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Dissertations / Theses on the topic 'Pre-hospital'
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1
Lockey, D. J. "Pre-hospital trauma interventions." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1416433/.
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Considerable variation exists in the type and quality of interventions carried out on victims of major trauma in the pre-hospital phase of care. One model of care consists of high level interventions delivered by a doctor-led team. Examining two controversial areas of treatment (traumatic cardiac arrest and advanced airway management), this thesis set out to determine the quality and potential shortfalls of current practice and how they might be improved. A systematic review of traumatic cardiac arrest survival confirmed that outcome was historically very poor. A study of the largest series of traumatic cardiac arrest reported to date then suggested that a doctor –led system was associated with survival rates which were greater, and which were compatible with those after medical cardiac arrest. A significant proportion of survivors were victims of penetrating trauma who had been treated with on-scene thoracotomy. I thus examined the use, success rate and place of this intervention through analysis of the only reported case series. Finally, I considered how new or established interventions might be best applied in the early phase of trauma care to improve outcome, proposing a treatment algorithm to guide current management. Advanced airway management is presented as a controversial subject with uncertainty about who should deliver it and how it should be performed. The data presented demonstrates that, in a UK system ambulance service, interventions fail to deliver adequate airway care to trauma victims. In terms of doctor-delivered care, a meta-analysis is presented which demonstrates that doctors have better intubation success rates than paramedics, even when drug assistance and high levels of training are provided. The largest series of physician-delivered intubation then confirms this position. Lastly, a pre-hospital airway consensus process is described which attempts to improve the quality of data to guide future service development and research.
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Pavlenko, A., and T. Sytnik. "Pre-hospital management of stroke." Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/27518.
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Moore, Janet Lynn. "Pre-hospital Pain Assessment of Pediatric Trauma." University of Toledo Health Science Campus / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=mco1147291564.
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Sampalis, John Sotirios. "Evaluation of pre-hospital trauma services in Montreal." Thesis, McGill University, 1990. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=74365.
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The objectives of this observational study were to describe and evaluate the impact of emergency services on trauma mortality in Montreal. Urgences-Sante provides pre-hospital care in the greater Montreal region. Physicians provide on-scene care including advanced life support (ALS). Basic life support (BLS) is provided by emergency medical technicians or physicians. The study was conducted over a one-year period from April 1, 1987 to March 31, 1988.The results of this study showed that the response and total pre-hospital times of Urgences-Sante were similar to those in other North American cities. Pre-hospital time exceeding 60 minutes was associated with increased mortality. A significant trend towards lesser mortality in hospitals with higher level trauma care was observed. The use of ALS by physicians was not associated with reduced mortality. However, ALS and the presence of a physician were significantly associated with increased pre-hospital time.
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Gardner, Lyndsay E. "Advanced Practitioner Provided Pre-Hospital Discharge Asthma Education." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2654.
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Asthma is a leading cause of pediatric hospital admissions. Parents of children under the age of 18 with asthma require education to recognize and manage the signs and symptoms of the disease. Parent education has shown to decrease their children's hospital admission and readmission rates. The purpose of this pilot project was to develop an asthma educational module for the parents of children with asthma and obtain parent feedback on the content. Families with children under the age of 18 who had been admitted to the hospital with a diagnosis of asthma, an asthma exacerbation, or status asthmaticus were invited to participate. A nurse practitioner provided three parents with information on the signs, symptoms, and medication management of asthma, as well as hands-on demonstration of inhaler use. Twenty-eight staff nurses provided verbal feedback on module content, including educational benefit and readability for parents. Parent and staff verbal feedback indicated the module was both a useful and effective tool for asthma education. Clinical leaders plan to expand the pilot study on two additional pediatric units using the same module used in the pilot program with intent to analyze readmission rates. The project promotes social change through parent empowerment to care for their child in the home environment.
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Kulmala, Louise, and Nina Bergqvist. "PATIENTENS UPPLEVELSE AV OMVÅRDNAD PRE-HOSPITALT." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap, HV, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-20264.
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Walters, Geraldine. "Strategies for dealing with pre-hospital cardiac arrest in London." Thesis, University of Surrey, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.305057.
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Whitley, Aaron, and Aaron Whitley. "Pre-Hospital Providers Use of Ketamine for Rapid Sequence Intubation." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624581.
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Patients are injected with anesthetics to produce analgesia, amnesia, and arreflexia for many different reasons such as surgery, invasive procedures, and emergency interventions; one anesthetic induction technique is rapid sequence intubation (RSI). The RSI technique is performed to safely control the airway in patients needing immediate airway management. A particular induction anesthetic with increased use in the pre-hospital arena is ketamine. In October 2016, Ketamine was added to the RSI protocol of one pre-hospital organization whereby providers can use ketamine as an induction agent.
Purpose. The purpose of this project is to determine if there is a relationship between pre-hospital providers (PHPs) choice of using ketamine to facilitate intubation and knowledge about the anesthetic agent in regards to the adult trauma patient.
Setting. The setting to this project was a local pre-hospital organization located in Gilbert, Arizona.
Participants. The participants of this project are PHPs who maintain an active national and Arizona Department of Health Services (AZDHS) certification as emergency medical technician-paramedics (EMT-P).
Method. An online survey was disseminated that included questions regarding frequency of ketamine use, knowledge of ketamine as well as questions regarding their choice of induction agent.
Results. The response rate was 32.3%. The majority of PHP's have greater than 10 years experience as a certified emergency paramedic (68.8%) and less than half (38.7%) of the certified emergency paramedics (CEP) have used ketamine for RSI. Of the respondents that have 10 used ketamine as an induction agent, the majority (66.0%) would choose ketamine over another induction agent. While the majority of respondents rate themselves as knowledgeable in the pharmacological profile of ketamine (93.8%), the majority has also had less than five hours of training on ketamine (59.4%). The overwhelming majority agreed that they would benefit from training on aspects of ketamine.
Conclusion. The seasoned CEP's would choose ketamine over other induction agents for RSI of the adult patient. The choice to use ketamine is based upon self-reported pharmacological knowledge of the drug. The limited occurrence of RSI and use of ketamine supports continual training on the use of ketamine and the RSI technique.
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Gollan, Srisuda Siera. "A Mixed Methods Examination of Pre-Hospital Trauma Triage Decision Making." Thesis, Augusta University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10634622.
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The objective of pre-hospital trauma care is ensuring that the most severely injured persons are transported to the facility best suited to meet their complex needs (Fitzharris, Stevenson, Middleton, & Sinclair, 2011; Hoff, Tinkoff, Lucke, & Lehr, 1992; Leach et al., 2008; Sasser et al., 2012). To support pre-hospital decision making regarding trauma triage destination determinations, the Guidelines for Field Triage of Injured Patients decision scheme (FTDS) was developed as an algorithmic decision tool (Sasser et al., 2012).
The purpose of this study was to examine pre-hospital trauma triage transport decision making by EMS providers from multiple perspectives. This study used a concurrent mixed methods triangulation design (QUAL+QUANT). Mixed methods included: (1) Grounded theory methodology to describe a model of decision making used by EMS providers to make trauma triage determinations and (2) quantitative analysis of secondary data to determine how the FTDS criteria are utilized by EMS providers. The FTDS criteria were also examined relative to trauma outcomes: level of trauma team activation (TTA), patient disposition when leaving the emergency department (ED), and the injury severity score (ISS).
A model of Interpreting Trauma into Action was elucidated to describe the processes used by EMS providers. Pre-hospital providers based their trauma transport decisions on the perceived patient level of injury severity. The FTDS criteria were not explicitly used in this study region, but were interwoven into practice through employer policies and other training. The convergence of these findings indicated congruence between the model and trauma outcomes. The quantitative data indicated relationships (p<.05) between 12 of the 29 FTDS criteria and trauma outcomes. Both sources of evidence supported the relationships between the model of Interpreting Trauma into Action, the FTDS criteria, and specific trauma outcomes.
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Chaudery, Muzzafer. "A reflection of pre-hospital imaging on traumatic intra-abdominal haemorrhage." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/47965.
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Torso haemorrhage remains one of the leading causes of preventable morbidity and mortality from trauma particularly in the prehospital setting. Early identification of the haemorrhage source is essential in order to improve outcomes and an effective imaging modality may help to establish the diagnosis. This thesis examines how to improve abdominal haemorrhage identification in the prehospital setting in order to achieve rapid haemorrhage control. The current literature is appraised and a national questionnaire distributed to frontline trauma care physicians. For haemorrhage identification research into ultrasound is recommended and for haemorrhage control novel procedures such as Resuscitative endovascular balloon occlusion of the Aorta (REBOA) are valued. FAST (Focused abdominal sonography for trauma) is considered the most appropriate modality for haemorrhage identification in the prehospital setting but it is associated with a steep learning curve. In order to improve training, a face, content and construct validation of a FAST simulator model is undertaken. Furthermore to better understand an ideal performance, an ergonomic analysis of experts’ workspace and force during a FAST scan is conducted. From this, an expert set of metrics is derived of the ideal ultrasound probe position and force for each FAST region. A learning curve study is implemented to assess two randomised groups of novices one trained with the expert metrics and the other trained using a standardised curriculum. The expert metrics group are faster and more accurate at performing a FAST scan than the control. This is also the case in a prospective validity study. REBOA is being investigated as a novel technique for prehospital haemorrhage control. Accurate inflation of the balloon catheter within the correct zone is critical to gain control of bleeding and prevent adverse effects, particularly in the prehospital setting. A feasibility study identifies that ultrasound guidance and balloon insufflation with contrast agent enhances catheter placement within Zone III. Subsequently, two groups of physicians are randomised to perform REBOA with and without ultrasound guidance. The former are faster and more precise than the latter group hence supporting the robustness of the ultrasound imaging technique. Overall this thesis enhances prehospital abdominal haemorrhage identification by improving FAST training and augments haemorrhage control through accurate REBOA placement with the use of ultrasound and contrast agent.
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Oliver, Chantal. "Haemodialysis water pre-treatment plant wireless monitoring system Royal Perth Hospital." Thesis, Oliver, Chantal (2012) Haemodialysis water pre-treatment plant wireless monitoring system Royal Perth Hospital. Other thesis, Murdoch University, 2012. https://researchrepository.murdoch.edu.au/id/eprint/10209/.
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Currently most of the remotely monitored equipment at Royal Perth Hospital is hardwired, but is gradually being replaced with wireless systems with the development of cheaper and more reliable solutions.
This thesis tests and compares two wireless systems and analyses which one best fits Royal Perth Hospital’s requirements. Thorough testing and comparison was required because once installed, the selected solution was required to be the main monitoring system used in the future.
From there the selected system was installed and commissioned within the Pre-Treatment Plant of Haemodialysis. Commissioning of the chosen software entailed configuring the manufacturers Web Server with required sensor settings, alarm limits and email addresses. In addition to the installation, this thesis briefly investigates the possibility of a fully automated chlorine analyser for the Pre-Treatment Plant. This would create an excellent long term logging solution with the nurses no longer needing to hand test chlorine levels each day.
Although the Web Server satisfied the hospitals needs in the short term, a longer term solution needed to be found. Perl script was created to communicate from the Web Servers data tables to Royal Perth Hospitals’ server. This script was able to transfer all required data and pass it through to the new server, Fully Automated Nagios. This new script allows for improved data viewing, emailing capabilities, and longer term data storage.
This thesis summarises the work required to install, commission and configure a system that monitors pressures, temperature and contact switches, as well as educate the reader on the development, implementation and testing of such a system.
Since the Technical Services Division has an ISO 9001 accredited QA system, as required a large part of this thesis focused on the development of the project details, such as the development of wiring diagrams, server templates, comment logs, bill of materials and most importantly, the complete service and operator manuals.
Through the research and development of this thesis it was found that the project could be used to monitor other wards and so could be repeated in the future within Royal Perth Hospital and possibly Western Australian Health.
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Riopelle, Kent Richard. "Organization of hospital services a comparative analysis of pre operative patient preparation /." Zürich : ETH, 2005. http://e-collection.ethbib.ethz.ch/show?type=diss&nr=16377.
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Hassan, Tajek Basheer. "Strategies to improve the outcome of pre-hospital cardiac arrest in Leicestershire." Thesis, University of Leicester, 2000. http://hdl.handle.net/2381/29613.
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Despite the increasing complexity of pre-hospital care systems, the outcome from cardiac arrest (CA) remains extremely poor. The major objective of this thesis was to explore the ways in which outcome could be improved within a defined Emergency Medical Service (EMS) system in the UK. The four studies were designed to investigate certain structures and processes of care involved in achieving a successful outcome. The first study provides a detailed descriptive account of the incidence, processes of care and outcomes for adults suffering a pre-hospital CA in a defined EMS system with a predominant single tiered ALS response. Results are compared with other relevant work. In the second study, I evaluated the resource implications of additional single paramedic units with a priority dispatch system and their impact on the short term outcome of pre-hospital CA. Prioritised response and introduction of single paramedic units had no significant impact on the number of lives saved from pre-hospital CA. Significantly increased NHS costs were incurred per life year gained. The third study was a double blind placebo controlled trial using empirical intravenous magnesium sulphate as a therapeutic intervention. My hypothesis was that given early in the resuscitation phase for patients in refractory or recurring VF, outcome could be significantly improved. However, the results showed no significant improvement in outcome. Finally, I designed and carried out a study to develop consensus opinion on future design characteristics of EMS systems in the UK using senior expert staff from Ambulance Trusts in the UK. Consensus confirmed the need for multi-tiered systems, fully implemented priority dispatch and increasing use of 'first responders'. Opinion was significantly different from the present EMS model recommended by the Department of Health. This work has shown that despite a number of strategies to improve the outcome of pre-hospital CA in the Leicestershire EMS, no significant improvement could be produced. A more radical re-configuration of system design is suggested by experts in the field of EMS which could have a more significant impact on outcome. The thesis has also provided robust data which can be used locally in Leicestershire as well as providing avenues for future research.
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Zalgaonker, Mustafa. "Intravenous fluid resuscitation : surveillance of penetrating injury in the pre-hospital environment." Thesis, Cape Peninsula University of Technology, 2018. http://hdl.handle.net/20.500.11838/2738.
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Thesis (Master of Emergency Medical Care)--Cape Peninsula University of Technology, 2018.Physical injury is a major cause of premature death and disability worldwide (WHO, 2015). Mortality statistics for South Africa indicate that approximately half of all injury-related deaths were intentionally inflicted, often as a result of sharp-force injuries (Donson 2009). Cape Town is reputed to be a violent city (Nicol et al., 2014). Pre-hospital emergency care providers are often the first medical contact for injured patients. Previously, it was understood that high volume crystalloid administration would improve survival and was standardised in the management of shock (Santry & Alam 2010). However, over-administration of crystalloid fluid can cause patient harm by potentially worsening injuries and can be detrimental to a patients survival. Current evidence supports the practice of lower volume crystalloid intravenous fluid administration- permissive hypotension. Little is known about pre-hospital emergency care providers intravenous fluid management practices for penetrating injury. Injury surveillance data for victims of penetrating injury is also scarce with the majority of current data taken from mortality sources. Surveilling pre-hospital cases may yield opportunities for prevention from premature mortality and morbidity. The aim of this study is to undertake surveillance of penetrating injury and related intravenous fluid resuscitation in the pre-hospital emergency care environment. A prospective observational descriptive survey was conducted in the Cape Metropole1. Over three consecutive months, emergency care providers documented parameters related to mechanism of injury, scene vital signs, hospital vital signs, intravenous fluid resuscitation and basic patient demographic information for patients with penetrating injury. A predetermined inclusion and exclusion criteria was used to sample patients.
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Black, Sarah Louise. "Factors influencing pre-hospital decisions not to convey : a mixed methods study." Thesis, University of Exeter, 2017. http://hdl.handle.net/10871/32600.
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This study has used a mixed methodology to explore the impact of geographic, temporal and ambulance crew skill factors on ambulance clinicians’ decisions to leave a patient on scene after attending a 999 call. Four phases of work were undertaken using both qualitative and quantitative methods to build an understanding of the complex nature of pre-hospital clinical reasoning. A novel scale, the DMASC survey was developed, which indicated four factors influence decision-making in this context. More experienced staff scored significantly differently to other staff groups on the ‘Experience’ and ‘Patient characteristic’ subscales of the tool. Qualitative work explored these findings in more detail and five inter-related themes were identified, namely, ‘Communication’, ‘The three ‘E’s’, education, experience and exposure’, ‘System influences’, ‘Professionalism’ and ‘Patient characteristics’. The final phase of the study undertook to analyse retrospective call data from one large ambulance service over a one-year period. All of the five predictor variables, rurality, time of day, day of the week, patient condition and crew skill level, influenced the likelihood of conveyance. Of these the level of clinical skill of the first crew at scene was independently significant. The results of this work are discussed in relation to the strategic and operational context of NHS ambulance services. The thesis is structured as a series of papers yet to be submitted for publication. Although this confers a degree of repetition, it provides a logical analysis of the methods used to explore factors that may influence paramedic’s clinical decision making when deciding to leave patients at home following a 999-call attendance.
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Dippenaar, Enrico. "Identifying the role of pre-hospital intercostal chest drains in South Africa." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/2859.
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Garner, Alan. "The role of physician staffed helicopter emergency medical services in prehospital care of patients with severe traumatic brain injury." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/22005.
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This thesis examines the role of physician staffed helicopter emergency medical services (PS-HEMS) in the prehospital care of patients with severe injury with a particular emphasis on severe traumatic brain injury. The combination of physicians who can bring skills, knowledge and clinical judgement beyond that of non-physician clinical providers to the scene of a traumatic injury, with helicopters that can deliver physician teams to scenes over larger geographical areas and at greater speed than can be achieved with ground transport has many theoretical advantages. This thesis examines the published evidence for benefit in terms of patient morbidity and mortality associated with PS-HEMS extant at the time this research program commenced in addition to analysing retrospective data from the Sydney prehospital trauma system where PS-HEMS were historically utilised in a small proportion of cases. Based on these studies a prospective, randomised controlled trial to test the efficacy of PS-HEMS for severe traumatic brain injury was designed and implemented in the Sydney region. Unfortunately, policy changes in the jurisdiction in which the trial operated resulted in confounding of the trial when the treatment policy under investigation was implemented as the system standard before adequate patients could be recruited. As PS-HEMS had been accepted as standard of care the research program then moved on to compare different configurations of PS-HEMS systems, the benefits of PS-HEMS in prehospital paediatric airway management, optimal dispatch systems and PS-HEMS base distribution across New South Wales. Most chapters are published manuscripts and hence each chapter is self-contained, including references with the final chapter summarising the overall lessons learnt.
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Garner, Alan. "The role of physician staffed helicopter emergency medical services in prehospital care of patients with severe traumatic brain injury." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/21778.
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This thesis examines the role of physician staffed helicopter emergency medical services (PS-HEMS) in the prehospital care of patients with severe injury with a particular emphasis on severe traumatic brain injury. The combination of physicians who can bring skills, knowledge and clinical judgement beyond that of non-physician clinical providers to the scene of a traumatic injury, with helicopters that can deliver physician teams to scenes over larger geographical areas and at greater speed than can be achieved with ground transport has many theoretical advantages. This thesis examines the published evidence for benefit in terms of patient morbidity and mortality associated with PS-HEMS extant at the time this research program commenced in addition to analysing retrospective data from the Sydney prehospital trauma system where PS-HEMS were historically utilised in a small proportion of cases. Based on these studies a prospective, randomised controlled trial to test the efficacy of PS-HEMS for severe traumatic brain injury was designed and implemented in the Sydney region. Unfortunately, policy changes in the jurisdiction in which the trial operated resulted in confounding of the trial when the treatment policy under investigation was implemented as the system standard before adequate patients could be recruited. As PS-HEMS had been accepted as standard of care the research program then moved on to compare different configurations of PS-HEMS systems, the benefits of PS-HEMS in prehospital paediatric airway management, optimal dispatch systems and PS-HEMS base distribution across New South Wales. Most chapters are published manuscripts and hence each chapter is self-contained, including references with the final chapter summarising the overall lessons learnt.
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Gihwala, Raina Tara. "Out-of-hospital assessment and management of rape survivors by pre-hospital emergency care providers in the Western Cape." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21186.
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South African incidence of rape ranks amongst the highest worldwide. No direct policy exists for the emergency care provider management of rape victims in the pre-hospital setting. The pre-hospital exposure to rape cases is unknown as its health information system is not gender-based violence sensitive. In the absence of a clearly defined protocol, indiscretion in the emergency care treatment of rape victims remains undocumented. As a particularly vulnerable group globally, victims of rape are deserving of focused intervention. A qualitative, descriptive approach guided the research in which nine semi-structured voluntary interviews were held with emergency care providers, forensic medical practitioners and emergency consultants. Through a critical theory lens thematic content analysis was employed. University of Cape Town ethics approval was attained. The study found that pre-hospital providers lack knowledge and skills of rape victim identification and management but are desirous of evidence-informed guidelines for treatment and referral in a multidisciplinary approach. Educational and policy deficiencies are documented. The recommendations support a community of practice that is mutually inclusive of specialist rape-care centres, emergency department and pre-hospital providers in the interest of forensic emergency medicine. Due regard must be had for needs of practitioners at risk of vicarious traumatization from sexual assault management. Transformative curricula and responsive clinical guidelines are likely to redress any complicity of the health sector non-response to rape/sexual assault. This study is likely to benefit emergency care regulators, educators and researchers whose professional interest is to promote responsivity of the health system to rape.
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Batuka, Nabawesi Jennifer. "Pre and post computerized radiography film reject analysis in a private hospital in Kenya." Thesis, Nelson Mandela Metropolitan University, 2011. http://hdl.handle.net/10948/1574.
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The production of good quality radiographs is a complex process, given the high level of image quality required (Sniureviciute & Adliene, 2005: 260). Exposure of patients to x-rays, a factor in the production of quality radiographs also entails a risk of radiation injury. In 2006, computerized radiography (CR) was introduced at The Nairobi Hospital to try and reduce the film reject rate, decrease repeats, reduce financial costs of consumables like x-ray films and processing chemicals. However, to date, no formal film reject analysis has been conducted at The Nairobi Hospital. Four years after the incorporation of CR, there is apparently, still a significant number of film rejects, implying operational costs may still be high. The cause of film rejects and overall reject cost is not known. This has led to the research question: “Has the film reject rate in the A & E x-ray unit at The Nairobi Hospital reduced following incorporation of CR?” A quantitative, retrospective, descriptive study involving a reject film analysis of rejected radiographs in the Accident and Emergency (A&E) x-ray unit in the Nairobi Hospital, Kenya was conducted. The researcher collected data for a period of 6 months between 2/12/07 and 28/05/08 using a purpose-designed data collection form. All rejected x-ray films during the study period were included. Capture and analysis of the collected data was completed by the researcher using SPSS 10 and EPINFO computer packages. Permission to conduct the study was obtained from The Nairobi Hospital Education Committee and due consideration to patient and radiographer confidentiality was maintained throughout the study. A total of 851(2.5 percent) x-ray films were collected during the study period. Four hundred and fourteen (2.6 percent) radiographs and 437 (2.5 percent) radiographs were rejected prior to and after the incorporation of CR respectively. Chest radiographs were the most frequently rejected accounting for 277(66.9 percent) and 123 (28.1 percent) prior to and after the incorporation of CR respectively. The most frequently rejected film size was 35x35cm prior to the incorporation of CR (61.6 percent) and 26x35cm film size after the incorporation of CR (91.3 percent). The most frequent cause of film rejects was radiographer causes both prior to and after the incorporation of CR accounting for 496 (58.3 percent). The film reject rate did not significantly reduce after the incorporation of CR, suggesting that there are other factors which contribute to reject rate, other than CR. The study also shows that higher film consumption does not necessarily lead to high reject rates. The percentage value on annual rejects did not change after the incorporation of CR and a demonstrated increase in the annual cost of purchasing x-ray films was attributed to an increase in annual consumption after the incorporation of CR, and also to the higher cost of digital x-ray films. Despite some identified limitations to this study, some recommendations, which included conduction of regular reject analyses and regular continuing professional development with respect to radiographic technique amongst others, were suggested.
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王律文 and Lut-man Wong. "Contemporary pre-hospital ambulance services in Hong Kong: a study of development and reform." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41006057.
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Alshahrani, Hassan A. "Pre-hospital delay in patients presenting with myocardial infarction in Kingdom of Saudi Arabia." Thesis, Ulster University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.602698.
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Introduction: Pre-hospital delay (onset of symptoms to hospital arrival) has a significant impact on patients’ mortality and morbidity in myocardial infarction (MI). Many factors have been implicated in patients’ decision to seek care in MI, but most research has a Western origin and it is possible that the reasons for delay differ in Arab cultures. This study aimed to explore the factors that contribute to pre-hospital delay among MI patients in Saudi Arabia. It combined quantitative and qualitative methods using sequential explanatory design. Ethical approval was provided by University of Ulster. Method: This cross sectional study comprised a consecutive sample of research participants (n=311), who presented with a diagnosis of MI to 3 hospitals in Riyadh, from March 2011 to August 2011. Of these, 189 patients met the eligibility criteria and provided quantitative data. A further 18 patients were purposefully selected for semi-structured interviews that were taped and transcribed verbatim prior to thematic analysis. Findings: The median pre-hospital delay for males was 5 hours and for females it was 12.9 hours. A standard multiple regression determined female gender as the strongest predictor of transfer delay in this sample. Lack of knowledge and Control was the core theme in the thematic content interview analysis and it was evident that cultural issues such as wishing to seek permission to attend hospital from a male relative and inability to travel to hospital without a male escort contributed to female patients’ pre-hospital delay.Conclusion: Women’s pre-hospital delay was more than twice that of their male counterparts and the total pre-hospital delay time reported here for both genders is longer than in studies in other settings. Qualitative data indicate that cultural factors are implicated in the prolonged delay experienced by females. Further research to test the generalizability of these findings and to determine any potential impact on female mortality and morbidity for MI is needed. Primary and secondary prevention strategies for potential MI patients in Saudi should consider offering culturally- specific, gender related messages.
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Bertoncin, Adão Carlos. "Diagnostico citogenetico pre-natal em um hospital universitario : contribuição ao programa de medicina fetal." [s.n.], 2002. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311777.
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Orientador: Fatima Aparecida Bottcher LuizDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Objetivos: Investigar a participação do Laboratório de Cito genética na avaliação do diagnóstico pré-natal em um Hospital Universitário em Campinas, São Paulo, Brasil. Casuística e métodos: Foi realizado um estudo retrospectivo com todos resultados de cariótipo do laboratório, referentes ao período de abril de 1993 a novembro de 2001. Resultados: 673 resultados foram obtidos. 146 foram designados como controle (baixo risco para anomalias cromossômicas) e 527 foram designados como grupo de estudo. 84% dos diagnósticos foram realizados em pacientes com idade gestacional superior a 20 semanas. 546 (81%) cariótipos foram obtidos de sangue fetal através de cordocentese, e 127 (19%) a partir de cultura de líquido amniótico. Do total de cariótipos anormais, 53% foram encontrados em pacientes acima de 35 anos de idade. Anomalias do sistema nervoso central (SNC) constituíram 41 % de todas as indicações para realização de cariótipo, especialmente hidrocefalia e defeitos de tubo neural. Outras indicações foram: idade materna acima de 40 anos e malformações múltiplas (9%), historia familiar de malformações congênitas (9%), defeitos de sistema urinário (8%), hidropsia fetal (7%) e outras múltiplas ocorrências (26%). Cariótipo alterado foi encontrado em mais de 20% dos casos de malformações do sistema nervoso central, cardiopatia estrutural, onfalocele, higroma cístico e restrição de crescimento fetal. Conclusões: Os altos níveis de anomalias cromossômicas em gestantes acima de 35 anos confirmam a necessidade de aconselhamento pré-natal adequado. A analise de cariótipo pela cordocentese constitui uma estratégia segura e rápida para a instituição, uma vez que as pacientes são encaminhadas para um centro de medicina terciária em idade gestacional avançada
Abstract: OBJECTIVES: To investigate the participation of a Cytogenetics Laboratory in the assessment of the prenatal diagnosis in a Woman's university Hospital in Campinas, São Paulo, Brazil. PATIENTS AND METHODS: A retrospective study was performed with all analyzed karyotype results in the laboratory, regarding material collected from april1992 to November 2001. RESULTS: 673 results were obtained. 146 were designated as controls (low risk for chromosomal anomalies) and 527 were designated as the study group. 84% of the patients were diagnosed with gestational age above 20 weeks. 542 (81%) karyotype were obtained from fetal blood by cordocentesis and 126 (19%) from amniotic fluid cell culture. Of all abnormal karyotypes, 53% were found in patients over 35 years of age. Central nervous system (CNS) abnormalities constituted 41% of al indications for karyotype examination, mainly hydrocephaly and neural tube defects. Other defects included: maternal age over 40 years old and multiple malformations (9%), familial history of congenital malformations (9%), urinary system defects (8%) and fetal hydrops (7%) and other multiple occurrences (26%). Altered karyotype were found in more than 20% cases of CNS malformations, structural cardiopathy, ompha1ocele, cystic higroma and fetal growth restriction. CONCLUSIONS: higher levels of chromosomal abnormalities in pregnant womem over 35 year confirm the need for an adequate prenatal counseling. Karyotype ana1ysis through cordocentesis constitutes a faster and cheaper strategy for the institution once patients tend to be referred to a fetal medicine tertiary center at latter gestational ages
Mestrado
Ciencias Biomedicas
Mestre em Ciências Médicas
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Elofson, Kathryn, and Sarah Girardot. "Long-acting neuromuscular blocker use during pre-hospital transport of critically ill trauma patients." The University of Arizona, 2012. http://hdl.handle.net/10150/623607.
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Class of 2012 AbstractSpecific Aims: During pre-hospital transport, trauma patients may be given a long-acting neuromuscular blocker (NMB) to facilitate endotracheal intubation or to prevent movement. The purpose of this study was to determine the rate of long-acting NMB use and evaluate the concurrent use of sedatives. Methods: This was a retrospective cohort study conducted in a tertiary care, academic emergency department of trauma patients aged 18-89 years who were intubated in the pre-hospital setting. The primary outcome was to determine the rate of long-acting NMB use. The use of post- intubation sedatives was compared between the groups using Wilcoxon rank-sum test or Fisher’s exact test, using an a priori alpha level of 0.05 for all analyses. Main Result: A total of 51 patients were included in final analyses. All patients received etomidate or midazolam for intubation. 86% (n=44) received succinylcholine, 10% (n=5) were given rocuronium and 4% (n=2) did not receive a NMB. After intubation, 75% (n=38) received an additional long-acting NMB to prevent movement (vecuronium (n=22) or rocuronium (n=16)) . Overall, 82% (n=42) of patients received a long- acting NMB during transport. There was no difference in the rate of post-intubation sedative use between groups (79% versus 67%, respectively, p=0.42). The long-acting NMB group received midazolam less promptly after intubation (16 versus 7 minutes, respectively, p=0.04). Conclusions: The use of long-acting NMB is common during the pre-hospital transport of trauma patients. Some of these patients may not be given sedatives or have delays in receiving sedatives following intubation and be at risk of being paralyzed without sedation.
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Elofson, Kathryn, Sarah Girardot, and Asad Patanwala. "Long-Acting Neuromuscular Blocker use During Pre-Hospital Transport of Critically Ill Trauma Patients." The University of Arizona, 2012. http://hdl.handle.net/10150/614468.
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Class of 2012 AbstractSpecific Aims: During pre-hospital transport, trauma patients may be given a long-acting neuromuscular blocker (NMB) to facilitate endotracheal intubation or to prevent movement. The purpose of this study was to determine the rate of long-acting NMB use and evaluate the concurrent use of sedatives. Methods: This was a retrospective cohort study conducted in a tertiary care, academic emergency department of trauma patients aged 18-89 years who were intubated in the pre-hospital setting. The primary outcome was to determine the rate of long-acting NMB use. The use of post-intubation sedatives was compared between the groups using Wilcoxon rank-sum test or Fisher’s exact test, using an a priori alpha level of 0.05 for all analyses. Main Result: A total of 51 patients were included in final analyses. All patients received etomidate or midazolam for intubation. 86% (n=44) received succinylcholine, 10% (n=5) were given rocuronium and 4% (n=2) did not receive a NMB. After intubation, 75% (n=38) received an additional long-acting NMB to prevent movement (vecuronium (n=22) or rocuronium (n=16)) . Overall, 82% (n=42) of patients received a long-acting NMB during transport. There was no difference in the rate of post-intubation sedative use between groups (79% versus 67%, respectively, p=0.42). The long-acting NMB group received midazolam less promptly after intubation (16 versus 7 minutes, respectively, p=0.04). Conclusions: The use of long-acting NMB is common during the pre-hospital transport of trauma patients. Some of these patients may not be given sedatives or have delays in receiving sedatives following intubation and be at risk of being paralyzed without sedation.
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Wong, Lut-man. "Contemporary pre-hospital ambulance services in Hong Kong a study of development and reform /." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41006057.
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Smith, Cheryl. "Patients’ Perceptions of Patient-Centered Care and the Hospital Experience Pre- and Post-Discharge." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etd/3388.
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Florence Nightingale used the principles of patient-centered care as the foundation for nursing practice. Today, patient-centered care delivery is part of the healthcare reform process that extends interprofessionally throughout all settings of healthcare in the United States (U.S.). Patient satisfaction measurement is one primary determinant of effective patient-centered care. The standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and methods is a nation-wide tool used to measure patient satisfaction. However, this method of patient satisfaction assessment relies on recollections of patients’ hospital experiences and requires accurate memory and recall. This study sought to examine the effect of the memory-experience gap on patients’ perceptions of their hospital experiences and address this research question: Are there any statistical differences between in-hospital and two-week post-discharge perceptions of patient-centered care as measured with HCAHPS patient satisfaction ratings on (a) the composite scores for communication with nurses, communication with physicians, communication about medicines, pain management, staff responsiveness, (b) the individual scores for the hospital environment’s cleanliness and quietness, and the inclusion of patient and family preferences in the plan of care, and (c) the overall global rating score? The design was a non-experimental, prospective, descriptive correlational study. The setting was a 255-bed regional hospital that serves individuals from eight surrounding rural counties in southern middle Tennessee. The case-mix contained diverse individuals with multiple economic, environmental, physical, social and spiritual dynamics. A convenience sample of 82 adult patients ages 26 - 93 represented mainly Caucasian females with mostly cardiovascular and respiratory illnesses who had a minimum one-day stay.
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Cuthbertson, Joseph. "The effectiveness of airway management in the pre hospital treatment of traumatic brain injury : a retrospective, observational study of pre hospital treatment of traumatic brain injury (TBI) in the Western Australian ambulance service." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2012. https://ro.ecu.edu.au/theses/563.
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There is concern over mortality and the potential for secondary brain injury in the head-injured patient. The use of advanced airway management and rapid sequence intubation in the pre hospital treatment of patients with Traumatic Brain Injury is controversial. Currently in St John Ambulance Service Australia (WA) Inc. three forms of pre hospital treatment are utilized to manage the airway of the adult head-injured patient. If attended by on-road paramedic staff, basic airway management is utilized unless the patient is unconscious and areflexic, in which case advanced airway management utilising endotracheal intubation or laryngeal mask insertion is authorised. In the critical care paramedic setting, the severely head-injured patient can be managed utilising paramedic initiated rapid sequence intubation techniques and ongoing sedation, paralysis and ventilation. There is a lack of data evaluating the risk and outcomes involved with these techniques when utilised to treat head-injured patients by paramedics from the Western Australian ambulance service. This study provides an updated evaluation of outcomes associated with airway management. The research framework was that of a retrospective, observational study of patients transported and treated between January 2004 and January 2009 in Western Australia. As the designated state trauma centre, all major trauma patients admitted to Royal Perth Hospital trauma unit with a head abbreviated injury scale > 3 transported and treated pre hospital by St John Ambulance WA paramedics from January 2004 to January 2009 were included. Hospital records of patient outcomes were matched with pre hospital records. Whilst challenges were faced in the collection of quality, usable data; modifications in analysis methodology allowed achievement of some, but not all objectives. The use of advanced airway management was associated with increased odds of survival (OR of 8.9, p value .046). Results of this study indicate a significant association between advanced airway management practice performed by paramedics and survival for patients suffering TBI. Further research is recommended to accurately assess efficacy of practice of this skill set in the pre hospital environment.
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Andersson, Lena, and Karin Lundberg. "Patienters upplevelser av prehospital sjukvård : -En litteraturstudie." Thesis, University of Kalmar, School of Human Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hik:diva-1250.
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Introduction: In Sweden the definition of ambulance nursing is the examination and treatment of sick or injured people done by ambulance nurses during transport. This means not only focus on the illness or injury but also the human being treated. The paramedic service must be based on the presumption that the medical needs of the patients are guaranteed, and that the expectations and demands of the public are satisfied. Competence and availability are basic terms for a well-functional paramedic service. There is a lot of pressure put on the people working with pre-hospital nursing. One mistake can lead to serious consequences for the patient. Purpose: The purpose of this study is describing patient’s experience of pre-hospital nursing. Method: The study is based on ten scientific articles. The articles were found on the internet by searching in the databases Academic Search Elite, Cinahl and MedLine. Results: The following themes have been identified: a feeling of uncertainty of the patient – how ill am I?, ambulance or own car?, the patients worry about if the ambulance will arrive in time, voluntary self-surrender, patients experience of the competence of the staff, lack of understanding that an ambulance is more than a transport service. Discussion: Since the study is based on such a limited material it's not reasonable to draw any extensive conclusions. Still the results are so unanimous so we think that they are well worth to take into consideration.
Introduktion: I Sverige definieras ambulanssjukvård med undersökningen och behandlingen av sjuka eller skadade människor, vilket utförs av ambulanspersonal i samband med transport. Ambulanssjukvården måste bygga på förutsättningen att patientens medicinska behov säkerställs och att allmänhetens förväntningar och krav blir tillgodosedda. Kompetens och tillgänglighet är grundläggande begrepp för en väl fungerande ambulanssjukvård. Det ställs stora krav på personalen inom den akuta prehospitala sjukvården. Ett enda felaktiga beslut kan få svåra konsekvenser för patienten. Syfte: Syftet med studien är att belysa patienters upplevelser av prehospital sjukvård. Metod: Litterturstudie vars resultat baseras på tio vetenskapliga artiklar publicerade 2003-2008. Litteratursökningen utfördes med de elektroniska databaserna Academic Serch Elite, CINAHL och MedLine. Resultat: De rubriker som identifierades var: en känsla av osäkerhet hos patienten, hur sjuk är jag?, ambulans eller egen bil?, oro hos patienten, när kommer ambulansen?, frivilligt "självöverlämnande", patienters upplevelse av personalens kompetens, och brist på insikt om att ambulans är mer än en transportservice. Diskussion: Att, utifrån ett begränsat material som det vi har arbetat med, dra några långtgående slutsatser är inte rimligt. Vi anser dock att samstämmigheten i resultatet är så god att vi vill klassa resultatet som väl värt att ta i beaktande.
Presentation är gjord via webben.
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Hagiwara, Magnus. "Development and Evaluation of a Computerised Decision Support System for use in pre-hospital care." Doctoral thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-23781.
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The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care. The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design. The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time. The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.
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Liebenberg, Nuraan. "A critical analysis of pre-hospital clinical mentorship to enable learning in emergency medical care." Thesis, Cape Peninsula University of Technology, 2018. http://hdl.handle.net/20.500.11838/2737.
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Thesis (Master of Emergency Medical Care)--Cape Peninsula University of Technology, 2018.For emergency medical care (EMC), clinical mentorship can be thought of as the relationship between the EMC students and qualified emergency care personnel. Through this relationship, students may be guided, supported and provided with information to develop knowledge, skills, and professional attributes needed for delivering quality clinical emergency care. However, this relationship is poorly understood and the focus of this research was to explore how this relationship enabled or constrained learning. Through having experienced mentorship, first as a student in EMC, then as an operational paramedic, mentoring students, I was privy to an insider perspective of clinical mentorship, and the experiences of fellow students‘. Through this experience the practices I observed may not have promoted learning. This is when my interest in pre-hospital clinical mentorship in relation to learning began. The aim of this research was to present a qualitative analysis of the clinical mentorship relationship in pre-hospital EMC involving the qualified pre-hospital emergency care practitioner (ECP) and the EMC student. The objectives included gaining an understanding of what enabled and/or constrained learning EMC, exploring clinical mentorship and learning in the pre-hospital EMC context, and gaining understanding of the role and scope of community members in the clinical mentorship activity system. The purpose of this study was to qualitatively document, by means of a thematic analysis, the pre-hospital clinical mentorship relationship, as well as document, by means of a Cultural Historical Activity Theory (CHAT) analysis, the clinical mentorship activity system. The focus of this qualitative documentation was the enablements and constraints to learning during clinical mentorship. This research also made possible recommendations for EMC clinical mentorship and education and may also inform (PBEC) policy, as well as work integrated learning (WIL) policy. Data collection included the use of diaries and focus group interviews. Analysis involved a two-part analysis, where data was reduced and understood with thematic analysis guided by Braun and Clarke (2006) six phase thematic analysis process (explained in Chapter three, Section 3.6). Thereafter, a CHAT analysis was conducted to uncover contradictions within the clinical mentorship activity system that made working on the object of activity difficult, thereby also uncovering constraints to learning. Inductive reasoning was applied to the thematic analysis to reduce data and identify themes and subthemes which provided insight into the enablements and constraints to learning in the pre-hospital EMC clinical mentorship relationship. The CHAT analysis of the data collected and analysed brought to surface the affordances, tensions as well as the primary-level and secondary-level contradictions of the clinical mentorship activity system. The thematic analysis of the clinical mentorship relationship provided limited understanding of the enablements and constraints to learning, and thus further motivated deeper analysis with CHAT. The results of this research included primary and secondary-level contradictions for almost all elements of the clinical mentorship activity system. Contradictions amongst the Division of Labour (DoL), the rules of the activity system, and the tools/resources of the activity system existed in that it constrained the interaction and activity of the subject and the community while working on the object of the activity system possibly achieving a lesser or undesired outcome of clinical mentorship.
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Botha, Johanna Catharina. "Rapid sequence intubation: a survey of current practice in the South African pre-hospital setting." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32615.
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Background: Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. In South Africa, pre-hospital RSI was first approved for non-physician providers by the Health Professions Council of South Africa in 2009 and introduced as part of the scope of practice of degree qualified Emergency Care Practitioners (ECPs) only. The aim of the research study was to investigate and describe, based on the components of the minimum standards of pre-hospital RSI in South Africa, specific areas of interest related to current pre-hospital RSI practice. Methods: A descriptive cross-sectional study design in the form of an online survey were conducted amongst operational ECPs in the pre-hospital setting of South Africa, using convenience and snowball sampling strategies. Results: A total of 87 participants agreed to participate. Eleven (12.6%) incomplete survey responses were excluded while 76 (87.4%) were included in the data analysis. The survey response rate could not be calculated. Most participants were operational in Gauteng (n=27, 35.5%) and the Western Cape (n=25, 32.9%). Overall participants reported that their education and training were perceived as being of good quality. An overwhelming number of participants (n=69, 90.8%) did not participate in an internship programme before commencing duties as an independent practitioner. Most RSI and post-intubation equipment were reported to be available, however, our results found that introducer stylets and/or bougies and EtCO2 devices are not available to some participants. Only 50 (65.8%) participants reported the existence of a clinical governance system within their organisation. Furthermore, our results indicate a lack of clinical feedback, deficiency of an RSI database, infrequent clinical review meetings and a shortage of formal consultation frameworks. Conclusion: The practice of safe and effective pre-hospital RSI, performed by non-physician providers or ECPs, rely on comprehensive implementation and adherence to all the 51 components of the minimum standards. Although there is largely an apparent alignment with the minimum standards, recurrent revision of practice needs to occur to ensure alignment with recommendations. Additionally, there are areas that may benefit from further research to improve current practice.
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Rocos, Brett. "What is the route to high quality, joined up care for pre-hospital aeromedical trauma services?" Thesis, University of Bristol, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.715751.
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Labbate, Dario Victor 1959. "A importancia dos exames subsidiarios na avaliação pre-operatoria em hospital comunitario : analise de 1500 pacientes." [s.n.], 1993. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309324.
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Orientador : Nelson Adami AndreolloDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A solicitação de exames subsidiários, na avaliação pré-operatória do paciente candidato a uma cirurgia eletiva, tem sofrido significativo incremento ao longo dos últimos anos. Passou a se configurar como parte integrante, constituíndo-se atitude praticamente indissociável do ato global de corretamente avaliar o paciente cirúrgico. Foi criado o conceito de "rotina pré-operatória", na qual a análise criteriosa de solicitações, baseadas em apurada semiologia , cede seu posto ao esquema rígido, quase mecânico, de "prescrições" de listas de exames, em conformidade com a idade do paciente e/ou o tipo de procedimento a ser realizado. Existem múltiplas explicações para este fato e, provavelmente, nenhuma contém a resposta em sua plenitude. Existem autores que julgam científicamente justificáveis a solicitação de tais exames alegando que os mesmos poderiam servir como triagem para doenças insuspeitas clinicamente. Outros crêem que a existência de parâmetros laboratoriais, radiográficos e eletrocardiográficos prévios à agressão anestésico-cirúrgica, seriam importantes como elementos comparativos, na eventualidade de surgirem complicações. Existem ainda alguns autores que creditam aos exames subsidiários um papel importante na verificação do estágio de condições patológicas previamente reconhecidas . Outro aspecto hoje largamente considerado, sem caráter científico, porém de inegável importância prática, é a freqüência com que cirurgiões e anestesiologistas têm sido questionados quanto às suas práticas no âmbito legal. Esta eventualidade criou o que se poderia chamar de uma "síndrome de documentação", através da qual o profissional se sentiria mais seguro, caso seja obrigado a demonstrar posteriormente a diligência e prudência de sua conduta. (...continua)
Abstract: The solicitation of subsidiary exams, on the preoperatory evaluation of a patient candidate for an elective surgery, has suffered significative increase during the last years. It has become an integrant part of it, composing an atitude practically unseparable of the global act of correctly evaluating a surgical patient. The concept of "preoperatory routine" was created, in which a sensible analysis of solicitations, based on selected semiology, transfers its position to a rigid scheme, almost mechanic, of lists of exams, according to the patient's age and/or the type of procedure to be accomplished. There are multiple explanations for this fact. Probably none of them has the complete answer in its plenitude. There are authors that judge scientifically justifiable the solicitation of such exams, aledging that they could be useful in diagnosing unsuspected clinical diseases. Others believe that the existence of laboratorial, radiographic and electrocardiographic parameters, previous to the anesthetic-surgical agression, would be important as comparative elements, in the eventuality of arising complications. Furthermore there are those who give to the subsidiary exams an important role in the verification of the phase of pathologic conditions previously recognized. Another aspect fully considered today, without scientific character, but with undenied practical importance, is the frequence that surgeons and anesthesiologists have been questioned as to their practices in the legal ambit. This eventuality created what could be called a "documentation syndrome" through which the professional would fell more security, in case he was compelled to demonstrate later the diligence and prudence of his conduct. (...continue)
Mestrado
Mestre em Cirurgia
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Johansson, Ingela. "When time matters : Patients’ and spouses’ experiences of suspected acute myocardial infarction in the pre-hospital phase." Doctoral thesis, Linköping : Linköping University, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-6748.
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Bondéus, Emilia, and Josefin Ellmarker. "CareEagle - Det unika hjälpmedlet för ambulanssjukvården : CareEagle – The unique stand-by for the pre-hospital medical care." Thesis, Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-31853.
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Every year SOS Alarm receives 3.5 million emergency calls via 112 and an ambulance is needed in one million of these situations. Working as a paramedic is very physically demanding and the profession is over-represented, in terms of attritional wear on the lower back and the shoulders. Every day the paramedics need to perform many heavy lifts and the deadlift is one of the most demanding. They perform a deadlift when a patient should be lifted from the ground up to height of the haunch. When the deadlift is completed, the paramedics transport the patient to the ambulance. Work below the knees and over the shoulders should not occur by ergonomic recommendations. When the paramedics perform a deadlift it’s always start below their knees which means that the start position is not advantageous and there is a high risk to be injured. There are many factors that can affect the lifting situation in a negative way for example uneven surfaces, tight spaces and worried patients. In this project a unique product has been developed to replace the deadlift which is a huge problem that no one else has solved before. By using the product, the deadlift can now be done with minimal use of human power. The product significantly simplifies the care of the patients and will reduce work-related injuries in the pre-hospital medical care.
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Rööst, Mattias. "Pre-hospital Barriers to Emergency Obstetric Care : Studies of Maternal Mortality and Near-miss in Bolivia and Guatemala." Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-112481.
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Maternal mortality is a global health concern but inequalities in utilization of maternal health care are not clearly understood. Severe morbidity (near-miss) is receiving increased attention due to methodological difficulties in maternal mortality studies. The present thesis seeks to increase understanding of factors that impede utilization of emergency obstetric care (EmOC) in Bolivia and Guatemala. Studies I and IV employed qualitative interviews to explore the role of traditional birth attendants (TBAs) and the care-seeking behaviour of women who arrived at hospital with a near-miss complication. Studies II–III documented maternal mortality and near-miss morbidity at the hospital level and investigated the influence of socio-demographic factors and antenatal care (ANC) on near-miss upon arrival. The studies identified unfamiliarity with EmOC among TBAs and a lack of collaboration with formal care providers. A perception of being dissociated from the health care system and a mistrust of health care providers was common among near-miss women from disadvantaged social backgrounds. In the Bolivian setting, 187 maternal deaths per 100,000 live births and 50 cases of near-miss per 1000 were recorded. Causes of near-miss differed from those of maternal deaths. Most women with near-miss arrived at hospital in critical condition: severe preeclampsia, complications after childbirth at home and abortions were mostly encountered among them. Lack of ANC, low education, and rural residence were interactively associated with near-miss. ANC reduced socio-demographic differentials for near-miss. Complementing maternal mortality reviews with data on near-miss morbidity increases the understanding of priority needs and quality of maternal health care. Additionally, focusing on near-miss upon arrival was found useful in exploring pre-hospital barriers to EmOC. The findings identified subgroups of women who seemed especially vulnerable to pre-hospital barriers. They also underscored the need for initiatives to reduce the effect of social marginalization and to acknowledge the influential role of formal and informal care providers on the utilization of EmOC.La mortalidad materna es un tema de inquietud global, sin embargo la comprensión de las desigualdades en la utilización de los servicios de salud materna es limitada. La morbilidad obstétrica severa (near-miss) está recibiendo creciente atención, producto de problemas metodológicos en los estudios de mortalidad materna. El objetivo de la presente tesis es aumentar la comprensión de factores que impiden la utilización de la atención obstétrica de emergencia en Bolivia y Guatemala. Los estudios I y IV usaron metodologías cualitativas en un esfuerzo por explorar el rol de las parteras tradicionales y las estrategias de las mujeres que arriban a los hospitales con una morbilidad obstétrica severa. Los estudios II–III documentaron la mortalidad materna y la morbilidad obstétrica severa en el marco hospitalario e investigaron el impacto de los factores socio-demográficos y el control prenatal en la llegada a los establecimientos de salud con complicaciones severas. Los estudios identificaron la falta de familiaridad con atención obstétrica de emergencia entre las parteras tradicionales y la falta de cooperación con los profesionales de salud formales. La sensación de estar distanciadas del sistema de salud y la desconfianza hacia los profesionales de la salud eran aspectos comunes entre las mujeres de sectores marginales con experiencias de complicaciones severas. En el contexto boliviano, 187 muertes maternas por cada 100,000 nacidos vivos y 50 casos de morbilidad obstétrica severa por cada 1000 fueron registradas. Las causas de la morbilidad obstétrica severa y las muertes maternas se distinguieron. La major parte de las mujeres con morbilidad obstétrica severa llegaron al hospital en condiciones críticas: preeclampsia severa, complicaciones después de partos domiciliarios y abortos eran causas más frecuentes en esta categoría. Combinaciones del bajo nivel de educación con la falta de controles prenatales o la residencia en zonas rurales fueron asociadas con la morbilidad obstétrica severa. El control prenatal redujo diferencias socio-demográficas en lo concerniente a la morbilidad obstétrica severa. La complementación de estudios de mortalidad materna con datos sobre morbilidad obstétrica severa aumenta la comprensión de las prioridades y de la calidad en la atención de la salud materna. Además, centrándose en la morbilidad obstétrica severa a la llegada al establicimiento de salud, ha sido útil para investigar las barreras pre-hospitalarias en relación a la atención de emergencia obstétrica. Los resultados permiten identificar categorías específicas de mujeres que parecen ser especialmente vulnerables a las barreras pre-hospitalarias. Los resultados, también subrayan la necesidad de iniciativas que reduzcan los efectos de la marginalización social, y que reconozcan el importante rol que tanto el personal de salud formal como informal cumplen en la utilización de los servicios de atención obstétrica de emergencia.
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Thuresson, Marie. "The initial phase of an acute coronary syndrome : symptoms, patients' response to symptoms and opportunity to reduce time to seek care and to increase ambulance use." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-21672.
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This thesis aims to describe the initial phase of an acute coronary syndrome (ACS) in overall terms from a national perspective and to evaluate the impact of an information campaign designed to inform the public about how to act when suspecting an ACS. A total of 1939 patients at 11 hospitals in Swedenwith diagnosed ACS and symptom onset outside hospital completed a questionnaire(I-IV).In Study V, a questionnaire was completed by 116 patients withACS before the campaign and 122 after it. Register data were followed every year to evaluate ambulance use and emergency department (ED) visits. With regard to symptoms, patients with ST-elevation ACS (STE-ACS) more frequently had associated symptoms and pain with an abrupt onset reaching maximum intensity within minutes. However, fewer than half the patients with STE-ACS had this type of symptom onset. There were more similarities than differences between genders and differences between age groups were minor (I). Three-quarters of the patients interpreted the symptoms as cardiac in origin. The majority contacted a family member after symptom onset, whereas few called directly for an ambulance. Approaching someone after symptom onset and the belief that the symptoms were cardiac in origin were factors associated with a shorter pre-hospital delay (II). Half the patients went to hospital by ambulance. Independent factors for ambulance use were knowledge of the importance of quickly seeking medical care and calling for an ambulance when experiencing chest pain, severe symptoms, abrupt onset of pain, STE-ACS, increasing age and distance to hospital of > 5 km. Reasons for not calling for an ambulance were thinking self-transport would be faster or not being ill enough (III). Pain with abrupt onset, STE-ACS, symptoms such as vertigo or near syncope, experiencing the pain as frightening, interpreting the pain as cardiac in origin and knowledge were major factors associated with a short delay between symptom onset and decision to seek medical care, patient decision time (IV). The information campaign did not result in a reduction in patient decision time, but it appeared to increase ambulance use and the number of patients seeking the ED for acute chest pain (V).
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Guevorkian, Mark. "Is Prehospital Emergency Telemedicine Implementation Feasible In Non‐Traditional EMS Settings: A Systematic Literature Review." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/623626.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.The rate of technology expansion is rapidly covering even the most remote parts of the globe and in the lowest resource settings. With globalization however, low and middle income areas are facing emerging health issues such as injuries and chronic medical conditions. With these illnesses, there are inevitable demands on emergency services. It has been thought that technology be utilized to augment emergency medical care in such settings where formal Emergency Medical Services. To aggregate and analyze the existing literature on the topic a systematic literature review was conducted. This study analyzed the existing literature on prehospital emergency care in settings in which no formal EMS services were utilized. Four databases were searched with inclusion and exclusion criteria, yielding 1782 results. The initial screening excluded all but 21 articles. Of the 21 articles in full review, 15 were included in the final review. Studies included in the final review were grouped into those reporting outcomes from five categories: Feasibility, Quality of Care, Response Time, Patient Outcomes, and Cost Effectiveness. Only one study was identified to be of high quality. There was a lack of studies with adequate statistical analysis to conduct statistical aggregation. Most studies however reported prehospital telemedicine in settings without EMS to be feasible, provide quality care, are be cost effective. However, the lack of statistical analysis makes it difficult to make conclusions. Also, several studies did show response time of a trained basic life support volunteer to be faster than EMS in many of the settings. But no positive health outcomes were observed in patients treated with projects utilizing technology in the prehospital setting. The prehospital emergency medicine setting is a young field of study that may have significant hurdles in application. The studies conducted have shown promise in the use of technology in prehospital settings without formal EMS services, but are not robust enough to make strong conclusions or recommendations that could be put into practice. Thus, more robust, statistically oriented research is imperative in the field so that we can fully explore the potential of technology in the prehospital setting, especially in low resource and rural settings without formal EMS services. With more robust studies, we can hope to integrate new technologies into practice and better serve the populations without adequate EMS coverage to provide more timely emergency care.
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Granville-Chapman, Jeremy. "Adjuncts to pre-hospital resuscitation strategies for haemorrhagic shock and blast injury : supplemental oxygen and recombinant activated factor VII." Thesis, University of Newcastle upon Tyne, 2013. http://hdl.handle.net/10443/1907.
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Explosion is responsible for almost 80% of Coalition injuries in today’s conflicts. Haemorrhage is the leading cause of death and blast lung injury is evident in 11% of Coalition casualties surviving to reach the (UK) Field Hospital. Military prehospital evacuation times can be prolonged and the combined insults of haemorrhage and blast injury present a ‘double hit’ to oxygen delivery. Resuscitation strategies must be capable of preserving life from such trauma for several hours. Alongside fluid therapy, adjuncts to resuscitation might improve battlefield survival. This randomized controlled animal trial assessed two adjuncts: supplemental inspired oxygen and recombinant activated Factor VII (rFVIIa). Neither adjunct is currently available in the far-forward military echelon, but with modern technology, both are potentially deployable. 18 terminally anaesthetized swine were exposed to blast, controlled haemorrhage and grade IV liver laceration (uncontrolled haemorrhage). Animals were allocated randomly into three treatment groups. All animals were resuscitated with normal saline to a hypotensive systolic target (80mmHg), which continued until the 8hr end point. Thirty minutes after the onset of resuscitation each group received one of the following: single (180mcg/kg) dose of rFVIIa; supplemental oxygen (min FiO2 0.3 to maintain SaO2>95%) or the control group (breathed air throughout and received saline placebo 0.18ml/kg). 5/6 control animals died within 4 hours. Supplemental oxygen improved survival (4/6 survival to 8h endpoint, P=0.014). Single dose rFVIIa did not prolong survival compared to control (2/6 survived, p=0.65). Oxygen arrested physiological decline while control and rFVIIa animals continued to decline until death. Supplemental oxygen is a useful adjunct to fluid resuscitation in the context of haemorrhage and blast injury. Delivery of oxygen support capability to forward echelon units is recommended. By contrast, a single intravenous (pre-hospital) dose of rFVIIa was not an effective treatment for blast lung based on our model of complex battlefield injury.
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Anticona, Yauri Jackelin Noelia, and Colán Rabin Jair Paredes. "Complicaciones perinatales de la pre-eclampsia en gestantes adolescentes y gestantes adultas. Hospital Nacional Daniel Alcides Carrión, 2008-2010." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2012. https://hdl.handle.net/20.500.12672/16305.
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Publicación a texto completo no autorizada por el autorDescribe las complicaciones de la Pre-eclampsia que se presentan con mayor frecuencia en gestantes adolescentes y gestantes adultas en el Hospital Nacional Daniel Alcides Carrión – Callao, durante el periodo 2008 a 2010. El estudio es descriptivo, de corte transversal y retrospectivo en el cual se revisaron las historias clínicas de pacientes cuyo parto fue atendido en el servicio de Obstetricia y Ginecología del Hospital Nacional Daniel Alcides Carrión durante el periodo 2008 - 2010. Se revisó un total de 528 historias clínicas, entrando en el estudio 487 historias, que cumplieron con los criterios de inclusión y exclusión. El muestreo realizado fue no probabilístico por conveniencia. En el grupo de adolescentes la complicación más frecuente fue la Preeclampsia severa, con 85 casos, seguida por la eclampsia con 11 casos y en tercer lugar el síndrome HELLP. En el grupo de adultas la complicación más frecuente fue también la preeclampsia severa con 299 casos, seguida las alteraciones de la coagulación con 55 casos, y por el síndrome HELLP con 44 casos. Además, durante el tiempo estudiado se presentaron 10 muertes maternas, 8 de estas a causa de las complicaciones derivadas de la preeclampsia. En el caso de las gestantes adolescentes las principales complicaciones fueron la preeclampsia severa 76.5%, la restricción del crecimiento intrauterino con 27.1% y 9% el sufrimiento fetal agudo. En el grupo de gestantes adultas, las principales complicaciones fueron la preeclampsia severa con 79.5%, seguida de la restricción del crecimiento intrauterino con 19.1% y la alteración de la coagulación con 16.5%.
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Van, Wyngaard Tirsa. "Pre-operative localization and surgical outcomes for primary hyperparathyroidism (PHPT): An 11-year review at a South African hospital." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29225.
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Introduction:
Primary Hyperparathyroidism (PHPT) is characterized by hypersecretion of PTH leading to hypercalcaemia with successful surgery being the only definitive cure. Broadly, three techniques of parathyroidectomy exist: open bilateral neck exploration and minimally invasive parathyroidectomy, which is subdivided into open focused approaches and endoscopic focused approaches. A focused parathyroid gland exploration guided by pre-operative imaging is associated with less morbidity compared to a bilateral approach. Focused explorations may target either the side or the specific parathyroid gland identified.
Aim:
The primary aim of this study was to evaluate the accuracy of pre-operative localisation for PHPT in a single centre. The secondary aim was to review the type of parathyroid surgery performed and the final Parathyroid Hormone (PTH) levels in patients who have undergone parathyroidectomy for PHPT.
Methods:
This is a retrospective review of all patients who underwent primary surgery for PHPT between 2005 and 2015. Patients were identified from a general operative database. Data was collected from pathology records, operative notes, nuclear medicine and radiology reports and captured on a confidential data sheet.
Results:
Records of 98 patients were found and included. Sestamibi had a sensitivity of 88%, a positive predictive value of 83% and an accuracy of 75%. Ultrasound had a sensitivity of 52%, a positive predictive value of 78% and an accuracy of 44%. The total number of cases in which both ultrasound and sestamibi were done was 73. Sestamibi and ultrasound showed concordant results in 25 cases. The overall surgical success rate was 94% (92/98). The cure rate for patients in whom sestamibi and ultrasound were concordant, was 96% (24/25). The minimum and maximum calcium levels in the cohort were 2.2 and 4.41 respectively, with a mean of 2.86. PTH levels ranged between 4.2 and 186 with a mean of 33.8. One double adenoma was proven on histology. The rest were all single adenomas. The total number of malignancies were 3 of which 1 was part of a MEN syndrome.
Conclusion:
Our surgical success rate was 94%. When imaging modalities were concordant, surgical success was achieved in 24 cases, thus in 96% of the subgroup. Our figures compare favourably with international standards. There is scope for improvement in the accuracy of both ultrasound (46%) and sestamibi (75%) localization. Currently a combination of both imaging modalities is still recommended.
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Flores, Vásquez Tessy Margarita. "Factores de Riesgo asociados a pre eclampsia en mujeres gestantes atendidas en el Hospital Vitarte en el año 2015." Bachelor's thesis, Universidad Ricardo Palma, 2017. http://cybertesis.urp.edu.pe/handle/urp/991.
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OBJETIVO: Determinar factores de riesgo asociados a preeclampsia en mujeres gestantes atendidas en el Hospital Vitarte en el año 2015.
METODOLOGÍA: Se realizó un estudio observacional, analítico, de corte retrospectivo, transversal. La investigación contó con una muestra de 2746 pacientes .El estudio se llevó a cabo en el Servicio de Ginecología y Obstetricia del Hospital Vitarte durante el año 2015.
RESULTADOS: Se encontró una incidencia de preeclampsia de 14,06. El nivel educativo, es un factor de riesgo con un OR de 6,06; que se interpreta como que las gestantes de nivel educativo de solo primaria tienen 6,06 chances de tener preeclampsia frente a las que tenían nivel educativo de secundaria. En lo referente al sobrepeso y la obesidad nuestra investigación no encontró relación estadísticamente significativa como riesgo de padecer preeclampsia (p=0,591).En lo que respecta a hipertensión crónica, no es un factor de riesgo. Con respecto a los hábitos tabáquicos en las gestantes se encontró un OR= 1,47 y una relación que es estadísticamente significativa, un paciente que fuma tiene 1,47 veces más de sufrir de preeclampsia a comparación de los que no fuman. En el caso de haber padecido preeclampsia anterior, en este estudio se encontró un valor no estadísticamente significativo (p<0,592). Los controles prenatales (CPN), las gestantes con 5 o menos CPN tenían 2,6 veces el riesgo de tener preeclampsia frente a aquellas gestantes que tenían 6 o más CPN (OR: 2,6), y esta relación fue estadísticamente significativa (p<0,001).
CONCLUSIONES: Existe una incidencia de preeclampsia de 14,06 % en las gestantes del hospital Vitarte durante el periodo 2015. Existe una relación estadísticamente significativa con los factores de riesgos siguientes: HTA crónica, grado de instrucción, número de CPN, Preeclampsia anterior. No existe relación estadística mente significativa con la edad, IMC, tabaquismo.
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Huamaní, Mendoza Daisy A., and Auccapiña Karen Lesley Yactayo. "Nivel de conocimiento y prácticas de autocuidado que realizan las mujeres pre-menopaúsicas que acuden al Hospital de Huaycán." Bachelor's thesis, Universidad Ricardo Palma, 2016. http://cybertesis.urp.edu.pe/handle/urp/753.
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Introducción: En el mundo actual, la mujer vive ahora la tercera parte de su vida en el climaterio, por el aumento en su expectativa de vida. Es en esta etapa donde se da diversos cambios: biológicos, psicológicos y sociales que cada mujer lo experimentará de una forma individual y única. Por todo esto, el estudio es fundamental para que las mujeres puedan contribuir al mantenimiento integral de su salud. Objetivo: determinar el nivel de conocimiento y las prácticas de autocuidado que realizan las mujeres pre-menopaúsicas que acuden al Hospital de Huaycán, 2016. Material y Métodos: El enfoque de la investigación es cuantitativo, el tipo aplicada y el método no experimental, de diseño descriptivo; de corte transversal, se trabajó en una muestra de 317 mujeres de 35 a 45 años de edad, que acuden al Hospital de Huaycán, aplicó la técnica de la encuesta mediante un cuestionario que constó de 15 preguntas cerradas dicotómicas para medir el nivel de conocimiento sobre el autocuidado y 21 preguntas cerradas de opción múltiple para medir las prácticas de autocuidado. Resultados: Las mujeres en la etapa de la pre menopausia se encuentran en su mayoría con edades entre 41 a 45 años (65%), presentando un nivel de conocimiento bajo sobre el autocuidado (47%), con respecto a los conceptos generales 46% y en medidas de autocuidado 51% y por lo tanto tienen una práctica inadecuada de autocuidado 65%. Conclusión: El nivel de conocimiento sobre las prácticas de autocuidados en las mujeres pre-menopaúsicas de la Comunidad Autogestionaria de Huaycán son bajos y las prácticas de autocuidado en la dimensión biológica, psicológicas y sociales son inadecuadas.
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Mohaleni, Mamabolo Promise. "Pre-and post-HIV diagnosis help-seeking behaviour by patients receiving antiretroviral treatment at Witbank Hospital in Mpumalanga Province." Thesis, University of Limpopo (Turfloop Campus), 2013. http://hdl.handle.net/10386/1049.
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Thesis (M.A. (Clinical Psychology)) --University of Limpopo, 2013Studies have indicated that help-seeking behaviour of people living with HIV is not predictable and linear and may entail the utilization of western medicine, traditional medicine and/or complementary medicine. The aim of this study was to explore pre- and post- HIV diagnosis help-seeking behaviour by patients receiving antiretroviral treatment at Witbank Hospital in Mpumalanga Province (South Africa).A qualitative, descriptive phenomenological approach was utilized in the study. Ten participants (male = 5; female = 5, and aged between 30 and 50 years)diagnosed with HIV and who came to the hospital to collect their treatment and for medical review were interviewed using semi-structured interviews. Interpretive analysis method was used to analyse the data. The results suggest the preference for western medicine pre-and post-HIV diagnosis. The results further suggest that help-seeking behaviour is a dynamic process embedded mainly in the conceptualization of the health problem, perception of its severity, the treatment given, and social support experienced.
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Nguyen, Hoa L. "Age and Sex Differences in Duration of Pre-Hospital Delay, Hospital Treatment Practices, and Short-Term Outcomes in Patients Hospitalized with an Acute Coronary Syndrome/Acute Myocardial Infarction: A Dissertation." eScholarship@UMMS, 2010. https://escholarship.umassmed.edu/gsbs_diss/471.
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BackgroundThe prompt seeking of medical care after the onset of symptoms suggestive of acute coronary syndromes (ACS)/acute myocardial infarction (AMI) is associated with the receipt of coronary reperfusion therapy, and effective cardiac medications in patients with an ACS/AMI and is crucial to reducing mortality and the risk of serious clinical complications in these patients. Despite declines in important hospital complications and short-term death rates in patients hospitalized with an ACS/AMI, several patient groups remain at increased risk for these adverse outcomes, including women and the elderly. However, recent trends in age and sex differences in extent of pre-hospital delay, hospital management practices, and short-term outcomes associated with ACS/AMI remain unexplored.
The objectives of this study were to examine the overall magnitude, and changing trends therein, of age and sex differences in duration of pre-hospital delay (1986-2005), hospital management practices (1999-2007), and short-terms outcomes (1975-2005) in patients hospitalized with ACS/AMI.
MethodsData from 13,663 residents of the Worcester, MA, metropolitan area hospitalized at all greater Worcester medical centers for AMI 15 biennial periods between 1975 and 2005 (Worcester Heart Attack Study), and from 50,096 patients hospitalized with an ACS in 106 medical centers in 14 countries participating in the Global Registry of Acute Coronary Events (GRACE) between 2000 and 2007 were used for this investigation.
Results In comparison with men years, patients in other age-sex strata exhibited significantly longer pre-hospital delay, with the exception of women < 65 years; had a significantly lower odds of receiving aspirin, angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta blockers, statins, and undergoing coronary artery bypass graft surgery (CABG) surgery or percutaneous coronary intervention (PCI), and were significantly more likely to develop atrial fibrillation, cardiogenic shock, heart failure, and to die during hospitalization and in the first 30 days after admission. There was a significant interaction between age and sex in relation to the use of several medications and the development of several of these outcomes; in patients Conclusions Our results suggest that the elderly were more likely to experience longer prehospital delay, were less likely to be treated with evidence-based treatments during hospitalization for acute coronary syndrome, and were more likely to develop adverse outcomes compared to younger persons. Younger women were less likely to be treated with effective treatments and were more likely to develop adverse outcomes compared with younger men while there was no sex difference in these outcomes. Interventions targeted at older patients, in particular, are needed to encourage these high-risk patients to seek medical care promptly to maximize the benefits of currently available treatment modalities. More targeted treatment approaches during hospitalization for ACS/AMI for younger women and older patients are needed to improve their hospital prognosis.
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Kramar, Johanna. "Prostate brachytherapy: Pre-plan and real-time transperineal ultrasound guided Iodine-125 permanent seed implants at Södersjukhuset, Karolinska University Hospital." Thesis, Stockholm University, Medical Radiation Physics (together with KI), 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-8299.
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Purpose: The aim of this thesis is to study the European (ESTRO/EAU/EORTC) and American (ABS) guidelines how to report the permanent seed implant and the most significant dosimetric parameters. It will also report on the permanent seed implant at Södersjukhuset, Karolinska University Hospital according to the guidelines. A large number of studies on pre- and post-implant dosimetry on permanent seed implants have recently been published but none is considered a standard. This makes it difficult, if not impossible, to compare data from different centres. The differences in reporting will also be discussed in this thesis. Another part of the study is to investigate how the morbidity correlates with the dose. The results in this report will give an overview of the experience at Södersjukhuset.
Matherials and Methods: This study includes 198 patients who received implants between 2004-2007 with I-125 seeds under transperineal ultrasound at Södersjukhuset (to a prescribed dose of 145 Gy). The dose-planning system VariSeed 7.1 was used with an online connection to the ultrasound system with real-time verification. Dose constraints for the planning system are V(100)>99%, V(150)>60%, V(200)>25%, UrD(10)<130% and UrD(30)<125%. Outer and inner wall of rectum was outlined for 55 patients as recommended by ESTRO/EAU/EORTC and doses to rectum were also computed.
Results: The median value for dosimetric parameters at Södersjukhuset, Karolinska University Hospital are for the prostate; D(90)=174Gy (153-194Gy), V(100)= 99% (93-100%), V(150)= 57% (40-74%), for the urethra; UrD(30) = 130% (112-147%), UrD(10) = 124% (107-142%) and for the rectum; RD2cc= 98Gy (73-128Gy), RD0.1cc=164Gy (119-240Gy), RV(100)=0.3cc (0.0-1.3cc), RV(150)=0.0cc (0.0-0.2cc). These values correspond to recommended data, except for the V(150) value. Regarding the clinically observed results, 3 patients had a relapse in their cancer, 2 patients had mild proctitis and 15 patients had urinary problems.
Discussion and Conclusions: The significant dosimetric parameters for reporting according to ESTRO/EAU/EORTC and ABS for prostate are D90[Gy], V(100)[%] and V(150)[%], for urethra are D(30) and D(10), and for rectum RD2cc and RD0.1cc. These parameters consider as a minimum to use and they further recommend secondary parameters to report. Other authors have also recommended to report RV(100) and RV(150) for rectum. This study did not show any relationship between UrD(10), UrD(30) and urinary morbidity. According to the recommendations every patient should undergo a CT-based evaluation. Further investigations are needed on whether a post-implant CT-study is necessary for real-time implantation, as there is not enough published data on this aspect.
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Nevin, Daniel Gavin. "Pre-hospital paediatric intubation." Thesis, 2015. http://hdl.handle.net/10539/17919.
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"Analysis of a pre-hurricane hospital evacuation network." Tulane University, 2008.
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Escudeiro, Mariana Sofia Conde. "Epidemiology of MRSA and CPE in pre-hospital vehicles." Master's thesis, 2021. http://hdl.handle.net/10773/30939.
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According to the World Health Organization, antimicrobial resistance is a current serious global threat, in which methicillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing Enterobacteriaceae (CPE) are the most concerning bacteria. These microorganisms have developed resistance mechanisms towards antibiotics and so infections caused by them have since been becoming more difficult to treat. After being established in the healthcare setting, they have emerged in the community. Since it is where the population meets the healthcare personnel, the pre-hospital setting, namely the pre-hospital vehicles (PHV), became a point of interest.
In this study, the aim was to verify the extent to which the users of pre-hospital vehicles are or may be exposed to bacteriological risk, in “Centro Hospitalar do Baixo Vouga, E. P. E., Aveiro, Portugal”.
In the first chapter, to evaluate the efficiency of disinfectant product used in the surfaces of the PHV, a protocol was developed, where before and after-disinfection samples were treated and analysed. Despite the identification of some antibiotic-susceptible potentially pathogenic bacterial species before disinfection, there was no bacterial growth after disinfection in 82,2% of the episodes. The product used in the surfaces of PHV was found to be efficient, which has a great impact in eliminating bacteria on surfaces and, consequently, is a desirable feature for the hospital.
An analysis of the results of MRSA and CPE screening tests consumed for three years was performed in the second chapter. 70,6% were MRSA screening tests, while 29,4% correspond to CPE. The analysis indicated a possible decreasing tendency of the total number of the performed MRSA and CPE screening tests, as well as the number of positive tests, but it wasn’t statistically significant. Important for the hospital, by having organized data, healthcare professionals have a better perception of the numbers involved in the screening tests.
Moreover, the stimulation of scientific knowledge is still a major challenge in society. In the third chapter, an informative poster about the group of a few bacterial species that are concerning in terms of acquiring antibiotic resistance, known as ESKAPE bacteria, and a work about the pre-hospital setting were then developed. It was approached the topic of antimicrobial resistance, promoting awareness of this global threat we are currently facing.
The disinfection of the surfaces of PHV is indeed a very important step in bacterial reduction and, consequently, infection control. Overall, even though it was identified a few potentially pathogenic bacteria, they were generally antibiotic-susceptible and were eliminated after disinfection. It is possible to say that, with the resulting data, people that are transported in the PHV are not very exposed to resistant bacterial strains, specifically MRSA and CPE.Segundo a Organização Mundial de Saúde, a resistência a antibióticos é atualmente uma grave ameaça global, na qual Staphylococcus aureus resistente à meticilina (MRSA) e Enterobacteriaceae produtoras de carbapenemases (CPE) são as bactérias mais alarmantes. Esses microrganismos desenvolveram mecanismos de resistência aos antibióticos e, portanto, as infeções por eles causadas têm-se tornado mais difíceis de tratar. Depois de se estabelecerem no ambiente hospitalar, estas surgiram na comunidade. Sendo a ponte entre a população e os profissionais de saúde, o ambiente pré-hospitalar, nomeadamente os veículos pré-hospitalares (PHV), tornou-se um ponto de interesse. Neste estudo, pretendeu-se verificar em que medida os utilizadores de veículos pré-hospitalares estão ou podem estar expostos a um risco bacteriológico, no Centro Hospitalar do Baixo Vouga, E.P.E., Aveiro, Portugal. No primeiro capítulo, para avaliar a eficácia do produto desinfetante utilizado nas superfícies do PHV, foi desenvolvido um protocolo, onde amostras recolhidas antes e depois da desinfeção foram tratadas e analisadas. Apesar da identificação de algumas bactérias potencialmente patogénicas suscetíveis a antibióticos antes da desinfeção, não houve crescimento bacteriano após a desinfeção em 82,2% dos episódios. O produto utilizado nas superfícies do PHV mostrou ser eficiente, tendo grande impacto na eliminação de bactérias nas superfícies e, consequentemente, é um recurso favorável para o hospital. Uma análise dos resultados dos testes de rastreio de MRSA e CPE consumidos durante três anos foi realizada no segundo capítulo. 70,6% dos testes consumidos foram de MRSA, enquanto que 29,4% foram CPE. A análise indicou uma possível tendência decrescente do número total de testes de rastreio de MRSA e CPE realizados, bem como do número de testes positivos, no entanto não é estatisticamente significativo. Importante para o hospital, tendo dados organizados, os profissionais de saúde têm uma melhor perceção acerca dos números envolvidos nestes testes de rastreio. Para além disso, o estímulo ao conhecimento científico ainda é um grande desafio na sociedade. No terceiro capítulo, foi desenvolvido um póster informativo sobre o grupo de algumas espécies bacterianas preocupantes na aquisição de resistência aos antibióticos, conhecidas como bactérias ESKAPE, e um trabalho sobre o ambiente pré-hospitalar. Foi abordado o tema da resistência aos antibióticos, promovendo a sensibilização sobre esta ameaça global que enfrentamos. A desinfeção das superfícies dos PHV é um passo fundamental na redução de bactérias e, consequentemente, no controlo de infeções. Em geral, embora tenham sido identificadas algumas bactérias potencialmente patogénicas, estas eram suscetíveis a antibióticos e foram removidas após a desinfeção. Pode-se afirmar que, de acordo com os dados resultantes, as pessoas que sejam transportadas no PHV estão pouco expostas a estirpes bacterianas resistentes, especificamente MRSA e CPE.
Mestrado em Biotecnologia