To see the other types of publications on this topic, follow the link: Major Incident Medical Managemnt and Support.
Journal articles on the topic 'Major Incident Medical Managemnt and Support'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Major Incident Medical Managemnt and Support.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Nilsson, H., R. Lundin, E. Bengtsson, L. Gustafsson, C. Jonsson, and T. Vikström. "(P2-14) Support System for Medical Command and Control at Major Incidents." Prehospital and Disaster Medicine 26, S1 (May 2011): s140. http://dx.doi.org/10.1017/s1049023x11004584.
Full textAbstract:
IntroductionCommunication and information are cornerstones of management during major incidents and disasters. To support medical command and control, the Web-based support system called Paratus Major Incident can be used. The Paratus Major Incident system can provide management staff with online information from the incident area, and support management and patient handling at both single and mass-casualty incidents. The purpose of the Web-based information technology (IT) system is to ensure communication and information between the medical management at the scene, hospital management, and regional medical command and control (gold level).ExperiencesIn the region of Östergötland, Sweden, Paratus Major Incident system is used in operating topics such as: (1) information dissemination from the incident area; (2) communication between prehospital, regional, and hospital management; (3) continuous updates between the dispatch centre and medical commanders at all levels; (4) digital log-files for medical management and patient records; (4) database used for follow-up studies and quality control.ResultsDuring 2,161 incidents, 746 “first incident reports” from ambulance on scene were sent to regional medical command and control within 2 minutes. Four hundred and fifty-six “verification reports” were sent within 10 minutes. During 15 incidents, the designated duty officer on regional level confirmed “major incident” directly via the digital system, thereby notifying all arriving ambulance resources and involved medical managements.ConclusionThis Web-based IT system successfully has been used daily within prehospital management since 2005. The system includes medical command and control at the regional level and all involved hospitals in a major incident.
2
Noon, Adrian. "Book review: Major Incident Management System. The scene aid memoire for major incident medical management and support." Trauma 4, no. 2 (April 2002): 127. http://dx.doi.org/10.1191/1460408602ta232xx.
Full text
3
Morgan, Helen. "Major incident medical management and support: The practical approach at the scene Kevin Mackway-Jones Major Incident Medical Management and Support: The Practical Approach at the Scene Wiley-Blackwell £41.99 196pp 9781405187572 1405187573." Emergency Nurse 20, no. 3 (June 12, 2012): 9. http://dx.doi.org/10.7748/en.20.3.9.s2.
Full text
4
Gyllencreutz, Lina, Sofia Karlsson, and Britt-Inger Saveman. "Evaluating Full-Scale Exercises to Optimize Patient Outcome in an Underground Mine." Prehospital and Disaster Medicine 34, s1 (May 2019): s128. http://dx.doi.org/10.1017/s1049023x19002784.
Full textAbstract:
Introduction:Major incident exercises are expensive to plan and execute, and often difficult to evaluate objectively. There is a need for a generic methodology for reporting results and experiences from major incidents so that data can be used for analysis, to compare results, exchange experiences, and for international collaboration in methodological development. Most protocols use data describing the incident hazards, prehospital and hospital resources available and alerted transport resources, and communication systems. However, the successful management of a rescue response during a major incident also demands a high level of command skills.Aim:The aim of this study was to analyze the command and collaboration skills among the emergency service on-scene commanders and the mine director for safety and security during a full-scale major incident exercise in an underground mine.Methods:The commander functions were observed during a full-scale major incident exercise. Audio and video observations and notes were analyzed using a study-specific scheme developed through a Delphi study, including inter-agency collaborative support and efforts of early life-saving interventions; relevant resources and equipment; and shared and communicated decisions about safety, situation awareness and medical guidelines for response. After the exercise additional interviews were made with those responsible for the command functions.Results:Preliminary results indicate that most decisions were not taken in collaboration. Elaborated results will be presented at the conference.Discussion:Command and collaboration skills can benefit from objective evaluations of full-scale major incident exercises to identify areas that must be improved to optimize patient outcome.
5
Hylander, Johan, Britt-Inger Saveman, and Lina Gyllencreutz. "A Sense of Trust, the Norwegian Way of Improving Medical On-Scene Managing Major Tunnel Incidents: An Interview Study." Prehospital and Disaster Medicine 34, s1 (May 2019): s166. http://dx.doi.org/10.1017/s1049023x19003790.
Full textAbstract:
Introduction:Norway is a country with many road tunnels and therefore also has experience with rescue operations in tunnel environments. Major incidents always challenge involved emergency services’ management skills. Oslo, Norway has a specially trained medical on-scene commander, a function already existing in police and rescue service. Intra-agency communication and management of personnel are essential factors for a successful rescue effort.Aim:To investigate the medical management provided by the specially trained Norwegian medical on-scene commander in relation to tunnel incidents.Methods:Interviews were conducted with six of the seven medical on-scene commanders in Oslo. The collected data were analyzed using qualitative content analysis.Results:An overarching theme emerged: A need for mutual understanding of the tunnel incident. The medical on-scene commanders established guidelines for response in collaboration with the other emergency services. By creating a sense of trust, the collaboration between the emergency services became more fluent. Socializing outside of work resulted in improved reliance on their counterparts in the other services. The management also included that the medical on-scene commander supervised his personnel on site by providing support using knowledge of the risk object and surrounding area.Discussion:A forum for the emergency services on-scene commanders where they share ideas and knowledge, improve the on-scene intra-agency communication, and trust is desirable. A culture of trust between the organizations is needed for a mutual understanding. Further research on this subject is needed in other contexts and countries.
6
Sammut, John, Denys Cato, and Tony Homer. "Major Incident Medical Management and Support (MIMMS): A practical, multiple casualty, disaster-site training course for all Australian health care personnel." Emergency Medicine Australasia 13, no. 2 (June 2001): 174–80. http://dx.doi.org/10.1046/j.1442-2026.2001.00206.x.
Full text
7
Khorram-Manesh, Amir, Jakob Yttermyr, Josef Sörensson, and Eric Carlström. "The Impact of Disasters and Major Incidents on Vulnerable Groups: Risk and Medical Assessment of Swedish Patients With Advanced Care at Home." Home Health Care Management & Practice 29, no. 3 (March 16, 2017): 183–90. http://dx.doi.org/10.1177/1084822317699156.
Full textAbstract:
In this study, we assessed the overall risks that influence advanced care at home (ACH) patients enrolled in 8 municipalities in the western region of Sweden. We also conducted a medical assessment of a limited number of ACH cases based on the registered information from the university hospital in Gothenburg, with regard to survival after a disaster. Two different questionnaires were distributed, and the results were collected separately and analyzed using descriptive statistical analysis. The results indicate that there is a low level of preparedness among the health care service providers for addressing the needs of ACH patients following a major incident or disaster. For this group, the impact of a disaster depends on their vulnerability, specific diagnosis, the medical support required, and the duration of the incident or disaster.
8
Wachira, Benjamin W., Ramadhani O. Abdalla, and Lee A. Wallis. "Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident." Prehospital and Disaster Medicine 29, no. 5 (September 10, 2014): 538–41. http://dx.doi.org/10.1017/s1049023x1400096x.
Full textAbstract:
AbstractAt approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital.This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.WachiraBW, AbdallaRO, WallisLA. Westgate shootings: an emergency department approach to a mass-casualty incident. Prehosp Disaster Med. 2014;29(5):1-4.
9
Schwartz, Thomas J. "Model for Pre-Hospital Disaster Response." Prehospital and Disaster Medicine 2, no. 1-4 (1986): 80–82. http://dx.doi.org/10.1017/s1049023x00030417.
Full textAbstract:
I will present a process by which many of the prehospital providers in this country are trying to organize effective and efficient response plans for major medical incidents which could in fact include a disaster response.Many people in the emergency medical services community, including myself, have been involved in a planning process for voluntary national EMS standards, the program being coordinated by the American Society of Testing & Materials (ASTM) F30 Emergency Medical Services Standards Committee. I chair a subtask group on Disaster Management. The committee has prepared a document containing elements, suggestions, processes and procedures from MCI/disaster response plans from EMS agencies around the country. These places include the cities of Los Angeles, New York, Chicago, Washington, D.C. area, Phoenix, Arizona and other urban places. The intent of this task group is not to prepare a document as a rigid standard to cover every detail on an individual task response plan. Instead, the intent of our task group is to provide an overview of expectations of what an individual mass casualty plan should include; focusing on such topical areas as Incident Command Management, communications, triage, transportation, logistical support issues, mutual aid and ancillary support services and many other topical areas that agency planners must address in developing their respective operational response plans.
10
Hunt, Paul. "Lessons identified from the 2017 Manchester and London terrorism incidents. Part two: the reception and definitive care (hospital) phases." BMJ Military Health 166, no. 2 (May 21, 2018): 115–19. http://dx.doi.org/10.1136/jramc-2018-000935.
Full textAbstract:
The provision of medical care during the reception and definitive care phases of a terrorist incident will likely take place in designated receiving hospitals such as Major Trauma Centres. There is a need for an enhanced capability in such units to receive, initially manage and hold casualties with more serious injuries. Also, even less severely injured casualties may require significant time and clinical input such as risk management in potential bloodborne viruses.The distribution of casualties from the incident scene requires advance consideration of the injury pattern and regional network organisation of specialist services, such as maxillofacial, neurosurgery or severe burns care. Paediatric centres are also more sparsely distributed and often only in large city networks which represents a significant challenge for planners and responders in other regions. An effective response relies on a coordinated multidisciplinary approach including emergency and front-of-house teams, surgical, medical and clinical support services.
11
Hylander, Johan, Britt-Inger Saveman, Ulf Björnstig, and Lina Gyllencreutz. "Senior ambulance officers in Swedish emergency medical services: a qualitative study of perceptions and experiences of a new management role in challenging incidents." BMJ Open 10, no. 12 (December 2020): e042072. http://dx.doi.org/10.1136/bmjopen-2020-042072.
Full textAbstract:
ObjectivesIncreased demands are placed on emergency services and their role and ability to act in incidents in challenging environments, for example, road tunnels. Collaboration between officers from emergency services (fire brigade, police and ambulance services) is important for an effective rescue effort. In Gothenburg, Sweden, a position as a senior ambulance officer (SAO) within the emergency medical services (EMS) has been introduced to support the regular force during major incidents. The aim of this paper was to explore the perceptions and experiences of the SAO’s new management role in challenging incidents, such as those occurring in road tunnels.DesignA qualitative interview study.SettingThe study was carried out from February to June 2019 in Gothenburg, Sweden, which is a municipality with several road tunnels and a population of approximately 580 000 people. SAOs collaborate with the corresponding function within the police and fire brigade, both having senior officers at major incident sites.ParticipantsTwelve SAOs.MethodsThe study used semistructured interviews. The collected data were analysed using qualitative content analysis.ResultsAccording to SAOs’ experience, prehospital medical management included not only leadership, but also planning, training and indepth knowledge of, for example, tunnel environments. Furthermore, SAOs adopted an encouraging and teaching role for their colleagues. SAOs’ responsibilities also included proactive planning together with the fire brigade and police, which was regarded as enhancing interorganisational collaboration. An overall theme emerged which the SAOs described as ‘A new holistic approach to EMS leadership and management’.ConclusionsThe participants considered that the new SAO role not only seems to improve the prehospital medical management, but also makes the EMS command structure during challenging incidents symmetrical with the fire brigade and police command structure. The implementation of national guidelines is desirable and is requested by the SAOs.
12
Kaji, Arito, Hiromasa Yamamoto, and Naoto Morimura. "Revised Hospital-MIMMS Course for Japan." Prehospital and Disaster Medicine 34, s1 (May 2019): s165. http://dx.doi.org/10.1017/s1049023x19003753.
Full textAbstract:
Introduction:HMIMMS (Major Incident Medical Management and Support: The Practical Approach in the Hospital) has been introduced by ALSG (Advanced Life Support Group, Manchester, UK) and developed for many countries for preparing to accept huge numbers of casualties at a hospital during major incidents. The original HMIMMS course has been held in Japan since 2007, produced over 1,200 providers. Japan has a crucial history of natural disasters, earthquakes, tsunamis, and typhoons often resulting in extensive damages to infrastructure and communications.Aim:The MIMMS-JAPAN and the Japanese Association for Disaster Medicine have joined to plan to revise the original HMIMMS course from the point of view of the difference of the type of disaster.Method:By the permission of ALSG, two subjects were added “Hospital Evacuation” and “Business Continuity Plan” as lectures, workshops, and tabletops to the original HMIMMS course. Before attending the course, students were required to watch e-learning for deeper understanding and time-saving. Total program was organized into two days.Results:Main points of modification are to: 1.Replace a system peculiar to the UK with a Japanese system.2.Add unique contents of a Japanese disaster.3.Add the important subjects especially in Japan.4.Modify the presentation slides to understand easily for Japanese students. But the fundamental concept that hospital functions upon ‘CSCATTT’ is strictly preserved.Discussion:Newly revised HMIMMS course will start in 2019 for Japanese learners. Many reflections must be accumulated and further revisions will continue.
13
Gyllencreutz, Lina, Monica Rådestad, and Britt-Inger Saveman. "Templates for handling multi-agency collaboration activities and priorities in mining injury incidents: a Delphi study." International Journal of Emergency Services 9, no. 3 (April 30, 2020): 257–71. http://dx.doi.org/10.1108/ijes-06-2019-0026.
Full textAbstract:
PurposeThe purpose of this study was from a Swedish perspective to map experts' opinions on theoretical statements of essential collaboration activities for management of mining injury incidents.Design/methodology/approachA Delphi technique was performed, asking opinions from experts in iterative rounds to generate understanding and form consensus on group opinion around multi-agency management. The experts were personnel from emergency medical service, rescue service and mine industry, all with operative command positions.FindingsThree iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important multi-agency collaboration activities to optimize victim's outcome from an injury incident in an underground mine. This resulted in 63 statements and additional three were added during the second round. The statements were divided into one trajectory and seventh time phases and comprised, e.g. early alarm routines, support of early life-saving interventions, relevant resources and equipment for the assignment and command and control center and functions with predefined action plans for response. It also comprised shared and communicated decisions about each agency's responsibility and safety. All statements reached consensus among the experts in Round 3.Research limitations/implicationsThe experts included in this study seem to be adequate but there could be other experts and different statements that other researchers might consider.Practical implicationsThese statements could be used to evaluate collaboration in major incidents exercises. The statements can also be quality indicators for reporting results from multi-agency management.Originality/valueThis paper contributes to the research field of collaboration and joint practices between and among personnel involved in rescue operations.
14
Reilly, Michael, and David S. Markenson. "Education and Training of Hospital Workers: Who Are Essential Personnel during a Disaster?" Prehospital and Disaster Medicine 24, no. 3 (June 2009): 239–45. http://dx.doi.org/10.1017/s1049023x00006877.
Full textAbstract:
AbstractHospital plans often vary when it comes to the specific functional roles that are included in emergency and incident management positions.Bioterrorism coordinators and emergency managers for 31 hospitals in a seven-county region outside of a major metropolitan area, with urban, suburban, and rural demographics were surveyed to determine which specific functional roles were considered “essential” to their hospital's emergency operations plans. Furthermore, they were asked to estimate the percentage of their “essential” staff trained to perform the functional roles delineated in the hospital's plan. Responses were entered into a database and descriptive statistical computations were performed. Only three categories of hospital personnel were reported to be “essential” by all hospitals to their emergency preparedness plans: emergency department physicians, nurse, and support staff. Training for overall “essential” staff ranged by hospital 73.6–83.3%. Some hospitals reported that these staff members have received no training in their anticipated role based on the hospital emergency response plan. Allied health professionals and emergency medical technicians/paramedics (that are employed by hospitals) had the least amount of training on their role in the hospital preparedness and response plan, 33.3% and 22.2% respectively.Without improved guidance on benchmarks for preparedness from regulators and professional organizations, hospitals will continue to lack the capacity to effectively respond to disasters and public health emergencies.
15
Vermeulen, Lisa, and Dianne Stephens. "Regional Engagement Program: Supporting Local Leadership and Building Local Skills and Knowledge in Order to Develop a Systematic Approach to Disaster Medical Management." Prehospital and Disaster Medicine 34, s1 (May 2019): s162—s163. http://dx.doi.org/10.1017/s1049023x19003698.
Full textAbstract:
Introduction:One of the key components in any effective disaster response is the capacity of local communities to respond in a timely and efficient manner. Over the last 3 years, the National Critical Care and Trauma Response Centre in Darwin has been involved in building regional capacity across the Asia-Pacific, supporting local leadership and building local skills and knowledge in order to develop a systematic approach to disaster medical management.Aim:This presentation is to describe the Regional Engagement Program, its strengths, weaknesses, and outcomes.Methods:We will describe the background to the program, the process for regional engagement and the Results of our evaluation. The program used the Major Incident Medical Management Systems (MIMMS) approach which was delivered in-country and included identifying and using local personnel to deliver the program. The program was conducted across the region in Myanmar, Fiji, Tonga, Vanuatu, Samoa, Timor, and Indonesia. Initially the courses were run by personnel from Australia but through engagement with local Ministries of Health and collaboration with identified key stakeholders, we have been able to build local faculty to ensure sustainability and local ownership.Results:Thirty-six personnel have been trained across four countries. Thirty-six candidates are now instructors, with a further 36 identified for future development as instructors. The evaluation illustrates the long-term partnerships that have been developed and the ongoing capacity development of key regional partners.Discussion:The Regional Engagement program demonstrates that prolonged engagement with key regional stakeholders and adequate and sustained mentoring will successfully build local capacity to the level needed to mount a successful response to a disaster. Personnel trained through this program helped guide the response to the Lombok earthquake and in Fiji, a MIMMS Team Member training program was conducted with minimal external support.
16
Kulling, Per E. J., and Jonas E. A. Holst. "Educational and Training Systems in Sweden for Prehospital Response to Acts of Terrorism." Prehospital and Disaster Medicine 18, no. 3 (September 2003): 184–88. http://dx.doi.org/10.1017/s1049023x00001035.
Full textAbstract:
AbstractSweden has a long tradition in planning for disaster situations in which the National Board of Health and Welfare has a key responsibilty within the health sector. One important part of this disaster preparedness is education and training. Since 11 September 2001, much focus has been placed on the acts of terrorism with special reference to the effects of the use of chemical, biological, or nuclear/radiological (CBNR) agents. In the health sector, the preparedness for such situations is much the same as for other castastrophic events. The National Board of Health and Welfare of Sweden is a national authority under the government, and one of its responsibilities is planning and the provision of supplies for health and medical services, environmental health, and social services in case of war or crises. “Joint Central Disaster Committees” in each County Council/Region in the country are responsible for overseeing major incident planning for their respective counties/regions. The “Disaster Committee” is responsible for ensuring that: (1) plans are established and revised; (2) all personnel involved in planning receive adequate information and training; (3) equipment and supplies are available; and (4) maintenance arrangements are in place.Sweden adopts a “Total Defense” strategy, which means that it places a high value in preparing for peacetime and wartime major incidents. The Swedish Emergency Management Agency coordinates the civilian Total Defense strategy, and provides funding to the relevant responsible authority to this end. The National Board of Health and Welfare takes responsibility in this process. In this area, the main activities of the National Board of Health and Welfare are: (1) the establishment of national guidelines and supervision of standards in emergency and disaster medicine, social welfare, public health, and prevention of infectious diseases; (2) the introduction of new principles, standards, and equipment; (3) the conducting education and training programmes; and (4) the provision of financial support. The budget for National Board of Health and Welfare in this area is approximately 160 million SEK (US$18 million). The National Board of Health and Welfare also provides funding to the County Councils/Regions for the training of healthcare professionals in disaster medicine and crises management by arranging (and financing) courses primarily for teachers and by providing financial support to the County Councils/Regions for providing their own educational and training programmes. The National Board of Health and Welfare provides funding of approximately 20 million SEK (US$2.4 million) to the County Councils/Regions for this training of healthcare professionals in disaster medicine and crises.
17
Wojtalewicz, MS, CEM®, LTC (R), Cliff, Adam Kirby, MS, and J. Eric Dietz, PhD, PE, LTC (R). "Implementation and modeling of a Regional Hub Reception Center during mass evacuation operations." Journal of Emergency Management 12, no. 3 (May 1, 2014): 197. http://dx.doi.org/10.5055/jem.2014.0172.
Full textAbstract:
When developing response plans in the aftermath of a catastrophic incident, jurisdictions often fail to conduct the necessary interdisciplinary planning needed to fully address the needs across jurisdictional borders. The Purdue Homeland Security Institute (PHSI) was selected by the City of Chicago Office of Emergency Management and Communications (OEMC) in 2010 to lead an effort to address planning across jurisdictional borders during mass evacuations following a catastrophic incident. Specifically, PHSI was chosen to lead the effort in developing a planning and implementation guide for standing up a conceptual Regional Hub Reception Center (RHRC). A major component within the mass evacuation and sheltering continuum, the RHRC is designed to provide evacuees with quick-response mass care and emergency assistance while their other needs are assessed and appropriate shelter locations are identified. The RHRC also provides a central location to leverage governmental, nongovernmental, and private sector resources and is the first point in the evacuation, mass care, and sheltering concept of operations where more comprehensive support (food, shelter, medical, psychological, household pet sheltering, reunification, etc) can be expected. PHSI undertook this lead role working within the Illinois-Indiana-Wisconsin (IL-IN-WI) Combined Statistical Area (CSA) as part of the US Department of Homeland Security Regional Catastrophic Planning Grant Program. Coordinating closely with the City of Chicago OEMC and IL-IN-WI CSA Regional Catastrophic Planning Team, PHSI lead the research effort using resource and capability data compiled from all 17 jurisdictions within the IL-IN-WI CSA and validated the RHRC concept using three tabletop exercises. Upon completion, the PHSI team published the RHRC planning guide complete with procedures and processes that define the roles and responsibilities of government, nongovernment organizations, and private sector for providing RHRC mass care functions and RHRC capability and capacity assessments. This article further examines the potential for using simulation modeling as a cost-effective means to rapidly evaluate any facility for potential use as a RHRC and to measure and maximize RHRC operational efficiency. Using AnyLogic simulation software, PHSI developed a first-ever model of a theoretical RHRC capable of simulating, measuring, and manipulating RHRC operations under specified conditions/ scenarios determined by the emergency management planner. Future simulation modeling research promises to promote the Whole Community Approach to response and recovery by reinforcing interdisciplinary planning, enhancing regional situational awareness, and improving overall jurisdictional coordination and synchronization.
18
Bonaca, Marc P., Naomi M. Hamburg, and Mark A. Creager. "Contemporary Medical Management of Peripheral Artery Disease." Circulation Research 128, no. 12 (June 11, 2021): 1868–84. http://dx.doi.org/10.1161/circresaha.121.318258.
Full textAbstract:
Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis. Modifiable risk factors including cigarette smoking, dyslipidemia, diabetes, poor diet quality, obesity, and physical inactivity, along with underlying genetic factors contribute to lower extremity atherosclerosis. Patients with PAD often have coexistent coronary or cerebrovascular disease, and increased likelihood of major adverse cardiovascular events, including myocardial infarction, stroke and cardiovascular death. Patients with PAD often have reduced walking capacity and are at risk of acute and chronic critical limb ischemia leading to major adverse limb events, such as peripheral revascularization or amputation. The presence of polyvascular disease identifies the highest risk patient group for major adverse cardiovascular events, and patients with prior critical limb ischemia, prior lower extremity revascularization, or amputation have a heightened risk of major adverse limb events. Medical therapies have demonstrated efficacy in reducing the risk of major adverse cardiovascular events and major adverse limb events, and improving function in patients with PAD by modulating key disease determining pathways including inflammation, vascular dysfunction, and metabolic disturbances. Treatment with guideline-recommended therapies, including smoking cessation, lipid lowering drugs, optimal glucose control, and antithrombotic medications lowers the incidence of major adverse cardiovascular events and major adverse limb events. Exercise training and cilostazol improve walking capacity. The heterogeneity of risk profile in patients with PAD supports a personalized approach, with consideration of treatment intensification in those at high risk of adverse events. This review highlights the medical therapies currently available to improve outcomes in patients with PAD.
19
Domres, MD, Bernd D., AlBadi Rashid, MD, Jan Grundgeiger, MD, Stefan Gromer, MD, Tobias Kees, MD, Norman Hecker, and Hanno Peter. "European survey on decontamination in mass casualty incidents." American Journal of Disaster Medicine 4, no. 3 (May 1, 2009): 147–52. http://dx.doi.org/10.5055/ajdm.2009.0023.
Full textAbstract:
Objective: The goal of this study is to assess the European status in the case of mass casualties regarding legislation, responsibilities of ministries and organizations, education and training, material and equipment, and bottlenecks.Design: A questionnaire answered by 22 of 27 European Union member states and Croatia, Norway, and Switzerland. Results and recommendations of a European expert’s workshop on decontamination of victims of mass casualties.Setting: Ministries and responsible organizations of 22 European Union member states Croatia, Norway, and Switzerland.Subjects: Hazardous chemical agents are a global realistic risk. Therefore it is an important obligation to direct education, service activities and research towards priority concerns of prevention and response in case of an accidental or criminal liberation of toxic chemicals. The most effective procedures to save the life and health of contaminated persons are: (1) The decontamination of chemically contaminated casualties as soon as possible reduces both morbidity and mortality. (2) The removal of clothing as the first stage of the decontamination process reduces the amount of contamination by 75-85 percent. The decontamination in case of a mass casualty incident needs a high number of personnel, personal protection equipment (PPE), a decontamination unit, education and permanent training, and a management of command, communication, and coordination; all these in the shortest time of preparedness, reaction, and cross border nationally and internationally.1Interventions: During the German EU Council Presidency in the first 6 months of 2007 the Federal Ministry of the Interior held a 3 days seminar (Ahrweiler, February 22-24, 2007) on the “Decontamination of Casualties Involved in Incidents with Hazardous Chemical Materials—European Inventory and Perspectives.” The aim was to arrange an exchange of information and experience on the various systems in place in Europe which would be beneficial to all parties concerned. The seminar was organized by the Federal Office of Civil Protection and Disaster Assistance.Main outcome measure: (1) Results of a nine question enquiry, (2) results of four workgroups with the focus on medicine, organization, equipment, and education.Results: In most countries, the medical sector is the weakest part of the integrated approach. Decontamination has two goals: to decontaminate the casualties and to avoid secondary contamination of personnel, equipment, and institutions (hospitals). The most effective method for decontamination is to undress patients as soon as possible. The procedures for undressing, triage, basic life support, etc have to be evidence based by research. Cooperation between MS should be developed including transborder cooperation, designing modules in the framework of the EU Mechanism, and considering reinforcement between MS as precautionary measures, for example, for major international events. Interoperability of equipment is recommended and achievable. Need for European inventory of decontamination units. Need for national stockpiles of antidotes and drugs as well as logistics.Conclusions: The following recommendations were given to the EU Commission: Organize focused experts meetings on the above mentioned subjects. Promote common exercises. Collect and promote best practices by supporting research for evidence-based results. Promote crossborder cooperation and possibly preplanned reinforcements.
20
Pettersson, RN Jenny, Carl-Oscar Jonson, Peter Berggren, Rogier Woltjer, Jonas Hermelin, and Erik Prytz. "Resilience Training of Regional Medical Command and Control." Prehospital and Disaster Medicine 34, s1 (May 2019): s164—s165. http://dx.doi.org/10.1017/s1049023x19003741.
Full textAbstract:
Introduction:Resilience is often described as a desirable holistic approach to disaster preparedness. However, the term has a wide variety of meanings and is hard to operationalize and implement in disaster management. A goal for the EU H2020 project DARWIN was to operationalize resilience for incident management teams.Aim:To test the resilience operationalization by analyzing command team behaviors in a major incident exercise and trace observations to resilience theory.Methods:A regional medical command and control team (n=11) was observed when performing in a functional simulation exercise of a mass casualty incident (300 injured, 1800 uninjured) following the collision of a cruise ship and an oil tanker close to the Swedish coast. Audio and video recordings of behaviors and communications were reviewed for resilient behaviors based on the DARWIN guidelines using the “resilience markers for small teams” framework (Furniss et al., 2011).Results:A total of 121 observed instances of resilient behaviors were found in the material. In 95 cases (79%) the observed behaviors followed a priori hypothesized connections between resilient strategies and general markers. Certain marker-strategy combinations occurred frequently, such as 18 observations where the strategy “understand crucial assumptions” occurred together with the marker “adapting to expected and unexpected events.”Discussion:Resilience has the potential to contribute to a more holistic disaster management approach. The findings that the observations, in general, correspond to the expected relationship between theoretical concretization and contextualization supports the DARWIN effort to operationalize resilience theory. This is a prerequisite for developing observational protocols for training and further studies of resilient behaviors in disaster management teams.
21
Alenyo, Annet Ngabirano, Wayne P. Smith, Michael McCaul, and Daniel J. Van Hoving. "A Comparison Between Differently Skilled Prehospital Emergency Care Providers in Major-Incident Triage in South Africa." Prehospital and Disaster Medicine 33, no. 6 (August 29, 2018): 575–80. http://dx.doi.org/10.1017/s1049023x18000699.
Full textAbstract:
AbstractIntroductionMajor-incident triage ensures effective emergency care and utilization of resources. Prehospital emergency care providers are often the first medical professionals to arrive at any major incident and should be competent in primary triage. However, various factors (including level of training) influence their triage performance.Hypothesis/ProblemThe aim of this study was to determine the difference in major-incident triage performance between different training levels of prehospital emergency care providers in South Africa utilizing the Triage Sieve algorithm.MethodsThis was a cross-sectional study involving differently trained prehospital providers: Advanced Life Support (ALS); Intermediate Life Support (ILS); and Basic Life Support (BLS). Participants wrote a validated 20-question pre-test before completing major-incident training. Two post-tests were also completed: a 20-question written test and a three-question face-to-face evaluation. Outcomes measured were triage accuracy and duration of triage. The effect of level of training, gender, age, previous major-incident training, and duration of service were determined.ResultsA total of 129 prehospital providers participated. The mean age was 33.4 years and 65 (50.4%) were male. Most (n=87; 67.4%) were BLS providers. The overall correct triage score pre-training was 53.9% (95% CI, 51.98 to 55.83), over-triage 31.4% (95% CI, 29.66 to 33.2), and under-triage 13.8% (95% CI, 12.55 to 12.22). Post-training, the overall correct triage score increased to 63.6% (95% CI, 61.72 to 65.44), over-triage decreased to 17.9% (95% CI, 16.47 to 19.43), and under-triage increased to 17.8% (95% CI, 16.40 to 19.36). The ALS providers had both the highest likelihood of a correct triage score post-training (odds ratio 1.21; 95% CI, 0.96-1.53) and the shortest duration of triage (median three seconds, interquartile range two to seven seconds; P=.034). Participants with prior major-incident training performed better (P=.001).ConclusionAccuracy of major-incident triage across all levels of prehospital providers in South Africa is less than optimal with non-significant differences post-major-incident training. Prior major-incident training played a significant role in triage accuracy indicating that training should be an ongoing process. Although ALS providers were the quickest to complete triage, this difference was not clinically significant. The BLS and ILS providers with major-incident training can thus be utilized for primary major-incident triage allowing ALS providers to focus on more clinical roles.AlenyoAN, SmithWP, McCaulM, Van HovingDJ. A comparison between differently skilled prehospital emergency care providers in major-incident triage in South Africa. Prehosp Disaster Med. 2018;33(6):575–580.
22
Vivekanantham, A., D. Prieto-Alhambra, and D. E. Robinson. "POS1098 PREVALENT COMORBIDITIES ASSOCIATED WITH CLINICALLY DIAGNOSED OSTEOARTHRITIS: A CASE-CONTROL ANALYSIS INCLUDING 1,936,792 PEOPLE." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 829.1–829. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3202.
Full textAbstract:
Background:Osteoarthritis (OA) is the most common form of arthritis and a major cause of pain and disability worldwide. Individuals with OA have increased cardiovascular morbidity and mortality, and other comorbidities are also more common amongst them than in the general population. In this study, we examined the prevalence and timing of the diagnosis of co-morbidities prior to the clinical diagnosis of OA.Objectives:To determine the odds of comorbidities in newly diagnosed OA cases versus matched controls in the up to 10 years prior to diagnosis.Methods:Case-control study of people registered in the Information System for Research in Primary Care (SIDIAP). SIDIAP includes primary care records covering over 80% of the population of Catalonia, Spain.Participants with an incident diagnosis of OA, based on ICD-10-CM disease codes, were matched to up to 4 controls by age (within 2 years), gender and primary care practice. The first diagnosis date of OA used the index date, with matched controls using the same index date, to retrospectively review for comorbidities. Patients were required to have at least 3 years continuous registration prior to the index date. A total of 57 comorbidities were considered, based on prior knowledge and clinical consensus.Descriptive statistics were used to obtain the demographic information about cases and controls. Counts of any comorbidity were calculated, and univariable and multivariable logistic regression were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of individual comorbidities adjusted for age, gender and socio-economic status.Results:In total, there were 455,494 OA cases and 1,481,298 matched controls. The cases and controls were similar with regards to age, gender and deprivation level.The incident diagnosis of any comorbidity at any time prior to index date was 77% (n= 350,913) in cases versus 61% (n= 909,497) in controls.The results from the multivariable analysis [Table 1] showed that OA patients had higher prevalence of many comorbidities up to 1 year prior to their diagnosis of OA compared to up to 10 years prior to diagnosis. They were most likely to be diagnosed with another musculoskeletal condition followed by neuro-psychiatric and metabolic and cardiovascular conditions. Conversely, patients with OA were less likely to be diagnosed with cancer up to 10 years prior to index date than matched controls.Table 1.Multivariable analysis at 1 year and 10 year prior to index dateCo-morbidityMultivariable analysis 1-year prior (OR, 95% CI)Multivariable analysis 10-year prior (OR, 95% CI)Musculoskeletal conditionsAnkylosing Spondylosis3.12 (2.41, 4.05)1.27 (1.12, 1.43)Fibromyalgia4.24 (3.96, 4.54)1.85 (1.80, 1.91)Rheumatoid Arthritis2.67 (2.40, 2.97)1.27 (1.20, 1.34)Back/ neck pain2.41 (2.38, 2.45)1.76 (1.75, 1.78)Neuro-psychiatricAnxiety1.69 (1.65, 1.73)1.23 (1.22, 1.24)Depression1.87 (1.81, 1.93)1.25 (1.24, 1.27)Irritable Bowel Syndrome1.90 (1.71, 2.11)1.28 (1.22, 1.34)Migraine1.81 (1.69, 1.94)1.23 (1.20, 1.27)CancerLeukaemia1.07 (0.88, 1.30)0.91 (0.82, 1.00)Lymphoma0.84 (0.68, 1.03)0.90 (0.82, 0.99)Solid malignancy0.95 (0.91, 0.99)0.95 (0.93, 0.97)Other medical conditionsStroke1.15 (1.10, 1.20)0.95 (0.93, 0.97)Hypertension1.70 (1.68, 1.74)1.26 (1.25, 1.28)Diabetes1.34 (1.30, 1.38)1.07 (1.06, 1.09)Obesity1.96 (1.92, 2.01)1.60 (1.58, 1.62)Conclusion:Patients with OA have multiple chronic conditions. Our results found that the diagnosis of these other co-morbidities (particularly musculoskeletal and neuro-psychiatric conditions) were more likely to occur in the 1-year prior to their diagnosis of OA, compared to in the 10-year prior, except for lymphoma and solid malignancy. These results help us to further understand the relationship and timing of the development of multiple co-morbidities in patients with OA.Disclosure of Interests:Arani Vivekanantham: None declared, Daniel Prieto-Alhambra: None declared, Danielle E Robinson Grant/research support from: Dr. Prieto-Alhambra reports grants and other from AMGEN, grants, non-financial support and other from UCB Biopharma, grants from Les Laboratoires Servier, outside the submitted work; and Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums, and Synapse Management Partners have supported training programmes organised by DPA’s department and open for external participants.
23
Doligalski, Christina Teeter, and Douglas L. Jennings. "Device-Related Thrombosis in Continuous-Flow Left Ventricular Assist Device Support." Journal of Pharmacy Practice 29, no. 1 (November 24, 2015): 58–66. http://dx.doi.org/10.1177/0897190015615894.
Full textAbstract:
Advanced heart failure therapy has been revolutionized with the advent of continuous-flow ventricular assist devices (CF-LVADs) which have improved both survival and quality of life. Despite this, support with CF-LVADs is frequently complicated, with 70% of recipients experiencing a major complication in the first year of durable support. The most concerning of these complications to emerge is device-related thrombosis, which is associated with increased morbidity and mortality. Pathophysiology and diagnosis are multifaceted and complex, with pump-specific and patient-specific factors to be considered. Incidence estimates are evolving with increases seen in the past 2 years compared with earlier implant data. Evidence for treatment is limited to case series and reports, which are subject to significant publication bias. Finally, appropriate primary and secondary prophylaxis is imprecise with multiple antiplatelet and antithrombotic strategies described. This review seeks to summarize the current literature surrounding the pathophysiology, diagnosis, and management of thrombosis in CF-LVAD recipients.
24
Beauchesne, Marie-France. "Management of Chronic Obstructive Pulmonary Disease: A Review." Journal of Pharmacy Practice 14, no. 2 (April 2001): 126–42. http://dx.doi.org/10.1106/777c-kd4j-ym5x-xw1m.
Full textAbstract:
Chronic obstructive pulmonary disease (COPD) affects about 14 million persons in the United States and is the only common cause of death that is increasing in incidence. Chronic management of this disorder includes nonpharmacologic interventions such as smoking cessation, immunization, nutritional support, and pulmonary rehabilitation. The pharmacotherapy of COPD is based on regular administration of bronchodilators, when symptoms are persistent. Long-acting bronchodilators have been shown to improve quality of life in patients with COPD. Ipratropium remains the anticholinergic of choice, but more specific agents with a longer duration of action should become available. Four recent large clinical trials on the use of inhaled corticosteroids (ICS) have been published. The results demonstrate that ICS do not alter the decline in lung function in patients with COPD. Patients with more severe COPD and frequent exacerbations may have a better quality of life and a reduced rate of exacerbations with ICS. Management of acute exacerbations involves three major pharmacologic treatment modalities: antibiotics, short-acting bronchodilators, and systemic steroids. Recent data shows the benefits of systemic corticosteroids in the management of acute exacerbations.
25
Dashti, H. S., B. Cade, G. Stutaite, R. Saxena, S. Redline, and E. Karlson. "1164 Prospective Associations Between Sleep Duration, Variability and Timing and Diseases from an Electronic Health Record Biobank in 24,065 Individuals." Sleep 43, Supplement_1 (April 2020): A444—A445. http://dx.doi.org/10.1093/sleep/zsaa056.1158.
Full textAbstract:
Abstract Introduction Implementation of electronic health records (EHR) across healthcare systems linking clinical to survey data has enabled systematic assessments of longitudinal relationships between sleep traits and diseases classified by PheWAS codes where ICD-9/10 codes are collapsed to categories based on clinical similarity. In the Partners Biobank, a hospital-based virtual cohort from Mass General Brigham in greater Boston, MA, we aimed to assess associations between sleep traits and incident diseases. Methods Self-reported weekday/weekend bed and wake times from a survey at consent were used to derive sleep traits. Incident diseases were defined as two incident PheWAS codes on separate dates ≥1y after consent. Cox proportional hazards models compared short (<7h) and long (≥9h) sleep duration, with 7-8h (referent group), adjusted for age, gender, race/ethnicity, and employment status, then further adjusted for BMI. Similarly, sleep midpoint (midpoint between weekend wake/bed times), sleep debt (difference in weekend/weekday sleep duration), and social jetlag (difference in weekend/weekday sleep midpoint) were assessed. Results The analytical sample consisted of 24,065 adults (mean sleep duration =8.12h) seeking regular care with sleep data. Participants had a total of 7,513,649 ICD codes of which incident 323,946 ICD codes mapped to 137,137 PheWAS codes. Over a median follow-up of 2.73 years (interquartile range: 1.82-3.98), participants sleeping <7h had a significantly higher risk of incident Acute pain [hazard ratio(95% confidence interval)=1.46(1.2-1.78)], Tobacco use disorder [1.42(1.18-1.71)], Sciatica [1.72(1.3-2.27)], and Edema [1.69(1.25-2.28)]. Each additional hour of later sleep midpoint and increased sleep debt and social jetlag associated with higher risk of incident Major depressive disorder [midpoint:1.30(1.14-1.49); debt:1.23(1.09-1.38); jetlag:1.54(1.27-1.84)]. Associations retained significance upon further adjustment for BMI, except for Edema, and no other associations were observed at the Bonferroni threshold (P=0.0125). Conclusion Our findings in a large hospital-based virtual cohort support unique inter-relationships between sleep duration/timing on somatic, behavioral, and mental health outcomes. Support H.S.D. and R.S. are supported by NIDDK grant R01DK107859. B.C. is supported by K01-HL135405-01. S.R. and R.S. are partially supported by R35 NHLBI HL 135816.
26
Gao, L., P. Li, L. Cui, O. Johnson-Akeju, and K. Hu. "1159 Sleep Traits And Incident Delirium During A Decade Of Follow-up In 173,000 Participants." Sleep 43, Supplement_1 (April 2020): A442. http://dx.doi.org/10.1093/sleep/zsaa056.1153.
Full textAbstract:
Abstract Introduction Delirium is an acute decline in attention and cognition that is with associated long-term cognitive dysfunction in elderly patients. Accumulating evidence points to strong associations between sleep health and disorders of the brain. We tested whether baseline sleep duration, chronotype, daytime dozing, insomnia or sleep apnea predict incident delirium during hospitalization. Methods We studied participants from the UK Biobank who have been followed for up to 10 years until 2017. We included 173,221 participants (mean age 60±5; range 50-71 at baseline) who had at least one episode of hospitalization/surgery and were free from prior episodes of delirium. Delirium diagnosis, hospitalization and surgical events were derived using ICD-10 coding. Multivariate logistic regression models were performed to examine the associations of self-reported baseline sleep duration (<6hrs/6-9h/>9h), daytime dozing (often/rarely), insomnia (often/rarely) and presence of sleep apnea (ICD-10 and self-report) with incident delirium during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, and major confounders (number of hospitalizations/surgical procedures, BMI, diabetes, major cardiovascular diseases and risk factors, major neurological diseases, major respiratory diseases, cancer, alcohol, depression/anxiety, sedatives/sleep aides, antipsychotics, steroids and opioids). Results In total, 1,023 (5.7 per 1,000 subjects) developed delirium. A prior diagnosis of sleep apnea (n=1,294) saw almost a two-fold increased odds (OR 1.96, 95% CI: 1.30-2.30 p=0.001) while those who often had daytime dozing were also at increased risk (OR 1.35, 95% CI: 1.02-1.80, p=0.025). Both these effects were independent of each other. No independent effects on incident delirium were observed from sleep duration, insomnia, or chronotype. Conclusion Certain sleep disturbances, in particular sleep apnea and daytime dozing, are independently associated with an increased risk for developing delirium. Further work is warranted to examine underlying mechanisms and to test whether optimizing sleep health can reduce the risk of developing delirium. Support This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.
27
Rossouw, Theresa Marié, Marietjie Van Rooyen, and Karin Louise Richter. "Exposure incidents among medical students in a high-prevalence HIV setting." Journal of Infection in Developing Countries 11, no. 01 (January 30, 2017): 65–72. http://dx.doi.org/10.3855/jidc.8940.
Full textAbstract:
Introduction: Occupational injuries in medical students are concerning, especially in countries with a high prevalence of bloodborne infections. With more HIV-infected patients on antiretroviral treatment, appropriate post-exposure prophylaxis (PEP) depends on knowledge of source patients’ infection status and treatment response. This study determined the number and type of exposure incidents, reporting practices, and PEP use among medical students at the University of Pretoria, South Africa. Methodology: Data were collected from an anonymous voluntary questionnaire completed by medical students from years 1 to 6 of study as well as from incident records archived at the Department of Family Medicine. Data were described and tests of association performed in Stata 11. Results: Thirteen percent of students overall and 21% of senior students reported an incident in the preceding year. The majority of incidents occurred during phlebotomy, with fatigue and work pressure found to be major contributing factors. Underreporting was common and many students displayed a lack of risk awareness and a preference for managing the incident privately. Although 59% knew the HIV-status of the source patient, less than a third knew the viral load and only 16.9% the regimen. Side-effects on antiretroviral treatment used for PEP were common and only about three-quarters of the students completed the course. Conclusions: We recommend targeted training, especially in the senior years, together with improving the work environment through attention to working hours, sharps disposal and ready availability of safety devices, improved reporting systems, individualised PEP, and possibly the implementation of an occupational injury support line.
28
Hrdina, Chad M., C. Norman Coleman, Sandy Bogucki, Judith L. Bader, Robert E. Hayhurst, Joseph D. Forsha, David Marcozzi, Kevin Yeskey, and Ann R. Knebel. "The “RTR” Medical Response System for Nuclear and Radiological Mass-Casualty Incidents: A Functional TRiage-TReatment-TRansport Medical Response Model." Prehospital and Disaster Medicine 24, no. 3 (June 2009): 167–78. http://dx.doi.org/10.1017/s1049023x00006774.
Full textAbstract:
AbstractDeveloping a mass-casualty medical response to the detonation of an improvised nuclear device (IND) or large radiological dispersal device (RDD) requires unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. In order for medical care and resources to be collocated and matched to the requirements, a [US] Federal interagency medical response-planning group has developed a conceptual approach for responding to such nuclear and radiological incidents. The “RTR” system (comprising Radiation-specific TRiage, TReatment, TRansport sites) is designed to support medical care following a nuclear incident. Its purpose is to characterize, organize, and efficiently deploy appropriate materiel and personnel assets as close as physically possible to various categories of victims while preserving the safety of responders. The RTR system is not a medical triage system for individual patients. After an incident is characterized and safe perimeters are established, RTR sites should be determined in real-time that are based on the extent of destruction, environmental factors, residual radiation, available infrastructure, and transportation routes. Such RTR sites are divided into three types depending on their physical/situational relationship to the incident. The RTR1 sites are near the epicenter with residual radiation and include victims with blast injuries and other major traumatic injuries including radiation exposure; RTR2 sites are situated in relationship to the plume with varying amounts of residual radiation present, with most victims being ambulatory; and RTR3 sites are collection and transport sites with minimal or no radiation present or exposure risk and a victim population with a potential variety of injuries or radiation exposures. Medical Care sites are predetermined sites at which definitive medical care is given to those in immediate need of care. They include local/regional hospitals, medical centers, other sites such as nursing homes and outpatient clinics, nationwide expert medical centers (such as cancer or burn centers), and possible alternate care facilities such as Federal Medical Stations. Assembly Centers for displaced or evacuating persons are predetermined and spontaneous sites safely outside of the perimeter of the incident, for use by those who need no immediate medical attention or only minor assistance. Decontamination requirements are important considerations for all RTR, Medical Care, and Assembly Center sites and transport vehicles. The US Department of Health and Human Services is working on a long-term project to generate a database for potential medical care sites and assembly centers so that information is immediately available should an incident occur.
29
Al-Wathinani, Ahmed, Attila J. Hertelendy, Abdulmajeed M. Mobrad, Riyadh Alhazmi, Saqer Althunayyan, Michael S. Molloy, and Krzysztof Goniewicz. "Emergency Medical Providers’ Knowledge Regarding Disasters during Mass Gatherings in Saudi Arabia." Sustainability 13, no. 6 (March 18, 2021): 3342. http://dx.doi.org/10.3390/su13063342.
Full textAbstract:
The Hajj is a recurring annual mass gathering event with over three million attendants taking place at the same site for six days. During such events, major incidents and disasters can occur. It is crucial that Emergency Medical Services providers are sufficiently trained regarding disaster preparedness to respond appropriately. EMS-providers of the Saudi Red Crescent Authority who worked during the Hajj in 2016 were asked to complete a web-based survey, utilizing predetermined responses with 5-point Likert scale responses. Seven hundred respondents identified real disasters as the most common source of information about disaster preparedness and also indicated that a disaster management course was the most desired course for improving knowledge. The study has also highlighted a list of Life Support Courses providers feel should be offered as part of a disaster response training package. These findings highlight the importance of continuing education, which may be obtained through short, focused courses, or for small numbers of specialists through higher educational degrees, such as masters or doctorates. This study also examines the importance of media and its impact on increasing knowledge and awareness for EMS-providers. Consideration should be given to pairing novice providers with experienced personnel to disseminate knowledge and practical experience during Hajj missions. Simulated disaster drilling should be considered to introduce novices to the stress of mass casualty disaster response.
30
Wake, Deborah J., Fraser W. Gibb, Partha Kar, Brian Kennon, David C. Klonoff, Gerry Rayman, Martin K. Rutter, Chris Sainsbury, and Robert K. Semple. "ENDOCRINOLOGY IN THE TIME OF COVID-19: Remodelling diabetes services and emerging innovation." European Journal of Endocrinology 183, no. 2 (August 2020): G67—G77. http://dx.doi.org/10.1530/eje-20-0377.
Full textAbstract:
The COVID-19 pandemic is a major international emergency leading to unprecedented medical, economic and societal challenges. Countries around the globe are facing challenges with diabetes care and are similarly adapting care delivery, with local cultural nuances. People with diabetes suffer disproportionately from acute COVID-19 with higher rates of serious complications and death. In-patient services need specialist support to appropriately manage glycaemia in people with known and undiagnosed diabetes presenting with COVID-19. Due to the restrictions imposed by the pandemic, people with diabetes may suffer longer-term harm caused by inadequate clinical support and less frequent monitoring of their condition and diabetes-related complications. Outpatient management need to be reorganised to maintain remote advice and support services, focusing on proactive care for the highest risk, and using telehealth and digital services for consultations, self-management and remote monitoring, where appropriate. Stratification of patients for face-to-face or remote follow-up should be based on a balanced risk assessment. Public health and national organisations have generally responded rapidly with guidance on care management, but the pandemic has created a tension around prioritisation of communicable vs non-communicable disease. Resulting challenges in clinical decision-making are compounded by a reduced clinical workforce. For many years, increasing diabetes mellitus incidence has been mirrored by rising preventable morbidity and mortality due to complications, yet innovation in service delivery has been slow. While the current focus is on limiting the terrible harm caused by the pandemic, it is possible that a positive lasting legacy of COVID-19 might include accelerated innovation in chronic disease management.
31
Basnet, Anupama, Bijay Thapa, Prativa Dhoubadel, and Anuj Kayastha. "Five years experiences in diagnosis and management of jejuno-ileal atresia in Kanti children’s hospital." Journal of Society of Surgeons of Nepal 23, no. 2 (December 31, 2020): 4–8. http://dx.doi.org/10.3126/jssn.v23i2.35794.
Full textAbstract:
Introduction: Jejuno-ileal atresia is a major cause of neonatal intestinal obstruction. The aim of this study is to evaluate the incidence, clinical presentation, management, and outcome of jejunoileal atresia at our institute over a period of five years.
Methods: The medical records of the patients with the diagnosis of jejunoileal atresia during a period of five years (April 2014 to April 2019) were obtained from the hospital record section and surgical intensive care unit, and were reviewed and analyzed.
Results: There were 61 cases of jejunoileal atresia among 144 cases of intestinal atresia. Twenty-nine (47.5%) of them were male. Laparotomy with resection of atretic part with anti-mesenteric tapering enteroplasty and end to end anastomosis was done in 15, and resection without tapering enteroplasty with end to end anastomosis was done in 39 patients. Thirty-eight patients (62.3%) were discharged while Twenty-three (37.7%) cases were lost to mortality.
Conclusions: Although the mortality and morbidity rate are high in jejunoileal atresia, early diagnosis, improvement in surgical technique, modern ventilatory support and advanced in intensive care unit has led to the significant increase in the survival rate.
32
Haraguchi, Yoshikura, Yozo Tomoyasu, Tohru Tsubata, Tetsu Ishihara, Motohiro Sakai, and Iyasu Nagata. "Medical Measurement Against the Mega-Disaster: The Necessity of Systematization of the Disaster Medicine or the Disaster Medicine Compendium." Prehospital and Disaster Medicine 34, s1 (May 2019): s149—s150. http://dx.doi.org/10.1017/s1049023x19003340.
Full textAbstract:
Introduction:The large number of casualties during major or mega-disasters are a global problem.Aim:The role of medicine against mega-disasters is analyzed from a worldwide perspective.Methods:Chernobyl incident, the Tokyo Subway Sarin Attack, the 9-11 attack, the Indian Ocean earthquake/tsunami, Hurricane Katrina, the Flu pandemic, the Higashi Nihon Earthquake followed by the Fukushima nuclear plant incident, etc. are critically analyzed, based on the actual medical experiences.Results:These mega-disasters often have a wide, severe negative influence. Linked catastrophes often form catastrophic circulus vitiosus (CCV) or malignant cycles on a global scale. The typical example is the Chernobyl incident which caused not only many deaths by radiation exposure/thyroid cancer and world anxiety, but also is considered to have contributed to the end of the Eastern European Communism system in 1989 (East Germany) and 1991 (ESSR).Discussion:Many roles of medical doctors and staff were requested, including creating preventive life-saving systems, in addition to the prevention of mega-disaster measurement to minimize the unhappiness. Moreover, medical ethics and philosophy are important, which were often overlooked. It is necessary for medical care and support to have a broad perspective. Although the classical philosophy of utilitarianism is often accepted without suspicion, it comes with the risk of disregarding vulnerable/weak people. The concept of justice according to John Rawls (USA) and the Minimal Unhappiness Theory by Naoto Kan (Japanese politician) should be considered, too. From such viewpoints, it is our conclusion to urge the establishment of systematic disaster medicine or to compile a disaster medicine compendium. Although the tentative first version was compiled with 22 volumes in 2005, only one-fourth was available in English. The English part increased up to nearly three-fourths by adding several new versions in which the nuclear/biological/chemical hazard version, tsunami measurement, and psychological care version are included at the moment.
33
Baker, David. "Civilian Exposure to Toxic Agents: Emergency Medical Response." Prehospital and Disaster Medicine 19, no. 2 (June 2004): 174–78. http://dx.doi.org/10.1017/s1049023x00001709.
Full textAbstract:
AbstractCivilian populations are at risk from exposure to toxic materials as a result of accidental or deliberate exposure. In addition to industrial hazards, toxic agents designed for use in warfare now are a potential hazard in everyday life through terrorist action. Civil emergency medical responders should be able to adapt their plans for dealing with casualties from hazardous materials (HazMat) to deal with the new threat.Chemical and biological warfare (CBW) and HazMat agents can be viewed as a continuous spectrum. Each of these hazards is characterized by qualities of toxicity, latency of action, persistency, and transmissibility. The incident and medical responses to release of any agent is determined by these characteristics.Chemical and biological wardare agents usually are classified as weapons of mass destruction, but strictly, they are agents of mass injury. The relationship between mass injury and major loss of life depends very much on the protection, organization, and emergency care provided.Detection of a civil toxic agent release where signs and symptoms in casualties may be the first indicator of exposure is different from the military situation where intelligence information and tuned detection systems generally will be available.It is important that emergency medical care should be given in the context of a specific action plan. Within an organized and protected perimeter, triage and decontamination (if the agent is persistent) can proceed while emergency medical care is provided at the same time.The provision of advanced life support (TOXALS) in this zone by protected and trained medical responders now is technically feasible using specially designed ventilation equipment. Leaving life support until after decontamination may have fatal consequences. Casualties from terrorist attacks also may suffer physical as well as toxic trauma and the medical response also should be capable of dealing with mixed injuries.
34
Blumenthal, Daniel J., Judith L. Bader, Doran Christensen, John Koerner, John Cuellar, Sidney Hinds, John Crapo, Erik Glassman, A. Bradley Potter, and Lynda Singletary. "A Sustainable Training Strategy for Improving Health Care Following a Catastrophic Radiological or Nuclear Incident." Prehospital and Disaster Medicine 29, no. 1 (February 2014): 80–86. http://dx.doi.org/10.1017/s1049023x1400003x.
Full textAbstract:
AbstractThe detonation of a nuclear device in a US city would be catastrophic. Enormous loss of life and injuries would characterize an incident with profound human, political, social, and economic implications. Nevertheless, most responders have not received sufficient training about ionizing radiation, principles of radiation safety, or managing, diagnosing, and treating radiation-related injuries and illnesses. Members throughout the health care delivery system, including medical first responders, hospital first receivers, and health care institution support personnel such as janitors, hospital administrators, and security personnel, lack radiation-related training. This lack of knowledge can lead to failure of these groups to respond appropriately after a nuclear detonation or other major radiation incident and limit the effectiveness of the medical response and recovery effort. Efficacy of the response can be improved by getting each group the information it needs to do its job. This paper proposes a sustainable training strategy for spreading curricula throughout the necessary communities. It classifies the members of the health care delivery system into four tiers and identifies tasks for each tier and the radiation-relevant knowledge needed to perform these tasks. By providing education through additional modules to existing training structures, connecting radioactive contamination control to daily professional practices, and augmenting these systems with just-in-time training, the strategy creates a sustainable mechanism for giving members of the health care community improved ability to respond during a radiological or nuclear crisis, reducing fatalities, mitigating injuries, and improving the resiliency of the community.BlumethalD, BaderJ, ChristensenD, KoernerJ, CuellarJ, HindsS, CrapoJ, GlassmanES, PotterAB, SingletaryL. A sustainable training strategy for improving health care following a catastrophic radiological or nuclear incident. Prehosp Disaster Med. 2014;29(1):80-86.
35
Coleman, C. Norman, Monique K. Mansoura, Maria Julia Marinissen, Surbhi Grover, Manjit Dosanjh, Harmar D. Brereton, Lawrence Roth, Eugenia Wendling, David A. Pistenmaa, and Donna M. O'Brien. "Achieving flexible competence: bridging the investment dichotomy between infectious diseases and cancer." BMJ Global Health 5, no. 12 (December 2020): e003252. http://dx.doi.org/10.1136/bmjgh-2020-003252.
Full textAbstract:
Today’s global health challenges in underserved communities include the growing burden of cancer and other non-communicable diseases (NCDs); infectious diseases (IDs) with epidemic and pandemic potential such as COVID-19; and health effects from catastrophic ‘all hazards’ disasters including natural, industrial or terrorist incidents. Healthcare disparities in low-income and middle-income countries and in some rural areas in developed countries make it a challenge to mitigate these health, socioeconomic and political consequences on our globalised society. As with IDs, cancer requires rapid intervention and its effective medical management and prevention encompasses the other major NCDs. Furthermore, the technology and clinical capability for cancer care enables management of NCDs and IDs. Global health initiatives that call for action to address IDs and cancer often focus on each problem separately, or consider cancer care only a downstream investment to primary care, missing opportunities to leverage investments that could support broader capacity-building. From our experience in health disparities, disaster preparedness, government policy and healthcare systems we have initiated an approach we call flex-competence which emphasises a systems approach from the outset of program building that integrates investment among IDs, cancer, NCDs and disaster preparedness to improve overall healthcare for the local community. This approach builds on trusted partnerships, multi-level strategies and a healthcare infrastructure providing surge capacities to more rapidly respond to and manage a wide range of changing public health threats.
36
Ulsa, Ma Cherrysse, Xi Zheng, Peng Li, Kun Hu, and Lei Gao. "547 Earlier-life sleep patterns and risk for delirium in elderly hospitalized patients from a 14-year longitudinal cohort." Sleep 44, Supplement_2 (May 1, 2021): A215—A216. http://dx.doi.org/10.1093/sleep/zsab072.545.
Full textAbstract:
Abstract Introduction Delirium is an acute decline in attention and cognition that is associated with cognitive dysfunction in elderly patients. While accumulating evidence points to associations between sleep disturbances and neurocognitive disorders, the temporal relationship between sleep patterns and delirium remains unclear. We tested whether earlier-life sleep duration, daytime dozing, insomnia, and sleep apnea predict incident delirium during hospitalization. Methods We studied 315,989 participants (mean age 58.3±7.9; range 37.4–73.7) from the UK Biobank with up to 14 years follow-up, and at least one hospitalization episode. Delirium diagnosis was derived using ICD-10 coding from hospitalization records. Multivariate logistic regression models examined the associations of self-reported baseline sleep duration (less than 6h/6-9h/more than 9h), daytime dozing (often/rarely), insomnia (often/rarely), and presence of prior sleep apnea (ICD-10), with incident delirium. Models were adjusted for age, sex, education, Townsend deprivation index, and major confounders (including number of hospitalizations during follow-up, BMI, neurological/cardiovascular/respiratory diseases, depression/anxiety, chronotype, and sedatives). Results 4,025 developed delirium (12.7/1,000). There was a U-shaped association between sleep duration and delirium, where short [17.3/1,000; OR 1.18, 95% CI: 1.05–1.33, p=0.006] and long (28.8/1,000; OR 1.49, 95% CI: 1.30–1.70, p<0.001) sleepers had elevated risk compared to regular 6-9h sleepers. Often daytime dozing (25.3/1,000; OR 1.38, 95% CI: 1.20–1.58, p<0.001) and sleep apnea (21.7/1,000; OR 1.21, 95% CI: 1.03–1.42 p=0.02) also had increased the risk for delirium, but the latter was attenuated by the inclusion of BMI and hypertension. However, we did observe further risk when two or more of the above traits were present (OR 1.59, 95% CI: 1.29–1.95 p<0.001). No effects on incident delirium were observed from insomnia. Conclusion Earlier-life sleep patterns, in particular longer sleep and daytime dozing, are associated with an increased risk for delirium. Sleep patterns may reflect unmeasured health status; further work is warranted to confirm the associations using objective sleep/circadian measures, examine underlying mechanisms, and test whether optimizing sleep patterns can reduce the risk of developing delirium. Support (if any) NIH [T32GM007592 and R03AG067985 to L.G. RF1AG059867, RF1AG064312, to K.H.], the BrightFocus Foundation A2020886S to P.L. and the Foundation of Anesthesia Education and Research MRTG-02-15-2020 to L.G.
37
Hakim, HA Nazmul, Kazi Mazharul Islam, Md Aminul Islam, ANM Nure Azam, Md Tuhin Talukder, and Mohammad Mahmud Sarder. "Outcome and management strategy of traumatic liver injury in a tertiary hospital in Bangladesh." Journal of Surgical Sciences 22, no. 1 (March 22, 2020): 36–42. http://dx.doi.org/10.3329/jss.v22i1.44013.
Full textAbstract:
Background: Liver remains the second most common injured organ in both blunt and penetrating trauma of the abdomen. Management of blunt or penetrating injury to the liver remains a significant challenge to trauma surgeons. Unstable patients require immediate laparotomy. Selective patients can be managed without surgery and with careful monitoring. Mortality is mainly due to damage to major hepatic blood vessels, massive parenchymal and biliary injury. Associated non-hepatic injuries contribute greatly to the overall mortality. With improved understanding of the major causes of mortality from hepatic injury, adequate resuscitation, well planned surgical intervention and better intensive care facilities have decreased mortality and morbidity
Objectives: Performed to assess incidence, mechanisms, management and outcome of traumatic liver injury. Methods: This prospective study was performed in Dhaka Medical College Hospital between January 2013 to December 2014. Sixty patients with hepatic injury were included in the study. Data collected in data collection sheet regarding demographic data, severity of liver injury, hemodynamic status on admission, investigations reports, concomitant injuries, management scheme, and outcome of patients which were then analyzed.
Results: There were 39 male and 21 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (71%). 20 patients (33%) were in shock at the time of admission. 48 patients (80%) with liver injury had associated injuries of other organs. Majority of the patients (41%) were found with grade Ill injury. 50 patients (83%) needed surgical interventions. Most common (16%) complication was wound infection. 3 patients (5%) died in this series. 5 patients (8%) developed liver abscess on subsequent follow up. Conclusion: Most of the trauma victims are young and in the active state of life. Prompt resuscitative measures, assessment of extend of hepatic injury and associated injuries, well justified surgical intervention along with critical care support can contribute greatly to the survival of victims of hepatic injury.
Journal of Surgical Sciences (2018) Vol. 22 (1): 36-42
38
North, Carol S., Betty Pfefferbaum, Pushpa Narayanan, Samuel Thielman, Gretchen McCoy, Cedric Dumont, Aya Kawasaki, Natsuko Ryosho, and Edward L. Spitznagel. "Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City." British Journal of Psychiatry 186, no. 6 (June 2005): 487–93. http://dx.doi.org/10.1192/bjp.186.6.487.
Full textAbstract:
BackgroundAfrican disaster-affected populations are poorly represented in disaster mental health literature.AimsTo compare systematically assessed mental health in populations directly exposed to terrorist bombing attacks on two continents, North America and Africa.MethodStructured diagnostic interviews compared citizens exposed to bombings of the US Embassy in Nairobi, Kenya (n=227) and the Oklahoma City Federal Building (n=182).ResultsPrevalence rates of post-traumatic stress disorder (PTSD) and major depression were similar after the bombings. No incident (new since the bombing) alcohol use disorders were observed in either site. Symptom group C was strongly associated with PTSD in both sites. The Nairobi group relied more on religious support and the Oklahoma City group used more medical treatment, drugs and alcohol.ConclusionsPost-disaster psycho-pathology had many similarities in the two cultures; however, coping responses and treatment were quite different. The findings suggest potential for international generalisability of post-disaster psychopathology, but confirmatory studies are needed.
39
Aho-Glélé, L. S., H. Giraudon, K. Astruc, Z. Soltani, A. Lefebvre, P. Pothier, J. B. Bour, and C. Manoha. "Investigation of a Case of Genotype 5a Hepatitis C Virus Transmission in a French Hemodialysis Unit Using Epidemiologic Data and Deep Sequencing." Infection Control & Hospital Epidemiology 37, no. 2 (October 29, 2015): 134–39. http://dx.doi.org/10.1017/ice.2015.263.
Full textAbstract:
BACKGROUNDHepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. A patient was recently found to be HCV seropositive during hemodialysis follow-up.OBJECTIVETo determine whether nosocomial transmission had occurred and which viral populations were transmitted.DESIGNHCV transmission case.SETTINGA dialysis unit in a French hospital.METHODSMolecular and epidemiologic investigations were conducted to determine whether 2 cases were related. Risk analysis and auditing procedures were performed to determine the transmission pathway(s).RESULTSSequence analyses of the NS5b region revealed a 5a genotype in the newly infected patient. Epidemiologic investigations suggested that a highly viremic genotype 5a HCV-infected patient who underwent dialysis in the same unit was the source of the infection. Phylogenetic analysis of NS5b and hypervariable region-1 sequences revealed a genetically related virus (>99.9% nucleotide identity). Deep sequencing of hypervariable region-1 indicated that HCV quasispecies were found in the source whereas a single hypervariable region-1 HCV variant was found in the newly infected patient, and that this was identical to the major variant identified in the source patient. Risk analysis and auditing procedures were performed to determine the transmission pathway(s). Nosocomial patient-to-patient transmission via healthcare workers’ hands was the most likely explanation. In our dialysis unit, this unique incident led to the adjustment of infection control policy.CONCLUSIONSThe data support transmission of a unique variant from a source with a high viral load and genetic diversity. This investigation also underlines the need to periodically evaluate prevention and control practices.Infect. Control Hosp. Epidemiol.2016;37(2):134–139
40
Pilemalm, Sofie. "Using Security Guards and Civil Volunteers as First Responders in Medical Emergency Response - Tasks, Needs, and Challenges." Prehospital and Disaster Medicine 34, s1 (May 2019): s175—s176. http://dx.doi.org/10.1017/s1049023x19004035.
Full textAbstract:
Introduction:Public sector challenges have initiated new forms of collaboration between emergency response organizations, occupations from other societal sectors, and civil citizens, not the least in socio-economically vulnerable areas. As collaborations emerge, there is a need to explore the tasks, needs, and challenges of the new resources when providing medical emergency response.Aim:To explore two cases of 1) security guards and 2) organized civil volunteers collaborating with the ambulance services and municipal rescue services, and identifying relevant tasks, needs and challenges. The presentation will focus on their dispatch on medical alerts. A brief comparison of the two groups will also be performed.Methods:A case study approach was applied involving interviews and workshops with security guards, civil volunteers, ambulance services, and rescue services personnel.Results:The civil volunteers are dispatched on medical alerts concerning heart failures and accidents requiring first aid, including stopping major bleedings. The scope of tasks of security guards is broader since they are also dispatched on suicide and assault alerts. Needs in both cases include, e.g., proper training, joint exercises, equipment in terms of defibrillators, torquedos, and first aid kits, and proper ICT/GPS positioning support for dispatching. Challenges are mainly organizational and legal where security guards are somewhat protected by their own employer (e.g., through agreements, trauma support, and safety measures such as receiving a hepatitis vaccine) while civil volunteers do not have sufficient protection in any of these respects.Discussion:Both groups are useful resources in future medical emergency response since they are often close to the incident site and can provide first response while waiting for the professional resources, thereby saving lives and reducing consequences of trauma. However, they need to be better integrated into the professional emergency response system.
41
Holzmann, Patrick, Christian Wankmüller, Dietfried Globocnik, and Erich J. Schwarz. "Drones to the rescue? Exploring rescue workers' behavioral intention to adopt drones in mountain rescue missions." International Journal of Physical Distribution & Logistics Management 51, no. 4 (April 2, 2021): 381–402. http://dx.doi.org/10.1108/ijpdlm-01-2020-0025.
Full textAbstract:
PurposeMountaineering and related activities are increasingly becoming popular and are accompanied by an increase in medical incidents. Emergency operations in mountainous terrain are time-critical and often pose major logistical challenges for rescuers. Drones are expected to improve the operational performance of mountain rescuers. However, they are not yet widely used in mountain rescue missions. This paper examines the determinants that drive the behavioral intention of mountain rescuers to adopt drones in rescue missions.Design/methodology/approachThis is a behavioral study that builds upon an extended model of the unified theory of acceptance and use of technology (UTAUT) and investigates the relationship between individual attitudes, perceptions, and intentions for drone adoption. Original survey data of 146 mountain rescuers were analyzed using moderated ordinary least squares (OLS) regression analysis.FindingsResults indicate that the behavioral intention to use drones in mountain rescue missions is driven by the expected performance gains and facilitating conditions. Favorable supporting conditions and experience with drones further moderate the relationship between performance expectancy and behavioral intention. The effects for effort expectancy, social influence, and demonstrations were not significant.Practical implicationsRescue organizations and stakeholders are recommended to consider the identified determinants in the implementation of drones in emergency logistics. Drone manufacturers targeting mountain rescue organizations are advised to focus on operational performance, provide sufficient support and training, and promote the gathering of practical experience.Originality/valueA tailored-model that provides first empirical results on the relevance of personal and environmental factors for the acceptance of drones in emergency logistics is presented.
42
Elkhadragy, Nervana, Amanda P. Ifeachor, Julie B. Diiulio, Karen J. Arthur, Michael Weiner, Laura G. Militello, Peter A. Glassman, Alan J. Zillich, and Alissa L. Russ. "Medication decision-making for patients with renal insufficiency in inpatient and outpatient care at a US Veterans Affairs Medical Centre: a qualitative, cognitive task analysis." BMJ Open 9, no. 5 (May 2019): e027439. http://dx.doi.org/10.1136/bmjopen-2018-027439.
Full textAbstract:
BackgroundMany studies identify factors that contribute to renal prescribing errors, but few examine how healthcare professionals (HCPs) detect and recover from an error or potential patient safety concern. Knowledge of this information could inform advanced error detection systems and decision support tools that help prevent prescribing errors.ObjectiveTo examine the cognitive strategies that HCPs used to recognise and manage medication-related problems for patients with renal insufficiency.DesignHCPs submitted documentation about medication-related incidents. We then conducted cognitive task analysis interviews. Qualitative data were analysed inductively.SettingInpatient and outpatient facilities at a major US Veterans Affairs Medical Centre.ParticipantsPhysicians, nurses and pharmacists who took action to prevent or resolve a renal-drug problem in patients with renal insufficiency.OutcomesEmergent themes from interviews, as related to recognition of renal-drug problems and decision-making processes.ResultsWe interviewed 20 HCPs. Results yielded a descriptive model of the decision-making process, comprised of three main stages: detect, gather information and act. These stages often followed a cyclical path due largely to the gradual decline of patients’ renal function. Most HCPs relied on being vigilant to detect patients’ renal-drug problems rather than relying on systems to detect unanticipated cues. At each stage, HCPs relied on different cognitive cues depending on medication type: for renally eliminated medications, HCPs focused on gathering renal dosing guidelines, while for nephrotoxic medications, HCPs investigated the need for particular medication therapy, and if warranted, safer alternatives.ConclusionsOur model is useful for trainees so they can gain familiarity with managing renal-drug problems. Based on findings, improvements are warranted for three aspects of healthcare systems: (1) supporting the cyclical nature of renal-drug problem management via longitudinal tracking mechanisms, (2) providing tools to alleviate HCPs’ heavy reliance on vigilance and (3) supporting HCPs’ different decision-making needs for renally eliminated versus nephrotoxic medications.
43
Murugaiyan, Sivaji, Akshaya Rathin Sivaji, A. Marian Jude Vijay, Indumathi Sundaramurthi, and Jawahar Marimuthu. "A study on prevalence of various mood disorders in patients with multiple sclerosis in South Indian population Chennai, Tamil Nadu." International Journal of Research in Medical Sciences 9, no. 5 (April 28, 2021): 1301. http://dx.doi.org/10.18203/2320-6012.ijrms20211439.
Full textAbstract:
Background: The prevalence of depressive disorders are more common in demyelination diseases like multiple sclerosis. Patients with multiple sclerosis have higher rates of depressive episodes than the general population. It is found that 40-50% incidence reported in many number of previous research studies .The aim is to study the prevalence of various depressive disorders in multiple sclerosis (MS) patient population.Methods: 176 MS patients were randomly selected from neurology outpatient department (OPD) of Tamil Nadu Government Multi Super Specialty Hospital and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, from September 2018 to December 2019. 128 patients were analyzed with the following methods of examinations such as the structured psychiatric clinical interview with diagnostic and statistical manual of mental disorders (DSM)-5 and international classification of diseases (ICD)-10 criteria, Hamilton depression rating scale (HAM-D) scale.Results: Various subtypes of mood disorders were found as follows major depressive disorder (MDD)-4%, MDD with anxiety-6%, pervasive developmental disorders (PDD) mixed-4%, premenstrual dysphoric disorder (PMDD)-8%, MIDD-2% and depressive disorders due to general medical conditions (secondary depression)-22%. In this present study 46% of the MS population were diagnosed with various depressive illness.Conclusions: Early identification and treatment of depressive disorders definitely favour the outcome of MS patients. The coping skills and good social support system play a vital role in the outcome of depressive disorders in MS population in addition to psychopharmacological management.
44
Lin, Cheng-Wei, David G. Armstrong, Chia-Hung Lin, Pi-Hua Liu, Shih-Yuan Hung, Shu-Ru Lee, Chung-Huei Huang, and Yu-Yao Huang. "Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period." BMJ Open Diabetes Research & Care 7, no. 1 (October 2019): e000795. http://dx.doi.org/10.1136/bmjdrc-2019-000795.
Full textAbstract:
ObjectiveTo study the prevalence and trends of lower extremity complications of diabetes over an 8-year period in a single nation.Research design and methodsNationwide data for people with type 2 diabetes (T2D) and diabetic foot complications (DFCs) were analyzed over an 8-year period (2007–2014) from National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision disease coding. The DFCs were defined as ulcers, infections, gangrene, and hospitalization for peripheral arterial disease (PAD). Trends of patient characteristics, foot presentation, and the execution of major procedures were studied, including lower-extremity amputations (LEAs).ResultsAlong with the T2D population increasing over time, the absolute number of people with DFCs increased by 33.4%, but retained a prevalence of around 2% per year. The annual incident of LEAs decreased from 2.85 to 2.06 per 1000 T2D population (p=0.001) with the major LEA proportion decreasing from 56.2% to 47.4% (p<0.001).The mean age of patients increased from 65.3 to 66.3 years and most of the associated comorbidities of diabetes were increased. For example, end-stage renal disease increased from 4.9% to 7.7% (p=0.008). The incidence of gangrene on presentation decreased from 14.7% to 11.3% (p<0.001) with a concomitant increase in vascular interventions (6.2% to 19.5%, p<0.001).ConclusionsDFCs remain a sustained major medical problem. These nationwide long-term data suggest trends toward older people with greater comorbidities such as PAD and renal disease. Nevertheless, promising trends of reducing gangrene on presentation paired with increases in vascular interventions support continued vigilance and rapid, coordinated interdisciplinary diabetic foot care.
45
Jortani, Saeed A., James W. Snyder, and Roland Valdes Jr. "The Role of the Clinical Laboratory in Managing Chemical or Biological Terrorism." Clinical Chemistry 46, no. 12 (December 1, 2000): 1883–93. http://dx.doi.org/10.1093/clinchem/46.12.1883.
Full textAbstract:
Abstract Background: Domestic and international acts of terrorism using chemicals and pathogens as weapons have recently attracted much attention because of several hoaxes and real incidents. Clinical laboratories, especially those affiliated with major trauma centers, should be prepared to respond rapidly by providing diagnostic tests for the detection and identification of specific agents, so that specific therapy and victim management can be initiated in a timely manner. As first-line responders, clinical laboratory personnel should become familiar with the various chemical or biological agents and be active participants in their local defense programs. Approach: We review the selected agents previously considered or used in chemical and biological warfare, outline their poisonous and pathogenic effects, describe techniques used in their identification, address some of the logistical and technical difficulties in maintaining such tests in clinical laboratories, and comment on some of the analytical issues, such as specimen handling and personal protective equipment. Content: The chemical agents discussed include nerve, blistering, and pulmonary agents and cyanides. Biological agents, including anthrax and smallpox, are also discussed as examples for organisms with potential use in bioterrorism. Available therapies for each agent are outlined to assist clinical laboratory personnel in making intelligent decisions regarding implementation of diagnostic tests as a part of a comprehensive defense program. Summary: As the civilian medical community prepares for biological and chemical terrorist attacks, improvement in the capabilities of clinical laboratories is essential in supporting counterterrorism programs designed to respond to such attacks. Accurate assessment of resources in clinical laboratories is important because it will provide local authorities with an alternative resource for immediate diagnostic analysis. It is, therefore, recommended that clinical laboratories identify their current resources and the extent of support they can provide, and inform the authorities of their state of readiness.
46
Lin, Michael, Mary Carl Froilan, Jinal Makhija, Ellen Benson, Sarah Bartsch, Pamela B. Bell, Stephanie Black, et al. "Regional Impact of a CRE Intervention Targeting High Risk Postacute Care Facilities (Chicago PROTECT)." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s48—s49. http://dx.doi.org/10.1017/ice.2020.531.
Full textAbstract:
Background: Carbapenem-resistant Enterobacteriaceae (CRE) are endemic in the Chicago region. We assessed the regional impact of a CRE control intervention targeting high-prevalence facilities; that is, long-term acute-care hospitals (LTACHs) and ventilator-capable skilled nursing facilities (vSNFs). Methods: In July 2017, an academic–public health partnership launched a regional CRE prevention bundle: (1) identifying patient CRE status by querying Illinois’ XDRO registry and periodic point-prevalence surveys reported to public health, (2) cohorting or private rooms with contact precautions for CRE patients, (3) combining hand hygiene adherence, monitoring with general infection control education, and guidance by project coordinators and public health, and (4) daily chlorhexidine gluconate (CHG) bathing. Informed by epidemiology and modeling, we targeted LTACHs and vSNFs in a 13-mile radius from the coordinating center. Illinois mandates CRE reporting to the XDRO registry, which can also be manually queried or generate automated alerts to facilitate interfacility communication. The regional intervention promoted increased automation of alerts to hospitals. The prespecified primary outcome was incident clinical CRE culture reported to the XDRO registry in Cook County by month, analyzed by segmented regression modeling. A secondary outcome was colonization prevalence measured by serial point-prevalence surveys for carbapenemase-producing organism colonization in LTACHs and vSNFs. Results: All eligible LTACHs (n = 6) and vSNFs (n = 9) participated in the intervention. One vSNF declined CHG bathing. vSNFs that implemented CHG bathing typically bathed residents 2–3 times per week instead of daily. Overall, there were significant gaps in infection control practices, especially in vSNFs. Also, 75 Illinois hospitals adopted automated alerts (56 during the intervention period). Mean CRE incidence in Cook County decreased from 59.0 cases per month during baseline to 40.6 cases per month during intervention (P < .001). In a segmented regression model, there was an average reduction of 10.56 cases per month during the 24-month intervention period (P = .02) (Fig. 1), and an estimated 253 incident CRE cases were averted. Mean CRE incidence also decreased among the stratum of vSNF/LTACH intervention facilities (P = .03). However, evidence of ongoing CRE transmission, particularly in vSNFs, persisted, and CRE colonization prevalence remained high at intervention facilities (Table 1). Conclusions: A resource-intensive public health regional CRE intervention was implemented that included enhanced interfacility communication and targeted infection prevention. There was a significant decline in incident CRE clinical cases in Cook County, despite high persistent CRE colonization prevalence in intervention facilities. vSNFs, where understaffing or underresourcing were common and lengths of stay range from months to years, had a major prevalence challenge, underscoring the need for aggressive infection control improvements in these facilities.Funding: The Centers for Disease Control and Prevention (SHEPheRD Contract No. 200-2011-42037)Disclosures: M.Y.L. has received research support in the form of contributed product from OpGen and Sage Products (now part of Stryker Corporation), and has received an investigator-initiated grant from CareFusion Foundation (now part of BD).
47
Ramachandran, Karthik, K. K. Arvind Manoj, and A. Vishnu Sankar. "Critical analysis of factors determining mechanical failures in proximal femoral nailing." International Journal of Research in Orthopaedics 5, no. 2 (February 23, 2019): 275. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20190504.
Full textAbstract:
<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures are one of the commonest fractures encountered in elderly population. Though there are various implants, proximal femoral nail has been the standard choice for management of unstable fractures. Inspite of its biomechanical advantages, various complications like screw cut out, Z effect, reverse Z effect does occur in proximal femoral nailing. The aim of the study is to analyse various factors determining the mechanical failures in patients operated with proximal femoral nail.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study conducted in our institution from June 2014 to May 2018. The study included 72 patients with unstable intertrochanteric fractures treated with proximal femoral nail. All patients were followed for average period of 2 years. Functional outcome was assessed using Harris Hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the patients<strong> </strong>33%<strong> </strong>had excellent outcome. 42% had good and 14% had fair outcome. 11% of cases ended with poor outcome. Mechanical failure rate was less in patients with positive medial cortical support (PMCS) and in patients with tip apex distance difference between antirotation screw and lag screw (TAD<sub>AR </sub>-TAD<sub>LS</sub>) more than 15 mm. Whereas the difference in the position of lag screw centre had no significant influence in the mechanical failure rate in our study.</p><p class="abstract"><strong>Conclusions:</strong> From our study we like to conclude that the<strong> </strong>fracture reduction with positive medial cortical support and the TAD difference play a major role in determining the incidence of mechanical failure in proximal femoral nailing.</p>
48
Christiansen, Nanna, Tayyaba Javid, Jasper Thomson, Heather Calvert, and Olapeju Bolarinwa. "P29 Impact of a medicines facilitation pharmacist on a paediatric ward." Archives of Disease in Childhood 103, no. 2 (January 19, 2018): e2.32-e2. http://dx.doi.org/10.1136/archdischild-2017-314585.38.
Full textAbstract:
AimRecruiting sufficient numbers of nurses can provide a challenge for hospitals. Pharmacists have been identified as being able to support nurses by taking on medicines management tasks alongside traditional nursing responsibilities such as medicines administration and discharge planning.1 At Barts Health NHS Trust there was increased pressure on nursing staff particularly on one of the complex medical wards during the winter pressure months. Paediatric pharmacists were identified as being able to support nurse:Safe nursing time by taking on some of nursing responsibilitiesActive discharge planning and coordinationReduce discharge prescription waiting timesImprove education and training for nurses, doctors and patients in relation to medicines management.MethodA pilot project on one paediatric medical ward was started in February 2016. The pharmacist is supernumerary to standard ward pharmacy service, reporting to the ward manager and lead pharmacist. Working hours are 9 am–5 pm Monday to Friday.Intensive training was provided over 2.5 weeks with subsequent sign off for administration of oral medication, 2nd checking for intravenous (IV) medication and IV giving.Drug listing for discharge prescription (TTA) was introduced, which involves a discussion with the doctor for medicines on discharge, transcribing these onto the TTA and using ward based dispensing where possible. Results were collected pre and post implementation.ResultsMedication administration activity:Nurse time – 60 hours/month (medication administration and 2nd checking) saved.Discharge information:Proportion of TTAs dispensed at ward level increased from 19% to 78% post implementation, avoiding delays in dispensary.Average time writing TTA to being ready for discharge reduced from 280 min to 91 min.Drug listing reduced discharge time further to 52 min.Missed and delayed doses:Random sample of 5 patients audited over 48 hour period, shown to reduce missed doses from 14% to 0%.Comments from staff:‘Because of skill mix and use of agency staff, assisting in preparing and giving IVABs has been a major help as on many days only 1 IV giver.’‘Junior staff value and support WFP and have felt has been useful to them.’‘Junior and agency staff feels better supported in understanding medicines usage’.‘Lot of complex patients with many drugs, the pharmacist has helped reducing delay in administration times’.‘TTAs for patients identified as going home have been validated sooner’.‘She helped us to reduce the number of incidents with expiry dates of medicines’.ConclusionThe role of the medicines facilitation pharmacist has been very well received by the nursing staff and the pharmacist is now an integral part of the ward team. The pharmacist was able to save a significant amount of nursing time and reduced risks of delayed and missed doses significantly and is able to provide continuous input into all aspects of medicines management. The average discharge time has reduced to substantially due to improved discharge planning, drug listing and ward based dispensing.ReferenceRobinson S. Hospital hires pharmacists for wards amid nurse shortage. Pharmaceutical Journal 23/30 May 2015;294(7863/4). [online] doi:10.1211/PJ.2015.20068544
49
Preum, Sarah Masud, Sile Shu, Homa Alemzadeh, and John A. Stankovic. "EMSContExt: EMS Protocol-Driven Concept Extraction for Cognitive Assistance in Emergency Response." Proceedings of the AAAI Conference on Artificial Intelligence 34, no. 08 (April 3, 2020): 13350–55. http://dx.doi.org/10.1609/aaai.v34i08.7048.
Full textAbstract:
This paper presents a technique for automated curation of a domain-specific knowledge base or lexicon for resource-constrained domains, such as Emergency Medical Services (EMS) and its application to real-time concept extraction and cognitive assistance in emergency response. The EMS responders often verbalize critical information describing the situations at an incident scene, including patients' physical condition and medical history. Automated extraction of EMS protocol-specific concepts from responders' speech data can facilitate cognitive support through the selection and execution of the proper EMS protocols for patient treatment. Although this task is similar to the traditional NLP task of concept extraction, the underlying application domain poses major challenges, including low training resources availability (e.g., no existing EMS ontology, lexicon, or annotated EMS corpus) and domain mismatch. Hence, we develop EMSContExt, a weakly-supervised concept extraction approach for EMS concepts. It utilizes different knowledge bases and a semantic concept model based on a corpus of over 9400 EMS narratives for lexicon expansion. The expanded EMS lexicon is then used to automatically extract critical EMS protocol-specific concepts from real-time EMS speech narratives. Our experimental results show that EMSContExt achieves 0.85 recall and 0.82 F1-score for EMS concept extraction and significantly outperforms MetaMap, a state-of-the-art medical concept extraction tool. We also demonstrate the application of EMSContExt to EMS protocol selection and execution and real-time recommendation of protocol-specific interventions to the EMS responders. Here, EMSContExt outperforms MetaMap with a 6% increase and six times speedup in weighted recall and execution time, respectively.
50
Pacholewicz, Jerzy, Wiktor Kuliczkowski, Jacek Kaczmarski, Michał Zakliczyński, Marcin Garbacz, Marian Zembala, and Victor Serebruany. "Activated Hemostatic Biomarkers in Patients with Implanted Left Ventricle Assist Devices: Are Heparin and/or Clopidogrel Justified?" Cardiology 131, no. 3 (2015): 172–76. http://dx.doi.org/10.1159/000375232.
Full textAbstract:
Background: Adequate anticoagulation represents a major problem for left ventricle assist device (LVAD) utilization in patients awaiting heart transplantation as well as for regeneration of the native heart. The proper management of hemostatic abnormalities during LVAD support may improve survival by reducing the incidence of hemorrhagic and/or thromboembolic complications. Case Report: A 40-year-old man with implanted pulsatile LVAD due to dilated cardiomyopathy received aspirin and warfarin. The patient underwent serial weekly monitoring of hemostatic biomarkers including international normalization ratio, prothrombin time, prothrombin activity, activated partial thromboplastin time, fibrinogen, D-dimer, platelet aggregation induced by adenosine diphosphate and arachidonic acid, platelet count, and mean platelet volume. The external pump was exchanged three times - twice because of a clot formation in the blood chamber of the pump, and once according to the standard protocol. Results: LVAD use was consistently associated with enhanced adenosine diphosphate-induced platelet aggregation independent from the timing of clot formation or external pump exchange. Among coagulation indices, increased D-dimer holds predictive value for clot formation. The fibrinogen level peaked before the first pump exchange and was twice as high than the average values. Gradual improvement in exercise capacity was observed 2 years after implantation, after which the patient underwent a controlled stress test in the stop mode of the LVAD and the device was successfully explanted. Conclusions: Serial assessment of hemostatic biomarkers may benefit and triage LVAD patients. Consistent platelet activation during long-term LVAD may justify the addition of clopidogrel, while high D-dimer and/or elevated fibrinogen may indicate adding heparin to the conventional antithrombotic regimen. Randomized evidence is needed to test such a hypothesis.