Examining the effects of an interprofessional crew resource management training intervention on perceptions of patient safety.

This article reports the results from a study that employed an interprofessional crew resource management (CRM) education programme in the emergency and critical care departments. The study aimed to investigate the effectiveness of this intervention of participants' satisfaction and safety attitude changes using a satisfaction questionnaire and the Human Factors Attitude Survey (HFAS). Overall, participants responded positively to the CRM training-93.4% were satisfied, 93.1% agreed that it enhanced patient safety and care quality, 85.7% agreed that it increased their confidence, 86.4% agreed that it reduced practice errors, and 90.8% agreed that it would change their behaviours. Overall, the participants reported positive changes in their attitudes regarding 22 of the 23 HFAS questions.

Outcomes of out-of-hospital cardiac arrests after a decade of system-wide initiatives optimising community chain of survival in Taipei city.

OBJECTIVE: A strengthened chain of survival benefits patient outcomes after out-of-hospital cardiac arrest (OHCA).2 Over the past decade, the Taipei Fire Department (TFD) has continuously implemented system-wide initiatives on this issue.We hypothesised that for adult, non-trauma OHCA patients, the bundle of these system-wide initiatives are associated with better outcomes. METHODS: We conducted a registry-based, retrospective study to examine the association between consecutive system-level initiatives and OHCA survival on a two-yearly basis using trend analysis and multivariable logistic regression. The primary outcome was survival to hospital discharge (STHD) and favourable neurological status. RESULTS: We analysed 18,076 cases from 2008 to 2017. The numbers of two-yearly cases of OHCA with resuscitation attempts from 2008 to 2017 were 3,576, 3,456, 3,822, 3,811, and 3,411. There was a significant trend of improved STHD (Two-fold) and favourable neurological outcome (Six-fold) over the past decade. Similar trends were observed in the shockable and non-shockable groups. Considering the first 2 years as baseline, the odds of STHD and favourable neurological status in the end of the initiatives increased significantly after adjusting for universally recognised predictors for OHCA survival. CONCLUSION: For non-trauma adult OHCA in Taipei, continuous, multifaceted system-wide initiatives on the community chain of survival were associated with improved odds of STHD and favourable neurologic outcomes.

Can simulation-based team resource management training help students to pass entrustable professional activities 13?

Objective: Simulation technology has been integrated into team resource management (TRM) training in many hospitals. We designed a simulation-based TRM training scenario (SBTRM) aiming to help post graduate year (PGY) physicians to fulfil the requirements of the entrustable professional activities 13 (EPA 13). In this study, we investigate and report the SBTRM effectiveness. Methods: A total of 61 physicians received the SBTRM from March to November 2017. The SBTRM covers the core contents of teamwork skills. The trainees were evaluated with qualified clinical instructors after SBTRM training. The evaluation form is a 15-item questionnaire that evaluates the communication, situation monitoring, attitudes and clinical treatment of trainee behaviour. Results: A total of 75% of trainees agreed that the simulation is close to the usual care behaviour and helpful in thinking about changes in the surrounding conditions. More than 80% of trainees can actively communicate the care process; 82% of trainees can provide appropriate clinical treatment for patients. We found that physicians did not pay enough attention to the definition of 'nursing work'. 75% of the overall performance of teamwork and patient safety reached only 'good' level. Conclusions: Current medical education is increasingly using simulation to learn teamwork skills, with the hope that trainees use systematic thinking to carry out the care process. In this study, we designed a SBTRM and evaluation form that meets the requirements of EPA 13 for trainees. This training should improve physicians' safety awareness in the first post-graduate year.

Pregnancy-induced acute intestinal infarction in a woman with chronic idiopathic mesenteric vein thrombosis under regular anticoagulation treatment.

OBJECTIVE: We present a case of acute intestinal infarction in a pregnant woman with chronic idiopathic mesenteric vein thrombosis (MVT) under regular anticoagulation treatment. CASE PRESENTATION AND INTERVENTION: The condition of the 26-year-old woman who was diagnosed with chronic idiopathic MVT after detailed investigation was stable after receiving regular anticoagulation with warfarin. One year later, she presented with a 7-day episode of intermittent epigastric pain. Acute intestinal infarction and concomitant 7-week pregnancy were diagnosed. To preserve her life, a dilation and curettage procedure and emergency laparotomy with bowel resection were performed. Ten days later, she was discharged, having made a good recovery. CONCLUSION: Although pregnancy was not the primary cause of chronic MVT, it did play a role in inducing the acute intestinal infarction. This case indicates that pregnant patients with known chronic idiopathic MVT should be counseled about the high risk of acute mesenteric thrombosis. This case also serves to remind physicians that there should always be a high level of suspicion of intestinal infarction in patients with an acute abdomen who are in a hypercoagulable state.

Spontaneous septic diskitis: a common complaint with a serious pathologic cause that should not been overlooked.

Many people who have low back pain are likely to be out of work and taking medication and probably make demands on both primary and secondary health care as well as the private sector. Septic diskitis is a rare cause of back pain, accounting for less than 0.01% of cases in the primary care setting (Carragee EJ. Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am. 1997;79:874-80). It has been associated with a high morbidity and mortality in the past. Although it is an unusual complication in a postoperative patient, it is even more rare in a nonoperative patient. It accounts for 2% of all osteomyelitis (Maiuri F, Iaconetta G, Gallicchio B, Manto A, Briganti F. Spondylodiscitis. Clinical and magnetic resonance diagnosis. Spine. 1997;22:1741-6) and may occur spontaneously, after surgery (especially after epidural anesthesia), in the immunosuppressed, and systemic infections. It has the potential to be an orthopedic pitfall in the emergency department because it can be presented with nonspecific symptoms, nonspecific laboratory abnormalities, and nondiagnostic radiographic studies. We present a case of low back pain in a previously healthy individual as a result of spontaneous septic diskitis, which had been initially misdiagnosed in the private sector as herniation of an intervertebral disk.

Clinical characteristics of renal infarction in an Asian population.

INTRODUCTION: Renal infarction is a rare and easily missed disease. There is even less meaningful information on renal infarction in the Asian population. Thus, the aim of this study was to clarify the clinical characteristics of the disease in Asian patients. CLINICAL PICTURE: Over a period of 10 years, 38 Chinese patients with renal infarction diagnosed by contract-enhanced CT or angiography were enrolled in this study. Their demographic data, clinical characteristics, laboratory and image results, risk factors or suspected causes, treatment and final outcomes were retrospectively reviewed. The results were also compared with the analogous Western data. The mean age of the sample population was 60.8 +/- 17.6 years, with patients aged over 50 years and males predominating. The most common symptoms/signs were abdominal (57.9%) and flank pain/tenderness (50%). Only 23.7% of patients had suffered previous thromboembolic events such as coronary or peripheral artery diseases, or cerebral infarction. Cardiogenic factors, such as atrial fibrillation, intra-cardiac thrombus, infective endocarditis and valvular heart disease, were the main causes of renal infarction (57.9%). The most common laboratory abnormalities were elevated serum LDH (92.1%) and proteinuria (76.3%). Only half of the cases involved haematuria at initial presentation. TREATMENT AND OUTCOME: One-third of the sample suffered renal impairment after the renal infarction. Overall mortality rate during admission was 13.2% (n = 5). The cause of death was usually not the renal infarction itself but rather the underlying disease and its complications. There was no difference in outcome for anticoagulation treatment with or without thrombolytics. Compared to their Western counterparts, the proportion of males (71.1% versus 48.3%) and bilateral renal infarctions (31.6% versus 12.4%) were significantly higher, and the percentage of leukocytosis (50% versus 85%) significantly lower in our Asian patients. CONCLUSION: Clinical presentation of renal infarction is usually non-specific and differs for Asian and Western populations. In our Asian patients, the most common clinical characteristics were abdominal pain/tenderness, flank pain/tenderness, elevated serum LDH and proteinuria. Early diagnosis and treatment are imperative because of the high rate of renal impairment and associated mortality. If this disease is suspected, contrast-enhanced CT is suggested to exclude or confirm renal infarction and anticoagulation alone is currently the favored treatment.

Life-threatening episode after ingestion of toad eggs: a case report with literature review.

It is known that toad possesses several toxic substances in the skin and parotid glands. In the past, toad-venom poisoning had been reported from ingestion of toad soup, Kyushin and aphrodisiac pills, but the poisoning from toad eggs is observed for the first time. The case of a healthy female who had previously eaten toad soup twice without any discomfort is reported. She developed gastrointestinal symptoms and life-threatening cardiac rhythm after ingestion of toad eggs.

Different clinical presentations in chinese people with acute myocardial infarction in the emergency department.

BACKGROUND: The purpose of this study was to investigate the clinical characteristics of younger- ( 45 years) Chinese patients presenting to the emergency department (ED) with an initial acute myocardial infarction (AMI). METHODS: A retrospective review of 372 patients who had suffered an AMI (134 younger-aged, 238 older-aged), from 2,858 suspected AMI or ischemia patients during the period January 1996 to June 2003 inclusive, was conducted. Only patients who were diagnosed with AMI and who had been admitted to our institution's ED were enrolled into this study. RESULTS: The incidence of AMI for individuals who were < or = 45 years old was approximately 12.3% of those admitted to hospital under the impression of AMI. The percentage of males was more predominant in the younger-aged group (p < 0.01). Regarding major risk factors for coronary artery disease (CAD), younger patients were more likely to have a family history of cardiac disease (p < 0.01), obesity with an elevated body mass index (26.2 +/- 4.1 vs. 24.2 +/- 3.7, p < 0.01),and hyperlipidemia (p < 0.01) when compared to the older-aged patients, who were more likely to suffer from hypertension (p < 0.01) and/or diabetes mellitus than their younger-aged counterparts (p < 0.01). Younger patients also featured a higher incidence of single-vessel CAD (p = 0.05), an insignificant rate of CAD (p = 0.02), and a lower rate of triple-vessel CAD (p = 0.03). CONCLUSION: For Chinese, male gender and incidences of chest pain, positive family history of heart disease, obesity and hyperlipidemia were significantly greater in the younger-aged AMI patient group than in the older-aged AMI patient group. Younger-aged patients also had a greater rate of single-vessel CAD but a lower rate of triple-vessel CAD than older-aged patients.

Life-threatening episode after ingestion of toad eggs: a case report with literature review.

It is known that the toad possesses several toxic substances in the skin and parotid glands. In the past, toad-venom poisoning has been reported from ingestion of toad soup, Kyushin and aphrodisiac pills, but poisoning from toad eggs is observed for the first time. The case of a healthy female who had previously eaten toad soup twice without any discomfort is reported. She developed gastrointestinal symptoms and life-threatening cardiac rhythm after ingestion of toad eggs. A transvenous temporary pacemaker was used promptly to prevent from lethal bradyarrhythmia. Hyperkalaemia was managed with insulin, glucose water and sodium bicarbonate. A digoxin-specific Fab fragment was administered to this young woman 4 h subsequent to her admission.