bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cyberthreats and Healthcare
Authors: Tin Derrick , Hata Ryan , Staynings Richard , Granholm Fredrik , Ciottone Gregory 
Published: June 2023

Introduction:Cyberattacks against healthcare have been growing at an alarming rate globally targeting the theft of clinical research intellectual property, personally identifiable information, and personal health information. Recent studies have also shown a concerning correlation between cyberattacks and patient morbidity and mortality rates. Many top security experts consider cyberattacks a top national security concern.This paper is a descriptive analysis of healthcare-related breaches in the United States in the past decade and an analysis of cybersecurity threats that are currently facing the industry.Method:Breach reports of unsecured protected health information affecting 500 or more individuals in the US are publicly accessible through the U.S. Department of Health and Human Services Office for Civil Rights portal. The database was downloaded and searched for all reported breaches occurring between January 1, 2011 - December 31, 2021. Breaches were subdivided by states, dates, location, entity type, and individuals affected.Results:Of the 3,822 PHI breaches recorded, 1,593 (41.7%) were hacking/IT related, 1,055 (27.6%) were listed as unknown, 819 (21.4%) were theft related, 194 (5.1%) were loss related, 97 (2.5%) were related to improper disposal and 64 (1.7%) were listed as “others.”Breaches occurred within the main categories as follows: network server (957 [25%]), email (877 [23%]), paper/films (665 [17%]), other (454 [12%]), laptop (341 [9%]), desktop (309 [8%]), and electronic medical records (220 [6%]).Conclusion:A total of 3,822 breaches affecting 283,335,803 people in the United States were recorded from January 1, 2011 to December 31, 2021.The most reported breaches were from healthcare providers with 2,827 (75.1%) events, followed by health plans (500 [13.1%]), business associates (480 [12.6%]) and healthcare clearinghouses (10 [0.3%]). 4 (0.1%) breaches were from unknown sources.This report may help healthcare providers understand the extent of the issue and mitigate some of the associated risks.
Cyber-shock and “digital withdrawal”: Organizational lLeadership and Crisis Management During a Hospital-wide Computer Shutdown Following a Ransomware Attack
Authors: Ofir Anna , Koren Rafael 
Published: June 2023

Introduction:In October 2021, Hillel Yaffe, MC, suffered a ransomware attack which shutdown most hospital computer systems, including patient EMR, pharmacy, communications, administration and backup systems. Staff were left in a state of “cyber-shock” without access to essential information for maintaining safety, quality and continuity of care. The aim of this presentation is to share the hospitals' experience and insights of this cyber-attack, outlining preparedness and response strategies.Method:This attack required a multifaceted emergency response strategy, including:
Immediate response activated according to specific pre-prepared emergency scenario action listsLeadership decision making in real time under conditions of uncertaintyIdentifying the extent of systems affectedEstablishing alternative communication across the organizationDistributing real-time status updates and proactive guidelines, based on pre-existing emergency preparedness protocolsFinding alternative access to patient health historiesAdaptation and distribution of alternative hardcopy versions of patient evaluation and documentation normally done by EMRDistribution of instruction materials for staff via alternative communication, ensuring quick and correct adoption of alternative protocolsSpecial emphasis on patient safety, risk management, quality and continuity of careRecognition, support and resilience-building for staff facing uncertainty and unprecedented conditionsResults:Required preparations include pre-prepared standing orders and procedures, exercises and simulations. Advanced preparation of alternative documentation and care protocols will enable uninterrupted, safe, high-quality patient care. Familiarity with pen-and-paper documentation may minimize shock and disorientation from “digital withdrawal”, especially among younger workers lacking manual documentation experience. Staff members should also be instructed in maintaining “digital hygiene”, such as using strong passwords and awareness about cyber-security threats.Conclusion:Hospitals must prepare for potential cyber-attacks and EMR/digital system shutdowns. Cyber-attack should be treated by organizations as an emergency event, and they should prepare incident response and contingency plans, to assure business continuity and quick disaster recovery.
Health Problems and Healthcare use During the COVID-19 Pandemic: Impact on Vulnerable Groups.
Authors: Bosmans Mark , Duinkerken Anouk van , Tak Nannah , Dückers Michel , Baliatsas Christos 
Published: June 2023

Introduction:The COVID-19 pandemic and the countermeasures taken form a threat to the physical and mental health of the population, especially for more vulnerable groups. In this study, which is part of the Integrated Health Monitor COVID-19, the impact of the COVID-19 pandemic on the healthcare use of the Dutch population and specific vulnerable groups was examined.Method:In this study two data-sources were combined. The first consists of electronic patient records of general practices (GP) participating in the Nivel Primary Care Database. These records are representative of the Dutch population and provide insight into acute complaints, chronic conditions, medication prescriptions and primary care use. For the current study, primary care use in pre-COVID years (2018 and 2019) was compared to that in 2021. This data was coupled with microdata from Statistics Netherlands, containing such information as socio-economic status and migration background. Analyses were conducted using longitudinal mixed-effects regression models.Results:Results show that risk factors play a role in the utilization of primary care. Women and those with a low household income visited the GP more often for mental complaints. Individuals with a migrant background visited the GP more often for coughing, fatigue, and social problems. Those with pre-existing chronic physical conditions were seen less often by their GP for shortness of breath. Among those with pre-existing mental problems GPs more often registered shortness of breath, yet less problems with access to care or social problems.Conclusion:Combining GP registry data with relevant background data has deepened our understanding of changes in health problems and healthcare use among the general population during the COVID-19 pandemic. This study provides insight into how specific vulnerable groups are affected more strongly, and emphasizes the importance of monitoring these groups during a health crisis.
Assessing the Preparedness for a Cyanide Poisoning Mass Casualty Incident in Brooklyn
Authors: Pandya Jay , Doukas Donald , Daniel Pia , Silverberg Mark 
Published: June 2023

Introduction:Urban communities are under constant threat of numerous potential disasters, including cyanide exposure events. Exposure can occur in settings such as structure fires, industrial accidents, or even intentional acts of terrorism. The typical treatment modality for cyanide toxicity employs the antidote, hydroxocobalamin. While studies regarding antidote availability have been conducted in Korea and Hong Kong, a literature search did not reveal any such studies in any part of New York City.The borough of Brooklyn has a population of 2.57 million people. In the setting of a mass casualty incident (MCI) involving cyanide toxicity, such as a large structural fire or a chemical attack, it is uncertain of the region's capability to provide hydroxocobalamin. The objective of this study is to assess the stockpile of hydroxocobalamin across acute care hospitals in Brooklyn.The amount of hydroxocobalamin required to treat a cyanide-related MCI was based on recommendations from the 2018 US Expert Consensus Guidelines for Stockpiling Antidotes. Ten grams of hydroxocobalamin are needed for each 100-kg patient. Theoretically, a minimum of 50 grams of hydroxocobalamin would be required for a mass casualty incident (5 patients).Method:Fifteen acute care hospitals within Brooklyn were identified as potential treatment sites for cyanide exposure. Each site’s emergency manager was sent a survey identifying hydroxocobalamin availability in both their pharmacy and their emergency department.Results:All 15 hospitals responded to the survey. Two of the 15 hospitals had at least 50g of hydroxocobalamin in their inventory, however, no hospital had 50g stored in their emergency department. The median amount of hydroxocobalamin stored was 20g or two doses.Conclusion:Should a mass casualty incident involving cyanide exposure occur, only two hospitals in the borough of Brooklyn would be prepared to treat five or more patients presenting to their hospital.
Worldwide Impact of COVID-19 on Frontline Pharmacists’ Roles and Services: INSPIRE International Questionnaire
Authors: Watson Kaitlyn , Lee Dillon , Nusair Mohammad , Al Hamarneh Yazid 
Published: June 2023

Introduction:Pharmacists have been recognized as essential healthcare professionals during the COVID-19 pandemic. However, evidence of the challenges that were faced by the profession and the way pharmacists adapted their roles throughout the pandemic are largely unknown. This study aimed to describe the impact of COVID-19 on pharmacy practice around the world.Method:A cross-sectional online questionnaire with pharmacists who provided direct patient care during the pandemic. Pharmacists were recruited through social media with assistance from national/international pharmacy organizations. The questionnaire was divided into three sections; 1) demographics, 2) pharmacists’ roles/services during the pandemic, and 3) practice challenges. The questionnaire was adapted from the established, piloted, and published INSPIRE Canadian Survey. The data were analyzed using SPSS 28. Descriptive statistics were used to report frequencies and percentages.Results:A total of 505 pharmacists practicing in 25 countries consented and completed the questionnaire. Only 26.4% (132/500) of participants were engaged with local disaster and public health agencies during the pandemic to coordinate pandemic response. The most common role that pharmacists undertook was responding to drug information requests (89.4%, 448/501), followed by allaying patients' fears/anxieties about COVID-19 (82.7%, 413/499), educating the public on reducing the spread of COVID-19 (81.3%, 409/503), and addressing misinformation on COVID-19 treatments/vaccinations (79.1%, 397/502). The most common services provided by pharmacists were performing medication reviews (78.5%, 391/498) and managing and/or monitoring patients’ chronic diseases (72.3%, 362/501). Almost half of the participants reported administering COVID-19 vaccines (44.9%, 225/501). The most common challenge that pharmacists encountered was increased stress level (82.2%, 415/505), followed by medication shortages (72.3%, 360/505).Conclusion:Despite the unprecedented nature of the COVID-19 pandemic and the various challenges associated with it, pharmacists around the world adapted their roles and services to continue to meet the needs of their patients and be their safe-haven for ongoing care.
Changing the Scene: Lessons Learned and Actioned into General Practice from Australian Flood Fire Drought & Heat through Primary Health Networks
Authors: Burns Penelope , Pettigrew Donna , Harding Joanne 
Published: June 2023

Introduction:General Practitioners (GPs) manage the majority of usual healthcare needs in a community. These healthcare needs do not cease in disasters; they increase and expand. However, inclusion of GPs in disaster healthcare systems is only just beginning. Systematic review of the health effects of disasters over days, months, and years, shows the major burden of healthcare needs associated with disasters is within the realm of usual general practice. In Australia, Primary Health Networks (PHNs) represent local GPs in each region. They offer the best option for systematic linkage of GPs to the broader DHM system.Method:A systematic review of the literature on the health effects of disasters and three qualitative studies reviewing the current experiences, barriers and facilitators to GP involvement in DHM systems were undertaken through a PhD at the Australian National University in 2022. A knowledge to action framework was developed and utilized to provide a systematic strategy to guide efforts to diffuse, disseminate, and implement the research as it emerged, with a focus on sustaining those changes through integration of PHNs into Australian DHM systems.Results:Integration of GPs, through PHNs, is evolving, through systematic inclusion in planning and policy in local health districts. Over time, evidence-based knowledge of disaster healthcare needs has been incorporated into GP disaster planning and preparedness, and resource development, and utilized by GPs during the recent 2019 Black Summer Bushfires, and East coast Floods.Conclusion:As our knowledge of the healthcare needs of disasters continues to reflect our increasingly challenging and complex world, the proven benefit of active involvement in holistic, comprehensive continuity of healthcare through General Practice in DHM systems through PHN linkage becomes more urgent.
Effects of the Six C's Psychological First Aid Model on Acute Stress Responses in a Simulated Emergency Situation
Authors: Farchi Moshe , Gidron Yori 
Published: June 2023

Introduction:Arrival to the emergency room (ER) can increase stress levels in patients and family members. Thus, there is a need for a short and effective form of PFA provided by ER staff members, to reduce acute stress responses (ASR). Past studies have shown that psychological interventions based on emotional expression do not help to regulate extreme emotional expressions nor does it prevent post-traumatic stress disorder (PTSD). Alternatively, the Six C's model adopts a neuropsychological approach that focuses on cognitive communication, challenging for efficient activation, organizing the event's chronological order and reduction in loneliness by committing to stay with them. This experimental design study examined the effectiveness of the Six C's model on reducing signs of ASR.Method:Sixty-three participants (mean age 41.8 years) voluntarily took part. They were randomly assigned to the Six C's intervention (experimental condition) or to supportive emotional expression (control condition). They listened to a three minute audio recording of a real emergency 911 phone call. Interventions (SIX C's or emotional) were provided before and after listening to the recording. Before, immediately after, and five minutes after the recording, participants' anxiety, heart-rate variability (HRV) and mental resilience levels were measured.Results:For all three outcomes, the Time x Group interactions were statistically significant. Following "simple effects", analysis revealed that The Six Cs participants showed lower anxiety and less reductions in HRV and resilience than controls immediately after the stressor. Furthermore, the Six C's participants recovered faster on all three outcomes compared to controls, five minutes after the stressor.Conclusion:This study showed the Six C's model moderates people's ASR. Furthermore, the Six C's method helps people to "bounce back" faster psychologically and neuro-physiologically. These findings support using the Six C's model to reduce ASR and increase resilience, which is highly relevant to ER staff.
Festina Lente: Bradycardia as a Presenting Feature of Life-Threatening Intra-Abdominal Hemorrhage
Authors: Andrews Robin , Orsmond Brendan , Abraham Ria , Bilal Muhammad , Conradie Maria , Dowle Ashleigh , Rensburg Rochelle Janse Van , Jordaan Phillip , Kelly Thomas , Kennedy Keith , Smit Marco , Taqvi Syed Yousuf Raza , Vegte Andrea Van Der , Vythilingam Darshini , Wickham Bryce , Molloy Michael 
Published: June 2023

Introduction:Trauma is one of the leading causes of death in patients under 40 years of age. The Advanced Trauma Life Support (ATLS) Guidelines are widely accepted as the standardized approach to trauma and classify hemorrhagic shock according to heart rate (HR), blood pressure (BP), urinary output, and mental status. Paradoxical bradycardia (defined as HR <60 bpm) in hemorrhagic shock is an uncommon presenting feature and presents a diagnostic challenge to the physician; its true incidence is unknown.Method:A case of paradoxical bradycardia was examined as a presenting feature in hemorrhagic shock.Results:A 17-year-old male patient presented to our Emergency Department (ED) with collapse and abdominal pain following a collision with another player during a sports match.The patient was hypotensive (BP 92/42) and bradycardic at triage, with a heart rate of 50. He was pale and diaphoretic with a Glasgow Coma Scale of 13/15, thready pulses, and localized peritonitis in the left upper quadrant of his abdomen.An increase in blood pressure was observed following initial fluid resuscitation; however, this was transient and preceded the onset of profound hypotension (BP 64/30). Bradycardia with a heart rate between 50-60bpm was persistent despite resuscitative efforts.Abdominal ultrasound demonstrated intraperitoneal free-fluid, and Computerized Tomography confirmed the presence of a grade V splenic laceration. He was taken to the operating theater for emergency laparotomy and underwent splenectomy. A 2.3 liter hemoperitoneum was found intraoperatively. There were no further complications post-operatively, and he made a full recovery.Conclusion:Tachycardia is a potentially unreliable marker of blood loss, especially in young, healthy patients. A high index of suspicion is necessary to prevent this uncommon but life-threatening feature of hemorrhagic shock from being overlooked.
Educating the Public for the Nuclear Reality: Understanding Likely Behaviors in the Aftermath of a Nuclear Detonation
Authors: Taylor Morgan , Andino Stephanie , Zwald Zachary , Berejikian Jeffrey 
Published: June 2023

Introduction:Amid the escalating nuclear arms race in the latter half of the 20th century, civil defense preparedness drills, commonly known as “Duck-and-Cover” drills, were practiced throughout classrooms in the United States. Since then, education and preparedness measures have been largely replaced by fire evacuation and active shooter drills. This study endeavored to understand the likely actions that members of the public may take in the event of a nuclear detonation in the 21st century.Method:Scenarios for 5 kiloton and 100 kiloton near-surface nuclear detonations were modeled using the Hazard Prediction Assessment and Capability (HPAC) software. A video was created animating the models with a voiceover that explained the initial effects of a nuclear detonation. Using the Qualtrics platform, a survey was created in which the order of behavior-based questions and the video was randomized. Lucid distributed the survey to a representative sample of the American public.Results:Among 3,087 participants, only 921 (30%) indicated their confidence in knowing what to do in the event of a nuclear detonation in their city. Participants were most likely to listen to the radio, hide in an interior room, and seal windows or doors. Two thirds indicated they would “duck and cover” (n = 2034, 66%), an action that ranked below helping others (n = 2183, 71%) and wearing a mask (n = 2174, 70%). Study participants who indicated their likely behaviors after watching the video were significantly more likely to listen to the radio (p = 0.044) than those who answered such questions before watching the video.Conclusion:The results of this study suggest there remains a need for emergency preparedness education for members of the public in the United States. As the threat of a nuclear detonation grows, educational methods such as video explanations may increase the preparedness of the American public.
The Usefulness of a Digital Whiteboard for Communication During Disasters
Authors: Iwasaki Megumi , Shoko Tomohisa , Ogawa Mayu , Suzuki Tensei , Asakura Yuri , Mochida Yuzuru , Tanizawa Shu , Kuriyama Keiichi , Nakamoto Raira , Kojima Mitsuaki 
Published: June 2023

Introduction:Information sharing during disasters tends to be confusing. We started the trial operation of a digital whiteboard (DWB) as a communication tool during disasters in 2019 and fully introduced it in 2022. The DWB is a large tablet that allows interactive communication in close to real-time in remote locations through Wi-Fi.Method:To verify the usefulness of the system, DWBs were placed at triage posts in severely, moderately, and mildly damaged areas during a 2022 disaster drill responding to mass casualties to facilitate the sharing of patient information between Disaster Response Headquarters and each treatment area. In each treatment area, doctors, nurses and paramedics completed a standard form to share information about each patient. Information collected included the triage tag number, patient name, age, gender, type of injury or disease, and description of the treatment.Results:Six DWBs were remotely shared, with the triage post noting the number of patients passing through each severity level, and each treatment area noting the treatment status of each patient. The Disaster Response Headquarters replied with the results of adjustments such as hospitalization ward and time to start surgery. The descriptions were reflected in the remotely shared DWBs in about one second. Text conversations through the DWBs were also seen. In the post-event survey, some said that the smooth sharing of information led to quick decisions. Compared to conventional radios, DWBs have the advantage of allowing communication through text, which allows more detailed and accurate patient information to be communicated quickly. The results suggest the survival rate can be improved by assisting early medical intervention or rapid entry of patients into operating rooms. The next goal is to use DWBs for medical coordination among disaster base hospitals.Conclusion:DWBs are effective for the rapid and accurate sharing of patient information during disasters.