Impact of the Christchurch Earthquakes on Hospital Staff

In the Patient Platform article, “Living with Asthma in Low- and Middle-Income Countries in the Six WHO Regions”, originally published December 26, 2023 (DOI: https://doi.org/10.1056/EVIDpp2300292), in the section “Aydın P. Turkey, European Region”, where it reads “…there was a big earthquake in September 2023…”, it should have read, “…there was a big earthquake in February 2023…”. A corrected version of the article has been posted at evidence.nejm.org.

Although research in general medicine is diverse, it has not been compared with research in a different medical specialty. The study aim was to understand the characteristics of research produced at Japanese university departments of general medicine and published in English-language journals, via comparison with another academic specialty, cardiology.In this cross-sectional study, a nationwide survey of the official websites of 82 university-affiliated medical schools in Japan was conducted in April 2020 to identify the heads of general medicine departments. We then surveyed the research output of these individuals in terms of original article output and research field diversity for journals listed in the Web of Science Core Collection of journals from 2010 to 2019. A similar survey of cardiology department publications was also conducted to provide a reference for intergroup comparisons and analysis of covariance.The analysis included 128 researchers from 78 general medicine departments and 96 researchers from 81 cardiology departments. The dominant research field of general medicine was general and internal medicine; that of cardiology was cardiac/cardiovascular systems. Data stratification by research field showed that general medicine researchers published significantly more articles than researchers in cardiology, a field that contains relatively few researchers. Furthermore, a comparison of individual researchers with the same number of published articles showed that researchers in general medicine departments published across a significantly wider range of fields than those in cardiology.This is the first study to describe the research characteristics of general medicine university departments in Japan through comparison with research in a different academic specialty. General medicine researchers in Japan comprise a heterogeneous group that mainly publishes research on general and internal medicine. Some general medicine researchers take a multidisciplinary approach to research and publishing.

This paper tests the applicability of two existing international methodologies - HAZUS (USA) and SYNER-G (Europe) - for predicting electrical substation damage. It compares observed damage from the September 2010 and February 2011 Canterbury earthquakes in New Zealand with damage/failure probabilities generated by the two methodologies based on observed ground accelerations. Only two substations were damaged in the September earthquake, and only one in the February earthquake. For both methodologies, failure probabilities were calculated for each substation and a short Monte Carlo simulation exercise was run in which the probabilities were used to generate 1,000 potential city-wide damage scenarios. Both simulations yielded results which over-predicted the collective level of damage, with probabilities of less than 1 in 1000 that the observed scenarios could occur. This indicates that neither method is appropriate and that new fragility functions should be developed for New Zealand for future seismic risk assessments.

International Journal of Clinical PracticeVolume 37, Issue 6 p. 223-224 Article Value of Routine Chest Radiography in General Medical and Geriatric Wards M. G. Patel MB, LRCP & S, M. G. Patel MB, LRCP & S Senior House Officer Department of Geriatric and General Medicine, Preston Hospital, North Shields, Tyne and WearSearch for more papers by this authorS. K. Datta MD, MRCP, S. K. Datta MD, MRCP Registrar Department of Geriatric and General Medicine, Preston Hospital, North Shields, Tyne and WearSearch for more papers by this authorS. K. Mandal MBBS, FRCP, S. K. Mandal MBBS, FRCP Consultant Physician Department of Geriatric and General Medicine, Preston Hospital, North Shields, Tyne and WearSearch for more papers by this author M. G. Patel MB, LRCP & S, M. G. Patel MB, LRCP & S Senior House Officer Department of Geriatric and General Medicine, Preston Hospital, North Shields, Tyne and WearSearch for more papers by this authorS. K. Datta MD, MRCP, S. K. Datta MD, MRCP Registrar Department of Geriatric and General Medicine, Preston Hospital, North Shields, Tyne and WearSearch for more papers by this authorS. K. Mandal MBBS, FRCP, S. K. Mandal MBBS, FRCP Consultant Physician Department of Geriatric and General Medicine, Preston Hospital, North Shields, Tyne and WearSearch for more papers by this author First published: 01 June 1983 https://doi.org/10.1111/j.1742-1241.1983.tb07185.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume37, Issue6June 1983Pages 223-224 RelatedInformation

Although the improvement of therapeutic strategies is leading to a dramatic decline of in-hospital acute coronary syndrome (ACS) death rates, differences in care and prognosis of ACS patients exist when age, gender and admission department are considered. The national hospital informative system was used. Only data recorded in three Italian Regions from December 1, 2005 to November 30, 2007 were analyzed. This approach allowed to identify 70 413 patients reporting ACS as primary or secondary diagnosis. The ACS cohort was stratified by age (≤64, 65-74 and ≥75 years) and gender. ACS events were divided into two groups: 42 503 patients with non-ST-elevation ACS (NSTE-ACS) and 27 910 patients with ST-elevation ACS (STEMI). The proportion of NSTE-ACS and STEMI patients treated in general medicine or cardiology departments requiring a coronary procedure or extensive investigations, and in-hospital 30-day mortality rates adjusted by age and gender were analyzed. 19% of STEMI and 15% of NSTE-ACS patients are admitted to a general medicine department. For STEMI patients, the proportion increases up to 37.6% when females aged ≥75 years are considered. Patients undergo a coronary procedure or extensive investigations less commonly in general medicine than in cardiology departments; in-hospital 30-day adjusted mortality rates in general medicine departments are approximately 2-fold higher than those recorded in cardiology departments (STEMI: 26.4 vs 16.7%; NSTE-ACS: 7.7 vs 4.2%). In-hospital mortality rates of ACS patients admitted to cardiology departments are lower than those reported in general medicine departments. Nevertheless, in-hospital management of women and elderly ACS patients does not completely comply with the recommended guidelines and exposes them to unfavorable prognosis.

BackgroundThe competencies of college senior students in general practice medicine have attracted attention. This study aimed to construct an evaluation index system of competencies for college senior students in general practice medicine and to promote the reform and optimization of training programs for general medicine talent in colleges.MethodsThe two-round Delphi method was used to determine the evaluation index system of competencies for college senior students in general practice medicine, and the analytic hierarchy process (AHP) was used to calculate the weights of all levels of elements.ResultsThe evaluation index system of competencies for college senior students in general practice medicine was established with 3 primary factors, 9 secondary factors and 32 tertiary factors. The Delphi results revealed that the active coefficient of experts was 1 and the authority coefficient was 0.858. The 3 primary factors were knowledge level, job skills and professionalism with weights of 0.1532, 0.4207 and 0.4261, respectively. Among the secondary factors, the top three weight coefficients were professional ethics (0.2614), community practice (0.1526) and communication skills (0.1308). Among tertiary factors, “scientific research” exhibited the lowest value with a weight coefficient of 0.0049.ConclusionIn this study, we constructed an evaluation index system of competencies for college senior students in general practice medicine. The consensus on the content of the competencies of college senior students in general practice medicine suggests that these elements are necessary for those who will become general practitioners. This system can be used as the basis to evaluate the ability of college senior students in general practice medicine and provide guidance for the cultivation and evaluation of general medicine talent.

On February 22, 2011 at 12:51 pm an earthquake measuring 6.3 on the Richter scale struck the city of Christchurch, population 376,700 in the South Island of New Zealand. This followed a 7.3 magnitude earthquake in September 2010, but the shallowness (5km) and proximity of the February earthquake to the central city, resulted in far more devastation, with Modified Mercalli scores reaching ten in some areas and upward ground acceleration exceeding 2.4G. The application of the Coordinated Incident Management System (CIMS) routinely used by New Zealand Civil Defence agencies was swift, innovative and efficient, facilitating rapid deployment of local and international emergency teams and response resources. The effectiveness of this response was partially attributed to lessons learnt from the September earthquake which, with hindsight, was a practise for the more serious February event. The community response was equally remarkable, with standard approaches to measuring preparedness and resilience suggesting that community resilience in Canterbury was high. A number of initiatives by the New Zealand Ministry of Civil Defence and Emergency Management may have fostered some of this resilience,particularly community- based resilience-building projects initiated by the Regional Emergency Management Office on 2009 and 2010, supported by the Ministry of Civil Defence and Emergency Management. In addition, website education resources and media promotion (“Get Ready Get Thru”) and a travelling exhibition called “The Pandemic Roadshow” had been particularly well received and remembered by Canterbury residents. However, two key events provided an impetus for the Canterbury community to burnish its resilience. First, the Swine flu (AH1N1) pandemic in 2009 resulted in a greater awareness of public health in emergencies along with a doubling of neighbourhood support groups. Secondly, the September 2010 earthquake resulted in the establishment of the student army of volunteers and improvement of public information management. This presentation will describe the markers of community resilience following the Christchurch earthquake and discuss how such resilience can be fostered in communities where emergency preparedness is not recognised as a priority.

BackgroundAlthough general medicine (GM) faculty in Japanese medical schools have an important role in educating medical students, the importance of residents’ rotation training in GM in postgraduate education has not been sufficiently recognized in Japan. To evaluate the relationship between the rotation of resident physicians in the GM department and their In-Training Examination score.MethodsThis study is a nationwide multi-center cross-sectional study in Japan. Participants of this study are Japanese junior resident physicians [postgraduate year (PGY)-1 and PGY-2] who took the General Medicine In-Training Examination (GM-ITE) in fiscal years 2016 to 2018 at least once (n = 11,244). The numbers of participating hospitals in the GM-ITE were 381, 459, and 503 in 2016, 2017, and 2018.The GM-ITE score consisted of four categories (medical interview/professionalism, symptomatology/clinical reasoning, physical examination/procedure, and disease knowledge). We evaluated relationship between educational environment (including hospital information) and the GM-ITE score.ResultsA total of 4464 (39.7%) residents experienced GM department rotation training. Residents who rotated had higher total scores than residents who did not rotate (38.1 ± 12.1, 36.8 ± 11.7, and 36.5 ± 11.5 for residents who experienced GM rotation training, those who did not experience this training in hospitals with a GM department, and those who did not experience GM rotation training in hospitals without a GM department, p = 0.0038). The association between GM rotation and competency remained after multivariable adjustment in the multilevel model: the score difference between GM rotation training residents and non-GM rotation residents in hospitals without a GM department was estimated as 1.18 (standard error, 0.30, p = 0.0001), which was approximately half of the standard deviation of random effects due to hospital variation (estimated as 2.00).ConclusionsGM rotation training improved the GM-ITE score of residents and should be considered mandatory for junior residents in Japan.

British Journal of DermatologyVolume 156, Issue 4 p. 748-749 AL amyloidosis enhances development of amyloid A amyloidosis J.C.H. Van Der Hilst, J.C.H. Van Der Hilst Departments of General Internal Medicine (463)Search for more papers by this authorJ.W.M. Van Der Meer, J.W.M. Van Der Meer Departments of General Internal Medicine (463)Search for more papers by this authorJ.P.H. Drenth, J.P.H. Drenth Gastroenterology and Hepatology, Radboud University Medical Centre St Radboud, Geert Grooteplein 8, PO Box 9101, 6500 HB Nijmegen, the NetherlandsSearch for more papers by this authorA. Simon, A. Simon Departments of General Internal Medicine (463) National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, U.S.A. E-mail: j.vanderhilst@aig.umcn.nlSearch for more papers by this author J.C.H. Van Der Hilst, J.C.H. Van Der Hilst Departments of General Internal Medicine (463)Search for more papers by this authorJ.W.M. Van Der Meer, J.W.M. Van Der Meer Departments of General Internal Medicine (463)Search for more papers by this authorJ.P.H. Drenth, J.P.H. Drenth Gastroenterology and Hepatology, Radboud University Medical Centre St Radboud, Geert Grooteplein 8, PO Box 9101, 6500 HB Nijmegen, the NetherlandsSearch for more papers by this authorA. Simon, A. Simon Departments of General Internal Medicine (463) National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, U.S.A. E-mail: j.vanderhilst@aig.umcn.nlSearch for more papers by this author First published: 30 January 2007 https://doi.org/10.1111/j.1365-2133.2006.07709.xCitations: 7 Conflicts of interest: none declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume156, Issue4April 2007Pages 748-749 RelatedInformation

Step forward: Hospitals’ journey to ‘Just Culture’

Communities and individuals rely on third-sector organizations (TSOs) following natural disasters to complement formal government recovery activities by providing targeted support. In this way, TSOs can fulfill important niche roles, but the picture becomes complicated if residents and organizations relocate and connectivity is lost. Recovery might be compromised, especially for vulnerable and marginalized individuals, if communities are displaced from the service provision area of the TSOs that are most sensitive to their needs. This study focuses on TSOs in Christchurch, New Zealand, where an earthquake in February 2011 devastated parts of the city, precipitating a migration of residents from northeast neighborhoods to suburbs in the west and southwest of the central business district. Traditional social vulnerability metrics, derived from the 2006 and 2013 New Zealand censuses, show shifting ethnic, livelihood, and household structure related vulnerabilities throughout the city and comparisons of ward and area unit level unweighted and weighted suitability indexes illustrate how relocation has affected TSO proximity for marginalized groups. Ethnic and emergent marginalized groups, in particular, struggle to maintain interpersonal networks postdisaster due to cultural norms and resource access, which is particularly concerning given income disparities, increasing rents, and emotional trauma across the region. Impacts of livelihood marginalization are also evident for emergent groups of immigrant construction workers, whose ability to acclimate is contingent on accessing information on social services. Although the city has proven to have a resilient economy and public awareness of TSO involvement in areas of population influx has increased, understanding population dynamics is imperative to informed recovery planning.

BackgroundOur hospital’s department of general medicine is often involved in the diagnosis and treatment of diseases that are considered by other hospitals or other departments in our hospital to be difficult to diagnose correctly.ObjectiveThe aim of this study was to clarify how patients with infective endocarditis (IE) being admitted to our hospital’s department of general medicine were examined and treated and to elucidate their prognosis compared with patients admitted to other departments.Materials and MethodsInpatients of Saga University Hospital with definite IE from September 2007 to August 2017 were divided into 2 groups: those admitted to the general medicine department (the GM group) and those admitted to other departments (the non-GM group).ResultsSeventy-four patients were included; 17 (23%) were admitted to the general medicine department. In the GM group, the percentage of patients diagnosed with definite or suspected IE was lower (0% vs 32%, p=0.008), as was the rate of patients with echocardiographic findings that fulfilled the major modified Duke’s criteria (71% vs 98%, p≤0.001), preadmission. The GM group had higher percentages of patients with back or joint pain (41% vs 9%, p=0.001) and complications, including pyogenic spondylitis (35% vs 2%, p≤0.001), deep-seated abscesses (24% vs 5%, p=0.024), pyogenic arthritis (18% vs 0%, p=0.001), and glomerulonephritis (77% vs 37%, p=0.004) than did the non-GM group. Mortality within 30 days of admission to our hospital (12% vs 14%, p=0.753) and overall in-hospital mortality (12% vs 18%, p=0.570) did not significantly differ.ConclusionThe general medicine department could have accurately diagnosed IE, given appropriate treatments, and obtained similar prognoses to those of IE patients treated by other departments, including cardiology and cardiovascular surgery, even in patients for whom diagnosing IE was more difficult or who had less typical echocardiographic findings preadmission.

The Canterbury earthquake sequence began in September 2010 with the Mw 7.1 (source: GeoNet catalog, http://geonet.org.nz/canterbury-quakes/) Darfield earthquake that ruptured the previously unknown 40-km-long Greendale fault 30 km west of Christchurch (Gledhill et al. 2011). Extreme ground accelerations as high as 1.8 g near the epicenter were recorded. The event caused intense liquefaction in the eastern suburbs of Christchurch as well as closer to downtown, near the course of the Avon River. The Darfield earthquake was followed by a major aftershock on 22 February local time (21 February UTC) of magnitude Mw 6.2 (source: GeoNet), but Me 6.7 (source: USGS, http://earthquake.usgs.gov/earthquakes/eqinthenews/2011/usb0001igm/neic\_b0001igm\_e.php). This earthquake was centred only a few kilometers south of the Christchurch city center. Extremely high accelerations (as high as 2.2 g) were also recorded near the epicenter (Kaiser, Benites et al. 2011). In addition to the extreme liquefaction seen after the Darfield earthquake, this event also caused landslides, large rockfalls, widespread damage to earthquake-risk buildings in Christchurch, and, most tragically, about 180 casualties. Another large aftershock of Mw 6.0 (source: GeoNet), but with Me 6.7 (source: USGS), subsequently occurred on 13 June local time (12 June UTC) just a few kilometers south of the February event, causing further damage, landslides, rockfalls, and liquefaction. Following the Darfield earthquake, the GeoNet network (New Zealand National Hazard Monitoring Network) and its regional component the CanNet network (Berrill et al. 2011) was supplemented by the deployment of 13 additional strong motion instruments regionally (and another nine following the February earthquake). We used this dense network of strong motion instruments to constrain the source kinematics of the February event. We present the inversion scheme and discuss its limitations. These results are preliminary, since more thorough data processing is needed; however, they already provide a key model that will help in understanding the sequence …

BackgroundThe daily morning round is a routine activity performed by medical teams. During the morning round, updates on the patient’s clinical condition, new laboratory results, and other test results are reviewed and discussed between team members, the patient, and at times the family. Completing these tasks takes time. The design of the patient location differs between hospitals, and significant distance between patients can considerably affect round times. This study assesses physicians’ time spent on clinical activities, the distance traveled, and the time they spend walking between patients during daily morning rounds to identify better reorganization methods to reduce wasted time.MethodologyThe survey was self-administered and had no intervention needing ethical approval. The research team’s leader engaged two observers (a general practitioner from another department and a general internal medicine department case manager) to collect the data. The general practitioner was a medical graduate doctor, while the bed manager was not a medical college graduate. They observed 10 rounds over 10 non-consecutive days from July 1 to July 30, 2022. They recorded daily activities during the daily morning round, including time spent with patients, family conversations, bedside education, medication, social issues, and the time and distance required to move from patient to patient and from one location to location. The informal conversations about age, work history, and other small talk were recorded and converted into quantitative data. In each round, records were given to a statistician for rechecking. Subsequently, the records were imported into a Microsoft Excel spreadsheet for further statistical analysis. For continuous variables, the data were summarized as mean, median, and standard deviation. For categorical variables, the data were summarized as counts or proportions.ResultsOn average, the duration of the daily morning round was 161.7 ± 17.3 minutes. The average number of patients seen by the general internal medicine round team was 14. The median patient encounter time per patient was 14 minutes (11-19 minutes), with an average of 12 minutes. An average of 8.6 employees participated in the 10-day rounds. The physician spent 41.2% of the time in direct contact with the patient during the morning round, 11.4% in maintaining electronic medical records, and 18.20% in bedside teaching. Additionally, 7.1% of the round time was spent because of interruptions by clinical and non-clinical staff other than team members or family members who were not in the room. Furthermore, a team member walked an average of 763 ± 54.5 m (667-872 m) per round, costing 35.7 minutes (22.1%) of the total round time.ConclusionsThe daily morning round time was significantly longer compared with the reported round times. Relocating patient beds to a common location reduced the rounding time by 22.30%. Disruption, teaching, and medical instruction must also be considered and shortened to reduce the morning round time.

<p>We aim to investigate the role of insurance in business recovery following the devastating Christchurch earthquake in February, 22nd, 2011. We analyze data from two business surveys conducted after the earthquake to examine how insurance affected business operation in the aftermath of the earthquake both in the short-term and longer-term. For the short-term analysis, we use a combination of propensity score matching (PSM) and linear probability model (LPM) to analyze the data. We first estimate the propensity scores for insurance take-up of each firm conditional on the firm’s individual characteristics. Stratification based on the estimated propensity scores is used to match the treated (insured) and the control (uninsured) firms. We then estimate the probability of firms’ continuing operations with a set of control variables to account for the level of damage and disruption caused by the quake in each stratum. We find little evidence of any beneficial effect of insurance coverage on business continuity in the short-run. For the longer-term analysis, we analyze the available survey data using logistic regression. The result suggests that business interruption insurance significantly promotes increased level of long-term productivity for surviving firms following the earthquake.</p>