Standardised data collection in prehospital critical care: a comparison of medical problem categories and discharge diagnoses.

BACKGROUND: Prehospital medical problem reporting is essential in the management of helicopter emergency medical services (HEMS) operations. The consensus-based template for reporting and documenting in physician-staffed prehospital services exists and the classification of medical problems presented in the template is widely used in research and quality improvement. However, validation of the reported prehospital medical problem is lacking. This study aimed to describe the in-hospital diagnoses, patient characteristics and medical interventions in different categories of medical problems. METHODS: This retrospective, observational registry study examined the 10 most common in-hospital International Statistical Classification of Disease (ICD-10) diagnoseswithin different prehospital medical problem categories, defined by the HEMS physician/paramedic immediately after the mission was completed. Data were gathered from a national HEMS quality registry and a national hospital discharge registry. Patient characteristics and medical interventions related to different medical problem categories are also described. RESULTS: A total of 33,844 patients were included in the analyses. All the medical problem categories included a broad spectrum of ICD-10 diagnoses (the number of diagnosis classes per medical problem category ranged from 73 to 403). The most frequent diagnoses were mainly consistent with the reported medical problems. Overlapping of ICD-10 diagnoses was mostly seen in two medical problem categories: stroke and acute neurology excluding stroke. Additionally, typical patient characteristics and disturbances in vital signs were related to adequate medical problem categories. CONCLUSIONS: Medical problems reported by HEMS personnel have adequate correspondence to hospital discharge diagnoses. However, the classification of cerebrovascular accidents remains challenging.

Cerebral oxygen desaturation events during and functional outcomes after prehospital anaesthesia: A prospective pilot study.

BACKGROUND: During prehospital anaesthesia, oxygen delivery to the brain might be inadequate to match the oxygen consumption, with unknown long-term functional outcomes. We aimed to evaluate the feasibility of monitoring cerebral oxygenation during prehospital anaesthesia and determining the long-term outcomes. METHODS: We performed a prospective observational feasibility study in two helicopter emergency medical services units. Frontal lobe regional oxygen saturation (rSO2 ) of adult patients undergoing prehospital anaesthesia was monitored with near-infrared spectroscopy (NIRS) by a Nonin H500 oximeter. The outcome was evaluated with a modified Rankin Scale (mRS) at 30 days and 1 year. Health-related quality of life (HRQoL) was measured with a 15D instrument at 1 year. RESULTS: Of 101 patients enrolled, 83 were included. The mean baseline rSO2 was 79% (73-84). Desaturation for at least 5 min to rSO2 below 50% or a decrease of 10% from baseline occurred in four (5%, 95% CI 2%-12%) and 19 (23%, 95% CI 15-93) patients. At 1 year, 32 patients (53%, 95% CI 41-65) achieved favourable neurological outcomes. The median 15D score was 0.889 (Q1-Q3, 0.796-0.970). CONCLUSION: Monitoring cerebral oxygenation with a hand-held oximeter during prehospital anaesthesia and collecting data on functional outcomes and HRQoL are feasible. Only half of the patients achieved a favourable functional outcome. The effects of cerebral oxygenation on outcomes during prehospital critical care need to be assessed in future studies.

Diversity and Resistance to Change: Macro Conditions for Marginalization in Post-industrial Societies.

We argue that two society-level properties-resistance to change and diversity within a culture-significantly affect agents' degrees of marginalization, which is here defined as access to cultural knowledge and institutional means for accomplishing cultural goals. We develop an agent-based model using findings from Norasakkunkit et al. (Norasakkunkit and Uchida, 2011, 2014; Norasakkunkit et al., 2012). We found that varying the degrees of resistance to change and diversity affected similarities between the mainstream subculture and other subcultures, changes in subcultures over time, and the relative population proportion of each subculture. In particular, we found that high diversity and low resistance to change created the greatest cultural changes within the marginalized subculture over time and allowed for maximal growth of rebellious subcultures. Also, low diversity and high resistance to change allowed for maximal growth of the marginalized subcultures and the greatest overlap between the marginalized and mainstream subcultures. These have important implications for understanding the emergence and maintenance of marginalization in post-industrial societies.

Between reforms and birth rates: Germany, Japan, and family policy discourse.

This paper examines the development of employment-oriented family policy in Germany and Japan, two countries united by conservative welfare legacies and very low birthrates, through a close analysis of discourse. Why have recent reforms in Germany moved well beyond those in Japan despite remarkably similar "human capital" discourses? The relative strength of interpretative patterns­in this case, discursive patterns that successfully frame family policy reform as an economic imperative­and the role of employers are identified as critical explanatory factors. Further comparative attention is called to the role of the state as a guarantor of new family policy entitlements.

Unable to conform, unwilling to rebel? Youth, culture, and motivation in globalizing Japan.

This paper investigates the effects of globalization on Japanese young adults from sociological and psychological perspectives. While Japan's socio-economic institutions have shown mainly resistant (or "hot") reactions to globalization, individual-level adaptations remain oriented toward conformity to dominant life expectations, which remain largely unchanged, despite decreasing rewards. However, a socially withdrawn sub-group (the so-called hikikomori) appears to be unable to conform yet is also unwilling to rebel. The experimental evidence we review suggests such youth deviate from typical Japanese motivational patterns but have not necessarily become more Western. This poses serious problems in an interdependence-oriented culture, but the paralysis of this group seems to be an outcome of labor market change rather than a psychopathology. Finally, we also identify a contrasting group - whom we call the quiet mavericks - that adapts in creative and integrative (or "cool") ways by negotiating conformist pressures tactfully. Our account sheds light on just how complex and painful the psychological and sociological effects of globalization can be for young people in conformist societies, with implications to policy and social sustainability.