"It's a Burden You Carry": Describing Moral Distress in Emergency Nursing.

PubMed

Wolf, Lisa A; Perhats, Cydne; Delao, Altair M; Moon, Michael D; Clark, Paul R; Zavotsky, Kathleen E

2016-01-01

Moral distress in nursing has been studied in many settings, but there is a paucity of research on moral distress as it manifests in the emergency department. One study suggests a correlation between moral distress and aspects of burnout, and other researchers report that nurses have considered leaving their position or even their profession because of moral distress. Further exploration of these issues may provide insight into their effects on ED patient care and the emergency nursing profession. The purpose of this study was to explore the nature of moral distress as it is experienced and described by emergency nurses. A qualitative, exploratory design was employed using semi-structured focus groups for data collection. Using an iterative process, transcripts were analyzed for emerging themes by the research team. Six researchers analyzed the transcripts using a thematic analysis approach. Themes from the data included dysfunctional practice arena, being overwhelmed, and adaptive/maladaptive coping. Participants described, overall, a profound feeling of not being able to provide patient care as they wanted to. Causes of moral distress in emergency nurses are environment driven, not incident driven, as is described in other settings, and include a high-acuity, high-demand, technical environment with insufficient resources. Interventions should be targeted to improve environmental factors that contribute to the moral distress of emergency nurses. Future research should focus on the development and validation of an instrument to measure moral distress in this setting. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Study on Mine Emergency Mechanism based on TARP and ICS

NASA Astrophysics Data System (ADS)

Xi, Jian; Wu, Zongzhi

2018-01-01

By analyzing the experiences and practices of mine emergency in China and abroad, especially the United States and Australia, normative principle, risk management principle and adaptability principle of constructing mine emergency mechanism based on Trigger Action Response Plans (TARP) and Incident Command System (ICS) are summarized. Classification method, framework, flow and subject of TARP and ICS which are suitable for the actual situation of domestic mine emergency are proposed. The system dynamics model of TARP and ICS is established. The parameters such as evacuation ratio, response rate, per capita emergency capability and entry rate of rescuers are set up. By simulating the operation process of TARP and ICS, the impact of these parameters on the emergency process are analyzed, which could provide a reference and basis for building emergency capacity, formulating emergency plans and setting up action plans in the emergency process.

Servant Leadership Theory and the Emergency Services Student

ERIC Educational Resources Information Center

Russell, Eric James

2014-01-01

This present case study explores the influence a servant leadership class had on a group of emergency service students' understanding of the roles and characteristics of a leader. The setting for the study was a state university in the Western United States. The six participants were undergraduate emergency services majors that underwent a 15-week…

Mental Health Literacy in Emerging Adults in a University Setting: Distinctions between Symptom Awareness and Appraisal

ERIC Educational Resources Information Center

Gagnon, Michelle M.; Gelinas, Bethany L.; Friesen, Lindsay N.

2017-01-01

Despite the high prevalence of mental health concerns in university populations, students are unlikely to seek formal help. The current study examined help-seeking behaviors among emerging adults in a university setting using a mental health literacy framework. Responses from 122 university undergraduates were examined. Students ranged in age from…

48 CFR 52.219-20 - Notice of Emerging Small Business Set-Aside.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Clauses 52.219-20 Notice of Emerging Small Business Set-Aside. As prescribed in 19.1008(b), insert the following provision: Notice of Emerging Small Business Set-Aside (JAN 1991) Offers or quotations under this acquisition are solicited from emerging small business concerns only. Offers that are not from an emerging...

Emergency Protocol and Violence Prevention in a University Setting

ERIC Educational Resources Information Center

Rust, Dylan

2012-01-01

This study analyzed the emergency protocol and violence prevention methods utilized at an American university. The four research questions were: (1) What are the sources of violence at the university? a. How has the university addressed these sources? (2) What constitutes an emergency in the eyes of the university? (3) How do emergency protocols…

Emergency residential care settings: A model for service assessment and design.

PubMed

Graça, João; Calheiros, Maria Manuela; Patrício, Joana Nunes; Magalhães, Eunice Vieira

2018-02-01

There have been calls for uncovering the "black box" of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Teamwork skills in actual, in situ, and in-center pediatric emergencies: performance levels across settings and perceptions of comparative educational impact.

PubMed

Couto, Thomaz Bittencourt; Kerrey, Benjamin T; Taylor, Regina G; FitzGerald, Michael; Geis, Gary L

2015-04-01

Pediatric emergencies require effective teamwork. These skills are developed and demonstrated in actual emergencies and in simulated environments, including simulation centers (in center) and the real care environment (in situ). Our aims were to compare teamwork performance across these settings and to identify perceived educational strengths and weaknesses between simulated settings. We hypothesized that teamwork performance in actual emergencies and in situ simulations would be higher than for in-center simulations. A retrospective, video-based assessment of teamwork was performed in an academic, pediatric level 1 trauma center, using the Team Emergency Assessment Measure (TEAM) tool (range, 0-44) among emergency department providers (physicians, nurses, respiratory therapists, paramedics, patient care assistants, and pharmacists). A survey-based, cross-sectional assessment was conducted to determine provider perceptions regarding simulation training. One hundred thirty-two videos, 44 from each setting, were reviewed. Mean total TEAM scores were similar and high in all settings (31.2 actual, 31.1 in situ, and 32.3 in-center, P = 0.39). Of 236 providers, 154 (65%) responded to the survey. For teamwork training, in situ simulation was considered more realistic (59% vs. 10%) and more effective (45% vs. 15%) than in-center simulation. In a video-based study in an academic pediatric institution, ratings of teamwork were relatively high among actual resuscitations and 2 simulation settings, substantiating the influence of simulation-based training on instilling a culture of communication and teamwork. On the basis of survey results, providers favored the in situ setting for teamwork training and suggested an expansion of our existing in situ program.

Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature.

PubMed

Hood, Natalie; Considine, Julie

2015-08-01

Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings. In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation. EMBASE was searched for keywords 'spinal injury OR 'spinal cord injury' OR 'spine fracture AND 'emergency care' OR 'prehospital care'. There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation. There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

Research Ethics in Emerging Forms of Online Learning: Issues Arising from a Hypothetical Study on a MOOC

ERIC Educational Resources Information Center

Esposito, Antonella

2012-01-01

This paper is concerned with how research ethics is evolving along with emerging online research methods and settings. In particular, it focuses on ethics issues implied in a hypothetical virtual ethnography study aiming to gain insights on participants' experience in an emergent context of networked learning, namely a MOOC--Massive Online Open…

Safety Hazards in Child Care Settings. CPSC Staff Study.

ERIC Educational Resources Information Center

Consumer Product Safety Commission, Washington, DC.

Each year, thousands of children in child care settings are injured seriously enough to need emergency medical treatment. This national study identified potential safety hazards in 220 licensed child care settings in October and November 1998. Eight product areas were examined: cribs, soft bedding, playground surfacing, playground surface…

The attitudes of Ohio dentists and dental hygienists regarding the use of automated external defibrillators in the dental setting--a follow-up study.

PubMed

Pieren, Jennifer A; Gadbury-Amyot, Cindy C; Kandray, Diane P; Van Ness, Christopher J; Mitchell, Tanya Villalpando

2013-06-01

In 2004, the attitudes toward and use of automated external defibrillators (AEDs) by Ohio dental professionals were examined. While willing to use an AED, most did not have access to one. With new AED-related legislation and increased awareness of the benefits of AEDs since the initial study in 2004, the purpose of this study was to document the prevalence of and attitudes toward AED usage in the dental setting 7 years following the initial study. A 2 page survey instrument was mailed to a random sample of 1,629 dentists and 1,801 dental hygienists in Ohio. A 24% overall response rate was achieved (36% dentists and 64% hygienists). Data were analyzed using SPSS. Results indicate 16% of respondents experienced a cardiac emergency in their practice that required contacting emergency personnel. AEDs are available in 48% of dental practices. Comparing the 2004 and 2011 data, statistically significant differences were found between the responses of dentists and dental hygienists. While hygienists reported more positive attitudes toward AEDs than dentists, the majority of all respondents feel AEDs should be mandated in the dental setting. These findings suggest an increase in cardiac emergencies in Ohio dental settings, an increase in the prevalence of AEDs in Ohio dental settings and that the perceptions of dental professionals are changing in favor of the use of AEDs in the dental setting since the 2004 study.

The Drug Abuse Screening Test preserves its excellent psychometric properties in psychiatric patients evaluated in an emergency setting.

PubMed

Giguère, Charles-Édouard; Potvin, Stéphane

2017-01-01

Substance use disorders (SUDs) are significant risk factors for psychiatric relapses and hospitalizations in psychiatric populations. Unfortunately, no instrument has been validated for the screening of SUDs in psychiatric emergency settings. The Drug Abuse Screening Test (DAST) is widely used in the addiction field, but is has not been validated in that particular context. The objective of the current study is to examine the psychometric properties of the DAST administered to psychiatric populations evaluated in an emergency setting. The DAST was administered to 912 psychiatric patients in an emergency setting, of which 119 had a SUD (excluding those misusing alcohol only). The internal consistency, the construct validity, the test-retest reliability and the predictive validity (using SUD diagnoses) of the DAST were examined. The convergent validity was also examined, using a validated impulsivity scale. Regarding the internal consistency of the DAST, the Cronbach's alpha was 0.88. The confirmatory factor analysis showed that the DAST has one underlying factor. The test-retest reliability analysis produced a correlation coefficient of 0.86. ROC curve analyses produced an area under the curve of 0.799. Interestingly, a sex effect was observed. Finally, the convergent validity analysis showed that the DAST total score is specifically correlated with the sensation seeking dimension of impulsivity. The results of this validation study shows that the DAST preserves its excellent psychometric properties in psychiatric populations evaluated in an emergency setting. These results should encourage the use of the DAST in this unstable clinical situation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Epidemiologic Comparison of Injured High School Basketball Athletes Reporting to Emergency Departments and the Athletic Training Setting

PubMed Central

Fletcher, Erica N.; McKenzie, Lara B.; Comstock, R. Dawn

2014-01-01

Context: Basketball is a popular US high school sport with more than 1 million participants annually. Objective: To compare patterns of athletes with basketball-related injuries presenting to US emergency departments from 2005 through 2010 and the high school athletic training setting from the 2005–2011 seasons. Design: Descriptive epidemiology study. Setting: Data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission and the High School Reporting Information Online database. Main Outcome Measure(s): Complex sample weights were used to calculate national estimates of basketball-related injuries for comparison. Patients or Other Participants: Adolescents from 13 to 19 years of age treated in US emergency departments for basketball-related injuries and athletes from 13 to 19 years of age from schools participating in High School Reporting Information Online who were injured while playing basketball. Results: Nationally, an estimated 1 514 957 (95% confidence interval = 1 337 441, 1 692 474) athletes with basketball-related injuries reported to the emergency department and 1 064 551 (95% confidence interval = 1 055 482, 1 073 620) presented to the athletic training setting. Overall, the most frequent injuries seen in the emergency department were lacerations and fractures (injury proportion ratios [IPRs] = 3.45 and 1.72, respectively), whereas those seen in the athletic training setting were more commonly concussions and strains/sprains (IPRs = 2.23 and 1.19, respectively; all P values < .0001). Comparisons of body site and diagnosis combinations revealed additional differences. For example, athletes with lower leg fractures more often presented to the emergency department (IPR = 6.53), whereas those with hand fractures more frequently presented to the athletic training setting (IPR = 1.18; all P values < .0001). Conclusions: Patterns of injury differed among high school basketball players presenting for treatment in the emergency department and the athletic training setting. Understanding differences specific to clinical settings is crucial to grasping the full epidemiologic and clinical picture of sport-related injuries. Certified athletic trainers play an important role in identifying, assessing, and treating athletes with sport-related injuries who might otherwise present to clinical settings with higher costs, such as the emergency department. PMID:24758246

[Substance related disorder in emergency services: Which attitudes?

PubMed

Rica, M; Principe, A; Le Reste, J-Y; Guillou Landreat, M

2017-02-01

Substance related disorders are more prevalent in emergency services than in the general population, about 20% of individuals in emergency care test positive for alcohol. Emergency services are strategic places to identify alcohol misuse. Attitudes to individuals presenting substance related disorders are important in developing therapeutic relationships and applying interventions. This study explores the attitudes of an emergency staff to these individuals across a range of roles, and evolution in face of an addictology care improvement. Data were gathered from an emergency service sample from the emergency department of a general hospital in Morlaix (France). We used a short questionnaire, adapted from previous similar French studies. Twenty-five persons answered the first questionnaire and 18 the second. A self-administrated attitudes questionnaire showed its interest in our study and helped us to identify attitudes and to initiate a reflection on behaviours in emergency care. Moreover, it helped to change attitudes towards individuals presenting substance related disorders. The daily setting of an addictive disorders specialized unit in emergency changed the point of view on addictive disorders of both physicians and nurses. We showed differences in addictive related disorders prevalence perception among patients attending emergency care between the two evaluations. But we also showed that physicians and nurses stressed that it was more difficult to ask patients in emergency care on the second evaluation, after and despite a daily addictive disorders specialized setting. We showed several limits in emergency staff care relationship with patients with substance related disorders. They identified difficulties to talk about addictive disorders, especially in younger and older patients. Regarding literature, we discuss our study limits and different ways of improving addictology care in emergency services. Copyright © 2015 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Management of trauma pain in the emergency setting: low-dose methoxyflurane or nitrous oxide? A systematic review and indirect treatment comparison.

PubMed

Porter, Keith M; Siddiqui, Mohd Kashif; Sharma, Ikksheta; Dickerson, Sara; Eberhardt, Alice

2018-01-01

Low-dose methoxyflurane and nitrous oxide (N 2 O; 50:50 with oxygen) are both self-administered, self-titrated, rapid-acting, nonnarcotic, and noninvasive inhalational agents with similar onset times of pain relief. The aim of this review was to compare the clinical efficacy, safety, and tolerability of these analgesics in emergency care. A systematic literature search and review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were performed using Embase, Medline, the Cochrane Library, several clinical trial registers, and emergency-medicine conference material. Although both compounds have been used for many years in emergency care, the search found only a few controlled studies and no head-to-head trials performed in this setting. Two double-blind, randomized studies comparing their respective study medication (low-dose methoxyflurane or N 2 O) to placebo were identified that could be compared in an indirect approach by using placebo as a bridging comparator. Both agents provided rapid pain relief to trauma patients, with no significant differences between them; both treatments were generally well tolerated. Both low-dose methoxyflurane and N 2 O are suitable options for the pain treatment of trauma patients in the emergency setting. Due to the ease of administration and portability, inhaled low-dose methoxyflurane, however, may not only offer advantages in emergency situations in remote or difficult-to-reach locations and mass-casualty situations but also be of significant value in urban and rural environments.

Knowledge translation studies in paediatric emergency medicine: A systematic review of the literature.

PubMed

Wilson, Catherine L; Johnson, David; Oakley, Ed

2016-02-01

Systematic review of knowledge translation studies focused on paediatric emergency care to describe and assess the interventions used in emergency department settings. Electronic databases were searched for knowledge translation studies conducted in the emergency department that included the care of children. Two researchers independently reviewed the studies. From 1305 publications identified, 15 studies of varied design were included. Four were cluster-controlled trials, two patient-level randomised controlled trials, two interrupted time series, one descriptive study and six before and after intervention studies. Knowledge translation interventions were predominantly aimed at the treating clinician, with some targeting the organisation. Studies assessed effectiveness of interventions over 6-12 months in before and after studies, and 3-28 months in cluster or patient level controlled trials. Changes in clinical practice were variable, with studies on single disease and single treatments in a single site showing greater improvement. Evidence for effective methods to translate knowledge into practice in paediatric emergency medicine is fairly limited. More optimal study designs with more explicit descriptions of interventions are needed to facilitate other groups to effectively apply these procedures in their own setting. © 2016 The Authors Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Emergency department care for trauma patients in settings of active conflict versus urban violence: all of the same calibre?

PubMed

Valles, Pola; Van den Bergh, Rafael; van den Boogaard, Wilma; Tayler-Smith, Katherine; Gayraud, Olivia; Mammozai, Bashir Ahmad; Nasim, Masood; Cheréstal, Sophia; Majuste, Alberta; Charles, James Philippe; Trelles, Miguel

2016-11-01

Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts. A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014. 31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians' maximum working capacity was exceeded in both centres, and mainly during rush hours. This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Cardiovascular emergencies in primary care: an observational retrospective study of a large-scale telecardiology service.

PubMed

Marcolino, Milena Soriano; Santos, Thales Matheus Mendonça; Stefanelli, Fernanda Cotrim; Oliveira, João Antonio de Queiroz; E Silva, Maíra Viana Rego Souza; Andrade, Diomildo Ferreira; Silva, Grace Kelly Matos E; Ribeiro, Antonio Luiz

2017-01-01

Electrocardiograms (ECGs) are an essential examination for identification and management of cardiovascular emergencies.The aim of this study was to report on the frequency and recognition of cardiovascular emergencies in primary care units. Observational retrospective study assessing consecutive patients whose digital ECGs were sent for analysis to the team of the Telehealth Network of Minas Gerais. Data from patients diagnosed with cardiological emergencies in the primary care setting of 750 municipalities in Minas Gerais, Brazil, between March and September 2015, were collected via telephone contact with the healthcare practitioner who performed the ECG. After collection, the data were subjected to statistical analysis. Over the study period, 304 patients with cardiovascular emergencies were diagnosed within primary care. Only 73.4% of these were recognized by the local physicians. Overall, the most frequent ECG abnormalities were acute ischemic patterns (44.7%) and the frequency of such patterns was higher among the ECGs assigned as emergency priority (P = 0.03). It was possible to obtain complete information on 231 patients (75.9%). Among these, the mean age was 65 ± 14.4 years, 57.1% were men and the most prevalent comorbidity was hypertension (68.4%). In total, 77.9% were referred to a unit caring for cases of higher complexity and 11.7% of the patients died. In this study, cardiovascular emergencies were misdiagnosed in primary care settings, acute myocardial ischemia was the most frequent emergency and the mortality rate was high.

Emergent symbolic relations in speakers and nonspeakers.

PubMed

Brady, N C; McLean, L K

2000-01-01

Eight adults with developmental disabilities and four typically developing preschool children participated in an experiment studying emergent stimulus-stimulus relations after match-to-sample instruction. Participants were taught to match lexigrams (arbitrary graphic stimuli) to objects. Each object was functionally related to another object in the teaching set. For example, brush and comb were members of the teaching set. Most participants were able to select objects when the objects were named in pretests. Postteaching probes assessed emergent relations between spoken names and lexigrams. In addition, we included probes to detect emergent relations between related lexigrams. That is, would participants select the lexigram for comb when the experimenter displayed the lexigram for brush (without explicit teaching)? Two preschool children and five adults with developmental disabilities showed emergent relations between lexigrams and spoken words. However, only two preschool children showed the emergent lexigram to related lexigram relations.

Child protection assessment in humanitarian emergencies: case studies from Georgia, Gaza, Haiti and Yemen.

PubMed

Ager, Alastair; Blake, Courtney; Stark, Lindsay; Daniel, Tsufit

2011-12-01

The paper reviews the experiences of conducting child protection assessments across four humanitarian emergencies where violence and insecurity, directly or indirectly, posed a major threat to children. We seek to identify common themes emerging from these experiences and propose ways to guide the planning and implementation of assessments that effectively identify, and suggest means of response to, threats to children's rights and well-being in emergency settings. In the context of a field evaluation of an inter-agency resource kit, crisis settings where an inter-agency assessment of child protection had been considered in the period August 2008 to July 2010 were identified. Email correspondence, telephone-based structured interviews and documentary review collated information from child protection coordinating agencies from a total of twenty sites, the minority of which had proceeded to complete an assessment. This paper presents case studies of the experience in Georgia (following the conflict between Russian and Georgian forces in August 2008), Gaza (following the Israeli military incursion beginning in December 2008), Haiti (following the earthquake of January 2010), and Yemen (following the ceasefire agreement between the government and rebel forces in early 2010). CASE STUDY FINDINGS: In each setting the context of the humanitarian emergency is outlined. The processes of the planning (and, where appropriate, implementation) of the child protection assessment is described. Where available, the findings of the child protection assessment and their use in shaping interventions are summarized. Case studies document experience across humanitarian settings widely divergent in terms of the nature of the emergency, social-political context, and institutional capacity. Despite such differences, analysis suggests securing inter-agency coordination, preparation and capacity building, and means of ensuring timeliness of findings to be recurrent themes in the effective mobilization of an effective assessment able to inform programming. Copyright © 2011 Elsevier Ltd. All rights reserved.

Safety of Rural Nursing Home-to-Emergency Department Transfers: Improving Communication and Patient Information Sharing Across Settings.

PubMed

Tupper, Judith B; Gray, Carolyn E; Pearson, Karen B; Coburn, Andrew F

2015-01-01

The "siloed" approach to healthcare delivery contributes to communication challenges and to potential patient harm when patients transfer between settings. This article reports on the evaluation of a demonstration in 10 rural communities to improve the safety of nursing facility (NF) transfers to hospital emergency departments by forming interprofessional teams of hospital, emergency medical service, and NF staff to develop and implement tools and protocols for standardizing critical interfacility communication pathways and information sharing. We worked with each of the 10 teams to document current communication processes and information sharing tools and to design, implement, and evaluate strategies/tools to increase effective communication and sharing of patient information across settings. A mixed methods approach was used to evaluate changes from baseline in documentation of patient information shared across settings during the transfer process. Study findings showed significant improvement in key areas across the three settings, including infection status and baseline mental functioning. Improvement strategies and performance varied across settings; however, accurate and consistent information sharing of advance directives and medication lists remains a challenge. Study results demonstrate that with neutral facilitation and technical support, collaborative interfacility teams can assess and effectively address communication and information sharing problems that threaten patient safety.

Young women's accounts of factors influencing their use and non-use of emergency contraception: in-depth interview study

PubMed Central

Free, Caroline; Lee, Raymond M; Ogden, Jane

2002-01-01

Objectives To explore young women's accounts of their use and non-use of emergency contraception. Design Qualitative study using in-depth interviews. Participants 30 women aged 16-25; participants from socially deprived inner city areas were specifically included. Setting Community, service, and educational settings in England. Results Young women's accounts of their non-use of emergency contraception principally concerned evaluations of the risk conferred by different contraceptive behaviours, their evaluations of themselves in needing emergency contraception, and personal difficulties in asking for emergency contraception. Conclusions The attitudes and concerns of young women, especially those from disadvantaged backgrounds, may make them less able or willing than others to take advantage of recent increases in access to emergency contraception. Interventions that aim to increase the use of emergency contraception need to address the factors that influence young women's non-use of emergency contraception. What is already known on this topicLimited knowledge of, or poor access to, emergency contraception, and concerns about side effects and moral issues may reduce the use of emergency contraception in women at riskYoung people can be embarrassed about using contraception servicesInterventions to increase knowledge of and access to emergency contraception have had limited success among teenagersWhat this study addsPerceptions of low vulnerability to pregnancy, negative self evaluations about the need for such contraception, and concerns about what others think deter young women from using emergency contraceptionThese women find it difficult to ask for emergency contraceptionThe attitudes and concerns of young women, especially those from deprived inner city areas, may render them least willing and able to obtain emergency contraception PMID:12480855

Factors Contributing to the Uptake and Maintenance of Regular Exercise Behaviour in Emerging Adults

ERIC Educational Resources Information Center

Langdon, Jody; Johnson, Chad; Melton, Bridget

2017-01-01

Objective: To identify the influence of parental autonomy support, basic need satisfaction and motivation on emerging adults' physical activity level and exercise behaviours. Design: Cross-sectional survey. Setting: This study convenience-sampled approximately 435 college students identified as emerging adults--aged 18-25 years, who did not have a…

Knowledge of Good Blood Culture Sampling Practice among Healthcare Staffs in An Emergency Department - Are We Getting It Right?

PubMed

Chew, K S; Mohd Hashairi, F; Jusoh, A F; Aziz, A A; Nik Hisamuddin, N A R; Siti Asma, H

2013-08-01

Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice. All healthcare staffs in emergency department, HUSM who consented to this study were given a set of selfadministered anonymous questionnaire to fill. More than half (53.1%) of the 64 participants are emergency medicine residents. Majority of them (75%) have been working in the emergency medicine, HUSM for more than 2 years. More than half of them were able to answer correctly the amount of blood volume needed for culture in adult and pediatric patients. When asked what are the factors required to improve the true yield as well as to reduce the risk of culture contamination, the four commonest answers given were observing proper aseptic technique during blood sampling, donning sterile glove, proper hand scrubbing as well as ensuring the sterility of the equipments. This study suggests that there is a lack of proper knowledge of good blood culture sampling practice among our healthcare staffs in emergency department.

Antibacterial cleaning and hygiene products as an emerging risk factor for antibiotic resistance in the community.

PubMed

Aiello, Allison E; Larson, Elaine

2003-08-01

Antibiotic resistance within the community setting is an emerging public-health concern. Infection with antibiotic-resistant organisms in the community among people lacking traditional risk factors has been reported. In addition, prevalence studies have identified individuals carrying antibiotic-resistant organisms in the absence of known risk factors. These studies strongly suggest the presence of contributing factors that have yet to be identified. In this paper we review the burden of antibiotic resistance and known risk factors within the community setting, assess the potential role of antibacterial cleaning and hygiene products containing triclosan in the emergence of resistance, and recommend future research on the assessment of household cleaning and hygiene products containing triclosan.

Factors relating to the perceived management of emergency situations: a survey of former Advanced Life Support course participants' clinical experiences.

PubMed

Rasmussen, Maria B; Tolsgaard, Martin G; Dieckmann, Peter; Issenberg, S Barry; Ostergaard, Doris; Søreide, Eldar; Rosenberg, Jens; Ringsted, Charlotte V

2014-12-01

This study explored individual, team, and setting factors associated with the quality of management of in-hospital emergency situations experienced by former Advanced Life Support (ALS) course participants. This study was a survey of former ALS course participants' long-term experience of management of in-hospital, emergency situations. The survey was carried out in 2012 in Denmark and Norway. A questionnaire was send to 526 potential responders and (281/479 × 100) 58.7% responded. The results demonstrated that 75% of the emergency situations were perceived as "managed well". In general, the responders' confidence in being ALS providers was high, mean 4.3 (SD 0.8), scale 1-5. Significant differences between the perceived "well" and "not well" managed situations were found for all questions, p<0.001. The largest differences related to perception of co-workers' ability to apply ALS principles, the team atmosphere and communication. Responders' ratings of quality of management of emergency situations increased with intensity of setting. However, the 'clinical setting' was rated significantly lower as attributor to ability to apply ALS principles compared to 'co-workers familiarity with ALS principles', 'own confidence as ALS-provider' and 'own social/inter-personal skills'. The results of this survey emphasise that ALS providers' perceived ability to apply ALS skills were substantially affected by teamwork skills and co-workers' skills. Team related factors associated with successful outcome were related to clear role distribution, clear inter-personal communication and attentive listening, as well as respectful behaviour and positive team atmosphere. Although intensity of setting was attributed to ability to apply ALS principles, this did not affect management of emergency situations to the same extent as individual and team factors. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

48 CFR 5119.1070-2 - Emerging small business set-aside.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Emerging small business set... ACQUISITION REGULATIONS SMALL BUSINESS AND SMALL DISADVANTAGED BUSINESS CONCERNS Small Business Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations for...

The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system.

PubMed

Mortaro, Alberto; Pascu, Diana; Zerman, Tamara; Vallaperta, Enrico; Schönsberg, Alberto; Tardivo, Stefano; Pancheri, Serena; Romano, Gabriele; Moretti, Francesca

2015-07-01

The role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives. An ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010. During the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population. Despite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a "learning organization" and improve both efficacy and safety of first aid care.

Clinician Attitudes Toward Adoption of Pediatric Emergency Telemedicine in Rural Hospitals.

PubMed

Ray, Kristin N; Felmet, Kathryn A; Hamilton, Melinda F; Kuza, Courtney C; Saladino, Richard A; Schultz, Brian R; Watson, R Scott; Kahn, Jeremy M

2017-04-01

Although there is growing evidence regarding the utility of telemedicine in providing care for acutely ill children in underserved settings, adoption of pediatric emergency telemedicine remains limited, and little data exist to inform implementation efforts. Among clinician stakeholders, we examined attitudes regarding pediatric emergency telemedicine, including barriers to adoption in rural settings and potential strategies to overcome these barriers. Using a sequential mixed-methods approach, we first performed semistructured interviews with clinician stakeholders using thematic content analysis to generate a conceptual model for pediatric emergency telemedicine adoption. Based on this model, we then developed and fielded a survey to further examine attitudes regarding barriers to adoption and strategies to improve adoption. Factors influencing adoption of pediatric emergency telemedicine were identified and categorized into 3 domains: contextual factors (such as regional geography, hospital culture, and individual experience), perceived usefulness of pediatric emergency telemedicine, and perceived ease of use of pediatric emergency telemedicine. Within the domains of perceived usefulness and perceived ease of use, belief in the relative advantage of telemedicine was the most pronounced difference between telemedicine proponents and nonproponents. Strategies identified to improve adoption of telemedicine included patient-specific education, clinical protocols for use, decreasing response times, and simplifying the technology. More effective adoption of pediatric emergency telemedicine among clinicians will require addressing perceived usefulness and perceived ease of use in the context of local factors. Future studies should examine the impact of specific identified strategies on adoption of pediatric emergency telemedicine and patient outcomes in rural settings.

Perceptions of emergency department staff of the role of physiotherapists in the system: a qualitative investigation.

PubMed

Lefmann, S A; Sheppard, L A

2014-03-01

To investigate the perceptions of doctors, nurses and physiotherapists of emergency department physiotherapy for acute patients, and explore the scope of its contribution in an otherwise nontraditional allied health setting in Australia. Qualitative investigation using semi-structured interviews. A large, metropolitan tertiary hospital with a well-established emergency department physiotherapy/allied health network in place. Two emergency department doctors, two emergency department nurses and two senior physiotherapists working in an emergency department were recruited purposefully from the study hospital. Semi-structured interviews lasting from 20 minutes to 1 hour were conducted with each participant by the lead investigator. Data were analysed using NVivo software, coded manually and verified with member checking, facilitating constant case comparisons. Issues explored included defining the role of physiotherapists, uncovering organisational themes from the introduction of physiotherapy into the established emergency department setting, and conflicts around preserving and expanding an allied health identity in a highly-medicalised clinical environment. Participants described the benefits of having physiotherapists located in the emergency department, and the physiotherapists were eager to advance their roles and responsibilities, but were, at times, restricted by a complicated organisational landscape influencing professional autonomy and capacity for professional advocacy. Ongoing evidence supporting the breadth of physiotherapy practice in the emergency department is needed to further advocate the usefulness of the profession in this acute setting. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Randomization Methods in Emergency Setting Trials: A Descriptive Review

ERIC Educational Resources Information Center

Corbett, Mark Stephen; Moe-Byrne, Thirimon; Oddie, Sam; McGuire, William

2016-01-01

Background: Quasi-randomization might expedite recruitment into trials in emergency care settings but may also introduce selection bias. Methods: We searched the Cochrane Library and other databases for systematic reviews of interventions in emergency medicine or urgent care settings. We assessed selection bias (baseline imbalances) in prognostic…

Emergent Writing in Preschoolers: Preliminary Evidence for a Theoretical Framework

ERIC Educational Resources Information Center

Puranik, Cynthia S.; Lonigan, Christopher J.

2014-01-01

Researchers and educators use the term "emergent literacy" to refer to a broad set of skills and attitudes that serve as foundational skills for acquiring success in later reading and writing; however, models of emergent literacy have generally focused on reading and reading-related behaviors. Hence, the primary aim of this study was to…

Nurses' Comfort Level with Emergency Interventions in the Rural Hospital Setting

ERIC Educational Resources Information Center

Ross, Erin L.; Bell, Sue E.

2009-01-01

Context: One quarter of the persons living in the United States receive their emergency care in a rural hospital. Nurses employed in these hospitals see few emergencies but must be prepared to provide expert and efficient care when they do occur. Purpose: The purpose of this study was to determine the influence of registered nurses' certifications…

Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya

PubMed Central

Burke, Thomas F; Hines, Rosemary; Ahn, Roy; Walters, Michelle; Young, David; Anderson, Rachel Eleanor; Tom, Sabrina M; Clark, Rachel; Obita, Walter; Nelson, Brett D

2014-01-01

Objective Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting. Methods We conducted an assessment within all 30 primary and secondary hospitals and within a stratified random sampling of 30 dispensaries and health centres in western Kenya. The key informants were the most senior facility healthcare provider and manager available. Emergency physician researchers utilised a semistructured assessment tool, and data were analysed using descriptive statistics and thematic coding. Results No lower level facilities and 30% of higher level facilities reported having a defined, organised approach to trauma. 43% of higher level facilities had access to an anaesthetist. The majority of lower level facilities had suture and wound care supplies and gloves but typically lacked other basic trauma supplies. For cardiac care, 50% of higher level facilities had morphine, but a minority had functioning ECG, sublingual nitroglycerine or a defibrillator. Only 20% of lower level facilities had glucometers, and only 33% of higher level facilities could care for diabetic emergencies. No facilities had sepsis clinical guidelines. Conclusions Large gaps in essential emergency care capabilities were identified at all facility levels in western Kenya. There are great opportunities for a universally deployed basic emergency care package, an advanced emergency care package and facility designation scheme, and a reliable prehospital care transportation and communications system in resource-limited settings. PMID:25260371

The effects of single versus mixed gender treatment for adolescent girls with ADHD.

PubMed

Babinski, Dara E; Sibley, Margaret H; Ross, J Megan; Pelham, William E

2013-01-01

This study evaluated the social behavior of adolescents with attention deficit hyperactivity disorder (ADHD) in single and mixed gender treatment settings. We collected ratings of social behavior (i.e., prosocial peer interactions, assertiveness, self-management, compliance, physical aggression, relational aggression) during single and mixed gender games within the Summer Treatment Program-Adolescent for 10 girls (M age = 13.17, 80% Hispanic) and 11 boys (M age = 12.89, 54.55% Hispanic). Counselors completed ratings immediately following 10 recreational periods for each adolescent they supervised (5 single gender games, 5 mixed gender games). Gender (female vs. male) × Setting (single vs. mixed gender) ANOVAs were conducted. If a significant interaction emerged, post hoc tests were also conducted. Several Gender × Setting interactions emerged, suggesting that girls benefit more from single gender formats than mixed gender formats. Girls showed more assertiveness, self-management, and compliance in single compared to mixed gender settings. A somewhat different pattern of results emerged for boys, which showed more appropriate social behavior (i.e., self-management, compliance) and less inappropriate social behavior (i.e., physical and relational aggression) in mixed gender settings compared to single gender settings. In contrast to previous ADHD treatment studies, these findings suggest that gender may impact treatment response for adolescents. Therefore, it is important that future studies evaluate whether current treatments for ADHD are appropriate for girls with ADHD and whether gender-specific treatments are necessary to address the unique difficulties of adolescent girls with ADHD.

The effects of single versus mixed gender treatment for adolescent girls with ADHD

PubMed Central

Babinski, Dara E.; Sibley, Margaret H.; Ross, J. Megan; Pelham, William E.

2013-01-01

Objective This study evaluated the social behavior of adolescents with ADHD in single and mixed gender treatment settings. Method We collected ratings of social behavior (i.e., prosocial peer interactions, assertiveness, self-management, compliance, physical aggression, relational aggression) during single and mixed gender games within the Summer Treatment Program-Adolescent (STP-A) for 10 girls (mean age 13.17, 80% Hispanic) and 11 boys (mean age 12.89, 54.55% Hispanic). Counselors completed ratings immediately following 10 recreational periods for each adolescent they supervised (5 single gender games, 5 mixed gender games). Gender (female versus male) x setting (single versus mixed gender) ANOVAs were conducted. If a significant interaction emerged, post hoc tests were also conducted. Results Several gender by setting interactions emerged, suggesting that girls benefit more from single gender formats than mixed gender formats. Girls showed more assertiveness, self-management, and compliance in single compared to mixed gender settings. A somewhat different pattern of results emerged for boys, which showed more appropriate social behavior (i.e., self-management, compliance) and less inappropriate social behavior (i.e., physical and relational aggression) in mixed gender settings compared to single gender settings. Conclusions In contrast to previous ADHD treatment studies, these findings suggest that gender may impact treatment response for adolescents. Therefore, it is important that future studies evaluate whether current treatments for ADHD are appropriate for girls with ADHD, and if gender-specific treatments are necessary to address the unique difficulties of adolescent girls with ADHD. PMID:23330787

Promising Practices: A Case Study on Public Health Emergency Preparedness at a University

ERIC Educational Resources Information Center

Mathes, Amy L.

2013-01-01

There is little published literature on operational coordination during a real time disaster regardless of the setting. This study describes a university's emergency management plan and its execution in response to a specific natural disaster, the May 8, 2009 "inland hurricane," which was later classified as a "Super Derecho."…

Emergency department-based interventions for women suffering domestic abuse: a critical literature review.

PubMed

Ansari, Sereena; Boyle, Adrian

2017-02-01

Domestic abuse represents a serious public health and human rights concern. Interventions to reduce the risk of abuse include staff training and standardized documentation improving detection and adherence to referral pathways. Interventional studies have been conducted in primary care, maternity and outpatient settings. Women disclosing abuse in emergency departments differ from women attending other healthcare settings, and it is unclear whether these interventions can be transferred to the emergency care setting. This review examines interventional studies to evaluate the effectiveness of emergency department-based interventions in reducing domestic abuse-related morbidity. Medline, EMBASE, CINAHL, PsycINFO and Cochrane Library were searched, according to prespecified selection criteria. Study quality was assessed using the Jadad scale. Of 273 search results, nine were eligible for review. Interventions involving staff training demonstrated benefits in subjective measures, such as staff knowledge regarding abuse, but no changes in clinical practice, based on detection and referral rates. When staff training was implemented in conjunction with supporting system changes - for example, standardized documentation for assessment and referral - clinically relevant improvements were noted. Interventions centred around staff training are insufficient to bring about improvements in the management and, thus, outcome of patients suffering abuse. Instead, system changes, such as standardized documentation and referral pathways, supported by training, may bring about beneficial changes. It remains uncertain whether surrogate outcomes employed by most studies translate to changes in abuse-related morbidity: the ultimate goal.

Under-Resourced, Undervalued, and Underutilized: Making the Case for Teachers in Refugee and Emergency Contexts

ERIC Educational Resources Information Center

West, Amy R.; Ring, Hannah Reeves

2015-01-01

Teachers are a critical resource for children in refugee and emergency settings. Yet few studies have examined what motivates or demotivates teachers, especially in refugee and emergency contexts. In this article we explore the key findings from field research conducted in Algeria and Ethiopia by the American Institutes for Research (AIR) as part…

Teaching Manual Signs to Adults With Mental Retardation Using Matching-to-Sample Procedures and Stimulus Equivalence

PubMed Central

Elias, Nassim Chamel; Goyos, Celso; Saunders, Muriel; Saunders, Richard

2008-01-01

The objective of this study was to teach manual signs through an automated matching-to-sample procedure and to test for the emergence of new conditional relations and imitative behaviors. Seven adults with mild to severe mental retardation participated. Four were also hearing impaired. Relations between manual signs (set A) and pictures (set B) were initially taught, followed by the training of corresponding printed words (set C) and pictures (set B). Further presentations of conditional discriminations tested for the emergence of AC, followed by tests for the emergence of imitative signing behavior (D) in the presence of either pictures (B) or printed words (C). Each stimulus set was comprised of 9 elements. The stimuli were still pictures, printed words, and dynamic presentations of manual signs. A pretest was conducted to determine which signs the participants could make pre-experimentally. Teaching was arranged in a multiple baseline design across 3 groups of 3 words each. The purpose of the present study was to determine whether participants would emit manual signs in expressive signs tests as a result of observation (video modeling) during match-to-sample training in the absence of explicit training. Five of the 7 subjects passed tests of emergence and emitted at least 50% of the signs. Two were hearing impaired with signing experience, and 3 were not hearing impaired and had no signing experience. Thus, observation of video recorded manual signs in a matching-to-sample training procedure was effective at establishing some signs by adults with mental retardation. PMID:22477400

Emergency nurses’ ways of coping influence their ability to empower women to move beyond the oppression of intimate partner violence

PubMed Central

van Wyk, Neltjie; van Rensburg, Elsie Janse

2016-01-01

Background Millennium Developmental Goal 3 (MDG 3) aims at enhancing gender equity and empowerment of women. Emergency nurses who often encounter women injured by their intimate partners are at risk of developing vicarious traumatisation, which may influence their ability to empower women to move beyond the oppression of intimate partner violence. Aim This article aims to, (1) describe emergency nurses’ ways of coping with the exposure to survivors of intimate partner violence, and (2) recommend a way towards effective coping that will enhance emergency nurses’ abilities to empower women to move beyond the oppression of intimate partner violence to contribute to the achievement of MDG 3. Setting The study was conducted in emergency units of two public hospitals in an urban setting in South Africa. Method A qualitative design and descriptive phenomenological method was used. Emergency nurses working in the setting were purposively sampled and interviewed. The data were analysed by searching for the essence and meaning attached to the exposure of emergency nurses to survivors of intimate partner violence. Results Emergency nurses’ coping responses were either aimed at avoiding or dealing with their exposure to survivors of intimate partner violence. Coping aimed at dealing with the exposure included seeking support, emotion regulation and accommodative coping. Conclusion Emergency nurses employ either effective or ineffective ways of coping. Less effective ways of coping may increase their risk of vicarious and secondary traumatisation, which in turn may influence their ability to empower women to move beyond the oppression of intimate partner violence. PMID:27380838

Quantum Physics Principles and Communication in the Acute Healthcare Setting: A Pilot Study.

PubMed

Helgeson, Heidi L; Peyerl, Colleen Kraft; Solheim-Witt, Marit

This pilot study explores whether clinician awareness of quantum physics principles could facilitate open communication between patients and providers. In the spirit of action research, this study was conceptualized with a holistic view of human health, using a mixed method design of grounded theory as an emergent method. Instrumentation includes surveys and a focus group discussion with twelve registered nurses working in an acute care hospital setting. Findings document that the preliminary core phenomenon, energy as information, influences communication in the healthcare environment. Key emergent themes include awareness, language, validation, open communication, strategies, coherence, incoherence and power. Research participants indicate that quantum physics principles provide a language and conceptual framework for improving their awareness of communication and interactions in the healthcare environment. Implications of this pilot study support the feasibility of future research and education on awareness of quantum physics principles in other clinical settings. Copyright © 2016 Elsevier Inc. All rights reserved.

Screening emergency department patients for opioid drug use: A qualitative systematic review.

PubMed

Sahota, Preet Kaur; Shastry, Siri; Mukamel, Dana B; Murphy, Linda; Yang, Narisu; Lotfipour, Shahram; Chakravarthy, Bharath

2018-05-24

The opioid drug epidemic is a major public health concern and an economic burden in the United States. The purpose of this systematic review is to assess the reliability and validity of screening instruments used in emergency medicine settings to detect opioid use in patients and to assess psychometric data for each screening instrument. PubMed/MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for articles published up to May 2018. The extracted articles were independently screened for eligibility by two reviewers. We extracted 1555 articles for initial screening and 95 articles were assessed for full-text eligibility. Six articles were extracted from the full-text assessment. Six instruments were identified from the final article list: Screener and Opioid Assessment for Patients with Pain - Revised; Drug Abuse Screening Test; Opioid Risk Tool; Current Opioid Misuse Measure; an Emergency Medicine Providers Clinician Assessment Questionnaire; and an Emergency Provider Impression Data Collection Form. Screening instrument characteristics, and reliability and validity data were extracted from the six studies. A meta-analysis was not conducted due to heterogeneity between the studies. There is a lack of validity and reliability evidence in all six articles; and sensitivity, specificity and predictive values varied between the different instruments. These instruments cannot be validated for use in emergency medicine settings. There is no clear evidence to state which screening instruments are appropriate for use in detecting opioid use disorders in emergency medicine patients. There is a need for brief, reliable, valid and feasible opioid use screening instruments in the emergency medicine setting. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effect of rapid set binder on early strength and permeability of HES latex modified road repair pre-packed concrete

NASA Astrophysics Data System (ADS)

Han, J. W.; Lee, S. K.; Yu, C.; Park, C. G.

2015-12-01

The early strength development characteristics and permeability resistance of high early strength (HES) pre-packed road repair concrete incorporating a rapid-set binder material were evaluated for emergency repairs to road pavement. The rapid-set binder is a mixture of rapid-set cement and silica sands whose fluidity improves with the addition of styrene butadiene latex (latex). The resulting mixture has a compressive strength of 21 MPa or higher and a flexural strength of greater than 3.5 MPa after 4 hours, the maximum curing age allowed for emergency repair materials. This study examines the strength development properties and permeability resistance of HES latex-modified pre-packed road repair concrete using a rapid- set binder as a function of the latex-to-binder mixing ratio at values of 0.40, 0.33, 0.29 and 0.25. Both early strength development properties and permeability resistance increased as the ratio of latex to rapid-set binder decreased. The mixture showed a compressive strength of 21 MPa or higher after 4 hours, which is the design standard of emergency repair concrete, only when this ratio was 0.29 or lower. A flexural strength of 3.5 MPa or greater was observed after hours only when this ratio was 0.33 or lower. The standard for permeability resistance, less than 2,000 C of chloride after 7 days of curing, was satisfied by all ratios. The ratio of latex to rapid-set binder satisfying all of the conditions for an emergency road repair material was 0.29 or less.

The Influence of Servant Leadership Theory on the Emergency Services Student

ERIC Educational Resources Information Center

Russell, Eric James

2013-01-01

The purpose of this qualitative case study was to explore how participation in a class on servant leadership influenced the emergency services student's understanding of the role and characteristics of a servant leader. The setting for the study was a state university in the Western United States, with the six participants being declared emergency…

Intrajudge Consistency Using the Angoff Standard-Setting Method.

ERIC Educational Resources Information Center

Plake, Barbara S.; Impara, James C.

This study investigated the intrajudge consistency of Angoff-based item performance estimates. The examination used was a certification examination in an emergency medicine specialty. Ten expert panelists rated the same 24 items twice during an operational standard setting study. Results indicate that the panelists were highly consistent, in terms…

Emergency medicine versus primary care: a case study of three prevalent, costly, and non-emergent diagnoses at a community teaching hospital.

PubMed

Martin, B C

2000-01-01

The high cost of emergency department (ED) care is often viewed as an area for achieving cost savings through reduced utilization for inappropriate conditions. The implementation of outpatient prospective payment for Medicare ED patients heightens scrutiny of costs and utilization in the ED versus primary care settings. Data from hospital clinical records, financial records, and a provider survey was used to develop a costing methodology and complete a comparative analysis of the cost of care for three diagnoses by setting. Total costs were significantly higher in the ED due primarily to differences in ancillary tests and prescription drugs ordered.

How Familiar are Clinician Teammates in the Emergency Department?

PubMed Central

Patterson, P. Daniel; Pfeiffer, Anthony J.; Lave, Judith R.; Weaver, Matthew D.; Abebe, Kaleab; Krackhardt, David; Arnold, Robert M.; Yealy, Donald M.

2016-01-01

Objectives Lack of familiarity between teammates is linked to worsened safety in high-risk settings. The Emergency Department (ED) is a high-risk health care setting where unfamiliar teams are created by diversity in clinician shift schedules and flexibility in clinician movement across the department. We sought to characterize familiarity between clinician teammates in one urban teaching hospital Emergency Department (ED) over a 22-week study period. Methods We used a retrospective study design of shift-scheduling data to calculate the mean weekly hours of familiarity between teammates at the dyadic level, and the proportion of clinicians with a minimum of 2-hours, 5-hours, 10-hours, and 20-hours of familiarity at any given hour during the study period. Results Mean weekly hours of familiarity between ED clinician dyads was 2 hours (SD 1.5). At any given hour over the study period, the proportion of clinicians with a minimum of 2, 5, 10, or 20-hours of familiarity was 80%, 51%, 27%, and 0.8%, respectively. Conclusions In our study, few clinicians could be described as having a high level of familiarity with teammates. The limited familiarity between ED clinicians identified in this study may be a natural feature of ED care delivery in academic settings. We provide a template for measurement of ED team familiarity. PMID:24351519

A Review of the Burden of Trauma Pain in Emergency Settings in Europe.

PubMed

Dißmann, Patrick D; Maignan, Maxime; Cloves, Paul D; Gutierrez Parres, Blanca; Dickerson, Sara; Eberhardt, Alice

2018-06-02

Trauma pain represents a large proportion of admissions to emergency departments across Europe. There is currently an unmet need in the treatment of trauma pain extending throughout the patient journey in emergency settings. This review aims to explore these unmet needs and describe barriers to the delivery of effective analgesia for trauma pain in emergency settings. A comprehensive, qualitative review of the literature was conducted using a structured search strategy (Medline, Embase and Evidence Based Medicine Reviews) along with additional Internet-based sources to identify relevant human studies published in the prior 11 years (January 2006-December 2017). From a total of 4325 publications identified, 31 were selected for inclusion based on defined criteria. Numerous barriers to the effective treatment of trauma pain in emergency settings were identified, which may be broadly defined as arising from a lack of effective pain management pan-European and national guidelines, delayed or absent pain assessment, an aversion to opioid analgesia and a delay in the administration of analgesia. Several commonly used analgesics also present limitations in the treatment of trauma pain due to the routes of administration, adverse side effect profiles, pharmacokinetic properties and suitability for use in pre-hospital settings. These combined barriers lead to the inadequate and ineffective treatment of trauma pain for patients. An unmet need therefore exists for novel forms of analgesia, wider spread use of available analgesic agents which overcome some limitations associated with several treatment options, and the development of protocols for pain management which include patient assessment of pain. Mundipharma International Ltd.

Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol.

PubMed

Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

2016-05-18

The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Formal ethical approval is not required. The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. CRD42014009685. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework.

PubMed

Khan, Yasmin; Sanford, Sarah; Sider, Doug; Moore, Kieran; Garber, Gary; de Villa, Eileen; Schwartz, Brian

2017-04-28

Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. This research indicates that relationships are central to effective communication between public health agencies and emergency department clinicians at the local level. Our framework which is grounded in qualitative evidence focuses on strategies to promote effective communication in the emerging public health incident setting and may be useful in informing practice.

Digital Immigrants: An Exploration of Their Technological Knowledge and Skill Sets

ERIC Educational Resources Information Center

Walker, Benjamin

2012-01-01

This instrumental case study explored the knowledge and skill set levels of adult learners over the age of 35 with an emphasis in emerging educational technologies. The case study focused on EdD students in four cohorts at the Drexel University Center for Graduate Studies in Sacramento, CA. This research sought to answer the following research…

Errors in imaging patients in the emergency setting

PubMed Central

Reginelli, Alfonso; Lo Re, Giuseppe; Midiri, Federico; Muzj, Carlo; Romano, Luigia; Brunese, Luca

2016-01-01

Emergency and trauma care produces a “perfect storm” for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting. PMID:26838955

The Emergency Care of Patients With Cancer: Setting the Research Agenda.

PubMed

Brown, Jeremy; Grudzen, Corita; Kyriacou, Demetrios N; Obermeyer, Ziad; Quest, Tammie; Rivera, Donna; Stone, Susan; Wright, Jason; Shelburne, Nonniekaye

2016-12-01

To identify research priorities and appropriate resources and to establish the infrastructure required to address the emergency care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, emergency medicine, and palliative care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the emergency care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative care in the emergency department setting. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Errors in imaging patients in the emergency setting.

PubMed

Pinto, Antonio; Reginelli, Alfonso; Pinto, Fabio; Lo Re, Giuseppe; Midiri, Federico; Muzj, Carlo; Romano, Luigia; Brunese, Luca

2016-01-01

Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.

Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting

PubMed Central

2012-01-01

Background Rapid and accurate diagnosis and management can be lifesaving for patients with acute dyspnea. However, making a differential diagnosis and selecting early treatment for patients with acute dyspnea in the emergency setting is a clinical challenge that requires complex decision-making in order to achieve hemodynamic balance, improve functional capacity, and decrease mortality. In the present study, we examined the screening potential of rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating acute heart failure syndromes (AHFS) from primary pulmonary disease in patients with acute dyspnea in the emergency setting. Methods Between March 2011 and March 2012, 90 consecutive patients (45 women, 78.1 ± 9.9 years) admitted to the emergency room of our hospital for acute dyspnea were enrolled. Within 30 minutes of admission, all patients underwent conventional physical examination, rapid ultrasound (lung-cardiac-inferior vena cava [LCI] integrated ultrasound) examination with a hand-held device, routine laboratory tests, measurement of brain natriuretic peptide, and chest X-ray in the emergency room. Results The final diagnosis was acute dyspnea due to AHFS in 53 patients, acute dyspnea due to pulmonary disease despite a history of heart failure in 18 patients, and acute dyspnea due to pulmonary disease in 19 patients. Lung ultrasound alone showed a sensitivity, specificity, negative predictive value, and positive predictive value of 96.2, 54.0, 90.9, and 75.0%, respectively, for differentiating AHFS from pulmonary disease. On the other hand, LCI integrated ultrasound had a sensitivity, specificity, negative predictive value, and positive predictive value of 94.3, 91.9, 91.9, and 94.3%, respectively. Conclusions Our study demonstrated that rapid evaluation by LCI integrated ultrasound is extremely accurate for differentiating acute dyspnea due to AHFS from that caused by primary pulmonary disease in the emergency setting. PMID:23210515

State Laws on Emergency Holds for Mental Health Stabilization.

PubMed

Hedman, Leslie C; Petrila, John; Fisher, William H; Swanson, Jeffrey W; Dingman, Deirdre A; Burris, Scott

2016-05-01

Psychiatric emergency hold laws permit involuntary admission to a health care facility of a person with an acute mental illness under certain circumstances. This study documented critical variation in state laws, identified important questions for evaluation research, and created a data set of laws to facilitate the public health law research of emergency hold laws' impact on mental health outcomes. The research team built a 50-state, open-source data set of laws currently governing emergency holds. A protocol and codebook were developed so that the study may be replicated and extended longitudinally, allowing future research to accurately capture changes to current laws. Although every state and the District of Columbia have emergency hold laws, state law varies on the duration of emergency holds, who can initiate an emergency hold, the extent of judicial oversight, and the rights of patients during the hold. The core criterion justifying an involuntary hold is mental illness that results in danger to self or others, but many states have added further specifications. Only 22 states require some form of judicial review of the emergency hold process, and only nine require a judge to certify the commitment before a person is hospitalized. Five states do not guarantee assessment by a qualified mental health professional during the emergency hold. The article highlights variability in state law for emergency holds of persons with acute mental illness. How this variability affects the individual, the treatment system, and law enforcement behavior is unknown. Research is needed to guide policy making and implementation on these issues.

Modulation for emergent networks: serotonin and dopamine.

PubMed

Weng, Juyang; Paslaski, Stephen; Daly, James; VanDam, Courtland; Brown, Jacob

2013-05-01

In autonomous learning, value-sensitive experiences can improve the efficiency of learning. A learning network needs be motivated so that the limited computational resources and the limited lifetime are devoted to events that are of high value for the agent to compete in its environment. The neuromodulatory system of the brain is mainly responsible for developing such a motivation system. Although reinforcement learning has been extensively studied, many existing models are symbolic whose internal nodes or modules have preset meanings. Neural networks have been used to automatically generate internal emergent representations. However, modeling an emergent motivational system for neural networks is still a great challenge. By emergent, we mean that the internal representations emerge autonomously through interactions with the external environments. This work proposes a generic emergent modulatory system for emergent networks, which includes two subsystems - the serotonin system and the dopamine system. The former signals a large class of stimuli that are intrinsically aversive (e.g., stress or pain). The latter signals a large class of stimuli that are intrinsically appetitive (e.g., pleasure or sweet). We experimented with this motivational system for two settings. The first is a visual recognition setting to investigate how such a system can learn through interactions with a teacher, who does not directly give answers, but only punishments and rewards. The second is a setting for wandering in the presence of a friend and a foe. Copyright © 2012 Elsevier Ltd. All rights reserved.

ACOG Committee Opinion No. 487: Preparing for clinical emergencies in obstetrics and gynecology.

PubMed

2011-04-01

Patient care emergencies may periodically occur at any time in any setting, particularly the inpatient setting. To respond to these emergencies, it is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies that might occur, creating plans that include establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Having such systems in place may reduce or prevent the severity of medical emergencies.

Subjective sensation on sleep, fatigue, and thermal comfort in winter shelter-analogue settings

NASA Astrophysics Data System (ADS)

Maeda, Kazuki; Mochizuki, Yosuke; Tsuzuki, Kazuyo; Nabeshima, Yuki

2017-10-01

We aimed to examine sleep in shelter-analogue settings in winter to determine the subjective sensation and environmental conditions in evacuation shelters. Twelve young healthy students took part in the sleep study of two nights for seven hours from Midnight to 7 AM in the gymnasium. One night the subject used a pair of futons and on the other the subject used the emergency supplies of four blankets and a set of portable partitions. During the night, air temperature, humidity and air velocity were measured in the area around the sleeping subjects. Sleep parameters measured by actigraphy, skin temperature, microclimate temperature, rectal temperature, and the heart rates of the subjects were continuously measured and recorded during the sleeping period. The subjects completed questionnaires regarding their thermal comfort and subjective sleep before and after the sleep. The subjects felt more coldness on their head and peripheral parts of the body using the emergency blankets than the futon during the sleep. Moreover, fatigue was felt more on the lower back and lower extremities from using emergency blankets than the futon after sleep. However, the sleep efficiency index and subjective sleep evaluation by OSA questionnaire did not reveal any good correlationship. The emergency supplies should be examined for their suitability to provide comfortable and healthy sleep in the shelter-analogue settings.

Psychotherapy and despair in the prison setting.

PubMed

Gee, Joanna; Loewenthal, Del; Cayne, Julia

2015-01-01

The purpose of this paper is to outline research which aimed to explore psychotherapists' experience of working with despair, in the UK prison setting, through a qualitative phenomenological approach. Within the forensic psychological literature, despair is considered a pathology, associated with suicide and self-harm, resulting from the prisoners histories and the coercive prison setting. In turn, therapeutic writings outline the importance of therapy in the prison setting with despair in providing coping skills, containment and learning opportunities for the prisoners involved. Within the study, ten psychotherapists were interviewed as to their experience of working with clients in despair in the prison setting. The data were analysed via the phenomenological research method Empirical Phenomenological Analysis (EPA), and a secondary analysis through reverie. Through the analysis by EPA, despair emerged in the prison setting as a destabilising phenomenon to which there was no protocol for working with it. Participants also described the prisoners' despair and the despairing prison setting, touching on their own sense of vulnerability and despair. However, drawing on the secondary analysis by reverie, the researcher also became aware of how the phenomenon of despair emerged not simply through the said, but also through the intersubjective. It was therefore through the secondary analysis by reverie that the importance of the attendance to aspects of intersubjectivity in prison research emerged. This paper contributes to the therapeutic writings on despair in the prison setting, alongside holding implications for qualitative research in the prison setting.

Emergency medical equipment storage: benefits of visual cues tested in field and simulated settings.

PubMed

Grundgeiger, Tobias; Harris, Bonnie; Ford, Nicholas; Abbey, Michael; Sanderson, Penelope M; Venkatesh, Balasubramanian

2014-08-01

We tested the effectiveness of an illustrated divider ("the divider") for bedside emergency equipment drawers in an intensive care unit (ICU). In Study I, we assessed whether the divider increases completeness and standardizes the locations of emergency equipment within the drawer. In Study 2, we investigated whether the divider decreases nurses' restocking and retrieval times and decreases their workload. Easy access to fully stocked emergency equipment is important during emergencies. However, inefficient equipment storage and cognitively demanding work settings might mean that drawers are incompletely stocked and access to items is slow. A pre-post-post study investigated drawer completeness and item locations before and after the introduction of the divider to 30 ICU drawers. A subsequent experiment measured item restocking time, item retrieval time, and subjective workload for nurses. At 2 weeks and 10 weeks after the divider was introduced, the completeness of the drawer increased significantly compared with before the divider was introduced. The divider decreased the variability of the locations of the 17 items in the drawer to 16% of its original value. Study 2 showed that restocking times but not retrieval times were significantly faster with the divider present For both tasks, nurses rated their workload lower with the divider. The divider improved the standardization and completeness of emergency equipment. In addition, restocking times and workload were decreased with the divider. Redesigning storage for certain equipment using human factors design principles can help to speed and standardize restocking and ease access to equipment.

Epidemiology of Pediatric Convulsive Status Epilepticus With Fever in the Emergency Department: A Cohort Study of 381 Consecutive Cases.

PubMed

Hayakawa, Itaru; Miyama, Sahoko; Inoue, Nobuaki; Sakakibara, Hiroshi; Hataya, Hiroshi; Terakawa, Toshiro

2016-09-01

Pediatric convulsive status epilepticus with fever is common in the emergency setting but leads to severe neurological sequelae in some patients. To explore the epidemiology of convulsive status epilepticus with fever, a retrospective cohort covering all convulsive status epilepticus cases with fever seen in the emergency department of a tertiary care children's hospital were consecutively collected. Of the 381 consecutive cases gathered, 81.6% were due to prolonged febrile seizure, 6.6% to encephalopathy/encephalitis, 0.8% to meningitis, and 7.6% to epilepsy. In addition, seizures were significantly longer in encephalopathy/encephalitis cases than in prolonged febrile seizure cases (log rank test, P < .001). These results provide for the first time the pretest probability of final diagnoses in children with convulsive status epilepticus with fever in the emergency setting, and will help optimize the management of pediatric patients presenting to the emergency department with convulsive status epilepticus with fever. © The Author(s) 2016.

Iconicity and the Emergence of Combinatorial Structure in Language.

PubMed

Verhoef, Tessa; Kirby, Simon; de Boer, Bart

2016-11-01

In language, recombination of a discrete set of meaningless building blocks forms an unlimited set of possible utterances. How such combinatorial structure emerged in the evolution of human language is increasingly being studied. It has been shown that it can emerge when languages culturally evolve and adapt to human cognitive biases. How the emergence of combinatorial structure interacts with the existence of holistic iconic form-meaning mappings in a language is still unknown. The experiment presented in this paper studies the role of iconicity and human cognitive learning biases in the emergence of combinatorial structure in artificial whistled languages. Participants learned and reproduced whistled words for novel objects with the use of a slide whistle. Their reproductions were used as input for the next participant, to create transmission chains and simulate cultural transmission. Two conditions were studied: one in which the persistence of iconic form-meaning mappings was possible and one in which this was experimentally made impossible. In both conditions, cultural transmission caused the whistled languages to become more learnable and more structured, but this process was slightly delayed in the first condition. Our findings help to gain insight into when and how words may lose their iconic origins when they become part of an organized linguistic system. Copyright © 2015 Cognitive Science Society, Inc.

Optimized maritime emergency resource allocation under dynamic demand.

PubMed

Zhang, Wenfen; Yan, Xinping; Yang, Jiaqi

2017-01-01

Emergency resource is important for people evacuation and property rescue when accident occurs. The relief efforts could be promoted by a reasonable emergency resource allocation schedule in advance. As the marine environment is complicated and changeful, the place, type, severity of maritime accident is uncertain and stochastic, bringing about dynamic demand of emergency resource. Considering dynamic demand, how to make a reasonable emergency resource allocation schedule is challenging. The key problem is to determine the optimal stock of emergency resource for supplier centers to improve relief efforts. This paper studies the dynamic demand, and which is defined as a set. Then a maritime emergency resource allocation model with uncertain data is presented. Afterwards, a robust approach is developed and used to make sure that the resource allocation schedule performs well with dynamic demand. Finally, a case study shows that the proposed methodology is feasible in maritime emergency resource allocation. The findings could help emergency manager to schedule the emergency resource allocation more flexibly in terms of dynamic demand.

Optimized maritime emergency resource allocation under dynamic demand

PubMed Central

Yan, Xinping; Yang, Jiaqi

2017-01-01

Emergency resource is important for people evacuation and property rescue when accident occurs. The relief efforts could be promoted by a reasonable emergency resource allocation schedule in advance. As the marine environment is complicated and changeful, the place, type, severity of maritime accident is uncertain and stochastic, bringing about dynamic demand of emergency resource. Considering dynamic demand, how to make a reasonable emergency resource allocation schedule is challenging. The key problem is to determine the optimal stock of emergency resource for supplier centers to improve relief efforts. This paper studies the dynamic demand, and which is defined as a set. Then a maritime emergency resource allocation model with uncertain data is presented. Afterwards, a robust approach is developed and used to make sure that the resource allocation schedule performs well with dynamic demand. Finally, a case study shows that the proposed methodology is feasible in maritime emergency resource allocation. The findings could help emergency manager to schedule the emergency resource allocation more flexibly in terms of dynamic demand. PMID:29240792

48 CFR 5119.1070-2 - Emerging small business set-aside.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Emerging small business... ARMY ACQUISITION REGULATIONS SMALL BUSINESS AND SMALL DISADVANTAGED BUSINESS CONCERNS Small Business Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations for...

48 CFR 5119.1070-2 - Emerging small business set-aside.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Emerging small business... ARMY ACQUISITION REGULATIONS SMALL BUSINESS AND SMALL DISADVANTAGED BUSINESS CONCERNS Small Business Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations for...

48 CFR 5119.1070-2 - Emerging small business set-aside.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 7 2011-10-01 2011-10-01 false Emerging small business... ARMY ACQUISITION REGULATIONS SMALL BUSINESS AND SMALL DISADVANTAGED BUSINESS CONCERNS Small Business Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations for...

48 CFR 5119.1070-2 - Emerging small business set-aside.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Emerging small business... ARMY ACQUISITION REGULATIONS SMALL BUSINESS AND SMALL DISADVANTAGED BUSINESS CONCERNS Small Business Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations for...

An hypnotic suggestion: review of hypnosis for clinical emergency care.

PubMed

Iserson, Kenneth V

2014-04-01

Hypnosis has been used in medicine for nearly 250 years. Yet, emergency clinicians rarely use it in emergency departments or prehospital settings. This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses reasons why the technique has not been widely adopted, and suggests methods of increasing its use in emergency care, including some potential research areas. A limited number of clinical studies and case reports suggest that hypnosis may be effective in a wide variety of conditions applicable to emergency medical care. These include providing analgesia for existing pain (e.g., fractures, burns, and lacerations), providing analgesia and sedation for painful procedures (e.g., needle sticks, laceration repair, and fracture and joint reductions), reducing acute anxiety, increasing children's cooperation for procedures, facilitating the diagnosis and treatment of acute psychiatric conditions, and providing analgesia and anxiolysis for obstetric/gynecologic problems. Although it is safe, fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due, in part, to the myths surrounding hypnosis and its association with alternative-complementary medicine. Genuine barriers to its increased clinical use include a lack of assured effectiveness and a lack of training and training requirements. Based on the results of further research, hypnosis could become a powerful and safe nonpharmacologic addition to the emergency clinician's armamentarium, with the potential to enhance patient care in emergency medicine, prehospital care, and remote medical settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Mortality related to acute illness and injury in rural Uganda: task shifting to improve outcomes.

PubMed

Chamberlain, Stacey; Stolz, Uwe; Dreifuss, Bradley; Nelson, Sara W; Hammerstedt, Heather; Andinda, Jovita; Maling, Samuel; Bisanzo, Mark

2015-01-01

Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients. Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department's quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit. Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives. This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening.

Intuition in emergency nursing: a phenomenological study.

PubMed

Lyneham, Joy; Parkinson, Camillus; Denholm, Carey

2008-04-01

The evidence of experience of intuitive knowing in the clinical setting has to this point only been informal and anecdotal. Reported experiences thus need to be either validated or refuted so that its place in emergency nursing can be determined. The history, nature and component themes captured within the intuitive practice of emergency nursing are described. This study was informed by the philosophy and method of phenomenology. Participants were 14 experienced emergency nurses. Through their narrative accounts and recall of events their experience of knowing was captured. Through a Van Manen process and a Gadamerian analysis, six themes associated with the ways in which the participants experienced intuition in clinical practice, were identified. This paper reveals the six emerging themes as knowledge, experience, connection, feeling, syncretism and trust.

Changes in the Structure of Relations Between Groups and the Emergence of Political Movements: The Student Movement at Harvard and Wisconsin, 1930-1969. A Thesis.

ERIC Educational Resources Information Center

Swirski, Shlomo

This study presents a theoretical approach to the study of the emergence of movements for political change. It was postulated that changes outside the university role set --industrial systems development, political, military, scientific competition between the United States and Soviet Union-- brought about the following structural changes within…

Teacher Perception of Cultural Difference in L2 Materials: Is Filtering Culture the Right Approach?

ERIC Educational Resources Information Center

Hermessi, Tarek

2017-01-01

With the emergence of the intercultural approach to L2 teaching, several studies investigated teachers' attitudes and beliefs concerning the cultural dimension of L2 teaching in different foreign language settings. This study explored teachers' perceptions of the relationship between teaching English and culture in Tunisia, an EFL setting where…

Learning and Teaching as Emergent Features of Informal Settings: An Ethnographic Study in an Environmental Action Group

ERIC Educational Resources Information Center

Boyer, Leanna; Roth, Wolff-Michael

2006-01-01

Around the world, many people concerned with the state of the environment participate in environmental action groups. Much of their learning occurs informally, simply by participating in the everyday, ongoing collective life of the chosen group. Such settings provide unique opportunities for studying how people learn science in complex settings…

Emergency Skills Resources for Range-Related Driver Education.

ERIC Educational Resources Information Center

Council, Forrest M.; And Others

The document presents a rationale for expanding the current emergency skills curriculum in North Carolina's 18 multi-vehicle range laboratories for driver education, and includes a review of past and current programs in other locations, a review of past North Carolina accident studies directly related to this area, and a recommended set of…

The Emergent Practice of Infant Compliance: An Exploration in Two Cultures

ERIC Educational Resources Information Center

Reddy, Vasudevi; Liebal, Katja; Hicks, Kerry; Jonnalagadda, Srujana; Chintalapuri, Beena

2013-01-01

Complying with directives is an important indicator of developing cooperativeness and of the awareness of others' intentions for one's own actions. Nonetheless, little is known about the early emergence of compliance. In the present longitudinal study, we explore this phenomenon in naturalistic settings in two cultural groups. Nine middle-class…

An assessment of priority setting process and its implication on availability of emergency obstetric care services in Malindi District, Kenya.

PubMed

Nyandieka, Lilian Nyamusi; Kombe, Yeri; Ng'ang'a, Zipporah; Byskov, Jens; Njeru, Mercy Karimi

2015-01-01

In spite of the critical role of Emergency Obstetric Care in treating complications arising from pregnancy and childbirth, very few facilities are equipped in Kenya to offer this service. In Malindi, availability of EmOC services does not meet the UN recommended levels of at least one comprehensive and four basic EmOC facilities per 500,000 populations. This study was conducted to assess priority setting process and its implication on availability, access and use of EmOC services at the district level. A qualitative study was conducted both at health facility and community levels. Triangulation of data sources and methods was employed, where document reviews, in-depth interviews and focus group discussions were conducted with health personnel, facility committee members, stakeholders who offer and/ or support maternal health services and programmes; and the community members as end users. Data was thematically analysed. Limitations in the extent to which priorities in regard to maternal health services can be set at the district level were observed. The priority setting process was greatly restricted by guidelines and limited resources from the national level. Relevant stakeholders including community members are not involved in the priority setting process, thereby denying them the opportunity to contribute in the process. The findings illuminate that consideration of all local plans in national planning and budgeting as well as the involvement of all relevant stakeholders in the priority setting exercise is essential in order to achieve a consensus on the provision of emergency obstetric care services among other health service priorities.

Investigating Fourth Amendment Judicial Outcomes across Contrasting Minority School Settings: Subjectivity in Disciplinary Decision Making in Diverse Settings?

ERIC Educational Resources Information Center

Torres, Mario S., Jr.; Callahan, Jamie L.

2008-01-01

This study explores the court system's treatment of students' Fourth Amendment rights in cases emerging from contrasting minority school settings and whether discrepancies exist in case outcomes between these extremes. From virtually every search and seizure case that occurred between the 1985 U.S. Supreme Court case in "New Jersey v.…

A Comprehensive Approach for the Ergonomic Evaluation of 13 Emergency and Transport Ventilators.

PubMed

Marjanovic, Nicolas; L'Her, Erwan

2016-05-01

Mechanical ventilation is an important part of emergency medicine and is frequently used for transportation. Human errors during ventilator settings are frequent and may be associated with high morbidity/mortality. The aim of the study was to provide a complete ergonomic evaluation of emergency and transport ventilators, taking into account objective and subjective human-machine interface assessments and individual mental work load. We performed a prospective bench ergonomic evaluation of 13 emergency and transport ventilators, using standardized conditions and a global methodological approach. The study was performed in an evaluation laboratory dedicated to respiratory care, and 12 emergency physicians unfamiliar with the tested devices were included in the evaluation. The ventilators were classified into 3 categories (simple, sophisticated, and ICU-like). Objective chronometric evaluations were conducted considering 9 tasks, and subjective evaluations were performed (ease of use, willingness to use, and user-friendliness of monitoring) using Likert scales. Mental work load evaluation was performed using the NASA Task Load Index scale. Overall task failure rate represented 4% of all attempts. Setting modifications, ventilation mode changes, and powering down durations were different between simple and other emergency and transport ventilator categories (P < .005). There was no difference between ventilator categories for the ease of use and user-friendliness of the monitoring. In contrast, the willingness to use was lower for simple devices, compared with sophisticated and ICU-like emergency and transport ventilators (2.9 ± 1.4 vs 3.9 ± 1.2, P = .002 and 4.3 ± 1, P < .001). No differences were observed between devices regarding the mental work load, except for several specific devices in the sophisticated category. A comprehensive ergonomic evaluation provides valuable information while investigating operational friendliness in emergency and transport ventilators. The choice of a device not only depends on its technical characteristics but should take into account its clinical operational setting and ergonomics in order to decrease mental work load. Sophisticated emergency and transport ventilators should only be used by clinicians who demonstrate expertise in mechanical ventilation. Copyright © 2016 by Daedalus Enterprises.

An exploration of emergency nurses' perceptions, attitudes and experience of teamwork in the emergency department.

PubMed

Grover, Elise; Porter, Joanne E; Morphet, Julia

2017-05-01

Teamwork may assist with increased levels of efficiency and safety of patient care in the emergency department (ED), with emergency nurses playing an indispensable role in this process. A descriptive, exploratory approach was used, drawing on principles from phenomenology and symbolic interactionism. Convenience, purposive sampling was used in a major metropolitan ED. Semi structured interviews were conducted, audio recorded, and transcribed verbatim. Transcripts were analysed using thematic analysis. Three major themes emerged from the data. The first theme 'when teamwork works' supported the notion that emergency nurses perceived teamwork as a positive and effective construct in four key areas; resuscitation, simulation training, patient outcomes and staff satisfaction. The second theme 'team support' revealed that back up behaviour and leadership were critical elements of team effectiveness within the study setting. The third theme 'no time for teamwork' centred around periods when teamwork practices failed due to various contributing factors including inadequate resources and skill mix. Outcomes of effective teamwork were valued by emergency nurses. Teamwork is about performance, and requires a certain skill set not necessarily naturally possessed among emergency nurses. Building a resilient team inclusive of strong leadership and communication skills is essential to being able to withstand the challenging demands of the ED. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Narratives of the Leadership Development of Adults Who Served as Summer Camp Staff in the Mennonite Setting: A Multiple Case Study

ERIC Educational Resources Information Center

Harrison, Jason

2013-01-01

Problem: Leaders today need a new set of knowledge and skills to be effective in collaborative environments. The focus of this study was to investigate how collaborative environments can contribute to leadership development. The purpose of this study was to describe how the collaborative environment of summer camp helped shape emerging adults as…

Global Health and Emergency Care: Defining Clinical Research Priorities.

PubMed

Hansoti, Bhakti; Aluisio, Adam R; Barry, Meagan A; Davey, Kevin; Lentz, Brian A; Modi, Payal; Newberry, Jennifer A; Patel, Melissa H; Smith, Tricia A; Vinograd, Alexandra M; Levine, Adam C

2017-06-01

Despite recent strides in the development of global emergency medicine (EM), the field continues to lag in applying a scientific approach to identifying critical knowledge gaps and advancing evidence-based solutions to clinical and public health problems seen in emergency departments (EDs) worldwide. Here, progress on the global EM research agenda created at the 2013 Academic Emergency Medicine Global Health and Emergency Care Consensus Conference is evaluated and critical areas for future development in emergency care research internationally are identified. A retrospective review of all studies compiled in the Global Emergency Medicine Literature Review (GEMLR) database from 2013 through 2015 was conducted. Articles were categorized and analyzed using descriptive quantitative measures and structured data matrices. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting then further conceptualized and defined global EM research priorities utilizing consensus-based decision making. Research trends in global EM research published between 2013 and 2015 show a predominance of observational studies relative to interventional or descriptive studies, with the majority of research conducted in the inpatient setting in comparison to the ED or prehospital setting. Studies on communicable diseases and injury were the most prevalent, with a relative dearth of research on chronic noncommunicable diseases. The Global Emergency Medicine Think Tank Clinical Research Working Group identified conceptual frameworks to define high-impact research priorities, including the traditional approach of using global burden of disease to define priorities and the impact of EM on individual clinical care and public health opportunities. EM research is also described through a population lens approach, including gender, pediatrics, and migrant and refugee health. Despite recent strides in global EM research and a proliferation of scholarly output in the field, further work is required to advocate for and inform research priorities in global EM. The priorities outlined in this paper aim to guide future research in the field, with the goal of advancing the development of EM worldwide. © 2017 by the Society for Academic Emergency Medicine.

Impact of Implementing a Wiki to Develop Structured Electronic Order Sets on Physicians' Intention to Use Wiki-Based Order Sets

PubMed Central

Beaupré, Pierre; Bégin, Laura; Dupuis, Audrey; Côté, Mario; Légaré, France

2016-01-01

Background Wikis have the potential to promote best practices in health systems by sharing order sets with a broad community of stakeholders. However, little is known about the impact of using a wiki on clinicians’ intention to use wiki-based order sets. Objective The aims of this study were: (1) to describe the use of a wiki to create structured order sets for a single emergency department; (2) to evaluate whether the use of this wiki changed emergency physicians’ future intention to use wiki-based order sets; and (3) to understand the impact of using the wiki on the behavioral determinants for using wiki-based order sets. Methods This was a pre/post-intervention mixed-methods study conducted in one hospital in Lévis, Quebec. The intervention was comprised of receiving access to and being motivated by the department head to use a wiki for 6 months to create electronic order sets designed to be used in a computer physician order entry system. Before and after our intervention, we asked participants to complete a previously validated questionnaire based on the Theory of Planned Behavior. Our primary outcome was the intention to use wiki-based order sets in clinical practice. We also assessed participants’ attitude, perceived behavioral control, and subjective norm to use wiki-based order sets. Paired pre- and post-Likert scores were compared using Wilcoxon signed-rank tests. The post-questionnaire also included open-ended questions concerning participants’ comments about the wiki, which were then classified into themes using an existing taxonomy. Results Twenty-eight emergency physicians were enrolled in the study (response rate: 100%). Physicians’ mean intention to use a wiki-based reminder was 5.42 (SD 1.04) before the intervention, and increased to 5.81 (SD 1.25) on a 7-point Likert scale (P=.03) after the intervention. Participants’ attitude towards using a wiki-based order set also increased from 5.07 (SD 0.90) to 5.57 (SD 0.88) (P=.003). Perceived behavioral control and subjective norm did not change. Easier information sharing was the most frequently positive impact raised. In order of frequency, the three most important facilitators reported were: ease of use, support from colleagues, and promotion by the departmental head. Although participants did not mention any perceived negative impacts, they raised the following barriers in order of frequency: poor organization of information, slow computers, and difficult wiki access. Conclusions Emergency physicians’ intention and attitude to use wiki-based order sets increased after having access to and being motivated to use a wiki for 6 months. Future studies need to explore if this increased intention will translate into sustained actual use and improve patient care. Certain barriers need to be addressed before implementing a wiki for use on a larger scale. PMID:27189046

Injury in China: a systematic review of injury surveillance studies conducted in Chinese hospital emergency departments

PubMed Central

2011-01-01

Background Injuries represent a significant and growing public health concern in China. This Review was conducted to document the characteristics of injured patients presenting to the emergency department of Chinese hospitals and to assess of the nature of information collected and reported in published surveillance studies. Methods A systematic search of MEDLINE and China Academic Journals supplemented with a hand search of journals was performed. Studies published in the period 1997 to 2007 were included and research published in Chinese was the focus. Search terms included emergency, injury, medical care. Results Of the 268 studies identified, 13 were injury surveillance studies set in the emergency department. Nine were collaborative studies of which eight were prospective studies. Of the five single centre studies only one was of a prospective design. Transport, falls and industrial injuries were common mechanisms of injury. Study strengths were large patient sample sizes and for the collaborative studies a large number of participating hospitals. There was however limited use of internationally recognised injury classification and severity coding indices. Conclusion Despite the limited number of studies identified, the scope of each highlights the willingness and the capacity to conduct surveillance studies in the emergency department. This Review highlights the need for the adoption of standardized injury coding indices in the collection and reporting of patient health data. While high level injury surveillance systems focus on population-based priority setting, this Review demonstrates the need to establish an internationally comparable trauma registry that would permit monitoring of the trauma system and would by extension facilitate the optimal care of the injured patient through the development of informed quality assurance programs and the implementation of evidence-based health policy. PMID:22029774

Evaluation, modification and validation of a set of asthma illustrations in children with chronic asthma in the emergency department.

PubMed

Tulloch, Joanie; Irwin, Danica; Pascuet, Elena; Vaillancourt, Régis

2012-01-01

To test, modify and validate a set of illustrations depicting different levels of asthma control and common asthma triggers in pediatric patients (and⁄or their parents) with chronic asthma who presented to the emergency department at the Children's Hospital of Eastern Ontario, Ottawa, Ontario. Semistructured interviews using guessability and translucency questionnaires tested the comprehensibility of 15 illustrations depicting different levels of asthma control and common asthma triggers in children 10 to 17 years of age, and parents of children one to nine years of age who presented to the emergency department. Illustrations with an overall guessability score <80% and⁄or translucency median score <6, were reviewed by the study team and modified by the study's graphic designer. Modifications were made based on key concepts identified by study participants. A total of 80 patients were interviewed. Seven of the original 15 illustrations (47%) required modifications to obtain the prespecified guessability and translucency goals. The authors successfully developed, modified and validated a set of 15 illustrations representing different levels of asthma control and common asthma triggers. These illustrations will be incorporated into a child-friendly asthma action plan that enables the child to be involved in his or her asthma self-management care.

Multiscaling Edge Effects in an Agent-based Money Emergence Model

NASA Astrophysics Data System (ADS)

Oświęcimka, P.; Drożdż, S.; Gębarowski, R.; Górski, A. Z.; Kwapień, J.

An agent-based computational economical toy model for the emergence of money from the initial barter trading, inspired by Menger's postulate that money can spontaneously emerge in a commodity exchange economy, is extensively studied. The model considered, while manageable, is significantly complex, however. It is already able to reveal phenomena that can be interpreted as emergence and collapse of money as well as the related competition effects. In particular, it is shown that - as an extra emerging effect - the money lifetimes near the critical threshold value develop multiscaling, which allow one to set parallels to critical phenomena and, thus, to the real financial markets.

Assessing the physical service setting: a look at emergency departments.

PubMed

Steinke, Claudia

2015-01-01

To determine the attributes of the physical setting that are important for developing a positive service climate within emergency departments and to validate a measure for assessing physical service design. The design of the physical setting is an important and contributing factor for creating a service climate in organizations. Service climate is defined as employee perceptions of the practices, procedures, and behaviors that get rewarded, supported, and expected with regard to customer service and customer service quality. There has been research conducted which identifies antecedents within organization that promotes a positive service climate which in turn creates service-oriented behaviors by employees toward clients. The antecedent of the physical setting and its impact on perceptions of service climate has been less commonly explored. Using the concept of the physical service setting (which may be defined as aspects of the physical, built environment that facilitate the delivery of quality service), attributes of the physical setting and their relationship with service climate were explored by means of a quantitative paper survey distributed to emergency nurses (n = 180) throughout a province in Canada. The results highlight the validity and reliability of six scales measuring the physical setting and its relation to service. Respondents gave low ratings to the physical setting of their departments, in addition to low ratings of service climate. Respondents feel that the design of the physical setting in the emergency departments where they work is not conducive to providing quality service to clients. Certain attributes of the physical setting were found to be significant in influencing perceptions of service climate, hence service quality, within the emergency department setting. © The Author(s) 2015.

Incorporating teledermatology into emergency medicine.

PubMed

Muir, Jim; Xu, Cathy; Paul, Sanjoy; Staib, Andrew; McNeill, Iain; Singh, Philip; Davidson, Samantha; Soyer, H Peter; Sinnott, Michael

2011-10-01

The aim of the present study was to investigate the feasibility of using a store-and-forward Skin Emergency Telemedicine Service (SETS) to provide rapid specialist diagnostic and management advice for dermatological cases in an ED. This pilot study was conducted at the Princess Alexandra Hospital between August 2008 and August 2009. Study subjects were consenting patients over 18 years of age who presented with a dermatological condition to the ED. The ED doctor sent the patient's history, examination findings and the digital images of the skin conditions to a secure email address, which automatically forwarded this to the teledermatologist. The teledermatologist reviewed the cases and sent advice on diagnosis and management to the referring ED doctor via email and/or telephone. Face-to-face follow-up consultations with the patients were conducted within 2 weeks. The diagnostic and management concordance between ED doctors, teledermatologists and reviewing dermatologists were analysed. A total of 60 patients participated in the present study. SETS provided a rapid response with 56 (93%) of ED consultations receiving a dermatology opinion within 2 h. Face-to-face follow up occurred in 50 patients (83%). Statistical analysis showed significant levels of agreement between tele-diagnosis and ED diagnosis of 71.2% (Kappa 0.42) and tele-diagnosis and final clinical diagnosis of 98% (Kappa: 0.93). The clinical management concordance was 96% in complete agreement and 4% in relative agreement between the teledermatologists and reviewing dermatologists, based on chart review. The present study has shown that SETS can provide rapid and accurate diagnostic and treatment advice from a specialist for dermatological presentations to the ED. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Prioritizing the 21st Century Superintendent's Skill Set and Knowledge Base from the School Board Leadership Perspective

ERIC Educational Resources Information Center

Shaw, Teri L.

2014-01-01

The purpose of this study was to identify the extent that specific research based skill sets and areas of knowledge emerged as highly important, moderately important, and less important from the perspective of school board leadership as it pertains to 21st century superintendents. The study further disaggregated the data by specific school…

Using Drawings to Bridge the Transition from Student to Future Teacher of Mathematics

ERIC Educational Resources Information Center

Lee, Ji-Eun; Zeppelin, Mary

2014-01-01

This study examines a group of prospective teachers' reflections upon the way they were taught (Set 1) and the way they want to teach (Set 2) through drawings which respectively describe their past learning experiences as students and their future plans as teachers. The purpose of this study is to identify: (a) the emerging themes that appear in…

Review article: Paediatric status epilepticus in the pre-hospital setting: An update.

PubMed

Furyk, Jeremy; Watt, Kerriane; Emeto, Theophilus I; Dalziel, Stuart; Bodnar, Daniel; Riney, Kate; Babl, Franz E

2017-08-01

Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Developmental Differences in Parenting Behavior: Comparing Adolescent, Emerging Adult, and Adult Mothers

ERIC Educational Resources Information Center

Lewin, Amy; Mitchell, Stephanie J.; Ronzio, Cynthia R.

2013-01-01

The nationally representative Early Childhood Longitudinal Study-Birth cohort data set was used to compare parenting behaviors of adolescent mothers (less than 19 years old), emerging adult mothers (19-25 years old), and adult mothers (greater than 25 years old) when their children were 2 years old. Regression models controlling for socioeconomic…

Emergency Contraception Education for Health and Human Service Professionals: An Evaluation of Knowledge and Attitudes

ERIC Educational Resources Information Center

Colarossi, Lisa; Billowitz, Marissa; Breitbart, Vicki

2010-01-01

Objective: To assess the knowledge and attitudes of health care providers, health educators, and social service providers before and after a training session on emergency contraceptive pills. Design: A survey study using pre-post training measurements. Setting: Two hundred and twenty-three medical, social service, and health education providers in…

Emerging Interaction of Political Processes: The Effect on a Study Abroad Program in Cuba

ERIC Educational Resources Information Center

Clarke, Ruth

2007-01-01

The emerging interaction of political processes sets the stage for the level of macro uncertainty and specific risk events that may occur in an international relationship. Strongly defined social control in Cuba, formal and informal, dominates the dynamics of the relationship, while simultaneously government, formal, action in the U.S. dominates…

Vibration Signaling in Mobile Devices for Emergency Alerting: A Study with Deaf Evaluators

ERIC Educational Resources Information Center

Harkins, Judith; Tucker, Paula E.; Williams, Norman; Sauro, Jeff

2010-01-01

In the United States, a nationwide Commercial Mobile Alert Service (CMAS) is being planned to alert cellular mobile device subscribers to emergencies occurring near the location of the mobile device. The plan specifies a unique audio attention signal as well as a unique vibration attention signal (for mobile devices set to vibrate) to identify…

Teachers' Use of Linguistic Scaffolding to Support the Academic Language Development of First-Grade Emergent Bilingual Students

ERIC Educational Resources Information Center

Lucero, Audrey

2014-01-01

Research suggests that teachers need to scaffold emergent bilingual students as they develop the complex language associated with school success. This may especially be true in dual language settings, where children are learning two languages simultaneously. In this study, therefore, I investigate the linguistic scaffolding practices of…

Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings.

PubMed

Pekurinen, Virve; Willman, Laura; Virtanen, Marianna; Kivimäki, Mika; Vahtera, Jussi; Välimäki, Maritta

2017-10-18

Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective health and work ability than both of the non-psychiatric nursing groups, while their psychiatric wellbeing is better and they have less sleep problems compared to medical and surgical nurses. Psychiatric nurses maintain better psychiatric wellbeing and experience fewer sleep problems than non-psychiatric nurses after events of exposure to patient aggression. This suggest that more attention should be given to non-psychiatric settings for maintaining the wellbeing of nurses after exposure to patient aggression.

Risk assessment for patient perpetrated violence: Analysis of three assaults against healthcare workers.

PubMed

Bresler, Scott; Gaskell, Michael B

2015-01-01

Workplace violence in healthcare settings is a complex topic with many different environments in which aggression is sometimes expressed by patients toward those entrusted with providing their healthcare. The assessment of violence risk in a nursing home containing many patients with organic brain syndrome is quite distinct from assessment in forensic psychiatric units, inner city emergency rooms, or outpatient pain clinics. Three cases are presented that are composite summaries of actual assaults which took place across different hospital settings, all within an urban Midwestern city in the United States: (1) an emergency department; (2) a psychiatric emergency services (PES) center; (3) a short stay (typically 72 hours to 5 days) civil psychiatric inpatient unit. These case studies exemplify specific risk factors that violent patients have, depending upon the specific healthcare setting where the patient presents. Research is cited relevant to all three case studies and how one should assess their risk. Lastly, the complexity of this issue is highlighted by a brief discussion of the pitfalls entailed in profiling ``the dangerous patient.'' It is demonstrated that when violence is expressed by a patient toward a healthcare provider, it is usually a maladaptive response, one in which characteristics of that setting and behavior of those who work within it must be carefully considered when determining what factors precipitated the patient's violent act.

Critical period of weed control in winter canola (Brassica napus L.) in a semi-arid region.

PubMed

Aghaalikhani, M; Yaghoobi, S R

2008-03-01

In order to determine the critical period of weed control in winter canola (Brassica napus L. cv. Okapi) an experiment was carried out at research field of Tarbiat Modarres University, Tehran, Iran on 2004-2005 growing season. Fourteen experimental treatments which divided into two sets were arranged in Randomized complete blocks design with four replications. In the first set, the crop was kept weed-free from emergence time to two-leaf stage (V2), four-leaf stage (V4), six-leaf stage (V6), eight-leaf stage (V8), early flowering (IF), 50% of silique set (50% SS) and final harvest (H). In the second set, weeds where permitted to grow with the crop until above mentioned stages. In this study critical period of weed control was determined according to evaluate seed bank emerged weed biomass effect on canola grain yield loss using Gompertz and logistic equations. Result showed a critical time of weed control about 25 days after emergence (between four to six-leaf stages) with 5% accepted yield loss. Therefore, weed control in this time could provide the best result and avoid yield loss and damage to agroecosystem.

Hypoalbuminemia, Low Base Excess Values, and Tachypnea Predict 28-Day Mortality in Severe Sepsis and Septic Shock Patients in the Emergency Department.

PubMed

Seo, Min Ho; Choa, Minhong; You, Je Sung; Lee, Hye Sun; Hong, Jung Hwa; Park, Yoo Seok; Chung, Sung Phil; Park, Incheol

2016-11-01

The objective of this study was to develop a new nomogram that can predict 28-day mortality in severe sepsis and/or septic shock patients using a combination of several biomarkers that are inexpensive and readily available in most emergency departments, with and without scoring systems. We enrolled 561 patients who were admitted to an emergency department (ED) and received early goal-directed therapy for severe sepsis or septic shock. We collected demographic data, initial vital signs, and laboratory data sampled at the time of ED admission. Patients were randomly assigned to a training set or validation set. For the training set, we generated models using independent variables associated with 28-day mortality by multivariate analysis, and developed a new nomogram for the prediction of 28-day mortality. Thereafter, the diagnostic accuracy of the nomogram was tested using the validation set. The prediction model that included albumin, base excess, and respiratory rate demonstrated the largest area under the receiver operating characteristic curve (AUC) value of 0.8173 [95% confidence interval (CI), 0.7605-0.8741]. The logistic analysis revealed that a conventional scoring system was not associated with 28-day mortality. In the validation set, the discrimination of a newly developed nomogram was also good, with an AUC value of 0.7537 (95% CI, 0.6563-0.8512). Our new nomogram is valuable in predicting the 28-day mortality of patients with severe sepsis and/or septic shock in the emergency department. Moreover, our readily available nomogram is superior to conventional scoring systems in predicting mortality.

Health promoting attitudes and behaviors of emergency physicians: exploring gender differences.

PubMed

Rondeau, Kent V; Francescutti, Louis H; Cummings, Garnet E

2006-01-01

The purpose of this paper is to report on gender differences in emergency physicians with respect to their attitudes, knowledge, and practices concerning health promotion and disease prevention. A mail survey of 325 male and 97 female Canadian emergency physicians. Results suggest female emergency physicians report having greater knowledge of health promotion topics, spend more time with each of their patients in the emergency setting, and engage in more health promotion counseling in the emergency setting than do their male counterparts. The paper argues that in the future, educating and socializing emergency physicians, both male and female, in the practice of health promotion will enhance the potential of the emergency department to be a more effective resource for their community.

Adoption of trastuzumab for breast cancer in four emerging countries in the use of health technology assessment: a case study.

PubMed

Martín-Ruiz, Eva; Espín Balbino, Jaime; Lemgruber, Alexandre; Caro-Martínez, Araceli; Lessa, Fernanda; Olry-de-Labry-Lima, Antonio; Pérez-Velasco, Roman; García-Mochón, Leticia

2016-07-01

To describe processes for the adoption of trastuzumab in four countries in the use of health technology assessment (HTA): Poland, Albania, Brazil and Colombia. Mixed methods were used for collection and triangulation of data. Data were examined following a conceptual framework connecting HTA process steps and key principles. Trastuzumab was generally assessed following well-structured HTA processes. Nonetheless, areas of improvement were detected in terms of transparency and inclusiveness, as well as in methods used. The extent to which different criteria influenced decisions was unclear. This study covers an area in which information may not always be available, and sets the example for emerging countries interested in HTA. Further studies to gain a better understanding on decision-making across settings are warranted.

The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study

PubMed Central

2014-01-01

Background Together with the ambulances staffed with emergency medical technicians (EMTs), general practitioners (GPs) on call are the primary resources for handling emergencies outside hospitals in Norway. The benefit of the GP accompanying the ambulance to pre-hospital calls is a matter of controversy in Norway. The purpose of the present study was to gain better insight into the EMT’s experiences with the role of the GPs in the care for critically ill patients in the pre-hospital setting. Methods We conducted four focus group interviews with EMTs at four different ambulance stations in Norway. Three of the stations were located at least 2 hours driving distance from the nearest hospital. The interviews were transcribed and analyzed using systematic text condensation. Results The EMTs described increasing confidence in emergency medicine during the last few years. However, they felt the need for GP participation in the ambulance when responding to a critically ill patient. The presence of GPs made the EMTs feel more confident, especially in unclear and difficult cases that did not fit into EMT guidelines. The main contributions of the GPs were described as diagnosis and decision-making. Bringing the physician to the patient shortened transportation time to the hospital and important medication could be started earlier. Several examples of sub-optimal treatment in the absence of the GP were given. The EMTs described discomfort with GPs not responding to the calls. They also experienced GPs responding to calls that did not function in the pre-hospital emergency setting. The EMTs reported a need for professional requirements for GPs taking part in out-of-hours work and mandatory interdisciplinary training on a regular basis. Conclusions EMTs want GPs to be present in challenging pre-hospital emergency settings. The presence of GPs is perceived as improving patient care. However, professional requirements are needed for GPs taking part in out-of-hours work, and the informants suggested a formalized area for training between EMTs and GPs on call. PMID:25145390

Nanobioinformatics: Emerging Computational Tools to Understand Nano-Bio Interaction

DTIC Science & Technology

2012-11-16

followed for using animals for toxicity studies, Organization for Economic Co- operation and Development ( OECD ) has set guidelines for toxicity studies...operation and Development ( OECD ) has set guidelines for toxicity studies in guideline number 420, which says that only dosages of 50-2000 mg/kg body weight...GSH, SOD, GSSH, MDA, ALK , ALT, LDH), Cell lines. Preprocessing: After collection of data from the published articles preprocessing of the data is

Endotracheal Intubation With and Without Night Vision Goggles in a Helicopter and Emergency Room Setting: A Manikin Study.

PubMed

Gellerfors, Mikael; Svensén, Christer; Linde, Joacim; Lossius, Hans Morten; Gryth, Dan

2015-09-01

Securing the airway by endotracheal intubation (ETI) is a key issue in prehospital critical care. Night vision goggles (NVG) are used by personnel operating in low-light environments. We examined the feasibility of an anesthesiologist performed ETI using NVG in a helicopter setting. Twelve anesthesiologists performed ETI on a manikin in an emergency room (ER) setting and two helicopter settings, with randomization to either rotary wing daylight (RW-D) or rotary wing in total darkness using binocular NVG (RW-NVG). Primary endpoint was intubation time. Secondary endpoints included success rate, Cormack-Lehane (CL) score, and subjective difficulty according to the Visual Analoge Scale (VAS). The median intubation time was shorter for the RW-D compared to the RW-NVG setting (16.5 seconds vs. 30.0 seconds; p = 0,03). We found no difference in median intubation time for the ER and RW-D settings (16.8 seconds vs. 16.5 seconds; p = 0.91). For all scenarios, success rate was 100%. CL and VAS varied between the ER setting (CL 1.8, VAS 2.8), RW-D setting (CL 2.0, VAS 3.0), and RW-NVG setting (CL 3.0, VAS 6.5). This study suggests that anesthesiologists successfully and quickly can perform ETI in a helicopter setting both in daylight and in darkness using binocular NVG, but with shorter intubation times in daylight. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Modification of Obstetric Emergency Simulation Scenarios for Realism in a Home-Birth Setting.

PubMed

Komorowski, Janelle; Andrighetti, Tia; Benton, Melissa

2017-01-01

Clinical competency and clear communication are essential for intrapartum care providers who encounter high-stakes, low-frequency emergencies. The challenge for these providers is to maintain infrequently used skills. The challenge is even more significant for midwives who manage births at home and who, due to low practice volume and low-risk clientele, may rarely encounter an emergency. In addition, access to team simulation may be limited for home-birth midwives. This project modified existing validated obstetric simulation scenarios for a home-birth setting. Twelve certified professional midwives (CPMs) in active home-birth practice participated in shoulder dystocia and postpartum hemorrhage simulations. The simulations were staged to resemble home-birth settings, supplies, and personnel. Fidelity (realism) of the simulations was assessed with the Simulation Design Scale, and satisfaction and self-confidence were assessed with the Student Satisfaction and Self-Confidence in Learning Scale. Both utilized a 5-point Likert scale, with higher scores suggesting greater levels of fidelity, participant satisfaction, and self-confidence. Simulation Design Scale scores indicated participants agreed fidelity was achieved for the home-birth setting, while scores on the Student Satisfaction and Self-Confidence in Learning indicated high levels of participant satisfaction and self-confidence. If offered without modification, simulation scenarios designed for use in hospitals may lose fidelity for home-birth midwives, particularly in the environmental and psychological components. Simulation is standard of care in most settings, an excellent vehicle for maintaining skills, and some evidence suggests it results in improved perinatal outcomes. Additional study is needed in this area to support home-birth providers in maintaining skills. This pilot study suggests that simulation scenarios intended for hospital use can be successfully adapted to the home-birth setting. © 2016 by the American College of Nurse-Midwives.

A Novel Approach to Study Medical Decision Making in the Clinical Setting: The "Own-point-of-view" Perspective.

PubMed

Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Charlin, Bernard

2017-07-01

Making diagnostic and therapeutic decisions is a critical activity among physicians. It relies on the ability of physicians to use cognitive processes and specific knowledge in the context of a clinical reasoning. This ability is a core competency in physicians, especially in the field of emergency medicine where the rate of diagnostic errors is high. Studies that explore medical decision making in an authentic setting are increasing significantly. They are based on the use of qualitative methods that are applied at two separate times: 1) a video recording of the subject's actual activity in an authentic setting and 2) an interview with the subject, supported by the video recording. Traditionally, activity is recorded from an "external perspective"; i.e., a camera is positioned in the room in which the consultation takes place. This approach has many limits, both technical and with respect to the validity of the data collected. The article aims at 1) describing how decision making is currently being studied, especially from a qualitative standpoint, and the reasons why new methods are needed, and 2) reporting how we used an original, innovative approach to study decision making in the field of emergency medicine and findings from these studies to guide further the use of this method. The method consists in recording the subject's activity from his own point of view, by fixing a microcamera on his temple or the branch of his glasses. An interview is then held on the basis of this recording, so that the subject being interviewed can relive the situation, to facilitate the explanation of his reasoning with respect to his decisions and actions. We describe how this method has been used successfully in investigating medical decision making in emergency medicine. We provide details on how to use it optimally, taking into account the constraints associated with the practice of emergency medicine and the benefits in the study of clinical reasoning. The "own-point-of-view" video technique is a promising method to study clinical decision making in emergency medicine. It is a powerful tool to stimulate recall and help physicians make their reasoning explicit, thanks to a greater psychological immersion. © 2017 by the Society for Academic Emergency Medicine.

Impact of point-of-care ultrasound on clinical decision-making at an urban emergency department in Tanzania.

PubMed

Reynolds, Teri Ann; Amato, Stas; Kulola, Irene; Chen, Chuan-Jay Jeffrey; Mfinanga, Juma; Sawe, Hendry Robert

2018-01-01

Point of care ultrasound (PoCUS) is an efficient, inexpensive, safe, and portable imaging modality that can be particularly useful in resource-limited settings. However, its impact on clinical decision making in such settings has not been well studied. The objective of this study is to describe the utilization and impact of PoCUS on clinical decision making at an urban emergency department in Dar es Salaam, Tanzania. This was a prospective descriptive cross-sectional study of patients receiving PoCUS at Muhimbili National Hospital's Emergency Medical Department (MNH EMD). Data on PoCUS studies during a period of 10 months at MNH EMD was collected on consecutive patients during periods when research assistants were available. Data collected included patient age and sex, indications for ultrasound, findings, interpretations, and provider-reported diagnostic impression and disposition plan before and after PoCUS. Descriptive statistics, including medians and interquartile ranges, and counts and percentages, are reported. Pearson chi squared tests and p-values were used to evaluate categorical data for significant differences. PoCUS data was collected for 986 studies performed on 784 patients. Median patient age was 32 years; 56% of patients were male. Top indications for PoCUS included trauma, respiratory presentations, and abdomino-pelvic pain. The most frequent study types performed were eFAST, cardiac, and obstetric or gynaecologic studies. Overall, clinicians reported that the use of PoCUS changed either diagnostic impression or disposition plan in 29% of all cases. Rates of change in diagnostic impression or disposition plan increased to 45% in patients for whom more than one PoCUS study type was performed. In resource-limited emergency care settings, PoCUS can be utilized for a wide range of indications and has substantial impact on clinical decision making, especially when more than one study type is performed.

Trainees May Add Value to Patient Care by Decreasing Addendum Utilization in Radiology Reports.

PubMed

Balthazar, Patricia; Konstantopoulos, Christina; Wick, Carson A; DeSimone, Ariadne K; Tridandapani, Srini; Simoneaux, Stephen; Applegate, Kimberly E

2017-11-01

The purpose of this study was to evaluate the impact of trainee involvement and other factors on addendum rates in radiology reports. This retrospective study was performed in a tertiary care pediatric hospital. From the institutional radiology data repository, we extracted all radiology reports from January 1 to June 30, 2016, as well as trainee (resident or fellow) involvement, imaging modality, patient setting (emergency, inpatient, or outpatient), order status (routine vs immediate), time of interpretation (regular work hours vs off-hours), radiologist's years of experience, and sex. We grouped imaging modalities as advanced (CT, MRI, and PET) or nonadvanced (any modality that was not CT, MRI, or PET) and radiologist experience level as ≤ 20 years or > 20 years. Our outcome measure was the rate of addenda in radiology reports. Statistical analysis was performed using multivariate logistic regression. From 129,033 reports finalized during the study period, 418 (0.3%) had addenda. Reports generated without trainees were 12 times more likely than reports with trainee involvement to have addenda (odds ratio [OR] = 12.2, p < 0.001). Advanced imaging studies were more likely than nonadvanced studies to be associated with addendum use (OR = 4.7, p < 0.001). Reports generated for patients in emergency or outpatient settings had a slightly higher likelihood of addendum use than those in an inpatient setting (OR = 1.5, p = 0.04; and OR = 1.3, p = 0.04, respectively). Routine orders had a slightly higher likelihood of addendum use compared with immediate orders (OR = 1.3, p = 0.01). We found no difference in addendum use by radiologist's sex, radiologist's years of experience, emergency versus outpatient setting, or time of interpretation. Trainees may add value to patient care by decreasing addendum rates in radiology reports.

Emergency general surgery in a low-middle income health care setting: Determinants of outcomes.

PubMed

Shah, Adil A; Latif, Asad; Zogg, Cheryl K; Zafar, Syed Nabeel; Riviello, Robert; Halim, Muhammad Sohail; Rehman, Zia; Haider, Adil H; Zafar, Hasnain

2016-02-01

Emergency general surgery (EGS) has emerged as an important component of frontline operative care. Efforts in high-income settings have described its burden but have yet to consider low- and middle-income health care settings in which emergent conditions represent a high proportion of operative need. The objective of this study was to describe the disease spectrum of EGS conditions and associated factors among patients presenting in a low-middle income context. March 2009-April 2014 discharge data from a university teaching hospital in South Asia were obtained for patients (≥16 years) with primary International Classification of Diseases, 9(th) revision, Clinical Modification diagnosis codes consistent with an EGS condition as defined by the American Association for the Surgery of Trauma. Outcomes included in-hospital mortality and occurrence of ≥1 major complication(s). Multivariable analyses were performed, adjusting for differences in demographic and case-mix factors. A total of 13,893 discharge records corresponded to EGS conditions. Average age was 47.2 years (±16.8, standard deviation), with a male preponderance (59.9%). The majority presented with admitting diagnoses of biliary disease (20.2%), followed by soft-tissue disorders (15.7%), hernias (14.9%), and colorectal disease (14.3%). Rates of death and complications were 2.7% and 6.6%, respectively; increasing age was an independent predictor of both. Patients in need of resuscitation (n = 225) had the greatest rates of mortality (72.9%) and complications (94.2%). This study takes an important step toward quantifying outcomes and complications of EGS, providing one of the first assessments of EGS conditions using American Association for the Surgery of Trauma definitions in a low-middle income health care setting. Further efforts in varied settings are needed to promote representative benchmarking worldwide. Copyright © 2016 Elsevier Inc. All rights reserved.

The Feasibility of Utilizing a Comic for Education in the Emergency Department Setting.

PubMed

Hanson, Aaron; Drendel, Amy L; Ashwal, Gary; Thomas, Alex

2017-05-01

The objective of this study was to determine the feasibility of a comic education module in the Emergency Department setting. A convenience sample of 50 injured children and their caregivers were enrolled. The comic was found to be likeable, easy to read, and provided important information to both children and their caregivers. Total time to read the comic was three minutes (SD 1.4, range 1.4-7.1). Most children (60%) read the comic independently, including all children over age 14 years. At 72-hour phone follow-up, 86% of caregivers had accurate recall of all three comic teaching points. This innovative comic educational module is feasible for use for children ages 4-18 years in the Emergency Department. Though this comic was intended to educate children, caregivers recalled all three teaching points 72 hours after discharge.

Capnography as a tool to detect metabolic changes in patients cared for in the emergency setting

PubMed Central

Cereceda-Sánchez, Francisco José; Molina-Mula, Jesús

2017-01-01

ABSTRACT Objective: to evaluate the usefulness of capnography for the detection of metabolic changes in spontaneous breathing patients, in the emergency and intensive care settings. Methods: in-depth and structured bibliographical search in the databases EBSCOhost, Virtual Health Library, PubMed, Cochrane Library, among others, identifying studies that assessed the relationship between capnography values and the variables involved in blood acid-base balance. Results: 19 studies were found, two were reviews and 17 were observational studies. In nine studies, capnography values were correlated with carbon dioxide (CO2), eight with bicarbonate (HCO3), three with lactate, and four with blood pH. Conclusions: most studies have found a good correlation between capnography values and blood biomarkers, suggesting the usefulness of this parameter to detect patients at risk of severe metabolic change, in a fast, economical and accurate way. PMID:28513767

Emergent Themes from Recent Research Syntheses in Science Education and Their Implications for Research Design, Replication, and Reporting Practices

ERIC Educational Resources Information Center

Taylor, Joseph; Furtak, Erin; Kowalski, Susan; Martinez, Alina; Slavin, Robert; Stuhlsatz, Molly; Wilson, Christopher

2016-01-01

This article draws upon the experiences of four recent efforts to synthesize the findings of quantitative studies in science education research. After establishing the need for research syntheses in advancing generalizable knowledge and causal effects research in our field, we identify a set themes that emerged in the process of conducting these…

PEACETIME RADIATION HAZARDS IN THE FIRE SERVICE, BASIC COURSE, RESOURCE MANUAL.

ERIC Educational Resources Information Center

BERNDT, WILLIAM

FOR USE BY FIREMEN AND OTHER EMERGENCY PERSONNEL WHO MAY HAVE TO DEAL WITH FIRES OR SIMILAR EMERGENCIES INVOLVING RADIATION HAZARDS, THIS MANUAL IS CORRELATED WITH THE FOLLOWING INSTRUCTIONAL MATERIALS FOR THE 15-HOUR COURSE -- (1) AN INSTRUCTOR'S GUIDE (VT 002 117), (2) A STUDENT STUDY GUIDE (VT 001 878), AND (3) A SET OF TWENTY-TWO 20- BY…

Emergency Management and Tourism Stakeholder Responses to Crises: A Global Survey.

PubMed

Morakabati, Yeganeh; Page, Stephen J; Fletcher, John

2017-03-01

This article examines the contested area of the responsibility for destinations and tourists, within emergency settings. It incorporates a Delphi-Scenario technique to facilitate a structured discussion of emergency management for different destination stakeholders. The Delphi exercise engaged 123 senior international stakeholders, from 9 different industry sectors, across 34 countries to provide a global perspective. The study's principal focus is on the notion of emergency management, to identify the challenges that stakeholders would face within a disaster scenario. The exercise asked stakeholders to identify with whom the responsibility rests for 18 distinct disaster-related activities. The study proposes a responsibility allocation building-block framework that could help speed up the emergency management responses by "knowing who is going to do what" with a particular focus on dealing with international tourists as a community in a disaster zone.

Clinical and translational research in global health and emergency care: a research agenda.

PubMed

Runyon, Michael S; Sawe, Hendry R; Levine, Adam C; Pousson, Amelia; House, Darlene R; Agrawal, Pooja; Osei-Ampofo, Maxwell; Weiner, Scott G; Douglass, Katherine

2013-12-01

As policy-makers increasingly recognize emergency care to be a global health priority, the need for high-quality clinical and translational research in this area continues to grow. As part of the proceedings of the 2013 Academic Emergency Medicine consensus conference, this article discusses the importance of: 1) including clinical and translational research in the initial emergency care development plan, 2) defining the burden of acute disease and the barriers to conducting research in resource-limited settings, 3) assessing the appropriateness and effectiveness of local and global acute care guidelines within the local context, 4) studying the local research infrastructure needs to understand the best methods to build a sustainable research infrastructure, and 5) studying the long-term effects of clinical research programs on health care systems. © 2013 by the Society for Academic Emergency Medicine.

Nosocomial infection control in healthcare settings: Protection against emerging infectious diseases.

PubMed

Fu, Chuanxi; Wang, Shengyong

2016-04-12

The Middle East respiratory syndrome (MERS) outbreak in Korea in 2015 may be attributable to poor nosocomial infection control procedures implemented. Strict infection control measures were taken in the hospital where an imported case with MERS was treated in southern China and 53 health care workers were confirmed to be MERS-CoV negative. Infection control in healthcare settings, in which patients with emerging infectious diseases such as MERS, Ebola virus disease, and the severe acute respiratory syndrome (SARS) are diagnosed and treated, are often imperfect. When it comes to emerging or unknown infectious diseases, before the imported case was finally identified or community transmission was reported, cases have often occurred in clusters in healthcare settings. Nosocomial infection control measures should be further strengthened among the workers and inpatients in designated healthcare settings that accommodate suspected cases suffering from emerging or unknown infectious diseases.

Triage and the Lost Art of Decoding Vital Signs: Restoring Physiologically Based Triage Skills in Complex Humanitarian Emergencies.

PubMed

Burkle, Frederick M

2018-02-01

Triage management remains a major challenge, especially in resource-poor settings such as war, complex humanitarian emergencies, and public health emergencies in developing countries. In triage it is often the disruption of physiology, not anatomy, that is critical, supporting triage methodology based on clinician-assessed physiological parameters as well as anatomy and mechanism of injury. In recent times, too many clinicians from developed countries have deployed to humanitarian emergencies without the physical exam skills needed to assess patients without the benefit of remotely fed electronic monitoring, laboratory, and imaging studies. In triage, inclusion of the once-widely accepted and collectively taught "art of decoding vital signs" with attention to their character and meaning may provide clues to a patient's physiological state, improving triage sensitivity. Attention to decoding vital signs is not a triage methodology of its own or a scoring system, but rather a skill set that supports existing triage methodologies. With unique triage management challenges being raised by an ever-changing variety of humanitarian crises, these once useful skill sets need to be revisited, understood, taught, and utilized by triage planners, triage officers, and teams as a necessary adjunct to physiologically based triage decision-making. (Disaster Med Public Health Preparedness. 2018;12:76-85).

Nursing models in a special hospital: cybernetics, hyperreality and beyond.

PubMed

Mason, T; Chandley, M

1992-11-01

Two emerging themes that resulted from research carried out in a special hospital on the use of nursing models are identified. The first theme to emerge was the tendency of the subjects to perceive the models as concrete entities thus undergoing a process of reification. The second theme identified was the adherence to the models outside the contextual nature of the setting which limited their effectiveness. A theoretical framework in which to locate the results of the study is explored using cybernetic learning theory and the notion of hyperreality, using the works of Jean Baudrillard. A method for innovation and changing practice in the special hospital setting is suggested.

Emergency ultrasound usage among recent emergency medicine residency graduates of a convenience sample of 14 residencies.

PubMed

Dean, Anthony J; Breyer, Michael J; Ku, Bon S; Mills, Angela M; Pines, Jesse M

2010-02-01

Emergency Medicine (EM) residency graduates are trained to perform Emergency Medicine bedside ultrasound (EMBU). However, the degree to which they use this skill in their practice after graduation is unknown. We sought to test the amount and type of usage of EMBU among recent residency graduates, and how usage and barriers vary among various types of EM practice settings. Graduates from 14 EM residency programs in 2003-2005 were surveyed on their current practice setting and use of EMBU. There were 252 (73%) graduates who completed the survey. Of the 73% of respondents reporting access to EMBU, 98% had used it within the past 3 months. Access to EMBU was higher in academic (97%) vs. community teaching (79%) vs. community non-teaching settings (62%) (p < 0.001), and in Emergency Departments (EDs) where yearly census exceeded 60,000 visits (87% vs. 65%, p < 0.001). Physicians in academic settings reported "high use" of EMBU more frequently than those in community settings for most modalities. FAST (focused assessment by sonography in trauma) was the most common high-use application and the most useful in practice. The greatest impediment to EMBU use was "not enough time" (61%). Ultrasound usage among recent EM residency graduates is significantly higher in teaching than in community settings and in high-volume EDs. Its use is more widespread than in previous reports in all types of practice. There is a wide range of utilization of ultrasound in the various applications in emergency practice, with the evaluation of trauma being the most common. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Customizing anaphylaxis guidelines for emergency medicine.

PubMed

Nowak, Richard; Farrar, Judith Rosen; Brenner, Barry E; Lewis, Lawrence; Silverman, Robert A; Emerman, Charles; Hays, Daniel P; Russell, W Scott; Schmitz, Natalie; Miller, Judi; Singer, Ethan; Camargo, Carlos A; Wood, Joseph

2013-08-01

Most episodes of anaphylaxis are managed in emergency medical settings, where the cardinal signs and symptoms often differ from those observed in the allergy clinic. Data suggest that low recognition of anaphylaxis in the emergency setting may relate to inaccurate coding and lack of a standard, practical definition. Develop a simple, consistent definition of anaphylaxis for emergency medicine providers, supported by clinically relevant consensus statements. Definitions of anaphylaxis and criteria for diagnosis from current anaphylaxis guidelines were reviewed with regard to their utilization in emergency medical settings. The agreed-upon working definition is: Anaphylaxis is a serious reaction causing a combination of characteristic findings, and which is rapid in onset and may cause death. It is usually due to an allergic reaction but can be non-allergic. The definition is supported by Consensus Statements, each with referenced discussion. For a positive outcome, quick diagnosis and treatment of anaphylaxis are critical. However, even in the emergency setting, the patient may not present with life-threatening symptoms. Because mild initial symptoms can quickly progress to a severe, even fatal, reaction, the first-line treatment for any anaphylaxis episode--regardless of severity--is intramuscular injection of epinephrine into the anterolateral thigh; delaying its administration increases the potential for morbidity and mortality. When a reaction appears as "possible anaphylaxis," it is generally better to err on the side of caution and administer epinephrine. We believe that this working definition and the supporting Consensus Statements are a first step to better management of anaphylaxis in the emergency medical setting. Copyright © 2013 Elsevier Inc. All rights reserved.

A systematic review of team-building interventions in non-acute healthcare settings.

PubMed

Miller, Christopher J; Kim, Bo; Silverman, Allie; Bauer, Mark S

2018-03-01

Healthcare is increasingly delivered in a team-based format emphasizing interdisciplinary coordination. While recent reviews have investigated team-building interventions primarily in acute healthcare settings (e.g. emergency or surgery departments), we aimed to systematically review the evidence base for team-building interventions in non-acute settings (e.g. primary care or rehabilitation clinics). We conducted a systematic review in PubMed and Embase to identify team-building interventions, and conducted follow-up literature searches to identify articles describing empirical studies of those interventions. This process identified 14 team-building interventions for non-acute healthcare settings, and 25 manuscripts describing empirical studies of these interventions. We evaluated outcomes in four domains: trainee evaluations, teamwork attitudes/knowledge, team functioning, and patient impact. Trainee evaluations for team-building interventions were generally positive, but only one study associated team-building with statistically significant improvement in teamwork attitudes/knowledge. Similarly mixed results emerged for team functioning and patient impact. The evidence base for healthcare team-building interventions in non-acute healthcare settings is much less developed than the parallel literature for short-term team function in acute care settings. Only one intervention we identified has been tested in multiple non-acute settings by distinct research teams. Positive findings regarding the utility of team-building interventions are tempered by a lack of control conditions, inconsistency in outcome measures, and high probability of bias. Considering these results alongside the well-recognized costs of poor healthcare teamwork suggests that additional research is sorely needed to develop the evidence base for team-building in non-acute settings.

48 CFR 6.207 - Set-asides for local firms during a major disaster or emergency.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ACQUISITION REGULATION ACQUISITION PLANNING COMPETITION REQUIREMENTS Full and Open Competition After Exclusion of Sources 6.207 Set-asides for local firms during a major disaster or emergency. (a) To fulfill the...

Advance provision of emergency contraception to young men: An exploratory study in a clinic setting.

PubMed

Garbers, Samantha; Bell, D L; Ogaye, K; Marcell, A V; Westhoff, C L; Rosenthal, S L

2018-04-17

To explore the acceptability of advance provision of emergency contraceptive pills (ECPs) to young men seeking health care. For this exploratory study in a clinic setting, we approached young men aged 16-35 to participate in a survey eliciting socio-demographics, sexual and contraceptive history, and knowledge about ECPs. We offered young men advance provision of ECPs and compared characteristics of 126 young men who did and did not accept the ECPs. Most (76%) of the participants accepted advance provision and left with an ECP pack, with even higher proportions among males whose sexual histories were suggestive of increased risk of involvement in an unintended pregnancy. This study holds promise to inform scale up of advance provision of ECPs among young men. Copyright © 2018 Elsevier Inc. All rights reserved.

[Effectiveness of an integrated treatment for severe personality disorders. A 36-month pragmatic follow-up].

PubMed

Lana, Fernando; Sánchez-Gil, Carmen; Ferrer, Laia; López-Patón, Nuria; Litvan, Lia; Marcos, Susana; Sierra, Ana C; Soldevilla, Joan M; Feixas, Guillem; Pérez, Víctor

2015-01-01

Over the past 25 years, several studies have shown the efficacy of a number of psychological interventions for severe personality disorders. However, the generalizability of these positive results from long traditional research settings to more ordinary ones has been questioned, requiring a need for replication in pragmatic studies. This pragmatic study compares hospitalizations and Emergency Room visits before and during a 6-month therapeutic program for severe personality disorders, and at 36 months after starting it. The therapeutic program, which integrates several specific interventions within a coherent framework, was carried out in an ordinary clinical setting. Fifty-one patients, evaluated according DSM-IV criteria by using the Spanish version of the Structured Clinical Interview for Personality Disorders (SCID-II), were included. The clinical characteristics showed a group of severely disturbed patients, of which 78.4% met criteria for borderline personality disorder. The percentage of patients hospitalized and visiting the Emergency Room, as well as the number of days of hospitalization and Emergency Room visits was significantly reduced during the treatment, and this improvement was maintained throughout. An integrated treatment for severe personality disorders could be effective in preventing reliance on readmissions, or prolonged hospital stays, when it is implemented by clinicians in ordinary clinical settings. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

Evaluation, modification and validation of a set of asthma illustrations in children with chronic asthma in the emergency department

PubMed Central

Tulloch, Joanie; Vaillancourt, Régis; Irwin, Danica; Pascuet, Elena

2012-01-01

OBJECTIVES: To test, modify and validate a set of illustrations depicting different levels of asthma control and common asthma triggers in pediatric patients (and/or their parents) with chronic asthma who presented to the emergency department at the Children’s Hospital of Eastern Ontario, Ottawa, Ontario. METHODS: Semistructured interviews using guessability and translucency questionnaires tested the comprehensibility of 15 illustrations depicting different levels of asthma control and common asthma triggers in children 10 to 17 years of age, and parents of children one to nine years of age who presented to the emergency department. Illustrations with an overall guessability score <80% and/or translucency median score <6, were reviewed by the study team and modified by the study’s graphic designer. Modifications were made based on key concepts identified by study participants. RESULTS: A total of 80 patients were interviewed. Seven of the original 15 illustrations (47%) required modifications to obtain the prespecified guessability and translucency goals. CONCLUSION: The authors successfully developed, modified and validated a set of 15 illustrations representing different levels of asthma control and common asthma triggers. PRACTICE IMPLICATIONS: These illustrations will be incorporated into a child-friendly asthma action plan that enables the child to be involved in his or her asthma self-management care. PMID:22332128

Sketching Awareness: A Participatory Study to Elicit Designs for Supporting Ad Hoc Emergency Medical Teamwork

PubMed Central

Kusunoki, Diana; Sarcevic, Aleksandra; Zhang, Zhan; Yala, Maria

2014-01-01

Prior CSCW research on awareness in clinical settings has mostly focused on higher-level team coordination spanning across longer-term trajectories at the department and inter-department levels. In this paper, we offer a perspective on what awareness means within the context of an ad hoc, time- and safety-critical medical setting by looking at teams treating severely ill patients with urgent needs. We report findings from four participatory design workshops conducted with emergency medicine clinicians at two regional emergency departments. Workshops were developed to elicit design ideas for information displays that support awareness in emergency medical situations. Through analysis of discussions and clinicians’ sketches of information displays, we identified five features of teamwork that can be used as a foundation for supporting awareness from the perspective of clinicians. Based on these findings, we contribute rich descriptions of four facets of awareness that teams manage during emergency medical situations: team member awareness, elapsed time awareness, teamwork-oriented and patient-driven task awareness, and overall progress awareness. We then discuss these four awareness types in relation to awareness facets found in the CSCW literature. PMID:25870498

Antimicrobial Stewardship in the Emergency Department: Challenges, Opportunities, and a Call to Action for Pharmacists.

PubMed

Bishop, Bryan M

2016-12-01

Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance. © The Author(s) 2015.

Evaluation of a collaborative model: a case study analysis of watershed planning in the intermountain west

Treesearch

Gary Bentrup

2001-01-01

Collaborative planning processes have become increasingly popular for addressing environmental planning issues, resulting in a number of conceptual models for collaboration. A model proposed by Selin and Chavez suggests that collaboration emerges from a series of antecedents and then proceeds sequentially through problem-setting, direction-setting, implementation, and...

A Meta-Analytic Review of Tactile-Cued Self-Monitoring Interventions Used by Students in Educational Settings

ERIC Educational Resources Information Center

McDougall, Dennis; Ornelles, Cecily; Mersberg, Kawika; Amona, Kekama

2015-01-01

In this meta-analytic review, we critically evaluate procedures and outcomes from nine intervention studies in which students used tactile-cued self-monitoring in educational settings. Findings suggest that most tactile-cued self-monitoring interventions have moderate to strong effects, have emerged only recently, and have not yet achieved the…

Understanding How Emergent Bilinguals Bridge Belonging and Languages in Dual Language Immersion Settings

ERIC Educational Resources Information Center

Di Stefano, Marialuisa

2017-01-01

This dissertation covers the purpose, findings, and implication of a 10-week ethnographic research study in a dual language immersion (DLI) third-grade classroom in the northeastern U.S. The purpose was to promote a better understanding of the processes and products of identity development in a DLI setting. Sense of belonging and language…

Patient Preference for Physician Gender in the Emergency Department

PubMed Central

Nolen, Haley A.; Moore, Justin Xavier; Rodgers, Joel B.; Wang, Henry E.; Walter, Lauren A.

2016-01-01

Despite historical gender bias against female physicians, few studies have investigated patients’ physician gender preference in the emergency department (ED) setting. We sought to determine if there is an association between ED patient demographics and physician gender preference. We surveyed patients presenting to an ED to determine association between patient demographics and patient physician gender preference for five ED situations: 1) ‘routine’ visit, 2) emergency visit, 3) ‘sensitive’ medical visit, 4) minor surgical/‘procedural’ visit, and 5) ‘bad news’ delivery. A total of 200 ED patients were surveyed. The majority of ED patients reported no physician gender preference for ‘routine’ visits (89.5 percent), ‘emergent’ visits (89 percent), ‘sensitive’ medical visits (59 percent), ‘procedural’ visits (89 percent) or when receiving ‘bad news’ (82 percent). In the setting of ‘routine’ visits and ‘sensitive’ medical visits, there was a propensity for same-sex physician preference. PMID:27354840

Emergency shock wave lithotripsy for ureteric stones.

PubMed

Dasgupta, Ranan; Hegarty, Nicholas; Thomas, Kay

2009-03-01

Extracorporeal shock wave lithotripsy has been used for over 2 decades, but its application in the acute setting remains under review. With continuing refinements to the technology, it is timely to review its efficacy in the emergency setting. The procedure has an overall low morbidity and is generally well tolerated. Success rates of 70-80% are reported in a number of studies, with relatively low complication rates. Although much attention has been given to the improvements in the outcome of ureteroscopic stone clearance, the benefits of a noninvasive procedure which does not require general anaesthesia may be appealing and indeed preferable for many patients. This should remain a valid alternative treatment option offered to patients, and its provision may be restricted by resource availability rather than clinical evidence. Centres should be identified that can offer an emergency extracorporeal shock wave lithotripsy service and patients informed of outcome data from such centres.

Emerged/Emerging Disruptive Technologies (E2DT) (Technologies de rupture apparues/emergentes (E2DT)). Proceedings of the RTO Information Systems Technology Panel (IST) Symposium held in Madrid, Spain on 7-8 May 2011

DTIC Science & Technology

2011-05-01

with the potential to impact future military Information Systems. The second is to explore and identify innovative applications of these emerging or...NATO) BP 25, F-92201 Neuilly- sur -Seine Cedex, France RTO-MP-IST-099 Approved for Public release, distribution unlimited. Supporting documents are...Analysis and Studies Panel • SCI Systems Concepts and Integration Panel • SET Sensors and Electronics Technology Panel These bodies are made up of

Psychosocial risk and protective factors for the health and well-being of professionals working in emergency and non-emergency medical transport services, identified via questionnaires.

PubMed

Navarro Moya, P; González Carrasco, M; Villar Hoz, E

2017-09-06

Medical transport (MT) professionals are subject to considerable emotional demands due to their involvement in life-or-death situations and their exposure to the serious health problems of their clients. An increase in the demand for MT services has, in turn, increased interest in the study of the psychosocial risk factors affecting the health of workers in this sector. However, research thus far has not distinguished between emergency (EMT) and non-emergency (non-EMT) services, nor between the sexes. Furthermore, little emphasis has been placed on the protective factors involved. The main objective of the present study is to identify any existing differential exposure - for reasons of work setting (EMT and non-EMT) or of gender - to the various psychosocial risk and protective factors affecting the health of MT workers. Descriptive and transversal research with responses from 201 professionals. The scores obtained on the various psychosocial scales in our study - as indicators of future health problems - were more unfavourable for non-EMT workers than they were for EMT workers. Work setting, but not gender, was able to account for these differences. The scores obtained for the different psychosocial factors are generally more favourable for the professionals we surveyed than those obtained in previous samples. The significant differences observed between EMT and non-EMT personnel raise important questions regarding the organization of work in companies that carry out both services at the same time in the same territory. The relationships among the set of risk/protective factors suggests a need for further investigation into working conditions as well as a consideration of the workers' sense of coherence and subjective well-being as protective factors against occupational burnout syndrome.

D-Dimer Use and Pulmonary Embolism Diagnosis in Emergency Units: Why Is There Such a Difference in Pulmonary Embolism Prevalence between the United States of America and Countries Outside USA?

PubMed

Pernod, Gilles; Caterino, Jeffrey; Maignan, Maxime; Tissier, Cindy; Kassis, Jeannine; Lazarchick, John

2017-01-01

Although diagnostic guidelines are similar, there is a huge difference in pulmonary embolism (PE) prevalence between the United States of America (US) and countries outside the USA (OUS) in the emergency care setting. In this study, we prospectively analyze patients' characteristics and differences in clinical care that may influence PE prevalence in different countries. An international multicenter prospective diagnostic study was conducted in a standard-of-care setting. Consecutive outpatients presenting to the emergency unit and suspected for PE were managed using the Wells score, STA-Liatest® D-Dimers and imaging. The prevalence of PE in the study was 7.9% in low and moderate risk patients. Among the 1060 patients with low or moderate pre-test probability (PTP), PE prevalence was four times higher in OUS (10.7%) than in the US (2.5%) (P < 0.0001). The mean number of imaging procedures performed for one new PE diagnosis was 3.3 in OUS vs 17 in the US (P < 0.001). Stopping investigation in the case of negative D-dimers (DD combined) with low/moderate PTP was more frequent in OUS (92.7%) than in the US (75.7%) (P < 0.01). Moreover, the use of imaging was much higher in the US (44.4% vs 19.2% in OUS) in the case of moderate PTP combined with negative DD. Differences between US and OUS PE prevalence in emergency setting might be explained by differences in patients' characteristics and mostly in care patterns. US physicians performed computed tomographic pulmonary angiography more often than in Europe in cases of low/moderate PTP combined with negative DD. ClinicalTrials.gov NCT01221805.

RNA transcriptional biosignature analysis for identifying febrile infants with serious bacterial infections in the emergency department: a feasibility study.

PubMed

Mahajan, Prashant; Kuppermann, Nathan; Suarez, Nicolas; Mejias, Asuncion; Casper, Charlie; Dean, J Michael; Ramilo, Octavio

2015-01-01

To develop the infrastructure and demonstrate the feasibility of conducting microarray-based RNA transcriptional profile analyses for the diagnosis of serious bacterial infections in febrile infants 60 days and younger in a multicenter pediatric emergency research network. We designed a prospective multicenter cohort study with the aim of enrolling more than 4000 febrile infants 60 days and younger. To ensure success of conducting complex genomic studies in emergency department (ED) settings, we established an infrastructure within the Pediatric Emergency Care Applied Research Network, including 21 sites, to evaluate RNA transcriptional profiles in young febrile infants. We developed a comprehensive manual of operations and trained site investigators to obtain and process blood samples for RNA extraction and genomic analyses. We created standard operating procedures for blood sample collection, processing, storage, shipping, and analyses. We planned to prospectively identify, enroll, and collect 1 mL blood samples for genomic analyses from eligible patients to identify logistical issues with study procedures. Finally, we planned to batch blood samples and determined RNA quantity and quality at the central microarray laboratory and organized data analysis with the Pediatric Emergency Care Applied Research Network data coordinating center. Below we report on establishment of the infrastructure and the feasibility success in the first year based on the enrollment of a limited number of patients. We successfully established the infrastructure at 21 EDs. Over the first 5 months we enrolled 79% (74 of 94) of eligible febrile infants. We were able to obtain and ship 1 mL of blood from 74% (55 of 74) of enrolled participants, with at least 1 sample per participating ED. The 55 samples were shipped and evaluated at the microarray laboratory, and 95% (52 of 55) of blood samples were of adequate quality and contained sufficient RNA for expression analysis. It is possible to create a robust infrastructure to conduct genomic studies in young febrile infants in the context of a multicenter pediatric ED research setting. The sufficient quantity and high quality of RNA obtained suggests that whole blood transcriptional profile analysis for the diagnostic evaluation of young febrile infants can be successfully performed in this setting.

Estimated financial savings associated with health information exchange and ambulatory care referral.

PubMed

Frisse, Mark E; Holmes, Rodney L

2007-12-01

Data and financial models based on an operational health information exchange suggest that health care delivery costs can be reduced by making clinical data available at the time of care in urban emergency departments. Reductions are the result of decreases in laboratory and radiographic tests, fewer admissions for observation, and lower overall emergency department costs. The likelihood of reducing these costs depends on the extent to which clinicians alter their workflow and take into account information available through the exchange from other institutions prior to initiating a treatment plan. Far greater savings can be realized in theory by identifying individuals presenting to emergency departments whose acute and long-term care needs are more suitably addressed at lower costs in ambulatory settings or medical homes. These alternative ambulatory settings can more effectively address the chronic care needs of those who receive most of their care in emergency departments. To support a shift from emergency room care to clinic care, health care information available through the health information exchange must be made available in both emergency department and ambulatory care settings. If practice workflow and patient behavior can be changed, a more effective and efficient care delivery system will be made possible through the secure exchange of clinical information across regional settings. These projections support the case for the financial viability of regional health information exchanges and motivate participation of hospitals and ambulatory care organizations-particularly in urban settings.

Vibration signaling in mobile devices for emergency alerting: a study with deaf evaluators.

PubMed

Harkins, Judith; Tucker, Paula E; Williams, Norman; Sauro, Jeff

2010-01-01

In the United States, a nationwide Commercial Mobile Alert Service (CMAS) is being planned to alert cellular mobile device subscribers to emergencies occurring near the location of the mobile device. The plan specifies a unique audio attention signal as well as a unique vibration attention signal (for mobile devices set to vibrate) to identify that the incoming message pertains to an emergency. Ratings of vibration signals of varying lengths and patterns were obtained from 44 deaf users of mobile devices for the perceived effectiveness of the signal in getting their attention in an emergency situation. Longer signals received higher ratings than shorter ones, and three signals with temporal on-off patterns were rated significantly better than a constant vibration. The U.S. government's recommended vibration signal for the CMAS, an important feature for access to emergency alerts by deaf persons, is supported by the results of the study.

65. FORWARD EMERGENCY DIESEL GENERATOR SET AFT LOOKING FORWARD ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

65. FORWARD EMERGENCY DIESEL GENERATOR SET - AFT LOOKING FORWARD SHOWING TOP HALF OF FAIRBANKS MORSE 36D81/8 TEN CYLINDER DIESEL ENGINE SERIAL #951230 AND EXHAUST SYSTEM. - U.S.S. HORNET, Puget Sound Naval Shipyard, Sinclair Inlet, Bremerton, Kitsap County, WA

Emergency nurses' ways of coping influence their ability to empower women to move beyond the oppression of intimate partner violence.

PubMed

Van der Wath, Annatjie; Van Wyk, Neltjie; Van Rensburg, Elsie Janse

2016-04-15

Millennium Developmental Goal 3 (MDG 3) aims at enhancing gender equity and empowerment of women. Emergency nurses who often encounter women injured by their intimate partners are at risk of developing vicarious traumatisation, which may influence their ability to empower women to move beyond the oppression of intimate partner violence. This article aims to, (1) describe emergency nurses' ways of coping with the exposure to survivors of intimate partner violence, and (2) recommend a way towards effective coping that will enhance emergency nurses' abilities to empower women to move beyond the oppression of intimate partner violence to contribute to the achievement of MDG 3. The study was conducted in emergency units of two public hospitals in an urban setting in South Africa. A qualitative design and descriptive phenomenological method was used. Emergency nurses working in the setting were purposively sampled and interviewed. The data were analysed by searching for the essence and meaning attached to the exposure of emergency nurses to survivors of intimate partner violence. Emergency nurses' coping responses were either aimed at avoiding or dealing with their exposure to survivors of intimate partner violence. Coping aimed at dealing with the exposure included seeking support, emotion regulation and accommodative coping. Emergency nurses employ either effective or ineffective ways of coping. Less effective ways of coping may increase their risk of vicarious and secondary traumatisation, which in turn may influence their ability to empower women to move beyond the oppression of intimate partner violence.

Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes.

PubMed

Mpirimbanyi, Christophe; Nyirimodoka, Alexandre; Lin, Yihan; Hedt-Gauthier, Bethany L; Odhiambo, Jackline; Nkurunziza, Theoneste; Havens, Joaquim M; Omondi, Jack; Rwamasirabo, Emile; Ntirenganya, Faustin; Toma, Gabriel; Mubiligi, Joel; Bayitondere, Scheilla; Riviello, Robert

2017-12-01

Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda. This retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes. In 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15-60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p < 0.001), with the shortest being urological emergencies at 1.5 days (interquartile range (IQR):1, 6) and the longest being complicated hernia at 17.5 days (IQR: 1, 208). Of all patients, 54% were operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p < 0.001). In addition, the general surgeon was more likely to treat patients with complex diagnoses such as acute abdominal conditions (33.3% vs 4.1%, p < 0.001) compared to general practitioners. For patients who received surgery, 73.3% had no postoperative complications and 3.2% died. While acute abdominal conditions are often considered the most common emergency general surgical condition in sub-Saharan Africa, soft tissue infections were the most common in our setting. This could represent a true difference in epidemiology in rural settings compared to referral facilities in urban settings. Patients were more likely to receive an operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients.

Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings

PubMed Central

Willman, Laura; Virtanen, Marianna; Kivimäki, Mika; Vahtera, Jussi; Välimäki, Maritta

2017-01-01

Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective health and work ability than both of the non-psychiatric nursing groups, while their psychiatric wellbeing is better and they have less sleep problems compared to medical and surgical nurses. Psychiatric nurses maintain better psychiatric wellbeing and experience fewer sleep problems than non-psychiatric nurses after events of exposure to patient aggression. This suggest that more attention should be given to non-psychiatric settings for maintaining the wellbeing of nurses after exposure to patient aggression. PMID:29057802

The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes.

PubMed

Keller, Deborah S; Pedraza, Rodrigo; Flores-Gonzalez, Juan Ramon; LeFave, Jean Paul; Mahmood, Ali; Haas, Eric M

2016-08-01

Population-based studies evaluating laparoscopic colectomy and outcomes compared with open surgery have concentrated on elective resections. As such, data assessing non-elective laparoscopic colectomies are limited. Our goal was to evaluate the current usage and outcomes of laparoscopic in the urgent and emergent setting in the USA. A national inpatient database was reviewed from 2008 to 2011 for right, left, and sigmoid colectomies in the non-elective setting. Cases were stratified by approach into open or laparoscopic groups. Demographics, perioperative clinical variables, and financial outcomes were compared across each group. A total of 22,719 non-elective colectomies were analyzed. The vast majority (95.8 %) was open. Most cases were performed in an urban setting at non-teaching hospitals by general surgeons. Colorectal surgeons were significantly more likely to perform a case laparoscopic than general surgeons (p < 0.001). Demographics were similar between open and laparoscopic groups; however, the disease distribution by approach varied, with significantly more severe cases in the open colectomy arm (p < 0.001). Cases performed laparoscopically had significantly better mortality and complication rates. Laparoscopic cases also had significantly improved outcomes, including shorter length of stay and hospital costs (all p < 0.001). Our analysis revealed less than 5 % of urgent and emergent colectomies in the USA are performed laparoscopically. Colorectal surgeons were more likely to approach a case laparoscopically than general surgeons. Outcomes following laparoscopic colectomy in this setting resulted in reduced length of stay, lower complication rates, and lower costs. Increased adoption of laparoscopy in the non-elective setting should be considered.

THE MIXED EVIDENCE FOR BRIEF INTERVENTION IN EMERGENCY DEPARTMENTS, TRAUMA CARE CENTERS AND INPATIENT HOSPITAL SETTINGS: WHAT SHOULD WE DO?

PubMed Central

Field, Craig Andrew; Baird, Janette; Saitz, Richard; Caetano, Raul; Monti, Peter M.

2010-01-01

The purpose of this review is to provide a broad overview of the status of brief intervention in the emergency department, trauma center and inpatient hospital setting. This review is based on a symposia presented at the 2009 annual conference of the Research Society on Alcoholism (Baird et al., 2009; Field, et al., 2009; Monti et al., 2009; Saitz et al., 2009). While the general efficacy of brief alcohol interventions in these settings has been recognized, the evidence is increasingly mixed. Herein we discuss possible confounding factors; including the inconsistencies in interventions provided, differences in target population, study design and assessment procedures. Recent studies investigating potential moderators of treatment outcomes suggest that a more sophisticated approach to evaluating the effectiveness of brief interventions across varying patient populations is needed in order to further understand its effectiveness. Current dissemination efforts represent a significant advance in broadening the base of treatment for alcohol problems by providing an evidenced based intervention in health care settings and should not be curtailed. However, additional research is required to enhance treatment outcomes, refine current practice guidelines and continue to bridge the gap between science and practice. Given the current state of research, a multi-setting clinical trial is recommended to account for potential contextual differences while controlling for study design. PMID:20860610

Unrecognized magic mushroom abuse in a 28-year-old man.

PubMed

McClintock, Ryan L; Watts, David J; Melanson, Scott

2008-10-01

A 28-year-old man with a history of drug and alcohol abuse presented multiple times to the hospital over 2 months with an elusive constellation of symptoms, resolving spontaneously in each instance. This patient required a high level of care for management and stabilization, including 3 emergency department visits, 2 medical floor admissions, and 1 intensive care unit admission. In both the emergency department and inpatient setting, all laboratory and imaging study results, including gas chromatography/mass spectrophotometry of the urine, were negative/normal. A definitive diagnosis eluded multiple emergency medicine, critical care, and consulting physicians. His symptoms included altered mental status, vomiting, diaphoresis, and mydriasis. The patient later admitted using mushrooms to a nurse. In the absence of confirmatory testing, but supported by exclusionary and anecdotal data, we believe that our patient's symptoms are consistent with Psilocybe mushroom toxicity. We feel that had this been considered initially, the correct diagnosis would have led to a better utilization of resources, and we want to remind emergency physicians of the possibility of mushroom abuse in any similar clinical setting.

EPA activities related to emerging air sensor technology

EPA Science Inventory

This slide set was developed through contributions of NERL and NRMRL research groups and organized to explain the diversity of ongoing research related to emerging air sensor technology for an international audience. Gayle will be walking OAQPS through the slide set in advance o...

Childbirth attendance strategies and their impact on maternal mortality and morbidity in low-income settings: a systematic review.

PubMed

Pyone, Thidar; Sorensen, Bjarke Lund; Tellier, Siri

2012-09-01

To review quantitative evidence of the effect on maternal health of different childbirth attendance strategies in low-income settings. Systematic review. Studies using quantitative methods, referring to the period 1987-2011, written in English and reporting the impact of childbirth attendance strategies on maternal mortality or morbidity in low-income settings were included. Guidelines developed by the Cochrane collaboration and the Centre for Review and Dissemination, University of York were followed. The included articles were read and sorted by category of strategy that emerged from the reading. The search criteria yielded 29 articles. The following three main categories of strategy emerged: (i) those primarily intended to improve quality of care; (ii) "centrifugal strategies," which sought to bring services to the women; and (iii) "centripetal strategies," which sought to bring the women to the services. Few of the studies had a design that provided strong evidence for the impact of the strategy concerned. The evidence emerging from the studies was difficult to compare, because concepts were not defined in a consistent manner (such as "skilled birth attendance") and many studies examined the impact of a package of interventions without ferreting out the impact of individual components. Yet, some studies described individual aspects with great promise (such as cost, transport, outreach-friendly drugs or targeted training). There is a need for clearer conceptual frameworks, including some which permit assessment of packages of interventions. © 2012 The Authors  Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

A cross-sectional questionnaire study of the rules governing pupils' carriage of inhalers for asthma treatment in secondary schools in North East England.

PubMed

Funston, Wendy; Howard, Simon J

2016-01-01

Objectives. The primary objective of this study was to assess the rules governing secondary school pupils' carriage of inhalers for emergency treatment of asthma in the North East of England. Design. This study was based upon a postal questionnaire survey. Setting. The setting for this study was mainstream free-to-attend secondary schools which admit 16 year old pupils within the 12 Local Authority areas which make up the North East of England. Participants. All 153 schools meeting the inclusion criteria were invited to participate in the study, of which 106 (69%) took part. Main Outcome Measures. Our three main outcome measures were: whether pupils are permitted to carry inhalers on their person while at school; whether advance permission is required for pupils to carry inhalers, and from whom; and whether the school has an emergency 'standby' salbutamol inhaler for use in asthma emergencies, as permitted since October 2014 under recent amendments to The Human Medicines Regulations 2012. Results. Of 98 schools submitting valid responses to the question, 99% (n = 97) permitted pupils to carry inhalers on their person while at school; the remaining school stored pupils' inhalers in a central location within the school. A total of 22% of included schools (n = 22) required parental permission before pupils were permitted to carry inhalers. Of 102 schools submitting valid responses to the question, 44% (n = 45) had purchased a 'standby' salbutamol inhaler for use in asthma emergencies. Conclusions. Most secondary schools in North East England permit pupils to carry inhalers on their person. The requirement in a minority of schools for parental permission to be given possibly contravenes the standard ethical practices in clinical medicine for children of this age. Only a minority of schools hold a 'standby' salbutamol inhaler for use in asthma emergencies. Wider availability may improve outcomes for asthma emergencies occurring in schools.

Integrating a framework for conducting public health systems research into statewide operations-based exercises to improve emergency preparedness

PubMed Central

2012-01-01

Background Due to the uncommon nature of large-scale disasters and emergencies, public health practitioners often turn to simulated emergencies, known as “exercises”, for preparedness assessment and improvement. Under the right conditions, exercises can also be used to conduct original public health systems research. This paper describes the integration of a research framework into a statewide operations-based exercise program in California as a systems-based approach for studying public health emergency preparedness and response. Methods We developed a research framework based on the premise that operations-based exercises conducted by medical and public health agencies can be described using epidemiologic concepts. Using this framework, we conducted a survey of key local and regional medical and health agencies throughout California following the 2010 Statewide Medical and Health Exercise. The survey evaluated: (1) the emergency preparedness capabilities activated and functions performed in response to the emergency scenario, and (2) the major challenges to inter-organizational communications and information management. Results Thirty-five local health departments (LHDs), 24 local emergency medical services (EMS) agencies, 121 hospitals, and 5 Regional Disaster Medical and Health Coordinators/Specialists (RDMHC) responded to our survey, representing 57%, 77%, 26% and 83%, respectively, of target agencies in California. We found two sets of response capabilities were activated during the 2010 Statewide Exercise: a set of core capabilities that were common across all agencies, and a set of agency-specific capabilities that were more common among certain agency types. With respect to one response capability in particular, inter-organizational information sharing, we found that the majority of respondents’ comments were related to the complete or partial failure of communications equipment or systems. Conclusions Using the 2010 Statewide Exercise in California as an opportunity to develop our research framework, we characterized several aspects of the public health and medical system’s response to a standardized emergency scenario. From a research perspective, this study provides a potential new framework for conducting exercise-based research. From a practitioner’s perspective, our results provide a starting point for preparedness professionals’ dialogue about expected and actual organizational roles, responsibilities, and resource capacities within the public health system. Additionally, the identification of specific challenges to inter-organizational communications and information management offer specific areas for intervention. PMID:22905991

Evaluation of a discussion forum for knowledge sharing among emergency practitioners: a social network approach.

PubMed

Curran, Janet; Abidi, Syed Sibte Raza

2006-01-01

Peer to peer knowledge sharing is recognized as a key contributor to the development of expert practice for health care professionals. Emergency departments with access to extensive expertise, such as in urban hospital settings, present greater potential for rich collaborative learning opportunities as compared with rural settings where expertise is at times scarce. Collaborative technologies such as electronic discussion boards may assist in leveling the "knowledge" playing field and increase opportunities for the growth of a strong social network for emergency clinicians. A social network perspective is used to explore the effectiveness of a discussion forum to support knowledge sharing among emergency practitioners in rural and urban emergency departments in Nova Scotia.

Methodological Issues Surrounding the Use of Baseline Health-Related Quality of Life Data to Inform Trial-Based Economic Evaluations of Interventions Within Emergency and Critical Care Settings: A Systematic Literature Review.

PubMed

Dritsaki, Melina; Achana, Felix; Mason, James; Petrou, Stavros

2017-05-01

Trial-based cost-utility analyses require health-related quality of life data that generate utility values in order to express health outcomes in terms of quality-adjusted life years (QALYs). Assessments of baseline health-related quality of life are problematic where trial participants are incapacitated or critically ill at the time of randomisation. This review aims to identify and critique methods for handling non-availability of baseline health-related quality of life data in trial-based cost-utility analyses within emergency and critical illness settings. A systematic literature review was conducted, following PRISMA guidelines, to identify trial-based cost-utility analyses of interventions within emergency and critical care settings. Databases searched included the National Institute for Health Research (NIHR) Journals Library (1991-July 2016), Cochrane Library (all years); National Health Service (NHS) Economic Evaluation Database (all years) and Ovid MEDLINE/Embase (without time restriction). Strategies employed to handle non-availability of baseline health-related quality of life data in final QALY estimations were identified and critiqued. A total of 4224 published reports were screened, 19 of which met the study inclusion criteria (mean trial size 1670): 14 (74 %) from the UK, four (21%) from other European countries and one (5%) from India. Twelve studies (63%) were based in emergency departments and seven (37%) in intensive care units. Only one study was able to elicit patient-reported health-related quality of life at baseline. To overcome the lack of baseline data when estimating QALYs, eight studies (42%) assigned a fixed utility weight corresponding to either death, an unconscious health state or a country-specific norm to patients at baseline, four (21%) ignored baseline utilities, three (16%) applied values from another study, one (5%) generated utility values via retrospective recall and one (5%) elicited utilities from experts. A preliminary exploration of these methods shows that incremental QALY estimation is unlikely to be biased if balanced trial allocation is achieved and subsequent collection of health-related quality of life data occurs at the earliest possible opportunity following commencement of treatment, followed by an adequate number of follow-up assessments. Trial-based cost-utility analyses within emergency and critical illness settings have applied different methods for QALY estimation, employing disparate assumptions about the health-related quality of life of patients at baseline. Where baseline measurement is not practical, measurement at the earliest opportunity following commencement of treatment should minimise bias in QALY estimation.

Teachers' Perceptions of the Emergence of a Middle School Culture: Studying How Culture Develops in Educational Settings.

ERIC Educational Resources Information Center

Daniel, Larry G.

Organizational theorists have viewed organizations as "mini-societies" based upon commonly held cultural values and assumptions, which may serve to revolutionize organizational practices or to bring about new organization structures. The middle school is an example of an educational institution that has arisen as a result of a particular set of…

Teaching Manual Signs to Adults with Mental Retardation Using Matching-to-Sample Procedures and Stimulus Equivalence

ERIC Educational Resources Information Center

Elias, N. C.; Goyos, C.; Saunders, M.; Saunders, R.

2008-01-01

The objective of this study was to teach manual signs through an automated matching-to-sample procedure and to test for the emergence of new conditional relations and imitative behaviors. Seven adults with mild to severe mental retardation participated. Four were also hearing impaired. Relations between manual signs (set A) and pictures (set B)…

Sensitivity and Specificity of Emergency Physicians and Trainees for Identifying Internally Concealed Drug Packages on Abdominal Computed Tomography Scan: Do Lung Windows Improve Accuracy?

PubMed

Asha, Stephen Edward; Cooke, Andrew

2015-09-01

Suspected body packers may be brought to emergency departments (EDs) close to international airports for abdominal computed tomography (CT) scanning. Senior emergency clinicians may be asked to interpret these CT scans. Missing concealed drug packages have important clinical and forensic implications. The accuracy of emergency clinician interpretation of abdominal CT scans for concealed drugs is not known. Limited evidence suggests that accuracy for identification of concealed packages can be increased by viewing CT images on "lung window" settings. To determine the accuracy of senior emergency clinicians in interpreting abdominal CT scans for concealed drugs, and to determine if this accuracy was improved by viewing scans on both abdominal and lung window settings. Emergency clinicians blinded to all patient identifiers and the radiology report interpreted CT scans of suspected body packers using standard abdominal window settings and then with the addition of lung window settings. The reference standard was the radiologist's report. Fifty-five emergency clinicians reported 235 CT scans. The sensitivity, specificity, and accuracy of interpretation using abdominal windows was 89.9% (95% confidence interval [CI] 83.0-94.7), 81.9% (95% CI 73.7-88.4), and 86.0% (95% CI 81.5-90.4), respectively, and with both window settings was 94.1% (95% CI 88.3-97.6), 76.7% (95% CI 68.0-84.1), 85.5% (95% CI 81.0-90.0), respectively. Diagnostic accuracy was similar regardless of the clinician's experience. Interrater reliability was moderate (kappa 0.46). The accuracy of interpretation of abdominal CT scans performed for the purpose of detecting concealed drug packages by emergency clinicians is not high enough to safely discharge these patients from the ED. The use of lung windows improved sensitivity, but at the expense of specificity. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

A multi-level model of emerging technology: An empirical study of the evolution of biotechnology from 1976 to 2003

PubMed Central

van Witteloostuijn, Arjen

2018-01-01

In this paper, we develop an ecological, multi-level model that can be used to study the evolution of emerging technology. More specifically, by defining technology as a system composed of a set of interacting components, we can build upon the argument of multi-level density dependence from organizational ecology to develop a distribution-independent model of technological evolution. This allows us to distinguish between different stages of component development, which provides more insight into the emergence of stable component configurations, or dominant designs. We validate our hypotheses in the biotechnology industry by using patent data from the USPTO from 1976 to 2003. PMID:29795575

Understanding the factors which promote registered nurses' intent to stay in emergency and critical care areas.

PubMed

Van Osch, Mary; Scarborough, Kathy; Crowe, Sarah; Wolff, Angela C; Reimer-Kirkham, Sheryl

2018-03-01

To explore the influential factors and strategies that promote an experienced nurse's intent to stay in their emergency or critical care area. Turnover among registered nurses (herein referred to as nurses) working in specialty areas of practice can result in a range of negative outcomes. The retention of specialty nurses at the unit level has important implications for hospital and health systems. These implications include lost knowledge and experience which may in turn impact staff performance levels, patient outcomes, hiring, orientating, development of clinical competence and other aspects of organizational performance. This qualitative study used an interpretive descriptive design to understand nurses' perceptions of the current factors and strategies that promote them staying in emergency or critical care settings for two or more years. Focus groups were conducted with 13 emergency and critical care nurses. Data analysis involved thematic analysis that evolved from codes to categories to themes. Four themes were identified: leadership, interprofessional relationships, job fit and practice environment. In addition, the ideas of feeling valued, respected and acknowledged were woven throughout. Factors often associated with nurse attrition such as burnout and job stresses were not emphasised by the respondents in our study as critical to their intent to stay in their area of practice. This study has highlighted positive aspects that motivate nurses to stay in their specialty areas. To ensure quality care for patients, retention of experienced emergency and critical care nurses is essential to maintaining specialty expertise in these practice settings. © 2017 John Wiley & Sons Ltd.

Adult Status Epilepticus: A Review of the Prehospital and Emergency Department Management

PubMed Central

Billington, Michael; Kandalaft, Osama R.; Aisiku, Imoigele P.

2016-01-01

Seizures are a common presentation in the prehospital and emergency department setting and status epilepticus represents an emergency neurologic condition. The classification and various types of seizures are numerous. The objectives of this narrative literature review focuses on adult patients with a presentation of status epilepticus in the prehospital and emergency department setting. In summary, benzodiazepines remain the primary first line therapeutic agent in the management of status epilepticus, however, there are new agents that may be appropriate for the management of status epilepticus as second- and third-line pharmacological agents. PMID:27563928

The optimization of nuclear power plants operation modes in emergency situations

NASA Astrophysics Data System (ADS)

Zagrebayev, A. M.; Trifonenkov, A. V.; Ramazanov, R. N.

2018-01-01

An emergency situations resulting in the necessity for temporary reactor trip may occur at the nuclear power plant while normal operating mode. The paper deals with some of the operation c aspects of nuclear power plant operation in emergency situations and during threatened period. The xenon poisoning causes limitations on the variety of statements of the problem of calculating characteristics of a set of optimal reactor power off controls. The article show a possibility and feasibility of new sets of optimization tasks for the operation of nuclear power plants under conditions of xenon poisoning in emergency circumstances.

Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting

PubMed Central

Yang, Heechul; Lee, Chun Kyon; Kim, Gun Bea

2016-01-01

Purpose To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. Materials and Methods From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. Results All technical and clinical success–i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control–was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12–32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. Conclusion Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding. PMID:27189294

Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings

PubMed Central

Schiavo, Renata; Leung, May May; Brown, Mason

2014-01-01

Objective This review aims to identify and assess evidence on interventions to communicate risk and promote disease mitigation measures in epidemics and emerging disease outbreak settings. The study focuses on data that are relevant to low and middle-income country (LMIC) settings. Methods We conducted a comprehensive literature search using five major electronic databases (Pubmed Medline, Biomed Central, EMBASE, Science of Citation Index, and Cochrane Library) and other sources to identify relevant studies published from January 2002 to July 2013. The review was guided by the socio-ecological model/perspective of public health and the ideation theory and focused on interventions at the community, healthcare, and multi-sectoral settings, which also reflect key intervention levels of the Ottawa Charter for Health Promotion. Eligible quantitative studies were selected according to specific study criteria and assessed using the Critical Appraisal Skills Program (CASP) framework. Conversely, qualitative studies, reviews, case studies, and editorials were not included. Studies were selected by two independent reviewers. Results Twenty-nine relevant studies from 16 countries were included. Most studies focused on a single intervention or intervention level, rather than multi-sectoral interventions. The majority of the evidence relates to programs aimed at behavioral and social results (or relevant intermediate steps) within a specific population group. Two studies included implications for improvements in health service delivery, two studies examined the intervention’s impact on health systems-related outcomes, and three had also implications for environmental health outcomes. Cost- and health equity-related implications for select evidence were also discussed. Conclusions The paucity of well-designed quantitative evaluations of interventions to communicate health risk and promote disease control measures in LMICs does not allow for any definitive conclusions. Yet, the review identified several promising interventions and areas for future investigation. Among them, community-based and participatory interventions seemed to be central within epidemic and emerging disease settings, particularly in low-resource settings. Yet, evidence on their effectiveness is not conclusive and needs to be explored by future studies. Other promising areas for future investigation include multi-component and multi-sectoral approaches to intervention design. Major research gaps referred to any evaluation of the impact of these kinds of interventions on health policy adoption and/or implementation, and social determinants of health. Research on cost-effectiveness also needs to be strengthened. This review identified several research gaps and questions, and discusses potential future directions for increasing capacity for future and more rigorous assessments. PMID:24649867

Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings.

PubMed

Schiavo, Renata; May Leung, May; Brown, Mason

2014-03-01

This review aims to identify and assess evidence on interventions to communicate risk and promote disease mitigation measures in epidemics and emerging disease outbreak settings. The study focuses on data that are relevant to low and middle-income country (LMIC) settings. We conducted a comprehensive literature search using five major electronic databases (Pubmed Medline, Biomed Central, EMBASE, Science of Citation Index, and Cochrane Library) and other sources to identify relevant studies published from January 2002 to July 2013. The review was guided by the socio-ecological model/perspective of public health and the ideation theory and focused on interventions at the community, healthcare, and multi-sectoral settings, which also reflect key intervention levels of the Ottawa Charter for Health Promotion. Eligible quantitative studies were selected according to specific study criteria and assessed using the Critical Appraisal Skills Program (CASP) framework. Conversely, qualitative studies, reviews, case studies, and editorials were not included. Studies were selected by two independent reviewers. Twenty-nine relevant studies from 16 countries were included. Most studies focused on a single intervention or intervention level, rather than multi-sectoral interventions. The majority of the evidence relates to programs aimed at behavioral and social results (or relevant intermediate steps) within a specific population group. Two studies included implications for improvements in health service delivery, two studies examined the intervention's impact on health systems-related outcomes, and three had also implications for environmental health outcomes. Cost- and health equity-related implications for select evidence were also discussed. The paucity of well-designed quantitative evaluations of interventions to communicate health risk and promote disease control measures in LMICs does not allow for any definitive conclusions. Yet, the review identified several promising interventions and areas for future investigation. Among them, community-based and participatory interventions seemed to be central within epidemic and emerging disease settings, particularly in low-resource settings. Yet, evidence on their effectiveness is not conclusive and needs to be explored by future studies. Other promising areas for future investigation include multi-component and multi-sectoral approaches to intervention design. Major research gaps referred to any evaluation of the impact of these kinds of interventions on health policy adoption and/or implementation, and social determinants of health. Research on cost-effectiveness also needs to be strengthened. This review identified several research gaps and questions, and discusses potential future directions for increasing capacity for future and more rigorous assessments.

Nonurgent use of a pediatric emergency department: a preliminary qualitative study.

PubMed

Chin, Nancy P; Goepp, Julius G; Malia, Timothy; Harris, LeWanza; Poordabbagh, Armin

2006-01-01

To understand patterns of decision making among families presenting to a pediatric emergency department (ED) for nonacute care and to understand pediatric ED staff responses. Cross-sectional qualitative study using in-depth interviews, direct observations, and nonidentifying demographic data. Eleven percent of visits made during the study period were identified as nonacute. All were made by families from low-income areas. Three main themes emerged: (1) most families had been referred by their primary care providers; (2) the complexity of living in low-income areas makes the ED a choice of convenience for these stressed families; and (3) mistrust of primary health services was not identified by our respondents as a motivator for ED utilization, in contrast with other published data. Two themes emerged from ED staff: (1) actual nonurgent visit rates were lower than staff estimates; and (2) these visits produced frustration among staff members, although their degrees of insight and understanding of factors motivating these visits were variable. In this setting, nonacute visits occurred with lower than perceived frequency and caused disproportionate frustration among staff and families. These visits appear to be driven more by consequences of system design and structure than by family members' decision making. Mistrust of primary care services was not a strong family decision-making factor; the study's setting may have limited its ability to capture such data. Recommended system changes to lower barriers to primary care include expanded office hours, subsidized staffing for offices in medically underserved areas, and lowering barriers to sick care.

Assessment of Emergency Medical Services in the Ashanti Region of Ghana.

PubMed

Mould-Millman, N K; Oteng, R; Zakariah, A; Osei-Ampofo, M; Oduro, G; Barsan, W; Donkor, P; Kowalenko, T

2015-09-01

We aimed to assess the structure, function and performance of Ashanti Region's emergency medical services system in the context of the regional need for prehospital emergency care. A mixed-methods approach was employed, using retrospective collection of quantitative data and prospectively gathered qualitative data. Setting - pertinent data were collected from Ghanaian and international sources; interviews and technical assessments were performed primarily in the Ashanti Region of Ghana. All stakeholders relevant to emergency medical services in the Ashanti Region of Ghana were assessed; there was a special focus on National Ambulance Service (NAS) and Ashanti Region healthcare personnel. This was an observational study using qualitative and quantitative assessment techniques. The structure, function and performance of the Ashanti emergency medical services system, guided by a relevant technical assessment framework. NAS is the premier and only true prehospital agency in the Ashanti Region. NAS has developed almost every essential aspect of an EMS system necessary to achieve its mission within a low-resource setting. NAS continues to increase its number of response units to address the overwhelming Ashanti region demand, especially primary calls. Deficient areas in need of development are governance, reliable revenue, public access, community integration, clinical care guidelines, research and quality assurance processes. The Ashanti Region has a growing and thriving emergency medical services system. Although many essential areas for development were identified, NAS is well poised to meet the regional demand for prehospital emergency care and transport.

Understanding the drivers on medical workloads: an analysis of spectators at the Australian Football League.

PubMed

Zeitz, Kathryn; Haghighi, Pari Delir; Burstein, Frada; Williams, Jeffrey

2013-06-01

The present study was designed to further understand the psychosocial drivers of crowds impacting on the demand for healthcare. This involved analysing different spectator crowds for medical usage at mass gatherings; more specifically, did different football team spectators (of the Australian Football League) generate different medical usage rates. In total, 317 games were analysed from 10 venues over 2 years. Data were analysed by the ANOVA and Pearson correlation tests. RESULTS; Spectators who supported different football teams generated statistically significant differences in patient presentation rates (PPR) (F15, 618=1.998, P=0.014). The present study confirmed previous findings that there is a positive correlation between the crowd size and PPR at mass gatherings but found a negative correlation between density and PPR (r = -0.206, n=317, P<0.0005). The present study has attempted to scientifically explore psychosocial elements of crowd behaviour as a driver of demand for emergency medical care. In measuring demand for emergency medical services there is a need to develop a more sophisticated understanding of a variety of drivers in addition to traditional metrics such as temperature, crowd size and other physical elements. In this study we saw that spectators who supported different football teams generated statistically significant differences in PPR. What is known about this topic? Understanding the drivers of emergency medical care is most important in the mass gathering setting. There has been minimal analysis of psychological 'crowd' variables. What does this paper add? This study explores the psychosocial impact of supporting a different team on the PPR of spectators at Australian Football League matches. The value of collecting and analysing these types of data sets is to support more balanced planning, better decision support and knowledge management, and more effective emergency medical demand management. What are the implications for practitioners? This information further expands the body of evidence being created to understand the drivers of emergency medical demand and usage. In addition, it supports the planning and management of emergency medical and health-related requirements by increasing our understanding of the effect of elements of 'crowd' that impact on medical usage and emergency healthcare.

Patient- and family-centered care of children in the emergency department.

PubMed

O'Malley, Patricia J; Brown, Kathleen; Krug, Steven E

2008-08-01

Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and health care professionals. Providing patient- and family-centered care to children in the emergency department setting presents many opportunities and challenges. This technical report draws on previously published policy statements and reports, reviews the current literature, and describes the present state of practice and research regarding patient- and family-centered care for children in the emergency department setting as well as some of the complexities of providing such care. This technical report has been endorsed by the Academic Pediatric Association (formerly the Ambulatory Pediatric Association), the American College of Osteopathic Emergency Physicians, the National Association of Emergency Medical Technicians, the Institute for Family-Centered Care, and the American College of Emergency Physicians. This report is also supported by the Emergency Nurses Association.

Use of Oral Cholera Vaccine in Complex Emergencies: What Next? Summary Report of an Expert Meeting and Recommendations of WHO

PubMed Central

Chaignat, Claire-Lise; Monti, Victoria

2007-01-01

Two meetings of the World Health Organization (WHO)—in 1999 and 2002—had examined the potential use of oral cholera vaccines (OCVs) as an additional public-health tool for the control of cholera. In the light of the work accomplished since 2002, WHO convened a third meeting to reexamine with a group of experts the role that OCVs might play in preventing potential outbreaks of cholera in crisis situations and to discuss the use of OCVs in endemic settings. The aim of the meeting was to agree a framework for the recommendations of WHO on these subjects and to consider the pertinence of further demonstration projects in endemic settings. The meeting addressed key issues, including currently-available vaccines, surveillance, and cholera-control measures in complex emergencies, and past experiences of using OCVs. More than 40 participants took part in the discussions, representing cholera-prone countries, humanitarian organizations, scientific institutions, United Nations agencies, and WHO. The experts agreed that when considering the use of OCVs in emergencies, a multidisciplinary approach is essential and that the prevention and control of cholera should be envisaged within the larger context of public-health priorities in times of crisis. As for the use of OCVs in endemic settings, all participants acknowledged that further data need to be collected before a clear definition of endemicity and potential vaccination strategies can be established. Results of further studies on the vaccines per se are also awaited. Recommendations relating to the use of OCVs (a) in complex emergencies and (b) in endemic settings were elaborated, and a decision-making tool for assessing the pertinence of use of OCVs in emergency settings was drafted. The document was finalized by an ad-hoc working group convened in Geneva on 1 March 2006 and is now available for field-testing. After testing, that should be carried out with the involvement of WHO and feedback from field partners, the decision-making tool will be adapted and disseminated. PMID:17985828

Use of oral cholera vaccine in complex emergencies: what next? Summary report of an expert meeting and recommendations of WHO.

PubMed

Chaignat, Claire-Lise; Monti, Victoria

2007-06-01

Two meetings of the World Health Organization (WHO)-in 1999 and 2002-had examined the potential use of oral cholera vaccines (OCVs) as an additional public-health tool for the control of cholera. In the light of the work accomplished since 2002, WHO convened a third meeting to reexamine with a group of experts the role that OCVs might play in preventing potential outbreaks of cholera in crisis situations and to discuss the use of OCVs in endemic settings. The aim of the meeting was to agree a framework for the recommendations of WHO on these subjects and to consider the pertinence of further demonstration projects in endemic settings. The meeting addressed key issues, including currently-available vaccines, surveillance, and cholera-control measures in complex emergencies, and past experiences of using OCVs. More than 40 participants took part in the discussions, representing cholera-prone countries, humanitarian organizations, scientific institutions, United Nations agencies, and WHO. The experts agreed that when considering the use of OCVs in emergencies, a multidisciplinary approach is essential and that the prevention and control of cholera should be envisaged within the larger context of public-health priorities in times of crisis. As for the use of OCVs in endemic settings, all participants acknowledged that further data need to be collected before a clear definition of endemicity and potential vaccination strategies can be established. Results of further studies on the vaccines per se are also awaited. Recommendations relating to the use of OCVs (a) in complex emergencies and (b) in endemic settings were elaborated, and a decision-making tool for assessing the pertinence of use of OCVs in emergency settings was drafted. The document was finalized by an ad-hoc working group convened in Geneva on 1 March 2006 and is now available for field-testing. After testing, that should be carried out with the involvement of WHO and feedback from field partners, the decision-making tool will be adapted and disseminated.

Emergent Writing in Preschoolers: Preliminary Evidence for a Theoretical Framework

PubMed Central

Puranik, Cynthia S.; Lonigan, Christopher J.

2014-01-01

Researchers and educators use the term emergent literacy to refer to a broad set of skills and attitudes that serve as foundational skills for acquiring success in later reading and writing; however, models of emergent literacy have generally focused on reading and reading-related behaviors. Hence, the primary aim of this study was to articulate and evaluate a theoretical model of the components of emergent writing. Alternative models of the structure of individual and developmental differences of emergent writing and writing-related skills were examined in 372 preschool children who ranged in age from 3- to 5-years using confirmatory factor analysis. Results from a confirmatory factor analysis provide evidence that these emergent writing skills are best described by three correlated but distinct factors, (a) Conceptual Knowledge, (b) Procedural Knowledge, and (c) Generative Knowledge. Evidence that these three emergent writing factors show different patterns of relations to emergent literacy constructs is presented. Implications for understanding the development of writing and assessment of early writing skills are discussed. PMID:25316955

A 2-year retrospective study of pediatric dental emergency visits at a hospital emergency center in Taiwan.

PubMed

Jung, Chia-Pei; Tsai, Aileen I; Chen, Ching-Ming

2016-06-01

There is a paucity of information regarding pediatric dental emergencies in Taiwan. This study investigates the prevalence and characteristics of the pediatric dental emergency services provided at a medical center. This study included a retrospective chart review of patients under 18 years of age with dental complaints who visited the Emergency Department (ED) of Linkou Medical Center of Chang Gung Memorial Hospital from January 2012 to December 2013. Information regarding age, gender, time/day/month of presentation, diagnosis, treatment, and follow-up was collected and analyzed. Statistical analysis included descriptive statistics and Pearson's Chi-square test with the significance level set as p < 0.05. This study revealed that dental emergencies in the medical center ED were predominantly related to orodental trauma (47.1%) and pulpal pain (29.9%). Most patients were male (p < 0.001) and <5 years of age (p < 0.001). The most frequent orodental trauma was luxation, both in primary and permanent dentition. The major management for dental emergencies was prescribing medication for pulp-related problems and orodental trauma. The follow-up rate of orodental trauma was the highest (p < 0.001). For children, trauma and toothache constituted the most common reasons for dental emergency visits at a hospital emergency center in Taiwan. While dental emergencies are sometimes unforeseeable or unavoidable, developing community awareness about proper at-home care as well as regular dental preventive measures can potentially reduce the number of emergency visits. Copyright © 2016 Chang Gung University. Published by Elsevier B.V. All rights reserved.

Servant Leadership through Distance Learning: A Case Study

ERIC Educational Resources Information Center

Russell, Eric James

2013-01-01

This qualitative study explored the influence a distance learning servant leadership course had on the emergency service students' understanding of leadership. The research study utilized a case study design in order to tell the story of the lived experiences of the participants. The setting for the study was a state university in Utah, with the…

Index Blood Tests and National Early Warning Scores within 24 Hours of Emergency Admission Can Predict the Risk of In-Hospital Mortality: A Model Development and Validation Study

PubMed Central

Mohammed, Mohammed A.; Rudge, Gavin; Watson, Duncan; Wood, Gordon; Smith, Gary B.; Prytherch, David R.; Girling, Alan; Stevens, Andrew

2013-01-01

Background We explored the use of routine blood tests and national early warning scores (NEWS) reported within ±24 hours of admission to predict in-hospital mortality in emergency admissions, using empirical decision Tree models because they are intuitive and may ultimately be used to support clinical decision making. Methodology A retrospective analysis of adult emergency admissions to a large acute hospital during April 2009 to March 2010 in the West Midlands, England, with a full set of index blood tests results (albumin, creatinine, haemoglobin, potassium, sodium, urea, white cell count and an index NEWS undertaken within ±24 hours of admission). We developed a Tree model by randomly splitting the admissions into a training (50%) and validation dataset (50%) and assessed its accuracy using the concordance (c-) statistic. Emergency admissions (about 30%) did not have a full set of index blood tests and/or NEWS and so were not included in our analysis. Results There were 23248 emergency admissions with a full set of blood tests and NEWS with an in-hospital mortality of 5.69%. The Tree model identified age, NEWS, albumin, sodium, white cell count and urea as significant (p<0.001) predictors of death, which described 17 homogeneous subgroups of admissions with mortality ranging from 0.2% to 60%. The c-statistic for the training model was 0.864 (95%CI 0.852 to 0.87) and when applied to the testing data set this was 0.853 (95%CI 0.840 to 0.866). Conclusions An easy to interpret validated risk adjustment Tree model using blood test and NEWS taken within ±24 hours of admission provides good discrimination and offers a novel approach to risk adjustment which may potentially support clinical decision making. Given the nature of the clinical data, the results are likely to be generalisable but further research is required to investigate this promising approach. PMID:23734195

Creating an automated trigger for sepsis clinical decision support at emergency department triage using machine learning

PubMed Central

Halpern, Yoni; Jernite, Yacine; Shapiro, Nathan I.; Nathanson, Larry A.

2017-01-01

Objective To demonstrate the incremental benefit of using free text data in addition to vital sign and demographic data to identify patients with suspected infection in the emergency department. Methods This was a retrospective, observational cohort study performed at a tertiary academic teaching hospital. All consecutive ED patient visits between 12/17/08 and 2/17/13 were included. No patients were excluded. The primary outcome measure was infection diagnosed in the emergency department defined as a patient having an infection related ED ICD-9-CM discharge diagnosis. Patients were randomly allocated to train (64%), validate (20%), and test (16%) data sets. After preprocessing the free text using bigram and negation detection, we built four models to predict infection, incrementally adding vital signs, chief complaint, and free text nursing assessment. We used two different methods to represent free text: a bag of words model and a topic model. We then used a support vector machine to build the prediction model. We calculated the area under the receiver operating characteristic curve to compare the discriminatory power of each model. Results A total of 230,936 patient visits were included in the study. Approximately 14% of patients had the primary outcome of diagnosed infection. The area under the ROC curve (AUC) for the vitals model, which used only vital signs and demographic data, was 0.67 for the training data set, 0.67 for the validation data set, and 0.67 (95% CI 0.65–0.69) for the test data set. The AUC for the chief complaint model which also included demographic and vital sign data was 0.84 for the training data set, 0.83 for the validation data set, and 0.83 (95% CI 0.81–0.84) for the test data set. The best performing methods made use of all of the free text. In particular, the AUC for the bag-of-words model was 0.89 for training data set, 0.86 for the validation data set, and 0.86 (95% CI 0.85–0.87) for the test data set. The AUC for the topic model was 0.86 for the training data set, 0.86 for the validation data set, and 0.85 (95% CI 0.84–0.86) for the test data set. Conclusion Compared to previous work that only used structured data such as vital signs and demographic information, utilizing free text drastically improves the discriminatory ability (increase in AUC from 0.67 to 0.86) of identifying infection. PMID:28384212

Creating an automated trigger for sepsis clinical decision support at emergency department triage using machine learning.

PubMed

Horng, Steven; Sontag, David A; Halpern, Yoni; Jernite, Yacine; Shapiro, Nathan I; Nathanson, Larry A

2017-01-01

To demonstrate the incremental benefit of using free text data in addition to vital sign and demographic data to identify patients with suspected infection in the emergency department. This was a retrospective, observational cohort study performed at a tertiary academic teaching hospital. All consecutive ED patient visits between 12/17/08 and 2/17/13 were included. No patients were excluded. The primary outcome measure was infection diagnosed in the emergency department defined as a patient having an infection related ED ICD-9-CM discharge diagnosis. Patients were randomly allocated to train (64%), validate (20%), and test (16%) data sets. After preprocessing the free text using bigram and negation detection, we built four models to predict infection, incrementally adding vital signs, chief complaint, and free text nursing assessment. We used two different methods to represent free text: a bag of words model and a topic model. We then used a support vector machine to build the prediction model. We calculated the area under the receiver operating characteristic curve to compare the discriminatory power of each model. A total of 230,936 patient visits were included in the study. Approximately 14% of patients had the primary outcome of diagnosed infection. The area under the ROC curve (AUC) for the vitals model, which used only vital signs and demographic data, was 0.67 for the training data set, 0.67 for the validation data set, and 0.67 (95% CI 0.65-0.69) for the test data set. The AUC for the chief complaint model which also included demographic and vital sign data was 0.84 for the training data set, 0.83 for the validation data set, and 0.83 (95% CI 0.81-0.84) for the test data set. The best performing methods made use of all of the free text. In particular, the AUC for the bag-of-words model was 0.89 for training data set, 0.86 for the validation data set, and 0.86 (95% CI 0.85-0.87) for the test data set. The AUC for the topic model was 0.86 for the training data set, 0.86 for the validation data set, and 0.85 (95% CI 0.84-0.86) for the test data set. Compared to previous work that only used structured data such as vital signs and demographic information, utilizing free text drastically improves the discriminatory ability (increase in AUC from 0.67 to 0.86) of identifying infection.

Cost-effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective.

PubMed

April, Michael D; Murray, Brian P

2017-06-01

Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policymakers have any formal training in CEA methodology. This paper provides an introduction to the interpretation and use of CEA with a focus on application to emergency medicine problems and settings. It applies a previously published CEA to the hypothetical case of a patient presenting to the ED with chest pain who requires risk stratification. This paper uses a widely cited checklist to appraise the CEA. This checklist serves as a vehicle for presenting basic CEA terminology and concepts. General topics of focus include measurement of costs and outcomes, incremental analysis, and sensitivity analysis. Integrated throughout the paper are recommendations for good CEA practice with emphasis on the guidelines published by the U.S. Panel on Cost-Effectiveness in Health and Medicine. Unique challenges for emergency medicine CEAs discussed include the projection of long-term outcomes from emergent interventions, costing ED services, and applying study results to diverse patient populations across various ED settings. The discussion also includes an overview of the limitations inherent in applying CEA results to clinical practice to include the lack of incorporation of noncost considerations in CEA (e.g., ethics). After reading this article, emergency medicine leaders and researchers will have an enhanced understanding of the basics of CEA critical appraisal and application. The paper concludes with an overview of economic evaluation resources for readers interested in conducting ED-based economic evaluation studies. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?

PubMed

Klinginsmith, Michael; Jolley, Jennifer; Lomelin, Daniel; Krause, Crystal; Heiden, Jace; Oleynikov, Dmitry

2016-05-01

Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 % were performed laparoscopically and 15.3 % open. 24.6 % of cases were classified urgent/emergent upon admission, and almost 70 % of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 % of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 % LHR vs. 26.3 % OHR). Almost 90 % of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. We demonstrate that laparoscopic PEH repair has become accepted in emergent cases. Open PEH repair is often reserved for emergent surgeries and less commonly includes an AR procedure. Laparoscopy with an AR procedure is clearly the standard of care in elective surgery. The decision to perform an open or laparoscopic surgery, with or without adjunctive techniques, may be based more on the physician's comfort with laparoscopic surgery and surgical practices than the patient's condition. Long-term follow-up studies are needed to determine the functional outcomes of these strategies.

Earthwork haul-truck cycle-time monitoring : a case study.

DOT National Transportation Integrated Search

2016-03-01

Recent developments in autonomous technologies have motivated practitioners to adopt new technologies in highway and : earthwork construction projects. This project set out to (1) identify new and emerging autonomous earthwork technologies and : (2) ...

Emergency primary repair of grade V bladder neck injury complicating pelvic fracture

PubMed Central

2014-01-01

We report a case of a grade V bladder injury complicating an open-book pelvic fracture following a road traffic accident. The bladder neck injury was primarily repaired in the emergency setting of a poor-resourced area with successful outcome. The dangers of urinary extravasation are still to be considered of importance and we advocate and encourage immediate/emergency open intervention although it remains controversial to say the least in a lesser resourced healthcare set up. PMID:25076980

The Daily Events and Emotions of Master's-Level Family Therapy Trainees in Off-Campus Practicum Settings

ERIC Educational Resources Information Center

Edwards, Todd M.; Patterson, Jo Ellen

2012-01-01

The Day Reconstruction Method (DRM) was used to assess the daily events and emotions of one program's master's-level family therapy trainees in off-campus practicum settings. This study examines the DRM reports of 35 family therapy trainees in the second year of their master's program in marriage and family therapy. Four themes emerged from the…

Improving the Understanding of Progressing and Emerging Health Informatics Roles and Skill Sets among Health Information Management Professionals: An Action Research Study

ERIC Educational Resources Information Center

Palkie, Brooke N.

2013-01-01

The Health Information Management (HIM) profession is evolving to meet the technology demands of the current healthcare landscape. The 2009 enactment of the HITECH Act has placed unprecedented emphasis on utilizing technology to improve the quality of care and to decrease healthcare costs. Expectations of deep analytical skills have set the stage…

Sustaining SBIRT in the wild: simulating revenues and costs for Screening, Brief Intervention and Referral to Treatment programs.

PubMed

Cowell, Alexander J; Dowd, William N; Mills, Michael J; Hinde, Jesse M; Bray, Jeremy W

2017-02-01

To examine the conditions under which Screening, Brief Intervention and Referral to Treatment (SBIRT) programs can be sustained by health insurance payments. A mathematical model was used to estimate the number of patients needed for revenues to exceed costs. Three medical settings in the United States were examined: in-patient, out-patient and emergency department. Components of SBIRT were delivered by combinations of health-care practitioners (generalists) and behavioral health specialists. Practitioners in seven SBIRT programs who received grants from the US Substance Abuse and Mental Health Services Administration (SAMHSA). Program costs and revenues were measured using data from grantees. Patient flows were measured from administrative data and adjusted with prevalence and screening estimates from the literature. SBIRT can be sustained through health insurance reimbursement in out-patient and emergency department settings in most staffing mixes. To sustain SBIRT in in-patient programs, a patient flow larger than the national average may be needed; if that flow is achieved, the range of screens required to maintain a surplus is narrow. Sensitivity analyses suggest that the results are very sensitive to changes in the proportion of insured patients. Screening, Brief Intervention and Referral to Treatment programs in the United States can be sustained by health insurance payments under a variety of staffing models. Screening, Brief Intervention and Referral to Treatment programs can be sustained only in an in-patient setting with above-average patient flow (more than 2500 screens). Screening, Brief Intervention and Referral to Treatment programs in out-patient and emergency department settings can be sustained with below-average patient flows (fewer than 125 000 out-patient visits and fewer than 27 000 emergency department visits). © 2017 Society for the Study of Addiction.

An Emergency Medicine Research Priority Setting Partnership to establish the top 10 research priorities in emergency medicine.

PubMed

Smith, Jason; Keating, Liza; Flowerdew, Lynsey; O'Brien, Rachel; McIntyre, Sam; Morley, Richard; Carley, Simon

2017-07-01

Defining research priorities in a specialty as broad as emergency medicine is a significant challenge. In order to fund and complete the most important research projects, it is imperative that we identify topics that are important to all clinicians, society and to our patients. We have undertaken a priority setting partnership to establish the most important questions facing emergency medicine. The top 10 questions reached through a consensus process are discussed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

48 CFR 26.206 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2012 CFR

2012-10-01

... provision at 52.226-3, Disaster or Emergency Area Representation, in solicitations involving the local area... at 52.226-4, Notice of Disaster or Emergency Area Set-aside in solicitations and contracts involving local area set-asides. (c) The contracting officer shall insert the clause at 52.226-5, Restrictions on...

48 CFR 26.206 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... provision at 52.226-3, Disaster or Emergency Area Representation, in solicitations involving the local area... at 52.226-4, Notice of Disaster or Emergency Area Set-aside in solicitations and contracts involving local area set-asides. (c) The contracting officer shall insert the clause at 52.226-5, Restrictions on...

48 CFR 26.206 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2013 CFR

2013-10-01

... provision at 52.226-3, Disaster or Emergency Area Representation, in solicitations involving the local area... at 52.226-4, Notice of Disaster or Emergency Area Set-aside in solicitations and contracts involving local area set-asides. (c) The contracting officer shall insert the clause at 52.226-5, Restrictions on...

48 CFR 26.206 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2014 CFR

2014-10-01

... provision at 52.226-3, Disaster or Emergency Area Representation, in solicitations involving the local area... at 52.226-4, Notice of Disaster or Emergency Area Set-aside in solicitations and contracts involving local area set-asides. (c) The contracting officer shall insert the clause at 52.226-5, Restrictions on...

48 CFR 26.206 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... provision at 52.226-3, Disaster or Emergency Area Representation, in solicitations involving the local area... at 52.226-4, Notice of Disaster or Emergency Area Set-aside in solicitations and contracts involving local area set-asides. (c) The contracting officer shall insert the clause at 52.226-5, Restrictions on...

64. FORWARD EMERGENCY DIESEL GENERATOR SET STARBOARD LOOKING TO ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

64. FORWARD EMERGENCY DIESEL GENERATOR SET - STARBOARD LOOKING TO PORT SHOWING BOTTOM HALF OF FAIRBANKS MORSE 36D81/8 TEN CYLINDER DIESEL ENGINE SERIAL #951230 AND GENERAL ELECTRIC 1,000KW GENERATOR KVA 1250, RPM 720, SERIAL #6920274. - U.S.S. HORNET, Puget Sound Naval Shipyard, Sinclair Inlet, Bremerton, Kitsap County, WA

The Emerging Educator: Working in Early Childhood Settings. Book Review.

ERIC Educational Resources Information Center

Chandler, Karen

1998-01-01

Reviews the textbook "The Emerging Educator: Working in Early Childhood Settings" by Diane Nyistor and Eva Stelzer Rudick. Maintains that it serves as an introduction to the field, but also suggest that the work would benefit from including Canadian foundations, expanded presentation of personnel policies, employment climate, budget management,…

Emergency psychiatric care for children and adolescents: a literature review.

PubMed

Janssens, Astrid; Hayen, Sarah; Walraven, Vera; Leys, Mark; Deboutte, Dirk

2013-09-01

Over the years, increasing numbers of children and adolescents have sought help for acute psychiatric problems. The responses to this treatment-seeking behavior are heterogeneous in different settings and nations. This review aimed to provide an answer to the questions "which care should be offered to children and adolescents presenting with a psychiatric emergency or crisis and how should it be organized." We committed a literature review to find out if any recommendations can be made regarding the organization of emergency care for children and adolescents with acute mental health problems. The lack of a clear definition of emergencies or urgencies hampered this review; we note the differences between adult and child or adolescent psychiatry. The theoretical models of care found in the literature are built up from several process and structural components, which we describe in greater detail. Furthermore, we review the main service delivery models that exist for children and adolescents. Currently, emergency psychiatric care for children and adolescents is practiced within a wide range of care models. There is no consensus on recommended care or recommended setting for this population. More research is needed to make exact recommendations on the standardization of psychiatric care for young people in emergency settings.

Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes.

PubMed

Blackwell, Rebecca Wright Née; Lowton, Karen; Robert, Glenn; Grudzen, Corita; Grocott, Patricia

2017-03-01

Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of - and preferences for - palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting. To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work. an Emergency Department in a large teaching hospital in the United Kingdom. Experience-based Co-design incorporating: 150h of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members. the study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the 'voice' of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process. Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the 'accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Verification Method for MASOES.

PubMed

Perozo, N; Aguilar Perozo, J; Terán, O; Molina, H

2013-02-01

MASOES is a 3agent architecture for designing and modeling self-organizing and emergent systems. This architecture describes the elements, relationships, and mechanisms, both at the individual and the collective levels, that favor the analysis of the self-organizing and emergent phenomenon without mathematically modeling the system. In this paper, a method is proposed for verifying MASOES from the point of view of design in order to study the self-organizing and emergent behaviors of the modeled systems. The verification criteria are set according to what is proposed in MASOES for modeling self-organizing and emerging systems and the principles of the wisdom of crowd paradigm and the fuzzy cognitive map (FCM) theory. The verification method for MASOES has been implemented in a tool called FCM Designer and has been tested to model a community of free software developers that works under the bazaar style as well as a Wikipedia community in order to study their behavior and determine their self-organizing and emergent capacities.

Resource allocation on the frontlines of public health preparedness and response: report of a summit on legal and ethical issues.

PubMed

Barnett, Daniel J; Taylor, Holly A; Hodge, James G; Links, Jonathan M

2009-01-01

In the face of all-hazards preparedness challenges, local and state health department personnel have to date lacked a discrete set of legally and ethically informed public health principles to guide the distribution of scarce resources in crisis settings. To help address this gap, we convened a Summit of academic and practice experts to develop a set of principles for legally and ethically sound public health resource triage decision-making in emergencies. The invitation-only Summit, held in Washington, D.C., on June 29, 2006, assembled 20 experts from a combination of academic institutions and nonacademic leadership, policy, and practice settings. The Summit featured a tabletop exercise designed to highlight resource scarcity challenges in a public health infectious disease emergency. This exercise served as a springboard for Summit participants' subsequent identification of 10 public health emergency resource allocation principles through an iterative process. The final product of the Summit was a set of 10 principles to guide allocation decisions involving scarce resources in public health emergencies. The principles are grouped into three categories: obligations to community; balancing personal autonomy and community well-being/benefit; and good preparedness practice. The 10 Summit-derived principles represent an attempt to link law, ethics, and real-world public health emergency resource allocation practices, and can serve as a useful starting framework to guide further systematic approaches and future research on addressing public health resource scarcity in an all-hazards context.

Challenges Facing Families at the End of Life in Three Settings

PubMed Central

Kehl, Karen A.; Kirchhoff, Karin T.; Kramer, Betty J.; Hovland-Scafe, Cyndi

2010-01-01

This study examined the challenges faced by family members at the end of life in different care settings and how those challenges compare across settings. A total of 30 participants, who had a family member die in inpatient hospice, a skilled nursing facility or a community support program were interviewed. Semi-structured interviews were recorded and transcribed. Text was coded using qualitative thematic analysis. Themes were determined by consensus. Twelve challenges were identified across care sites. Two themes emerged in all three settings: bearing witness and the experience of loss. The study findings contribute to our knowledge of family perceptions of care in different settings and raises awareness of the need for further research describing the experiences at the end of life in different settings and the importance of creating and testing interventions for both setting specific needs and universal issues. PMID:20563315

Concerted Creativity: Emergence in the Socio-(Im)Material and Intangible Practice of Making Music.

PubMed

Hvidtfeldt, Dan Lund

2018-06-01

The purpose of this article is to explore how the basic conception of 'emergence' informs the study of creativity as a socio-material practice. Initially, the article explicates how creative processes, products and performances involve not only tangible, but also intangible and social elements. Secondly, the theoretical conception of creativity as socio-material and the general philosophical notion of emergence are introduced. Inspired by the idea that a 'whole' is other than the sum of its 'parts' and by examples primarily from the world of music, the article argues that the relationship between subject and object - the main analytical focus of studies on creativity as a socio-material practice - is fundamentally embedded in an emergent process. The article concludes by highlighting how emergence theory acknowledges the performance or product as an intangible material for creative processes of musicians, and that studies of the socio-materiality of creative practices clearly involving tangible, intangible and social elements must refer to the emergent process through which the creative product or performance evolves meaning. The theoretical framework suggested is relevant for researchers interested in exploring how materials, social settings and physical environments are involved in creative processes.

Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland.

PubMed

Sugrue, M; Maier, R; Moore, E E; Boermeester, M; Catena, F; Coccolini, F; Leppaniemi, A; Peitzman, A; Velmahos, G; Ansaloni, L; Abu-Zidan, F; Balfe, P; Bendinelli, C; Biffl, W; Bowyer, M; DeMoya, M; De Waele, J; Di Saverio, S; Drake, A; Fraga, G P; Hallal, A; Henry, C; Hodgetts, T; Hsee, L; Huddart, S; Kirkpatrick, A W; Kluger, Y; Lawler, L; Malangoni, M A; Malbrain, M; MacMahon, P; Mealy, K; O'Kane, M; Loughlin, P; Paduraru, M; Pearce, L; Pereira, B M; Priyantha, A; Sartelli, M; Soreide, K; Steele, C; Thomas, S; Vincent, J L; Woods, L

2017-01-01

Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was therefore convened to look at resources for optimal care of emergency surgery. The aim of the Donegal Summit was to set a platform in place to develop guidelines and KPIs in emergency surgery. The project had multidisciplinary global involvement in producing consensus statements regarding emergency surgery care in key areas, and to assess feasibility of producing KPIs that could be used to monitor process and outcome of care in the future. Forty-four key opinion leaders in emergency surgery, across 7 disciplines from 17 countries, composed evidence-based position papers on 14 key areas of emergency surgery and 112 KPIs in 20 acute conditions or emergency systems. The summit was successful in achieving position papers and KPIs in emergency surgery. While position papers were limited by non-graded evidence and non-validated KPIs, the process set a foundation for the future advancement of emergency surgery.

Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives.

PubMed

Silva, Diego S; Gibson, Jennifer L; Robertson, Ann; Bensimon, Cécile M; Sahni, Sachin; Maunula, Laena; Smith, Maxwell J

2012-03-26

Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans.

An Ethnographic Study of Stigma and Ageism in Residential Care or Assisted Living

PubMed Central

Dobbs, Debra; Eckert, J. Kevin; Rubinstein, Bob; Keimig, Lynn; Clark, Leanne; Frankowski, Ann Christine; Zimmerman, Sheryl

2013-01-01

Purpose This study explored aspects of stigmatization for older adults who live in residential care or assisted living (RC–AL) communities and what these settings have done to address stigma. Design and recognition of resident preferences and strengths, rather than their limitations. Methods We used ethnography and other qualitative data-gathering and analytic techniques to gather data from 309 participants (residents, family and staff) from six RC–AL settings in Maryland. We entered the transcript data into Atlas.ti 5.0. We analyzed the data by using grounded theory techniques for emergent themes. Results Four themes emerged that relate to stigma in RC–AL: (a) ageism in long-term care; (b) stigma as related to disease and illness; (c) sociocultural aspects of stigma; and (d) RC–AL as a stigmatizing setting. Some strategies used in RC–AL settings to combat stigma include family member advocacy on behalf of stigmatized residents, assertion of resident autonomy, and administrator awareness of potential stigmatization. Implications: Findings suggest that changes could be made to the structure as well as the process of care delivery to minimize the occurrence of stigma in RC–AL settings. Structural changes include an examination of how best, given the resident case mix, to accommodate care for persons with dementia (e.g., separate units or integrated care); processes of care include staff PMID:18728301

Emergency Management and Tourism Stakeholder Responses to Crises

PubMed Central

Morakabati, Yeganeh; Page, Stephen J.; Fletcher, John

2016-01-01

This article examines the contested area of the responsibility for destinations and tourists, within emergency settings. It incorporates a Delphi-Scenario technique to facilitate a structured discussion of emergency management for different destination stakeholders. The Delphi exercise engaged 123 senior international stakeholders, from 9 different industry sectors, across 34 countries to provide a global perspective. The study’s principal focus is on the notion of emergency management, to identify the challenges that stakeholders would face within a disaster scenario. The exercise asked stakeholders to identify with whom the responsibility rests for 18 distinct disaster-related activities. The study proposes a responsibility allocation building-block framework that could help speed up the emergency management responses by “knowing who is going to do what” with a particular focus on dealing with international tourists as a community in a disaster zone. PMID:29708106

Building clinicians-researchers partnerships: lessons from diverse natural settings and practice-oriented initiatives.

PubMed

Castonguay, Louis G; Youn, Soo Jeong; Xiao, Henry; Muran, J Christopher; Barber, Jacques P

2015-01-01

In this concluding paper, we identify the type of studies conducted by 11 teams of contributors to a special issue on building clinicians-researchers partnerships. Those studies were conducted across a variety of clinical settings. We also integrate the lessons that have emerged from their collaborative initiatives in terms of obstacles faced, strategies adopted to address these challenges, benefits gained, and general recommendations offered to facilitate studies conducted with or by clinicians. The paper ends with the authors' thoughts about the future success of practice-oriented research in general.

Impact of Nitrate Use on Survival in Acute Heart Failure: A Propensity-Matched Analysis.

PubMed

Ho, Edwin C; Parker, John D; Austin, Peter C; Tu, Jack V; Wang, Xuesong; Lee, Douglas S

2016-02-12

There is limited evidence that the use of nitrates in acute decompensated heart failure early after presentation to a hospital can improve clinical outcomes. We aimed to determine whether early nitrate exposure is associated with improved survival in a large retrospective cohort study. We examined 11 078 acute decompensated heart failure patients who presented to emergency departments in Ontario, Canada, between 2004 and 2007, in the Enhanced Feedback For Effective Cardiac Treatment and the Emergency Heart failure Mortality Risk Grade studies. In propensity-matched analyses, we examined the effect of nitrate administration in the acute emergency department setting for its impact on death at 7, 30, and 365 days. In propensity-matched analyses, we found no difference in survival between those who received nitrates in the emergency department and the non-nitrate comparator group. Hazard ratios for mortality were 0.76 (95% CI; 0.51, 1.12) over 7 days, 0.97 (95% CI; 0.77, 1.21) over 30 days, and 0.91 (95% CI; 0.82, 1.02) over 1 year of follow-up. There was no significant difference in survival or hospital length of stay between nitrate and non-nitrate controls in extended follow-up. There was also no significant effect of nitrates in subgroups stratified by presence of chest pain, troponin elevation, chronic nitrate use, and known coronary artery disease. In acute decompensated heart failure, use of nitrates acutely in the emergency department setting was not associated with improvement in short-term or near-term survival. Our study does not support generalized use of nitrates when the primary goal of therapy is to reduce mortality. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Tales from the crypt: a parasitoid manipulates the behaviour of its parasite host

PubMed Central

Liu, Sean M.; Forbes, Andrew A.; Egan, Scott P.

2017-01-01

There are many examples of apparent manipulation of host phenotype by parasites, yet few examples of hypermanipulation—where a phenotype-manipulating parasite is itself manipulated by a parasite. Moreover, few studies confirm manipulation is occurring by quantifying whether the host's changed phenotype increases parasite fitness. Here we describe a novel case of hypermanipulation, in which the crypt gall wasp Bassettia pallida (a phenotypic manipulator of its tree host) is manipulated by the parasitoid crypt-keeper wasp Euderus set, and show that the host's changed behaviour increases parasitoid fitness. Bassettia pallida parasitizes sand live oaks and induces the formation of a ‘crypt’ within developing stems. When parasitized by E. set, B. pallida adults excavate an emergence hole in the crypt wall, plug the hole with their head and die. We show experimentally that this phenomenon benefits E. set, as E. set that need to excavate an emergence hole themselves are about three times more likely to die trapped in the crypt. In addition, we discuss museum and field data to explore the distribution of the crypt-keeping phenomena. PMID:28123089

Anticipating the Future, Influencing the Present: Assessing the Societal Implications of Emerging Technologies

NASA Astrophysics Data System (ADS)

Michelson, Evan S.

A growing challenge for the American policymaking system is to respond effectively to a wide range of interconnected, complex, long-term science and technology issues. Simultaneously, current approaches and institutions of governance are ill suited to address these multidimensional challenges. As the next generation of innovations in science and technology is arriving at an accelerating rate, the governance system is lagging behind. This realization leads to a vital overarching consideration that steers this study: What approaches are well suited to anticipate the longer-term societal implications of emerging technologies in the 21st Century? This study identifies and examines strategies for anticipating the longer-term societal implications of emerging technologies by way of a qualitative case study. It explores one area of technology (nanotechnology), in one particular governance system (the United States), and with a focus on one high profile non-governmental organization (NGO) involved in addressing a range of nanotechnology's societal and policy implications: the Project on Emerging Nanotechnologies (PEN). Based at the Woodrow Wilson International Center for Scholars, PEN's goal was to ensure "that as nanotechnologies advance, possible risks are minimized, public and consumer engagement remains strong, and the potential benefits of these new technologies are realized." The conceptual framework of anticipatory governance guides the research, which offers a real-world example about how anticipatory governance applies in the nongovernmental sector and shows how this idea links to broader theoretical debates about the policymaking process. The study's main conclusion is that PEN utilized a set of interconnected strategies related to advancing foresight, operating in a boundary-spanning role, and promoting communications and public engagement in its attempt to influence, anticipate, and shape the societal implications of emerging technologies. The findings are informed by evidence from a range of sources, including document analysis, semi-structured interviews, and multiple media analyses. Finally, this study highlights a set of cross-cutting, transferable lessons that can be applied as future emerging technologies arise over time. The intention is that the insights gained from this study can help address these pressing issues as they rapidly unfold.

Identifying the turning point: using the transtheoretical model of change to map intimate partner violence disclosure in emergency department settings.

PubMed

Catallo, Cristina; Jack, Susan M; Ciliska, Donna; Macmillan, Harriet L

2012-01-01

Background. The transtheoretical model of change (TTM) was used as a framework to examine the steps that women took to disclose intimate partner violence (IPV) in urban emergency departments. Methods. Mapping methods portrayed the evolving nature of decisions that facilitated or inhibited disclosure. This paper is a secondary analysis of qualitative data from a mixed methods study that explored abused women's decision making process about IPV disclosure. Findings. Change maps were created for 19 participants with movement from the precontemplation to the maintenance stages of the model. Disclosure often occurred after a significant "turning point event" combined with a series of smaller events over a period of time. The significant life event often involved a weighing of options where participants considered the perceived risks against the potential benefits of disclosure. Conclusions. Abused women experienced intrusion from the chaotic nature of the emergency department. IPV disclosure was perceived as a positive experience when participants trusted the health care provider and felt control over their decisions to disclose IPV. Practice Implications. Nurses can use these findings to gauge the readiness of women to disclose IPV in the emergency department setting.

Identifying the Turning Point: Using the Transtheoretical Model of Change to Map Intimate Partner Violence Disclosure in Emergency Department Settings

PubMed Central

Catallo, Cristina; Jack, Susan M.; Ciliska, Donna; MacMillan, Harriet L.

2012-01-01

Background. The transtheoretical model of change (TTM) was used as a framework to examine the steps that women took to disclose intimate partner violence (IPV) in urban emergency departments. Methods. Mapping methods portrayed the evolving nature of decisions that facilitated or inhibited disclosure. This paper is a secondary analysis of qualitative data from a mixed methods study that explored abused women's decision making process about IPV disclosure. Findings. Change maps were created for 19 participants with movement from the precontemplation to the maintenance stages of the model. Disclosure often occurred after a significant “turning point event” combined with a series of smaller events over a period of time. The significant life event often involved a weighing of options where participants considered the perceived risks against the potential benefits of disclosure. Conclusions. Abused women experienced intrusion from the chaotic nature of the emergency department. IPV disclosure was perceived as a positive experience when participants trusted the health care provider and felt control over their decisions to disclose IPV. Practice Implications. Nurses can use these findings to gauge the readiness of women to disclose IPV in the emergency department setting. PMID:22792480

Optimising the emergency to ward handover process: A mixed methods study.

PubMed

Bakon, Shannon; Millichamp, Tracey

2017-11-01

The effective handover of patient health data from the emergency department to other hospital units is integral for the continuity of patient care. Yet no handover process has been identified as superior to others within this context. This study within a regional Australian hospital employed mixed methods approach including focus groups and key stakeholder consultation to develop a handover form appropriate for patient transfer from the emergency department to a variety of clinical areas. Paper-based surveys and audits were then employed to evaluate the implementation and understand staff perceptions of the form. The implementation of a patient handover form within the emergency setting was well received. Participants indicated that the form is clear, well designed and easy to navigate. It provided prompts to standardise their clinical handover and increased their accountability and responsibility within this process. To deliver an optimal nursing handover from the emergency department to various wards handovers should be structured and provide standardised content. The positive reception and use of this form provides evidence that a structured handover process can ensure standardisation of emergency department to ward nursing handovers. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Establishing an NP-staffed minor emergency area.

PubMed

Buchanan, L; Powers, R D

1997-04-01

Patients with problems of high acuity need fully trained emergency physicians and nurses. Some patients with nonurgent problems can be cared for within the emergency department (ED) in a lower-cost setting designed and staffed specifically for this purpose. Staffing a fast track or minor emergency area (MEA) with nurse practitioners (NPs) is one way to satisfy the ED's care needs. One site analysis of the effectiveness of NPs indicates that patients are satisfied with their care, that nurses' interpersonal skills are better than those of physicians, that technical skills are equivalent, that patient outcomes are equivalent or superior and that NPs improve access to care. A nurse practitioner-staffed minor emergency area provides high quality care for approximately 21% of this site's adult emergency department population. Patients are triaged based on set criteria, allowing for short treatment times. The physical layout, triage criteria, and the NPs' scope of practice in the level 1 trauma center's ED are detailed.

An evaluation of the quality of Emergency Nurse Practitioner services for patients presenting with minor injuries to one rural urgent care centre in the UK: a descriptive study.

PubMed

McDevitt, Joe; Melby, Vidar

2015-02-01

To evaluate the quality of the emergency nurse practitioner service provided to people presenting to a rural urgent care centre with minor injuries. The three objectives that were focused were an evaluation of the safety and effectiveness of the emergency nurse practitioner service, an assessment of patients' satisfaction with the emergency nurse practitioner service and a determination of factors that may enhance the quality of the emergency nurse practitioner service. Urgent care centres have become increasingly prevalent across the UK. Emergency nurse practitioner services at these rural urgent care centres remain largely unevaluated. This study attempts to redress this deficit by evaluating the quality of an emergency nurse practitioner service in relation to the care of patients presenting with minor injuries to a rural urgent care centre. This descriptive study used a case-note review and a survey design with one open-ended exploratory question. Patient views were collected using a self-completed questionnaire and a data extraction tool to survey patients' case notes retrospectively. Despite comparatively low total length-of-stay times, most patients felt they had enough time to discuss things fully with the emergency nurse practitioner. Although emergency nurse practitioners routinely impart injury advice, feedback from some patients suggests a need for the provision of more in-depth information regarding their injury. The vast majority (97·3%) of patients felt that the quality of the emergency nurse practitioner service was of a high standard. Contrary to some other studies, the findings in this study indicate that patient satisfaction is not influenced by waiting times. Emergency nurse practitioners in rural urgent care centres have the potential to deliver a safe and effective quality service that is reflected in high levels of patient satisfaction. This study provides some evidence to support the continued expansion of the emergency nurse practitioner service in rural settings in the UK. © 2014 John Wiley & Sons Ltd.

Patients Presenting to the Emergency Unit with Gynaecological Lower Abdominal Pain, with and without Pathological Clinical Findings - Service Utilisation, Pain History, Implications.

PubMed

Siedentopf, F; Wowro, E; Möckel, M; Kentenich, H; David, M

2016-09-01

Introduction: Few studies have evaluated the utilisation of emergency gynaecological services, although lower abdominal pain (LAP) is one of the most common symptoms prompting emergency presentation. Although such pain may be caused by potentially life-threatening gynaecological diseases, very often no clinical cause is found. The aim of this study was to describe the characteristics of emergency presentations in order to enable quicker identification of real emergencies in routine clinical practice. Materials and Methods: Standardised, so-called first aid cards of 1066 consecutive patients with LAP presenting acutely to one emergency unit were analysed in this retrospective, cross-sectional study. Results: Over one third of cases did not constitute actual medical emergencies on objective criteria, with investigations yielding "no pathological findings". Parameters were identified that more often lead to hospital admission, e.g. palpation of a mass/resistance or at least one pathological ultrasound finding. In addition, it was found that symptoms of longer duration (average 8 days), and not only acute LAP, were also often experienced by patients as emergencies. Conclusion: A diagnosis of "no pathological findings", which was common in our study, suggests a subjective experience of an emergency from the patient's point of view, although the possibility of unrecognised pathology has to be borne in mind. Apart from functional disorders, the origins of symptoms may include psychosomatic causes and psychosocial problems, which cannot be further defined in the emergency care setting. Also, the phenomenon of increased utilisation of emergency services parallel to the assumed opening hours of routine outpatient care facilities must be seen in a critical light.

New and emerging weight management strategies for busy ambulatory settings: a scientific statement from the American Heart Association

USDA-ARS?s Scientific Manuscript database

The purpose of this statement is to provide an overview of new and emerging tools and strategies for discussing weight and assisting overweight and obese patients. Only tools and strategies that can be used practically in busy ambulatory settings are included. The goal is to provide clinicians with ...

Taking on Substance Abuse in the Emergency Room: One Hospital's SBIRT Story

ERIC Educational Resources Information Center

Parker, Gary; Libart, Dane; Fanning, Linda; Higgs, Tracy; Dirickson, Cathy

2012-01-01

Screening for alcohol and drugs seems to be gaining traction and is becoming more commonplace in the healthcare setting. With emergency departments often being a point of contact for many individuals needing healthcare services, it makes sense to provide screening for substance misuse within this setting. The purpose of this paper is to share how…

Between Two Advisors: Interconnecting Academic and Workplace Settings in an Emerging Field

ERIC Educational Resources Information Center

Hytönen, Kaisa; Palonen, Tuire; Lehtinen, Erno; Hakkarainen, Kai

2016-01-01

This article examines a new training design for continuing professional development that aims to support the learning of the novel knowledge and skills needed in emerging professional fields by interconnecting academic and workplace settings. The training design is based on using two advisors, one from working life and the other from an academic…

Dealing with Gender in the Classroom: A Portrayed Case Study of Four Teachers

ERIC Educational Resources Information Center

Giraldo, Elida; Colyar, Julia

2012-01-01

This paper emerges from a qualitative case study that takes place in a US preschool setting and explores teachers' influences on the construction of children's gender identities. According to postmodern theories of gender, identity is constructed and constituted through social interactions and performances. This study focuses on the gender…

A lack of anaesthetic clinical attachments for emergency medicine advanced trainees in New Zealand: perceptions of directors of emergency medicine training.

PubMed

Browne, Alexander

2015-08-07

Anaesthetic skills are a core competency for emergency physicians. Anecdotally, there are limited anaesthetic attachments specifically available for Emergency Medicine Advanced Trainees (ATs). This study had several aims: Firstly, to quantify anaesthetic terms set aside for ATs; secondly, to gauge the opinions of Directors of Emergency Medicine Training (DEMTs) regarding the importance and difficulty in securing and maintaining anaesthetic training terms for ATs in their institutions; thirdly, to outline strategies that DEMTs used to get or maintain these posts and their opinions about what institutions should do to provide anaesthetic training for ATs. An online qualitative survey was emailed to all DEMTs of hospitals accredited for vocational ED training within New Zealand. Registered Medical Officer (RMO) units at accredited hospitals were asked to provide numbers of anaesthetic places available specifically for ATs. Annually there are 15 anaesthetic training posts set aside for 145 ATs. Most DEMTs thought that an anaesthetic term was important for progression of vocational training, and a majority thought that term availability was a significant barrier to progression of training. A number of DEMTs felt that procuring and maintaining anaesthetic posts was difficult, some citing a lack of collegiality from anaesthetic departments. Some DEMTs and ATs used novel approaches to procure anaesthetic attachments. Anaesthetic skills are an essential component of emergency medicine vocational training. It is in the best interests of hospitals to provide anaesthetic training positions for ATs. There are few training positions currently available.

Five-year forward view: lessons from emergency care at the extremes of age.

PubMed

Minhas, J S; Minhas, D; Coats, T; Banerjee, J; Roland, D

2018-03-01

Objective The progressive rise in demand on NHS emergency care resources is partly attributable to increases in attendances of children and older people. A quality gap exists in the care provision for the old and the young. The Five Year Forward View suggested new models of care but that the "answer is not one-size-fits-all". This article discusses the urgent need for person-centred outcome measures to bridge the gap that exists between demand and provision. Design This review is based on evidence gathered from literature searching across several platforms using a variety of search terms to account for the obvious heterogeneity, drawing on key 'think-tank' evidence. Settings Qualitative and quantitative studies examining approaches to caring for individuals at the extremes of age. Participants Individuals at the extremes of age (infants and older people). Main Outcome Measures Understanding similarities and disparities in the care of individuals at the extremes of age in an emergency and non-emergency context. Results There exists several similarities and disparities in the care of individuals at the extremes of age. The increasing burden of health disease on the economy must acknowledge the challenges that exist in managing patients in emergency settings at the extremes of age and build systems to acknowledge the traits these individuals exhibit. Conclusion Commissioners of services must optimise the models of care delivery by appreciating the similarities and differences between care requirements in these two large groups seeking emergency care.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vogt, B.M.; Sorensen, J.H.

The CSEPP (Chemical Stockpile Emergency Preparedness Program) was created to improve emergency planning and response capabilities at the eight sites around the country that store chemical weapons. These weapons are scheduled to be destroyed in the near future. In preparation of the Draft Programmatic Environmental Impact Statement (DPEIS) for the Chemical Stockpile Disposal Program (CSDP), it was proposed that the Army mitigate accidents through an enhanced community emergency preparedness program at the eight storage sites. In 1986, the Army initiated the development of an Emergency Response Concept Plan (ERCP) for the CSDP, one of 12 technical support studies conducted duringmore » preparation of the Final Programmatic Environmental Impact Statement (FPEIS). The purpose of this document is to provide a fairly comprehensive source book on risk, risk management, risk communication research and recommended risk communication practices. It does not merely summarize each publication in the risk communication literature, but attempts to synthesize them along the lines of a set of organizing principles. Furthermore, it is not intended to duplicate other guidance manuals (such as Covello et al.`s manual on risk comparison). The source book was developed for the CSEPP in support of the training module on risk communications. Although the examples provided are specific to CSEPP, its use goes beyond that of CSEPP as the findings apply to a broad spectrum of risk communication topics. While the emphasis is on communication in emergency preparedness and response specific to the CSEPP, the materials cover other non-emergency communication settings. 329 refs.« less

Pharmaceutical advertising in emergency departments.

PubMed

Marco, Catherine A

2004-04-01

Promotion of prescription drugs represents a growing source of pharmaceutical marketing expenditures. This study was undertaken to identify the frequency of items containing pharmaceutical advertising in clinical emergency departments (EDs). In this observational study, emergency physician on-site investigators quantified a variety of items containing pharmaceutical advertising present at specified representative times and days, in clinical EDs. Measurements were obtained by 65 on-site investigators, representing 22 states. Most EDs in this study were community EDs (87% community and 14% university or university affiliate), and most were in urban settings (50% urban, 38% suburban, and 13% rural). Investigators measured 42 items per ED (mean = 42; median = 31; interquartile range of 14-55) containing pharmaceutical advertising in the clinical area. The most commonly observed items included pens (mean 15 per ED; median 10), product brochures (mean 5; median 3), stethoscope labels (mean 4; median 2), drug samples (mean 3; median 0), books (mean 3.4), mugs (mean 2.4), and published literature (mean 3.1). EDs with a policy restricting pharmaceutical representatives in the ED had significantly fewer items containing pharmaceutical advertising (median 7.5; 95% CI = 0 to 27) than EDs without such a policy (median 35; 95% CI = 27 to 47, p = 0.005, nonparametric Wilcoxon two-sample test). There were no differences in quantities of pharmaceutical advertising for EDs in community compared with university settings (p = 0.5), rural compared with urban settings (p = 0.3), or annual ED volumes (p = 0.9). Numerous items containing pharmaceutical advertising are frequently observed in EDs. Policies restricting pharmaceutical representatives in the ED are associated with reduced pharmaceutical advertising.

The Development of a Veterans Health Administration Emergency Management Research Agenda

PubMed Central

Dobalian, Aram; Claver, Maria; Riopelle, Deborah; Wyte-Lake, Tamar; Canelo, Ismelda

2017-01-01

Introduction: The Veterans Health Administration (VHA), the largest integrated healthcare delivery system in the United States, is charged with ensuring timely access to high-quality care for veterans during disasters, and supporting national, state, local, and tribal emergency management and homeland security efforts. In 2008, the VHA Office of Public Health (OPH) sponsored the first VHA Emergency Management Research Agenda-setting conference to develop research priorities that address the needs of veterans and to position VHA as a national leader in emergency management by having VHA serve as a “laboratory” for the development of evidence-based emergency management practices. Methods: We focused on four steps: #1: Appraising the emergency management research portfolio of VHA-based researchers; #2: Obtaining systematic information on VHA’s role in emergency management and the healthcare needs of veterans during disasters; #3: Based upon gaps between the current research portfolio and the existing evidence base, identifying strategic priorities using a research agenda-setting conference; and #4: Laying the groundwork to foster the conduct of emergency management research within VHA. Results: Identified research priorities included how to prevent and treat behavioral health problems related to a disaster, the efficacy of training programs, crisis communication strategies, workforce resilience, and evacuating veterans from health care facilities. Conclusion: VHA is uniquely situated to answer research questions that cannot be readily addressed in other settings. VHA should partner with other governmental and private entities to build on existing work and establish shared research priorities. PMID:28439447

Portal venous gas detected on computed tomography in emergency situations: surgery is still necessary.

PubMed

Monneuse, Olivier; Pilleul, Frank; Barth, Xavier; Gruner, Laurent; Allaouchiche, Bernard; Valette, Pierre-Jean; Tissot, E

2007-05-01

Portal venous gas (PVG) has been reported to be associated with lethal surgical diagnosis. Recent studies tend to confirm the clinical significance of gas in the portal vein; however, some patients are managed without surgical treatment. The aim of this study was to assess both the diagnoses and the treatment of patients with PVG in an emergency surgical setting. We performed a retrospective chart review of 15 patients with PVG in the emergency setting detected by computed tomography (CT) between July 1999 and July 2004. Characteristics assessed included age, sex, clinical presentation, first CT diagnosis of both PVG and the underlying pathology, American Society of Anesthesiologists (ASA) score, surgical findings, final clinical diagnosis, duration of hospitalization, and evolution of the illness/mortality. All patients were examined one month after operation. This series of 5 women and 10 men ranged in age from 38 to 90 years at the time they underwent emergency surgical treatment. The mean preoperative ASA score was 4.20. Computed tomography diagnosed the underlying pathology in all cases: bowel obstruction (4 cases), bowel necrosis (9 cases), and diffuse peritonitis (2 cases). The mean length of hospital stay was 12.4 days. The mortality rate was 46.6%; (7 patients). A wide range of pathologies can generate PVG. Computed tomography can detect both the presence of gas and the underlying pathology. In emergency situations, all the diagnosed causal pathologies required a surgical procedure without delay. We report that the prognosis was related to the pathology itself and was not influenced by the presence of PVG.

The impact of emerging technology on nursing care: warp speed ahead.

PubMed

Huston, Carol

2013-05-31

While myriad forces are changing the face of contemporary healthcare, one could argue that nothing will change the way nursing is practiced more than current advances in technology. Indeed, technology is changing the world at warp speed and nowhere is this more evident than in healthcare settings. This article identifies seven emerging technologies that will change the practice of nursing; three skill sets nurses will need to develop to acquire, use, and integrate these emerging technologies; and four challenges nurse leaders will face in integrating this new technology.

Faith-Based Mental Health Interventions with African Americans: A Review

ERIC Educational Resources Information Center

Hays, Krystal; Aranda, Maria P.

2016-01-01

Faith-based interventions have emerged culturally sensitive way to address mental health issues among African Americans. This systematic review explores the scope and efficacy of faith-based mental health intervention outcomes among African Americans. Extracted data included the study population, setting, study design, intervention, adaptations,…

Intelligence Testing and the Emergence of School Psychology.

ERIC Educational Resources Information Center

Rickman, David L.

School psychology, defined as the study and application of psychological principles to the educational setting, encompasses the study of learning and cognition, development, social behavior, individual differences, and measurement and statistics. The purpose of this paper is to provide an historical account of the origins of educational psychology…

Flauto: An Ethnographic Study of a Highly Successful Private Studio

ERIC Educational Resources Information Center

Montemayor, Mark

2008-01-01

This study examined the instructional settings, pedagogical techniques, interpersonal dynamics and personal characteristics of a teacher and her adolescent students in a renowned private flute studio. Using ethnographic techniques including observations and interviews, four main themes emerged that seem to contribute to the satisfaction of the…

Telepsychiatry in juvenile justice settings.

PubMed

Kaliebe, Kristopher E; Heneghan, James; Kim, Thomas J

2011-01-01

Telepsychiatry is emerging as a valuable means of providing mental health care in juvenile justice settings. Youth in the juvenile justice system have high levels of psychiatric morbidity. State and local juvenile justice systems frequently struggle to provide specialized psychiatric care, as these systems have limited resources and often operate in remote locations. Case studies in the use of telepsychiatry to provide improved care in juvenile corrections in 4 states are described, along with a review of advantages and disadvantages of telepsychiatry in these settings. Copyright © 2011 Elsevier Inc. All rights reserved.

Improving pain management of abdominal pain in children presenting to the paediatric emergency department: a pre-post interventional study.

PubMed

Williams, Suzanne; Holzhauser, Kerri; Bonney, Donna; Burmeister, Elizabeth; Gilhotra, Yuri; Oliver, Randall; Gordon, Kerry

2012-08-01

In 2007, the Mater Children's Hospital Emergency Department participated in the Emergency Care Pain Management Initiative funded by the National Health and Medical Research Council National Institute of Clinical Studies (NHMRC-NICS). The findings of this NHMRC-NICS research across eleven paediatric emergency departments highlighted deficits in pain management of abdominal pain. Specifically pain assessment, timeliness of analgesia, and pain management guidelines were found to be lacking. In response to the NICS report local practice was reviewed and a pilot research project undertaken to develop a clinical guideline for the pain management of abdominal pain in children presenting to the emergency department. The guideline was developed by an expert panel and trialled using a pre and post intervention design. The results demonstrated improved compliance to assessment and documentation of pain scores and assimilation of the best practice principles recommended in the guideline. This project raised local awareness in the pain management of abdominal pain and provides baseline information for future improvement. The guideline has been trialled in the clinical setting of paediatric emergency and has the potential to improve pain management practices in children presenting to the emergency department with abdominal pain. Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study

PubMed Central

Ro, Young Sun; Shin, Sang Do; Jeong, Joongsik; Kim, Min Jung; Jung, Young Hee; Kamgno, Joseph; Alain, Etoundi Mballa Georges; Hollong, Bonaventure

2017-01-01

Objectives To assess the burden of emergent illnesses and emergency care system usage by Yaoundé residents and to evaluate unmet needs for emergency care and associated barriers. Design A cross-sectional study using a community-based survey. Setting Yaoundé, Cameroon. Participants All residents living in Yaoundé were selected as the target population to investigate the needs and usage of emergency care in Yaoundé. 14 households in every health area (47 in total) were selected using 2-stage sampling. Primary outcome measures Unmet needs for emergency care. Results Among the 3201 participants from 619 households who completed the survey, 1113 (34.8%) with median age of 22 experienced 1 or more emergency conditions in the previous year. Respondents who experienced emergency conditions used emergency units (7.0%), outpatient clinics (46.5%) or hospitalisation (13.0%), and in overall, 68.8% of them reported unmet needs for emergency care. The primary reasons for not seeking healthcare were economic issues (37.2%) and use of complementary medicine (22.2%). Young age (adjusted OR (95% CI) 1.80 (1.23 to 2.62)), rental housing (1.50 (1.11 to 2.03)) and moderate household income (0.60 (0.36 to 0.99)) were associated with unmet needs for emergency care. Conclusions Residents of Yaoundé had a high demand for emergency care, and high unmet needs were observed due to low emergency care usage. Development of a cost-effective, universal emergency care system is urgently needed in Cameroon. PMID:28167749

The impact of unstable housing on emergency department use in a cohort of HIV-positive people in a Canadian setting

PubMed Central

Chan, Keith; Milan, David; Grafstein, Eric; Palmer, Alexis K.; Rhodes, Chelsey; Montaner, Julio S.G.; Hogg, Robert S.

2014-01-01

The social-structural challenges experienced by people living with HIV (PHA) have been shown to contribute to increased use of the Emergency Department (ED). This study identified factors associated with frequent and non-urgent ED use within a cohort of people accessing antiretroviral therapy (ART) in a Canadian setting. Interviewer-administered surveys collected socio-demographic information; clinical variables were obtained through linkages with the provincial drug treatment registry; and ED admission data were abstracted from the Department of Emergency Medicine database. Multivariate logistic regression was used to compute odds of frequent and non-urgent ED use. Unstable housing was independently associated with ED use (adjusted odds ratio [AOR]=1.94, 95% confidence interval [CI] 1.24–3.04]), having three or more ED visits within 6 months of interview date [AOR: 2.03 (95% CI: 1.07–3.83)] and being triaged as non-urgent (AOR=2.71, 95% CI: 1.19–6.17). Frequent and non-urgent use of the ED in this setting is associated with conditions requiring interventions at the social-structural level. Supportive housing may contribute to decreased healthcare costs and improved health outcomes amongst marginalized PHA. PMID:23656484

Perceptions of the importance of physical setting in substance abuse treatment.

PubMed

Grosenick, J K; Hatmaker, C M

2000-01-01

Research indicates that architectural design can provide therapeutic effects. Six setting characteristics are considered of primary importance in health-care facilities: comforts and conveniences, safety, attractiveness, size, privacy, and arrangement/location. This study presents the perceptions regarding these and other setting features held by female clients and staff from a substance abuse treatment facility. Results support the importance of these six setting characteristics in influencing clients' treatment goals. Four other setting variables emerged as important to women's recovery: participation in a residential, drug-free, gender-specific program that provides on-site child care. Attention to these variables may provide facilities with an advantage in today's competitive market for clients.

Neighborhood organization activities: evacuation drills, clusters, and fire safety awareness

Treesearch

Dick White

1995-01-01

Emergency preparedness activities of one Berkeley-Oakland Hills neighborhood at the wildland/urban interface include establishing clusters that reduce fire hazards and fuel loads, setting aside emergency supplies, and identifying evacuation routes; taking emergency preparedness courses from the Offices of Emergency Services of Berkeley and Oakland (the CERT and CORE...

49 CFR 193.2509 - Emergency procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... types and places of emergencies other than fires that may reasonably be expected to occur at an LNG... (a) of this section and each fire emergency, each operator must follow one or more manuals of written... emergency evacuation plan, which sets forth the steps required to protect the public in the event of an...

49 CFR 193.2509 - Emergency procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... types and places of emergencies other than fires that may reasonably be expected to occur at an LNG... (a) of this section and each fire emergency, each operator must follow one or more manuals of written... emergency evacuation plan, which sets forth the steps required to protect the public in the event of an...

49 CFR 193.2509 - Emergency procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... types and places of emergencies other than fires that may reasonably be expected to occur at an LNG... (a) of this section and each fire emergency, each operator must follow one or more manuals of written... emergency evacuation plan, which sets forth the steps required to protect the public in the event of an...

Garrison Clinical Setting Inadequate for Maintenance of Procedural Skills for Emergency Medicine Physicians: A Cross-Sectional Study.

PubMed

Schauer, Steven G; Varney, Shawn M; Cox, Kristin L

2015-01-01

Emergency medicine physicians (EPs) are often placed in far-forward, isolated areas in theater. Maintenance of their emergency intervention skills is vital to keep the medical forces deployment ready. The US Army suggests that working at a Military Treatment Facility (MTF) is sufficient to keep emergency procedural skills at a deployment-ready level. We sought to compare the volume of emergency procedures that providers reported necessary to maintain their skills with the number available in the MTF setting. EPs were surveyed to quantify the number of procedures they reported they would need to perform yearly to stay deployment-ready. We obtained procedure data for their duty stations and compared the procedure volume with the survey responses to determine if working at an MTF is sufficient to keep providers' skills deployment ready. The reported necessary average numbers per year were as follows: tube thoracostomy (5.9), intubation (11.4), cricothyrotomy (4.2), lumbar puncture (5.2), central line (10.0), focused assessment with sonography for trauma (FAST) (21.3), reductions (10.6), splints (10.5), and sedations (11.7). None of the procedure volumes at MTFs met provider requirements with the exception of FAST examinations at the only trauma center. This suggests the garrison clinical environment is inadequate for maintaining procedure skills. Further research is needed to determine modalities that will provide adequate training volume. 2015.

On the Automaticity of the Evaluative Priming Effect in the Valent/Non-Valent Categorization Task

PubMed Central

Spruyt, Adriaan; Tibboel, Helen

2015-01-01

It has previously been argued (a) that automatic evaluative stimulus processing is critically dependent upon feature-specific attention allocation and (b) that evaluative priming effects can arise in the absence of dimensional overlap between the prime set and the response set. In line with both claims, research conducted at our lab revealed that the evaluative priming effect replicates in the valent/non-valent categorization task. This research was criticized, however, because non-automatic, strategic processes may have contributed to the emergence of this effect. We now report the results of a replication study in which the operation of non-automatic, strategic processes was controlled for. A clear-cut evaluative priming effect emerged, thus supporting initial claims concerning feature-specific attention allocation and dimensional overlap. PMID:25803444

On the automaticity of the evaluative priming effect in the valent/non-valent categorization task.

PubMed

Spruyt, Adriaan; Tibboel, Helen

2015-01-01

It has previously been argued (a) that automatic evaluative stimulus processing is critically dependent upon feature-specific attention allocation and (b) that evaluative priming effects can arise in the absence of dimensional overlap between the prime set and the response set. In line with both claims, research conducted at our lab revealed that the evaluative priming effect replicates in the valent/non-valent categorization task. This research was criticized, however, because non-automatic, strategic processes may have contributed to the emergence of this effect. We now report the results of a replication study in which the operation of non-automatic, strategic processes was controlled for. A clear-cut evaluative priming effect emerged, thus supporting initial claims concerning feature-specific attention allocation and dimensional overlap.

Improving emergency physician performance using audit and feedback: a systematic review.

PubMed

Le Grand Rogers, R; Narvaez, Yizza; Venkatesh, Arjun K; Fleischman, William; Hall, M Kennedy; Taylor, R Andrew; Hersey, Denise; Sette, Lynn; Melnick, Edward R

2015-10-01

Audit and feedback can decrease variation and improve the quality of care in a variety of health care settings. There is a growing literature on audit and feedback in the emergency department (ED) setting. Because most studies have been small and not focused on a single clinical process, systematic assessment could determine the effectiveness of audit and feedback interventions in the ED and which specific characteristics improve the quality of emergency care. The objective of the study is to assess the effect of audit and feedback on emergency physician performance and identify features critical to success. We adhered to the PRISMA statement to conduct a systematic review of the literature from January 1994 to January 2014 related to audit and feedback of physicians in the ED. We searched Medline, EMBASE, PsycINFO, and PubMed databases. We included studies that were conducted in the ED and reported quantitative outcomes with interventions using both audit and feedback. For included studies, 2 reviewers independently assessed methodological quality using the validated Downs and Black checklist for nonrandomized studies. Treatment effect and heterogeneity were to be reported via meta-analysis and the I2 inconsistency index. The search yielded 4332 articles, all of which underwent title review; 780 abstracts and 131 full-text articles were reviewed. Of these, 24 studies met inclusion criteria with an average Downs and Black score of 15.6 of 30 (range, 6-22). Improved performance was reported in 23 of the 24 studies. Six studies reported sufficient outcome data to conduct summary analysis. Pooled data from studies that included 41,124 patients yielded an average treatment effect among physicians of 36% (SD, 16%) with high heterogeneity (I2=83%). The literature on audit and feedback in the ED reports positive results for interventions across numerous clinical conditions but without standardized reporting sufficient for meta-analysis. Characteristics of audit and feedback interventions that were used in a majority of studies were feedback that targeted errors of omission and that was explicit with measurable instruction and a plan for change delivered in the clinical setting greater than 1 week after the audited performance using a combination of media and types at both the individual and group levels. Future work should use standardized reporting to identify the specific aspects of audit or feedback that drive effectiveness in the ED. Copyright © 2015 Elsevier Inc. All rights reserved.

The "prudent layperson" definition of an emergency medical condition.

PubMed

Li, James; Galvin, Hannah K; Johnson, Sandra C

2002-01-01

The study objectives, based on federal and state legislative language, were to objectively define symptoms and signs commonly agreed on by "prudent laypersons" as "emergency medical conditions." After comprehensive tabulation of symptom classifications from the International Classification of Diseases (ICD-9), we performed a survey of nonmedical laypersons. Data analysis included descriptive statistics, proportional calculations, and 95% confidence intervals. A minority of symptoms and signs (25/87, 29%) were considered emergency medical conditions by more than half of nonmedical survey respondents who were self-defined as prudent laypersons. The leading conditions deemed emergencies were loss of consciousness, seizure, no recognition of one side of the body, paralysis, shock, gangrene, coughing blood, trouble breathing, chest pain, and choking. Pain, except for renal colic or chest pain, was not considered an emergency. No symptoms or signs specifically related to gynecologic disorders were considered emergencies. Most symptoms and signs tabulated in the diagnostic coding manual, ICD-9, are not considered emergency medical conditions by self-designated prudent laypersons. These include many conditions that are commonly investigated and treated in the emergency department setting. Use of the prudent layperson standard for reimbursable emergency health services may not reflect the actual scope of symptoms necessitating emergency care.

Factors influencing emergency nurses' ethical problems during the outbreak of MERS-CoV.

PubMed

Choi, Jeong-Sil; Kim, Ji-Soo

2018-05-01

Whenever there has been a worldwide contagious disease outbreak, there have been reports of infection and death of healthcare workers. Particularly because emergency nurses have contact with patients on the front line, they experience ethical problems in nursing while struggling with infectious diseases in an unfavorable environment. The objective of this study was to explore emergency nurses' ethical problems and to identify factors influencing these problems during the outbreak of Middle East respiratory syndrome-coronavirus in Korea. For this cross-sectional study, a questionnaire survey was conducted with emergency nurses working in six hospitals selected through convenience sampling from the hospitals designated for Middle East respiratory syndrome-coronavirus patients in the capital area. Data were collected from 169 emergency nurses in Korea during August 2015. Ethical considerations: This research was approved by the Institutional Review Board of G University in Korea. The findings of this study suggest that during the Middle East respiratory syndrome-coronavirus outbreak, emergency nurses experienced ethical problems tied to a mind-set of avoiding patients. Three factors were found to influence emergency nurses' ethical problems (in order of influence): cognition of social stigmatization, level of agreement with infection control measures, and perceived risk. Through this study, we obtained information on emergency nurses' ethical problems during the Middle East respiratory syndrome-coronavirus outbreak and identified the factors that influence them. As found in this study, nurses' ethical problems were influenced most by cognitions of social stigmatization. Accordingly, to support nurses confidently care for people during future health disasters, it is most urgent to promote appropriate public consciousness that encourages healthcare workers.

How familiar are clinician teammates in the emergency department?

PubMed

Patterson, P Daniel; Pfeiffer, Anthony J; Lave, Judith R; Weaver, Matthew D; Abebe, Kaleab; Krackhardt, David; Arnold, Robert M; Yealy, Donald M

2015-04-01

Lack of familiarity between teammates is linked to worsened safety in high risk settings. The emergency department (ED) is a high risk healthcare setting where unfamiliar teams are created by diversity in clinician shift schedules and flexibility in clinician movement across the department. We sought to characterise familiarity between clinician teammates in one urban teaching hospital ED over a 22 week study period. We used a retrospective study design of shift scheduling data to calculate the mean weekly hours of familiarity between teammates at the dyadic level, and the proportion of clinicians with a minimum of 2, 5, 10 and 20 h of familiarity at any given hour during the study period. Mean weekly hours of familiarity between ED clinician dyads was 2 h (SD 1.5). At any given hour over the study period, the proportions of clinicians with a minimum of 2, 5, 10 and 20 h of familiarity were 80%, 51%, 27% and 0.8%, respectively. In our study, few clinicians could be described as having a high level of familiarity with teammates. The limited familiarity between ED clinicians identified in this study may be a natural feature of ED care delivery in academic settings. We provide a template for measurement of ED team familiarity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Emergency medical systems in low- and middle-income countries: recommendations for action.

PubMed Central

Kobusingye, Olive C.; Hyder, Adnan A.; Bishai, David; Hicks, Eduardo Romero; Mock, Charles; Joshipura, Manjul

2005-01-01

Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care. PMID:16184282

Advances in Educational and Psychological Testing: Theory and Applications. Evaluation in Education and Human Services Series.

ERIC Educational Resources Information Center

Hambleton, Ronald K., Ed.; Zaal, Jac N., Ed.

The 14 chapters of this book focus on the technical advances, advances in applied settings, and emerging topics in the testing field. Part 1 discusses methodological advances, Part 2 considers developments in applied settings, and Part 3 reviews emerging topics in the field of testing. Part 1 papers include: (1) "Advances in…

Which features of primary care affect unscheduled secondary care use? A systematic review

PubMed Central

Huntley, Alyson; Lasserson, Daniel; Wye, Lesley; Morris, Richard; Checkland, Kath; England, Helen; Salisbury, Chris; Purdy, Sarah

2014-01-01

Objectives To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. Setting Observational studies at primary care practice level. Participants Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. Primary and secondary outcome measures The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. Results 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. Conclusions The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions. PMID:24860000

Feasibility of Energy Medicine in a Community Teaching Hospital: An Exploratory Case Series

PubMed Central

Dufresne, Francois; Simmons, Bonnie; Vlachostergios, Panagiotis J.; Fleischner, Zachary; Joudeh, Ramsey; Blakeway, Jill

2015-01-01

Abstract Background: Energy medicine (EM) derives from the theory that a subtle biologic energy can be influenced for therapeutic effect. EM practitioners may be trained within a specific tradition or work solo. Few studies have investigated the feasibility of solo-practitioner EM in hospitals. Objective: This study investigated the feasibility of EM as provided by a solo practitioner in inpatient and emergent settings. Design: Feasibility study, including a prospective case series. Settings: Inpatient units and emergency department. Outcome measures: To investigate the feasibility of EM, acceptability, demand, implementation, and practicality were assessed. Short-term clinical changes were documented by treating physicians. Participants: Patients, employees, and family members were enrolled in the study only if study physicians expected no or slow improvement in specific symptoms. Those with secondary gains or who could not communicate perception of symptom change were excluded. Results: EM was found to have acceptability and demand, and implementation was smooth because study procedures dovetailed with conventional clinical practice. Practicality was acceptable within the study but was low upon further application of EM because of cost of program administration. Twenty-four of 32 patients requested relief from pain. Of 50 reports of pain, 5 (10%) showed no improvement; 4 (8%), slight improvement; 3 (6%), moderate improvement; and 38 (76%), marked improvement. Twenty-one patients had issues other than pain. Of 29 non–pain-related problems, 3 (10%) showed no, 2 (7%) showed slight, 1 (4%) showed moderate, and 23 (79%) showed marked improvement. Changes during EM sessions were usually immediate. Conclusions: This study successfully implemented EM provided by a solo practitioner in inpatient and emergent hospital settings and found that acceptability and demand justified its presence. Most patients experienced marked, immediate improvement of symptoms associated with their chief complaint. Substantial practicality issues must be addressed to implement EM clinically in a hospital, however. PMID:26035025

Becoming an A & E nurse.

PubMed

Sbaih, L C

1997-10-01

This is the first of four papers which examine the work of Accident and Emergency (A & E) nurses. The descriptions in this and the following three papers have emerged from an ethnomethodological study which sought to obtain the views of what A & E nurses believed their work to be. All are rooted in nurses' accounts of the ways in which nursing work is talked about and accomplished within the A & E setting. It should be noted that all four papers describe the ordinary rather than the extraordinary and should hold no surprises for those familiar with A & E nursing work. This first paper explores the ways in which nurses become A & E nurses, however, before descriptions can be put forward, an introduction to the study from which they have emerged needs to be made.

Building of communication system for nuclear accident emergency disposal based on IP multimedia subsystem

NASA Astrophysics Data System (ADS)

Wang, Kang; Gao, Guiqing; Qin, Yuanli; He, Xiangyong

2018-05-01

The nuclear accident emergency disposal must be supported by an efficient, real-time modularization and standardization communication system. Based on the analysis of communication system for nuclear accident emergency disposal which included many functions such as the internal and external communication, multiply access supporting and command center. Some difficult problems of the communication system were discussed such as variety access device type, complex composition, high mobility, set up quickly, multiply business support, and so on. Taking full advantages of the IP Multimedia Subsystem (IMS), a nuclear accident emergency communication system was build based on the IMS. It was studied and implemented that some key unit and module functions of communication system were included the system framework implementation, satellite access, short-wave access, load/vehicle-mounted communication units. The application tests showed that the system could provide effective communication support for the nuclear accident emergency disposal, which was of great practical value.

Hospital emergency on-call coverage: is there a doctor in the house?

PubMed

O'Malley, Ann S; Draper, Debra A; Felland, Laurie E

2007-11-01

The nation's community hospitals face increasing problems obtaining emergency on-call coverage from specialist physicians, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. The diminished willingness of specialist physicians to provide on-call coverage is occurring as hospital emergency departments confront an ever-increasing demand for services. Factors influencing physician reluctance to provide on-call coverage include decreased dependence on hospital admitting privileges as more services shift to non-hospital settings; payment for emergency care, especially for uninsured patients; and medical liability concerns. Hospital strategies to secure on-call coverage include enforcing hospital medical staff bylaws that require physicians to take call, contracting with physicians to provide coverage, paying physicians stipends, and employing physicians. Nonetheless, many hospitals continue to struggle with inadequate on-call coverage, which threatens patients' timely access to high-quality emergency care and may raise health care costs.

Development and clinical study of mobile 12-lead electrocardiography based on cloud computing for cardiac emergency.

PubMed

Fujita, Hideo; Uchimura, Yuji; Waki, Kayo; Omae, Koji; Takeuchi, Ichiro; Ohe, Kazuhiko

2013-01-01

To improve emergency services for accurate diagnosis of cardiac emergency, we developed a low-cost new mobile electrocardiography system "Cloud Cardiology®" based upon cloud computing for prehospital diagnosis. This comprises a compact 12-lead ECG unit equipped with Bluetooth and Android Smartphone with an application for transmission. Cloud server enables us to share ECG simultaneously inside and outside the hospital. We evaluated the clinical effectiveness by conducting a clinical trial with historical comparison to evaluate this system in a rapid response car in the real emergency service settings. We found that this system has an ability to shorten the onset to balloon time of patients with acute myocardial infarction, resulting in better clinical outcome. Here we propose that cloud-computing based simultaneous data sharing could be powerful solution for emergency service for cardiology, along with its significant clinical outcome.

Apropos: Plasmodium knowlesi malaria an emerging public health problem in Hulu Selangor, Selangor, Malaysia (2009-2013): epidemiologic and entomologic analysis.

PubMed

Waugh, Sheldon

2015-02-05

The use of detailed methodologies and legitimate settings justifications in spatial analysis is imperative to locating areas of significance. Studies missing this action may enact interventions in improper areas.

Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study

PubMed Central

Broccoli, Morgan C; Calvello, Emilie J B; Skog, Alexander P; Wachira, Benjamin; Wallis, Lee A

2015-01-01

Objectives We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members’ thoughts regarding high impact solutions to expand access to essential emergency services. Design We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. Setting Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. Results Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care—a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. Conclusions Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region. PMID:26586324

A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health-care settings.

PubMed

Cowell, Alexander J; Dowd, William N; Landwehr, Justin; Barbosa, Carolina; Bray, Jeremy W

2017-02-01

Screening and brief intervention for harmful substance use in medical settings is being promoted heavily in the United States. To justify service provision fiscally, the field needs accurate estimates of the number and type of staff required to provide services, and thus the time taken to perform activities used to deliver services. This study analyzed the time spent in activities for the component services of the substance misuse Screening, Brief Intervention and Referral to Treatment (SBIRT) program implemented in emergency departments, in-patient units and ambulatory clinics. Observers timed activities according to 18 distinct codes among SBIRT practitioners. Twenty-six US sites within four grantees. Five hundred and one practitioner-patient interactions; 63 SBIRT practitioners. Timing of practitioner activities. Delivery of component services of SBIRT. The mean (standard error) time to deliver services was 1:19 (0:06) for a pre-screen (n = 210), 4:28 (0:24) for a screen (n = 97) and 6:51 (0:38) for a brief intervention (n = 66). Estimates of service duration varied by setting. Overall, practitioners spent 40% of their time supporting SBIRT delivery to patients and 13% of their time delivering services. In the United States, support activities (e.g. reviewing the patient's chart, locating the patient, writing case-notes) for substance abuse Screening, Brief Intervention and Referral to Treatment require more staff time than delivery of services. Support time for screens and brief interventions in the emergency department/trauma setting was high compared with the out-patient setting. © 2017 Society for the Study of Addiction.

Overcoming barriers to the use of osteopathic manipulation techniques in the emergency department.

PubMed

Roberge, Raymond J; Roberge, Marc R

2009-08-01

Osteopathic Manipulation Techniques (OMT) have been shown to be effective therapeutic modalities in various clinical settings, but appear to be underutilized in the emergency department (ED) setting. To examine barriers to the use of OMT in the ED and provide suggestions to ameliorate these barriers. Literature review While the medical literature cites numerous obstacles to the use of OMT in the ED setting, most can be positively addressed through education, careful planning, and ongoing research into use of these techniques. Recent prospective clinical trials of OMT have demonstrated the utility of these modalities. Osteopathic Manipulation Techniques are useful therapeutic modalities that could be utilized to a greater degree in the ED. As the number of osteopathic emergency physicians increases, the opportunity to employ these techniques should increase.

[Investigation of the burnout syndrome among the employees of the Department of Emergency Medicine at the University of Szeged].

PubMed

Hompoth, Emőke Adrienn; Töreki, Annamária; Pető, Zoltán

2018-01-01

Burnout has been described as a growing problem amongst healthcare workers. Emergency department staffs experience the burden of stress day by day, yet only a few studies have examined their burnout. In this study we wanted to investigate the burnout and its relations to other variables amongst the employees of the Department of Emergency Medicine in Szeged. Cross-sectional design utilizing a self-administered questionnaire was used to collect data from the staff of the Department. Burnout was measured using the Maslach Burnout Inventory. Burnout is considerably prevalent among the workers of the Emergency Department, especially nurses and physicians. The study found negative relation between burnout and age, number of children, number of years in the healthcare system, number of physical symptoms, social support and psychological immune system. Being single was a risk factor. The risks and protective factors found to be associated with burnout in this study might help to set up institutional prevention and intervention strategies. Orv Hetil. 2018; 159(3): 113-118.

44 CFR 351.3 - Limitation of scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... plans and preparedness capabilities. Furthermore, this part does not set forth Federal agency... Emergency Response Plan” (50 FR 46542, November 8, 1985). (b) Nothing in this part authorizes access to or... Section 351.3 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF...

44 CFR 351.3 - Limitation of scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... plans and preparedness capabilities. Furthermore, this part does not set forth Federal agency... Emergency Response Plan” (50 FR 46542, November 8, 1985). (b) Nothing in this part authorizes access to or... Section 351.3 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF...

44 CFR 351.3 - Limitation of scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... plans and preparedness capabilities. Furthermore, this part does not set forth Federal agency... Emergency Response Plan” (50 FR 46542, November 8, 1985). (b) Nothing in this part authorizes access to or... Section 351.3 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF...

44 CFR 351.3 - Limitation of scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... plans and preparedness capabilities. Furthermore, this part does not set forth Federal agency... Emergency Response Plan” (50 FR 46542, November 8, 1985). (b) Nothing in this part authorizes access to or... Section 351.3 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF...

Using Mixed Methods to Study First-Year College Impact on Liberal Arts Learning Outcomes

ERIC Educational Resources Information Center

Seifert, Tricia A.; Goodman, Kathleen; King, Patricia M.; Baxter Magolda, Marcia B.

2010-01-01

This study details the collection, analysis, and interpretation of data from a national multi-institutional longitudinal mixed methods study of college impact and student development of liberal arts outcomes. The authors found three sets of practices in the quantitative data that corroborated with the themes that emerged from the qualitative data:…

Emergency information management needs and practices of older adults: A descriptive study.

PubMed

Turner, Anne M; Osterhage, Katie; Loughran, Julie; Painter, Ian; Demiris, George; Hartzler, Andrea L; Phelan, Elizabeth A

2018-03-01

To better understand how older adults currently manage emergency information, the barriers and facilitators to planning and management of emergency information, as well as the potential role of information technology to facilitate emergency planning and management. Older adults face a much higher risk of sudden illness/injury and are the age group with the largest percentages of emergent and urgent healthcare visits. Emergency information (health information needed in an emergency situation such as emergency contact information, diagnoses, and advance directives) needs to be maintained and easily accessible to ensure older adults get appropriate care and treatment consistent with their wishes in emergency situations. Current health information technologies rarely take into consideration the emergency information needs of older adults, their caregivers, and emergency responders. As part of a larger study we performed in-depth interviews with 90 older adults living in a variety of residential settings (independent living, retirement communities, assisted living) regarding how they manage information about their health. Interview sessions included photos of important health information artifacts. Interviews were transcribed and coded. Analysis of in-depth interviews revealed that emergency information is a type of health information that older adults frequently manage. Participants differed in whether they practice emergency planning (e.g. the preparation and continued management of emergency information), and in whether they involve others in emergency information and emergency planning. Despite its importance, emergency information was often not up-to-date and not always kept in locations readily apparent to emergency responders. Emergency information, such as emergency contact information, diagnoses, and advance directives, is a type of health information that older adults manage. Considering emergency information in the design of health information technologies for older adults could address some of the barriers and support the facilitators to emergency planning and information management. Copyright © 2017 Elsevier B.V. All rights reserved.

The CHAP-EMS health promotion program: a qualitative study on participants' views of the role of paramedics.

PubMed

Brydges, Madison; Denton, Margaret; Agarwal, Gina

2016-08-24

Expanded roles for paramedics, commonly termed community paramedicine, are becoming increasingly common. Paramedics working in community paramedicine roles represent a distinct departure away from the traditional emergency paradigm of paramedic services. Despite this, little research has addressed how community paramedics are perceived by their clients. This study took an interpretivist qualitative approach to examine participants' perceptions of paramedics providing a community paramedicine program, named the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS). Both participant observation and semi-structured interviews conducted with program participants were used to gain insight into the on-the-ground experiences of the program. Thematic analysis was employed to analyze all data. Three themes emerged: i) Caring and trusting relationships; ii) paramedics as health advocates; iii) the added value of EMS skills. Paramedics were perceived by residents as having dual identities: first in a novel role as health advocates and secondly in a traditional role as emergency experts despite lacking contextual features associated with emergency response. From this exploratory, qualitative study we present an emerging framework in which to conceptualize paramedic roles in community paramedicine settings. Future research should address the saliency of these roles in different contexts and how these roles relate to paramedic practice.

Uncovering the Hidden Structure of Platoons: Formal and Emergent Leaders’ Perceptions of Organizational Networks

DTIC Science & Technology

2008-12-01

perceptions of formal and emergent leaders differ from those of non-leaders, and if so, how. We approach this topic through the lens of social network...analysis. 1.1 Social Networks The term “ social network” refers to a set of actors who are connected by a set of ties. Actors, often referred to as...the structure of any social system can be defined as a set of relations between all pairs of individuals who are members of the network (Krackhardt

The effect of patient death on medical students in the emergency department.

PubMed

Batley, Nicholas J; Bakhti, Rinad; Chami, Ali; Jabbour, Elsy; Bachir, Rana; El Khuri, Christopher; Mufarrij, Afif J

2017-07-10

The emotional consequences of patient deaths on physicians have been studied in a variety of medical settings. Reactions to patient death include distress, guilt, and grief. Comparatively, there are few studies on the effects of patient death on physicians and residents in the Emergency Department (ED). The ED setting is considered unique for having more sudden deaths that likely include the young and previously healthy and expectations for the clinician to return to a dynamic work environment. To date, no studies have looked at the effects of patient deaths on the more vulnerable population of medical students in the ED. This study examined aspects of patient deaths in the ED that most strongly influence students' reactions while comparing it to those of an inpatient setting. Semi-structured qualitative interviews were carried out with a total of 16 medical students from the American University of Beirut, Medical Center in Lebanon who had recently encountered a patient death in the ED. Questions included their reaction to the death, interaction with patients and their family members, the response of the medical team, and coping mechanisms adopted. The analysis revealed the following as determinant factors of student reaction to patient death: context of death; including age of patient, expectation of death, first death experience, relating patient death to personal deaths, and extent of interaction with patient and family members. Importantly, deaths in an inpatient setting were judged as more impactful than ED deaths. ED deaths, however, were especially powerful when a trauma case was deemed physically disturbing and cases in which family reactions were emotionally moving. The study demonstrates that students' emotional reactions differ as a function of the setting (surprise and shock in the ED versus sadness and grief in an inpatient setting). Debriefing and counseling sessions on ED deaths may benefit from this distinction.

The role of emergency medicine clerkship e-Portfolio to monitor the learning experience of students in different settings: a prospective cohort study.

PubMed

Cevik, Arif Alper; Shaban, Sami; El Zubeir, Margret; Abu-Zidan, Fikri M

2018-04-12

Although emergency departments provide acute care learning opportunities for medical students, student exposure to recommended curriculum presentations and procedures are limited. In this perspective, clinical environments providing learning opportunities for students should be monitored as part of an ongoing quality improvement process. This study aims to analyze student exposures and their involvement levels in two different hospitals (Tawam and Al Ain) so as to improve the teaching and learning activities. This is a prospective study on all 76 final year medical students' electronic logbooks (e-Portfolio) of the academic year 2016/2017. Students recorded 5087 chief complaints and 3721 procedures. The average patient and procedure exposure in a shift per student in Al Ain Hospital compared with Tawam Hospital were 7.2 vs 6.4 and 5.8 vs 4.3, respectively. The highest full involvement with presentations was seen in the pediatric unit (67.1%, P < 0.0001). Urgent care shifts demonstrated the highest area of "full involvement" with procedures for our students (73.2%, P < 0.0001). Students' highest involvement with presentations and procedures were found during the night shifts (P < 0.0001, 66.5 and 75.1%, respectively). The electronic portfolio has proven to be a very useful tool in defining the learning activities of final year medical students during their emergency medicine clerkship and in comparing activities in two different clinical settings. Data collected and analyzed using this e-Portfolio has the potential to help medical educators and curriculum designers improve emergency medicine teaching and learning activities.

Athletic Trainers' Facilitators of Professional Commitment in the Collegiate Setting

PubMed Central

Eason, Christianne M.; Mazerolle, Stephanie M.; Pitney, William A.

2015-01-01

Context: Professional responsibility, rewards and respect, and time for rejuvenation are factors supporting professional commitment for athletic trainers (ATs) in the high school setting. The inherent complexities of an occupational setting can mitigate perceptions of professional commitment. Thus far, evidence is lacking regarding professional commitment for ATs in other occupational settings. Objective: To extend the literature on professional commitment of the AT to the collegiate setting. Design: Qualitative study. Setting: Collegiate. Patients or Other Participants: Thirty-three Board of Certification-certified ATs employed in the collegiate setting (National Collegiate Athletic Association Division I = 11, Division II = 9, Division III = 13) with an average of 10 ± 8 years of clinical experience volunteered. Data saturation guided the total number of participants. Data Collection and Analysis: Online journaling via QuestionPro was used to collect data from all participants. Two strategies, multiple-analyst triangulation and peer review, were completed to satisfy data credibility. Data were evaluated using a general inductive approach. Results: Likert-scale data revealed no differences regarding levels of professional commitment across divisions. Two themes emerged from the inductive-content analysis: (1) professional responsibility and (2) coworker support. The emergent theme of professional responsibility contained 4 subthemes: (1) dedication to advancing the athletic training profession, (2) ardor for job responsibilities, (3) dedication to the student-athlete, and (4) commitment to education. Our participants were able to better maintain their own professional commitment when they felt their coworkers were also committed to the profession. Conclusions: The collegiate ATs investigated in this study, regardless of division, demonstrated professional commitment propelled by their aspiration to advance the profession, as well as their dedication to student-athletes and athletic training students. Maintaining commitment was influenced by a strong sense of coworker support. PMID:25761135

A systematic review of emergency department based HIV testing and linkage to care initiatives in low resource settings.

PubMed

Hansoti, Bhakti; Kelen, Gabor D; Quinn, Thomas C; Whalen, Madeleine M; DesRosiers, Taylor T; Reynolds, Steven J; Redd, Andrew; Rothman, Richard E

2017-01-01

Only 45% of people currently living with HIV infection in sub-Saharan Africa are aware of their HIV status. Unmet testing needs may be addressed by utilizing the Emergency Department (ED) as an innovative testing venue in low and middle-income countries (LMICs). The purpose of this review is to examine the burden of HIV infection described in EDs in LMICs, with a focus on summarizing the implementation of various ED-based HIV testing strategies. We performed a systematic review of Pubmed, Embase, Scopus, Web of Science and the Cochrane Library on June 12, 2016. A three-concept search was employed with emergency medicine (e.g., Emergency department, emergency medical services), HIV/AIDS (e.g., human immunodeficiency virus, acquired immunodeficiency syndrome), and LMIC terms (e.g., developing country, under developed countries, specific country names). The search returned 2026 unique articles. Of these, thirteen met inclusion criteria and were included in the final review. There was a large variation in the reported prevalence of HIV infection in the ED population ranging from to 2.14% in India to 43.3% in Uganda. The proportion HIV positive patients with previously undiagnosed infection ranged from 90% to 65.22%. In the United States ED-based HIV testing strategies have been front and center at curbing the HIV epidemic. The limited number of ED-based studies we observed in this study may represent the paucity of HIV testing in this venue in LMICs. All of the studies in this review demonstrated a high prevalence of HIV infection in the ED and an extraordinarily high percentage of previously undiagnosed HIV infection. Although the numbers of published reports are few, these diverse studies imply that in HIV endemic low resource settings EDs carry a large burden of undiagnosed HIV infections and may offer a unique testing venue.

Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives

PubMed Central

2012-01-01

Background Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. Methods To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Results Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Conclusions Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans. PMID:22449119

The impracticality of MRI for the diagnosis of atypical penile fracture in the emergency setting.

PubMed

Maurice, Matthew J; Spirnak, J Patrick

2014-05-01

We report the case of a patient who presented to the emergency department with a history suspicious for penile fracture without typical physical exam findings. A small penile fracture was present on MRI, but the diagnosis was missed, and surgery was withheld owing to this misinformation. Despite its technical accuracy, MRI may be impractical for the diagnosis of penile fracture in the emergency setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Designing a Predictive Model of Student Satisfaction in Online Learning

ERIC Educational Resources Information Center

Parahoo, Sanjai K; Santally, Mohammad Issack; Rajabalee, Yousra; Harvey, Heather Lea

2016-01-01

Higher education institutions consider student satisfaction to be one of the major elements in determining the quality of their programs. The objective of the study was to develop a model of student satisfaction to identify the influencers that emerged in online higher education settings. The study adopted a mixed method approach to identify…

A Quantitative Research Study on the Implementation of the Response-to-Intervention Model

ERIC Educational Resources Information Center

Mahoney, Jamie

2011-01-01

Response to Intervention (RTI) emerged as a new service delivery model designed to meet the learning needs of all students prior to diagnosis and placement in the special education setting. The problem was few research studies had been conducted between general education teachers with intensive professional development and those without…

Teachers as Informal Learners: Workplace Professional Learning in the United States and Lithuania

ERIC Educational Resources Information Center

Jurasaite-Harbison, Elena; Rex, Lesley A.

2013-01-01

This study demonstrates the understandings that result from teachers' explanations of how they learn when they encounter everyday situations that evoke their learning. The study renders these explanations as a framework for further research on teacher workplace learning in informal settings. The framework emerged from a constant-comparative…

Construction of an Instrument to Measure Social Valuation in an Emerging Market Context

ERIC Educational Resources Information Center

Katono, Isaac Wasswa

2011-01-01

Purpose: This study aims to construct a parsimonious instrument to measure social valuation in a collective setting using Uganda as an example. Design/methodology/approach: A triangulation technique was used in this study. Conversations with students, parents, teaching and non-teaching staff at Uganda Christian University (UCU) main campus were…

A Case Study of Conflict in an Educational Workplace: Managing Personal and Cultural Differences

ERIC Educational Resources Information Center

Torpey, Michael John

2006-01-01

This article is about conflict in an educational workplace setting. It reports on a case study investigating the emergence, development, and management of conflict among diverse native English speakers working as language instructors within a Japanese university. The example of conflict presented, which deals with divergent assumptions about the…

Constructing Baccalaureate Nursing Students' Ethical Experiences of Classroom Lessons and Clinical Practice

ERIC Educational Resources Information Center

Knowles, Amy J. B.

2014-01-01

Ethics is an integral component of the nursing profession. This phenomenological study aimed to describe how baccalaureate nursing students experience learning ethics both in the classroom and clinical setting. The interviews in this study were conducted with eight second semester senior nursing students. Four themes emerged from analyses of the…

Soil health: an emergent set of soil properties that result from synergy among agricultural management practices

USDA-ARS?s Scientific Manuscript database

The responses of a selected soil microbial property to a single agricultural management practice are often inconsistent among field studies, possibly reflecting the site-specific nature of field studies. An equally compelling explanation is that in complex systems where outcomes are the result of n...

Traumatic Brain Injury: Are We Conducting Enough Resarch

DTIC Science & Technology

2017-04-17

Autism Spectrum Disorder (ASD), whose current rate of total study growth was 2.08. Within subsets of ASD studies, the current rate of RCT growth was...the lack of emerging treatments. As neurological disorders are notoriously complex, we set out to compare the state of TBI research to that of the 11

Youth Perspectives on Restrictive Mental Health Placement: Unearthing a Counter Narrative

ERIC Educational Resources Information Center

Polvere, Lauren

2011-01-01

Though research has focused on clinical characteristics and behavioral problems of youth in out-of-home mental health placement settings, few studies have examined how adolescents and emerging adults (Arnett, 2000) experience and make sense of treatment. In this study, semistructured interviews regarding the experience of mental health placement…

Frequency of in-office emergencies in primary care

PubMed Central

Liddy, Clare; Dreise, Heather; Gaboury, Isabelle

2009-01-01

ABSTRACT OBJECTIVE To quantify the frequency and types of in-office emergencies seen by FPs. DESIGN A retrospective descriptive analysis of the frequency and types of in-office emergencies seen by FPs was done using the City of Ottawa Emergency Medical Services database. SETTING Community medical offices in the Ottawa, Ont, region during a 3-year period (2004 to 2006). PARTICIPANTS All patients for whom an ambulance was called to a medical office or clinic during the study period. MAIN OUTCOME MEASURES Number of emergency calls from FPs’ offices, primary complaints, seasonal variation, distance to the nearest emergency facility, and patients’ demographic characteristics. RESULTS A total of 3033 code 04 (life-threatening) emergency calls were received from FPs’ offices during the study period. Demographic analysis of the calls showed that 91.3% of calls were regarding adult patients with an average age of 51.5 years. There was an overall statistically significant difference in the sex of the patients presenting (P < .001), but it was attributable to calls about genitourinary emergencies, which were almost all for women. The most common type of emergency reported was cardiovascular complaints. Of the 992 cardiovascular emergencies, 74.3% were complaints of ischemic chest pain. CONCLUSION There is a great burden on the health care system from emergency calls, with continued unpreparedness from FPs. Clearly, FPs must take seriously the risk of being unprepared for in-office emergencies. Dissemination strategies must be developed so that the guidelines that have been developed can be effectively implemented in FP offices across the country. PMID:19826161

Interprofessional education in a student-led emergency department: A realist evaluation.

PubMed

Ericson, Anne; Löfgren, Susanne; Bolinder, Gunilla; Reeves, Scott; Kitto, Simon; Masiello, Italo

2017-03-01

This article reports a realist evaluation undertaken to identify factors that facilitated or hindered the successful implementation of interprofessional clinical training for undergraduate students in an emergency department. A realist evaluation provides a framework for understanding how the context and underlying mechanisms affect the outcome patterns of an intervention. The researchers gathered both qualitative and quantitative data from internal documents, semi-structured interviews, observations, and questionnaires to study what worked, for whom, and under what circumstances in this specific interprofessional setting. The study participants were medical, nursing, and physiotherapy students, their supervisors, and two members of the emergency department's management staff. The data analysis indicated that the emergency ward provided an excellent environment for interprofessional education (IPE), as attested by the students, supervisors, and the clinical managers. An essential prerequisite is that the students have obtained adequate skills to work independently. Exemplary conditions for IPE to work well in an emergency department demand the continuity of effective and encouraging supervision throughout the training period and supervisors who are knowledgeable about developing a team.

Validity of the International Classification of Diseases 10th revision code for hyperkalaemia in elderly patients at presentation to an emergency department and at hospital admission

PubMed Central

Fleet, Jamie L; Shariff, Salimah Z; Gandhi, Sonja; Weir, Matthew A; Jain, Arsh K; Garg, Amit X

2012-01-01

Objectives Evaluate the validity of the International Classification of Diseases, 10th revision (ICD-10) code for hyperkalaemia (E87.5) in two settings: at presentation to an emergency department and at hospital admission. Design Population-based validation study. Setting 12 hospitals in Southwestern Ontario, Canada, from 2003 to 2010. Participants Elderly patients with serum potassium values at presentation to an emergency department (n=64 579) and at hospital admission (n=64 497). Primary outcome Sensitivity, specificity, positive-predictive value and negative-predictive value. Serum potassium values in patients with and without a hyperkalaemia code (code positive and code negative, respectively). Results The sensitivity of the best-performing ICD-10 coding algorithm for hyperkalaemia (defined by serum potassium >5.5 mmol/l) was 14.1% (95% CI 12.5% to 15.9%) at presentation to an emergency department and 14.6% (95% CI 13.3% to 16.1%) at hospital admission. Both specificities were greater than 99%. In the two settings, the positive-predictive values were 83.2% (95% CI 78.4% to 87.1%) and 62.0% (95% CI 57.9% to 66.0%), while the negative-predictive values were 97.8% (95% CI 97.6% to 97.9%) and 96.9% (95% CI 96.8% to 97.1%). In patients who were code positive for hyperkalaemia, median (IQR) serum potassium values were 6.1 (5.7 to 6.8) mmol/l at presentation to an emergency department and 6.0 (5.1 to 6.7) mmol/l at hospital admission. For code-negative patients median (IQR) serum potassium values were 4.0 (3.7 to 4.4) mmol/l and 4.1 (3.8 to 4.5) mmol/l in each of the two settings, respectively. Conclusions Patients with hospital encounters who were ICD-10 E87.5 hyperkalaemia code positive and negative had distinct higher and lower serum potassium values, respectively. However, due to very low sensitivity, the incidence of hyperkalaemia is underestimated. PMID:23274674

REMOVAL OF ALACHLOR FROM DRINKING WATER

EPA Science Inventory

Alachlor (Lasso) is a pre-emergent herbicide used in the production of corn and soybeans. U.S. EPA has studied control of alachlor in drinking water treatment processes to define treatability before setting maximum contaminant levels and to assist water utilities in selecting con...

Maternal and neonatal factors associated with mode of delivery under a universal newborn hearing screening programme in Lagos, Nigeria

PubMed Central

Olusanya, Bolajoko O; Solanke, Olumuyiwa A

2009-01-01

Background Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may also include outcomes that undermine optimal early childhood development of the surviving newborns. However, the potential pathways for this association have not been reported particularly in the context of a resource-poor setting. This study therefore set out to establish the pattern of delivery and the associated neonatal outcomes under a UNHS programme. Methods A cross-sectional study in which all consenting mothers who delivered in an inner-city tertiary maternity hospital in Lagos, Nigeria from May 2005 to December 2007 were enrolled during the UNHS programme. Socio-demographic, obstetric and neonatal factors independently associated with vaginal, elective and emergency caesarean deliveries were determined using multinomial logistic regression analyses. Results Of the 4615 mothers enrolled, 2584 (56.0%) deliveries were vaginal, 1590 (34.4%) emergency caesarean and 441 (9.6%) elective caesarean section. Maternal age, parity, social class and all obstetric factors including lack of antenatal care, maternal HIV and multiple gestations were associated with increased risk of emergency caesarean delivery compared with vaginal delivery. Only parity, lack of antenatal care and prolonged/obstructed labour were associated with increased risk of emergency compared with elective caesarean delivery. Infants delivered by vaginal method or by emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section. Emergency caesarean delivery was also associated with male gender, low five-minute Apgar scores and admission into special care baby unit compared with vaginal or elective caesarean delivery. Conclusions The vast majority of caesarean delivery in this population occur as emergencies and are associated with socio-demographic factors as well as several obstetric complications. Mode of delivery is also associated with the risk of sensorineural hearing loss and other adverse birth outcomes that lie on the causal pathways for potential developmental deficits. PMID:19732443

44 CFR 62.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Definitions. 62.2 Section 62.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... OF CLAIMS Issuance of Policies § 62.2 Definitions. The definitions set forth in part 59 of this...

44 CFR 64.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Definitions. 64.2 Section 64.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... OF INSURANCE § 64.2 Definitions. The definitions set forth in part 59 of this subchapter are...

44 CFR 67.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Definitions. 67.2 Section 67.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... ELEVATION DETERMINATIONS § 67.2 Definitions. The definitions set forth in part 59 of this subchapter are...

Emergency nurses' perceptions of emergency department preparedness for an ebola outbreak: A qualitative descriptive study.

PubMed

Pincha Baduge, Mihirika Sds; Moss, Cheryle; Morphet, Julia

2017-05-01

Ebola Virus Disease is highly contagious and has high mortality. In 2014, when the outbreak in West Africa was declared a public health emergency, emergency departments in Australia commenced preparation and vigilance for people presenting with ebola like symptoms, to limit spread of the disease. To examine Australian emergency nurses' perceptions regarding their own and their emergency departments' preparedness to manage an ebola outbreak. A qualitative descriptive design was used to collect and analyse data in one metropolitan emergency department in Victoria, Australia. Four focus groups were conducted with 13 emergency nurses. Data were thematically analysed. Major themes emerged from the data: organisational, personal and future preparedness. Participants' believed that both the organisation and themselves had achieved desirable and appropriate preparedness for ebola in their emergency setting. Participants trusted their organisation to prepare and protect them for ebola. Appropriate policies, procedures, and equipment infrastructure were reportedly in place. Nurses' decisions to care for a patient with ebola were informed by professional commitment, and personal responsibilities. Participants were concerned about transmitting ebola to their families, and suggested that more regular training in personal protective equipment would increase confidence and skill in self-protection. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Patient satisfaction with triage nursing care in Hong Kong.

PubMed

Chan, Jaime Nga Han; Chau, Janita

2005-06-01

This paper reports a study to examine the relationship between patient satisfaction and triage nursing care in order to assist nurses in defining more clearly their roles, and ultimately to improve the quality of care delivered to emergency patients. Patient satisfaction is considered an important indicator of quality care from the perspective of the consumer and has been widely studied in many settings. However, few studies have examined patient satisfaction with emergency nursing services in the particular area of triage. A descriptive, correlational study was conducted in 2001 in one urban acute hospital in Hong Kong using Consumer Emergency Care Satisfaction Scale (CECSS), and patient and nurse demographic data were also collected. Following a power calculation, systematic sampling was carried out, and the final sample consisted of 56 urgent, semi-urgent and non-urgent patients triaged. The response rate was 61%. The majority of the participants were satisfied with their triage nursing care and teaching. However, difficulties were encountered during the data collection process, resulting in a relatively low response rate. Correlational analyses revealed that patient satisfaction with triage nursing care was statistically significantly correlated with age and the type of nursing intervention received. Older people were more satisfied with the teaching offered by triage nurses and patients who had received specific nursing interventions gave more positive ratings on the teaching subscale of the CECSS. There were no statistically significant relationships between patient satisfaction with triage nursing care and nurse characteristics, including gender, work experiences and educational level. Patients were generally satisfied with the care provided by the triage nurses. Measuring patient satisfaction with triage nursing care remains a major challenge for health care providers in emergency care settings.

Emergency medicine in the developing world: a Delphi study.

PubMed

Hodkinson, Peter W; Wallis, Lee A

2010-07-01

Emergency medicine (EM) as a specialty has developed rapidly in the western world, but remains largely immature in developing nations. There is an urgent need for emergency services, but no clear guidelines are available on the priorities for establishing EM in the developing world. This study seeks to establish consensus on key areas of EM development in developing world settings, with respect to scope of EM, staffing needs, training requirements, and research priorities. A three-round Delphi study was conducted via e-mail. A panel was convened of 50 EM specialists or equivalent, with experience in or interest in EM in the developing world. In the first round, panelists provided free-text statements on scope, staffing, training, and research priorities for EM in the developing world. A five-point Likert scale was used to rate agreement with the statements in Rounds 2 and 3. Consensus statements are presented as a series of synopsis statements for each of the four major themes. A total of 168 of 208 statements (81%) had reached consensus at the end of the study. Key areas in which consensus was reached included EM being a specialist-driven service, with substantial role for nonphysicians. International training courses should be adapted to local needs. EM research in developing countries should be clinically driven and focus on local issues of importance. The scope and function of EM and relationships with other specialties are defined. Unambiguous principles are laid out for the development of the specialty in developing world environments. The next step required in this process is translation into practical guidelines for the development of EM in developing world settings where they may be used to drive policy, protocols, and research. 2010 by the Society for Academic Emergency Medicine

Independent component analysis decomposition of hospital emergency department throughput measures

NASA Astrophysics Data System (ADS)

He, Qiang; Chu, Henry

2016-05-01

We present a method adapted from medical sensor data analysis, viz. independent component analysis of electroencephalography data, to health system analysis. Timely and effective care in a hospital emergency department is measured by throughput measures such as median times patients spent before they were admitted as an inpatient, before they were sent home, before they were seen by a healthcare professional. We consider a set of five such measures collected at 3,086 hospitals distributed across the U.S. One model of the performance of an emergency department is that these correlated throughput measures are linear combinations of some underlying sources. The independent component analysis decomposition of the data set can thus be viewed as transforming a set of performance measures collected at a site to a collection of outputs of spatial filters applied to the whole multi-measure data. We compare the independent component sources with the output of the conventional principal component analysis to show that the independent components are more suitable for understanding the data sets through visualizations.

Emergency Response and Long Term Planning: Two sides of the Coin for Managing Water Resources

NASA Astrophysics Data System (ADS)

Metchis, K.; Beller-Simms, N.

2014-12-01

As projected by the US National Climate Assessment and the IPCC, extreme climate and weather events are occurring more frequently and with more intensity across the nation. Communities - and the water resource managers that serve them - are facing difficult choices to increase emergency preparedness, recover from costly impacts, and increase long term resilience. The presentation is based on a recent set of case studies about what happened in six communities that experienced one or more extreme events, focusing on water resource management. Two of the case studies will be presented, revealing that building climate resilience is not just about long term planning - it is also about taking the steps to be prepared for - and to be able to recover from - emergency events. The results of this study have implications for educating local officials on ways to think about resilience to balance both long-term and short-term preparedness.

[Traumatic Stress in Emergency Medical Technicians: Protective Role of Age and Education].

PubMed

Kılıç, Cengiz; İnci, Figen

2015-01-01

Some professions carry higher risk of being traumatised; health care workers, especially those working at emergency services, are at higher risk in this respect. This study aims to examine the psychological effects of different types of work-related traumatic events on emergency health care staff and possible protective effects of factors such as age, education and experience. The targeted population was all emergency health care workers working at emergency wards and first-aid stations within the province of Nigde. Consenting subjects were given self-report questionnaires on traumatic stress and work-related traumatic events. 135 emergency workers (90 female, 45 male), with complete data sets were included in the study. The subjects reported experiencing 6.8 types of different work-related traumas. Those who are older and with higher education reported higher numbers of event types. Traumatic stress levels were predicted by higher number of reported work-related trauma types. When analyzed separately within age and education groups, number of work-related traumatic events predicted traumatic stress among younger subjects and those with lower education; no such prediction was observed among older or more educated subjects. Findings suggest that lower education and younger age independently predict negative psychological effects of work-related traumatic events. These findings may lead to changes in how emergency health care is organized in Turkey.

Precision, time, and cost: a comparison of three sampling designs in an emergency setting.

PubMed

Deitchler, Megan; Deconinck, Hedwig; Bergeron, Gilles

2008-05-02

The conventional method to collect data on the health, nutrition, and food security status of a population affected by an emergency is a 30 x 30 cluster survey. This sampling method can be time and resource intensive and, accordingly, may not be the most appropriate one when data are needed rapidly for decision making. In this study, we compare the precision, time and cost of the 30 x 30 cluster survey with two alternative sampling designs: a 33 x 6 cluster design (33 clusters, 6 observations per cluster) and a 67 x 3 cluster design (67 clusters, 3 observations per cluster). Data for each sampling design were collected concurrently in West Darfur, Sudan in September-October 2005 in an emergency setting. Results of the study show the 30 x 30 design to provide more precise results (i.e. narrower 95% confidence intervals) than the 33 x 6 and 67 x 3 design for most child-level indicators. Exceptions are indicators of immunization and vitamin A capsule supplementation coverage which show a high intra-cluster correlation. Although the 33 x 6 and 67 x 3 designs provide wider confidence intervals than the 30 x 30 design for child anthropometric indicators, the 33 x 6 and 67 x 3 designs provide the opportunity to conduct a LQAS hypothesis test to detect whether or not a critical threshold of global acute malnutrition prevalence has been exceeded, whereas the 30 x 30 design does not. For the household-level indicators tested in this study, the 67 x 3 design provides the most precise results. However, our results show that neither the 33 x 6 nor the 67 x 3 design are appropriate for assessing indicators of mortality. In this field application, data collection for the 33 x 6 and 67 x 3 designs required substantially less time and cost than that required for the 30 x 30 design. The findings of this study suggest the 33 x 6 and 67 x 3 designs can provide useful time- and resource-saving alternatives to the 30 x 30 method of data collection in emergency settings.

Precision, time, and cost: a comparison of three sampling designs in an emergency setting

PubMed Central

Deitchler, Megan; Deconinck, Hedwig; Bergeron, Gilles

2008-01-01

The conventional method to collect data on the health, nutrition, and food security status of a population affected by an emergency is a 30 × 30 cluster survey. This sampling method can be time and resource intensive and, accordingly, may not be the most appropriate one when data are needed rapidly for decision making. In this study, we compare the precision, time and cost of the 30 × 30 cluster survey with two alternative sampling designs: a 33 × 6 cluster design (33 clusters, 6 observations per cluster) and a 67 × 3 cluster design (67 clusters, 3 observations per cluster). Data for each sampling design were collected concurrently in West Darfur, Sudan in September-October 2005 in an emergency setting. Results of the study show the 30 × 30 design to provide more precise results (i.e. narrower 95% confidence intervals) than the 33 × 6 and 67 × 3 design for most child-level indicators. Exceptions are indicators of immunization and vitamin A capsule supplementation coverage which show a high intra-cluster correlation. Although the 33 × 6 and 67 × 3 designs provide wider confidence intervals than the 30 × 30 design for child anthropometric indicators, the 33 × 6 and 67 × 3 designs provide the opportunity to conduct a LQAS hypothesis test to detect whether or not a critical threshold of global acute malnutrition prevalence has been exceeded, whereas the 30 × 30 design does not. For the household-level indicators tested in this study, the 67 × 3 design provides the most precise results. However, our results show that neither the 33 × 6 nor the 67 × 3 design are appropriate for assessing indicators of mortality. In this field application, data collection for the 33 × 6 and 67 × 3 designs required substantially less time and cost than that required for the 30 × 30 design. The findings of this study suggest the 33 × 6 and 67 × 3 designs can provide useful time- and resource-saving alternatives to the 30 × 30 method of data collection in emergency settings. PMID:18454866

Response of larval sea lampreys (Petromyzon marinus) to pulsed DC electrical stimuli in laboratory experiments

USGS Publications Warehouse

Bowen, Anjanette K.; Weisser, John W.; Bergstedt, Roger A.; Famoye, Felix

2003-01-01

Four electrical factors that are used in pulsed DC electrofishing for larval sea lampreys (Petromyzon marinus) were evaluated in two laboratory studies to determine the optimal values to induce larval emergence over a range of water temperatures and conductivities. Burrowed larvae were exposed to combinations of pulsed DC electrical factors including five pulse frequencies, three pulse patterns, and two levels of duty cycle over a range of seven voltage gradients in two separate studies conducted at water temperatures of 10, 15, and 20°C and water conductivities of 25, 200, and 900 μS/cm. A four-way analysis of variance was used to determine significant (α = 0.05) influences of each electrical factor on larval emergence. Multiple comparison tests with Bonferroni adjustments were used to determine which values of each factor resulted in significantly higher emergence at each temperature and conductivity. Voltage gradient and pulse frequency significantly affected emergence according to the ANOVA model at each temperature and conductivity tested. Duty cycle and pulse pattern generally did not significantly influence the model. Findings suggest that a setting of 2.0 V/cm, 3 pulses/sec, 10% duty, and 2:2 pulse pattern seems the most promising in waters of medium conductivity and across a variety of temperatures. This information provides a basis for understanding larval response to pulsed DC electrofishing gear factors and identifies electrofisher settings that show promise to increase the efficiency of the gear during assessments for burrowed sea lamprey larvae.

Adoption of the HPV vaccine: a case study of three emerging countries.

PubMed

Caro Martínez, Araceli; Espín Balbino, Jaime; Lemgruber, Alexandre; Martín Ruiz, Eva; Olry de Labry Lima, Antonio; García-Mochón, Leticia; Lessa, Fernanda

2017-05-01

The human papillomavirus (HPV) vaccine has recently attracted considerable attention in emerging countries, due to its potential to reduce the impact of HPV-related diseases. This case study sheds new light about the variety of HTA arrangements, methods and processes involved in the adoption and use of HPV vaccines in a selected sample of central, eastern and southern Europe and Latin America and the Caribbean, all of them emerging in the use of HTA. A multi-country case study was designed. Mixed methods, document review, semi-structured surveys and personal communication with experts, were used for data collection and triangulation. This study shows that common elements of good practice exist in the processes and methods used, with all countries arriving at the same appraisal recommendations. However, the influence of socio-politico-economic factors appears to be determinant on the final decisions and restrictions to access made. This case study intends to draw useful lessons for policymakers in emerging settings interested in the adoption of the HPV vaccine supported by evidence-informed processes, such as those offered by institutionalized HTA. Future studies are also recommended to elucidate the specific roles that social values and uncertainties play in vaccine decision-making across different societies.

A protocol for a pragmatic randomized controlled trial evaluating outcomes of emergency nurse practitioner service.

PubMed

Jennings, Natasha; Gardner, Glenn; O'Reilly, Gerard

2014-09-01

To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Pragmatic randomized controlled trial at one site with 260 participants. This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce. Trial registration details: Australian and New Zealand Clinical Trials Registry dated 18th August 2013, ACTRN12613000933752. © 2014 John Wiley & Sons Ltd.

Global Emergency Medicine: A Review of the Literature From 2016.

PubMed

Becker, Torben K; Hansoti, Bhakti; Bartels, Susan; Hayward, Alison Schroth; Hexom, Braden J; Lunney, Kevin M; Marsh, Regan H; Osei-Ampofo, Maxwell; Trehan, Indi; Chang, Julia; Levine, Adam C

2017-09-01

The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review. © 2017 The Authors. Academic Emergency Medicine published by Wiley Periodicals, Inc. on behalf of the Society for Academic Emergency Medicine (SAEM).

Evolution of an experiential learning partnership in emergency management higher education.

PubMed

Knox, Claire Connolly; Harris, Alan S

2016-01-01

Experiential learning allows students to step outside the classroom and into a community setting to integrate theory with practice, while allowing the community partner to reach goals or address needs within their organization. Emergency Management and Homeland Security scholars recognize the importance, and support the increased implementation, of this pedagogical method in the higher education curriculum. Yet challenges to successful implementation exist including limited resources and time. This longitudinal study extends the literature by detailing the evolution of a partnership between a university and office of emergency management in which a functional exercise is strategically integrated into an undergraduate course. The manuscript concludes with a discussion of lessons learned from throughout the multiyear process.

Mycoplasmas and their host: emerging and re-emerging minimal pathogens.

PubMed

Citti, Christine; Blanchard, Alain

2013-04-01

Commonly known as mycoplasmas, bacteria of the class Mollicutes include the smallest and simplest life forms capable of self replication outside of a host. Yet, this minimalism hides major human and animal pathogens whose prevalence and occurrence have long been underestimated. Owing to advances in sequencing methods, large data sets have become available for a number of mycoplasma species and strains, providing new diagnostic approaches, typing strategies, and means for comprehensive studies. A broader picture is thus emerging in which mycoplasmas are successful pathogens having evolved a number of mechanisms and strategies for surviving hostile environments and adapting to new niches or hosts. Copyright © 2013 Elsevier Ltd. All rights reserved.

Rapid detection of D-Dimers with mLabs® whole blood method for venous thromboembolism exclusion. Comparison with Vidas® D-Dimers assay.

PubMed

Gerotziafas, Grigoris T; Ray, Patrick; Gkalea, Vasiliki; Benzarti, Ahlem; Khaterchi, Amir; Cast, Claire; Pernet, Julie; Lefkou, Eleftheria; Elalamy, Ismail

2016-12-01

Easy to use point of care assays for D-Dimers measurement in whole blood from patients with clinical suspicion of venous thromboembolism (VTE) will facilitate the diagnostic strategy in the Emergency Department (ED) setting. We prospectively evaluated the diagnostic performance of the point-of-care mLabs® Whole Blood D-Dimers test and we compared it with the Vidas® D-Dimers assay. As part of the diagnostic algorithm applied in patients with clinical suspicion of VTE, the VIDAS® D-Dimers Test was prescribed by the emergency physician in charge. The mLabs® Whole Blood D-Dimers Test was used on the same samples. All patients had undergone exploration with the recommended imaging techniques for VTE diagnosis. Both assays were performed, on 99 emergency patients (mean age was 65 years) with clinical suspicion of VTE. In 3% of patients, VTE was documented with a reference imaging technique. The Bland and Altman test showed significant agreement between the two methods. Both assays showed equal sensitivity and negative predictive value for VTE. The mLabs whole blood assay is a promising point of care method for measurement of D-Dimers and exclusion of VTE diagnosis in the emergency setting which should be validated in a larger prospective study.

Medication errors in the obstetrics emergency ward in a low resource setting.

PubMed

Kandil, Mohamed; Sayyed, Tarek; Emarh, Mohamed; Ellakwa, Hamed; Masood, Alaa

2012-08-01

To investigate the patterns of medication errors in the obstetric emergency ward in a low resource setting. This prospective observational study included 10,000 women who presented at the obstetric emergency ward, department of Obstetrics and Gynecology, Menofyia University Hospital, Egypt between March and December 2010. All medications prescribed in the emergency ward were monitored for different types of errors. The head nurse in each shift was asked to monitor each pharmacologic order from the moment of prescribing till its administration. Retrospective review of the patients' charts and nurses' notes was carried out by the authors of this paper. Results were tabulated and statistically analyzed. A total of 1976 medication errors were detected. Administration errors were the commonest error reported. Omitted errors ranked second followed by unauthorized and prescription errors. Three administration errors resulted in three Cesareans were performed for fetal distress because of wrong doses of oxytocin infusion. The rest of errors did not cause patients harm but may have lead to an increase in monitoring. Most errors occurred during night shifts. The availability of automated infusion pumps will probably decrease administration errors significantly. There is a need for more obstetricians and nurses during the nightshifts to minimize errors resulting from working under stressful conditions.

Investigating the Acquisition, Generalization, and Emergence of Untrained Verbal Operants for Mands Acquired Using the Picture Exchange Communication System in Adults With Severe Developmental Disabilities

PubMed Central

Ziomek, Megan M; Rehfeldt, Ruth Anne

2008-01-01

This study compared the total amount of training time and total number of trial blocks for individuals with severe developmental disabilities to acquire mands under control of unconditioned establishing operations and mands under control of transitive conditioned establishing operations for manual sign and for the Picture Exchange Communication System (PECS). Also examined was the generalization of mands across settings and communicative partners, as well as the emergence of untrained tacts and intraverbals for mands acquired using PECS. Mands for preferred items and for items needed to complete a chained task were acquired more rapidly and in fewer training blocks for PECS than for manual sign. Moreover, mands established using PECS generalized across settings and communicative partners. Finally, untrained tacts and intraverbals using PECS were shown to emerge for some of the participants following PECS training. These results suggest that PECS may be a viable alternative communication system for adults with severe developmental disabilities who have little or no history of systematic instruction and limited imitative repertoires. PMID:22477401

Investigating the acquisition, generalization, and emergence of untrained verbal operants for mands acquired using the picture exchange communication system in adults with severe developmental disabilities.

PubMed

Ziomek, Megan M; Rehfeldt, Ruth Anne

2008-01-01

This study compared the total amount of training time and total number of trial blocks for individuals with severe developmental disabilities to acquire mands under control of unconditioned establishing operations and mands under control of transitive conditioned establishing operations for manual sign and for the Picture Exchange Communication System (PECS). Also examined was the generalization of mands across settings and communicative partners, as well as the emergence of untrained tacts and intraverbals for mands acquired using PECS. Mands for preferred items and for items needed to complete a chained task were acquired more rapidly and in fewer training blocks for PECS than for manual sign. Moreover, mands established using PECS generalized across settings and communicative partners. Finally, untrained tacts and intraverbals using PECS were shown to emerge for some of the participants following PECS training. These results suggest that PECS may be a viable alternative communication system for adults with severe developmental disabilities who have little or no history of systematic instruction and limited imitative repertoires.

Maximizing value and minimizing barriers: Patient-centered community consultation for research in emergency settings.

PubMed

Fordyce, Christopher B; Roe, Matthew T; Dickert, Neal W

2017-02-01

Patients with cardiac arrest and other life-threatening emergencies are unable to provide prospective consent for clinical trials. In the United States and other countries, regulations permit an exception from the requirement for informed consent in emergency settings. However, many potential barriers exist, as evidenced by the scarcity of US trials conducted under exception from the requirement for informed consent. One persistent challenge is the requirement that investigators consult communities prior to study approval. To improve the community consultation process for emergency studies under exception from the requirement for informed consent, we propose that prioritizing engagement of individuals who have experienced the condition under study, or are at high risk for the condition, fulfills regulatory goals and represents the interests of potential enrollees and the community without impeding research. Prioritizing patients engages individuals who are more likely to understand the concerns and experiences of study subjects, to appreciate risks and benefits of the study, and to understand the impact of the disease and intervention on patients' lives than are members of the general public. Similarly, those explicitly at high risk are more likely to identify as potential participants and may impart some level of accountability on the investigator. Finally, the most logical community of relevance is defined by a combination of condition-related experience and living in the area where a study will be conducted; geographic and condition-related communities should not be treated as distinct. In this sense, patients, their family members, and individuals at high risk within the catchment area represent the appropriate "community." Exception from the requirement for informed consent regulations have advanced the goal of improving care for emergency conditions, but common interpretations of the community consultation requirement threaten research in the United States. Focusing on the goals of learning from and demonstrating respect for those most directly affected by a study through engaging people most connected to the condition of interest will make community consultation more valuable, better inform institutional review boards, and increase efficiency.

Routine cervical spine immobilisation is unnecessary in patients with isolated cerebral gunshot wounds: A South African experience.

PubMed

Kong, Victor Y; Weale, Ross D; Sartorius, Benn; Bruce, John L; Laing, Grant L; Clarke, Damian L

2018-04-25

Routine immobilisation of the cervical spine in trauma has been a long established practice. Very little is known in regard to its appropriateness in the specific setting of isolated traumatic brain injury secondary to gunshot wounds (GSWs). A retrospective study was conducted over a 5 year period (January 2010 to December 2014) at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa in order to determine the actual incidence of concomitant cervical spine injury (CSI) in the setting of isolated cerebral GSWs. During the 5 year study period, 102 patients were included. Ninety-two per cent (94/102) were male and the mean age was 29 years. Ninety-eight per cent of the injuries were secondary to low velocity GSWs. Twenty-seven (26%) patients had cervical collar placed by the Emergency Medical Service. The remaining 75 patients had their cervical collar placed in the resuscitation room. Fifty-five (54%) patients had a Glasgow Coma Scale (GCS) of 15 and underwent plain radiography, all of which were normal. Clearance of cervical spine based on normal radiography combined with clinical assessment was achieved in all 55 (100%) patients. The remaining 47 patients whose GCS was <15 all underwent a computed tomography (CT) scan of their cervical spine and brain. All 47 CT scans of the cervical spine were normal and there was no detectable bone or soft tissue injury noted. Patients who sustain an isolated low velocity cerebral GSW are highly unlikely to have concomitant CSI. Routine cervical spine immobilisation is unnecessary, and efforts should be directed at management strategies aiming to prevent secondary brain injury. Further studies are required to address the issue in the setting of high velocity GSWs. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Can primary care and community-based models of emergency care substitute for the hospital accident and emergency (A & E) department?

PubMed

Roberts, E; Mays, N

1998-06-01

This systematic review assesses the extent to which primary-secondary substitution is possible in the field of emergency care where the range of options for the delivery of care is increasing in the UK and elsewhere. Thirty-four studies were located which met the review inclusion criteria, covering a range of interventions. This evidence suggested that broadening access to primary care and introducing user charges or other barriers to the hospital accident and emergency (A & E) department can reduce demand for expensive secondary care, although the relative cost-effectiveness of these interventions remains unclear. On a smaller scale, employing primary care professionals in the hospital A & E department to treat patients attending with minor illness or injury seems to be a cost-effective method of substituting primary for secondary care resources. Interventions that addressed both sides of the primary-secondary interface and recognised the importance of patient preferences in the largely demand-driven emergency service were more likely to succeed in complementing rather than duplicating existing services. The evidence on other interventions such as telephone triage, minor injuries units and general practitioner out of hours co-operatives was sparse despite the fact that these interventions are growing rapidly in the UK. Quantifying the scope for substitution in any one health system is difficult since the evidence comes from international research studies undertaken in a variety of very different health settings. Simply transferring interventions which succeed in one setting without understanding the underlying process of change is likely to result in unexpected consequences locally. Nevertheless, the review findings clearly demonstrate that shifting the balance of care is possible. It also highlights a persistent gap in professional and lay perceptions of appropriate sources of care for minor illness and injury.

Case-control analysis of ambulance, emergency room, or inpatient hospital events for epilepsy and antiepileptic drug formulation changes.

PubMed

Zachry, Woodie M; Doan, Quynhchau D; Clewell, Jerry D; Smith, Brien J

2009-03-01

Although antiepileptic drugs (AEDs) with multisource generic alternatives are becoming more prevalent, no case-control studies have been published examining multisource medication use and epilepsy-related outcomes. This study evaluated the association between inpatient/emergency epilepsy care and the occurrence of a recent switch in AED formulation. A case-control analysis was conducted utilizing the Ingenix LabRx Database. Eligible patients were 12-64 years of age, received >or=145 days of AEDs in the preindex period, had continuous eligibility for 6 months preindex, and no prior inpatient/emergency care. Cases received care between 7/1/2006 and 12/31/2006 in an ambulance, emergency room, or inpatient hospital with a primary epilepsy diagnosis. Controls had a primary epilepsy diagnosis in a physician's office during the same period. The index date was the earliest occurrence of care in each respective setting. Cases and controls were matched 1:3 by epilepsy diagnosis and age. Odds of a switch between "A-rated" AEDs within 6 months prior to index were calculated. Cases (n = 416) had 81% greater odds of having had an A-rated AED formulation switch [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.25 to 2.63] relative to controls (n = 1248). There were no significant differences between groups regarding demographics or diagnosis. Significant differences were found with regard to medical coverage type (case Medicaid = 4.6%, control Medicaid = 1.8%, p = 0.002). Post hoc analysis results excluding Medicaid recipients remained significant and concordant with the original analysis. This analysis found an association between patients receiving epilepsy care in an emergency or inpatient setting and the recent occurrence of AED formulation switching involving A-rated generics.

[Road traffic injuries in Catalonia (Spain): an approach using the minimum data set for acute-care hospitals and emergency resources].

PubMed

Clèries, Montse; Bosch, Anna; Vela, Emili; Bustins, Montse

2015-09-01

To verify the usefulness of the minimum data set (MDS) for acute-care hospitals and emergency resources for the study of road traffic injuries and to describe the use of health resources in Catalonia (Spain). The study population consisted of patients treated in any kind of emergency service and patients admitted for acute hospitalization in Catalonia in 2013. A descriptive analysis was performed by age, gender, time and clinical variables. A total of 48,150 patients were treated in hospital emergency departments, 6,210 were attended in primary care, and 4,912 were admitted to hospital. There was a higher proportion of men (56.2%), mainly aged between 20 and 40 years. Men accounted for 54.9% of patients with minor injuries and 75.1% of those with severe injuries. Contusions are the most common injury (30.2%), followed by sprains (28.7%). Fractures mostly affected persons older than 64 years, internal injuries particularly affected men older than 64 years, and wounds mainly affected persons younger than 18 years and older than 64 years. In the adult population, the severity of the injuries increased with age, leading to longer length of stay and greater complexity. Hospital mortality was 0.2%. Fractures, internal injuries and wounds were more frequent in the group of very serious injuries, and sprains and contusions in the group of minor injuries. MDS records (acute hospitals and emergency resources) provide information that is complementary to other sources of information on traffic accidents, increasing the completeness of the data. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Trends in rates of acetaminophen-related adverse events in the United States

PubMed Central

Major, Jacqueline M.; Zhou, Esther H.; Wong, Hui-Lee; Trinidad, James P.; Pham, Tracy M.; Mehta, Hina; Ding, Yulan; Staffa, Judy A.; Iyasu, Solomon; Wang, Cunlin; Willy, Mary E.

2017-01-01

Purpose The goal of this study is to summarize trends in rates of adverse events attributable to acetaminophen use, including hepatotoxicity and mortality. Methods A comprehensive analysis of data from three national surveillance systems estimated rates of acetaminophen-related events identified in different settings, including calls to poison centers (2008–2012), emergency department visits (2004–2012), and inpatient hospitalizations (1998–2011). Rates of acetaminophen-related events were calculated per setting, census population, and distributed drug units. Results Rates of poison center calls with acetaminophen-related exposures decreased from 49.5/1000 calls in 2009 to 43.5/1000 calls in 2012. Rates of emergency department visits for unintentional acetaminophen-related adverse events decreased from 58.0/1000 emergency department visits for adverse drug events in 2009 to 50.2/1000 emergency department visits in 2012. Rates of hospital inpatient discharges with acetaminophen-related poisoning decreased from 119.8/100 000 hospitalizations in 2009 to 108.6/100 000 hospitalizations in 2011. After 2009, population rates of acetaminophen-related events per 1million census population decreased for poison center calls and hospitalizations, while emergency department visit rates remained stable. However, when accounting for drug sales, the rate of acetaminophen-related events (per 1 million distributed drug units) increased after 2009. Prior to 2009, the rates of acetaminophen-related hospitalizations had been slowly increasing (p-trend = 0.001). Conclusions Acetaminophen-related adverse events continue to be a public health burden. Future studies with additional time points are necessary to confirm trends and determine whether recent risk mitigation efforts had a beneficial impact on acetaminophen-related adverse events. PMID:26530380

44 CFR 351.3 - Limitation of scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HOMELAND SECURITY PREPAREDNESS RADIOLOGICAL EMERGENCY PLANNING AND PREPAREDNESS General § 351.3 Limitation... State and local emergency plans and preparedness measures. It does not set forth criteria used in the... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Limitation of scope. 351.3...

75 FR 8180 - Proposed Agency Information Collection Activities; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-23

... Emergency Preparedness. OMB Control Number: 2130-0545. Type of Request: Extension of a currently approved... passenger train emergency regulations set forth in 49 CFR Parts 223 and 239 which require railroads to meet minimum Federal standards for the preparation, adoption, and implementation of emergency preparedness...

44 CFR 75.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Definitions. 75.2 Section 75.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... PROPERTIES UNDER SELF-INSURANCE PLAN General § 75.2 Definitions. The definitions set forth in part 59 of this...

Readying the Health Education Specialist for Emergencies

ERIC Educational Resources Information Center

Geiger, Brian F.; Firsing, Stephen L., III; Beric, Bojana; Rodgers, Joel B.

2013-01-01

This article provides a resourceful guide for the health education specialist to improve emergency management knowledge and skills specific to their setting, including training and preparing for emergencies and providing adequate support to students, clients, and colleagues. Five steps guide competent health education practice before, during, and…

46 CFR 112.50-7 - Compressed air starting.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Diesel and Gas Turbine Engine Driven Generator Sets § 112.50-7 Compressed... emergency power source. If this compressor supplies other auxiliaries, there must be a non-return valve at...

"Handy Manny" and the Emergent Literacy Technology Toolkit

ERIC Educational Resources Information Center

Hourcade, Jack J.; Parette, Howard P., Jr.; Boeckmann, Nichole; Blum, Craig

2010-01-01

This paper outlines the use of a technology toolkit to support emergent literacy curriculum and instruction in early childhood education settings. Components of the toolkit include hardware and software that can facilitate key emergent literacy skills. Implementation of the comprehensive technology toolkit enhances the development of these…

46 CFR 169.815 - Emergency signals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Emergency signals. 169.815 Section 169.815 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Operations § 169.815 Emergency signals. (a) The station bill must set forth the various signals used for...

46 CFR 169.815 - Emergency signals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Emergency signals. 169.815 Section 169.815 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Operations § 169.815 Emergency signals. (a) The station bill must set forth the various signals used for...

75 FR 27002 - Petitions for Modification

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-13

...,000 feet of the working face, which contain the Hubble Breathable Air Unit Emergency Supply Container, (``HBA Unit Emergency Supply Container''), and otherwise complying with all applicable provisions set forth in 30 CFR 75.1506(b) through (g). The HBA Unit Emergency Supply Container is a steel reinforced...

Hydrothermal emergence model for ripgut brome (Bromus diandrus)

USDA-ARS?s Scientific Manuscript database

A model that describes the emergence of ripgut brome (Bromus diandrus) was developed using a two-season data set from a no-tilled field in northeastern Spain. The relationship between cumulative emergence and hydrothermal time (HTT) was described by a sigmoid growth function (Chapman equation). HTT ...

The effect of different foot and hand set-up positions on backstroke start performance.

PubMed

de Jesus, Karla; de Jesus, Kelly; Abraldes, J Arturo; Mourão, Luis; Borgonovo-Santos, Márcio; Medeiros, Alexandre I A; Gonçalves, Pedro; Chainok, Phornpot; Fernandes, Ricardo J; Vaz, Mário A P; Vilas-Boas, João Paulo

2016-11-01

Foot and hand set-up position effects were analysed on backstroke start performance. Ten swimmers randomly completed 27 starts grouped in trials (n = 3) of each variation, changing foot (totally immersed, partially and totally emerged) and hand (lowest, highest horizontal and vertical) positioning. Fifteen cameras recorded kinematics, and four force plates collected hands and feet kinetics. Standardised mean difference and 95% confidence intervals were used. Variations with feet immersed have shown lower vertical centre of mass (CM) set-up position (0.16 m), vertical impulse exerted at the hands, horizontal and vertical impulse exerted at the feet (0.28, 0.41, 0.16 N/BW.s, respectively) than feet emerged with hands horizontal and vertically positioned. Most variations with feet partially emerged exhibited higher and lesser vertical impulse exerted at hands than feet immersed and emerged (e.g. vertical handgrip, 0.13, 0.15 N/BW.s, respectively). Variation with feet emerged and hands on the lowest horizontal handgrip depicted shorter horizontal (0.23, 0.26 m) and vertical CM positioning at flight (0.16, 0.15 m) than the highest horizontal and vertical handgrip, respectively. Start variations have not affected 15-m time. Variations with feet partially or totally emerged depicted advantages, but focusing on the entry and underwater biomechanics is relevant for a shorter start time.

Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department

PubMed Central

Roberge, Raymond J.; Roberge, Marc R.

2009-01-01

Background: Osteopathic Manipulation Techniques (OMT) have been shown to be effective therapeutic modalities in various clinical settings, but appear to be underutilized in the emergency department (ED) setting. Objective: To examine barriers to the use of OMT in the ED and provide suggestions to ameliorate these barriers. Methods: Literature review Results: While the medical literature cites numerous obstacles to the use of OMT in the ED setting, most can be positively addressed through education, careful planning, and ongoing research into use of these techniques. Recent prospective clinical trials of OMT have demonstrated the utility of these modalities. Conclusion: Osteopathic Manipulation Techniques are useful therapeutic modalities that could be utilized to a greater degree in the ED. As the number of osteopathic emergency physicians increases, the opportunity to employ these techniques should increase. PMID:19718381

Ventilation-associated pneumonia after intubation in the prehospital or the emergency unit.

PubMed

Decelle, Lydie; Thys, Frédéric; Zech, Francis; Verschuren, Franck

2013-02-01

The aim of the study was to evaluate the prevalence and the risk factors of ventilation-associated pneumonia (VAP) for out-of-hospital or in the emergency department intubated patients. This was a retrospective descriptive study. All intubated adults subsequently admitted to the ICU over 1-year period were included. Among 75 patients, 15 patients developed VAP (20%; 95% CI 12-31%). A multivariate analysis revealed three variables independently associated with VAP: cardiorespiratory arrest as the reason of intubation (P=0.001), out-of-hospital as the location of intubation (P=0.011), and clinical macroaspiration as clinical characteristic at the time of intubation (P=0.024). Death rate was 17% and was not significantly higher for patients with VAP (P=0.9; 95% CI 0.32-4.95%). Emergency care workers should be aware of the potential 20% occurrence of VAP when they intubate and ventilate a patient. Preventive strategies, which have been proven effective in ICUs, should be implemented in the emergency setting.

Research on the Improvements of the Assembly Areas, Evacuation Routes, and Shelters against Multiple Disasters

NASA Astrophysics Data System (ADS)

Jin, S.; Lee, Y. M.; Jeong, S. Y.; Hong, S. J.

2016-12-01

The considerable casualties were resulted at the tsunami shelters during the Great East Japan Tsunami on 11 March 2011. The one of the important lessons learned from the Great East Japan Tsunami and the Fukushima NPP accidents provided the nuclear power plant emergency plan should consider the natural disaster. However, most of cases, the nuclear emergency preparedness strategies have not incorporated the natural disaster management plan. In this study, we reviewed the safety of the assembly areas, evacuation routes, and shelters of some nuclear emergency planning zone using the new tsunami hazard mapping results through the characteristic inundation analysis. As the result of this study, the improvements can be achieved by considering both natural and nuclear disaster to set up the assembly areas, evacuation routes, and shelters against the multiple disasters. Also, The most important protective measures can be achieved by integrating and linking the emergency preparedness strategy both natural disasters and nuclear disaster in the future.

Understanding Eating Behaviors through Parental Communication and the Integrative Model of Behavioral Prediction.

PubMed

Scheinfeld, Emily; Shim, Minsun

2017-05-01

Emerging adulthood (EA) is an important yet overlooked period for developing long-term health behaviors. During these years, emerging adults adopt health behaviors that persist throughout life. This study applies the Integrative Model of Behavioral Prediction (IMBP) to examine the role of childhood parental communication in predicting engagement in healthful eating during EA. Participants included 239 college students, ages 18 to 25, from a large university in the southern United States. Participants were recruited and data collection occurred spring 2012. Participants responded to measures to assess perceived parental communication, eating behaviors, attitudes, subjective norms, and behavioral control over healthful eating. SEM and mediation analyses were used to address the hypotheses posited. Data demonstrated that perceived parent-child communication - specifically, its quality and target-specific content - significantly predicted emerging adults' eating behaviors, mediated through subjective norm and perceived behavioral control. This study sets the stage for further exploration and understanding of different ways parental communication influences emerging adults' healthy behavior enactment.

School Nurses on the Front Lines of Medicine: The Approach to a Student After a Syncopal Event: Don't "PASS OUT".

PubMed

Hackett, Gretchen; Brady, Jodi; Olympia, Robert P

2018-03-01

Students presenting with syncope and/or seizure occur occasionally in the school setting. Several studies have shown that seizures as well as respiratory distress are the most common medical emergencies that prompt school nurses and staff to contact emergency medical services (EMS) to transport students to the closest emergency department (Knight 1999, Olympia 2005). It is important to develop a differential diagnosis for syncope, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow-up at their primary health care provider's office, or directly to the closest emergency department via EMS). This article describes the initial assessment and management of two students presenting after syncopal events.

Discovery and Characterization of a Highly Potent and Selective Aminopyrazoline-Based in Vivo Probe (BAY-598) for the Protein Lysine Methyltransferase SMYD2.

PubMed

Eggert, Erik; Hillig, Roman C; Koehr, Silke; Stöckigt, Detlef; Weiske, Jörg; Barak, Naomi; Mowat, Jeffrey; Brumby, Thomas; Christ, Clara D; Ter Laak, Antonius; Lang, Tina; Fernandez-Montalvan, Amaury E; Badock, Volker; Weinmann, Hilmar; Hartung, Ingo V; Barsyte-Lovejoy, Dalia; Szewczyk, Magdalena; Kennedy, Steven; Li, Fengling; Vedadi, Masoud; Brown, Peter J; Santhakumar, Vijayaratnam; Arrowsmith, Cheryl H; Stellfeld, Timo; Stresemann, Carlo

2016-05-26

Protein lysine methyltransferases have recently emerged as a new target class for the development of inhibitors that modulate gene transcription or signaling pathways. SET and MYND domain containing protein 2 (SMYD2) is a catalytic SET domain containing methyltransferase reported to monomethylate lysine residues on histone and nonhistone proteins. Although several studies have uncovered an important role of SMYD2 in promoting cancer by protein methylation, the biology of SMYD2 is far from being fully understood. Utilization of highly potent and selective chemical probes for target validation has emerged as a concept which circumvents possible limitations of knockdown experiments and, in particular, could result in an improved exploration of drug targets with a complex underlying biology. Here, we report the development of a potent, selective, and cell-active, substrate-competitive inhibitor of SMYD2, which is the first reported inhibitor suitable for in vivo target validation studies in rodents.

Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff

PubMed Central

Langhan, Melissa L.; Riera, Antonio; Kurtz, Jordan C.; Schaeffer, Paula; Asnes, Andrea G.

2015-01-01

Objective Technologies are not always successfully implemented into practise. We elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. Methods A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within ten emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Results Five major categories emerged: decision-making factors, the impact on practise, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use, and access difficulties. A positive outlook, sufficient training, support staff, and user friendliness were facilitators. Conclusions This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology. PMID:25367721

Emerging therapies for the management of chronic hyperkalemia in the ambulatory care setting.

PubMed

Henneman, Amy; Guirguis, Erenie; Grace, Yasmin; Patel, Dimple; Shah, Bhoomi

2016-01-15

Emerging treatment options for the management of chronic hyperkalemia in the outpatient setting are reviewed. Current treatment options for the management of hyperkalemia are limited and often accompanied by serious adverse effects. Two investigational drugs for the treatment of hyperkalemia are being evaluated in Phase III trials: sodium zirconium cyclosilicate and patiromer. Both of these drugs are administered orally and act by enhancing potassium's removal, predominantly through the gastrointestinal tract. The safety and efficacy of sodium zirconium cyclosilicate and patiromer were evaluated in Phase II and III trials. Both agents were studied in patients with chronic mild-to-severe hyperkalemia, chronic kidney disease (CKD), or heart failure as well as those taking a renin-angiotensin system (RAS) inhibitor, an aldosterone antagonist, or both therapies. These clinical trials found that sodium zirconium cyclosilicate and patiromer normalized serum potassium levels quickly and maintained normalized serum potassium levels over several weeks. Both medications caused a rapid decrease in serum potassium, with two studies examining efficacy endpoints for 12 weeks or longer. The overall frequency of adverse effects in these clinical trials was low, with gastrointestinal adverse events being the most commonly observed. Options for the management of hyperkalemia, particularly chronic hyperkalemia in the outpatient setting, are limited. Both sodium zirconium cyclosilicate and patiromer are emerging therapies that may provide long-term management of hyperkalemia, particularly in patients with underlying heart failure or CKD as well as those taking an RAS inhibitor, an aldosterone antagonist, or both. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Consistent boldness behaviour in early emerging fry of domesticated Atlantic salmon (Salmo salar): Decoupling of behavioural and physiological traits of the proactive stress coping style.

PubMed

Vaz-Serrano, J; Ruiz-Gomez, M L; Gjøen, H M; Skov, P V; Huntingford, F A; Overli, O; Höglund, E

2011-06-01

Individual variation in the way animals cope with stressors has been documented in a number of animal groups. In general, two distinct sets of behavioural and physiological responses to stress have been described: the proactive and the reactive coping styles. Some characteristics of stress coping style seem to be coupled to the time to emerge of fry from spawning redds in natural populations of salmonid fishes. In the present study, behavioural and physiological traits of stress coping styles were compared two and five months after emergence in farmed Atlantic salmon (Salmo salar), using individuals with an early or late time to emerge. Initially, compared to late emerging individuals, early emerging individuals showed a shorter time to resume feeding after transfer to rearing in isolation. Resumption of feeding after isolation was suggested to be related to boldness behaviour, rather than hunger, in the present study. This observation was repeated five months after emergence, demonstrating behavioural consistency over time in this trait. However, in other traits of proactive and reactive stress coping styles, such as social status, resting metabolism or post stress cortisol concentrations, early and late emerging individuals did not differ. Therefore, this study demonstrates that boldness in a novel environment is uncoupled from other traits of the proactive and reactive stress coping styles in farmed salmonids. It is possible that this decoupling is caused by the low competitive environment in which fish were reared. In natural populations of salmonids, however, the higher selection pressure at emergence could select for early emerging individuals with a proactive coping style. Copyright © 2011. Published by Elsevier Inc.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part II: Benefits of and Barriers in the Athletics Model

PubMed Central

Goodman, Ashley; Mazerolle, Stephanie M.; Eason, Christianne M.

2017-01-01

Context: The athletics model, in which athletic training clinical programs are part of the athletics department, is the predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of this model, particularly as it relates to organizational hierarchy. Objective: To explore the perceived benefits of and barriers in the athletics model. Design: Qualitative study. Setting: National Collegiate Athletic Association Divisions I and III. Patients or Other Participants: Eight full-time ATs (5 men, 3 women; age = 41 ± 13 years, time employed at the current institution = 14 ± 14 years, experience as a certified AT = 18 ± 13 years) working in the collegiate setting using the athletics model. Data Collection and Analysis: We conducted semistructured interviews via telephone or in person and used a general inductive approach to analyze the qualitative data. Multiple-analyst triangulation and peer review established trustworthiness. Results: Two benefits and 3 barriers emerged from the data. Role identity emerged as a benefit that occurred with role clarity, validation, and acceptance of the collegiate AT personality. Role congruence emerged as a benefit of the athletics model that occurred with 2 lower-order themes: relationship building and physician alignment and support. Role strain, staffing concerns, and work-life conflict emerged as barriers in the athletics model. Role strain occurred with 2 primary lower-order themes: role incongruity and role conflict. Conclusions: The athletics model is the most common infrastructure for employing ATs in collegiate athletics. Participants expressed positive experiences via character identity, support, trust relationships, and longevity. However, common barriers remain. To reduce role strain, misaligning values, and work-life conflict, ATs working in the athletics model are encouraged to evaluate their relationships with coaches and their supervisor and consider team physician alignment. Moreover, measures to increase quality athletic training staff from a care rather than a coverage standpoint should be considered. PMID:27977301

Prevalence and characteristics of general and football-specific emergency medical service activations by high school and collegiate certified athletic trainers: a national study.

PubMed

Decoster, Laura C; Swartz, Erik E; Cappaert, Thomas A; Hootman, Jennifer M

2010-11-01

To describe frequency and characteristics of emergency medical services (EMS) activations by certified athletic trainers (ATs) and effects of pre-season planning meetings on interactions between ATs and EMS both generally and specifically during football head/neck emergencies. Retrospective cross-sectional survey. 2009 Web-based survey. Athletic trainers (n = 1884; participation rate, 28%) in high school and collegiate settings. Athletic trainer work setting, AT demographics, history of pre-season planning meetings. Proportions and 95% confidence intervals (CIs) estimated the prevalence of EMS activation, planning meetings, and characteristics of AT-EMS interactions (eg, episodes of AT-perceived inappropriate care and on-field disagreements). Chi square tests tested differences (P < 0.05) in proportions. Associations (odds ratio = OR and 95% CI) between work setting, demographics, preseason meetings and fall 2008 1) episodes of AT-perceived inappropriate care, and 2) on-field disagreements were assessed using multivariate logistic regression. High school ATs activated EMS more frequently than collegiate ATs (eg, fall 2008 EMS activation for football injury, 59.9% vs 27.5%; P < 0.01) and reported fewer pre-season planning meetings (eg, met with EMS to practice, 38.1% vs 55.8%; P < 0.01). During the Fall 2008 football season, high school ATs perceived more episodes of inappropriate care (10.4% vs 3.9%; P < 0.01) and on-field disagreements (5.4 vs 2.2%; P < 0.01) than collegiate ATs. High school work setting was independently associated with episodes of AT-perceived inappropriate care (adjusted OR = 2.76; 95% CI, 1.65-4.62) and on-field disagreements (adjusted OR = 2.33; 95% CI, 1.17-4.64). Athletic trainer-EMS interactions are common and sometimes involve AT-perceived episodes of inappropriate care and on-field disagreements between emergency care providers.

Describing team development within a novel GP-led urgent care centre model: a qualitative study.

PubMed

Morton, Sarah; Ignatowicz, Agnieszka; Gnani, Shamini; Majeed, Azeem; Greenfield, Geva

2016-06-23

Urgent care centres (UCCs) co-located within an emergency department were developed to reduce the numbers of inappropriate emergency department admissions. Since then various UCC models have developed, including a novel general practitioner (GP)-led UCC that incorporates both GPs and emergency nurse practitioners (ENPs). Traditionally these two groups do not work alongside each other within an emergency setting. Although good teamwork is crucial to better patient outcomes, there is little within the literature about the development of a team consisting of different healthcare professionals in a novel healthcare setting. Our aim was therefore to describe staff members' perspectives of team development within the GP-led UCC model. Open-ended semistructured interviews, analysed using thematic content analysis. GP-led urgent care centres in two academic teaching hospitals in London. 15 UCC staff members including six GPs, four ENPs, two receptionists and three managers. Overall participants were positive about the interprofessional team that had developed and recognised that this process had taken time. Hierarchy within the UCC setting has diminished with time, although some residual hierarchical beliefs do appear to remain. Staff appreciated interdisciplinary collaboration was likely to improve patient care. Eight key facilitating factors for the team were identified: appointment of leaders, perception of fair workload, education on roles/skill sets and development of these, shared professional understanding, interdisciplinary working, ED collaboration, clinical guidelines and social interactions. A strong interprofessional team has evolved within the GP-led UCCs over time, breaking down traditional professional divides. Future implementation of UCC models should pro-actively incorporate the eight facilitating factors identified from the outset, to enable effective teams to develop more quickly. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Importance of Place for International Students' Choice of University: A Case Study at a Malaysian University

ERIC Educational Resources Information Center

Singh, Jasvir Kaur Nachatar; Schapper, Jan; Jack, Gavin

2014-01-01

The scholarly bias toward Western and English-speaking settings in the study of international education overlooks the experiences of international students in emerging education hubs in Asia. To redress this imbalance, this article offers insights into the crucial role of place in the study destination choices of a group of international…

Using Dynamic Geometry Software To Add Contrast to Geometric Situations--A Case Study.

ERIC Educational Resources Information Center

Holzl, Reinhard

2001-01-01

Uses of Dynamic Geometry Software (DGS) are often limited purely to a verifying role. Presents a case study that emerged from a project in which DGS formed an integral part of the pedagogical arrangement. The study demonstrates how the contrasting power of DGS might be utilized in a guided discovery setting. (Contains 17 references.) (Author/ASK)

[Impact of quality-indicator-based measures to improve the treatment of acute poisoning in pediatric emergency patients].

PubMed

Martínez Sánchez, Lidia; Trenchs Sainz de la Maza, Victoria; Azkunaga Santibáñez, Beatriz; Nogué-Xarau, Santiago; Ferrer Bosch, Nuria; García González, Elsa; Luaces I Cubells, Carles

2016-02-01

To analyze the impact of quality-indicator-based measures for improving quality of care for acute poisoning in pediatric emergency departments. Recent assessments of quality indicators were compared with benchmark targets and with results from previous studies. The first study evaluated 6 basic indicators in the pediatric emergency departments of members of to the working group on poisoning of the Spanish Society of Pediatric Emergency Medicine (GTI-SEUP). The second study evaluated 20 indicators in a single emergency department of GTI-SEUP members. Based on the results of those studies, the departments implemented the following corrective measures: creation of a team for gastric lavage follow-up, preparation of a new GTI-SEUP manual on poisoning, implementation of a protocol for poisoning incidents, and creation of specific poisoning-related fields for computerized patient records. The benchmark targets were reached on 4 quality indicators in the first study. Improvements were seen in the availability of protocols, as indicators exceeded the target in all the pediatric emergency departments (vs 29.2% of the departments in an earlier study, P < .001). No other significant improvements were observed. In the second study the benchmarks were reached on 13 indicators. Improvements were seen in compliance with incident reporting to the police (recently, 44.4% vs 19.2% previously, P = .036), case registration in the minimum basic data set (51.0% vs 1.9%, P < .001), and a trend toward increased administration of activated carbon within 2 hours (93.1% vs 83.5%, P = .099). No other significant improvements were seen. The corrective measures led to improvements in some quality indicators. There is still room for improvement in these emergency departamens' care of pediatric poisoning.

Confronting Ethical and Regulatory Challenges of Emergency Care Research With Conscious Patients.

PubMed

Dickert, Neal W; Brown, Jeremy; Cairns, Charles B; Eaves-Leanos, Aaliyah; Goldkind, Sara F; Kim, Scott Y H; Nichol, Graham; O'Conor, Katie J; Scott, Jane D; Sinert, Richard; Wendler, David; Wright, David W; Silbergleit, Robert

2016-04-01

Barriers to informed consent are ubiquitous in the conduct of emergency care research across a wide range of conditions and clinical contexts. They are largely unavoidable; can be related to time constraints, physical symptoms, emotional stress, and cognitive impairment; and affect patients and surrogates. US regulations permit an exception from informed consent for certain clinical trials in emergency settings, but these regulations have generally been used to facilitate trials in which patients are unconscious and no surrogate is available. Most emergency care research, however, involves conscious patients, and surrogates are often available. Unfortunately, there is neither clear regulatory guidance nor established ethical standards in regard to consent in these settings. In this report-the result of a workshop convened by the National Institutes of Health Office of Emergency Care Research and Department of Bioethics to address ethical challenges in emergency care research-we clarify potential gaps in ethical understanding and federal regulations about research in emergency care in which limited involvement of patients or surrogates in enrollment decisions is possible. We propose a spectrum of approaches directed toward realistic ethical goals and a research and policy agenda for addressing these issues to facilitate clinical research necessary to improve emergency care. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Building workforce capacity to detect and respond to child abuse and neglect cases: A training intervention for staff working in emergency settings in Vietnam.

PubMed

Flemington, Tara; Fraser, Jennifer

2017-09-01

Too many children are brought to hospital emergency departments on numerous occasions before they are recognised as victims of child abuse and neglect. For this reason, improving knowledge and response behaviors of emergency staff at all levels is likely to have a significant impact on better outcomes. An Australian based training programme was the first of its kind to address this issue in a Vietnamese Emergency Department. Titled 'Safe Children Vietnam', the programme aimed to improve knowledge, attitudes and reporting behaviors concerning child abuse in the emergency setting. A pre-post test design was used to evaluate the impact of 'Safe Children Vietnam' on emergency staff knowledge, attitudes and intentions to report child abuse and neglect. Emergency staff including doctors, nurses and healthcare staff (n=116) participated in the clinical training programme. Linear Mixed Model analyses showed that on programme completion, they were more likely to recognise serious cases of all types of abuse. The 'Safe Children Vietnam' programme was effective at improving emergency staff knowledge of child abuse and neglect. A systems wide approach may be necessary to impact on emergency staff attitudes towards reporting cases of abuse. Copyright © 2017 Elsevier Ltd. All rights reserved.

Integrated Baseline System (IBS), Version 1. 03. [Chemical Stockpile Emergency Preparedness Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bailey, B.M.; Burford, M.J.; Downing, T.R.

The Integrated Baseline System (IBS), operated by the Federal Emergency Management Agency (FEMA), is a system of computerized tools for emergency planing and analysis. This document is the user guide for the IBS and explains how to operate the IBS system. The fundamental function of the IBS is to provide tools that civilian emergency management personnel can use in developing emergency plans and in supporting emergency management activities to cope with a chemical-releasing event at a military chemical stockpile. Emergency management planners can evaluate concepts and ideas using the IBS system. The results of that experience can then be factoredmore » into refining requirements and plans. This document provides information for the general system user, and is the primary reference for the system features of the IBS. It is designed for persons who are familiar with general emergency management concepts, operations, and vocabulary. Although the IBS manual set covers basic and advanced operations, it is not a complete reference document set. Emergency situation modeling software in the IBS is supported by additional technical documents. Some of the other LBS software is commercial software for which more complete documentation is available. The IBS manuals reference such documentation where necessary. IBS is a dynamic system. Its capabilities are in a state of continuing expansion and enhancement.« less

The Development, Description and Appraisal of an Emergent Multimethod Research Design to Study Workforce Changes in Integrated Care Interventions.

PubMed

Busetto, Loraine; Luijkx, Katrien; Calciolari, Stefano; González-Ortiz, Laura G; Vrijhoef, Hubertus J M

2017-03-08

In this paper, we provide a detailed and explicit description of the processes and decisions underlying and shaping the emergent multimethod research design of our study on workforce changes in integrated chronic care. The study was originally planned as mixed method research consisting of a preliminary literature review and quantitative check of these findings via a Delphi panel. However, when the findings of the literature review were not appropriate for quantitative confirmation, we chose to continue our qualitative exploration of the topic via qualitative questionnaires and secondary analysis of two best practice case reports. The resulting research design is schematically described as an emergent and interactive multimethod design with multiphase combination timing. In doing so, we provide other researchers with a set of theory- and experience-based options to develop their own multimethod research and provide an example for more detailed and structured reporting of emergent designs. We argue that the terminology developed for the description of mixed methods designs should also be used for multimethod designs such as the one presented here.

Exploratory study of emergency physicians' use of a prescription monitoring program using a framework of technology acceptance.

PubMed

Fleming, Marc L; Hatfield, Mark D; Wattana, Monica K; Todd, Knox H

2014-03-01

Emergency physicians (EPs) are faced with significant challenges regarding pain management, while preventing abuse of prescription opioids. Prescription monitoring programs (PMPs) are increasingly used to help allay the abuse of controlled substances. The objective of this study was to determine EPs' intention to use the Texas PMP within the framework of the Technology Acceptance Model. A cross-sectional, 24-item survey instrument was developed and distributed to EPs attending an emergency medicine conference. PMP nonusers reported a positive intention to use the PMP in the future, with attitude (β = 0.61, p < 0.01) as the only statistically significant predictor of intention. PMP users reported a positive intention to use the PMP, with perceived usefulness (β = 0.62, p < 0.01) as the only statistically significant predictor of intention for PMP users. This exploratory study provides a basis for understanding EPs' intention to use a PMP. The use of PMPs by EPs may lead to a decrease in prescription opioid abuse and improve patient safety related to opioid prescribing in the emergency department setting.

Emergent Reader--Mid-Year: A Demonstration of Book Buddies in Action. [Videotape].

ERIC Educational Resources Information Center

Invernizzi, Marcia; Juel, Connie

The "Book Buddies" manual and "Emergent Reader" training videos provide comprehensive and easy-to-implement guidelines for setting up and running a successful tutorial program in the early grades. Portraying the "Book Buddies" model in practice, this 44-minute videotape, entitled "Emergent Reader--Mid-Year"…

46 CFR 112.50-7 - Compressed air starting.

Code of Federal Regulations, 2011 CFR

2011-10-01

... AND POWER SYSTEMS Emergency Diesel and Gas Turbine Engine Driven Generator Sets § 112.50-7 Compressed... emergency generator room and a handcranked, diesel-powered air compressor for recharging the air receiver..., and energy storing devices must be in the emergency generator room, except for the main or auxiliary...

46 CFR 112.50-7 - Compressed air starting.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND POWER SYSTEMS Emergency Diesel and Gas Turbine Engine Driven Generator Sets § 112.50-7 Compressed... emergency generator room and a handcranked, diesel-powered air compressor for recharging the air receiver..., and energy storing devices must be in the emergency generator room, except for the main or auxiliary...

Emergent Reader--Day One: A Demonstration of Book Buddies in Action. [Videotape].

ERIC Educational Resources Information Center

Invernizzi, Marcia; Juel, Connie

The "Book Buddies" manual and "Emergent Reader" training videos provide comprehensive and easy-to-implement guidelines for setting up and running a successful tutorial program in the early grades. Portraying the "Book Buddies" model in practice, this 51-minute videotape entitled "Emergent Reader--Day One"…

Neonatal survival in complex humanitarian emergencies: setting an evidence-based research agenda

PubMed Central

2014-01-01

Background Over 40% of all deaths among children under 5 are neonatal deaths (0–28 days), and this proportion is increasing. In 2012, 2.9 million newborns died, with 99% occurring in low- and middle-income countries. Many of the countries with the highest neonatal mortality rates globally are currently or have recently been affected by complex humanitarian emergencies. Despite the global burden of neonatal morbidity and mortality and risks inherent in complex emergency situations, research investments are not commensurate to burden and little is known about the epidemiology or best practices for neonatal survival in these settings. Methods We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritize research questions on neonatal health in complex humanitarian emergencies. Experts evaluated 35 questions using four criteria (answerability, feasibility, relevance, equity) with three subcomponents per criterion. Using SAS 9.2, a research prioritization score (RPS) and average expert agreement score (AEA) were calculated for each question. Results Twenty-eight experts evaluated all 35 questions. RPS ranged from 0.846 to 0.679 and the AEA ranged from 0.667 to 0.411. The top ten research priorities covered a range of issues but generally fell into two categories– epidemiologic and programmatic components of neonatal health. The highest ranked question in this survey was “What strategies are effective in increasing demand for, and use of skilled attendance?” Conclusions In this study, a diverse group of experts used the CHRNI methodology to systematically identify and determine research priorities for neonatal health and survival in complex humanitarian emergencies. The priorities included the need to better understand the magnitude of the disease burden and interventions to improve neonatal health in complex humanitarian emergencies. The findings from this study will provide guidance to researchers and program implementers in neonatal and complex humanitarian fields to engage on the research priorities needed to save lives most at risk. PMID:24959198

Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

PubMed

Popat, H; Thomas, K; Farnell, D J J

2016-07-08

Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations.

Antimicrobial Stewardship in the Emergency Department and Guidelines for Development

PubMed Central

May, Larissa; Cosgrove, Sara; L’Archeveque, Michelle; Talan, David A.; Payne, Perry; Rothman, Richard E.

2013-01-01

Antimicrobial resistance is a mounting public health concern. Emergency departments (EDs) represent a particularly important setting for addressing inappropriate antimicrobial prescribing practices, given the frequent use of antibiotics in this setting that sits at the interface of the community and the hospital. This article outlines the importance of antimicrobial stewardship in the ED setting and provides practical recommendations drawn from existing evidence for the application of various strategies and tools that could be implemented in the ED including advancement of clinical guidelines, clinical decision support systems, rapid diagnostics, and expansion of ED pharmacist programs. PMID:23122955

Declarations on euthanasia and assisted dying.

PubMed

Inbadas, Hamilton; Zaman, Shahaduz; Whitelaw, Sandy; Clark, David

2017-10-01

Declarations on end-of-life issues are advocacy interventions that seek to influence policy, raise awareness and call others to action. Despite increasing prominence, they have attracted little attention from researchers. This study tracks the emergence, content, and purpose of declarations concerned with assisted dying and euthanasia, in the global context. The authors identified 62 assisted dying/euthanasia declarations covering 1974-2016 and analyzed them for originating organization, geographic scope, format, and stated viewpoint on assisted dying/euthanasia. The declarations emerged from diverse organizational settings and became more frequent over time. Most opposed assisted dying/euthanasia.

Identifying and treating a life-threatening disease.

PubMed

Cole, Beverley

2014-02-01

Meningococcal septicaemia is a life-threatening condition that all nurses working in emergency and urgent care settings are likely to come across during their careers. This article presents, and reflects on, a case study involving a woman with the disease whose signs and symptoms were atypical, and who was not therefore diagnosed with the condition immediately. The author aims to raise awareness among emergency nurses and nurse practitioners of the atypical signs and symptoms of the infection, and its consequences. The article also discusses how referring to patient scenarios can improve practice.

Mental health and psychosocial support in crisis and conflict: report of the Mental Health Working Group.

PubMed

Allden, K; Jones, L; Weissbecker, I; Wessells, M; Bolton, P; Betancourt, T S; Hijazi, Z; Galappatti, A; Yamout, R; Patel, P; Sumathipala, A

2009-01-01

The Working Group on Mental Health and Psychosocial Support was convened as part of the 2009 Harvard Humanitarian Action Summit. The Working Group chose to focus on ethical issues in mental health and psychosocial research and programming in humanitarian settings. The Working Group built on previous work and recommendations, such as the Inter-Agency Standing Committee's Guidelines on Mental Health and Psychosocial Support in Emergency Settings. The objective of this working group was to address one of the factors contributing to the deficiency of research and the need to develop the evidence base on mental health and psychosocial support interventions during complex emergencies by proposing ethical research guidelines. Outcomes research is vital for effective program development in emergency settings, but to date, no comprehensive ethical guidelines exist for guiding such research efforts. Working Group members conducted literature reviews which included peer-reviewed publications, agency reports, and relevant guidelines on the following topics: general ethical principles in research, cross-cultural issues, research in resource-poor countries, and specific populations such as trauma and torture survivors, refugees, minorities, children and youth, and the mentally ill. Working Group members also shared key points regarding ethical issues encountered in their own research and fieldwork. The group adapted a broad definition of the term "research", which encompasses needs assessments and data gathering, as well as monitoring and evaluation. The guidelines are conceptualized as applying to formal and informal processes of assessment and evaluation in which researchers as well as most service providers engage. The group reached consensus that it would be unethical not to conduct research and evaluate outcomes of mental health and psychosocial interventions in emergency settings, given that there currently is very little good evidence base for such interventions. Overarching themes and issues generated by the group for further study and articulation included: purpose and benefits of research, issues of validity, neutrality, risk, subject selection and participation, confidentiality, consent, and dissemination of results. The group outlined several key topics and recommendations that address ethical issues in conducting mental health and psychosocial research in humanitarian settings. The group views this set of recommendations as a living document to be further developed and refined based on input from colleagues representing different regions of the globe with an emphasis on input from colleagues from low-resource countries.

Simulating Real-World Exposures during Emergency Events: Studying Effects of Indoor and Outdoor Releases in the Urban Dispersion Project in Upper Manhattan, NY

EPA Science Inventory

A prospective personal exposure study, involving indoor and outdoor releases, was conducted in upper Midtown Manhattan in New York City as part of the Urban Dispersion Program (UDP) focusing on atmospheric dispersion of chemicals in complex urban settings. The UDP experiments inv...

The Relation between Eating- and Weight-Related Disturbances and Depression in Adolescence: A Review

ERIC Educational Resources Information Center

Rawana, Jennine S.; Morgan, Ashley S.; Nguyen, Hien; Craig, Stephanie G.

2010-01-01

Depression often emerges during adolescence and persists into adulthood. Thus, it is critical to study risk factors that contribute to the development of depression in adolescence. One set of risk factors that has been recently studied in adolescent depression research is eating- and weight-related disturbances (EWRDs). EWRDs encompass negative…

Multidisciplinary Case Study on Higher Education: An Innovative Experience in the Business Management Degree

ERIC Educational Resources Information Center

Martínez-Cañas, Ricardo; del Pozo-Rubio, Raúl; Mondéjar-Jiménez, José; Ruiz-Palomino, Pablo

2012-01-01

Higher education is constantly changing and looking for innovative educational solutions in order to increase the level of the student's knowledge and skills. As an important part of this set of educational policies, a new process is emerging for the ideation, planning and implementation of multidisciplinary case studies for students with the aim…

The Delivery of Professional Development in the Middle School: Exploring Optimal Settings, Times, and Participants

ERIC Educational Resources Information Center

Mohr, Carrie A.

2017-01-01

The purpose of this study was to describe and understand the experiences of teachers and instructional leaders related to the delivery of professional development at the middle school level. This qualitative study examines four professional development experiences and provides a summary of emerging themes related to those experiences for both…

Critical Thinking Skills and Academic Maturity: Emerging Results from a Five-Year Quality Enhancement Plan (QEP) Study

ERIC Educational Resources Information Center

Toppin, Ian N.; Chitsonga, Shadreck

2016-01-01

The QEP that was implemented in this study focused on enhancing students' critical thinking skills. A pretest/posttest approach was used to assess students' critical thinking progress in freshman level core English and Math courses. An intervention was performed involving intensive instruction and assignments relating to a set of reasoning…

A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises.

PubMed

Singh, Neha S; Aryasinghe, Sarindi; Smith, James; Khosla, Rajat; Say, Lale; Blanchet, Karl

2018-01-01

Women and girls are affected significantly in both sudden and slow-onset emergencies, and face multiple sexual and reproductive health (SRH) challenges in humanitarian crises contexts. There are an estimated 26 million women and girls of reproductive age living in humanitarian crises settings, all of whom need access to SRH information and services. This systematic review aimed to assess the utilisation of services of SRH interventions from the onset of emergencies in low- and middle-income countries. We searched for both quantitative and qualitative studies in peer-reviewed journals across the following four databases: EMBASE, Global Health, MEDLINE and PsychINFO from 1 January 1980 to 10 April 2017. Primary outcomes of interest included self-reported use and/or confirmed use of the Minimum Initial Service Package services and abortion services. Two authors independently extracted and analysed data from published papers on the effect of SRH interventions on a range of SRH care utilisation outcomes from the onset of emergencies, and used a narrative synthesis approach. Of the 2404 identified citations, 23 studies met the inclusion criteria. 52.1% of the studies (n=12) used quasi-experimental study designs, which provided some statistical measure of difference between intervention and outcome. 39.1% of the studies (n=9) selected were graded as high quality, 39.1% moderate quality (n=9) and 17.4% low quality (n=4). Evidence of effectiveness in increasing service utilisation was available for the following interventions: peer-led and interpersonal education and mass media campaigns, community-based programming and three-tiered network of community-based reproductive and maternal health providers. Despite increased attention to SRH service provision in humanitarian crises settings, the evidence base is still very limited. More implementation research is required to identify interventions to increase utilisation of SRH services in diverse humanitarian crises settings and populations.

A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises

PubMed Central

Aryasinghe, Sarindi; Smith, James; Khosla, Rajat; Say, Lale; Blanchet, Karl

2018-01-01

Introduction Women and girls are affected significantly in both sudden and slow-onset emergencies, and face multiple sexual and reproductive health (SRH) challenges in humanitarian crises contexts. There are an estimated 26 million women and girls of reproductive age living in humanitarian crises settings, all of whom need access to SRH information and services. This systematic review aimed to assess the utilisation of services of SRH interventions from the onset of emergencies in low- and middle-income countries. Methods We searched for both quantitative and qualitative studies in peer-reviewed journals across the following four databases: EMBASE, Global Health, MEDLINE and PsychINFO from 1 January 1980 to 10 April 2017. Primary outcomes of interest included self-reported use and/or confirmed use of the Minimum Initial Service Package services and abortion services. Two authors independently extracted and analysed data from published papers on the effect of SRH interventions on a range of SRH care utilisation outcomes from the onset of emergencies, and used a narrative synthesis approach. Results Of the 2404 identified citations, 23 studies met the inclusion criteria. 52.1% of the studies (n=12) used quasi-experimental study designs, which provided some statistical measure of difference between intervention and outcome. 39.1% of the studies (n=9) selected were graded as high quality, 39.1% moderate quality (n=9) and 17.4% low quality (n=4). Evidence of effectiveness in increasing service utilisation was available for the following interventions: peer-led and interpersonal education and mass media campaigns, community-based programming and three-tiered network of community-based reproductive and maternal health providers. Conclusions Despite increased attention to SRH service provision in humanitarian crises settings, the evidence base is still very limited. More implementation research is required to identify interventions to increase utilisation of SRH services in diverse humanitarian crises settings and populations. PMID:29736272

IEMIS (Integrated Emergency Management Information System) Floodplain Mapping Based on a Lidar Derived Data Set.

DTIC Science & Technology

1988-02-05

0-A193 971 IEMIS (INTEGRATED EMERGENCY MANAGEMENT INFORMATION SYSTEM ) FLOODPLRIN MAP.. (U) ARMY ENGINEER WATERWAYS EXPERIMENT STATION VICKSBURG HS J...illustrate the application of the automated mapping capabilities of the Integrated Emergency Management Information System (IEMIS) to FISs. Unclassified...mapping capabilities of the Integrated Emergency Management Information System (IEMIS) to FISs. II. BACKGROUND The concept of mounting laser ranging

Consumer attitudes towards and satisfaction with emergency contraception counselling: experience from clinic and retail pharmacy settings.

PubMed

Ragland, Denise; Battle, Marlene; Kueter, Teddi J; Payakachat, Nalin

2015-10-01

To collectively assess consumer attitudes towards and satisfaction with emergency contraception (EC) counselling by student pharmacists in two different locations: an academic healthcare clinic and a retail pharmacy. EC counselling was provided by trained student pharmacists utilizing a standardized education toolkit. Participants were asked to rate the counselling at the end of the knowledge survey. In addition to descriptive statistics, we compared the self-reported attitudes and satisfaction with the counselling between the two sites. The majority of participants from both settings rated 'strongly agree' on the attitude and satisfaction statements for the EC counselling. Participants from the clinic setting rated higher in two of the four statements than the participants from the retail setting. Participants had positive attitudes towards and were highly satisfied with the EC counselling in both settings. EC counselling should be encouraged in practice settings. © 2014 Royal Pharmaceutical Society.

The emergence of a global right to health norm--the unresolved case of universal access to quality emergency obstetric care.

PubMed

Hammonds, Rachel; Ooms, Gorik

2014-02-27

The global response to HIV suggests the potential of an emergent global right to health norm, embracing shared global responsibility for health, to assist policy communities in framing the obligations of the domestic state and the international community. Our research explores the extent to which this global right to health norm has influenced the global policy process around maternal health rights, with a focus on universal access to emergency obstetric care. In examining the extent to which arguments stemming from a global right to health norm have been successful in advancing international policy on universal access to emergency obstetric care, we looked at the period from 1985 to 2013 period. We adopted a qualitative case study approach applying a process-tracing methodology using multiple data sources, including an extensive literature review and limited key informant interviews to analyse the international policy agenda setting process surrounding maternal health rights, focusing on emergency obstetric care. We applied John Kingdon's public policy agenda setting streams model to analyse our data. Kingdon's model suggests that to succeed as a mobilising norm, the right to health could work if it can help bring the problem, policy and political streams together, as it did with access to AIDS treatment. Our analysis suggests that despite a normative grounding in the right to health, prioritisation of the specific maternal health entitlements remains fragmented. Despite United Nations recognition of maternal mortality as a human rights issue, the relevant policy communities have not yet managed to shift the policy agenda to prioritise the global right to health norm of shared responsibility for realising access to emergency obstetric care. The experience of HIV advocates in pushing for global solutions based on right to health principles, including participation, solidarity and accountability; suggest potential avenues for utilising right to health based arguments to push for policy priority for universal access to emergency obstetric care in the post-2015 global agenda.

A task analysis of emergency physician activities in academic and community settings.

PubMed

Chisholm, Carey D; Weaver, Christopher S; Whenmouth, Laura; Giles, Beverly

2011-08-01

We characterize and compare the work activities, including peak patient loads, associated with the workplace in the academic and community emergency department (ED) settings. This allows assessment of the effect of future ED system operational changes and identifies potential sources contributing to medical error. This was an observational, time-motion study. Trained observers shadowed physicians, recording activities. Data included total interactions, distances walked, time sitting, patients concurrently treated, interruptions, break in tasks, physical contact with patients, hand washing, diagnostic tests ordered, and therapies rendered. Activities were classified as direct patient care, indirect patient care, or personal time with a priori definitions. There were 203 2-hour observation periods of 85 physicians at 2 academic EDs with 100,000 visits per year at each (N=160) and 2 community EDs with annual visits of 19,000 and 21,000 (N=43). Reported data present the median and minimum-maximum values per 2-hour period. Emergency physicians spent the majority of time on indirect care activities (academic 64 minutes, 29 to 91 minutes; community 55 min, 25 to 95 minutes), followed by direct care activities (academic 36 minutes, 6 to 79 minutes; community 41 minutes, 5 to 60 minutes). Personal time differed by location type (academic 6 minutes, 0 to 66 minutes; community 13 minutes, 0 to 69 minutes). All physicians simultaneously cared for multiple patients, with a median number of patients greater than 5 (academic 7 patients, 2 to 16 patients; community 6 patients, 2 to 12 patients). Emergency physicians spend the majority of their time involved in indirect patient care activities. They are frequently interrupted and interact with a large number of individuals. They care for a wide range of patients simultaneously, with surges in multiple patient care responsibilities. Physicians working in academic settings are interrupted at twice the rate of their community counterparts. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Research priorities for the influence of gender on diagnostic imaging choices in the emergency department setting.

PubMed

Ashurst, John V; Cherney, Alan R; Evans, Elizabeth M; Kennedy Hall, Michael; Hess, Erik P; Kline, Jeffrey A; Mitchell, Alice M; Mills, Angela M; Weigner, Michael B; Moore, Christopher L

2014-12-01

Diagnostic imaging is a cornerstone of patient evaluation in the acute care setting, but little effort has been devoted to understanding the appropriate influence of sex and gender on imaging choices. This article provides background on this issue and a description of the working group and consensus findings reached during the diagnostic imaging breakout session at the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." Our goal was to determine research priorities for how sex and gender may (or should) affect imaging choices in the acute care setting. Prior to the conference, the working group identified five areas for discussion regarding the research agenda in sex- and gender-based imaging using literature review and expert consensus. The nominal group technique was used to identify areas for discussion for common presenting complaints to the emergency department where ionizing radiation is often used for diagnosis: suspected pulmonary embolism, suspected kidney stone, lower abdominal pain with a concern for appendicitis, and chest pain concerning for coronary artery disease. The role of sex- and gender-based shared decision-making in diagnostic imaging decisions is also raised. © 2014 by the Society for Academic Emergency Medicine.

Foundations of Phenomenological Psychology.

ERIC Educational Resources Information Center

Aanstoos, Christopher M.

Phenomenology, hermeneutics and experiential psychology form the backbone of an emerging paradigm within psychology known as human science. Human science's use of phenomenology provides a way to set aside the naturalistic presupposition and directly study the irreducible involvement of human existence within a meaningful world, as it is given in…

The Carpool: A Socializing Adjunct to the Educational Experience.

ERIC Educational Resources Information Center

Adler, Particia A.; Adler, Peter

1984-01-01

Socializing effects that carpooling has on pre-school and elementary students were studied. The behavioral patterns and roles that emerge in this setting were examined and their impact on the developing child analyzed. Three carpool-generated relationships identified were intimate, combatant, and obligatory. Socialization occured concurrently…

Effect of level of autonomy on the amount of physical activity in young children

USDA-ARS?s Scientific Manuscript database

BACKGROUND: Emerging research has indicated that providing choice of exercise options increases the amount of physical activity children perform. However, these studies have not yet assessed this effect using physical activities children typically have access to in a naturalistic setting. PURPOSE...

Acting and Reacting: Youth's Behavior in Corrupt Educational Settings

ERIC Educational Resources Information Center

Sabic-El-Rayess, Amra

2014-01-01

With its broader employability to the issues of underperformance that may emerge in educational systems internationally, this empirical study redefines and expands Albert Hirschman's theory of voice, exit, and loyalty within higher education. The article formulates a new education-embedded theoretical framework that explains reactionary behaviors…

Standards for Reporting Mathematics Professional Development in Research Studies

ERIC Educational Resources Information Center

Sztajn, Paola

2011-01-01

This Research Commentary addresses the need for standards for describing mathematics professional development in mathematics education research reports. Considering that mathematics professional development is an emerging research field, it is timely to set expectations for what constitutes high-quality reporting in this field. (Contains 2 tables.)

Implementing Pre-Vocational Studies in Venezuela.

ERIC Educational Resources Information Center

Kim, Young Mi

This paper describes prevocational education in Venezuela on each educational level. First, it sets a historical context by identifying aspects of technical education that emerged at different times in its development; then it identifies certain strategies created to support the implementation of prevocationalization, and finally it concludes by…

Athletic trainers' facilitators of professional commitment in the collegiate setting.

PubMed

Eason, Christianne M; Mazerolle, Stephanie M; Pitney, William A

2015-05-01

Professional responsibility, rewards and respect, and time for rejuvenation are factors supporting professional commitment for athletic trainers (ATs) in the high school setting. The inherent complexities of an occupational setting can mitigate perceptions of professional commitment. Thus far, evidence is lacking regarding professional commitment for ATs in other occupational settings. To extend the literature on professional commitment of the AT to the collegiate setting. Qualitative study. Collegiate. Thirty-three Board of Certification-certified ATs employed in the collegiate setting (National Collegiate Athletic Association Division I = 11, Division II = 9, Division III = 13) with an average of 10 ± 8 years of clinical experience volunteered. Data saturation guided the total number of participants. Online journaling via QuestionPro was used to collect data from all participants. Two strategies, multiple-analyst triangulation and peer review, were completed to satisfy data credibility. Data were evaluated using a general inductive approach. Likert-scale data revealed no differences regarding levels of professional commitment across divisions. Two themes emerged from the inductive-content analysis: (1) professional responsibility and (2) coworker support. The emergent theme of professional responsibility contained 4 subthemes: (1) dedication to advancing the athletic training profession, (2) ardor for job responsibilities, (3) dedication to the student-athlete, and (4) commitment to education. Our participants were able to better maintain their own professional commitment when they felt their coworkers were also committed to the profession. The collegiate ATs investigated in this study, regardless of division, demonstrated professional commitment propelled by their aspiration to advance the profession, as well as their dedication to student-athletes and athletic training students. Maintaining commitment was influenced by a strong sense of coworker support.

Validity of the International Classification of Diseases, Tenth Revision code for acute kidney injury in elderly patients at presentation to the emergency department and at hospital admission

PubMed Central

Hwang, Y Joseph; Shariff, Salimah Z; Gandhi, Sonja; Wald, Ron; Clark, Edward; Fleet, Jamie L; Garg, Amit X

2012-01-01

Objective To evaluate the validity of the International Classification of Diseases, Tenth Revision (ICD-10) code N17x for acute kidney injury (AKI) in elderly patients in two settings: at presentation to the emergency department and at hospital admission. Design A population-based retrospective validation study. Setting Southwestern Ontario, Canada, from 2003 to 2010. Participants Elderly patients with serum creatinine measurements at presentation to the emergency department (n=36 049) or hospital admission (n=38 566). The baseline serum creatinine measurement was a median of 102 and 39 days prior to presentation to the emergency department and hospital admission, respectively. Main outcome measures Sensitivity, specificity and positive and negative predictive values of ICD-10 diagnostic coding algorithms for AKI using a reference standard based on changes in serum creatinine from the baseline value. Median changes in serum creatinine of patients who were code positive and code negative for AKI. Results The sensitivity of the best-performing coding algorithm for AKI (defined as a ≥2-fold increase in serum creatinine concentration) was 37.4% (95% CI 32.1% to 43.1%) at presentation to the emergency department and 61.6% (95% CI 57.5% to 65.5%) at hospital admission. The specificity was greater than 95% in both settings. In patients who were code positive for AKI, the median (IQR) increase in serum creatinine from the baseline was 133 (62 to 288) µmol/l at presentation to the emergency department and 98 (43 to 200) µmol/l at hospital admission. In those who were code negative, the increase in serum creatinine was 2 (−8 to 14) and 6 (−4 to 20) µmol/l, respectively. Conclusions The presence or absence of ICD-10 code N17× differentiates two groups of patients with distinct changes in serum creatinine at the time of a hospital encounter. However, the code underestimates the true incidence of AKI due to a limited sensitivity. PMID:23204077

Designing Science Learning Environments That Support Emerging Bilingual Students to Problematize Electrical Phenomena

NASA Astrophysics Data System (ADS)

Suarez, Enrique A.

This dissertation investigates how emerging bilingual students make sense of natural phenomena through engaging in certain epistemic practices of science, and the elements of the learning environment that created those opportunities. Specifically, the dissertation focuses on how emerging bilingual students problematized electrical phenomena, like electric flow and electrical resistance, and how the design features of the environment (e.g., sequencing of activities, linguistic practices) may have supported students as they made sense of phenomena. The first study describes how for students presented and evaluated mechanistic models of electric flow, focusing specifically on how students identified and negotiated a disagreement between their explanatory models. The results from this study highlight the complexity of students' disagreements, not only because of the epistemological aspects related to presenting and evaluating knowledge, but also due to interpersonal dynamics and the discomfort associated with disagreeing with another person. The second study focuses on the design features of the learning environment that supported emerging bilingual students' investigations of electrical phenomena. The findings from this study highlight how a carefully designed set of activities, with the appropriate material resources (e.g., experimental tools), could support students to problematize electrical resistance. The third study describes how emerging bilingual students engaged in translanguaging practices and the contextual features of the learning environment that created and hindered opportunities for translanguaging. The findings from this study identify and articulate how emerging bilingual students engaged in translanguaging practices when problematizing electrical resistance, and strengthen the perspective that, in order to be equitable for emerging bilingual students, science learning environments need to act as translanguaging spaces. This dissertation makes three contributions to how science educators understand how elementary-aged emerging bilingual students learning science. First, I offer a detailed account of how emerging bilingual students engaged in epistemic practices to problematize electrical phenomena. Secondly, I argue learning environments need to create opportunities for emerging bilingual students to engage in productive epistemic work through leveraging multiple kinds of resources from their semiotic repertoires. Finally, this dissertation contributes to our understanding of how emerging bilingual students engage in translanguaging practices as they investigate and talk about the natural world.

Treatment of acute burn blisters in unscheduled care settings.

PubMed

Payne, Sarah; Cole, Elaine

2012-09-01

Many patients with minor burns present at emergency departments and urgent care centres, where their management is often undertaken by experienced nurses rather than experts in treating burns. This article describes a small study of the clinical decision making that underpins nurses' management of minor burns in these non-specialist settings. The results suggest that, due to a lack of relevant research, nurses base their decisions on previous experience or expert colleagues' opinions and advice rather than on the evidence.

Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department.

PubMed

Stolz, Lori A; Muruganandan, Krithika M; Bisanzo, Mark C; Sebikali, Mugisha J; Dreifuss, Bradley A; Hammerstedt, Heather S; Nelson, Sara W; Nayabale, Irene; Adhikari, Srikar; Shah, Sachita P

2015-08-01

To describe the outcomes and curriculum components of an educational programme to train non-physician clinicians working in a rural, Ugandan emergency department in the use of POC ultrasound. The use of point-of-care ultrasound was taught to emergency care providers through lectures, bedsides teaching and hands-on practical sessions. Lectures were tailored to care providers' knowledge base and available therapeutic means. Every ultrasound examination performed by these providers was recorded over 4.5 years. Findings of these examinations were categorised as positive, negative, indeterminate or procedural. Other radiologic studies ordered over this same time period were also recorded. A total of 22,639 patients were evaluated in the emergency department by emergency care providers, and 2185 point-of-care ultrasound examinations were performed on 1886 patients. Most commonly used were the focused assessment with sonography in trauma examination (53.3%) and echocardiography (16.4%). Point-of-care ultrasound studies were performed more frequently than radiology department-performed studies. Positive findings were documented in 46% of all examinations. We describe a novel curriculum for point-of-care ultrasound education of non-physician emergency practitioners in a resource-limited setting. These non-physician clinicians integrated ultrasound into clinical practice and utilised this imaging modality more frequently than traditional radiology department imaging with a large proportion of positive findings. © 2015 John Wiley & Sons Ltd.

Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use.

PubMed

Vandenberg, Ann E; Vaughan, Camille P; Stevens, Melissa; Hastings, Susan N; Powers, James; Markland, Alayne; Hwang, Ula; Hung, William; Echt, Katharina V

2017-02-01

Clinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers. Existing prescribing order entry processes were mapped at an initial Veterans Administration Medical Center site, demonstrating cognitive burden, effort and safety concerns. Geriatric order sets incorporating 2012 Beers guidelines and including geriatric prescribing advice and prepopulated order options were developed. Geriatric order sets were implemented at two sites as part of the multicomponent 'Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department' quality improvement initiative. Facilitators and barriers to order sets use at the two sites were evaluated. Phone interviews were conducted with two provider groups (n = 20), those 'EQUiPPED' with the interventions (n = 10, 5 at each site) and Comparison providers who were only exposed to order sets through a clickable option on the ED order menu within the patient's medical record (n = 10, 5 at each site). All providers were asked about order set 'use' and 'usefulness'. Users (n = 11) were asked about 'usability'. Order set adopters described 'usefulness' in terms of 'safety' and 'efficiency', whereas order set consultants and order set non-users described 'usefulness' in terms of 'information' or 'training'. Provider 'autonomy', 'comfort' level with existing tools, and 'learning curve' were stated as barriers to use. Quantifying efficiency advantages and communicating safety benefit over preexisting practices and tools may improve adoption of CDS in ED and in other settings of care. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Occupational therapy practice in emergency care: Occupational therapists' perspectives.

PubMed

Spang, Lisa; Holmqvist, Kajsa

2015-01-01

Emergency care takes place in a complex work environment that is characterized by critically ill patients, short hospital stays, and a wide variety of different healthcare professionals. Studies of occupational therapists' (OTs) experiences of working within emergency care have shown that they often experience difficulties in explaining the essence of occupational therapy and have to justify their approaches. Much effort has been made in Sweden to help OTs dispel the notion that occupational therapy is difficult to explain, and the aim of this study was to describe how Swedish OTs perceive their work in emergency care. A qualitative descriptive approach was taken, and 14 interviews were conducted with OTs working in emergency care. Qualitative content analysis was used to analyse the data. The overall theme that emerged was "Feeling established through deliberate occupation-based work". The underlying categories showed different strategies used by the OTs to provide occupational therapy in an emergency care context. Deliberate strategies were used to demonstrate the effectiveness of occupational therapy and its approaches to patients and other health care professionals, and this resulted in the OTs feeling both established and needed. Unlike the OTs in previous studies, the Swedish OTs experienced no difficulties in explaining occupational therapy and could make convincing arguments for their interventions. Parallel to their clinical work, the OTs worked with on-going development to find ways to improve their approaches. In summary, these Swedish OTs seem to have been provided with a professional language and the knowledge required to establish themselves in an emergency care setting.

The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care.

PubMed

Dvorak, Jiri; Kramer, Efraim B; Schmied, Christian M; Drezner, Jonathan A; Zideman, David; Patricios, Jon; Correia, Luis; Pedrinelli, André; Mandelbaum, Bert

2013-12-01

Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.

Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association.

PubMed

Amsterdam, Ezra A; Kirk, J Douglas; Bluemke, David A; Diercks, Deborah; Farkouh, Michael E; Garvey, J Lee; Kontos, Michael C; McCord, James; Miller, Todd D; Morise, Anthony; Newby, L Kristin; Ruberg, Frederick L; Scordo, Kristine Anne; Thompson, Paul D

2010-10-26

The management of low-risk patients presenting to emergency departments is a common and challenging clinical problem entailing 8 million emergency department visits annually. Although a majority of these patients do not have a life-threatening condition, the clinician must distinguish between those who require urgent treatment of a serious problem and those with more benign entities who do not require admission. Inadvertent discharge of patients with acute coronary syndrome from the emergency department is associated with increased mortality and liability, whereas inappropriate admission of patients without serious disease is neither indicated nor cost-effective. Clinical judgment and basic clinical tools (history, physical examination, and electrocardiogram) remain primary in meeting this challenge and affording early identification of low-risk patients with chest pain. Additionally, established and newer diagnostic methods have extended clinicians' diagnostic capacity in this setting. Low-risk patients presenting with chest pain are increasingly managed in chest pain units in which accelerated diagnostic protocols are performed, comprising serial electrocardiograms and cardiac injury markers to exclude acute coronary syndrome. Patients with negative findings usually complete the accelerated diagnostic protocol with a confirmatory test to exclude ischemia. This is typically an exercise treadmill test or a cardiac imaging study if the exercise treadmill test is not applicable. Rest myocardial perfusion imaging has assumed an important role in this setting. Computed tomography coronary angiography has also shown promise in this setting. A negative accelerated diagnostic protocol evaluation allows discharge, whereas patients with positive findings are admitted. This approach has been found to be safe, accurate, and cost-effective in low-risk patients presenting with chest pain.

Resuscitation and Obstetrical Care to Reduce Intrapartum-Related Neonatal Deaths: A MANDATE Study.

PubMed

Kamath-Rayne, Beena D; Griffin, Jennifer B; Moran, Katelin; Jones, Bonnie; Downs, Allan; McClure, Elizabeth M; Goldenberg, Robert L; Rouse, Doris; Jobe, Alan H

2015-08-01

To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.

Using quantitative wastewater analysis to measure daily usage of conventional and emerging illicit drugs at an annual music festival.

PubMed

Lai, Foon Yin; Thai, Phong K; O'Brien, Jake; Gartner, Coral; Bruno, Raimondo; Kele, Benjamin; Ort, Christoph; Prichard, Jeremy; Kirkbride, Paul; Hall, Wayne; Carter, Steve; Mueller, Jochen F

2013-11-01

Wastewater analysis provides a non-intrusive way of measuring drug use within a population. We used this approach to determine daily use of conventional illicit drugs [cannabis, cocaine, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA)] and emerging illicit psychostimulants (benzylpiperazine, mephedrone and methylone) in two consecutive years (2010 and 2011) at an annual music festival. Daily composite wastewater samples, representative of the festival, were collected from the on-site wastewater treatment plant and analysed for drug metabolites. Data over 2 years were compared using Wilcoxon matched-pair test. Data from 2010 festival were compared with data collected at the same time from a nearby urban community using equivalent methods. Conventional illicit drugs were detected in all samples whereas emerging illicit psychostimulants were found only on specific days. The estimated per capita consumption of MDMA, cocaine and cannabis was similar between the two festival years. Statistically significant (P < 0.05; Z = -2.0-2.2) decreases were observed in use of methamphetamine and one emerging illicit psychostimulant (benzyl piperazine). Only consumption of MDMA was elevated at the festival compared with the nearby urban community. Rates of substance use at this festival remained relatively consistent over two monitoring years. Compared with the urban community, drug use among festival goers was only elevated for MDMA, confirming its popularity in music settings. Our study demonstrated that wastewater analysis can objectively capture changes in substance use at a music setting without raising major ethical issues. It would potentially allow effective assessments of drug prevention strategies in such settings in the future. © 2013 Australasian Professional Society on Alcohol and other Drugs.

Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure?

PubMed

Jiménez Fuertes, Montiel; Costa Navarro, David

2012-05-01

Large-bowel obstruction and perforation are still frequently occurring entities for the acute care surgeon. In these cases, Hartmann's procedure is the most commonly used surgical technique. However, recent papers demonstrate that colon resection and primary anastomosis (RPA) in the emergency setting is a safe and feasible procedure. We present our series of left colon resection and primary anastomosis procedures from Torrevieja Hospital (Alicante, Spain), performed without bowel irrigation or a diverting ileostomy. Thirty-two RPA procedures were performed in emergency settings for perforation or obstruction, or both, during an 18-month period. The following data were prospectively collected: age, gender, nationality, diagnoses, ASA score, body mass index (BMI), POSSUM score (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity), and the score according to the Hinchey classification. Furthermore, duration of the operation, length of postoperative hospital stay, and mortality and morbidity data were recorded. Sixteen of these patients were diagnosed with acute diverticulitis, 14 patients with neoplasm (of which 9 cases had obstruction, 2 cases had perforation, and 3 cases had both), and foreign body perforation in the remaining 2 cases. The mean hospital stay was 7.8 (range, 4-10) days. The physiological POSSUM score was 24.4 (range, 15-39), and the surgical POSSUM score was 19.8 (range, 16-24). None of the patients died (0% mortality). Seven patients developed some kind of complication (21.9%), all of which were managed conservatively. The results of this study suggest that RPA for left colon obstruction and perforation in emergency settings can be safely performed in certain surgical conditions.

Medical emergencies in the dermatology office: incidence and options for crisis preparedness.

PubMed

Hazen, Paul G; Daoud, Shaza; Hazen, Brent P; Engstrom, Conley W; Turgeon, Karen L; Reep, Michael D; Tanphaichitr, Arthapol; Styron, Brandie T

2014-05-01

Medical emergencies may occur in any setting, including dermatology offices. We examined the incidence of medical emergencies in a survey of 34 dermatologists northeast Ohio. Fifty-five events occurred over 565 combined years of clinical practice, an incidence of 1 episode every 10.3 years. We also review options for better preparedness for medical emergencies in dermatology practices, ranging from an emergency action plan for emergency personnel, basic life support (BLS) certification, advanced cardiac life support (ACLS) certification, and on-site automatic electronic defibrillators (AEDs).

The training and support needs of faculty and students using a health information technology system were significant: a case study in a dental school.

PubMed

Hill, Heather K; Stewart, Denice C L; Ash, Joan S

2010-11-13

Health Information Technology Systems (HITS) are becoming more widely integrated into patient care in the dental school setting. The purpose of this study was to evaluate the impact of a chairside HITS on users in the dental school setting. Qualitative techniques, including interviews, focus groups and observations, were used. Using grounded theory, we saw 9 themes emerge. One theme of particular interest was that "training and support needs of end-users were significant." This paper explores this theme in detail and discusses the implications.

Self-study packets: an in-service strategy for today's emergency department.

PubMed

Macari, G H

1993-04-01

The self-study program has been a great success. Staff seized the opportunity for "hands-on," nonthreatening learning. The fear of asking questions and appearing less knowledgeable than peers in a group setting is removed, and new employees are grateful for the rapid accessibility of concise reference material. Everyone enjoys the freedom of fitting the in-service program into a routine day, rather than trying to adapt to a set time. Last, but not least, management reaps to the benefit of a program that satisfies the expectations of regulatory agencies and is virtually cost-free.

Increasing access to emergency contraception through online prescription requests.

PubMed

Averbach, Sarah; Wendt, Jacqueline Moro; Levine, Deborah K; Philip, Susan S; Klausner, Jeffrey D

2010-01-01

To describe a pilot program, Plan B Online Prescription Access, to provide easy access to prescriptions for emergency contraception via the Internet. We measured electronic prescriptions for Plan B (Duramed Pharmaceuticals, Cincinnati, Ohio) by month over time. Pharmacists faxed patient-generated prescriptions back to the Department of Public Health for confirmation. Despite no marketing, within the first 18 months of the program, 152 electronic prescriptions for Plan B were requested by 128 female San Francisco residents. Seventy-eight prescriptions were filled (51%) by pharmacists. If correctly marketed, online prescriptions for Plan B have the potential to be an effective means of increasing emergency contraception access in both urban and rural settings across the United States. Further user-acceptability studies are warranted.

Understanding the role of physician attire on patient perceptions: a systematic review of the literature— targeting attire to improve likelihood of rapport (TAILOR) investigators

PubMed Central

Petrilli, Christopher Michael; Mack, Megan; Petrilli, Jennifer Janowitz; Hickner, Andy; Saint, Sanjay; Chopra, Vineet

2015-01-01

Objectives Despite a growing body of literature, uncertainty regarding the influence of physician dress on patients’ perceptions exists. Therefore, we performed a systematic review to examine the influence of physician attire on patient perceptions including trust, satisfaction and confidence. Setting, participants, interventions and outcomes We searched MEDLINE, Embase, Biosis Previews and Conference Papers Index. Studies that: (1) involved participants ≥18 years of age; (2) evaluated physician attire; and (3) reported patient perceptions related to attire were included. Two authors determined study eligibility. Studies were categorised by country of origin, clinical discipline (eg, internal medicine, surgery), context (inpatient vs outpatient) and occurrence of a clinical encounter when soliciting opinions regarding attire. Studies were assessed using the Downs and Black Scale risk of bias scale. Owing to clinical and methodological heterogeneity, meta-analyses were not attempted. Results Of 1040 citations, 30 studies involving 11 533 patients met eligibility criteria. Included studies featured patients from 14 countries. General medicine, procedural (eg, general surgery and obstetrics), clinic, emergency departments and hospital settings were represented. Preferences or positive influence of physician attire on patient perceptions were reported in 21 of the 30 studies (70%). Formal attire and white coats with other attire not specified was preferred in 18 of 30 studies (60%). Preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs; four of five studies in intensive care and emergency settings also found no attire preference. Only 3 of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions. Conclusions Although patients often prefer formal physician attire, perceptions of attire are influenced by age, locale, setting and context of care. Policy-based interventions that target such factors appear necessary. PMID:25600254

Emergency Medical Technician-Ambulance: National Standard Curriculum. Instructor's Lesson Plans (Third Edition).

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This set of instructor's lesson plans is one of three documents prepared for the Emergency Medical Technician (EMT) National Standard Curriculum. It contains detailed outlines of course content and guidance for teaching each course lesson. The training course contains 33 lessons covering all emergency medical techniques currently considered to be…

Exploring a "Space" for Emergent Learning to Occur: Encouraging Creativity and Innovation in the Workplace

ERIC Educational Resources Information Center

Armson, Genevieve

2009-01-01

This research set out to explore perceptions about the concept of an emergent learning space within private organisations, as the current literature on learning does not adequately differentiate between organised learning and emergent learning. The research objectives explored the existence of, and perceived level of organisational encouragement…

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 5. CPR, Oxygen Therapy. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This student manual, the fifth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains two sections covering the following course content; cardiopulmonary resuscitation (CPR) (including artificial ventilation, foreign body obstructions, adjunctive equipment and special techniques, artificial…

A Simple Model to Teach Business Cycle Macroeconomics for Emerging Market and Developing Economies

ERIC Educational Resources Information Center

Duncan, Roberto

2015-01-01

The canonical neoclassical model is insufficient to understand business cycle fluctuations in emerging market and developing economies. The author reformulates the model proposed by Aguiar and Gopinath (2007) in a simple setting that can be used to teach business cycle macroeconomics for emerging market and developing economies at the…

46 CFR 169.815 - Emergency signals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Emergency signals. 169.815 Section 169.815 Shipping... Operations § 169.815 Emergency signals. (a) The station bill must set forth the various signals used for... vessels of 100 gross tons and over the following signals must be used. (1) The first alarm signal must be...

46 CFR 169.815 - Emergency signals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Emergency signals. 169.815 Section 169.815 Shipping... Operations § 169.815 Emergency signals. (a) The station bill must set forth the various signals used for... vessels of 100 gross tons and over the following signals must be used. (1) The first alarm signal must be...

46 CFR 169.815 - Emergency signals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Emergency signals. 169.815 Section 169.815 Shipping... Operations § 169.815 Emergency signals. (a) The station bill must set forth the various signals used for... vessels of 100 gross tons and over the following signals must be used. (1) The first alarm signal must be...

48 CFR 26.202-1 - Local area set-aside.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Local area set-aside. 26... SOCIOECONOMIC PROGRAMS OTHER SOCIOECONOMIC PROGRAMS Disaster or Emergency Assistance Activities 26.202-1 Local area set-aside. The contracting officer may set aside solicitations to allow only local firms within a...

Data collection tools for maternal and child health in humanitarian emergencies: a systematic review

PubMed Central

Dickinson, Fiona; Kerr, Robbie; Boschi-Pinto, Cynthia; Mathai, Matthews; van den Broek, Nynke

2015-01-01

Abstract Objective To describe tools used for the assessment of maternal and child health issues in humanitarian emergency settings. Methods We systematically searched MEDLINE, Web of Knowledge and POPLINE databases for studies published between January 2000 and June 2014. We also searched the websites of organizations active in humanitarian emergencies. We included studies reporting the development or use of data collection tools concerning the health of women and children in humanitarian emergencies. We used narrative synthesis to summarize the studies. Findings We identified 100 studies: 80 reported on conflict situations and 20 followed natural disasters. Most studies (76/100) focused on the health status of the affected population while 24 focused on the availability and coverage of health services. Of 17 different data collection tools identified, 14 focused on sexual and reproductive health, nine concerned maternal, newborn and child health and four were used to collect information on sexual or gender-based violence. Sixty-nine studies were done for monitoring and evaluation purposes, 18 for advocacy, seven for operational research and six for needs assessment. Conclusion Practical and effective means of data collection are needed to inform life-saving actions in humanitarian emergencies. There are a wide variety of tools available, not all of which have been used in the field. A simplified, standardized tool should be developed for assessment of health issues in the early stages of humanitarian emergencies. A cluster approach is recommended, in partnership with operational researchers and humanitarian agencies, coordinated by the World Health Organization. PMID:26478629

Age-related variation in primary care-type presentations to emergency departments.

PubMed

Freed, Gary; Gafforini, Sarah; Carson, Norman

2015-08-01

A significant amount of attention has been paid to the increase in emergency department (ED) presentations in Australia. Questions have arisen regarding whether all of those presenting to the ED are actually in need of true emergency services. Under-standing the characteristics of those patients who may be cared for in non-emergency settings is important for future health system strategies. The aim of this study was to identify age-related variation in primary care type emergency department (ED) presentations over time. A secondary analysis of data from the Victorian emergency minimum dataset (VEMD) between 2002-13 was conducted. The main outcomes were patterns of primary care type ED presentations for different ages groups over time, age-specific patterns of specific primary care type exclusion criteria and primary care type ED presentations by residents from aged care facilities. The proportion of triage category 4 or 5 ED presentations that met the criteria for a primary care type visit was greatest in the 0-4-year age group and tended to decrease as the age of the patient increased. Triage category 4 or 5 presentation by ambulance was uncommon in the younger age groups, surpassed 10% in the 50-54-year age group, and was >70% for those aged >90 years. The greater proportion of residential aged care facility patients who arrived by ambulance resulted in a much smaller proportion of primary care type visits. There are marked differences by age in the proportion of triage category 4 or 5 ED presentations that met the criteria for primary care type visits. These results indicate it was primarily younger patients who presented to the ED with non-urgent conditions. Most might be able to safely receive care in a primary care setting.

Establishment of ultrasound as a diagnostic aid in the referral of patients with abdominal pain in an emergency department – a pilot study

PubMed Central

Poulsen, Liv la Cour; Bækgaard, Emilie Stokholm; Istre, Per Grosen; Schmidt, Thomas Andersen; Larsen, Torben

2015-01-01

Purpose Ultrasonography is a noninvasive, cheap, and fast way of assessing abdominal pain in an emergency department. Many physicians working in emergency departments do not have pre-existing ultrasound experience. The purpose of this study was to investigate the ability of first-year internship doctors to perform a reliable ultrasound examination on patients with abdominal pain in an emergency setting. Materials and methods This study took place in an emergency department in Denmark. Following a 1-day ultrasound introduction course, three doctors without prior ultrasound experience scanned 45 patients during a 2-month period. The applicability of the examinations was evaluated by subsequent control examination: computed tomography, operation, or ultrasound by a trained radiologist or gynecologist or, in cases where the patient was immediately discharged, by ultrasound image evaluation. Results In 14 out of 21 patients with a control examination, there was diagnostic agreement between the project ultrasound examination and the control. Image evaluation of all patients showed useful images of the gallbladder, kidneys, liver, abdominal aorta, and urinary bladder, but no useful images for either the pancreas or colon. Conclusion With only little formal training, it is possible for first-year internship doctors to correctly visualize some abdominal organs with ultrasonography. However, a longer study time frame, including more patients, and an ultrasound course specifically designed for the purpose of use in an emergency department, is needed to enhance the results. PMID:27147884

Emergency treatment of hypoglycaemia: a guideline and evidence review.

PubMed

Villani, M; de Courten, B; Zoungas, S

2017-09-01

To examine the current treatment guidelines for the emergency management of hypoglycaemia and the evidence underpinning recommendations. International diabetes agencies were searched for hypoglycaemia treatment guidelines. Guidelines were assessed using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument. An electronic database search was conducted for evidence regarding emergency treatment of hypoglycaemia in adults, and relevant articles were critically appraised. Of the international diabetes agencies, six sets of guidelines were deemed relevant and of sufficient detail for appraisal by AGREE II. The evidence search returned 2649 articles, of which 17 pertaining to the emergency management of hypoglycaemia were included. High-quality evidence for the management of hypoglycaemia was lacking, limiting treatment recommendations. In general, guidelines and studies were somewhat concordant and recommended 15-20 g of oral glucose or sucrose, repeated after 10-15 min for treatment of the responsive adult, and 10% intravenous dextrose or 1 mg intramuscular glucagon for treatment of the unresponsive adult. No evidence was found for other treatment approaches. Evidence for the emergency treatment of hypoglycaemia in adults is limited, is often low grade and mostly pre-dates contemporary management of diabetes. Guideline recommendations are limited by the lack of randomized trials. Further high-quality studies are required to inform the optimum management of this frequently occurring emergency condition. © 2017 Diabetes UK.

Analysis of good practice of public health Emergency Operations Centers.

PubMed

Xu, Min; Li, Shi-Xue

2015-08-01

To study the public health Emergency Operations Centers (EOCs)in the US, the European Union, the UK and Australia, and summarize the good practice for the improvement of National Health Emergency Response Command Center in Chinese National Health and Family Planning Commission. Literature review was conducted to explore the EOCs of selected countries. The study focused on EOC function, organizational structure, human resources and information management. The selected EOCs had the basic EOC functions of coordinating and commanding as well as the public health related functions such as monitoring the situation, risk assessment, and epidemiological briefings. The organizational structures of the EOCs were standardized, scalable and flexible. Incident Command System was the widely applied organizational structure with a strong preference. The EOCs were managed by a unit of emergency management during routine time and surge staff were engaged upon emergencies. The selected EOCs had clear information management framework including information collection, assessment and dissemination. The performance of National Health Emergency Response Command Center can be improved by learning from the good practice of the selected EOCs, including setting clear functions, standardizing the organizational structure, enhancing the human resource capacity and strengthening information management. Copyright © 2015 Hainan Medical College. Production and hosting by Elsevier B.V. All rights reserved.

How to teach emergency procedural skills in an outdoor environment using low-fidelity simulation.

PubMed

Saxon, Kathleen D; Kapadia, Alison P R; Juneja, Nadia S; Bassin, Benjamin S

2014-03-01

Teaching emergency procedural skills in a wilderness setting can be logistically challenging. To teach these skills as part of a wilderness medicine elective for medical students, we designed an outdoor simulation session with low-fidelity models. The session involved 6 stations in which procedural skills were taught using homemade low-fidelity simulators. At each station, the students encountered a "victim," who required an emergency procedure that was performed using the low-fidelity model. The models are easy and inexpensive to construct, and their design and implementation in the session is described here. Using low-fidelity simulation models in an outdoor setting is an effective teaching tool for emergency wilderness medicine procedures and can easily be reproduced in future wilderness medicine courses. © 2014 Wilderness Medical Society Published by Wilderness Medical Society All rights reserved.

A Survey over the Dentists’ and Endodntists’ Approaches towards the Management of Endodontic Emergencies in Mashhad, Iran

PubMed Central

Bidar, Maryam; Gharechahi, Maryam; Soleimani, Tayebeh; Eslami, Neda

2015-01-01

Introduction: Pain or swelling caused by various stages of inflammation/infection of the pulp/periradicular area is among endodontic emergencies. Determining the most effective method of emergency treatment is a challenging issue in endodontics. The goal of this study was to determine and compare the level of knowledge in general dentists and endodontists about endodontic emergency treatment plan in Mashhad, Iran in 2012-2013. Methods and Materials: In this cross-sectional descriptive study, 152 questionnaires were distributed among 120 general dentists and 32 endodontists of Mashhad. The questionnaire contained two separate parts. The first part included demographic information and in the second part different treatment protocols were suggested for 12 various conditions of pulp/periapical emergencies, and the participants were asked to choose the correct option(s). To determine the relationship between qualitative variables, the chi-square analysis was used. The level of significance was set at 0.05. Results: There were significant differences between treatment plans presented by general dentists and endodontists about endodontic emergencies, especially in cases of necrotic pulp and subsequent swelling. Conclusion: Level of knowledge of dentists about the indications of incision and drainage, intra-canal medicament, root filing beyond the apical foramen and antibiotic prescription was not enough. These findings highlight the importance of refreshing courses for general dentists to improve their competency in the management of endodontic emergencies. PMID:26523142

A Survey over the Dentists' and Endodntists' Approaches towards the Management of Endodontic Emergencies in Mashhad, Iran.

PubMed

Bidar, Maryam; Gharechahi, Maryam; Soleimani, Tayebeh; Eslami, Neda

2015-01-01

Pain or swelling caused by various stages of inflammation/infection of the pulp/periradicular area is among endodontic emergencies. Determining the most effective method of emergency treatment is a challenging issue in endodontics. The goal of this study was to determine and compare the level of knowledge in general dentists and endodontists about endodontic emergency treatment plan in Mashhad, Iran in 2012-2013. In this cross-sectional descriptive study, 152 questionnaires were distributed among 120 general dentists and 32 endodontists of Mashhad. The questionnaire contained two separate parts. The first part included demographic information and in the second part different treatment protocols were suggested for 12 various conditions of pulp/periapical emergencies, and the participants were asked to choose the correct option(s). To determine the relationship between qualitative variables, the chi-square analysis was used. The level of significance was set at 0.05. There were significant differences between treatment plans presented by general dentists and endodontists about endodontic emergencies, especially in cases of necrotic pulp and subsequent swelling. Level of knowledge of dentists about the indications of incision and drainage, intra-canal medicament, root filing beyond the apical foramen and antibiotic prescription was not enough. These findings highlight the importance of refreshing courses for general dentists to improve their competency in the management of endodontic emergencies.

Approaches to Identifying the Emerging Innovative Water Technology Industry in the United States.

PubMed

Wood, Allison R; Harten, Teresa; Gutierrez, Sally C

2018-04-25

Clean water is vital to sustaining our natural environment, human health, and our economy. As infrastructure continues to deteriorate and water resources become increasingly threatened, new technologies will be needed to ensure safe and sustainable water in the future. Though the US water industry accounts for approximately 1% gross domestic product and regional "clusters" for water technology exist throughout the country, this emerging industry has not been captured by recent studies. As use of the term "cluster" becomes more prevalent, regional mapping efforts have revealed international differences in definition yet showcase this industry's economic impact. In reality, institutional processes may inhibit altering industry coding to better describe water technology. Forgoing the benefits of national economic tracking, alternative data sets are available, which may support new ways of identifying these clusters. This work provides cluster definitions; summarizes current approaches to identifying industry activity using data, interviews, and literature; and sets a foundation for future research.

Have infant gross motor abilities changed in 20 years? A re-evaluation of the Alberta Infant Motor Scale normative values

PubMed Central

Darrah, Johanna; Bartlett, Doreen; Maguire, Thomas O; Avison, William R; Lacaze-Masmonteil, Thierry

2014-01-01

Aim To compare the original normative data of the Alberta Infant Motor Scale (AIMS) (n=2202) collected 20 years ago with a contemporary sample of Canadian infants. Method This was a cross-sectional cohort study of 650 Canadian infants (338 males, 312 females; mean age 30.9wks [SD 15.5], range 2wks–18mo) assessed once on the AIMS. Assessments were stratified by age, and infants proportionally represented the ethnic diversity of Canada. Logistic regression was used to place AIMS items on an age scale representing the age at which 50% of the infants passed an item on the contemporary data set and the original data set. Forty-three items met the criterion for stable regression results in both data sets. Results The correlation coefficient between the age locations of items on the original and contemporary data sets was 0.99. The mean age difference between item locations was 0.7 weeks. Age values from the original data set when converted to the contemporary scale differed by less than 1 week. Interpretation The sequence and age at emergence of AIMS items has remained similar over 20 years and current normative values remain valid. Concern that the ‘back to sleep’ campaign has influenced the age at emergence of gross motor abilities is not supported. PMID:24684556

Riding Third: Social Work in Ambulance Work

ERIC Educational Resources Information Center

Campbell, Hilary; Rasmussen, Brian

2012-01-01

This research explored the possible role of social work alongside emergency ambulance services. An ethnographic study included semistructured interviews and direct observations collected over 300 hours while riding in ambulances in an urban setting. The data suggest that social work could play a role by providing needed psychosocial care during…

Adolescents' Experience with Workplace Aggression: School Health Implications

ERIC Educational Resources Information Center

Smith, Carolyn R.; Fisher, Bonnie S.; Gillespie, Gordon L.; Beery, Theresa A.; Gates, Donna M.

2013-01-01

Aggression exposure is a critical health issue facing adolescents in the United States. Exposure occurs in various settings including home, school, and the community. An emerging context for aggression exposure is in the workplace. Thirty adolescent employees age 16-18 participated in a qualitative study exploring proposed responses to future…

Cell wall composition and biomass recalcitrance differences within a set of Brachypodium distachyon inbred lines

USDA-ARS?s Scientific Manuscript database

Brachypodium distachyon (Brachypodium) has emerged as a useful model system for studying traits unique to graminaceous species, owing to its amenability to laboratory experimentation and the availability of extensive genetic and germplasm resources. We assessed the extent of natural variation for tr...

Making the Invisible Visible: A Methodological and a Substantive Issue

ERIC Educational Resources Information Center

Dagley, Valerie

2004-01-01

This article discusses the issue of "making the invisible visible" from a methodological and a substantive viewpoint. The ideas emerged from a doctoral research study into individual target setting with middle ability students in an English secondary school. The students involved had been identified by assessments as "average"…

Multi-Party, Whole-Body Interactions in Mathematical Activity

ERIC Educational Resources Information Center

Ma, Jasmine Y.

2017-01-01

This study interrogates the contributions of multi-party, whole-body interactions to students' collaboration and negotiation of mathematics ideas in a task setting called walking scale geometry, where bodies in interaction became complex resources for students' emerging goals in problem solving. Whole bodies took up overlapping roles representing…

None of the Above: Strategies for Inclusive Teaching with "Representative" Data

ERIC Educational Resources Information Center

Nowakowski, Alexandra C. H.; Sumerau, J. E.; Mathers, Lain A. B.

2016-01-01

This conversation explores emerging debates concerning teaching to and about marginalized populations often left out of "representative" data sets. Based on our experiences studying, teaching, and belonging to some of these unrepresented populations, we outline some strategies sociologists may use to transform the limitations of data…

Feminist Popular Education in Transnational Debates: Building Pedagogies of Possibility. Comparative Feminist Studies

ERIC Educational Resources Information Center

Manicom, Linzi, Ed.; Walters, Shirley, Ed.

2012-01-01

This book is a collection of grounded accounts by feminist popular educators reflecting critically on processes of collective learning and self- and social transformation in various geopolitical settings. Engaging contemporary feminist political issues and theory, contributors explore emerging pedagogical practices. This book contains the…

Leading Learning-Focused Teacher Leadership in Urban High Schools

ERIC Educational Resources Information Center

Portin, Bradley S.; Russell, Felice Atesoglu; Samuelson, Catherine; Knapp, Michael S.

2013-01-01

Drawing on findings from a national study of learning-focused leadership in challenging urban settings, this article examines the work of teacher leadership in urban high schools. In this context, a recently emerging cadre of nonsupervisory teacher leaders, working in collaboration with supervisory leaders, exercises a form of "distributed…

Perspectives on the "Silent Period" for Emergent Bilinguals in England

ERIC Educational Resources Information Center

Bligh, Caroline; Drury, Rose

2015-01-01

This article draws together the research findings from two ethnographic studies as a means to problematize the "silent period" as experienced by young bilingual learners in two English speaking early-years settings in England. Most teachers and senior early-years practitioners in England are monolingual English speakers. The children…

Robots as Language Learning Tools

ERIC Educational Resources Information Center

Collado, Ericka

2017-01-01

Robots are machines that resemble different forms, usually those of humans or animals, that can perform preprogrammed or autonomous tasks (Robot, n.d.). With the emergence of STEM programs, there has been a rise in the use of robots in educational settings. STEM programs are those where students study science, technology, engineering and…

En-Route Care Capability from Point of Injury Impacts Mortality after Severe Wartime Injury

DTIC Science & Technology

2013-02-01

tranexamic acid .5,6 The greatest proportion of com- bat deaths, however, continue to occur in the prehospital setting, with noncompressible torso...Morrison JJ, DuBose JJ, Rasmussen TE, et al. Military Application of Tranex- amic acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg

Video Making, Production Pedagogies, and Educational Policy

ERIC Educational Resources Information Center

Smythe, Suzanne; Toohey, Kelleen; Dagenais, Diane

2016-01-01

The promise of "21st century learning" is that digital technologies will transform traditional learning and mobilize skills deemed necessary in an emerging digital culture. In two case studies of video making, one in a Grade 4 classroom, and one in an adult literacy setting, the authors develop the concept of "production…

Emerging Action Research Traditions: Rigor in Practice

ERIC Educational Resources Information Center

Watkins, Karen E.; Nicolaides, Aliki; Marsick, Victoria J.

2016-01-01

The authors argue here that contemporary use of action research shares the exploratory, inductive nature of many qualitative research approaches--no matter the type of data collected--because the type of research problems studied are set in complex, dynamic, rapidly changing contexts and because action research is undertaken to support social and…

'In situ simulation' versus 'off site simulation' in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Unexpected obstetric emergencies threaten the safety of pregnant women. As emergencies are rare, they are difficult to learn. Therefore, simulation-based medical education (SBME) seems relevant. In non-systematic reviews on SBME, medical simulation has been suggested to be associated with improved learner outcomes. However, many questions on how SBME can be optimized remain unanswered. One unresolved issue is how 'in situ simulation' (ISS) versus 'off site simulation' (OSS) impact learning. ISS means simulation-based training in the actual patient care unit (in other words, the labor room and operating room). OSS means training in facilities away from the actual patient care unit, either at a simulation centre or in hospital rooms that have been set up for this purpose. Methods and design The objective of this randomized trial is to study the effect of ISS versus OSS on individual learning outcome, safety attitude, motivation, stress, and team performance amongst multi-professional obstetric-anesthesia teams. The trial is a single-centre randomized superiority trial including 100 participants. The inclusion criteria were health-care professionals employed at the department of obstetrics or anesthesia at Rigshospitalet, Copenhagen, who were working on shifts and gave written informed consent. Exclusion criteria were managers with staff responsibilities, and staff who were actively taking part in preparation of the trial. The same obstetric multi-professional training was conducted in the two simulation settings. The experimental group was exposed to training in the ISS setting, and the control group in the OSS setting. The primary outcome is the individual score on a knowledge test. Exploratory outcomes are individual scores on a safety attitudes questionnaire, a stress inventory, salivary cortisol levels, an intrinsic motivation inventory, results from a questionnaire evaluating perceptions of the simulation and suggested changes needed in the organization, a team-based score on video-assessed team performance and on selected clinical performance. Discussion The perspective is to provide new knowledge on contextual effects of different simulation settings. Trial registration ClincialTrials.gov NCT01792674. PMID:23870501

'In situ simulation' versus 'off site simulation' in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial.

PubMed

Sørensen, Jette Led; Van der Vleuten, Cees; Lindschou, Jane; Gluud, Christian; Østergaard, Doris; LeBlanc, Vicki; Johansen, Marianne; Ekelund, Kim; Albrechtsen, Charlotte Krebs; Pedersen, Berit Woetman; Kjærgaard, Hanne; Weikop, Pia; Ottesen, Bent

2013-07-17

Unexpected obstetric emergencies threaten the safety of pregnant women. As emergencies are rare, they are difficult to learn. Therefore, simulation-based medical education (SBME) seems relevant. In non-systematic reviews on SBME, medical simulation has been suggested to be associated with improved learner outcomes. However, many questions on how SBME can be optimized remain unanswered. One unresolved issue is how 'in situ simulation' (ISS) versus 'off site simulation' (OSS) impact learning. ISS means simulation-based training in the actual patient care unit (in other words, the labor room and operating room). OSS means training in facilities away from the actual patient care unit, either at a simulation centre or in hospital rooms that have been set up for this purpose. The objective of this randomized trial is to study the effect of ISS versus OSS on individual learning outcome, safety attitude, motivation, stress, and team performance amongst multi-professional obstetric-anesthesia teams.The trial is a single-centre randomized superiority trial including 100 participants. The inclusion criteria were health-care professionals employed at the department of obstetrics or anesthesia at Rigshospitalet, Copenhagen, who were working on shifts and gave written informed consent. Exclusion criteria were managers with staff responsibilities, and staff who were actively taking part in preparation of the trial. The same obstetric multi-professional training was conducted in the two simulation settings. The experimental group was exposed to training in the ISS setting, and the control group in the OSS setting. The primary outcome is the individual score on a knowledge test. Exploratory outcomes are individual scores on a safety attitudes questionnaire, a stress inventory, salivary cortisol levels, an intrinsic motivation inventory, results from a questionnaire evaluating perceptions of the simulation and suggested changes needed in the organization, a team-based score on video-assessed team performance and on selected clinical performance. The perspective is to provide new knowledge on contextual effects of different simulation settings. ClincialTrials.gov NCT01792674.

Responses of two understory herbs, Maianthemum canadense and Eurybia macrophylla, to experimental forest warming: early emergence is the key to enhanced reproductive output.

PubMed

Jacques, Marie-Hélène; Lapointe, Line; Rice, Karen; Montgomery, Rebecca A; Stefanski, Artur; Reich, Peter B

2015-10-01

Understory herbs might be the most sensitive plant form to global warming in deciduous forests, yet they have been little studied in the context of climate change. A field experiment set up in Minnesota, United States simulated global warming in a forest setting and provided the opportunity to study the responses of Maianthemum canadense and Eurybia macrophylla in their natural environment in interaction with other components of the ecosystem. Effects of +1.7° and +3.4°C treatments on growth, reproduction, phenology, and gas exchange were evaluated along with treatment effects on light, water, and nutrient availability, potential drivers of herb responses. Overall, growth and gas exchanges of these two species were modestly affected by warming. They emerged up to 16 (E. macrophylla) to 17 d (M. canadense) earlier in the heated plots than in control plots, supporting early-season carbon gain under high light conditions before canopy closure. This additional carbon gain in spring likely supported reproduction. Eurybia macrophylla only flowered in the heated plots, and both species had some aspect of reproduction that was highest in the +1.7°C treatment. The reduced reproductive effort in the +3.4°C plots was likely due to reduced soil water availability, counteracting positive effects of warming. Global warming might improve fitness of herbaceous species in deciduous forests, mainly by advancing their spring emergence. However, other impacts of global warming such as drier soils in the summer might partly reduce the carbon gain associated with early emergence. © 2015 Botanical Society of America.

Hospital treatment for fluid overload in the Medicare hemodialysis population.

PubMed

Arneson, Thomas J; Liu, Jiannong; Qiu, Yang; Gilbertson, David T; Foley, Robert N; Collins, Allan J

2010-06-01

Fluid overload in hemodialysis patients sometimes requires emergent dialysis, but the magnitude of this care has not been characterized. This study aimed to estimate the magnitude of fluid overload treatment episodes for the Medicare hemodialysis population in hospital settings, including emergency departments. Point-prevalent hemodialysis patients were identified from the Centers for Medicare and Medicaid Renal Management Information System and Standard Analytical Files. Fluid overload treatment episodes were defined by claims for care in inpatient, hospital observation, or emergency department settings with primary discharge diagnoses of fluid overload, heart failure, or pulmonary edema, and dialysis performed on the day of or after admission. Exclusion criteria included stays >5 days. Cost was defined as total Medicare allowable costs for identified episodes. Associations between patient characteristics and episode occurrence and cost were analyzed. For 25,291 patients (14.3%), 41,699 care episodes occurred over a mean follow-up time of 2 years: 86% inpatient, 9% emergency department, and 5% hospital observation. Heart failure was the primary diagnosis in 83% of episodes, fluid overload in 11%, and pulmonary edema in 6%. Characteristics associated with more frequent events included age <45 years, female sex, African-American race, causes of ESRD other than diabetes, dialysis duration of 1 to 3 years, fewer dialysis sessions per week at baseline, hospitalizations during baseline, and most comorbid conditions. Average cost was $6,372 per episode; total costs were approximately $266 million. Among U.S. hemodialysis patients, fluid overload treatment is common and expensive. Further study is necessary to identify prevention opportunities.

Suitability of current definitions of ambulatory care sensitive conditions for research in emergency department patients: a secondary health data analysis.

PubMed

Frick, Johann; Möckel, Martin; Muller, Reinhold; Searle, Julia; Somasundaram, Rajan; Slagman, Anna

2017-10-22

The aim of this study was to investigate the suitability of existing definitions of ambulatory care sensitive conditions (ACSC) in the setting of an emergency department (ED) by assessing ACSC prevalence in patients admitted to hospital after their ED stay. The secondary aim was to identify ACSC suitable for specific application in the ED setting. Observational clinical study with secondary health data. Two EDs of the Charité-Universitätsmedizin Berlin. All medical ED patients of the 'The Charité Emergency Medicine Study' (CHARITEM) study, who were admitted as inpatients during the 1-year study period (n=13 536). Prevalence of ACSC. Prevalence of ACSC in the study population differed significantly depending on the respective ACSC set used. Prevalence ranged between 19.1% (95% CI 18.4% to 19.8%; n=2586) using the definition by Albrecht et al and 36.6% (95% CI 35.8% to 37.5%; n=4960) using the definition of Naumann et al . (p<0.001). Overall ACSC prevalence (ie, when using all diagnoses used in any of the assessed ACSC-definitions) was 48.1% (95% CI 47.2% to 48.9%; n=6505). Some frequently observed diagnoses such as ' convulsion and epilepsy ' (prevalence: 3.4%, 95% CI 3.1% to 3.7%; n=455), ' diseases of the urinary system ' (prevalence: 1.4%; 95% CI 1.2% to 1.6%; n=191) or ' atrial fibrillation and flutter ' (prevalence: 1.0%, 95% CI 0.8% to 1.2%, n=134) are not included in all of the current ACSC definitions. The results highlight the need for an optimised, ED-specific ACSC definition. Particular ACSC diagnoses (such as ' convulsion and epilepsy ' or ' diseases of the urinary system ' and others) seem to be of special relevance in an ED population but are not included in all available ACSC definitions. Further research towards the development of a suitable and specific ACSC definition for research in the ED setting seems warranted. German Clinical Trials Register Deutsches Register für Klinische Studien: DRKS-ID: DRKS00000261. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Using a Delphi approach to develop a strategy for A&E in defence nursing.

PubMed

Kenward, Gary; Berry, Andy; Despres, Julian; McLeod, Judith

The Armed Forces has seen an increase in the number of operational deployments overseas and a greater demand for Accident and Emergency (A&E) trained nurses. This article describes a modified Delphi study used to contribute to the development of a strategy for emergency nursing in the Defence Nursing Services. Twenty-eight A&E specialists took part and the key issues raised were recruitment and retention, staff development, new roles, research priorities, increased internal recruitment of A&E nurses to meet operational demands, and the need for a structured career pathway to help retention. The most pressing areas requiring research were evaluation of the nurse practitioner role, clinical competencies and managing heat injuries in the operational setting. The modified Delphi study provided a valuable and detailed insight into the challenges and aspirations of the military A&E nursing cadre and has assisted in developing a strategy for emergency nursing.

Minor emergency clinic: key to the future of successful hospitals.

PubMed

Chawla, S; Kathawala, Y; Elmuti, D

1992-01-01

This project set out to determine whether there is a relationship between the minor emergency facility an individual uses and their choice of a hospital for in-patient care. In studying this relationship, the factors that are important to persons choosing a clinic or hospital facility, as well as the influence of a physician, were also identified. A structured, undisguised telephone survey was used for interviewing a randomly selected sample population of 189 San Angelo residents. Analysis of the survey data indicated that dependency does exist between minor emergency clinic use and the hospital chosen for in-patient care. The results of this study also suggested that hospitals' marketing strategy should shift the emphasis of their advertising from the hospital itself to their physician association and clinics. In addition, a number of other interesting observations concerning the relative importance of various medical factors to the participants was also explored.

Application of four-dimension criteria to assess rigour of qualitative research in emergency medicine.

PubMed

Forero, Roberto; Nahidi, Shizar; De Costa, Josephine; Mohsin, Mohammed; Fitzgerald, Gerry; Gibson, Nick; McCarthy, Sally; Aboagye-Sarfo, Patrick

2018-02-17

The main objective of this methodological manuscript was to illustrate the role of using qualitative research in emergency settings. We outline rigorous criteria applied to a qualitative study assessing perceptions and experiences of staff working in Australian emergency departments. We used an integrated mixed-methodology framework to identify different perspectives and experiences of emergency department staff during the implementation of a time target government policy. The qualitative study comprised interviews from 119 participants across 16 hospitals. The interviews were conducted in 2015-2016 and the data were managed using NVivo version 11. We conducted the analysis in three stages, namely: conceptual framework, comparison and contrast and hypothesis development. We concluded with the implementation of the four-dimension criteria (credibility, dependability, confirmability and transferability) to assess the robustness of the study, RESULTS: We adapted four-dimension criteria to assess the rigour of a large-scale qualitative research in the emergency department context. The criteria comprised strategies such as building the research team; preparing data collection guidelines; defining and obtaining adequate participation; reaching data saturation and ensuring high levels of consistency and inter-coder agreement. Based on the findings, the proposed framework satisfied the four-dimension criteria and generated potential qualitative research applications to emergency medicine research. We have added a methodological contribution to the ongoing debate about rigour in qualitative research which we hope will guide future studies in this topic in emergency care research. It also provided recommendations for conducting future mixed-methods studies. Future papers on this series will use the results from qualitative data and the empirical findings from longitudinal data linkage to further identify factors associated with ED performance; they will be reported separately.

Dose versus diagnosis: iatrogenic radiation exposure by multidetector computerised tomography in an academic emergency department with measurement of clinically actionable results and emergently treatable findings.

PubMed

Baskerville, J R; Chang, J H; Viator, M; Rutledge, W; Miryala, R; Duval, K E; Nishino, T K

2009-01-01

To determine the iatrogenic absorbed dosage of radiation of the patient in milligray (mGy) computerised tomography dose index volume (CTDIvol) when tested with multidetector computerised tomography (MDCT) in the emergency department (ED) setting and calculate the absorbed dosage of radiation per clinically actionable result and emergently treatable finding (ETF). The University of Texas Medical Branch (UTMB) ED located in Galveston, Texas, USA, is a level 1 trauma and tertiary referral centre treating 70,000 patients per annum. A retrospective cross-sectional data analysis of 770 emergency patients investigated by MDCT in July 2007. The presence of actionable results and ETF were determined by chart review. A total of 5320 emergency patients was treated in the UTMB ED in July 2007. This included 4508 medical and 812 trauma patients. A total of 1094 MDCT studies was performed, of which complete data were available on 1046. A total of 770 patients was investigated by MDCT, representing 14.47% of all emergency patients. This included 33.99% of trauma patients and 10.96% of medical patients. Actionable results were found in 341 studies and ETF in 105 studies. The mean radiation was 163.27 and 530.23 mGy CTDIvol for actionable results and ETF, respectively, for all studies. The mean radiation was 53.27 and 106.36 mGy CTDIvol for medical and trauma patients, respectively. The absorbed dosage of radiation of patients investigated by MDCT is clinically significant. The actionable results and ETF in our study demonstrate considerable opportunity for improvement in the utilisation of this technology by physicians.

Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease

PubMed Central

Chand, Manish; Siddiqui, Muhammed RS; Gupta, Ashish; Rasheed, Shahnawaz; Tekkis, Paris; Parvaiz, Amjad; Mirnezami, Alex H; Qureshi, Tahseen

2014-01-01

Laparoscopic surgery has become well established in the management of both and malignant colorectal disease. The last decade has seen increasing numbers of surgeons trained to a high standard in minimally-invasive surgery. However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery. There is a perception that emergent surgery is technically more difficult and may lead to worse outcomes. The present review aims to provide a comprehensive and critical appraisal of the available literature on the use of laparoscopic colorectal surgery (LCS) in the emergency setting. The literature is broadly divided by the underlying pathology; that is, inflammatory bowel disease, diverticulitis and malignant obstruction. There were no randomized trials and the majority of the studies were case-matched series or comparative studies. The overall trend was that LCS is associated with shorter hospital stay, par or fewer complications but an increased operating time.Emergency LCS can be safely undertaken for both benign and malignant disease providing there is appropriate patient selection, the surgeon is adequately experienced and there are sufficient resources to allow for a potentially more complex operation. PMID:25493008

Emergency contraception amongst female college students – knowledge, attitude and practice

PubMed Central

Nibabe, Wendwosen T.

2014-01-01

Background Unwanted teenage pregnancies have a notable detrimental impact on the learners’ trajectory and have been associated with jeopardising the students’ educational progress and future career prospects. These pregnancies are mostly unplanned and unintended and many are terminated, either legally or illegally. Aim The aim of this study was to explore the contributory role played by the knowledge, attitude and practices of female college students with respect to the utilisation of emergency contraceptives. Setting Three tertiary institutions in Dessie, Ethiopia. Methods Quantitative self-administered questionnaires were used to collect descriptive data from 352 female college students. Results The study revealed that there was a high percentage (78.3%) of unwanted pregnancies amongst those engaging in sex. Significantly, nearly half (43.3%) of these unwanted pregnancies resulted in abortion. Only 10% of the students sampled admitted to ever having used emergency contraception. Even though more than half (69.9%) of the students knew about emergency contraception, only 27% of them felt confident that they understood when it was most effective. Conclusion These and other observed findings confirm the need for improvement of female college students’ knowledge and timely utilisation of emergency contraception. PMID:26245395

Relationship between Bullying and Suicidal Behaviour in Youth presenting to the Emergency Department

PubMed Central

Alavi, Nazanin; Reshetukha, Taras; Prost, Eric; Antoniak, Kristen; Patel, Charmy; Sajid, Saad; Groll, Dianne

2017-01-01

Objective Increasing numbers of adolescents are visiting emergency departments with suicidal ideation. This study examines the relationship between bullying and suicidal ideation in emergency department settings. Method A chart review was conducted for all patients under 18 years of age presenting with a mental health complaint to the emergency departments at Kingston General or Hotel Dieu Hospitals in Kingston, Canada, between January 2011 and January 2015. Factors such as age, gender, history of abuse, history of bullying, type and time of bullying, and diagnoses were documented. Results 77% of the adolescents had experienced bullying, while 68.9% had suicide ideation at presentation. While controlling for age, gender, grade, psychiatric diagnosis, and abuse, a history of bullying was the most significant predictor of suicidal ideation. Individuals in this study who reported cyber bullying were 11.5 times more likely to have suicidal ideation documented on presentation, while individuals reporting verbal bullying were 8.4 times more likely. Conclusions The prevalence of bullying in adolescent patients presenting to emergency departments is high. The relationship found between suicidal ideation and bullying demonstrates that clinicians should ask questions about bullying as a risk factor for suicide ideation during the assessment of children and adolescents. PMID:28747929

Libraries as 'everyday' settings: the Glasgow MCISS project.

PubMed

Whitelaw, Sandy; Coburn, Jonathan; Lacey, Marion; McKee, Martin J; Hill, Carol

2017-10-01

A settings-based approach is now well-established in health promotion, initially undertaken in conventional places like schools and workplaces, but more recently being expressed in a wider range of what Torp et al. call 'everyday' settings. In this context, libraries have emerged as another potential setting whose ubiquity and accessibility suggests that they may be particularly effective in addressing health inequalities. Drawing on a case study-the Glasgow Macmillan Cancer Information and Support Services Library project-this paper reports on the potential for seeing 'libraries as settings' and in the context of a set of associated theoretical resources, specifically scrutinizes the nature of initiative implementation. Data were drawn from multiple sources: semi-structured interviews and focus groups with strategic partners and stakeholders, operational staff, project volunteers, service users and members of the general public. Qualitative data were complemented by quantitative insights from surveys with members of the partnership, libraries staff and volunteers. Despite some concerns associated with potentially hostile cultural and financial contexts that might threaten longer term sustainability, insights suggested that in pragmatic terms, the project was attracting sizable 'footfall' and successfully addressing a range of needs. Additionally, the formal implementation processes associated with project implementation were considered to have been highly successful in embedding the model into the library culture. In summary, there is evidence that libraries have the potential to be considered as supportive settings and could act as a model for an emergent vision of what libraries do. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Are prehospital airway management resources compatible with difficult airway algorithms? A nationwide cross-sectional study of helicopter emergency medical services in Japan.

PubMed

Ono, Yuko; Shinohara, Kazuaki; Goto, Aya; Yano, Tetsuhiro; Sato, Lubna; Miyazaki, Hiroyuki; Shimada, Jiro; Tase, Choichiro

2016-04-01

Immediate access to the equipment required for difficult airway management (DAM) is vital. However, in Japan, data are scarce regarding the availability of DAM resources in prehospital settings. The purpose of this study was to determine whether Japanese helicopter emergency medical services (HEMS) are adequately equipped to comply with the DAM algorithms of Japanese and American professional anesthesiology societies. This nationwide cross-sectional study was conducted in May 2015. Base hospitals of HEMS were mailed a questionnaire about their airway management equipment and back-up personnel. Outcome measures were (1) call for help, (2) supraglottic airway device (SGA) insertion, (3) verification of tube placement using capnometry, and (4) the establishment of surgical airways, all of which have been endorsed in various airway management guidelines. The criteria defining feasibility were the availability of (1) more than one physician, (2) SGA, (3) capnometry, and (4) a surgical airway device in the prehospital setting. Of the 45 HEMS base hospitals questioned, 42 (93.3 %) returned completed questionnaires. A surgical airway was practicable by all HEMS. However, in the prehospital setting, back-up assistance was available in 14.3 %, SGA in 16.7 %, and capnometry in 66.7 %. No HEMS was capable of all four steps. In Japan, compliance with standard airway management algorithms in prehospital settings remains difficult because of the limited availability of alternative ventilation equipment and back-up personnel. Prehospital health care providers need to consider the risks and benefits of performing endotracheal intubation in environments not conducive to the success of this procedure.

Development of balanced key performance indicators for emergency departments strategic dashboards following analytic hierarchical process.

PubMed

Safdari, Reza; Ghazisaeedi, Marjan; Mirzaee, Mahboobeh; Farzi, Jebrail; Goodini, Azadeh

2014-01-01

Dynamic reporting tools, such as dashboards, should be developed to measure emergency department (ED) performance. However, choosing an effective balanced set of performance measures and key performance indicators (KPIs) is a main challenge to accomplish this. The aim of this study was to develop a balanced set of KPIs for use in ED strategic dashboards following an analytic hierarchical process. The study was carried out in 2 phases: constructing ED performance measures based on balanced scorecard perspectives and incorporating them into analytic hierarchical process framework to select the final KPIs. The respondents placed most importance on ED internal processes perspective especially on measures related to timeliness and accessibility of care in ED. Some measures from financial, customer, and learning and growth perspectives were also selected as other top KPIs. Measures of care effectiveness and care safety were placed as the next priorities too. The respondents placed least importance on disease-/condition-specific "time to" measures. The methodology can be presented as a reference model for development of KPIs in various performance related areas based on a consistent and fair approach. Dashboards that are designed based on such a balanced set of KPIs will help to establish comprehensive performance measurements and fair benchmarks and comparisons.

Integrated Baseline System (IBS), Version 1.03. User guide: Chemical Stockpile Emergency Preparedness Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bailey, B.M.; Burford, M.J.; Downing, T.R.

The Integrated Baseline System (IBS), operated by the Federal Emergency Management Agency (FEMA), is a system of computerized tools for emergency planing and analysis. This document is the user guide for the IBS and explains how to operate the IBS system. The fundamental function of the IBS is to provide tools that civilian emergency management personnel can use in developing emergency plans and in supporting emergency management activities to cope with a chemical-releasing event at a military chemical stockpile. Emergency management planners can evaluate concepts and ideas using the IBS system. The results of that experience can then be factoredmore » into refining requirements and plans. This document provides information for the general system user, and is the primary reference for the system features of the IBS. It is designed for persons who are familiar with general emergency management concepts, operations, and vocabulary. Although the IBS manual set covers basic and advanced operations, it is not a complete reference document set. Emergency situation modeling software in the IBS is supported by additional technical documents. Some of the other LBS software is commercial software for which more complete documentation is available. The IBS manuals reference such documentation where necessary. IBS is a dynamic system. Its capabilities are in a state of continuing expansion and enhancement.« less

Nurse case management: negotiating care together within a developing relationship.

PubMed

Yamashita, Mineko; Forchuk, Cheryl; Mound, Bronwyn

2005-01-01

TOPIC/PROBLEM: The purpose of this study was to explicate the process of nurse case management involving clients afflicted with chronic mental illness. Grounded theory was the method of choice. Interviews were conducted with nurses in inpatient, transitional, and community settings in four cities in southern Ontario, Canada. Negotiating care together within a developing relationship emerged as the basic social process. "Building a trusting relationship" was identified as the foundation of case management. Salient differences were found between the three settings, yet the basic social process was consistent across settings. This underscores the therapeutic relationship as the basis for nurse psychiatric case management.

Application of quality improvement analytic methodology in emergency medicine research: A comparative evaluation.

PubMed

Harries, Bruce; Filiatrault, Lyne; Abu-Laban, Riyad B

2018-05-30

Quality improvement (QI) analytic methodology is rarely encountered in the emergency medicine literature. We sought to comparatively apply QI design and analysis techniques to an existing data set, and discuss these techniques as an alternative to standard research methodology for evaluating a change in a process of care. We used data from a previously published randomized controlled trial on triage-nurse initiated radiography using the Ottawa ankle rules (OAR). QI analytic tools were applied to the data set from this study and evaluated comparatively against the original standard research methodology. The original study concluded that triage nurse-initiated radiographs led to a statistically significant decrease in mean emergency department length of stay. Using QI analytic methodology, we applied control charts and interpreted the results using established methods that preserved the time sequence of the data. This analysis found a compelling signal of a positive treatment effect that would have been identified after the enrolment of 58% of the original study sample, and in the 6th month of this 11-month study. Our comparative analysis demonstrates some of the potential benefits of QI analytic methodology. We found that had this approach been used in the original study, insights regarding the benefits of nurse-initiated radiography using the OAR would have been achieved earlier, and thus potentially at a lower cost. In situations where the overarching aim is to accelerate implementation of practice improvement to benefit future patients, we believe that increased consideration should be given to the use of QI analytic methodology.

Measuring situation awareness in emergency settings: a systematic review of tools and outcomes

PubMed Central

Cooper, Simon; Porter, Joanne; Peach, Linda

2014-01-01

Background Nontechnical skills have an impact on health care outcomes and improve patient safety. Situation awareness is core with the view that an understanding of the environment will influence decision-making and performance. This paper reviews and describes indirect and direct measures of situation awareness applicable for emergency settings. Methods Electronic databases and search engines were searched from 1980 to 2010, including CINAHL, Ovid Medline, Pro-Quest, Cochrane, and the search engine, Google Scholar. Access strategies included keyword, author, and journal searches. Publications identified were assessed for relevance, and analyzed and synthesized using Oxford evidence levels and the Critical Appraisal Skills Programme guidelines in order to assess their quality and rigor. Results One hundred and thirteen papers were initially identified, and reduced to 55 following title and abstract review. The final selection included 14 papers drawn from the fields of emergency medicine, intensive care, anesthetics, and surgery. Ten of these discussed four general nontechnical skill measures (including situation awareness) and four incorporated the Situation Awareness Global Assessment Technique. Conclusion A range of direct and indirect techniques for measuring situation awareness is available. In the medical literature, indirect approaches are the most common, with situation awareness measured as part of a nontechnical skills assessment. In simulation-based studies, situation awareness in emergencies tends to be suboptimal, indicating the need for improved training techniques to enhance awareness and improve decision-making. PMID:27147872

Feasibility of energy medicine in a community teaching hospital: an exploratory case series.

PubMed

Dufresne, Francois; Simmons, Bonnie; Vlachostergios, Panagiotis J; Fleischner, Zachary; Joudeh, Ramsey; Blakeway, Jill; Julliard, Kell

2015-06-01

Energy medicine (EM) derives from the theory that a subtle biologic energy can be influenced for therapeutic effect. EM practitioners may be trained within a specific tradition or work solo. Few studies have investigated the feasibility of solo-practitioner EM in hospitals. This study investigated the feasibility of EM as provided by a solo practitioner in inpatient and emergent settings. Feasibility study, including a prospective case series. Inpatient units and emergency department. To investigate the feasibility of EM, acceptability, demand, implementation, and practicality were assessed. Short-term clinical changes were documented by treating physicians. Patients, employees, and family members were enrolled in the study only if study physicians expected no or slow improvement in specific symptoms. Those with secondary gains or who could not communicate perception of symptom change were excluded. EM was found to have acceptability and demand, and implementation was smooth because study procedures dovetailed with conventional clinical practice. Practicality was acceptable within the study but was low upon further application of EM because of cost of program administration. Twenty-four of 32 patients requested relief from pain. Of 50 reports of pain, 5 (10%) showed no improvement; 4 (8%), slight improvement; 3 (6%), moderate improvement; and 38 (76%), marked improvement. Twenty-one patients had issues other than pain. Of 29 non-pain-related problems, 3 (10%) showed no, 2 (7%) showed slight, 1 (4%) showed moderate, and 23 (79%) showed marked improvement. Changes during EM sessions were usually immediate. This study successfully implemented EM provided by a solo practitioner in inpatient and emergent hospital settings and found that acceptability and demand justified its presence. Most patients experienced marked, immediate improvement of symptoms associated with their chief complaint. Substantial practicality issues must be addressed to implement EM clinically in a hospital, however.

Reflective Teachers and Teacher Educators in the Pacific Region: Conversations with Us Not about Us

ERIC Educational Resources Information Center

Burnett, Greg; Lingam, Govinda Ishwar

2007-01-01

This article reports on a study of Pacific primary school teachers' and university lecturers' reflections on their involvement in the in-service Bachelor of Education degree programme offered at the regional University of the South Pacific (USP) in Fiji. Two rich sets of data have emerged from this study. Firstly, there are a number of critical…

Improving Homework Compliance in Career Counseling with a Behavioral Activation Functional Assessment Procedure: A Pilot Study

ERIC Educational Resources Information Center

Baruch, David E.; Kanter, Jonathan W.; Bowe, William M.; Pfennig, Sherri L.

2011-01-01

Behavioral activation has emerged as a widely used treatment for depression in a number of health care settings due to its concrete, straightforward emphasis on out-of-session client homework, but it lacks explicit guidelines for identifying and overcoming barriers that interfere with homework completion. The purpose of this pilot study was to…

Scenario studies as a synthetic and integrative research activity for Long-Term Ecological Research

Treesearch

Jonathan R. Thompson; Arnim Wiek; Frederick J. Swanson; Stephen R. Carpenter; Nancy Fresco; Teresa Hollingsworth; Thomas A. Spies; David R. Foster

2012-01-01

Scenario studies have emerged as a powerful approach for synthesizing diverse forms of research and for articulating and evaluating alternative socioecological futures. Unlike predictive modeling, scenarios do not attempt to forecast the precise or probable state of any variable at a given point in the future. Instead, comparisons among a set of contrasting scenarios...

Interaction in a Blended Environment for English Language Learning

ERIC Educational Resources Information Center

Romero Archila, Yuranny Marcela

2014-01-01

The purpose of this research was to identify the types of interaction that emerged not only in a Virtual Learning Environment (VLE) but also in face-to-face settings. The study also assessed the impact of the different kinds of interactions in terms of language learning. This is a qualitative case study that took place in a private Colombian…

Emerging from the bottleneck: Benefits of the comparative approach to modern neuroscience

PubMed Central

Brenowitz, Eliot A.; Zakon, Harold H.

2015-01-01

Neuroscience historically exploited a wide diversity of animal taxa. Recently, however, research focused increasingly on a few model species. This trend accelerated with the genetic revolution, as genomic sequences and genetic tools became available for a few species, which formed a bottleneck. This coalescence on a small set of model species comes with several costs often not considered, especially in the current drive to use mice explicitly as models for human diseases. Comparative studies of strategically chosen non-model species can complement model species research and yield more rigorous studies. As genetic sequences and tools become available for many more species, we are poised to emerge from the bottleneck and once again exploit the rich biological diversity offered by comparative studies. PMID:25800324

Design of a pulse oximeter for price sensitive emerging markets.

PubMed

Jones, Z; Woods, E; Nielson, D; Mahadevan, S V

2010-01-01

While the global market for medical devices is located primarily in developed countries, price sensitive emerging markets comprise an attractive, underserved segment in which products need a unique set of value propositions to be competitive. A pulse oximeter was designed expressly for emerging markets, and a novel feature set was implemented to reduce the cost of ownership and improve the usability of the device. Innovations included the ability of the device to generate its own electricity, a built in sensor which cuts down on operating costs, and a graphical, symbolic user interface. These features yield an average reduction of over 75% in the device cost of ownership versus comparable pulse oximeters already on the market.

Implementing resilience engineering for healthcare quality improvement using the CARE model: a feasibility study protocol.

PubMed

Anderson, J E; Ross, A J; Back, J; Duncan, M; Snell, P; Walsh, K; Jaye, P

2016-01-01

Resilience engineering (RE) is an emerging perspective on safety in complex adaptive systems that emphasises how outcomes emerge from the complexity of the clinical environment. Complexity creates the need for flexible adaptation to achieve outcomes. RE focuses on understanding the nature of adaptations, learning from success and increasing adaptive capacity. Although the philosophy is clear, progress in applying the ideas to quality improvement has been slow. The aim of this study is to test the feasibility of translating RE concepts into practical methods to improve quality by designing, implementing and evaluating interventions based on RE theory. The CARE model operationalises the key concepts and their relationships to guide the empirical investigation. The settings are the Emergency Department and the Older Person's Unit in a large London teaching hospital. Phases 1 and 2 of our work, leading to the development of interventions to improve the quality of care, are described in this paper. Ethical approval has been granted for these phases. Phase 1 will use ethnographic methods, including observation of work practices and interviews with staff, to understand adaptations and outcomes. The findings will be used to collaboratively design, with clinical staff in interactive design workshops, interventions to improve the quality of care. The evaluation phase will be designed and submitted for ethical approval when the outcomes of phases 1 and 2 are known. Study outcomes will be knowledge about the feasibility of applying RE to improve quality, the development of RE theory and a validated model of resilience in clinical work which can be used to guide other applications. Tools, methods and practical guidance for practitioners will also be produced, as well as specific knowledge of the potential effectiveness of the implemented interventions in emergency and older people's care. Further studies to test the application of RE at a larger scale will be required, including studies of other healthcare settings, organisational contexts and different interventions.

Understanding management and support for domestic violence and abuse within emergency departments: A systematic literature review from 2000-2015.

PubMed

Hinsliff-Smith, Kathryn; McGarry, Julie

2017-12-01

To identify, review and critically evaluate published empirical studies concerned with the prevalence, management and support for survivors of domestic violence and abuse who present at emergency department. Domestic violence and abuse is a global phenomenon with a wealth of studies that explore the different aspects of the issue including the economic, social and health effects on survivors and on society as a whole. Emergency department is widely recognised as one healthcare facility where domestic violence and abuse survivors will often disclose domestic violence and abuse. In the UK, National Institute of Clinical Excellence produced guidelines in 2014 requiring all sectors of health care and those they work alongside to recognise support and manage survivors of domestic violence and abuse. Whilst there is an increasing body of research on domestic violence and abuse, limited synthesised work has been conducted in the context of domestic violence and abuse within emergency department. This review encompasses empirical studies conducted in emergency department for screening interventions, management and support for domestic violence and abuse patients including prevalence. This review included studies that included emergency department staff, emergency department service users and domestic violence and abuse survivors. A systematic approach across five electronic bibliographic databases found 35 studies meeting the inclusion criteria published between 2000-2015. From the 35 studies, four descriptive overarching themes were identified (i) prevalence of domestic violence and abuse in emergency department, (ii) use of domestic violence and abuse screening tools and emergency department interventions, (iii) current obstacles for staff working in emergency department and (iv) emergency department users and survivor perspectives. Having knowledgeable and supportive emergency department staff can have a positive benefit for the longer-term health of the domestic violence and abuse survivor who seeks help. The physical characteristics of domestic violence and abuse are often easier to identify and manage, but emotional and psychological aspects of domestic violence and abuse are often more complex and difficult for staff to identify. This therefore raises questions as to what approaches can be used, within these busy settings, when often survivors do not want to disclose. Domestic violence and abuse has been shown to have a direct impact on the health and well-being of survivors who will often access emergency department services with direct injuries and associated medical conditions. This article is relevant to those working in the emergency department in raising awareness in a number of areas of practice for example the prevalence of male intimate partner violence survivors. Furthermore, patients do not always disclose domestic violence and abuse even in cases where there is clear sustained injury thus requiring staff to be vigilant to repeat attendees and patient history. This requires a well-maintained and effective reporting system for instances of suspected and disclosed domestic violence and abuse in order that staff can provide the appropriate care and support. Emergency department staff often deal with complex cases, this includes different aspects of domestic violence and abuse including physical, emotional and psychological abuse. Continual support and guidance, including educational interventions, would assist emergency department clinical staff to manage and discuss instances of domestic violence and abuse in their workplace and their interactions with domestic violence and abuse patients. Whilst training for emergency department staff is welcomed, there also needs to be a greater awareness of the potential complexity of domestic violence and abuse presentations beyond physical injury in order for staff to remain observant throughout consultations. It is also suggested that clear domestic violence and abuse assessment and referral mechanisms should be embedded into clinical practice, including emergency department, as described in the UK National Institute of Clinical Excellence guidelines (2014). Overall improvements in reporting mechanisms in emergency department for the identification, management and support for domestic violence and abuse survivors would add to the collective and growing body of evidence surrounding domestic violence and abuse and their presentations within healthcare settings. Such measures would enable those working in emergency department to support disclosure of domestic violence and abuse more effectively. © 2017 John Wiley & Sons Ltd.

The CO₂ GAP Project--CO₂ GAP as a prognostic tool in emergency departments.

PubMed

Shetty, Amith L; Lai, Kevin H; Byth, Karen

2010-12-01

To determine whether CO₂ GAP [(a-ET) PCO₂] value differs consistently in patients presenting with shortness of breath to the ED requiring ventilatory support. To determine a cut-off value of CO₂ GAP, which is consistently associated with measured outcome and to compare its performance against other derived variables. This prospective observational study was conducted in ED on a convenience sample of 412 from 759 patients who underwent concurrent arterial blood gas and ETCO₂ (end-tidal CO₂) measurement. They were randomized to test sample of 312 patients and validation set of 100 patients. The primary outcome of interest was the need for ventilatory support and secondary outcomes were admission to high dependency unit or death during stay in ED. The randomly selected training set was used to select cut-points for the possible predictors; that is, CO₂ GAP, CO₂ gradient, physiologic dead space and A-a gradient. The sensitivity, specificity and predictive values of these predictors were validated in the test set of 100 patients.   Analysis of the receiver operating characteristic curves revealed the CO₂ GAP performed significantly better than the arterial-alveolar gradient in patients requiring ventilator support (area under the curve 0.950 vs 0.726). A CO₂ GAP ≥10 was associated with assisted ventilation outcomes when applied to the validation test set (100% sensitivity 70% specificity). The CO₂ GAP [(a-ET) PCO₂] differs significantly in patients requiring assisted ventilation when presenting with shortness of breath to EDs and further research addressing the prognostic value of CO₂ GAP in this specific aspect is required. © 2010 The Authors. EMA © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Chronic substance use and self-harm in a primary health care setting.

PubMed

Breet, Elsie; Bantjes, Jason; Lewis, Ian

2018-06-19

Chronic substance use (CSU) is associated with health problems, including selfharm, placing a significant burden on health care resources and emergency departments (EDs). This is problematic in low- and middle-income countries like South Africa (SA), where primary care facilitates and emergency departments (EDs) are often poorly resourced. To investigate the epidemiology of CSU and self-harm and to consider the implications for primary health care service delivery and suicide prevention in SA. Data were collected from 238 consecutive self-harm patients treated at the emergency department (ED) of an urban hospital in SA. The data were analysed using bivariate and multivariate analyses. Approximately 37% of self-harm patients reported CSU. The patients in the CSU subgroup, compared to other self-harm patients, were more likely to be men (odds ratio[OR] = 8.33, 95% confidence interval [CI] = 3.19-20.9, p < 0.001), to have self-harmed by inflicting damage to their body tissue OR = 4.45, 95% CI = 1.77-11.2, p < 0.01) and to have a history of self-harm (OR = 3.71, 95% CI = 1.44-9.54, p = 0.007). A significantly smaller proportion of CSU patients, compared to other self-harm patients, were referred for psychiatric assessment (OR = 8.05, 95% CI = 4.16-15.7, p < 0.001). The findings of this study confirm that CSU is associated with greater service utilisation and repetition of self-harm among patients in primary health care settings. Treating self-harm as the presenting problem within primary care settings does not necessarily ensure that patients receive the care that they need. It might be helpful to include psychiatric assessments and screening for CSU as an integral component of care for self-harm patientswho present in primary health care settings.

Predictors of aggression in 3.322 patients with affective disorders and schizophrenia spectrum disorders evaluated in an emergency department setting.

PubMed

Blanco, Emily A; Duque, Laura M; Rachamallu, Vivekananda; Yuen, Eunice; Kane, John M; Gallego, Juan A

2018-05-01

The aim of this study is to determine odds of aggression and associated factors in patients with schizophrenia-spectrum disorders (SSD) and affective disorders who were evaluated in an emergency department setting. A retrospective study was conducted using de-identified data from electronic medical records from 3.322 patients who were evaluated at emergency psychiatric settings. Data extracted included demographic information, variables related to aggression towards people or property in the past 6months, and other factors that could potentially impact the risk of aggression, such as comorbid diagnoses, physical abuse and sexual abuse. Bivariate analyses and multivariate regression analyses were conducted to determine the variables significantly associated with aggression. An initial multivariate regression analysis showed that SSD had 3.1 times the odds of aggression, while bipolar disorder had 2.2 times the odds of aggression compared to unipolar depression. A second regression analysis including bipolar subtypes showed, using unipolar depression as the reference group, that bipolar disorder with a recent mixed episode had an odds ratio (OR) of 4.3, schizophrenia had an OR of 2.6 and bipolar disorder with a recent manic episode had an OR of 2.2. Generalized anxiety disorder was associated with lower odds in both regression analyses. As a whole, the SSD group had higher odds of aggression than the bipolar disorder group. However, after subdividing the groups, schizophrenia had higher odds of aggression than bipolar disorder with a recent manic episode and lower odds of aggression than bipolar disorder with a recent mixed episode. Copyright © 2017 Elsevier B.V. All rights reserved.

Is emergency right hemicolectomy still associated with significant morbidity and mortality rates? An institution's experience of 207 cases over 6 years.

PubMed

Tan, Ker-Kan; Liu, Jody Zhiyang; Yeow, Yuyi; Gunasekaran, Sivaraj; Tan, Jane Jye-Yng

2011-09-01

Emergency right hemicolectomy has been associated with dismal outcome. But, data in Asians is lacking as pathologies that require emergency right hemicolectomy may differ from that in the Western population. The aims of our study were to review our institution's experience with emergency right hemicolectomies and to identify factors that could predict the per-operative outcome. A retrospective review of all patients who underwent emergency right hemicolectomy from August 2003 to April 2008 was performed. Emergency right hemicolectomy was defined as a right colectomy, comprising of an ileo-colic resection, in the emergency setting without the benefit of preoperative bowel preparation. All the complications were graded according to the classification proposed by Clavien and group. A total of 207 patients, median age 62 years (range, 19-94 years), underwent emergency right hemicolectomy during the study period. Neoplasia and complicated diverticular disease were the most common pathologies in 46.4% and 21.7%, respectively. Intestinal obstruction (44.4%) and perforation (26.6%) were the two main indications for surgical intervention in our series. Twenty (9.7%) patients died, and another 39 patients (18.8%) had severe complications. Eight (3.9%) patients had anastomotic dehiscence, while burst abdomen was seen in ten (4.8%) patients. The two independent factors associated with worse outcome were high ASA score and stoma creation. Factors such as age and site of perforation were not related. Emergency right hemicolectomy is associated with a significant morbidity and mortality rate. Patients with higher ASA score and who had stoma created fared worse.

Emergency Preparedness--The Role of the School Nurse. Position Statement

ERIC Educational Resources Information Center

Cagginello, Joan B.; Clark, Sandra; Compton, Linda; Davis, Catherine; Healy, Marilyn; Hoffmann, Susan; Tuck, Christine M.

2011-01-01

It is the position of the National Association of School Nurses (NASN) that school nurses provide leadership in all phases of emergency preparedness and management and are a vital part of the school team that develops emergency response procedures for the school setting, using an all-hazards approach. The school nurse is a vital school…

Bioterrorism and Emergency Preparedness in Aging (BTEPA): HRSA-Funded GEC Collaboration for Curricula and Training

ERIC Educational Resources Information Center

Johnson, Arleen; Roush, Robert E., Jr.; Howe, Judith L.; Sanders, Margaret; McBride, Melen R.; Sherman, Andrea; Palmisano, Barbara; Tumosa, Nina; Perweiler, Elyse A.; Weiss, Joan

2006-01-01

Frail elders living alone or in long-term care settings are particularly vulnerable to bioterrorism and other emergencies due to their complex physical, social and psychological needs. This paper provides an overview of the recent literature on bioterrorism and emergency preparedness in aging (BTEPA); discusses federal initiatives by the health…

A Standardized Method of Preventing and Managing Emergencies within the Context of Evidence-Based Therapy Implementation

ERIC Educational Resources Information Center

Urgelles, Jessica; Donohue, Brad; Wilks, Chelsey; Van Hasselt, Vincent B.; Azrin, Nathan H.

2012-01-01

Families served within child welfare settings evidence a wide range of emergencies or unexpected crises or circumstances that may lead to danger and make it difficult for them to focus on treatment planning. Mental health treatment providers are often unprepared to effectively manage emergencies during implementation of evidence-based prescribed…

Emergency obstetric simulation training: how do we know where we are going, if we don't know where we have been?

PubMed

Calvert, Katrina L; McGurgan, Paul M; Debenham, Edward M; Gratwick, Frances J; Maouris, Panos

2013-12-01

Obstetric emergencies contribute significantly to maternal morbidity and mortality. Current training in the management of obstetric emergencies in Australia and internationally focusses on utilising a multidisciplinary simulation-based model. Arguments for and against this type of training exist, using both economic and clinical reasoning. To identify the evidence base for the clinical impact of simulation training in obstetric emergencies and to address some of the concerns regarding appropriate delivery of obstetric emergency training in the Australian setting. A literature search was performed to identify research undertaken in the area of obstetric emergency training. The initial literature search using broad search terms identified 887 articles which were then reviewed and considered for inclusion if they provided original research with a specific emphasis on the impact of training on clinical outcomes. Ninety-two articles were identified, comprising evidence in the following clinical situations: eclampsia, shoulder dystocia, postpartum haemorrhage, maternal collapse, cord prolapse and teamwork training. Evidence exists for a benefit in knowledge or skills gained from simulation training and for the benefit of training in small units without access to high-fidelity equipment or facilities. Evidence exists for a positive impact of training in obstetric emergencies, although the majority of the available evidence applies to evaluation at the level of participants' confidence, knowledge or skills rather than at the level of impact on clinical outcomes. The model of simulation-based training is an appropriate one for the Australian setting and should be further utilised in rural and remote settings. © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 2. Equipment, Safe Driving Practices, Legal Aspects, Controlling the Situation, Action Evaluation Conference. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This student manual, the second in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains five sections that cover the following course content: ambulance equipment, safe driving practices for emergency vehicle drivers, legal aspects of the EMT's job, how to maintain control at an accident scene…

Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service.

PubMed

Pascual, Juan C; Córcoles, David; Castaño, Juan; Ginés, Jose M; Gurrea, Alfredo; Martín-Santos, Rocio; Garcia-Ribera, Carlos; Pérez, Victor; Bulbena, Antonio

2007-09-01

This study aimed to determine factors associated with hospitalization and decisions to prescribe psychotropic medication for patients with borderline personality disorder seeking care at psychiatric emergency units. A total of 11,578 consecutive visits were reviewed over a four-year period at a psychiatric emergency service in a tertiary hospital in Spain. Some patients were repeat visitors. Data collected included sociodemographic, clinical, social, and therapeutic information and the Severity of Psychiatric Illness (SPI) score. Borderline personality disorder was the diagnosis in 1,032 of the visits (9%) to the emergency department, which corresponded to 540 individuals. Of these visits, 11% required hospitalization. Multivariate statistical logistic regression analysis showed that the decision to hospitalize was associated with risk of suicide, danger to others, severity of symptoms, difficulty with self-care, and noncompliance with treatment. The decision to prescribe benzodiazepines was related to male sex, anxiety as the reason for seeking care, little difficulty with self-care, few medical or drug problems, and housing instability. Factors related to the prescription of antipsychotics were male sex, risk of endangering others, and psychosis as the reason for the visit. Factors associated with the prescription of antidepressants were depression as the reason for seeking help and little premorbid dysfunction. Patients with borderline personality disorder had greater clinical severity, but the percentage of hospitalizations was lower than for patients without the disorder. Although a psychiatric emergency service is not the ideal setting to initiate pharmacotherapy, in practice, psychiatrists often prescribe medications in this setting. The SPI was a good tool to assess the severity of illness of these patients.

A multi-method approach to curriculum development for in-service training in China's newly established health emergency response offices.

PubMed

Wang, Yadong; Li, Xiangrui; Yuan, Yiwen; Patel, Mahomed S

2014-01-01

To describe an innovative approach for developing and implementing an in-service curriculum in China for staff of the newly established health emergency response offices (HEROs), and that is generalisable to other settings. The multi-method training needs assessment included reviews of the competency domains needed to implement the International Health Regulations (2005) as well as China's policies and emergency regulations. The review, iterative interviews and workshops with experts in government, academia, the military, and with HERO staff were reviewed critically by an expert technical advisory panel. Over 1600 participants contributed to curriculum development. Of the 18 competency domains identified as essential for HERO staff, nine were developed into priority in-service training modules to be conducted over 2.5 weeks. Experts from academia and experienced practitioners prepared and delivered each module through lectures followed by interactive problem-solving exercises and desktop simulations to help trainees apply, experiment with, and consolidate newly acquired knowledge and skills. This study adds to the emerging literature on China's enduring efforts to strengthen its emergency response capabilities since the outbreak of SARS in 2003. The multi-method approach to curriculum development in partnership with senior policy-makers, researchers, and experienced practitioners can be applied in other settings to ensure training is responsive and customized to local needs, resources and priorities. Ongoing curriculum development should reflect international standards and be coupled with the development of appropriate performance support systems at the workplace for motivating staff to apply their newly acquired knowledge and skills effectively and creatively.

Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur.

PubMed

Souza, Renato; Yasuda, Silvia; Cristofani, Susanna

2009-07-21

There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Most patients were diagnosed with epilepsy (47%) and psychosis (31%) and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1-10.2) to 7.1 (95%CI 5.9-8.2) p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6-7.0) p < 0.0001. The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.

Systematic review of the economic value of diarrheal vaccines

PubMed Central

Rheingans, Richard; Amaya, Mirna; Anderson, John D; Chakraborty, Poulomy; Atem, Jacob

2014-01-01

Diarrheal disease is a leading cause of child mortality in low-income settings and morbidity across a range of settings. A growing number of studies have addressed the economic value of new and emerging vaccines to reduce this threat. We conducted a systematic review to assess the economic value of diarrheal vaccines targeting a range of pathogens in different settings. The majority of studies focused on the economic value of rotavirus vaccines in different settings, with most of these concluding that vaccination would provide significant economic benefits across a range of vaccine prices. There is also evidence of the economic benefits of cholera vaccines in specific contexts. For other potential diarrheal vaccines data are limited and often hypothetical. Across all target pathogens and contexts, the evidence of economic value focuses the short-term health and economic gains. Additional information is needed on the broader social and long-term economic value of diarrhea vaccines. PMID:24861846

Research on Group Decision-Making Mechanism of Internet Emergency Management

NASA Astrophysics Data System (ADS)

Xie, Kefan; Chen, Gang; Qian, Wu; Shi, Zhao

With the development of information technology, internet has become a popular term and internet emergency has an intensive influence on people's life. This article offers a short history of internet emergency management. It discusses the definition, characteristics, and factor of internet emergency management. A group decision-making mechanism of internet emergency is presented based on the discussion. The authors establish a so-called Rough Set Scenario Flow Graphs (RSSFG) of group decision-making mechanism of internet emergency management and make an empirical analysis based on the RSSFG approach. The experimental results confirm that this approach is effective in internet emergency decision-making.

Stressful incidents of physical violence against emergency nurses.

PubMed

Gillespie, Gordon Lee; Gates, Donna M; Berry, Peggy

2013-01-31

Physical violence against nurses has become an endemic problem affecting nurses in all settings. The purpose of this study was to describe acts of physical violence against emergency nurses perceived as stressful using a qualitative descriptive design with a national sample of emergency nurses. The guiding conceptual model for the study was the Ecological Occupational Health Model of Workplace Assault. Narrative accounts of physical violence were analyzed using a constant comparative analysis method. Key findings included risks related to employee, workplace, and aggressor factors, and descriptions of physical violence. Discussion of the study findings suggests that efforts to prevent violence and promote workplace safety need to focus on designing work environments that allow for the quick egress of employees, establishing and consistently enforcing policies aimed at violence prevention, and maintaining positive working relationships with security officers. While patients with mental health or substance use complaints are deemed most likely to commit physical violence, they are not the only patients to become violent. Risk reduction efforts should target all patients and visitors.

Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low-income countries: a cost-benefit study in Mozambique.

PubMed

Kayihura, Vicente; Osman, Nafissa Bique; Bugalho, Antonio; Bergström, Staffan

2003-07-01

There is a need to assess the cost-benefit of different models of antibiotic administration for the prevention of post cesarean infection, particularly in resource-scarce settings. Randomized, nonblinded comparative study of a single combined preoperative dose of gentamicin and metronidazole vs. a post cesarean scheme for infection prophylaxis. Pregnant women (n = 288) with indication for emergency cesarean section were randomly allotted to two groups. Group 1 (n = 143) received the single, combined dose of prophylactic antibiotics and group 2 (n = 145) received, over 7 days, the postoperative standard scheme of antibiotics followed in the department. Both groups were followed up during 7 days for detection of signs of wound infection, endometritis, peritonitis and urinary tract infection. Prevalence of postoperative infection, mean hospital stay and costs of antibiotics used. Women completing the study (n = 241) were distributed into group 1 (n = 116) and group 2 (n = 125). No significant difference was found neither in the prevalence of postoperative infection nor in the mean hospital stay. No death occurred. The cost of the single dose of prophylactic antibiotics was less than one-tenth of the cost of the standard postoperative scheme. In our setting, the administration of a single dose of 160 mg of gentamicin in combination with 500 mg of metronidazole before emergency cesarean section for prevention of infection is clinically equivalent to existing conventional week-long postoperative therapy, but at approximately one-tenth of the cost.

Reptile Critical Care and Common Emergencies.

PubMed

Music, Meera Kumar; Strunk, Anneliese

2016-05-01

Reptile emergencies are an important part of exotic animal critical care, both true emergencies and those perceived as emergencies by owners. The most common presentations for reptile emergencies are addressed here, with information on differential diagnoses, helpful diagnostics, and approach to treatment. In many cases, reptile emergencies are actually acute presentations originating from a chronic problem, and the treatment plan must include both clinical treatment and addressing husbandry and dietary deficiencies at home. Accurate owner expectations must be set in order to have owner compliance to long-term treatment plans. Copyright © 2016 Elsevier Inc. All rights reserved.

Emergency Manuals Improved Novice Physician Performance During Simulated ICU Emergencies

PubMed Central

Wang, Jacob; Stiegler, Marjorie P.; Nguyen, Dung; Rebel, Annette; Isaak, Robert S.

2017-01-01

Background Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU). Methods PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant. Results The participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group. Conclusions The use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase). PMID:29600255

Emergency Manuals Improved Novice Physician Performance During Simulated ICU Emergencies.

PubMed

Kazior, Michael R; Wang, Jacob; Stiegler, Marjorie P; Nguyen, Dung; Rebel, Annette; Isaak, Robert S

2017-01-01

Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU). PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant. The participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group. The use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase).

PAin SoluTions In the Emergency Setting (PASTIES); a protocol for two open-label randomised trials of patient-controlled analgesia (PCA) versus routine care in the emergency department

PubMed Central

Smith, Jason E; Rockett, Mark; Squire, Rosalyn; Hayward, Christopher J; Creanor, Siobhan; Ewings, Paul; Barton, Andy; Pritchard, Colin; Benger, Jonathan Richard

2013-01-01

Introduction Pain is the commonest reason that patients present to an emergency department (ED), but it is often not treated effectively. Patient controlled analgesia (PCA) is used in other hospital settings but there is little evidence to support its use in emergency patients. We describe two randomised trials aiming to compare PCA to nurse titrated analgesia (routine care) in adult patients who present to the ED requiring intravenous opioid analgesia for the treatment of moderate to severe pain and are subsequently admitted to hospital. Methods and analysis Two prospective multi-centre open-label randomised trials of PCA versus routine care in emergency department patients who require intravenous opioid analgesia followed by admission to hospital; one trial involving patients with traumatic musculoskeletal injuries and the second involving patients with non-traumatic abdominal pain. In each trial, 200 participants will be randomised to receive either routine care or PCA, and followed for the first 12 h of their hospital stay. The primary outcome measure is hourly pain score recorded by the participant using a visual analogue scale (VAS) over the 12 h study period, with the primary statistical analyses based on the area under the curve of these pain scores. Secondary outcomes include total opioid use, side effects, time spent asleep, patient satisfaction, length of hospital stay and incremental cost effectiveness ratio. Ethics and dissemination The study is approved by the South Central—Southampton A Research Ethics Committee (REC reference 11/SC/0151). Data collection will be completed by August 2013, with statistical analyses starting after all final data queries are resolved. Dissemination plans include presentations at local, national and international scientific meetings held by relevant Colleges and societies. Publications should be ready for submission during 2014. A lay summary of the results will be available to study participants on request, and disseminated via a publically accessible website. Registration details The study is registered with the European Clinical Trials Database (EudraCT Number: 2011-000194-31) and is on the ISCRTN register (ISRCTN25343280). PMID:23418302

Does Mental Status Impact Therapist and Patient Communication in Emergency Department Brief Interventions Addressing Alcohol Use?

PubMed Central

Borsari, Brian; Apodaca, Timothy R.; Yurasek, Ali; Monti, Peter M.

2016-01-01

Motivational interviewing (MI) is often incorporated into screening, brief intervention, and referral to treatment (SBIRT) interventions in critical care settings to address alcohol and other drug use. However, cognitive status has been linked to differential response to MI sessions in emergency department (ED) settings. The current study examined one possible explanation for this differential response: whether higher versus lower mental status impacts patient response to clinician statements during MI sessions conducted in an ED. Participants were 126 patients receiving an MI-based single-session alcohol brief intervention, and 13 therapists who provided treatment. Participants completed a mental status exam (MSE) as part of the screening process, and intervention sessions were audio-taped, and transcribed and coded using the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003). The MISC 2.0 coded therapist behaviors that are related to the use of motivational interviewing, and patient language reflecting movement toward (change talk) or away from (sustain talk) changing personal alcohol use. Overall, patients responded in a similar manner to therapist MI behaviors regardless of high versus low level of mental functioning at the time of the intervention. Group differences emerged on patient response to only three specific therapist skills: giving information, open questions, and complex reflection. Thus, the differential effects of SBIRT in critical care settings do not appear to be a result of differences in the therapist and patient communication process. PMID:28017179

Elucidating a Goal-Setting Continuum in Brain Injury Rehabilitation.

PubMed

Hunt, Anne W; Le Dorze, Guylaine; Trentham, Barry; Polatajko, Helene J; Dawson, Deirdre R

2015-08-01

For individuals with brain injury, active participation in goal setting is associated with better rehabilitation outcomes. However, clinicians report difficulty engaging these clients in goal setting due to perceived or real deficits (e.g., lack of awareness). We conducted a study using grounded theory methods to understand how clinicians from occupational therapy facilitate client engagement and manage challenges inherent in goal setting with this population. Through constant comparative analysis, a goal-setting continuum emerged. At one end of the continuum, therapists embrace client-determined goals and enable clients to decide their own goals. At the other, therapists accept preset organization-determined goals (e.g., "the goal is discharge") and pay little attention to client input. Although all participants aspired to embrace client-determined goal setting, most felt powerless to do so within perceived organizational constraints. Views of advocacy and empowerment help to explain our findings and inform more inclusive practice. © The Author(s) 2015.

The Imperial Paediatric Emergency Training Toolkit (IPETT) for use in paediatric emergency training: development and evaluation of feasibility and validity.

PubMed

Lambden, Simon; DeMunter, Claudine; Dowson, Anne; Cooper, Mehrengise; Gautama, Sanjay; Sevdalis, Nick

2013-06-01

To develop and test the feasibility, reliability, and validity of a practical toolkit for the assessment and feedback of skills required to manage paediatric emergencies in critical care settings. The Imperial Paediatric Emergency Training Toolkit (IPETT) was developed based on current evidence-base and expert input. IPETT assesses both technical and non-technical skills. The technical component covers skills in the areas of clinical assessment, airway and breathing, cardiovascular, and drugs. The non-technical component is based on the validated NOTECHS tool and covers communication and interaction, cooperation and team skills, leadership and managerial skills, and decision-making. The reliability (internal consistency), content validity (inter-correlations between different skills) and concurrent validity (correlations between global technical and non-technical scores) of IPETT were prospectively evaluated in 45 simulated paediatric crises carried out in a PICU with anaesthetic and paediatric trainees (N=52). Non-parametric analyses were carried out. Significance was set at P<0.05. Cronbach alpha reliability coefficients were overall acceptable for the technical (alpha range=0.638-0.810) and good for the non-technical (alpha range=0.701-0.899) component of IPETT. The median inter-skill correlation was rho=0.564 and rho=0.549 for the technical and non-technical components, respectively. These indicate good content validity, as the skills were inter-related but not redundant. We also demonstrate a correlation between the global technical and non-technical scores (rho=0.471) - all Ps<0.05 during the assessments. IPETT offers a psychometrically viable and feasible to use tool in the context of paediatric emergencies training. This study shows that assessment of technical and non-technical skills in combination may offer a more clinically relevant model for training in paediatric emergencies. Further validation should aim to demonstrate skill retention over time and skill transfer from simulation-based training to real emergencies. Copyright © 2013. Published by Elsevier Ireland Ltd.

49 CFR 229.206 - Design requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-climber, emergency egress, emergency interior lighting, and interior configuration design requirements set... 49 Transportation 4 2010-10-01 2010-10-01 false Design requirements. 229.206 Section 229.206..., DEPARTMENT OF TRANSPORTATION RAILROAD LOCOMOTIVE SAFETY STANDARDS Locomotive Crashworthiness Design...

Safe Handling of Snakes in an ED Setting.

PubMed

Cockrell, Melanie; Swanson, Kristofer; Sanders, April; Prater, Samuel; von Wenckstern, Toni; Mick, JoAnn

2017-01-01

Efforts to improve consistency in management of snakes and venomous snake bites in the emergency department (ED) can improve patient and staff safety and outcomes, as well as improve surveillance data accuracy. The emergency department at a large academic medical center identified an opportunity to implement a standardized process for snake disposal and identification to reduce staff risk exposure to snake venom from snakes patients brought with them to the ED. A local snake consultation vendor and zoo Herpetologist assisted with development of a process for snake identification and disposal. All snakes have been identified and securely disposed of using the newly implemented process and no safety incidents have been reported. Other emergency department settings may consider developing a standardized process for snake disposal using listed specialized consultants combined with local resources and suppliers to promote employee and patient safety. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Containment of Ebola and Polio in Low-Resource Settings Using Principles and Practices of Emergency Operations Centers in Public Health.

PubMed

Shuaib, Faisal M; Musa, Philip F; Muhammad, Ado; Musa, Emmanuel; Nyanti, Sara; Mkanda, Pascal; Mahoney, Frank; Corkum, Melissa; Durojaiye, Modupeoluwa; Nganda, Gatei Wa; Sani, Samuel Usman; Dieng, Boubacar; Banda, Richard; Ali Pate, Muhammad

Emergency Operations Centers (EOCs) have been credited with driving the recent successes achieved in the Nigeria polio eradication program. EOC concept was also applied to the Ebola virus disease outbreak and is applicable to a range of other public health emergencies. This article outlines the structure and functionality of a typical EOC in addressing public health emergencies in low-resource settings. It ascribes the successful polio and Ebola responses in Nigeria to several factors including political commitment, population willingness to engage, accountability, and operational and strategic changes made by the effective use of an EOC and Incident Management System. In countries such as Nigeria where the central or federal government does not directly hold states accountable, the EOC provides a means to improve performance and use data to hold health workers accountable by using innovative technologies such as geographic position systems, dashboards, and scorecards.

Declarations on euthanasia and assisted dying

PubMed Central

Inbadas, Hamilton; Zaman, Shahaduz; Whitelaw, Sandy; Clark, David

2017-01-01

ABSTRACT Declarations on end-of-life issues are advocacy interventions that seek to influence policy, raise awareness and call others to action. Despite increasing prominence, they have attracted little attention from researchers. This study tracks the emergence, content, and purpose of declarations concerned with assisted dying and euthanasia, in the global context. The authors identified 62 assisted dying/euthanasia declarations covering 1974–2016 and analyzed them for originating organization, geographic scope, format, and stated viewpoint on assisted dying/euthanasia. The declarations emerged from diverse organizational settings and became more frequent over time. Most opposed assisted dying/euthanasia. PMID:28398131

Predicting film genres with implicit ideals.

PubMed

Olney, Andrew McGregor

2012-01-01

We present a new approach to defining film genre based on implicit ideals. When viewers rate the likability of a film, they indirectly express their ideal of what a film should be. Across six studies we investigate the category structure that emerges from likability ratings and the category structure that emerges from the features of film. We further compare these data-driven category structures with human annotated film genres. We conclude that film genres are structured more around ideals than around features of film. This finding lends experimental support to the notion that film genres are set of shifting, fuzzy, and highly contextualized psychological categories.

Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments.

PubMed

Schnitker, Linda M; Martin-Khan, Melinda; Burkett, Ellen; Brand, Caroline A; Beattie, Elizabeth R A; Jones, Richard N; Gray, Len C

2015-03-01

The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs). A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria. At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment. This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs. © 2015 by the Society for Academic Emergency Medicine.

English and More: A Multisite Study of Roles and Conceptualisations of Language in English Medium Multilingual Universities from Europe to Asia

ERIC Educational Resources Information Center

Baker, Will; Hüttner, Julia

2017-01-01

The rapid increase in English medium instruction (EMI) in higher education has resulted in the need for a greater evidence base documenting EMI in practice spanning a range of settings. Studies of EMI focusing on linguistic issues are beginning to emerge but there are few comparative studies looking at multiple sites, levels and stakeholders. In…

Relationship between ambient temperature and frequency and severity of cardiovascular emergencies: A prospective observational study based on out-of-hospital care data.

PubMed

Hensel, Mario; Stuhr, Markus; Geppert, Daniel; Kersten, Jan F; Lorenz, Jürgen; Kerner, Thoralf

2017-02-01

To test the hypothesis that more cardiovascular emergencies occur at low rather than at high temperatures under moderate climatic conditions. This was a prospective observational study performed in a prehospital setting. Data from the Emergency Medical Service in Hamburg (Germany) and from the local weather station were evaluated over a 5-year period. Temperature data were matched with the associated rescue mission data. Lowess-Regression analysis was performed to assess the relationship between the temperature and the frequency of individual cardiovascular emergencies. In addition, three threshold-temperatures (0°C, 10°C, 20°C) were defined in order to determine the frequency of cardiovascular emergencies above and below each cut-off value. The severity of emergencies was assessed using the National Advisory Committee for Aeronautics (NACA) scoring system. A total of 35,390 cardiovascular emergencies were treated by Emergency Physicians. Transient Loss of Consciousness increased at high temperatures (above 20°C): +43% (95%-CI: [27%; 59%]). In contrast, Coronary Artery Disease +26% (95%-CI: [17%; 34%]), Cardiac Pulmonary Edema +21% (95%-CI: [14%; 27%]), Hypertensive Urgency +18% (95%-CI: [10%; 25%]) and Cerebrovascular Accident +17% (95%-CI: [8%; 24%]) increased at low temperatures, particularly below 10°C (significance level for all: p<0.001). No temperature-related effect was seen in Cardiac Arrhythmia and Pulmonary Embolism and no significant correlation was found between the severity of emergencies and temperature. Our findings suggest that some cardiovascular emergencies such as Coronary Artery Disease, Cardiac Pulmonary Edema, Hypertensive Urgency and Cerebrovascular Accident are more frequent in low temperatures even under mild climatic conditions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Development, Description and Appraisal of an Emergent Multimethod Research Design to Study Workforce Changes in Integrated Care Interventions

PubMed Central

Luijkx, Katrien; Calciolari, Stefano; González-Ortiz, Laura G.

2017-01-01

Introduction: In this paper, we provide a detailed and explicit description of the processes and decisions underlying and shaping the emergent multimethod research design of our study on workforce changes in integrated chronic care. Theory and methods: The study was originally planned as mixed method research consisting of a preliminary literature review and quantitative check of these findings via a Delphi panel. However, when the findings of the literature review were not appropriate for quantitative confirmation, we chose to continue our qualitative exploration of the topic via qualitative questionnaires and secondary analysis of two best practice case reports. Results: The resulting research design is schematically described as an emergent and interactive multimethod design with multiphase combination timing. In doing so, we provide other researchers with a set of theory- and experience-based options to develop their own multimethod research and provide an example for more detailed and structured reporting of emergent designs. Conclusion and discussion: We argue that the terminology developed for the description of mixed methods designs should also be used for multimethod designs such as the one presented here. PMID:29042843

A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST).

PubMed

Babl, Franz E; Lyttle, Mark D; Bressan, Silvia; Borland, Meredith; Phillips, Natalie; Kochar, Amit; Dalziel, Stuart R; Dalton, Sarah; Cheek, John A; Furyk, Jeremy; Gilhotra, Yuri; Neutze, Jocelyn; Ward, Brenton; Donath, Susan; Jachno, Kim; Crowe, Louise; Williams, Amanda; Oakley, Ed

2014-06-13

Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting. This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The performance accuracy of each of the rules will be assessed using rule specific outcomes and inclusion and exclusion criteria. This study will allow the simultaneous comparative application and validation of three major paediatric head injury clinical decision rules outside their derivation setting. The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR)- ACTRN12614000463673 (registered 2 May 2014).

Comparison of the International Crowding Measure in Emergency Departments (ICMED) and the National Emergency Department Overcrowding Score (NEDOCS) to measure emergency department crowding: pilot study.

PubMed

Boyle, Adrian; Abel, Gary; Raut, Pramin; Austin, Richard; Dhakshinamoorthy, Vijayasankar; Ayyamuthu, Ravi; Murdoch, Iona; Burton, Joel

2016-05-01

There is uncertainty about the best way to measure emergency department crowding. We have previously developed a consensus-based measure of crowding, the International Crowding Measure in Emergency Departments (ICMED). We aimed to obtain pilot data to evaluate the ability of a shortened form of the ICMED, the sICMED, to predict senior emergency department clinicians' concerns about crowding and danger compared with a very well-studied measure of emergency department crowding, the National Emergency Department Overcrowding Score (NEDOCS). We collected real-time observations of the sICMED and NEDOCS and compared these with clinicians' perceptions of crowding and danger on a visual analogue scale. Data were collected in four emergency departments in the East of England. Associations were explored using simple regression, random intercept models and models accounting for correlation between adjacent time points. We conducted 82 h of observation in 10 observation sets. Naive modelling suggested strong associations between sICMED and NEDOCS and clinician perceptions of crowding and danger. Further modelling showed that, due to clustering, the association between sICMED and danger persisted, but the association between these two measures and perception of crowding was no longer statistically significant. Both sICMED and NEDOCS can be collected easily in a variety of English hospitals. Further studies are required but initial results suggest both scores may have potential use for assessing crowding variation at long timescales, but are less sensitive to hour-by-hour variation. Correlation in time is an important methodological consideration which, if ignored, may lead to erroneous conclusions. Future studies should account for such correlation in both design and analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Alternative Setting-Wide Positive Behavior Support

ERIC Educational Resources Information Center

Simonsen, Brandi; Jeffrey-Pearsall, Jennifer; Sugai, George; McCurdy, Barry

2011-01-01

School-wide positive behavior support (SWPBS) has an established evidence base in general education settings, and emerging evidence suggests that SWPBS may be effective in alternative settings (e.g., alternative, residential, or hospital schools; psychiatric hospitals). Given the intense educational and behavioral needs of students typically…