Humpback whales (Megaptera novaeangliae) were hunted commercially in Canada's Pacific region until 1966. Depleted to an estimated 1,400 individuals throughout the North Pacific, humpback whales are ...listed as Threatened under Canada's Species at Risk Act (SARA) and Endangered under the US Endangered Species Act. We conducted an 8-year photo-identification study to monitor humpback whale usage of a coastal fjord system in British Columbia (BC), Canada that was recently proposed as candidate critical habitat for the species under SARA. This participatory research program built collaborations among First Nations, environmental non-governmental organizations and academics. The study site, including the territorial waters of Gitga'at First Nation, is an important summertime feeding destination for migratory humpback whales, but is small relative to the population's range. We estimated abundance and survivorship using mark-recapture methods using photographs of naturally marked individuals. Abundance of humpback whales in the region was large, relative to the site's size, and generally increased throughout the study period. The resulting estimate of adult survivorship (0.979, 95% CI: 0.914, 0.995) is at the high end of previously reported estimates. A high rate of resights provides new evidence for inter-annual site fidelity to these local waters. Habitat characteristics of our study area are considered ecologically significant and unique, and this should be considered as regulatory agencies consider proposals for high-volume crude oil and liquefied natural gas tanker traffic through the area. Monitoring population recovery of a highly mobile, migratory species is daunting for low-cost, community-led science. Focusing on a small, important subset of the animals' range can make this challenge more tractable. Given low statistical power and high variability, our community is considering simpler ecological indicators of population health, such as the number of individuals harmed or killed each year by human activities, including ship strikes and entanglement in fishing gear.
The northeastern USA has experienced a dramatic increase in total and extreme precipitation over the past 30 years, yet how precipitation will evolve across the Northeast by the end of the ...twenty-first century remains uncertain. To examine the future of precipitation across the Northeast, we use the Weather Research and Forecasting (WRF) regional climate model driven by the National Center for Atmospheric Research Community Earth System Model (CESM) to simulate precipitation for historical (1976–2005) and future (2070–2099) periods. We compare precipitation from CESM-WRF hindcasts to gridded observations (Daymet), finding a 4.6% dry bias and 7.7% wet bias for total and extreme precipitation, respectively. CESM-WRF projections have increases in both total (9.7%) and extreme (51.6%) precipitation by the end of the twenty-first century, with winter having the largest increases in total precipitation (16.4%) and extreme precipitation (109.3%). These results are consistent with additional WRF simulations forced with the Max Planck Institute Earth System Model and the North American Coordinated Regional Downscaling Experiment archive. To investigate the drivers of precipitation change, we analyze several atmospheric variables and find that the projected increases in extreme precipitation are strongly related to increasing precipitable water over the eastern USA and the Atlantic Ocean. Understanding projected increases in total and extreme precipitation is critical for stakeholders to prepare for the impacts of intensified precipitation.
Swift recognition of cardiac arrest is required for survival, however failure to recognize (and delayed response) is common. Studying online cardiac arrest videos may aid recognition, however the ...ethical implications of this are unknown. We examined their use from the perspective of persons with lived experience of cardiac arrest, seeking to understand the experience of having one’s cardiac arrest recorded and available online.
We gathered qualitative data using focused interviews of persons affected by cardiac arrest. Inductive thematic analysis was performed, as well as a deductive ethical analysis. Co-researcher survivors and co-survivors were involved in all stages of this project.
We identified themes of ‘shock, hurt and helplessness’ and ‘surreality and reality’ to describe the experience of having one’s (or a family member’s) cardiac arrest captured and distributed online. Participants provided guidance on the use of online videos for education and research, emphasising beneficence, autonomy, non-maleficence, and justice.
Finding one’s own, or a family member’s cardiac arrest video online is shocking and potentially harmful for families. If ethical principles are followed however, there may be acceptable procedures for the use of online videos of cardiac arrest for education or research purposes. The careful use of online videos of cardiac arrest for education and research may help improve recognition and response, though additional research is required to confirm or refute this claim.
•Personal protective equipment errors are common.•Bundled infection prevention control audits and continuous quality improvement may reduce pathogen spread.•Audits by trained observers (dofficers) ...can be used by outbreak response teams to identify opportunities for infection prevention and control quality improvement.•Real-time feedback from dofficers, and quality improvement feedback from an outbreak response team may be associated with a reduction in infection control errors.•Further research is needed to determine if dofficers are causally linked with error reductions.
In response to a facility-wide COVID-19 outbreak, our tertiary acute care hospital implemented an evidence-based bundle of infection control practices including the use of audits and trained observers “dofficers” to provide real-time constructive feedback.
We trained furloughed staff to perform the role of dofficer. They offered support and corrective feedback on proper PPE use and completed 21-point audits during a 4-week intervention period. Audits tracked appropriate signage, placement and availability of supplies (equipment), correct PPE use, enhanced environmental cleaning, along with cohorting and social distancing rates. Audit data was used to provide weekly quality improvement reports to units.
Nine hundred and sixty two separate audits recorded 36,948 observations, over 7,696 observer-hours. The most common errors were with environmental cleaning and PPE use; the least common were with regards to equipment availability and cohorting and social distancing. Mean error rates decreased from 9.81% to 2.88% (P < .001). The largest reduction, 22.57%, occurred in the category of PPE doffing errors.
Dofficer led audits effectively identified areas for improvement. Feedback through weekly reports and real-time correction of PPE errors by dofficers led to statistically significant improvements; however, error rates remained high. Further research is needed establish if these relationships are causal.
Emergency departments use triage to ensure that patients with the highest level of acuity receive care quickly and safely. Triage is typically a nursing process that is documented as structured and ...unstructured (free text) data. Free-text triage narratives have been studied for specific conditions but never reviewed in a comprehensive manner.
The objective of this paper was to identify and map the academic literature that examines triage narratives. The paper described the types of research conducted, identified gaps in the research, and determined where additional review may be warranted.
We conducted a scoping review of unstructured triage narratives. We mapped the literature, described the use of triage narrative data, examined the information available on the form and structure of narratives, highlighted similarities among publications, and identified opportunities for future research.
We screened 18,074 studies published between 1990 and 2022 in CINAHL, MEDLINE, Embase, Cochrane, and ProQuest Central. We identified 0.53% (96/18,074) of studies that directly examined the use of triage nurses' narratives. More than 12 million visits were made to 2438 emergency departments included in the review. In total, 82% (79/96) of these studies were conducted in the United States (43/96, 45%), Australia (31/96, 32%), or Canada (5/96, 5%). Triage narratives were used for research and case identification, as input variables for predictive modeling, and for quality improvement. Overall, 31% (30/96) of the studies offered a description of the triage narrative, including a list of the keywords used (27/96, 28%) or more fulsome descriptions (such as word counts, character counts, abbreviation, etc; 7/96, 7%). We found limited use of reporting guidelines (8/96, 8%).
The breadth of the identified studies suggests that there is widespread routine collection and research use of triage narrative data. Despite the use of triage narratives as a source of data in studies, the narratives and nurses who generate them are poorly described in the literature, and data reporting is inconsistent. Additional research is needed to describe the structure of triage narratives, determine the best use of triage narratives, and improve the consistent use of triage-specific data reporting guidelines.
RR2-10.1136/bmjopen-2021-055132.
Abdominal-pelvic hemorrhage (i.e., originates below the diaphragm and above the inguinal ligaments) is a major cause of death. It has diverse etiology but is typically associated with gunshot or stab ...wounds, high force or velocity blunt trauma, aortic rupture, and peripartum bleeds. Because there are few immediately deployable, temporizing measures, and the standard approaches such as direct pressure, hemostatics, and tourniquets are less reliable than they are with compressible extremity injuries, risk for death resulting from abdominal-pelvic hemorrhage is high. This review concerns the exciting potential of proximal external aortic compression (PEAC) as a temporizing technique for life-threatening lower abdominal-pelvic hemorrhage. PEAC can be accomplished by means of a device, two locked arms (manual), or a single knee (genicular) to press over the midline supra-umbilical abdomen. The goal is to compress the descending aorta and slow or halt downstream hemorrhage while not delaying more definitive measures such as hemostatic packing, tourniquets, endovascular balloons, and ultimately operative repair.
Clinical review of the Ovid MEDLINE, In-Process, & Other Non-Indexed, and Google Scholar databases was performed for the period ranging from 1946 to 3 May 2019 for studies that included the following search terms: proximal external aortic compression OR vena cava compression AND (abdomen or pelvis) OR (hemorrhage) OR (emergency or trauma). In addition, references from included studies were assessed.
Sixteen studies met the inclusion criteria. Evidence was grouped and summarized from the specialties of trauma, aortic surgery, and obstetrics to help prehospital responders and guide much-needed additional research, with the goal of decreasing the high risk for death after life-threatening abdominal-pelvic hemorrhage.
To conduct a systematic review of the use of the recovery position in adults and children with non-traumatic decreased levels of responsiveness changes outcomes in comparison with other positioning ...strategies.
We searched Medline (Ovid), Embase, Cochrane Library, CINAHL, medRxiv and Google Scholar from inception to 15 March 2021 for studies involving adults and children in an out-of-hospital, first aid setting who had reduced levels of responsiveness of non-traumatic aetiology but did not require resuscitative interventions. We used the ROBINS-I tool to assess risk of bias and GRADE methodology to determine the certainty of evidence.
Of 17,947 citations retrieved, three prospective observational studies and four case series were included. The prone and semi-recumbent positions were associated with a decreased rate of suspected aspiration pneumonia in acute poisoning. Use of the recovery position in paediatric patients with decreased levels of responsiveness was associated with a deceased admission rate and the prone position was the position most commonly associated with sudden unexpected death in epilepsy. High risk of bias, imprecision and indirectness of evidence limited our ability to perform pooled analyses.
We identified a limited number of observational studies and case series comparing outcomes following use of the recovery position with outcomes when other patient positions were used. There was limited evidence to support or revise existing first aid guidance; however, greater emphasis on the initial assessment of responsiveness and need for CPR, as well as the detection and management of patient deterioration of a person identified with decreased responsiveness, is recommended.
IntroductionThe first clinical interaction most patients have in the emergency department occurs during triage. An unstructured narrative is generated during triage and is the first source of ...in-hospital documentation. These narratives capture the patient’s reported reason for the visit and the initial assessment and offer significantly more nuanced descriptions of the patient’s complaints than fixed field data. Previous research demonstrated these data are useful for predicting important clinical outcomes. Previous reviews examined these narratives in combination or isolation with other free-text sources, but used restricted searches and are becoming outdated. Furthermore, there are no reviews focused solely on nurses’ (the primary collectors of these data) narratives.Methods and analysisUsing the Arksey and O’Malley scoping review framework and PRISMA-ScR reporting guidelines, we will perform structured searches of CINAHL, Ovid MEDLINE, ProQuest Central, Ovid Embase and Cochrane Library (via Wiley). Additionally, we will forward citation searches of all included studies. No geographical or study design exclusion criteria will be used. Studies examining disaster triage, published before 1990, and non-English language literature will be excluded. Data will be managed using online management tools; extracted data will be independently confirmed by a separate reviewer using prepiloted extraction forms. Cohen’s kappa will be used to examine inter-rater agreement on pilot and final screening. Quantitative data will be expressed using measures of range and central tendency, counts, proportions and percentages, as appropriate. Qualitative data will be narrative summaries of the authors’ primary findings.Patient and public involvementNo patients involved.Ethics and disseminationNo ethics approval is required. Findings will be submitted to peer-reviewed conferences and journals. Results will be disseminated using individual and institutional social media platforms.
PDF
