Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians ...Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.展开更多
Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1...Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1-month mortality.Methods:We retrospectively analysed data from a Japanese rapid response system registry with 35 participating hospitals.We included consecutive patients with congenital heart disease who required rapid response system activation between January 2014 and March 2018.Logistic regression analyses were performed to examine the associations between 1-month mortality and other patient-specific variables.Results:Among 9,607 patients for whom the rapid response system was activated,only 82(0.9%)had congenital heart disease.Only few patients with congenital heart disease were being treated at the cardiology and cardiovascular surgery departments(12.3%and 9.9%,respectively).Moreover,the incidences of rapid-response events after intensive care unit discharge or surgery were low(6.8% and 12.2%,respectively).The most common reason for rapid response system activation was respiratory dysfunction(desaturation:35.4%,tachypnoea:25.6%,and new dyspnoea:19.5%).Rapid response system interventions and intensive care unit transfers were required for 65.9% and 20.7%of patients,respectively.The mortality rate was 1.2% at the end of the rapid response system intervention and 11.0% after 1 month.Moreover,decreased respiratory rate and decreased heart rate at rapid response system activation were associated with increased 1-month mortality.The adjusted odds ratio was 1.10(95% confidence interval 1.02–1.19)and 1.02(95% confidence interval,1.00–1.04) for respiratory rate and heart rate,respectively.Conclusions:Rapid response systems were rarely activated after cardiac surgery and intensive care unit discharge,which were situations with a high risk of sudden deterioration in patients with congenital heart disease.Therefore,encouraging the use of the rapid response system in these departments will enable intervention by a third,specialised team for in-hospital emergencies and help provide comprehensive medical care to patients.Furthermore,1-month mortality was associated with vital signs at rapid response system activation.These findings may guide treatment selection for patients with congenital heart disease showing deterioration.展开更多
<b>Background:</b> Emergency endotracheal intubations (EEI) performed outside of operating theatre (OT) tend to be more challenging and associated with higher risk of complications. In 2011, with the objec...<b>Background:</b> Emergency endotracheal intubations (EEI) performed outside of operating theatre (OT) tend to be more challenging and associated with higher risk of complications. In 2011, with the objective of improving patient outcomes, we set up an Emergency Airway Service (EAS) at our 1000-bed regional hospital, with the aim of providing specialized assistance for outside of OT difficult airway management. <b>Method:</b> A retrospective audit of EAS activation from 12/9/2016 and 27/10/2020 was conducted. EAS forms and electronic medical records were reviewed. We collected information on patient characteristics, EAS activation characteristics and its outcomes. Descriptive analysis method was used to present the collected data. <b>Results:</b> There were a total of 275 activations, of which 268 were analysed. Reasons for activation were anticipated difficult intubation (42.2% n = 113), failed intubation attempt (52.6%, n = 141) and advanced intubation equipment required (5.2% n = 14). Intubation was attempted in 261/268 (97.4%) cases by the EAS team. Of these, 255 (97.7%) cases were successful while 6 (2.3%) cases failed intubation. Of the successful intubations by the EAS team, 208/255 (81.5%) were successful on the first attempt. Out of the 6 unsuccessful intubation cases, 1 case required a rescue cricothyroidotomy and 4 cases required an open tracheostomy. Intubation was deemed easy by the EAS team in 170/261 (65.1%) cases. 64/170 (37.6%) cases were intubated with a video laryngoscope (VL). There were 85 cases (32.3%) classified as difficult intubation by the EAS specialist, 13/85 (15.3%) were intubated using only VL, 54/85 (63.5%) cases were intubated using VL with style/bougie. <b>Conclusion:</b> Audit results showed that providing an experienced and well-equipped team of airway specialists round-the-clock to assist in difficult and potentially difficult endotracheal intubations is justifiable and may reduce complications associated with EEI.展开更多
Organizational and end user data breaches are highly implicated by the role of information security conscious care behavior in respective incident responses.This research study draws upon the literature in the areas o...Organizational and end user data breaches are highly implicated by the role of information security conscious care behavior in respective incident responses.This research study draws upon the literature in the areas of information security,incident response,theory of planned behaviour,and protection motivation theory to expand and empirically validate a modified framework of information security conscious care behaviour formation.The applicability of the theoretical framework is shown through a case study labelled as a cyber-attack of unprecedented scale and sophistication in Singapore’s history to-date,the 2018 SingHealth data breach.The single in-depth case study observed information security awareness,policy,experience,attitude,subjective norms,perceived behavioral control,threat appraisal and self-efficacy as emerging prominently in the framework’s applicability in incident handling.The data analysis did not support threat severity relationship with conscious care behaviour.The findings from the above-mentioned observations are presented as possible key drivers in the shaping information security conscious care behaviour in real-world cyber incident management.展开更多
目的针对我院分担国家应急医疗救援任务的特殊性,基于无线射频识别(Radio Frequency Identification,RFID)技术实现在紧急任务下,医疗救援物资的快速出入库、定位、盘点,药品和耗材效期提醒,设备维修警告等功能,提高医疗物资的应急保障...目的针对我院分担国家应急医疗救援任务的特殊性,基于无线射频识别(Radio Frequency Identification,RFID)技术实现在紧急任务下,医疗救援物资的快速出入库、定位、盘点,药品和耗材效期提醒,设备维修警告等功能,提高医疗物资的应急保障响应速度和日常养护追溯能力。方法运用RFID、传感设备等物联网技术,在应急医疗救援队仓储中,给每个货物箱、货物袋安装RFID标签,出入库按照货物箱、货物袋为单位,实现远距离RFID自动扫描的快速出入库。结果安装系统前,进行10次任务演练,医疗物资均次出库时间为33 h,均次准确率为74%;安装系统后,进行同一类型任务演练,医疗物资均次出库时间为11 h,均次准确率为96%。安装系统后在出库时间上明显低于安装系统前,差异有统计学意义(P<0.05)。结论物资快速响应管理系统的建立很大程度上提高了物资收发流转的效率,实现医疗物资管理的精确化、可视化。展开更多
文摘Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.
基金This work was supported by the Japan Society for the Promotion of Science KAKENHI(Grant Nos.JP24592755,JP18K16548)the Japanese Society of Intensive Care Medicine,and the Japanese Society of Emergency Medicine.
文摘Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1-month mortality.Methods:We retrospectively analysed data from a Japanese rapid response system registry with 35 participating hospitals.We included consecutive patients with congenital heart disease who required rapid response system activation between January 2014 and March 2018.Logistic regression analyses were performed to examine the associations between 1-month mortality and other patient-specific variables.Results:Among 9,607 patients for whom the rapid response system was activated,only 82(0.9%)had congenital heart disease.Only few patients with congenital heart disease were being treated at the cardiology and cardiovascular surgery departments(12.3%and 9.9%,respectively).Moreover,the incidences of rapid-response events after intensive care unit discharge or surgery were low(6.8% and 12.2%,respectively).The most common reason for rapid response system activation was respiratory dysfunction(desaturation:35.4%,tachypnoea:25.6%,and new dyspnoea:19.5%).Rapid response system interventions and intensive care unit transfers were required for 65.9% and 20.7%of patients,respectively.The mortality rate was 1.2% at the end of the rapid response system intervention and 11.0% after 1 month.Moreover,decreased respiratory rate and decreased heart rate at rapid response system activation were associated with increased 1-month mortality.The adjusted odds ratio was 1.10(95% confidence interval 1.02–1.19)and 1.02(95% confidence interval,1.00–1.04) for respiratory rate and heart rate,respectively.Conclusions:Rapid response systems were rarely activated after cardiac surgery and intensive care unit discharge,which were situations with a high risk of sudden deterioration in patients with congenital heart disease.Therefore,encouraging the use of the rapid response system in these departments will enable intervention by a third,specialised team for in-hospital emergencies and help provide comprehensive medical care to patients.Furthermore,1-month mortality was associated with vital signs at rapid response system activation.These findings may guide treatment selection for patients with congenital heart disease showing deterioration.
文摘<b>Background:</b> Emergency endotracheal intubations (EEI) performed outside of operating theatre (OT) tend to be more challenging and associated with higher risk of complications. In 2011, with the objective of improving patient outcomes, we set up an Emergency Airway Service (EAS) at our 1000-bed regional hospital, with the aim of providing specialized assistance for outside of OT difficult airway management. <b>Method:</b> A retrospective audit of EAS activation from 12/9/2016 and 27/10/2020 was conducted. EAS forms and electronic medical records were reviewed. We collected information on patient characteristics, EAS activation characteristics and its outcomes. Descriptive analysis method was used to present the collected data. <b>Results:</b> There were a total of 275 activations, of which 268 were analysed. Reasons for activation were anticipated difficult intubation (42.2% n = 113), failed intubation attempt (52.6%, n = 141) and advanced intubation equipment required (5.2% n = 14). Intubation was attempted in 261/268 (97.4%) cases by the EAS team. Of these, 255 (97.7%) cases were successful while 6 (2.3%) cases failed intubation. Of the successful intubations by the EAS team, 208/255 (81.5%) were successful on the first attempt. Out of the 6 unsuccessful intubation cases, 1 case required a rescue cricothyroidotomy and 4 cases required an open tracheostomy. Intubation was deemed easy by the EAS team in 170/261 (65.1%) cases. 64/170 (37.6%) cases were intubated with a video laryngoscope (VL). There were 85 cases (32.3%) classified as difficult intubation by the EAS specialist, 13/85 (15.3%) were intubated using only VL, 54/85 (63.5%) cases were intubated using VL with style/bougie. <b>Conclusion:</b> Audit results showed that providing an experienced and well-equipped team of airway specialists round-the-clock to assist in difficult and potentially difficult endotracheal intubations is justifiable and may reduce complications associated with EEI.
基金Taif University Researchers Supporting Project number(TURSP-2020/98).
文摘Organizational and end user data breaches are highly implicated by the role of information security conscious care behavior in respective incident responses.This research study draws upon the literature in the areas of information security,incident response,theory of planned behaviour,and protection motivation theory to expand and empirically validate a modified framework of information security conscious care behaviour formation.The applicability of the theoretical framework is shown through a case study labelled as a cyber-attack of unprecedented scale and sophistication in Singapore’s history to-date,the 2018 SingHealth data breach.The single in-depth case study observed information security awareness,policy,experience,attitude,subjective norms,perceived behavioral control,threat appraisal and self-efficacy as emerging prominently in the framework’s applicability in incident handling.The data analysis did not support threat severity relationship with conscious care behaviour.The findings from the above-mentioned observations are presented as possible key drivers in the shaping information security conscious care behaviour in real-world cyber incident management.
文摘目的针对我院分担国家应急医疗救援任务的特殊性,基于无线射频识别(Radio Frequency Identification,RFID)技术实现在紧急任务下,医疗救援物资的快速出入库、定位、盘点,药品和耗材效期提醒,设备维修警告等功能,提高医疗物资的应急保障响应速度和日常养护追溯能力。方法运用RFID、传感设备等物联网技术,在应急医疗救援队仓储中,给每个货物箱、货物袋安装RFID标签,出入库按照货物箱、货物袋为单位,实现远距离RFID自动扫描的快速出入库。结果安装系统前,进行10次任务演练,医疗物资均次出库时间为33 h,均次准确率为74%;安装系统后,进行同一类型任务演练,医疗物资均次出库时间为11 h,均次准确率为96%。安装系统后在出库时间上明显低于安装系统前,差异有统计学意义(P<0.05)。结论物资快速响应管理系统的建立很大程度上提高了物资收发流转的效率,实现医疗物资管理的精确化、可视化。
