Service Protocol Research Articles

The Impact of Food Services Protocol on the Quality and Safety of Egg Served in Hospitals in Khartoum State

The Impact of Food Services Protocol on the Quality and Safety of Egg Served in Hospitals in Khartoum State

The Impact of Food Services Protocol on the Quality and Safety of Egg Served by Hospitals in Khartoum State, Sudan

The Impact of Food Services Protocol on the Quality and Safety of Egg Served by Hospitals in Khartoum State, Sudan

Prehospital care for traumatic cardiac arrest in the US: A cross-sectional analysis and call for a national guideline

AimWe describe emergency medical services (EMS) protocols and prehospital practice patterns related to traumatic cardiac arrest (TCA) management in the U.S. MethodsWe examined EMS management of TCA by 1) assessing variability in recommended treatments in state EMS protocols for TCA and 2) analyzing EMS care using a nationwide sample of EMS activations. We included EMS activations involving TCA in adult (≥18 years) patients where resuscitation was attempted by EMS. Descriptive statistics for recommended and actual treatments were calculated and compared between blunt and penetrating trauma using χ2 and independent 2-group Mann-Whitney U tests. ResultsThere were 35 state EMS protocols publicly available for review, of which 16 (45.7%) had a specific TCA protocol and 17 (48.5%) had a specific termination of resuscitation protocol for TCA. Recommended treatments varied. We then analyzed 9,565 EMS activations involving TCA (79.1% blunt, 20.9% penetrating). Most activations (93%) were managed by advanced life support. Return of spontaneous circulation was achieved in 25.5% of activations, and resuscitation was terminated by EMS in 26.4% of activations. Median prehospital scene time was 16.4 minutes; scene time was shorter for penetrating mechanisms than blunt (12.0 vs 17.0 min, p < 0.001). Endotracheal intubation was performed in 32.0% of activations, vascular access obtained in 66.6%, crystalloid fluids administered in 28.8%, and adrenaline administered in 60.1%. ConclusionActual and recommended approaches to EMS treatment of TCA vary nationally. These variations in protocols and treatments highlight the need for a standardized approach to prehospital management of TCA in the U.S.

Smart Card-Based Identity Management Protocols for V2V and V2I Communications in CCAM: A Systematic Literature Review

Besides developing new Cooperative, Connected and Automated Mobility (CCAM) services for the improvement of road safety and travel experience, researchers are considering protection mechanisms to ensure the security of these services and the safety of involved users (drivers but also, e.g., cyclists and pedestrians). In particular, several Identity Management (IDM) protocols have been designed as the first line of defence against external attackers. Among these protocols, a promising trend in research consists in the use of a Smart Card (SC) as a technical enabler for strong authentication. Indeed, many SC-based IDM protocols for Vehicle-to-Vehicle (V2V) and Vehicle-to-Infrastructure (V2I) communications in real-time CCAM services have been proposed in the literature which present interesting features and promising usability experimental results. However, this research line is far from being exhausted, especially considering the recent spread of SC technologies and use cases. For this reason, in this paper we propose a systematic literature review on SC-based IDM protocols for real-time CCAM services. In particular, we identify characterising assumptions of CCAM scenarios and extrapolate a unified high-level view of the steps composing a SC-based IDM protocol. Then, we present a detailed survey of several SC-based IDM protocols. Finally, we identify trends in research and formulate guidelines and useful recommendations to provide a solid base which researchers can use as a starting point for the design of new and improved SC-based IDM protocols for CCAM scenarios.

Internet of things based electrocardiogram monitoring system using machine learning algorithm

&lt;span&gt;In Bangladesh’s rural regions, almost 30% of the population lives in poverty. Rural residents also have restricted access to nursing and diagnostic services due to obsolete healthcare infrastructure. Consequently, as cardiac failure occurs, they usually fail to call the services and adopt the facilities. The internet of things (IoT) offers a massive advantage in addressing cardiac problems. This study proposed a smart IoT-based electrocardiogram (ECG) monitoring system for heart patients. The system is divided into several parts: ECG sensing network (data acquisition), IoT cloud (data transmission), result analysis (data prediction) and monetization. P, Q, R, S, and T are ECG signal properties fetched, pre-processed, analyzed and predicted to age level for future health management. ECG data are saved in the cloud and accessible via message queuing telemetry transport (MQTT) and hypertext transfer protocol (HTTP) servers. The linear regression method is utilized to determine the impact of electrocardiogram signal characteristics and error rate. The prediction was made to see how much variation there was in PQRST regularity and its sufficiency to be utilized in an ECG monitoring device. Recognizing the quality parameter values, acceptable outcomes are achieved. The proposed system will diminish future medical costs and difficulties for heart patients.&lt;/span&gt;

Peer to peer (P2P) and cloud computing on infrastructure as a service (IaaS) performance analysis

The resources of information technology and the availability of services on non-cloud network systems are limited. This constitutes problems for companies, especially in the efficient management of information technology. The high investment in infrastructure procurement is an obstacle in building centralized systems, including the adoption of cloud computing through Infrastructure as a Service (IaaS), as an elective solution. This research aims to analyze the performance of cloud servers on IaaS services using the parameters of cloud service availability, resource utilization, and throughput transfer which were implemented in companies engaged in the toll road concession sector. Furthermore, the results are expected to be a reference in supporting company decisions/policies related to cloud system adoption. The methodology involved the Network Development Life Cycle (NDLC), a system constituted by 6 (six) stages of management, namely user, proxy server, database, web service, monitoring service, and Remote Desktop Protocol (RDP). The results of cloud service availability indicate that the cloud system provides service availability (system interface, broad network access, and resource pooling). Furthermore, cloud systems have a significant performance on resource utilization (CPU) and throughput transfer parameters, while non-cloud systems only excel in response time and resource utilization (Memory) parameters. The overall result analysis based on this research scenario showed that the cloud system provides services according to user needs and has a better speed in data transmission, but has shortcomings in response time.

Legal review of state emergency medical services policies and protocols for naloxone administration

BackgroundGiven the continued rise in opioid-related overdoses, many states have expanded access to the opioid antagonist naloxone. We sought to provide comprehensive data on one such strategy: the authority of providers at different emergency medical services (EMS) licensure levels to administer naloxone. MethodsWe conducted a systematic legal review of state laws and protocols governing the authority of different EMS licensure levels to administer naloxone. We used Westlaw, state government websites and scope of practice protocols. We coded relevant policies regarding which, if any, administration routes and dosages of naloxone are permitted for each licensure level: emergency medical responder (EMR), emergency medical technician (EMT), advanced emergency medical technician (AEMT), and paramedic. ResultsAs of July 2020, all states with relevant laws or protocols authorize paramedics, AEMTs, and EMTs to administer naloxone. Thirty-nine states with an EMR licensure level and statewide protocol authorize naloxone administration by EMRs, up from only two in 2013. Permissible routes of administration have increased across all EMS provider levels, providing advanced life support providers (i.e., paramedics and AEMTs) with expanded discretion; however, authorization for intravenous and intramuscular administration remains relatively uncommon for basic life support (BLS) providers. When specified, maximum doses authorized ranged widely, from 2.0 to 12.0 milligrams. ConclusionsNaloxone administration authority is now widely granted to EMS providers. Most states allow all licensed EMS provider levels to administer naloxone, a substantial increase for EMRs and EMTs since 2013. Paramedics and AEMTs have the greatest authority to select the dosage and route of administration.

Differences in the pre-hospital management of women and men with stroke by emergency medical services in New South Wales.

ObjectivesTo examine whether pre‐hospital emergency medical service care differs for women and men subsequently admitted to hospital with stroke.Design, setting, participantsPopulation‐based cohort study; analysis of linked Admitted Patient Data Collection and NSW Ambulance data for people admitted to New South Wales hospitals with a principal diagnosis of stroke at separation, 1 July 2005 – 31 December 2018.Main outcome measuresEmergency medical service assessments, protocols, and management for patients subsequently diagnosed with stroke, by sex.ResultsOf 202 231 people hospitalised with stroke (mean age, 73 [SD, 14] years; 98 599 women [51.0%]), 101 357 were conveyed to hospital by ambulance (50.1%). A larger proportion of women than men travelled by ambulance (52.4% v 47.9%; odds ratio [OR], 1.09; 95% CI, 1.07–1.11), but time between the emergency call and emergency department admission was similar for both sexes. The likelihood of being assessed as having a stroke (adjusted OR [aOR], 0.97; 95% CI, 0.93–1.01) or subarachnoid haemorrhage (aOR, 1.22; 95% CI, 0.73–2.03) was similar for women and men, but women under 70 years of age were less likely than men to be assessed as having a stroke (aOR, 0.89; 95% CI, 0.82–0.97). Women were more likely than men to be assessed by paramedics as having migraine, other headache, anxiety, unconsciousness, hypertension, or nausea. Women were less likely than men to be managed according to the NSW Ambulance pre‐hospital stroke care protocol (aOR, 0.95; 95% CI, 0.92–0.97), but the likelihood of basic pre‐hospital care was similar for both sexes (aOR, 1.01; 95% CI, 0.99–1.04).ConclusionOur large population‐based study identified sex differences in pre‐hospital management by emergency medical services of women and men admitted to hospital with stroke. Paramedics should receive training that improves the recognition of stroke symptoms in women.

Performance evaluation of a non-invasive one-step multiplex RT-qPCR assay for detection of SARS-CoV-2 direct from saliva

Polymerase chain reaction (PCR) has proven to be the gold-standard for SARS-CoV-2 detection in clinical settings. The most common approaches rely on nasopharyngeal specimens obtained from swabs, followed by RNA extraction, reverse transcription and quantitative PCR. Although swab-based PCR is sensitive, swabbing is invasive and unpleasant to administer, reducing patient compliance for regular testing and resulting in an increased risk of improper sampling. To overcome these obstacles, we developed a non-invasive one-step RT-qPCR assay performed directly on saliva specimens. The University of Nottingham Asymptomatic Testing Service protocol simplifies sample collection and bypasses the need for RNA extraction, or additives, thus helping to encourage more regular testing and reducing processing time and costs. We have evaluated the assay against the performance criteria specified by the UK regulatory bodies and attained accreditation (BS EN ISO/IEC 17,025:2017) for SARS-CoV-2 diagnostic testing by the United Kingdom Accreditation Service. We observed a sensitivity of 1 viral copy per microlitre of saliva, and demonstrated a concordance of > 99.4% between our results and those of other accredited testing facilities. We concluded that saliva is a stable medium that allows for a highly precise, repeatable, and robust testing method.

Design and Implementation of Semi-Physical Platform for Label Based Frame Switching in Integrated Satellite Terrestrial Networks

With the explosion of traffic demand in recent years, the integration of satellite optical networks and terrestrial networks (ISTN) creates a promising networking solution for future low-latency, high-rate, and high-capacity communications. Owing to the high cost of deploying and maintaining a satellite optical network, it is critical to carefully design and plan the network to ensure the performance of the network. Thus, a semi-physical simulation platform based on software-defined networks (SDNs) is developed to simulate a satellite optical network and evaluate the performance of the proposed label-based advanced orbiting system (AOS) frame switching method that adheres to the Consultative Committee for Space Data Systems’ recommended standard (CCSDS). The semi-physical simulation platform has two major innovations: (1) adapting and integrating network protocols between the CCSDS and open system interconnect (OSI) reference models, particularly at the data link layer, and (2) the foundation for an SDN-based satellite optical network. In the control plane, real-time VxWorks Simulators serve as controllers to establish and manage various network protocols and the link manager protocol (LMP). Here, network protocols include open shortest path first (OSPF) for routing managing and controlling messages, constraint shortest path first–traffic engineering (CSPF-TE), and constraint-label distribution protocol (CR-LDP) for routing data services. LMP is used to assign and reserve satellite optical link resources. The performance of the architecture and protocols is evaluated via a semi-physical simulation platform.

Safety of an Alternative Care Protocol for EMS non-transport in the COVID-19 Pandemic

Aim: Our primary goal was to evaluate safety of a new emergency medical services (EMS) protocol directing non-transport of low-acuity patients during the COVID-19 pandemic. Methods: We performed a retrospective cohort analysis of all patients in Marion County, Indiana, from March 23, 2020 to May 25, 2020 for whom a novel non-transport protocol was used by EMS for patients with low-acuity COVID-19 symptoms. We assessed paramedic compliance with the protocol to determine numbers and types of deviations. We further reviewed a statewide health information exchange database to identify any patients with emergency department (ED) visits, hospital admissions, or death within 30 days of the EMS non-transport. For ED and hospital visits, we collected ED or admission diagnoses to determine if the etiologies were COVID-related. Results: Between March 24, 2020 and May 25, 2020, 222 patients were documented as “Treated, Released (per protocol).” The protocol was correctly applied 144 times (64.8%). The other 78 times, although the EMS clinicians documented use of the protocol, it was not actually used (e.g., another protocol such as “no medical emergency” was used). Of the 144 patients for whom the protocol was used, in 55 cases (38.2%), the clinicians documented patient factors that should have contraindicated use of the protocol (e.g., chest pain, past medical history of asthma). The protocol was applied 5 times (3.5%) in pediatric patients. Two patients were admitted to the hospital within 72 hours of incorrect application of the protocol; both were for COVID-related complaints. Two patients were admitted to the hospital within 72 hours of correct protocol use; one was for a COVID-related complaint. Conclusion: In this case series, paramedics demonstrated large deviations from the novel non-transport protocol. Several patients were admitted to the hospital within 72 hours of non-transport both when the protocol was used correctly, and when it was used incorrectly.

An Observational Study on the Walking Proximity between Off licenses plus Bookmakers and Community Mental Health Facilities in County Dublin

IntroductionDual diagnosis is commonly treated by Community Mental Health Team (CMHT). Addiction is a common complicating factor in individuals with major mental illnesses. It is established that businesses on high streets impact on the public’s health.ObjectivesWe hope to generate discussion about the planning and the placement of community mental health services.MethodsThe location of County Dublin community mental health teams’ outpatient clinics’ and day hospitals’ were obtained from the Health Service Executive directory website. All off licenses’ and bookmakers’ addresses in County Dublin were obtained from the Irish Revenue Commissioners website. The distances were measured using Google Maps and a programming script to generate a matrix under one-kilometre radius walking distances between the locations. No ethical approval is required. All Data are sought from publicly available websites.ResultsOn average, there are 6.29 (SD 4.20; Median 5.) off-licenses and 2.4 (SD 2.28; Median 2) bookmarkers offices per mental health facility within1 km walking distance. The Central Dublin Mental Health Service has the highest prevalence of off-licenses (45, 34.4%), and the Central South Dublin Service(20, 39.2%) has the highest prevalence of bookmakers. Southeast Dublin Service has the lowest in both businesses. The closest distance to an off-license from mental health facilities was 0 meters.ConclusionsPsychiatrists have a role in advocating the needs of individuals with dual diagnoses. The Department of Health and Health Service Executive (HSE) should develop a guideline and protocol for the community health services in the structuring and planning mental health services in the community health outpatient service setup.DisclosureNo significant relationships.

QoS and Privacy-Aware Routing for 5G-Enabled Industrial Internet of Things: A Federated Reinforcement Learning Approach

The development and maturity of the fifth-generation (5G) wireless communication technology provides the industrial Internet of Things (IIoT) with ultra-reliable and low-latency communications and massive machine-type communications, and forms a novel IIoT architecture, 5G-IIoT. However, massive data transfer between interconnecting industrial devices also brings new challenges for the 5G-IIoT routing process in terms of latency, load balancing, and data privacy, which affect the development of 5G-IIoT applications. Moreover, the existing research works on IIoT routing mostly focus on the latency and the reliability of the routing, disregarding the privacy security in the routing process. To solve these problems, in this article, we propose a quality of service (QoS) and data privacy-aware routing protocol, named QoSPR, for 5G-IIoT. Specifically, we improve the community detection algorithm info-map to divide the routing area into optimal subdomains, based on which the deep reinforcement learning algorithm is applied to build the gateway deployment model for latency reduction and load-balancing improvement. To eliminate areal differences, while considering the privacy preservation of the routing data, the federated reinforcement learning is applied to obtain the universal gateway deployment model. Then, based on the gateway deployment, the QoS and data privacy-aware routing is accomplished by establishing communications along the load-balancing routes of the minimum latencies. The validation experiment is conducted on real datasets. The experiment results show that as a data privacy-aware routing protocol, the QoSPR can significantly reduce both average latency and maximum latency, while maintaining excellent load balancing in 5G-IIoT.

Assessment of Maternal Infant and Young Child Nutrition (MIYCN) Knowledge and Practices Among Obstetricians and Pediatricians in Private Health Facilities in India

Objectivesi) To assess current MIYCN knowledge and practices among obstetricians and pediatricians in private facilities ii) To identify bottlenecks to adopting evidence- based MIYCN guidelines in private facilities MethodsThe study used an observational cross-sectional design and mixed methods for an online self-administered survey with 360 pediatricians and 99 obstetricians (members of the Indian Academy of Pediatrics and Federation of Obstetric and Gynaecological Societies of India). The study included onsite interviews with 55 obstetricians and 59 pediatricians selected randomly during assessments in 114 private health facilities where they provided services across 3 purposefully selected cities in each of the 5 states (Uttar Pradesh, Bihar, Gujrat, Maharashtra and Karnataka). States were purposefully selected for high burden of undernutrition and high number of private practitioners. ResultsHalf of obstetricians knew the recommended dosage of iron supplementation during pregnancy, while 42% knew recommendations postpartum. Knowledge around weight gain during pregnancy and dietary requirements was limited. 75% of providers reported delayed initiation of breastfeeding in C-section deliveries. Over 90% of pediatricians knew about exclusive breastfeeding; but 40% of obstetricians and 11% of pediatricians had prescribed breastmilk substitutes. Only one third of pediatricians understood the importance of dietary diversity in complementary feeding. 70% of facilities had no maternal nutrition protocols. Roadblocks to optimal practices were lack of training and of evidence-based protocols, as well as non- recruitment of lactation counselors and dieticians. Half of the obstetricians and pediatricians reported ever being trained on MIYCN. ConclusionsFindings reveal a need to improve private obstetricians and pediatricians’ knowledge on MIYCN and prioritize nutrition in medical associations’ continuing education. Data support calls to action to institutionalize the integration of MIYCN into MNCH service protocols in private health facilities. Funding SourcesBill & Melinda Gates Foundation through Alive & Thrive FHI Solutions.

Identification and Treatment of Opioid-Associated Out-of-Hospital Cardiac Arrest in Emergency Medical Service Protocols

This cross-sectional study reviews emergency medical services (EMS) treatment protocols for adults presenting with cardiac arrest or overdose to evaluate whether current protocols include the consideration of opioid overdose for patients with possible out-of-hospital cardiac arrest.

Hospice Patient-Focused Emergency Medical Services Protocols: An Evaluation of Emergency Medical Service Protocols in the United States (RP503)

Hospice Patient-Focused Emergency Medical Services Protocols: An Evaluation of Emergency Medical Service Protocols in the United States (RP503)

Setting up a Registry for Oral Potentially Malignant Disorders (OPMD)

Background: Oral cancer accounts for 3% of all malignancies. Progression to malignancy occurs with a gradual process. Oral potentially malignant disorders (OPMD) are associated with the development of malignant transformation toward oral cancer. Objectives: This registry aimed at introducing an exact data gathering method for detecting, managing, and monitoring patients with OPMD to decrease the occurrence of oral cancer. Methods: In this registry, all patients with OPMD such as leukoplakia, erythroplakia, and oral lichen planus at Shahid Beheshti Dental School, Tehran, Iran were included. Patients' information including demographics, clinical, and histopathological features, the type of OPMD, treatment measures, and lesion changes in follow-up intervals were recorded in the registry software. In addition, a quality assurance team supervised and guaranteed the quality control of the entire registry process. Results: The following measures have been accomplished so far: development of an ethically-approved proposal, development of a comprehensive data form, development of web-based registration software, development of a manual of operation, signing of a collaborative contract with more than 8 dental schools throughout Iran, identification of 100 eligible patients, signing a contract with the Research Deputy of Shahid Beheshti University of Medical Sciences, and codification of a verified and ethically approved quality assurance proposal. This registry is getting the advantage of being supervised and sponsored by the Disease Registry Center of Shahid Beheshti University of Medical Sciences. Conclusions: The prospect of this registry is to provide patients with OPMD with a nationwide diagnostic service and continuous monitoring protocol through a collaborative network of all dental schools in Iran.

Designing the temporary dental clinic in the Covid-19 global pandemic

Covid-19 pandemic has directed hospitals to concentrate services for patients who are positive or still in undefined status. Some countries are even forced to build temporary structures or utilize multifunctional buildings such as sports/public halls. On the other hand, hospitals still have to keep performing other routine services and this becomes a challenge for them. When global attention nowadays focuses more on how hospitals serve the Covid-19 cases, this research proposes another side of healthcare service needed by people in the pandemic, which is the dental clinic. The spread of Covid-19 through droplets puts both dental patients and practitioners at risk target of Covid-19 transmission. Therefore, particular standards and protocols are mandatory to be deployed. A prototype design of the temporary dental clinic is the main output from this research. The main objective is to provide service for the community without being afraid of contracting the pandemic as the clinic will be isolated from the regular hospital buildings. To achieve this objective, this research employed three approaches for the methodology. It was started with the desk study to review references on recent technology of temporary building structures. Followed by the online questionnaire using the Google platform distributed to 206 registered dental practitioners in Aceh, in collaboration with the Indonesian Dental Association, Aceh Province, Indonesia. The questionnaire collected the data related to the needs, standards, procedures, and dental service protocols under the Covid-19 pandemic as the main reference for the design process. The last approach was gathering feedback from dentists and international architects who are experts in building science and technology. This was done through a series of pre-design reviews. This research has a high degree of urgency globally, including Saudi Arabia, which is also impacted by the Covid-19 pandemic. It is also in line with Saudi Vision 2030 to enhance the standard quality and sustainability of healthcare services. The prototype design proposed in this research does not only contribute to the Covid-19 pandemic in particular but also post-Covid scenarios or other possible global pandemics in the future.

Impact of queue buffer size awareness on single and multi service real-time routing protocols for WSNs

Wireless Sensor Networks (WSNs) are increasingly used and will certainly be part of our everyday lives. Many routing protocols were designed with respect to WSNs capacities to allow the achievement of numerous applications. One of the not well investigated areas in WSNs is the queue management issue. The purpose of this paper is to present an analysis of the impact of queue buffer size awareness on the Quality of Service (QoS) of real-time (RT) routing protocols in WSNs. The studied protocols are SPEED and its extension Multipath Multi-speed (MMSPEED). SPEED protocol yields RT routing for only one class of traffic, by maintaining a desired packet’s progression speed (PS) across the WSN. On the other hand, MMSPEED protocol extends SPEED by offering multiple types of service to packets according to their class of traffic. The main contribution is that the routing decision is made on neighbors’ available queue buffer size at each level in addition to PS metric. Simulations have proved that the two metrics are compatible, the routing decision is efficient in case of single service protocol and multiservice one and improves two QoS domains namely timeliness and reliability.

Analysis of an Intervention for Emergency Medical Services Personnel to Reduce Epinephrine Dosing Errors in Infants

This quality improvement study investigates whether a simulation-driven emergency medical services protocol of using a 1-mL syringe to administer small epinephrine doses could reduce dosing errors in infants.