Challenges & barriers for real-time integration of drones in emergency cardiac care: Lessons from the United States, Sweden, & Canada.

Importance: Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality in the US and Europe (∼600,000 incident events annually) and around the world (∼3.8 million). With every minute that passes without cardiopulmonary resuscitation or defibrillation, the probability of survival decreases by 10%. Preliminary studies suggest that uncrewed aircraft systems, also known as drones, can deliver automated external defibrillators (AEDs) to OHCA victims faster than ground transport and potentially save lives. Objective: To date, the United States (US), Sweden, and Canada have made significant contributions to the knowledge base regarding AED-equipped drones. The purpose of this Special Communication is to explore the challenges and facilitators impacting the progress of AED-equipped drone integration into emergency medicine research and applications in the US, Sweden, and Canada. We also explore opportunities to propel this innovative and important research forward. Evidence review: In this narrative review, we summarize the AED-drone research to date from the US, Sweden, and Canada, including the first drone-assisted delivery of an AED to an OHCA. Further, we compare the research environment, emergency medical systems, and aviation regulatory environment in each country as they apply to OHCA, AEDs, and drones. Finally, we provide recommendations for advancing research and implementation of AED-drone technology into emergency care. Findings: The rates that drone technologies have been integrated into both research and real-life emergency care in each country varies considerably. Based on current research, there is significant potential in incorporating AED-equipped drones into the chain of survival for OHCA emergency response. Comparing the different environments and systems in each country revealed ways that each can serve as a facilitator or barrier to future AED-drone research. Conclusions and relevance: The US, Sweden, and Canada each offers different challenges and opportunities in this field of research. Together, the international community can learn from one another to optimize integration of AED-equipped drones into emergency systems of care.

Understudied social influences on work-related and parental burnout: Social media-related emotions, comparisons, and the "do it all discrepancy".

Recent societal changes, including a global pandemic, have exacerbated experiences of and attention to burnout related to work and parenting. In the present study, we investigated how several social forces can act as demands and resources to impact work-related and parental burnout. We tested two primary hypotheses in a sample of women who responded to an online survey (N for analyses ranged from 2376 to 3525). We found that social comparisons, social media use, negative emotions when comparing oneself to others on social media, and a high do it all discrepancy (feeling one should be able to do it all more so than perceptions that one can) were correlated with higher reports of work-related and parental burnout. Alternatively, positive emotions when comparing oneself to others and social support were related to lower reports of work-related and parental burnout. The influence of social media use on burnout was mediated by the emotions experienced when comparing oneself to others on social media. Tests of moderation indicated that social comparisons had stronger relationships with burnout for those with higher expectations that they should be able to do it all verses can do it all. Tests of social support as a moderator of the relationships between social demands and burnout were largely non-significant. Based on these findings, we make practical suggestions for interventions to increase positive emotions experienced from social media use, and to mediate the do it all discrepancy by redefining expectations around "doing it all."

A team-based learning model using clinical vignettes in an advanced undergraduate pre-health professional physiology course facilitated by medical students.

There is evidence that demonstrates that teaching preclinical and clinical material can have numerous benefits for both students and teachers, with the majority of literature focusing on peer medical student teaching. There is a dearth of literature exploring the benefit of medical students teaching undergraduate, pre-health professional students and using clinical cases in this setting. We explore our implementation of a team-based learning curriculum built around clinical cases to teach advanced physiology and introduce pathology, pharmacology, and interprofessional collaboration for pre-health students. This course was entirely taught by medical students. Course evaluations and future implications are discussed.

Out-of-Hospital Cardiac Arrest Bystander Defibrillator Search Time and Experience With and Without Directional Assistance: A Randomized Simulation Trial in a Community Setting.

INTRODUCTION: Probability of survival after out-of-hospital cardiac arrest (OHCA) doubles when a bystander initiates cardiopulmonary resuscitation and uses an automated external defibrillator (AED) rapidly. National, state, and community efforts have increased placement of AEDs in public spaces; however, bystander AED use remains less than 2% in the United States. Little is known about the effect of giving bystanders directional assistance to the closest public access AED. METHODS: We conducted 35 OHCA simulations using a life-sized manikin with participants aged 18 through 65 years who searched for public access AEDs in 5 zones on a university campus. Zones varied by challenges to pedestrian AED acquisition and number of fixed AEDs. Participants completed 2 searches-first unassisted and then with verbal direction to the closest AED-and we compared AED delivery times. We conducted pretest and posttest surveys. RESULTS: In all 5 zones, the median time from simulated OHCA onset to AED delivery was lower when the bystander received directional assistance. Time savings (minutes:seconds) varied by zone, ranging from a median of 0:53 (P = 0.14) to 3:42 (P = 0.02). Only 3 participants immediately located the closest AED without directional assistance; more than half reported difficulty locating an AED. CONCLUSIONS: These findings may inform strategies to ensure that AEDs are consistently marked and placed in visible, accessible locations. Continued emphasis on developing strategies to improve lay bystanders' ability to locate and use AEDs may improve AED retrieval times and OHCA outcomes.

Impact of Using Drones in Emergency Medicine: What Does the Future Hold?

The use of unmanned aerial vehicles or "drones" has expanded in the last decade, as their technology has become more sophisticated, and costs have decreased. They are now used routinely in farming, environmental surveillance, public safety, commercial product delivery, recreation, and other applications. Health-related applications are only recently becoming more widely explored and accepted. The use of drone technology in emergency medicine is especially promising given the need for a rapid response to enhance patient outcomes. The purpose of this paper is to describe some of the main current and expanding applications of drone technology in emergency medicine and to describe challenges and future opportunities. Current applications being studied include delivery of defibrillators in response to out-of-hospital cardiac arrest, blood and blood products in response to trauma, and rescue medications. Drones are also being studied and actively used in emergency response to search and rescue operations as well as disaster and mass casualty events. Current challenges to expanding their use in emergency medicine and emergency medical system (EMS) include regulation, safety, flying conditions, concerns about privacy, consent, and confidentiality, and details surrounding the development, operation, and maintenance of a medical drone network. Future research is needed to better understand end user perceptions and acceptance. Continued technical advances are needed to increase payload capacities, increase flying distances, and integrate drone networks into existing 9-1-1 and EMS systems. Drones are a promising technology for improving patient survival, outcomes, and quality of life, particularly for those in areas that are remote or that lack funds or infrastructure. Their cost savings compared with ground transportation alone, speed, and convenience make them particularly applicable in the field of emergency medicine. Research to date suggests that use of drones in emergency medicine is feasible, will be accepted by the public, is cost-effective, and has broad application.

Uterine Cellular Blue Nevus Arising in Mullerian and Pelvic Dendritic Melanocytosis: Case Report of a Rare Phenomenon to Be Distinguished From Uterine Melanoma.

A 37-yr-old woman presented to the gynecology clinic with abnormal uterine bleeding in the setting of known, large uterine fibroids. Preoperative endometrial biopsy identified atypical melanocytic cells concerning for uterine melanoma. Care was transferred to the gynecologic oncology service for hysterectomy. Intraoperative findings included macular, blue-black pigmentation of the peritoneum of the bladder and cervix, which was resected and sent for frozen section, confirming melanocytic neoplasia. The hysterectomy revealed multiple tan leiomyomas up to 12 cm, and a distinct 3 cm black, incompletely circumscribed mass in the endomyometrium composed of bland spindled cells with delicate melanin granules. The tumor cells were positive for Sox-10, BAP1, and Mart-1 (Melan-A) and negative for PRAME, PD-L1, and BRAFV600E by immunostains. Microscopic elements of similar melanocytes and melanophages were found in the cervix and bladder peritoneum. Molecular analysis of the uterine tumor identified a GNA11 mutation but no TERT or BAP1 mutation. The uterine melanocytic tumor has characteristic findings of a cellular blue nevus arising in association with dendritic melanocytosis of Mullerian and pelvic tissues, a rarely seen benign phenomenon that should be distinguished from malignant melanoma of the upper genital tract.

Some Rest for the Weary? A Qualitative Analysis of Clergy Methods for Managing Demands.

In many ways, clergy (i.e., religious leaders including pastors, ministers) are a high-risk population. In their efforts to ensure the spiritual well-being of their congregations, clergy may neglect their own well-being and be unaware of the potentially detrimental effects that their work has on their health. The purpose of this study was to add to the growing knowledge base about how clergy perceive the relationship between their work and their well-being, the strategies they use to recover from their work, and the ways they balance work and nonwork areas of their lives. This qualitative study explores these areas to further understand the nature of clergy work and recovery from work. Clergy (N = 332) were asked to respond to a set of open-ended prompts related to their perceptions of work interference with health, and strategies at and outside of work they use to manage work and nonwork demands. The present study sheds light on recovery strategies (i.e., self-care practices) and practices clergy may use to successfully manage demands in the work and nonwork areas of their lives. Specifically, prioritizing, personal time (e.g., time spent in hobbies), and physical activities emerged as common strategies and practices. Our results have the potential to guide researchers in how to design interventions aimed at assisting individuals in this at-risk population.

Delivery of Automated External Defibrillators via Drones in Simulated Cardiac Arrest: Users' Experiences and the Human-Drone Interaction.

BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) in the United States is approximately 10%. Automatic external defibrillators (AEDs) are effective when applied early, yet public access AEDs are used in <2% of OHCAs. AEDs are often challenging for bystanders to locate and are rarely available in homes, where 70% of OHCAs occur. Drones have the potential to deliver AEDs to bystanders efficiently; however, little is known about the human-drone interface in AED delivery. OBJECTIVES: To describe user experiences with AED-equipped drones in a feasibility study of simulated OHCA in a community setting. METHODS: We simulated an OHCA in a series of trials with age-group/sex-matched participant pairs, with one participant randomized to search for a public access AED and the other to call a mock 9-1-1 telephone number that initiated the dispatch of an AED-equipped drone. We investigated user experience of 17 of the 35 drone recipient participants via semi-structured qualitative interviews and analyzed audio-recordings for key aspects of user experience. RESULTS: Drone recipient participants reported largely positive experiences, highlighting that this delivery method enabled them to stay with the victim and continue cardiopulmonary resuscitation. Concerns were few but included drone arrival timing and direction as well as bystander safety. Participants provided suggestions for improvements in the AED-equipped drone design and delivery procedures. CONCLUSION: Participants reported positive experiences interacting with an AED-equipped drone for a simulated OHCA in a community setting. Early findings suggest a role for drone-delivered AEDs to improve bystander AED use and improve outcomes for OHCA victims.

Impact of spousal work restrictions on expatriates' work life and overall life satisfaction.

Our understanding of the challenges and the broader role of spouses of expatriates is extremely limited. This study examined the impact of spousal work restrictions on expatriates' work life and overall life satisfaction using qualitative and quantitative analyses based on data from a sample of 409 Indian Information Technology professionals working in USA. Furthermore, hypothesised conditional process model (tested with PROCESS analysis tool) was supported, showing that spousal work restrictions created complications in personal lives of expatriates, which interfered with work lives resulting in lower overall life satisfaction. We identified six core classes of challenges faced by spouses of expatriates: wasted skills, financial issues, boredom, social isolation, quality time and domestic tension. Our mixed method approach also helps to provide a more comprehensive picture of these complications. This study may help organisational leaders and policy makers to more fully consider the implications of visa-related policy changes on expatriate families.

The Sacred and Stressed: Testing a Model of Clergy Health.

In many ways, clergy and religious leaders are an ignored, yet high-risk population. A clergy member unable to cope with challenges in his or her own life may be ineffective at helping church members to cope with their stress. In the present study, we developed and tested an operational model of clergy holistic health, including occupational demands, and personal and job-related resources. Data were collected from clergy (N = 418) and analyzed using correlational and regression-based techniques. Results from the present study provide support for the demands-control-support model (Johnson and Hall in Am J Public Health 78(10):1336-1342, 1988). Specifically, our findings suggest that clergy mental health may be improved by (a) an increase in the work-related social support needed to take advantage of job control followed by (b) an increase in job control. Furthermore, the present findings expand on previous research by identifying spiritual well-being as an important outcome that may be impacted by job-related demands. The present findings also underscore the value of contextualized or occupation-specific measures, given the stronger correlations that were observed between the occupation-specific measure of perceived job demands than the general measure of perceived job demands.

Delivery of Automated External Defibrillators (AED) by Drones: Implications for Emergency Cardiac Care.

PURPOSE OF REVIEW: Out-of-hospital cardiac arrest (OHCA) remains a significant health problem in the USA and only 8.6% of victims survive with good neurological function, despite advances in emergency cardiac care. The likelihood of OHCA survival decreases by 10% for every minute without resuscitation. RECENT FINDINGS: Automatic external defibrillators (AEDs) have the potential to save lives yet public access defibrillators are underutilized (< 2% of the time) because they are difficult to locate and rarely available in homes or residential areas, where the majority (70%) of OHCA occur. Even when AEDs are within close proximity (within 100 m), they are not used 40% of the time.

Perceptions of Chaplains' Value and Impact Within Hospital Care Teams.

Many scholars have written about the role of spirituality in health care. One mechanism for incorporating spirituality into the care of patients is to integrate clinically trained chaplains into hospital care teams. We examined in a mixed-methods fashion, the effects of this type of integrated care team within a teaching hospital setting. The quality and impact of chaplain involvement were studied from patient and physician-in-training perspectives, using data from more than 200 patients and physicians in training. Findings clearly show that clinically trained chaplains can contribute meaningful expertise and real value to the quality and comprehensiveness of patient and physician experiences.

Explaining Student Interest and Confidence in Providing Care for Older Adults: The Role of Demographics and Life Experiences.

America's aging population needs interprofessional health care providers committed to providing high-quality, patient-centered care. Considering the often negative attitudes held by health care students about older adults and the impact that can have on their care, it is important to explore factors that influence student attitudes and desire to provide geriatric care. Five hundred seventy-two students pursuing nursing, physical therapy, athletic training, dietetics, and social work degrees were surveyed. Students reported demographic factors, amount of contact with older adults, how rewarding that contact had been, and confidence and interest in working with older adults. Higher levels of confidence were associated with gender, studying nursing or physical therapy, and being older. Overall, confidence and interest were positively correlated with (a) positive attitudes toward aging, (b) contact frequency, and (c) quality experiences with older adults. Therefore, confident students with an interest in working with the geriatric population upon graduation have more exposure and more rewarding experiences with older adults before entering their program. [Journal of Gerontological Nursing, 43(3), 13-18.].

Linking Nurse Leadership and Work Characteristics to Nurse Burnout and Engagement.

BACKGROUND: Burnout and engagement are critical conditions affecting patient safety and the functioning of healthcare organizations; the areas of worklife model suggest that work environment characteristics may impact employee burnout and general worklife quality. OBJECTIVES: The purpose was to present and test a conditional process model linking perceived transformational nurse leadership to nurse staff burnout and engagement via important work environment characteristics. METHODS: Working nurses (N = 120) provided perceptions of the core study variables via Internet- or paper-based survey. The hypothesized model was tested using the PROCESS analysis tool, which enables simultaneous testing of multiple, parallel, indirect effects within the SPSS statistical package. RESULTS: Findings support the areas of worklife model and suggest that transformational leadership is strongly associated with work environment characteristics that are further linked to nurse burnout and engagement. Interestingly, different work characteristics appear to be critical channels through which transformational leadership impacts nurse burnout and engagement. DISCUSSION: There are several methodological and practical implications of this work for researchers and practitioners interested in preventing burnout and promoting occupational health within healthcare organizations. These implications are tied to the connections observed between transformational leadership, specific work environment characteristics, and burnout and engagement outcomes.

Understanding time use, stress and recovery practices among early career physicians: an exploratory study.

Early career physicians (ECPs) work an average of 80 h per week, and at times may approach 24 continuous hours working. These hours, combined with a stressful work environment, and an inability to physically and psychologically detach from work make ECPs likely to experience burnout and other negative health-related consequences. This study provides insight into the stress and recovery challenges faced by ECPs in a typical hospital environment. Rich qualitative and quantitative data were gathered from participants regarding daily time usage, and recovery practices and needs. ECPs report longer working hours, less leisure time and shorter amounts of sleep than average working adults. ECPs do not participate in many resource-replenishing activities while at work, and when out of work, they tend to participate in more passive than active forms of recovery. Resource-draining activities were identified as requiring much of ECP's nonwork time, further limiting recovery. The prevention of burnout and other negative health consequences among ECPs requires the building of a workplace and educational culture that supports regular resource replenishment. This includes the need for a curriculum of medical education that teaches ECPs to identify the signs of stress and recovery needs, and how to effectively address these needs.

Rational versus empirical prediction of nursing student success.

Undergraduate and graduate nursing education programs can offer a very limited number of positions to a very large number of student applicants. Although practices vary widely across schools of nursing, it is common in many programs to use rational or holistic judgment when determining which student applicants to admit. The present applied study demonstrates a method and several examples of alternative selection models that can improve administrators' ability to efficiently and effectively identify student applicants with the highest probability of success. The example models are also tested within a sample of students (N = 283) from a very active bachelor of science in nursing program, and recommendations for use are provided. Results clearly support the use of admission formula scores generated from regression-based methods versus admission formula scores generated from a typical rational points-based method of weighting applicant admission criteria.

Preparing for bike-sharing: insight from focus groups and surveys, Chattanooga, Tennessee, 2010.

OBJECTIVES: To obtain in-depth community input using qualitative and quantitative methods to guide development and marketing of a bike-share program in Chattanooga, Tennessee. METHOD: Focus groups and surveys assessed bicycling attitudes, beliefs, barriers, and behaviors of residents, workers, and university students. The authors completed nine focus groups (N = 56): five sessions with downtown workers, three with downtown residents, and one with university students. RESULTS: Health, recreation and transportation benefits of bicycling were commonly identified. Concerns regarding bicycling in traffic are apparent because of lack of facilities and a need for public education on safe motorist and bicyclist behavior. Practical limitations can inhibit bicycling during the day, including shower access and personal hygiene concerns. CONCLUSIONS: Public desire for environmental, educational, and enforcement tactics to support safe bicycling was noted. Marketing tactics for bike-share usage should emphasize health, recreational, and transportation benefits. Worksites can reduce barriers related to bicycling and encourage bike-share use. Future studies should assess bike-share impact on perceptions and behavior, as well as the resulting policy and environmental changes.

Disclosure and documentation of reported unanticipated medical events or outcomes: need for healthcare provider education.

In 2001 the Joint Commission on Accreditation of Healthcare Organizations added "requirement to disclose unanticipated outcomes" to accreditation standards. Full disclosure increases patient satisfaction and trust in physicians. Though studies suggest elements of complete disclosure, there are no national standards.

Not all resources are created equal: COR theory, values, and stress.

The common usage of conservation of resources (COR) theory highlights the quantity of resources in explaining stress reactions and responses. To expand the theoretical understanding and explanatory power of COR theory, this study tested the proposition that the perceived importance of an individual's resources is a function of personal values. Using a value framework based on Schwartz (1994), it was expected that values would influence both the appraisal of resource importance and coping behaviors. Results from both student and working samples indicated that while resource importance did not clearly mediate all of the coping outcomes, values did have an influence on the importance an individual assigns to resources. Measurement and theoretical implications related to COR theory are discussed.