bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Current Cold Chain Management Equipment in Controlling the Temperature of Pharmaceutical Stores in an Australian Defence Force Exercise Environment
Authors: Daly Liz 
Published: May 2019

Aim:The purpose of this pilot study was to analyze the current cold chain storage methods of Class 8 stores, specifically thermolabile medications and temperature sensitive diagnostics, dressings, and fluids, for the Australian Army in a training area within Australia. This research was designed to identify deficiencies in current storage methods, including the inability to maintain the recommended storage temperature of pharmaceutical stores in accordance with the Therapeutic Goods Administration, as well as foster communication between key stakeholders, including the Royal Australian Army Medical Corps and the Department of Defence Joint Health Command, and to develop a cold chain protocol specific for the Australian Defence Force.Methods:This pilot study identified the common occurrence of breaches in a specific climate and recommends that current mission essential equipment be replaced. It also discusses the need for clearly defined guidelines with accountability of the stakeholders to ensure that the provision of health support to all Australian Defence Force personnel is in accordance with civilian standards.Results:This pilot study identified that the carried thermolabile medications and temperature sensitive diagnostics, dressings, and fluids were commonly exposed to temperatures outside the range recommended by the manufacturers. These findings related mainly to the storage equipment for Class 8 stores used by the Army. As a result, it is recommended that such equipment is replaced so that the cold chain storage meets the Therapeutic Goods Administration Guidelines to ensure that health support to Australian Defence Force Personnel in the field is in accordance with the standard of care expected at a civilian health facility.Discussion:This pilot study has enabled the Australian Defence Force to qualify and quantify the temperature exposure of the medications and stores and engage with key stakeholders to trial and apply new technologies and processes for the management of the cold chain.
The Efficacy of Blood Lactate on Predicting the Prognosis of Patients with Multiple Trauma
Authors: Hao Di 
Published: May 2019

Introduction:Because of the rapid progress of multiple trauma patients, the early mortality rate is high. Therefore, early assessment of the severity and prognosis of multiple injuries is crucial for timely treatment and improvement of prognosis. So we need to find parameters related to mortality and severity of multiple trauma.Aim:To find out parameters related to mortality and severity of multiple trauma.Methods:This was a single center, trauma registry based, observational cohort study. Data were collected from consecutive patients with multiple trauma who presented to the emergency department of a tertiary referral hospital between April 2015 and December 2016. The main outcomes studied were 28-day in-hospital mortality, 24-hours mortality, emergency operation rate, and ICU admission rate.Results:444 patients were eventually included in the study, including 337 males (75.9%) and 107 females (24.1%). The 28-day survival group consisted of 381 patients (85.8%) and the death group accounted for the other 14.2%. Multivariate logistic regression analysis showed that heart rate, peripheral oxygen saturation, lactic acid, partial pressure of carbon dioxide, plasma albumin, hematocrit, and Glasgow score were independent risk factors for 28-day mortality. The area under the ROC curve (AUC) of the above indicators was 0.669, 0.547, 0.868, 0.512, 0.740, 0.627, and 0.815, and the AUC value of lactate was the maximum.Discussion:When the body suffers from severe trauma, it loses a lot of blood and reduces the circulating blood volume, which leads to absolutely insufficient hemoglobin content and hypoxia of tissue cells. The plasma lactate content increases at this time. Therefore, lactate can be used as an important prognostic parameter for patients with multiple trauma. In addition, we can use lactate to revise the existing trauma score to enhance its effectiveness.
Establishment of Research Model on the Correlation Between Psychological Stress Intensity and Personality in Nursing Students Under Different Pressure Sources
Authors: lei xu , Xiwen Liu 
Published: May 2019

Introduction:In recent years, sudden disasters are occurring frequently, resulting in inestimable casualties and losses. Hence, knowing what personality traits are suitable for stressful works is of vital importance for selecting applicable nurses for disaster relief operation, and helping the nursing students to have a clearer career orientation when choosing the specialty direction. Stress response is divided into psychological response and physiological response. This study focused on the process of physiological response and evaluated the psychological stress intensity through monitoring physiological indexes related to the autonomic nervous system during the stress process.Method: The experimental subjects were 16 nursing students. In the monitoring experiment, three kinds of pressures were set, including time limitation, threat assessment, and task- interference. The physiological indexes under the resting state of the experimental subjects were recorded as the resting period group (RT). Then, the nursing students performed the operation without setting the pressure condition, called the baseline period group (BL). The experimenter would record all important time nodes. The physiological indexes recorded under the three pressures were the time stress group (TS), the assessment stress group (AS), and the task-interference stress group (INS).Results:There was no statistically significant difference in heart rate and skin temperature between RT and BL, but there was a statistically significant difference in skin resistance. The heart rate and skin temperature in the stress phase were significantly higher than those in RT and BL. According to the analysis of HRV, the difference between RT and BL has no statistical significance.Discussion:Models can eliminate the interference of the operation itself to the recording of physiological signals. The time-stress condition caused a more psychological-stress response in nursing students than assessment and task interference. The pressure source was set up effectively and the stress model was established successfully.
Evidence for Residual Immunity to Smallpox After Vaccination
Authors: Kunasekaran Mohana , Chen Xin , Costantino Valentina , Chughtai Abrar , MacIntyre Raina 
Published: May 2019

Introduction:Smallpox has been eradicated, but advances in synthetic biology have increased the risk of its re-emergence. Residual immunity in individuals who were previously vaccinated may mitigate the impact of an outbreak, but there is a high degree of uncertainty regarding the duration and degree of residual immunity.Methods:A systematic literature review using the PRISMA criteria was conducted to quantify the duration and extent of residual immunity to smallpox after vaccination. 29 papers related to quantifying residual immunity to smallpox after vaccination were identified.Results:Duration of protection of >20 years was consistently shown in the 16 retrospective cross-sectional studies, while the lowest estimated duration of protection was 11.7 years among the modeling studies. Childhood vaccination conferred longer duration of protection than vaccination in adulthood. Multiple vaccinations did not appear to improve immunity. Most studies suggest a longer duration of residual immunity (at least 20 years) than assumed in smallpox guidelines. Estimates from modeling studies were less but still greater than the 3-10 years suggested by the WHO Committee on International Quarantine or US CDC guidelines. These recommendations were probably based on observations and studies conducted while smallpox was endemic. The cut-off values for pre-existing antibody levels of >1:20 and >1:32 reported during the period of endemic smallpox circulation may not be relevant to the contemporary population but have been used as a threshold for identifying people with residual immunity in post-eradication era studies.Discussion:Of the total antibodies produced in response to smallpox vaccination, neutralizing antibodies have shown to contribute significantly to immunological memory. Although the mechanism of immunological memory and boosting is unclear, revaccination is likely to result in a more robust response. There is a need to improve the evidence base for estimates on residual immunity to better inform planning and preparedness for re-emergent smallpox.
The Experience of Using Informational Systems to Improve the ACLS Process Optimization in the Emergency Department
Authors: Lai Pei Fang , Zhou Ying Fang , Chen Pin Shou 
Published: May 2019

Introduction:The best first-aid treatment for cardiac arrest patients is Advanced Cardiac Life Support (ACLS) to not only hope to save lives but to also leave minimal sequelae. The American Heart Association (AHA) published updated ACLS guidelines for care in 2015 emphasizing the concept of teamwork in resuscitation. However, the actual use of ACLS is not easy due to stress and unfamiliarity with the process.Aim:Therefore, we want to use the information technology to assist the medical team to implement the ACLS process. This information system can help us to save time and labor, as well as increase precision. In addition to this, data analysis is more convenient, which facilitates the management and supervision of resuscitation quality.Methods:An information system was developed using responsive web design (RWD) website. It can be used on a variety of devices, such as desktops, tablets, or mobile phones, and can be updated simultaneously. The system requires non-synchronous operation to be used in a wireless network environment. When the information system is in operation, the medical personnel can perform the resuscitation actions according to voice prompts, which can periodically remind staff to check rhythm, give correct medication dose, and identify whether defibrillation shock is needed. At the same time, the entire process can be recorded instantly. After the file is uploaded, the medical records are complete at the same time.Results:After 3 months, the satisfaction of medical staff reached 80.3%, the rate of return of spontaneous circulation (ROSC) of OHCA cases elevated to 45% from 15%, and discharge without neurological sequelae elevated to 33% from 27.4%.Discussion:All hospital staff can use this system to assist in the correct implementation of advanced CPR. It improves the quality of resuscitation and reduces the burden on clinical and writing medical records of medical staff.
First Aid Management of Hypothermia and Cold Injuries
Authors: Christiansen Rowena 
Published: May 2019

Introduction:Best practice first aid management of accidental hypothermia and cold injuries in the prehospital setting is relevant for disaster management in cold environments as well as for wilderness and expedition medicine, and space medicine. In the Australasian context, guidance is currently taken from the Australian Resuscitation Council (“ARC”) Guidelines dealing with these issues.Aim:To review and update the recommendations of the ARC Guideline 9.3.3 Hypothermia: First-Aid Management (February 2009) and ARC Guideline 9.3.6 Cold Injury (March 2000).Method: The review is being undertaken through a combination of a focused literature review and expert opinion. Through the author’s membership of the International Commission for Alpine Rescue (“ICAR”) Alpine Emergency Medicine Commission, two northern-hemisphere experts on hypothermia have reviewed the guidelines and provided commentary and recommendations.Results:Much of the literature around accidental hypothermia and cold injuries (including frostbite, frostnip, and chilblains), relies on expert opinion and case studies. There are relatively few randomized controlled trials, and these are often confined to the laboratory setting. As a result, there is a heavier reliance on expert opinion than in any other areas of medicine.Discussion:This presentation will summarize the current best practice recommendations for the first aid management of accidental hypothermia and cold injuries through combining the existing ARC Guidelines with key advances identified through the literature review, and the key management recommendations stemming from expert opinion. This will provide attendees with a cohesive set of clinical practice recommendations which can be used in the field.
Health Needs Assessment in Disasters by Emergency Medical Teams in the ASEAN Region
Authors: Takada Yosuke , Keeratipongpaiboon Kanin ,   ARCH Project Expert Team
Published: May 2019

Introduction:Japan International Cooperation Agency has started the project for strengthening the ASEAN regional capacity on disaster health management (ARCH Project) since 2016. This project conducted the start-up regional collaboration drill in ASEAN. All participants from ASEAN countries realized the need for a standardized assessment tool. Several UN agencies and international organizations launched assessment tools, but there is no standard assessment tool.Aim:To develop an integrated rapid health needs assessment (HNA) tool in the ASEAN region. This paper reports the development process of the HNA tool.Methods:The project established the project working group (PWG) to developing some tools. PWG consisted of the expert team, project team, Japanese Advisory group and twenty delegates from ten ASEAN member states. PWG established the cycle of the developing process of the HNA tool.Results:We created a health needs assessment form and a summary form. The assessment form consists of (1) Informant information, (2) Site information, (3) Overall situation of the site, (4) Public health, (5) Health facility damage. The summary form consists of (1) Informant information, (2) Site information, (3) Critical areas for support, (4) Situation of the site.Discussion:Frequently, the public health emergency operation center in an affected country is not able to obtain the critical information of an affected area in the acute phase of disasters. This HNA tool would be used in the acute phase by the Emergency Medical Teams (EMTs) because the EMT has mobility and workforce for assisting the affected country. We have agreed on the usage of the assessment form as a kind of an “interview guide”. The purpose of this assessment form is to assess a disaster situation. The next step will be to provide more opportunities for the ASEAN member states to use and learn more about this HNA form.
The Incidence of Post-Traumatic Stress Disorder Among Healthcare Providers After the 2018 Taiwan Hualien Earthquake
Authors: Nieh Jen-Hao , Lai Pei-Fang , Niu Kuang-Yu 
Published: May 2019

Introduction:On February 6, 2018, a magnitude 6.2 earthquake struck Hualien, Taiwan. Over 150 patients crammed into the emergency department of nearby hospitals within two hours. Mass casualty incident (MCI) management was activated. During the recovery phase, little attention was paid to the mental health of hospital staff.Aim:To analyze the prevalence of post-traumatic stress disorder (PTSD) among healthcare providers (HCPs) and explore the possible risk factors.Methods:63 HCPs in the emergency department of the single tertiary hospital near the epicenter were included. The Chinese version of the Davidson Trauma Scale (DTS-C) was used to evaluate the prevalence of PTSD. Questionnaires were sent to explore the possible contributing factors.Results:The average age of the HCPs was 32.7 years (30.3 years for nurses; 40.4 years for physicians). The prevalence of PTSD was 3.2% eight months after the incident. The mean DTS-C score was 8.9/136. Nurses had a higher score than physicians (10.8 and 4.7). HCPs with 6-10 years working experience had the highest score (14.2), while those with less than 3 years experience had the lowest (4.8).Discussion:We found HCPs had a lower prevalence of PTSD compared with earthquake survivors (Chou 2007), and physicians had longer working years and lower DTS-C scores. The professional training may help HCPs going through psychological impacts during the disaster. HCPs with 6-10 years of experience in the emergency department were found to have a higher risk of developing PTSD. Most of them were taking the responsibility of a team leader during the MCI, which may cause significant stress to these staff. Adequate training regarding MCI management could help to relieve tension and frustration, hoping to prevent the development of PTSD. Based on our study, PTSD among HCPs is an ignored issue, and we should follow-up HCPs’ psychological condition in the future.
Incident Command Adaptations during Sustained Mega-Shelter Medical Clinic Operations during 2017 Hurricane Harvey Response in Dallas, Texas
Authors: Liu E. Liang , Flax Lindsay A. , Klein Kelly R. , Fowler Raymond L. , E. Swienton Raymond 
Published: May 2019

Introduction:The Dallas Convention Center received over 3800 evacuees because of the unprecedented flooding caused by Hurricane Harvey. A multidisciplinary medical clinic was established onsite to address evacuee needs for medical evaluations, emergency care, chronic disease management, pharmaceuticals, durable medical equipment, and local health services integration. To operate efficiently, the Dallas Mega-Shelter Emergency Operations Center (EOC) worked with the Mega-Shelter Medical Clinic (MMC) under a fluid incident command (IC) structure that was National Incident Management System (NIMS) compliant. Iterations of MMC IC demonstrated maturations in organizational structure while supporting MMC operations that varied from rigid NIMS doctrine.Aim:To explore the use of a fluid IC structure at a large evacuation medical shelter after Hurricane Harvey.Methods:We observed evolutions of IC organizational charts and operational impacts.Results:Modifications through just-in-time iterations of the IC organizational chart were posted and reviewed with MMC IC and EOC sector chiefs. Changes in the organizational chart were noted to improve identification of logistical needs, supply delivery, coordinate with other agencies, and to make decisions for resource typing and personnel utilization. Adaptations also improved communication, which led to timely situational awareness and reporting accuracy.Discussion:MMC medical services were improved by allowing modifications and adaptations to NIMS compliant MMC IC organizational roles and duty assignments. The fluidity of IC structure with ability for just-in-time modifications directly impacted the provision of disaster medical services. Unique situational awareness, coordination of care pathways within the local innate health infrastructure, compliance with health service regulations, and personnel resource typing all contributed to and benefitted from these IC modifications. MMC and EOC IC collaboration facilitated effective communication and maintained an appropriate span of control and efficient activity reporting.
An Introduction to Coastal Wilderness Medicine: BEACCHEs
Authors: Pahalawatta Upuli , Dawson Amanda 
Published: May 2019

Introduction:Beginning Education at Central Coast Hospitals (BEACCHEs) was developed as an experiential wilderness experience to assist with student exposure to new hazards when commencing at a coastal regional hospital. The coast has several hazards which are specific to the area.Aim:To provide students with first responder education for situations commonly encountered on the Central Coast.Methods:Sessions on first responder training specific to coastal and remote locations included: first aid and surf safety with the Ocean Beach Surf-Lifesaving Club and anti-venom education with the Australian Reptile Park. Education was provided regarding the transition from academic to clinical medicine including support and workload management. A two-day workshop was held on the Central Coast. Pre- and post-workshop surveys were conducted with a combination of matrix questions, Likert response scales, and long answer questions. Ethics was obtained. Both quantitative and qualitative responses were analyzed.Results:Excellent feedback regarding this program was received. All students reported an increase in knowledge in all three domains of critical medicine and evacuation issues, student health and workload management, and Central Coast community and environment. The areas of greatest knowledge in each of these domains were the management of surf incidents, signs and symptoms of PTSD, and Central Coast marine and ocean environment. A confidence increase was seen in responding effectively to an emergency, particularly, in response to improvisation in the field. All findings were statistically significant with all P-values <0.01.Discussion:The addition of BEACCHEs to the orientation of medical students at the Central Coast Medical School has demonstrated to be an effective program for allowing students to adjust more quickly to the new clinical environment. Following the success of this program, BEACCHEs is expected to become part of the new Junior Medical Officer orientation in 2019.
Learning Effects of Cross Road Game Using a Clicker-Nano System
Authors: Mitani Satoko 
Published: May 2019

Introduction:There are some tools for teaching disaster countermeasure in Japan. Cross Road Game was developed to get a concrete image of a disaster situation and is based on interviews from Kobe city government officers in an area affected by the 1995 Great Hanshin-Awaji Earthquake. The alternative includes a lot of ‘dilemmas’ that sacrifice something based on whichever outcome is chosen. For example, “There are 2000 meals at the evacuation center with 3000 refugees. Do you distribute these foods or not?” This game was developed for five to seven players, however, it is not suitable for class lessons with a hundred students. Thus, we tried to employ the Clicker-Nano system for an interactive lesson.Aim:To provide a brief introduction to this new style of teaching disaster countermeasure.Methods:The study included involved a classroom discussion using Clickers-Nano system in addition to Cross Road Game.Results:Nursing students could learn the concrete details of disaster countermeasure in an enjoyable format. They could share thoughts and compare opinions while deciding how to resolve the dilemma at the time of disaster.Discussion:The most important issue faced was how to develop an educational effect for nursing students. Even if five or seven students (players) could enjoy the game, it would not lead to the accumulation of unified knowledge of disaster countermeasure compared to a lecture at the university. The use of the Clickers-Nano system avoided differences in the reach of learning due to differences of facilitators’ capabilities. This study suggests a new style that combines interactive discussion not only with small but also large numbers of students.