Comparing Sources of Disruptions to Telemedicine-Enabled Stroke Care in an Ambulance

2021 ◽  
pp. 193758672110547
Author(s):  
Sahar Mihandoust ◽  
Anjali Joseph ◽  
Kapil Chalil Madathil ◽  
Hunter Rogers ◽  
Roxana Jafarifiroozabadi ◽  
...  
Keyword(s):  
Evaluation Process ◽  
Stroke Care ◽  
Video Recordings ◽  
Impact Location ◽  
Remote Assessment ◽  
Computer Workstation ◽  
Adequate Evaluation ◽  
The Right ◽  
Evaluation Space ◽  
Care Evaluation

Objective: The purpose of this study is to understand the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care. Background: Telemedicine is emerging as an efficient approach to provide timely remote assessment of patients experiencing acute stroke in an ambulance. These consults are facilitated by connecting the patient and paramedic with a remotely located neurologist and nurse using cameras, audio systems, and computers. However, ambulances are typically retrofitted to support telemedicine-enabled care, and the placement of these systems inside the ambulance might lead to spatial challenges and disruptions during patient evaluation. Method: Video recordings of 13 simulated telemedicine-based stroke consults were coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. For each observed disruption—the type, severity or impact, location in the ambulance, and equipment involved in the disruption were recorded. Results: Seat size, arrangement of assessment equipment, location of telemedicine equipment (computer workstation), and design of telemedicine camera were among the factors that impacted telemedicine-related disruptions. The left ambulance seat zone and head of the patient bed were more involved in environmental hazard–related disruptions, while the right zone of the ambulance was more prone to interruptions and communication-related disruptions. Conclusion: Adequate evaluation space for the paramedic, proper placement of evaluation equipment, and telemedicine computer location could facilitate the stroke care evaluation process and reduce FDs in the ambulance.

scholarly journals Utilization of Life Skills Training Results In Enhancing Self-Employed Alumni LKP Nuning Kota Cimahi

Empowerment ◽  
2018 ◽  
Vol 7 (2) ◽  
pp. 224
Author(s):  
NISMA NURUL BILAD
Keyword(s):  
Life Skills ◽  
Skill Training ◽  
Implementation Process ◽  
Evaluation Process ◽  
Skills Training ◽  
Professional Organization ◽  
Life Skills Training ◽  
Process Implementation ◽  
The Subject ◽  
The Right

Entrepreneurship is the right choice to improve the life of the economy independently. Whether it's the economy of ourselves personally, even the economy in general in a bigger scope. Cimahi City as one of the cities in Indonesia that has the number of unemployed as many as 2,903 people in 2015. Based on data obtained from the Department of Manpower Cimahi City in 2016, it is known that only about 25.2% alone the amount of unemployment that can be absorbed on the job there is. Based on the conditions in this field, needed an empowerment to overcome the condition. One of the empowerment activities that can be done to overcome this condition through life skills training in the field of bridal makeup organized by Course and Training Institute. But the activity of the alumni of post life skill training training needs to be seen again. Like what the alumni are applying the results of training in entrepreneurship.               This research uses qualitative approach with descriptive method. The subject of this research is alumni of LKP Nuning Kota Cimahi in bridal make up. Data collection techniques in this study using interview techniques, observation, and documentation studies. The results of this study indicate that the life skills training process in bridal makeup field consists of preparation process, implementation process, evaluation process, and mentoring process. It can be said that 75% of LKP Nuning alumni in the field of bridal makeup have successfully entrepreneurship independently.               This bridal makeup training really helps the alumni in improving their economic and social position in the community. After the training, the alumni began to pioneer their business independently. Promoting online and offline, improving existence through professional organization activities, as well as setting aside funds for upgrading on her dressing skills. In addition, they begin to encounter the obstacles in it. In general, the obstacles faced are divided into 4 issues namely, capital constraints, business competition obstacles, barriers to trend changes that are too fast, and hambantan management of business management. However, not all alumni succeeded in becoming bridal cosmetic. There are also alumni who return to their original job or remain a housewife. Keywords: Entrepreneurship Independence, Life Skills, Bridal Makeup

Abstract WP247: Paramedic Perspectives on Prehospital Stroke Care: A Qualitative Analysis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
J A Oostema ◽  
Maria Tecos ◽  
Deborah Sleight ◽  
Brian Mavis
Keyword(s):  
Qualitative Analysis ◽  
Focus Groups ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Structured Interview ◽  
Time Frame ◽  
System Level ◽  
Stroke Patients ◽  
Interview Format ◽  
The Right

Introduction: Ischemic stroke patients who arrive by emergency medical service (EMS) receive faster emergency department evaluations and improved rates of thrombolytic treatment. However, EMS stroke recognition and compliance with prehospital stroke quality measures are inconsistent. We hypothesized that EMS stroke care is influenced by a complex interaction of knowledge, beliefs, and system-level variables that influence behavior. Methods: Focus groups of paramedics from a single urban/suburban county were assembled to discuss their experiences identifying and transporting stroke patients. Focus groups were conducted using a semi-structured interview format and audio recorded. Transcripts of focus groups were qualitatively analyzed to identify themes, subthemes, and patterns of paramedic responses. The Clinical Practice Guidelines Framework provided the initial coding scheme, which was modified during the coding process by three coders using grounded theory methods, who came to consensus on which codes to apply. Results: Three focus groups (n=13) were conducted to reach theme saturation. Overall, paramedics reported high confidence in clinical gestalt for assessing stroke patients and a strong desire to “do the right thing,” but were unfamiliar with published guidelines. Paramedics identified variability in the clinical presentations of stroke, inadequate or inconsistent hospital guidance, and lack of feedback regarding care as principle barriers to ideal prehospital stroke care. Participants reported conflicting hospital guidance regarding the appropriate time frame for a high priority transport and hospital prenotification. Feedback regarding final diagnosis was viewed as critical for developing improved clinical acumen. Direct to CT protocols were cited as an effective way to integrate EMS into hospital stroke response. Conclusion: In this qualitative analysis, paramedics expressed a desire for clear, hospital-directed guidance and consistent feedback regarding outcomes for suspected stroke patients.

Artificial nutrition and hydration

2015 ◽  
pp. 237-246
Author(s):  
Michelle S. Gabriel ◽  
Jennifer A. Tschanz
Keyword(s):  
Decision Making ◽  
Quality Care ◽  
Artificial Nutrition ◽  
Terminal Phase ◽  
Informed Decision Making ◽  
Artificial Nutrition And Hydration ◽  
Cultural Considerations ◽  
Nutrition And Hydration ◽  
The Right ◽  
Care Evaluation

Decreased appetite or inability to tolerate or enjoy food and fluids is often a hallmark of the terminal phase of an illness. Discussions and decisions regarding initiating or withholding artificial nutrition and hydration at the end of life are guided by goals of care, evaluation of benefits and burden, ethical and cultural considerations, and the beliefs and wishes of the patient and family. Patients have the right to refuse hydration and nutrition, whether parenteral or oral. Nurses are responsible for promoting patient autonomy, providing education regarding benefits and burdens of interventions in order, promoting informed decision making, and delivering quality care with the rest of the are team.

OP47 Need For New Thrombectomy Centers? A Practical Decision Framework

2019 ◽  
Vol 35 (S1) ◽  
pp. 11-11
Author(s):  
Maria Vutcovici Nicolae ◽  
Lucy Boothroyd ◽  
Leila Azzi ◽  
Laurie Lambert ◽  
Michèle de Guise
Keyword(s):  
Decision Making ◽  
Real World ◽  
Critical Mass ◽  
Evaluation Process ◽  
Field Evaluation ◽  
Stroke Care ◽  
Healthcare Services ◽  
Performance Criteria ◽  
Sources Of Information

IntroductionStroke is a major contributor to mortality, disability and long-term use of healthcare services. As for all chrono-dependant conditions, clinical results are associated with timely access to appropriate care. Thrombectomy (EVT) is an effective treatment for large vessel occlusions, but can only be provided in highly-specialized centers by experienced personnel. We sought to develop a framework to aid decision-making on the appropriateness of opening new EVT centers in Québec, Canada.MethodsData sources included provincial administrative healthcare databases, population density statistics, field evaluation of Québec's four existing EVT care networks, and literature review concerning structural and performance criteria for EVT centers. We consulted EVT clinical teams, interdisciplinary stroke experts, patients, professional association representatives, healthcare managers and decision-makers.ResultsAccess to EVT is suboptimal in all 17 regions of Québec, with virtually no access in remote areas. Results of key performance indicators indicated favorable treatment delays after arrival at the EVT center. However, door-to-needle and door-in-door-out times were long for patients transferred from non-EVT centers. High use of ambulances indicated the potential to transport patients to the most appropriate center. In light of ‘real world’ results and other sources of information, the need for a new EVT center should consider the following criteria: sub-optimal EVT access within the region; transport time to an existing EVT center >1 hour; expected patient volume within 2 hours of transport; impact on volume of existing programs; availability of long-term financial support; availability of a critical mass of neurointerventionists, vascular neurologists, and neurosurgeons; demonstrated quality of stroke care; and, presence of a stroke unit.ConclusionsThe triangulation of literature, clinician experience and the Québec context enriched the evaluation process. Furthermore, this facilitated the development of a framework that was broadly applicable across regions to the real-world setting of decision-making in a complex system of care.

scholarly journals (A84) Video Documentation as a Supplemental Teaching Tool for Multi-Focused Emergency Management Exercises

2011 ◽  
Vol 26 (S1) ◽  
pp. s23-s24
Author(s):  
C. Tedeschi ◽  
L.M. Hilmi
Keyword(s):  
Emergency Management ◽  
Large Scale ◽  
Life Support ◽  
Management Education ◽  
Evaluation Process ◽  
Video Footage ◽  
Video Recordings ◽  
Ongoing Training ◽  
Short Video ◽  
Evaluation And Monitoring

IntroductionEmergency management education and large-scale disaster drills help to increase local capacity for dealing with a multitude of hazards. Video recordings of disaster drills offer participants with little exposure to fundamental emergency management principles an introduction to important topics and scenarios. Such resources allow ongoing training and education, thus maximizing the investment required to mount a large-scale exercise.MethodsDuring emergency management exercises in Mumbai, India between 2008 and 2010, video recordings of prior exercises were used to augment training for clinicians, administrators and public health practitioners. During the exercises, videos depicting scenario-based disaster drills were produced for use as teaching and evaluation tools focused on pre-hospital care, trauma life support, and hospital operations. Videos are distributed digitally and online, extending the teaching impact of multi-day courses and serving as a benchmark for future exercises.ResultsDuring the 2010 exercise in Mumbai, approximately eight hours of video footage were recorded by professional producers, and by participants in the evaluation and monitoring track of the course. That footage was added to a library from exercises in Ahmedabad and Mumbai, India, in 2007 and 2008. Video was used as a tool for immediate feedback on participant performance as well as the foundation for ongoing instruction. Videos allowed students to be sensitized to important issues prior to taking part in a drill, and to participate in the post-drill evaluation process.ConclusionVideo documents of disaster management exercises serve as a valuable addition to an ongoing program of emergency management education and preparedness. Short video pieces increase the effectiveness of a teaching program by providing re-usable, easily accessible, and setting-specific teaching tools.

scholarly journals Stretch–excitation correlation in the toad heart

2020 ◽  
Vol 223 (23) ◽  
pp. jeb228882
Author(s):  
Vladimir A. Vityazev ◽  
Jan E. Azarov
Keyword(s):  
Bolus Injection ◽  
Ventricular Myocardium ◽  
Bufo Bufo ◽  
Interquartile Range ◽  
Video Recordings ◽  
Ventricular Activation ◽  
Potential Mapping ◽  
Activation Times ◽  
The Right ◽  
Activation Sequence

ABSTRACTThe activation sequence of the ventricular myocardium in ectotherms is a matter of debate. We studied the correlation between the ventricular activation sequence and the pattern of local stretches in 13 toads (Bufo bufo). Epicardial potential mapping was done with a 56-lead sock array. Activation times were determined as dV/dt (min) in each lead. Initial epicardial foci of activation were found on the left side of the ventricular base, whereas regions on the apex and the right side of the base demonstrated late activation. Video recordings (50 frames s−1) showed that the median presystolic stretch in left-side ventricular regions was greater than that in right-side regions [4.70% (interquartile range 3.25–8.85%) versus 1.45% (interquartile range 0.38–3.05%), P=0.028, respectively]. Intracardiac bolus injection elicited ventricular activation with a similar sequence and duration. Thus, ventricular areas of earliest activation were associated with greater presystolic stretch, implying the existence of a stretch–excitation relationship in ectotherm hearts.

scholarly journals Deep Regressor: Cross Subject Academic Performance Prediction System for University Level Students

2019 ◽  
Vol 8 (11S) ◽  
pp. 1265-1267
Keyword(s):  
Machine Learning ◽  
Academic Performance ◽  
Evaluation Process ◽  
Education Institution ◽  
Drop Out ◽  
Machine Learning Techniques ◽  
Learning Techniques ◽  
Current Program ◽  
The Right ◽  
The University

Predicting the academic performance of students has been an important research topic in the Educational field. The main aim of a higher education institution is to provide quality education for students. One way to accomplish a higher level of quality of education is by predicting student’s academic performance and there by taking earlyre- medial actions to improve the same. This paper presents a system which utilizes machine learning techniques to classify and predict the academic performance of the students at the right time before the drop out occurs. The system first accepts the performance parameters of the basic level courses which the student had already passed as these parameters also influence the further study. To pre- dict the performance of the current program, the system continuously accepts the academic performance parame- ters after each academic evaluation process. The system employs machine learning techniques to study the aca- demic performance of the students after each evaluation process. The system also learns the basic rules followed by the University for assessing the students. Based on the present performance of the students, the system classifies the students into different levels and identify the students at high risk. Earlier prediction can help the students to adopt suitable measures in advance to improve the per for- man ce. The systems can also identify the factor saffecting the performance of the same students which helps them to take remedial measures in advance.

scholarly journals Model Bantuan Rumah Tidak Layak Huni Menggunakan SPK Desa Cangkringrembang Demak

2019 ◽  
Vol 10 (1) ◽  
pp. 7-16
Author(s):  
Mukhamad Nurkamid ◽  
Keyword(s):  
Decision Support ◽  
Home Ownership ◽  
Evaluation Process ◽  
Financial Assistance ◽  
System Model ◽  
Income Status ◽  
Building Area ◽  
The Government ◽  
The Right ◽  
The Village

The need for clean livable houses complete with adequate infrastructure is the right of every citizen. The state in this case the government has clearly set it up in Law No. 6 of 2014 or known as the Village Law and Regents Regulation No.5 of 2016 concerning the allocation of village funds. In this law the spirit of the community to build a better village is not an impossible thing to achieve, moreover financial assistance from the center to the regions is given more than activities for other institutions. But the fact remains on the ground that many residents, especially in the villages, still do not have a place to live that can be said to be livable (prosperous). In this study a Sistem Pendukung Keputusan (SPK) model was built to determine the provision of assistance to villagers. The object of the study was conducted in the Cangkring Rembang Village, Karanganyar District, Demak Regency. The results of this study are a decision support system model with the Multifactor Evaluation Process (MFEP) method to determine the assistance for restoration of unfit homes according to criteria for home ownership, home status, home wall status, home floor status, home roof status, building area status and income status

scholarly journals Evaluation of a Public Technology-Based Traffic Enforcement Program

2021 ◽  
Vol 13 (21) ◽  
pp. 11966
Author(s):  
Gila Albert ◽  
Dimitry Bukchin ◽  
Tomer Toledo
Keyword(s):  
Red Light ◽  
Evaluation Process ◽  
Traffic Enforcement ◽  
Unique Type ◽  
Red Light Running ◽  
Rigorous Evaluation ◽  
Video Recordings ◽  
Traffic Violations ◽  
Police Enforcement ◽  
Simple Technology

While police enforcement is a well-known means of reducing traffic violations, it is also recognized that other agents should be involved in creating sustainable deterrence. This paper describes and evaluates the Israeli Road Guards program, a new and unique type of traffic enforcement, which enables simple technology-based enforcement of traffic violations by citizens. In its 24 months of operation, more than 3400 volunteers who submitted over 64,000 violation reports were involved in this program. Each report went through a rigorous evaluation process. More than 80% of the submitted reports were rejected in the various stages of the procedure. In 13.7% of the cases a notice letter was sent, and in 4.3% of cases (reflecting the most severe offenses) a citation was issued by the police. The monthly rate of report submission by the volunteers was at its highest initially, then decreased and stabilized after about six months at 1.4 reports per month. The proportion of active volunteers also decreased over time to a level of 0.26 at the end of the study period. The violation types reported within the program differed substantially from those captured by police enforcement. These differences are likely due to the manner in which each mode of enforcement was performed. The most common violations reported by volunteers were lane deviations, red light running and driving on the roads’ shoulders, which are easily documented by means of video recordings. They are also associated with higher crash risks. Thus, the results show that such public technology-based traffic enforcement, which can be carried out during regular daily driving and does not require anyone to make extra trips, may efficiently complement traditional police enforcement.

Insider versus outsider – who is better? The case of Zyne furnishings

2021 ◽  
Vol 11 (4) ◽  
pp. 1-19
Author(s):  
Gopal Venkata Vajjhala ◽  
K.S. Venu Gopal Rao
Keyword(s):  
Objective Assessment ◽  
Evaluation Process ◽  
Leadership Role ◽  
Sales Manager ◽  
Western Region ◽  
Content Type ◽  
High Point ◽  
Academic Level ◽  
Pros And Cons ◽  
The Right

Case overview/synopsis Zyne is a mid-sized Delhi-based firm engaged in the home linen business under the company’s brand name. Raman was the Managing Director of Zyne. In 2019, Prashanth the head of the second-best region (West) quit abruptly without grooming a successor. Prashanth’s team consisted of greenhorn executives whom he recruited from colleges. Raman has options of selecting a replacement for Prashanth from within the organization. Two candidates are in the reckoning, namely, Amit and Neha. Amit was 48 years old, a veteran in the business and associated with the Zyne group for over 15 years. He was a top sales performer in the Central region and was interested in relocating to the West. Twenty-seven-year-old Neha was industrious, talented and creative. Within three years of joining Zyne, she had proven herself as a go-getter with remarkable ability to develop strong channel partner relations. Raman had to decide whom to select from among the two or go for an outsider from the industry. Raman has to contend with selection issues related to insider vs an outsider. If one of the internal candidates is chosen how could he motivate the other to continue to perform and deliver? The case focuses on the challenges of recruitment of a Sales Manager (SM) in a small home furnishing business. Use of competency framing to validate the candidates is the high point of the case Learning objectives By the end of case discussion participants should be able to understand the following: differentiate skills required in a sales leadership role as compared to that of a sales executive; evaluate the pros and cons of internal promotions versus hiring an outsider; apply the concept of competency framework to evaluate different candidates vying for the same position; and understand how a candidate not selected for the position understands the reasons thereof to enable improvements. Complexity academic level Started in 2010, Zyne Furnishings headquartered at Delhi, was in the business of selling home furnishings. Raman, a second-generation entrepreneur was Zyne’s Managing Partner. With help from his father Rajesh Gupta, Raman worked toward expanding Zyne’s business operations in India. Raman was facing a challenge because of the abrupt resignation of Prashanth, the Western Region SM. Prashant had done well in the region and assiduously built Zyne brand’s presence there. As Raman pondered over the ways of filling up the SM position, questions confronted him for which he did not have immediate answers. He had 30 days in which a replacement must be finalized. Raman looked at the file containing the applications of the two internal candidates, namely, Amit (Southern region) and Neha (Western region) who had applied for the position. What evaluation process should he adopt to ensure an objective assessment is done before deciding on which of the two candidates fit the bill? Given that it was the first week of January 2020 and the year-end targets had to be met by March, Raman knew time was running out. He had to take a quick call. Use of competency mapping to evaluate candidates is a high point of the case. This case can be used to enhance the participants understanding of the challenges of identifying the right candidate for a senior position and weigh the pros and cons associated with the selection. Motivating the rejected internal candidate through the procedural justice system adds value to the case. Supplementary materials Teaching notes are available for educators only. Subject code CSS 8: Marketing.

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