Clinical Effectiveness of Pre-hospital and In-hospital Optimized Emergency Care Procedures for Patients With Acute Craniocerebral Trauma

Acute craniocerebral injury is a common traumatic disease in clinical practice, characterized by rapid changes in condition and a high rate of death and disability. Early and effective emergency care throughout the pre-hospital and in-hospital period is the key to reducing the rate of death and disability and promoting the recovery of patients. In this study, we conducted an observational study of 130 patients with acute craniocerebral injury admitted between May 2020 and May 2021. Patients were randomly divided into a regular group and an optimization group of 65 patients each, with patients in the regular group receiving the conventional emergency care model and patients in the optimization group receiving the pre-hospital and in-hospital optimal emergency care process for intervention. In this study, we observed and compared the time taken to arrive at the scene, assess the condition, attend to the patient and provide emergency care, the success rate of emergency care within 48 h, the interleukin-6 (IL-6), interleukin-8 (IL-8), and intercellular adhesion molecule-1 (ICAM-1) after admission and 1 day before discharge, the National Institute of Health Stroke Scale (NIHSS) and the Short Form 36-item Health Survey (SF-36) after resuscitation and 1 day before discharge, and the complications of infection, brain herniation, central hyperthermia, and electrolyte disturbances in both groups. We collected and statistically analyzed the recorded data. The results showed that the time taken to arrive at the consultation site, assess the condition, receive the consultation, provide first aid was significantly lower in the optimized group than in the regular group (P < 0.05); the success rate of treatment was significantly higher in the optimized group than in the regular group (P < 0.05). In both groups, IL-6, IL-8, and ICAM-1 decreased on the day before discharge compared with the day of rescue, with the levels of each index lower in the optimization group than in the regular group (P < 0.05); the NIHSS scores decreased and the SF-36 scores increased on the day before discharge compared with the successful rescue in both groups, with the NIHSS scores in the optimization group lower than in the regular group and the SF-36 scores higher than in the control group (P < 0.05). The overall complication rate in the optimization group was significantly lower than that in the regular group (P < 0.05). This shows that optimizing pre-hospital and in-hospital emergency care procedures can significantly shorten the time to emergency care for patients with acute craniocerebral injury, increase the success rate, reduce inflammation, improve neurological function and quality of life, reduce the occurrence of complications, and improve patient prognosis.

Guidelines for volcano-observatory operations during crises: recommendations from the 2019 volcano observatory best practices meeting

In November 2019, the fourth Volcano Observatory Best Practices workshop was held in Mexico City as a series of talks, discussions, and panels. Volcanologists from around the world offered suggestions for ways to optimize volcano-observatory crisis operations. By crisis, we mean unrest that may or may not lead to eruption, the eruption itself, or its aftermath, all of which require analysis and communications by the observatory. During a crisis, the priority of the observatory should be to acquire, process, analyze, and interpret data in a timely manner. A primary goal is to communicate effectively with the authorities in charge of civil protection. Crisis operations should rely upon exhaustive planning in the years prior to any actual unrest or eruptions. Ideally, nearly everything that observatories do during a crisis should be envisioned, prepared, and practiced prior to the actual event. Pre-existing agreements and exercises with academic and government collaborators will minimize confusion about roles and responsibilities. In the situation where planning is unfinished, observatories should prioritize close ties and communications with the land and civil-defense authorities near the most threatening volcanoes.To a large extent, volcanic crises become social crises, and any volcano observatory should have a communication strategy, a lead communicator, regular status updates, and a network of colleagues outside the observatory who can provide similar messaging to a public that desires consistent and authoritative information. Checklists permit tired observatory staff to fulfill their duties without forgetting key communications, data streams, or protocols that need regular fulfilment (Bretton et al. Volcanic Unrest. Advances in Volcanology, 2018; Newhall et al. Bull Volcanol 64:3–20, 2020). Observatory leaders need to manage staff workload to prevent exhaustion and ensure that expertise is available as needed. Event trees and regular group discussions encourage multi-disciplinary thinking, consideration of disparate viewpoints, and documentation of all group decisions and consensus. Though regulations, roles and responsibilities differ around the world, scientists can justify their actions in the wake of an eruption if they document their work, are thoughtful and conscientious in their deliberations, and carry out protocols and procedures developed prior to volcanic unrest. This paper also contains six case studies of volcanic eruptions or observatory actions that illustrate some of the topics discussed herein. Specifically, we discuss Ambae (Vanuatu) in 2017–2018, Kīlauea (USA) in 2018, Etna (Italy) in 2018, Bárðarbunga (Iceland) in 2014, Cotopaxi (Ecuador) in 2015, and global data sharing to prepare for eruptions at Nyiragongo (Democratic Republic of Congo). A Spanish-language version of this manuscript is provided as Additional file 1.

Enhancing the learning and transfer of preprocedural communication skills during clerkship using audio-visual material: a prospective case-controlled study over 2 years

Objective/design/settingThis study aims to develop preprocedural communication-specific framework that emphasises the use of audiovisual materials and compares its acceptability by trainees with a regular module.TraineesBetween October 2018 and July 2021, 96 medical clerks were enrolled and randomly divided into regular and intervention groups. Another 48 trainees whose did not join the framework-based training but complete self-assessments were enrolled as the control group.InterventionsIn the intervention training module, the key steps of preprocedural communication-specific skills were structuralised into a framework using the acronym of OSCAR.Primary and secondary outcome measuresThis study compared the acceptability of trainees for two modules by measuring the degree of increase in the end-of-rotation and follow up (4 weeks later) competency from baseline by trainees’ self-assessments and physician assessments after serial trainings.ResultsIn comparison with regular group trainees, greater degree of improvements (framework-1 statement: 111%±13% vs 27%±5%, p<0.001; framework-2 statement: 77%±9% vs 48%±2%, p<0.05; skill-1 statement: 105%±9% vs 48%±3%, p<0.001); skill-2 statement: 71%±11% vs 50%±9%, p<0.05) were noted in the framework-related and skill-related statement 1–2 (the familiarity and confidence to use the framework and skills) than those of intervention group. At the end-of-rotation stage, the trainees ability to use the ‘A-step: using audiovisual materials’ of the OSCAR was significantly improved (229%±13%, p<0.001), compared with other steps. In the intervention group, the degree of improvement of the end-of-rotation data of trainees’ self-assessment from baseline was significantly correlated with the degree of the improvement in physicians’ assessment data in the aspects of skills, framework and steps in framework (R=0.872, p<0.01; R=0.813, p<0.001; R=0.914, p<0.001).ConclusionsThe OSCAR framework-based intervention module is well accepted by medical clerks and motivates them to integrate the acquired skills in clinical practice, which leads to trainees’ primary care patients being satisfied with their preprocedural communication.

The Impact of COVID-19 Pandemic on the Learning Outcomes of Medical Students in Taiwan: A Two-Year Prospective Cohort Study of OSCE Performance

Background/Aims: To avoid the negative impacts of the COVID-19 pandemic on clinical clerkship, supplemental teachings such as digital materials in the scenario-based distal simulations were implemented. This study utilized the OSCE (objective-structured clinical examination) to evaluate the impact of COVID-19 pandemic on the learning outcome of medical students from the regular group (class of 2020) and pandemic-impacted group (class of 2021). Methods: All medical students serially took, firstly, the mock-OSCE, secondly, the mock-OSCE, and the national OSCE. Then, the serial OSCE scores were compared between groups. Results: Although with similar scores in the first mock OSCE, the regular group (n = 78) had a higher average score in the national OSCE than the pandemic-impacted group (n = 80) (872.18 vs. 834.96, p = 0.003). In terms of improvement, the performances of the regular group were also better than the pandemic-impacted group between the second mock OSCE and the national OSCE (79.10 vs. 38.14, p = 0.014), and between the second mock OSCE and the national OSCE (125.11 vs. 77.52, p = 0.003). While separating distinct genres, the regular group had more of a score increment in standardized patient-based stations between the second mock OSCE and the national OSCE (regular vs. pandemic-impacted: 57.03 vs. 18.95, p = 0.003), as well as between the first mock OSCE and the national OSCE (75.97 vs. 26.36, p < 0.001), but there was no significant difference among the skill-based stations. In particular, the scores of the emergency medicine associated station in the national OSCE of the pandemic-impacted group was lower. Conclusions: Our study implies that the pandemic significantly hampered the learning outcomes of final year medical students in their clinical participation. Especially facing the COVID-19 pandemic, more supplemental teachings are needed to compensate the decreasing emergency medicine exposure.

Application of Self-Adhesive Soft Silicone Common Foam Dressing in Reducing Intraoperative Pressure Ulcers in Elderly ICU Patients

Pressure ulcer (PU), also called pressure injury, is localized damage to the skin and underlying soft tissues, usually over bony prominences, as a result of sustained mechanical loads applied to the tissues. However, in many situations, complete off-loading of sacral PUs is not possible. Minimising the exposure of wounds and their surroundings to elevated mechanical loads is crucial for healing. We for the first time reported the application of Meipicang in the prevention and treatment of intraoperative pressure ulcers in elderly ICU patients with severe illness. We found that the pressure ulcer risk score ( 20.15 ± 2.17 ) in the dressing group after intervention was higher than that ( 17.42 ± 3.62 ) in the regular group. The incidence of pressure sores in the dressing group was 3.77% lower than the 18.88% in the regular group. The psychological concern score ( 31.41 ± 3.15 ) of the dressing group was higher than that ( 26.92 ± 3.43 ) of the regular group. The trust score ( 29.57 ± 2.61 ) of the dressing group was higher than the score ( 24.28 ± 2.29 ) of the regular group. The score of physiological problems in the dressing group ( 34.69 ± 3.82 ) is higher than that in the regular group ( 29.88 ± 3.54 ). The skin complication rate of the dressing group was 5.56% lower than that of the regular group (22.64%). The comfort score (92.46 ± 4.15) of the dressing group was higher than that ( 80.59 ± 5.43 ) of the regular group. The nursing satisfaction score ( 94.53 ± 3.72 ) of the dressing group was higher than that ( 81.79 ± 4.61 ) of the regular group. To conclude, in this study, we found that the Meipicang dressing can reduce the incidence of pressure ulcers in ICU patients with severe ICU and improve the comfort and nursing satisfaction of elderly ICU patients with severe ICU, which is worthy of promotion.

Whole Team, Whole Person High-Involvement Quality Improvement Training for VA Community Living Center Leaders

Long-term care is a challenging environment for quality improvement due to the high resident acuity, wide variation in resident needs, and wide variation in types and backgrounds of the large staff across three daily shifts. We report results from a learning collaborative undertaken to improve care quality and staff quality improvement skills in the VA CLCs through development of high functioning relationally coordinated teams operating in accord with person-centered care principles. The collaborative included 27 CLCs. Over 9 months leadership teams completed action assignments supported by 5 workshops and regular group coaching calls. Evaluation included fidelity monitoring (attendance, mid- and final progress reports), satisfaction questionnaires, and review of the VA quality measures (CLC Compare). Pre-post participant evaluations revealed a significant increase in positive responses to the question “to what extent do you think applying these new skills/knowledge will improve quality in your CLC?” and positive responses trending toward significance in ratings of abilities to apply new skills. Open-ended survey comments were positive and indicated change in understanding and practice: “utilizing the daily huddle to facilitate real time communication afforded the team a proactive approach to providing care and reducing acute exacerbations. We are able to avert, evaluate as a real time team and make it happen in the now not as a look back.”; “definitely unified front-line staff and CLC leadership.” Some changes were achieved in CLC Compare quality scores (e.g., falls with major injury rate had a 9.6 reduction (average rate = 3.39 pre, 3.07 post)).

Focus group findings on clinicians’ perceived barriers and facilitators to giving rights information to involuntary psychiatrics patients in British Columbia, Canada

Background In British Columbia, Canada, clinicians are responsible for giving information about rights to patients involuntarily hospitalized under the Mental Health Act. But a survey commissioned by the Ministry of Health and an investigation by the BC Office of the Ombudsperson found that patients were not consistently receiving rights information. Methods Focus groups were used to probe clinicians’ perceived barriers and facilitators to giving patients rights information. Focus group transcripts were thematically analyzed, and the themes were coded using the Theoretical Domains Framework to identify interventions that could encourage clinicians to consistently give patients complete rights information. Results Eighty-one psychiatric clinicians participated. Analysis identified these barriers: (a) clinicians receive inadequate training on the Mental Health Act and rights notification; (b) newly admitted patients might not be receptive to new information; (c) the tool used to communicate rights to patients is inadequate; (d) many patients don’t speak English; (e) clinicians have competing priorities during the admission process; (f) clinicians face pressure from other staff to give incomplete information; (g) the clinical workflow doesn’t facilitate follow-up and accountability; and (h) staff don’t receive enough support from their employer. The following facilitators were identified: (a) a team approach allows clinicians to share knowledge about the Mental Health Act and rights notification, (b) having one person take responsibility for rights information clarifies roles and increases accountability, (c) accreditation reminds clinicians of the importance of giving patients rights information, and (d) checklists remind clinicians of their rights-notification responsibilities. Conclusions These interventions may help clinicians give rights information more consistently: (a) training about the Mental Health Act and rights notification, (b) an accessible legal resource for clinicians and patients, (c) regular group sessions about rights for patients, (d) an improved rights-communication tool, in multiple languages, and (e) checklists, reminders, and accountability and feedback systems.

The Way of Steve Lacy: Finding Individuality through Musical Genealogy

<p>This research project traces Lacy’s life in music, looking at his long period of apprenticeship, the brief but important period in which he focussed exclusively on free improvisation, and the subsequent years spent formulating and creating his own music. It uses both musical analysis of his improvisations and his compositions and commentary on the path he chose, in an attempt to define his place in 20th century music and the legacy he leaves us. The second part of the project involves my own compositions, which investigate areas similar to those which Lacy explored in his lifetime. These include finding a relationship between composition and improvisation in which both methods are given equal value. Their respective qualities, such as the collective interplay found in improvisation or the structure that composition supplies, are being cultivated. The point of these works is not to investigate methods of composition or conduction in which improvisation or semi-improvisation can be integrated. In this music the improvisers have as few limitations as possible, so that they are free to improvise. The works merely look to find a balance where these two methods can co-exist. The pieces are mostly idiomatic although they use genre as a point of departure rather than a fixed entity. They attempt to transcend, or in some cases to subvert, the idiom to which they are referring. They have been written intuitively and developed and refined through live performance. The compositions for the ensemble, The Troubles, were developed over a year of weekly live performances and there was a degree of autonomy and democracy for all the performers. A score in this music is perhaps akin to many of the practices to be found in the creation of contemporary theatre, where a text can be treated, elaborated upon, toyed with, where there are moments where things have been devised by the ensemble, rather than viewed as a sacred object. It is possible to imagine that Lacy too worked in this manner with his regular group. In these pieces I have tried to heed Braque’s lessons, and to avoid mimicry, yet in this work I hope to capture something of the spirit of Steve Lacy.</p>

The Way of Steve Lacy: Finding Individuality through Musical Genealogy

<p>This research project traces Lacy’s life in music, looking at his long period of apprenticeship, the brief but important period in which he focussed exclusively on free improvisation, and the subsequent years spent formulating and creating his own music. It uses both musical analysis of his improvisations and his compositions and commentary on the path he chose, in an attempt to define his place in 20th century music and the legacy he leaves us. The second part of the project involves my own compositions, which investigate areas similar to those which Lacy explored in his lifetime. These include finding a relationship between composition and improvisation in which both methods are given equal value. Their respective qualities, such as the collective interplay found in improvisation or the structure that composition supplies, are being cultivated. The point of these works is not to investigate methods of composition or conduction in which improvisation or semi-improvisation can be integrated. In this music the improvisers have as few limitations as possible, so that they are free to improvise. The works merely look to find a balance where these two methods can co-exist. The pieces are mostly idiomatic although they use genre as a point of departure rather than a fixed entity. They attempt to transcend, or in some cases to subvert, the idiom to which they are referring. They have been written intuitively and developed and refined through live performance. The compositions for the ensemble, The Troubles, were developed over a year of weekly live performances and there was a degree of autonomy and democracy for all the performers. A score in this music is perhaps akin to many of the practices to be found in the creation of contemporary theatre, where a text can be treated, elaborated upon, toyed with, where there are moments where things have been devised by the ensemble, rather than viewed as a sacred object. It is possible to imagine that Lacy too worked in this manner with his regular group. In these pieces I have tried to heed Braque’s lessons, and to avoid mimicry, yet in this work I hope to capture something of the spirit of Steve Lacy.</p>

Group Mentoring of New Graduate Midwives: Emerging Professional Capacity: A Naturalistic Inquiry

<p>This research explores an innovative group mentoring model developed at the request of four newly graduated midwives who were mentored as a group by four experienced midwives. Since virtually all research on mentoring, both internationally and in New Zealand assumes that mentoring is a one-to-one activity, this study aimed to describe how this group mentoring model operated and explore whether it was successful in supporting new midwives to gain confidence. A naturalistic study design was used with a mixed methods approach to collecting and analysing a large amount of richly descriptive data. Data were gathered from records of individual contacts between mentors and new graduates, from a series of interviews with each of the eight participants, and from the actual audio recordings of regular group mentoring meetings across the mentoring year. Simple descriptive analysis of quantitative data and detailed thematic analysis of qualitative data were undertaken. The study found the group mentoring model provided everything that is expected of one-to-one mentoring and the new graduates felt well supported as they gained confidence during their first year in practice as autonomous self-employed midwives. The group model provided new graduates with 24/7 one-to-one mentor support whenever they asked for it. This was found to occur mostly in the first half of the year and was highly valued. The new graduates and the mentors all agreed that the most important part of the model were the regular group meetings. These meetings were entirely focused on day to day experiences that the new graduates chose to present to the group. Analysis of the meeting transcripts showed that the new graduates' issues ranged across the whole scope of practice; that they were sometimes prompted by self-reflection, sometimes by issues to do with relationships with others, and sometimes by a need to discuss technical matters. The mentors' responses were variously supportive; listening and exploring; directing or informing; and questioning or challenging. The group aspect of this mentoring model added a number of features that would not be possible in one-to-one mentoring. The new graduates valued how the group meetings exposed them to multiple perspectives from several mentors. The group meetings modelled a supportive and collegial way of working together that facilitated their emerging professional capacity now and into their future. The group provided a safe yet challenging space: a "stimulating sanctuary" for the new graduates' development. Overall the study found that group mentoring can successfully meet the needs of new graduates and provides several advantages over one-to-one mentoring. Group mentoring may be a more sustainable model than one-to-one, particularly where there are shortages of mentor midwives available. It is a model that promotes a supportive professional midwife culture, contributes to new knowledge in the area and is the preferred approach to mentoring in the future.</p>