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Organizational Changes Needed in Disasters and Public Health Emergencies:A Qualitative Study among Managers at a Major Hospital

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International Journal of Disaster Risk Science 2022年第4期13卷 481-494页

作者： Ingela Wennman Catharina Jacobson Eric Carlström Anders Hyltander amir khorram‑manesh Institute of Health and Care Sciences Sahlgrenska AcademyGothenburg University41346GothenburgSweden Preparedness Unit Sahlgrenska University Hospital41305 GothenburgSweden Institute of Clinical Sciences Department of SurgerySahlgrenska AcademyGothenburg University41345GothenburgSweden

Most hospitals have a contingency plan,based on all-risks and all-hazards assessment ***,emerging threats and risks often necessitate a flexible approach to emergency management at several levels of a disaster response system,for example,in ***,and possibly other countries,has limited possibilities of surge capacity in the management of large-scale disasters and emergencies,which necessitates a local/national partnership and a flexible local disaster and contingency *** study evaluates the opinions of a selected managerial group,both at operative and strategic levels,regarding possible changes in a major hospital's contingency plan during the ongoing COVID-19 *** interviews were conducted to explore the elements of surge capacity and an operational tool,consisting of command and control,safety,communication,assessment,triage,treatment,and *** results show a need to create feasible management methods that can be evaluated,establish clear leadership,put preparedness as a constant point on the highest managerial agenda,improve external monitoring,and create a regional coordinating ***,the results emphasize the significant role played by the incident command system and qualified leadership to facilitate competent and crucial medical decision making,as well as to provide reliable communication,collaboration,and coordination in a multi-agency response system during dynamic and unexpected *** steps enable a constant connection between reactive contingency plans and the proactivity in continuous risk assessment and enhance the flexibility of the contingency plans.

关键词： Disaster risks Organizational changes Public health emergencies Sweden

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Assessing Thai Hospitals’Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool

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International Journal of Disaster Risk Science 2023年第1期14卷 52-63页

作者： Phatthranit Phattharapornjaroen Eric Carlström Lina Dahlén Holmqvist Yuwares Sittichanbuncha amir khorram-manesh Institute of Clinical Sciences Department of SurgerySahlgrenska AcademyUniversity of Gothenburg40530GothenburgSweden Department of Emergency Medicine Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkok10400Thailand Institute of Health and Care Sciences Sahlgrenska AcademyUniversity of Gothenburg40100GothenburgSweden Gothenburg Emergency Medicine Research Group Sahlgrenska AcademyUniversity of Gothenburg40530GothenburgSweden USN School of Business University of South-Eastern Norway3603KongsbergNorway Institute of Medicine Department of Internal Medicine and Clinical NutritionSahlgrenska University Hospital40530GothenburgSweden

According to the concept of“flexible surge capacity,”hospitals may need to be evacuated on two occasions:(1)when they are exposed to danger,such as in war;and(2)when they are contaminated,such as during the Covid-19 *** the former,the entire hospital must be evacuated,while in the latter,the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff,patients,and routine activities to other *** occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse *** study aimed to investigate the extent of hospital evacuation preparedness in Thailand,using the main elements of the flexible surge capacity concept.A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation *** tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential *** 143 secondary care,tertiary care,and university hospitals received the questionnaire;43 hospitals provided *** findings indicate glitches in evacuation protocols,particularly triage systems,the inadequacies of surge planning and multiagency collaboration,and knowledge limitations in community *** conclusion,the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises.

关键词： Collaborative tool Disaster preparedness Flexible surge capacity Hospital evacuation Multiagency collaboration Thailand

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Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context

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International Journal of Disaster Risk Science 2023年第2期14卷 183-193页

作者： Mohammed Ali Salem Sultan amir khorram-manesh Jarle Lφwe Sφrensen Johan Berlin Eric Carlstrōm Model of Care Healthcare TransformationRegional Health DirectorateNajran66255Saudi Arabia Institute of Health and Care Sciences Sahlgrenska AcademyGothenburg University40530GothenburgSweden Institute of Clinical Sciences Sahlgrenska AcademyGothenburg University40530GothenburgSweden Gothenburg Emergency Medicine Research Group(GEMREG) Sahlgrenska Academy41345GothenburgSweden USN School of Business University of South-Eastern Norway3199BorreNorway Department of Social and Behavioural Studies University West46186TrolhättanSweden

This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises,through observation and interview *** and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power,hierarchies,and *** three-level collaboration tabletop exercises and the Command and control,Safety,Communication,Assessment,Treatment,Triage,Transport(CSCATTT)instrument,100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated *** results show a lack of integration and team maturity among participants in the first scenario,leading to the delayed start of the activity,task distribution,and decision *** shortcomings were improved in the second ***-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills,self-confidence,and ability in team building within trans-professional groups in the second scenario,which in concordance with the integration theory,was due to the attempts made in the first ***,there was an improvement in the team’s maturity,which in concordance with the maturity theory,was due to the knowledge and practical skills during scenario *** results indicate the importance of continuous tabletop training,and the use of CSCATTT as a collaborative instrument,to promote the development of collaboration and to test the concept of preparedness.

关键词： Collaboration exercises Disaster education Emergency management Healthcare personnel training Saudi Arabia Teamwork

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Impact of Virtual Disaster Collaboration Exercises on Disaster Leadership at Hospitals in Saudi Arabia

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International Journal of Disaster Risk Science 2021年第6期12卷 879-889页

作者： Mohammed Ali Salem Sultan amir khorram-manesh Eric Carlström Johan Berlin Jarle Løwe Sørensen Healthcare Transformation Model of CareRegional Health DirectorateNajran 66255Saudi Arabia Institute of Health and Care Sciences Sahlgrenska AcademyGothenburg University40530 GothenburgSweden Institute of Clinical Sciences Sahlgrenska AcademyGothenburg University40530 GothenburgSweden Department of Research and Development Swedish Armed Forces Centre for Defence Medicine42676 Gothenburg Sweden Gothenburg Emergency Medicine Research Group(GEMREG) Sahlgrenska Academy41345 GothenburgSweden USN School of Business Campus VestfoldUniversity of South-Eastern Norway3603 KongsbergNorway Department of Social and Behavioural StudiesUniversity West46186 TrolhattanSweden

This study measured the impact of virtual three-level collaboration (3LC) exercises on participants’ perceived levels of collaboration, learning, and utility (CLU) at hospitals in the southern region of Saudi Arabia. Our 3LC exercise is a tabletop training tool used to facilitate disaster education and document CLU. This model enables the practitioner to acquire new knowledge and promotes active learning. An English version of the CLU scale, the validated Swedish survey tool, was applied to 100 healthcare managers or leaders in various positions at both the operational and tactical levels after conducting the 3LC exercises. The response rate was 100%, although not all questions were answered in some cases. The results show that most participants strongly agreed that the exercises focused on collaboration (r^(2) = 0.767) and that they had acquired new knowledge during the exercises. There was a statistically significant association between participation in the collaboration exercises and perceived learning (r^(2) = 0.793), as well as between perceived learning and utility (r^(2) = 0.811). The collaboration exercises enhance the perceived effects of CLU. They also improve the ability of participants to adapt situational strategies to achieve a safer society. Although exercises were conducted virtually, they were well received by the participants and achieved a value M = 4.4 CLU score, which opens up new dimensions in collaboration simulation exercises.

关键词： Collaboration exercises Disaster education Emergency management Healthcare personnel training Saudi Arabia

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Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy

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World Journal of Gastroenterology 2007年第43期13卷 5745-5749页

作者： Bahram Pourseidi amir khorram-manesh Department of Surgery Kerman University of Medical Science Kerman Iran Department of Surgery Kung?lv and Sahlgrenska University Hospitals Gteborg Sweden

AIM: To evaluate the impact of a preoperative "triple non-invasive diagnostic test" for diagnosis and/or exclusion of common bile duct stones. METHODS: All patients with symptomatic gallstone disease, operated on by laparoscopic cholecystectomy from March 2004 to March 2006 were studied retrospectively. Two hundred patients were included and reviewed by using a triple diagnostic test including: patient's medical history, routine liver function tests and routine ultrasonography. All patients were followed up 2-24 mo after surgery to evaluate the impact of triple diagnostic test. RESULTS: Twenty-five patients were identified to have common bile duct stones. Lack of history of stones, negative laboratory tests and normal ultrasonography alone was proven to exclude common bile duct stones in some patients. However, a combination of these three components (triple diagnostic), was proven to be the most statistically significant test to exclude common bile duct stones in patients with gallstone disease. CONCLUSION: Using a combination of routinely used diagnostic components as triple diagnostic modality would increase the diagnostic accuracy of common bile duct stones preoperatively. This triple non-invasive test is recommended for excluding common bile duct stones and to identify patients in need for other investigations.

关键词：胆管结石诊断方法胆囊切除术临床

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Impact of metabolic dysfunction-associated steatotic liver disease on COVID-19 hospitalizations:A propensity-matched analysis of the United States

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World Journal of Virology 2024年第1期13卷 51-60页

作者： Abdullah Sohail Hassam Ali Pratik Patel Subanandhini Subramanium Dushyant Singh Dahiya amir H Sohail manesh Kumar Gangwani Sanjaya K Satapathy Department of Internal Medicine University of Iowa Roy J and Lucille A Carver College of MedicineIowaIA 52242United States Division of Gastroenterology and Hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Gastroenterology Mather Hospital/Hofstra University Zucker School of MedicineNY11777United States Department of Internal Medicine East Carolina University Brody School of MedicineGreenvilleNC 27834United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Department of Surgery University of New MexicoAlbuquerqueNM 87106United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Section on Gastroenterology and Hepatology North Shore University Hospital and Long Island Jewish Medical CenterManhassetNY 11030United States

BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD),formally known as nonalcoholic fatty liver disease,is the most common chronic liver disease in the United *** with MASLD have been reported to be at a higher risk of developing severe coronavirus disease 2019(COVID-19)and ***,most studies are single-center studies,and nationwide data in the AIM To study the influence of MASLD on COVID-19 hospitalizations during the initial phase of the *** We retrospectively analyzed the 2020 National Inpatient Sample(NIS)database to identify primary COVID-19 hospitalizations based on an underlying diagnosis of MASLD.A matched comparison cohort of COVID-19 hospit-alizations without MASLD was identified from NIS after 1:N propensity score matching based on gender,race,and comorbidities,including hypertension,heart failure,diabetes,and *** primary outcomes included inpatient mortality,length of stay,and hospitalization *** outcomes included the prevalence of systemic *** A total of 2210 hospitalizations with MASLD were matched to 2210 hospitalizations without MASLD,with a good comorbidity ***,there was a higher prevalence of severe disease with more intensive care unit admissions(9.5%vs 7.2%,P=0.007),mechanical ventilation(7.2%vs 5.7%,P=0.03),and septic shock(5.2%vs 2.7%,P<0.001)in the MASLD cohort than in the non-MASLD ***,there was no difference in mortality(8.6%vs 10%,P=0.49),length of stay(5 d vs 5 d,P=0.25),and hospitalization costs(42081.5$vs 38614$,P=0.15)between the MASLD and non-MASLD *** The presence of MAFLD with or without liver cirrhosis was not associated with increased mortality in COVID-19 hospitalizations;however,there was an increased incidence of severe COVID-19 *** data(2020)predates the availability of COVID-19 vaccines,and many MASLD patients have since been *** will be interesting to see if these trends are

关键词： COVID-19 Metabolic dysfunction-associated steatotic liver disease Prevalence Hospital charges Inpatient resource utilization

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Role of fecal microbiota transplant in management of hepatic encephalopathy: Current trends and future directions

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World Journal of Hepatology 2024年第1期16卷 17-32页

作者： Yash R Shah Hassam Ali Angad Tiwari David Guevara-Lazo Natalia Nombera-Aznaran Bhanu Siva Mohan Pinnam manesh Kumar Gangwani Harishankar Gopakumar amir H Sohail SriLakshmiDevi Kanumilli Ernesto Calderon-Martinez Geetha Krishnamoorthy Nimish Thakral Dushyant Singh Dahiya Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and Hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Internal Medicine Maharani Laxmi Bai Medical CollegeJhansi 284001India Faculty of Medicine Universidad Peruana Cayetano HerediaLima 15102Peru Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Gastroenterology and Hepatology University of Illinois College of Medicine at PeoriaPeoriaIL 61605United States Department of Surgery University of New MexicoAlbuquerqueNM 87106United States Department of Internal Medicine GSL Medical CollegeRajamahendravaram 533296India Department of Internal Medicine Universidad Nacional Autonoma de MexicoCiudad De Mexico 04510Mexico Department of Digestive Diseases and Nutrition University of KentuckyLexingtonKY 40536United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States

Fecal microbiota transplantation(FMT)offers a potential treatment avenue for hepatic encephalopathy(HE)by leveraging beneficial bacterial displacement to restore a balanced gut *** prevalence of HE varies with liver disease severity and *** pathogenesis involves ammonia toxicity,gut-brain communication disruption,and *** aims to restore gut microbiota balance,addressing these ***'s efficacy has been explored in various conditions,including *** suggest that FMT can modulate gut microbiota,reduce ammonia levels,and alleviate *** has shown promise in alcohol-associated,hepatitis B and C-associated,and non-alcoholic fatty liver *** include improved liver function,cognitive function,and the slowing of disease ***,larger,controlled studies are needed to validate its effectiveness in these *** have shown cognitive improvements through FMT,with potential benefits in cirrhotic ***,trials have demonstrated reduced serious adverse events and cognitive enhancements in FMT arms compared to the standard of *** evidence is promising,challenges remain:Limited patient numbers,varied dosages,administration routes,and donor *** large-scale,controlled trials are essential to establish standardized guidelines and ensure FMT's clinical applications and *** FMT holds potential for HE management,ongoing research is needed to address these challenges,optimize protocols,and expand its availability as a therapeutic option for diverse hepatic conditions.

关键词： Hepatic encephalopathy Fecal microbiota transplant Cognitive impairment Liver cirrhosis Chronic liver disease

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Global trends in hepatitis C-related hepatocellular carcinoma mortality:A public database analysis(1999-2019)

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World Journal of Virology 2024年第1期13卷 69-83页

作者： Hassam Ali Fnu Vikash Vishali Moond Fatima Khalid Abdur Rehman Jamil Dushyant Singh Dahiya amir Humza Sohail manesh Kumar Gangwani Pratik Patel Sanjaya K Satapathy Department of Internal Medicine/Gastroenterology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Jacobi Medical Center/Albert Einstein College of MedicineBronxNY 10461United States Department of Internal Medicine Saint Peter's University Hospital/Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States Department of Internal Medicine Quaid-e-Azam Medical CollegeBahawalpur 63100PunjabPakistan Department of Internal Medicine Samaritan Medical CentreWatertownMA 13601United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Department of Surgery New York University Winthrop HospitalNew YorkMineloaNY 11501United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Gastroenterology Mather Hospital/Hofstra University Zucker School of MedicineNY 11777United States Division of Hepatology Department of MedicineNorth Shore University HospitalManhassetNY 11030United States

BACKGROUND Hepatitis C is the leading cause of chronic liver disease worldwide and it significantly contributes to the burden of hepatocellular carcinoma(HCC).However,there are marked variations in the incidence and mortality rates of HCC across different geographical *** the advent of new widely available treatment modalities,such as direct-acting antivirals,it is becoming increasingly imperative to understand the temporal and geographical trends in HCC mortality associated with Hepatitis ***,gender disparities in HCC mortality related to Hepatitis C are a crucial,yet underexplored aspect that adds to the disease's global *** some studies shed light on gender-specific trends,there is a lack of comprehensive data on global and regional mortality rates,particularly those highlighting gender *** gap in knowledge hinders the development of targeted interventions and resource allocation *** The results of our study show an overall decline in the mortality rates of patients with hepatitis C-related HCC over the last two ***,females exhibited a remarkable decrease in mortality compared to ***,East Asia and the Pacific displayed a significant decline in mortality,while Europe and Central Asia witnessed an upward *** America and the Caribbean also experienced an increase in mortality ***,no significant difference was observed in the Middle East and North *** America exhibited a notable upward *** Asia and Sub-Saharan Africa significantly declined throughout the study *** raises the hope of identifying areas for implementing more targeted *** some progress,multiple challenges remain in meeting the WHO 2030 goal of eliminating viral hepatitis[24].

关键词： Carcinoma Hepatocellular Antiviral agents Global Burden of Disease Quality indicators Health care Liver neoplasms Hepatitis C Chronic hepatitis C

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Remimazolam for sedation in gastrointestinal endoscopy:A comprehensive review

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 385-395页

作者： Dushyant Singh Dahiya Ganesh Kumar Syeda Parsa manesh Kumar Gangwani Hassam Ali amir Humza Sohail Saqr Alsakarneh Umar Hayat Sheza Malik Yash R Shah Bhanu Siva Mohan Pinnam Sahib Singh Islam Mohamed Adishwar Rao Saurabh Chandan Mohammad Al-Haddad Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityMO 66160United States Department of Internal Medicine Chandka Medical CollegeSindh 77280Pakistan Department of Gastroenterology and Hepatology University of Arkansas For Medical SciencesLittle RockAR 72205United States Division of Gastroenterology Hepatology and NutritionEast Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Department of Internal Medicine University of Missouri-Kansas CityKansas CityMO 64108United States Department of Internal Medicine Geisinger Wyoming Valley Medical CenterWilkes BarrePA 18711United States Department of Internal Medicine Rochester General HospitalRochesterNY 14621United States Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine Sinai hospitalBaltimoreMD 21215United States Department of Hepatology University of MissouriColumbiaMO 65211United States Department of Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Division of Gastroenterology and Hepatology Creighton University School of MedicineOmahaNE 68131United States Division of Gastroenterology and Hepatology Indiana University School of MedicineIndianapolisIN 46202United States

Worldwide,a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient ***,benzodiazepines and opioids continue to be widely ***,in recent years,Remimazolam is gaining immense popularity for procedural sedation in gastrointestinal(GI)*** is an ultra-short-acting benzodiazepine sedative which was approved by the Food and Drug Administration in July 2020 for use in procedural *** has shown a favorable pharmacokinetic and pharmacodynamic profile in terms of its non-specific metabolism by tissue esterase,volume of distribution,total body clearance,and negligible drug-drug *** also has satisfactory efficacy and has achieved high rates of successful sedation in GI ***,studies have demonstrated that the efficacy of Remimazolam is non-inferior to Propofol,which is currently a gold standard for procedural sedation in most parts of the ***,the use of Propofol is associated with hemodynamic instability and respiratory *** contrast,Remimazolam has lower incidence of these adverse effects intra-procedurally and hence,may provide a safer alternative to Propofol in procedural *** this comprehensive narrative review,highlight the pharmacologic characteristics,efficacy,and safety of Remimazolam for procedural *** also discuss the potential of Remimazolam as a suitable alternative and how it can shape the future of procedural sedation in gastroenterology.

关键词： Remimazolam Endoscopy Sedation Outcomes Efficacy Safety Pharmacokinetics

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An experimental study on plunging depth of density currents

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Frontiers of Earth Science 2017年第4期11卷 388-395页

作者： Hassan GOLEIJ amir Hamzeh HAGHIABI Abbas PARSAIE Department of Water Engineering Lorestan University Khorram Abad Iran

Mass density of the current flows is the one of the important problem in the hydraulics of the dam reservoir. Plunge point occurs when the mass density current penetrates in the stagnant fluid. Recognition the place of this point is very important because of clearing the boundary of the density current flow and ambient fluid. In this study the influences of bed slope and hydraulic parameters on plunging depth were experimentally investigated. The results show that the slope has a minor effect on the plunging depth. The height of plunging depth is increased by increasing the density of the current flow. Also increasing the densimetric Froude number caused of decreasing the plunging depth. Finally an equation was proposed to estimate the plunging depth using as function of flow characteristics.

关键词： dense current plunge point Densimetric Froude Number dam reservoirs

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