Search results for: emergency medical team

Authors: Laila Khawaja

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In recent years, an increasing emphasis has been placed on measuring program implementation, in part because of the great variability in how complex interventions are delivered in real-life settings. There is an increased awareness that while conducting process evaluations, one should aim to identify and understand the complexities of intervention if they are to be used for future intervention development or the strategies needed to implement the same intervention in a different setting. Complex interventions are public health interventions that are not drugs or surgical procedures but have many potential active aspects of intervention. In this paper, process evaluations are aligned with MRC guidelines to identify contextual factors related to outcomes to assess the quality of implementation. This paper briefly discusses the perceptions of research team on the implementation of the intervention of ‘Engaging Adolescents in Changing Behaviour’ (EACH-B), a school-based complex intervention study aiming to improve diet and physical activity among adolescents aged 12-13 years. Through qualitative interviews and focus groups with 10 staff members, we aimed to understand their experiences and reflections on implementing the EACH-B trial delivered in 49 Schools around Hampshire, England. Data were uploaded into NVivo, and analysis was conducted using thematic analysis. The investigation revealed two overarching themes: (a) how the communication patterns with teachers were impacted during the delivery of implementation and (b) what were the team’s strategies to keep logistics aligned with the research process that impacted the overall implementation of the trial. The paper informs adaptation strategies used by the research team to establish and maintain effective communication with the teachers as well as the thoughtfulness of the team’s logistic strategy for the successful delivery of the trial.

Keywords: complex interventions, process evaluation, adaptation strategies, randomised controlled trial

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Authors: Geetha Jayapathy, Lakshmi Muthukrishnan, Manoj Kumar Reddy Pulim , Radhika Raman

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Introduction: Ketones are the end products of fatty acid metabolism and a source of energy for vital organs such as the brain, heart and skeletal muscles. Ketones are produced in excess when glucose is not available as a source of energy or it cannot be utilized as in diabetic ketoacidosis. Children admitted in the emergency department often have starvation ketosis which is not clinically manifested. Decision on admission of children to the emergency room with subtle signs can be difficult at times. Point of care blood ketone testing can be done at the bedside even in a primary level care setting to supplement and guide us in our management decisions. Hence this study was done to explore the utility of this simple bedside parameter as a supplement in assessing pediatric patients presenting to the emergency department. Objectives: To estimate blood ketones of children admitted in the emergency department. To analyze the significance of blood ketones in various disease conditions. Methods: Blood ketones using point of care testing instrument (ABOTTprecision Xceed Pro meters) was done in patients getting admitted in emergency room and in out-patients (through sample collection centre). Study population: Children aged 1 month to 18 years were included in the study. 250 cases (In-patients) and 250 controls (out-patients) were collected. Study design: Prospective observational study. Data on details of illness and physiological status were documented. Blood ketones were compared between the two groups and all in patients were categorized into various system groups and analysed. Results: Mean blood ketones were high in in-patients ranging from 0 to 7.2, with a mean of 1.28 compared to out-patients ranging from 0 to 1.9 with a mean of 0.35. This difference was statistically significant with a p value < 0.001. In-patients with shock (mean of 4.15) and diarrheal dehydration (mean of 1.85) had a significantly higher blood ketone values compared to patients with other system involvement. Conclusion: Blood ketones were significantly high (above the normal range) in pediatric patients who are sick requiring admission. Patients with various forms of shock had very high blood ketone values as found in diabetic ketoacidosis. Ketone values in diarrheal dehydration were moderately high correlating to the degree of dehydration.

Keywords: admission, blood ketones, paediatric emergencies, point of care testing

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Authors: Nor Wahiza Abdul Wahat, Nor Haniza Abdul Wahat, Siti Noormi Alias, Mohamad Sazali Shaari

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This study prepares the groundwork for the development of a strategic model and instrument for workplace inclusivity for deaf and hard-of-hearing employees in Malaysia. In the past, scholars have discussed inclusivity of workplaces to the extent to which employees feel they are significantly part of the organizational processes. Such processes include access to information, connectedness to colleagues and team members as well as their ability to participate in and influence decision-making processes. A qualitative study was conducted to explore on experiences of employed deaf and hard-of-hearing employees in a few Malaysian organizations. Data were collected from two focus group discussions involving male and female deaf and hard of hearing employees. Three in-depth interviews were also conducted with employer representatives. Generated themes highlighted individual, and team approaches towards crafting workplace inclusivity for deaf and hard of hearing employees in Malaysia. The adaptiveness of deaf and hard-of-hearing employees and social inclusion by colleagues were among the emerged sub-themes. This study allowed the researchers to further develop workplace inclusivity instruments and models for the benefit of deaf and hard of hearing Malaysian employees, as well as their employers.

Keywords: deaf, hard of hearing, workplace inclusivity, disabilities

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Authors: Madhavi-Priya Singh, Liam Lowe, Farouk Arnaout, Ludmilla Pillay, Giordan Perez, Luke Mischker, Steve Costa

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Introduction: An Emergency Department consultant identified the failure of medical students to complete the task of clerking a patient in its entirety. As six medical students on our first clinical placement, we recognised our own failure and endeavored to examine why this failure was consistent among all medical students that had been given this task, despite our best motivations as adult learners. Aim: Our aim is to understand and investigate the elements which impeded our ability to learn and perform as medical students in the clinical environment, with reference to the prescribed task. We also aim to generate a discussion around the delivery of medical education with potential solutions to these barriers. Methods: Six medical students gathered together to have a comprehensive reflective discussion to identify possible factors leading to the failure of the task. First, we thoroughly analysed the delivery of the instructions with reference to the literature to identify potential flaws. We then examined personal, social, ethical, and cultural factors which may have impacted our ability to complete the task in its entirety. Results: Through collation of our shared experiences, with support from discussion in the field of medical education and ethics, we identified two major areas that impacted our ability to complete the set task. First, we experienced an ethical conflict where we believed the inconvenience and potential harm inflicted on patients did not justify the positive impact the patient interaction would have on our medical learning. Second, we identified a lack of confidence stemming from multiple factors, including the conflict between preclinical and clinical learning, perceptions of perfectionism in the culture of medicine, and the influence of upward social comparison. Discussion: After discussions, we found that the various factors we identified exacerbated the fears and doubts we already had about our own abilities and that of the medical education system. This doubt led us to avoid completing certain aspects of the tasks that were prescribed and further reinforced our vulnerability and perceived incompetence. Exploration of philosophical theories identified the importance of the role of doubt in education. We propose the need for further discussion around incorporating both pedagogic and andragogic teaching styles in clinical medical education and the acceptance of doubt as a driver of our learning. Conclusion: Doubt will continue to permeate our thoughts and actions no matter what. The moral or psychological distress that arises from this is the key motivating factor for our avoidance of tasks. If we accept this doubt and education embraces this doubt, it will no longer linger in the shadows as a negative and restrictive emotion but fuel a brighter dialogue and positive learning experience, ultimately assisting us in achieving our full potential.

Keywords: ethics, medical student, doubt, medical education, faith

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Authors: Anyia Nduka, Aslan Bin Amad Senin, Ayu Azrin Binti Abdul Aziz

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Telemedicine is a rapidly developing discipline with enormous promise for better healthcare results for patients. To meet the demands of patients and the healthcare sector, medical providers must be proficient in telemedicine and also need government funding for infrastructure and core competencies. In this study, we surveyed general hospitals in Kuala Lumpur and Selangor to investigate patient’s impressions of both the positive and negative aspects of government funding for telemedicine and its level of acceptance. This survey was conducted in accordance with the Diffusion of Innovations (DOI) hypothesis; the survey instruments were designed through a Google Form and distributed to patients and every member of the medical team. The findings suggested a framework for categorizing patients' levels of technology use and acceptability, which provided practical consequences for healthcare. We therefore recommend the increase in technical assistance and government-backed funding of telemedicine by bolstering the entire system.

Keywords: technology acceptance, quality assurance, digital transformation, cost management.

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Authors: Peer M. Sathikh

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Creativity and innovation have become an important phenomenon today, whose potential is being realized through the success of Apple, Google/Android, Nike, Virgin, Dyson and other multinationals that are a household name today. Creativity and Innovation are, many times, used interchangeably, causing confusion as to what each represents and are capable of. Attempts to understand creativity and innovation clearly point to the difference, and at the same time, inter-dependency of one on the other. The assumption that having more creative personnel in a team will translate into innovation sooner or later seems generally counterproductive. What helps define the role of creativity and innovation in an organization and how can one build an innovative team? This paper points to the importance of understanding creative culture and innovation culture in order to bring about the desired innovation outcome and proposes a means to transform one to another as ideas move from mere ideas to useful innovation.

Keywords: creativity, innovation, creative culture, innovation culture, transformal operators

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Authors: E. Gouya Bozorg

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The issue of ranking of sports teams, in particular soccer teams is of primary importance in the professional sports. However, it is still based on classical statistics and models outside of area of mathematics. Rigorous mathematics and then statistics despite the expectation held of them have not been able to effectively engage in the issue of ranking. It is something that requires serious pathology. The purpose of this study is to change the approach to get closer to mathematics proper for using in the ranking. We recommend using theoretical mathematics as a good option because it can hermeneutically obtain the theoretical concepts and criteria needful for the ranking from everyday language of a League. We have proposed a framework that puts the issue of ranking into a new space that we have applied in soccer as a case study. This is an experimental and theoretical study on the issue of ranking in a professional soccer league based on theoretical mathematics, followed by theoretical statistics. First, we showed the theoretical definition of constant number Є = 1.33 or ‘golden number’ of a soccer league. Then, we have defined the ‘efficiency of a team’ by this number and formula of μ = (Pts / (k.Є)) – 1, in which Pts is a point obtained by a team in k number of games played. Moreover, K.Є index has been used to show the theoretical median line in the league table and to compare top teams and bottom teams. Theoretical coefficient of σ= 1 / (1+ (Ptx / Ptxn)) has also been defined that in every match between the teams x, xn, with respect to the ability of a team and the points of both of them Ptx, Ptxn, and it gives a performance point resulting in a special ranking for the League. And it has been useful particularly in evaluating the performance of weaker teams. The current theory has been examined for the statistical data of 4 major European Leagues during the period of 1998-2014. Results of this study showed that the issue of ranking is dependent on appropriate theoretical indicators of a League. These indicators allowed us to find different forms of ranking of teams in a league including the ‘special table’ of a league. Furthermore, on this basis the issue of a record of team has been revised and amended. In addition, the theory of ranking can be used to compare and classify the different leagues and tournaments. Experimental results obtained from archival statistics of major professional leagues in the world in the past two decades have confirmed the theory. This topic introduces a new theory for ranking of a soccer league. Moreover, this theory can be used to compare different leagues and tournaments.

Keywords: efficiency of a team, ranking, special table, theoretical mathematic

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Authors: Rinat Gabbay-Benziv, Merav Ben-Natan, Ariel Roguin, Benyamine Abbou, Anna Ofir, Adi Klein, Dikla Dahan-Shriki, Mordechai Hallak, Boris Kessel, Mickey Dudkiewicz

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Introduction: Over recent decades, technology has become integral to healthcare, with electronic health records and advanced medical equipment now standard. However, this reliance has made healthcare systems increasingly vulnerable to ransomware attacks. On October 13, 2021, Hillel Yaffe Medical Center experienced a severe ransomware attack that disrupted all IT systems, including electronic health records, laboratory services, and staff communications. The attack, carried out by the group DeepBlueMagic, utilized advanced encryption to lock the hospital's systems and demanded a ransom. This incident caused significant operational and patient care challenges, particularly impacting the obstetrics department. Objective: The objective is to describe the challenges facing the obstetric division following a cyberattack and discuss ways of preparing for and overcoming another one. Methods: A retrospective descriptive study was conducted in a mid-sized medical center. Division activities, including the number of deliveries, cesarean sections, emergency room visits, admissions, maternal-fetal medicine department occupancy, and ambulatory encounters, from 2 weeks before the attack to 8 weeks following it (a total of 11 weeks), were compared with the retrospective period in 2019 (pre-COVID-19). In addition, we present the challenges and adaptation measures taken at the division and hospital levels leading up to the resumption of full division activity. Results: On the day of the cyberattack, critical decisions were made. The media announced the event, calling on patients not to come to our hospital. Also, all elective activities other than cesarean deliveries were stopped. The number of deliveries, admissions, and both emergency room and ambulatory clinic visits decreased by 5%–10% overall for 11 weeks, reflecting the decrease in division activity. Nevertheless, in all stations, there were sufficient activities and adaptation measures to ensure patient safety, decision-making, and workflow of patients were accounted for. Conclusions: The risk of ransomware cyberattacks is growing. Healthcare systems at all levels should recognize this threat and have protocols for dealing with them once they occur.

Keywords: ransomware attack, healthcare cybersecurity, obstetrics challenges, IT system disruption

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Authors: Thitima Plejai

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The practice in the operating room has been continually performed according to standards of services; however, undesirable incidents from surgical services are found such as surgical complications in the operating room. This participation action research aimed to develop practice guidelines for surgical safety management to reduce undesirable incidents from surgical services in the operating room of Songkhla Hospital. The target population was all 84 members of the multidisciplinary team who were involved in surgical services in the operating room consisting of 28 surgeons from five branches of surgery, 27 anesthetists and nurse anesthetists, and 29 surgical nurses. The data were collected through in-depth interviews, and non-participatory observations. The research instrument was tested by three experts, and the steps of the development consisted of four cycles, each consisting of assessment, planning, practice, practice reflection, and improvement until every step is practicable. The data were validated through triangulation research method, analyzed through content analysis and statistical analysis with number and percentage. The results of the development of practice guidelines surgical safety management to reduce undesirable incidents from surgical services could be concluded as follows. 1) The multidisciplinary team in surgery participated in the needs assessment for development of practice guidelines for surgical patient safety, and agreed on adapting the WHO Surgical Safety Checklists for use. 2) The WHO Surgical Safety Checklists was implemented, and meetings were held for the multidisciplinary team in surgery and the organizational risk committee to improve the practice guidelines to make them more practicable. 3) The multidisciplinary team consisting of surgeons from five branches of surgery, anesthetists, nurse anesthetists, surgical nurses, and the organizational risk committee announced policy on safety for surgical patients; the organizational risk committee designated the Surgical Safety Checklist as an instrument for surgical patient safety. The results of the safety management found that the surgical team members who could follow 100 percent of the guidelines were: professional nurses who checked patient identity and information before taking the patient to the operating room and kept complete records of data on the patients; surgical nurses who checked readiness of the patient before surgery; nurse anesthetists who assessed readiness before administering anesthetic drugs, and confirmed correctness of the patient; and circulating perioperative nurses who gave confirmation to the surgical team after completion of the surgery. The rates of undesirable incidents (surgical complications rates) before and after the implementation of the surgical safety management were 1.60 percent and 0.66 percent, respectively. The satisfaction of the surgery-related teams towards the use of the guidelines was 89 percent. The practice guidelines for surgical safety management to reduce undesirable incidents were taken as guidelines for surgical safety that the multidisciplinary team involved in the surgical process implemented correctly and in the same direction and clearly reduced undesirable incidents in surgical patients.

Keywords: practice guidelines, surgical safety management, reduce undesirable incidents, operating Room

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Authors: Jonathan D. Recchi

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Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

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Authors: Zahra Abdolkarimi, Naser Zouri

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Nowadays, there is unbelievable growing of Robots created a collection of complex and motivate subject in robotic and intellectual ornate, also it made a mechatronics style base of theoretical and technical way in Robocop. Additionally, robotics system recommended RoboCup factor as a provider of some standardization and testing method in case of computer discussion widely. The actual purpose of RoboCup is creating independent team of robots in 2050 based of FiFa roles to bring the victory in compare of world star team. In addition, decision making of robots depends to environment reaction, self-player and rival player with using inductive Fuzzy system valuation subsidiary to solve issue of robots in land game. The measure of selection in compare with other methods depends to amount of victories percentage in the same team that plays accidently. Consequences, shows method of our discussion is the best way for Particle Swarm Optimization and Fuzzy system compare to other decision of robotics algorithmic.

Keywords: PSO algorithm, inference fuzzy system, chaos theory, soccer robot league

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Authors: Sarah Al-Lumai, Fatima Al-Attar, Nour Jamal, Badria Al-Dabbous, Manal Abdulla

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Today, many commonly used Industrial Engineering tools and techniques are being used in hospitals around the world for the goal of producing a more efficient and effective healthcare system. A common quality improvement methodology known as Lean Six-Sigma has been successful in manufacturing industries and recently in healthcare. The objective of our project is to use the Lean Six-Sigma methodology to reduce waiting time in the Emergency Department (ED), in a local private hospital. Furthermore, a comprehensive literature review was conducted to evaluate the success of Lean Six-Sigma in the ED. According to the study conducted by Ibn Sina Hospital, in Morocco, the most common problem that patients complain about is waiting time. To ensure patient satisfaction many hospitals such as North Shore University Hospital were able to reduce waiting time up to 37% by using Lean Six-Sigma. Other hospitals, such as John Hopkins’s medical center used Lean Six-Sigma successfully to enhance the overall patient flow that ultimately decreased waiting time. Furthermore, it was found that capacity constraints, such as staff shortages and lack of beds were one of the main reasons behind long waiting time. With the use of Lean Six-Sigma and bed management, hospitals like Memorial Hermann Southwest Hospital were able to reduce patient delays. Moreover, in order to successfully implement Lean Six-Sigma in our project, two common methodologies were considered, DMAIC and DMADV. After the assessment of both methodologies, it was found that DMAIC was a more suitable approach to our project because it is more concerned with improving an already existing process. With many of its successes, Lean Six-Sigma has its limitation especially in healthcare; but limitations can be minimized if properly approached.

Keywords: lean six sigma, DMAIC, hospital, methodology

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Authors: Alok Kumar, Raviraj Patil

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The ability to respond to an incident of a disastrous event in a vulnerable area is very crucial an aspect of emergency management. The ability to constantly predict the likelihood of an event along with its severity in an area and react to those significant events which are likely to have a high impact allows the authorities to respond by allocating resources optimally in a timely manner. It provides for measuring, monitoring, and modeling facilities that integrate underlying systems into one solution to improve operational efficiency, planning, and coordination. We were particularly involved in this innovative incubation work on the current state of research and development in collaboration. technologies & systems for a disaster.

Keywords: predictive analytics, advanced analytics, area flood likelihood model, area flood severity model, level of impact model, mortality score, economic loss score, resource allocation, crew allocation

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Authors: Sai Rajeev Reddy, Ishita Roy, M. Anji Reddy

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The paper describes the importance of preventive measures and immediate Emergency logistics during accidents and unfortunate Disasters for the Hyderabad Metro Rails in their various stages of construction. This is the need of the modern generation where accidents, explosions, attacks and sudden crisis are frequent casualties which take huge tolls of life in the present world. The paper utilizes the workflow and application of Geographical information System (GIS) to provide information about problems and crisis structures for efficient Metro Transportation in the city. The study analyzes the difficulties and problems which cause accidents during operation and maintenance stages of the Metro Rail. The paper focuses upon the intermediate and firsthand information of Crisis with the help of GIS technology to share Disaster data for effective measures by the Cyber Police stations, Emergency Responders, Hospitals and First Aid Centre to act immediately and save lives. The results and conclusions have nevertheless proved very informative and useful for the safety board authorities of the Hyderabad Metro Rail. The operation and Maintenance are integral stages in the development of any Multipurpose transportation Projects and are usually prone to various Disasters and tragedies. Hence, the GIS technologies help in distribution of information among the masses with the web Technologies and advanced software developed to prevent and manage crisis widely and in a cost-benefits manner.

Keywords: Geographical Information System, emergency assessment, accident zones, surveillance

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Authors: Rubaiat S. Ahmed, Jemer Garrido, Sergey M. Motov

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Clinical informatics (CI) enables the transformation of data into a systematic organization that improves the quality of care and the generation of positive health outcomes.Innovative technology through informatics that compiles accurate data on analgesic utilization in the emergency department can enhance pain management in this important clinical setting. We aim to establish a simplified reporting system through CI to examine and assess the analgesic prescribing practices in the EDthrough executing a U.S. federal grant project on opioid reduction initiatives. Queried data points of interest from a level-one trauma ED’s electronic medical records were used to create data sets and develop informational/visual reporting dashboards (on Microsoft Excel and Google Sheets) concerning analgesic usage across several pre-defined parameters and performance metrics using CI. The data was then qualitatively analyzed to evaluate ED analgesic prescribing trends by departmental clinicians and leadership. During a 12-month reporting period (Dec. 1, 2020 – Nov. 30, 2021) for the ongoing project, about 41% of all ED patient visits (N = 91,747) were for pain conditions, of which 81.6% received analgesics in the ED and at discharge (D/C). Of those treated with analgesics, 24.3% received opioids compared to 75.7% receiving opioid alternatives in the ED and at D/C, including non-pharmacological modalities. Demographics showed among patients receiving analgesics, 56.7% were aged between 18-64, 51.8% were male, 51.7% were white, and 66.2% had government funded health insurance. Ninety-one percent of all opioids prescribed were in the ED, with intravenous (IV) morphine, IV fentanyl, and morphine sulfate immediate release (MSIR) tablets accounting for 88.0% of ED dispensed opioids. With 9.3% of all opioids prescribed at D/C, MSIR was dispensed 72.1% of the time. Hydrocodone, oxycodone, and tramadol usage to only 10-15% of the time, and hydromorphone at 0%. Of opioid alternatives, non-steroidal anti-inflammatory drugs were utilized 60.3% of the time, 23.5% with local anesthetics and ultrasound-guided nerve blocks, and 7.9% with acetaminophen as the primary non-opioid drug categories prescribed by ED providers. Non-pharmacological analgesia included virtual reality and other modalities. An average of 18.5 ED opioid orders and 1.9 opioid D/C prescriptions per 102.4 daily ED patient visits was observed for the period. Compared to other specialties within our institution, 2.0% of opioid D/C prescriptions are given by ED providers, compared to the national average of 4.8%. Opioid alternatives accounted for 69.7% and 30.3% usage, versus 90.7% and 9.3% for opioids in the ED and D/C, respectively.There is a pressing need for concise, relevant, and reliable clinical data on analgesic utilization for ED providers and leadership to evaluate prescribing practices and make data-driven decisions. Basic computer software can be used to create effective visual reporting dashboards with indicators that convey relevant and timely information in an easy-to-digest manner. We accurately examined our ED's analgesic prescribing practices using CI through dashboard reporting. Such reporting tools can quickly identify key performance indicators and prioritize data to enhance pain management and promote safe prescribing practices in the emergency setting.

Keywords: clinical informatics, dashboards, emergency department, health informatics, healthcare informatics, medical informatics, opioids, pain management, technology

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Authors: Nelomi Anandagoda, Leanne J. Eveson

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During the COVID-19 pandemic, the surge in in-patient admissions across the medical directorate of a district general hospital necessitated the implementation of an incident rota. Conscious of the impact on training and professional development, the idea of developing a virtual teaching programme was conceived. The programme initially aimed to provide junior doctors, specialist nurses, pharmacists, and allied healthcare professionals from medical specialties and those re-deployed from other specialties (e.g., ophthalmology, GP, surgery, psychiatry) the knowledge and skills to manage the deteriorating patient with COVID-19. The programme was later developed to incorporate the general internal medicine curriculum. To facilitate continuing medical education whilst maintaining social distancing during this period, a virtual platform was used to deliver teaching to junior doctors across two large district general hospitals and two community hospitals. Teaching sessions were recorded and uploaded to a common platform, providing a resource for participants to catch up on and re-watch teaching sessions, making strides towards reducing discrimination against the professional development of less than full-time trainees. Thus, creating a learning environment, which is inclusive and accessible to adult learners in a self-directed manner. The negative impact of the pandemic on the well-being of healthcare professionals is well documented. To support the multi-disciplinary team, the virtual teaching programme evolved to included sessions on well-being, resilience, and work-life balance. Providing teaching for learners across the multi-disciplinary team (MDT) has been an eye-opening experience. By challenging the concept that learners should only be taught within their own peer groups, the authors have fostered a greater appreciation of the strengths of the MDT and showcased the immense wealth of expertise available within the trust. The inclusive nature of the teaching and the ease of joining a virtual teaching session has facilitated the dissemination of knowledge across the MDT, thus improving patient care on the frontline. The weekly teaching programme has been running for over eight months, with ongoing engagement, interest, and participation. As described above, the teaching programme has evolved to accommodate the needs of its learners. It has received excellent feedback with an appreciation of its inclusive, multi-disciplinary, and holistic nature. The COVID-19 pandemic provided a catalyst to rapidly develop novel methods of working and training and widened access/exposure to the virtual technologies available to large organisations. By merging pedagogical expertise and technology, the authors have created an effective online learning environment. Although the authors do not propose to replace face-to-face teaching altogether, this model of virtual multidisciplinary team, cross-site teaching has proven to be a great leveler. It has made high-quality teaching accessible to learners of different confidence levels, grades, specialties, and working patterns.

Keywords: cross-site, cross-speciality, inter-disciplinary, multidisciplinary, virtual teaching

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Authors: Belbaly Nassim

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Virtual teams (VT) initiatives, in which teams are geographically dispersed and communicate via modern computer-driven technologies, have attracted increasing attention from researchers and professionals. The growing need to examine how to balance and optimize VT is particularly important given the exposure experienced by companies when their employees encounter globalization and decentralization pressures to monitor VT performance. Hence, organization is regularly limited due to misalignment between the behavioral capabilities of the team’s dispersed competences and knowledge capabilities and how trust issues interplay and influence these VT dimensions and the effects of such exchanges. In fact, the future success of business depends on the extent to which VTs are managing efficiently their dispersed expertise, skills and knowledge to stimulate VT creativity. Transactive memory system (TMS) may enhance VT creativity using its three dimensons: knowledge specialization, credibility and knowledge coordination. TMS can be understood as a composition of both a structural component residing of individual knowledge and a set of communication processes among individuals. The individual knowledge is shared while being retrieved, applied and the learning is coordinated. TMS is driven by the central concept that the system is built on the distinction between internal and external memory encoding. A VT learns something new and catalogs it in memory for future retrieval and use. TMS uses the role of information technology to explain VT behaviors by offering VT members the possibility to encode, store, and retrieve information. TMS considers the members of a team as a processing system in which the location of expertise both enhances knowledge coordination and builds trust among members over time. We build on TMS dimensions to hypothesize the effects of specialization, coordination, and credibility on VT creativity. In fact, VTs consist of dispersed expertise, skills and knowledge that can positively enhance coordination and collaboration. Ultimately, this team composition may lead to recognition of both who has expertise and where that expertise is located; over time, the team composition may also build trust among VT members over time developing the ability to coordinate their knowledge which can stimulate creativity. We also assess the reciprocal relationship between TMS dimensions and VT creativity. We wish to use TMS to provide researchers with a theoretically driven model that is empirically validated through survey evidence. We propose that TMS provides a new way to enhance and balance VT creativity. This study also provides researchers insight into the use of TMS to influence positively VT creativity. In addition to our research contributions, we provide several managerial insights into how TMS components can be used to increase performance within dispersed VTs.

Keywords: virtual team creativity, transactive memory systems, specialization, credibility, coordination

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Authors: Gulseren Mutlu, Gurupdesh Pandher

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This paper studies the strategic interplay between innovation, incentives, expropriation threat and disputes arising from expropriation from an intra-organization perspective. We present a simple principal-agent model with hidden actions and hidden information in which two employees can choose how much (innovative) effort to exert, whether to expropriate the innovation of the other employee and whether to dispute if innovation is expropriated. The organization maximizes its expected payoff by choosing the optimal reward scheme for both employees as well as whether to encourage or discourage disputes. We analyze two mechanisms under which innovative ideas are not expropriated. First, we show that under a non-contestable mechanism (in which the organization discourages disputes among employees), the organization has to offer a “rent” to the potential expropriator. However, under a contestable mechanism (in which the organization encourages disputes), there is no need for such rent. If the cost of resolving the dispute is negligible, the organization’s expected payoff is higher under a contestable mechanism. Second, we develop a comparable team mechanism in which innovation takes place as a result of the joint efforts of employees and innovation payments are made based on the team outcome. We show that if the innovation value is low and employees have similar productivity, then the organization is better off under a contestable mechanism. On the other hand, if the innovation value is high, the organization is better off under a team mechanism. Our results have important practical implications for the design of innovation reward system for employees, hiring policy and governance for different companies.

Keywords: innovation, incentives, expropriation threat, dispute resolution

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Authors: Fayez Hanna, Viet Tran

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A 20 years old lady- primigravida 6 weeks pregnant with unremarkable past history, presented to the emergency department at the Royal Hobart Hospital, Tasmania, Australia, with hyperemesis gravidarum associated with, dehydration and complicated with hematemesis and chest pain resistant. Accordingly, we conducted laboratory investigations which revealed: FBC: WBC 23.9, unremarkable U&E, LFT, lipase and her VBG showed a pH 7.4, pCo2 36.7, cK+ 3.2, cNa+ 142. The decision was made to do a chest X-ray (CXR) after explaining the risks/benefit of performing radiographic investigations during pregnancy and considering the patient's plan for the termination of the pregnancy as she was not ready for motherhood for shared decision-making and consent to look for pneumoperitoneum to suggest perforated viscus that might cause the hematemesis. However, the CXR showed pneumomediastinum but no evidence of pneumoperitoneum or pneumothorax. Consequently, a decision was made to proceed with CT oesophagography with imaging pre and post oral contrast administration to identify a potential oesophageal tear since it could not be excluded using a plain film of the CXR. The CT oesophagography could not find a leak for the administered oral contrast and thus, no oesophageal tear could be confirmed but could not exclude the Mallory-Weiss tear (lower oesophageal tear). Further, the CT oesophagography showed an extensive pneumomediastinum that could not be confirmed to be pulmonary in origin noting the presence of bilateral pulmonary interstitial emphysema and pneumothorax in the apex of the right lung that was small. The patient was admitted to the Emergency Department Inpatient Unit for monitoring, supportive therapy, and symptomatic management. Her hyperemesis was well controlled with ondansetron 8mg IV, metoclopramide 10mg IV, doxylamine 25mg PO, pyridoxine 25mg PO, esomeprazole 40mg IV and oxycodone 5mg PO was given for pain control and 2 litter of IV fluid. The patient was stabilized after 24 hours and discharged home on ondansetron 8mg every 8 hours whereas the patient had a plan for medical termination of pregnancy. Three weeks later, the patient represented with nausea and vomiting complicated by a frank hematemesis. Her observation chart showed HR 117- other vital signs were normal. Pathology showed WBC 14.3 with normal U&E and Hb. The patient was managed in the Emergency Department with the same previous regimen and was discharged home on same previous regimes. Five days later, she presented again with nausea, vomiting and hematemesis and was admitted under obstetrics and gynaecology for stabilization then discharged home with a plan for surgical termination of pregnancy after 3-days rather than the previously planned medical termination of pregnancy to avoid extension of potential oesophageal tear. The surgical termination and follow up period were uneventful. The case is considered rare as pneumomediastinum is a very rare complication of hyperemesis gravidarum where vomiting-induced barotrauma leads to a ruptured oesophagus and air leak into the mediastinum. However no rupture oesophagus in our case. Although the combination of pneumothorax and pneumomediastinum without oesophageal tear was reported only 8 times in the literature, but none of them was due to hyperemesis gravidarum.

Keywords: Pneumothorax, pneumomediastinum, hyperemesis gravidarum, pneumopericardium

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Authors: Manjari Srivastsva, Ruta Vyas

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The research in the area of self leadership advocates employee/team empowerment. It is well understood that empowered employees would contribute more and better to their organizational outcomes. This research is a part of an ongoing larger research in the area of empowering leadership behavior. The present research aims to understand some of the antecedents to empowering behavior of leaders such that the organizations can focus on the right elements and invest in the appropriate areas during their leadership development activities. The research is exploratory field study. Sampling is purposive, employing triadic design i.e. a manager and two of his/her subordinates are selected for data collection. The total no. of respondents is 240, with 80 managers and 160 of their direct reports. Initially focus group interview was done and based on the inputs from focus group, quantitative data was collected personally by the researchers using questionnaire. The sample is drawn from seven professionally run organization including those of Indian origin as well as multi-national companies. This study proposes to explore the constituents of empowering behavior both from leaders’ and their subordinates’ perspective and also see the relationship between some of the personal variables of leaders as an antecedent to empowering behavior. Similarly, the study aims to explore the subordinates’ perspectives as an antecedent to empowering behavior. The relationship between antecedent variables and empowering behavior is tested for moderation employing organization culture. Exploratory and confirmatory factor analysis was done to establish the validity of the questionnaires. Further hierarchical regression analysis results revealed that organization based self-esteem and global self-esteem impact leaders’ empowering behavior and this relationship is further moderated by organization culture. Team members’ perspective showed higher importance for task characteristics and members' readiness from the point of view of empowerment. The relation between task characteristics and members’ readiness was not moderated by culture. The finding from this research may be utilized by professionals to guide organizations desiring rapid and sustainable growth, to develop leaders who empower their teams such that they act as leaders themselves and become stimulants for the growth of organizations.

Keywords: empowering behavior, team leaders, subordinates, self-esteem, organization culture, task characteristics, team members readiness

Procedia PDF Downloads 424

Authors: Nicholus M. Warstadt, Andres D. Mallipudi, Oluwadamilola Idowu, Joshua Rodriguez, Madison M. Hunt, Soma Pathak, Laura P. Weber

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Endotracheal intubation is a core procedure performed by emergency physicians. This procedure is a high risk, and failure results in substantial morbidity and mortality. Fiberoptic intubation (FOI) is the standard of care in difficult airway protocols, yet no widespread practice exists for training emergency medicine (EM) residents in the technical acquisition of FOI skills. Simulation on mannequins is commonly utilized to teach advanced airway techniques. As part of a program to introduce FOI into our ED, residents received hands-on training in FOI as part of our weekly resident education conference. We hypothesized that prior to the hands-on training, residents had little experience with FOI and were uncomfortable with using fiberoptic as a modality. We further hypothesized that resident comfort with FOI would increase following the training. The education intervention consisted of two hours of focused airway teaching and skills acquisition for PGY 1-4 residents. One hour was dedicated to four case-based learning stations focusing on standard, pediatric, facial trauma, and burn airways. Direct, video, and fiberoptic airway equipment were available to use at the residents’ discretion to intubate mannequins at each station. The second hour involved direct instructor supervision and immediate feedback during deliberate practice for FOI of a mannequin. Prior to the hands-on training, a pre-survey was sent via email to all EM residents at NYU Grossman School of Medicine. The pre-survey asked how many FOI residents have performed in the ED, OR, and on a mannequin. The pre-survey and a post-survey asked residents to rate their comfort with FOI on a 5-point Likert scale ("extremely uncomfortable", "somewhat uncomfortable", "neither comfortable nor uncomfortable", "somewhat comfortable", and "extremely comfortable"). The post-survey was administered on site immediately following the training. A two-sample chi-square test of independence was calculated comparing self-reported resident comfort on the pre- and post-survey (α ≤ 0.05). Thirty-six of a total of 70 residents (51.4%) completed the pre-survey. Of pre-survey respondents, 34 residents (94.4%) had performed 0, 1 resident (2.8%) had performed 1, and 1 resident (2.8%) had performed 2 FOI in the ED. Twenty-five residents (69.4%) had performed 0, 6 residents (16.7%) had performed 1, 2 residents (5.6%) had performed 2, 1 resident (2.8%) had performed 3, and 2 residents (5.6%) had performed 4 FOI in the OR. Seven residents (19.4%) had performed 0, and 16 residents (44.4%) had performed 5 or greater FOI on a mannequin. 29 residents (41.4%) attended the hands-on training, and 27 out of 29 residents (93.1%) completed the post-survey. Self-reported resident comfort with FOI significantly increased in post-survey compared to pre-survey questionnaire responses (p = 0.00034). Twenty-one of 27 residents (77.8%) report being “somewhat comfortable” or “extremely comfortable” with FOI on the post-survey, compared to 9 of 35 residents (25.8%) on the pre-survey. We show that dedicated FOI training is associated with increased learner comfort with such techniques. Further direction includes studying technical competency, skill retention, translation to direct patient care, and optimal frequency and methodology of future FOI education.

Keywords: airway, emergency medicine, fiberoptic intubation, medical simulation, skill acquisition

Procedia PDF Downloads 180

Authors: Teng Zhang, Shenshi Huang, Gang Xu, Xuelin Zhang, Shouxiang Lu

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With the acceleration of urbanization and the increasing of the population in the city, the evacuation of pedestrians suffering from disaster environments such as fire in a room or other limited space becomes a vital issue in modern society. Mice have been used in experimental crowd evacuation in recent years for its good similarities to human in physical structure and stress reaction. In this study, the effect of experience or memory on the collective behavior of mice was explored. To help mice familiarize themselves with the design of the space and the stimulus caused by smoke, we trained them repeatedly for 2 days so that they can escape from the emergency conditions as soon as possible. The escape pattern, trajectories, walking speed, turning angle and mean individual escape time of mice in each training trail were analyzed. We found that mice can build memory quickly after the first trial on the first day. On the second day, the evacuation of mice was maintained in a stable and efficient state. Meanwhile, the group with size of 30 (G30) had a shorter mean individual escape time compared with G12. Furthermore, we tested the experience of evacuation skill of mice after several days. The results showed that the mice can hold the experience or memory over 3 weeks. We proposed the importance of experience of evacuation skill and the research of training methods in experimental evacuation of mice. The results can deepen our understanding of collective behavior of mice and conduce to the establishment of animal models in the study of pedestrian crowd dynamics in emergency conditions.

Keywords: experience, evacuation, mice, group size, behavior

Procedia PDF Downloads 270

Authors: M. Hussaina, K. Mahboobb, S. Z. Ilyasa, S. Shaheena

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Plume dispersion modeling is a computational procedure to establish a relationship between emissions, meteorology, atmospheric concentrations, deposition and other factors. The emission characteristics (stack height, stack diameter, release velocity, heat contents, chemical and physical properties of the gases/particle released etc.), terrain (surface roughness, local topography, nearby buildings) and meteorology (wind speed, stability, mixing height, etc.) are required for the modeling of the plume dispersion and estimation of ground and air concentration. During the early phase of Fukushima accident, plume dispersion modeling and decisions were taken for the implementation of protective measures. A difference in estimated results and decisions made by different countries for taking protective actions created a concern in local and international community regarding the exact identification of the safe zone. The current study is focused to highlight the importance of accurate and exact weather data availability, scientific approach for decision making for taking urgent protective actions, compatible and harmonized approach for plume dispersion modeling during a nuclear emergency. As a case study, the influence of meteorological data on plume dispersion modeling and decision-making process has been performed.

Keywords: decision making process, radiation doses, nuclear emergency, meteorological implications

Procedia PDF Downloads 183

Authors: Fiona Jensen, Barb Goodwin, Nancy Kleiman, Rhonda Usunier

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Background: Clinical simulation is now a common component in many health profession curricula in preparation for clinical practice. In the Rady Faculty of Health Sciences (RFHS) college leads in simulation and interprofessional (IP) education, planned an eight hour simulated hospital day shift, where seventy students from six health professions across two campuses, learned with each other in a safe, realistic environment. Learning about interprofessional collaboration, an expected competency for many health professions upon graduation, was a primary focus of the simulation event. Method: Faculty representatives from the Colleges of Nursing, Medicine, Pharmacy and Rehabilitation Sciences (Physical Therapy, Occupation Therapy, Respiratory Therapy) and Pharmacy worked together to plan the IP event in a simulation facility in the College of Nursing. Each college provided a faculty mentor to guide the same profession students. Students were placed in interprofessional teams consisting of a nurse, physician, pharmacist, and then sharing respiratory, occupational, and physical therapists across the team depending on the needs of the patients. Eight patient scenarios were role played by health profession students, who had been provided with their patient’s story shortly before the event. Each team was guided by a facilitator. Results and Outcomes: On the morning of the event, all students gathered in a large group to meet mentors and facilitators and have a brief overview of the six competencies for effective collaboration and the session objectives. The students assuming their same profession roles were provided with their patient’s chart at the beginning of the shift, met with their team, and then completed professional specific assessments. Shortly into the shift, IP team rounds began, facilitated by the team facilitator. During the shift, each patient role-played a spontaneous health incident, which required collaboration between the IP team members for assessment and management. The afternoon concluded with team rounds, a collaborative management plan, and a facilitated de-brief. Conclusions: During the de-brief sessions, students responded to set questions related to the session learning objectives and expressed many positive learning moments. We believe that we have a sustainable simulation IP collaborative learning opportunity, which can be embedded into curricula, and has the capacity to grow to include more health profession faculties and students. Opportunities are being explored in the RFHS at the administrative level, to offer this event more frequently in the academic year to reach more students. In addition, a formally structured event evaluation tool would provide important feedback and inform the qualitative feedback to event organizers and the colleges about the significance of the simulation event to student learning.

Keywords: simulation, collaboration, teams, interprofessional

Procedia PDF Downloads 131

Authors: S. Selman, T. Gout

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Microbial keratitis is a serious complication of contact lens wear that can be vision and eye-threatening. Diverse presentations relating to contact lens wear include dry corneal surface, corneal infiltrate, ulceration, scarring, and complete corneal melt leading to perforation. Contact lens wear is a major risk factor and, as such, is an important consideration in any patient presenting with a red eye in the primary care setting. This paper aims to provide an overview of the risk factors, common organisms, and spectrum of contact lens-associated keratitis (CLAK) complications. It will highlight some of the salient points relevant to the assessment and workup of patients suspected of CLAK in the emergency department based on the recent literature and therapeutic guidelines. An overview of the management principles will also be provided.

Keywords: microbial keratitis, corneal pathology, contact lens-associated complications, painful vision loss

Procedia PDF Downloads 111

Authors: Yu-Chuan Huang

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Introduction: There is a higher mortality rate for unplanned transfer to intensive care units. It also needs a longer length of stay and makes the intensive care unit beds cannot be effectively used. It affects the immediate medical treatment of critically ill patients, resulting in a drop in the quality of medical care. Purpose: The purpose of this study was using SOFA and APACHEII score to analyze the mortality rate of the cases transferred from ED to ICU. According to the score that should be provide an appropriate care as early as possible. Methods: This study was a descriptive experimental design. The sample size was estimated at 220 to reach a power of 0.8 for detecting a medium effect size of 0.30, with a 0.05 significance level, using G-power. Considering an estimated follow-up loss, the required sample size was estimated as 242 participants. Data were calculated by medical system of SOFA and APACHEII score that cases transferred from ED to ICU in 2016. Results: There were 233 participants meet the study. The medical records showed 33 participants’ mortality. Age and sex with QSOFA , SOFA and sex with APACHEII showed p>0.05. Age with APCHHII in ED and ICU showed r=0.150, 0,268 (p < 0.001**). The score with mortality risk showed: ED QSOFA is r=0.235 (p < 0.001**), exp(B)=1.685(p = 0.007); ICU SOFA 0.78 (p < 0.001**), exp(B)=1.205(p < 0.001). APACHII in ED and ICU showed r= 0.253, 0.286 (p < 0.001**), exp(B) = 1.041,1.073(p = 0.017,0.001). For SOFA, a cutoff score of above 15 points was identified as a predictor of the 95% mortality risk. Conclusions: The SOFA and APACHE II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hours of ICU admission. In conclusion, the SOFA and APACHII score is significantly associated with mortality and strongly predicting mortality. Early predictors of morbidity and mortality, which we can according the predicting score, and provide patients with a detail assessment and proper care, thereby reducing mortality and length of stay.

Keywords: SOFA, APACHEII, mortality, ICU

Procedia PDF Downloads 147

Authors: Alisha M. Ebrahim, Bijoy K. Menon, Eddy Lang, Shelagh B. Coutts, Katie Lin

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Introduction: Frontline emergency physicians require clear and evidence-based approaches to guide neuroimaging investigations for patients presenting with suspected acute stroke or transient ischemic attack (TIA). Various forms of computed tomography (CT) are currently available for initial investigation, including non-contrast CT (NCCT), CT angiography head and neck (CTA), and CT perfusion (CTP). However, there is uncertainty around optimal imaging choice for cost-effectiveness, particularly for minor or resolved neurological symptoms. In addition to the cost of CTA and CTP testing, there is also a concern for increased incidental findings, which may contribute to the burden of overdiagnosis. Methods: In this cross-sectional observational study, analysis was conducted on 586 anonymized triage and diagnostic imaging (DI) reports for neuroimaging orders completed on patients presenting to adult emergency departments (EDs) with a suspected stroke or TIA from January-December 2019. The primary outcome of interest is the diagnostic yield of NCCT+CTA compared to NCCT alone for patients presenting to urban academic EDs with Canadian Emergency Department Information System (CEDIS) complaints of “symptoms of stroke” (specifically acute stroke and TIA indications). DI reports were coded into 4 pre-specified categories (endorsed by a panel of stroke experts): no abnormalities, clinically significant findings (requiring immediate or follow-up clinical action), incidental findings (not meeting prespecified criteria for clinical significance), and both significant and incidental findings. Standard descriptive statistics were performed. A two-sided p-value <0.05 was considered significant. Results: 75% of patients received NCCT+CTA imaging, 21% received NCCT alone, and 4% received NCCT+CTA+CTP. The diagnostic yield of NCCT+CTA imaging for prespecified clinically significant findings was 24%, compared to only 9% in those who received NCCT alone. The proportion of incidental findings was 30% in the NCCT only group and 32% in the NCCT+CTA group. CTP did not significantly increase the yield of significant or incidental findings. Conclusion: In this cohort of patients presenting with suspected stroke or TIA, an NCCT+CTA neuroimaging strategy had a higher diagnostic yield for clinically significant findings than NCCT alone without significantly increasing the number of incidental findings identified.

Keywords: stroke, diagnostic yield, neuroimaging, emergency department, CT

Procedia PDF Downloads 101

Authors: Asmaa Hamdy, Israa Nassar, Tarek Aly

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Introduction: Femoral fractures are the most common presentation in the Emergency Department (ED), and they can present as isolated injuries or as part of a polytrauma situation. To provide optimum pain management care to these patients, practitioners must be well prepared and current with utilizing modern evidence-based knowledge and practices. Management of pain associated with fracture femur in the emergency department has a critical role in the satisfaction of patients and preventing further complications. This study aimed to evaluate the analgesic efficacy of ultrasound-guided femoral nerve block compared with intravenous fentanyl in fractures of the femur in patients presented to the Emergency Department. Patients and Methods: Fifty patients with femur fractures were divided into two groups: Group A: In this group (twenty-five patients) were given intravenous fentanyl 2 micro-grams/kg and re-assessed for pain by Visual Analogue Score (VAS). Group B: In this group (twenty-five patients) underwent ultrasonography-guided femoral nerve block and were re-assessed for pain by VAS. Results: VAS score on the movement of the fractured limb between group A and group B at a 10-minute post-intervention period shows P= 0.043, and hence the difference is significant. VAS score on the movement of the fractured limb between group A and group B during a 10-minute post-intervention period showed a significant difference. Seventeen patients in group A had major PID with a percentage of 63% VS 10 patients in group B with a percentage of 37%. conclusion: both femoral nerve block and intravenous fentanyl are effective in relieving pain in patients with femur fractures. But femoral nerve block provides better and more intense analgesia and major pain intensity difference in less time. Moreover, the use of FNB had fewer side effects and more Hemodynamics stability compared to opioids.

Keywords: femur fracture, nerve block, fentanyl, ultrasound guided

Procedia PDF Downloads 100

Authors: Cristina Costa-Lobo, Ana Martins, Maria Das Dores Formosinho, Ana Campina, Filomena Ponte

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This paper is a report on the findings of a study conducted at an international leading food group. Documentary analysis and discourse analysis techniques were used to examine how corporate social responsibility and career education are valued by this international group. The Survey on Corporate Social Responsibility and Career Education was used, with 18 open-ended questions, the first six related to Corporate Social Responsibility and the last 12 related to Education for the Career. The Survey on the Social Emergency Fund was made up of 16 open-ended questions. The Social Welfare Survey was used to investigate the contribution of social workers in this area, as well as to understand their status. The sample of this investigation is composed by the Director of the development area, by the Coordinator and two Social Assistants of the Social Emergency Fund. Their collaboration was the provision of information in the form of an interview where the two main axes of this study were explored: Corporate Social Responsibility and Career Education. With regard to the analysis of data obtained from interviews, it was accomplished through the content analysis according to the Bardin's method (2004), through the pre-analytical, exploratory and qualitative treatment and interpretation of responses. Critical review of documents was also used. The success and effectiveness of this international group are marked by ambition, ability to resist difficulties, sharing of values, spirit of unity and team sense that is shared in its different companies, its leadership position is also due to the concern to see reinforced and developed values of work, discipline, rigor and competence, its management is geared towards responding to immediate challenges from a Corporate Social Responsibility perspective that is characteristic of it, incorporating concerns about impacts both in the medium and long term. In addition to internal training, it directs investments for external training by promoting actions such as participation in seminars and congresses worldwide and the creation of partnerships in various areas of management with prestigious teaching entities. Findings indicate the creation of a training school, with initiatives for internal and external training, in partnerships with prestigious teaching entities. Of particular note is the Management Trainees Program, developed for more than 25 years, characterized by building a career by obtaining knowledge and skills acquired in the combination of on-the-job experience and a training program.

Keywords: career education, corporate social responsibility, training school, management trainees program

Procedia PDF Downloads 229

Authors: Dalia El Hadi, Alaa Bou Ghannam, Hala Mostafa, Hana Mansour, Ibrahim Hashim, Soubhi Tahhan, Tharwat El Zahran

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Introduction: Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. Some would require neuroimaging. Most commonly used are the CT and MRI of the Brain. They can be over-used when not indicated. Their yield remains dependent on multiple factors relating to the clinical scenario. Methods: A retrospective cross-sectional study was conducted by reviewing the electronic medical records of patients presenting to the Emergency Department (ED) with isolated neuro-ophthalmologic complaints. For each patient, data were collected on the clinical presentation, whether neuroimaging was performed (and which type), and the result of neuroimaging. Analysis of the performed neuroimaging was made, and its yield was determined. Results: A total of 211 patients were reviewed. The complaints or symptoms at presentation were: blurry vision, change in the visual field, transient vision loss, floaters, double vision, eye pain, eyelid droop, headache, dizziness and others such as nausea or vomiting. In the ED, a total of 126 neuroimaging procedures were performed. Ninety-four imagings (74.6%) were normal, while 32 (25.4%) had relevant abnormal findings. Only 2 symptoms were significant for abnormal imaging: blurry vision (p-value= 0.038) and visual field change (p-value= 0.014). While 4 physical exam findings had significant abnormal imaging: visual field defect (p-value= 0.016), abnormal pupil reactivity (p-value= 0.028), afferent pupillary defect (p-value= 0.018), and abnormal optic disc exam (p-value= 0.009). Conclusion: Risk indicators for abnormal neuroimaging in the setting of neuro-ophthalmological emergencies are blurred vision or changes in the visual field on history taking. While visual field irregularities, abnormal pupil reactivity with or without afferent pupillary defect, or abnormal optic discs, are risk factors related to physical testing. These findings, when present, should sway the ED physician towards neuroimaging but still individualizing each case is of utmost importance to prevent time-consuming, resource-draining, and sometimes unnecessary workup. In the end, it suggests a well-structured patient-centered algorithm to be followed by ED physicians.

Keywords: emergency department, neuro-ophthalmology, neuroimaging, risk indicators

Procedia PDF Downloads 179