Telephone triage, expert systems and clinical expertise

This paper reports on a qualitative study of the use of an expert system developed for the British telephone triage service NHS Direct. This system, known as CAS, is designed to standardise and control the interaction between NHS Direct nurses and callers. The paper shows, however, that in practice the nurses use CAS in a range of ways and, in so doing, privilege their own expertise and deliver an individualised service. The paper concludes by arguing that NHS Direct management's policy of using CAS as a means of standardising service delivery will achieve only limited success due not only to the professional ideology of nursing but also to the fact that rule-based expert systems capture only part of what 'experts' do.     

Effective mental health response to catastrophic events: lessons learned from Hurricane Katrina

This article describes how a mental health disaster response plan, which resulted from a collaborative effort between the Arkansas Department of Health and the Arkansas Chapter of the National Association of Social Workers, was used successfully to meet the needs of more than 1,000 displaced survivors of Hurricane Katrina. Included is a discussion of how the components of established disaster response protocols can be integrated with evolving theory on the psychological effect of catastrophic events on micro-, mezzo-, and macro-level systems to advance the field of disaster mental health response.     

Challenges in the validation of triage systems at emergency departments

ObjectivesTriage systems, developed by consensus of experts and based on decision rules, are typically not validated. The objective is to discuss the challenges to evaluate the reliability and validity of triage systems.Study Design and SettingTheoretical–conceptual approach to validate triage systems.ResultsThe consensus-based triage systems have to be applied to a broad population with a variety of signs and symptoms. For the individual patient-specific decision, rules are used and the outcome measure is, typically, one of five prognosis-specific urgency categories. In contrast, prediction rules in diagnostic research are developed for a narrow specific subpopulation and based on a combination of parameters to predict presence of a specific diagnosis. Reliability is based on case scenario and simultaneous triage studies. The first step in triage validation is to decide on the best proxy for prognosis, “the reference standard” for the urgency classification. The next step is modification of the triage decision rules, including a multivariate approach. The final step is the validation in different settings and to evaluate the impact in clinical practice.ConclusionTriage should be viewed as diagnostic research and would benefit if it would use the available methodology in diagnostic research.     

Pathways linking drug use and labour market trajectories: the role of catastrophic events

People affected by substance use disorders often experience sub‐optimal employment outcomes. The role of drug use in processes that produce and entrench labour market precarity among people who inject drugs (PWID) have not, however, been fully described. We recruited 22 PWID from ongoing prospective cohort studies in Vancouver, Canada, with whom we conducted semi‐structured retrospective interviews and then employed a thematic analysis that drew on concepts from life course theory to explore the mechanisms and pathways linking drug use and labour market trajectories. The participants' narratives identified processes corresponding to causation, whereby suboptimal employment outcomes led to harmful drug use; direct selection, where impairment, health complications or drug‐seeking activities selected individuals out of employment; and indirect selection, where external factors, such as catastrophic events, marked the initiation or intensification of substance use concurrent with sudden changes in capacities for employment. Catastrophic events linking negative transitions in both drug use and labour market trajectories were of primary importance, demarcating critical initiation and transitional events in individual risk trajectories. These results challenge conventional assumptions about the primacy of drug use in determining employment outcomes among PWID and suggest the importance of multidimensional support to mitigate the initiation, accumulation and entrenchment of labour market and drug‐related disadvantage.     

Families, schools, and disaster: the mental health consequences of catastrophic events

Children have always experienced or witnessed disaster and mass casualty events in their schools and communities. However, the psychological impact of such events was not recognized until the middle of the 20th century. Children's responses to disaster and other traumatic events are based on developmental stage, the specific threat, injury and loss, and the child's coping skills as well as previous traumatic experiences. Schools and communities can serve as a sanctuary for children and their families during such devastating times. Lessons learned from the terrorist attacks of September 2001 and the gulf coast hurricanes offer strategies and approaches to assist children for families, teachers, schools, and communities. Resources for schools and communities include national organizations with evidence-based guidelines, program development, and guides for policy and communication.     

Tips for effective telephone triage

With the tight schedules imposed by managed care, physicians find themselves providing more initial care over the phone. These pointers will help your office staff take over the chore of determining which patients need to see you and which don't.     

重特大疾病医疗救助因病致贫对象界定的理论与方法探析

重特大疾病医疗救助对象界定关乎医疗救助的公平性和精准性,然而我国重特大疾病因病致贫对象界定仍缺乏理论和方法依据。重特大疾病相对费用理论考虑了家庭支付能力,同时灾难性和致贫性卫生支出测量方法不仅反映了家庭疾病经济负担和贫困状态,而且能够反映救助对象的因病致贫广度和深度。因此,基于重特大疾病相对费用理论及其测量方法的因病致贫对象界定思路能够支持我国重特大疾病因病致贫对象的界定。     

新冠肺炎疫情下大型综合医院门诊预检分诊体系的构建与实践

新型冠状病毒肺炎(简称新冠肺炎)疫情下,大型综合医院通过构建门诊预检分诊体系,实施有效的预检分诊措施、严格执行发热门诊患者接诊流程、普通门诊患者接诊流程,尽早筛查发热或有流行病学接触史的患者分流至发热门诊就诊,做到早发现、早报告、早隔离、早治疗.通过该体系的运行,医院达到了零漏检、零漏报、零感染的目标.     

Water contamination events in UK drinking-water supply systems

Water supply companies in the UK have a duty under prime UK legislation to notify the Drinking Water Inspectorate of events affecting or potentially affecting the quality of drinking-water supplies. Under the same legislation, the Inspectorate has a duty to investigate each event. After assessing all of the information available, including companies' reports, the Inspectorate advises on the way in which the event was handled and whether any statutory requirements were contravened. If appropriate, a prosecution of the water company may be initiated. Copies of the assessment are sent to the water company, relevant local and health authorities, Ofwat (the economic regulator), the regional Consumer Council for Water and any other interested parties, including consumers who request it. Generic guidance may be issued to the industry on matters of wider concern.     

Water contamination events in UK drinking-water supply systems

Water supply companies in the UK have a duty under prime UK legislation to notify the Drinking Water Inspectorate of events affecting or potentially affecting the quality of drinking-water supplies. Under the same legislation, the Inspectorate has a duty to investigate each event. After assessing all of the information available, including companies' reports, the Inspectorate advises on the way in which the event was handled and whether any statutory requirements were contravened. If appropriate, a prosecution of the water company may be initiated. Copies of the assessment are sent to the water company, relevant local and health authorities, Ofwat (the economic regulator), the regional Consumer Council for Water and any other interested parties, including consumers who request it. Generic guidance may be issued to the industry on matters of wider concern. This paper considers the role of the Inspectorate, the powers available to it and reporting arrangements. An overview is presented of events that occurred between 1990 and 2005 and common features are identified. Causes of different types of event are discussed. The importance of well-established contacts between the various interested parties involved in protecting public health is emphasised through discussion of example incidents.     

大型活动禁、慎用食品类别判定原则探讨

在大型活动食品卫生监督保障工作中,卫生监督人员通过审查菜谱和现场检查的方式,及时发现禁止和慎重使用、食用的食品是大型活动食品卫生监督保障的一项重要工作。由于大型活动期间的食品卫生安全影响面大,关系到举办城市的社会形象,所以各地卫生监督机构都严把大型活动接待单位禁、慎用食品关,为保障大型活动接待单位食品卫生安全起到了积极作用,但有时卫生监督人员在判定禁、慎用食品时仍会遇到难度,不易把握,甚至会与接待单位产生矛盾和分歧,影响了食品卫生监督保障工作的开展。本文围绕食品感官检查、快速检测、食品加工时间与温度、加…     

Adjusting weighted kappa for severity of mistriage decreases reported reliability of emergency department triage systems: a comparative study

ObjectiveMistriage can have serious consequences for patients with urgent complaints. We therefore reviewed the assessment of triage-reliability, and propose an alternative weighted kappa that accounts for severity of mistriage.Study Design and SettingA systematic literature search was performed in three online databases and a search engine. An alternative kappa weighting scheme was developed (triage-weighted kappa), and kappas of previous conducted reliability studies were recalculated.ResultsKappa is the most frequently used statistic in triage-reliability studies (n = 33). More than half of the studies did not report the type of kappa that was used. Linear and quadratically weighted kappa values do not reflect the seriousness of mistriage. Several studies reported almost perfect agreement, whereas percentages of mistriage ranged between 11.1% and 43.4%. In all studies, triage-weighted kappa was lower than reported kappas with a mean difference of 0.17 (range: 0.04–0.32).ConclusionNo existing studies on reliability of triage systems account for mistriage. Using triage-weighted kappa, which reflects severity of mistriage, shows that the reliability of triage systems is lower than reported.     

Model uniform core criteria for mass casualty triage

There is a need for model uniform core criteria for mass casualty triage because disasters frequently cross jurisdictional lines and involve responders from multiple agencies who may be using different triage tools. These criteria (Tables 1-4) reflect the available science, but it is acknowledged that there are significant research gaps. When no science was available, decisions were formed by expert consensus derived from the available triage systems. The intent is to ensure that providers at a mass-casualty incident use triage methodologies that incorporate these core principles in an effort to promote interoperability and standardization. At a minimum, each triage system must incorporate the criteria that are listed below. Mass casualty triage systems in use can be modified using these criteria to ensure interoperability. The criteria include general considerations, global sorting, lifesaving interventions, and assignment of triage categories. The criteria apply only to providers who are organizing multiple victims in a discrete geographic location or locations, regardless of the size of the incident. They are classified by whether they were derived through available direct scientific evidence, indirect scientific evidence, expert consensus, and/or are used in multiple existing triage systems. These criteria address only primary triage and do not consider secondary triage. For the purposes of this document the term triage refers to mass-casualty triage and provider refers to any person who assigns primary triage categories to victims of a mass-casualty incident.     

便携低功耗军用分检心电图机

便携低功耗军用分检心电图机是为救护人员在战场上进行火线抢救而设计的一款微型生命信息检测设备。利用该设备能够准确迅速地获得伤员生命的状态,从而加快伤员分检的速度,减少人员伤亡。系统以C8051F310微处理器为控制核心,采用高精度、低温漂放大器AD620和超低功耗图形点阵液晶显示模块LMS019对采集到的心电信号进行实时和准确的显示。该设备使用方便,价格低廉,能够符合我军野战部队大量装备的要求。