bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Qualitative Study on the Use of the Hospital Safety Index and the Formulation of Recommendations for Future Adaptations.
Authors: Lamine Hamdi , Lamberti-Castronuovo Alessandro , Singh Prinka , Chebili Naoufel , Zedini Chekib , Achour Nebil , Ragazzoni Luca , Valente Martina 
Published: June 2023

Introduction:Hospitals around the world need to be safe and prepared to face disasters, being these man-made or caused by natural hazards. The Hospital Safety Index (HSI) is a tool developed by the World Health Organization (WHO) that allows access to the level of preparedness of hospitals; it is the most widely used instrument of its kind. Although the HSI is frequently used by hospitals and healthcare facilities around the world, scientific literature on its application in real life is scarce and qualitative studies are absent. By adopting a qualitative methodology, this study aims to investigate the use of the HSI to assess disaster preparedness in hospitals and healthcare facilities, identify challenges and facilitators of the HSI use, and devise recommendations for future adaptations of the tool.Method:A retrospective qualitative study employing semi-structured online interviews was conducted to gather opinions and perspectives of professionals using the HSI to assess disaster preparedness. Participants were recruited by contacting via email the authors of scientific publications on the use of the HSI.Results:In total, nine people from three different countries (Serbia, Sri Lanka, and Indonesia) and having different professional backgrounds agreed to participate in this study. They shared the reasons for their choice of using the HSI, against other tools, as well as the steps taken before and during data collection. Strengths and weaknesses of the HSI were identified and authors reported the challenges they encountered in the preparatory phase and during data collection. Modifications of the tool and recommendations for the future were proposed targeting both researchers and hospital managers.Conclusion:As far as the authors know, this is the first qualitative study examining the methodological implications of using the HSI and providing practical recommendations that can advance the HSI tool and foster its use for disaster preparedness assessments worldwide.
Gallstone Ileus, A Rare Yet Deadly Cause of Small Bowel Obstruction
Authors: Yugendra Paul , Joshi Chinmaya 
Published: June 2023

Introduction:Gallstone ileus is a rare cause of intestinal obstruction. It commonly affects older patients with significant medical conditions. This disease has a high mortality rate (12-17%), hence should be an important diagnosis to consider, especially as the geriatric population grows worldwide.Method: Case Report:84-year old gentleman, with diabetes and ischemic heart disease, presented with diarrhea, vomiting and fever for one day. He was febrile, tachycardic and hypotensive. There was lower abdominal tenderness with guarding. Labs done revealed metabolic acidosis with a raised lactate along with raised inflammatory markers. Impression was intra-abdominal sepsis, with a need to rule out mesenteric ischemia. He underwent CTAP which revealed gallstone ileus. The gallbladder was collapsed and pneumobilia was present in keeping with fistulation. Dilated small bowel loops were present with a transition point at the distal jejunum or proximal ileum, where there are two gallstones. Patient underwent exploratory laparotomy. There was an obstructing large gallstone 100cm from the DJ flexure. After removal of gallstone and decompression, the bowel was pink with areas of bruising. Patient was hypotensive intra-operatively likely contributed by septic shower, requiring dual vasopressors. He was transferred to the ICU post-operatively and developed cardiogenic shock with type 2 respiratory failure precipitated by sepsis. He demised on Day 2 post-operatively.Results:Gallstone ileus is caused by intestinal impaction of a gallstone that has migrated through a cholecystoenteric fistula. The classic radiologic sign of gallstone ileus is Rigler's triad. This is only picked up 15% of the time on plain abdominal x-rays. Early CT scans can reveal Rigler triad up to 80% of the time. Surgical management remains the cornerstone of treatment.Conclusion:Gallstone ileus remains a diagnostic challenge as patients present with non-specific signs and symptoms. It is prudent for emergency physicians to consider this disease in elderly patients who present with small bowel obstruction.
Mixed Reality–To Better Prepare Medical First Responders for Mass-Casualty Incident Response
Authors: Gyllencreutz Lina , Schulz Fredrik , Schrom-Feiertag Helmut 
Published: June 2023

Introduction:Mass-casualty incidents (MCI) featuring a large number of injured persons caused by human-made or by natural disasters are increasing globally. During these incidents, medical first responders (MFR) need to take appropriate action that saves lives. In this context, the adage “practice makes perfect” is befitting to MCI training. However, providing large-scale MCI training is often difficult due to the significant effort required to create these types of exercises. Drawbacks include a large number of actors needed to portray victims, availability of infrastructure, and realistic treatments. Virtual Reality (VR) has been demonstrated in several domains to be a serious alternative, and in some areas also a significant improvement to conventional training. As an advanced alternative to VR, Mixed Reality (MR) have the potential to provide a dynamic simulation of an VR environment and hands-on practice on injured victims.The aim is: 1) to present insights of a newly developed MR training system for increasing MCI preparedness and 2) discuss pedagogical aspects e.g. how the intended learning outcomes are perceived in MR training, how the participants experience the learning in MR training, and what impact MR training will have in their future work practice.Method:An MR training system, designed for teams of up to four MFRs to perform training in real-time, will be pilot-tested at the beginning of 2023. The system features a fully functional touch-enabled human manikin design for practicing skills in emergency situations. The pilot tests will be carried out within the Med1stMR project (https://www.med1stmr.eu/) where approximately four teams of MFR will be evaluated based on the intended learning outcome.Results:Preliminary results from the pilot tests will be available at the conference.Conclusion:Research is needed to strengthen the knowledge and impact of MR training as a pedagogical method to better support MCI training and preparedness.
Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya
Authors: Aluisio Adam , Bergam Scarlett , Sugut Janet , Guthrie Kate , Kinuthia John , Mello Michael 
Published: June 2023

Introduction:Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged in HIV Testing Services (HTS). In Kenya, these persons are often treated in emergency departments (EDs) for injuries, a healthcare interaction where HTS including HIV self-testing (HIVST) could be leveraged. There is, however, limited data from stakeholders on ED-HTS which impedes programmatic advancement.Method:A qualitative study was completed to understand facilitators and challenges for ED-HTS and HIVST delivery in Kenya (12/2021-03/2022). Data were collected via 28 in-depth patient interviews (14 males and 14 females) who had been treated in the Kenyatta National Hospital (KNH) ED and through seven focus-group discussions conducted with 49 ED healthcare personnel (nurses, doctors, HIV testing counselors, and administrators). Transcripts were double-coded and thematically analyzed with Dedoose™ software using a parallel inductive and deductive approach to capture both a priori and emergent themes.Results:Patients and providers viewed ED-HTS as a beneficial provision that was facilitated by engaged staff, education, perceived high HIV risk, and confidentiality. However, ED-HTS was limited by burdens on staff time and material resources, lacking systems integration, and patient illness severity. Facilitators of ED-HIVST delivery were perceived to have greater autonomy and confidentiality as well as lower health resource utilization. Challenges for ED-HIVST identified included patients’ concerns about HIVST accuracy and psychological stress, as well as providers’ concerns for loss to follow up and inability to complete confirmatory testing.Conclusion:ED stakeholders are receptive to HTS and HIVST provisions. This data provides insight into the patient, provider, and systems aspects that can be leveraged in ED-based HTS to enhance program impacts via intervention functions in the forms of education, care integration, resource scaling, and solidified post-self-testing follow-up mechanisms.
Response to Mass-Casualty Incidents and Outbreaks: A Prehospital Disaster Training Package Developed for the National Emergency Medical Service in Sierra Leone
Authors: Caviglia Marta , Silva-Moniz Josè Da , Venturini Francesco , Jambai Amara , Vandi Matthew , Wurie Abdul , Sartie Moi , Putoto Giovanni , Ragazzoni Luca 
Published: June 2023

Introduction:In 2018 Sierra Leone, a country highly prone to disasters, launched its first National Emergency Medical Service (NEMS) aiming to strengthen the provision of essential health services to the population with the long-term goal of creating a resilient health system able to effectively respond to and recover from emergencies. The Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), together with the Italian NGO Doctors with Africa (CUAMM), under the supervision of the Ministry of Health and Sanitation (MoHS), developed a prehospital Disaster Training Package (DTP) delivered to all NEMS personnel to boost the prehospital management of mass-casualty incidents (MCIs) and outbreaks.Method:The DTP was designed following the six-step approach to curriculum and training development with the ultimate goal of creating a workforce comprising qualified emergency responders with specific professional competencies to respond to outbreaks and MCIs. The DTP included a first phase in which NEMS local trainers underwent a training-of-trainers (ToT) course, enabling them to deliver cascade trainings to 16 district ambulance supervisors, 441 paramedics, 441 ambulance drivers, and 36 operators working in the NEMS operation center.Results:Starting on July 19, 2021, the ToT course was delivered to the seven national trainers. All trainers successfully passed the final examination and achieved high scores in the practical sessions, demonstrating active participation, commitment to the project, and good awareness. Following the ToT course, the series of cascade trainings started on August 2, 2021, delivered by the just-trained national trainers under the direct supervision of the two training managers.Conclusion:The NEMS’ DTP is the very first Disaster Medicine training course delivered to prehospital healthcare providers in Sierra Leone. The authors believe that the provision of the DTP to all NEMS personnel has the potential to improve Disaster Medicine culture among health professionals in the Country.
Creating an International Resource Center for Pandemic and Disaster Nursing Education and Training
Authors: Meyer Diane , Veenema Tener 
Published: June 2023

Introduction:Globally, nurses play pivotal roles in epidemic and emergency response. Nurses’ actions include supporting and informing surveillance and detection, dispensing live-saving medical countermeasures, implementing prevention and response interventions, providing direct care for patients, educating patients and the public, providing health systems leadership, and counseling community members. Despite these roles, there exist gaps in how countries train and prepare their nursing workforce for these health threats.Method:To help address this gap, the Johns Hopkins Center for Health Security has developed an International Resource Center for Pandemic and Disaster Nursing. We have established an international working group to provide input on the goals and mission of the center, website development and functionality, and advocacy efforts. This working group has met four times over the course of the last year. We have also met with several organizations involved in nursing and epidemic and disaster preparedness and response, including the World Health Organization and the International Council of Nurses (ICN), to identify ways to align our work with other ongoing efforts.Results:Presently, we have developed a static website that provides access to evidence-based, open-source trainings and educational resources applicable to pandemic and disaster nursing. The website also provides listings of upcoming webinars, guest blog posts, trainings, and conferences relevant to disaster and pandemic nursing. The website will be launched in early 2023.Conclusion:The long-term vision for this center is to expand beyond a static website and create a vibrant and fully staffed virtual center. This center would be the first of its kind dedicated to developing the resources, technical assistance, partnerships, and advocacy efforts needed to build and support a global nursing workforce that is prepared for outbreaks and disasters. It would build on the existing wealth of expertise within the working group and forge lasting connections between disaster nurse experts across the globe.
Remote Teaching in a Rwandan Emergency Medicine Residency: A Viable Option with Limited In-person Staff During a Pandemic
Authors: Beck Andrew , Diaz Maria Isabel , Odoom Enyonam , Niyigirimbabazi Claudien , Longerstaey Oriane , Ndebwanimana Vincent , Uwamahoro Doris , Karim Naz 
Published: June 2023

Introduction:Low/middle-income countries (LMIC) in Africa face unique, systemic challenges in medical education. Africa faces a shortage of medical schools; only one school serves 24 countries. 11 countries have no medical school. Residency programs are few. The effect of this shortage is far-reaching. Africa has 3.5% of the world’s health workforce and 1.7% of the world’s physicians, yet 27% of the global disease burden. COVID-19 created further resource constraints, especially in emergency medicine (EM). Non-clinical physician functions such as student and resident education suffered. In Rwanda, we implemented a pre-recorded, remote teaching model to substitute in-person instruction. This study evaluates whether remote teaching is received positively by EM learners and whether it is a viable alternative during times of limited in-person availability.Method:28 lectures were recorded by American EM faculty. The recordings were presented to Rwandan EM residents within their standard didactic curriculum. Lecturers were available in real time via Zoom. Topics were chosen by Rwandan faculty based on curricular needs. Program evaluation followed the Kirkpatrick framework. Attendees completed a post-lecture Likert-scale survey assessing the first Kirkpatrick level related to satisfaction, lecture and learning method quality, and suitability. Qualitative and free-response data was also collected.Results:Responses were analyzed with descriptive statistics using means and standard deviations. The mean response range across questions was 3.6-4.3 (1 = worst, 5 = best); the standard deviation range was 0.4-1.6, indicating an overall positive result. Qualitative feedback, which reached saturation, did not indicate significant dissatisfaction with the quality or suitability. Points for improvement included lecturer accents and rate of speech.Conclusion:When in-person lecturers are unavailable, pre-recorded and remote instructional methods may be a suitable substitute. Future directions may include piloting the project with a multinational cohort or in LMICs with greater technological or resource limitations, and assessing higher Kirkpatrick framework objectives.
Using Personal Learning Goals for Participants in Collaborative an International Health Partnership Project: Experiences from the Region Östergötland Model
Authors: Carlsson Henrik , Ljungwald Sara , Lidberg Henrik , Hodza-Beganovic Ruhija , Berggren Peter 
Published: June 2023

Introduction:International health partnerships have often been characterized by wealthier countries or organizations pushing resources and money into projects in countries with different needs. This can be new technologies, building facilities, and/or training personnel. Often this has been assessed in the amount of money spent. In recent years more focus has been put on synergy effects in involved organizations. Hence the change from aid to partnerships. A previous study focused on the subjective perception of the workforce regarding clinical skills, management skills, communication & teamwork, etc. (Jones et al., 2013). This paper focuses on defining learning goals and using a model by Patzauer (2022) as a complement to traditional partnership evaluation measures.Method:Seven team members from a health partnership participated in a project for implementing ambulance service treatment guidelines through training of the partner's ambulance personnel and instructors. The training took place during one week in the partnership country. All Swedish participants were nurses actively working as ambulance personnel or had previously worked in ambulances. Before the training week the participants answered a questionnaire with open questions about their personal learning goals and expectations for the training week. At the end of the week, after having trained ambulance personnel, they answered another questionnaire with open questions addressing what they had learned.Results:Analysis of the responses showed that the participants expected to acquire both personal and clinical skills. Afterwards, they had improved language skills, self-efficacy, and becoming better instructors.Conclusion:The model of using learning goals as an integral part of evaluating health care partnerships provides knowledge that is useful both in terms of assessing the project, and also as input to participants' managers showing clinical and organizational benefits. Including personal learning goals as a part of partnership projects' evaluation, provide useful knowledge about benefits and experiences that improves the organizations.
If We Open the Door–An Analysis of Prehospital Emergency Cases with the Need to Force the Door Open from Dresden, Germany
Authors: Frank Mark , Petrowski Katja , Haacke Wladimir , Keller Yacin 
Published: June 2023

Introduction:Germany is a highly developed country. Nevertheless, there are reports that people have supply problems or die lonely and alone in their homes. Despite a differentiated social system, there seem to be significant gaps for individuals or old people. The rescue service is often involved in situations with unclear emergency calls or calls from third parties regarding social and supply problems. In some emergency cases the rescue service is alerted to someone's home but there is no response. Depending on the available information, a timely decision must be made to have the opportunity for life-saving. The door opening procedure is executed by the fire department. Afterward, the medical emergency teams take over. The goal of the study is to analyze findings discovered after opening the door.Method:Data of all emergencies from the dispatch center of Dresden operated by the fire and rescue department between January 2021 and December 2021 were recorded and transferred to a central database. All cases with the need to force the door open were extracted and analyzed.Results:There was a total number of 157.522 cases of emergency. In 847 cases the door was opened by the fire department. After door opening there was no emergency reported in 265 cases. 100 patients were found dead, six patients had cardiac arrest and received cardiopulmonary resuscitation, and 310 patients were transported to a hospital. The causes for emergencies were social problems, downfall and injuries, hypoglycemia, convulsion, stroke, psychiatric emergencies, dementia and suicide attempt. The mean age was 71 [18-103], 54,15% of patients were female.Conclusion:There is a high number of emergencies with the need to open the door. The number of patients transported to a hospital is also high and justified the procedure. Since numerous patients were found dead, this underlines a gap in the German social system.
Disaster Knowledge, Skills, and Preparedness among Emergency Medical Services in Saudi Arabia.
Authors: Almukhlifi Yasir , Crowfoot Gary , Hutton Alison 
Published: June 2023

Introduction:Emergency Medical Service (EMS) workers are critical to effective disaster response in Saudi Arabia. The World Health Organization requires countries and governments to have prepared emergency health workers and disaster action plans. Therefore, it is important to understand the disaster knowledge, skills, and preparedness of Saudi Arabian EMS workers. This study investigated factors influencing EMS workers’ disaster knowledge, skills, and preparedness in the Saudi Arabian context.Method:A descriptive cross-sectional survey using The Disaster Preparedness Evaluation Tool was distributed to EMS workers in military and government hospitals across three Saudi Arabian cities. Responses were recorded on a 6-point Likert scale where higher scores indicated higher knowledge, skills, or preparedness. The results were analyzed using descriptive and inferential statistical analysis.Results:272 EMS workers participated in this study. EMS workers reported a moderate level of knowledge (3.56), skills (3.44), and preparedness (3.73) for disasters. Despite the moderate level, EMS workers reported a high level of involvement in regular disaster drills (M=4.24, SD=1.274) and a strong interest in further disaster education opportunities (M=5.43, SD=1.121). Participants also reported a high skill level with the triage principles used in their workplace during a disaster (M=4.06, SD=1.218). The study findings revealed a significant positive correlation between disaster preparedness levels and age, years of experience, education level, and the facility worked in.Conclusion:EMS workers have moderate disaster knowledge, skills, and preparedness levels. Knowledge, skill, and preparedness have a significant relationship with the EMS workers’ demographics. These findings demonstrate the need to invest in preparing Saudi Arabian EMS workers to effectively respond to bioterrorism disasters.