Abstract WP431: Comparing EMS and Emergency Department Last Known Well Times in Ohio

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mussa Zatreh ◽  
Melissa Richardson
Keyword(s):  
Emergency Department ◽  
Negative Impact ◽  
Improve Patient Care ◽  
Accurate Information ◽  
Hospital Size ◽  
Patient Demographics ◽  
Significant Negative Impact ◽  
The Mean ◽  
The Difference ◽  
Revascularization Therapy

Introduction: During the hyperacute phase of acute stroke management, time the patient was last known well (LKW) is a critical data element. Hospital Emergency Department (ED) personnel rely on accurate information reported by Emergency Medical Services (EMS) prior to arrival, which triggers the intensity of resources organized to determine patient eligibility for revascularization therapy. Over-triage can cause “alarm fatigue”, provider burnout, and/or overutilization of valuable resources. Conversely, under triage may cause a delay in, or lack of, revascularization therapy, which can have significant negative impact on the patient’s outcome. A review of the literature revealed contradictory data about the accuracy of LKW as reported by EMS. Purpose: The purpose of this project is to determine frequency and magnitude of discrepancies between LKW as reported by EMS and ED. The data was analyzed for trends that may influence discrepancies, such as hospital size, location, and patient demographics. Methods: Data on 2,092 patients from 49 hospitals was analyzed from Get With The Guidelines®-Stroke. The difference in the LKW (ΔLKW) was calculated based on source of documentation from EMS or ED. Three datasets were created based on the magnitude of the ΔLKW. For each dataset, the mean, median and patient demographics such as mean age, race, and stroke type were calculated. Results: Of 2,092 patients, 951 (45%) showed an exact match between LKW as reported by EMS and ED (ΔLKW=0), whereas 1,141 patients (55%) showed a discrepancy in the LKW (ΔLKW>0). Discrepancies were not influenced by hospital location or size. Of the overall population, 54% were male, 18% were black, and 73% were diagnosed with an ischemic stroke. The mean age was 72 years. Further collaboration is needed between EMS and ED personnel to improve the accuracy of LKW, and thereby improve patient care and provider efficiency.

On the Major Differences between the Banking Systems of the EAEU States

2020 ◽  
Vol 26 (4) ◽  
pp. 397-406
Author(s):  
T. E. Chekanova
Keyword(s):  
Financial Stability ◽  
Systems Approach ◽  
Negative Impact ◽  
Banking Regulation ◽  
Member States ◽  
Banking Systems ◽  
Significant Negative Impact ◽  
The Difference ◽  
The Government ◽  
Major Factors

The presented study examines the problems of integration of the national banking systems of the member states of the Eurasian Economic Union (EAEU).Aim. The study aims to examine the major differences in various aspects of functioning of banking systems in the EAEU member states in terms of their impact on integration processes.Tasks. The author identifies the most prominent features of the banking systems of the EAEU states; reveals the depth of the existing differences through a comparative analysis of various indicators of national banking systems; outlines ways of overcoming integration problems associated with differences in the banking sectors of the Union states.Methods. This study is based on universal general scientific methods and elements of comparative, functional, and economic analysis within the framework of a systems approach. The author uses regulatory documents and banking reports of the EAEU states, statistical and analytical materials of the Eurasian Economic Commission (EEC), and data of Moody’s international rating agency.Results. The study identifies a number of aspects that contain the major differences in the functioning of banking systems in the EAEU member states; highlights the disproportions in the scale, level of development, financial stability, and risks of the banking spheres of the Union states; comparatively analyzes the proportion of banking and non-banking structures in the system and the share of the government and non-resident companies in the capital of banks; marks the difference in the pricing of banking services; determines differences in the existing approaches to banking regulation and the established standards; analyzes the major differences in the legislative acts of the central banks and governments of the EAEU member states and in the terms and definitions used. According to the results of the study, the major factors hindering the development of integration processes between the banking systems of the EAEU states are identified.Conclusions. The existing differences between the banking systems of the EAEU countries are diverse and multifaceted. The author states that the aspects addressed in this study have a significant negative impact on the further development of integration processes, describing the major directions and actions of the member states aimed at minimizing the exiting differences, which are required to facilitate the convergence of the states and the transition towards a common financial market.

Fatigue Assessment of Mooring Chain Considering the Effects Of Mean Load and Corrosion

2021 ◽  
Author(s):  
Erling N. Lone ◽  
Thomas Sauder ◽  
Kjell Larsen ◽  
Bernt J. Leira
Keyword(s):  
Negative Impact ◽  
Fatigue Tests ◽  
Design Practice ◽  
Extended Formulation ◽  
Considerable Influence ◽  
Corrosion Condition ◽  
Capacity Model ◽  
Significant Negative Impact ◽  
The Mean ◽  
Mooring Chain

Abstract Results from full scale fatigue tests of offshore mooring chains performed in recent years have revealed considerable influence of both mean load and corrosion condition on the fatigue capacity. It has been shown that a reduction of the mean load gives an increase in fatigue life, whereas the corrosion experienced by used chains have a significant negative impact. Neither of these effects are properly addressed by current S-N design curves or design practice. This paper suggests an extended S-N curve formulation, that includes the effects of mean load and corrosion condition. The parameters of the extended formulation are estimated empirically from mooring chain test data that includes new and used chains, with various mean loads and with different degrees of corrosion. The fitted capacity model is then used for fatigue calculation for the mooring system of a semi-submersible, showing the importance of using realistic mean loads and mooring chain corrosion in fatigue assessments.

The Quality Analysis of Hallux Valgus Videos on YouTube

2021 ◽  
Author(s):  
Enes Sari ◽  
Levent FAZLI Umur
Keyword(s):  
Hallux Valgus ◽  
Information Quality ◽  
Statistical Significance ◽  
Poor Quality ◽  
Quality Analysis ◽  
Accurate Information ◽  
Youtube Videos ◽  
The Mean ◽  
The Difference

BACKGROUND:The aim of this study was to evaluate the information quality of YouTube videos on hallux valgus. METHODS:A YouTube search was performed using the keyword 'hallux valgus' to determine the first 300 videos related to hallux valgus. A total of 54 videos met our inclusion criteria and evaluated for information quality by using DISCERN, Journal of the American Medical Association (JAMA) and hallux valgus information assessment (HAVIA) scores. Number of views, time since the upload date, view rate, number of comments, number of likes, number of dislikes, video power index (VPI) values were calculated to determine video popularity. Video length (sec), video source and video content were also noted. The relation between information quality and these factors were statistically evaluated. RESULTS:The mean DISCERN score was 30.35{plus minus}11.56 (poor quality) (14-64), the mean JAMA score was 2.28{plus minus}0.96 (1-4), and the mean HAVIA score was 3.63{plus minus}2.42 (moderate quality) (0.5-8.5). Although videos uploaded by physicians had higher mean DISCERN, JAMA, and HAVIA scores than videos uploaded by non-physicians, the difference was not statistically significant. Additionally, view rates and VPI values were higher for videos uploaded by health channels, but the difference did not reach statistical significance. A statistically significant positive correlation was found between video length and DISCERN (r= 0.294, p= 0.028), and HAVIA scores (r= 0.326, p= 0.015). CONCLUSIONS:This present study demonstrated that the quality of information available on YouTube videos about hallux valgus was low and insufficient. Videos containing accurate information from reliable sources are needed to educate patients on hallux valgus, especially in less frequently mentioned topics such as postoperative complications and healing period.

scholarly journals RADIOGRAPHIC IMPLICATIONS OF THE SURGICAL WAITING LIST FOR THE TREATMENT OF SPINAL DEFORMITY

2018 ◽  
Vol 17 (1) ◽  
pp. 19-22
Author(s):  
LEONARDO YUKIO JORGE ASANO ◽  
MARINA ROSA FILÉZIO ◽  
MATEUS PIPPA DEFINO ◽  
VINÍCIUS ALVES DE ANDRADE ◽  
ANDRÉ EVARISTO MARCONDES CESAR ◽  
...  
Keyword(s):  
Surgical Planning ◽  
Negative Impact ◽  
Waiting Times ◽  
Waiting List ◽  
Surgical Morbidity ◽  
Level Of Evidence ◽  
Mean Waiting Time ◽  
Significant Negative Impact ◽  
Double Approach ◽  
The Mean

ABSTRACT Objective: The aim of this study was to evaluate the implications of long waiting times on surgery lists for the treatment of patients with scoliosis. Methods: Radiographs of 87 patients with scoliosis who had been on the waiting list for surgery for more than six months were selected. Two surgeons answered questionnaires analyzing the radiographs when entering the waiting list and the current images of each patient. Results: Data from 87 patients were analyzed. The mean waiting time for surgery was 21.7 months (ranging from seven to 32 months). The average progression of the Cobb angle in the curvature was 21.1 degrees. Delayed surgery implied changes in surgical planning, such as greater need of instrumentation, osteotomies, and double approach. Conclusions: Long waiting lists have a significant negative impact on surgical morbidity of patients with scoliosis, since they increase the complexity of the surgery. Level of evidence: IV. Type of study: Descriptive study.

scholarly journals Effect of Immediately-After-Birth Weaning on the Development of Goat Kids Born to Small Ruminant Lentivirus-Positive Dams

Animals ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. 822 ◽  
Author(s):  
Nalbert ◽  
Czopowicz ◽  
Szaluś-Jordanow ◽  
Moroz ◽  
Mickiewicz ◽  
...  
Keyword(s):  
Body Weight ◽  
Sexual Maturity ◽  
Linear Models ◽  
Small Ruminant ◽  
Negative Impact ◽  
Body Weight Gain ◽  
Mixed Linear Models ◽  
Daily Body Weight ◽  
The Mean ◽  
The Difference

A longitudinal study was carried out to investigate the influence of two different rearing systems of young kids on their development to sexual maturity. Kids born to small ruminant lentiviruses-infected (SRLV) female goats were split into two groups: the immediately-after-birth weaned group and the unweaned group. Kids’ body weight (BWT) was measured before the first consumption of colostrum, and then at the age of one week, and one, two, four, and seven months. The relationship between the rearing system and BWT at each age was investigated using mixed linear models adjusted for potential confounders. The mean BWT of kids of the immediately-after-birth weaned group was significantly lower at the age of one week, one month, and two months, and then the difference became insignificant. The mean daily body weight gain (DWG) was significantly lower in the immediately-after-birth weaned group during the whole first month of life, but then DWG in both groups became equal. Crude mortality rate did not differ significantly between groups. This study shows that weaning kids immediately after birth does not appear to have any negative impact on kids’ development except transient growth retardation, which is fully compensated until they reach sexual maturity.

scholarly journals P108: Characterizing use of next-day ultrasound from the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S103
Author(s):  
C. Roberts ◽  
T. Oyedokun ◽  
B. Cload ◽  
L. Witt
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Additional Stress ◽  
Start Date ◽  
The Mean ◽  
Tertiary Care Hospitals ◽  
Improve Patient

Introduction: Formal ultrasound imaging, with use of ultrasound technicians and radiologists, provides a valuable diagnostic component to patient care in the Emergency Department (ED). Outside of regular weekday hours, ordering formal ultrasounds can produce logistical difficulties. EDs have developed protocols for next-day ultrasounds, where the patient returns the following day for imaging and reassessment by an ED physician. This creates additional stress on ED resources – personnel, bed space, finances – that are already strained. There is a dearth of literature regarding the use of next-day ultrasounds or guidelines to direct efficient use. This study sought to accumulate data on the use of ED next-day ultrasounds and patient oriented clinical outcomes. Methods: This study was a retrospective chart review of 150 patients, 75 from each of two different tertiary care hospitals in Saskatoon, Saskatchewan. After a predetermined start date, convenience samples were collected of all patients who had undergone a next-day ultrasound ordered from the ED until the quota was satisfied. Patients were identified by an electronic medical record search for specific triage note phrases indicating use of next-day ultrasounds. Different demographic, clinical, and administrative parameters were collected and analyzed. Results: Of the 150 patients, the mean age was 35.9 years and 75.3% were female. Median length of stay for the first visit was 4.1 hours, and 2.2 hours for the return visit. Most common ultrasound scans performed were abdomen and pelvis/gyne (34.7%), complete abdomen (30.0%), duplex extremity venous (10.0%). Most common indications on the ultrasound requisition were nonspecific abdominal pain (18.7%), vaginal bleeding with or without pregnancy (17.3%), and hepatobiliary pathology (15.3%). Ultrasounds results reported a relevant finding 56% of the time, and 34% were completely normal. After the next-day ultrasound 5.3% of patients had a CT scan, 10.7% had specialist consultation, 8.2% were admitted, and 7.3% underwent surgery. Conclusion: Information was gathered to close gaps in knowledge about the use of next-day ultrasounds from the ED. A large proportion of patients are discharged home without further interventions. Additional research and the development of next-day ultrasound guidelines or outpatient pathways may improve patient care and ED resource utilization.

scholarly journals Analgesia for extremity fractures in the paediatric emergency department

2020 ◽  
Vol 29 (2) ◽  
pp. 108-112
Author(s):  
Siew Ming Tan ◽  
Yong-Kwang Gene Ong ◽  
Jen Heng Pek
Keyword(s):  
Emergency Department ◽  
Pain Score ◽  
Lower Limb ◽  
Key Management ◽  
Current Practice ◽  
Paediatric Emergency Department ◽  
Patient Demographics ◽  
Paediatric Emergency ◽  
The Mean ◽  
The Impact

Background: Extremity fractures are an important and common presentation at the Paediatric Emergency Department (PED). Provision of analgesia is a key management principle, but it is often suboptimal. Although there is an increase in awareness of this issue, the impact on current practice is not known. We aimed to review the current practice of providing analgesia for extremity fractures in the PED. Objective: Our objective was to determine the utilisation, adequacy and timeliness of analgesia provided for these patients. Methods: A retrospective study was carried out from November to December 2017. Patients with a diagnosis of extremity fracture involving the upper or lower limb were included. Information about patient demographics, diagnosis, pain score, analgesia use and clinical progress were collected for analysis. Results: There were 101 cases. The mean age was 8.5±4.2 years old, and 62 (61.4%) patients were male. There were 76 (75.3%) cases of fractures involving the upper limb, and 25 (24.7%) cases of fractures involving the lower limb. The mean pain score at presentation was 3.3±2.3. Analgesia was administered to only 10 (9.9%) patients, with oral paracetamol ( n=5; 5.0%) being the most common medication administered. The median time between arrival in the PED to analgesia administration was 69 minutes (range 25–328 minutes). Conclusions: Despite the increase in awareness, analgesia for these patients remains underutilised, inadequate and delayed. Further efforts at pain assessment, analgesia selection and administration are necessary to improve the provision of analgesia for these patients.

Presence of undertriage and overtriage in simple triage and rapid treatment

2017 ◽  
Vol 12 (3) ◽  
pp. 147-154 ◽  
Author(s):  
J. J. Hong, MEd ◽  
Gerard Carroll, MD ◽  
Rick Hong, MD
Keyword(s):  
Emergency Department ◽  
Inner City ◽  
Emergency Medical Services ◽  
Outcome Measures ◽  
Chart Review ◽  
Tertiary Care ◽  
Treatment Start ◽  
The Mean ◽  
The Difference ◽  
Rapid Treatment

Objective: We evaluated the use of the Simple Triage and Rapid Treatment (START) method by Emergency Medical Services (EMS) and hypothesized that EMS can categorize patients using the START algorithm accurately.Design: Retrospective Chart Review.Setting: Inner-city Tertiary-Care Institutional Emergency Department (ED).Participants: Patients ≥ 18 years transported by EMS with a START color of Red, Yellow, or Green during the state triage tag exercise, October 9-15, 2011.Interventions: EMS assigned each patient a START triage tag. Chart review of the electronic EMS run sheets was performed by investigators to determine a START color.Main Outcome Measures: START triage colors were re-categorized as Red = 1, Yellow = 2, and Green = 3. The difference between the investigators’ color and EMS color were coded as: 0 for agreement in triage, -1 for undertriage by one category, -2 for undertriage by two categories, 1 for overtriage by one category, 2 for overtriage by two categories.Results: Of 224 participants, START triage colors were: Red = 7.1 percent, Yellow = 19.2 percent, Green = 73.7 percent. The mean difference in triage categories was 0.228 (95% CI: 0.114-0.311, p.001). 71.0 percent of patients were triaged to the same category, 5.8 percent undertriaged by one category, 0 percent undertriaged by two categories, 17.9 percent overtriaged by one category, and 5.4 percent overtriaged by two categories.Conclusion: EMS was more likely to overtriage using START. All patients who were overtriaged by two categories were ambulatory at the scene, which implies other findings not in START may affect triage.

scholarly journals The effect of characteristics differences in vertical pair of executives and equity incentives on enterprise performance

2021 ◽  
Vol 336 ◽  
pp. 09009
Author(s):  
Yu Lu ◽  
Ruijie Xu
Keyword(s):  
Linear Regression ◽  
Negative Impact ◽  
Positive Impact ◽  
Multiple Linear Regression Model ◽  
Enterprise Performance ◽  
Senior Executives ◽  
Equity Incentives ◽  
Significant Negative Impact ◽  
The Difference ◽  
Leading Enterprises

Taken the leading enterprises in the Shanghai and Shenzhen A-share listed companies from 2013 to 2017 as the research samples, the effect of characteristics differences in vertical pair of executives and equity incentives on enterprise performance was empirically analyzed. Constructing multiple linear regression model tested hypothesis. The results show that the interaction between equity incentives and the difference in age of vertical pair of senior executives has a significant negative impact on enterprise performance; the interaction between equity incentives and the difference in education of vertical pair of senior executives has a significant positive impact on enterprise performance.

scholarly journals Multi-objective calibration of MIKE SHE with SMAP soil moisture datasets

2018 ◽  
Vol 50 (2) ◽  
pp. 644-654 ◽  
Author(s):  
Dayang Li ◽  
Zhongmin Liang ◽  
Binquan Li ◽  
Xiaohui Lei ◽  
Yan Zhou
Keyword(s):  
Soil Moisture ◽  
Root Zone ◽  
Negative Impact ◽  
Hydrological Models ◽  
Distributed Hydrological Model ◽  
Mike She ◽  
Multi Objective ◽  
The Mean ◽  
The Difference ◽  
Better Than

Abstract Root zone soil moisture plays an important role in water storage in hydrological processes. The recently launched Soil Moisture Active Passive (SMAP) mission has produced a high-resolution assimilation product of global root zone soil moisture that can be applied to improve the performance of hydrological models. In this study, we compare three calibration approaches in the Beimiaoji watershed. The first approach is single-objective calibration, in which only observed streamflow is used as a benchmark for comparison with the other approaches. The second and third approaches use multi-objective calibration based on SMAP root zone soil moisture and observed streamflow. The difference between the second and third approaches is the metric used to characterize the root zone soil moisture. The second approach applies the mean, which was commonly used in previous studies, whereas the third approach applies the hydrologic complexity μ, a dimensionless metric based on information entropy theory. These approaches are implemented to calibrate the distributed hydrological model MIKE SHE. Results show that the root zone soil moisture simulation is clearly improved, whereas streamflow simulation suffers from a slightly negative impact with multi-objective calibration. The hydrologic complexity μ performs better than the mean in capturing the features of root zone soil moisture.

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