Smartphone based alerting of first responders during the corona virus disease-19 pandemic: An observational study.

ABSTRACT: Smartphone alerting systems (SAS) for first responders potentially shorten the resuscitation-free interval of patients with acute cardiac arrest. During the corona virus disease-19 (COVID-19) pandemic, many systems are suspended due to potential risks for the responders.Objective of the study was to establish a concept for SAS during the COVID-19 pandemic and to evaluate whether a SAS can safely be operated in pandemic conditions.A SAS had been implemented in Freiburg (Germany) in 2018 alerting nearby registered first responders in case of emergencies with suspected cardiac arrest. Due to the pandemic, SAS was stopped in March 2020. A concept for a safe restart was elaborated with provision of a set with ventilation bag/mask, airway filter, and personal protective equipment (PPE) for every volunteer. A standard operating procedure was elaborated following the COVID-19 guidelines of the European Resuscitation Council.Willingness of the participants to respond alarms during the pandemic was investigated using an online survey. The response rates of first responders were monitored before and after deactivation, and during the second wave of the pandemic.The system was restarted in May 2020. The willingness to respond to alarms was lower during the pandemic without PPE. It remained lower than before the pandemic when the volunteers had been equipped with PPE, but the alarm response rate remained at approximately 50% during the second wave of the pandemic.When volunteers are equipped with PPE, the operation of a SAS does not need to be paused, and the willingness to respond remains high among first responders.

Six steps from head to hand: a simulator based transfer oriented psychological training to improve patient safety.

UNLABELLED: The incidence of human errors in the field of medicine is high. Two strategies to increase patient safety are simulator training and crew resource management (CRM) seminars, psychological courses on human performance and error management. AIM: To establish a CRM course combining psychological training on human error with simulator training. METHODS: Evaluation of a new 1-day training approach targeting physicians, nurses, and paramedics. The course was divided into four modules focusing on situation awareness, task management, teamwork, and decision-making. Each of the modules was set up according to a new six-step approach. The course started with an introduction into good CRM behaviour and an instructor demonstration of a simulator scenario. The participants had to debrief the instructors regarding their human performance. Step 2 was a lecture about the psychological background, and the third step consisted of psychological exercises related to the topic of the module. A psychological exercise in a medical context (MiniSim) made up step 4, which involved a patient simulator. The last two steps were a simulator scenario and a debriefing, as in other simulator courses. A psychologist and a physician were the facilitators in all steps. Two pilot courses were evaluated. RESULTS: Seventeen evaluation questionnaires were received. All participants rated the course as good (10) and very good (7). The psychological exercises were highly valued (good, 5; very good, 11 participants). Thirteen participants agreed that the course content was related to their work. CONCLUSION: We established the first course curriculum combining psychological teaching with simulator training for healthcare professionals in emergency medicine. Similar concepts using the six-step approach can be applied to other medical specialties.

Toxicity of sulfide to early life stages of wild rice (Zizania palustris).

The sensitivity of wild rice (Zizania palustris) to sulfide is not well understood. Because sulfate in surface waters is reduced to sulfide by anaerobic bacteria in sediments and historical information indicated that 10 mg/L sulfate in Minnesota (USA) surface water reduced Z. palustris abundance, the Minnesota Pollution Control Agency established 10 mg/L sulfate as a water quality criterion in 1973. A 21-d daily-renewal hydroponic study was conducted to evaluate sulfide toxicity to wild rice and the potential mitigation of sulfide toxicity by iron (Fe). The hydroponic design used hypoxic test media for seed and root exposure and aerobic headspace for the vegetative portion of the plant. Test concentrations were 0.3, 1.6, 3.1, 7.8, and 12.5 mg/L sulfide in test media with 0.8, 2.8, and 10.8 mg/L total Fe used to evaluate the impact of iron on sulfide toxicity. Visual assessments (i.e., no plants harvested) of seed activation, mesocotyl emergence, seedling survival, and phytoxicity were conducted 10 d after dark-phase exposure. Each treatment was also evaluated for time to 30% emergence (ET30), total plant biomass, root and shoot lengths, and signs of phytotoxicity at study conclusion (21 d). The results indicate that exposure of developing wild rice to sulfide at ≥3.1 mg sulfide/L in the presence of 0.8 mg/L Fe reduced mesocotyl emergence. Sulfide toxicity was mitigated by the addition of Fe at 2.8 mg/L and 10.8 mg/L relative to the control value of 0.8 mg Fe/L, demonstrating the importance of iron in mitigating sulfide toxicity to wild rice. Ultimately, determination of site-specific sulfate criteria taking into account factors that alter toxicity, including sediment Fe and organic carbon, are necessary. Environ Toxicol Chem 2017;36:2217-2226. © 2017 SETAC.

Toxicity of sulfate and chloride to early life stages of wild rice (Zizania palustris).

Despite the importance of wild rice (Zizania palustris) in the Great Lakes region of North America, its sensitivity to sulfate is not well understood. A 21-d hydroponic experiment was performed to determine the toxicity of sulfate to wild rice seeds and seedlings. Effects of 6 sulfate concentrations ranging from 10 mg/L to 5000 mg/L and of chloride salts at equivalent conductivity were evaluated to determine whether adverse effects were attributable to sulfate or to conductivity-related stress. Sulfate treatment decreased root length, shoot length, and leaf number, and increased phytotoxic effects at concentrations of 5000 mg/L relative to a 50 mg/L control. The time to 30% mesocotyl emergence decreased at 2500 mg/L sulfate, indicating a potential stimulatory effect. Sulfate exposures of ≤ 5000 mg/L had no effect on 5 additional end points. Multiple regression analysis indicated that most observed changes could be attributed to conductivity-related stress rather than sulfate per se, with the exception of shoot length and leaf number. Chloride was more toxic than sulfate, as determined by root length and phytotoxicity. In summary, sulfate concentrations below 5000 mg/L did not adversely affect early-life stage wild rice during a 21-d period, and effects at 5000 mg/L sulfate were attributable to conductivity-related stress rather than sulfate toxicity in 2 of 4 end points.

Dresden Faculty selection procedure for medical students: what impact does it have, what is the outcome?

Since 2004 German universities have been able to use a selection procedure to admit up to 60 percent of new students. In 2005, the Carl Gustav Carus Faculty of Medicine at Dresden introduced a new admission procedure. In order to take account of cognitive as well as non-cognitive competencies the Faculty used the following selection criteria based on the legal regulations for university-admissions:the grade point average of the school-leaving exam (SSC, Abitur), marks in relevant school subjects; profession and work experience; premedical education; and a structured interview. In order to evaluate the effects of the Faculty admission procedures applied in the years 2005, 2006 and 2007, the results on the First National Medical Examination (FNME) were compared between the candidates selected by the Faculty procedures (CSF-group) and the group of candidates admitted by the Central Office for the Allocation of Places in Higher Education (the ZVS group, comprising the subgroups: ZVS best, ZVS rest and ZVS total). The rates of participation in the FNME within the required minimum time of 2 years of medical studies were higher in the CSF group compared to the ZVS-total group. The FNME pass rates were lowest in the ZVS rest group and highest in the ZVS best group. The ZVS best group and the ZVS total group showed the best FMNE results, whereas the results of the CSF-group were equal or worse compared to the ZVS rest group. No correlation was found between the interview results and the FNME results. According to studies of the prognostic value of various selection instruments, the school leaving grade point average seems the best predictor of success on the FNME. In order to validate the non-cognitive selection instruments of the Faculty procedure, complementary instruments are needed to measure non-cognitive aspects that are not captured by the FNME-results.

Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study.

BACKGROUND: Simulator training is well established to improve technical and non-technical skills in critical situations. Few data exist about stress experienced during simulator training. This study aims to evaluate performance and stress in intensivists before and after two different simulator-based training approaches. METHODS: Thirty-two intensivists took part in one of six 1-day simulator courses. The courses were randomised to either crew resource management (CRM) training, which contains psychological teaching and simulator scenarios, or classic simulator training (MED). Before and after the course each participant took part in a 10-min test scenario. Before (T1) and after (T2) the scenario, and then again 15 min later (T3), saliva samples were taken, and amylase and cortisol were measured. Non-technical skills were evaluated using the Anaesthetist's Non-Technical Skills (ANTS) assessment tool. Clinical performance of the participants in the test scenarios was rated using a checklist. RESULTS: Twenty-nine participants completed the course (17-CRM, 12-MED). ANTS scores as well as clinical performances were significantly better in the post-intervention scenario, with no differences between the groups. Both cortisol concentration and amylase activity showed a significant increase during the test scenarios. In the post-intervention scenario, the increase in amylase but not cortisol was significantly smaller. There were no differences between the CRM and MED group. CONCLUSIONS: High fidelity patient simulation produces significant stress. After a 1-day simulator training, stress response measured by salivary alpha-amylase was reduced. Clinical performance and non-technical skills improved after 1 day of simulator training. Neither stress nor performance differed between the groups.