A Smartphone application to provide real-time cardiopulmonary resuscitation quality feedback.

BACKGROUND: Quality of cardiopulmonary resuscitation (CPR) contributes significantly to outcomes. Key determinants of CPR quality pertaining to chest compressions are compression rate, compression depth, duration of interruptions, and chest recoil. Several studies have demonstrated that real-time audiovisual feedback improves CPR quality. We hypothesize that a mobile application using sensor data from built-in accelerometers in smartphones can provide accurate chest compression quality feedback in real time. This study aims to develop and validate an application for smartphone which can provide real-time audiovisual and haptic feedback on determinants of CPR quality. METHODS: A mobile application was developed to detect the compression depth and compression rate in real time using data captured from a smartphone's intrinsic accelerometer. The mobile device was placed on an adult manikin's chest at the point of compressions. In a simulated environment, data obtained using the application was compared directly to data obtained from a validated standard CPR quality tool. RESULTS: CPR quality parameters were obtained from the application and industry standard for 60, 30s-long sessions. Bland-Altman plot analysis for compression depth showed agreement between the app measurements and standard within ±4 mm (<10% error). The interclass correlation for agreement in the measurement of compression count was 0.92 (95% CI: 0.88-0.95), indicative of very strong agreement. CONCLUSIONS: Smart device applications using acceleration sensor data derived from smart phones can accurately provide real-time CPR quality feedback. With further development and validation, they can provide a ubiquitously available CPR feedback tool valuable for out-of-hospital arrests and in-hospital arrests in under-privileged areas.

Using fisher-contributed secondary fins to fill critical shark-fisheries data gaps.

Developing-world shark fisheries are typically not assessed or actively managed for sustainability; one fundamental obstacle is the lack of species and size-composition catch data. We tested and implemented a new and potentially widely applicable approach for collecting these data: mandatory submission of low-value secondary fins (anal fins) from landed sharks by fishers and use of the fins to reconstruct catch species and size. Visual and low-cost genetic identification were used to determine species composition, and linear regression was applied to total length and anal fin base length for catch-size reconstruction. We tested the feasibility of this approach in Belize, first in a local proof-of-concept study and then scaling it up to the national level for the 2017-2018 shark-fishing season (1,786 fins analyzed). Sixteen species occurred in this fishery. The most common were the Caribbean reef (Carcharhinus perezi), blacktip (C. limbatus), sharpnose (Atlantic [Rhizoprionodon terraenovae] and Caribbean [R. porosus] considered as a group), and bonnethead (Sphyrna cf. tiburo). Sharpnose and bonnethead sharks were landed primarily above size at maturity, whereas Caribbean reef and blacktip sharks were primarily landed below size at maturity. Our approach proved effective in obtaining critical data for managing the shark fishery, and we suggest the tools developed as part of this program could be exported to other nations in this region and applied almost immediately if there were means to communicate with fishers and incentivize them to provide anal fins. Outside the tropical Western Atlantic, we recommend further investigation of the feasibility of sampling of secondary fins, including considerations of time, effort, and cost of species identification from these fins, what secondary fin type to use, and the means with which to communicate with fishers and incentivize participation. This program could be a model for collecting urgently needed data for developing-world shark fisheries globally. Article impact statement: Shark fins collected from fishers yield data critical to shark fisheries management in developing nations.

Uso de Aletas Secundarias Proporcionadas por Pescadores para Llenar Vacíos Importantes de Información sobre las Pesquerías de Tiburones Resumen Con frecuencia no se evalúan las pesquerías de tiburones del mundo en desarrollo ni cuentan con un manejo activo de sustentabilidad. Uno de los principales obstáculos para esto es la falta de información sobre las especies y la composición de los tamaños en las capturas. Probamos e implementamos una estrategia nueva y potencialmente aplicable en todas partes para la recolección de estos datos: la entrega obligatoria de las aletas secundarias de bajo valor económico (aletas anales) obtenidas de los tiburones desembarcados por parte de los pescadores y el uso de estas aletas para reconstruir las especies y tamaños en la captura. Usamos identificaciones genéticas de bajo costo e identificaciones visuales para determinar la composición de las especies y aplicamos una regresión lineal a la longitud total y a la de la base de la aleta anal para la reconstrucción del tamaño en captura. Probamos la viabilidad de esta estrategia en Belice, primero en un estudio de prueba de concepto y después subiendo al nivel nacional para la temporada de pesca de tiburón 2017-2018 (1,786 aletas analizadas). Se registraron 16 especies en esta pesquería. Las más comunes fueron Carcharhinus perezi, C. limbatus, Rhizoprionodon terraenovae y R. porosus (consideradas como un grupo) y Sphyrna cf. tiburo. Las últimas tres especies fueron desembarcadas principalmente por encima del tamaño maduro, mientras que con las dos primeras especies lo hacían por debajo del tamaño maduro. Nuestra estrategia demostró ser efectiva en la obtención de información crítica para el manejo de la pesquería de tiburones y sugerimos que las herramientas desarrolladas como parte de este programa puedan ser exportadas a otras naciones en esta región y aplicadas casi de manera inmediata si existen los medios para comunicarse con los pescadores e incentivarlos a proporcionar las aletas anales. Fuera del Atlántico Occidental tropical, recomendamos una mayor investigación de la viabilidad del muestreo de aletas secundarias, incluyendo la consideración del tiempo, esfuerzo y costo de la identificación de especies a partir de estas aletas; cuál tipo de aleta secundaria utilizar; y los medios mediante los cuales comunicarse con los pescadores e incentivarlos a participar. Este programa podría ser un modelo para la recolección de información de necesidad urgente para las pesquerías del mundo en desarrollo.

Resident perceptions of autonomy in a complex tertiary care environment improve when supervised by hospitalists.

BACKGROUND AND OBJECTIVE: Increasingly, academic hospitals have adopted hospitalist-based systems of inpatient pediatric care. Some studies comparing hospitalists with other attending physicians have suggested trainees are more satisfied with education from hospitalists. However, there are published concerns that the increased presence of hospitalists may reduce residents' autonomy. The objective of the current study was to evaluate pediatric residents' perceptions of their own autonomy after a broad ward restructuring to hospitalist-led teams. METHODS: We analyzed data from standardized attending evaluations before and after a pediatric ward restructuring at an academic tertiary care hospital. Provision of most inpatient pediatric care changed from subspecialist-led teams to hospitalist-led teams. Numerical scores from evaluations before and after the restructuring were compared quantitatively. Comments from the evaluations were analyzed qualitatively to identify key themes. RESULTS: Before the restructuring, there were 65 evaluations of 5 hospitalists and 602 evaluations of 32 subspecialists. After the restructuring, there were 188 evaluations of 8 hospitalists. Hospitalists were rated significantly higher on all teaching attributes compared with all attending physicians before the restructuring. The attending role in promoting autonomy was mentioned infrequently and reflected residents' perceived lack of autonomy before the restructuring. The primary theme after the restructuring was autonomy, specifically emphasizing resident leadership and decision-making and the appropriate balance of resident autonomy and supervision. CONCLUSIONS: Although patient complexity was unchanged, a comparison of numerical ratings and resident comments before and after the restructuring indicates that hospitalists lead teams differently from subspecialists, with more emphasis on resident decision-making and autonomy.

A review of patient safety in women's healthcare: why has our progress been so slow?

The rate of improvement in patient safety is slow. The goal of this review is to address the results of a survey of Ob-Gyn physicians regarding important patient safety issues. A sample of 600 obstetricians and gynecologists were sent a survey asking them about their beliefs, activities, problems, and source of information regarding patient safety with a response rate of 53.2%. Results about beliefs and patient safety activities have been reported [Stumpf et al., 2009]. Misdiagnosis (95.6%), failure to follow-up with patients (94.9%), and administration of the wrong medication or dosage of a medication (90.5%) were the most often reported patient safety problems. Obstetricians and gynecologists most often use printed materials, CMEs, journals, and practice guidelines for information regarding patient safety. Ob-Gyns prefer to learn new patient safety information using printed materials and post graduate classes rather than materials on compact disk or online webcasts. A majority of respondents recognize patient safety as an important issue. Education about the importance of patient safety may be a less pertinent topic when compared to the need for education about implementing specific tools for patient safety and moving from awareness to action.