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Stefan Markun,1,* Daniel P Franzen,2,* Kaba Dalla Lana,1 Swantje Beyer,3 Stephan Wieser,4 Thomas Hess,3 Malcolm Kohler,2 Thomas Rosemann,1 Oliver Senn,1 Claudia Steurer-Stey1,5 1Institute of Primary Care, 2Department of Pneumology, University Hospital Zurich, University of Zurich, Zurich, 3Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur, 4Department of Pneumology, City Hospital Waid, 5MediX Group Practice Ltd, Zurich, Switzerland *These authors contributed equally to this work Introduction: Hospitalizations because of acute exacerbated COPD (AECOPD) are a major burden to patients and the health care system. Interventions during acute and post-acute hospital care exist not only to improve short-term outcomes but also to prevent future exacerbations and disease progression. We aimed at measuring the implementation rates of acute and post-acute hospital care interventions for AECOPD.Methods: We performed 24 months (January 1, 2012, to December 31, 2013) retrospective medical chart review of consecutive cases hospitalized to one of three public hospitals in the canton of Zurich due to AECOPD. Implementation rates of five acute care and seven post-acute care interventions were assessed.Results: Data from 263 hospitalizations (61% male, mean age 68.5 years, 47% active smokers) were analyzed. The median length of stay was 9 days (interquartile range [IQR] 6–12 days). In all, 32% of hospitalizations were caused by individuals with previous hospitalizations because of AECOPD. Implementation rates of four acute care interventions were >75% (lowest was appropriate antibiotic therapy with 56%). Compared to this, implementation rates of five post-acute care interventions were

Many analyses in ecology and forestry require wood volume estimates of trees. However, non-destructive measurements are not straightforward because trees are differing in their three-dimensional structures and shapes. In this paper we compared three methods (one voxel-based and two cylinder-based methods) for wood volume calculation of trees from point clouds obtained by terrestrial laser scanning. We analysed a total of 24 young trees, composed of four different species ranging between 1.79 m to 7.96 m in height, comparing the derived volume estimates from the point clouds with xylometric reference volumes for each tree. We found that both voxel- and cylinder-based approaches are able to compute wood volumes with an average accuracy above 90% when compared to reference volumes. The best results were achieved with the voxel-based method (r2 = 0.98). Cylinder-model based methods (r2 = 0.90 and 0.92 respectively) did perform slightly less well but offer valuable additional opportunities to analyse structural parameters for each tree. We found that the error of volume estimates from point clouds are strongly species-specific. Therefore, species-specific parameter sets for point-cloud based wood volume estimation methods are required for more robust estimates across a number of tree species.

Emergency Medicine (EM) has become more competitive in recent years with a marked increase in the number of applications per student, raising costs for students and programs. Disseminating accurate advising information to applicants and programs could reduce excessive applying. Advising students applying to EM is a critical role for educators, clerkship directors, and program leaders. There are a variety of advising resources available through social media and individual organizations, however currently there are no consensus recommendations that bridge these resources. The Council of Residency Directors (CORD) Student Advising Task Force (SATF) was initiated in 2013 to improve medical student advising. The SATF developed bestpractice consensus recommendations and resources for student advising. Four documents (Medical Student Planner, EM Applicant’s Frequency Asked Questions, EM Applying Guide, EM Medical Student Advisor Resource List) were developed and are intended to support prospective applicants and their advisors. The recommendations are designed for the mid-range EM applicant and will need to be tailored based on students’ individual needs.

Michael W Hess Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USACorrespondence: Michael W Hess Department of Internal MedicineWestern Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USAEmail michael.hess@med.wmich.edu I read with great interest the relatively recent editorial by Dr Richard Russell entitled “COVID-19 and COPD: A Personal Reflection”.1 I especially focused on the line “Anxiety can drive malbehavior.” Indeed, we healthcare personnel treating patients with respiratory diseases may not be completely absolved of anxiety-driven malbehavior in this COVID-19 world, as we try to come to grips with an indefatigable virus and wrap our heads around ways to slow it down and stop it. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought into sharp focus how healthcare personnel must approach the treatment of patients with respiratory disease. While we wait for the clinical or quantitative evidence necessary to establish true best practices, there is a concern that healthcare personnel, patients, and healthcare systems are prioritizing one form of therapy over another based on assumptions or partial information rather than evidence. This is certainly an issue that requires further consideration. View the original paper by Russell

BackgroundAlthough previous research shows broad differences in the impact of online health information on patient-practitioner decision making, specific research is required to identify and conceptualize patient decision-making styles related to the use of online health information and to differentiate segments according to the influence of online information on patient decision making and interactions with health professionals. ObjectiveThis study aimed to investigate patients’ decision making in relation to online health information and interactions with health care practitioners. We also aimed to present a typology of patients based on significant differences in their decision making. MethodsWe applied a large-scale cross-sectional research design using a survey. Data, generated using a questionnaire that was administered by companies specializing in providing online panels, were collected from random samples of baby boomers in the United Kingdom, the United States, and New Zealand. The total sample comprised 996 baby boomers born between 1946 and 1964, who had used the internet in the previous 6 months to search for and share health-related information. Data were analyzed using hierarchical cluster analysis and confirmatory factor analysis, as well as one-way analysis of variance, chi-square tests, and paired sample t tests. ResultsAnalyses identified 3 key decision-making styles that served as the base for 4 unique and stable segments of patients with distinctive decision-making styles: the Collaborators (229/996, 23.0%), the Autonomous-Collaborators (385/996, 38.7%), the Assertive-Collaborators (111/996, 11.1%), and the Passives (271/996, 27.2%). Profiles were further developed for these segments according to key differences in the online health information behavior, demographics, and interactional behaviors of patients. The typology demonstrates that collaborative decision making is dominant among patients either in its pure form or in combination with autonomous or assertive decision making. In other words, most patients (725/996, 72.8%) show significant collaboration in their decision making with health care professionals. However, at times, patients in the combination Autonomous-Collaborative segment prefer to exercise individual autonomy in their decision making, and those in the combination Assertive-Collaborative segment prefer to be assertive with health professionals. Finally, this study shows that a substantial number of patients adopt a distinctly passive decision-making style (271/996, 27.2%). ConclusionsThe patient typology provides a framework for distinguishing practice-relevant and addressable segments with important implications for health care practitioners, including better-targeted communication programs for patients and more successful outcomes for health care services in the long term.

Aim of the study: Poor safety culture, bad teamwork, non-functional inter-departmental working relationships and increased cognitive demands are associated with higher amounts of adverse events in hospitals. To improve patient safety, one of the first steps is to assess safety culture among health care providers in an institution. Considering the sparsity of studies addressing patient safety culture in Europe and Switzerland, the aim of the present study was to assess patient safety culture in the emergency department of a University Hospital in Switzerland. Methods: We employed the Hospital Survey On Patient Safety Culture, developed by the U.S. Agency for Healthcare Research and Quality. 140 questionnaires were distributed to nurses and physicians. Two weeks after the first questionnaire, we performed a sensitization campaign addressed to health care providers, and then repeated the survey. We calculated composite scores for each question category and percentages of positive responses for each dimension. For group comparisons such as possible differences relating to education and duration of employment and to compare results of the first and second survey we used T-tests. The results were compared to other published surveys outside of Switzerland. Results: Particularly positive assessments were found for the categories “nonpunitive response to errors”, “teamwork within units”, “supervisor/manager expectations and actions promoting patient safety” and, compared to other hospitals, also “staffing”. The lowest average percent positive responses were found in the categories “frequencies of reported event”, “teamwork across units” and “handoffs and transitions”. Nurses and health care personnel with a longer employment history had an overall more negative assessment of patient safety culture, when compared to physicians and personnel with a shorter duration of employment, respectively.Conclusions: The present study has identified strengths and potential weaknesses in the safety culture of a large university hospital emergency department in Switzerland. The results provide opportunities for improvement of patient safety in particular in the reporting of adverse events, in interaction across units and patient transitions. Furthermore, as we employed a standardized self-assessment tool similar to previously published studies, the work contributes to the establishment of a benchmark for hospital safety culture at the national, European and international level.

Disruption is an inevitable factor in business and society, while inability to mitigate and manage risk can cause irreparable damage to business, the economy, and our ways of life. The COVID-19 pandemic has heightened interest in standards-based strategies for risk management and crisis preparedness to enhance organizational and societal resilience. University curricula that integrate national and international standards offer students a rich skill-set for effective performance in their careers. Moving forward, we must cultivate capable professionals who understand the challenges and risks facing society, and who grasp standards and systems for strategic planning, response, and recovery to promote organizational resilience and sustainable development. This paper focuses on the effectiveness of integrating risk management and continuity standards into university curricula, based on implementation at a large private university and regional community college in the Northeastern United States. We propose and evaluate a modular approach to introduce students to specific national and international standards, and teach them to identify and apply relevant standards based on the locally driven, whole community nature of disaster preparedness, response, and recovery. Education using standards-based curriculum and the competencies that result will be key to readiness for tomorrow's graduates.

This paper tells the story of how one school leveraged the expertise of a family to build an equitable collaboration that transformed the educational experiences of Jake, a fifth-grade student with Fetal Alcohol Spectrum Disorder (FASD). Personal accounts from 3 teachers, 2 administrators, and a parent illustrate the power of leaning into relationships to gain knowledge and compassion for reaching some of our most vulnerable students. The major themes that emerge across their reflections include: the power of families and educators working together, the need for FASD training, and the need to re-evaluate the systemic structures that are in place. Their insights illustrate the importance of nurturing teachers to collaborate with families, to take pedagogical risks, and to advocate for their neurodiverse students.