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991.
992.
Christian J. Dameff Jordan A. Selzer Jonathan Fisher James P. Killeen Jeffrey L. Tully 《The Journal of emergency medicine》2019,56(2):233-238
Background
Cybersecurity risks in health care systems have traditionally been measured in data breaches of protected health information, but compromised medical devices and critical medical infrastructure present risks of disruptions to patient care. The ubiquitous prevalence of connected medical devices and systems may be associated with an increase in these risks.Objective
This article details the development and execution of three novel high-fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices.Methods
Clinical simulations were developed that incorporated patient-care scenarios featuring hacked medical devices based on previously researched security vulnerabilities.Results
Clinicians did not recognize the etiology of simulated patient pathology as being the result of a compromised device.Conclusions
Simulation can be a useful tool in educating clinicians in this new, critically important patient-safety space. 相似文献993.
David L. Murphy Thomas D. Rea Andrew M. McCoy Michael R. Sayre Carol E. Fahrenbruch Lihua Yin Benjamin A. Tonelli Aaron M. Joffe Steven H. Mitchell 《The American journal of emergency medicine》2019,37(5):937-941
Purpose
In hospital-based studies, patients intubated by physicians while in an inclined position compared to supine position had a higher rate of first pass success and lower rate of peri-intubation complications. We evaluated the impact of patient positioning on prehospital endotracheal intubation in an EMS system with rapid sequence induction capability. We hypothesized that patients in the inclined position would have a higher first-pass success rate.Methods
Prehospital endotracheal intubation cases performed by paramedics between 2012 and 2017 were prospectively collected in airway registries maintained by a metropolitan EMS system. We included all adult (age?≥?18?years) non-traumatic, non-arrest patients who received any attempt at intubation. Patients were categorized according to initial positioning: supine or inclined. The primary outcome measure was first pass success with secondary outcomes of laryngoscopic view and challenges to intubation.Results
Of the 13,353 patients with endotracheal intubation attempted by paramedics during the study period, 4879 were included for analysis. Of these, 1924 (39.4%) were intubated in the inclined position. First pass success was 86.3% among the inclined group versus 82.5% for the supine group (difference 3.8%, 95% CI: 1.5%–6.1%). First attempt laryngeal grade I view was 62.9% in the inclined group versus 57.1% for the supine group (difference 5.8%, 2.0–9.6). Challenges to intubation were more frequent in the supine group (42.3% versus 38.8%, difference 3.5%, 0.6–6.3).Conclusion
Inclined positioning was associated with a better grade view and higher rate of first pass success. The technique should be considered as a viable approach for prehospital airway management. 相似文献994.
995.
Stephanie Lareau Howard Blumstein Laura Hopson Barbara L. Keller Micelle J. Haydel Mohamad Ali Cheaito Eveline A. Hitti Michael Epter Amin Kazzi 《The Journal of emergency medicine》2019,56(5):e91-e93
Having an advisor offers medical students many advantages, including increased likelihood of matching into their top choices. Interestingly, students who choose emergency medicine (EM) as a specialty are more likely to seek advising. However, finding and optimally utilizing an EM faculty advisor is often challenging for the medical student. In this article, we tackle the different ways to seek advising, including the ‘virtual advisor program’ implemented by the Society for Academic Emergency Medicine, the ‘e-Advisor Program’ instigated by the Clerkship Director in EM Group, the ‘member exclusive mentorship program’ of the Emergency Medicine Residency Association, as well as peer-based mentoring. More so, we discuss the consensus recommendations developed by the Student Advising Task Force to guide both students planning to apply to EM and their advisors to ensure high-caliber advising. 相似文献
996.
李珍 《中国卫生政策研究》2019,12(12):1-6
新中国成立70年以来,政府在医疗保险领域做了大量的努力,尤其是进入21世纪以来,基本医疗保险制度实现了人群基本全覆盖,各项制度筹资水平和保障水平不断提高,城镇居民医疗服务利用水平和健康水平明显提高。中国基本医疗保险发展的基本经验可以表述为选择了社会保险的模式,遵循了全覆盖、保基本、多层次、可持续的原则。本文认为当前基本医疗保险应发挥核心作用,商业健康保险提供差异化、多样性的医保服务;面临的医保二元结构等问题,可通过职工家庭联保和属地参保来增加职工参保人减少居民参保人,实现全民统一覆盖、平等且充分的目标。 相似文献
997.
《Health & place》2019
Medical accessibility is an important indicator for evaluating the effectiveness of public health services. However, the previous medical accessibility studies mainly focus on spatial accessibility without considering temporal variation in population distribution which is significant for evaluating access to emergency medical service (EMS). This paper proposes a model of spatio-temporal accessibility to EMS called ST-E2SFCA based on adapting the enhanced two-step floating catchment area (E2SFCA) method. We apply our method to the greater Tokyo area for a large volume of GPS dataset with millions of users and compare the accessibility difference over space and time. To evaluate our model, we also analyze the distinction of our model over different weight sets and compare the performance of ST-E2SFCA with the traditional E2SFCA. The result shows that our method can illustrate the temporal difference and is suitable for measuring the spatio-temporal accessibility to EMS, thus can guide the hospital location selection and urban planning. 相似文献
998.
999.
历代本草著作均为博物之作,中药理论的形成与发展受多方面因素影响。传统文化中的鸟文化与禽类药物理论、饮食文化与滑类药物理论关系密切。药物在传统手工业、加工业及日常生活中的应用,同样影响到中药理论的形成与发展。文献学知识及实地采集辨识药物也是理解学习中药理论的基础。 相似文献
1000.
Translation and validation of the Canadian diabetes risk assessment questionnaire in China
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Jia Guo RN PhD Zhengkun Shi RN MSN Jyu‐Lin Chen PhD Jane K. Dixon PhD James Wiley PhD Monica Parry NP‐Adult PhD 《Public health nursing (Boston, Mass.)》2018,35(1):18-28