scholarly journals P064: A randomized trial comparing telephone tree, text messaging, and instant messaging app for emergency department staff recall for disaster response

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S86
Author(s):  
V. Homier ◽  
R. Hamad ◽  
J. Larocque ◽  
P. Chassé ◽  
E. Khalil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Response Time ◽  
Instant Messaging ◽  
Median Response ◽  
Median Response Time ◽  
Staff Members ◽  
Significant Difference ◽  
Tree Group ◽  
Recall Methods

Introduction: A crucial component of a hospital's disaster plan is an efficient staff recall communication method. Many hospitals use a “calling tree” protocol to contact staff members and recall them to work. Alternative staff recall methods have been proposed and explored. Methods: An unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00AM and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time. Results: One-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P = .018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: -5.7% to 38.0%; P = .17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P = .000006). Conclusion: Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods.

A Randomized Trial Comparing Telephone Tree, Text Messaging, and Instant Messaging App for Emergency Department Staff Recall for Disaster Response

2018 ◽  
Vol 33 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Valerie Homier ◽  
Raphael Hamad ◽  
Josée Larocque ◽  
Pierre Chassé ◽  
Elene Khalil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Response Time ◽  
Disaster Response ◽  
Text Messaging ◽  
Instant Messaging ◽  
Median Response ◽  
Median Response Time ◽  
Staff Members ◽  
Emergency Department Staff ◽  
Significant Difference

AbstractIntroductionA crucial component of a hospital’s disaster plan is an efficient staff recall communication method. Many hospitals use a “calling tree” protocol to contact staff members and recall them to work. Alternative staff recall methods have been proposed and explored.MethodsAn unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00am and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time.ResultsOne-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P=.018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: −5.7% to 38.0%; P=.17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P=.000006).Conclusion:Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods.HomierV, HamadR, LarocqueJ, ChasséP, KhalilE, FrancJM.A randomized trial comparing telephone tree, text messaging, and instant messaging app for emergency department staff recall for disaster response. Prehosp Disaster Med. 2018;33(5):471–477.

scholarly journals Organ responses with daratumumab therapy in previously treated AL amyloidosis

2020 ◽  
Vol 4 (3) ◽  
pp. 458-466 ◽  
Author(s):  
Alfred Chung ◽  
Gregory P. Kaufman ◽  
Surbhi Sidana ◽  
Erik Eckhert ◽  
Stanley L. Schrier ◽  
...  
Keyword(s):  
Response Time ◽  
Cardiac Response ◽  
Al Amyloidosis ◽  
Median Response ◽  
Median Response Time ◽  
Hematologic Response ◽  
Cardiac Responses ◽  
Wide Range ◽  
Significant Difference ◽  
Previously Treated

Abstract Immunoglobulin light chain amyloidosis (AL amyloidosis) involves deposition of abnormally folded light chains into a wide range of tissues causing organ dysfunction, including in the heart and kidney. Daratumumab, a CD38-targeted antibody, has recently demonstrated efficacy in producing hematologic responses in previously treated disease. However, data on survival outcomes and organ responses to daratumumab are lacking. Seventy-two patients with previously treated AL amyloidosis who received daratumumab monotherapy with dexamethasone were retrospectively evaluated. With a median follow-up of 27 months, 2-year overall survival (OS) was 86.9% (median OS, not reached) and 2-year time-to-next treatment or death (TTNT)–free survival was 62% (median TTNT, not reached). Forty of 52 evaluable patients achieved a hematologic response (77%), with >60% of patients achieving a very good partial response or better; median time-to-hematologic response was 1 month. Fifty-seven patients (79%) had cardiac involvement, and 55% of evaluable patients achieved a cardiac response, with a median response time of 3.2 months among responders. Cardiac responses were associated with an improvement in OS, with landmark analysis for cardiac responses at 3 months trending toward statistical significance (100% vs 55% at 30 months, P = .051). Forty-seven patients (65%) had renal involvement, and 52% of evaluable patients achieved a renal response, with a median response time of 6 months among responders; there was no significant difference in OS between renal responders and nonresponders. This study demonstrates that daratumumab is highly effective in the treatment of previously treated AL amyloidosis, and a significant proportion of patients can achieve deep hematologic responses, as well as improvements in organ function.

A Typology of Players: Between Instinctive and Contemplative *

2016 ◽  
Vol 131 (2) ◽  
pp. 859-890 ◽  
Author(s):  
Ariel Rubinstein
Keyword(s):  
Response Time ◽  
The Other ◽  
Spearman Correlation ◽  
Median Response ◽  
Median Response Time ◽  
Shed Light

Abstract A new typology of players is proposed based on the classification of actions as either instinctive or contemplative. A person’s type is the probability of him choosing a contemplative action. To test the typology, results of 10 games are analyzed. Actions in each game were classified depending on whether their response time was more or less, respectively, than the median response time of all subjects who played the game. It is argued that fast actions are more instinctive and slow actions are more contemplative. A subject’s contemplative index (CI) is defined as the proportion of games in which he chose a contemplative action. It is found that for 8 of the 10 games, the CI in the other 9 games is positively correlated with a player’s choice of a contemplative action in that game (average Spearman correlation of 9%). The CI is used to shed light on the nature of choice in five additional games.

scholarly journals Pediatric interfacility transport effects on mortality and length of stay

2021 ◽  
Author(s):  
Rod M. Shinozaki ◽  
Andreas Schwingshackl ◽  
Neeraj Srivastava ◽  
Tristan Grogan ◽  
Robert B. Kelly
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Response Time ◽  
Pediatric Intensive Care ◽  
Hospital Length Of Stay ◽  
Median Response ◽  
Median Response Time ◽  
Transport Response ◽  
Mode Of Transport

Abstract Background We aimed to evaluate the effects of interfacility pediatric critical care transport response time, physician presence during transport, and mode of transport on mortality and length of stay (LOS) among pediatric patients. We hypothesized that a shorter response time and helicopter transports, but not physician presence, are associated with lower mortality and a shorter LOS. Methods Retrospective, single-center, cohort study of 841 patients (< 19 years) transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records. Multivariate linear and logistic regression analyses adjusted for age, diagnosis, mode of transport, response time, stabilization time, return duration, mortality risk (pediatric index of mortality-2 and pediatric risk of mortality-3), and inotrope, vasopressor, or mechanical ventilation presence on admission. Results Four hundred and twenty-eight (50.9%) patients were transported by helicopter, and 413 (49.1%) were transported by ambulance. Physicians accompanied 239 (28.4%) transports. The median response time was 2.0 (interquartile range 1.4–2.9) hours. Although physician presence increased the median response time by 0.26 hours (P = 0.020), neither physician presence nor response time significantly affected mortality, ICU length of stay (ILOS) or hospital length of stay (HLOS). Helicopter transports were not significantly associated with mortality or ILOS, but were associated with a longer HLOS (3.24 days, 95% confidence interval 0.59–5.90) than ambulance transports (P = 0.017). Conclusions These results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Helicopter transports were only associated with a longer HLOS. Our analysis provides a framework for examining transport workforce needs and associated costs.

How to score acute pancreatitis in the emergency setting: five systems against ED-SAS

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Acute Pancreatitis ◽  
Confidence Interval ◽  
Scoring Systems ◽  
Apache Ii ◽  
Youden Index ◽  
Automation System ◽  
Emergency Setting ◽  
Death Rates ◽  
Significant Difference

To assess the effectiveness of a new scale known as “Emergency department SpO2 (peripheral capillary oxygen saturation), age, and SIRS (Systemic inflammatory response syndrome)” (ED-SAS) that can be used to predict prognosis within 24 hours following presentation compatible with acute pancreatitis in patients admitted to the emergency department. This research project was conducted as a single-center, retrospective, cohort study. The Acute Physiology and Chronic Health Evaluation II (APACHE II), SIRS, Bedside Index for Severity in Acute Pancreatitis (BISAP), ED-SAS, modified Glasgow Scale and Ranson criteria scoring of the patients were evaluated using their presentation data screened from the hospital automation system. Then, the efficiencies of these evaluation systems were compared using the receiving operating curve (ROC). The conformity of the data to the normal distribution was checked with the Kolmogorov-Smirnov test. The ROC analyses were employed to identify the cut-off values of the scoring systems in calculating death rates. The method developed by DeLong et al. was used to compare the ROC curves of the scoring systems. The study has been completed with 235 patients, 91 (38.7%) male and 144 (61.3%) female, with a mean age of 63.1 ± 17.7 years. In the ROC analysis of the ED-SAS evaluation tool to predict death rates, the area under the curve (AUC) value was found to be 0.85 (95% confidence interval: 0.79–0.89), and the Youden index was 0.62, with a p value of 0.001. Mortality prediction with ED-SAS significantly differed compared to the Ranson and SIRS scoring systems (P = 0.001 and P = 0.03, respectively). However, no statistically significant difference was found in the comparison of the ED-SAS score with the modified Glasgow and APACHE II scores (P = 0.12 and P = 0.54, respectively). It was concluded that the Baseband ED-SAS scores provided equally significant results in terms of AUC at the 95% confidence interval (P = 0.05). Statistical analyses revealed that the APACHE II, SIRS, BISAP, modified Glasgow and ED-SAS scores were found to be significantly higher among the dead in comparison to the survivors (P < 0.05). ED-SAS constitutes a simple, fast, expedient and effective evaluation system that can be utilized to predict mortality in acute pancreatitis in the emergency setting.

Abstract 148: A Machine Learning-based Dispatch Rule for Drone-delivered Defibrillators

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jamal Chu ◽  
K.H. Benjamin Leung ◽  
Sheldon Cheskes ◽  
Paul Snobelen ◽  
Gordon Nevils ◽  
...  
Keyword(s):  
Machine Learning ◽  
Response Time ◽  
Response Times ◽  
Time Of Day ◽  
Sign Test ◽  
Type I ◽  
Similar Response ◽  
Median Response ◽  
Optimal Dispatch ◽  
Median Response Time

Introduction: Drone-delivered defibrillators may reduce response time for out-of-hospital cardiac arrest (OHCA). However, an optimal dispatch rule is not yet known. Methods: We identified all suspected OHCAs in Peel Region, Ontario, Canada from Jan. 2014 to Dec. 2019. We trained a neural network model to predict emergency medical services (EMS) response times using OHCA location, distance from responding ambulance, day of week and time of day. Instead of least-squares loss, our model optimized a loss function that penalized weighted errors in the dispatch decision (type I/II error). Assuming drones were deployed from three bases in the region, we calculated drone response time to each suspected OHCA using real drone specifications. Our dispatch rule dispatched a drone when its calculated response time was shorter than the predicted EMS response time. Response time was calculated as the minimum of the drone and EMS response times. The performance of our dispatch rule was compared on out-of-sample OHCAs using 5-fold cross validation to the baseline cases of (1) no drones, and (2) drone dispatch to every suspected OHCA. Statistical analysis on the median response times was performed using a right-tailed sign test. Results: We identified 4774 suspected OHCAs with a median historical EMS response time of 6.0 minutes. Using our dispatch rule, median response time was significantly shorter at 3.9 minutes (P<0.001). Drones were dispatched to 3803 cases (79.7%) and of those, drone response was faster than EMS in 3076 cases (80.9%). When the drone was not dispatched, it would have been slower than EMS in 856 cases (88.1%). Sending a drone to every suspected OHCA resulted in an identical median response time of 3.9 minutes (P<0.001), with drones arriving before EMS in 3191 cases (66.8%). Conclusion: A machine learning-based dispatch rule can achieve similar response times as a policy that dispatches a drone to all suspected OHCAs, while dispatching drones less frequently.

scholarly journals Adolescents’ pain and distress during peripheral intravenous cannulation in a paediatric emergency setting

2021 ◽  
Author(s):  
Giorgio Cozzi ◽  
Marta Cognigni ◽  
Riccardo Busatto ◽  
Veronica Grigoletto ◽  
Manuela Giangreco ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Relief ◽  
Local Anaesthesia ◽  
Cross Sectional Study ◽  
Emergency Setting ◽  
Older Children ◽  
Cross Sectional ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Significant Difference

AbstractThe objective of the study is to investigate pain and distress experienced by a group of adolescents and children during peripheral intravenous cannulation in a paediatric emergency department. This cross-sectional study was performed between November 2019 and June 2020 at the paediatric emergency department of the Institute for Maternal and Child Health of Trieste, Italy. Eligible subjects were patients between 4 and 17 years old undergoing intravenous cannulation, split into three groups based on their age: adolescents (13–17 years), older children (8–12 years), and younger children (4–7 years). Procedural distress and pain scores were recorded through validated scales. Data on the use of topical anaesthesia, distraction techniques, and physical or verbal comfort during procedures were also collected. We recruited 136 patients: 63 adolescents, 48 older children, and 25 younger children. There was no statistically significant difference in the median self-reported procedural pain found in adolescents (4; IQR = 2–6) versus older and younger children (5; IQR = 2–8 and 6; IQR = 2–8, respectively). Furthermore, no significant difference was observed in the rate of distress between adolescents (79.4%), older (89.6%), and younger (92.0%) children. Adolescents received significantly fewer pain relief techniques.Conclusion: This study shows that adolescents experience similar pain and pre-procedural distress as younger children during peripheral intravenous cannulation. What is Known:• Topical and local anaesthesia, physical and verbal comfort, and distraction are useful interventions for pain and anxiety management during intravenous cannulation in paediatric settings. • No data is available on pain and distress experienced by adolescents in the specific setting of the emergency department. What is New:• Adolescents experienced high levels of pre-procedural distress in most cases and similar levels of pain and distress when compared to younger patients• The number of pain relief techniques employed during procedures was inversely proportional to patient’s age, topical or local anaesthesia were rarely used

Blood contamination of the pharmaceutical staff by irinotecan and its two major metabolites inside and outside a compounding unit

2021 ◽  
pp. 107815522110120
Author(s):  
Victoire Béchet ◽  
Hubert Benoist ◽  
Frédéric Beau ◽  
Fabienne Divanon ◽  
Stéphanie Lagadu ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Antineoplastic Drug ◽  
Blood Contamination ◽  
Staff Members ◽  
Adverse Health Effects ◽  
Healthcare Settings ◽  
Significant Difference ◽  
Drug Contamination ◽  
Contamination Levels

Background Caregivers in healthcare settings are exposed to a risk of antineoplastic drug contamination which can lead to adverse health effects. Biological monitoring is necessary to estimate the actual level of exposure of these workers. This study was conducted with the aim of assessing blood contamination levels by irinotecan and its metabolites of pharmaceutical staff operating inside and outside a compounding unit. Methods The study took place within the pharmaceutical unit of a French comprehensive cancer centre. Blood samples were collected from the pharmacy workers operating inside and outside the compounding unit, and analysed by UHPLC-MS/MS. Plasma and red blood cell irinotecan and its metabolites (SN-38; APC) were determined with a validated analytical method detection test. Results A total of 17/78 (21.8%) plasma and red blood cell-based assays were found to be contaminated among staff. Overall, the total number of positive assays was significantly higher for staff members working outside the compounding unit than for workers working inside it ( P = 0.022), with respectively 5/42 (11.9%) and 12/36 (33.3%) positive assays. For plasma dosages, the “outside” group had a significantly higher number of positive assays ( P = 0.014). For red blood cell-based assays, no significant difference was found ( P = 0.309). Conclusions This study reveals that pharmaceutical staff serving in health care settings are exposed to a risk of antineoplastic drug contamination, not only inside the compounding room but also in adjacent rooms. The results would help to raise awareness and potentially establish protective measures for caregivers working in areas close to the compounding room as well.

scholarly journals Association of interleukin-17A rs2275913 polymorphism with rheumatoid arthritis susceptibility in Sudanese population

2021 ◽  
Vol 9 ◽  
pp. 205031212110202
Author(s):  
Rgda Mohamed Osman ◽  
Mounkaila Noma ◽  
Abdallah Elssir Ahmed ◽  
Hanadi Abdelbagi ◽  
Rihab Ali Omer ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Confidence Interval ◽  
Statistical Tests ◽  
Demographic Data ◽  
Control Group ◽  
P Value ◽  
Case Group ◽  
Molecular Technique ◽  
Interleukin 17A ◽  
Significant Difference

Objectives: Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed to determine the association of interleukin-17A-197G/A polymorphism with rheumatoid arthritis in Sudanese patients. Methods: A case–control study was conducted between March and December 2018. Clinical and demographic data of the study participants were collected and analyzed. Polymerase chain reaction restriction fragment length polymorphism molecular technique was done to investigate interleukin-17A-197G/A polymorphisms. All statistical tests were considered statistically significant when p < 0.05. Results: The study population included 266 participants aged between 1 and 85 years, with an average of 40 years, classified into 85 (31.2%) cases (mean age 48.5 ± 11.3 years), and 181 (68.8%) controls (mean age 35.3 ± 15.9 years). The interleukin-17A homozygote AA genotype was more frequent among the control group compared to the case group; 95 (52.5%) and 7 (8.2%), respectively. The homozygote GG and the heterozygote AG genotypes were proportionally not different among the cases and control groups; 13 (54.2%) and 11 (45.8%), and 65 (46.4%) and 75 (53.6%), respectively. According to the distribution of interleukin-17A genotypes, a statistically significant difference was observed among cases with the interleukin-17A AA and AG genotypes, p values 0.001 and 0.004, respectively. For the association interleukin-17A genotypes and family history a negatively significant association was reported (95% confidence interval, –0.219, p value = 0.001). There was also a negatively significant association of interleukin-17A genotypes and anti-cyclic citrullinated peptide (95% confidence interval, −0.141, p value = 0.002). Conclusion: This study is the first study in Sudan established the association between interleukin-17A-197G/A (rs2275913) polymorphisms and susceptibly to rheumatoid arthritis. These findings appeal for further research in Sudan to investigate the exact role of IL-17A in immunopathology and disease severity among Sudanese rheumatoid arthritis

scholarly journals Evaluating Endoscopic Ipsilateral Endonasal Corridor Approaches to the Anterolateral Wall of the Maxillary Sinus: A Computerized Tomography Study

2021 ◽  
Author(s):  
Navarat Vatcharayothin ◽  
Pornthep Kasemsiri ◽  
Sanguansak Thanaviratananich ◽  
Cattleya Thongrong
Keyword(s):  
Confidence Interval ◽  
Maxillary Sinus ◽  
Inferior Turbinate ◽  
Radial Access ◽  
Sinus Wall ◽  
Nasal Floor ◽  
Significant Difference ◽  
Anterolateral Wall ◽  
The Mean ◽  
Maxillary Sinuses

Abstract Introduction The endoscopic access to lesions in the anterolateral wall of the maxillary sinus is a challenging issue; therefore, the evaluation of access should be performed. Objective To assess the accessibility of three endoscopic ipsilateral endonasal corridors. Methods Three corridors were created in each of the 30 maxillary sinuses from 19 head cadavers. Accessing the anterolateral wall of the maxillary sinus was documented with a straight stereotactic navigator probe at the level of the nasal floor and of the axilla of the inferior turbinate. Results At level of the nasal floor, the prelacrimal approach, the modified endoscopic Denker approach, and the endoscopic Denker approach allowed mean radial access to the anterolateral maxillary sinus wall of 42.6 ± 7.3 (95% confidence interval [CI]: 39.9–45.3), 56.0 ± 6.1 (95%CI: 53.7–58.3), and 60.1 ± 6.2 (95%CI: 57.8–62.4), respectively. Furthermore, these approaches provided more lateral access to the maxillary sinus at the level of the axilla of the inferior turbinate, with mean radial access of 45.8 ± 6.9 (95%CI: 43.3–48.4) for the prelacrimal approach, 59.8 ± 4.7 (95% CI:58.1–61.6) for the modified endoscopic Denker approach, and 63.6 ± 5.5 (95%CI: 61.6–65.7) for the endoscopic Denker approach. The mean radial access in each corridor, either at the level of the nasal floor or the axilla of the inferior turbinate, showed a statistically significant difference in all comparison approaches (p < 0.05). Conclusions The prelacrimal approach provided a narrow radial access, which allows access to anteromedial lesions of the maxillary sinus, whereas the modified endoscopic Denker and the endoscopic Denker approaches provided more lateral radial access and improved operational feasibility on far anterolateral maxillary sinus lesions.

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