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Objective:To develop an early warning index system to identify the outbreak of respiratory infectious diseases and to assess the epidemic risk of these diseases in Shanghai. Methods:A two-round Delphi survey with a panel of 31 experts was used to select the modifying indicators. All indicators were evaluated for necessity，feasibility，stability， and sensitivity through online questionnaires. Results:The consultation recovery rates of both rounds were 100%. The authority coefficient was 0.88， and the Kendall's W of the second-round consultation was 0.138 （P<0.001）， suggesting a good coordination among experts’ opinion. Our early warning index system was developed after the two-round Delphi survey and included two sets of indicators， one for rapid risk assessment and another for monitoring and tracing risk. Both sets of the indicators involved three aspects： transmissibility， clinical severity and potential influence of emerging diseases. The rapid risk assessment system part covered 10 indicators while the risk monitor system part covered 23 indicators. In the rapid risk assessment system part， the weight value of the top three indicators were greater than 0.10， with the highest weight value of 0.171 for titled visiting rate of influenza-like illness patients in the Emergency Department or other outpatient visits. In the risk monitor system part， the weight value of the top eight indicators were greater than 0.05， and the greatest was 0.087 for R0 （basic reproductive number）. Conclusion:The developed scientific and reliable evaluation indicator system can be used to forecast the outbreak and epidemic risk of respiratory infectious diseases. However， sensitivity and stability of the indicators need further validation and evaluation.
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China's prevention and control of parasitic diseases has made remarkable achievements. However,the prevalence and transmission of parasitic diseases is impacted by the complicated natural and social factors of environment ,natural disas-ters,population movements,and so on. Therefore,there are still the risks of the outbreak of emergency parasitic diseases af-fairs,which may affect the control effectiveness of parasitic diseases and endanger the social stability seriously. In this article , we aim at the analysis of typical cases of emergency parasitic disease affairs and their impacts on public health security in China in recently years,and we also elaborate the disposal characteristics of emergency parasitic disease affairs,and propose the estab-lishment of response system to emergency parasitic disease affairs in China,including the organizational structure and response flow path,and in addition,point out that,in the future,we should strengthen the system construction and measures of the re-sponse system to emergency parasitic disease affairs,so as to control the risk and harm of parasitic disease spread as much as possible and to realize the early intervention and proper disposal of emergency parasitic disease affairs.
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Objective To investigate the effects of rapid response system of chest pain on the short-term and long-term prognosis of patients with acute ST segment elevation myocardial infarction (STEMI).Methods Referring to the international association of chest pain centers,the chest pain center was established in this hospital,and the corresponding management system and treatment process were worked out.A total of 374 acute STEMI patients who were recruited as the observation group were admitted to this hospital after the establishment of the chest pain center (December 2014 to June 2016),and 250 STEMI patients admitted before the establishment of the chest pain center (January 2012 to December 2012) were recruited as control group.Patients in observation group were treated in the chest pain center,and those in control groupreceived conventional treatment.The general situation,basic diseases,the finishing time of the first electrocardiogram(ECG),the time of door-to balloon expansion(D2B),the time of hospital stay,the average hospitalization expenses,in-hospital cardiac events and in-6-month cardiac events were compared between the two groups.All patients were followed up for 1 years,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter (LVEDD),left ventricular aneurysm,B type natriuretic peptide (pro-BNP),serum creatinine (Scr),C-reactive protein (CRP) levels and adverse cardiac events (heart failure,death,readmission rate etc.)were compared between two groups.Results Compared with the control group,the average completion time of the first electrocardiogram in the observation group was shortened (P=0.001),the time of entry balloon dilatation,the time of hospital stay,the average hospitalization expenses were less than that of the control group (P＜0.05),the adverse cardiac events (hospital death and heart failure) were lower in the observation group than in the control group (P＜0.05).After 6 months of follow-up,LVEF was significantly higher in the observation group than in the control group (P＜0.05).the levels of LVEDD,pro-BNP,CRP and adverse cardiac events in the observation group were significantly lower than those in the control group (P＜0.05),there was no significant difference in the formation rate of ventricular aneurysm and Scr between the observation group and the control group (P＞0.05).After 1 year of follow-up,LVEF was still higher in the observation group than in the control group (P＜0.05).The incidence of LVEDD,pro-BNP,CREA,CRP,left ventricular aneurysm formation rate,the incidence of adverse cardiac events were lower in the observation group than in the control group (P＜0.05).Conclusion The establishment of rapid response system of chest pain treatment not only effectively shortenthe treatment time of STEMI patients,improve the treatment efficiency,shorten the hospital stay,reduce the cost of hospitalization,but also improve the quality of life and disease prognosis.
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The China Infectious Disease Automated-alert and Response System (CIDARS) was successfully implemented and became operational nationwide in 2008.The CIDARS plays an important role in and has been integrated into the routine outbreak monitoring efforts of the Center for Disease Control (CDC) at all levels in China.In the CIDARS,thresholds are determined using the'Mean+2SD'in the early stage which have limitations.This study compared the performance of optimized thresholds defined using the'Mean +2SD'method to the performance of 5 novel algorithms to select optimal 'Outbreak Gold Standard (OGS)'and corresponding thresholds for outbreak detection.Data for infectious disease were organized by calendar week and year.The'Mean+2SD',C1,C2,moving average (MA),seasonal model (SM),and cumulative sum (CUSUM) algorithms were applied.Outbreak signals for the predicted value (Px) were calculated using a percentile-based moving window.When the outbreak signals generated by an algorithm were in line with a Px generated outbreak signal for each week,this Px was then defined as the optimized threshold for that algorithm.In this study,six infectious diseases were selected and classified into TYPE A (chickenpox and mumps),TYPE B (influenza and rubella) and TYPE C [hand foot and mouth disease (HFMD) and scarlet fever].Optimized thresholds for chickenpox (P55),mumps (P50),influenza (P40,P55,and P75),rubella (P45 and P75),HFMD (P65 and P70),and scarlet fever (P75 and Ps0) were identified.The C1,C2,CUSUM,SM,and MA algorithms were appropriate for TYPE A.All 6 algorithms were appropriate for TYPE B.C1 and CUSUM algorithms were appropriate for TYPE C.It is critical to incorporate more flexible algorithms as OGS into the CIDRAS and to identify the proper OGS and corresponding recommended optimized threshold by different infectious disease types.
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BACKGROUND: To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available. METHODS: In Seoul St. Mary's Hospital, the St. Mary's Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016. RESULTS: The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation. CONCLUSIONS: Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.
Subject(s)
Humans , Epidemiology , Intensive Care Units , Korea , Length of Stay , Mass Screening , Patient Safety , Physiology , Reaction Time , Retrospective Studies , Seoul , Survival RateABSTRACT
BACKGROUND: To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available. METHODS: In Seoul St. Mary's Hospital, the St. Mary's Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016. RESULTS: The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation. CONCLUSIONS: Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.
Subject(s)
Humans , Epidemiology , Intensive Care Units , Korea , Length of Stay , Mass Screening , Patient Safety , Physiology , Reaction Time , Retrospective Studies , Seoul , Survival RateABSTRACT
<p> We report on our experience at the highly interactive special session "General Cardiology Hangout" at the 63rd Annual Scientific Session of the Japanese College of Cardiology, in which the e-portfolio system of Tokyo Medical University and a personal response system (PRS) were used to collect real-time free comments and feedback from the audience.</p><p></p><p> In order to effectively manage an interactive session at an academic meeting by collecting feedback from the audience through a PRS and free comments, it is necessary to train facilitators who have the ability to organically extract and integrate the opinions and feedback from the audience in a relevant matter, and to develop tools that are both more user-friendly and secure.</p>
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The rapid response system (RRS) is an innovative system designed for in-hospital, at-risk patients but underutilization of the RRS generally results in unexpected cardiopulmonary arrests. We implemented an extended RRS (E-RRS) that was triggered by actively screening at-risk patients prior to calls from primary medical attendants. These patients were identified from laboratory data, emergency consults, and step-down units. A four-member rapid response team was assembled that included an ICU staff, and the team visited the patients more than twice per day for evaluation, triage, and treatment of the patients with evidence of acute physiological decline. The goal was to provide this treatment before the team received a call from the patient's primary physician. We sought to describe the effectiveness of the E-RRS at preventing sudden and unexpected arrests and in-hospital mortality. Over the 1-yr intervention period, 2,722 patients were screened by the E-RRS program from 28,661 admissions. There were a total of 1,996 E-RRS activations of simple consultations for invasive procedures. After E-RRS implementation, the mean hospital code rate decreased by 31.1% and the mean in-hospital mortality rate was reduced by 15.3%. In conclusion, the implementation of E-RRS is associated with a reduction in the in-hospital code and mortality rates.
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Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Education, Professional , Heart Arrest/mortality , Hospital Mortality , Hospital Rapid Response Team , Hospitals, University , Intensive Care UnitsABSTRACT
A multi-disciplinary study is proposed for emergency response management of disaster medical and mathematical discipline in the paper. The authors propose to evaluate the physical and chemical fragility and social fragility of Hainan province to search for methods to minimize local fragility; predict the level of disaster pre-warning using the time sequence model; calculate the medical personnel, equipments and drugs to be deployed at specific time and space by means of the probability method, and calculate on this basis the probability of the number of persons to be rescued against various emergencies. This aims at sending warning in advance and precisely mobilizing resources for medical emergency response.
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The paper reviewed the significance and methodology of building a hospital emergency response system, and recommended on coordinating hospital emergency response work. The practices to build emergency response norms include persistent improvement of hospital emergency response system,unifying hospital emergency pre-plan, scheduling emergency drills, training and assessment, performance appraisal, and quantified indicators. The paper also summarized such operation principles as system development, unified management, job division, standardized operation, and routine operations.
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The paper analyzes the operation of the public health administration system under normal circumstances and the dilemmas the system faces in case of a crisis, sums up the new features presented by e-mergent public health crises under the new circumstances: rapid spread, multiplier amplification and superimposed resonance, and discusses issues related to the establishment of an emergency response system. It argues that in order to meet the universal demands in preventing and controlling modern crises, it is imperative for the existing public health administration system to transform into the structurally differentiated and greatly enlarged emergency response system; and it is also imperative to establish the three subsystems of emergency decision-making, emergency mobilization and operations, and control and correction so as to improve and strengthen the functions of the original system.
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Objective To study current situation and existed problems in the public health emergency alert and response system so as to formulate more advices to consummate it and help to establish a more reasonable system adapting to our country. Methods A qualitative study was carried out among CDC working staff including two focus group discussions(FGD). Results Although government had put more emphasis on public health,increasing its devotion and strengthening the alert and response capability after SARS outbreak, some problems still existed, such as ① absence of correlative laws and rules; ② lack of government devotion; ③ insufficient utilization of surveillance information; ④ lack of the canonical response guidance. Conclusions With regard to the building up of the public health emergency alert and response system, the following proposals are put forward: increasing payout on public health; consummating the construction of disease surveillance network; affording more education and training to correlative staff engaged in the disease control to improve their abilities.
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Objective To set up a successful after service response system for medical equipment. Methods After service response system for medical equipment company was further studied by using model analysis method. Results It was demonstrated that medical equipment companies must improve the after service response system. After service strategies were made according to the requirement of clients and the strategies were embodied in the response system. Conclusion The market competitive power of medical equipment companies are raised.