Culture Framework: Tight or Loose

COVID-19 tent at a Swedish hospital emergency entrance. (Wikimedia)

Shankar Vedamtam, NPR Hidden Brain host, interviewed Dr. Michele Gelfand, a psychologist at the University of Maryland about her framework of “tight” and “loose” cultures.

Tight cultures, she says, are more rules-oriented. Loose cultures are more permissive. “Countries like Japan, Singapore, Germany, and Austria tend to veer tight,” she says. “And countries like New Zealand, Brazil, the Netherlands, and Greece tended to veer loose. And of course, all countries have tight and loose elements.”
Her article “To Survive the Coronavirus, The United States Must Tighten Up”, published 3/15/2020 in the Boston Globe describes how the cultural norms of a culture directly impact the trajectory of the virus.

The empty Olympic stadium, Germany (Wikimedia).

How has your culture responded to coronavirus rules instituted to protect your country? Is it working?

Covid-19 Information on CMES Server from WHO & EM:RAP

CMES participants…you will find EM:RAP Corependium chapter & WHO Covid-19 information for USB and Pi users on the TWB server. Topics range from Hand Sanitizer Formulation to Critical Preparedness. We will update frequently, so check back weekly.
A reminder from our partner in the DRC, HandUp Congo,
“A South African word, Ubuntu describes our recognition that we are all bound together in ways that can be invisible to the eye; that there is a oneness to humanity; that we fulfill ourselves by sharing ourselves and caring for those around us.” Stay well and thank you for being on the frontlines of healthcare.

Digital Divide: Closing the Gap

The Raspberry-Pi is a small computer installed in an Emergency Department or clinic and allows access to up-to-date medical education through smart-phone apps.

Can digital technology help fill the medical education gap? The World Health Assembly in May 2018 agreed on a digital health resolution that urged member states to prioritize the “development, evaluation, implementation, scale up and greater utilization of digital technologies as a means of promoting equitable, affordable and universal access to health for all.”

The recommendations focus on areas such as improved access to care, technical support for developing digital systems and improved health-care delivery systems. The TWB team were encouraged to note there is also mention of; “developing guidance for digital health…including through the identification and promotion of best practices, such as evidence-based digital health interventions and standards…”.
Our Continuing Medical Education on Stick (CMES) and CMES-Pi deliver continuing medical education digitally to doctors and nurses in resource-constrained countries through a novel IT solution that doesn’t depend on a constant source of electricity or Internet, making it ideal in countries with under-developed infrastructure. It allows them access to up-to-date medical information and treatment plans.
More about how CMES affects a doctor’s everyday practice with a story from Fiji to be posted next week.

Dataplicity

Dr. Manoj Thomas and Dataplicity Founder, Elliot Mackenzie, London, England May 2018.

Techies Without Borders (TWB) partners with Dataplicity. Dataplicity is the foundation for IoT remote support and provides TWB with a generous allowance to keep track of our Raspberry-Pi data.

IoT = Internet of Things…sounds like a scifi book but means using the “Internet” as the backbone of connectivity and the “Things” are your devices. Your things collect data and send it to the Internet. Put it all together and IoT converts a normal device into a smart device. TWB installs Dataplicty on CMES-Pis before it gets to the clinics and hospitals. With Dataplicity, we are able to manage and update CMES-Pi devices located in remote and hard to reach areas. This means we can monitor and fix any issues without long distance phone calls and walking non-technology users through diagnostics.

Who Knew: Data geeks knew…there are a lot of data jokes on the web…one of my favorite.

 

 

Testicular Torsion – A Convoluted Case

What do Chubby Checker and testicular torsion have in common? (Wikimedia photo)

The 14-year-old male patient complained of right lower quadrant pain which varied in intensity for 1 day. He denied nausea, vomiting or fever. The abdominal exam revealed bowel sounds and mild tenderness to palpation in the right lower quadrant without rebound. His abdominal ultrasound was inconclusive; the white blood cell count mildly elevated, and the urine microscopy normal. He was admitted for observation. Twelve hours later the patient developed a fever and severe groin pain. A genital exam revealed classic findings for testicular torsion. The testicle was not salvageable. Unfortunately, the patient was born monorchism and rendered sterile by the orchidectomy. The lesson from this case: always include a genital exam in patients with lower abdominal pain.

Can you rely on the history and physical exam to rule out testicular torsion? Is the testicle salvageable after 6 hours? Wrench yourself away from your music downloads and listen to the EM:RAP August podcast called Testicular Torsion by Rob Orman MD and Larry Mellick MD. Get an update and review on this twisted entity and you won’t spiral out of control when faced with the possibility.

Who Knew? “The Twist” is an American pop song written and originally released in 1959 by Hank Ballard and the Midnighters. It was made popular by Chubby Checker, an American rock n’ roll icon, who put his stamp on the song with the twist dance style.

So what do Chubby Checker and testicular torsion have in common? As Mr. Checker said, “Come on let’s twist again…”. Testicular torsion pain can come and go.

 

Thumbs Up Nigeria

 

Meet Dr. Dare Ogunlusi from Ekiti State University Teaching Hospital in Nigeria. He is an attending in the Department of Accident and Emergency.

He is the newest recipient and participant in CMES. Techies Without Borders (TWB) was referred to Dr. Dare by his friend and colleague Dr. Lisa Charles from Victoria Hospital in St. Lucia. TWB mailed a thumb drive to Dr. Dare after discussing the cme options that would best work for him. He will be testing the thumb drive and providing feedback on usability and content for his specific location.

CME development and utilization face challenges worldwide because resources are limited and infrastructure for the delivery of healthcare and information is fragile. Feedback from locations around the globe helps us improve our services and products. If you have colleagues who would be interested in either CMES or CMES-Pi, please contact Dr. Debra Stoner at: deb.twb@gmail.com

Time to Charge Your Battery…

With a jolt of information on button battery ingestions by pediatrician Ilene Claudius. The November 2017 EM:RAP edition has a podcast sure to shock you. From one end of the tail to the other, your patient outcomes can range from benign ingestion and passage over a few days to death.

A variety of button batteries found in toys. (Photo from Wikimedia Commons.)

The leakage of alkaline materials will cause liquefaction necrosis rapidly. (Photo from Wikimedia Commons.)

Button battery or coin? Read the EMRAP PDF or listen to the podcast to learn how to differentiate. (Photo from http://www.radiologypics.com)

 

The National Capital Poison Center posted the NBIH Button Battery Ingestion Triage and Treatment Guideline: https://www.poison.org/battery/guideline

Battery ingestions are no laughing matter but I can’t end without one bad joke: What did the depleted battery say to the judge? “Feel free to charge me.”

 

Changing the World One CMES at a Time

Greetings CMES Users,

This blog is your educational arena. Tell us about yourselves, where you work, the challenges you face in your practice and how CMES is helping you meet your education objectives.

Share an interesting case and how you managed your patient’s care. Comment on a CMES article. Do you agree or disagree with the information?

We want to get to know each of you.  Send a picture of yourself or where you live to share with your colleagues and we will post it here on the blog.

Although I have met many of you I will start the introductions. I am Dr. Debra Stoner, a board certified emergency medicine doctor living in Pennsylvania, USA. I retired a few years ago but I listen to my cme monthly to stay up-to-date because I volunteer in several countries. I started working on CMES over one year ago and am inspired by every doctor I meet.

 

Remember…each one of you makes a difference to each life you touch.