models shift costs from EDs to EMSs, and therefore appropriate redistribution of benefits may be necessary to incentivise EMS investment. Policymakers for EMSs could consider negotiating with their health department, local ED or insurers to introduce a rebate for successful community paramedic non-ED-transportations. Following this, geographical areas with suitable non-emergency demand could be identified, and community paramedic models introduced and tested with a prospective economic evaluation or, where this is not feasible, with sufficient data collection to enable a post hoc analysis.
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Affiliation(s)
- Matt Wilkinson-Stokes
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Michelle Tew
- Melbourne Health Economics, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Celene Y L Yap
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Di Crellin
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Marie Gerdtz
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
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Aurizki GE, Efendi F, Indarwati R, Andriani F, Sari DW, Noguchi-Watanabe M. The Perceptions and Experiences of Older People Living in the Aftermath of Lombok Earthquakes, Indonesia: A Qualitative Study. Int J Older People Nurs 2024; 19:e12640. [PMID: 39148351 DOI: 10.1111/opn.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/11/2024] [Accepted: 07/29/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Despite the growing knowledge of people's vulnerability following natural disasters, the perspective of older people has received limited attention. This study aimed to explore the perceptions and experiences of older people encountering the 2018 Lombok earthquakes. METHODS This exploratory qualitative study involved 16 older people living in one of the villages most affected by the 2018 earthquakes in Lombok Island, Nusa Tenggara Barat, Indonesia. The data were collected in June 2019 using semi-structured interviews. Participants' responses were digitally recorded and transcribed verbatim for analysis. The data were analysed using qualitative content analysis managed in NVivo. RESULTS From older people's perspectives, three themes were generated: surviving the disaster, dealing with life changes and navigating through challenges and hope. Each theme comprised two categories, which reflected the journey of older people from the early to the later phase of the disaster. CONCLUSIONS Older people experienced critical conditions and difficulties both physically and mentally. They also experienced various emotional responses before accepting living situations following a disaster. Nurses should play a role in fulfilling the physical and mental health needs of older people in post-disaster conditions. IMPLICATIONS FOR PRACTICE This study can inform nurses and other key stakeholders about the needs of older people during and after natural disasters. Nurses need to be equipped with the skills and abilities to identify and meet the needs of older people in difficult situations and with limited resources.
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Affiliation(s)
- Gading Ekapuja Aurizki
- Department of Fundamental Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Ferry Efendi
- Department of Advanced Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Retno Indarwati
- Department of Advanced Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Firma Andriani
- Governor Team for Regional Development Acceleration of Nusa Tenggara Barat (TGP2D NTB), Mataram, NTB, Indonesia
| | - Dianis Wulan Sari
- Department of Advanced Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Maiko Noguchi-Watanabe
- Department of Home Health and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Rozel JS, Soliman L. Lessons of the Boom: A Playbook for Crisis Centers to Prevent, Survive, and Respond to Active Assailants, Targeted Violence, and Mass Violence. Psychiatr Clin North Am 2024; 47:547-561. [PMID: 39122345 DOI: 10.1016/j.psc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Modern crisis centers need to be prepared for mass shootings, active assailant incidents, and related forms of targeted violence. While crisis engagement has traditionally been seen as a "right of boom" or post-incident responder, crisis leaders need to prepare their teams to identify people at risk for violence, use tools like Behavioral Threat Assessment and Management to reduce risk in those persons, and prepare their teams for potential incidents in their community. Evidence suggests that acute stressors are a common proximal risk factor for severe violence implying a potential synergy for using crisis services as a tool for prevention of violence.
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Affiliation(s)
- John S Rozel
- Resolve Crisis Services of UPMC Western Behavioral Health, University of Pittsburgh, 333 North Braddock Avenue, Pittsburgh, PA 15208, USA.
| | - Layla Soliman
- Atrium Health - Wake Forest Baptist School of Medicine, 501 Billingsley Road, Charlotte, NC 28211, USA
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Shrestha GS, Battaglini D, Sodhi K, Schultz MJ. Medical Triage: Ethical Implications and Management Strategies. Anesthesiol Clin 2024; 42:457-472. [PMID: 39054020 DOI: 10.1016/j.anclin.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Natural or man-made medical disasters have repeatedly affected human communities. The impact on health care resources may vary depending on the magnitude of each crisis, catastrophe or pandemic, and the resources available. Medical triage protocols serve as invaluable tools to address clinical needs, particularly when resources, including supplies, equipment, and personnel, are limited. Although resources should be allocated to maximize the benefit, resource allocations need to be ethically sound. Existing triage protocols have inherent limitations.
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Affiliation(s)
- Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
| | - Denise Battaglini
- Department of Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
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Davis CA, Lowry C, Billin A, Laskowski-Jones L, Sheets A, Fifer D, Hawkins SC. Wilderness Medical Society Clinical Practice Guidelines for Medical Direction of Search and Rescue Teams. Wilderness Environ Med 2024; 35:314-327. [PMID: 38710506 DOI: 10.1177/10806032241249126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The Wilderness Medical Society convened a panel to review available evidence supporting practices for medical direction of search and rescue teams. This panel included of members of the Wilderness Medical Society Search and Rescue Committee, the National Association of EMS Physicians Wilderness Committee, and leadership of the Mountain Rescue Association. Literature about definitions and terminology, epidemiology, currently accepted best practices, and regulatory and legal considerations was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking.
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Affiliation(s)
- Christopher A Davis
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cassie Lowry
- WMS Search and Rescue Committee, San Diego, CA, USA
| | - Aaron Billin
- Powell Valley Healthcare Emergency Department and Department of Emergency Medicine, Powell, WY, USA
| | - Linda Laskowski-Jones
- Blue Mountain Ski Patrol, Palmerton, PA, and Appalachian Center for Wilderness Medicine, Morganton, NC, USA
| | - Alison Sheets
- Mountain Rescue Association, International Commission on Alpine Rescue MEDCOM, Zurich, Switzerland, and Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - David Fifer
- RedSTAR Wilderness Emergency Medical Services and Eastern Kentucky University Center for Wilderness and Outdoor Public Safety, Richmond, KY, USA
| | - Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Kuntz JC, Moorfield J. Exploring athletes' gendered views of coaches and their impact of coach competency ratings. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 74:102664. [PMID: 38777116 DOI: 10.1016/j.psychsport.2024.102664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/21/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024]
Abstract
This study draws on social role theory, role congruity theory, and the black sheep effect to explore athletes' gendered perceptions of coach competence. The study relied on a sample of 308 New Zealand athletes across sports levels and modalities who completed an online survey. Participants were randomly assigned to one of four vignettes, in which coach gender (female vs. male) and coaching style (communal vs. agentic) were manipulated, and athlete gender was considered. The results show that male and female coaches did not receive significantly different coach competency scores (relational and strategic competencies), that a communal coaching style was linked to higher ratings in both relational and strategic competencies, and that the interplay of athlete gender, coach gender, and gender conforming/non-conforming coaching style did not significantly affect coach competence scores. However, participants' comments to the open-ended question presented at the end of the survey suggest that athletes still hold gendered views of coaching competence at the elite level. We discuss the research and practical implications of our findings.
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Affiliation(s)
- Joana C Kuntz
- University of Canterbury, PB4800, Christchurch, 8140, New Zealand.
| | - Jacqui Moorfield
- University of Canterbury, PB4800, Christchurch, 8140, New Zealand.
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Lengen G, Hugli O, De Ridder D, Guessous I, Ladoy A, Joost S, Carron PN. Spatial dependence of non-traumatic out-of-hospital cardiac arrest in a Swiss region: A retrospective analysis. Resusc Plus 2024; 19:100713. [PMID: 39104443 PMCID: PMC11299561 DOI: 10.1016/j.resplu.2024.100713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 06/28/2024] [Indexed: 08/07/2024] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) incidence and survival often vary within regions according to patient-related and contextual factors. This study aims to establish the overall spatial dependence of incidence, bystander cardiopulmonary resuscitation (BCPR) and 48-h survival of OHCA with their associated demographic and socioeconomic characteristics in a Swiss region. Methods We conducted a retrospective study using data of all OHCAs recorded between 2007 and 2019 in the canton of Vaud and, more specifically, in the Lausanne area. Provision of BCPR and 48-h survival were analysed using Getis-Ord Gi statistics and OHCA incidence by local Moran's I with empirical Bayes standardised rates. Demographic and socioeconomic characteristics were compared between incidence clusters generated by local Moran's I method. Results Significant spatial variations of OHCA incidence, BCPR and 48-h mortality were observed. Although BCPR was statistically more likely in rural areas, 48-h survival was improved in a few main cities. At the cantonal level, postcode areas with a higher incidence of OHCAs were less densely inhabited with lower salary levels, more Swiss citizens, and an older population. At city level, small area variations were detected within urban neighbourhoods. The more affected hectares with more OHCAs were less inhabited, with a better median salary, more Swiss citizens, and off-centre. Conclusions Spatial variations associated with demographic and socioeconomic factors were observed for OHCA incidence and survival, with sparsely populated areas particularly at risk. These data suggest an unmet need for targeted prevention interventions and structural modifications of the existing prehospital system at the cantonal level.
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Affiliation(s)
- Guillaume Lengen
- University of Lausanne, Faculty of Biology and Medicine, 21 Rue du Bugnon, 1005 Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital and University of Lausanne, 46 Rue du Bugnon, 1011 Lausanne, Switzerland
| | - David De Ridder
- Geospatial Molecular Epidemiology Group, Laboratory for Biological Geochemistry, School of Architecture, Civil and Environmental Engineering, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
- Group of Geographic Information Research and Analysis in Population Health, Switzerland
| | - Idris Guessous
- Group of Geographic Information Research and Analysis in Population Health, Switzerland
- Unit of Population Epidemiology, Division and Department of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Anaïs Ladoy
- Geospatial Molecular Epidemiology Group, Laboratory for Biological Geochemistry, School of Architecture, Civil and Environmental Engineering, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
- Group of Geographic Information Research and Analysis in Population Health, Switzerland
| | - Stéphane Joost
- Geospatial Molecular Epidemiology Group, Laboratory for Biological Geochemistry, School of Architecture, Civil and Environmental Engineering, Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
- Group of Geographic Information Research and Analysis in Population Health, Switzerland
- Unit of Population Epidemiology, Division and Department of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
- ‘La Source’ School of Nursing, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, 46 Rue du Bugnon, 1011 Lausanne, Switzerland
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Finke K, Meertens M, Macherey-Meyer S, Heyne S, Braumann S, Baldus S, Lee S, Adler C. Exercise related versus non exercise related out of hospital cardiac arrest - A retrospective single-center study. Resusc Plus 2024; 19:100742. [PMID: 39185282 PMCID: PMC11344011 DOI: 10.1016/j.resplu.2024.100742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/24/2024] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Background Physical activity prevents cardiovascular disease, but it may also trigger acute cardiac events like sudden cardiac death in patients with underlying heart disease. The chance of surviving an out-of-hospital cardiac arrest remains low, despite improving medical treatment and rescue chain. Prior studies signaled increased survival in exercise related out-of-hospital cardiac arrest. Objective The aim of this study was to evaluate the differences between exercise related out-of-hospital cardiac arrest and out-of-hospital cardiac arrest during daily activity in an urban setting. Methods Retrospective analysis of all out-of-hospital cardiac arrests from 2014 to 2021 treated at a cardiac arrest center of a tertiary hospital. The primary outcome was survival to discharge. Secondary outcomes included differences in pre-hospital care, in-hospital treatment, hypoxic ischemic encephalopathy, and laboratory parameters. Results 478 OHCA patients were reviewed of which 432 patients (exercise related 36 (8.4%) vs. daily activity 396 (91.6%)) were included in the analysis. Patients suffering an exercise related arrest were younger (57 vs 65 years, p = 0.002) and mostly male (88.9 vs 74.5%, p = 0.054).The exercise related cohort received bystander cardiopulmonary resuscitation (77.8 vs 53.4%, p = 0.005) to a higher extent and had a shorter no-flow time (1.5 vs 2 min, p = 0.049). Exercise related arrest patients more often presented with a shockable rhythm (80.6 vs 64.1%, p = 0.032).At hospital admission exercise related arrest patients had a higher initial pH (7.24 vs 7.19, p = 0.015). In the exercise related group, a cardiac cause was numerically more frequent compared to the daily activity group (80.6 vs 68.7%, p = 0.09). In both groups myocardial infarction (47.2 vs 43.2%) was the most common cause, but a primary arrhythmic event (33.3 vs 25.5%) was more often documented in exercise related arrest patients. Exercise related arrest was mostly related to endurance training (52.8%) followed by ball sports (19.4%) and occurred directly during exercise in 77.8% of cases. Patients suffering exercise related arrest had higher survival till discharge (66.7 vs 47.7%, p = 0.036). Conclusion Based on this observational data from a highly selected group of out-of-hospital cardiac arrest patients treated at a cardiac arrest center, patients suffering an exercise related out-of-hospital cardiac arrest, differed in substantial characteristics and in the first line response compared to daily activity out-of-hospital cardiac arrest patients. The better survival to discharge of the exercise related out-of-hospital cardiac arrest group might be driven by these beneficial differences. This study underlines the need for public awareness for the importance of a fast first response and a broad distribution of automated external defibrillators in public sport areas since most of the exercise related out-of-hospital cardiac arrest patients presented with a cardiac cause and an initial shockable rhythm.
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Affiliation(s)
- K. Finke
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - M.M. Meertens
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center of Cardiology, Cardiology III - Angiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - S. Macherey-Meyer
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S. Heyne
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S. Braumann
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S. Baldus
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S. Lee
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - C. Adler
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Emergency Department, Leverkusen Medical Center, Leverkusen, Germany
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Bakkaloğlu SA, Delibaş A, Sürmeli Döven S, Taner S, Yavuz S, Erfidan G, Danacı Vatansever E, Aynacı F, Yilmaz K, Taşdemir M, Akacı O, Akıncı N, Güven S, Çiçek N, Dursun I, Keleşoğlu E, Sancaktar M, Alaygut D, Saygılı S, Yavaşcan Ö, Yılmaz A, Gülleroğlu K, Ertan P, Demir BK, Poyrazoğlu H, Pınarbaşı S, Gençler A, Baştuğ F, Günay N, Çeleğen K, Noyan A, Parmaksız G, Avcı B, Çaycı FŞ, Bayrakçı U, Özlü SG, Aksoy ÖY, Yel S, İnal GA, Köse S, Bayazıt AK, Atmış B, Sarıbaş E, Çağlı Ç, Tabel Y, Elmas AT, Zırhlı Selçuk Ş, Demircioğlu Kılıç B, Akbalık Kara M, Büyükçelik M, Balat A, Durucu Tiryaki B, Erdoğdu B, Aksu B, Mahmudova G, Dursun H, Candan C, Göknar N, Mutlubaş F, Çamlar SA, Başaran C, Akbulut BB, Düzova A, Gülhan B, Oruç Ç, Peru H, Alpay H, Türkkan ÖN, Gülmez R, Çelakıl M, Doğan K, Bilge I, Pehlivanoğlu C, Büyükkaragöz B, Leventoğlu E, Alpman N, Zeybek C, Tülpar S, Çiçek Gülşan RY, Kara A, Gürgöze MK, Akyol Önder EN, Özdemir Atikel Y, Pul S, Sönmez F, Yıldız G, Akman S, Elmacı M, Küçük N, Yüksel S, Kavaz A, Nalçacıoğlu H, Alparslan C, Dinçel N, Elhan AH, Sever L. Pediatric kidney care experience after the 2023 Türkiye earthquake. Nephrol Dial Transplant 2024; 39:1514-1522. [PMID: 38327222 DOI: 10.1093/ndt/gfae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. METHOD Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded. RESULTS A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of >120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% at 3000-4000 mL/m2 BSA and only 2% at >4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age >15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume <3000-4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. CONCLUSIONS These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.
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Affiliation(s)
- Sevcan A Bakkaloğlu
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Ali Delibaş
- Mersin University, Faculty of Medicine, Department of Pediatric Nephrology, Mersin, Türkiye
| | - Serra Sürmeli Döven
- Mersin University, Faculty of Medicine, Department of Pediatric Nephrology, Mersin, Türkiye
| | - Sevgin Taner
- Adana City Hospital, Pediatric Nephrology Unit, Adana, Türkiye
| | - Sevgi Yavuz
- Başakşehir Çam ve Sakura City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Gökçen Erfidan
- Diyarbakır Gazi Yaşargil Hospital, Pediatric Nephrology Unit, Diyarbakır, Türkiye
| | | | - Fatma Aynacı
- Mersin City Hospital, Pediatric Nephrology Unit, Mersin, Türkiye
| | - Kenan Yilmaz
- Şanlıurfa Training Hospital, Pediatric Nephrology Unit, Şanlıurfa, Türkiye
| | - Mehmet Taşdemir
- İstinye University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Okan Akacı
- Bursa Yüksek İhtisas Hospital, Pediatric Nephrology Unit, Bursa, Türkiye
| | | | - Serçin Güven
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Neslihan Çiçek
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Ismail Dursun
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Emre Keleşoğlu
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | | | - Demet Alaygut
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Seha Saygılı
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Önder Yavaşcan
- İstanbul Medipol University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Alev Yılmaz
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Kaan Gülleroğlu
- Başkent University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Pelin Ertan
- Manisa Celal Bayar University, Faculty of Medicine, Department of Pediatric Nephrology, Manisa, Türkiye
| | - Belde Kasap Demir
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Hakan Poyrazoğlu
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Seda Pınarbaşı
- Diyarbakır Children's Hospital, Pediatric Nephrology Unit, Diyarbakır, Türkiye
| | - Aylin Gençler
- Harran University, Faculty of Medicine, Department of Pediatric Nephrology, Şanlıurfa, Türkiye
| | - Funda Baştuğ
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Neslihan Günay
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Kübra Çeleğen
- Kayseri City Hospital, Pediatric Nephrology Unit, Kayseri, Türkiye
| | - Aytül Noyan
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Gönül Parmaksız
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | - Begüm Avcı
- Başkent University, Adana Dr Turgut Noyan Training and Research Center, Department of Pediatric Nephrology, Adana, Türkiye
| | | | - Umut Bayrakçı
- Bilkent City Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | - Sare Gülfem Özlü
- Bilkent City Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | | | - Sibel Yel
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Güldane Aylin İnal
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Seçil Köse
- Erciyes University, Faculty of Medicine, Department of Pediatric Nephrology, Kayseri, Türkiye
| | - Aysun Karabay Bayazıt
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Bahriye Atmış
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Emel Sarıbaş
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Çağla Çağlı
- Çukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Türkiye
| | - Yılmaz Tabel
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | - Ahmet Taner Elmas
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | - Şenay Zırhlı Selçuk
- İnönü University, Faculty of Medicine, Department of Pediatric Nephrology, Malatya, Türkiye
| | | | - Mehtap Akbalık Kara
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Mithat Büyükçelik
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Ayşe Balat
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Betül Durucu Tiryaki
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Bilge Erdoğdu
- Gaziantep University, Faculty of Medicine, Department of Pediatric Nephrology, Gaziantep, Türkiye
| | - Bağdagül Aksu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Günay Mahmudova
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Hasan Dursun
- SBÜ Prof. Dr Cemil Taşçıoğlu City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Cengiz Candan
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Nilüfer Göknar
- İstanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Fatma Mutlubaş
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Seçil Arslansoyu Çamlar
- SBÜ İzmir Tepecik Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Cemaliye Başaran
- İzmir Tepecik Hospital, Pediatric Nephrology Unit, İzmir, Türkiye
| | - Burcu Bulum Akbulut
- Acıbadem University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Ali Düzova
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Bora Gülhan
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Çiğdem Oruç
- Hacettepe University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Harun Peru
- Selçuk University, Faculty of Medicine, Department of Pediatric Nephrology, Konya, Türkiye
| | - Harika Alpay
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Özde Nisa Türkkan
- Marmara University Faculty of Medicine, Department of Pediatric Nephrology Pendik Hospital, İstanbul, Türkiye
| | - Rüveyda Gülmez
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Mehtap Çelakıl
- Sakarya University, Faculty of Medicine, Department of Pediatric Nephrology, Sakarya, Türkiye
| | - Kenan Doğan
- Kocaeli University, Faculty of Medicine, Department of Pediatric Nephrology, Kocaeli, Türkiye
| | - Ilmay Bilge
- Koç University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Cemile Pehlivanoğlu
- Koç University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Bahar Büyükkaragöz
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Emre Leventoğlu
- Gazi University, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Nuray Alpman
- Gülhane Hospital, Pediatric Nephrology Unit, Ankara, Türkiye
| | - Cengiz Zeybek
- SBÜ Gülhane Hospital, Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye
| | - Sebahat Tülpar
- Bakırköy Dr Sadi Konuk Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | | | - Aslıhan Kara
- Fırat University, Faculty of Medicine, Department of Pediatric Nephrology, Elazığ, Türkiye
| | - Metin Kaya Gürgöze
- Fırat University, Faculty of Medicine, Department of Pediatric Nephrology, Elazığ, Türkiye
| | | | | | - Serim Pul
- Ümraniye Training and Research Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Ferah Sönmez
- Bezm-i Alem University, Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
| | - Gizem Yıldız
- Dokuz Eylül University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Sema Akman
- Akdeniz University, Faculty of Medicine, Department of Pediatric Nephrology, Antalya, Türkiye
| | - Midhat Elmacı
- Karamanoğlu Mehmetbey University, Faculty of Medicine, Department of Pediatric Nephrology, Karaman, Türkiye
| | - Nuran Küçük
- Kartal Dr Lütfi Kırdar City Hospital, Pediatric Nephrology Unit, İstanbul, Türkiye
| | - Selçuk Yüksel
- Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Pediatric Nephrology, Çanakkale, Türkiye
| | - Aslı Kavaz
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Nephrology, Eskişehir, Türkiye
| | - Hülya Nalçacıoğlu
- Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Nephrology, Samsun, Türkiye
| | - Caner Alparslan
- İzmir Demokrasi University, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Nida Dinçel
- SBÜ İzmir Dr Behçet Uz Hospital, Faculty of Medicine, Department of Pediatric Nephrology, İzmir, Türkiye
| | - Atilla H Elhan
- Ankara University, School of Medicine Department of Biostatistics, Ankara, Türkiye
| | - Lale Sever
- İstanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul, Türkiye
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Bousigues M, Pretalli JB, Vivien B, Lambert C, Outrey J, Khoury A. Damage Control Training: A Cross-sectional Survey of Health care Personnel of French Emergency Medicine Structures. Mil Med 2024; 189:e2257-e2263. [PMID: 39028221 DOI: 10.1093/milmed/usae258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/29/2024] [Accepted: 05/16/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Terrorist threats are a worldwide phenomenon. The injuries caused with military weapons or explosives are multiple and unusual for civilian care services. Damage control (DC) training has then become a critical need. In response to the November 2015 attacks, the French authorities launched a national DC training campaign for emergency care personnel. The aim was to describe the implementation of DC training campaign and its perception according to the respondent's profession, DC teaching levels, and the history of terrorist attacks in the last decade of the hospital center's activities. MATERIALS AND METHODS A survey was distributed to all Casualty Department staff in France. The answers were collected between June 9, 2020 and July 22, 2020. The project was qualified as not involving humans and participation was on voluntary basis. The study is out of the French Jardé law. RESULTS Two-thirds of the 1,525 respondents considered themselves trained in DC (emergency physicians [76.8%], nurse anesthetists [68.1%], and ambulance drivers [65.3%]). Less than half considered their theoretical (41.1%) and practical (44.7%) knowledge excellent or good. More than 95% of the untrained personnel wanted to receive this type of training. Trained personnel were in favor of annual refresher training (95.7%) and training for practical applications (95.1%). Personnel at teaching centers were more frequently trained than personnel at nonteaching centers (respectively 75.3% and 64.3%, P < .0001) and had applied their knowledge significantly more often (50.1% vs. 43.4%, P = .038). They often considered their knowledge to be excellent (respectively 50.8% vs. 42.4%, P = .064). CONCLUSION The training of emergency personnel in DC is far from being generalized in France. Among the trained personnel, it was often deemed insufficient, in theory and in practice. There was an inequity of training in favor of those in teaching centers. It is therefore essential that training in DC techniques in France be continued, generalized, improved, and standardized throughout the country in order to guarantee an optimal response from the health care systems in the event of new terrorist attacks.
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Affiliation(s)
- Maud Bousigues
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, Besançon 25030, France
| | - Jean-Baptiste Pretalli
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, Besançon 25030, France
- INSERM CIC 1431, Besançon University Hospital, Besançon 25030, France
| | - Benoit Vivien
- Intensive Care Unit, Anesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris 75015, France
| | - Christophe Lambert
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, Besançon 25030, France
| | - Justin Outrey
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, Besançon 25030, France
| | - Abdo Khoury
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, Besançon 25030, France
- INSERM CIC 1431, Besançon University Hospital, Besançon 25030, France
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Turner MD, Sapp J. Nord-Ost: Russia's Medical Failure in the 2002 Crisis. Mil Med 2024; 189:228-230. [PMID: 38019675 DOI: 10.1093/milmed/usad467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
The 2002 hostage crisis at a Moscow theater transfixed the attention of the world. While the initial assault, led by Spetsnaz commandos, successfully secured the building, the Russian security force's utter failure at coordinating with medical services led to the preventable deaths of over 100 hostages.
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Affiliation(s)
- Matthew D Turner
- U.S. Army, Emergency Medicine Program, Penn State Hershey S. Milton Medical Center, Hershey, PA 17033, USA
| | - Jason Sapp
- U.S. Army, Transitional Year Program/Department of Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA
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Jeffers KL, Cohen J, Chin E, Thompson N, Tekmal S, Lombardo R, Barlow J, Billstrom A, Aden J, Myers M. Point of Care Ultrasounds Obtained by Novice Physician Assistant Residents (POCUS ON PAR). Mil Med 2024; 189:e2242-e2247. [PMID: 38743577 DOI: 10.1093/milmed/usae219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/19/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION The integration of Point of Care Ultrasound (POCUS) into the care of trauma patients, specifically the E-FAST, has improved the accuracy of initial diagnoses and improved time to surgical intervention in critically ill patients. Physician assistants (PAs) are critically important members of any military trauma resuscitation team and are often team leaders in a pre-hospital setting. They may receive training in ultrasound but there are little data to support their use or evaluate their effectiveness in using POCUS. We designed a study to evaluate the image quality of an E-FAST Exam performed by Emergency Medicine Physician Assistant (EMPA) Fellows and Emergency Medicine (EM) Interns following identical training. Our hypothesis is that image quality obtained by EMPAs will be non-inferior to those images obtained by EM Interns. MATERIALS AND METHODS This is a prospective single-blinded study comparing the image quality of E-FAST exams performed by first year EM interns and first year EMPA fellows. All participants completed standard POCUS training prior to enrollment in the study. A total of 8 EMPAs and 8 EM first year residents completed 10 recorded E-FAST exams to be used as study images. Participants also viewed a 15-question slide show containing images of positive (6) and negative (9) E-FAST exams and recorded their interpretations. Images were reviewed by expert reviewers who were blinded to which images were collected by which group. An image quality score was recorded for each view as well as an overall image quality score. Image quality was rated on a 1 to 5 image quality scale. RESULTS For overall image quality, the mean score for EMPAs was 3.6 ± 0.5 and for EM residents was 3.2 ± 0.5 with statistical significance favoring better image quality from the EMPAs. The time to completion for the EFAST exam for EMPAs was 4.8 ± 1.3 minutes and for interns it was 3.4 ± 1.4 minutes (P value = 0.02). There was no difference in image interpretation quiz scores between the groups (mean score 92% among interns and 95% among PAs). CONCLUSIONS POCUS is an imaging modality which is very portable and relatively inexpensive which makes it ideal for military medicine. PAs are essential members of military trauma teams, and often run an initial trauma resuscitation. Being able to correctly identify patients who have free fluid early in the course of treatment allows for more correct evacuation criteria to ensure the sickest patients get to care the fastest. Although there are limited data to support POCUS use by non-physicians, our data support a growing body of evidence that it is not the profession or baseline medical education that determines an individual's ability to use and incorporate ultrasound into bedside and clinical practice. Our study shows that with training and experience PAs or other members of the military health care team can use the EFAST to better care for trauma patients.
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Affiliation(s)
| | - Jared Cohen
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Eric Chin
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | | | | | - Robyn Lombardo
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Jessica Barlow
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Amie Billstrom
- Marquette University College of Health Sciences Physician Assistant Studies, Milwaukee, WI 53233, USA
| | - James Aden
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Melissa Myers
- Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
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Rajan S, Buttar N, Ladhani Z, Caruso J, Allegrante JP, Branas C. School Violence Exposure as an Adverse Childhood Experience: Protocol for a Nationwide Study of Secondary Public Schools. JMIR Res Protoc 2024; 13:e56249. [PMID: 39196631 DOI: 10.2196/56249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/31/2024] [Accepted: 07/15/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Poor mental health and adverse childhood experiences (ACEs) predict extensive adverse outcomes in youth, including increases in long-term risk for chronic disease and injury, impaired emotional development, and poor academic outcomes. Exposure to school violence, specifically intentional gun violence, is an increasingly prevalent ACE. The anticipation of school shootings has led to the implementation of school safety and security interventions that may increase anxiety, depression, and other indicators of poor mental well-being among students and staff alike. Despite this, the association between exposure to existing school safety interventions and early adolescent student mental health outcomes, while accounting for one's history of ACEs, has not been previously investigated. OBJECTIVE The study protocol described here aims to determine whether there is a significant difference in the prevalence of mental health outcomes, perceived school safety, and academic engagement between adolescent students (grades 6-12) at schools who have experienced a school shooting and those who have not; whether existing interventions to promote school safety and security are associated with poor mental health outcomes among students and school staff; and what the strength of the association between school safety interventions and mental health outcomes among students and teachers is in schools that have experienced a school shooting versus schools that have never experienced a school shooting. METHODS This observational study will collect cross-sectional survey data from a nationwide sample of students, teachers, and principals at 12 secondary public schools across the United States. The participants come from 6 randomly selected exposure schools that have either experienced a recent (<2 years ago) intentional school shooting or have experienced an intentional school shooting less recently (>2 years ago). Data from these schools are being directly compared with 6 secondary schools that have never experienced a school shooting. RESULTS Institutional review board approval for this research project was obtained and the study subsequently began its recruitment and data collection phase in January 2024. Data collection is currently ongoing and the expected completion date is January 2025. The analytic plan is designed to determine if the strength of the association between school safety interventions and mental health outcomes differs among students and school staff in schools with varying levels of school violence exposure. Analyses will be used to evaluate the role of ACEs on the relationships among exposure to an intentional school shooting, exposure to school safety strategies, and student outcomes (ie, mental health and well-being, perceptions of school safety, and educational outcomes). CONCLUSIONS The results from this study promise to generate meaningful and novel findings on the extent to which having a prior history of ACEs moderates the relationships among exposure to intentional school gun violence, school safety strategies, and student outcomes (ie, mental health and well-being, and perceptions of school safety). TRIAL REGISTRATION ClinicalTrials.gov NCT06153316; https://clinicaltrials.gov/study/NCT06153316. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56249.
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Affiliation(s)
- Sonali Rajan
- Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York, NY, United States
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Navjot Buttar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Zahra Ladhani
- Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Jennifer Caruso
- Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York, NY, United States
| | - John P Allegrante
- Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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Faisal HP, Nakayama M. Implementation of the World Health Organization Minimum Dataset for Emergency Medical Teams to Create Disaster Profiles for the Indonesian SATUSEHAT Platform Using Fast Healthcare Interoperability Resources: Development and Validation Study. JMIR Med Inform 2024; 12:e59651. [PMID: 39196270 DOI: 10.2196/59651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/10/2024] [Accepted: 07/21/2024] [Indexed: 08/29/2024] Open
Abstract
Background The National Disaster Management Agency (Badan Nasional Penanggulangan Bencana) handles disaster management in Indonesia as a health cluster by collecting, storing, and reporting information on the state of survivors and their health from various sources during disasters. Data were collected on paper and transferred to Microsoft Excel spreadsheets. These activities are challenging because there are no standards for data collection. The World Health Organization (WHO) introduced a standard for health data collection during disasters for emergency medical teams (EMTs) in the form of a minimum dataset (MDS). Meanwhile, the Ministry of Health of Indonesia launched the SATUSEHAT platform to integrate all electronic medical records in Indonesia based on Fast Healthcare Interoperability Resources (FHIR). Objective This study aims to implement the WHO EMT MDS to create a disaster profile for the SATUSEHAT platform using FHIR. Methods We extracted variables from 2 EMT MDS medical records-the WHO and Association of Southeast Asian Nations (ASEAN) versions-and the daily reporting form. We then performed a mapping process to match these variables with the FHIR resources and analyzed the gaps between the variables and base resources. Next, we conducted profiling to see if there were any changes in the selected resources and created extensions to fill the gap using the Forge application. Subsequently, the profile was implemented using an open-source FHIR server. Results The total numbers of variables extracted from the WHO EMT MDS, ASEAN EMT MDS, and daily reporting forms were 30, 32, and 46, with the percentage of variables matching FHIR resources being 100% (30/30), 97% (31/32), and 85% (39/46), respectively. From the 40 resources available in the FHIR ID core, we used 10, 14, and 9 for the WHO EMT MDS, ASEAN EMT MDS, and daily reporting form, respectively. Based on the gap analysis, we found 4 variables in the daily reporting form that were not covered by the resources. Thus, we created extensions to address this gap. Conclusions We successfully created a disaster profile that can be used as a disaster case for the SATUSEHAT platform. This profile may standardize health data collection during disasters.
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Affiliation(s)
- Hiro Putra Faisal
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan, 81 22-717-7572, 81 22-717-7505
- Department of Physiology, Faculty of Medicine, UIN Syarif Hidayatullah Jakarta, Tangerang Selatan, Indonesia
| | - Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan, 81 22-717-7572, 81 22-717-7505
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Zainal H, Hui XX, Thumboo J, Fong W, Yong FK. Patients' Expectations of Doctors' Clinical Competencies in the Digital Health Care Era: Qualitative Semistructured Interview Study Among Patients. JMIR Hum Factors 2024; 11:e51972. [PMID: 39190915 DOI: 10.2196/51972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/31/2024] [Accepted: 05/05/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Digital technologies have impacted health care delivery globally, and are increasingly being deployed in clinical practice. However, there is limited research on patients' expectations of doctors' clinical competencies when using digital health care technologies (DHTs) in medical care. Understanding these expectations can reveal competency gaps, enhance patient confidence, and contribute to digital innovation initiatives. OBJECTIVE This study explores patients' perceptions of doctors' use of DHTs in clinical care. Using Singapore as a case study, it examines patients' expectations regarding doctors' communication, diagnosis, and treatment skills when using telemedicine, health apps, wearable devices, electronic health records, and artificial intelligence. METHODS Findings were drawn from individual semistructured interviews with patients from outpatient clinics. Participants were recruited using purposive sampling. Data were analyzed qualitatively using thematic analysis. RESULTS Twenty-five participants from different backgrounds and with various chronic conditions participated in the study. They expected doctors to be adept in handling medical data from apps and wearable devices. For telemedicine, participants expected a level of assessment of their medical conditions akin to in-person consultations. In addition, they valued doctors recognizing when a physical examination was necessary. Interestingly, eye contact was appreciated but deemed nonessential by participants across all age bands when electronic health records were used, as they valued the doctor's efficiency more than eye contact. Nonetheless, participants emphasized the need for empathy throughout the clinical encounter regardless of DHT use. Furthermore, younger participants had a greater expectation for DHT use among doctors compared to older ones, who preferred DHTs as a complement rather than a replacement for clinical skills. The former expected doctors to be knowledgeable about the algorithms, principles, and purposes of DHTs such as artificial intelligence technologies to better assist them in diagnosis and treatment. CONCLUSIONS By identifying patients' expectations of doctors amid increasing health care digitalization, this study highlights that while basic clinical skills remain crucial in the digital age, the role of clinicians needs to evolve with the introduction of DHTs. It has also provided insights into how DHTs can be integrated effectively into clinical settings, aligning with patients' expectations and preferences. Overall, the findings offer a framework for high-income countries to harness DHTs in enhancing health care delivery in the digital era.
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Affiliation(s)
- Humairah Zainal
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - Xin Xiao Hui
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fong Kok Yong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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Perera Y, Raitt J, Poole K, Metcalfe D, Lewinsohn A. Non-invasive versus arterial pressure monitoring in the pre-hospital critical care environment: a paired comparison of concurrently recorded measurements. Scand J Trauma Resusc Emerg Med 2024; 32:77. [PMID: 39192296 DOI: 10.1186/s13049-024-01240-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/17/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Blood pressure monitoring is important in the pre-hospital management of critically ill patients. Non-invasive blood pressure (NIBP) measurements are commonly used but the accuracy of standard oscillometric cuff devices may be affected by extremes of physiology and adverse conditions (e.g. vibration) during transport. This study aimed to quantify the accuracy of NIBP measurements amongst patients requiring pre-hospital critical care. METHODS A retrospective cohort study was undertaken using data from patients treated by a pre-hospital critical team between 1st May 2020 and 30th April 2023 that had NIBP measured concurrently with invasive blood pressure (IBP) arterial manometry. An acceptable difference was determined a priori to be < 20mmHg for systolic blood pressure (SBP) and diastolic blood pressure (DBP), and < 10mmHg for mean arterial pressure (MAP). The primary outcome was "pairwise agreement", i.e. the proportion of paired observations that fell within this range of acceptability. Bland-Altman plots were constructed together with 95% limits of agreement to visualise differences between pairs of data. Associations with patient age, reason for critical care, transport status, haemodynamic shock, severe hypertension, and arterial catheter position were explored in univariate analyses and by fitting multivariable logistic regression models. RESULTS There were 2,359 paired measurements from 221 individual patients with a median age of 57. The most frequent reason for transport was cardiac arrest (79, 35.7%). Bland-Altman analyses suggested unacceptably wide limits of agreement with NIBP overestimating both SBP and MAP during hypotension and underestimating these values during hypertension. Haemodynamic shock (SBP < 90mmHg) was independently associated with reduced pairwise agreement for SBP (adjusted odds ratio [aOR] 0.52, 95% CI 0.35 to 0.77), DBP (aOR 0.65, 95% CI 0.42 to 0.99) and MAP (aOR 0.53, 95% CI 0.36 to 0.78) and severe hypertension (SBP > 160mmHg) with reduced pairwise agreement for SBP (aOR 0.17, 95% CI 0.11 to 0.27). There was no association between patient transport and agreement between the methods for SBP, DBP, or MAP. CONCLUSIONS Non-invasive blood pressure measurements are often inaccurate in the pre-hospital critical care setting, particularly in patients with haemodynamic instability. Clinicians should be cautious when interpreting NIBP measurements and consider direct arterial pressure monitoring when circumstances allow.
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Affiliation(s)
- Yani Perera
- Thames Valley Air Ambulance, Stokenchurch House, Oxford Road, Stokenchurch, HP14 3SX, Buckinghamshire, UK
| | - James Raitt
- Thames Valley Air Ambulance, Stokenchurch House, Oxford Road, Stokenchurch, HP14 3SX, Buckinghamshire, UK
- Frimley Health NHS Foundation Trust, Camberley, Surrey, UK
| | - Kurtis Poole
- Thames Valley Air Ambulance, Stokenchurch House, Oxford Road, Stokenchurch, HP14 3SX, Buckinghamshire, UK
| | - David Metcalfe
- Frimley Health NHS Foundation Trust, Camberley, Surrey, UK
- Oxford Trauma & Emergency Care (OxTEC), University of Oxford, Oxford, UK
- Emergency Medicine Research Oxford (EMROx), John Radcliffe Hospital, Oxford, UK
| | - Asher Lewinsohn
- Thames Valley Air Ambulance, Stokenchurch House, Oxford Road, Stokenchurch, HP14 3SX, Buckinghamshire, UK.
- Bedfordshire Hospitals NHS Foundation Trust, Luton, Bedfordshire, UK.
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Hubble MW, Taylor S, Martin M, Houston S, Kaplan GR. Optimal weight-based epinephrine dosing for patients with a low likelihood of survival following out-of-hospital cardiac arrest. Ir J Med Sci 2024:10.1007/s11845-024-03797-0. [PMID: 39190288 DOI: 10.1007/s11845-024-03797-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 08/22/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Cardiac arrest patients presenting with non-shockable rhythms have a low probability of survival, and epinephrine is one of the few pharmaceutical options for this group. The recommended 1.0 mg adult dose is extrapolated from early animal studies and lacks adjustment for patient weight. Although several prior studies have investigated "low-" and "high-" dose epinephrine, none have identified a benefit to either strategy. AIMS To identify an optimal weight-based epinephrine dose for return-of-spontaneous-circulation (ROSC) after a single bolus among patients with low likelihood of survival. METHODS Included were adult patients who experienced a witnessed, non-traumatic out-of-hospital cardiac arrest prior to EMS arrival. Patients with shockable presenting rhythms or receiving bystander CPR were excluded. The AUROC was used to assess the predictive value of epinephrine dose (mg/kg) for ROSC following a single bolus. From the ROC curve, the optimal threshold dosage (OTD) was determined using the Youden Index. A logistic regression model calculated the adjusted odds ratio of OTD on ROSC. RESULTS A total of 2,463 patients met inclusion criteria, of which 190 (7.7%) attained ROSC after the first epinephrine administration. The dosage AUROC for ROSC was 0.603 (p < 0.01). As calculated by the Youden index, the OTD was 0.013 mg/kg. Patients receiving ≥ OTD were more likely to attain ROSC after a single epinephrine bolus (OR = 2.25,p < 0.001). CONCLUSIONS Among patients with a low likelihood of survival, the optimal dose of epinephrine for attaining ROSC with a single bolus of epinephrine was 0.013 mg/kg. These findings should inspire further investigation into optimal dosing strategies for epinephrine.
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Affiliation(s)
- Michael W Hubble
- Department of Emergency Medical Science, Wake Technical Community College, 2901 Holston Lane, Raleigh, NC, 27610, USA.
| | | | - Melisa Martin
- Department of EMS and Health Care Administration, Methodist University, Fayetteville, NC, USA
| | | | - Ginny R Kaplan
- Department of EMS and Health Care Administration, Methodist University, Fayetteville, NC, USA
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Myrskykari H, Nordquist H. Paramedics' experiences and observations: work-related emotions and well-being resources during the initial months of the COVID-19 pandemic-a qualitative study. BMC Emerg Med 2024; 24:152. [PMID: 39183333 PMCID: PMC11346295 DOI: 10.1186/s12873-024-01072-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND As first responders, paramedics are an extremely important part of the care chain. COVID-19 significantly impacted their working circumstances. We examined, according to the experiences and observations of paramedics, (1) what kinds of emotions the Emergency Medical Service (EMS) personnel experienced in their new working circumstances, and (2) what work-related factors became resources for the well-being of EMS personnel during the initial months of the COVID-19 pandemic. METHODS This qualitative study utilized reflective essay material written by experienced, advanced-level Finnish paramedics (n = 30). The essays used in this study were written during the fall of 2020 and reflected the period when Finland had declared a state of emergency (on 17.3.2020) and the Emergency Powers Act was implemented. The data was analyzed using an inductive thematic analysis. RESULTS The emotions experienced by the EMS personnel in their new working circumstances formed three themes: (1) New concerns arose that were constantly present; (2) Surviving without proper guidance; and (3) Rapidly approaching breaking point. Three themes were formed from work-related factors that were identified as resources for the well-being of the EMS personnel. These were: (1) A high level of organizational efficiency was achieved; (2) Adaptable EMS operations; and (3) Encouraging atmosphere. CONCLUSIONS Crisis management practices should be more attentive to personnel needs, ensuring that managerial and psychological support is readily available in crisis situations. Preparedness that ensures effective organizational adaptation also supports personnel well-being during sudden changes in working circumstances.
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Affiliation(s)
- Henna Myrskykari
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Emergency Medical Services, University of Turku and Turku University Hospital, Turku, Finland.
| | - Hilla Nordquist
- Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland
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Shafiei A, Arsalani N, Beyrami Jam M, Khankeh HR. The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study. BMC Emerg Med 2024; 24:153. [PMID: 39183329 PMCID: PMC11346052 DOI: 10.1186/s12873-024-00930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/03/2024] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION Hospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge capacity of hospitals. Accordingly, the present study aimed to assess the effect of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response. METHODS All nursing managers employed at Motahari Hospital in Tehran took part in this interventional pre- and post-test action research study. Ultimately, a total of 20 nursing managers were chosen through a census method and underwent training in hospital capacity fluctuations. The Iranian version of the "Hospital Emergency Response Checklist" was used to measure hospital disaster preparedness and response before and after the intervention. RESULTS The overall hospital disaster preparedness and response score was 184 (medium level) before the intervention and 216 (high level) after the intervention. The intervention was effective in improving the dimensions of hospital disaster preparedness, including "command and control", "triage", "human resources", "communication", "surge capacity", "logistics and supply", "safety and security", and "recovery", but had not much impact on the "continuity of essential services" component. CONCLUSION The research demonstrated that enhancing the disaster preparedness of hospitals can be achieved by training nursing managers using an action research approach. Encouraging their active participation in identifying deficiencies, problems, and weaknesses related to surge capacity, and promoting the adoption and implementation of suitable strategies, can enhance overall hospital disaster preparedness.
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Affiliation(s)
- Alireza Shafiei
- Department of Nursing, University of Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Narges Arsalani
- Iranian Research Center on Aging, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Beyrami Jam
- Department of Pre-Hospital Medical Emergencies, School of Paramedical, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hamid Reza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Yamamoto C, Takita M, Higuchi A, Aizawa M, Konno K, Yamamoto K, Kami M, Tsubokura M. Impact of the Great East Japan Earthquake followed by the nuclear power plant accident on the nursing students' academic progress in Soma, Fukushima, Japan: a retrospective cohort study with questionnaire survey. BMC Nurs 2024; 23:586. [PMID: 39183265 PMCID: PMC11346269 DOI: 10.1186/s12912-024-02225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 08/05/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The Great East Japan Earthquake and the subsequent Fukushima nuclear power plant accident in 2011 posed significant challenges to the educational sector, particularly affecting nursing students in the disaster area. However, to the best of our knowledge, there are no reports on the effects of the natural disaster coupled with the nuclear accident on the nursing students. Therefore, this study aimed to determine the impact of the Fukushima disasters on rate of academic failure events in nursing education. METHODS A retrospective cohort approach was conducted, focusing on 677 students from Soma Nursing School admitted between 2001 and 2017. Four failure events-failure to pass the national examination, student retention, suspension, and withdrawal from school-were compared between three time periods: pre-disaster, early peri-disaster, and later peri-disaster. This analysis was followed by a questionnaire survey among the students and an interview with faculty members to gain further insights. RESULTS Of the student cohort, 17% had at least one failure event. Students in the later peri-disaster phase faced an elevated failure rate at 29%. Variables such as being male, admission during later peri-disaster period, and local pre-admission residence played a significant role in these failure events in multivariate logistic regression analysis (adjusted odds ratio [95% confidence interval, p value]; 2.63 [1.49-4.64, < 0.001], 3.207 [2.00-5.15, < 0.001], and 1.84 [1.12-3.02, 0.02], respectively). CONCLUSIONS This study highlights the impact of the Great East Japan Earthquake and the following nuclear accident on nursing education. The elevated failure rates in the later peri-disaster period emphasize the challenges posed by continuing disaster phases. Thus, there is a need for intensified and tailored strategies in nursing education in disaster-affected regions.
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Affiliation(s)
- Chika Yamamoto
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, 1 hikarigaoka, Fukushima, 960-1295, Japan.
| | - Morihito Takita
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, 1 hikarigaoka, Fukushima, 960-1295, Japan
- Medical Governance Research Institute, Tokyo, Japan
| | - Asaka Higuchi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, 1 hikarigaoka, Fukushima, 960-1295, Japan
| | | | | | - Kana Yamamoto
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, 1 hikarigaoka, Fukushima, 960-1295, Japan
| | | | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, 1 hikarigaoka, Fukushima, 960-1295, Japan
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Pohan RA, Hidayah N, Ramli M, Atmoko A, Akbar S. Enhancing childhood obesity prevention through Milan systemic family therapy. J Public Health (Oxf) 2024; 46:e547-e548. [PMID: 38909169 DOI: 10.1093/pubmed/fdae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024] Open
Affiliation(s)
- Rizky Andana Pohan
- Department of Islamic Guidance and Counseling, Institut Agama Islam Negeri Langsa, Kota Langsa 24416, Aceh, Indonesia
- Department of Guidance and Counseling, Universitas Negeri Malang, Malang, East Java 64145, Indonesia
| | - Nur Hidayah
- Department of Guidance and Counseling, Universitas Negeri Malang, Malang, East Java 64145, Indonesia
| | - M Ramli
- Department of Guidance and Counseling, Universitas Negeri Malang, Malang, East Java 64145, Indonesia
| | - Adi Atmoko
- Department of Guidance and Counseling, Universitas Negeri Malang, Malang, East Java 64145, Indonesia
| | - Sa'dun Akbar
- Department of Guidance and Counseling, Universitas Negeri Malang, Malang, East Java 64145, Indonesia
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Corpuz JCG. Future implications of the West Philippine Sea conflict on public health. J Public Health (Oxf) 2024; 46:e601-e602. [PMID: 38364310 DOI: 10.1093/pubmed/fdae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/24/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Jeff Clyde G Corpuz
- Department of Theology and Religious Education, 2401, De La Salle University, Manila, 1004 Philippines
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