Role of Pulmonary Embolism Response Team in patients with intermediate-and high-risk pulmonary embolism:a concise review and preliminary experience from China

Intermediate-and high-risk pulmonary embolism(PE)is a life-threatening medical emergency with high morbidity and mortality.Many of the treatment options for PE involve clinicians from multiple disciplines.Pulmonary Embolism Response Teams(PERTs)have been developed to coordinate the multidisciplinary team of clinicians to streamline the decision making process and develop individualised treatment plans in a timely fashion.The first PERT was established in 2012 and subsequently multiple centres worldwide have introduced this model for the management of intermediate-and high-risk PE.In this review,we evaluate the organisational structure and algorithms of different PERT services and compare data from pre-and post-PERT services to determine the impact of PERT on outcomes.We consider the cost and time implications of this multidisciplinary 24-hour service and suggest areas for further research and review.

Characteristics of In-Hospital Patients with Congenital Heart Disease Requiring Rapid Response System Activations: A Japanese Database Study

Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1-month mortality.Methods:We retrospectively analysed data from a Japanese rapid response system registry with 35 participating hospitals.We included consecutive patients with congenital heart disease who required rapid response system activation between January 2014 and March 2018.Logistic regression analyses were performed to examine the associations between 1-month mortality and other patient-specific variables.Results:Among 9,607 patients for whom the rapid response system was activated,only 82(0.9%)had congenital heart disease.Only few patients with congenital heart disease were being treated at the cardiology and cardiovascular surgery departments(12.3%and 9.9%,respectively).Moreover,the incidences of rapid-response events after intensive care unit discharge or surgery were low(6.8% and 12.2%,respectively).The most common reason for rapid response system activation was respiratory dysfunction(desaturation:35.4%,tachypnoea:25.6%,and new dyspnoea:19.5%).Rapid response system interventions and intensive care unit transfers were required for 65.9% and 20.7%of patients,respectively.The mortality rate was 1.2% at the end of the rapid response system intervention and 11.0% after 1 month.Moreover,decreased respiratory rate and decreased heart rate at rapid response system activation were associated with increased 1-month mortality.The adjusted odds ratio was 1.10(95% confidence interval 1.02–1.19)and 1.02(95% confidence interval,1.00–1.04) for respiratory rate and heart rate,respectively.Conclusions:Rapid response systems were rarely activated after cardiac surgery and intensive care unit discharge,which were situations with a high risk of sudden deterioration in patients with congenital heart disease.Therefore,encouraging the use of the rapid response system in these departments will enable intervention by a third,specialised team for in-hospital emergencies and help provide comprehensive medical care to patients.Furthermore,1-month mortality was associated with vital signs at rapid response system activation.These findings may guide treatment selection for patients with congenital heart disease showing deterioration.

Knowledge Management Strategy for Handling Cyber Attacks in E-Commerce with Computer Security Incident Response Team (CSIRT)

Electronic Commerce (E-Commerce) was created to help expand the market share network through the internet without the boundaries of space and time. However, behind all the benefits obtained, E-Commerce also raises the issue of consumer concerns about the responsibility for personal data that has been recorded and collected by E-Commerce companies. The personal data is in the form of consumer identity names, passwords, debit and credit card numbers, conversations in email, as well as information related to consumer requests. In Indonesia, cyber attacks have occurred several times against 3 major E-Commerce companies in Indonesia. In 2019, users’ personal data in the form of email addresses, telephone numbers, and residential addresses were sold on the deep web at Bukalapak and Tokopedia. Even though E-Commerce affected by the cyber attack already has a Computer Security Incident Response Team (CSIRT) by recruiting various security engineers, both defense and attack, this system still has a weakness, namely that the CSIRT operates in the aspect of handling and experimenting with defense, not yet on how to store data and prepare for forensics. CSIRT will do the same thing again, and so on. This is called an iterative procedure, one day the attack will come back and only be done with technical handling. Previous research has succeeded in revealing that organizations that have Knowledge Management (KM), the organization has succeeded in reducing costs up to four times from the original without using KM in the cyber security operations. The author provides a solution to create a knowledge management strategy for handling cyber incidents in CSIRT E-Commerce in Indonesia. This research resulted in 4 KM Processes and 2 KM Enablers which were then translated into concrete actions. The KM Processes are Knowledge Creation, Knowledge Storing, Knowledge Sharing, and Knowledge Utilizing. While the KM Enabler is Technology Infrastructure and People Competency.

Recognizing Early Warning Signs (EWS) in Patients Is Critically Important

Introduction: Monitoring vital signs is a basic indicator of a patient’s health status and allows prompt detection of delayed recovery or adverse effects and early intervention. Patients with adverse events during hospitalization often display clinical decline for several hours before the event is observed. Non-critical care Nurses’ inconsistent recognition and response to patient deterioration lead to an increase in the length of hospital stay, unexpected admissions to the ICU, and increased morbidity and mortality. Aim: The study aimed to assess the factors that facilitate or impede the detection of early warning signs among adult patients hospitalized in tertiary care settings. Training should be provided to improve nurses’ knowledge, practice and attitude toward early warning signs of deteriorating patients leading to enhanced clinical judgment, skills and decision-making in addressing alerts. Methodology: A literature search was carried out in various databases;these were Cumulative Index to Nursing and Allied Health Literature (CINHAL), Google Scholar, PubMed, Science Direct, and Sage. The search area was narrowed from 2017 to 2022. The keywords used were “prevalence” AND “unplanned ICU admission”, “the importance of early warning signs” “outcome failure in rescue” “patient deterioration, communication” “improvement in early detection” AND “patient outcome admission” AND “early warning signs” AND “Pakistan”. After the analysis process, around 33 articles that met the inclusion criteria and were most relevant to the scope and context of the current study were considered. Conclusion: Most of the studies had reviewed literature in a qualitative retrospective observational study, content analysis, mixed method, and quasi-experimental study. The literature review identified that long hours of shift, nurse staffing levels, missed vital signs, lack of nursing training and education, and communication impact nurses’ ability to recognize and respond to early warning signs.

A cross-sectional study on the nurses’attitude towards rapid response system activation for clinically deteriorated patients

Background:Hospitals have reported that implementing rapid response system activation(RRS)activation has increased patient safety.As a result,there has been growing interest in identifying factors that lead to successful RRS activation.While introducing an automated RRS activation system has prompted nurses to be more vigilant about monitoring vital signs,it has not necessarily encouraged them to conduct thorough patient assessments to identify early signs of deterioration.Purpose:The current study aimed to assess nurses’attitudes towards RRS activation for clinically deteriorated patients in the clinical units of King Abdul-Aziz Hospital.Methods:A descriptive cross-sectional research design was utilised in the study,and 144 nurses working in the medical and surgical units of King Abdul-Aziz Hospital were recruited to participate using a convenient non-probability sampling technique.Results:The study’s findings reported that nurses have a positive attitude towards RRS benefits(Mean=3.70;SD=0.70).Their overall attitude towards RRS activation among clinically deteriorated patients is still low positive(Mean=2.71;SD=0.61).The nurses’attitudes towards RRS benefits significantly differ among nationalities and the clinical area/unit where they were assigned,with a P-value of 0.0194 and 0.000,respectively.Attitudes towards RRS barriers significantly differ among nationality(P-value=0.0037),education level(P-value=0.0032),area of assignment(P-value=0.020),and whether they have a good understanding of abnormal observations(P-value=0.0122).Regarding the nurses’attitude towards management belief,the significant result is only with the clinical area/unit of assignment with a P-value of 0.000.Conclusion:The current study found a low positive attitude towards RRS activation among ward nurses,especially given that monitoring vital signs is critical to their job.Nurses may fear being perceived as clinically inept for redundant activations caused by poor quality,but their attitude towards activating the RRS in clinical deterioration is still largely negative.This is because most RRSs rely on ward nurses to recognise clinical deterioration and manually alert responders through phone calls,hospital communication systems,or face-to-face communication.

An Audit of the Emergency Airway Service in a Regional Hospital in Singapore

Background: Emergency endotracheal intubations (EEI) performed outside of operating theatre (OT) tend to be more challenging and associated with higher risk of complications. In 2011, with the objective of improving patient outcomes, we set up an Emergency Airway Service (EAS) at our 1000-bed regional hospital, with the aim of providing specialized assistance for outside of OT difficult airway management. Method: A retrospective audit of EAS activation from 12/9/2016 and 27/10/2020 was conducted. EAS forms and electronic medical records were reviewed. We collected information on patient characteristics, EAS activation characteristics and its outcomes. Descriptive analysis method was used to present the collected data. Results: There were a total of 275 activations, of which 268 were analysed. Reasons for activation were anticipated difficult intubation (42.2% n = 113), failed intubation attempt (52.6%, n = 141) and advanced intubation equipment required (5.2% n = 14). Intubation was attempted in 261/268 (97.4%) cases by the EAS team. Of these, 255 (97.7%) cases were successful while 6 (2.3%) cases failed intubation. Of the successful intubations by the EAS team, 208/255 (81.5%) were successful on the first attempt. Out of the 6 unsuccessful intubation cases, 1 case required a rescue cricothyroidotomy and 4 cases required an open tracheostomy. Intubation was deemed easy by the EAS team in 170/261 (65.1%) cases. 64/170 (37.6%) cases were intubated with a video laryngoscope (VL). There were 85 cases (32.3%) classified as difficult intubation by the EAS specialist, 13/85 (15.3%) were intubated using only VL, 54/85 (63.5%) cases were intubated using VL with style/bougie. Conclusion: Audit results showed that providing an experienced and well-equipped team of airway specialists round-the-clock to assist in difficult and potentially difficult endotracheal intubations is justifiable and may reduce complications associated with EEI.

Organizational Data Breach:Building Conscious Care Behavior in Incident Response

Organizational and end user data breaches are highly implicated by the role of information security conscious care behavior in respective incident responses.This research study draws upon the literature in the areas of information security,incident response,theory of planned behaviour,and protection motivation theory to expand and empirically validate a modified framework of information security conscious care behaviour formation.The applicability of the theoretical framework is shown through a case study labelled as a cyber-attack of unprecedented scale and sophistication in Singapore’s history to-date,the 2018 SingHealth data breach.The single in-depth case study observed information security awareness,policy,experience,attitude,subjective norms,perceived behavioral control,threat appraisal and self-efficacy as emerging prominently in the framework’s applicability in incident handling.The data analysis did not support threat severity relationship with conscious care behaviour.The findings from the above-mentioned observations are presented as possible key drivers in the shaping information security conscious care behaviour in real-world cyber incident management.

COVID-19 contact tracing in a tertiary care hospital: A retrospective chart review

Background:Contact tracing is one of the strategies used to control COVID-19 pandemic.It played an important role in the beginning to identify all contacts and minimise the spread of the infection.Methods:A retrospective chart review was carried out of contact tracing records during the one-month period,starting from the onset of the first lockdown in India.The largest wave of 372 contacts was analysed in detail to find out the association between the result of COVID-19 test and various factors(age,gender,type of contact).Results:A total of 372 contacts(214 males and 158 females)were traced and around 21%contacts were tested positive on COVID-19 RT-PCR test.Chi-square test didn’t find the significant difference between COVID-19 test result and proportions of male and female contacts,X^(2)(1)0.033,p=0.855.Female positive contacts had lower mean age compared to male positive contacts,though not statistically significant,t(75)=-1.809,p=0.0745.No difference was found in either median or mean age of contacts with respect to COVID-19 test result.Odds of tested COVID-19 positive among household contacts much higher than community contacts,OR=24.52,95%CI 12.45e48.29,p<0.05.Conclusion:No difference was noted in the rate of contracting infection with respect to age and gender of contacts.Type of contact,household or community,significantly affected the probability of becoming infected with the coronavirus.Occupation of primary case was probably responsible for large number of contacts found positive for COVID-19.