CORD-19-Sentences  

CORD-19:5c0e34bf4f90c76993a32895fb0eb335dde787a4 JSONTXT 8 Projects

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Id Subject Object Predicate Lexical cue
TextSentencer_T1 0-8 Sentence denotes Abstract
TextSentencer_T2 9-73 Sentence denotes Emergency infection control measures are essential in hospitals.
TextSentencer_T3 74-204 Sentence denotes Although Japan was spared from the 2003 epidemic of severe acute respiratory syndrome (SARS), hospitals were placed on high alert.
TextSentencer_T4 205-347 Sentence denotes The actual preparedness level of hospitals can be determined by examining individual perceptions among the hospital healthcare workers (HCWs).
TextSentencer_T5 348-549 Sentence denotes The objective of this study was to assess the level of preparedness of emergency infection control measures in Japan and to quantify the differences in preparedness across institutions and disciplines.
TextSentencer_T6 550-727 Sentence denotes From July to September 2003, a questionnaire survey concerning the perceptions of risks and countermeasures and knowledge about SARS was distributed at seven tertiary hospitals.
TextSentencer_T7 728-839 Sentence denotes Disciplines were categorized as emergency room (ER)/intensive care unit (ICU), surgical, medical, and "others".
TextSentencer_T8 840-929 Sentence denotes Of the 9978 questionnaires administered, 6929 valid responses were received and analyzed.
TextSentencer_T9 930-1221 Sentence denotes After adjusting for age, sex, and job category, specific institutional measures (I-scores) were found to be more indicative of the level of preparedness across institutions and disciplines than were measures of overall effectiveness (E-scores) or knowledge of preventive measures (K-scores).
TextSentencer_T10 1222-1333 Sentence denotes In particular, the difference in Iscores was much more substantial across institutions than across disciplines.
TextSentencer_T11 1334-1399 Sentence denotes Across disciplines, surgical ranked lower than ER/ICU or medical.
TextSentencer_T12 1400-1612 Sentence denotes In conclusion, substantial differences in emergency infection control measures, as perceived by HCWs, exists among hospitals in Japan, with the differences across institutions exceeding those across disci-plines.
TextSentencer_T13 1613-1771 Sentence denotes To achieve a higher level of preparedness for infectious diseases, institutions should designate and implement effective emergency infection control measures.
TextSentencer_T14 1773-1867 Sentence denotes Epidemics of emerging and re-emerging infectious disease may cause health crises in hospitals.
TextSentencer_T15 1868-2071 Sentence denotes Due to the high risk of exposure of healthcare workers (HCWs) to known and unknown infectious agents, and the modes of transmission of the latter, health crises may first occur among critical care staff.
TextSentencer_T16 2072-2222 Sentence denotes For example, during the global outbreak of severe acute respiratory syndrome (SARS) in 2002-2003, 21% of a total of 8096 probable cases involved HCWs.
TextSentencer_T17 2223-2354 Sentence denotes 1 During the early stages of the SARS epidemic in Toronto, 60% of infected HCWs were critical care staff members in area hospitals.
TextSentencer_T18 2355-2569 Sentence denotes 2 To prevent the spread of nosocomial infection, effective emergency infection control measures, involving the full spectrum of HCWs including critical care staff, need to be implemented at the institutional level.
TextSentencer_T19 2570-2908 Sentence denotes During the SARS epidemic, hospitals in affected areas emphasized training and the issuing of guidelines on emergency infection control measures. [3] [4] [5] Hospitals in Japan were also at a stage of high alert, but because Japan was ultimately spared from the SARS epidemic, the efficacy of such institutional measures remained untested.
TextSentencer_T20 2909-3017 Sentence denotes However, the potential for future outbreaks of emerging and re-emerging infectious diseases is considerable.
TextSentencer_T21 3018-3241 Sentence denotes Hence, not only is the practice of infection control measures critical for every hospital, 6 but their actual state of preparedness, as perceived and achieved by their HCWs, carries important implications for global health.
TextSentencer_T22 3242-3512 Sentence denotes Our study had two aims: (i) to assess the perception of risk, knowledge of preventive measures, and the perceptions of emergency infection control measures for SARS among HCWs in Japan; and (ii) to compare the levels of these factors across institutions and disciplines.
TextSentencer_T23 3513-3654 Sentence denotes As regards the first aim, we have shown in a previous report that individual perception is likely to be influenced by institutional measures.
TextSentencer_T24 3655-3814 Sentence denotes 7 The present study was more concerned with our second aim, and in this study, we analyzed data at the collective (i.e., institutional and disciplinary) level.
TextSentencer_T25 3815-4052 Sentence denotes It should be noted that most institutional infection control measures in Japan at the time of the SARS epidemic were voluntary, 8, 9 and differences could have existed which entailed strengths and weaknesses in the state of preparedness.
TextSentencer_T26 4053-4264 Sentence denotes The objective of this study was, therefore, to assess the levels of preparedness in emergency infection control measures related to SARS, with particular focus on differences across institutions and disciplines.
TextSentencer_T27 4265-4368 Sentence denotes The study population consisted of 9978 HCWs working at seven tertiary-level hospitals throughout Japan.
TextSentencer_T28 4369-4456 Sentence denotes A questionnaire was administered to each of these HCWs between July and September 2003.
TextSentencer_T29 4457-4536 Sentence denotes Overall, 7463 HCWs responded to the questionnaire (crude response rate, 74.8%).
TextSentencer_T30 4537-4702 Sentence denotes After excluding missing/invalid responses to questions on sex, age, job category, or discipline, 6929 responses were analyzed (valid response rate, 69.0%; Table 1 ).
TextSentencer_T31 4703-4839 Sentence denotes The HCWs' disciplines were divided into four categories: emergency room (ER)/intensive care unit (ICU), surgical, medical, and "others".
TextSentencer_T32 4840-5007 Sentence denotes The ER/ICU category was equivalent to critical care, and the category "others" included radiographical services, laboratory services, administrative, and primary care.
TextSentencer_T33 5008-5166 Sentence denotes Institutions were categorized as universities (A, C, D, and E in Tables 1-5); municipal institutions (F and G in Tables 1-5); and private (B in Tables 1-5) .
TextSentencer_T34 5167-5454 Sentence denotes The questionnaire included 3 items regarding the perception of specific institutional measures (Institutional score), 1 item on the overall effectiveness of institutional measures (Effectiveness score), and 15 items on knowledge of preventive measures (Knowledge score; Appendix Table) .
TextSentencer_T35 5455-5710 Sentence denotes For each question, the responses were scored as "strongly disagree" (−3), "disagree" (−2), "probably disagree" (−1), "probably agree" (+1), "agree" (+2), "strongly agree" (+3), and "not applicable" (0), and these were used to calculate the I-and E-scores.
TextSentencer_T36 5711-5999 Sentence denotes The K-score was calculated by assigning 1 point for correct ("probably agree," "agree," "strongly agree") and 0 points for incorrect ("probably disagree," "disagree," "strongly disagree") responses, except for items regarding "paper mask" and "gauze mask," for which the reverse was true.
TextSentencer_T37 6000-6247 Sentence denotes Specifically, the I-score was the sum of the scores for three questions regarding "clear policies and protocols," "specialist available," and "adequate training," divided by 9 (full score of 3 for 3 questions), yielding possible scores of −1 to 1.
TextSentencer_T38 6248-6373 Sentence denotes The E-score was the score for "effectiveness," divided by 3 (full score of 3 for 1 question), for possible scores of −1 to 1.
TextSentencer_T39 6374-6578 Sentence denotes The K-score was the sum of correct responses to the 15 questions regarding the effectiveness of various preventive measures divided by 15 (full score of 1 for 15 questions), for possible scores of 0 to 1.
TextSentencer_T40 6579-6650 Sentence denotes The correct response was based on WHO guidelines 10 and other findings.
TextSentencer_T41 6651-6853 Sentence denotes The range of I-and E-scores between −1 and +1 reflected negative and positive perceptions, and accounted for the gradient in responses (probably agree/disagree, agree/disagree, strongly agree/disagree).
TextSentencer_T42 6854-7026 Sentence denotes In contrast, Kscores ranging between 0 and +1 corresponded to the proportion of correct knowledge, and accounted for binary responses (correct response/incorrect response).
TextSentencer_T43 7027-7136 Sentence denotes The Kscore thus reflected the mean rate of correct knowledge among respondents by institution and discipline.
TextSentencer_T44 7137-7253 Sentence denotes The I-and E-scores are, therefore, directly comparable, whereas the K-score is not comparable with the other scores.
TextSentencer_T45 7254-7386 Sentence denotes Cronbach's α was 0.87 for the K-score and 0.76 for the Iscore, which indicated a high degree of internal consistency for each score.
TextSentencer_T46 7387-7388 Sentence denotes 7
TextSentencer_T47 7389-7501 Sentence denotes The χ 2 test was used to evaluate differences in the proportions of respondents by institutions and disciplines.
TextSentencer_T48 7502-7792 Sentence denotes Analysis of variance was used to evaluate differences in the unadjusted scores, and analysis of covariance was used to evaluate the differences in mean scores by institutions and disciplines (after adjusting for age, sex, and job category), as well as to calculate the adjusted mean scores.
TextSentencer_T49 7793-7855 Sentence denotes The adjusted mean scores were then categorized into quartiles.
TextSentencer_T50 7856-7977 Sentence denotes Bonferroni's t-test was used for pairwise comparisons of adjusted mean scores, while correcting for multiple comparisons.
TextSentencer_T51 7978-8064 Sentence denotes All data were analyzed using SPSS, version 11.5J for Windows (SPSS, Chicago, IL, USA).
TextSentencer_T52 8065-8189 Sentence denotes The crude means and standard errors (SE) for the I-, E-, and K-scores by institutions and disciplines are shown in Table 1 .
TextSentencer_T53 8190-8352 Sentence denotes There were significant differences in the mean values of the three scores among institutions and disciplines (P < 0.001 to P = 0.005 for each of the three items).
TextSentencer_T54 8353-8417 Sentence denotes The range of each crude score was wider across institutions (−0.
TextSentencer_T55 8418-8601 Sentence denotes 16 Overall, there were statistically significant differences in the mean values of each of these three scores across institutions (P < 0.001) and disciplines (P < 0.001 to P = 0.005).
TextSentencer_T56 8602-8942 Sentence denotes When we categorized the mean I-scores for the seven institutions into quartiles, we found that A was in the lowest quartile; B and C were in the lower-middle quartile; D, E, and F were in the upper-middle quartile; and G was in the highest quartile, with a 0.66-point difference from institution A (−0.17) to institution G (0.49; Table 2 ).
TextSentencer_T57 8943-9200 Sentence denotes Similarly, when we categorized the four disciplines, we found that "others" and "surgical" were in the lower-middle quartile, while "medical" and "ER/ICU" were in upper-middle quartile, with a 0.18-point difference between others (−0.03) and medical (0.15).
TextSentencer_T58 9201-9325 Sentence denotes Thus, in effect, the difference in mean I-score was larger and more significant across institutions than across disciplines.
TextSentencer_T59 9326-9893 Sentence denotes In addition, pairwise comparisons showed that institution G had a higher mean I-score than the other institutions, and that, across disciplines, "medical" and "ER/ICU" had the highest mean I-scores and "others" had a particularly low mean I-score (Table 2 and Table 5 ) Numbers in parentheses show ranks adjusted for equal ranks a Ranks are based on the values of the I-, E-, and K-scores shown in Tables 2-4 b Based on the rank sum Table 2 also shows the differences across institutions according to each discipline, when institutions and disciplines were combined.
TextSentencer_T60 9894-10039 Sentence denotes For the "ER/ICU" discipline, the mean scores differed by 0.87 points across institutions, from −0.29 for institution A to 0.59 for institution G.
TextSentencer_T61 10040-10187 Sentence denotes For the "surgical" discipline, the mean scores differed by 0.66 points across institutions, from −0.16 for institution B to 0.50 for institution G.
TextSentencer_T62 10188-10283 Sentence denotes The difference across institutions in the mean I-score was largest for the "ER/ICU" discipline.
TextSentencer_T63 10284-10670 Sentence denotes When the seven institutions were categorized into quartiles for their mean E-score, we found that B was in the lowest quartile; A, C, and D were in the lower-middle quartile; E was in the upper-middle quartile; and F and G were in the highest quartile, with a 0.42-point difference in mean E-score across institutions, from −0.35 for institution B to 0.07 for institution G ( Table 3) .
TextSentencer_T64 10671-10916 Sentence denotes Categorization of the four disciplines showed that "others" was in the lowermiddle quartile, whereas "medical," "surgical," and "ER/ ICU" were in the upper-middle quartile, with a 0.06-point difference between others (−0.21) and medical (−0.15).
TextSentencer_T65 10917-11035 Sentence denotes In effect, the difference in mean E-score was larger and more significant across institutions than across disciplines.
TextSentencer_T66 11036-11282 Sentence denotes In addition, pairwise comparisons showed that institutions G and F had higher mean E-scores than the other institutions, whereas the discipline "others" had a significantly lower mean E-score than the discipline "medical" (Table 3 and Table 5 ).
TextSentencer_T67 11283-11416 Sentence denotes Table 3 also shows the differences across institutions according to each discipline, when institutions and disciplines were combined.
TextSentencer_T68 11417-11562 Sentence denotes For the "ER/ICU" discipline, the mean scores differed by 0.65 points across institutions, from −0.50 for institution B to 0.15 for institution G.
TextSentencer_T69 11563-11658 Sentence denotes The difference across institutions in the mean E-score was largest for the "ER/ICU" discipline.
TextSentencer_T70 11659-11752 Sentence denotes We also categorized the seven institutions into quartiles for their mean K-scores (Table 4 ).
TextSentencer_T71 11753-12065 Sentence denotes We found that institutions A and D were in the lowest quartile, B and C were in the lower-middle quartile, E and F were in the uppermiddle quartile, and G was in the highest quartile, with a 0.13-point difference in mean K-scores across institutions, from 0.64 for institutions A and D to 0.77 for institution G.
TextSentencer_T72 12066-12313 Sentence denotes The four disciplines were similarly categorized, with "others" and "surgical" being in the lower-middle quartile, while "medical" and "ER/ICU" were in the upper-middle quartile, with a 0.06-point difference between others (0.65) and ER/ICU (0.72).
TextSentencer_T73 12314-12432 Sentence denotes In effect, the difference in mean Kscores was larger and more significant across institutions than across disciplines.
TextSentencer_T74 12433-12708 Sentence denotes In addition, pairwise comparisons showed that institutions G, followed by F and E, had higher mean K-scores than the other institutions, whereas the disciplines "others" and "surgical" had significantly lower mean K-scores than "ER/ICU" and "medical" (Table 4 and Table 5 ).
TextSentencer_T75 12709-12842 Sentence denotes Table 4 also shows the differences across institutions according to each discipline, when institutions and disciplines were combined.
TextSentencer_T76 12843-12989 Sentence denotes For the "surgical" discipline, the mean scores differed by 0.16 points across institutions, from 0.61 for institution B to 0.77 for institution G.
TextSentencer_T77 12990-13156 Sentence denotes Although the difference across institutions in mean K-scores was largest for the "surgical" discipline, these differences were smaller than those in the other scores.
TextSentencer_T78 13157-13273 Sentence denotes The grand mean K-score was 0.66, indicating that the overall correct knowledge level of preventive measures was 66%.
TextSentencer_T79 13274-13496 Sentence denotes Taking statistically significant differences in K-scores into account, we found that institution G had the highest knowledge level (77%), followed by institutions E and F (70%-71%), and institutions A through D (64%-66%) .
TextSentencer_T80 13497-13654 Sentence denotes Similarly, when sorted by discipline, the ER/ICU and medical categories had the highest knowledge level (69%-72%), followed by surgical and others (65%-67%).
TextSentencer_T81 13655-13817 Sentence denotes The rank by each of the three scores (I, E, and K) was compared with the total rank of the three scores combined for both institutions and disciplines (Table 5) .
TextSentencer_T82 13818-13919 Sentence denotes We found that, for both institutions and disciplines, the I-rank correlated best with the total rank.
TextSentencer_T83 13920-14060 Sentence denotes The E-rank correlated with the total rank, but was correlated to a lesser extent for institutions, and was correlated least for disciplines.
TextSentencer_T84 14061-14149 Sentence denotes The Krank was correlated least for institutions but was correlated well for disciplines.
TextSentencer_T85 14150-14276 Sentence denotes Regardless of the score used, institution G ranked higher than the others, followed by F, whereas institution B ranked lowest.
TextSentencer_T86 14277-14375 Sentence denotes Similarly, for disciplines, ER/ ICU and medical ranked highest, followed by surgical and "others".
TextSentencer_T87 14376-14519 Sentence denotes A distinctive feature of the present analysis was that the data for individual HCWs were grouped at both institutional and disciplinary levels.
TextSentencer_T88 14520-14756 Sentence denotes In particular, the collective perception of HCWs at each hospital was deemed to be a natural output of the study, which could be used for comparative purposes, and a preliminary analysis was fed back to each facility (unpublished data).
TextSentencer_T89 14757-14861 Sentence denotes Most notably, the differences across institutions were consistently wider than those across disciplines.
TextSentencer_T90 14862-15116 Sentence denotes This suggested that the state of preparedness at the institutional level was more strongly associated with the perceived efficacy of the policies and measures at that institution than with the perception shared among HCWs belonging to common disciplines.
TextSentencer_T91 15117-15209 Sentence denotes Furthermore, the three score-ranks of institutions and disciplines showed consistent trends.
TextSentencer_T92 15210-15354 Sentence denotes Higher-ranking institutions (G and F) and disciplines (ER/ ICU and medical) for a particular score tended to show higher ranks for other scores.
TextSentencer_T93 15355-15515 Sentence denotes This suggested that particular institutions/disciplines could excel (or alternatively, lag behind) in various aspects of preparedness, as perceived by the HCWs.
TextSentencer_T94 15516-15718 Sentence denotes Among the three scores, the I-score was most reflective of the total rank for institutions and disciplines, as well as being the most efficient measure of differences among institutions and disciplines.
TextSentencer_T95 15719-15865 Sentence denotes The grand mean I-score (+0.01) was narrowly positive; three institutions (A, B, and C) had negative scores and the other four had positive scores.
TextSentencer_T96 15866-15981 Sentence denotes Among the four disciplines, medical, ER/ICU, and surgical had positive I-scores, and others had a negative I-score.
TextSentencer_T97 15982-16067 Sentence denotes Thus, the collective state of preparedness was clearly distin-guished by the I-score.
TextSentencer_T98 16068-16276 Sentence denotes It is plausible to assume that lower scores, and negative scores in particular, reflect poor institutional policy and countermeasures, as was observed in institutions A, B, and C, and the discipline "others".
TextSentencer_T99 16277-16405 Sentence denotes The grand mean E-score (−0.21) was negative, and all institutions except for A had negative scores, as did all four disciplines.
TextSentencer_T100 16406-16589 Sentence denotes Hence, the perception of the overall effectiveness of institutional measures (E-score) was more negative than the combined perception of three actual institutional measures (I-score).
TextSentencer_T101 16590-16797 Sentence denotes A possible explanation is that the Japanese system for emergency infection control has not been tested, which may have caused the lack of confidence among HCWs in the effectiveness of institutional measures.
TextSentencer_T102 16798-17093 Sentence denotes In fact, the positive response rates for effectiveness of institutional measures differed substantially between HCWs in Singapore (96%), where the institutional preventive measures were tested and found to be effective, and Japan (31%), where the institutional preventive measures were untested.
TextSentencer_T103 17094-17255 Sentence denotes 11 Although the difference in knowledge levels was not substantial, certain combinations of discipline and institution had higher-than-expected knowledge levels.
TextSentencer_T104 17256-17421 Sentence denotes For example, ER/ICU HCWs at institution C had a score of 74%, medical HCWs at institution B had a score of 69%, and "other" HCWs at institution B had a score of 68%.
TextSentencer_T105 17422-17618 Sentence denotes Indeed, if HCWs had acquired knowledge on a personal, as opposed to an institutional and/or disciplinary basis, the K-scores would be more randomly distributed across institutions and disciplines.
TextSentencer_T106 17619-17749 Sentence denotes In this survey, 91% of all respondents answered positively to the question "learn as much as you can about SARS" (data not shown).
TextSentencer_T107 17750-17882 Sentence denotes Thus, the individual acquisition of knowledge may have contributed to a narrowing of the differences among institutions/disciplines.
TextSentencer_T108 17883-18000 Sentence denotes Among disciplines, the three scores for ER/ICU and medical HCWs were higher than those for surgical and "other" HCWs.
TextSentencer_T109 18001-18350 Sentence denotes We expected that the ER/ICU HCWs would have higher scores, because staff engaged in critical care disciplines would have a higher risk of exposure to infectious agents, due to both the specific procedures they perform (e.g., endotracheal intubation, which increases the risk of SARS infection 13-fold) 12 and their exposure to severely ill patients.
TextSentencer_T110 18351-18484 Sentence denotes 13 Under such circumstances, the implementation of emergency infection control measures is imperative, especially for ER/ICU workers.
TextSentencer_T111 18485-18654 Sentence denotes When institutions and disciplines were combined, the differences in I-and E-scores across institutions were more apparent for ER/ICU HCWs than for the other disciplines.
TextSentencer_T112 18655-18728 Sentence denotes This was due to the lower scores for ER/ICU HCWs at institutions A and B.
TextSentencer_T113 18729-18817 Sentence denotes It was noteworthy that, for most institutions, the ER/ICU discipline scored the highest.
TextSentencer_T114 18818-18993 Sentence denotes Therefore, in the less-prepared hospitals (e.g., A and B), the implementation of emergency infection control measures should be stressed, especially among critical care staff.
TextSentencer_T115 18994-19134 Sentence denotes Although inferences are limited relative to the type of institution, we found that institutions G and F ranked high-est on all three scores.
TextSentencer_T116 19135-19268 Sentence denotes These two institutions are municipal hospitals, and one (F) has been designated to accommodate SARS patients if there is an outbreak.
TextSentencer_T117 19269-19402 Sentence denotes It should be noted, however, that G, a municipal hospital not designated for the treatment of SARS, excelled in all three indicators.
TextSentencer_T118 19403-19556 Sentence denotes Many researchers have emphasized the importance of policy and administrative support at the institutional level for effective infection control measures.
TextSentencer_T119 19557-19681 Sentence denotes Administrative support has been shown to enhance compliance with both universal precautions [14] [15] [16] and hand-washing.
TextSentencer_T120 19682-20035 Sentence denotes 17, 18 In our analysis, there was a significant difference in the positive response rate for "clear policies and protocols" across institutions, from 92% for institution G to 48% for institution A (data not shown), suggesting that institutional policies contribute to improving the efficacy of emergency infection control measures, as perceived by HCWs.
TextSentencer_T121 20036-20079 Sentence denotes There are several limitations to our study.
TextSentencer_T122 20080-20174 Sentence denotes First, the cross-sectional nature of the study prevents the determination of cause and effect.
TextSentencer_T123 20175-20306 Sentence denotes Second, there may have been responder bias, in that only workers with a strong interest in SARS may have been motivated to respond.
TextSentencer_T124 20307-20391 Sentence denotes This idea is negated, however, by the quite high response rate to our questionnaire.
TextSentencer_T125 20392-20574 Sentence denotes Third, there may have been a selection bias, in that the number of institutions surveyed was small, although we made an effort to select major hospitals distributed throughout Japan.
TextSentencer_T126 20575-20655 Sentence denotes Fourth, the K-score may not accurately reflect knowledge of preventive measures.
TextSentencer_T127 20656-20866 Sentence denotes HCWs who had accurate knowledge of preventive measures may have answered incorrectly to some items, due to conflicting information, e.g., alcohol rubs and shoe-covers were considered optimal in some guidelines.
TextSentencer_T128 20867-20957 Sentence denotes However, such information was limited, and, hence, its effect should not have been strong.
TextSentencer_T129 20958-21141 Sentence denotes Fifth, we evaluated the differences across institutions and disciplines from the viewpoint of HCWs, but we did not consider the organizational factors associated with this difference.
TextSentencer_T130 21142-21238 Sentence denotes This is also a very important point for each institution to promote their level of preparedness.
TextSentencer_T131 21239-21354 Sentence denotes Such evaluations constitute a separate theme, warranting another study, which will be conducted in the near future.
TextSentencer_T132 21355-21536 Sentence denotes In conclusion, we found substantial and consistent differences in emergency infection control measures for SARS, as perceived by HCWs, among major health care institutions in Japan.
TextSentencer_T133 21537-21600 Sentence denotes This institutional difference exceeded that across disciplines.
TextSentencer_T134 21601-21830 Sentence denotes Due to the potential for future epidemics of emerging and re-emerging infectious diseases, institutions should aim at higher levels of preparedness, by designating and implementing effective emergency infectious control measures.