bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Backup System for Clinical Information after the Great East Japan Earthquake and Tsunami
Authors: Nakayama Masaharu 
Published: May 2019

Introduction:On March 11, 2011, the Great East Japan Earthquake and Tsunami hit the northeastern part of Japan, causing 15,895 deaths and 2,539 missing persons as of March 1, 2018. Moreover, many medical facilities were destroyed, resulting in the loss of medical information stored in paper records or on servers in hospitals and clinics.Aim:To highlight the need for a backup system for saving all clinical information during disaster preparation.Results:In 2012, a prefectural medical network system - the Miyagi Medical and Welfare Information Network (MMWIN) - introduced a cloud backup data storage service for disasters. This system facilitates the sharing of clinical data among hospitals, clinics, pharmacies, and other care facilities. The backup system is based on the Standardized Structured Medical Information Exchange (SS-MIX), which enables data from medical record systems, developed by different vendors, to be stored in a common format. By the end of September 2018, the total backed up clinical data, including patients’ basic information, disease names, blood tests, and prescription list, reached 370 million items from 11.2 million persons. We renewed the system last year and initiated an image data sharing service this year. The number of facilities within the MMWIN was 948, while the number of opt-in patients exceeded 80,000.Discussion:Although the project was financed by the government, a usage fee was collected from the participating facilities. To sustain this project, it is crucial to improve the balance between cost and income by increasing the number of participating facilities and decreasing maintenance cost. Thus, our clinical information backup system for disasters facilitates information sharing among medical facilities.
Feasibility and Accuracy of a Wearable Biosensor Device for Vital Sign Monitoring in Septic Emergency Department Patients in Rwanda
Authors: Garbern Stephanie , Mbanjumucyo Gabin , Umuhoza Christian , Sharma Vinay , Mackey James , Martin Kyle , Twagirumukiza Francois , Rosman Samantha , McCall Natalie , Wegerich Stephan , Levine Adam 
Published: May 2019

Introduction:Low and middle-income countries (LMICs) bear a disproportionately high burden of sepsis, contributing to an estimated 90% of global sepsis-related deaths. Critical care capabilities needed for septic patients, such as continuous vital sign monitoring, are often unavailable in LMICs.Aim:This study aimed to assess the feasibility and accuracy of using a small wireless, wearable biosensor device linked to a smartphone, and a cloud analytics platform for continuous vital sign monitoring in emergency department (ED) patients with suspected sepsis in Rwanda.Methods:This was a prospective observational study of adult and pediatric patients (≥ 2 months) with suspected sepsis presenting to Kigali University Teaching Hospital ED. Biosensor devices were applied to patients’ chest walls and continuously recorded vital signs (including heart rate and respiratory rate) for the duration of their ED course. These vital signs were compared to intermittent, manually-collected vital signs performed by a research nurse every 6-8 hours. Pearson’s correlation coefficients were calculated over the study population to determine the correlation between the vital signs obtained from the biosensor device and those collected manually.Results:42 patients (20 adults, 22 children) were enrolled. Mean duration of monitoring with the biosensor device was 34.4 hours. Biosensor and manual vital signs were strongly correlated for heart rate (r=0.87, p<0.001) and respiratory rate (r=0.74 p<0.001). Feasibility issues occurred in 9/42 (21%) patients, although were minor and included biosensor falling off (4.8%), technical/connectivity problems (7.1%), removal by a physician (2.4%), removal for a procedure (2.4%), and patient/parent desire to remove the device (4.8%).Discussion:Wearable biosensor devices can be feasibly implemented and provide accurate continuous vital sign measurements in critically ill pediatric and adult patients with suspected sepsis in a resource-limited setting. Further prospective studies evaluating the impact of biosensor devices on improving clinical outcomes for septic patients are needed.
Prehospital Advanced Resuscitation with Video Direct Medical Control Using Mobile Smart Device
Authors: Wang Soon-Joo 
Published: May 2019

Introduction:The prognosis for out-of-hospital cardiac arrest (OHCA) remains controversial if a smart device or video is used. In this study, a system was used that provides advanced cardiac life support (ACLS) with direct medical control through remote video calls for OHCA patients. The study investigated how this system will improve survival.Aim:The effect of video remote direct medical control using a mobile smart device for cardiac arrest was the main objective of this research.Methods:Medical origin OHCA patients over 18 years old for one year were included in the video remote direct medical attempt. Trauma, intoxication, environmental origin, and family disagreement were excluded. The advanced field resuscitation was performed by paramedics with video communication-based medical direction, who were dispatched simultaneously by two ambulances. Video communication was performed by a mobile application or video call. The results and opinions were recorded in a mobile application and a specific website. We analyzed the general characteristics and outcomes of the prehospital ACLS using video communication.Results:A total of 11,054 consecutive out-of-hospital cardiopulmonary resuscitation cases were recorded, and 3,352 underwent prehospital ALS using video call. Prehospital ROSC was 23.3%, survival upon hospital arrival was 13.6%, survival admission was 19.5%, survival discharge was 10.6%, and survival with good neurologic outcome was 6.0%. The reasons for no prehospital ALS included no request from a provider (29.1%), cardiac arrest during transport (20.9%), communication failure (11.6%), and family refusal (11.1%).Discussion:As a result of providing prehospital ACLS with direct medical direction through remote video calls to cardiac arrest patients, the prehospital ROSC rate, survival admission, and discharge rate improved. Advantages of this type of medical control by video communication were ease of control of the patient`s family, more precise communication with paramedics, and continuous confirmation of the real patient’s status and monitoring parameters.
Watching to Save Lives
Authors: Herbst Raphael , Jaffe Eli 
Published: May 2019

Introduction:As Israel's National Emergency Medical Services (EMS) provider, Magen David Adom (MDA) is constantly looking for ways to improve the response to mass casualty incidents (MCIs). Previous research has shown that in an MCI situation, the demand for resources is disproportionate to the available resources, thus creating a dilemma of how to triage and treat the patients, as well as how to best prioritize and treat the critical patients.Aim:Smartwatches have become an integral part of society. MDA constantly looks for ways to integrate new technologies into their emergency response protocols. Smartwatches were used in this experiment to determine if in an MCI, relaying live information to the dispatch center would improve the time it takes for emergency crews to effectively treat and transport critical patients.Methods:A drill and scenario were designed to simulate an MCI in which there were 3 severe, 2 moderate, and 5 lightly wounded patients. There were then different colored smartwatches placed on each victim. The watches transmitted real-time blood pressure, pulse, and oxygen saturation readings to the dispatch center. The live information was transferred directly to responding teams. A second drill was conducted using the same scenario, same number of patients, but without watches to examine the differences in response times.Results:MDA found that the use of smartwatches directly improved the times (by 3.27 minutes) in which emergency teams were able to reach the most severely wounded patients and evacuate them to the hospital in a timely manner.Discussion:Using smartwatches to transmit live information to the dispatch center allowed for effective treatment and transport of patients in an MCI. Use of such information allows the dispatch center to direct teams to provide accurate treatment to the patients according to their needs.
Risk of Retrogression in Social Rights and Reduction of Brazilian Public Policies
Authors: Bellini Maria Isabel Barros , de Bellini e Soares Rodollfo 
Published: May 2019

Introduction:Brazil has 200 million descendants of African, Portuguese, Indigenous, German, Italian, and other peoples who have built their identities. The Federal Constitution was rewritten in 1988 to include a Social Protection System. Between 2000 and 2016, the federal government was governed by the Workers’ Party. This party invested in the creation of inclusive public policies and affirmative actions built through collective processes of citizenship that guaranteed better living conditions for the population. In one decade, it went from being underdeveloped to developing. In 2016, the elected president of the Workers’ Party was withdrawn from power through impeachment. In the next election, right-wing conservatives excluded speech, attacked minorities (e.g. LGBT population), and defended the traditional family.Aim:To understand the retreat of Brazilian public policies in a country that set public social policies, compensatory policies, and affirmative actions guaranteeing citizenship of men and women.Methods:Qualitative research with analysis and reflection on the regression of universalist public policies and affirmative policies with the creation of quotas.Results:The creation of affirmative actions was guaranteed. Vacancies in public tenders for the black population led to the establishment of 50% quotas for blacks in universities, and the creation of a universal health system, or universal expanded health indicators. The federal government created a group of SUS analysis by reducing actions.Discussion:Social inequality in Brazil is one of the worst in the world. 16 million people live below the poverty line (OXFAM, 2017). In recent decades, the population that was expanding and strengthening access to services, health, education, and social assistance network has seen a reduction of public policies. The importance of research that points to this reduction of rights is fundamental for documenting what has already been achieved.
Absence of Cultural Awareness Training in International Non-Governmental Organizations
Authors: Hart Alexander , Issa Fadi 
Published: May 2019

Introduction:Cultural awareness is the understanding of differences in cultures, and openness to these differences. It is a vital step in the development of cultural sensitivity and becoming operationally effective when working within different cultures. The benefits of Cultural Awareness have become apparent in recent decades, including within governments, militaries, and corporations. Many organizations have developed Cultural Awareness training for their staff to improve cross-cultural cooperation. However, there has not been a large movement toward cultural sensitivity training among Non-Governmental Organizations (NGOs) who provide aid across a number of countries and cultures. Cultural Awareness can be a useful tool which enables an NGO to better serve the populations with which they engage.Aim:To evaluate the presence within International NGOs of Cultural Awareness Training to employees and volunteers.Methods:Ten of the largest international NGOs were identified. Their websites were evaluated for any mention of training in Cultural Awareness available to their employees and volunteers. All 10 were then contacted via their public email addresses to find out if they provide any form of Cultural Awareness training.Results:Of the ten NGOs identified, none have any publicly available Cultural Awareness training on their websites. One NGO deals with cultural awareness by only hiring local staff, who are already a part of the prevalent culture of the area. None of the others who responded have any cultural awareness training which they provide.Discussion:Cultural awareness is a vital tool when acting internationally. Large NGOs, which operate in a wide range of cultures, have an obligation to act in a culturally aware and accepting manner. Most large NGOs currently lack cultural awareness training for their employees and volunteers. It is time for these NGOs to develop, and begin to employ, cultural awareness training to better prepare their staff to serve international populations.
Abu Dhabi Police Ambulance EMTs Medical Errors January-October 2018
Authors: Chalgham Riadh 
Published: May 2019

Introduction:Medical errors are a reality for Emergency Medical Technicians (EMT’s) working in a prehospital, high-stress environment. A “medical error” can be defined as a mistake or system failure which results in improper care of a patient’s injury.Aim:To study the frequency, severity, types, and causes of medical errors committed by Abu Dhabi Police Ambulance (ADPA) crews, and how to prevent these errors. The study is retrospective. All the data was collected using the Electronic Patient Care Report (EPCR) of all the patient treated and transported by ADPA crew from January to October 2018. After the EPCR auditing and monitoring, the medical errors were identified and discussed by a medical committee.Results:The total number of studied EPCR (trauma and medical cases) was 36.000. The medical errors identified were 265 cases (0.74%). 134 cases (51%) were moderate (can cause side effects), 115 cases (43%) were minor, and 16 cases (6%) were critical (can lead to death). The most common type of medical errors were cognitive errors. The causes were skill-based errors 27 times (10%) with 16 intravenous failures, 10 intraosseous failures, and one dislodged endotracheal tube after orotracheal intubation. The rule-based errors were committed five times (2%) when the Paramedics did not follow ACLS Algorithm, three times shockable cardiac arrest and two times Pulseless Electrical Activity. The knowledge-based errors were drug indications errors five times (2%). The three EMT’s levels in ADPA (Basic, Intermediate, and advanced) committed medical errors. The question to ask is not who made the mistake, but why the mistake was made. Preventing ADPA crew errors requires a systematic approach to modify the conditions that contribute to errors. The strategies are developing more awareness of cognitive errors by education and incorporating simulation into training.
Analysis of Disaster Psychiatric Assistant Team Activity During the Past Four Disasters in Japan
Authors: Takahashi Sho , Tachikawa Hirokazu , Fukuo Yasuhisa , Takagi Yoshifumi , Tetsuaki Arai , Watari Michiko 
Published: May 2019

Introduction:The Disaster Psychiatric Assistant Team (DPAT) is Japan’s original mental health care dispatched team during disasters. Established in 2013, this team has been involved in the response to many disaster-related mental issues.Aim:We Aimed to evaluate the DPAT activity in response to the past 4 disasters (Ontake volcano, Hiroshima flood, Joso flood, and Kumamoto earthquake), using the disaster mental health information support system (DMHISS).Methods:DMHISS data from the four disasters was extracted. Descriptive statistics were performed from the obtained dataset and the characteristics of the disaster victims from each disaster were compared and examined.Results:About 2,400 cases were obtained and tabulated to from the database. Based on descriptive statistics, the DPAT support objectives, activities and activity periods Aim to establish (1) the characteristics of the affected areas (population composition, psychiatric medical condition), (2) the scale and content of the disaster (the injured, building damage, number of evacuees), and (3) the activity ability. The number of counseling cases peaked several days after the disaster onset, and the importance of the DPAT activity during the acute phase was confirmed. The time course of the consultation number, which is a measure of the termination, could be predicted from the disaster scale and content. These results suggest that DPAT activity may be a guideline for local disasters for one month and for wide-reaching disasters for two months or longer.Discussion:It is suggested that the timing of activity and the termination period could be estimated from factors including the type of disaster, the size of the disaster, and the number of evacuees using the disaster mental health medical activities from four disasters. It should be considered necessary to accumulate data and examine indicators related to the DPAT activity.
Are Australian Pharmacists Willing to Work in a Disaster?
Authors: McCourt Elizabeth , Watson Kaitlyn , Singleton Judith , Tippett Vivienne , Nissen Lisa 
Published: May 2019

Introduction:Current literature suggests that a large percentage of the health workforce may be unwilling to work during a disaster. The willingness of pharmacists to work during a disaster is under-researched internationally and non-existent in Australia.Aim:To determine if Australian pharmacists are willing to work in a disaster and the factors that affect the willingness to work.Methods:A 13-question survey was developed from the current literature and released nationally through professional organizations and social media.Results:Sixty Australian pharmacists completed the survey. Most participants believed their pharmacy was an essential service for their community. Pharmacists reported they would be likely to report to work during a pandemic or biological disaster (73%) or natural disaster (78%). The two major factors likely to prevent pharmacists from working in a disaster are family and safety concerns. Pharmacists perceived that their duty of care to their patients would make them likely to work during a disaster. Most pharmacists noted they would work even if they were expected to work outside their scope of practice, or if their place of work lacked electricity or was damaged.Discussion:Depending on the disaster, up to 27% of the pharmacy workforce may be unwilling to work in a disaster. Family and safety concerns were the primary barriers to pharmacists reporting to work in the aftermath of a disaster. Providing guidelines on how pharmacists can prepare their family for a disaster may assist in ensuring pharmacists are willing to work. The pharmacists surveyed demonstrated a strong commitment to their duty of care with the majority stating they would be likely to work in austere work environments. This research raises questions of the safety of pharmacists working outside their scope and in austere environments and whether it is safe for them, their patients, and the broader community.
Assessment of HEMS Teams Performance in Out-of-Hospital Cardiac Arrest (OHCA)
Authors: Gula Przemyslaw , Rzonca Patryk , Galazkowski Robert , Podgórski Marcin 
Published: May 2019

Introduction:The Out of Hospital Cardiac Arrest (OHCA) procedures constitute one of the most quantifiable indicators of the quality of Emergency Medical Services (EMS). In Poland, HEMS teams perform such procedures both during primary missions and when they support EMS teams.Aim:To carry out a retrospective analysis of OHCA related calls received from January 1, 2011, to December 31, 2016.Methods:During the relevant period there were 2,447 OHCA related calls. Of those, 308 cases were excluded from the analysis because no cardiac arrest was confirmed or the patients showed signs of death that prevented any emergency procedures.Results:The Return of Spontaneous Circulation (ROSC) was achieved in 1,119 cases. Resuscitation was clearly much more effective if CPR procedures were commenced prior to the arrival of the HEMS team. The groups in which higher survival rates were obtained included women, patients younger than 40 and patients who had signs of shockable rhythms. The use of HEMS team allowed for faster transport of patients to relevant specialist institutions, specifically if an invasive cardiological intervention was needed.Discussion:The use of HEMS teams in OHCA related calls indicates that such actions are highly effective both in primary missions and when HEMS teams support other EMS terms. An additional advantage is the possibility of quick transportation to a relevant specialist medical center.
Comparing Training Techniques in Chemical Disaster Preparedness
Authors: Salway Richard , Williams Trenika , Londono Camilo , Arquilla Bonnie 
Published: May 2019

Introduction:Currently, there are no universally accepted personal protective equipment (PPE) training guidelines for Emergency Medicine physicians, though many hospitals offer training through a brief didactic presentation. Physicians’ response to hazmat events requires PPE utilization to ensure the safety of victims, facilities, and providers; providing effective and accessible training is crucial. In the event of a real disaster, time constraints may not allow a brief in-person presentation and an accessible video training may be the only resource available.Aim:To assess the effectiveness of video versus in-person training of 20 Emergency Medicine Residents in Level C PPE donning and doffing (chemical-resistant coverall, butyl gloves, boots, and an air-purifying respirator).Methods:A prospective observational study was performed with 20 Emergency Medicine residents as part of Emergency Preparedness training. Residents were divided into two groups, with Group A viewing a demonstration video developed by the emergency preparedness team, and Group B receiving in-person training by a Hazmat Team Member. Evaluators assessed critical tasks of donning and doffing PPE utilizing a prepared evaluation tool. At the drill’s conclusion, all participants completed a self-evaluation to determine their confidence in their respective trainings.Results:Both video and in-person training modalities showed significant improvement in participants’ confidence in doffing and donning a PPE suit (p>0.05). However, no statistically significant difference was seen between training modalities in the performance of donning or doffing (p>0.05).Discussion:Video and in-person training are equally effective in preparing residents for donning and doffing Level C PPE, with similar error rates in both modalities. Future trainings should focus on decreasing the overall rate of breaches across all training modalities.