Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

Science.gov (United States)

Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

2012-01-01

The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

Therapeutic approach to patients complaining of high blood pressure in a cardiological emergency room

Directory of Open Access Journals (Sweden)

Miguel Gus

1999-03-01

Full Text Available OBJECTIVE: To evaluate the management of patients complaining of high blood pressure (BP in a cardiological emergency room. METHODS: Patients referred to the cardiological emergency room with the main complaint of high blood pressure were consecutively selected. The prescriptions and the choice of antihypertensive drugs were assessed. The classification of these patients as hypertensive emergencies or pseudoemergencies, according to the physician who provided initial care, was recorded. RESULTS: From a total of 858 patients presenting to the emergency room, 80 (9.3% complained of high BP, and 61 (76.3% received antihypertensive drugs. Sublingual nifedipine was the most commonly used drug (59%. One patient received intravenous medication, one patient was hospitalized and 6 patients (7.5% were classified as hypertensive emergencies or pseudoemergencies. CONCLUSION: High BP could seldom be classified as a hypertensive emergency or pseudoemergency, even though it was a frequent complaint (9.3% of visits. Currently, the therapeutic approach is not recommended, even in specialized clinics.

Modernisation of Radiation Monitoring Room as a Part of Slovenian Emergency Response Centre

International Nuclear Information System (INIS)

Sarvari, A.; Mitic, D.

2003-01-01

In the year 2002 the Slovenian Nuclear Safety Administration (SNSA) moved to the new premises therefore it had to rearrange some of its rooms for the emergency situation. SNSA does not operate with a dedicated Emergency Response Centre (ERC), instead of it the SNSA has to rearrange the existing rooms in case of an emergency. Modernisation of the equipment, with the help of government of the United Kingdom of Great Britain and Northern Ireland, for the emergency situation was carried out, especially in the monitoring room. The radiation monitoring system, which is placed in the monitoring room, continuously collects, processes and archives the incoming data of exposure to radiation and meteorological parameters on the Slovenian territory (A model national emergency response plan for radiological accidents, IAEA, Vienna, 1993. IAEA-TECDOC-718). In the emergency situation the monitoring room transforms into the room for the Dose Assessment Group (DAG), which is part of ERC (IAEA emergency response network, IAEA, Vienna, 2000, EPR-ERNET (2000)). The modernisation of monitoring room and within the DAG room with new equipment and its purpose is described in this article. Modernisation of the monitoring room and the room for DAG showed to be inevitably needed. Modernisation of the monitoring room has brought the SNSA a sophisticated and reliable system of controlling the external exposure to radiation on the Slovenian territory. The equipment, especially the equipment for the use in the emergency situation, brought novelties for the Dose Assessment Group. The group has now better and easier control of radiation situation in case of an accident. In overall this modernisation has put the Slovenian Nuclear Safety Administration a step forward in having a dedicated Emergency Response Centre, since it does not need to rearrange the room for the Dose Assessment Group. (author)

Development, validation and testing of a nursing home to emergency room transfer checklist.

Science.gov (United States)

Tsai, Hsiu-Hsin; Tsai, Yun-Fang

2018-01-01

To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults

Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms

Science.gov (United States)

Myer, Gregory D.; Quatman, Carmen E.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

2014-01-01

Myer, GD, Quatman, CE, Khoury, J, Wall, EJ, and Hewett, TE. Youth versus adult “weightlifting” injuries presenting to united states emergency rooms: accidental versus nonaccidental injury mechanisms. J Strength Cond Res 23(7): 2054–2060, 2009—Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for “Weightlifting.” Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as “accidental” if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4, 111 patients. Accidental injuries decreased (p 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p injuries (n = 2, 565) showed that the oldest categories (19–22 and 23–30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to “dropping” and “pinching” in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p injuries are the result of accidents that are potentially

Multiple Trauma and Emergency Room Management.

Science.gov (United States)

Frink, Michael; Lechler, Philipp; Debus, Florian; Ruchholtz, Steffen

2017-07-24

The care of severely injured patients remains a challenge. Their initial treatment in the emergency room is the essential link between first aid in the field and definitive in-hospital treatment. We present important elements of the initial in-hospital care of severely injured patients on the basis of pertinent publications retrieved by a selective search in PubMed and the current German S3 guideline on the care of severely and multiply traumatized patients, which was last updated in 2016. The goal of initial emergency room care is the rapid recognition and prompt treatment of acutely life-threatening injuries in the order of their priority. The initial assessment includes physical examination and ultrasonography according to the FAST concept (Focused Assessment with Sonography in Trauma) for the recognition of intraperitoneal hemorrhage. Patients with penetrating chest injuries, massive hematothorax, and/or severe injuries of the heart and lungs undergo emergency thoracotomy; those with signs of hollow viscus perforation undergo emergency laparotomy. If the patient is hemo - dynamically stable, the most important diagnostic procedure that must be performed is computerized tomography with contrast medium. Therapeutic decision-making takes the patient's physiological parameters into account, along with the overall severity of trauma and the complexity of the individual injuries. Depending on the severity of trauma, the immediate goal can be either the prompt restoration of organ structure and function or so-called damage control surgery. The latter focuses, in the acute phase, on hemostasis and on the avoidance of secondary damage such as intra-abdominal contamination or compartment syndrome. It also involves the temporary treatment of fractures with external fixation and the planning of definitive care once the patient's organ functions have been securely stabilized. The care of the severely injured patient should be performed in structured fashion according to the

Assessment of Suicidal Behavior in a Psychiatric Emergency Room in Lisbon.

Science.gov (United States)

Marques, João Gama; Guerreiro, Diogo Frasquilho; Sampaio, Daniel

2015-01-01

Some studies alerted for the burden of suicidal attempters at emergency rooms. In this study we characterized the suicidal patients admitted to a Portuguese emergency room. For three years, all patients assessed by the first author after suicidal behaviour were included. Suicidal intentionality was evaluated with the Pierce Suicide Intent Scale. Clinical records were searched for follow-up status and satisfaction level was assessed through telephone call. From 120 included patients 70.8% were female, with mean age of 42.35 years. Pierce Suicide Intent Scale suicidal intentionality was low in 30.1%, medium in 59.3%, and high in 10.6% of the sample. The most important predictors of Pierce Suicide Intent Scale intentionality were male gender (p suicide (p Suicide Intent Scale is useful on suicidal behavior assessment at emergency rooms. Highly intentional suicidal behaviour is related to male sex, social problems and personal and familial psychiatric history. The quality of administrative records on this psychiatric emergency room setting are still unacceptable. The most important variables correlated with higher suicidal intentionality are the same described in other countries. Of the reachable patients, one fifth was satisfied with provided follow-up. We still need studies for better understanding of suicidal behaviour observed on this Portuguese emergency room.

Effect of National Football League games on small animal emergency room caseload.

Science.gov (United States)

Rozanski, Elizabeth A; Rondeau, Mark P; Shaw, Scott P; Rush, John E

2009-07-01

To evaluate whether games of popular professional football teams have an effect on small animal emergency room caseload and percentage of dogs and cats that subsequently are hospitalized, are euthanatized, or die following admission to veterinary emergency rooms located within a dedicated fan base. Prospective study. 818 dogs and cats admitted to the emergency room. During the 2007 New England Patriots (NEP) football season, small animal emergency room caseload was recorded for Sunday (4-hour blocks, 8:00 AM until 12:00 midnight) and Monday night (7:00 PM to 11:00 PM). Number of dogs and cats that subsequently were hospitalized, died, or were euthanatized was recorded. Mean game importance rating (GIR) was determined for NEP games (scale, 1 [mild] to 3 [great]). Percentage of dogs and cats admitted from 12:00 noon to 4:00 PM on Sundays during NEP games (mean GIR, 1.7) versus non-NEP games was not different. Mean +/- SD percentage of dogs and cats admitted from 4:00 PM to 8:00 PM on Sundays during NEP games (mean GIR, 2.4) versus non-NEP games was significantly different (18 +/- 5% and 25 +/- 7% of daily caseload, respectively). Percentage of dogs and cats admitted from 8:00 PM to 12:00 midnight on Sundays during NEP games (mean GIR, 2.1) versus non-NEP games was not different. Game type (NEP vs non-NEP) during emergency room admission did not influence whether dogs and cats subsequently were hospitalized, died, or were euthanatized. Professional sporting events may influence veterinary emergency room caseloads.

Listening to "How the Patient Presents Herself": A Case Study of a Doctor-Patient Interaction in an Emergency Room

Science.gov (United States)

Delbene, Roxana

2015-01-01

This is a case-study based on a micro-ethnography analyzing a doctor-patient interaction in an emergency room (ER) in New York City. Drawing on the framework of narrative medicine (Charon, 2006), the study examines how a phenomenological approach to listening to the patient facilitated the patient's narrative orientation not only to relevant…

The treatment of acute soft tissue trauma in Danish emergency rooms

DEFF Research Database (Denmark)

Johannsen, F; Langberg, Henning

1997-01-01

Rest, ice, compression, elevation (RICE) is the most recommended treatment for acute traumatic soft tissue injuries. A questionnaire was given to all Danish emergency rooms (n = 5) regarding their routines for acute treatment of ankle sprains and muscle contusions. Complete answers were received...... from 37 emergency rooms (73%), covering the treatment of 111 ankle sprains and 101 muscle contusions. Treatment with RICE was given in a minority of injuries, ice (21%), compression (32%) and elevation (58%) similarly between injury types. A complete RICE treatment was rarely applied (3%). Verbal...... information on RICE and rehabilitation was given in less than half of the cases. We conclude that the acute treatment of ankle sprains and muscle contusions in the Danish emergency rooms is not applied in accordance with consensus from international literature, and that the instruction in rehabilitation...

Emergency room management of radiation accidents

International Nuclear Information System (INIS)

Rosenberg, R.; Mettler, F.A. Jr.

1990-01-01

Emergency room management of radioactively contaminated patients who have an associated medical injury requiring immediate attention must be handled with care. Radioactive contamination of the skin of a worker is not a medical emergency and is usually dealt with at the plant. Effective preplanning and on-the-scene triage will allow the seriously injured and contaminated patients to get the medical care they need with a minimum of confusion and interference. Immediate medical and surgical priorities always take precedence over radiation injuries and radioactive contamination. Probably the most difficult aspect of emergency management is the rarity of such accidents and hence the unfamiliarity of the medical staff with the appropriate procedures. The authors discuss how the answer to these problems is preplanning, having a simple and workable procedure and finally having 24-h access to experts

Measures of Rehospitalization, Emergency Room Visit, and Community Discharge

Data.gov (United States)

U.S. Department of Health & Human Services — Measures of the Rate of Rehospitalization, Emergency Room Visit, and Community Discharge for Medicare Beneficiaries. These rates are based on Medicare claims data.

Evaluation of the preparedness of the children's emergency rooms ...

African Journals Online (AJOL)

PROMOTING ACCESS TO AFRICAN RESEARCH ... Background: The Children Emergency Room (CHER) is the first point of call for many sick children. ... limitation abounds with regards to personnel, high technology infrastructure, personnel ...

Emergency presentation of colon cancer is most frequent during summer.

Science.gov (United States)

Gunnarsson, H; Holm, T; Ekholm, A; Olsson, L I

2011-06-01

The frequency of emergency colon cancer (ECC) was determined using a reproducible definition of 'emergency' to analyse the impact of mode of presentation on long-term prognosis and to search for risk factors for an emergency presentation. All patients with colon cancer treated at one Swedish GDH between 1996 and 2005 (N = 604) were eligible. Patients admitted through the emergency room, operated on within three days and with an emergency condition confirmed at surgery were classified as ECC. Survival was analysed by Kaplan-Meier estimates and risk of death by Cox regression. The rate of ECC was 97/585 (17%). Patients with ECC were older (median 77 vs 74, P = 0.02), they had more stage III and IV cancers (65%vs 47%; χ(2) = 9.4, P Emergency presentation of colon cancer is an independent and adverse risk factor for long-term survival. The causes of a seasonal variation need to be clarified. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

[Management of an elderly patient in the emergency room at the end of life : A medical ethics challenge].

Science.gov (United States)

Michels, G; Nies, R; Ortmann, S; Pfister, R; Salomon, F

2018-04-01

A 94-year-old patient with cardiogenic shock due to myocardial infarction was admitted via the emergency room. A coronary angiography and intensive care were requested. The need for care due to dementia was known. After case discussion in the interdisciplinary and multiprofessional treatment team, the decision for a palliative care concept in the form of symptom control was made in the emergency room, taking into account the patient's medical history, the current situation, and the presumed patient consent. The integration of medical ethics aspects and palliative medicine into "geriatric emergency medicine" will present a challenge in the future.

Facets of operational performance in an emergency room (ER)

NARCIS (Netherlands)

van der Vaart, Taco; Vastag, Gyula; Wijngaard, Jacob

This paper, using detailed time measurements of patients complemented by interviews with hospital management and staff, examines three facets of an emergency room's (ER) operational performance: (1) effectiveness of the triage system in rationing patient treatment; (2) factors influencing ER's

Effects of a training workshop on suicide prevention among emergency room nurses.

Science.gov (United States)

Kishi, Yasuhiro; Otsuka, Kotaro; Akiyama, Keiko; Yamada, Tomoki; Sakamoto, Yumiko; Yanagisawa, Yaeko; Morimura, Hiroshi; Kawanishi, Chiaki; Higashioka, Hiroaki; Miyake, Yasushi; Thurber, Steven

2014-01-01

Suicide attempts are frequently encountered by emergency department nurses. Such encounters can potentially provide a foundation for secondary suicide prevention. The aim of the present investigation was to evaluate the effect of a 7-hr training program for emergency room nursing personnel in Japan. In all, 52 nurses completed the questionnaires before the workshop and 1 month after the workshop. The nurses' understanding of and willingness to care for suicidal patients positively changed. It is feasible to provide a 7-hr, relatively short, workshop on suicidal prevention aimed at emergency medical staff and to improve attitudes during a follow-up of 1 month. It is uncertain whether the positive attitudes of emergency nurses toward suicide and/or educational interventions could impact the outcomes of these interventions. Further studies are needed to address these important questions in this field.

Prevalence of thyroid dysfunction in patients with acute atrial fibrillation attended at a cardiology emergency room

Directory of Open Access Journals (Sweden)

Juarez Neuhaus Barbisan

Full Text Available CONTEXT: Atrial fibrillation occurs frequently in patients with thyrotoxicosis, while it has low prevalence in adults of the general population. The prevalence of thyroid dysfunction in subjects with atrial fibrillation is 0 to 24%, a wide variation that is attributed to the different methodologies applied. However, continuous use of amiodarone in patients with previous atrial fibrillation may interfere with these prevalence rates. OBJECTIVE: In this study, we present the prevalence of thyroid dysfunction in adult patients who presented at a cardiac emergency room with acute atrial fibrillation, using a sensitive thyroid-stimulating hormone (TSH assay and triiodothyronine (T3 and thyroxine (T4 determination. TYPE OF STUDY: Cross-sectional study SETTING: Emergency room of a tertiary care facility. PARTICIPANTS: A total of 72 patients with atrial fibrillation who presented at the emergency room not more than 48 hours after its onset. PROCEDURES: A standardized questionnaire and 12-lead electrocardiogram were applied, and T3, T4 and TSH were determined. MAIN MEASUREMENTS: TSH, T3 and T4 determination. RESULTS: Among these patients, 16.6% had altered thyroid function tests: 6.9% had hyperthyroidism, 5.6% hypothyroidism and 4.2% had increased T4 levels, by means of amiodarone use. CONCLUSION: The high prevalence of thyroid dysfunction in our study, especially hyperthyroidism, suggests that routine thyroid testing with sensitivethyroid-stimulating hormone assay is required in patients with acute atrial fibrillation.

CFD analysis of the temperature field in emergency pump room in Loviisa NPP

Energy Technology Data Exchange (ETDEWEB)

Rämä, Tommi, E-mail: tommi.rama@fortum.com [Fortum Power and Heat, P.O.B. 100, FI-00048 Fortum (Finland); Toppila, Timo, E-mail: timo.toppila@fortum.com [Fortum Power and Heat, P.O.B. 100, FI-00048 Fortum (Finland); Kelavirta, Teemu, E-mail: teemu.kelavirta@fortum.com [Fortum Power and Heat, Loviisa Power Plant, P.O.B. 23, FI-07901 Loviisa (Finland); Martin, Pasi, E-mail: pasi.martin@fortum.com [Fortum Power and Heat, Loviisa Power Plant, P.O.B. 23, FI-07901 Loviisa (Finland)

2014-11-15

Highlights: • Laser scanned room geometry from Loviisa NPP was utilized for CFD simulation. • Uncertainty of CFD simulation was estimated using the Grid Convergence Index. • Measured temperature field of pump room was reproduced with CFD simulation. - Abstract: In the Loviisa Nuclear Power Plant (NPP) six emergency pumps belonging to the same redundancy are located in the same room. During a postulated accident the cooling of the room is needed as the engines of the emergency pumps generate heat. Cooling is performed with fans blowing air to the upper part of the room. Temperature limits have been given to the operating conditions of the main components in order to ensure their reliable operation. Therefore the temperature field of the room is important to know. Temperature measurements were made close to the most important components of the pump room to get a better understanding of the temperature field. For these measurements emergency pumps and cooling fan units were activated. To simulate conditions during a postulated accident additional warm-air heaters were used. Computational fluid dynamic (CFD) simulations were made to support plant measurements. For the CFD study one of the pump rooms of Loviisa NPP was scanned with a laser and this data converted to detailed 3-D geometry. Tetrahedral computation grid was created inside the geometry. Grid sensitivity studies were made, and the model was then validated against the power plant tests. With CFD the detailed temperature and flow fields of the whole room were produced. The used CFD model was able to reproduce the temperature field of the measurements. Two postulated accident cases were simulated. In the cases the operating cooling units were varied. The temperature profile of the room changes significantly depending on which units are cooling and which only circulating the air. The room average temperature stays approximately the same. The simulation results were used to ensure the acceptable operating

Categorizing "frequent visitors" in the psychiatric emergency room: a semistructured interview study

DEFF Research Database (Denmark)

Buus, Niels

2011-01-01

Nurses can become demoralized and hostile toward frequent visitors in psychiatric emergency rooms because of the number of visits. The aim of this study was to develop more knowledge about the ways in which nurses categorize frequent visitors. Eleven nurses were interviewed, and their categorizing...... practices were examined from a social constructionist perspective. The results showed that the nurses did not categorize frequent visitors as particularly unlikeable or difficult to treat. Like other visitors, they could be categorized as difficult if they obstructed a smooth flow of successful referrals...... through the emergency room and/or there was poor rapport with the nurses....

Clinic exam room design: present and future.

Science.gov (United States)

Freihoefer, Kara; Nyberg, Gary; Vickery, Christine

2013-01-01

This article aims to deconstruct various design qualities and strategies of clinic exam rooms, and discuss how they influence users' interaction and behavior in the space. Relevant literature supports the advantages and disadvantages of different design strategies. Annotated exam room prototypes illustrate the design qualities and strategies discussed. Advancements in technology and medicine, along with new legislative policies, are influencing the way care providers deliver care and ultimately clinic exam room designs. The patient-centered medical home model has encouraged primary care providers to make patients more active leaders of their health plan which will influence the overall functionality and configuration of clinic exam rooms. Specific design qualities discussed include overall size, location of doors and privacy curtains, positioning of exam tables, influence of technology in the consultation area, types of seating, and placement of sink and hand sanitizing dispensers. In addition, future trends of exam room prototypes are presented. There is a general lack of published evidence to support design professionals' design solutions for outpatient exam rooms. Future research should investigate such topics as the location of exam tables and privacy curtains as they relate to patient privacy; typical size and location of consultation table as it relates to patient connection and communication; and placement of sinks and sanitization dispensers as they relate to frequency and patterns of usage. Literature review, outpatient, technology, visual privacy.

"Boarding" Psychiatric Patients in Emergency Rooms: One Court Says "No More".

Science.gov (United States)

Appelbaum, Paul S

2015-07-01

"Boarding" involuntary psychiatric patients in medical emergency rooms is common in many parts of the United States. The practice, driven by a shortage of alternative resources, including limited inpatient capacity, can result in patients' being held for days without treatment or a hospital room, often in busy corridors or treatment rooms. A recent challenge to this practice led the Washington Supreme Court to declare it illegal and resulted in the appropriation of substantial funding to create new psychiatric beds. Centralized psychiatric crisis services, with appropriate payment models, may offer another approach to reducing the need for holding patients awaiting inpatient admission.

Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room

Directory of Open Access Journals (Sweden)

VLAUDIMIR DIAS MARQUES

Full Text Available ABSTRACT Objective: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. Methods: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. Results: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n=187, the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values was performed in greater numbers when compared with cases led by surgeons (n=501. There was a statistically significant relationship (p<0.01 between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28 in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. Conclusion: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

Evaluation of the preparedness of the children's emergency rooms ...

African Journals Online (AJOL)

2017-02-09

Feb 9, 2017 ... beds per nurse ranges from 3-15, giving a nurse: patient ratio of 1:3-15. (Table 1) .... Emergency Rooms (CHER) in the tertiary health institu- .... vices offered in our tertiary centres must go beyond the mundane ... medical tourism abroad as most often any care beyond the basic ... of general practitioner care.

Suspected leaking abdominal aortic aneurysm: use of sonography in the emergency room.

Science.gov (United States)

Shuman, W P; Hastrup, W; Kohler, T R; Nyberg, D A; Wang, K Y; Vincent, L M; Mack, L A

1988-07-01

To determine the value of sonography in the emergent evaluation of suspected leaking abdominal aortic aneurysms, the authors examined 60 patients in the emergency department using sonography and a protocol involving advance radio notification from the ambulance; arrival of sonographic personnel and equipment in the triage room before patient arrival; and, during other triage activities, rapid sonographic evaluation of the aorta for aneurysm and of the paraaortic region for extraluminal blood. Sonographic findings were correlated with surgical results and clinical outcome. When performed under these circumstances, sonography was accurate in demonstrating presence or absence of aneurysm (98%), but its sensitivity for extraluminal blood was poor (4%). A combination of sonographic confirmation of aneurysm, abdominal pain, and unstable hemodynamic condition resulted in the correct decision to perform emergent surgery in 21 of 22 patients (95%). An abbreviated sonographic examination done in the emergency room can provide accurate, useful information about the presence of aneurysm; this procedure does not significantly delay triage of these patients.

Alcohol and Violence in the Emergency Room: A Review and Perspectives from Psychological and Social Sciences

Directory of Open Access Journals (Sweden)

Cheryl Cherpitel

2013-09-01

Full Text Available Our objective is to present a focused review of the scientific literature on the effect of alcohol consumption on violence related-injuries assessed in the emergency room (ER and to show how psychological and behavioral sciences could lead to a better understanding of the factors contributing to alcohol-related injuries in the ER. We retrieved published literature through a detailed search in Academic Search Premier, MEDLINE with Full Text PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, PUBMed and SocINDEX with Full Text for articles related to emergency rooms, medical problems and sociocognitive models addressing alcohol intoxication articles. The first search was conducted in June 2011 and updated until August 2013. Literature shows that compared to uninjured patients; injured ones have a higher probability of: (i having an elevated blood-alcohol concentration upon arrival at the ER; (ii reporting having drunk alcohol during the six hours preceding the event; and (iii suffering from drinking-related consequences that adversely affect their social life. The main neurocognitive and sociocognitive models on alcohol and aggression are also discussed in order to understand the aetiology of violence-related injuries in emergency rooms. Suggestions are made for future research and prevention.

Preparing for Sudden Death: Social Work in the Emergency Room.

Science.gov (United States)

Wells, Paula J.

1993-01-01

Provides guidelines from social work perspective on how social workers and health care professionals can provide bereavement counseling for families whose relatives have died in emergency room. Discusses providing family with privacy and accessibility; keeping family informed; using understandable terminology; speaking directly about death;…

Child Abuse: The Value of Systematic Screening at Emergency Rooms

NARCIS (Netherlands)

Sittig, J.S.

2015-01-01

There is no conclusive evidence that diagnostic tools detect physical child abuse among children coming to emergency rooms (ERs), but his evidence is urgently needed because both false-positive and false-negative diagnoses have serious adverse effects. This thesis describes several aspects of the

Digital image display system for emergency room

International Nuclear Information System (INIS)

Murry, R.C.; Lane, T.J.; Miax, L.S.

1989-01-01

This paper reports on a digital image display system for the emergency room (ER) in a major trauma hospital. Its objective is to reduce radiographic image delivery time to a busy ER while simultaneously providing a multimodality capability. Image storage, retrieval, and display will also be facilitated with this system. The system's backbone is a token-ring network of RISC and personal computers. The display terminals are higher- function RISC computers with 1,024 2 color or gray-scale monitors. The PCs serve as administrative terminals. Nuclear medicine, CT, MR, and digitized film images are transferred to the image display system

Prevalence of substance use among trauma patients treated in a Brazilian emergency room

Directory of Open Access Journals (Sweden)

Reis Alessandra Diehl

2006-01-01

Full Text Available OBJECTIVE: Although there is a considerable amount of data in the literature regarding the association between alcohol consumption and injuries treated in emergency rooms, little is known about the relationship between such injury and the use of other substances. The objective of this study was to estimate the prevalence of substance use in patients admitted to the emergency room for non-fatal injuries. METHOD: A prospective cross-sectional study assessing all patients admitted to the emergency room within 6 hours after a non-fatal injury was conducted over a three-month period. The following were used as measures of alcohol and drug use: a standardized World Health Organization questionnaire; a self-administered questionnaire related to drug consumption within the 24 hours preceding contact; the Drug Abuse Screening Test; urine screens for cannabis, cocaine and benzodiazepines; and determination of blood alcohol concentration. Descriptive analyses were performed and the confidence interval used was 95%. RESULTS: A total of 353 patients were included. Cannabis and cocaine screens were conducted for 242 patients and benzodiazepine screens were conducted for 166. Blood alcohol concentrations reached the level of positivity in 11% (n = 39, and 10% (n = 33 presented some degree of intoxication. Among the 242 patients screened, 13.6% (n = 33 tested positive for cannabis, and 3.3% (n = 8 tested positive for cocaine, whereas 4.2% (n = 7 of the 166 patients screened tested positive for benzodiazepines. CONCLUSIONS: Substance use was highly prevalent among these individuals. In this sample, the frequency for the use of cannabis (an illicit drug was comparable to that of alcohol. More studies are needed in order to characterize such use among Brazilians and to develop proper approaches to such cases, with the aim of reducing substance use and its consequences.

Cervical Spine Collar Removal by Emergency Room Nurses: A Quality Improvement Project.

Science.gov (United States)

Fontaine, Guillaume; Forgione, Massimo; Lusignan, Francis; Lanoue, Marc-André; Drouin, Simon

2018-05-01

The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians. The project began with the creation of an interdisciplinary team. Clinical guidelines were established by the interdisciplinary project team. Nine charge nurses of the emergency room were then trained to use the CCR (3 on each 8-hour shift). The use of the CCR was monitored throughout the project period, from June 1 to October 5, 2016. The 3 aims of this practice improvement project were attained successfully. Over a 5-month period, 114 patients were assessed with the CCR. Charge nurses removed the cervical collars for 54 of 114 patients (47%). A perfect agreement rate (114 of 114 patients, 100%) was attained between the assessments of the nurses and those of physicians. This project shows that the charge nurses of a secondary trauma center can use the CCR safely on alert, orientated, and low-risk adult trauma patients as demonstrated by the agreement in the assessments of emergency room nurses and physicians. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Evaluation of New-Onset Diabetes in Patients Presenting Emergency Service with a Diabetic Ketoacidosis Attack

Directory of Open Access Journals (Sweden)

Yavuz Yiğit

2013-12-01

Full Text Available Aim: The aim of this study was to investigate the rate of new-onset diabetes mellitus (DM in patients presenting to our emergency department with diabetic ketoacidosis. Methods: We retrospectively evaluated hospital records of patients who presented to the Emergency Department at Istanbul Goztepe Research and Training Hospital between 01 April 2009 and 01 April 2011 and were diagnosed with diabetic ketoacidosis. 57 patients having complete clinical data were included in the study. Results: 45.6%of patients had type 1 DM, 33.3%- type 2 DM, and 21%of them were with new-onset DM. No statistically significant difference was found between type 1 DM, type 2 DM and new-onset DM patients with respect to arterial blood pH and HCO3 levels and serum sodium, potassium and plasma glucose levels at presentation as well as time of presentation (p>0.05, while HbA1c levels showed statistically significant difference in new-onset DM patients. Conclusion: No statistically significant difference was found between types of DM in patients diagnosed with diabetic ketoacidosis except for precipitating factors, age and HbA1c. Detecting high blood glucose levels in patients presenting to emergency room for reasons other than DM is not a rare condition. Cautious evaluation and recognition of these patients in emergency room for the possibility of undiagnosed DM is important for prevention of future diabetic ketoacidosis episodes. (The Medical Bulletin of Haseki 2013; 51: 168-72

PM2.5 constituents and hospital emergency-room visits in Shanghai, China.

Science.gov (United States)

Qiao, Liping; Cai, Jing; Wang, Hongli; Wang, Weibing; Zhou, Min; Lou, Shengrong; Chen, Renjie; Dai, Haixia; Chen, Changhong; Kan, Haidong

2014-09-02

Although ambient PM2.5 has been linked to adverse health effects, the chemical constituents that cause harm are largely unclear. Few prior studies in a developing country have reported the health impacts of PM2.5 constituents. In this study, we examined the short-term association between PM2.5 constituents and emergency room visits in Shanghai, China. We measured daily concentrations of PM2.5, organic carbon (OC), elemental carbon (EC), and eight water-soluble ions between January 1, 2011 and December 31, 2012. We analyzed the data using overdispersed generalized linear Poisson models. During our study period, the mean daily average concentration of PM2.5 in Shanghai was 55 μg/m(3). Major contributors to PM2.5 mass included OC, EC, sulfate, nitrate, and ammonium. For a 1-day lag, an interquartile range increment in PM2.5 mass (36.47 μg/m(3)) corresponded to 0.57% [95% confidence interval (CI): 0.13%, 1.01%] increase of emergency room visits. In all the three models used, we found significant positive associations of emergency room visits with OC and EC. Our findings suggest that PM2.5 constituents from the combustion of fossil fuel (e.g., OC and EC) may have an appreciable influence on the health impact attributable to PM2.5.

Neuroimaging of Patients with Headache in the Emergency Room: A Retrospective Analysis

Directory of Open Access Journals (Sweden)

ibrahim Burak Atci

2015-03-01

Conclusion: In the emergency department during evaluation of headache, that should be done first is the exclusion of headaches which is caused by non beningn intracranial patologies. Therefore, from the entrance of the patients evaluated in the emergency room, it is important that they must be directed to rapid diagnosis and treatment with considering the red alert findings. [Cukurova Med J 2015; 40(1.000: 86-90

Errors in radiographic recognition in the emergency room

International Nuclear Information System (INIS)

Britton, C.A.; Cooperstein, L.A.

1986-01-01

For 6 months we monitored the frequency and type of errors in radiographic recognition made by radiology residents on call in our emergency room. A relatively low error rate was observed, probably because the authors evaluated cognitive errors only, rather than include those of interpretation. The most common missed finding was a small fracture, particularly on the hands or feet. First-year residents were most likely to make an error, but, interestingly, our survey revealed a small subset of upper-level residents who made a disproportionate number of errors

Youth versus adult "weightlifting" injuries presenting to United States emergency rooms: accidental versus nonaccidental injury mechanisms.

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Myer, Gregory D; Quatman, Carmen E; Khoury, Jane; Wall, Eric J; Hewett, Timothy E

2009-10-01

Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as "accidental" if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4,111 patients. Accidental injuries decreased (p 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p injuries (n = 2,565) showed that the oldest categories (19-22 and 23-30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to "dropping" and "pinching" in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p injuries are the result of accidents that are potentially preventable with increased supervision and stricter safety guidelines.

[Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP?].

Science.gov (United States)

Shafizadeh, S; Tjardes, T; Steinhausen, E; Balke, M; Paffrath, T; Bouillon, B; Bäthis, H

2010-08-01

There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

76 FR 76937 - Emerging Technology and Research Advisory Committee; Notice of Partially Closed Meeting-Room Change

Science.gov (United States)

2011-12-09

... DEPARTMENT OF COMMERCE Bureau of Industry and Security Emerging Technology and Research Advisory Committee; Notice of Partially Closed Meeting--Room Change The Emerging Technology and Research Advisory... emerging technology and research activities, including those related to deemed exports. Agenda Wednesday...

Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

Energy Technology Data Exchange (ETDEWEB)

Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Rochitte, Carlos Eduardo, E-mail: rochitte@cardiol.br [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Instituto do Coração - InCor - HCFMUSP, São Paulo, SP (Brazil)

2013-12-15

The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies.

Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

International Nuclear Information System (INIS)

Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro; Rochitte, Carlos Eduardo

2013-01-01

The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies

Occurrence rate and clinical predictors of hypertensive pseudocrisis in emergency room care.

Science.gov (United States)

Sobrinho, Silvestre; Correia, Luís C L; Cruz, Constança; Santiago, Mila; Paim, Ana Catarina; Meireles, Bruno; Andrade, Mariana; Kerner, Mariana; Amoedo, Paula; de Souza, Carlos Marcílio

2007-05-01

To describe the prevalence of hypertensive pseudocrisis in patients treated in emergency rooms with substantially elevated blood pressure levels. To compare this prevalence in private and public hospitals. To describe the frequency of wrong treatment for this condition. To identify, during triage, independent predictors of pseudocrisis. To evaluate the prognosis of patients with pseudocrisis. Patients above the age of 18, admitted to the Emergency Rooms of two hospitals (private and public) during a 6 month timeframe, with diastolic blood pressure > or = 120 mmHg were included in the study. Hypertensive pseudocrisis was determined when none of the criteria for hypertensive crisis were present (Guidelines of the Brazilian Society of Cardiology(1)). In the 110 patients studied, the prevalence of hypertensive pseudocrisis was 48% (95% CI = 39%-58%) and prevailed in the private hospital (59% vs 37%, p=0.02). The frequency of wrong treatment was similar between the two hospitals (94% vs 95%, p=0.87). After multivariate analysis, the presence of headache upon admission (Odds Ratio=5.4; 95% CI = 5.1-13; pcrisis group (0% vs 21%, p=0.0004). There is a high prevalence of hypertensive pseudocrisis in patients when hypertensive crisis is suspected, particularly in the private hospital. The frequency of wrong treatment was similar for both the private and public hospitals. Headaches and diastolic BP levels are independent predictors for this clinical condition. Hypertensive pseudocrisis has a low rate of lethality.

Educational paper Detection of child abuse and neglect at the emergency room

NARCIS (Netherlands)

Teeuw, Arianne Hélène; Derkx, Bert H. F.; Koster, Willeke A.; van Rijn, Rick R.

2012-01-01

The emergency room (ER) represents the main system entry for crises-based health care visits. It is estimated that 2% to 10% of children visiting the ER are victims of child abuse and neglect (CAN). Therefore, ER personnel may be the first hospital contact and opportunity for CAN victims to be

The application of a "6S Lean" initiative to improve workflow for emergency eye examination rooms.

Science.gov (United States)

Nazarali, Samir; Rayat, Jaspreet; Salmonson, Hilary; Moss, Theodora; Mathura, Pamela; Damji, Karim F

2017-10-01

Ophthalmology residents on call at the Royal Alexandra Hospital identified workplace disorganization and lack of standardization in emergency eye examination rooms as an impediment to efficient patient treatment. The aim of the study was to use the "6S Lean" model to improve workflow in eye examination rooms at the Royal Alexandra Hospital. With the assistance of quality improvement consultants, the "6S Lean" model was applied to the current operation of the emergency eye clinic examination rooms. This model, considering 8 waste categories, was then used to recommend and implement changes to the examination rooms and to workplace protocols to enhance efficiency and safety. Eye examination rooms were improved with regards to setup, organization of supplies, inventory control, and maintenance. All targets were achieved, and the 5S audit checklist score increased by 33 points from 44 to 77. Implementation of the 6S methodology is a simple approach that removes inefficiencies from the workplace. The ophthalmology clinic removed waste from all 8 waste categories, increased audit results, mitigated patient and resident safety risks, and ultimately redirected resident time back to patient care delivery. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Waiting room crowding and agitation in a dedicated psychiatric emergency service.

Science.gov (United States)

El-Mallakh, Rif S; Whiteley, Amanda; Wozniak, Tanya; Ashby, McCray; Brown, Shawn; Colbert-Trowel, Danya; Pennington, Tammy; Thompson, Michael; Tasnin, Rokeya; Terrell, Christina L

2012-05-01

Emergency department crowding is a growing problem that impacts patient care and safety. The effect of crowding has not been examined in emergency psychiatric services. The association between patient census and use of restraints, seclusion, and anti-agitation medications as needed was examined for 1 month. A total of 689 patients were seen in 31 days. The average hourly census was 6.8 ± 2.8 (range 0 to 18). There were 33 incidences of seclusion or restraint and an additional 15 instances of medications administered for agitation. The use of seclusion, restraint, or medication for agitation was significantly associated with census (r2 = 0.3, F = 5.47, P = .036). Crowding in emergency psychiatric waiting rooms may increase the need for seclusion, restraint, or medications for agitation.

Control room human engineering influences on operator performance

International Nuclear Information System (INIS)

Finlayson, F.C.

1977-01-01

Three general groups of factors influence operator performance in fulfilling their responsibilities in the control room: (1) control room and control system design, informational data displays (operator inputs) as well as control board design (for operator output); (2) operator characteristics, including those skills, mental, physical, and emotional qualities which are functions of operator selection, training, and motivation; (3) job performance guides, the prescribed operating procedures for normal and emergency operations. This paper presents some of the major results of an evaluation of the effect of human engineering on operator performance in the control room. Primary attention is given to discussion of control room and control system design influence on the operator. Brief observations on the influences of operator characteristics and job performance guides (operating procedures) on performance in the control room are also given. Under the objectives of the study, special emphasis was placed on the evaluation of the control room-operator relationships for severe emergency conditions in the power plant. Consequently, this presentation is restricted largely to material related to emergency conditions in the control room, though it is recognized that human engineering of control systems is of equal (or greater) importance for many other aspects of plant operation

The Obstetrics Gynecology and Children's Hospital Emergency ...

African Journals Online (AJOL)

EB

The efficiency of emergency rooms is becoming increasingly important and has been addressed by legislation. Prompt emergency room service is expected when patients present to an emergency room with urgent health problems. However, depending on various factors, the wait times for access to health services can be ...

Retained Products of Conception: An Atypical Presentation Diagnosed Immediately with Bedside Emergency Ultrasound

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Kristin Adkins

2016-01-01

Full Text Available Background. Retained products of conception is an important diagnosis to consider in patients presenting with postpartum complaints. Bedside ultrasound is a rapid, accurate, noninvasive modality to evaluate these patients. Objective. To report an atypical case of retained products of conception diagnosed with bedside ultrasound in the emergency department. Case Report. A 27-year-old female who was 1-month postpartum presented with vaginal bleeding, pelvic pain, and no fever. At the time of initial H&P, bedside ultrasound revealed echogenic material within the endometrial cavity with blood flow seen by color Doppler consistent with retained products of conception. The bedside ultrasound rapidly narrowed the differential and allowed a definitive diagnosis immediately. Ob/Gyn was consulted and dilation and curettage was performed in the operating room. Conclusions. Retained products of conception is an important diagnosis for the emergency physician to consider in at-risk patients. The sonographic findings are easily obtained and interpreted by emergency physicians. Earlier diagnosis of this disease process should lead to more focused patient evaluations and management.

Stroke Education in an Emergency Department Waiting Room: a Comparison of Methods

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Yu-Feng Yvonne Chan1

2015-03-01

Full Text Available Background: Since the emergency department (ED waiting room hosts a large, captive audience of patients and visitors, it may be an ideal location for conduct-ing focused stroke education. The aim of this study was to assess the effective-ness of various stroke education methods.Methods: Patients and visitors of an urban ED waiting room were randomized into one of the following groups: video, brochure, one-to-one teaching, combi-nation of these three methods, or control group. We administered a 13-question multiple-choice test to assess stroke knowledge prior to, immediately after, and at 1 month post-education to patients and visitors in the ED waiting room.Results: Of 4 groups receiving education, all significantly improved their test scores immediately post intervention (test scores 9.4±2.5-10.3±2.0, P<0.01. At 1 month, the combination group retained the most knowledge (9.4±2.4 exceed-ing pre-intervention and control scores (both 6.7±2.6, P<0.01.Conclusion: Among the various stroke education methods delivered in the ED waiting room, the combination method resulted in the highest knowledge reten-tion at 1-month post intervention.

[Índice de Saturación Modificado y Ambulancias (ISMA): Ambulance assignment and remote Emergency Room Bed Reservation].

Science.gov (United States)

Polanco-González, Carlos; Castañón-González, Jorge Alberto; Villanueva-Martínez, Sebastián; Samaniego-Mendoza, José Lino; Buhse, Thomas

2015-01-01

In most places all over the world–including our country–services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.

[Temperature that modifies the effect of air pollution on emergency room visits for circulatory and respiratory diseases in Beijing, China].

Science.gov (United States)

Wang, L L; Zhang, Q; Bai, R H; Mi, B B; Yan, H

2017-08-10

Objective: To analyze the temperature modification effect on emergency room visits for circulatory and respiratory diseases caused by air pollution, in Beijing. Methods: Data on both circulatory and respiratory diseases in 2010 and 2011 were collected, Both meteorological and air pollutants related data were obtained from the National Scientific Data Sharing Platform for Population and Health. By using the stratified time-series models, we analyzed the effects of air pollution on emergency room visits for circulatory and respiratory diseases under different temperature zones, from 2010 to 2011, in Beijing. Results: Low temperature (daily average temperatureeffect of air pollution index (API) on emergency room visits for circulatory diseases, Under 10 units of API, the relative risks and confidence interval appeared as 1.067 (1.054-1.080). However, high (daily average temperature between 24.4 ℃ and 28.5 ℃) and extra-high temperature (daily average temperature >28.5 ℃) could enhance the effect of API on emergency room visits for respiratory diseases, Under 10 units of API, the relative risks and confidence interval were 1.021 (1.015-1.028) and 1.006 (1.003-1.008), respectively. Conclusion: Temperature seemed to have modified the association between air pollution and both circulatory and respiratory diseases.

[Breaking bad news in the emergency room: Suggestions and future challenges].

Science.gov (United States)

Landa-Ramírez, Edgar; López-Gómez, Antonio; Jiménez-Escobar, Irma; Sánchez-Sosa, Juan José

2017-01-01

The aim of this paper is to describe educational programs that reportedly teach how to break bad news in the emergency department. We also suggest some recommendations on how to communicate bad news based on the research of evidence available in the field. The examined evidence points toward six major components with which physicians should familiarize when communicating bad news: 1) doctor-patient empathic communication, 2) establishing a proper space to give the news, 3) identifying characteristics of the person who receives the news, 4) essential aspects for communicating the news; 5) emotional support, and 6) medical and administrative aspects of the encounter. Finally, we point out several limitations in the studies in the field and future challenges identified in the communication of bad news in emergency room facilities.

Guidelines for the presentation of emergency operating procedures using advanced information technology

International Nuclear Information System (INIS)

Green, M.; Hollnagel, E.; Niwa, Yuji

1994-01-01

New methods of information presentation and interface design are changing the conditions for work in the modern NPP control room. One area receiving considerable attention is that of Emergency Operating Procedures (EOP). Conventionally such procedures are presented using hard copy manuals; however, development in IT means that there are new opportunities for the computerization of such procedures. This paper reports on the development of human factors guidelines for the computerized presentation of EOPs. After identifying the principle stages in the transition from procedures as documents to fully automated procedures, computerised procedure presentation is briefly discussed. Guidelines for the presentation of such procedures are outlined starting with the high level goals for guidelines themselves. Such goals also constitute the criteria against which the computerized procedures are measured during implementation. Six dimensions describing computerized procedure presentation are presented and two are explore in more detail by identifying points along each dimension that characterize different levels of IT sophistication. (author). 8 refs, 1 tab

A spatial analysis of heat stress related emergency room visits in rural Southern Ontario during heat waves.

Science.gov (United States)

Bishop-Williams, Katherine E; Berke, Olaf; Pearl, David L; Kelton, David F

2015-08-06

In Southern Ontario, climate change may have given rise to an increasing occurrence of heat waves since the year 2000, which can cause heat stress to the general public, and potentially have detrimental health consequences. Heat waves are defined as three consecutive days with temperatures of 32 °C and above. Heat stress is the level of discomfort. A variety of heat stress indices have been proposed to measure heat stress (e.g., the heat stress index (HSI)), and has been shown to predict increases in morbidity and/or mortality rates in humans and other species. Maps visualizing the distribution of heat stress can provide information about related health risks and insight for control strategies. Information to inform heat wave preparedness models in Ontario was previously only available for major metropolitan areas. Hospitals in communities of fewer than 100,000 individuals were recruited for a pilot study by telephone. The number of people visiting the emergency room or 24-hour urgent care service was collected for a total of 27 days, covering three heat waves and six 3-day control periods from 2010-2012. The heat stress index was spatially predicted using data from 37 weather stations across Southern Ontario by geostatistical kriging. Poisson regression modeling was applied to determine the rate of increased number of emergency room visits in rural hospitals with respect to the HSI. During a heat wave, the average rate of emergency room visits was 1.11 times higher than during a control period (IRR = 1.11, CI95% (IRR) = (1.07,1.15), p ≤ 0.001). In a univariable model, HSI was not a significant predictor of emergency room visits, but when accounting for the confounding effect of a spatial trend polynomial in the hospital location coordinates, a one unit increase in HSI predicted an increase in daily emergency rooms visits by 0.4% (IRR = 1.004, CI95%(IRR) = (1.0005,1.007), p = 0.024) across the region. One high-risk cluster and no low risk

Improving Patients Experience in Peadiatric Emergency Waiting Room.

Science.gov (United States)

Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

2016-01-01

When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear.

Outcome of burr hole surgery in the emergency room for severe acute subdural hematoma

International Nuclear Information System (INIS)

Park, Young-Soo; Hironaka, Yasuhiro; Motoyama, Yasushi; Asai, Hideki; Watanabe, Tomoo; Nishio, Kenji; Nakase, Hiroyuki; Okuchi, Kazuo

2010-01-01

We have performed burr hole surgery in the emergency room for severe acute subdural hematoma from April 2007 in twenty five patients. All patients were deep comatose and showed cerebral herniation sign with bilateral pupillary abnormalities. Burr hole surgeries were performed as soon as possible after CT evaluation. Continually decomporresive craiectomies were followed if clinical improvements were achieved and mild baribiturate-moderate hypothermia combined (MB-MH) therapy was induced postoperatively in some cases. The mean average was 65.6 years (range 16-93). The causes of head injuries were traffic accident in 9, fall down in 13 and unknown in 3. The mean Glasgow coma scale (GCS) on admission was 4.4 (range 3-9). The mean time interval from arrival to burr hole surgery was 33.5 minutes (range 21-50 minutes). Decompressive craniectomy was indicated in 14 cases and MB-MH therapy was induced in 13 cases. The overall clinical outcome consisted of good recovery in 3, moderate disability in 2, severe disability in 3, persistent vegetative state in 3 and death in 14. Favorable results can be expected even in patients with serious acute subdural hematoma. Emergent burr hole surgery was effective to decrease intracranial pressure rapidly and to save time. So active burr hole surgery in the emergency room is strongly recommended to all cases of severe acute subdural hematoma. (author)

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department.

Science.gov (United States)

Thomas, Anita A; Uspal, Neil G; Oron, Assaf P; Klein, Eileen J

2016-12-01

Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills ( P  < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use ( P  = .30, paired difference -0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use ( P  < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use ( P  < .05, paired difference -0.4 points). Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.

[Conflictive patients in the emergency room: Definition, classification and ethical aspects].

Science.gov (United States)

Herreros, B; García Casasola, G; Pintor, E; Sánchez, M A

2010-09-01

A conflictive patient is one who provokes a problem (a conflict) by their attitude or behavior for the physician. Ethical conflicts in emergency care are common and many of them occur with these patients. Among the most common types of patients who generate personal conflicts with health professionals are overly demanding patients, those who refuse medical interventions, those who are aggressive, litigators, excessively-recurrent users of the heath system and those who go to the emergency room without an urgent condition. A patient may include several of these profiles ("mixed" patient). When they appear, the approach should be, if possible, by a team, establishing a deliberative process. If there is doubt and when possible, the ethics committee of the institution should be consulted, seeking the protocols, this best being institutional, on the subject. After that, if the decision is difficult, support must be sought from the emergency staff and even management. The whole process should be reflected in the clinical history. Specific education in bioethics and communication skills can be of great help to minimize and cope better with long-term conflicts. Copyright 2009 Elsevier España, S.L. All rights reserved.

Role Allocations and Communications of Operators during Emergency Operation in Advanced Main Control Rooms

International Nuclear Information System (INIS)

Lee, June Seung

2009-01-01

The advanced main control room (MCR) in GEN III + nuclear power plants has been designed by adapting modern digital I and C techniques and an advanced man machine interface system (MMIS). Large Display Panels (LDPs) and computer based workstations are installed in the MCR. A Computerized Procedure System (CPS) and Computerized Operation Support System (COSS) with high degrees of automation are supplied to operators. Therefore, it is necessary to set up new operation concepts in advanced MCRs that are different from those applied in conventional MCRs regarding role allocations and communications of operators. The following presents a discussion of the main differences between advanced MCRs and conventional MCRs from the viewpoint of role allocations and communications. Efficient models are then proposed on the basis of a task analysis on a series of emergency operation steps

THE APPLICATION OF EVIDENCE BASED DESIGN IN EMERGENCY ROOM OF PUBLIC HOSPITAL OF DR. R. SOSODORO DJATIKOESOEMO BOJONEGORO

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Noerkayatin ,

2015-07-01

Full Text Available The Hospital facilities built under Evidence Based Design (EBD will create a safe and comfortable environment, lower the nosocomial infection, quicken the patient recovery, lower the treatment cost, and improve staffs’ performance. The emergency room of public hospital of Dr.R.Sosodoro Djatikoesoemo Bojonegoro needs to be redesigned because the existing design does not meet physical safety. The reparation should refer to Facilities and Safety Management (FMS, Indonesian regulation, EBD concept and benchmarking to RSCM Jakarta considered as an application sample. This research applies case study with descriptive single case study design. The result of the research shows that reparation should be done that includes site and location, building components, and rooms lay out. The width of the rooms should meet minimal standard. The placing of triage room and resuscitation should be in the front area. Sinks should be located near the entrance of every room. The isolation and decontamination rooms should be provided.

Ultrasound study of scrotal pathology presenting as acute scrotal pain in the emergency room setting

International Nuclear Information System (INIS)

Lozano, C.; Serrano, C.; Revilla, Y.; Miralles, M.; Pozo, G. del; Lopez, U.

1998-01-01

The purpose of this reports is to review the most significant ultrasonographic features of the clinical entries that most frequently present as acute scrotal pain in childhood. We review 145 cases of acute scrotal referred by the emergency unit to the Radiology Service over a four-year period (1992-1995). All the patients were studied by B-mode ultrasound and the great majority also underwent color duplex-Doppler ultrasound. A wide variety of diseases were recorded, comprised of epididymitis (n=38), epididymo-orchitis (n=24), hydrocele (n=26), testicular torsion (n=9), cord cyst (n=9), epididymal cyst (n=7), persisting peritoneal-vagina fistula (n=6), hydatid torsion (n=4), sheath hematoma (n=4), laceration (n=4), hematocele (n=3), varicocele (n=3), epididymal hematoma (n=2), testicular hematoma (n=2), tumor (n=2) and inguinoscrotal hernia (n=2). (Author) 20 refs

Patterns of ophthalmic emergencies presenting to a referral hospital in Medina City, Saudi Arabia

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Omar M. Alabbasi

2017-10-01

Full Text Available Background: Data are required on ophthalmic cases that present to the emergency eye clinics in Madinah, Saudi Arabia for proper allocation of healthcare resources. Objectives: To determine the frequency and various diagnoses of patients presenting to the A&E at Ohud Hospital, Madinah, Saudi Arabia. Methods: Data was collected prospectively for all patients who presented to the A&E ophthalmology clinic from June 2014 to September 2014. The data was analyzed and presented using frequency of incidence and percentages. Chi-square tests were used to evaluate the diagnoses based on age, sex and nationality. P ≤ 0.05 indicated statistical significance. Results: The study sample included 868 patients. The male-to-female ratio was 1.1:1.0. The main age categories included patients ≥45 years of age (256 patients and 251 patients between the ages of 15–30 years. Various types of Conjunctivitis was the most common diagnosis, reported in 282 patients (32.5%, and followed by dry eye syndrome in 156 (18% patients. Nasolacrimal duct obstruction in 156 patients (18%. Eyelid infections were detected in 102 patients (12%, corneal abrasion in 102 patients (9.3%. Various eye traumas was diagnosed in 30 patients (3.5%, increased intraocular pressure (IOP in 17 patients (2%, ruptured globe in 2 patients (0.2% and various other non-emergency pathologies in the remaining eyes. There were no significant differences in patient’s characteristics and categories of diagnoses. Conclusion: Non-emergent ophthalmic cases were the most common reason for the ophthalmology emergency room visits. It was observed that most cases could be referred to outpatient departments and potentially be managed by primary healthcare providers. This would be more cost effective and will also allow for better management of vision threatening ocular emergencies.

Information presentation in power plant control rooms

International Nuclear Information System (INIS)

Kautto, A.

1984-11-01

The objective of this study is to support operators' work especially in the control rooms of power plant. The exemplified process is a pressurized water (nuclear) reactor (PWR). The man-process interface is an information system that covers information refining, information presentation, information system handling, and process control. THe emphasis in this study is on the organization and presentation of information and on the alert function that is part of the information system. Another goal is to design the alert function so as to radically reduce the number of alarms during plant shutdown, e.g. during the refuelling or maintenance period and during a disturbance. Further, the experimental validation of CFMS (Critical Function Monitoring System), developed by Combustion Engineering, Inc. in the U.S.A. is described briefly. The validation was made at the Loviisa training simulator in the autumn of 1982. CFMS is a safety-related functional alarm system. The functional decomposition of information has turned out to be successful and it is helpful in designing displays. Preliminary criteria for designing displays, the structure of the information presentation system and the illustration of main interactions are presented. General practical ideas on designing the alert function seem very promising. Preliminary results of the CFMS validation are presented. Further, some ideas are presented on how to carry out the analysis and how to make such validations in the future. A new idea for the evaluation of core safety is presented, based on control theory concepts

Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucanía, Temuco, Chile.

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Díaz, Jaime; Bustos, Luís; Herrera, Samira; Sepulveda, Jaqueline

2009-12-01

The objective of this study was to investigate the level of knowledge and attitudes regarding first aid for dental trauma in children (TDI) by non-dental professionals and paramedical technicians of hospital emergency rooms in the South Araucanía Health Service, Chile, which was attained through application of a survey. Samples were collected from people with occupations in the respective emergency rooms. The participants were 82 people that were interviewed using a questionnaire regarding management of dental trauma. Paramedic technicians, general and specialist doctors, and nurses were included in this survey. The appraisal covered diverse aspects: birth date, age, sex, years of experience in the emergency room, and questions regarding specific dental trauma topics, which focused on crown fractures, luxation injuries in permanent dentition, avulsion in primary and permanent teeth, and the respective emergency treatments. Of the participants, 78.1% reported to have been presented with a TDI patient. The majority (90.2%) had not received formal training on TDI. These results revealed a wide distribution of responses. The overall dental trauma knowledge among the participants was relatively poor. For crown fractures management 54.9% indicated that they would ask the affected child about the crown remnants. In regard to transport and storage medium of avulsed permanent teeth, only 9.8% of the participants answered correctly and 43.9% of respondents stated that they would not replant an avulsed permanent tooth, since that procedure is considered the responsibility of a dentist. The majority of the respondents were not knowledgeable regarding TDI or the management and benefits of timely care, particularly in cases of avulsed permanent teeth. Therefore, formal education and training on the topic is suggested during undergraduate studies.

Sulfonylurea monotherapy and emergency room utilization among elderly patients with type 2 diabetes.

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Rajpathak, Swapnil N; Fu, Chunmay; Brodovicz, Kimberley; Engel, Samuel S; Heaton, Pamela C

2015-09-01

In elderly Americans with type 2 diabetes, use of insulin and oral antidiabetic drugs (OADs) accounts for almost one-fourth of drug adverse event-related hospitalizations. It is not clear, however, if sulfonylureas (SUs), frequently prescribed OADs known to cause hypoglycemia, increase the risk of emergency room (ER) visits compared to other OADs. The aim of this study was to compare the emergency room utilization between US elderly patients with diabetes on SU monotherapy vs. other non-SU monotherapies. This retrospective cohort study was conducted using MarketScan(®) database (2009-10) and aimed to evaluate the association between use of SU and ER visits. The analysis included 28,533 patients (aged ≥65 years) receiving SU monotherapy at baseline and 1:1 propensity score (PS)-matched group receiving monotherapy with other OADs. ER utilization was determined during a 1-year follow-up period. The SU and non-SU groups were overall well balanced after PS matching. The mean (SD) number of ER visits during the follow-up was 0.56 among users of SU users compared to 0.49 (Pmetformin users. Elderly patients with type 2 diabetes on SU monotherapy were more likely to use ER than those on other monotherapies. Further studies are needed to confirm our findings and evaluate other factors associated with ER visits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Quality of emergency rooms and urgent care services: user satisfaction.

Science.gov (United States)

Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida

2015-01-01

To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.

Emergency room visits due to external causes and alcohol consumption - Capitals and the Federal District, Brazil, 2011

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Márcio Dênis Medeiros Mascarenhas

2015-04-01

Full Text Available The study objective was to describe the profile and factors related to alcohol consumption among emergency room visits by external causes. It is a cross-sectional study with data from the Survey of Violence and Injuries in Emergency between September and October 2011, in 24 state capitals and the Federal District. Statistical analysis were performed for all cases treated in selected services, comparing the characteristics of the victims, according to the statement of alcohol consumption. 33,289 visits to emergency rooms by external causes in the population above 18 years of age were included. The prevalence of self-reported statement of alcohol consumption among these services was 14.9% for the 24 capitals and the Federal District, and was significantly higher among visits by violent causes than by accidents. For both accidents and violence the associated causes were victims male, black/brown, less educated, members of specific populations, occurrences on public roads. The results support global discussions on the importance of establishing policies and legal measures to restrict the consumption of alcohol and vehicular direction, control advertising of alcoholic beverages, and laws normalizing the functioning of sales points of alcoholic beverages.

Surgery of the elderly in emergency room mode. Is there a place for laparoscopy?

Science.gov (United States)

Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Zacharz, Krzysztof

2017-06-01

An important yet difficult problem is qualification for surgery in elderly patients. With age the risk of comorbidities increases - multi-disease syndrome. Elderly patients suffer from frailty syndrome. Many body functions become impaired. All these factors make the elderly patient a major challenge for surgical treatment. Analysis of the possibility of developing the indications and contraindications and the criteria for surgical treatment of the elderly based on our own cases. Discussion whether there is a place for laparoscopy during surgery of the elderly in emergency room (ER) mode. The analysis was performed based on seven cases involving surgical treatment of elderly patients who were admitted to the hospital in emergency room mode. The patients were hospitalized in the General and Minimally Invasive Surgery Clinic in Olsztyn in 2016. Surgical treatment of elderly patients should be planned with multidisciplinary teams. Geriatric surgery centers should be developed to minimize the risk of overzealous treatment and potential complications. Laparoscopy should always be considered in the case of ER procedures or diagnostics. Elderly patients should not be treated as typical adults, but as a separate group of patients requiring special treatment. Due to the existing additional disease in the elderly, the frailty syndrome, any surgical intervention should be minimally invasive. The discussion about therapy should be conducted by a team of specialists from a variety of medical fields.

Causes and outcomes of emergency presentation of rectal cancer.

Science.gov (United States)

Comber, Harry; Sharp, Linda; de Camargo Cancela, Marianna; Haase, Trutz; Johnson, Howard; Pratschke, Jonathan

2016-09-01

Emergency presentation of rectal cancer carries a relatively poor prognosis, but the roles and interactions of causative factors remain unclear. We describe an innovative statistical approach which distinguishes between direct and indirect effects of a number of contextual, patient and tumour factors on emergency presentation and outcome of rectal cancer. All patients diagnosed with rectal cancer in Ireland 2004-2008 were included. Registry information, linked to hospital discharge data, provided data on patient demographics, comorbidity and health insurance; population density and deprivation of area of residence; tumour type, site, grade and stage; treatment type and optimality; and emergency presentation and hospital caseload. Data were modelled using a structural equation model with a discrete-time survival outcome, allowing us to estimate direct and mediated effects of the above factors on hazard, and their inter-relationships. Two thousand seven hundred and fifty patients were included in the analysis. Around 12% had emergency presentations, which increased hazard by 80%. Affluence, private patient status and being married reduced hazard indirectly by reducing emergency presentation. Older patients had more emergency presentations, while married patients, private patients or those living in less deprived areas had fewer than expected. Patients presenting as an emergency were less likely to receive optimal treatment or to have this in a high caseload hospital. Apart from stage, emergency admission was the strongest determinant of poor survival. The factors contributing to emergency admission in this study are similar to those associated with diagnostic delay. The socio-economic gradient found suggests that patient education and earlier access to endoscopic investigation for public patients could reduce emergency presentation. © 2016 UICC.

Tratamento da cefaléia em uma unidade de emergência da cidade de Ribeirão Preto Headache treatment in an emergency room of the city of Ribeirão Preto, Brazil

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MARCELO EDUARDO BIGAL

1999-09-01

Full Text Available Cefaléia é dos sintomas mais comuns na prática clínica. Acarreta considerável impacto econômico e sobrecarrega as unidades de emergência. A maioria destas, em nosso país, não dispõe de triptans. O presente estudo analisa o tratamento instituído na Unidade de Emergência do Hospital das Clínicas de Ribeirão Preto. Em 1996, 1254 pacientes foram atendidos com esta queixa e 64 necessitaram de internação. Dos pacientes não internados (NI, 77% apresentavam cefaléias primárias, contra 29,7% dos pacientes internados (I. A percentagem de melhora nos pacientes com migrânea com a dipirona endovenosa foi 83,8%, com o diclofenaco intramuscular 66,7% e com a clorpromazina (endovenosa 81,8%. As percentagens de pacientes com cefaléia do tipo tensional que melhoraram, frente às mesmas drogas foram, respectivamente 77,8%, 80% e 100%. Dos NI 16,3% tiveram melhora sem qualquer tratamento medicamentoso. Concluímos que as drogas utilizadas apresentam perfis semelhantes de eficácia e custo, podendo ser utilizadas em unidades básicas de saúde. O maior inconveniente é a administração parenteral.Headache is one of the most common symptoms observed in clinical practice. It has a considerable economic impact and overburdens emergency rooms. In Brazil, most emergency rooms have no tryptans. The present study analyses the treatment provided by the Emergency Room of the University Hospital of Ribeirão Preto. In 1996, 1254 patients were treated for headache and 64 of them required hospitalization. Of the non-hospitalized (NH patients, 77% had primary headache, as opposed to 29.7% of hospitalized patients. Of the patients with migraine, 83.6% improved with intravenous dipyrone, 66.7% improved with intramuscular diclofenac and 81.8% improved with intravenous chlorpromazine. The percentages of patients with tension-type headache who improved with the same drugs were 77.8%, 80% and 100%, respectively. Among NH patients, 16.3% improved without any

The operating room of the future: observations and commentary.

Science.gov (United States)

Satava, Richard M

2003-09-01

The Operating Room of the Future is a construct upon which to develop the next generation of operating environments for the patient, surgeon, and operating team. Analysis of the suite of visions for the Operating Room of the Future reveals a broad set of goals, with a clear overall solution to create a safe environment for high-quality healthcare. The vision, although planned for the future, is based upon iteratively improving and integrating current systems, both technology and process. This must become the Operating Room of Today, which will require the enormous efforts described. An alternative future of the operating room, based upon emergence of disruptive technologies, is also presented.

Emergency room visits for work-related injuries: characteristics and associated factors - capitals and the Federal District, Brazil, 2011.

Science.gov (United States)

Mascarenhas, Márcio Dênis Medeiros; de Freitas, Mariana Gonçalves; Monteiro, Rosane Aparecida; da Silva, Marta Maria Alves; Malta, Deborah Carvalho; Gómez, Carlos Minayo

2015-03-01

Work-related injuries, often classified as occupational injuries (OI), stand out among visits due to external causes (accidents and violence) in health services. To describe the characteristics and factors associated with emergency room visits for OI, a cross-sectional study was conducted using data from the Survey of Violence and Injuries in Emergency Services (VIVA Inquérito 2011) in 24 state capitals and the Federal District. The prevalence of treatment for OI and prevalence ratios (PR) with confidence intervals of 95% (95%CI) were calculated. There were 29,463 emergency room visits due to accidental injuries in the population above 18 years of age. The prevalence of OI was 33.4% and was positively and significantly associated with the male gender, age 30-59 years old, industrial workers, agricultural sector or repair and maintenance services. The occurrence of OI was significantly higher in attendance for objects falling on people (PR = 3.37, 95% CI 2.80 to 4.05) and injuries due to perforating object (PR = 3.01, 95% CI 2.50-3.65). The results support the surveillance of external causes and direct public policies to promote occupational health.

CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting

International Nuclear Information System (INIS)

Choi, Ji Youn; Kwon, Woo Cheol; Kim, Young Ju

2012-01-01

Pulmonary embolism and deep vein thrombosis are the leading causes of elevated serum D-dimer levels in the emergency room. Although D-dimer is a useful screening test because of its high sensitivity and negative predictive value, it has a low specificity. In addition, D-dimer can be elevated in various diseases. Therefore, information on the various diseases with elevated D-dimer levels and their radiologic findings may allow for accurate diagnosis and proper management. Herein, we report the CT findings of various diseases with elevated D-dimer levels in an emergency room setting, including an intravascular contrast filling defect with associated findings in a venous thromboembolism, fracture with soft tissue swelling and hematoma formation in a trauma patient, enlargement with contrast enhancement in the infected organ of a patient, coronary artery stenosis with a perfusion defect of the myocardium in a patient with acute myocardial infarction, high density of acute thrombus in a cerebral vessel with a low density of affected brain parenchyma in an acute cerebral infarction, intimal flap with two separated lumens in a case of aortic dissection, organ involvement of malignancy in a cancer patient, and atrophy of a liver with a dilated portal vein and associated findings.

CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting

Energy Technology Data Exchange (ETDEWEB)

Choi, Ji Youn; Kwon, Woo Cheol; Kim, Young Ju [Dept. of Radiology, Wonju Christian Hospital, Yensei University Wonju College of Medicine, Wonju (Korea, Republic of)

2012-01-15

Pulmonary embolism and deep vein thrombosis are the leading causes of elevated serum D-dimer levels in the emergency room. Although D-dimer is a useful screening test because of its high sensitivity and negative predictive value, it has a low specificity. In addition, D-dimer can be elevated in various diseases. Therefore, information on the various diseases with elevated D-dimer levels and their radiologic findings may allow for accurate diagnosis and proper management. Herein, we report the CT findings of various diseases with elevated D-dimer levels in an emergency room setting, including an intravascular contrast filling defect with associated findings in a venous thromboembolism, fracture with soft tissue swelling and hematoma formation in a trauma patient, enlargement with contrast enhancement in the infected organ of a patient, coronary artery stenosis with a perfusion defect of the myocardium in a patient with acute myocardial infarction, high density of acute thrombus in a cerebral vessel with a low density of affected brain parenchyma in an acute cerebral infarction, intimal flap with two separated lumens in a case of aortic dissection, organ involvement of malignancy in a cancer patient, and atrophy of a liver with a dilated portal vein and associated findings.

Impact of visual art on patient behavior in the emergency department waiting room.

Science.gov (United States)

Nanda, Upali; Chanaud, Cheryl; Nelson, Michael; Zhu, Xi; Bajema, Robyn; Jansen, Ben H

2012-07-01

Wait times have been reported to be one of the most important concerns for people visiting emergency departments (EDs). Affective states significantly impact perception of wait time. There is substantial evidence that art depicting nature reduces stress levels and anxiety, thus potentially impacting the waiting experience. To analyze the effect of visual art depicting nature (still and video) on patients' and visitors' behavior in the ED. A pre-post research design was implemented using systematic behavioral observation of patients and visitors in the ED waiting rooms of two hospitals over a period of 4 months. Thirty hours of data were collected before and after new still and video art was installed at each site. Significant reduction in restlessness, noise level, and people staring at other people in the room was found at both sites. A significant decrease in the number of queries made at the front desk and a significant increase in social interaction were found at one of the sites. Visual art has positive effects on the ED waiting experience. Copyright © 2012 Elsevier Inc. All rights reserved.

Predictors of Frequent Emergency Room Visits among a Homeless Population.

Science.gov (United States)

Thakarar, Kinna; Morgan, Jake R; Gaeta, Jessie M; Hohl, Carole; Drainoni, Mari-Lynn

2015-01-01

Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER) visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use. A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH). This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits. In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, phomeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.

[The Effects of Violence Coping Program Based on Middle-Range Theory of Resilience on Emergency Room Nurses' Resilience, Violence Coping, Nursing Competency and Burnout].

Science.gov (United States)

Lee, Seung Min; Sung, Kyung Mi

2017-06-01

The purpose of this study was to examine the effects of a violence coping program (VCP) based on Polk's middle-range theory of resilience on nursing competency, resilience, burnout, and the ability to cope with violence in nurses working in emergency rooms. A quasi-experimental study, with a nonequivalent control group and a pretest-posttest design, was conducted. Participants were 36 nurses who worked in emergency rooms and had experienced violence; 18 nurses from D hospital and 18 nurses from C hospital were assigned to the experimental and control groups, respectively. The experimental group received the VCP twice per week for 8 weeks. Levels of resilience, F=59.41, pnursing competency, F=59.41 pburnout, F=52.74, pburnout and improving resilience, active coping behavior, and nursing competency. Therefore, it would be a useful intervention for improving the quality of nursing care provided in emergency rooms. © 2017 Korean Society of Nursing Science

Usefulness of technetium-99m tetrofosmin single-photon emission computed tomography for short-term risk stratification in patients with acute chest pain in the emergency room

International Nuclear Information System (INIS)

Kawahito, Michitomo; Kondo, Makoto; Abe, Yoshiteru

2003-01-01

High-risk patients with acute coronary syndrome are difficult to distinguish from low-risk patients with chest pain in the emergency room. Technetium-99 m ( 99m Tc) tetrofosmin single-photon emission computed tomography (SPECT) was investigated to exclude high-risk patients with chest pain in the emergency room. 99m Tc-tetrofosmin SPECT was evaluated using a four-point scoring system in 228 patients (144 men, 84 women, mean age 68±12 years) with chest pain. Negative was defined as the myocardial segments with a defect score (DS) of 99m Tc-tetrofosmin; no significance (NS)), 84.9% (NS) and 60.4% (p 99m Tc-tetrofosmin SPECT is a useful method to exclude high-risk patients among patients with chest pain in the emergency room. (author)

Predicting the success of noninvasive positive pressure ventilation in emergency room for patients with acute heart failure.

Science.gov (United States)

Shirakabe, Akihiro; Hata, Noritake; Yokoyama, Shinya; Shinada, Takuro; Kobayashi, Nobuaki; Tomita, Kazunori; Kitamura, Mitsunobu; Nozaki, Ayaka; Tokuyama, Hideo; Asai, Kuniya; Mizuno, Kyoichi

2011-01-01

Non-invasive positive pressure ventilation (NPPV) for acute heart failure (AHF) is increasingly used to avoid endotracheal intubation (ETI). We therefore reviewed our experience using respirator management in the emergency room for AHF, and evaluated the predictive factors in the success of NPPV in the emergency room. Three-hundred forty-three patients with AHF were analyzed. The AHF patients were assigned to either BiPAP-Synchrony (B-S; Respironics, Merrysville, PA, USA) period (2005-2007, n = 176) or BiPAP-Vision (B-V; Respironics) period (2008-2010, n = 167). The rate of carperitide use was significantly increased and dopamine use was significantly decreased in the B-V period. The total length of hospital stay was significantly shorter in the B-V period. AHF patients were also assigned to a failed trial of NPPV followed by ETI (NPPV failure group) or an NPPV success group in the emergency room for each period. NPPV was successfully used in 48 cases in the B-S period, and in 111 cases in the B-V period. Fifty-seven ETI patients included 45 direct ETI and 11 NPPV failure cases in the B-S period, and 16 ETI patients included 10 direct ETI and 6 NPPV failure cases in the B-V period. The pH values were significantly lower in the NPPV failure than in the NPPV success for both periods (7.19 ± 0.10 vs. 7.28 ± 0.11, B-S period, p successful estimates of NPPV with a high sensitivity and specificity, and the aortic blood gas level was above 7.03 pH when using the B-V system. Copyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room

OpenAIRE

Benjamin Louis Moresco; Benjamin Louis Moresco; Clinton Woosley; Clinton Woosley; Morris Sauter; Utpal Bhalala; Utpal Bhalala

2018-01-01

ObjectivesThis study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER) of a tertiary care children’s hospital.MethodsThis was a retrospective, observational study of children (0–18 years old) in The Children’s Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9) diagnostic codes for “severe sepsis” and “shocks.” Patients in the adhere...

Clinically useful predictors for premature mortality among psychiatric patients visiting a psychiatric emergency room

DEFF Research Database (Denmark)

Aagaard, Jørgen; Buus, Niels; Wernlund, Andreas Glahn

2016-01-01

OBJECTIVE: The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss...... linked to the Cause of Death Register and the Central Psychiatric Research Register, and logistic predictor analyses for premature death were performed. RESULTS: The standardised mortality ratio (SMR) of all visitors compared to the general Danish population was approximately 5. Overall, patients...

The BWR [Boiling Water Reactor] Emergency Operating Procedures Tracking System (EOPTS): Evaluation by control-room operating crews

International Nuclear Information System (INIS)

Spurgin, A.J.; Orvis, D.D.; Spurgin, J.P.; Luna, C.J.

1990-05-01

This report presents the results of a project sponsored by the Electric Power Research Institute (EPRI) and Taiwan Power Company (TPC) and conducted by APG and TPC to perform evaluation of the Emergency Operating Procedures Tracking System (EOPTS). The EOPTS is an expert system employing artificial intelligence techniques developed by EPRI for Boiling Water Reactor (BWR) plants based on emergency operating procedures (EOPs). EOPTS is a computerized decision aid used to assist plant operators in efficient and reliable use of EOPs. The main objective of this project was to evaluate the EOPTS and determine how an operator aid of this type could noticeably improve the response time and the reliability of control room crews to multi-failure scenarios. A secondary objective was to collect data on how crew performance was affected. Experiments results indicate that the EOPTS measurably improves crew performance over crews using the EOP flow charts. Time-comparison measurements indicate that crews using the EOPTS perform required actions more quickly than do those using the flowcharts. The results indicate that crews using the EOPTS are not only faster and more consistent in their actions but make fewer errors. In addition, they have a higher likelihood of recovering from the errors that they do make. Use of the EOPTS in the control room should result in faster termination and mitigation of accidents and reduced risk of power plant operations. Recommendations are made towards possible applications of the EOPTS to operator training and evaluation, and for the applicability of the evaluation methodology developed for this project to the evaluation of similar operator aides. 17 refs., 14 figs., 14 tabs

Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

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Frederico José Neves Mancuso

2014-12-01

Full Text Available Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods: One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results: The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

Energy Technology Data Exchange (ETDEWEB)

Mancuso, Frederico José Neves, E-mail: frederico.mancuso@grupofleury.com.br [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Gois, Aécio Flavio Teixeira [Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)

2014-12-15

Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

International Nuclear Information System (INIS)

Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando

2014-01-01

Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy

Cost-Benefit Analysis of an Otolaryngology Emergency Room Using a Contingent Valuation Approach.

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Naunheim, Matthew R; Kozin, Elliot D; Sethi, Rosh K; Ota, H Gregory; Gray, Stacey T; Shrime, Mark G

2015-10-01

Dedicated otolaryngology emergency rooms (ERs) provide a unique mechanism of health care delivery. Relative costs and willingness to pay (WTP) for these services have not been studied. This study aims to provide a cost-benefit analysis of otolaryngology-specific ER care. Cost-benefit analysis based on contingent valuation surveys. An otolaryngology-specific ER in a tertiary care academic medical center. Adult English-speaking patients presenting to an otolaryngology ER were included. WTP questions were used to assess patient valuations of specialty emergency care. Sociodemographic data, income, and self-reported levels of distress were assessed. State-level and institution-specific historical cost data were merged with WTP data within a cost-benefit analysis framework. The response rate was 75.6%, and 199 patients were included in the final analysis. Average WTP for otolaryngology ER services was $319 greater than for a general ER (95% CI: $261 to $377), with a median value of $200. The historical mean cost per visit at a general ER was $575, and mean cost at the specialty ER was $551 (95% CI: $529 to $574). Subtracting incremental cost from incremental WTP yielded a net benefit of $343. Dedicated otolaryngology ER services are valued by patients for acute otolaryngologic problems and have a net benefit of $343 per patient visit. They appear to be a cost-beneficial method for addressing acute otolaryngologic conditions. This study has implications for ER-based otolaryngologic care and direct-to-specialist services. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

Manejo da asma aguda em adultos na sala de emergência: evidências atuais Management of acute asthma in adults in the emergency room: current evidence

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Paulo de Tarso Roth Dalcin

2009-01-01

Full Text Available Asma é uma doença com uma alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver um aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda se constituem em uma emergência médica muito comum. As evidências têm demonstrado que o manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão, enfocaremos a avaliação e o tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. Serão consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento, avaliação das complicações, decisão sobre onde se realizará o tratamento adicional e orientações por ocasião da alta da emergência. Espera-se que estas recomendações contribuam para que o médico clínico tome as decisões apropriadas durante o manejo da asma aguda na sala de emergência.Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency

Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room

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Thiago Gatti Pianca

Full Text Available Abstract Objective: To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. Data source: This was a narrative literature review. Data summary: The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. Conclusion: The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications.

Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room.

Science.gov (United States)

Pianca, Thiago Gatti; Sordi, Anne Orgle; Hartmann, Thiago Casarin; von Diemen, Lisia

To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. This was a narrative literature review. The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Prepare to protect: Operating and maintaining a tornado safe room.

Science.gov (United States)

Herseth, Andrew; Goldsmith-Grinspoon, Jennifer; Scott, Pataya

2017-06-01

Operating and maintaining a tornado safe room can be critical to the effective continuity of business operations because a firm's most valuable asset is its people. This paper describes aspects of operations and maintenance (O&M) for existing tornado safe rooms as well as a few planning and design aspects that affect the ultimate operation of a safe room for situations where a safe room is planned, but not yet constructed. The information is based on several Federal Emergency Management Agency safe room publications that provide guidance on emergency management and operations, as well as the design and construction of tornado safe rooms.

Presentation and analysis of work at the emergency department – of the University children’s Hospital Ljubljana

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Tina Bregant

2013-05-01

Conclusions: Since 2010, the paediatric emergency department of the University Children’s Hospital Ljubljana has functioned in compliance wtih the guidelines used in similar international tertiary centres. However, there is still room for improvement in organization and staffing.

[Neonatological emergencies in delivery room] [Article in Italian] • Il neonatologo ed alcune emergenze in sala parto

OpenAIRE

Antonio Boldrini; Rosa Teresa Scaramuzzo

2014-01-01

Introduction: In the delivery room the neonatologist may deal with emergencies, not always predictable by pre-natal diagnosis. Among these dangerous situations, we include: i) extremely preterm birth of a newborn very/extremely low birth weight and ii) shoulder dystocia in term newborns. We will discuss in details these two clinical scenarios. Methods: We reviewed the main recent papers about resuscitation of very/extremely low birth weight preterm newborns and about dystocia of shoulder repo...

Ocular emergencies presenting to Menelik II Hospital.

Science.gov (United States)

Negussie, Dereje; Bejiga, Abebe

2011-01-01

Ocular conditions such as trauma, painful red eye of any cause, painless sudden visual loss and others are commonly seen as ocular emergencies, and can lead to ocular morbidity and visual loss. To determine types and causes of ocular emergencies seen at Menelik II hospital. A cross-sectional study was conducted from April to October, 2007. Consecutive patients who presented with ocular emergencies at any time of the day were prospectively evaluated and registered on a formatted questionnaire. Evaluation of the patients included history of presenting illness, visual acuity testing intraocular pressure measurement on non-perforated and non-infected eyes, and complete eye examination in order to arrive at the diagnosis. A total of 26,400 patients attended Menelik II hospital during the study period. Of these, 758 (3%) were persons with an ocular emergency. The majority of patients (n=551; 72.7%) were male, with a male to female ratio of 2.7:1. The age group of 16 to 30 years was the most affected (47.9%), followed by those aged 15 years or younger (27.3%). Ocular trauma and ocular infections accounted for 75.6% and 13.1% of cases, respectively. Of the total ocular emergencies, open globe injuries constituted 171 (22.6%), corneal foreign bodies and abrasion 125 (16.5%), and open adnexal injuries 119 (15.7%). Metal and wood were the commonest work-related causes of ocular injuries in adults, with both together accounting for 60% of all ocular injuries. Children, on the other hand, sustained ocular injury while playing with others in 128 (22.3%) of cases. This study was able to provide a more complete picture to improve understanding of the nature and circumstances of ocular emergencies in Ethiopia. Ocular emergencies were dominated by ocular trauma, particularly affecting males and working-age adults. Public education and use of protective safety measures are recommended to alleviate the problem.

Seismic simulation and functional performance evaluation of a safety related, seismic category I control room emergency air cleaning system

International Nuclear Information System (INIS)

Manley, D.K.; Porco, R.D.; Choi, S.H.

1985-01-01

Under a nuclear contract MSA was required to design, manufacture, seismically test and functionally test a complete Safety Related, Seismic Category I, Control Room Emergency Air Cleaning System before shipment to the Yankee Atomic Electric Company, Yankee Nuclear Station in Rowe, Massachusetts. The installation of this system was required to satisfy the NRC requirements of NUREG-0737, Section III, D.3.4, ''Control Room Habitability''. The filter system tested was approximately 3 ft. wide by 8 ft. high by 18 ft. long and weighed an estimated 8300 pounds. It had a design flow rate of 3000 SCFM and contained four stages of filtration - prefilters, upstream and downstream HEPA filters and Type II sideload charcoal adsorber cells. The filter train design followed the guidelines set forth by ANSI/ASME N509-1980. Seismic Category I Qualification Testing consisted of resonance search testing and triaxial random multifrequency testing. In addition to ANSI/ASME N510-1980 testing, triaxial response accelerometers were placed at specific locations on designated prefilters, HEPA filters, charcoal adsorbers and test canisters along with accelerometers at the corresponding filter seal face locations. The purpose of this test was to demonstrate the integrity of the filters, filter seals, and monitor seismic response levels which is directly related to the system's ability to function during a seismic occurrence. The Control Room Emergency Air Cleaning System demonstrated the ability to withstand the maximum postulated earthquake for the plant site by remaining structurally sound and functional

Hospital hero: a game for reducing stress and anxiety of children while waiting in emergency room

OpenAIRE

Tranquada, Sara Patrícia Fernandes

2014-01-01

This report tells a story which started as an idea that came to us to fight the battle-cry feeling commonly known as stress and anxiety. Before creating the solution of the idea, we first need to understand the feelings underneath and its effects on our well-being. Throughout the course of our lives, we experience states of weakness and fear. These feelings can arise, for instance, while we are in an emergency room. Needless to say, how much it would have imaginable effects on children,...

Emergências hipertensivas Hypertensive emergencies

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Gilson Soares Feitosa-Filho

2008-09-01

ão controlada. Este conhecimento deve ser rotineiro ao emergencista e Intensivista no momento de decidir sobre a conduta.Emergencies and hypertensive crises are clinical situations which may represent more than 25% of all medical emergency care. Considering such high prevalence, physicians should be prepared to correctly identify these crises and differentiate between urgent and emergent hypertension. Approximately 3% of all visits to emergency rooms are due to significant elevation of blood pressure. Across the spectrum of blood systemic arterial pressure, hypertensive emergency is the most critical clinical situation, thus requiring special attention and care. Such patients present with high blood pressure and signs of acute specific target organ damage (such as acute myocardial infarction, unstable angina, acute pulmonary edema, eclampsia, and stroke. Key elements of diagnosis and specific treatment for the different presentations of hypertensive emergency will be reviewed in this article. The MedLine and PubMed databases were searched for pertinent abstracts, using the key words "hypertensive crises" and "hypertensive emergencies". Additional references were obtained from review articles. Available English language clinical trials, retrospective studies and review articles were identified, reviewed and summarized in a simple and practical way. The hypertensive crisis is a clinical situation characterized by acute elevation of blood pressure followed by clinical signs and symptoms. These signs and symptoms may be mild (headache, dizziness, tinnitus or severe (dyspnea, chest pain, coma or death. If the patient presents with mild symptoms, but without acute specific target organ damage, diagnosis is hypertensive urgency. However, if severe signs and symptoms and acute specific target organ damage are present, then the patient is experiencing a hypertensive emergency. Some patients arrive at the emergency rooms with high blood pressure, but without any other sign or symptom. In

On-site emergency preparedness in Finland

International Nuclear Information System (INIS)

Vilkamo, O.

1998-01-01

General scheme of emergency preparedness in Finland is presented including legal framework, emergency organization and detailed description of plans and procedures. Emergency plan in Finland cover the following matters: classification of emergency situations and description of events and accidents, description of emergency organization, description of the arrangements for alerting and data transfer, management of an emergency situation and radiation protection, worker safety and radiation protection, on- and off-site radiation measurements during a preparedness situation, provision of information, rooms, equipment and facilities, post emergency debriefing and measures, a description of the maintenance of preparedness

The emergency room at the Rotunda Hospital: evidence of an improving service over the past 3 years.

LENUS (Irish Health Repository)

Talukdar, S

2014-12-01

This is a retrospective review of the Rotunda Hospital Emergency Room (ER) documentation with respect to attendances for a 4-month period (August-November) in both 2009 and 2012. The aim was to quantify the workload and assess the quality of care offered to patients attending the ER over the two time periods and to highlight any improvements in care after changes were implemented following the initial 2009 review.

Study on computerized presentation of emergency procedures of a nuclear plant (step 2). The guidelines of the prototype of the computerized procedure presentation system

International Nuclear Information System (INIS)

Niwa, Yuji; Hollnagel, E.; Iwaki, Toshio.

1995-01-01

New methods of information presentation and interface design are changing the working conditions in the modern Nuclear Power Plant (NPP) control room. One area receiving considerable attention is that of Emergency Operating Procedures (EOPs), which plays an essential role in NPPs. Conventionally procedures are presented in a hard copy form. However developments in information technology have offered new opportunities for the computerization of such procedures. Consideration for the first stage of computerization should be focused upon the presentation of procedures. The specification of the computerized presentation of procedures is discussed with respect to the issues which were central to the project: navigation through procedures; formatting and presentation of procedures; and process monitoring. Issues that would be included in more advanced systems, such as help and explanation facilities features, and process linking, are also discussed. This paper deals with the specific design guidelines that were implemented for the computerization of procedure presentation. Issues of principal concern that were identified from this experience are highlighted, such as the relationship between procedure presentation and format; the registration of progress through a procedure; compensation for the limitations of computer displays versus printed documents; and the way in which the added capabilities of computerized presentation can be generally utilized in the operators' working environment. (author)

Predictors of Frequent Emergency Room Visits among a Homeless Population.

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Kinna Thakarar

Full Text Available Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use.A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH. This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits.In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, p<0.01. HIV seropositivity was not predictive of frequent ER visits. In patients with history of illicit drug use, mental health (OR 2.53, 95% CI 1.07-5.95 and hepatitis C (OR 2.85, 95% CI 1.37-5.93 were predictors of frequent ER use. HIV seropositivity did not predict ER use (OR 0.45, 95% CI 0.21 - 0.97.In a HCH population, hepatitis C predicted frequent ER visits in homeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.

Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting.

Science.gov (United States)

Rydman, Eric; Ponzer, Sari; Ottosson, Carin; Järnbert-Pettersson, Hans

2017-04-01

To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting. Prospective cohort study. On the basis of a historic cohort (n = 130) of patients with a whiplash injury identified in an emergency room (ER, model-building set), we used logistic regression to construct an instrument consisting of two demographic variables (i.e. questions of educational level and work status) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months. We evaluated the instrument's ability to predict nonrecovery in a new cohort (n = 204) of patients originating from an insurance company setting (IC, validation set). The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort. The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort. The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort. The sensitivity and specificity in the insurance company setting was lower, 67 and 50 %. Clinical decision rules need validation before they are used in a new setting. An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting. The importance and type of the risk factors for not recovering probably differ between the settings, as well as the individuals.

Employee Perceptions of Their Organization's Level of Emergency Preparedness Following a Brief Workplace Emergency Planning Educational Presentation

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Lauren A. Renschler

2016-06-01

Full Text Available A brief emergency planning educational presentation was taught during work hours to a convenience sample of employees of various workplaces in Northern Missouri, USA. Participants were familiarized with details about how an emergency plan is prepared by management and implemented by management-employee crisis management teams – focusing on both employee and management roles. They then applied the presentation information to assess their own organization’s emergency preparedness level. Participants possessed significantly (p < 0.05 higher perceptions of their organization’s level of emergency preparedness than non-participants. It is recommended that an assessment of organizational preparedness level supplement emergency planning educational presentations in order to immediately apply the material covered and encourage employees to become more involved in their organization’s emergency planning and response. Educational strategies that involve management-employee collaboration in activities tailored to each workplace’s operations and risk level for emergencies should be implemented.

Use of the emergency room in Elliot Lake, a rural community of Northern Ontario, Canada.

Science.gov (United States)

Harris, L; Bombin, M; Chi, F; DeBortoli, T; Long, J

2004-01-01

There is ample documentation that use of hospital emergency facilities for reasons other than urgencies/emergencies results in clogged services in many urban centers. However, little has been published about similar misuse of emergency rooms/departments in rural and remote areas, where the situation is usually compounded by a scarcity of healthcare professionals. In Canada there is a shortage of physicians in rural and remote areas as a consequence of misdistribution (most physicians staying in southern urban centers after residence), and there is a chronic misuse of facilities meant for urgencies/emergencies to cope with primary healthcare needs. We address the problem in Elliot Lake, a rural Northern Ontario community of 12,000 people. The economy of Elliot Lake was based on uranium mining until the mid-1990s, when it drastically changed to become a center for affordable retirement and recreational tourism. As a consequence, at the present time the proportion of seniors in Elliot Lake doubles the Canadian average. Our objectives are to elucidate the demographics of emergency room (ER) clients and the effect of the elderly population; the nature of ER use; the perceived level of urgency of clients versus health professionals; and possible alternatives offered to non-urgent/emergency visits. This is the first study of the kind in Northern Ontario, a region the size of France. The study, conducted in July 2001, used a prospective survey, completed by patients and attending clinicians at the time of a patient's presentation to the ER of St Joseph's General Hospital. This hospital is staffed by family physicians, a nurse practitioner, and registered nurses (RNs). The catchment area population (town plus surrounding areas) of the hospital is approximately 18,000 people. ER clients were interviewed verbally, and the attending health professionals responded to written questionnaires. Demographics were recorded (age, sex, employment and marital status), as was each client

Protective benefits of mindfulness in emergency room personnel.

Science.gov (United States)

Westphal, Maren; Bingisser, Martina-Barbara; Feng, Tianshu; Wall, Melanie; Blakley, Emily; Bingisser, Roland; Kleim, Birgit

2015-04-01

Recent meta-analyses have found that mindfulness practice may reduce anxiety and depression in clinical populations and there is growing evidence that mindfulness may also improve well-being and quality of care in health professionals. This study examined whether mindfulness protects against the impact of work-related stress on mental health and burnout in emergency room (ER) nurses. ER nurses (N=50) were recruited from an urban teaching hospital in Switzerland and completed a survey on work-related stressors, mindfulness, burnout, depression, and anxiety. The most frequently reported work-related stressor was interpersonal conflict. Nurses working more consecutive days since last taking time off were at greater risk for depression and those reporting more work-related interpersonal conflicts were at greater risk for burnout. Mindfulness was associated with reduced anxiety, depression, and burnout. Mindfulness was a significant predictor of anxiety, depression, and burnout and moderated the impact of work-related stressors on mental health and burnout. The sample is limited to nurses and results need to be replicated in other groups (e.g., medical staff or ambulance workers). We assessed clinical symptoms with questionnaires and it would be desirable to repeat this assessment with clinical diagnostic interviews. The findings have implications for stress management in ER nurses and health professionals working in comparable settings (e.g., urgent care). The robust associations between mindfulness and multiple indices of psychological well-being suggest that ER staff exposed to high levels of occupational stress may benefit from mindfulness practice to increase resistance to mental health problems and burnout. Copyright © 2015 Elsevier B.V. All rights reserved.

Otolaryngology-specific emergency room as a model for resident training.

Science.gov (United States)

Sethi, Rosh K V; Kozin, Elliott D; Remenschneider, Aaron K; Lee, Daniel J; Gliklich, Richard E; Shrime, Mark G; Gray, Stacey T

2015-01-01

There is a paucity of data on junior resident training in common otolaryngology procedures such as ear debridement, nasal and laryngeal endoscopy, epistaxis management, and peritonsillar abscess drainage. These common procedures represent a critical aspect of training and are necessary skills in general otolaryngology practice. We sought to determine how a dedicated otolaryngology emergency room (ER) staffed by junior residents and a supervising attending provides exposure to common otolaryngologic procedures. Retrospective review. Diagnostic and procedural data for all patients examined in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013 were evaluated. A total of 12,234 patients were evaluated. A total of 5,673 patients (46.4%) underwent a procedure. Each second-year resident performed over 450 procedures, with the majority seen Monday through Friday (75%). The most common procedures in our study included diagnostic nasolaryngoscopy (52.0%), ear debridement (34.4%), and epistaxis control (7.0%) An otolaryngology-specific ER provides junior residents with significant diagnostic and procedural volume in a concentrated period of time. This study demonstrates utility of a unique surgical education model and provides insight into new avenues of investigation for otolaryngology training. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Frequent visitors at the psychiatric emergency room - A literature review.

Science.gov (United States)

Schmidt, Manuela

2018-03-01

Frequent visitors at the psychiatric emergency room (PER) constitute a small subgroup of patients, yet they are responsible for a disproportionate number of visits and thus claim considerable resources. Their needs are often left unmet and their repetitive visits reflect their dissatisfaction as well as that of PERs' staff. Motivated by these dilemmas, this study systematically reviews the literature about frequent visitors at PER and seeks to answer two questions: What characterizes frequent visitors at PER in the literature? and What characterizes PER in the literature? Based on 29 studies, this paper offers answers to the two questions based on a strength weakness opportunities and threats (SWOT) analysis. The results of the review and subsequent analysis of the literature revealed the multiplicity and complexity of frequent visitors' characteristics and how they appear to converge. Commonalities were more difficult to identify in PER characteristics. In some cases, this happened because the characteristics were poorly described or were context specific. As a result, it was not easy to compare the studies on PER. Based on SWOT and the findings of the analysis, the paper proposes new venues of research and suggests how the field of mental health might develop by taking into account its opportunities and threats.

Analysis of bacterial contamination on surface of general radiography equipment and CT equipment in emergency room of radiology

Energy Technology Data Exchange (ETDEWEB)

Hong, Dong Hee; KIm, Hyeong Gyun [Dept. of Radiological Science, Far East University, Eumseong (Korea, Republic of)

2016-09-15

We aim to offer basic materials about infection management through conducting bacterial contamination test about general radiography equipment and CT equipment installed in ER of three general hospitals with 100 sickbeds or more located in Gyeongsangbuk-do Province, and suggest management plan. It had been conducted from 1st December 2015 to 31st December, and objects were general radiography equipment and CT equipment of emergency room located in Gyeongsangbuk-do Province. For general radiography equipment, sources were collected from 4 places such as upper side of control box which employees use most, upper side of exposure button, whole upper side of table which is touching part of patient's skin, upper side of stand bucky's grid, and where patients put their jaws on. For CT equipment, sources were collected from 3 places such as upper side of control box which radiography room employees use most, X-ray exposure button, whole upper side of table which is touching part of patient's skin, and gantry inner. Surface contamination strain found at general radiography equipment in emergency room of radiology are Providencia stuartii(25%), Stenotrophomonas maltophilia(18%), Enterobacter cloacae(8%), Pseudomonas species(8%), Staphylococcus epidermidis(8%), Gram negative bacilli(8%), and ungrown bacteria at incubator after 48 hours of incubation (67%) which is the biggest. Most bacteria were found at upper side of stand bucky-grid and stand bucky of radiology's general radiography equipment, and most sources of CT equipment were focused at patient table, which means it is contaminated by patients who have various diseases, and patients who have strains with decreased immunity may get severe diseases. Thus infection prevention should be made through 70% alcohol disinfection at both before test and after test.

Analysis of bacterial contamination on surface of general radiography equipment and CT equipment in emergency room of radiology

International Nuclear Information System (INIS)

Hong, Dong Hee; KIm, Hyeong Gyun

2016-01-01

We aim to offer basic materials about infection management through conducting bacterial contamination test about general radiography equipment and CT equipment installed in ER of three general hospitals with 100 sickbeds or more located in Gyeongsangbuk-do Province, and suggest management plan. It had been conducted from 1st December 2015 to 31st December, and objects were general radiography equipment and CT equipment of emergency room located in Gyeongsangbuk-do Province. For general radiography equipment, sources were collected from 4 places such as upper side of control box which employees use most, upper side of exposure button, whole upper side of table which is touching part of patient's skin, upper side of stand bucky's grid, and where patients put their jaws on. For CT equipment, sources were collected from 3 places such as upper side of control box which radiography room employees use most, X-ray exposure button, whole upper side of table which is touching part of patient's skin, and gantry inner. Surface contamination strain found at general radiography equipment in emergency room of radiology are Providencia stuartii(25%), Stenotrophomonas maltophilia(18%), Enterobacter cloacae(8%), Pseudomonas species(8%), Staphylococcus epidermidis(8%), Gram negative bacilli(8%), and ungrown bacteria at incubator after 48 hours of incubation (67%) which is the biggest. Most bacteria were found at upper side of stand bucky-grid and stand bucky of radiology's general radiography equipment, and most sources of CT equipment were focused at patient table, which means it is contaminated by patients who have various diseases, and patients who have strains with decreased immunity may get severe diseases. Thus infection prevention should be made through 70% alcohol disinfection at both before test and after test

Employee Perceptions of Their Organization's Level of Emergency Preparedness Following a Brief Workplace Emergency Planning Educational Presentation.

Science.gov (United States)

Renschler, Lauren A; Terrigino, Elizabeth A; Azim, Sabiya; Snider, Elsa; Rhodes, Darson L; Cox, Carol C

2016-06-01

A brief emergency planning educational presentation was taught during work hours to a convenience sample of employees of various workplaces in Northern Missouri, USA. Participants were familiarized with details about how an emergency plan is prepared by management and implemented by management-employee crisis management teams - focusing on both employee and management roles. They then applied the presentation information to assess their own organization's emergency preparedness level. Participants possessed significantly (p employees to become more involved in their organization's emergency planning and response. Educational strategies that involve management-employee collaboration in activities tailored to each workplace's operations and risk level for emergencies should be implemented.

Guidelines for control room design reviews

International Nuclear Information System (INIS)

1981-09-01

The control room design review is part of a broad program being undertaken by the nuclear industry and the government to ensure consideration of human factors in nuclear power plant design and operation. The purpose of the control room design review described by these guidelines is to (1) review and evaluate the control room workspace, instrumentation, controls, and other equipment from a human factors engineering point of view that takes into account both system demands and operator capabilities; and (2) to identify, assess, and implement control room design modifications that correct inadequate or unsuitable items. The scope of the control room design review described by these guidelines covers the human engineering review of completed control rooms; i.e., operational control rooms or those at that stage of the licensing process where control room design and equipment selection are committed. These guidelines should also be of use during the design process for new control rooms. However, additional analyses to optimize the allocation of functions to man and machine, and further examination of advanced control system technology, are recommended for new control rooms. Guidelines and references for comprehensive system analyses designed to incorporate human factors considerations into the design and development of new control rooms are presented in Appendix B. Where possible, a generic approach to the control room design review process is encouraged; for example, when control room designs are replicated wholly or in part in two or more units. Even when designs are not replicated exactly, generic reviews which can be modified to account for specific differences in particular control rooms should be considered. Industry organizations and owners groups are encouraged to coordinate joint efforts and share data to develop generic approaches to the design review process. The control room design review should accomplish the following specific objectives. To determine

[Domestic and family violence against women: a case-control study with victims treated in emergency rooms].

Science.gov (United States)

Garcia, Leila Posenato; Duarte, Elisabeth Carmen; Freitas, Lúcia Rolim Santana de; Silva, Gabriela Drummond Marques da

2016-01-01

This study aimed to identify factors associated with treatment of victims of domestic and family violence in emergency rooms in Brazil. This is a case-control study based on the Surveillance System for Violence and Accidents (VIVA), 2011. Women ≥ 18 years who were victims of family and domestic violence were selected as cases and compared to accident victims (controls). Adjusted odds ratios were estimated by unconditional logistic regression. 623 cases and 10,120 controls were included. Risk factors according to the adjusted analysis were younger age (18-29 years), low schooling, lack of paid work, alcohol consumption, having sought treatment in a different health service, and violence on weekends or at night or in the early morning hours. The study concludes that domestic and family violence shows alcohol consumption as a strongly associated factor. Days and hours with the highest ocurrence reveal the need to adjust emergency services to treat victims.

Renal Angiomyolipoma Presenting as Acute Abdominal Emergency ...

African Journals Online (AJOL)

A 47-year-old woman presented as an acute abdominal emergency with rapid progression to shock following spontaneous rupture of a left renal angiomyolipoma. The diagnosis was missed clinically and on computerized tomographic scan. At different stages of management based on her pattern of symptoms, signs and ...

Room to Groove?

DEFF Research Database (Denmark)

Seabrooke, Leonard

. As long as they stay within the parameters of legitimate financial practice to signal institutional isomorphism, the `groove', creditors may well allow borrowers room for change in self-determined ways. This paper maps out the historical and conceptual terrain concerning civilizing ideas about...... the legitimacy of financial practices within global capital markets, and investigates relationships between Western `civilizers' and Emerging Market Economies during the last two periods of financial globalization, the late-nineteenth/ early-twentieth centuries and the late-twentieth century.......The use of a `standard of civilization', a preferred form of socio-political organization, in global capital markets presents both constraints and opportunities for creditors and borrowers. When imposed, civilizing standards may change how a borrower would prefer to conduct their affairs. Creditors...

Clinical Aspects and Emergent Management of Snake Bites Presented to Emergency Department

Directory of Open Access Journals (Sweden)

Bedriye Sonmez

2014-03-01

Full Text Available Aim: Evaluating the epidemiologic characteristics and management of snake bites presenting to emergency departments. Material and Method: In this retrospective study 74 cases of snakebites admitted to Emergency Department of Diyarbakir Training and Research Hospital between 2008 and 2009 were retrospectively evaluated. Results: Fourty-six (62.2% of patients were male and 28 (37.8% were female. Mean age of the study population was 34.85±19.17 (min 7- max 80 years. Most of the snakebites occurred between 18.00 to 06.00 hours and at home (73%. 79.7% of snake bites occurred to upper extremities. %93 of cases had intravenous administration of antivenin (one dose. Neither none of the patients needed recurrent administration. Discussion: Snake bites are still a major public health problem especially in rural areas. Particularly emergency care physicians should be adequately capable and sophisticated in multidisciplinary management of snake bites.

ATTENTION TO THE EMERGENCY ROOM WITH EMPHASIS ON PRE-HOSPITAL CARE: INTEGRATIVE REVIEW

Directory of Open Access Journals (Sweden)

B. S. Santos

2017-08-01

Full Text Available The study aims to identify the factors, which influence positively and negatively the implementation of public policies geared to the needs in scope of mobile, found in the publications of brazilian researchers since the implementation of the National Policy of Attention to the Emergency room in Brazil. This is a study of Integrative Literature Review. Composing the basis of methodology, have been used official documents to guide the findings that comprised the conceptual bases of the study and to guide the Integrative Review were used publications that report on the issue in question respecting all steps of the protocol review. The results show the changes in the organizational structure of the Service Mobile Emergency, given the regionalization as something positive for the growth of this service modality and discuss prematurely early articulation between the sectors that make up the public health system in Brazil. In conclusion, the policies of attention to the urgencies, in particular within mobile, have favored beneficially all of the users who require this type of care, in the meantime, make the necessary reflections about this theme in the attempt of a better understanding of the regionalization process and coordination among the municipalities that will offer the mobile care so as to ensure continuity of care through the mechanisms of reference and counter-reference

Conhecimento sobre anticoagulantes orais e seu manejo por médicos de pronto atendimento Emergency-room doctors' knowledge about oral anticoagulants and its management

Directory of Open Access Journals (Sweden)

Larissa Periotto Borlina

2010-06-01

Full Text Available Contexto: Desde sua descoberta, os anticoagulantes orais (AO têm sido cada vez mais estudados e aplicados em diferentes doenças. No entanto, eles apresentam reações medicamentosas com fármacos que trazem riscos ao paciente. Objetivo: Identificar o nível de conhecimento dos médicos plantonistas de pronto atendimento sobre os AO e suas interações, medicamentosas ou não, e verificar se o médico frentista está preparado para integrar o conteúdo teórico com a rotina de urgências. Método: Aplicou-se um questionário a 100 médicos atuantes em pronto atendimentos de dois hospitais públicos e três privados em Curitiba. Visou-se saber se o médico frentista questiona ao paciente sobre o uso de AO. Também, avaliou-se o conhecimento do profissional e seu interesse em saber mais sobre: AO (quais deles conhecia; exames para controle; sinergismo com AO; e manejo das complicações. Resultados: Dos 100 entrevistados, 60% declararam perguntar ao paciente sobre o uso de AO, 81% tinham conhecimento insuficiente a respeito do sinergismo de algumas substâncias apresentadas e os AO, 15% desconheciam qual exame é utilizado para acompanhamento dos pacientes anticoagulados, 50,7% não sabiam os nomes comercias dos AO, 4% desconheciam seu antídoto, e 92% manifestaram interesse em melhorar seus conhecimentos sobre os AO. Conclusão: É BAIXo o número de médicos que atende em pronto atendimentos que conhece sobre os AO e que sabe manejar pacientes anticoagulados. É alta a porcentagem de médicos que não perguntam aos pacientes sobre o uso de AO e que desconhecem princípios do sinergismo medicamentoso, sendo que a maioria se interessou em melhorar seus conhecimentos sobre os anticoagulantes.Background: Since its discovery, oral anticoagulants (OA have been increasingly studied and used to treat different diseases. However, OA may cause adverse drug interactions that bring risks for patients. Objective: To identify the emergency room doctors

Guidelines for control room systems design. Working material. Report

International Nuclear Information System (INIS)

1993-01-01

This report contains comprehensive technical and methodological information and recommendations for the benefit of Member States for advice and assistance in ''NPP control room systems'' design backfitting existing nuclear power plants and design for future stations. The term ''Control Room Systems'' refers to the entire human/machine interface for the nuclear stations - including the main control room, back-ups control room and the emergency control rooms, local panels, technical support centres, operating staff, operating procedures, operating training programs, communications, etc. Refs, figs and tabs

The influence and evaluation of different virtual reality presentations for the main control room of nuclear power plant

International Nuclear Information System (INIS)

Wang Rouwen; Lin Chiuhsiang Joe; Lin Shiaufeng; Yang Chihwei; Cheng Tsungchieh; Yang Lichen

2011-01-01

Certainly, a nuclear power plant (NPP) is a complex system and requires high reliability. Engineering technology plays an important role in NPP that requires complex technical equipment and interfaces in order to achieve public security and working safety. Through training, operators can understand the nuclear power system and further establish the fit between human operators and the system, in order to reduce human errors and to ensure the working safety of the control room of NPP. However, the operator trainings for the control room of NPP are difficult and time-consuming. Virtual control room is thus developed using the virtual reality (VR) technology to help the training process. Presently several researches have developed virtual system for NPP for the purpose of training. However, whether the virtual training system for the control room of NPP can give users realistic immersive context as in the real environment is unknown. Whether these virtual systems are helpful in training performance are yet to be confirmed. For this reason, the control room of Lung-Men NPP of Taiwan was constructed with VR technology in this study in order to compare the performances of two VR representation methods (Desktop VR and Project VR). A searching task was planned in which the operators have to find out the objects appointed by the experimenter in the virtual interface of the main control room. The time to complete the task was collected as dependent variables in this experiment. The subjects have to complete the questionnaire that was developed for evaluating the usability of the virtual interface of MRC after finishing the experiment. The result showed that the performance of the virtual interface of NPP presented by the VR projector was better than the desktop. (author)

Emerging contaminants: Presentations at the 2009 Toxicology and Risk Assessment Conference

International Nuclear Information System (INIS)

Murnyak, George; Vandenberg, John; Yaroschak, Paul J.; Williams, Larry; Prabhakaran, Krishnan; Hinz, John

2011-01-01

A session entitled 'Emerging Contaminants' was held in April 2009 in Cincinnati, OH at the 2009 Toxicology and Risk Assessment Conference. The purpose of the session was to share information on both programmatic and technical aspects associated with emerging contaminants. Emerging contaminants are chemicals or materials that are characterized by a perceived or real threat to human health or environment, a lack of published health standards or an evolving standard. A contaminant may also be 'emerging' because of the discovery of a new source, a new pathway to humans, or a new detection method or technology. The session included five speakers representing the Department of Defense (DoD), the Environmental Protection Agency (EPA), and each of the military services. The DoD created the Emerging Contaminant Directorate to proactively address environmental, health, and safety concerns associated with emerging contaminants. This session described the scan-watch-action list process, impact assessment methodology, and integrated risk management concept that DoD has implemented to manage emerging contaminants. EPA presented emerging trends in health risk assessment. Researchers made technical presentations on the status of some emerging contaminates in the assessment process (i.e. manganese, RDX, and naphthalene).

Virtual Seminar Room

DEFF Research Database (Denmark)

Forchhammer, Søren Otto; Fosgerau, Anders; Hansen, Peter Søren Kirk

1999-01-01

The initial design considerations and research goals for an ATM network based virtual seminar room with 5 sites are presented.......The initial design considerations and research goals for an ATM network based virtual seminar room with 5 sites are presented....

Use of the hospital anxiety and depression scale (HADS in a cardiac emergency room: chest pain unit

Directory of Open Access Journals (Sweden)

Gastão L. F. Soares-Filho

2009-03-01

Full Text Available OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered "probable case" of anxiety or depression. RESULTS: According to the protocol, 59 (45.4% of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6% presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1% had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. CONCLUSION: The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit.

Science.gov (United States)

Soares-Filho, Gastão L F; Freire, Rafael C; Biancha, Karla; Pacheco, Ticiana; Volschan, André; Valença, Alexandre M; Nardi, Antonio E

2009-01-01

To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. Patients were assessed by the 'Hospital Anxiety and Depression Scale' as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered 'probable case' of anxiety or depression. According to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

Emergency Medical Services - Multiple Languages

Science.gov (United States)

... Well-Being 11 - Emergency Room - Amarɨñña / አማርኛ (Amharic) MP3 Siloam Family Health Center Arabic (العربية) Expand Section ... Well-Being 11 - Emergency Room - myanma bhasa (Burmese) MP3 Siloam Family Health Center Dari (دری) Expand Section ...

AN ANALYSIS OF MALIGNANCIES PRESENTING AS ACUTE GENERAL SURGICAL EMERGENCIES

Directory of Open Access Journals (Sweden)

Kannan Ross

2017-02-01

Full Text Available BACKGROUND Malignancies in the setting of acute general surgical emergencies are rare to present. The commonly presenting malignancies to the general surgeon in emergency conditions are perforation, obstruction, haemorrhage or urinary retention. Though their incidence when compared to benign conditions presenting with same clinical presentations are rare, they should never be neglected. The general surgeon must be aware of such presentations and hereby decide the management and follow up according to the malignancy he encounters on the operation theatre. The management should aim at radical procedures and regular follow up if needed with chemotherapy or radiotherapy and also should be well informed of the morbidity and mortality following intervention considering the malignancy grade, age of patient, duration of presentation and co-morbid conditions. MATERIALS AND METHODS In this study, we consider all patients taken up in emergency operative procedures, study their findings on operation theatre, correlate with their biopsy report for any malignancy and follow up during their immediate postop up to <30 days and also late post beyond the procedure and bring about the incidence, common modes of presentation, malignancies encountered, age and sex distribution and the perioperative morbidity and mortality rates of the those malignancies. RESULTS The incidence of malignancies presenting as acute abdominal emergencies in this study was found to be around 8.27%. The number of males who presented with such malignancies outnumbered females in a significant manner in the ratio 1.6:1. Among the malignancies, gastric (25% and colonic malignancies (59.38% were the most common. Perforation was the only presentation as acute emergency in carcinoma stomach. Incidence of malignancy in gastric perforation was 57.14% when compared to that reported by Emer Ergul et al that about 10-16% of all gastric perforations are caused by gastric carcinoma. 11 Perioperative

Emergency Department Presentations following Tropical Cyclone Yasi.

Directory of Open Access Journals (Sweden)

Peter Aitken

Full Text Available Emergency departments see an increase in cases during cyclones. The aim of this study is to describe patient presentations to the Emergency Department (ED of a tertiary level hospital (Townsville following a tropical cyclone (Yasi. Specific areas of focus include changes in: patient demographics (age and gender, triage categories, and classification of diseases.Data were extracted from the Townsville Hospitals ED information system (EDIS for three periods in 2009, 2010 and 2011 to coincide with formation of Cyclone Yasi (31 January 2011 to six days after Yasi crossed the coast line (8 February 2012. The analysis explored the changes in ICD10-AM 4-character classification and presented at the Chapter level.There was a marked increase in the number of patients attending the ED during Yasi, particularly those aged over 65 years with a maximum daily attendance of 372 patients on 4 Feb 2011. The most marked increases were in: Triage categories--4 and 5; and ICD categories--diseases of the skin and subcutaneous tissue (L00-L99, and factors influencing health care status (Z00-Z99. The most common diagnostic presentation across all years was injury (S00-T98.There was an increase in presentations to the ED of TTH, which peaked in the first 24-48 hours following the cyclone and returned to normal over a five-day period. The changes in presentations were mostly an amplification of normal attendance patterns with some altered areas of activity. Injury patterns are similar to overseas experience.

The conference hybrid control room

International Nuclear Information System (INIS)

Gieci, A.; Caucik, J.; Macko, J.

2008-01-01

An original concept of a hybrid control room was developed for the Mochovce-3 and Mochovce-4 reactor units which are under construction. The basic idea underlying the concept is that the control room should be a main working place for the operators (reactor operator and turbine operator) and for the shift supervisor, designed as a comprehensive unit desk shaped so that all members of the control room crew are in a face-to-face contact constantly. The main desk consists of three clearly identified areas serving the operators and the unit supervisor as their main working places. A soft control system is installed at the main working places. A separate safety-related working place, designed as a panel with classical instrumentations at the conference hybrid control room, is provided in case of abnormal conditions or emergency situation. Principles of ergonomics and cognitive engineering were taken into account when designing the new conference hybrid control room for the Mochovce-3 and -4 reactor units. The sizes, propositions, shapes and disposition of the equipment at the control room have been created and verified by using virtual reality tools. (orig.)

Utilization of the emergency room: impact of geographic distance

Directory of Open Access Journals (Sweden)

Jae Eun Lee

2007-05-01

Full Text Available The aim of this study was to estimate the distance Mississippi patients must travel to access hospital-based emergency rooms (ERs and to determine whether an association exists between geographic distance and ER utilization. To that end, great circle distances between Census Block Group Centroid Points and 89 hospitals with emergency departments were calculated for the State of Mississippi. Data on the socio-demographic characteristics of each block group came from the 2000 US Census data. Logistic regression analyses were conducted to test if there was any association between ER utilization and travel distance. Compared to the national benchmark of 35.7%, more than one in two (56.7%, or 1,612,762 Mississippians visited ERs in 2003 with an estimated 6.1 miles per person annual travel for this purpose. The majority of the target population (54.9% was found to live within 5 miles of hospitals with ERs. Logistic analyses revealed that block groups associated with less miles traveled to hospitals with ERs had a higher proportion of African Americans, impoverished people, female householders, people with more than 12 years education, people older than 65 years, people with high median house values, and people without employment. Twenty-nine of the 89 hospitals (33% providing ER care in Mississippi were found to be in areas with above-average ER utilization rates. These hospitals served a smaller geographical area (28% of the total but had a greater proportion of visitors (57% and served a higher percentage (37% of the state population. People in areas served by the less utilized ERs traveled more miles to be cared for (7.1 miles vs 5.4 miles; p<0.0001. Logistic regression analysis revealed that shorter distances were associated with increased use of the ERs, even after controlling for socio-demographic factors. The conclusion is that Mississippi ERs are typically located in block groups with higher percentages of disadvantaged residents and that

Nuclear power plant control room ventilation system design for meeting general criterion 19

International Nuclear Information System (INIS)

Murphy, K.G.; Campe, K.M.

1975-01-01

The requirement for protection of control room personnel against radiation is specified in General Design Criterion 19 of Appendix A, 10 CFR Part 50. The evaluation of a control room design, especially its emergency ventilation system, with respect to radiation protection primarily consists of determining the radiation doses to control room personnel under accident conditions. The accident dose assessment involves modeling and evaluation of radiological source terms, atmospheric transport of airborne activity, and protection features of the control room ventilation system. Some of the assumptions and conservatisms used in the dose analyses are based on the technical review experience of existing or proposed control room designs. A review of over 50 control room designs has revealed a great variety of design concepts, not all of which seem to have been based on radiation protection criteria. A summary of the basic control room protection requirements, design features, dose acceptance criteria, and an outline of the methods used by the Regulatory staff for accident dose evaluation are presented. (U.S.)

Methodology for the identification of the factors that can influence the performance of operators of nuclear power plants control room under emergency situations

International Nuclear Information System (INIS)

Paiva, Bernardo Spitz; Santos, Isaac J.A. Luquetti

2009-01-01

In order to minimize the human errors of the operators in a nuclear power plan control room, during emergency situations, it has to be considered the factors which affect the human performance. Work situations adequately projected, compatible with the necessities, capacities and human limitations, taking into consideration the factors which affect the operator performance . This paper aims to develop a methodology for identification of the factors affecting the operator performance under emergency situation, using the aspects defined by the human reliability analysis focusing the judgment done by specialists

[Coma in the emergency room].

Science.gov (United States)

Braun, M; Ploner, C J; Lindner, T; Möckel, M; Schmidt, W U

2017-06-01

Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO. We propose an interdisciplinary standard operating procedure (SOP) for patients with acute CUO as has been established in our maximum care hospital. The SOP is triggered by simple triage criteria that are sufficient to identify CUO patients before arrival in hospital. The in-hospital response team is led by a neurologist. Collaboration with nursing staff, internal medicine, anesthesiology, neurosurgery and trauma surgery is organized along structured pathways that include standardized laboratory tests, including cerebrospinal fluid (CSF), toxicology, computed tomography (CT) and CT angiography imaging (CTA). Our data suggest that neurologists and internists need to be placed at the beginning of the diagnostic work-up. Imaging should not just be carried out depending on the clinical syndrome because sensitivity, specificity and inter-rater reliability of the latter are not sufficient and because in many cases, multiple pathologies can be detected that could each explain CUO alone. Clinical examination, imaging and laboratory testing should be regarded as components of an integrative diagnostic approach and the final aetiological classification should only be made after the diagnostic work-up is complete.

Factores predictores de uso problemático de alcohol en personas atendidas en una sala de emergencia Predictive factors of alcohol use problems among patients visiting an emergency room

Directory of Open Access Journals (Sweden)

Fabián Fiestas

2011-03-01

Full Text Available Objetivos. Valorar el efecto predictivo de características claves de pacientes atendidos en salas de emergencia para detectar casos de uso problemático de alcohol. Materiales y Métodos. La muestra de estudio estuvo constituida por 371 personas atendidas en el lapso de siete días completos de enero de 2005 en el servicio de emergencia de un hospital público de Lima, Perú. Se aplicó un cuestionario demográfico, el SIDUC/CICAD para uso reciente de sustancias psicoactivas en salas de emergencias (i.e., uso dentro de las seis horas previas a la atención y el AUDIT para uso problemático de alcohol en el último año. El análisis de regresión logística simple y multivariada permitió valorar el efecto predictor de la edad, sexo, especialidad del servicio de atención, presencia de daño físico y el uso reciente de alcohol para detectar casos problemáticos de su uso. Resultados. El odds de tener uso problemático de alcohol en los varones es 26 veces el odds de tener dicho problema entre las mujeres (pObjectives. To assess the predictive effect of key individual-level characteristics to identify cases of alcohol use problems among patients visiting an emergency room. Materials and methods. The study sample was composed of 371 people attending an emergency room in a public hospital in Lima, Peru, during a period of seven complete days in January, 2005. For data gathering, we used a questionnaire for demographic information, the SIDUC/CICAD for recent use (i.e., in the last 6 hours of psychoactive substances before arriving to the emergency room, and the AUDIT, to identify alcohol use problems in the last year. Univariate and multivariate logistic regression models were used to estimate the predictive effect of age, sex, area of attention in the emergency room, presence of physical injuries and recent use of alcohol. Results. The odds of being a case of alcohol use problem for males is 26 times the odds of having that problem for females (p

Feelings of nurses in the reception and risk classification evaluation in the emergency room

Directory of Open Access Journals (Sweden)

Andressa Midori Sakai

2016-05-01

Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

Feelings of nurses in the reception and risk classification evaluation in the emergency room

Directory of Open Access Journals (Sweden)

Andressa Midori Sakai

2016-01-01

Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

What Happens in the Emergency Room?

Science.gov (United States)

... was 4 years old, he loved to play Batman. He'd put on his Batman pajamas and pretend to fly all over the ... swollen) and he had trouble moving his arm. "Batman," she said, "We're going to the emergency ...

Sport and active recreation injuries in Australia: evidence from emergency department presentations

OpenAIRE

Finch, C.; Valuri, G.; Ozanne-Smith, J.

1998-01-01

OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Dat...

Room Acoustical Fields

CERN Document Server

Mechel, Fridolin

2013-01-01

This book presents the theory of room acoustical fields and revises the Mirror Source Methods for practical computational use, emphasizing the wave character of acoustical fields.  The presented higher methods include the concepts of “Mirror Point Sources” and “Corner sources which allow for an excellent approximation of complex room geometries and even equipped rooms. In contrast to classical description, this book extends the theory of sound fields describing them by their complex sound pressure and the particle velocity. This approach enables accurate descriptions of interference and absorption phenomena.

CEBAF Control Room Renovation

International Nuclear Information System (INIS)

Michael Spata; Thomas Oren

2005-01-01

The Machine Control Center (MCC) at Jefferson Lab's Continuous Electron Beam Accelerator Facility (CEBAF) was initially constructed in the early 1990s and based on proven technology of that era. Through our experience over the last 15 years and in our planning for the facility's 12 GeV upgrade we reevaluated the control room environment to capitalize on emerging visualization and display technologies and improve workflow processes and ergonomic attributes. This effort also sets the foundation for the redevelopment of the accelerator's control system to deliver high reliability performance with improvements in beam specifications management and information flow. The complete renovation was performed over a three-week maintenance period with no interruption to beam operations. We present the results of this effort

CEBAF Control Room Renovation

International Nuclear Information System (INIS)

Michael Spata; Thomas Oren

2005-01-01

The Machine Control Center at Jefferson Lab's Continuous Electron Beam Accelerator Facility was initially constructed in the early 1990s and based on proven technology of that era. Through our experience over the last 15 years and in our planning for the facilities 12 GeV upgrade we reevaluated the control room environment to capitalize on emerging visualization and display technologies and improve on workflow processes and ergonomic attributes. This effort also sets the foundation for the redevelopment of the accelerator's control system to deliver high reliability performance with improvements in beam specifications management and information flow. The complete renovation was performed over a three-week period with no interruption to beam operations. We present the results of this effort

Control room habitability Analysis and Testing for Wolsong Unit 1

Energy Technology Data Exchange (ETDEWEB)

Lee, J. B. [KHNP Central Research Institute, Daejeon (Korea, Republic of)

2013-05-15

In response to this recommendation, KHNP has established CRH program and performed tracer gas in leakage tests. These activities are described herein including the emergency ventilation system analysis, acceptance criteria calculation for the test and Control Room Envelope (CRE) discrimination, and the results of the tracer gas tests are presented. CRH analysis including unfiltered in leakage tests according to the methodology in ASTM E741 was performed for Wolsong Unit 1. The results show that the integrity of the control room of Wolsong Unit 1 is in good condition to maintain the reactor in a safe condition under accident conditions, which complies with the US NRC regulatory guides 1.78, 1.196 and 1.197.

Fire risk assessment for hydrogen at EDG/battery room

Energy Technology Data Exchange (ETDEWEB)

Jee, Moon Hak; Hong, Sung Yull; Choi, Kwang Hee; Jung, Hyun Jong; Park, Kyung Hyum [Korea electric Power Research Institute, Taejon (Korea, Republic of); Song, Jin Bae [KHNP, Wolsong (Korea, Republic of)

2004-07-01

At the design stage of Nuclear Power Plant, the fire hazard analysis for the fire zone or compartment is implemented according to the fire protection requirement and the document is required for the licensing approval. On the basis of fire hazard analysis, the evaluation for the safe shutdown capability is preceded for each fire zone that contains safety-important systems and facilities. The primary philosophy for the fire safety is to secure fire defense-in-depth at Nuclear Power Plants that represents fire prevention, fire protection, and mitigation from fire damage. One of the concerning fire zones that need quantitative fire hazard analysis as well as qualitative fire evaluation at Nuclear Power Plants is the battery room at Emergency Diesel Generator (EDG) Room. For an example, Emergency Power Supply System called as EPS at Wolsong Nuclear Power Plant generates emergency power and supply the electric power to the safety-related systems and essential facilities during the loss of on-site and off-site AC power. For the start of emergency power generator, it needs DC power from the battery units inside the EPS room. For the emergency supply of DC power, the battery at EPS room should be recharged during the standby period to compensate the reduced chemical energy that was converted to the electric energy or depleted through the natural process. During the recharge process, especially at the time of charging current becoming greater than the nominal floating current or at the time of over-charging period, the hydrogen and the oxygen are generated from the positive plate and cathodic part respectively and escaped through the vent holes or crevices. In this context, the fire hazard assessment should be done for the EPS/battery room with quantitative approach and the fire safety evaluation for the explosion of hydrogen gas must be done under the specific fire protection program at Nuclear Power Plants.

Fire risk assessment for hydrogen at EDG/battery room

International Nuclear Information System (INIS)

Jee, Moon Hak; Hong, Sung Yull; Choi, Kwang Hee; Jung, Hyun Jong; Park, Kyung Hyum; Song, Jin Bae

2004-01-01

At the design stage of Nuclear Power Plant, the fire hazard analysis for the fire zone or compartment is implemented according to the fire protection requirement and the document is required for the licensing approval. On the basis of fire hazard analysis, the evaluation for the safe shutdown capability is preceded for each fire zone that contains safety-important systems and facilities. The primary philosophy for the fire safety is to secure fire defense-in-depth at Nuclear Power Plants that represents fire prevention, fire protection, and mitigation from fire damage. One of the concerning fire zones that need quantitative fire hazard analysis as well as qualitative fire evaluation at Nuclear Power Plants is the battery room at Emergency Diesel Generator (EDG) Room. For an example, Emergency Power Supply System called as EPS at Wolsong Nuclear Power Plant generates emergency power and supply the electric power to the safety-related systems and essential facilities during the loss of on-site and off-site AC power. For the start of emergency power generator, it needs DC power from the battery units inside the EPS room. For the emergency supply of DC power, the battery at EPS room should be recharged during the standby period to compensate the reduced chemical energy that was converted to the electric energy or depleted through the natural process. During the recharge process, especially at the time of charging current becoming greater than the nominal floating current or at the time of over-charging period, the hydrogen and the oxygen are generated from the positive plate and cathodic part respectively and escaped through the vent holes or crevices. In this context, the fire hazard assessment should be done for the EPS/battery room with quantitative approach and the fire safety evaluation for the explosion of hydrogen gas must be done under the specific fire protection program at Nuclear Power Plants

Value of contrast enhanced CT scanning in the non-trauma emergency room patient

International Nuclear Information System (INIS)

Wood, L.P.; Parisi, M.; Finch, I.J.

1990-01-01

To determine the value of performing contrast CT in addition to non-contrast CT in the evaluation of acute non-traumatic central nervous system disorders, we retrospectively reviewed 322 cases originating from the emergency room at our institution. The most common indication for scanning was seizure activity (34% of total), followed by headache (30%), focal neurological deficit (10%), and altered mental status (8%). 75% of the noncontrast scans were normal. The contrast enhanced scan revealed abnormalities not evident on the non-contrast scan in only three of these cases, and the information did not alter patient management. We conclude that in the acute setting, if a non-contrast CT is normal, a contrast study is usually unnecessary. Therefore, given the additional risks of contrast infusion, the contrast study, if needed, is generally best obtained at a later date, after more careful evaluation of the patient's history and medical records. If the non-contrast CT scan is abnormal, a contrast enhanced CT scan may be beneficial, but, again, is often not needed to direct acute patient management. (orig.)

Emergency management of major bleeding in a case of maxillofacial trauma and anticoagulation: utility of prothrombin complex concentrates in the shock room

Directory of Open Access Journals (Sweden)

Alessandro Morotti

2015-03-01

Full Text Available Life-threatening bleeding in anticoagulation with Warfarin is an emergency challenging issue. Several approaches are available to treat bleeding in either over-anticoagulation or propeanticoagulation, including vitamin K, fresh frozen plasma and prothrombin complex concentrates (PCC administration. In coexisting trauma-induced bleeding and anticoagulation, reversal of anticoagulation must be a rapid and highly effective procedure. Furthermore the appropriate treatment must be directly available in each shock rooms to guarantee the rapid management of the emergency. PCC require a simple storage, rapid accessibility, fast administration procedures and high effectiveness. Here we report the utility of PCC in management of a craniofacial trauma in proper-anticoagulation.

Radiation Protection Elephants in the Room

International Nuclear Information System (INIS)

Vetter, R. J.

2004-01-01

As our system of radiological protection evolves, several significant issues loom within radiation protection discussions and publications. These issues influence the nature of epidemiological and radiobiological research and the establishment of radiation protection recommendations, standards, and regulations. These issues are like the proverbial e lephants in the room . They are large, and it is unwise to ignore them. This paper discusses the impact of three young elephants as they make their presence increasingly obvious: increased cancer susceptibility from early-life exposure to radiation, terrorism and fear of radiation, and patient safety. Increased cancer susceptibility from early-life exposure to radiation is emerging as a discussion topic related to the safety of computed tomography (CT) and other medical modalities. Shortly after publication of CT dose data, manufacturers were helping to reduce doses to children by increasing flexibility for adjustment of technique factors. Also, radiation epidemiological data are being used in the development of guidance on exposure to chemical carcinogens during early life. Re-emergence of public fear of radiation has been fueled by threats of radiological dispersion devises and confusing messages about personal decontamination, emergency room acceptance or rejection of contaminated victims, and environmental clean-up. Finally, several professional publications have characterized risk of medical radiation exposure in terms of patient deaths even though epidemiological data do not support such conclusions. All three of these elephants require excellent science and sophisticated data analysis to coax them from the room. Anecdotal communications that confuse the public should be avoided. These are not the only elephants in the room, but these three are making their presence increasingly obvious. This paper discusses the need for radiation protection professionals to rely on good science in the evolution of the system of

Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

Directory of Open Access Journals (Sweden)

Shafazand Masoud

2012-03-01

Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

A study of consumer attitudes about health care: the role of the emergency room.

Science.gov (United States)

Stratmann, W C; Ullman, R

1975-12-01

Contrary to the traditional role of the emergency room (ER) as a care source for the treatment of urgent medical needs, it is evident that substantial numbers of people now use the ER for the treatment of nonurgent problems. In this paper, we report on public opinion about the role of the ER, the accessibility of medical care, and factors that prompt the use of the ER rather than other sources of care. The data result from a community survey of households (N = 521) in the area of Rochester, New York, representative of a population of about 580,000 people. The findings, which relate ER utilization to source of payment, use of other sources of care, demographic variables, and consumer attitudes illustrate the rationality of the patient's use of ER facilities and reflect the patient's view of the ER as a place to obtain medical treatment when other sources are not available.

Ocorrência e preditores clínicos de pseudocrise hipertensiva no atendimento de emergência Occurrence rate and clinical predictors of hypertensive pseudocrisis in emergency room care

Directory of Open Access Journals (Sweden)

Silvestre Sobrinho

2007-05-01

Full Text Available OBJETIVOS: Descrever a prevalência de pseudocrise hipertensiva em pacientes atendidos em unidade de emergência com níveis de pressão arterial substancialmente elevados, comparando-a entre serviços privado e público; descrever a freqüência de tratamento indevido para essa condição; identificar, no momento da triagem, preditores independentes de pseudocrise; e avaliar o prognóstico dos pacientes com pseudocrise. MÉTODOS: Durante seis meses, foram incluídos pacientes com idade > 18 anos, atendidos nas Emergências de dois hospitais (privado e público, com pressão arterial diastólica > 120 mmHg. Pseudocrise hipertensiva foi definida na ausência de critérios para crise hipertensiva, segundo as Diretrizes da Sociedade Brasileira de Cardiologia. RESULTADOS: Em 110 pacientes estudados, a prevalência de pseudocrise hipertensiva foi de 48% (intervalo de confiança de 95% [IC 95%] = 39%-58%, predominando no serviço privado (59% vs 37%; p = 0,02. A freqüência de tratamento indevido foi semelhante nos dois serviços (94% vs 95%; p = 0,87. Após análise multivariada, a presença de cefaléia na admissão (odds ratio = 5,4; IC 95% = 5,1-13; p OBJECTIVES: To describe the prevalence of hypertensive pseudocrisis in patients treated in emergency rooms with substantially elevated blood pressure levels. To compare this prevalence in private and public hospitals. To describe the frequency of wrong treatment for this condition. To identify, during triage, independent predictors of pseudocrisis. To evaluate the prognosis of patients with pseudocrisis. METHODS: Patients above the age of 18, admitted to the Emergency Rooms of two hospitals (private and public during a 6 month timeframe, with diastolic blood pressure > 120 mmHg were included in the study. Hypertensive pseudocrisis was determined when none of the criteria for hypertensive crisis were present (Guidelines of the Brazilian Society of Cardiology¹. RESULTS: In the 110 patients studied

PFP Emergency Lighting Study

International Nuclear Information System (INIS)

BUSCH, M.S.

2000-01-01

NFPA 101, section 5-9 mandates that, where required by building classification, all designated emergency egress routes be provided with adequate emergency lighting in the event of a normal lighting outage. Emergency lighting is to be arranged so that egress routes are illuminated to an average of 1.0 footcandle with a minimum at any point of 0.1 footcandle, as measured at floor level. These levels are permitted to drop to 60% of their original value over the required 90 minute emergency lighting duration after a power outage. The Plutonium Finishing Plant (PFP) has two designations for battery powered egress lights ''Emergency Lights'' are those battery powered lights required by NFPA 101 to provide lighting along officially designated egress routes in those buildings meeting the correct occupancy requirements. Emergency Lights are maintained on a monthly basis by procedure ZSR-12N-001. ''Backup Lights'' are battery powered lights not required by NFPA, but installed in areas where additional light may be needed. The Backup Light locations were identified by PFP Safety and Engineering based on several factors. (1) General occupancy and type of work in the area. Areas occupied briefly during a shiftly surveillance do not require backup lighting while a room occupied fairly frequently or for significant lengths of time will need one or two Backup lights to provide general illumination of the egress points. (2) Complexity of the egress routes. Office spaces with a standard hallway/room configuration will not require Backup Lights while a large room with several subdivisions or irregularly placed rooms, doors, and equipment will require Backup Lights to make egress safer. (3) Reasonable balance between the safety benefits of additional lighting and the man-hours/exposure required for periodic light maintenance. In some plant areas such as building 236-Z, the additional maintenance time and risk of contamination do not warrant having Backup Lights installed in all rooms

Sport and active recreation injuries in Australia: evidence from emergency department presentations.

Science.gov (United States)

Finch, C; Valuri, G; Ozanne-Smith, J

1998-09-01

Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (15 years of age). Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury. The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia.

Sport and active recreation injuries in Australia: evidence from emergency department presentations

Science.gov (United States)

Finch, C.; Valuri, G.; Ozanne-Smith, J.

1998-01-01

OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (15 years of age). RESULTS: Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury. CONCLUSION: The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia. 


 PMID:9773170

Room acoustics modeling using a point-cloud representation of the room geometry

DEFF Research Database (Denmark)

Markovic, Milos; Olesen, Søren Krarup; Hammershøi, Dorte

2013-01-01

Room acoustics modeling is usually based on the room geometry that is parametrically described prior to a sound transmission calculation. This is a highly room-specific task and rather time consuming if a complex geometry is to be described. Here, a run time generic method for an arbitrary room...... geometry acquisition is presented. The method exploits a depth sensor of the Kinect device that provides a point based information of a scanned room interior. After post-processing of the Kinect output data, a 3D point-cloud model of the room is obtained. Sound transmission between two selected points...... level of user immersion by a real time acoustical simulation of a dynamic scenes....

High users of VA emergency room facilities: are outpatients abusing the system or is the system abusing them?

Science.gov (United States)

Schneider, K C; Dove, H G

1983-01-01

A phenomenon well known to emergency room personnel is the high use of ER facilities by a small number of patients. In this study of 335 patients followed in outpatient specialty clinics at a university-affiliated VA medical center, 23% of the patients accounted for 73% of the ER visits. Although some patients may be abusing the system, the problem is difficult to correct because of congressional legislation that deters the VA from providing primary care. Thus, a small subset of patients with chronic medical problems who live close to the hospital are likely to continue to consume a disproportionate amount of ER resources.

Presentation and management of nasal foreign bodies at a tertiary children's hospital in an American metro area.

Science.gov (United States)

Scholes, Melissa A; Jensen, Emily L

2016-09-01

To examine rates of otolaryngology intervention in children presenting to our emergency department with nasal foreign bodies, factors associated with otolaryngology involvement, rates of complications, and details on nasal button battery exposure. All patients presenting with a nasal foreign body to Children's Hospital Colorado from 2007 to 2012 were identified. Factors leading to referral to otolaryngology and operative intervention were examined, as well as complications. 102 patients were included. 36 (35%) patients were referred to the otolaryngology clinic, of which 58.9% required operating room intervention. 66 (64.7%) children had their nasal foreign bodies removed in the emergency room, however 30 (45%) of these were removed by an otolaryngology resident or attending physician. Overall, 64.7% of nasal foreign bodies required removal by otolaryngology. Of the 15 objects removed in the operating room, six were button batteries. No septal perforations occurred as a result of nasal button battery exposure. Multivariable logistic regression showed two significant predictors of OR removal: age and disc shaped objects. While emergency department providers are comfortable attempting removal of nasal foreign bodies, there was a high rate of otolaryngology intervention. Based on this data, there is a need to educate emergency room providers on nasal anatomy and techniques for nasal foreign body removal. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Emergency control centers for nuclear power plants

International Nuclear Information System (INIS)

Anon.

1979-01-01

Guidance is provided for the development and implementation of emergency control centers for nuclear power plants, including nuclear plant control room, nuclear plant company headquarters, emergency control center, and nuclear plant alternate emergency control center. Requirements and recommendations are presented for the mission, communications, instrumentation and equipment associated with each type of control center. Decisional aids, manning requirements and resources are also given; the decision aids cover both the accident assessment and protective action areas. Both normal and alternate means of communications are considered. Off-site emergency control centers, although not covered in the strict sense by this standard, are considered in an appendix

Pediatric cardiac emergencies: Children are not small adults

Directory of Open Access Journals (Sweden)

Frazier Aisha

2011-01-01

Full Text Available Compared with adults, cardiac emergencies are infrequent in children and clinical presentation is often quite variable. In adults, cardiac emergencies are most commonly related to complications of coronary artery disease; however, in pediatric cases, the coronaries are only rarely the underlying problem. Pediatric cardiac emergencies comprise a range of pathology including but not limited to undiagnosed congenital heart disease in the infant; complications of palliated congenital heart disease in children; arrhythmias related to underlying cardiac pathology in the teenager and acquired heart disease. The emergency room physician and pediatric intensivist will usually be the first and second lines of care for pediatric cardiac emergencies and thus it is imperative that they have knowledge of the diverse presentations of cardiac disease in order to increase the likelihood of delivering early appropriate therapy and referral. The objective of this review is to outline cardiac emergencies in the pediatric population and contrast the presentation with adults.

Abstract to publication ratio for papers presented at scientific meetings: how does emergency medicine compare?

Science.gov (United States)

Walby, A; Kelly, A M; Georgakas, C

2001-12-01

The aims of the present study were to determine the publication rate of abstracts presented by Australasian emergency physicians at major emergency medicine meetings and to identify the site of publication of papers. All free paper abstracts presented (oral and poster) by Australasian emergency physicians and trainees at five Australasian College for Emergency Medicine/Australasian Society for Emergency Medicine and International Conference on Emergency Medicine meetings between 1995 and 1998 were identified retrospectively from conference programmes. In order to determine whether or not the abstract had been published, the PubMed database (http://www4.ncbi.nlm.nih.gov/PubMed/) was searched using the presenter's name and key words from the abstract. In addition, a hand search of the non-abstracted journal Emergency Medicine was conducted. Of the 207 free paper abstracts identified, 73 (35%) had been published as full articles. Papers were published in a variety of journals; however, Emergency Medicine accounted for almost half the published papers. The mean time between presentation and publication was 12.6 months (median 11 months). The abstract to publication rate for papers presented by Australasian emergency physicians and trainees at Australasian College for Emergency Medicine/Australasian Society for Emergency Medicine and International Conference on Emergency Medicine meetings is 35%, which is lower than that reported by some other established specialities, but comparable to rates reported for US-based national and international emergency medicine meetings. Future research should look at barriers to the publication of findings and ways to assist the publication process.

Improving operating room safety

Directory of Open Access Journals (Sweden)

Garrett Jill

2009-11-01

Full Text Available Abstract Despite the introduction of the Universal Protocol, patient safety in surgery remains a daily challenge in the operating room. This present study describes one community health system's efforts to improve operating room safety through human factors training and ultimately the development of a surgical checklist. Using a combination of formal training, local studies documenting operating room safety issues and peer to peer mentoring we were able to substantially change the culture of our operating room. Our efforts have prepared us for successfully implementing a standardized checklist to improve operating room safety throughout our entire system. Based on these findings we recommend a multimodal approach to improving operating room safety.

Thigh infection and subcutaneous emphysema: an emergency, review of literature and case discussion.

LENUS (Irish Health Repository)

Thakral, R

2011-06-01

Thigh infection associated with local emphysematous signs on presentation to the emergency room should alert the medical staff at once of potential complication associated with it. The infection may be associated with underlying bowel pathology and has a high mortality rate. Hence, emergency treatment should be instituted. We discuss a case with this uncommon presentation, treatment administered and relevant literature.

Why do children present to emergency departments? Exploring motivators and measures of presentation appropriateness for children presenting to a paediatric emergency department.

Science.gov (United States)

Cheek, John A; Braitberg, George; Craig, Simon; West, Adam

2017-05-01

To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define 'primary care suitable' presentations to the ED. A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED. Surveys were distributed to the treating ED clinician, the child's parent/guardian, and the referring GP. Results between the three groups were analysed and compared. There were a total of 1069 presentations during the study period. Six hundred (58.4%, 95% CI 55.3-61.4%) presentations were judged as 'ED appropriate' by the treating ED clinician. When compared with methods used to retrospectively judge whether ED patients are considered 'primary care suitable', ED clinicians disagree between 22.4 and 38.8% of the time. For patients who presented directly to ED, 85.6% did so for a medical reason, whilst 32.1% did so for a GP access reason. Being referred by a GP improved the ED clinicians' opinion of the appropriateness of the presentation (49.2 vs. 73.9%, P motivators that drive this behaviour is needed. We believe the solution to increasing utilisation of EDs by children must be a balanced approach that addresses community expectations and appropriately resources EDs. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

The Virtual Dressing Room

DEFF Research Database (Denmark)

Holte, Michael Boelstoft; Gao, Yi; Petersson, Eva

2015-01-01

This paper presents the design and evaluation of a usability and user experience test of a virtual dressing room. First, we motivate and introduce our recent developed prototype of a virtual dressing room. Next, we present the research and test design grounded in related usability and user...... experience studies. We give a description of the experimental setup and the execution of the designed usability and user experience test. To this end, we report interesting results and discuss the results with respect to user-centered design and development of a virtual dressing room....

A room of one's own--Being cared for in a hospital with a single-bed room design.

Science.gov (United States)

Persson, Eva; Anderberg, Patrice; Ekwall, Anna Kristensson

2015-06-01

To illuminate patients' experiences of being hospitalised in a hospital with a single-bed room design. Many patients seem to prefer single-bed hospital rooms. However, studies have also shown that patients do see the advantages of multiple-bed rooms. Interviews were conducted with 16 inpatients from a surgical ward in a hospital building with a single-bed room design. A hermeneutical-phenomenological approach guided by van Manen's four life-world existentials was used to analyse the interviews. The essential meaning was that patients felt secure because they could create a personal environment without disruptive elements. The room was private, and this implied feelings of homeliness, which allowed patients to focus on themselves and was thought to facilitate the recovery process. The patients preferred staying in their room, and the relationship with the personnel was central. Feelings of loneliness and isolation could occur and could be frightening. Being hospitalised in a single-bed room meant balancing between feeling secure and feeling insecure. The following four themes emerged: A homely environment, The need for company and security, Time as unpredictable and involving waiting and Focus on healing the body. Patients experienced that a single-bed room allowed them to focus on their recovery, have visitors without disturbing others and create a feeling of homeliness. However, mobilisation is not a natural part of the recovery process when patients have all they need in their rooms. The patients' need for social interaction and confirmation was not satisfied without effort and planning on the part of staff. © 2014 Nordic College of Caring Science.

When to use the emergency room - adult

Science.gov (United States)

... feeling or inability to move Electric shock or lightning strike Severe burn Severe chest pain or pressure ... 2016. American College of Emergency Physicians. Urgent care fact sheet. newsroom.acep.org/fact_sheets?item=30033 . ...

Screening Criteria for a Room Cooling Failure of the AFW MDP Room

International Nuclear Information System (INIS)

Hwang, Mee Jeong; Yoon, Churl; Yang, Joon Eon; Park, Joo Hwan

2006-01-01

In this paper, we performed a heat up calculation for the Auxiliary Feedwater Motor Operated Pump (AFW MDP) room, PAB-077-11A with CFX-10 and RATT when the HVAC (Heating, Ventilation, and Air Condition) system is failed. We also reviewed the operability of the components under a loss of the HVAC. Room cooling failure does not need to be modeled if the components maintain their operability after a loss of a room cooling function during the mission time. ASME Standard describes that a recovery action can be credited if the related recovery action is included in the procedure or there are similar recovery experiences in the plant. However, there is no description about the recovery action of the HVAC in the EOP (Emergency Operation Procedure) of the UCN3, 4 under the situation of a loss of the HVAC. However, if we consider the HVAC failure in the PSA FT model, the problem is that the unavailability induced from a loss of the HVAC is unrealistically high. From a viewpoint of the PSA, it is not true that the related system always fails even if the HVAC system fails. Therefore, we reviewed the necessity of the HVAC model through two cases of a room heat up calculation under the situation of a loss of the HVAC system with conservative and realistic input data respectively

Perception and Attitude of Emergency Room Resident Physicians toward Middle East Respiratory Syndrome Outbreak

Directory of Open Access Journals (Sweden)

Mohammed Al Ghobain

2017-01-01

Full Text Available Introduction. Middle East respiratory syndrome (MERS outbreaks have had a considerable negative impact on health systems in Saudi Arabia. We aimed to study the psychological impact of a Middle East respiratory syndrome coronavirus (MERS-CoV outbreak on emergency room resident physicians (ERRPs. Methods. We assessed the MERS-related psychological impact and concerns of ERRPs using a self-report questionnaire. Results. The majority (91% of the ERRPs agreed that their work put them at risk of infection, but most (65% did not agree that they should not be looking after patients infected with MERS. Despite that, 54% of ERRPs reported being afraid of contracting the infection from infected patients and only 4.2% of them were willing to change their current job. The majority of the ERRPs (85% felt that their job would expose their families to risk of infection. Conclusions. Our study demonstrated the considerable psychological impact of MERS outbreaks on ERRPs. The ERRPs’ concerns and the psychological impact of MERS outbreaks should be considered in greater detail by hospital policymakers.

Developing Emergency Room Key Performance Indicators: What to Measure and Why Should We Measure It?

Science.gov (United States)

Khalifa, Mohamed; Zabani, Ibrahim

2016-01-01

Emergency Room (ER) performance has been a timely topic for both healthcare practitioners and researchers. King Faisal Specialist Hospital and Research Center, Saudi Arabia worked on developing a comprehensive set of KPIs to monitor, evaluate and improve the performance of the ER. A combined approach using quantitative and qualitative methods was used to collect and analyze the data. 34 KPIs were developed and sorted into the three components of the ER patient flow model; input, throughput and output. Input indicators included number and acuity of ER patients, patients leaving without being seen and revisit rates. Throughput indicators included number of active ER beds, ratio of ER patients to ER staff and the length of stay including waiting time and treatment time. The turnaround time of supportive services, such as lab, radiology and medications, were also included. Output indicators include boarding time and available hospital beds, ICU beds and patients waiting for admission.

Associations among emergency room visits, parenting styles, and psychopathology among pediatric patients with sickle cell.

Science.gov (United States)

Latzman, Robert D; Shishido, Yuri; Latzman, Natasha E; Elkin, T David; Majumdar, Suvankar

2014-10-01

To examine associations between frequency of emergency room (ER) visits and various parenting styles, both conjointly and interactively, and psychopathological outcomes among pediatric patients with sickle cell disease (SCD). Ninety-eight parents/caregivers of 6- to 18-year-old patients with SCD completed instruments assessing parenting style, child psychopathology, and reported on the frequency of ER visits during the previous year. ER visits were found to significantly explain Withdrawn/Depressed problems and parenting styles were found to incrementally contribute to the explanation of all forms of psychopathology. Further, Permissive parenting was found to explain Rule Breaking Behavior for those patients with low ER visit frequency but not for those with high ER visit frequency. Results of the current study confirm the importance of considering both the frequency of ER visits and parenting style in the explanation of psychopathology among pediatric patients with SCD. Results have important implications for both research and treatment. © 2014 Wiley Periodicals, Inc.

Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room.

Science.gov (United States)

Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando

2014-10-28

Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods: One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results: The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.Fundamento: As urgências cardiovasculares são causas importantes de procura por atendimento médico, sendo fundamentais a rapidez e a precisão no diagnóstico para diminuir sua morbimortalidade. Objetivo: Avaliar o uso da ecocardiografia

An unusual presentation of perforated appendicitis in epigastric region☆

Science.gov (United States)

Odabasi, Mehmet; Arslan, Cem; Abuoglu, Hasan; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, M.A. Tolga

2013-01-01

INTRODUCTION Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation. PRESENTATION OF CASE A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver. DISCUSSION While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. CONCLUSION Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia. PMID:24441442

[Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

Science.gov (United States)

Lin, Luo; Yueming, Zhang; Meisheng, Li; Jiexue, Wang; Yang, Ji

2017-12-01

To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (Pgeneral anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

Metabolites in Blood for Prediction of Bacteremic Sepsis in the Emergency Room.

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Anna M Kauppi

Full Text Available A metabolomics approach for prediction of bacteremic sepsis in patients in the emergency room (ER was investigated. In a prospective study, whole blood samples from 65 patients with bacteremic sepsis and 49 ER controls were compared. The blood samples were analyzed using gas chromatography coupled to time-of-flight mass spectrometry. Multivariate and logistic regression modeling using metabolites identified by chromatography or using conventional laboratory parameters and clinical scores of infection were employed. A predictive model of bacteremic sepsis with 107 metabolites was developed and validated. The number of metabolites was reduced stepwise until identifying a set of 6 predictive metabolites. A 6-metabolite predictive logistic regression model showed a sensitivity of 0.91(95% CI 0.69-0.99 and a specificity 0.84 (95% CI 0.58-0.94 with an AUC of 0.93 (95% CI 0.89-1.01. Myristic acid was the single most predictive metabolite, with a sensitivity of 1.00 (95% CI 0.85-1.00 and specificity of 0.95 (95% CI 0.74-0.99, and performed better than various combinations of conventional laboratory and clinical parameters. We found that a metabolomics approach for analysis of acute blood samples was useful for identification of patients with bacteremic sepsis. Metabolomics should be further evaluated as a new tool for infection diagnostics.

[The evaluation of academic emergency department design].

Science.gov (United States)

Deniz, Turgut; Aydinuraz, Kuzey; Oktay, Cem; Saygun, Meral; Ağalar, Fatih

2007-01-01

In our study which was based upon a questionnaire, the inner and outer architectural designs of emergency services of Emergency Medicine Departments were investigated. In this descriptive study, a standard questionnaire was sent to 26 Emergency Medicine Departments which were operating at that time. In the questionnaire, the internal, external architectural and functional features were questioned. Answers of 22 Emergency Medicine Departments were analysed. Two Emergency Medicine Departments that were not operating at that time were not included in the study. The analysis of the replies revealed that only 59% (n=13) of the Emergency Medicine Departments were designed as an emergency service prior to the construction. The ambulance parking areas were not suitable in 77% of the emergency units while only 54.5% (n=12) had protection against adverse weather conditions. In only 59% (n=13) of the emergency units, a triage unit was present and in only one of the in only one (4.5%), a decontamination room was available. It was understood that only 32% (n=8) of the emergency units were appropriate in enlarging their capacity taking the local risk factors into consideration. There was a toilette for disabled patients in only 18% (n=4) of the units as well. Considering a 12-year of history of the Emergency Medicine in Turkey, the presence of a lecture room is still 68% (n=15) in emergency departments which reflects that academic efforts in this field is emerging in challenging physical conditions. The results of our study revealed that emergency service architecture was neglected in Turkey and medical care given was precluded by the insufficient architecture. The design of emergency services has to be accomplished under guidance of scientific data and rules taking advices of architects who have knowledge and experience on this field.

Intraoperative and recovery room outcome | Edomwonyi | East ...

African Journals Online (AJOL)

Objectives: To identify and quantitate anaesthesia related complications in the intraoperative period and in the post anaesthesia recovery room. Design: A prospective study. Setting: University of Benin Teaching Hospital; a University - affiliated tertiary centre. Subjects: Patients scheduled for elective and emergency surgery ...

The interaction effects of temperature and humidity on emergency room visits for respiratory diseases in Beijing, China.

Science.gov (United States)

Su, Qin; Liu, Hongsheng; Yuan, Xiaoling; Xiao, Yan; Zhang, Xian; Sun, Rongju; Dang, Wei; Zhang, Jianbo; Qin, Yuhong; Men, Baozhong; Zhao, Xiaodong

2014-11-01

Few epidemiological studies have been reported as to whether there was any interactive effect between temperature and humidity on respiratory morbidity, especially in Asian countries. The present study used time-series analysis to explore the modification effects of humidity on the association between temperature and emergency room (ER) visits for respiratory, upper respiratory tract infection (URI), pneumonia, and bronchitis in Beijing between 2009 and 2011. Results showed that an obvious joint effect of temperature and humidity was revealed on ER visits for respiratory, URI, pneumonia, and bronchitis. Below temperature threshold, the temperature effect was stronger in low humidity level and presented a trend fall with humidity level increase. The effect estimates per 1 °C increase in temperature in low humidity level were -2.88 % (95 % confidence interval (CI) -3.08, -2.67) for all respiratory, -3.24 % (-3.59, -2.88) for URI, -1.48 % (-1.93, -1.03) for pneumonia, and -3.79 % (-4.37, -3.21) for bronchitis ER visits, respectively. However, above temperature threshold, temperature effect was greater in high humidity level and trending upward with humidity level increasing. In high humidity level, a 1 °C increase in temperature, the effect estimates were 1.84 % (1.55, 2.13) for all respiratory, 1.76 % (1.41, 2.11) for URI, and 7.48 % (4.41, 10.65) for bronchitis ER visits. But, there was no statistically significant for pneumonia. This suggests that the modifying effects of the humidity should be considered when analyzing health impacts of temperature.

Screening Criteria for Loss of Room Cooling Failure

Energy Technology Data Exchange (ETDEWEB)

Hwang, Mee Jeong; Yang, Joon Eon; Yoon, Churl

2007-01-15

In this report, we estimated the temperature of the pump rooms and reviewed the operability of the components under the loss of the HVAC (Heating, Ventilation, and Air Condition) system. The issues relevant to the HVAC system in the PSA (Probabilistic Safety Assessment) FT (Fault Tree) model are as follows: (1) Does the loss of the HVAC system bring about a function failure of other components? (2) Can the operator take action to reduce the temperature of the room in case of a HVAC function failure? At present, we do not know whether a component will lose its function or not under the loss of the HVAC. ASME Standard describes that a recovery action can be credited if the related recovery action is included in the procedure or there are similar recovery experiences in the plant. However, there is no description about the recovery action of the HVAC in the EOP (Emergency Operation Procedure) of the UCN3, 4 under the situation of a loss of the HVAC. Even though we consider this assumption positively, it would be limited to the rooms such as the Switchgear Room, Inverter Room, and Main Control Room etc. where a real recovery action can be performed easily. However, if we consider the HVAC failure in the PSA FT model according to the above background, the problem is that the unavailability induced from the loss of a HVAC is highly unrealistically. From a viewpoint of the PSA, it is not true that the related system always fails even though the HVAC system fails. Therefore, we reviewed the necessity of the HVAC model through the identification of the operable temperature of the components' within the pump room and the change of the temperature of the pump room under the situation of a loss of the HVAC system. In this paper, we performed a heat up calculation for the Auxiliary Feedwater Motor Operated Pump (AFW MDP) room, PAB-077-11A with CFX 10 and RATT when the HVAC system is failed. We also reviewed the operability of the components under a loss of the HVAC. Room

Screening Criteria for Loss of Room Cooling Failure

International Nuclear Information System (INIS)

Hwang, Mee Jeong; Yang, Joon Eon; Yoon, Churl

2007-01-01

In this report, we estimated the temperature of the pump rooms and reviewed the operability of the components under the loss of the HVAC (Heating, Ventilation, and Air Condition) system. The issues relevant to the HVAC system in the PSA (Probabilistic Safety Assessment) FT (Fault Tree) model are as follows: (1) Does the loss of the HVAC system bring about a function failure of other components? (2) Can the operator take action to reduce the temperature of the room in case of a HVAC function failure? At present, we do not know whether a component will lose its function or not under the loss of the HVAC. ASME Standard describes that a recovery action can be credited if the related recovery action is included in the procedure or there are similar recovery experiences in the plant. However, there is no description about the recovery action of the HVAC in the EOP (Emergency Operation Procedure) of the UCN3, 4 under the situation of a loss of the HVAC. Even though we consider this assumption positively, it would be limited to the rooms such as the Switchgear Room, Inverter Room, and Main Control Room etc. where a real recovery action can be performed easily. However, if we consider the HVAC failure in the PSA FT model according to the above background, the problem is that the unavailability induced from the loss of a HVAC is highly unrealistically. From a viewpoint of the PSA, it is not true that the related system always fails even though the HVAC system fails. Therefore, we reviewed the necessity of the HVAC model through the identification of the operable temperature of the components' within the pump room and the change of the temperature of the pump room under the situation of a loss of the HVAC system. In this paper, we performed a heat up calculation for the Auxiliary Feedwater Motor Operated Pump (AFW MDP) room, PAB-077-11A with CFX 10 and RATT when the HVAC system is failed. We also reviewed the operability of the components under a loss of the HVAC. Room

Effects of Ramadan on Forensic Cases Presenting to Emergency Service

Directory of Open Access Journals (Sweden)

F. Sarı Doğan

2015-06-01

Full Text Available The term "forensic case" is defined as disruption of physical and/or mental health of an individual due to external factors. Forensic cases are most frequently encountered in emergency services. Ramadan, the ninth month of Islamic calendar, is a month of fasting throughout which Muslims from all around the world worship by observing fasting. There are many studies focusing on the effects of fasting on health. The purpose of this study is to examine the effects of Ramadan on forensic cases presenting to emergency service.

Emergency Response Guideline Development

International Nuclear Information System (INIS)

Gary D Storrick

2007-01-01

Task 5 of the collaborative effort between ORNL, Brazil, and Westinghouse for the International Nuclear Energy Research Initiative entitled 'Development of Advanced Instrumentation and Control for an Integrated Primary System Reactor' focuses on operator control and protection system interaction, with particular emphasis on developing emergency response guidelines (ERGs). As in the earlier tasks, we will use the IRIS plant as a specific example of an integrated primary system reactor (IPSR) design. The present state of the IRIS plant design--specifically, the lack of a detailed secondary system design--precludes establishing detailed emergency procedures at this time. However, we can create a structure for their eventual development. This report summarizes our progress to date. Section 1.2 describes the scope of this effort. Section 2 compares IPSR ERG development to the recent AP1000 effort, and identifies three key plant differences that affect the ERGs and control room designs. The next three sections investigate these differences in more detail. Section 3 reviews the IRIS Safety-by-Design philosophy and its impact on the ERGs. Section 4 looks at differences between the IRIS and traditional loop PWR I and C Systems, and considers their implications for both control room design and ERG development. Section 5 examines the implications of having one operating staff control multiple reactor units. Section 6 provides sample IRIS emergency operating procedures (EOPs). Section 7 summarizes our conclusions

Cycling Injuries Presenting to an Irish Emergency Department

LENUS (Irish Health Repository)

J Foley, J

2016-06-01

There is little published data on cycling injuries in Ireland and the present study aims to describe the cycling related injuries presenting to the emergency department (ED), of a tertiary urban university hospital. This is a retrospective review of cycling-related injuries presenting to the ED of St. Vincent’s University Hospital (SVUH) from 1st of January to 31st of December 2014. There were 534 cycling related injuries presenting to the ED during the study period. Just over 71% of the patients were male, and 14.8% of patients presented following a collision with a motor vehicle. Forty patients required admission to hospital following their injury with 6 of these patients spending time in the intensive care unit. Cycling is now a very popular means of transport and exercise activity in Ireland and using hospital based data, it is possible that EDs may provide a vector for guiding injury prevention strategies in the future

Dysuria: An Uncommon Presentation in Emergency Department Following Bladder Neck Disruption

Directory of Open Access Journals (Sweden)

Ali Pourmand

2017-02-01

Full Text Available Prostate cancer is the most common life-threatening cancer diagnosed in men. Complications of prostatectomies vary and often include urinary incontinence, erectile dysfunction and pain, while other complications go unreported. While emergency physicians are already familiar with the more common post-operative complications presenting to their departments, including urinary retention, ileus, surgical site infections, venous thromboembolisms and urinary tract infections, they must have a high index of suspicion for rarer complications. We report a case of posterior bladder neck disruption as a complication of a robotic assisted laparoscopic prostatectomy that presented to the emergency department as dysuria and abdominal pain following urination.

Acute Abdomen in Interstitial Ectopic Pregnancy, An Emergency Laparoscopic Treatment

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E. Picardo

2014-01-01

Full Text Available The present case report demonstrates a laparoscopic approach to treat interstitial cornual pregnancy in emergency. Interstitial ectopic pregnancy develops in the uterine portion of the fallopian tube which accounts for 2–4% of all ectopic pregnancies and has the potential to cause life-threatening hemorrhage at rupture. The mortality rate for a woman diagnosed with such a pregnancy is 2–2.5%. Diagnosis of interstitial pregnancy is made by ultrasound. In this case a 32 year-old woman, Gravida 0 Parity 0 Living 0 Ectopic 1, presented to the emergency obstetrical room complaining acute abdominal pain. There was a history of 10 weeks of pregnancy but no pelvic ultrasound scan was performed before the access. A transvaginal ultrasound scan immediately performed demonstrated a gestational sac with viable fetus in the right interstitial region. Moreover there was an ultrasound evidence of hemoperitoneum. She was transferred to the operating room and an emergency laparoscopy surgery was performed. The postoperative course was uneventful and the patient was discharged two days after the surgery. Interstitial pregnancies present a difficult management problem with no absolute standard of care in literature. Laparoscopic technique is under study with favorable results. For our personal point of view a treatment via laparoscopy could be performed both in elective and in emergency cases.

A simulator-based nuclear reactor emergency response training exercise.

Science.gov (United States)

Waller, Edward; Bereznai, George; Shaw, John; Chaput, Joseph; Lafortune, Jean-Francois

Training offsite emergency response personnel basic awareness of onsite control room operations during nuclear power plant emergency conditions was the primary objective of a week-long workshop conducted on a CANDU® virtual nuclear reactor simulator available at the University of Ontario Institute of Technology, Oshawa, Canada. The workshop was designed to examine both normal and abnormal reactor operating conditions, and to observe the conditions in the control room that may have impact on the subsequent offsite emergency response. The workshop was attended by participants from a number of countries encompassing diverse job functions related to nuclear emergency response. Objectives of the workshop were to provide opportunities for participants to act in the roles of control room personnel under different reactor operating scenarios, providing a unique experience for participants to interact with the simulator in real-time, and providing increased awareness of control room operations during accident conditions. The ability to "pause" the simulator during exercises allowed the instructors to evaluate and critique the performance of participants, and to provide context with respect to potential offsite emergency actions. Feedback from the participants highlighted (i) advantages of observing and participating "hands-on" with operational exercises, (ii) their general unfamiliarity with control room operational procedures and arrangements prior to the workshop, (iii) awareness of the vast quantity of detailed control room procedures for both normal and transient conditions, and (iv) appreciation of the increased workload for the operators in the control room during a transient from normal operations. Based upon participant feedback, it was determined that the objectives of the training had been met, and that future workshops should be conducted.

Developing an active emergency medical service system based on WiMAX technology.

Science.gov (United States)

Li, Shing-Han; Cheng, Kai-An; Lu, Wen-Hui; Lin, Te-Chang

2012-10-01

The population structure has changed with the aging of population. In the present, elders account for 10.63% of the domestic population and the percentage is still gradually climbing. In other words, the demand for emergency services among elders in home environment is expected to grow in the future. In order to improve the efficiency and quality of emergency care, information technology should be effectively utilized to integrate medical systems and facilities, strengthen human-centered operation designs, and maximize the overall performance. The improvement in the quality and survival rate of emergency care is an important basis for better life and health of all people. Through integrated application of medical information systems and information communication technology, this study proposes a WiMAX-based emergency care system addressing the public demands for convenience, speed, safety, and human-centered operation of emergency care. This system consists of a healthcare service center, emergency medical service hospitals, and emergency ambulances. Using the wireless transmission capability of WiMAX, patients' physiological data can be transmitted from medical measurement facilities to the emergency room and emergency room doctors can provide immediate online instructions on emergency treatment via video and audio transmission. WiMAX technology enables the establishment of active emergency medical services.

LABORATORY BIOMARKERS TO FACILITATE DIFFERENTIAL DIAGNOSIS BETWEEN MEASLES AND KAWASAKI DISEASE IN A PEDIATRIC EMERGENCY ROOM: A RETROSPECTIVE STUDY

Directory of Open Access Journals (Sweden)

Danilo Buonsenso

2018-05-01

Full Text Available This retrospective study was conducted to analyze clinical and laboratoristic parameters to individuate specific differences and facilitate differential diagnosis between Measles and Kawasaki Disease (KD at first evaluation in a emergency room. We found similar clinical features as duration of fever and number of KD criteria (p >0.5 but significant differences in white blood cell count, neutrophils, CRP and LDH levels (p < 0.001. LDH value ≥ 800 mg/dl had sensibility of 89% and specificity of 90% for Measles while CRP ≥ 3 mg/dl had sensibility 89% and specificity of 85% for KD. The combined use of CRP, LDH and AST showed accuracy of 86.67%.

Assessment of chest pain in the emergency room: What is the role of multidetector CT?

International Nuclear Information System (INIS)

White, Charles; Read, Katrina; Kuo, Dick

2006-01-01

Chest pain is one of the most frequent complaints for patients seen in the emergency department. The current article describes the clinical stratification of patients who present to the emergency department with chest pain and discusses imaging options and analysis for these patients. It reviews conventional imaging approaches to assessing chest pain including chest radiography and stress testing. The main discussion focuses on the potential utility use of cross-sectional imaging, particularly multidetector CT, in the evaluation of chest pain in the emergency department

What clues are available for differential diagnosis of headaches in emergency settings?

Science.gov (United States)

Mert, Ertan; Ozge, Aynur; Taşdelen, Bahar; Yilmaz, Arda; Bilgin, Nursel G

2008-04-01

The correct diagnosis of headache disorders in an emergency room is important for developing early management strategies and determining optimal emergency room activities. This prospective clinical based study was performed in order to determine demographic and clinical clues for differential diagnosis of primary and secondary headache disorders and also to obtain a classification plot for the emergency room practitioners. This study included 174 patients older than 15 years of age presenting in the emergency room with a chief complaint of headache. Definite headache diagnoses were made according to ICHD-II criteria. Classification and regression tree was used as new method for the statistical analysis of the differential diagnostic process. Our 174 patients with headache were diagnosed as basically primary (72.9%) and secondary (27.1%) headaches. Univariate analysis with cross tabs showed three important results. First, unilateral pain location caused 1.431-fold increase in the primary headache risk (p = 0.006). Second, having any triggers caused 1.440-fold increase in the primary headache risk (p = 0.001). Third, having associated co-morbid medical disorders caused 4.643-fold increase in the secondary headache risk (p < 0.001). It was concluded that the presence of comorbidity, the patient's age, the existence of trigger and relaxing factors, the pain in other body parts that accompanies headache and the quality of pain in terms of location and duration were all important clues for physicians in making an accurate differentiation between primary and secondary headaches.

Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department.

Science.gov (United States)

Lobo, Rômulo Rebouças; Borges, Marcos Carvalho; Neves, Fábio Fernandes; Vidal de Moura Negrini, Bento; Colleto, Francisco Antonio; Romeo Boullosa, José Luiz; Camila de Miranda Cardoso, Maria; Pazin-Filho, Antonio

2011-09-01

Occupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed. To evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method. A group of patients in need of respiratory isolation were first identified--group I (2004; 29 patients; 44.1±3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year--group II (2007; 50 patients; 43.4±1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained. Implementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5±9.3 × 3.7±2.0; p=0.0180) and from indication to effective respiratory isolation (13.3±3.0 × 2.94±1.06; p=0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 × 75.4/100.000 patients; p<0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p<0.001 greater for 2007. Implementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

Relationship between Bullying and Suicidal Behaviour in Youth presenting to the Emergency Department.

Science.gov (United States)

Alavi, Nazanin; Reshetukha, Taras; Prost, Eric; Antoniak, Kristen; Patel, Charmy; Sajid, Saad; Groll, Dianne

2017-07-01

Increasing numbers of adolescents are visiting emergency departments with suicidal ideation. This study examines the relationship between bullying and suicidal ideation in emergency department settings. A chart review was conducted for all patients under 18 years of age presenting with a mental health complaint to the emergency departments at Kingston General or Hotel Dieu Hospitals in Kingston, Canada, between January 2011 and January 2015. Factors such as age, gender, history of abuse, history of bullying, type and time of bullying, and diagnoses were documented. 77% of the adolescents had experienced bullying, while 68.9% had suicide ideation at presentation. While controlling for age, gender, grade, psychiatric diagnosis, and abuse, a history of bullying was the most significant predictor of suicidal ideation. Individuals in this study who reported cyber bullying were 11.5 times more likely to have suicidal ideation documented on presentation, while individuals reporting verbal bullying were 8.4 times more likely. The prevalence of bullying in adolescent patients presenting to emergency departments is high. The relationship found between suicidal ideation and bullying demonstrates that clinicians should ask questions about bullying as a risk factor for suicide ideation during the assessment of children and adolescents.

FRAMEWORK AND APPLICATION FOR MODELING CONTROL ROOM CREW PERFORMANCE AT NUCLEAR POWER PLANTS

Energy Technology Data Exchange (ETDEWEB)

Ronald L Boring; David I Gertman; Tuan Q Tran; Brian F Gore

2008-09-01

This paper summarizes an emerging project regarding the utilization of high-fidelity MIDAS simulations for visualizing and modeling control room crew performance at nuclear power plants. The key envisioned uses for MIDAS-based control room simulations are: (i) the estimation of human error associated with advanced control room equipment and configurations, (ii) the investigative determination of contributory cognitive factors for risk significant scenarios involving control room operating crews, and (iii) the certification of reduced staffing levels in advanced control rooms. It is proposed that MIDAS serves as a key component for the effective modeling of cognition, elements of situation awareness, and risk associated with human performance in next generation control rooms.

FRAMEWORK AND APPLICATION FOR MODELING CONTROL ROOM CREW PERFORMANCE AT NUCLEAR POWER PLANTS

International Nuclear Information System (INIS)

Ronald L Boring; David I Gertman; Tuan Q Tran; Brian F Gore

2008-01-01

This paper summarizes an emerging project regarding the utilization of high-fidelity MIDAS simulations for visualizing and modeling control room crew performance at nuclear power plants. The key envisioned uses for MIDAS-based control room simulations are: (1) the estimation of human error associated with advanced control room equipment and configurations, (2) the investigative determination of contributory cognitive factors for risk significant scenarios involving control room operating crews, and (3) the certification of reduced staffing levels in advanced control rooms. It is proposed that MIDAS serves as a key component for the effective modeling of cognition, elements of situation awareness, and risk associated with human performance in next generation control rooms

[Operating room during natural disaster: lessons from the 2011 Tohoku earthquake].

Science.gov (United States)

Fukuda, Ikuo; Hashimoto, Hiroshi; Suzuki, Yasuyuki; Satomi, Susumu; Unno, Michiaki; Ohuchi, Noriaki; Nakaji, Shigeyuki

2012-03-01

Objective of this study is to clarify damages in operating rooms after the 2011 Tohoku Earthquake. To survey structural and non-structural damage in operating theaters, we sent questionnaires to 155 acute care hospitals in Tohoku area. Questionnaires were sent back from 105 hospitals (70.3%). Total of 280 patients were undergoing any kinds of operations during the earthquake and severe seismic tremor greater than JMA Seismic Intensity 6 hit 49 hospitals. Operating room staffs experienced life-threatening tremor in 41 hospitals. Blackout occurred but emergency electronic supply unit worked immediately in 81 out of 90 hospitals. However, emergency power plant did not work in 9 hospitals. During earthquake some materials fell from shelves in 44 hospitals and medical instruments fell down in 14 hospitals. In 5 hospitals, they experienced collapse of operating room wall or ceiling causing inability to maintain sterile operative field. Damage in electric power and water supply plus damage in logistics made many operating rooms difficult to perform routine surgery for several days. The 2011 Tohoku earthquake affected medical supply in wide area of Tohoku district and induced dysfunction of operating room. Supply-chain management of medical goods should be reconsidered to prepare severe natural disaster.

Investigating emergency room service quality using lean manufacturing.

Science.gov (United States)

Abdelhadi, Abdelhakim

2015-01-01

The purpose of this paper is to investigate a lean manufacturing metric called Takt time as a benchmark evaluation measure to evaluate a public hospital's service quality. Lean manufacturing is an established managerial philosophy with a proven track record in industry. A lean metric called Takt time is applied as a measure to compare the relative efficiency between two emergency departments (EDs) belonging to the same public hospital. Outcomes guide managers to improve patient services and increase hospital performances. The patient treatment lead time within the hospital's two EDs (one department serves male and the other female patients) are the study's focus. A lean metric called Takt time is used to find the service's relative efficiency. Findings show that the lean manufacturing metric called Takt time can be used as an effective way to measure service efficiency by analyzing relative efficiency and identifies bottlenecks in different departments providing the same services. The paper presents a new procedure to compare relative efficiency between two EDs. It can be applied to any healthcare facility.

Effects of electronic emergency-department whiteboards on clinicians' time distribution and mental workload

DEFF Research Database (Denmark)

Hertzum, Morten; Simonsen, Jesper

2016-01-01

Whiteboards are a central tool at emergency departments. We investigate how the substitution of electronic for dry-erase whiteboards affects emergency department clinicians’ mental workload and distribution of their time. With the electronic whiteboard, physicians and nurses spend more...... of their time in the work areas where other clinicians are present and whiteboard information is permanently displayed, and less in the patient rooms. Main reasons for these changes appear to be that the electronic whiteboard facilitates better timeouts and handovers. Physicians and nurses are, however......, in the patient rooms for longer periods at a time, suggesting a more focused patient contact. The physicians’ mental workload has increased during timeouts, whereas the nurses’ mental workload has decreased at the start of shifts when they form an overview of the emergency department. Finally, the secretaries...

Operating room manager game

NARCIS (Netherlands)

Hans, Elias W.; Nieberg, T.

2007-01-01

The operating room (OR) department of a hospital forms the heart of the organization, where the single largest cost is incurred. This document presents and reports on the “Operating Room Manager Game,” developed to give insight into managing a large hospital's OR department at various levels of

If Hunters End Up in the Emergency Room: A Retrospective Analysis of Hunting Injuries in a Swiss Emergency Department

OpenAIRE

Bestetti, Valentina; Fisher, Emma E.; Srivastava, David S.; Ricklin, Meret E.; Exadaktylos, Aristomenis K.

2015-01-01

Aim. to characterize the mechanisms, patterns, and outcomes of nonfatal hunting-related injuries in patients presenting to Bern University Hospital, Switzerland, and compare these to reports of hunting injuries worldwide. Methods. patients presenting with hunting-related injuries to the Emergency Department at Bern University hospital from 2000 to 2014 were identified by retrospectively searching the department database using the keyword “hunt.” Each case was analyzed in terms of the patient...

Full text publication rates of studies presented at an international emergency medicine scientific meeting.

Science.gov (United States)

Chan, Jannet W M; Graham, Colin A

2011-09-01

The publication rate of full text papers following an abstract presentation at a medical conference is variable, and few studies have examined the situation with respect to international emergency medicine conferences. This retrospective study aimed to identify the publication rate of abstracts presented at the 2006 International Conference on Emergency Medicine (ICEM) held in Halifax, Canada. The full text publication rate was 33.2%, similar to previous emergency medicine meetings. English language barriers may play a role in the low publication rate seen.

Gaining control room habitability margin at the Palisades Plant

International Nuclear Information System (INIS)

Harden, P.A.

1993-01-01

The bounding design-basis accident for control room habitability is the loss-of-coolant accident (LOCA). At Palisades, very little margin existed between the calculated control room operator thyroid dose and the 0.3-Sv (30-rem) limit of Standard Review Plan (SRP) 6.4. Also, a low rate of unfiltered air leakage into the control room during the emergency mode of operation, 5.5 x 10 -3 m 3 /s (11.6 ft 3 /min), was accounted for in the control room habitability analysis. The control room heating, ventilating and air-conditioning system at Palisades has louvered isolation dampers for the normal air intake that are exposed to a negative pressure. Considering the small margin to the thyroid dose limits and the leakage characteristics of louvered dampers, a low allowable rate of unfiltered air in-leakage raised some concern. A significant effort has been initiated to alleviate control room habitability concerns at Palisades. The first step in this effort was to evaluate the calculational models for control room habitability and gain margin through updated analytical methods. To accomplish this, a new radiological consequence analysis for the LOCA was completed

Advanced information technology for training and emergency management

International Nuclear Information System (INIS)

Wahlstroem, B.

1989-01-01

Modern information technology provides many possibilities for improving both the safety and the availability of nuclear installations. A Nordic research programme was started in 1977, in which several organizations in Denmark, Finland, Norway and Sweden has been participating. The work has on a general level been addressing control rooms, human reliability and information technology for nuclear power plants. The research has had impact on the development of the control room solutions and the training simulators in Finland and also in the other Nordic countries. The present phase of the Nordic cooperation is investigating the use of advanced information technology in emergency management. The paper gives a brief introduction to the use of advance information technology for training and emergency management, which is based on the experience from the Nordic projects and other similar application projects in Finland. The paper includes also references to results from several of the projects. (author)

Variação sazonal nos atendimentos de emergência por asma em Gama, Distrito Federal Seasonal variations in emergency room visits for asthma attacks in Gama, Brazil

Directory of Open Access Journals (Sweden)

Laércio Moreira Valença

2006-08-01

Full Text Available OBJETIVO: Quantificar o atendimento por asma em um serviço de emergência público e estudar a flutuação sazonal, considerando as condições climáticas locais, caracterizadas por duas estações, uma chuvosa e úmida e outra seca. MÉTODOS: Levantamento retrospectivo conduzido em um hospital geral comunitário. Um total de 37.642 consultas emergenciais por asma, bronquite, pneumonia, infecções de vias aéreas superiores e outras condições foram identificadas durante um período de dois anos. As informações constantes em cada guia de atendimento foram levantadas para posterior análise. RESULTADOS: Asma foi o segundo diagnóstico mais freqüente dentre as condições respiratórias (24%. A maioria das consultas por asma foi feita em crianças de zero a catorze anos (56,6%. A análise de regressão mostrou uma variação sazonal dos atendimentos, com concentração significativamente maior de casos de asma no mês de março (p = 0,0109 e concentração menor nos meses de agosto e setembro (p = 0,0485 e p = 0,0169, respectivamente. A correlação entre asma e clima foi mais significativa em relação à flutuação da umidade defasada de um e dois meses (p = 0,0026 e p = 0,0002, respectivamente. CONCLUSÃO: As visitas por asma ao pronto-socorro foram mais freqüentes durante a estação úmida. O aumento do número de casos cresceu um a dois meses após o aumento da umidade e diminuiu no período seco. Essa correlação positiva levanta a possibilidade de uma relação causal com a proliferação de ácaros domésticos e fungos ambientais.OBJECTIVE: To quantify the number of asthma attacks treated in the emergency room of a public hospital and to study seasonal fluctuations, taking into consideration the local climate, which is characterized by having only two seasons: a rainy/humid season and a dry season. METHODS: A retrospective survey was conducted in a community general hospital. A total of 37,642 emergency room consultations

Optimization of the main control room habitability system in nuclear power plant

International Nuclear Information System (INIS)

Zheng Guanghui; Zhao Xinyan

2013-01-01

This article describes the optimization of main control room habitability system in nuclear power plant. It also describes the design shortage in terms of habitability in the main control room. Through modification and optimization, habitable conditions are met for personnel staying in the emergency area of the main control room for a period of time, with an aim to take accident intervention measures smoothly and reduce the accident loss and radioactive contamination as low as possible. (authors)

Use of task analysis in control room evaluations

International Nuclear Information System (INIS)

Ross, K.C.

1981-01-01

Responding to recently formulated regulatory requirements, the BWR Owners' Group, working in conjunction with General Electric, has formulated a method for performing human factors design reviews of nuclear power plant control rooms. This process incorporates task analyses to analyze operational aspects of panel layout and design. Correlation of operator functions defined by emergency procedures against required controls and displays has proven successful in identifying instrumentation required in the control room to adequately respond to transient conditions, and in evaluating the effectiveness of panel design and physical arrangement. Extensions of the analysis have provided information on operator response paths, frequency of use of instruments, and control room layout. The techniques used were based on a need to identify primary controls and indications required by the operator in performing each step of the applicable procedure. The relative locations of these instruments were then analyzed for information on the adequacy of the control room design for those conditions

Differences between Impulsive and Non-Impulsive Suicide Attempts among Individuals Treated in Emergency Rooms of South Korea

Science.gov (United States)

Lim, Meerae; Lee, Soojung

2016-01-01

Objective A considerable proportion of suicide attempts are the result of sudden desires. Understanding such impulsive suicide attempts is necessary for effective interventions. We evaluated the impulsivity of suicide attempters treated in emergency rooms. The aim of the study was to identify the characteristics of impulsive suicide attempts by comparing these individuals to those who attempted to commit suicide in a non-impulsive manner. Methods This study analyzed suicide attempters who visited the emergency departments of seven selected university hospitals. A total of 269 medical records in which impulsivity of suicide attempt were confirmed were subject to be analyzed. The impulsivity of the suicide attempt was examined using a summative score of items 6 and 15 on the Suicide Intent Scale. Results A total of 48.0% of the participants were impelled by sudden inclinations to attempt suicide. Impulsive attempters were younger, unmarried and less physical illness than non-impulsive attempters, whereas no significant differences were found on psychiatric history and previous suicide history. Impulsive suicide attempters had suicide ideations that were not as severe (χ2=55.33, pimpulsive suicide attempts were better than non-impulsive suicide attempts (t=-3.77, psuicide attempts were the result of sudden inclinations. Impulsive attempts were made in relatively earlier stages of suicide ideation; consequently, they have less intent than non-impulsive attempts. PMID:27482239

Molar Pregnancy in the Emergency Department

Directory of Open Access Journals (Sweden)

Masterson, Lori

2009-11-01

Full Text Available A 15-year-old female presented to the emergency department with complaints of vaginal bleeding. She was pale, anxious, cool and clammy with tachycardic, thready peripheral pulses and hemoglobin of 2.4g/dL. Her abdomen was gravid appearing, approximately early to mid-second trimester in size. Pelvic examination revealed 2 cm open cervical os with spontaneous discharge of blood, clots and a copious amount of champagne-colored grapelike spongy material. After 2L boluses of normal saline and two units of crossmatched blood, patient was transported to the operating room. Surgical pathology confirmed a complete hydatidiform mole.[West J Emerg Med. 2009;10(4:295-296.

[Neonatological emergencies in delivery room] [Article in Italian] • Il neonatologo ed alcune emergenze in sala parto

Directory of Open Access Journals (Sweden)

Antonio Boldrini

2014-01-01

Full Text Available Introduction: In the delivery room the neonatologist may deal with emergencies, not always predictable by pre-natal diagnosis. Among these dangerous situations, we include: i extremely preterm birth of a newborn very/extremely low birth weight and ii shoulder dystocia in term newborns. We will discuss in details these two clinical scenarios. Methods: We reviewed the main recent papers about resuscitation of very/extremely low birth weight preterm newborns and about dystocia of shoulder reported in PubMed database. After that, we compared reported results with practice in our Unit and discussed the topics considering strategies to optimize the results and minimizing possible errors. Discussion and conclusions: In our opinion the optimization of clinical practice in Neonatology should be based on: i national or international recommendations drawn up by commissions or study groups of experts, on the basis of scientific evidence, ii local department protocols, in order to standardize staff interventions within the same unit; iii ongoing training of doctors, nurses and midwives, through simulation sessions and CRM (Crisis Resources Management. As regards shoulder dystocia, The Tuscan Group for Clinical Risk Management drawn a poster to be showed in every delivery room, in order to allow the staff to rapidly remember the correct clinical interventions. On the other hand, as regards ventilatory preterm newborns strategies, the Centro di Formazione e Simulazione NINA is working on a project of a mechatronich simulator for staff training (MERESSINA. Articoli Selezionati del “3° Convegno Pediatrico del Medio Campidano” · Guspini · 25 Maggio 2013 Guest Editor: Roberto Antonucci

Ambient temperature and emergency room admissions for acute coronary syndrome in Taiwan

Science.gov (United States)

Liang, Wen-Miin; Liu, Wen-Pin; Chou, Sze-Yuan; Kuo, Hsien-Wen

2008-01-01

Acute coronary syndrome (ACS) is an important public health problem around the world. Since there is a considerable seasonal fluctuation in the incidence of ACS, climatic temperature may have an impact on the onset of this disease. The objective of this study was to assess the relationship between the average daily temperature, diurnal temperature range and emergency room (ER) admissions for ACS in an ER in Taichung City, Taiwan. A longitudinal study was conducted which assessed the correlation of the average daily temperature and the diurnal temperature range to ACS admissions to the ER of the city’s largest hospital. Daily ER admissions for ACS and ambient temperature were collected from 1 January 2000 to 31 March 2003. The Poisson regression model was used in the analysis after adjusting for the effects of holiday, season, and air pollutant concentrations. The results showed that there was a negative significant association between the average daily temperature and ER admissions for ACS. ACS admissions to the ER increased 30% to 70% when the average daily temperature was lower than 26.2°C. A positive association between the diurnal temperature range and ACS admissions was also noted. ACS admissions increased 15% when the diurnal temperature range was over 8.3°C. The data indicate that patients suffering from cardiovascular disease must be made aware of the increased risk posed by lower temperatures and larger changes in temperature. Hospitals and ERs should take into account the increased demand of specific facilities during colder weather and wider temperature variations.

Prospective study of emergency presentation of abdominal tuberculosis

Directory of Open Access Journals (Sweden)

Akhilesh R. Mishra

2016-08-01

Full Text Available Background: In developing countries like India, where poverty, malnutrition and overcrowding prevail, tuberculosis continues to be one of the important causes of morbidity, mortality and loss of working man hours. Abdominal tuberculosis (TB can affect the gastrointestinal tract, the peritoneum, lymph nodes of the small bowel mesentery or the solid viscera (e.g. liver, spleen, pancreas etc Patient of abdominal Koch’s can present as those with a chronic undulating course and those with an acute or subacute abdominal catastrophe. In emergency the patient may present with various presentations like stricture causing obstruction or with perforation and require a different management from those routine such cases Aim and Objective: To study the varied presentation of patients with Abdominal Tuberculosis as acute surgical abdomen presenting in emergency setting to those with a subacute course. To evaluate the line of management whether operative or conservative, the operative details, post operative course and the final outcome of the disease. To study the incidence of HIV positivity in patients with abdominal tuberculosis. Methods and material: The study was designed as a prospective observational study conducted during a study period between June 2006 and June 2008 in a tertiary care centre in Mumbai. All patients with a clinical suspicion of abdominal tuberculosis were included in the study with confirmation on histopathological examination. Patient’s written informed valid consent was taken after explaining the nature of study. Result and Conclusion: Age group commonly affected was between 21-30 years with male predominance. Amongst the various complications of abdominal tuberculosis intestinal obstruction was the most common mainly due to stricture and less commonly due to hyperplastic ileocaecal mass. Next common complication observed was free perforation of the intestine which occurs at a site proximal to a tight stricture. All patients were

Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department.

Science.gov (United States)

Southard, Erik P; Neufeld, Jonathan D; Laws, Stephanie

2014-07-01

Mentally ill patients in crisis presenting to critical access hospital emergency rooms often face exorbitant wait times to be evaluated by a trained mental health provider. Patients may be discharged from the hospital before receiving an evaluation or boarded in a hospital bed for observation, reducing quality and increasing costs. This study examined the effectiveness of an emergency telemental health evaluation service implemented in a rural hospital emergency room. Retrospective data collection was implemented to consider patients presenting to the emergency room for 212 days prior to telemedicine interventions and for 184 days after. The study compared measures of time to treatment, length of stay (regardless of inpatient or outpatient status), and door-to-consult time. There were 24 patients seen before telemedicine was implemented and 38 seen using telemedicine. All patients had a mental health evaluation ordered by a physician and completed by a mental health specialist. Significant reductions in all three time measures were observed. Mean and median times to consult were reduced from 16.2 h (standard deviation=13.2 h) and 14.2 h, respectively, to 5.4 h (standard deviation =6.4 h) and 2.6 h. Similar reductions in length of stay and door-to-consult times were observed. By t tests, use of telemedicine was associated with a statistically significant reduction in all three outcome measures. Telemedicine appears to be an effective intervention for mentally ill patients by providing more timely access to mental health evaluations in rural hospital emergency departments.

Degree of agreement among sepsis diagnosis criteria in adult emergency room patients with infection

Science.gov (United States)

Sinto, R.; Chandra, A. T.; Lie, K. C.; Suwarto, S.

2018-03-01

The study on the degree of agreement among three established sepsis diagnosis criteria become the necessity to investigate the best sepsis diagnosis criteria in Indonesia further. A cross-sectional study of adult Emergency Room patients hospitalized with a diagnosis of infection in CiptoMangunkusumo Hospital, Indonesia was conducted during March and April 2017. We recorded diagnosis, gender, age, comorbidities, infection source, and origin. Every subject was classified into sepsis and non-sepsis based on 1991, 2001 and sepsis-3 criteria. Raw % and Kappa agreement coefficients (κ) were calculated according to previously established formula to measure the degree of agreement among three diagnostic criteria. As many as 278 subjects were included in this study. The raw % agreement and κ between 1991 and 2001 criteria is 69.07% and 0.34 respectively. The raw % agreement and κ between 2001 and sepsis-3 criteria is 56.12% and 0.15 respectively. The raw % agreement and κ between 1991 and sepsis-3 criteria is 48.19% and -0.02. In conclusions, there is afair agreement between 1991 and 2001 criteria, poor agreement between 2001 and sepsis-3 criteria, and poor disagreement between 1991 and sepsis-3 criteria. This necessitates further Indonesian study of the best diagnosis criteria to diagnose an infected patient with sepsis.

Stability of disposal rooms during waste retrieval

International Nuclear Information System (INIS)

Brandshaug, T.

1989-03-01

This report presents the results of a numerical analysis to determine the stability of waste disposal rooms for vertical and horizontal emplacement during the period of waste retrieval. It is assumed that waste retrieval starts 50 years after the initial emplacement of the waste, and that access to and retrieval of the waste containers take place through the disposal rooms. It is further assumed that the disposal rooms are not back-filled. Convective cooling of the disposal rooms in preparation for waste retrieval is included in the analysis. Conditions and parameters used were taken from the Nevada Nuclear Waste Storage Investigation (NNWSI) Project Site Characterization Plan Conceptual Design Report (MacDougall et al., 1987). Thermal results are presented which illustrate the heat transfer response of the rock adjacent to the disposal rooms. Mechanical results are presented which illustrate the predicted distribution of stress, joint slip, and room deformations for the period of time investigated. Under the assumption that the host rock can be classified as ''fair to good'' using the Geomechanics Classification System (Bieniawski, 1974), only light ground support would appear to be necessary for the disposal rooms to remain stable. 23 refs., 28 figs., 2 tabs

The effect of patient origin and relevance of contact on patient and caregiver satisfaction in the emergency room

DEFF Research Database (Denmark)

Mygind, Anna; Nørredam, Marie Louise; Nielsen, Anette S

2008-01-01

AIMS: This study examined (1) whether patient and caregiver satisfaction in the emergency room (ER) varies according to patient origin, and (2) whether relevance of visit can explain any variation. METHODS: Data were obtained from a questionnaire survey of walk-in patients and their caregivers...... at four ERs in Copenhagen. The patient questionnaire was available in nine languages, and addressed patient satisfaction. The caregiver questionnaire addressed caregiver satisfaction and relevance of the patient contact in the ER. A total of 3,809 patients and 3,905 caregivers responded. The response rate...... satisfaction rates when patients were of Middle Eastern compared with Danish origin. Satisfaction of both groups was associated with the relevance of the visit as assessed by the caregiver. Visits by patients of Middle Eastern origin were less often assessed as being relevant, but caregivers were less...

Alcohol-related presentations to emergency departments in Ireland: a descriptive prevalence study

LENUS (Irish Health Repository)

McNicholl, Brian

2018-05-24

To determine the prevalence of alcohol-related presentations in all 29 emergency departments (EDs) in Ireland and compare with non-alcohol-related presentations in order to identify opportunities for improvements in the quality of patient care and related data collection.

Commentary on nuclear power plant control room habitability - including a review of related LERs (1981-1983)

International Nuclear Information System (INIS)

Moeller, D.W.; Kotra, J.P.

1985-01-01

A review of Licensee Event Reports filed by the operator of commercial nuclear power plants from 1981 through 1983 has revealed that approximately 3% pertain to systems that maintain or monitor control room habitability. Dominant contributors were deficiencies in normal and emergency trains of heating, ventilation, air conditioning and air cleaning systems (45%), deficiencies in atmospheric monitors for toxic and radioactive substances (27%) and deficiencies in fire protection systems (13%). To correct the situation revealed by these analyses and by information provided from other sources, it is recommended that the NRC incorporate into its program plan the development of information that anticipates the conditions within a control room during emergencies, and that criteria for habitability within the control room be better defined. In addition, it is suggested than an improved protocol for testing control room air-related systems be developed, that the required thickness and number of layers of charcoal adsorption beds for control room air cleaning systems be re-evaluated, and that steps be taken to improve the quality of heating, ventilating, air conditioning and air cleaning components. It is also recommended that greater emphasis be placed on maintaining nuclear power plant control rooms in a habitable condition during emergencies so that the operators can remain there and safely shut down the plant, in contrast to placing reliance on the use of remote shutdown panels or auxiliary control facilities

Strategic emergency department design: An approach to capacity planning in healthcare provision in overcrowded emergency rooms.

Science.gov (United States)

Exadaktylos, Aristomenis K; Evangelopoulos, Dimitrios S; Wullschleger, Marcel; Bürki, Leo; Zimmermann, Heinz

2008-11-17

Healthcare professionals and the public have increasing concerns about the ability of emergency departments to meet current demands. Increased demand for emergency services, mainly caused by a growing number of minor and moderate injuries has reached crisis proportions, especially in the United Kingdom. Numerous efforts have been made to explore the complex causes because it is becoming more and more important to provide adequate healthcare within tight budgets. Optimisation of patient pathways in the emergency department is therefore an important factor.This paper explores the possibilities offered by dynamic simulation tools to improve patient pathways using the emergency department of a busy university teaching hospital in Switzerland as an example.

Impact of smartphone digital photography, email, and media communication on emergency room visits post-hypospadias repair.

Science.gov (United States)

Chua, Michael E; Saunders, Megan A; Bowlin, Paul R; Ming, Jessica M; Lopes, Roberto Iglesias; Farhat, Walid A; Dos Santos, Joana

2017-01-01

Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates. This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for ER visits within 30 days postoperatively was assessed by another physician, who was blinded of patient group assignment. The reasons were categorized as: unnecessary ER visit, indicated ER visit, or visit unrelated to hypospadias surgery. Chi-square test and T-test were used for statistical analysis. Relative risk (RR) and corresponding 95% confidence interval (CI) were also calculated. Statistical significance was set at pcommunication with the use of smartphone digital photography significantly reduced the number of unnecessary ER visits for post-hypospadias wound checks.

An exploration of emergency department presentations related to high heel footwear in Victoria, Australia, 2006-2010.

Science.gov (United States)

Williams, Cylie M; Haines, Terry P

2014-01-23

Many women are warned against the dangers of wearing high heel footwear however there is limited empirical evidence demonstrating an association between wearing high heel with injury. Gait laboratory testing has found a higher heel height placed the foot in a position that increases the risk of ankle sprain. Women have also been surveyed about wearing high heels and approximately half of those reported inconvenience and pain after wearing a high heel shoe. This study aims to explore emergency department presentations of injuries and the estimated costs that have been directly attributed to wearing high heeled footwear within Victoria, Australia during 2006-2010. The Victorian Emergency Minimum Dataset (VEMD) was searched for all injuries attributed to wearing high heel footwear presenting to emergency departments in Victoria Australia, between the years of 2006-2010. The VEMD produced a report detailing sex, age at presentation, month of presentation, time of day of presentation, day of presentation, location that injury occurred and type of injury for presentation. Monash Health in Victoria Australia, provided emergency department estimates for injury types to calculate an estimated cost of an acute injury related to wearing high heel footwear. There were 240 injuries presenting to Victorian emergency departments directly attributed to wearing high heeled footwear. The majority of people injured were women (n = 236) and all were less than 55 years of age. More injuries presented on a Sunday (n = 83) and more in the 8 am-12 pm time bracket (n = 64). There were also more injuries presenting in the months of November, December and January (n = 80). The most commonly injured body part was the ankle (n = 123). The emergency department estimate of the cost of these injuries over this time-frame was almost $72,000 (mean of $316.72 per presentation). People who wear high heel footwear on weekends appear to be at higher risk for injury that leads to

Noise and room acoustic conditions in a tertiary referral hospital in Seoul, Korea

DEFF Research Database (Denmark)

Jeong, Cheol-Ho; Cho, Wan-Ho; Chang, Ji-ho

2018-01-01

Noise levels and room acoustic parameters at a tertiary referral hospital, Seoul National University Hospital in Korea, are investigated. Through a questionnaire, acoustically problematic rooms are identified. Noise levels in emergency rooms (ERs) and intensive care units (ICUs) are measured over...... level for the first night was 66 dBA, which came down to 56 dBA for the next day. The reason for the higher noise level for the first night in the ICU was frequent alarm sound and treatment noise related to a critical patient. The noise level in the measured ERs is about 10 dB lower than those measured...... about three days. Acoustically critical and problematic rooms in the otolaryngology department are measured: examination rooms, operating rooms, nurse stations, patient rooms, and audiometric rooms. The equivalent A-weighted noise level, LAeq, ranges from 54 to 56 dBA in two ERs. In an ICU, the noise...

Sex differences in "weightlifting" injuries presenting to United States emergency rooms.

Science.gov (United States)

Quatman, Carmen E; Myer, Gregory D; Khoury, Jane; Wall, Eric J; Hewett, Timothy E

2009-10-01

Benefits of resistance training include improved muscle strength and sports performance and may include reduced injuries. However, few studies have examined sex differences in resistance training-related injuries. The objective of this investigation was to evaluate sex differences in injuries associated with strength training in adolescents and young adults by type (sprains and strains, fractures), mechanism (accidental, nonaccidental), and location (head, trunk, arm, hand, leg, foot) of injury. We hypothesized that there would be sex differences in type, mechanism, and location of strength training injuries. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 14 and 30 years were included in the study. CPSC sampling weights were used to calculate national estimates from the sample of 3,713 patients (men = 3,102; women = 611). Weighted Chi-square analyses were used to compare differences in mechanism, type, and location of injury for men versus women. Men had significantly more sprains and strains (p = 0.004), whereas women demonstrated increased accidental injuries compared to men (p injuries than women (p injuries than men (p injuries during strength training (sprains and strains) compared to women, especially at the trunk. Conversely, women may be more susceptible to lower-extremity injuries resulting from accidents during resistance training.

Interdisciplinary shock-room care: tasks for the radiologist from the viewpoint of the trauma surgeon

International Nuclear Information System (INIS)

Mutschler, W.; Kanz, K.G.

2002-01-01

Efficient resuscitation of major trauma requests an interdisciplinary communication between trauma surgeons, anaesthesiologists and radiologists. Trauma outcome is significantly influenced by horizontal trauma team organisation and coherence to clinical algorithms, which allow fast diagnosis and intervention. A radiologist present on patients arrival in the trauma room provides a major impact on trauma care. Nevertheless optimal integration in the trauma team implies profound knowledge of the priorities of advanced trauma life support and trauma algorithms. His or her involvement is not limited to patient care only, also active participation in trauma room design, interdisciplinary algorithm development and trauma research are essential tasks for radiologists devoted to emergency radiology. Based on the pathophysiology of polytrauma and the structure of German trauma system, current concepts and proven clinical algorithms with special regard to the radiologist and his duties and tasks will are presented. (orig.) [de

New technologies for control room habitability assessment

International Nuclear Information System (INIS)

Lahti, G.P.; Muraida, J.E.; Perchiazzi, W.T.; Harden, P.A.

1994-01-01

Older nuclear power plants typically considered only a nominal amount of unfiltered inleakage (typically 10 cfm) impacting their postaccident control room habitability. However, recent measurements of unfiltered inleakage show values in excess of the nominal 10 cfm. A reassessment for two of these ''older'' stations has been completed recently to show that the measured inleakage did not jeopardize the safety of the control room occupants. Recent concerns at the Zion Station and the Palisades Station about control room habitability in the event of a loss-of-coolant accident have led to an extensive effort to increase control room habitability margin. The heating, ventilating and air-conditioning (HVAC) system servicing each of the control rooms has the potential for unfiltered in-leakage through many locations. For example, at the Palisades Station, the current limiting control room habitability analysis allows for 25 cfm unfiltered in-leakage through its normal outside air intake louvered isolation dampers during emergency mode into the control room envelope. This leakage value was not thought to be achievable with the existing as-built configuration. Repairing the system was considered a potential solution; however, this would be costly and could negatively affect plant operation. In addition, the system would still be required to meet the low specified unfiltered in-leakage. An alternate approach was to review the analysis and reassess the most important parameters. The key effort was to determine the atmospheric dispersion factors (χ/Qs) through wind tunnel tests using scale models of the stations. The results of the wind tunnel testing could yield more realistic χ/Qs for control room habitability than previously employed methods. The wind tunnel study options were selected based on their ease of implementation, realistic results, and low cost. More importantly, the results of the studies would allow more realistic values of unfiltered inleakage

Surgical emergencies in obstetrics and gynaecology in a tertiary care hospital.

Science.gov (United States)

Pokharel, Hanoon P; Dahal, Prerana; Rai, Rubina; Budhathoki, ShyamSundar

2013-01-01

The management of Obstetrics and Gynaecological Emergency is directed at the preservation of life, health, sexual function and the perpetuation of fertility. Main aim of the study was to access the burden of Surgical Emergency in Obstetrics and Gynaecology and their course of management at BPKIHS. A total of 314 women presenting at the emergency admission room of Obstetrics and Gynaecology Department of BPKIHS over two years, who required surgical intervention were included in this hospital based descriptive study. Clinical assessment and routine laboratory investigations were performed in all cases. All patients who presented with shock were resuscitated and surgery was done at earliest possible time. The age of patients ranged from 15- 55 years with approximately 43% in the 25-34 years category. Ninety two percent of them were married. Among the unmarried, 64% came with problems related to unsafe abortion. About 61% of females presenting as acute surgical abdomen had ruptured ectopic pregnancy, 7.64% had twisted ovarian cyst, and 6.26% had haemoperitoneum and pyoperitoneum following vaginal hysterectomies, total abdominal hysterectomies and caesarean section. Almost half (47.8%) of the cases underwent salphingectomy. Women present with wide range of complaints and conditions in the admission room of Obstetrics and Gynecology department of BPKIHS. Skilled clinicians, immediate investigation facilities and experienced specialty Obstetrical and Gynaecological surgeons are the main backbone of the emergency case management and saving lives. Study indicates there is need of some prospective study to establish the causes of rising trend in Ectopic Pregnancies.

Association between weather conditions and the number of patients at the emergency room in an Argentine hospital

Science.gov (United States)

Rusticucci, Matilde; Bettolli, Laura M.; de los Angeles Harris, M.

2002-02-01

The aim of this paper is to study the relationships between hospital emergencies and weather conditions by analysing summer and winter cases of patients requiring attention at the emergency room of a hospital in the city of Buenos Aires, Argentina. Hospital data have been sorted into seven different diagnostic groups as follows: (1) respiratory, cardiovascular and chest-pain complaints; (2) digestive, genitourinary and abdominal complaints; (3) neurological and psychopathological disorders; (4) infections; (5) contusion and crushing, bone and muscle complaints; (6) skin and allergies and (7) miscellaneous complaints. In general, there is an increase of 16.7% in winter while, for group 2 and group 6, there are more patients in summer, 54% and 75% respectively. In summer, the total number of patients for group 6 shows a significant positive correlation with temperature and dew-point temperature, and a negative correlation with the sea-level pressure for the same day. In winter, the same relationship exists, however its correlation is not as strong. The lags observed between these three variables: maximum dew-point temperature, maximum temperature, minimum air pressure and the peaks in admissions are 1, 2 and 4 days respectively. In winter, increases in temperature and dew point and decreases in pressure are followed by a peak in admissions for group 2. In winter, there are significantly more cases in group 5 on warm, dry days and on warm, wet days in the summer.

Control room envelope unfiltered air inleakage test protocols

International Nuclear Information System (INIS)

Lagus, P.L.; Grot, R.A.

1997-01-01

In 1983, the Advisory Committee on Reactor Safeguards (ACRS) recommended that the US NRC develop a control room HVAC performance testing protocol. To date no such protocol has been forthcoming. Beginning in mid-1994, an effort was funded by NRC under a Small Business Innovation Research (SBIR) grant to develop several simplified test protocols based on the principles of tracer gas testing in order to measure the total unfiltered inleakage entering a CRE during emergency mode operation of the control room ventilation system. These would allow accurate assessment of unfiltered air inleakage as required in SRP 6.4. The continuing lack of a standard protocol is unfortunate since one of the significant parameters required to calculate operator dose is the amount of unfiltered air inleakage into the control room. Often it is assumed that, if the Control Room Envelope (CRE) is maintained at +1/8 in. w.g. differential pressure relative to the surroundings, no significant unfiltered inleakage can occur it is further assumed that inleakage due to door openings is the only source of unfiltered air. 23 refs., 13 figs., 2 tabs

Control room envelope unfiltered air inleakage test protocols

Energy Technology Data Exchange (ETDEWEB)

Lagus, P.L. [Lagus Applied Technology, San Diego, CA (United States); Grot, R.A. [Lagus Applied Technology, Olney, MD (United States)

1997-08-01

In 1983, the Advisory Committee on Reactor Safeguards (ACRS) recommended that the US NRC develop a control room HVAC performance testing protocol. To date no such protocol has been forthcoming. Beginning in mid-1994, an effort was funded by NRC under a Small Business Innovation Research (SBIR) grant to develop several simplified test protocols based on the principles of tracer gas testing in order to measure the total unfiltered inleakage entering a CRE during emergency mode operation of the control room ventilation system. These would allow accurate assessment of unfiltered air inleakage as required in SRP 6.4. The continuing lack of a standard protocol is unfortunate since one of the significant parameters required to calculate operator dose is the amount of unfiltered air inleakage into the control room. Often it is assumed that, if the Control Room Envelope (CRE) is maintained at +1/8 in. w.g. differential pressure relative to the surroundings, no significant unfiltered inleakage can occur it is further assumed that inleakage due to door openings is the only source of unfiltered air. 23 refs., 13 figs., 2 tabs.

TH-B-207B-01: Optimizing Pediatric CT in the Emergency Department

International Nuclear Information System (INIS)

Dodge, C.

2016-01-01

This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker will review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children

TH-B-207B-01: Optimizing Pediatric CT in the Emergency Department

Energy Technology Data Exchange (ETDEWEB)

Dodge, C. [Texas Children’s Hospital (United States)

2016-06-15

This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker will review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children.

Detecção de maus-tratos contra a criança: oportunidades perdidas em serviços de emergência na cidade do Rio de Janeiro, Brasil Detection of child abuse: missed opportunities in emergency rooms in Rio de Janeiro, Brazil

Directory of Open Access Journals (Sweden)

Anna Tereza Miranda Soares de Moura

2008-12-01

Full Text Available O enfrentamento da violência contra a criança é considerado um desafio nos serviços de emergência, onde a rotina atribulada pode dificultar a detecção dos casos. O presente estudo estimou a magnitude da violência contra crianças atendidas em dois hospitais de emergência no Rio de Janeiro, Brasil. Também avaliou o grau de sub-registro de casos, comparando a casuística notificada pelas equipes com aquela estimada pelo estudo. Para aferição da violência foi utilizado o instrumento Conflict Tactics Scales: Parent-Child (CTSPC, aplicado em 524 acompanhantes de crianças atendidas nos hospitais entre janeiro e março de 2005. Foram avaliadas todas as notificações originadas da identificação de casos pelas equipes em 2004. De acordo com a CTSPC, a prevalência de violência psicológica, negligência e violência física foi de 94,8% (IC95%: 92,9-96,2, 60,3% (IC95%: 55,9-64,7 e 47,2% (IC95%: 42,7-51,8, respectivamente. Já estas estimativas segundo as notificações foram de 0,007% (IC95%: 0,003-0,013, 0,24% (IC95%: 0,22-0,27 e 0,03% (IC95%: 0,02-0,04. Essa considerável diferença entre as estimativas do estudo e as relativas aos casos notificados sugere que as estratégias de identificação e notificação de casos de violência contra a criança nos serviços de emergência sejam reavaliadas.Emergency rooms require special consideration since their often-distressful routines may hamper the detection and handling of family violence cases. This study estimated the magnitude of violence against children reported by users of two emergency hospitals in Rio de Janeiro, Brazil. It also evaluated the degree of underreporting by contrasting the present findings to cases reported routinely. 524 parents/guardians of children under 12 treated at the hospitals from January to March 2005 were interviewed. Twelve-month prevalence of family violence was measured with the Conflict Tactics Scales: Parent-Child (CTSPC. All cases reported by staff

A Case of Lionfish Envenomation Presenting to an Inland Emergency Department.

Science.gov (United States)

Schult, Rachel F; Acquisto, Nicole M; Stair, Crystal K; Wiegand, Timothy J

2017-01-01

Lionfish envenomation can cause erythema, edema, necrosis, and severe pain at the exposed site. Treatment often includes supportive wound care, pain management, and hot water immersion. We report a case of lionfish exposure presenting to an inland emergency department treated successfully with these measures.

A Case of Lionfish Envenomation Presenting to an Inland Emergency Department

OpenAIRE

Schult, Rachel F.; Acquisto, Nicole M.; Stair, Crystal K.; Wiegand, Timothy J.

2017-01-01

Lionfish envenomation can cause erythema, edema, necrosis, and severe pain at the exposed site. Treatment often includes supportive wound care, pain management, and hot water immersion. We report a case of lionfish exposure presenting to an inland emergency department treated successfully with these measures.

Missed Fractures in Infants Presenting to the Emergency Department With Fussiness.

Science.gov (United States)

Kondis, Jamie S; Muenzer, Jared; Luhmann, Janet D

2017-08-01

The aim of this study was to evaluate incidence of prior fussy emergency visits in infants with subsequently diagnosed fractures suggestive of abuse. This was a retrospective chart review of infants younger than 6 months who presented to the pediatric emergency department (ED) between January 1, 2006, and December 31, 2011. Inclusion criteria included age 0 to 6 months, discharge diagnosis including "fracture," "broken" (or break), or "trauma" or any child abuse diagnosis or chief complaint of "fussy" or "crying" as documented in the electronic medical record by the triage nurse. Three thousand seven hundred thirty-two charts were reviewed, and 279 infants with fractures were identified. Eighteen (6.5%) of 279 infants had a prior ED visit for fussiness without an obvious source. Of these, 2 had a witnessed event causing their fracture, and therefore the fracture was not considered concerning for abuse. The remaining 16 had fractures concerning for abuse. Mean age was 2.5 (SD, 1.2) months. Fifteen (83%) of 18 infants were 3 months or younger at the time of the fussy visit. The mean interval between the first and second ED visits was 27 days (median, 20 days). Thirty-nine percent were evaluated by a pediatric emergency medicine-trained physician during their initial fussy visit, whereas 78% were evaluated by pediatric emergency medicine-trained physician during their subsequent visit. Most common injuries were multiple types of fractures followed by extremity and rib fractures. Fractures concerning for child abuse are an important cause of unexplained fussiness in infants presenting to the pediatric ED. A high index of suspicion is essential for prompt diagnosis and likely prevention of other abuse.

Emergency preparedness

International Nuclear Information System (INIS)

1998-01-01

According the conception of the Emergency Response Centre (ERC) of the Nuclear Regulatory Authority of the Slovak Republic (NRA), and the obtained experience from exercises, and as well as on the basis of recommendations of international missions, the NRA SR started, in 1997 the ERC extension. The new room enable the work for radiation protection group, reactor safety and logistic group separately. At the same time special room was build for work of the NECRA Technical Support Group of the Emergency Commission for Radiation Accidents of the SR.This group co-operates closely with ERC while evaluation the situation, and by using the information system of the NRA and database of ERC to generate the conditions of nuclear facilities in once of emergency. Extension of the mentioned rooms was carried out. The financing by the European Union helped to build the project RAMG. In this way the NRA gained a working site which, with its equipment and parameters belongs to the top working sites of regulatory bodies of developed European countries. The NRA preparation of exercise and special staff education was carried out in 1997, for employees of the NRA and members of Emergency Headquarters (EH) for work in ERC in case of nuclear installation accident. The task of education of member of EH was their preparation for carrying out three exercises. These exercises are described. In the area of emergency preparedness, in accordance with inspection plan of the Office, 7 team inspections were carried out in individual localities; in NPP Bohunice, two in NPP Mochovce and one in Bohunice Conditioning Centre for radioactive wastes. Solution of the task of development of science and technology in the area of 'Development of technical and programme means for analyses of accidents and solutions of crisis situations'continued in 1997. Another regulations were elaborated for activity of members of EH of the NRA. The following was was carried out: selection of data for transfer and the

[Vertigo and dizziness in the emergency room].

Science.gov (United States)

Zwergal, A; Möhwald, K; Dieterich, M

2017-06-01

Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests). For differentiation of peripheral and central etiologies in acute vestibular syndrome, the HINTS exam (head impulse test, nystagmus, test of skew) and examination of smooth pursuit and saccades should be applied. Nonselective use of neuroimaging is not indicated due to a low diagnostic yield. Cranial imaging should be done in the following constellations: (1) detection of focal neurological or central ocular motor and vestibular signs on clinical exam, (2) acute abasia with only minor ocular motor signs, (3) presence of various cardiovascular risk factors, (4) headache of unknown quality as an accompanying symptom. Besides the symptomatic therapy of vertigo and dizziness with antiemetics or analgesics, further diagnostic differentiation is urgent to guide proper treatment. Examples are the acute therapy in cerebral ischemia, the execution of positioning maneuvers in benign paroxysmal positional vertigo, the use of corticosteroids in acute unilateral vestibulopathy, as well as the readjustment of metabolic homeostasis in medical disorders.

A Case of Lionfish Envenomation Presenting to an Inland Emergency Department

Directory of Open Access Journals (Sweden)

Rachel F. Schult

2017-01-01

Full Text Available Lionfish envenomation can cause erythema, edema, necrosis, and severe pain at the exposed site. Treatment often includes supportive wound care, pain management, and hot water immersion. We report a case of lionfish exposure presenting to an inland emergency department treated successfully with these measures.

Feasibility study on emergency passive habitability systems of SPWR

International Nuclear Information System (INIS)

Obata, H.; Tabata, H.; Urakami, M.; Naito, T.

2000-01-01

The major characteristic of the Simplified Pressurized Water Reactor (SPWR) is that safety systems for the emergency core cooling and the core decay heat removal functions are achieved by passive equipment. The AP600 developed in the U.S adopts passive emergency habitability system for the main control room (MCR) and the electrical equipment rooms (EER) by using the concrete of the structures as a heat sink. For the SPWR, alternative natural circulation cooling systems have been investigated: for MCR cooling, a cold water reservoir is used as heat sink; for EER cooling, outside air is instead employed. The distribution of the air-velocity and temperature in those rooms were calculated by using a three-dimensional thermal fluid analysis code. The authors verified the conceptual feasibility of these systems as the emergency passive habitability systems in the SPWR. (author)

Patterns of 'at-home' alcohol-related injury presentations to emergency departments.

Science.gov (United States)

Bunker, Naomi; Woods, Cindy; Conway, Jane; Barker, Ruth; Usher, Kim

2017-01-01

This study aimed to establish the scale of alcohol-related injuries originating in the home. Despite recent media and public attention on alcohol-related injuries occurring at licensed venues, many occur in other locations including the home. A retrospective observational study. Emergency department surveillance data sourced from the Queensland Injury Surveillance Unit were interrogated for alcohol-related emergency department presentations from 2003-2012 (n = 12,296). Descriptive analysis was undertaken to assess alcohol involvement in injury, and analysis of variance was used to determine the differences among group means and their associated presentations. The relationship between demographic variables and injury location was assessed using p value of domestic violence by spouse or partner (n = 510), 59·5% occurred 'at home'. This is the first study to investigate alcohol-related injuries occurring at home. The home accounts for a greater proportion of injuries than the frequently assessed licensed premises location. Further research is required to validate these findings in a wider setting. A public health campaign is required to minimise harm associated with alcohol-related injuries in the home, and nurses are positioned to inform health policy makers around this issue. Furthermore, emergency department nurses are in a unique position to provide brief interventions around safe alcohol consumption and injury prevention. © 2016 John Wiley & Sons Ltd.

The Effect of Emergency Department Overcrowding on Efficiency of Emergency Medicine Residents’ Education

Directory of Open Access Journals (Sweden)

Anita Sabzghabaei

2014-09-01

Full Text Available Introduction: Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO on the training of emergency medicine residents (EMR is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR’s education. Methods: In this cross-sectional study, the effects of overcrowding on EMR’s education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs.  The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS. The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. Results: 130 questionnaires were filled out during 61 shifts. 47 (77.05% shifts were overcrowded. The attend’s ability to teach was not affected by overcrowding in the resuscitation room (p=0.008. The similar results were seen regarding the attend’s training ability in the acute care unit. Conclusion: It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs.

Fatores de risco para consultas em pronto-socorro por crianças asmáticas no Sul do Brasil Asthmatic children's risk factors for emergency room visits, Brazil

Directory of Open Access Journals (Sweden)

Moema Chatkin

2000-10-01

Full Text Available OBJETIVOS: Traçar um perfil das crianças asmáticas do município de Pelotas, RS, conhecer o manejo da doença e os fatores de risco associados a consultas em pronto-socorro, motivadas por asma. MÉTODOS: Estudo transversal aninhado a um estudo de coorte, realizado na área urbana de Pelotas, cidade de médio porte do Sul do Brasil. Participaram 981 crianças de 4-5 anos, pertencentes à coorte de 1993. RESULTADOS: A prevalência de asma encontrada na amostra estudada foi de 25,4%. A morbidade por asma foi elevada: 31% das crianças asmáticas haviam procurado o pronto-socorro no último ano, 57% tinham consultado médico e 26%, de 1 a 4 anos, foram internadas por asma. Na análise geral, escolaridade e renda familiar baixas associaram-se com consultas em pronto-socorro (RO=4,1 para 0 a 4 anos de escolaridade e RO=6,5 para menos de 1 salário-mínimo. Dormir em quartos com 3 ou mais pessoas também mostrou-se associado (RO=2,2, bem como severidade das crises (RO=2,7, uso de medicamentos para asma no último ano (RO=1,9 e internações por asma (RO=3,0. CONCLUSÕES: A prevalência de asma entre crianças pré-escolares em Pelotas é alta, levando a grande morbidade. Encontraram-se como fatores preditores de consultas em pronto-socorro por asma, após análise multivariada, a baixa escolaridade das mães, severidade das crises e internação por asma.OBJECTIVES: To study a sample of asthmatic children to get to know how the disease is managed by caretakers and to identify predictive factors associated with attendance in emergency room for asthma. METHODS: A cross-sectional study nested in a cohort was undertaken in the urban area of Pelotas, Southern Brazil. 981 children aged 4-5 years, who belong to the cohort of 1993, participated in this study. RESULTS: The asthma prevalence in the children sample was 25.4%. Morbidity for asthma was quite high: 31% of the children were seen in emergency rooms in the last year, 57% attended medical clinics and

Signs and symptoms of patients with brain tumors presenting to the emergency department.

Science.gov (United States)

Snyder, H; Robinson, K; Shah, D; Brennan, R; Handrigan, M

1993-01-01

This retrospective chart review was conducted to determine the presenting signs and symptoms of patients with primary brain tumors diagnosed in the emergency department. There were 101 patients (65 males and 36 females) identified with a hospital discharge diagnosis of primary brain tumor who were admitted through the emergency department. The presenting symptoms included headache (56 patients), altered mental status (51 patients), ataxia (41 patients), nausea or vomiting (37 patients), weakness (27 patients), speech deficits (21 patients), and sensory abnormalities (18 patients). The presenting signs included motor weakness (37 patients), ataxia (37 patients), papilledema (28 patients), cranial nerve palsies (26 patients), visual deficits (20 patients), and speech deficits (12 patients). The average age was 42.8 years, with a range of 3 days to 88 years. The majority of tumors were malignant astrocytomas. Tumor location was cortical in 68 patients, subcortical in 9 patients, and brainstem or cerebellum in 24 patients. In conclusion, patients of all ages may present to the emergency department with a variety of symptoms resulting from a primary brain tumor. Headache and altered mental status were common in our series of patients, but symptoms will depend on the size, location, and type of tumor. A complete neurologic examination is essential, including evaluation for papilledema.

Emergency department waiting room stress: can music or aromatherapy improve anxiety scores?

Science.gov (United States)

Holm, Lydia; Fitzmaurice, Laura

2008-12-01

The aim of this study was to determine the effect of music alone, aromatherapy alone, and music in addition to aromatherapy on anxiety levels of adults accompanying children to a pediatricemergency department waiting area. The study was conducted over 28 consecutive days, assigned to 1 of 4 groups: no intervention, music, aromatherapy, and both music and aromatherapy. Adults accompanying children to the emergency department of an urban pediatric tertiary care referral center were given a survey including a Spielberger state anxiety inventory with additional questions about whether they noticed an aroma or music and if so their response to it. The music was classic ingenre with a tempo of 60 to 70 beats per minute. The aromatherapyused the essential oil Neroli dispersed using 2 aromatherapydiffusers placed in strategic airflow ends of the emergency department. The 1104 surveys were completed. There was a statistically significant decrease in anxietylevel on those days when music was playing (36.3 vs. 39.2; P = 0.017). There was no difference in anxiety levels on those days when aromatherapy was present compared with the nonaromatherapy days (37.3 vs. 38.0; P = 0.347). Music is an easy and useful way to decrease the anxiety of visitors in an emergency department waiting area. Although no difference was detected for the aromatherapy group, this could be because of environmental conditions or imprecise application of the aromatherapy; further study is needed to either prove or disprove its effectiveness in this setting.

Urological Emergency Admissions to a Community Hospital: A Review

Science.gov (United States)

Atkins, Sam O.

1983-01-01

A one-year study was conducted on the impact of emergency admissions to the 125-bed Southwest Community Hospital in Atlanta, Georgia. During the study in 1979, 70 urological emergency room admissions were made, of which 44 (62.8 percent) were males and 26 (37.2 percent) were females. In comparison, 93 admissions were made directly from the private office. The study considered the timeliness of diagnosis and treatment, surgical procedures performed, impact on urological emergency room nursing and medical personnel, physician response to notification, cost containment, and implied legal ramifications and organization structure. Thus, an immediate close scrutiny of urological emergency admission at the nonuniversity affiliated Southwest Community Hospital was permitted. PMID:6876189

An 11-Year Analysis of Emergency Presentations of Melioidosis in Northeastern Malaysia.

Science.gov (United States)

Yazid, Mohd Boniami; Fauzi, Mohd Hashairi; Hasan, Habsah; Md Noh, Abu Yazid; Deris, Zakuan Zainy

2017-06-01

A neglected tropical disease, melioidosis is known to have variability in clinical presentations. Here, we described clinical features that should alert the physicians on the possibility of melioidosis. In this review of 86 cases from 2001 to 2011, the common presentations of melioidosis in the Emergency Department (ED), Hospital Universiti Sains Malaysia were; male gender (79.1 %), in working age group (47.8 ± 15.2 year-old), worked in contact with soil (73.3 %), presented with fever (91.9 %), in rainy season (55.8 %), have underlying diabetes mellitus (79.1 %), have leukocytosis (67.4 %) and high blood glucose (62.8 %) during presentation. In 34.9 % of cases, the antimicrobials were initiated at the ED and only 10.5 % include antimelioid drugs. Thirty-one patients (36.0 %) died due to melioidosis and 51.6 % of this were within 48 h of admission. Despite high mortality rate, the clinical awareness on the possibility of melioidosis among emergency physicians is still low and need to be strengthened.

Orchestrating Professional Development for Baby Room Practitioners: Raising the Stakes in New Dialogic Encounters

Science.gov (United States)

Goouch, Kathleen; Powell, Sacha

2013-01-01

This article has emerged from a research and development project, The Baby Room, which was designed to examine how babies are cared for in daycare settings. Within the project, a form of professional development was created which designated a central space for dialogic encounter, primarily to enable the baby room practitioners who participated in…

An approach to enhanced control room crew performance

International Nuclear Information System (INIS)

Frye, S.R.

1988-01-01

The function of a nuclear power plant control room team is similar to that of an airline cockpit crew or a critical task military team such as a flight crew, tank crew, combat squad or platoon. These teams encounter many of the same problems or challenges in their environments when dealing with abnormal or emergency situations. The competency of these teams in bringing about successful conclusions in situations depends on their ability to coordinate their actions. This is often referred to as teamwork and includes the interactions between team members which must occur during highly critical situations. The purpose of this paper is to present team skills training and the advances made in this crucial area by utilizing both classroom and high fidelity simulator training

If Hunters End Up in the Emergency Room: A Retrospective Analysis of Hunting Injuries in a Swiss Emergency Department

Directory of Open Access Journals (Sweden)

Valentina Bestetti

2015-01-01

Full Text Available Aim. to characterize the mechanisms, patterns, and outcomes of nonfatal hunting-related injuries in patients presenting to Bern University Hospital, Switzerland, and compare these to reports of hunting injuries worldwide. Methods. patients presenting with hunting-related injuries to the Emergency Department at Bern University hospital from 2000 to 2014 were identified by retrospectively searching the department database using the keyword “hunt.” Each case was analyzed in terms of the patient age and gender, the mechanism and pattern of injury, and management and patient follow-up. Results. 19 patients were identified. 16 were male with a mean age of 50 years (range: 16–74. Mechanisms of injury included firearm-related injuries, falls, and knife wounds. The most common patterns of injury were head injuries (7, followed by injuries to the upper (5 or lower limb (5 and trunk (2. Over half of the patients were admitted, and nine required emergency surgery. Conclusion. Nonfatal hunting accidents in Bern, Switzerland, are largely caused by firearms and falls and tend to occur in male hunters with a mean age of 50 years. The most common patterns of injury are orthopedic and head injuries, often requiring surgery. These findings are consistent with international studies of nonfatal hunting accidents.

Emergency radiology of the pediatric chest: What every radiologist should know

International Nuclear Information System (INIS)

Kirks, D.R.

1987-01-01

Radiology plays a critical role in the diagnosis, treatment, and follow-up of thoracic disease seen in the pediatric emergency room. The history and physical examination of a small infant or an ill child are less reliable than in the adult. Physical examination of the chest in an uncooperative infant is difficult or nonspecific at best and impossible at worst. This does not, however, negate the importance of an adequate history and physical examination before radiologic evaluation. Numerous chest abnormalities in children have a similar history and similar manifestations or physical examination despite specific radiolic features. Conversely, a nonspecific radiologic appearance may become diagnostic when interpreted in the proper clinical context. This paper presents an overview of emergency radiology of pediatric chest disease. The emphasis is on practical matters: acute pediatric chest conditions that are commonly seen in the emergency room, outpatient clinic, or private office are illustrated and discussed. Practical aspects of imaging techniques, interpretative approach, pulmonary infection, asthma, airway foreign body, hydrocarbon aspiration, and near-drowning are emphasized

NPP accident scenario. Which emergency measures are planned in Switzerland?

International Nuclear Information System (INIS)

Flury, Christoph

2016-01-01

As a consequence of the reactor accident in Fukushima the Swiss government has ordered an extensive analysis of emergency planning in case of a NPP accident Switzerland. A special working group has analyzed the possible improvements of Swiss emergency planning based on the experiences in Japan. Under the special direction of the Bundesamt fuer Bevoelkerungsschutz (BABS) the agreed improvements were integrated into the emergency concept. The reference scenarios have been re-assessed and the zone concept adapted. The emergency measures include shelter-type rooms (basement or window-less rooms), the preventive distribution of iodine pills, measures concerning agriculture, aquatic systems, preventive evacuation, traffic regulations, and delayed evacuation.

Epidemiological characteristics of pediatric epistaxis presenting to the emergency department.

Science.gov (United States)

Shay, Sophie; Shapiro, Nina L; Bhattacharyya, Neil

2017-12-01

Investigate the epidemiological characteristics of pediatric epistaxis in the emergency department setting. Cross-sectional study using national databases. Children (age epistaxis were extracted from the State Emergency Department Databases for New York, Florida, Iowa, and California for the calendar year 2010. Associated diagnoses, procedures, encounter characteristics, and demographic data were examined. There were 18,745 cases of pediatric epistaxis (mean age 7.54 years, 57.4% male). Overall, 6.9% of patients underwent procedures to control epistaxis, of which 93.5% had simple anterior epistaxis control. The distribution of pediatric epistaxis was highest in spring and summer months (p epistaxis presentations (38.8%, p epistaxis control procedure performed (p epistaxis control procedure (p epistaxis control procedure compared to those of minority backgrounds (p epistaxis are uninvolved cases that do not require procedural intervention. The overrepresentation of low socioeconomic status patients may suggest an overutilization of emergency services for minor cases of epistaxis, and perhaps a lack of access to primary care providers. This is the first study to evaluate racial and socioeconomic factors in relationship to pediatric epistaxis. Further investigation is needed to better elucidate these potential disparities. Copyright © 2017 Elsevier B.V. All rights reserved.

Control room philosophy: Principles of control room design and control room work

International Nuclear Information System (INIS)

Skriver, Jan; Ramberg, Jasmine; Allwin, Pernilla

2006-01-01

In order to provide insights for improvement of work in control rooms several factors have to be considered. Knowledge of principles including control room philosophies will guide the recommended improvements. In addition to knowledge about specific principles an advantage for an organization can be an understanding of similarities and policies used in other high risk industry. The report has been developed on the basis of a document analysis of international standards and other guiding documents. (NUREG 0711, ISO 11064, ISO 6385, IEC 60964). In addition to the document analysis which has strived to compare the documents to see similarities in important principals, experience from working with control room design, modifications and evaluations in other high risk industries has pervaded the report. Important principles have been identified which are recommended to be included in a control room philosophy. Many of these are similar to the principles identified in the international standards. An additional principal which is regarded as important is the utilization of Key Performance Indicators (KPI) which can be used as a measure to target preventative means. Further more it is critical that the control room philosophy is easy to access and comprehend for all users. One of the challenges that remain after having developed a control room philosophy is how to utilize it in the daily work situation. It is vital that the document remains as a living document, guiding the continual improvement of the control room in the various life cycle stages

Present state of the liner of the reactor

International Nuclear Information System (INIS)

Aguilar H, F.; Raya A, R.; Mazon R, R.

2001-07-01

When being presented to work the operation personnel of the reactor, on Monday January 10, 1983, they noticed that the reactor pool was overflowing of water and the floor of the room was partially flooded. The personnel proceeded to revise the feedwater systems to the pool, the Emergency Cooling System of the core and that of Water of Reinstatement, was found that the passing valve of this last it was lightly open. It was discovered that the water that was flooded in the floor of the room it came from the relief valves of the ports TW-1 and RW-2 and of three glides that were in the Thermal Column area. It was proceeded to lower the one level of water of the pool to their normal position and it was clean the water flooded in the salts. (Author)

Advanced nursing interventions and length of stay in the emergency department.

Science.gov (United States)

Stauber, Mary A

2013-05-01

Over the past 15 years, emergency departments have become overcrowded, with prolonged wait times and an extended length of stay (LOS). These factors cause delay in treatment, which reduces quality of care and increases the potential for adverse events. One suggestion to decrease LOS in the emergency department is to implement advanced nursing interventions (ANIs) at triage. The study purpose was to determine whether there was a difference in ED LOS between patients presenting with a chief complaint of abdominal pain who received ANIs at triage and patients who did not receive ANIs at triage. A retrospective chart review was performed to determine the ED LOS (mean time in department and mean time in room [TIR]). The convenience sample included ED patients who presented to a large Midwestern academic medical center's emergency department with a chief complaint of abdominal pain and Emergency Severity Index level 3. Independent-samples t tests were used to determine whether there was any statistical difference in LOS between the two groups. Cohen's d statistic was used to determine effect size. Implementation of ANIs at triage for patients with low-acuity abdominal pain resulted in an increased time in department and a decreased TIR with a medium effect size. A reduction in TIR optimizes bed availability in the emergency department. Low-acuity patients spend less time occupying an ED bed, which preserves limited bed space for the sickest patients. Results of diagnostic tests are often available by the time the patient is placed in a room, facilitating early medical decision making and decreasing treatment time. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Different causes of referral to ophthalmology emergency room

Directory of Open Access Journals (Sweden)

Alireza Keshtkar Jafari

2012-01-01

Full Text Available Background: Eye-related complaints compose approximately 1-6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions. Aim: The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran. Settings and Design: In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded. Materials and Methods: The patients′ demographic data, medical history and final diagnosis were recorded in a questionnaire. Results: The mean age of patients was 33.2±16.8 years and 2380 patients (75.6% were males. While 299 patients (9.5% were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%. In patients referred due to trauma (1950 patients, work-related injuries occurred in 955 patients (49% and occurred accidentally (by chance in 819 patients (42%. The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%. The most common etiologies of eye trauma (1950 patients were metal filings (814 patients; 41.8%, blunt trauma (338 patients; 17.3%, fireworks (236 patients; 12.1% and sharp objects (222 patients; 11.4%. Globe injury was diagnosed in 1865 patients (95.7% of trauma cases. In patients referred due to non-traumatic reason (1200 patients, eye infection occurred in 482 patients (40.2% and 299 patients (24.9% were referred for non-urgent reasons. There was little difference

Low-Reynolds Number Effects in Ventilated Rooms

DEFF Research Database (Denmark)

Davidson, Lars; Nielsen, Peter V.; Topp, Claus

In the present study, we use Large Eddy Simulations (LES) which is a suitable method for simulating the flow in ventilated rooms at low Reynolds number.......In the present study, we use Large Eddy Simulations (LES) which is a suitable method for simulating the flow in ventilated rooms at low Reynolds number....

Process improvement of the emergency operating procedures for Embalse Nuclear Power Plant

Energy Technology Data Exchange (ETDEWEB)

Mariotti, A.D.; Pomerantz, M.; Moreno, C., E-mail: dmariotti@na-sa.com.ar, E-mail: mpomerantz@na-sa.com.ar, E-mail: cmoreno@na-sa.com.ar [Embalse Nuclear Power Plant, Nuclear Safety Dept., Embalse (Argentina)

2014-07-01

Emergency Operating Procedures (EOP) package of the Embalse Nuclear Power Plant (CNE) were made entirely by the plant staff since the beginning of its operation. With the emergence of Severe Accidents Guidelines (SAMG) and the latest events related to Fukushima, the EOP philosophy should include a new concept. It should consider that the EOP may be unsuccessful and an exit to the SAMG must be necessary. However, due to abnormal event mitigation using EOP is the way to prevent the beginning of a severe accident, EOP always had significant relevance in the plant documentation. For this reason, added to the overall requirement of an exit to the SAMG, it emerges a general review of the use efficiency of the EOP during an abnormal event. For this reason, a comprehensive process improvement has emerged using the operating experience, full-scope simulator training of the control room staff, advances in technology and the arrival of new generations. In this work, fundamental changes, new document format and ergonomic redesign for validation at full-scope simulator and use at main control room of new EOP for CNE are presented. (author)

Requirements for Control Room Computer-Based Procedures for use in Hybrid Control Rooms

Energy Technology Data Exchange (ETDEWEB)

Le Blanc, Katya Lee [Idaho National Lab. (INL), Idaho Falls, ID (United States); Oxstrand, Johanna Helene [Idaho National Lab. (INL), Idaho Falls, ID (United States); Joe, Jeffrey Clark [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2015-05-01

Many plants in the U.S. are currently undergoing control room modernization. The main drivers for modernization are the aging and obsolescence of existing equipment, which typically results in a like-for-like replacement of analogue equipment with digital systems. However, the modernization efforts present an opportunity to employ advanced technology that would not only extend the life, but enhance the efficiency and cost competitiveness of nuclear power. Computer-based procedures (CBPs) are one example of near-term advanced technology that may provide enhanced efficiencies above and beyond like for like replacements of analog systems. Researchers in the LWRS program are investigating the benefits of advanced technologies such as CBPs, with the goal of assisting utilities in decision making during modernization projects. This report will describe the existing research on CBPs, discuss the unique issues related to using CBPs in hybrid control rooms (i.e., partially modernized analog control rooms), and define the requirements of CBPs for hybrid control rooms.

A typical presentation of acute myeloid leukemia

Directory of Open Access Journals (Sweden)

Udayakumar N

2006-01-01

Full Text Available A young man who presented with fever, altered sensorium and sudden onset tachypnea, is described. Arterial blood gas analysis, revealed the presence of severe high anion gap metabolic acidosis, with compensatory respiratory alkalosis and normal oxygen saturation. A detailed neurological, nephrological, biochemical and hematological evaluation, revealed the presence of Acute myeloid leukemia, with lactic acidosis and hyponatremia. There are very few reports of presentation of leukemia as lactic acidosis. This case report highlights the need for emergency room physicians, to consider the possibility of lactic acidosis, as one of the causes of high anion gap acidosis and to meticulously investigate the cause of lactic acidosis. We describe a rare clinical instance of lactic acidosis as the presenting manifestation of Acute myeloid leukemia.

Biased Decision Making in Realistic Extra-Procedural Nuclear Control Room Scenarios

DEFF Research Database (Denmark)

Andersen, Emil; Kozin, Igor; Maier, Anja

In normal operations and emergency situations, operators of nuclear control rooms rely on procedures to guide their decision making. However, in emergency situations, where several interacting problems can cause unpredictable adverse effects, these procedures may be insufficient in guiding...... improve safety by creating procedures that bear the risks of these biases in mind, or by specifically aiming to debias the users. Avenues for debiasing through design are discussed....

Publication rate of abstracts presented at the emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012.

Science.gov (United States)

Kalkan, Asim; Kose, Ozkan; Bilir, Ozlem; Ersunan, Gokhan; Ozel, Deniz; Guler, Ferhat

2015-09-01

The purpose of this study was to assess the publication rate of the abstracts presented at the 6th Mediterranean Emergency Medicine Congress, 2011 and the 7th European Congress on Emergency Medicine, 2012. All abstracts, both posters and oral presentations, from the international emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012 were identified. To establish whether these abstracts were subsequently published in peer-reviewed medical journals, the names of all the authors and the title of the abstracts were searched for in the databases of Clinical Key/Elsevier, EBSCO Discovery Service, MD Consult, Science Direct, Scopus, EMBASE, Medscape, Google Scholar and local ULAKBIM. The year of publication, consistency of author names and titles, the type of study, the journals in which papers were published and countries from which reports were submitted were all recorded. A total of 1721 abstracts were examined; 626 from 2011 (307 oral presentations and 319 posters) and 1095 from 2012 (154 oral presentations and 941 posters). Of all abstracts in 2011, 172 (27.5%) and of all abstracts in 2012, 265 (24.2%) were subsequently published as full-text reports in peer-reviewed journals. Of the 172 papers published in 2011, 152 (88.4%) were accepted by Science Citation Index (SCI) and/or SCI Expanded (SCI-E) journals and 155 (58.5%) of 265 papers were accepted by SCI and/or SCI-E journals in 2012 (p=0.0001). The publication rate of abstracts submitted to international emergency medicine congresses held by EUSEM over those 2 years was low compared with that of abstracts presented in other emergency medicine congresses. Presenters should be encouraged to send their studies to peer-reviewed journals. During the selection process by the scientific panel, constructive critics should be notified to the presenters instead of simply accepting or rejecting the studies that submitted to the congress, which may increase the

Clinic and Emergency Room Evaluation and Testing of Headache.

Science.gov (United States)

Nye, Barbara L; Ward, Thomas N

2015-10-01

Evaluation of the headache patient in the outpatient clinic and emergency department (ED) has different focuses and goals. The focus of this paper is to review the evaluation of patients in both settings with mention of evaluation in the pediatric and pregnant patient population.  The patient's history should drive the practitioner's decision and evaluation choices. We review recommendations made by the American Board of Internal Medicine and American Headache Society through the Choosing Wisely Campaign, which has an emphasis on choosing the right imaging modality for the clinical situation and elimination/prevention of medication overuse headache, as well as the US Headache Consortium guidelines for migraine headache. We will also review focusing on ED evaluation of the pediatric patient and pregnant patient presenting with headache. At the end of the review we hope to have provided you with a framework to think about the headache patient and what is the appropriate test in the given clinical setting in order to ensure that the patient gets the right diagnosis and is set on a path to the appropriate management plan. © 2015 American Headache Society.

[Emergency room services utilization in the province of Reggio Emilia: a comparison between immigrants and Italians].

Science.gov (United States)

Bonvicini, Laura; Broccoli, Serena; D'Angelo, Stefania; Candela, Silvia

2011-01-01

The aim of the study is to compare Italian and immigrant accesses to Emergency Room (ER) Services in the province of Reggio Emilia, with particular attention to time differences and to potentially inappropriate accesses. the database of ER accesses in the province of Reggio Emilia was analyzed for the years 2007- 2010. In the analysis of the resident population all autochthonous citizens and all immigrants from Developed Countries were considered Italians, while citizens from Developing Countries were Immigrants. Temporary Immigrants were those immigrants with residence and citizenship in a Developing Country. A descriptive analysis was conducted using demographic variables related to patients (age, gender, citizenship and residence) and variables related to access (admission emergency codes, cause of admission, hour, day of the week, month and discharge modality). Standardized access Ratios (SRs) were calculated for the resident population, together with 95%Confidence Intervals (95% CI). The SRs were calculated separately for children and for adults. In the years 2007-2010, 562,658 accesses to ER were recorded for Italians, 95,300 accesses for Immigrants and 6,800 for the Temporary Immigrants. Access rates for resident Immigrants were higher than Italian ones. In 2010, the SR for men was 1.24 (95%CI 1.22-1.27) while for women it was 1.18 (95%CI 1.15-1.27). Considering only non-urgent accesses, the SRs were even higher (SR men=1.65, 95% CI 1.58-1.72, women=1.43, 95% CI 1.36-1.50). Similar findings were observed in children. Immigrants access the ER services more than Italians do.They also show more non-urgent accesses in comparison with Italians. This finding is consistent with results of studies conducted in other European countries and it underlines the necessity to reorganize primary care in order to better meet immigrants' needs.

To provide care and be cared for in a multiple-bed hospital room.

Science.gov (United States)

Persson, Eva; Määttä, Sylvia

2012-12-01

To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

Patients' Experiences of Cancer Diagnosis as a Result of an Emergency Presentation: A Qualitative Study.

Science.gov (United States)

Black, Georgia; Sheringham, Jessica; Spencer-Hughes, Vicki; Ridge, Melanie; Lyons, Mairead; Williams, Charlotte; Fulop, Naomi; Pritchard-Jones, Kathy

2015-01-01

Cancers diagnosed following visits to emergency departments (ED) or emergency admissions (emergency presentations) are associated with poor survival and may result from preventable diagnostic delay. To improve outcomes for these patients, a better understanding is needed about how emergency presentations arise. This study sought to capture patients' experiences of this diagnostic pathway in the English NHS. Eligible patients were identified in a service evaluation of emergency presentations and invited to participate. Interviews, using an open-ended biographical structure, captured participants' experiences of healthcare services before diagnosis and were analysed thematically, informed by the Walter model of Pathways to Treatment and NICE guidance in an iterative process. Twenty-seven interviews were conducted. Three typologies were identified: A: Rapid investigation and diagnosis, and B: Repeated cycles of healthcare seeking and appraisal without resolution, with two variants where B1 appears consistent with guidance and B2 has evidence that management was not consistent with guidance. Most patients' (23/27) experiences fitted types B1 and B2. Potentially avoidable breakdowns in diagnostic pathways caused delays when patients were conflicted by escalating symptoms and a benign diagnosis given earlier by doctors. ED was sometimes used as a conduit to rapid testing by primary care clinicians, although this pathway was not always successful. This study draws on patients' experiences of their diagnosis to provide novel insights into how emergency presentations arise. Through these typologies, we show that the typical experience of patients diagnosed through an emergency presentation diverges significantly from normative pathways even when there is no evidence of serious service failures. Consultations were not a conduit to diagnosis when they inhibited patients' capacity to appraise their own symptoms appropriately and when they resulted in a reluctance to seek

Causes and consequences of occupational stress in emergency nurses, a longitudinal study.

Science.gov (United States)

Adriaenssens, Jef; De Gucht, Veronique; Maes, Stan

2015-04-01

This longitudinal study examines the influence of changes over time in work and organisational characteristics on job satisfaction, work engagement, emotional exhaustion, turnover intention and psychosomatic distress in emergency room nurses. Organisational and job characteristics of nurses are important predictors of stress-health outcomes. Emergency room nurses are particularly exposed to stressful work-related events and unpredictable work conditions. The study was carried out in 15 emergency departments of Belgian general hospitals in 2008 (T1) and 18 months later (T2) (n = 170). Turnover rates between T1 and T2 were high. Important changes over time were found in predictors and outcomes. Changes in job demand, control and social support predicted job satisfaction, work engagement and emotional exhaustion. In addition, changes in reward, social harassment and work agreements predicted work engagement, emotional exhaustion and intention to leave, respectively. Work-related interventions are important to improve occupational health in emergency room nurses and should focus on lowering job demands, increasing job control, improving social support and a well-balanced reward system. Nursing managers should be aware of the causes and consequences of occupational stress in emergency room nurses in order to enable preventive interventions. © 2013 John Wiley & Sons Ltd.

Use of Diuretics is not associated with mortality in patients admitted to the emergency department: results from a cross-sectional study.

Science.gov (United States)

Haider, Dominik G; Lindner, Gregor; Wolzt, Michael; Leichtle, Alexander Benedikt; Fiedler, Georg-Martin; Sauter, Thomas C; Fuhrmann, Valentin; Exadaktylos, Aristomenis K

2016-02-01

Patients with diuretic therapy are at risk for drug-induced adverse reactions. It is unknown if presence of diuretic therapy at hospital emergency room admission is associated with mortality. In this cross sectional analysis, all emergency room patients 2010 and 2011 at the Inselspital Bern, Switzerland were included. A multivariable logistic regression model was performed to assess the association between pre-existing diuretic medication and 28 day mortality. Twenty-two thousand two hundred thirty-nine subjects were included in the analysis. A total of 8.5%, 2.5%, and 0.4% of patients used one, two, or three or more diuretics. In univariate analysis spironolactone, torasemide and chlortalidone use were associated with 28 day mortality (all p 0.05). No difference existed between patients with or without diuretic therapy (P > 0.05). Age and creatinine were independent risk factors for mortaliy (both p diuretics is not associated with mortality in an unselected cohort of patients presenting in an emergency room.

HAMMLAB 1999 experimental control room: design - design rationale - experiences

International Nuclear Information System (INIS)

Foerdestroemmen, N. T.; Meyer, B. D.; Saarni, R.

1999-01-01

A presentation of HAMMLAB 1999 experimental control room, and the accumulated experiences gathered in the areas of design and design rationale as well as user experiences. It is concluded that HAMMLAB 1999 experimental control room is a realistic, compact and efficient control room well suited as an Advanced NPP Control Room (ml)

Poluição atmosférica devida à queima de biomassa florestal e atendimentos de emergência por doença respiratória em Rio Branco, Brasil - Setembro, 2005 Anthropogenic air pollution and respiratory disease-related emergency room visits in Rio Branco, Brazil - September, 2005

Directory of Open Access Journals (Sweden)

Márcio Dênis Medeiros Mascarenhas

2008-01-01

Full Text Available A poluição atmosférica é um importante problema de saúde pública, principalmente na Amazônia e grandes cidades brasileiras. Em setembro de 2005, observou-se elevada concentração de fumaça em Rio Branco, Acre, devido às queimadas. Para avaliar a relação entre a concentração diária de particulate matter Air pollution is a major public health problem in the Amazon forest and in large Brazilian cities. During September of 2005, high concentrations of smoke from biomass burning were observed in the city of Rio Branco. An ecological study was conducted to evaluate the relationship between daily concentrations of particulate matter < 2.5 µm (PM2.5 and the number of respiratory disease (RD-related emergency room visits. Daily PM2.5 concentrations exceeded recommended air quality limits on 23 days. The incidence of RDs was higher among children < 10 years of age. There was a significant positive correlation between PM2.5 concentrations and asthma emergency room visits.

From Smart Rooms to Smart Hotels

OpenAIRE

Petrevska, Biljana; Cingoski, Vlatko; Gelev, Saso

2016-01-01

This paper gives an overview of a potential path that new hotels have to satisfy to improve their status from a hotel with smart rooms towards a full-scale smart hotel facility. It presents a possible transitional way including innovative applications based on modern information technology for ambient settings in the domain of hotel industry that aims to improve the quality of offered services towards clients, starting from the present level of smart rooms. The main objective i...

The Toxiscape Hunt: An Escape Room-Scavenger Hunt for Toxicology Education

Directory of Open Access Journals (Sweden)

Megan Boysen-Osborn

2018-01-01

Full Text Available Audience: This scavenger hunt/escape room is a didactic activity for emergency medicine residents or fourth-year medical students rotating in emergency medicine. Introduction: Between 2008-2011, 1.1 million patients presented to U.S. emergency departments each year for poisonings,1 including acute ingestions, envenomations, occupational exposures, and overdoses. Toxicologic exposures are considered part of the core curriculum for emergency medicine (EM residents, who must understand the presentation and treatment of such patients.2 Educating residents in a unique, engaging format such as an “escape room” activity provides an alternative to the didactic format of teaching this material, which may build medical knowledge and team rapport amongst residents.3 Objectives: By the end of the activity, learners should be able to: Calculate an anion and osmolal gap. Recognize poisonings amenable to hemodialysis. Interpret EKG changes related to a variety of ingestions, including beta-blockers and calcium channel blockers, digitalis, and tricyclic antidepressants. Recognize poisonous plants and their clinical toxidromes. Calculate loading dose of N-acetylcysteine as antidote for acute acetaminophen ingestion. Collaborate as a team to arrive at solutions of problems. Recognize poisons that have available antidotes Know the clinical effect of various types of snake envenomations. Recognize the toxicity associated with at least four household chemicals. Know the antidotes for six common poisonings. Methods: This didactic exercise is a small group activity, utilizing puzzles to apply toxicology knowledge.

Creys-Malville control room and data processing

International Nuclear Information System (INIS)

Decuyper, J.

1984-01-01

After a brief definition of the control of a plant, this article presents the Creys-Malville control room: control means display and considerations on ergonomy and specific features in respect of the PWR control room. The Creys-Malville data processing is then rapidly presented with a brief description, the different data treatments and the specificity of the centralised data computer [fr

Virtual Presenters: Towards Interactive Virtual Presentations

NARCIS (Netherlands)

Nijholt, Antinus; Cappellini, V.; Hemsley, J.

2005-01-01

We discuss having virtual presenters in virtual environments that present information to visitors of these environments. Some current research is surveyed and we will look in particular to our research in the context of a virtual meeting room where a virtual presenter uses speech, gestures, pointing

Room Acoustics

Science.gov (United States)

Kuttruff, Heinrich; Mommertz, Eckard

The traditional task of room acoustics is to create or formulate conditions which ensure the best possible propagation of sound in a room from a sound source to a listener. Thus, objects of room acoustics are in particular assembly halls of all kinds, such as auditoria and lecture halls, conference rooms, theaters, concert halls or churches. Already at this point, it has to be pointed out that these conditions essentially depend on the question if speech or music should be transmitted; in the first case, the criterion for transmission quality is good speech intelligibility, in the other case, however, the success of room-acoustical efforts depends on other factors that cannot be quantified that easily, not least it also depends on the hearing habits of the listeners. In any case, absolutely "good acoustics" of a room do not exist.

Strategies of modeling the cognitive tasks of human operators for accident scenarios in nuclear power plant control rooms

International Nuclear Information System (INIS)

Cheon, Se Woo; Sur, Sang Moon; Lee, Yong Hee; Lee, Jeong Wun

1993-01-01

This paper presents the development strategies of cognitive task network modeling for accident scenarios in nuclear power plant control rooms. Task network modeling is used to provide useful predictions of operator's performance times and error rates, based upon plant procedures and/or control room changes. Two accident scenarios, small-break loss of coolant accident (LOCA) and steam generator tube rupture (SGTR), are selected for task simulation. To obtain the input data for the model, task elements are extracted by the task analysis of emergency operating procedures. The input data include task performance time, communication ink, panel location, component operating mode, and data for performance shaping factors (PSFs). Operator's verbs are categorized according to the elements of cognitive behavior. The simulation of the task network for the small-break LOCA scenario is presented in this paper. (Author)

New Emergency control center of Slovenske Elektrarne Bohunice NPP

International Nuclear Information System (INIS)

Pecko, E.

2012-01-01

Emergency preparedness of nuclear power plant and operation assurance in case of a possible emergency calls to have devices for emergency response with equipment for rapid detection and continuous evaluation of anticipated events. Chief executive body designated to manage a nuclear power plant during major events is the emergency committee (EC). Emergency Committee is a part of the Emergency Response Organization (ERO). The following centers are on alert to ensure the activities of the ERO - Emergency Response office: - control room (CR) and emergency control room (ECR); - emergency management center (EMC); - Monitoring Centre (MC); - emergency backup control center (EBCC); - congregations of civil protection (CP) and CP shelters; - communications with warning and notification system (VARVYR). From a historical and practical point of view in the vicinity of Jaslovske Bohunice has been set up a joint emergency control center. The center was located on the territory of the former already inoperative V1 NPP. V1 NPP is currently integrated into the organizational structure of JAVYS. Operating Bohunice V2 NPP plant is a designated part of the Slovenske Elektrarne, a. s., whose majority owner is an Italian operator ENEL. In terms of various relevant factors, it was decided to build a new emergency management center on the territory of operating V2 NPP, meet the current standards.

Quality of care using a multidisciplinary team in the emergency room

DEFF Research Database (Denmark)

Christensen, Dorthea; Maaløe, Rikke; Jensen, Nanna Martin

2011-01-01

Bispebjerg Hospital has implemented a multidisciplinary team reception of critically ill and severely injured patients at the Emergency Department (ED), termed emergency call (EC) and trauma call (TC). The aim of this study was to describe the course, medical treatment and outcome for patients re...... received by this multidisciplinary team and to evaluate the quality of acute medical treatment of these patients....

Family presence preference when patients are receiving resuscitation in an accident and emergency department.

Science.gov (United States)

Hung, Maria S Y; Pang, Samantha M C

2011-01-01

This paper is a report of a study to illuminate the experience of family members whose relatives survived the resuscitation in an accident and emergency department, and their preferences with regard to being present. Family presence during resuscitation can offer benefits to both patient and family members, and large healthcare organizations support and recommend offering the option for their presence. However, many staff believe that this is too distressing or traumatic for families and that they would interfere with the resuscitation process. An interpretive phenomenological approach was used to collect data in 2007-2008 with 18 family members of patients who survived life-sustaining interventions in an accident and emergency department in Hong Kong. Audio-recorded interviews were transcribed verbatim for thematic analysis and verified with the participants in second interviews. None of the family members was present in resuscitation room during the life-sustaining interventions, and five entered the room after the patients' condition was stable. The majority indicated a strong preference to be present if given the option. Three interrelated themes emerged: (i) emotional connectedness, (ii) knowing the patient, and (iii) perceived (in)appropriateness, with 10 subthemes representing affective, rational and contextual determinants of family presence preferences. The interplay of these determinants and how they contributed to strong or weak preference for family presence was analysed. Variations among the contributing determinants to each family member's preference to be present were revealed. Appropriate nursing interventions, policy and guidelines should be developed to meet individualized needs during such critical and life-threatening moments in accident and emergency departments. © 2010 Blackwell Publishing Ltd.

Epidemiological profile of work-related accidents with biological exposure among medical students in a surgical emergency room.

Science.gov (United States)

Reis, Phillipe Geraldo Teixeira de Abreu; Driessen, Anna Luiza; da Costa, Ana Claudia Brenner Affonso; Nasr, Adonis; Collaço, Iwan Augusto; Tomasich, Flávio Daniel Saavedra

2013-01-01

To evaluate the accidents with biological material among medical students interning in a trauma emergency room and identify key related situations, attributed causes and prevention. we conducted a study with a quantitative approach. Data were collected through a questionnaire applied via internet, with closed, multiple-choice questions regarding accidents with biological material. The sample comprised 100 students. thirty-two had accidents with biological material. Higher-risk activities were local anesthesia (39.47%), suture (18.42%) and needle recapping (15.79%). The main routes of exposure to biological material were the eyes or mucosa, with 34%, and syringe needle puncture, with 45%. After contamination, only 52% reported the accident to the responsible department. The main causes of accidents and routes of exposure found may be attributed to several factors, such as lack of training and failure to use personal protective equipment. Educational and preventive actions are extremely important to reduce the incidence of accidents with biological materials and improve the conduct of post-exposure. It is important to understand the main causes attributed and situations related, so as general and effective measures can be applied.

To stay or to go? Balancing the risk of reprocessing plant control room evacuation following a criticality alarm

International Nuclear Information System (INIS)

Love, Suzanne; McCrindle, David; Harris, Neil; Haworth, Justin

2003-01-01

Following a criticality alarm within the Magnox Separation Plant at Sellafield, there is a conflict of interest between the risks associated with complete evacuation versus continued manning of the control room. The historic emergency response policy would be to completely evacuate the control room upon a criticality alarm. If, however, the alarm was found to be false, the inevitable loss in control over the plant could have environmental, operational and radiological release consequences. Maintaining control room manning following a genuine alarm might, however, result in an avoidable high dose to an operator. Based upon the estimated dose equivalent to a control room operator for a range of criticality incident morphologies a risk analysis was undertaken. The results indicate that the differential risk between an operator who evacuates immediately and an operator who remains for a short time to complete diagnostic checks is very small. As a consequence a new emergency policy was therefore developed on plant which results in a relatively low risk to control room operators, but still allows control over the plant to be retained following a false criticality alarm. (author)

Observations of Chat Room Conversations on the Internet: Implications for Educators Addressing the Needs of Female Adolescents

Science.gov (United States)

Sanger, Dixie; Ritzman, Mitzi; LaCost, Barbara; Stofer, Keri; Long, Amie; Grady, Marilyn

2005-01-01

This qualitative study explored the meanings of chat room conversations through observations of teenagers using the Internet. Adolescent girls were a focus because of their shaky sense of self. Participants in ten chat rooms included 534 individuals. Six themes, emerging from analyzing 2526 utterances [descriptive statements], included (a)…

Sex Differences in “Weightlifting” Injuries Presenting to United States Emergency Rooms

OpenAIRE

Quatman, Carmen E.; Myer, Gregory D.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

2009-01-01

Benefits of resistance training include improved muscle strength and sports performance, and may include reduced injuries. However, few studies have examined sex differences in resistance training related injuries. The objective of this investigation was to evaluate sex differences in injuries associated with weightlifting, in adolescents and young adults by type (sprains and strains, fractures), mechanism (accidental, non-accidental) and location (head, trunk, arm, hand, leg, foot) of injury...

Sex Differences in “Weightlifting” Injuries Presenting to United States Emergency Rooms

Science.gov (United States)

Quatman, Carmen E.; Myer, Gregory D.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

2009-01-01

Benefits of resistance training include improved muscle strength and sports performance, and may include reduced injuries. However, few studies have examined sex differences in resistance training related injuries. The objective of this investigation was to evaluate sex differences in injuries associated with weightlifting, in adolescents and young adults by type (sprains and strains, fractures), mechanism (accidental, non-accidental) and location (head, trunk, arm, hand, leg, foot) of injury. We hypothesized that there would be sex differences in type, mechanism and location of “weightlifting” injuries. The US Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) was queried from 2002-2005, using the CPSC code for “Weightlifting.” Subjects between the ages of 14 and 30 were included in the study. CPSC sampling weights were used to calculate national estimates from the sample of 3,713 patients (Males= 3,102; Females= 611). Weighted Chi-square analyses were used to compare differences in mechanism, type, and location of injury for males versus females. Males had significantly more sprains and strains (P=0.004), while females demonstrated increased accidental injuries compared to males (Pinjuries than females (Pinjuries than males (Pinjuries during weightlifting (sprains and strains) compared to females, especially at the trunk. Conversely, females may be more susceptible to lower extremity injuries resulting from accidents during resistance training. PMID:19855331

Wind tunnel testing to predict control room atmospheric dispersion factors

International Nuclear Information System (INIS)

Holmquist, L.J.; Harden, P.A.; Muraida, J.E.

1993-01-01

Recent concerns at Palisades about control room habitability in the event of a loss-of-coolant accident have led to an extensive effort to increase control room habitability margin. The heating, ventilating and air-conditioning (HVAC) system servicing the control room has the potential for unfiltered in-leakage through its normal outside air intake louvered isolation dampers during emergency mode. The current limiting control room habitability analysis allows for 1.2 x 10 -2 m 3 /s (25 ft 3 /min) unfiltered in-leakage into the control room envelope. This leakage value was not thought to be achievable with the existing as-built configuration. Repairing the system was considered as a potential solution; however, this would be costly and could negatively affect plant operation. In addition, the system would still be required to meet the low specified unfiltered in-leakage. A second approach to this problem was to determine the atmospheric dispersion factors (x/Q's) through a wind tunnel test using a scale model of Palisades. The results of the wind tunnel testing could yield more realistic x/Q's for control room habitability than previously employed methods. Palisades selected the wind tunnel study option based on its ease of implementation, realistic results, and low cost. More importantly, the results of the study could increase the allowable unfiltered in-leakage

Child Maltreatment and Onset of Emergency Department Presentations for Suicide-Related Behaviors

Science.gov (United States)

Rhodes, Anne E.; Boyle, Michael H.; Bethell, Jennifer; Wekerle, Christine; Goodman, Deborah; Tonmyr, Lil; Leslie, Bruce; Lam, Kelvin; Manion, Ian

2012-01-01

Objectives: To determine whether the rates of a first presentation to the emergency department (ED) for suicide-related behavior (SRB) are higher among children/youth permanently removed from their parental home because of substantiated maltreatment than their peers. To describe the health care settings accessed by these children/youth before a…

Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.

Directory of Open Access Journals (Sweden)

Taro Takeshima

Full Text Available (1 To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER of community hospitals, and (2 to test the validity of that rule with a separate, independent set of data.Multicenter retrospective cohort study.To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation. We tested the rule using data from one other community hospital (validation, which was not among the three "derivation" hospitals.Adults (age ≥ 16 years old who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients, and for the validation data n = 467 (from 823 patients.We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the "ID-BactER" score. Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC were computed.There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation and 0.74 (validation. For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively.The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.

Assessing Nurse Anaesthetists' Non-Technical Skills in the operating room.

Science.gov (United States)

Lyk-Jensen, H T; Jepsen, R M H G; Spanager, L; Dieckmann, P; Østergaard, D

2014-08-01

Incident reporting and fieldwork in operating rooms have shown that some of the errors that arise in anaesthesia relate to inadequate use of non-technical skills. To provide a tool for training and feedback on nurse anaesthetists' non-technical skills, this study aimed to adapt the Anaesthetists' Non-Technical Skills (ANTS) as a behavioural marker system for the formative assessment of nurse anaesthetists' non-technical skills in the operating room. A qualitative approach with focus group interviews was used to identify the non-technical skills of nurse anaesthetists in the operating room. The interview data were transcribed verbatim. Directed content analysis was used to code and sort data deductively into the ANTS categories: task management, team working, situation awareness and decision making. The prototype named Nurse Anaesthetists' Non-Technical Skills (N-ANTS) was presented and discussed in a group of subject matter experts to ensure face validity. The N-ANTS system consists of the same four categories as ANTS and 15 underlying elements. Three to five good and poor behavioural markers for each element were identified. The headings and definitions of the categories and elements were adjusted to encompass the behavioural markers in N-ANTS. The differences that emerged mainly reflected statements regarding the establishment of role, competence, and task delegation. A behavioural marker system, N-ANTS, for nurse anaesthetists was adapted from a behavioural marker system, ANTS, for anaesthesiologists. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Management of Radiological emergencies

International Nuclear Information System (INIS)

Lentijo, J. C.; Gil, E.; San Nicolas, J.; Lazuen, J. A.

2004-01-01

Spain has a system of planning and response to emergency situations that is structured and coordinated by the General Directorship of civil Defense of the Ministry of the Interior and in which all levels of the Public Administration. state, autonomous and municipal-and owners of potentially hazardous activities participate. Activities involving a nuclear or radiological risk have specific emergency plans whose general principles are based on the general emergency system and whose technical bases are consistent with international practices and recommendations. The Consejo de Seguridad Nuclear actively participates in the design, implementation and activation of these plans, and for this purpose has an organization superimposed on its ordinary working organization that is activated in the event of an accident, as well as an Emergency Room specifically designed to deal with nuclear and radiological emergencies. (Author)

Nuclear power station main control room habitability

International Nuclear Information System (INIS)

Paschal, W.B.; Knous, W.S.

1989-01-01

The main control room at a nuclear power station must remain habitable during a variety of plant conditions and postulated events. The control room habitability requirement and the function of the heating, ventilating, air-conditioning, and air treatment system are to control environmental factors, such as temperature, pressure, humidity, radiation, and toxic gas. Habitability requirements provide for the safety of personnel and enable operation of equipment required to function in the main control room. Habitability as an issue has been gaining prominence with the Advisor Committee of Reactor Safeguards and the Nuclear Regulatory Commission since the incident at Three Mile Island. Their concern is the ability of the presently installed habitability systems to control the main control room environment after an accident. This paper discusses main control room HVAC systems; the concern, requirements, and results of NRC surveys and notices; and an approach to control room habitability reviews

Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources.

Science.gov (United States)

Henize, Adrienne W; Beck, Andrew F; Klein, Melissa D; Morehous, John; Kahn, Robert S

2018-06-01

Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center. Design experts sought input about an optimal waiting room from families, community partners and medical providers. Family caregivers were surveyed before and after redesign regarding perceived availability of help with social needs and access to community resources, and hospitality and feelings of stress. Pre-post differences were assessed using the Chi square or Wilcoxon rank sum test. Results The key redesign concepts that emerged included linkages to community organizations, a welcoming environment, and positive distractions for children. A total of 313 caregiver surveys were completed (pre-160; post-153). Compared to pre-redesign, caregivers surveyed post-redesign were significantly more likely to perceive the waiting room as a place to obtain help connecting to community resources and find information about clinical and educational resources (both p < 0.05). Families were also significantly more likely to report the waiting room as more welcoming and relaxing, with sufficient privacy and space (all p < 0.05). Discussion Waiting rooms, typically a place of wasted time and space, can be redesigned to enhance families' engagement and connection to community resources.

Managing psychiatric emergencies in persons with mental health ...

African Journals Online (AJOL)

Background: Psychiatric emergencies are commonly encountered by the emergency room team where non-mental health specialists are often the first care providers. Materials and Methods: The study took place at the University of Ibadan Health Service, it was a descriptive cross-sectional study and participants were ...

Self-Presentation and Interaction in Blogs of Adolescents and Young Emerging Adults

Science.gov (United States)

Mazur, Elizabeth; Kozarian, Lauri

2010-01-01

This article analyzed 124 blogs, chronological, journal-type entries published on public hosting Web sites, as new and popular places for adolescents and emerging adults aged 15 to 19 to play openly with their self-presentation, an important aspect of identity exploration. Findings indicate that most young persons write emotionally toned entries;…

The "Emerging" and "Emergent" Present: A View on the Indeterminate Nature of Mathematics Lessons

Science.gov (United States)

Roth, Wolff-Michael; Maheux, Jean-François

2014-01-01

The notion of emergence has considerable currency in mathematics education. However, the notion tends to be used in a descriptive way rather than being theorized and developed as a phenomenon sui generis. The purpose of this article is to contribute to building a theory of "emergence." After providing an exemplifying description and…

Emergency thyroidectomy in infected thyroid cyst due to spontaneous gas forming organisms

International Nuclear Information System (INIS)

Masood, R.; Chudhary, I.A.; Shaumaila, T.

2008-01-01

We are reporting a case of a young female, who presented to emergency room with sudden increase in thyroid swelling, high fever and acute respiratory distress. Clinical diagnosis of spontaneous infection of thyroid cyst was made. Operative finding was infection of thyroid cyst with gas formation. Systemic antibiotics and operative intervention by subtotal thyroidectomy led to recovery of the patient. (author)

Digital angiography and surgery in the same room

International Nuclear Information System (INIS)

Goldman, M.L.; Hack, S.N.; Sarrafizadeh, M.S.; Marar, H.G.; Behar, D.J.; Chigurupati, R.C.; Klein, S.I.; Widlus, D.M.; Fortune, J.B.

1986-01-01

Albany Medical Center and private industries (XRE and United X-ray corporations) have collaborated to develop a room within the operating suite that allows high-speed and high-resolution digital angiography and surgery to be performed simultaneously. Patients who have sustained massive trauma can be transferred directly from the ambulance to this new facility. While the patient is undergoing exploratory laparotomy, other vital areas of the body can be evaluated by angiography. This combined approach of surgery and angiography has also led to improved management of patients with massive or occult intestinal hemorrhage and patients with peripheral vascular disease. Other patients undergoing difficult emergency or elective surgery, as in the biliary tract, can now have available the benefits of an operating room facility that also allows high-resolution fluoroscopy and complete angiography to be undertaken

Measurement of low-frequency noise in rooms

DEFF Research Database (Denmark)

Pedersen, Steffen; Møller, Henrik; Persson-Waye, Kerstin

2006-01-01

Measurement of low-frequency noise in rooms is problematic due to standing wave patterns. The spatial variation in the sound pressure level can typically be as much as 20-30 dB. For assessment of annoyance from low-frequency noise in dwellings, it is important to measure a level close...... rooms. The sound pressure level was measured 1) in three-dimensional corners and 2) according to current Swedish and Danish measurement methods. Furthermore, the entire sound pressure distributions were measured by scanning. The Swedish and Danish measurement methods include a corner measurement...... to the highest level present in a room, rather than a room average level. In order to ensure representative noise measurements, different positions were investigated based on theoretical considerations and observations from numerical room simulations. In addition measurements were performed in three different...

Perceptual effects in auralization of virtual rooms

Science.gov (United States)

Kleiner, Mendel; Larsson, Pontus; Vastfjall, Daniel; Torres, Rendell R.

2002-05-01

By using various types of binaural simulation (or ``auralization'') of physical environments, it is now possible to study basic perceptual issues relevant to room acoustics, as well to simulate the acoustic conditions found in concert halls and other auditoria. Binaural simulation of physical spaces in general is also important to virtual reality systems. This presentation will begin with an overview of the issues encountered in the auralization of room and other environments. We will then discuss the influence of various approximations in room modeling, in particular, edge- and surface scattering, on the perceived room response. Finally, we will discuss cross-modal effects, such as the influence of visual cues on the perception of auditory cues, and the influence of cross-modal effects on the judgement of ``perceived presence'' and the rating of room acoustic quality.

The Virtual Dressing Room

DEFF Research Database (Denmark)

Holte, Michael Boelstoft

2013-01-01

This paper presents a review of recent developments and future perspectives, addressing the problem of creating a virtual dressing room. First, we review the current state-of-the-art of exiting solutions and discuss their applicability and limitations. We categorize the exiting solutions into three...... kinds: (1) virtual real-time 2D image/video techniques, where the consumer gets to superimpose the clothes on their real-time video to visualize themselves wearing the clothes. (2) 2D and 3D mannequins, where a web-application uses the body measurements provided by the customer, to superimpose...... and their demands to a virtual dressing room....

Three-dimensional point-cloud room model in room acoustics simulations

DEFF Research Database (Denmark)

Markovic, Milos; Olesen, Søren Krarup; Hammershøi, Dorte

2013-01-01

acquisition and its representation with a 3D point-cloud model, as well as utilization of such a model for the room acoustics simulations. A room is scanned with a commercially available input device (Kinect for Xbox360) in two different ways; the first one involves the device placed in the middle of the room...... and rotated around the vertical axis while for the second one the device is moved within the room. Benefits of both approaches were analyzed. The device's depth sensor provides a set of points in a three-dimensional coordinate system which represents scanned surfaces of the room interior. These data are used...... to build a 3D point-cloud model of the room. Several models are created to meet requirements of different room acoustics simulation algorithms: plane fitting and uniform voxel grid for geometric methods and triangulation mesh for the numerical methods. Advantages of the proposed method over the traditional...

Three-dimensional point-cloud room model for room acoustics simulations

DEFF Research Database (Denmark)

Markovic, Milos; Olesen, Søren Krarup; Hammershøi, Dorte

2013-01-01

acquisition and its representation with a 3D point-cloud model, as well as utilization of such a model for the room acoustics simulations. A room is scanned with a commercially available input device (Kinect for Xbox360) in two different ways; the first one involves the device placed in the middle of the room...... and rotated around the vertical axis while for the second one the device is moved within the room. Benefits of both approaches were analyzed. The device's depth sensor provides a set of points in a three-dimensional coordinate system which represents scanned surfaces of the room interior. These data are used...... to build a 3D point-cloud model of the room. Several models are created to meet requirements of different room acoustics simulation algorithms: plane fitting and uniform voxel grid for geometric methods and triangulation mesh for the numerical methods. Advantages of the proposed method over the traditional...

Prallethrin Poisoning Presenting as Status Epilepticus

Directory of Open Access Journals (Sweden)

D Vijayaraju

2014-02-01

Full Text Available Mosquito repellents contain pyrethroid derivatives, as the active ingredient. Data regarding human toxicity following oral intake is limited. This is a case report of an individual who presented with neurotoxicity following oral ingestion of prallethrin (2.4% w/w of a higher concentration present in formulations commercially available than previously. A 22 year old male presented to the emergency Room (ER in status epilepticus. He was managed in the Intensive Care Unit (ICU. No cause for his status could be determined after all laboratory investigations. A review of history with the patient revealed that he had ingested a bottle of liquid mosquito repellent (45 ml. The patient has had no further symptoms on follow up and has been off anti epileptics. Pyrethroid containing mosquito repellents act on neuronal sodium channels causing hyperexcitiability. With no known specific antidotes, symptomatic treatment is the main stay of management.

Control room MMI 2000 for NORS simulator in HAMMLAB

International Nuclear Information System (INIS)

Saarni, R.; Foerdestroemmen, N.T.; Meyer, B.D.; Skjerve, A.B.M.

2001-03-01

The report presents the control room MMI as of year 2000 for the NORS simulator in HAMMLAB. It consists of two main parts: NORS Reference Control Room MMI and NORS Experimental Control Room MMI. They are both utilised in human factors experiments in HAMMLAB. The HAMMLAB Experimental Control Room 2000 is presented together with the NORS Reference CR MMI, which includes the following display types: Overview displays, process and control displays, trend displays, supplementary alarm displays and logic displays for the protection system and other automatic control systems. User experiences based on feedback from professional Loviisa NPP operators are also given. For the Experimental Control Room MMI, main emphasis is on presenting the design of a new large screen overview display called; experimental Automatic Information Presentation (AIP) display. It was used for the first time last year in the HCA-2000 experiment in HAMMLAB. The design is quite different from previous overview displays being developed and used in HAMMLAB. The display presents the overall dynamic status of both the process and the automatic systems. The plans for the future include to develop and user test an upgraded AIP overview display, and to enhance and user test a limited set of task-based display prototypes. (Author)

A STUDY ON VARIOUS MODES OF PRESENTATION OF GASTROINTESTINAL TUBERCULOSIS AT EMERGENCY, ITS MANAGEMENT AND OUTCOMES

Directory of Open Access Journals (Sweden)

Krishna Mohan

2016-02-01

Full Text Available Abdominal tuberculosis is the 6th most common form of extrapulmonary tuberculosis, among which ileocaecal tuberculosis is most common. Tuberculosis has been declared a global emergency by the World Health Organization (WHO and is the most important communicable disease worldwide. Approximately one third of the world population is infected and about three millions die each year from this disease. It presents with a wide variety of symptoms and signs. Gastrointestinal tuberculosis presents to emergency department as subacute intestinal obstruction, acute intestinal obstruction and peritonitis. Although Antitubercular chemotherapy is the mainstay in treatment of abdominal tuberculosis, surgical intervention becomes necessary for two reasons- diagnostic and therapeutic. Diagnostic laparotomy becomes necessary for histopathological/microbiological diagnosis, more often in patients with peritoneal or lymph node TB. Therapeutic surgery is the treatment of choice in emergency for treating intestinal obstruction & peritonitis. Morbidity and mortality will be high in patients with late presentation and associated comorbidities. AIMS AND OBJECTIVES: (1 To study various modes of presentation and management of Gastrointestinal Tuberculosis at emergency surgical care, in our hospital, its management and outcomes. (2 To evaluate the morbidity and mortality in acute presentations of Gastrointestinal tuberculosis. MATERIALS AND METHODS An Observational study of 40 patients admitted in the acute surgical care unit of Our Hospital, Hyderabad, presenting with acute abdomen who have been confirmed to have Gastrointestinal tuberculosis at laparotomy and on histopathology from Aug 2013 to Aug 2015. The patient was managed by laparotomy and procedure according to the mode of presentation. All the patients were given ATT post operatively. RESULTS Gastrointestinal tuberculosis is more common in 2nd and 3rd decade of life. Acute presentations were found to be more common

[Cirurgia Taurina--emergency medical treatment of bullfighters in Spain].

Science.gov (United States)

Lehmann, V; Lehmann, J

2003-08-01

A considerable risk of life-threatening injury is inherent to bullfighting. Thus, a unique form of emergency treatment has evolved over recent decades of organized bull-fighting. Today bullfight arenas in larger cities are equipped with emergency facilities including fully furnished operating rooms. During a fiesta these facilities are run by a medical team consisting of three surgeons, one intensive care specialist, and one anesthesiologist with their supporting medical personnel. In smaller arenas or villages immediate care units consist of emergency vehicles, and a mobile container equipped with a fully functional operating room. Of all toreros the matadores including the novilleros are most often injured in 56 % of cases. This rate decreases for banderillos (30 %), and for picadores (14 %). Parts of the body that are most frequently affected are thighs, and the inguinal region (54 %). Head and neck injuries are seen in 19 %, and 12 % of cases present with open abdominal wounds including liver or gastrointestinal tract traumas. 10 % of injuries affect the thorax, and 4 % the pelvic floor. The particular form of organised medical treatment for bullfighters in Spain has only developed since the nineteen-thirties. In 1972 a scientific society for bullfight surgery was founded in Spain by specialized surgeons, and immediate care specialists holding a first convention that year. The society is continuously striving to improve technical and logistical aspects of immediate medical care for injured bullfighters.

Emergency room management of ureteral calculi: current practices.

Science.gov (United States)

Phillips, Elizabeth; Kieley, Sam; Johnson, Elizabeth B; Monga, Manoj

2009-06-01

To evaluate current practice patterns in U.S. emergency departments (EDs) for the diagnosis, treatment, and counseling of patients with ureteral calculi. Hospital-based ED physicians were invited by e-mail to participate in a Survey-Monkey survey. E-mails were delivered in March 2008 by Direct Medical Data using a listserv provided by the American Medical Association. Of the e-mails sent, 173 e-mails were opened, and 135 physicians responded. Physicians were compensated with a $10 Amazon.com gift card. Ninety percent of ED physicians use noncontrast CT as their initial imaging modality, and 63% use alpha-blockers for medical expulsive therapy. Only 13% of evaluated EDs have guidelines for the management of renal colic, and only 58% of these guidelines that recommend the use of an alpha-blocker. Alpha-blocker use was more common with physicians who have been practicing fewer than 5 years (81%) compared with those with more than 10 years of experience (56%). The majority of physicians used ketorolac and morphine to achieve effective analgesia. Although the average responses concerning the chance of spontaneous stone passage for stones 4 mm (44%) were close to evidence-based values, great variation in the answers was noted (standard deviations: 12% and 22%, respectively). Indeed, 38% of respondents stated that stones 95% chance of passage. Twenty-eight percent of ED physicians would arrange follow-up with a primary care physician, while the remainder would arrange follow-up with a urologist. This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.

Evaluation of the Recognition of Stroke in the Emergency Room (ROSIER scale in Chinese patients in Hong Kong.

Directory of Open Access Journals (Sweden)

Hui-lin Jiang

Full Text Available BACKGROUND AND PURPOSE: The objective of this study was to determine the performance of the Recognition Of Stroke In the Emergency Room (ROSIER scale in risk-stratifying Chinese patients with suspected stroke in Hong Kong. METHODS: This was a prospective cohort study in an urban academic emergency department (ED over a 7-month period. Patients over 18 years of age with suspected stroke were recruited between June 2011 and December 2011. ROSIER scale assessment was performed in the ED triage area. Logistic regression analysis was used to estimate the impacts of diagnostic variables, including ROSIER scale, past history and ED characteristics. FINDINGS: 715 suspected stroke patients were recruited for assessment, of whom 371 (52% had acute cerebrovascular disease (302 ischaemic strokes, 24 transient ischaemic attacks (TIA, 45 intracerebral haemorrhages, and 344 (48% had other illnesses i.e. stroke mimics. Common stroke mimics were spinal neuropathy, dementia, labyrinthitis and sepsis. The suggested cut-off score of>0 for the ROSIER scale for stroke diagnosis gave a sensitivity of 87% (95%CI 83-90, a specificity of 41% (95%CI 36-47, a positive predictive value of 62% (95%CI 57-66, and a negative predictive value of 75% (95%CI 68-81, and the AUC was 0.723. The overall accuracy at cut off>0 was 65% i.e. (323+141/715. INTERPRETATION: The ROSIER scale was not as effective at differentiating acute stroke from stroke mimics in Chinese patients in Hong Kong as it was in the original studies, primarily due to a much lower specificity. If the ROSIER scale is to be clinically useful in Chinese suspected stroke patients, it requires further refinement.

The Clock Is Ticking: Library Orientation as Puzzle Room

Science.gov (United States)

Reade, Tripp

2017-01-01

Tripp Reade is the school librarian at Cardinal Gibbons High School in Raleigh, North Carolina. This article describes how he redesigned his school's library orientation program after learning about escape rooms and a variant known as puzzle rooms. Puzzle rooms present players with a set of challenges to solve; they require "teamwork,…

Room with a View: Ethical Encounters in Room 13

Science.gov (United States)

Grube, Vicky

2012-01-01

In this article, the author describes ethical encounters in Room 13, a schoolroom where children made what they wanted, posed their own questions, and ran an art room like a small business. In Room 13 children had the responsibility to maintain all aspects of the art studio. Specific decisions fell to an annually elected management team, a small…

Room temperature creep in metals and alloys

Energy Technology Data Exchange (ETDEWEB)

Deibler, Lisa Anne [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Materials Characterization and Performance

2014-09-01

Time dependent deformation in the form of creep and stress relaxation is not often considered a factor when designing structural alloy parts for use at room temperature. However, creep and stress relaxation do occur at room temperature (0.09-0.21 T_m for alloys in this report) in structural alloys. This report will summarize the available literature on room temperature creep, present creep data collected on various structural alloys, and finally compare the acquired data to equations used in the literature to model creep behavior. Based on evidence from the literature and fitting of various equations, the mechanism which causes room temperature creep is found to include dislocation generation as well as exhaustion.

An Informationally Structured Room for Robotic Assistance

Directory of Open Access Journals (Sweden)

Tokuo Tsuji

2015-04-01

Full Text Available The application of assistive technologies for elderly people is one of the most promising and interesting scenarios for intelligent technologies in the present and near future. Moreover, the improvement of the quality of life for the elderly is one of the first priorities in modern countries and societies. In this work, we present an informationally structured room that is aimed at supporting the daily life activities of elderly people. This room integrates different sensor modalities in a natural and non-invasive way inside the environment. The information gathered by the sensors is processed and sent to a centralized management system, which makes it available to a service robot assisting the people. One important restriction of our intelligent room is reducing as much as possible any interference with daily activities. Finally, this paper presents several experiments and situations using our intelligent environment in cooperation with our service robot.

Antimicrobial Non-Susceptibility of Escherichia coli from Outpatients and Patients Visiting Emergency Rooms in Taiwan.

Directory of Open Access Journals (Sweden)

Jann-Tay Wang

Full Text Available Longitudinal nationwide surveillance data on antimicrobial non-susceptibility and prevalence of extended-spectrum β-lactamases (ESBLs as well as AmpC β-lactamases producers among Escherichia coli from different sources in the community settings are limited. Such data may impact treatment practice. The present study investigated E. coli from outpatients and patients visiting emergency rooms collected by the Taiwan Surveillance of Antimicrobial Resistance (TSAR program. A total of 3481 E. coli isolates were studied, including 2153 (61.9% from urine and 1125 (32.3% from blood samples. These isolates were collected biennially between 2002 and 2012 from a total of 28 hospitals located in different geographic regions of Taiwan. Minimum inhibitory concentrations (MIC were determined using methods recommended by the Clinical Laboratory Standards Institute (CLSI. The prevalence and factors associated with the presence of ESBL and AmpC β-lactamase-producers were determined. Significant increases in non-susceptibility to most β-lactams and ciprofloxacin occurred during the study period. By 2012, non-susceptibility to cefotaxime and ciprofloxacin reached 21.1% and 26.9%, respectively. The prevalence of ESBL- and AmpC- producers also increased from 4.0% and 5.3%, respectively, in 2002-2004, to 10.7% for both in 2010-2012 (P < 0.001. The predominant ESBL and AmpC β-lactamase genes were CTX-M and CMY-types, respectively. Non-susceptibility of urine isolates to nitrofurantoin remained at around 8% and to fosfomycin was low (0.7% but to cefazolin (based on the 2014 CLSI urine criteria increased from 11.5% in 2002-2004 to 23.9% in 2010-2012 (P <0.001. Non-susceptibility of isolates from different specimen types was generally similar, but isolates from elderly patients were significantly more resistant to most antimicrobial agents and associated with the presence of ESBL- and AmpC- β-lactamases. An additional concern is that decreased ciprofloxacin

Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

Science.gov (United States)

Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

2018-04-01

The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

Operating room management and operating room productivity: the case of Germany.

Science.gov (United States)

Berry, Maresi; Berry-Stölzle, Thomas; Schleppers, Alexander

2008-09-01

We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals. Our empirical analysis links improved operating room productivity to greater operating room capacity, appropriate scheduling behavior and management methods to realign interests. From this analysis, the enforcing jurisdiction and avoiding advance over-scheduling appear to be the implementable tools for improving operating room productivity.

Improving cancer patient emergency room utilization: A New Jersey state assessment.

Science.gov (United States)

Scholer, Anthony J; Mahmoud, Omar M; Ghosh, Debopyria; Schwartzman, Jacob; Farooq, Mohammed; Cabrera, Javier; Wieder, Robert; Adam, Nabil R; Chokshi, Ravi J

2017-12-01

Due to its increasing incidence and its major contribution to healthcare costs, cancer is a major public health problem in the United States. The impact across different services is not well documented and utilization of emergency departments (ED) by cancer patients is not well characterized. The aim of our study was to identify factors that can be addressed to improve the appropriate delivery of quality cancer care thereby reducing ED utilization, decreasing hospitalizations and reducing the related healthcare costs. The New Jersey State Inpatient and Emergency Department Databases were used to identify the primary outcome variables; patient disposition and readmission rates. The independent variables were demographics, payer and clinical characteristics. Multivariable unconditional logistic regression models using clinical and demographic data were used to predict hospital admission or emergency department return. A total of 37,080 emergency department visits were cancer related with the most common diagnosis attributed to lung cancer (30.0%) and the most common presentation was pain. The disposition of patients who visit the ED due to cancer related issues is significantly affected by the factors of race (African American OR=0.6, p value=0.02 and Hispanic OR=0.5, p value=0.02, respectively), age aged 65 to 75years (SNF/ICF OR 2.35, p value=0.00 and Home Healthcare Service OR 5.15, p value=0.01, respectively), number of diagnoses (OR 1.26, p value=0.00), insurance payer (SNF/ICF OR 2.2, p value=0.02 and Home Healthcare Services OR 2.85, p value=0.07, respectively) and type of cancer (breast OR 0.54, p value=0.01, prostate OR 0.56, p value=0.01, uterine OR 0.37, p value=0.02, and other OR 0.62, p value=0.05, respectively). In addition, comorbidities increased the likelihood of death, being transferred to SNF/ICF, or utilization of home healthcare services (OR 1.6, p value=0.00, OR 1.18, p value=0.00, and OR 1.16, p value=0.04, respectively). Readmission is

Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room

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Benjamin Louis Moresco

2018-04-01

Full Text Available ObjectivesThis study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER of a tertiary care children’s hospital.MethodsThis was a retrospective, observational study of children (0–18 years old in The Children’s Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9 diagnostic codes for “severe sepsis” and “shocks.” Patients in the adherent group were those who met all three elements of adherence: (1 rapid vascular access with at most one IV attempt before seeking alternate access (unless already in place, (2 fluids administered within 15 min from sepsis recognition, and (3 antibiotic administration started within 1 h of sepsis recognition. Comparisons between groups with and without sepsis guideline adherence were performed using Student’s t-test (the measurements expressed as median values. The proportions were compared using chi-square test. p-Value ≤0.05 was considered significant.ResultsA total of 43 patients who visited the ER from July 2014 to July 2015 had clinically proven severe sepsis or SS ICD-9 codes. The median age was 5 years. The median triage time, times from triage to vascular access, fluid administration and antibiotic administration were 26, 48.5, 76, and 135 min, respectively. Adherence to vascular access, fluid, and antibiotic administration guidelines was 21, 26, and 34%, respectively. Appropriate fluid bolus (20 ml/kg over 15–20 min was only seen in 6% of patients in the non-adherent group versus 38% in the adherent group (p = 0.01. All of the patients in the non-adherent group used an infusion pump for fluid resuscitation. Hypotension and ≥3 organ dysfunction were more commonly observed in patients in adherent group as compared to patients in non-adherent group (38 vs. 14% p = 0.24; 63 vs. 23% p = 0.03.Conclusion

Optimization of recirculating laminar air flow in operating room air conditioning systems

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Enver Yalcin

2016-04-01

Full Text Available The laminar flow air-conditioning system with 100% fresh air is used in almost all operating rooms without discrimination in Turkey. The laminar flow device which is working with 100% fresh air should be absolutely used in Type 1A operating rooms. However, there is not mandatory to use of 100% fresh air for Type 1B defined as places performed simpler operation. Compared with recirculating laminar flow, energy needs of the laminar flow with 100 % fresh air has been emerged about 40% more than re-circulated air flow. Therefore, when a recirculating laminar flow device is operated instead of laminar flow system with 100% fresh air in the Type 1B operating room, annual energy consumption will be reduced. In this study, in an operating room with recirculating laminar flow, optimal conditions have been investigated in order to obtain laminar flow form by analyzing velocity distributions at various supply velocities by using computational fluid dynamics method (CFD.

Strengthening Emergency Care Systems to Mitigate Public Health Challenges Arising from Influxes of Individuals with Different Socio-Cultural Backgrounds to a Level One Emergency Center in South East Europe.

Science.gov (United States)

Twomey, Michèle; Šijački, Ana; Krummrey, Gert; Welzel, Tyson; Exadaktylos, Aristomenis K; Ercegovac, Marko

2018-03-12

Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision. As part of a joint emergency care system strengthening and patient safety initiative, the Serbian Ministry of Health in collaboration with the Centre of Excellence in Emergency Medicine (CEEM) introduced a standardized triage process at the Clinical Centre of Serbia (CCS). This paper describes four crucial stages that were considered for the integration of a standardized triage process into acute care pathways.

Strengthening Emergency Care Systems to Mitigate Public Health Challenges Arising from Influxes of Individuals with Different Socio-Cultural Backgrounds to a Level One Emergency Center in South East Europe

Directory of Open Access Journals (Sweden)

Michèle Twomey

2018-03-01

Full Text Available Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision. As part of a joint emergency care system strengthening and patient safety initiative, the Serbian Ministry of Health in collaboration with the Centre of Excellence in Emergency Medicine (CEEM introduced a standardized triage process at the Clinical Centre of Serbia (CCS. This paper describes four crucial stages that were considered for the integration of a standardized triage process into acute care pathways.

Criteria for the design of the control room complex for a nuclear power generating station

International Nuclear Information System (INIS)

Anon.

1981-01-01

This Standard addresses the central control room of a nuclear power generating station and the overall complex in which this room is housed. It is not intended to cover special or normally unattended control rooms, such as those provided for radioactive waste handling or for emergency shutdown operations. The nuclear power generating station control room complex provides a protective envelope for plant operating personnel and for instrument and control equipment vital to the operation of the plant during normal and abnormal conditions. In this capacity, the control room complex must be designed and constructed to meet the following criteria contained in Appendix A of 10CFR50, General Design criteria for Nuclear Power Plants: (1) Criterion 2: design bases for protection against natural phenomena; (2) Criterion 3: fire protection; (3) Criterion 4: environmental and missile design bases; (4) Criterion 5: sharing of structures, systems and components (multiunit stations only); and (5) Criterion 19: control room

Clinical statistics of patients with dizziness consulting the emergency outpatient clinic

International Nuclear Information System (INIS)

Ogawa, Yasuo; Hagiwara, Akira; Kitajima, Naoharu; Inagaki, Taro; Shimizu, Masaaki; Furuse, Hiroko; Konomi, Ujimoto; Yukawa, Kumiko; Suzuki, Mamoru

2007-01-01

Between May 2004 and April 2006, 468 emergency patients with vertigo or dizziness consulted the otorhinolarygological emergency room of Tokyo Medical University. Patients with vertigo or dizziness comprised about 9% of the whole otorhinolaryngological emergency patients. The number of female patients was larger than that of male patients. About half of the patients were brought to our hospital by ambulance. Nystagmus was observed in 219 patients (46.8%). Incidence of nystagmus was highest on positional nystagmus test. Brain CT was obtained in 185 patients (39.5%), but there were no abnormal findings in any patients. The most frequent diagnosis was inner ear disorder (22%), followed by Meniere's disease (7%), vestibular neuritis (6%), Benign paroxysmal positional vertigo (BPPV) (6%). Cerebral infarction was observed in 1.9%. Eighty-four patients were admitted. Major diseases requiring admission were vestibular neuritis and inner ear disorder. In patients with cerebral infarction, brain CT was normal. These patients were all elderly males over 60 years old. Their nystagmus in the emergency room did not suggest central disorder, or they did not have other neurological findings. Neurological signs and symptoms appeared thereafter. In the emergency room, establishing a diagnosis by limited examination is difficult. Careful examination is necessary, since vertigo or dizzy patient with a central disorder can show sudden change. (author)

Work-Practice Changes Associated with an Electronic Emergency-Department Whiteboard

DEFF Research Database (Denmark)

Hertzum, Morten; Simonsen, Jesper

2013-01-01

, existing work practices, and the clinicians’ experience. Another change in the work practices is distributed access to whiteboard information from the computers in patient rooms. A decrease in the mental workload of the coordinating nurse was envisaged but has not emerged. Achieving more changes appears......Electronic whiteboards are introduced at emergency departments (EDs) to improve work practices. This study investigates whether the time physicians and nurses at an ED spend in patient rooms versus at the control desk increases after the introduction of an electronic whiteboard. After using...... this whiteboard for four months nurses, but not physicians, spend more of their time with the patients. With the electronic whiteboard, nurses spend 28% of their time in patient rooms and physicians 20%. Importantly, the changes facilitated by the electronic whiteboard are also dependent on implementation issues...

Emergency response planning in hospitals, United States: 2003-2004.

Science.gov (United States)

Niska, Richard W; Burt, Catharine W

2007-08-20

This study presents baseline data to determine which hospital characteristics are associated with preparedness for terrorism and natural disaster in the areas of emergency response planning and availability of equipment and specialized care units. Information from the Bioterrorism and Mass Casualty Preparedness Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in hospital emergency response plans and resources by residency and medical school affiliation, hospital size, ownership, metropolitan statistical area status, and Joint Commission accreditation. Of 874 sampled hospitals with emergency or outpatient departments, 739 responded for an 84.6 percent response rate. Estimates are presented with 95 percent confidence intervals. About 92 percent of hospitals had revised their emergency response plans since September 11, 2001, but only about 63 percent had addressed natural disasters and biological, chemical, radiological, and explosive terrorism in those plans. Only about 9 percent of hospitals had provided for all 10 of the response plan components studied. Hospitals had a mean of about 14 personal protective suits, 21 critical care beds, 12 mechanical ventilators, 7 negative pressure isolation rooms, and 2 decontamination showers each. Hospital bed capacity was the factor most consistently associated with emergency response planning and availability of resources.

Short-term effects of ambient air pollution on emergency room admissions due to cardiovascular causes in Beijing, China.

Science.gov (United States)

Ma, Yuxia; Zhao, Yuxin; Yang, Sixu; Zhou, Jianding; Xin, Jinyuan; Wang, Shigong; Yang, Dandan

2017-11-01

Ambient air pollution has been a major global public health issue. A number of studies have shown various adverse effects of ambient air pollution on cardiovascular diseases. In the current study, we investigated the short-term effects of ambient air pollution on emergency room (ER) admissions due to cardiovascular causes in Beijing from 2009 to 2012 using a time-series analysis. A total of 82430 ER cardiovascular admissions were recorded. Different gender (male and female) and age groups (15yrs ≤ age pollutant model. Three major pollutants (SO 2 , NO 2 and PM 10 ) had lag effects of 0-2 days on cardiovascular ER admissions. The relative risks (95% CI) of per 10 μg/m 3 increase in PM 10 , SO 2 and NO 2 were 1.008 (0.997-1.020), 1.008(0.999-1.018) and 1.014(1.003-1.024), respectively. The effect was more pronounced in age ≥65 and males in Beijing. We also found the stronger acute effects on the elderly and females at lag 0 than on the younger people and males at lag 2. Copyright © 2017 Elsevier Ltd. All rights reserved.

Closed-loop approach for situation awareness of medical devices and operating room infrastructure

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Rockstroh Max

2015-09-01

Full Text Available In recent years, approaches for information and control integration in the digital operating room have emerged. A major step towards an intelligent operating room and a cooperative technical environment would be autonomous adaptation of medical devices and systems to the surgical workflow. The OR staff should be freed from information seeking and maintenance tasks. We propose a closed-loop concept integrating workflow monitoring, processing and (semi-automatic interaction to bridge the gap between OR integration of medical devices and workflow-related information management.

Clean industrial room for drift tube assembling

International Nuclear Information System (INIS)

Glonti, G.L.; Gongadze, A.L.; Evtukhovich, P.G.

2001-01-01

Description of a clean industrial room for assembly of drift tubes for the muon spectrometer of the ATLAS experiment is presented. High quality specifications on the detectors to be produced demanded creation of a workplace with stable temperature and humidity, as well as minimum quantity of dust in the room. Checking of parameters of intra-room air during long period of continuous work has confirmed correctness of the designed characteristics of the climatic system installed in the clean room. The room large volume (∼ 190 m 3 ), the powerful and flexible climatic system, and simplicity of service allow assembling of detectors with length up to 5 m. Subsequent checking of functionality of the assembled detectors has shown high quality of assembling (the amount of rejected tubes does not exceed 2%). It demonstrates conformity to the assembling quality requirements for mass production of drift chambers for the muon spectrometer. (author)

Clean Industrial Room for Drift Tube Assembling

CERN Document Server

Glonti, GL; Evtoukhovitch, P G; Kroa, G; Manz, A; Potrap, I N; Rihter, P; Stoletov, G D; Tskhadadze, E G; Chepurnov, V F; Chirkov, A V; Shelkov, G A

2001-01-01

Description of a clean industrial room for assembly of drift tubes for the muon spectrometer of the ATLAS experiment is presented. High quality specifications on the detectors to be produced demanded creation of a workplace with stable temperature and humidity, as well as minimum quantity of dust in the room. Checking of parameters of intra-room air during long period of continuous work has been confirmed correctness of the designed characteristics of the climatic system installed in the clean room. The room large volum (\\sim 190 m^3), the powerful and flexible climatic system, and simplicity of service allow assembling of detectors with length up to 5 m. Subsequent checking of functionality of the assembled detectors has shown high quality of assembling (the amount of rejected tubes does not exceed 2 %). It demonstrates conformity to the assembling quality requirements for mass production of drift chambers for the muon spectrometer.

The role of the control room operator

International Nuclear Information System (INIS)

Williams, M.C.

A control room operator at an Ontario Hydro nuclear power plant operates a reactor-turbine unit according to approved procedures within imposed constraints to meet the objectives of the organization. A number of operating and administrative tasks make up this role. Control room operators spend approximately six percent of their time physically operating equipment exclusive of upset conditions, and another one percent operating in upset conditions. Testing occupies five percent of an operator's time. Operators must be trained to recognize the entire spectrum of inputs available to them and use them all effectively. Any change in system or unit state is always made according to an approved procedure. Extensive training is required; operators must be taught and pracised in what to do, and must know the reasons behind their actions. They are expected to memorize emergency procedures, to know when to consult operating procedures, and to have sufficient understanding and practice to perform these procedures reliably

Physics escape room as an educational tool

Science.gov (United States)

Vörös, Alpár István Vita; Sárközi, Zsuzsa

2017-12-01

Escape rooms have flourished in the last decade. These are adventure games in which players work together to solve puzzles using hints, clues and a strategy to escape from a locked room. In many cases they use different phenomena related to physics. Hence the idea of using escape rooms in science centers or even in classroom activities. Escape rooms are designed for one single team of players, the method is more suitable for activities in a science centre. In our paper, we show that escape rooms' puzzle solving methods could be used in physics classroom activities as well, taking into account that several teams have to work together in the same room/place. We have developed an educational escape game for physics of fluids, as this topic is left out from the Romanian high-school curriculum. We have tried out our game during the project week called "Şcoala altfel" ("school in a different way") and in a physics camp for gifted students. We present the designed physics escape game and the results.

Current practices in the management of patients with ureteral calculi in the emergency room of a university hospital

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Oliver Rojas Claros

2012-01-01

Full Text Available OBJECTIVE: Urinary lithiasis is a common disease. The aim of the present study is to assess the knowledge regarding the diagnosis, treatment and recommendations given to patients with ureteral colic by professionals of an academic hospital. MATERIALS AND METHODS: Sixty-five physicians were interviewed about previous experience with guidelines regarding ureteral colic and how they manage patients with ureteral colic in regards to diagnosis, treatment and the information provided to the patients. RESULTS: Thirty-six percent of the interviewed physicians were surgeons, and 64% were clinicians. Forty-one percent of the physicians reported experience with ureterolithiasis guidelines. Seventy-two percent indicated that they use noncontrast CT scans for the diagnosis of lithiasis. All of the respondents prescribe hydration, primarily for the improvement of stone elimination (39.3%. The average number of drugs used was 3.5. The combination of nonsteroidal anti-inflammatory drugs and opioids was reported by 54% of the physicians (i.e., 59% of surgeons and 25.6% of clinicians used this combination of drugs (p = 0.014. Only 21.3% prescribe alpha blockers. CONCLUSION: Reported experience with guidelines had little impact on several habitual practices. For example, only 21.3% of the respondents indicated that they prescribed alpha blockers; however, alpha blockers may increase stone elimination by up to 54%. Furthermore, although a meta-analysis demonstrated that hydration had no effect on the transit time of the stone or on the pain, the majority of the physicians reported that they prescribed more than 500 ml of fluid. Dipyrone, hyoscine, nonsteroidal anti-inflammatory drugs, and opioids were identified as the most frequently prescribed drug combination. The information regarding the time for the passage of urinary stones was inconsistent. The development of continuing education programs regarding ureteral colic in the emergency room is necessary.

Injury-related visits and comorbid conditions among homeless persons presenting to emergency departments.

Science.gov (United States)

Hammig, Bart; Jozkowski, Kristen; Jones, Ches

2014-04-01

The authors examined the clinical characteristics of homeless patients presenting to emergency departments (EDs) in the United States, with a focus on unintentional and intentional injury events and related comorbid conditions. The study included a nationally representative sample of patients presenting to EDs with data obtained from the 2007 through 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). Descriptive and analytical epidemiologic analyses were employed to examine injuries among homeless patients. Homeless persons made 603,000 visits annually to EDs, 55% of which were for injuries, with the majority related to unintentional (52%) and self-inflicted (23%) injuries. Multivariate logistic regression analyses revealed that homeless patients had a higher odds of presenting with injuries related to unintentional (odds ratio [OR]=1.4. 95% confidence interval [CI]=1.1 to 1.9), self-inflicted (OR=6.0, 95% CI=3.7 to 9.5), and assault (OR=3.0, 95% CI=1.5 to 5.9) injuries. A better understanding of the injuries affecting homeless populations may provide medical and public health professionals insight into more effective ways to intervene and limit further morbidity and mortality related to specific injury outcomes. © 2014 by the Society for Academic Emergency Medicine.

Patient satisfaction, preventive services, and emergency room use among African-Americans with type 2 diabetes.

Science.gov (United States)

Gary, Tiffany L; Maiese, Eric M; Batts-Turner, Marian; Wang, Nae-Yuh; Brancati, Fredrick L

2005-12-01

The aim of this study was to determine the relationship between patient satisfaction and diabetes- related preventive health care and emergency room (ER) use. We studied 542 urban African-Americans with type 2 diabetes aged > or =25 years who were enrolled in a primary carebased intervention trial to improve diabetes control and reduce adverse health events; 73% female, mean age 58 years, 35% had yearly household incomes of Consumer Assessment of Health Plans Survey (CAHPS) and use of diabetes-related preventive health care and ER were assessed by self-report. We then followed participants for 12 months to determine ER use prospectively. In general, participants gave favorable ratings of their care; over 70% reported that they had no problem getting care, over 60% reported the highest ratings on the communication and courtesy domains, and mean ratings (0-10 scale) for personal doctor and overall health care were high (8.8 and 8.4, respectively). Using poisson regression models adjusted for age, education, and self-reported rating of health, several aspects of patient satisfaction were associated with subsequent ER use. Participants who reported that medical staff were usually helpful or that doctors and nurses usually spent enough time were 0.49 and 0.37 times, respectively, less likely to use the ER (all p < 0.05). However, few aspects of patient satisfaction were associated with better preventive services. These data suggest that greater patient satisfaction was associated with lower ER use in urban African-Americans. Whether measures to improve patient satisfaction would reduce ER use requires further prospective study.

Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania.

Science.gov (United States)

Shari, Catherine R; Sawe, Hendry R; Murray, Brittany L; Mwafongo, Victor G; Mfinanga, Juma A; Runyon, Michael S

2017-01-01

Severe anaemia contributes significantly to mortality, especially in children under 5 years of age. Timely blood transfusion is known to improve outcomes. We investigated the magnitude of anaemia and emergency blood transfusion practices amongst children under 5 years presenting to the Emergency Department (ED) of Muhimbili National Hospital (MNH) in Tanzania. This prospective observational study enrolled children under 5 years old with anaemia, over a 7-week period in August and September of 2015. Anaemia was defined as haemoglobin of MNH. Less than a quarter of children with indications for transfusion receive it in the EMD, the median time to transfusion is nearly 8 h, and those not transfused have nearly a 3-fold higher mortality. Future quality improvement and research efforts should focus on eliminating barriers to timely blood transfusion.

Emergency room visits for respiratory conditions in children increased after Guagua Pichincha volcanic eruptions in April 2000 in Quito, Ecuador Observational Study: Time Series Analysis

Directory of Open Access Journals (Sweden)

Jagai Jyotsna S

2007-07-01

Full Text Available Abstract Background This study documented elevated rates of emergency room (ER visits for acute upper and lower respiratory infections and asthma-related conditions in the children of Quito, Ecuador associated with the eruption of Guagua Pichincha in April of 2000. Methods We abstracted 5169 (43% females ER records with primary respiratory conditions treated from January 1 – December 27, 2000 and examined the change in pediatric ER visits for respiratory conditions before, during, and after exposure events of April, 2000. We applied a Poisson regression model adapted to time series of cases for three non-overlapping disease categories: acute upper respiratory infection (AURI, acute lower respiratory infection (ALRI, and asthma-related conditions in boys and girls for three age groups: 0–4, 5–9, and 10–15 years. Results At the main pediatric medical facility, the Baca Ortiz Pediatric Hospital, the rate of emergency room (ER visits due to respiratory conditions substantially increased in the three weeks after eruption (RR = 2.22, 95%CI = [1.95, 2.52] and RR = 1.72 95%CI = [1.49, 1.97] for lower and upper respiratory tract infections respectively. The largest impact of eruptions on respiratory distress was observed in children younger than 5 years (RR = 2.21, 95%CI = [1.79, 2.73] and RR = 2.16 95%CI = [1.67, 2.76] in boys and girls respectively. The rate of asthma and asthma-related diagnosis doubled during the period of volcano fumarolic activity (RR = 1.97, 95%CI = [1.19, 3.24]. Overall, 28 days of volcanic activity and ash releases resulted in 345 (95%CI = [241, 460] additional ER visits due to respiratory conditions. Conclusion The study has demonstrated strong relationship between ash exposure and respiratory effects in children.

Emergency room visits for respiratory conditions in children increased after Guagua Pichincha volcanic eruptions in April 2000 in Quito, Ecuador observational study: time series analysis.

Science.gov (United States)

Naumova, Elena N; Yepes, Hugo; Griffiths, Jeffrey K; Sempértegui, Fernando; Khurana, Gauri; Jagai, Jyotsna S; Játiva, Edgar; Estrella, Bertha

2007-07-24

This study documented elevated rates of emergency room (ER) visits for acute upper and lower respiratory infections and asthma-related conditions in the children of Quito, Ecuador associated with the eruption of Guagua Pichincha in April of 2000. We abstracted 5169 (43% females) ER records with primary respiratory conditions treated from January 1-December 27, 2000 and examined the change in pediatric ER visits for respiratory conditions before, during, and after exposure events of April, 2000. We applied a Poisson regression model adapted to time series of cases for three non-overlapping disease categories: acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), and asthma-related conditions in boys and girls for three age groups: 0-4, 5-9, and 10-15 years. At the main pediatric medical facility, the Baca Ortiz Pediatric Hospital, the rate of emergency room (ER) visits due to respiratory conditions substantially increased in the three weeks after eruption (RR = 2.22, 95%CI = [1.95, 2.52] and RR = 1.72 95%CI = [1.49, 1.97] for lower and upper respiratory tract infections respectively. The largest impact of eruptions on respiratory distress was observed in children younger than 5 years (RR = 2.21, 95%CI = [1.79, 2.73] and RR = 2.16 95%CI = [1.67, 2.76] in boys and girls respectively). The rate of asthma and asthma-related diagnosis doubled during the period of volcano fumarolic activity (RR = 1.97, 95%CI = [1.19, 3.24]). Overall, 28 days of volcanic activity and ash releases resulted in 345 (95%CI = [241, 460]) additional ER visits due to respiratory conditions. The study has demonstrated strong relationship between ash exposure and respiratory effects in children.

Level of agitation of psychiatric patients presenting to an emergency department.

Science.gov (United States)

Zun, Leslie S; Downey, La Vonne A

2008-01-01

The primary purpose of this study was to determine the level of agitation that psychiatric patients exhibit upon arrival to the emergency department. The secondary purpose was to determine whether the level of agitation changed over time depending upon whether the patient was restrained or unrestrained. An observational study enrolling a convenience sample of 100 patients presenting with a psychiatric complaint was planned, in order to obtain 50 chemically and/or physically restrained and 50 unrestrained patients. The study was performed in summer 2004 in a community, inner-city, level 1 emergency department with 45,000 visits per year. The level of patient agitation was measured using the Agitated Behavior Scale (ABS) and the Richmond Agitation-Sedation Scale (RASS) upon arrival and every 30 minutes over a 3-hour period. The inclusion criteria allowed entry of any patient who presented to the emergency department with a psychiatric complaint thought to be unrelated to physical illness. Patients who were restrained for nonbehavioral reasons or were medically unstable were excluded. 101 patients were enrolled in the study. Of that total, 53 patients were not restrained, 47 patients were restrained, and 1 had incomplete data. There were no differences in gender, race, or age between the 2 groups. Upon arrival, 2 of the 47 restrained patients were rated severely agitated on the ABS, and 13 of 47 restrained patients were rated combative on the RASS. There was a statistical difference (p = .01) between the groups on both scales from time 0 to time 90 minutes. Scores on the agitation scales decreased over time in both groups. One patient in the unrestrained group became unarousable during treatment. This study demonstrated that patients who were restrained were more agitated than those who were not, and that agitation levels in both groups decreased over time. Some restrained patients did not meet combativeness or severe agitation criteria, suggesting either that use of

Ontario Power Generation Fukushima emergency response drill strengthens and lessons learned - Ontario Power Generation Fukushima Emergency Response Drill Highlights

International Nuclear Information System (INIS)

Miller, David W.

2014-01-01

Japan's Fukushima Daiichi severe nuclear accident in March 2011 has resulted in a reassessment of nuclear emergency response and preparedness in Canada. On May 26, 27 and 28, 2014 Ontario Power Generation (OPG) conducted the first North American full scale nuclear emergency response exercise designed to include regional, provincial and federal bodies as well as the utility. This paper describes the radiological aspects of the OPG Exercise Unified Response (ExUR) with emphasis on deployment of new Fukushima equipment on the Darlington site, management of emergency workers deplored in the vicinity of Darlington to collect environmental samples and radiation measurements, performance of dose calculations, communication of dose projections and protective actions to local, provincial and federal agencies and conduct of vehicle, truck and personnel monitoring and decontamination facilities. The ExUR involved more than 1000 personnel from local, provincial and federal bodies. Also, 200 OPG employees participated in the off-site emergency response duties. The objective of the ExUR was to test and enhance the preparedness of the utility (OPG), government and non-government agencies and communities to respond to a nuclear emergency. The types of radiological instrumentation and mobile facilities employed are highlighted in the presentation. The establishment of temporary emergency rooms with 8 beds and treatment facilities to manage potentially contaminated injuries from the nuclear emergency is also described. (author)

Surgical management of acutely presenting gastrointestinal stromal tumors of the stomach among elderly: experience of an emergency surgery department.

Science.gov (United States)

Marano, Luigi; Arru, Giovanni Maria Antonio; Piras, Mario; Fiume, Stefania; Gemini, Sergio

2014-01-01

The incidence of gastrointestinal stromal tumors (GISTs), requiring often an emergency surgical management, is extremely rare among elderly. We aimed to present the experience of the Emergency Surgery Department, Brotzu Hospital, in the management of elderly patients with GIST related emergencies. This study was carried out on 12 patients with gastrointestinal stromal tumors who presented to in an emergency situation during the period from January 2010 to December 2013. All patients' data, clinical presentations, surgical procedures, complications, and survival data were collected and analyzed. Between 2010 and 2013, 12 patients (8 males and 4 females), with a mean age of 70 years (range: 65-79 years) were admitted with different emergency presentations of clinically and radiologically suspected GISTs. The incidence of proximal obstruction was 41.7% of all gastric GIST cases, resulting acute gastrointestinal bleeding and perforation in 41.7% and 16.6% respectively. The mean length of hospitalization was 9.1 ± 2.3 days and there were no posterative complications or mortalities. At a mean follow-up of 21 months, 11 patients (91.6%) were alive and disease free. Although GISTs are uncommon among elderly, their incidence is increasing especially in their emergency presentation and surgeon should be prepared to treat this condition following the principles of GIST surgery as stated by the GIST consensus conference. In conclusion our data demonstrate that age itself does not affect the outcome of surgical treatment of GISTs in emergency situation. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Emergency Contraception: a survey of Hospital Emergency Departments Staffs

Directory of Open Access Journals (Sweden)

Marco Bo

2011-06-01

Full Text Available The World Health Organization defines emergency contraception (EC as a means to prevent unwanted pregnancy. In countries where EC is dispensed behind the counter, emergency departments are a preferred point of care for its prescription and dispensing. In light of this situation and as no studies on emergency contraception in emergency departments in Italy have been conducted to date, this study was designed with a view to analyze the responses of emergency room physicians in relation to their prescribing habits and knowledge about the drug and in relation to frequency and profile of women arriving for care at hospital emergency departments in Piedmont and requesting prescription for the morning-after pill. This cross-sectional survey involved 29 hospital emergency departments in Piedmont where no gynecologists are on active duty. The survey instrument was a 24-item questionnaire. Analysis of responses revealed that in the physicians’ opinion the vast majority of requests came from Italian nationals (97% ranging in age from 18 to 30 years (76%, single and not cohabiting with a partner (60%, and nulliparous (64.0%. Women mostly request EC for first-time and the most common reasons were condom breakage or slippage. Just over half the physicians (52% stated that emergency contraception prescription was not an appropriate part of care provided at an emergency department and 72% stated they felt uneasy about prescribing emergency contraception. The survey also revealed gaps in physician knowledge about the pharmacokinetic and pharmacodynamic properties of emergency contraception pills.

Emergency Contraception: a survey of Hospital Emergency Departments Staffs

Directory of Open Access Journals (Sweden)

Marco Bo

2011-03-01

Full Text Available The World Health Organization defines emergency contraception (EC as a means to prevent unwanted pregnancy. In countries where EC is dispensed behind the counter, emergency departments are a preferred point of care for its prescription and dispensing. In light of this situation and as no studies on emergency contraception in emergency departments in Italy have been conducted to date, this study was designed with a view to analyze the responses of emergency room physicians in relation to their prescribing habits and knowledge about the drug and in relation to frequency and profile of women arriving for care at hospital emergency departments in Piedmont and requesting prescription for the morning-after pill. This cross-sectional survey involved 29 hospital emergency departments in Piedmont where no gynecologists are on active duty. The survey instrument was a 24-item questionnaire. Analysis of responses revealed that in the physicians’ opinion the vast majority of requests came from Italian nationals (97% ranging in age from 18 to 30 years (76%, single and not cohabiting with a partner (60%, and nulliparous (64.0%. Women mostly request EC for first-time and the most common reasons were condom breakage or slippage. Just over half the physicians (52% stated that emergency contraception prescription was not an appropriate part of care provided at an emergency department and 72% stated they felt uneasy about prescribing emergency contraception. The survey also revealed gaps in physician knowledge about the pharmacokinetic and pharmacodynamic properties of emergency contraception pills.

Short-term effects of ambient air pollution on emergency room admissions due to cardiovascular causes in Beijing, China

International Nuclear Information System (INIS)

Ma, Yuxia; Zhao, Yuxin; Yang, Sixu; Zhou, Jianding; Xin, Jinyuan; Wang, Shigong; Yang, Dandan

2017-01-01

Ambient air pollution has been a major global public health issue. A number of studies have shown various adverse effects of ambient air pollution on cardiovascular diseases. In the current study, we investigated the short-term effects of ambient air pollution on emergency room (ER) admissions due to cardiovascular causes in Beijing from 2009 to 2012 using a time-series analysis. A total of 82430 ER cardiovascular admissions were recorded. Different gender (male and female) and age groups (15yrs ≤ age <65 yrs and age ≥ 65 yrs) were also examined by single model and multiple-pollutant model. Three major pollutants (SO 2 , NO 2 and PM 10 ) had lag effects of 0–2 days on cardiovascular ER admissions. The relative risks (95% CI) of per 10 μg/m 3 increase in PM 10 , SO 2 and NO 2 were 1.008 (0.997–1.020), 1.008(0.999–1.018) and 1.014(1.003–1.024), respectively. The effect was more pronounced in age ≥65 and males in Beijing. We also found the stronger acute effects on the elderly and females at lag 0 than on the younger people and males at lag 2. - Highlights: • Significant associations were found between air pollution and emergency admissions of cardiovascular diseases. • Air pollutants had lag effects on age and gender groups. • Stronger effects of air pollutants were observed for age ≥65 yrs and males. • More acute effects of air pollutants were found for age ≥65 yrs and females. - Air pollutants had significant lag effects on different age and gender groups. The effects were more pronounced in age ≥65 and males in Beijing, China.

Hypoxia Room

Data.gov (United States)

Federal Laboratory Consortium — The Hypoxia Room is a 8x8x8 ft. clear vinyl plastic and aluminum frame construction enclosure located within USAREIM laboratory 028. The Hypoxia Room (manufactured...

Early effect of American Academy of Pediatrics Urinary Tract Infection Guidelines on radiographic imaging and diagnosis of vesicoureteral reflux in the emergency room setting.

Science.gov (United States)

Arlen, Angela M; Merriman, Laura S; Kirsch, Jared M; Leong, Traci; Scherz, Hal C; Smith, Edwin A; Broecker, Bruce H; Kirsch, Andrew J

2015-05-01

In 2011 the AAP revised practice parameters on febrile urinary tract infection in infants and children 2 to 24 months old. New imaging recommendations invigorated the ongoing debate regarding the diagnosis and management of vesicoureteral reflux. We compared evaluations in these patients with febrile urinary tract infection before and after guideline publication. During 2 separate 6-month periods 350 patients 2 to 24 months old were evaluated in the emergency room setting. Demographics, urine culture, renal-bladder ultrasound, voiding cystourethrogram and admission status were assessed. A total of 172 patients presented with initial febrile urinary tract infection in 2011, of whom 47 (27.3%) required hospitalization, while 42 of 178 (23.6%) were admitted in 2012. Admission by year did not significantly differ (p = 0.423). After guideline revision 41.2% fewer voiding cystourethrograms were done (72.1% of cases in 2011 vs 30.9% in 2012, p urinary tract infection. We found no relationship between renal-bladder ultrasound and abnormal voiding cystourethrogram, consistent with previous findings that call ultrasound into question as the determinant for additional imaging. Whether forgoing routine voiding cystourethrogram results in increased morbidity is the subject of ongoing study. Copyright © 2015. Published by Elsevier Inc.

Clean room actuators

Energy Technology Data Exchange (ETDEWEB)

Higuchi, Toshiro

1987-06-01

This report explains on the present status of the clean room actuators including the author's research results. In a clean room, there exists a possibility of dust generation, even when a direct human work is eliminated by the use of robots or automatic machines, from the machines themselves. For this, it is important to develop such clean robots and transfer/positioning mechanism that do not generate dusts, and to develop an actuator and its control technique. Topics described in the report are as follows: 1. Prevention of dust diffusion by means of sealing. 2. Elimination of mechanical contact (Linear induction motor and pneumatic float, linear motor and magnetic attraction float, linear motor and air bearing, and magnetic bearing). 3. Contactless actuator having a positioning mechanism (Use of linear step motor and rotary contactless actuator). (15 figs, 11 refs)

Contaminant Distribution Around Persons in Rooms Ventilated by Displacement Ventilation

DEFF Research Database (Denmark)

Brohus, Henrik; Nielsen, Peter V.

An optimal design of the ventilation system needs a proper prediction of the velocity, temperature and contaminant distribution in the room. Traditionally this is done either by the use of simplified models or by a somewhat more comprehensive CFD-simulation. Common to both methods is usually...... the lack of consideration for the persons present in the room. This paper deals with some of the effects of persons present in a displacement ventilated room, especially the effect on the contaminant distribution....

Assessment of daylight quality in simple rooms

DEFF Research Database (Denmark)

Johnsen, Kjeld; Dubois, Marie-Claude; Sørensen, Karl Grau

The present report documents the results of a study on daylight conditions in simple rooms of residential buildings. The overall objective of the study was to develop a basis for a method for the assessment of daylight quality in a room with simple geometry and window configurations. As a tool...... in daylighting conditions for a number of lighting parameters. The results gave clear indications of, for instance, which room would be the brightest, under which conditions might glare be a problem and which type of window would yield the greatest luminous variation (or visual interest), etc....

Speaker comfort and increase of voice level in lecture rooms

DEFF Research Database (Denmark)

Brunskog, Jonas; Gade, Anders Christian; Bellester, G P

2008-01-01

Teachers often suffer health problems or tension related to their voice. These problems may be related to there working environment, including room acoustics of the lecture rooms which forces them to stress their voices. The present paper describes a first effort in finding relationships between...... were also measured in the rooms and subjective impressions from about 20 persons who had experience talking in these rooms were collected as well. Analysis of the data revealed significant differences in the sound power produced by the speaker in the different rooms. It was also found...

Planets in a Room

Science.gov (United States)

Giacomini, l.; Aloisi, F.; De Angelis, I.

2017-09-01

Teaching planetary science using a spherical projector to show the planets' surfaces is a very effective but usually very expensive idea. Whatsmore, it usually assumes the availability of a dedicated space and a trained user. "Planets in a room" is a prototypal low cost version of a small, spherical projector that teachers, museum, planetary scientists and other individuals can easily build and use on their own, to show and teach the planets The project of "Planets in a Room" was made by the italian non-profit association Speak Science with the collaboration of INAF-IAPS of Rome and the Roma Tre University (Dipartimento di Matematica e Fisica). This proposal was funded by the Europlanet Outreach Funding Scheme in 2016. "Planets in a room" will be presented during EPSC 2017 to give birth to the second phase of the project, when the outreach and research community will be involved and schools from all over Europe will be invited to participate with the aim of bringing planetary science to a larger audience.

A systematic approach to emergencies in uveitis.

Science.gov (United States)

Al-Dhibi, Hassan A; Al-Mahmood, Ammar M; Arevalo, J Fernando

2014-01-01

Uveitis is a common cause of preventable blindness although it is consider a sight-threatening condition particularly in cases with posterior segment inflammation. To deal with emergency conditions in uveitis, we must aware of the essential signs and symptoms that reflect a true uveitic emergency. Failure to recognize these essential signs and symptoms of a true uveitic emergency may result in a devastating visual outcome. This review provides general ophthalmologists and residents, clinical guidelines for the main uveitic entities that require immediate recognition and urgent intervention in the emergency room to prevent severe permanent visual loss.

Effect of Room Ventilation Rates in Rodent Rooms with Direct-Exhaust IVC Systems.

Science.gov (United States)

Geertsema, Roger S; Lindsell, Claire E

2015-09-01

When IVC are directly exhausted from a rodent housing room, the air quality of the room can become independent of the intracage air quality and may reduce the need for high room ventilation rates. This study assessed the effect of decreasing the ventilation rate in rodent rooms using direct-exhaust IVC systems. The study was conducted over 16 wk and compared conditions in 8 rodent rooms that had ventilation rates of 5 to 6 air changes per hour (ACH) with those in rooms at 10 to 12 ACH. At the low ventilation rate, rooms had higher CO₂ concentrations, higher dew point temperature, and lower particulate levels and spent a greater percentage of time above the temperature set point than did rooms at the high rate. The levels of allergens and endotoxins in room air were the same regardless of the ventilation rate. Differences seen in parameters within cages at the 2 ventilation rates were operationally irrelevant. We detected no total volatile organic compounds in the room that were attributable to ammonia, regardless of the ventilation rate. Clearing the air of ethanol after a spill took longer at the low compared with high rate. However, ethanol clearance was faster at the low rate when the demand-control system was activated than at the high ventilation rate alone. Air quality in the room and in the cages were acceptable with room ventilation rates of 5 to 6 ACH in rodent rooms that use direct-exhaust IVC systems.

Nuclear power plant control room task analysis. Pilot study for pressurized water reactors

International Nuclear Information System (INIS)

Barks, D.B.; Kozinsky, E.J.; Eckel, S.

1982-05-01

The purposes of this nuclear plant task analysis pilot study: to demonstrate the use of task analysis techniques on selected abnormal or emergency operation events in a nuclear power plant; to evaluate the use of simulator data obtained from an automated Performance Measurement System to supplement and validate data obtained by traditional task analysis methods; and to demonstrate sample applications of task analysis data to address questions pertinent to nuclear power plant operational safety: control room layout, staffing and training requirements, operating procedures, interpersonal communications, and job performance aids. Five data sources were investigated to provide information for a task analysis. These sources were (1) written operating procedures (event-based); (2) interviews with subject matter experts (the control room operators); (3) videotapes of the control room operators (senior reactor operators and reactor operators) while responding to each event in a simulator; (4) walk-/talk-throughs conducted by control room operators for each event; and (5) simulator data from the PMS

Preliminary considerations on safety of computerized control rooms

International Nuclear Information System (INIS)

Vittet, J.

1983-02-01

Safety problems are analyzed in this report by the study of the interaction: ''human behavior in a rigid environment/information overload in perturbed situation''. For pedagogy the study is presented as a research of factors influencing operator performance in a control room and a dialogue between an analyst and a conceiving engineer. Danger of all control room where the strategy for data acquisition is too rigid and without spatial reference is stressed in conclusion. Orientations for an advanced control room are outlined [fr

Room temperature superconductors

International Nuclear Information System (INIS)

Sleight, A.W.

1995-01-01

If the Holy Grail of room temperature superconductivity could be achieved, the impact on could be enormous. However, a useful room temperature superconductor for most applications must possess a T c somewhat above room temperature and must be capable of sustaining superconductivity in the presence of magnetic fields while carrying a significant current load. The authors will return to the subject of just what characteristics one might seek for a compound to be a room temperature superconductor. 30 refs., 3 figs., 1 tab

Presentation of a semiempirical method for the calculation of doses due to neutrons and capture gamma rays inside high energy accelerators rooms

International Nuclear Information System (INIS)

Larcher, A.M.; Bonet Duran, S.M.

1998-01-01

Full text: Medical electron accelerators operating above 10 MeV produce radiation beams that are contaminated with neutrons. Therefore, shielding design for high energy accelerator rooms must consider the neutron component of the radiation field. In this paper a semiempirical method is presented to calculate doses due to neutrons and capture gamma rays inside the room and the maze. The calculation method is based on the knowledge of the neutron yield Q (neutrons/Gy of photons at isocenter) and the average energy of the primary beam of neutrons Eo (MeV). The method constitutes an appropriate tool for shielding facilities evaluation. The accuracy of the method has been contrasted with data obtained from the literature and an excellent correlation among the calculations and the measured values was achieved. In addition, the method has been used in the verification of experimental data corresponding to a 15 MeV linear accelerator installed in the country with similar results. (author) [es

[Hospital-based acute care of emergency patients: the importance of interdisciplinary teamwork].

Science.gov (United States)

Gräff, I; Lenkeit, S

2014-10-01

The care of emergency patients with life-threatening injuries or diseases presents a special challenge to the treatment team. Good interdisciplinary cooperation is essential for fast, priority-oriented, and efficient emergency room management. Particularly in complex situations, such as trauma room care, so-called human factors largely determine the safety and performance of the individual as well as the team. Approximately 70 % of all adverse events stem from human factors rather than from a lack of medical expertise. It has been shown that 70-80 % of such incidents are preventable through special training. Established course concepts based on so-called ABCDE schemes are a good basis for creating algorithms for targeted therapy, yet they are not sufficient for the training of team-specific issues. For this, special course concepts are required, such as crew resource management, which is provided through simulator-based training scenarios. This includes task management, teamwork, decision-making, and communication. The knowledge of what needs to be done in a team under the adverse and complex conditions of a medical emergency must be gained by training based on realistic and effective measures. Course concepts that are geared toward interdisciplinary and interprofessional team training optimize patient safety and care by supporting the nontechnical abilities of team members.

TUGAS ROOM ATTENDANT DALAM MENANGANI COMPLAINT TAMU DELUXE ROOM HOTEL HYAAT REGENCY BANDUNG

Directory of Open Access Journals (Sweden)

Reza Gustia Purnama

2016-05-01

Full Text Available Abstract - The problem is how meticulous the duties and responsibilities of the room attendant in the deluxe room Hotel Hyatt Regency Bandung, standard operational procedures in the deluxe room Hotel Hyatt Regency Bandung, and handling guest complaint in deluxe room Hotel Hyatt Regency Bandung. Author uses descriptive analysis, which is a form of writing in the actual situation describes strive about the object of research, then the data obtained in the form of a report compiled in. Based on the results of observation it can be concluded that the task and responsibility of the room attendant in the deluxe room Hyatt Regency Bandung already carry it out in accordance with standard operational procedures (SOP which is divided into two shifts, morning and evening shift which has a slightly different task, standard operational procedures in the deluxe room Hyatt Regency Bandung has been standard operating procedure in applying it at the hotel Hyatt Regency Bandung, and Guest complaint handling in deluxe room Hyatt Regency Bandung Hotel how to deal with and resolve the complaint vary slightly in view of the type of complaint. Based on the results of observation and discussion, the authors conclude that the Duty room attendant in handling customers compaint deluxe room in the Hyatt Regency Bandung Hotel when his handlers was conducted appropriately and propesional effects will be good for the image of the hyatt regency hotel bandung.   Keywords: Room Attendant, Complaint, Deluxe room   Abstraksi - Masalah yang di teliti adalah tugas dan tanggung jawab room attendant di deluxe room Hotel Hyatt Regency Bandung, standar operasional prosedur di deluxe room Hotel Hyatt Regency Bandung, dan penanganan complaint tamu di deluxe room Hotel Hyatt Regency Bandung.  Metode yang di gunakan menggunakan analisis deskriptif, yaitu bentuk penulisan yang di upayakan menggambarkan keadaan yang sebenarnya tetang objek penelitian,kemudian data yang di peroleh disusun

Children Presenting at the Emergency Department With Right Lower Quadrant Pain

Directory of Open Access Journals (Sweden)

Chien-Heng Lin

2009-01-01

Full Text Available Right lower quadrant (RLQ pain is a common complaint in children presenting at emergency departments. This study analyzed the etiologies of RLQ pain, and compared the clinical presentations, laboratory test results and imaging findings in patients with appendicitis with those in other groups of patients. We also investigated if active observation resulted in delayed diagnosis, to the detriment of patients. Medical records for the period January 2006 to July 2006 were reviewed for children (age < 18 years who presented to the emergency department of one medical center, complaining of RLQ pain. Out of a total of 100 patients (age range: 2–17 years; mean: 11 years, 46 patients presented with only one symptom of RLQ pain, while 32 patients had ≥ 2 associated signs or symptoms, including fever, nausea/vomiting, diarrhea, or rebound tenderness. Imaging studies, including abdominal sonography and/or computed tomography, were performed in 73 patients; 44 underwent surgery for presumed appendicitis and one received surgery for a right paraduodenal hernia. Eleven patients underwent surgery because of peritoneal signs, and eight because of persistent or aggravated RLQ pain. Postoperative pathologic examinations revealed 53 cases of appendicitis, six normal appendices, and other morbidities (1 perforated peptic ulcer, 1 pelvic inflammatory disease, 1 ovarian cyst, 1 diverticulitis, and 1 right paraduodenal hernia. Thirty-three patients were discharged after several hours of observation (range: 0.5–18 hours; mean: 4 hours, and three patients were admitted for further observations. All were discharged without operation. There were significant differences in the incidences of fever (p = 0.004 and rebound tenderness (p = 0.019, and in white cell counts (p < 0.001, neutrophil percentages (p < 0.001, and C-reactive protein levels (p < 0.001 between patients with appendicitis and patients with other causes of RLQ pain. Clinical signs and symptoms, laboratory

Room for iodo therapy

International Nuclear Information System (INIS)

Pinto, A.L.A.; Derivi, A.; Bacelar, A.; Ramos, F.R.; Dias, T.M.; Baptista, I.S.

1996-01-01

A description of rules to assemble, to install and to maintain a room for iodo therapy is presented. The necessities of the patients and procedures to meet the norms of radiologic protection established by the Comissao Nacional de Energia Nuclear (CNEN), Rio de Janeiro, RJ (Brazil) are highlighted

Free-energy minimization and the dark-room problem.

Science.gov (United States)

Friston, Karl; Thornton, Christopher; Clark, Andy

2012-01-01

Recent years have seen the emergence of an important new fundamental theory of brain function. This theory brings information-theoretic, Bayesian, neuroscientific, and machine learning approaches into a single framework whose overarching principle is the minimization of surprise (or, equivalently, the maximization of expectation). The most comprehensive such treatment is the "free-energy minimization" formulation due to Karl Friston (see e.g., Friston and Stephan, 2007; Friston, 2010a,b - see also Fiorillo, 2010; Thornton, 2010). A recurrent puzzle raised by critics of these models is that biological systems do not seem to avoid surprises. We do not simply seek a dark, unchanging chamber, and stay there. This is the "Dark-Room Problem." Here, we describe the problem and further unpack the issues to which it speaks. Using the same format as the prolog of Eddington's Space, Time, and Gravitation (Eddington, 1920) we present our discussion as a conversation between: an information theorist (Thornton), a physicist (Friston), and a philosopher (Clark).

Resilience and Brittleness in a Nuclear Emergency Response Simulation: Focusing on Team Coordination Activity

International Nuclear Information System (INIS)

Costa, Wagner Schenkel; Buarque, Lia; Voshell, Martin; Branlat, Matthieu; Woods, David D.; Gomes, Jose Orlando

2008-01-01

The current work presents results from a cognitive task analysis (CTA) of a nuclear disaster simulation. Audio-visual records were collected from an emergency room team composed of individuals from 26 different agencies as they responded to multiple scenarios in a simulated nuclear disaster. This simulation was part of a national emergency response training activity for a nuclear power plant located in a developing country. The objectives of this paper are to describe sources of resilience and brittleness in these activities, identify cues of potential improvements for future emergency simulations, and leveraging the resilience of the emergency response System in case of a real disaster. Multiple CTA techniques were used to gain a better understanding of the cognitive dimensions of the activity and to identify team coordination and crisis management patterns that emerged from the simulation training. (authors)

The crisis in United States hospital emergency services.

Science.gov (United States)

Harrison, Jeffrey P; Ferguson, Emily D

2011-01-01

Emergency services are critical for high-quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (U.S.) acute care hospital staffs ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers. Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities. U.S. acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, U.S. emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staffs ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state-of-the-art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement. This research uses the AHA annual surveys,which represent self-reported data by individual hospital staff. However, the AHA expendssignificant resources to validate reported information and the annual survey data are widely used for hospital research. The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure. This article has important information on US emergency service availability in the hospital industry.

Influence of Diffusivity in Room on its Acoustic Response

Directory of Open Access Journals (Sweden)

D. Šumarac Pavlović

2010-11-01

Full Text Available Diffusivity is a geometrical feature of the room which is proportional to the dimension of relief on its interior surfaces. This paper presents the results of analysis which investigates the correlation between diffusivity in a room and parameters calculated from a recorded impulse response. The analysis was performed using a specially prepared physical model of a parallelepipedic room with different combinations of flat and diffusive interior surfaces.

Review of the Operability for the Components Under the Loss of the HVAC System of the Pump Room

International Nuclear Information System (INIS)

Hwang Mee Jeong; Yoon, Churl; Yang, Joon Eon; Park, Joo Hwan

2005-01-01

In this paper, we estimated the temperature of the pump rooms and reviewed the operability of the components under the loss of the HVAC (Heating, Ventilation, and Air Condition) system. The issues relevant to the HVAC system in the PSA (Probabilistic Safety Assessment) FT (Fault Tree) model are as follows: does the loss of the HVAC system bring about a function failure of other components?. Can the operator take action to reduce the temperature of the room in case of a HVAC function failure?. At present we do not know whether a component will lose its function or not under the loss of the HVAC. ASME Standard describes that a recovery action can be credited if the related recovery action is included in the procedure or there are similar recovery experiences in the plant. However, there is no description about the recovery action of the HVAC in the EOP (Emergency Operation Procedure) of the UCN3, 4 under the situation of a loss of the HVAC. Even though we consider this assumption positively, it would be limited to the rooms such as the Switchgear Room, Inverter Room, and Main Control Room etc. where a real recovery action can be performed easily. However, if we consider the HVAC failure in the PSA FT model according to the above background, the problem is that the unavailability induced from the loss of a HVAC is highly unrealistically. From a viewpoint of the PSA, it is not true that the related system always fails even though the HVAC system fails. Therefore, we reviewed the necessity of the HVAC model through the identification of the operable temperature of the components' within the pump room and the change of the temperature of the pump room under the situation of a loss of the HVAC system

Acute stress in residents during emergency care: a study of personal and situational factors.

Science.gov (United States)

Dias, Roger Daglius; Scalabrini Neto, Augusto

2017-05-01

Providing care for simulated emergency patients may induce considerable acute stress in physicians. However, the acute stress provoked in a real-life emergency room (ER) is not well known. Our aim was to assess acute stress responses in residents during real emergency care and investigate the related personal and situational factors. A cross-sectional observational study was carried out at an emergency department of a tertiary teaching hospital. All second-year internal medicine residents were invited to voluntarily participate in this study. Acute stress markers were assessed at baseline (T1), before residents started their ER shift, and immediately after an emergency situation (T2), using heart rate, systolic, and diastolic blood pressure, salivary α-amylase activity, salivary interleukin-1 β, and the State-Trait Anxiety Inventory (STAI-s and STAI-t). Twenty-four residents were assessed during 40 emergency situations. All stress markers presented a statistically significant increase between T1 and T2. IL-1 β presented the highest percent increase (141.0%, p stress in residents. Resident experience, trait anxiety, and number of emergency procedures were independently associated with acute stress response.

Relación entre consultas a urgencias por enfermedad respiratoria y contaminación atmosférica en Ciudad Juárez, Chihuahua Relationship between emergency room visits for respiratory disease and atmospheric pollution in Ciudad Juárez, Chihuahua

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Leticia Hernández-Cadena

2000-08-01

Full Text Available OBJETIVO: Analizar la relación entre las concentraciones ambientales de partículas de diámetro OBJECTIVE: To assess the relationship of <=10 µm particles (PM10 and atmospheric ozone concentrations, with the daily number of emergency visits due to asthma and acute respiratory diseases, among children aged under 15, living in Ciudad Juarez, Chihuahua, Mexico. MATERIAL AND METHODS: Between 1998 and 1999, an ecologic study was conducted. Atmospheric data were obtained from the Environmental Protection Agency (EPA, from eight monitoring stations located in Ciudad Juarez, Chihuahua, and El Paso, Texas. From July 1997 to December 1998, data from emergency room visits for respiratory illness were abstracted from existing medical records of two Mexican Institute of Social Security (IMSS hospitals in Ciudad Juarez. Diagnoses were classified into two groups: a asthma, and b upper respiratory infections (URI, according to the International Classification of Diseases (ICD-9 and/or IDC-10. Statistical analysis was carried out using the Poisson regression time series method. RESULTS: During the study period, the mean 24-hour PM10 level was 34.46 µg/m³ (SD=17.99 and the mean ozone level was 51.60 ppb (SD=20.70. The model shows that an increase of 20 µg/m³ in the mean 24-hour exposure to PM10 was related to an increase of 4.97% (95% CI 0.97-9.13 in emergency visits for asthma, with a 5-day lag, as well as to an increase of 9% (95% CI 1.8-16.8 when a cumulative 5-day exposure was considered. URI increased 2.95% as a cause of emergency room visits, for each 20 µg/m³ increase in the mean 24-hour exposure to PM10. The impact of PM10 on emergency visits for asthma was greater on days with ozone ambient levels exceeded 49 ppb (median value. CONCLUSIONS: A positive association was found between environmental PM10 and ozone concentrations and the daily number of emergency room visits due to asthma and acute respiratory diseases, even with levels lower than the

Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

Science.gov (United States)

Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick

2013-11-01

U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.

The state of emergency care in Democratic Republic of Congo

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Luc Malemo Kalisya

2015-12-01

Full Text Available The Democratic Republic of Congo (DRC is the second largest country on the African continent with a population of over 70 million. It is also a major crossroad through Africa as it borders nine countries. Unfortunately, the DRC has experienced recurrent political and social instability throughout its history and active fighting is still prevalent today. At least two decades of conflict have devastated the civilian population and collapsed healthcare infrastructure. Life expectancy is low and government expenditure on health per capita remains one of the lowest in the world. Emergency Medicine has not been established as a specialty in the DRC. While the vast majority of hospitals have emergency rooms or salle des urgences, this designation has no agreed upon format and is rarely staffed by doctors or nurses trained in emergency care. Presenting complaints include general and obstetric surgical emergencies as well as respiratory and diarrhoeal illnesses. Most patients present late, in advanced stages of disease or with extreme morbidity, so mortality is high. Epidemics include HIV, cholera, measles, meningitis and other diarrhoeal and respiratory illnesses. Lack of training, lack of equipment and fee-for-service are cited as barriers to care. Pre-hospital care is also not an established specialty. New initiatives to improve emergency care include training Congolese physicians in emergency medicine residencies and medic ranger training within national parks.

Present status and problems of radionuclide studies in emergency cases

International Nuclear Information System (INIS)

Ogawa, Kiyoshi

1983-01-01

Scintigraphy is just right for diagnosing emergency cases due to its noninvasive and simple method, but emergency radionuclide studies have not become practical as a result of difficulty problems. Recently, nuclear medical devices have become easier to use in operations. It is become of this, that I have submitted this report regarding the problems of radionuclide studies in emergency cases. There were 101 cases (1.4 %) out of 7,310 cases for the year period Sept. 1981 - Aug. 1982. The studies consisted of 12 brain imaging cases, 9 plumonary imaging cases, 22 cardiac study cases (cardio-angiography cases 8, 99m-Tc-PYP myocardium imaging cases 12, 201-Tl myocardium imaging cases 2), 12 renal study cases, 11 G.I. blood loss cases, 35 peripheral angiography cases. In the near future, we will have to be ready to perform emergency radionuclide studies if the need arises. (author)

Working conditions of a radiodiagnostic room

International Nuclear Information System (INIS)

Chikirdin, Eh.G.

1983-01-01

The concept of ''operating load'' of an X-ray diagnostic room is explained. The concept includes the calculation of the Week's maximum exposure calculation and monitoring of stationary radiation shielding, measurements of exposure dose rate at working places. In this case the substitution of the actual repeated short-time regime of emitter operation for the calculated continuous regime is performed. The data on the ''operating load'' of X-ray diagnostic room are presented taking into account the method of X-ray investigation

Emergency response facility technical data system of Taiwan Power Company

International Nuclear Information System (INIS)

Lin, E.; Liang, T.M.

1987-01-01

Taiwan Power Company (Taipower) has developed its emergency response facility program since 1981. This program is integrated with the following activities to enhance the emergency response capability of nuclear power plants: (1) survey of the plant instrumentation based on the requirements of R.G. 1.97; (2) improvement of plant specific emergency operating procedures based on the emergency response guidelines developed by the Owners group; (3) implementation of the detailed control room design review with the consideration of human engineering and task analysis; and (4) organization, staff and communication of emergency planning of nuclear power plant. The emergency response facility programs of Taipower are implemented in Chinshan (GE BWR4/MARK I), Kuosheng (GE BWR6/MARK III) and Maanshan (W PWR). The major items included in each program are: (1) to establish new buildings for On-Site Technical Support Center, Near-Site Emergency Operation Facility; (2) to establish an Emergency Executive Center at Taipower headquarters; (3) to establish the communication network between control room and emergency response facilities; and (4) to install a dedicated Emergency Response Facility Technical Data System (ERFTDS) for each plant. The ERFTDS provides the functions of data acquisition, data processing, data storage and display in meeting with the requirements of NUREG 0696. The ERFTDS is designed with plant specific requirements. These specific requirements are expected to be useful not only for the emergency condition but also for normal operation conditions

Importância da proteína C-reativa no diagnóstico e no prognóstico intra-hospitalar em pacientes com dor torácica na sala de emergência C-reactive protein diagnostic and prognostic value in patients presenting at the emergency room with chest pain

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Alfredo Antonio Potsch

2006-09-01

patients admitted to the emergency room (ER with chest pain (CP without ST-segment elevation on the electrocardiogram (ECG. METHODS: From January 2002 to December 2003, 980 patients were consecutively seen in the ER with CP suggestive of acute coronary syndrome (ACS (age = 64.9 ± 14.3, men = 55%, diabetic = 18%, normal ECG = 84%. Serial CRP, creatine kinase MB mass (CKMB-mass and troponin I determinations were performed on admission, in addition to serial ECG. CRP measurements were standardized (s-CRP by the upper limit of normal (ULN of the test used (3.0 mg/L for high-sensitivity C-reactive protein [hs-CRP] and 0.1 mg/dL for titrated CRP [t-CRP]. RESULTS: One hundred and twenty-five patients were diagnosed with acute myocardial infarction (AMI, and their s-CRP values were 1.31 ± 2.90 (median = 0.47 compared to 0.79 ± 1.39 (0.30 in no-AMI patients (p = 0.031. The s-CRP > 1.0 showed 30% sensitivity and 80% specificity, plus negative and positive predictive values of 6.1% and 96.7%, respectively, for AMI diagnosis. There were forty in-hospital cardiac events (16 deaths, 22 urgent revascularizations, and 2 acute myocardial infarction. In the first quartile of the s-CRP ( 0.93 15 events (p = 0.003 occurred. In the logistic regression model, masculine gender and s-CRP > 0.32 (odds ratio 7.6, 2.8 and 2.2, respectively were independent predictors of cardiac events and left ventricular failure. CONCLUSION: In patients with chest pain presenting at the emergency room, s-CRP was not a good marker of AMI, although this diagnosis is virtually excluded by a normal value; in addition, values one-third above the upper limit of normal (>1 mg/L for hs-CRP or >0.33 mg/dL for t-CRP were predictive of in-hospital adverse cardiac events.

CEBAF Control Room Renovation

International Nuclear Information System (INIS)

Michael Spata; Anthony Cuffe; Thomas Oren

2005-01-01

The Machine Control Center (MCC) at Jefferson Lab's Continuous Electron Beam Accelerator Facility (CEBAF) was constructed in the early 1990s and based on proven technology of that era. Through our experience over the last 15 years and in our planning for the facilities 12 GeV upgrade we reevaluated the control room environment to capitalize on emerging visualization and display technologies and improve on work-flow processes and ergonomic attributes. The renovation was performed in two phases during the summer of 2004, with one phase occurring during machine operations and the latter, more extensive phase, occurring during our semi-annual shutdown period. The new facility takes advantage of advances in display technology, analog and video signal management, server technology, ergonomic workspace design, lighting engineering, acoustic ceilings and raised flooring solutions to provide a marked improvement in the overall environment of machine operations

Delayed presentation of popliteal artery transection following undisplaced lateral condyle fracture of tibia

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Mohit Gupta

2016-01-01

Full Text Available Literature suggests that vascular damage occurring with orthopedic injury of the lower extremity is rare and uncommon. We present a case of a young adult male who presented to the emergency room with a history of road traffic accident with complaints of pain in the right ankle diagnosed as medial malleolus fracture and pain in the left knee diagnosed as undisplaced lateral tibial condyle fracture. At the time of presentation, the left leg appeared normal and was stabilized with a knee brace, which on the next day developed severe swelling with absence of distal pulses. Doppler revealed no blood flow distal to popliteal artery with severe soft tissue edema. The patient was posted for emergency basis vascular exploration where popliteal artery was surprisingly found transected and was repaired followed by timely fasciotomy. This case report has also been prepared to stress the importance of secondary survey in patients after high energy trauma as it can prevent the important injuries from being missed.

Control room philosophy: Principles of control room design and control room work; Kontrollrumsfilosofi: Principer foer kontrollrumsutformning och kontrollrumsarbete

Energy Technology Data Exchange (ETDEWEB)

Skriver, Jan; Ramberg, Jasmine; Allwin, Pernilla [Scandpower Risk Management AB, Uppsala (Sweden)

2006-01-15

In order to provide insights for improvement of work in control rooms several factors have to be considered. Knowledge of principles including control room philosophies will guide the recommended improvements. In addition to knowledge about specific principles an advantage for an organization can be an understanding of similarities and policies used in other high risk industry. The report has been developed on the basis of a document analysis of international standards and other guiding documents. (NUREG 0711, ISO 11064, ISO 6385, IEC 60964). In addition to the document analysis which has strived to compare the documents to see similarities in important principals, experience from working with control room design, modifications and evaluations in other high risk industries has pervaded the report. Important principles have been identified which are recommended to be included in a control room philosophy. Many of these are similar to the principles identified in the international standards. An additional principal which is regarded as important is the utilization of Key Performance Indicators (KPI) which can be used as a measure to target preventative means. Further more it is critical that the control room philosophy is easy to access and comprehend for all users. One of the challenges that remain after having developed a control room philosophy is how to utilize it in the daily work situation. It is vital that the document remains as a living document, guiding the continual improvement of the control room in the various life cycle stages.

Radiological investigation in the outside area of expedition's room during radiopharmaceuticals' expedition

International Nuclear Information System (INIS)

Reina, Luiz C.; Monteiro, Ilka H.T.S.; Silva, Joao Carlos P. da; Teixeira, Danilo L.; Pedro, C.R.; Santos, J. Regis dos

2013-01-01

Radiopharmaceuticals produced in IEN - Instituto de Engenharia Nuclear of the Brazilian Nuclear Energy Commission, are issued by the radiation protection team, which is responsible for preparing and issuing the packaged documentation required for movement in modal transportation. The documents are: Invoice , Shipper's Declaration of Radioactive Material , Shipper's Declaration of Dangerous Goods - (form IATA ) , Emergency Sheet, sketch of packed. All this documentation is inserted in an envelope of emergency. The Department of Radiological Protection is responsible for issuing such documents except the invoice that is issued by the Commercial Sector (Setcom). A employee of this sector is responsible for delivering it to the shipment sector. The preparation of packaged and documentation is performed in a room located in the building of Radiopharmaceutical Division. The vehicles which are used in the transport are parked outside this building, where are monitored after commissioning of packaged. The present study aims to evaluate potential and occupational radiation risks of people in transit or remain in the area where radioactive material circulates due to the shipment of radiopharmaceuticals for the classification of the area during the operation of dispatch

Abdominal emergencies after liver transplantation: Presentation and surgical management.

Science.gov (United States)

Cesaretti, Manuela; Dioguardi Burgio, Marco; Zarzavadjian Le Bian, Alban

2017-11-01

With an increasing number of liver transplantation (LT) and an enhanced overall survival, LT recipients are more likely to be admitted in emergency departments of general hospitals. Yet, in LT recipients, common but also benign symptoms may reveal a LT-related (or not) severe condition. To improve management of LT recipients by emergency physicians and general surgeons and potentially improve long-term outcomes, a clinical review was performed. Overall, CT scan and blood tests should be systematically performed. Immunosuppressive side effects should be excluded using blood tests. LT-related complications are more likely to occur during the first three months after LT, including mainly bile leak, arterial aneurysm, and pseudoaneurysm. Patients should be referred in emergency to tertiary centers. Non-LT-related complications and common abdominal conditions may also be diagnosed in LT recipients. Except in case of diffuse peritonitis or in hemodynamically unstable patients when surgical procedure should be performed, most conditions should be reassessed regarding the immunosuppressive treatment and the adhesive abdominal cavity. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Czech Tea Profession and the Phenomenon of Tea Rooms

OpenAIRE

Schröderová, Karolína

2015-01-01

In this bachelor thesis I have focused on the Czech tea culture and tea profession across tea rooms. I have dealt with influences that led to the present tea rooms' appearances. Furthermore I am dealing with ways of tea culture spreading, and what conduces to the tea room establishing. I am using the term of subculture in the connection with the tea culture, its meaning and position in the Czech culture. The main data source were semi- structured interviews with the tea rooms owners, all comp...

Reliability of estimating the room volume from a single room impulse response

OpenAIRE

Kuster, M.

2008-01-01

The methods investigated for the room volume estimation are based on geometrical acoustics, eigenmode, and diffuse field models and no data other than the room impulse response are available. The measurements include several receiver positions in a total of 12 rooms of vastly different sizes and acoustic characteristics. The limitations in identifying the pivotal specular reflections of the geometrical acoustics model in measured room impulse responses are examined both theoretically and expe...

Human-Like Room Segmentation for Domestic Cleaning Robots

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David Fleer

2017-11-01

Full Text Available Autonomous mobile robots have recently become a popular solution for automating cleaning tasks. In one application, the robot cleans a floor space by traversing and covering it completely. While fulfilling its task, such a robot may create a map of its surroundings. For domestic indoor environments, these maps often consist of rooms connected by passageways. Segmenting the map into these rooms has several uses, such as hierarchical planning of cleaning runs by the robot, or the definition of cleaning plans by the user. Especially in the latter application, the robot-generated room segmentation should match the human understanding of rooms. Here, we present a novel method that solves this problem for the graph of a topo-metric map: first, a classifier identifies those graph edges that cross a border between rooms. This classifier utilizes data from multiple robot sensors, such as obstacle measurements and camera images. Next, we attempt to segment the map at these room–border edges using graph clustering. By training the classifier on user-annotated data, this produces a human-like room segmentation. We optimize and test our method on numerous realistic maps generated by our cleaning-robot prototype and its simulated version. Overall, we find that our method produces more human-like room segmentations compared to mere graph clustering. However, unusual room borders that differ from the training data remain a challenge.

New method for presenting offsite radiological monitoring data during emergency preparedness exercises

International Nuclear Information System (INIS)

Moeller, M.P.; Martin, G.F.; Hickey, E.E.; Jamison, J.D.

1986-09-01

As scenarios for exercises become more complicated and flexible to challenge emergency response personnel, improved means of presenting data must be developed. To provide maximum realism and free play during an exercise, staff at the Pacific Northwest Laboratory (PNL) have recently devised a simple method of presenting realistic radiological field monitoring information for a range of possible releases. The method uses only two pieces of paper. The first is a map of the offsite area showing the shape of the plume for the duration of the exercise. The second is a semilog graph containing curves that relate exposure rate and iodine concentration to downwind distance and time. Several techniques are used to maximize the information on the graph

Testing of Method for Assessing of Room Thermal Stability

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Charvátová Hana

2017-01-01

Full Text Available The paper presents the interim results of our research on the developing methodological procedure which could be used for assessment of a thermal stability of buildings with regards to its thermal accumulative parameters. The principle of testing is based on a combination of computer simulation of cooled room model developed in COMSOL Multiphysics software and on theoretical calculations with respect to compliance with valid European and Czech technical standards used in building industry and architecture under conditions obtained by real measurement for the room to be tested. The presented example shows the effect of the heataccumulation properties of the outside wall insulation materials on the course of the cooling room for winter conditions.

Emergency support centre concept for the enhanced CANDU 6

International Nuclear Information System (INIS)

Nadimian, R.M.; Leger, R.

2013-01-01

In a two-unit Enhanced CANDU 6 (EC6) design, the overall management of an emergency is by the plant emergency support staff using the Emergency Support Centre (ESC). The ESC is a shared facility between both units and is separate from the plant control rooms. ESC is used to provide support for managing overall emergency response, coordinating radiological and environmental assessments, determining recommended public protective actions, and coordinating emergency response activities with federal, provincial, and municipal agencies. Such a facility provides provisions to protect its occupants from hazards resulting from accident conditions, and applicable natural external hazards. (author)

Alcopops, taxation and harm: a segmented time series analysis of emergency department presentations.

Science.gov (United States)

Gale, Marianne; Muscatello, David J; Dinh, Michael; Byrnes, Joshua; Shakeshaft, Anthony; Hayen, Andrew; MacIntyre, Chandini Raina; Haber, Paul; Cretikos, Michelle; Morton, Patricia

2015-05-06

In Australia, a Goods and Services Tax (GST) introduced in 2000 led to a decline in the price of ready-to-drink (RTD) beverages relative to other alcohol products. The 2008 RTD ("alcopops") tax increased RTD prices. The objective of this study was to estimate the change in incidence of Emergency Department (ED) presentations for acute alcohol problems associated with each tax. Segmented regression analyses were performed on age and sex-specific time series of monthly presentation rates for acute alcohol problems to 39 hospital emergency departments across New South Wales, Australia over 15 years, 1997 to 2011. Indicator variables represented the introduction of each tax. Retail liquor turnover controlled for large-scale economic factors such as the global financial crisis that may have influenced demand. Under-age (15-17 years) and legal age (18 years and over) drinkers were included. The GST was associated with a statistically significant increase in ED presentations for acute alcohol problems among 18-24 year old females (0 · 14/100,000/month, 95% CI 0 · 05-0 · 22). The subsequent alcopops tax was associated with a statistically significant decrease in males 15-50 years, and females 15-65 years, particularly in 18-24 year old females (-0 · 37/100,000/month, 95% CI -0 · 45 to -0 · 29). An increase in retail turnover of liquor was positively and statistically significantly associated with ED presentations for acute alcohol problems across all age and sex strata. Reduced tax on RTDs was associated with increasing ED presentations for acute alcohol problems among young women. The alcopops tax was associated with declining presentations in young to middle-aged persons of both sexes, including under-age drinkers.

Qualities of Inpatient Hospital Rooms: Patients' Perspectives.

Science.gov (United States)

Devlin, Ann Sloan; Andrade, Cláudia Campos; Carvalho, Diana

2016-04-01

The aim of this qualitative study was to investigate what design features of hospital rooms are valued by inpatients. Little research has explored how patients evaluate the physical environment of their hospital rooms. Most responses are captured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which includes only two questions about the physical environment. Two hundred thirty-six orthopedic patients (78 in the United States and 158 in Portugal) listed three features of their hospital room that influenced their level of satisfaction with their hospital stay, indicating whether the feature was positive or negative. The comments were more positive (71.4%) than negative (28.6%). Using the framework of supportive design from Ulrich, over half the comments (64.31%) could be categorized in one of the three dimensions: 33.2% (positive distraction), 22.4% (perceived control), and 6.0% (social support). This total includes Internet (2.7%), which could be categorized as either social support or positive distraction. Comments called "other aspects" focused on overall environmental appraisals, cleanliness, and functionality and maintenance. The majority of comments could be accommodated by Ulrich's theory, but it is noteworthy that other aspects emerge from patients' comments and affect their experience. Cross-cultural differences pointed to the greater role of light and sun for Portuguese patients and health status whiteboard for U.S. Qualitative research can add significantly to our understanding of the healthcare experience and may inform design decisions. © The Author(s) 2015.

Well-being and employee health-how employees' well-being scores interact with demographic factors to influence risk of hospitalization or an emergency room visit.

Science.gov (United States)

Gandy, William M; Coberley, Carter; Pope, James E; Rula, Elizabeth Y

2014-02-01

The goal of this study was to determine the relationship between individual well-being and risk of a hospital event in the subsequent year. The authors hypothesized an inverse relationship in which low well-being predicts higher likelihood of hospital use. The study specifically sought to understand how well-being segments and demographic variables interact in defining risk of a hospital event (inpatient admission or emergency room visit) in an employed population. A retrospective study design was conducted with data from 8835 employees who completed a Well-Being Assessment questionnaire based on the Gallup-Healthways Well-Being Index. Cox proportional hazards models were used to examine the impact of Individual Well-Being Score (IWBS) segments and member demographics on hazard ratios (HRs) for a hospital event during the 12 months following assessment completion. Significant main effects were found for the influence of IWBS segments, sex, education, and relationship status on HRs of a hospital event, but not for age. However, further analysis revealed significant interactions between age and IWBS segments (P=0.005) and between age and sex (Pwell-being and higher risk of an event in employees ages 44 years and older is mitigated in younger age groups. These results suggest that youth attenuates the risk engendered in poor well-being; therefore, methods to maintain or improve well-being as individuals age presents a strong opportunity for reducing hospital events.

Nuclear power plant control room operators' performance research

International Nuclear Information System (INIS)

Gray, L.H.; Haas, P.M.

1984-01-01

A research program is being conducted to provide information on the performance of nuclear power plant control room operators when responding to abnormal/emergency events in the plants and in full-scope training simulators. The initial impetus for this program was the need for data to assess proposed design criteria for the choice of manual versus automatic action for accomplishing safety-related functions during design basis accidents. The program also included studies of training simulator capabilities, of procedures and data for specifying and verifying simulator performance, and of methods and applications of task analysis

Reaction of Medical Students to Experiences in Dissection Room ...

African Journals Online (AJOL)

Conclusion: The present study findings show that smell of the dissection room, touch and fear of cadaver were the commonest cause of their symptoms experienced while study in dissection room for the majority of students. Thus, instructors are should give awareness raising education before the commencement of the ...

Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study: interventions with nurses.

Science.gov (United States)

Le May, Sylvie; Johnston, C Celeste; Choinière, Manon; Fortin, Christophe; Kudirka, Denise; Murray, Louise; Chalut, Dominic

2009-08-01

Children's pain in emergency departments (EDs) is poorly managed by nurses, despite evidence that pain is one of the most commonly presenting complaints of children attending the ED. Our objectives were 2-fold: to verify if tailored educational interventions with emergency pediatric nurses would improve nurses' knowledge of pain management and nurses' pain management practices (documentation of pain, administration of analgesics, nonpharmacological interventions). This intervention study with a pre-post design (baseline, immediately after the intervention [T-2], and 6 months after intervention [T-3]) used a sample of nurses (N = 50) and retrospective chart reviews of children (N = 450; 150 charts reviewed each at baseline, T-2, and T-3) who presented themselves in the ED with a diagnosis known to generate moderate to severe pain (burns, acute abdominal pain, deep lacerations, fracture, sprain). Principal outcomes: nurses' knowledge of pain management (Pediatric Nurses Knowledge and Attitudes Survey [PNKAS] on pain) and nurses' clinical practices of pain management (Pain Management Experience Evaluation [PMEE]). Response rate on the PNKAS was 84% (42/50) at baseline and 50% (21/42) at T-2. Mean scores on PNKAS were 28.2 (SD, 4.9; max, 42.0) at baseline and 31.0 (SD, 4.6) at T-2. Results from paired t test showed significant difference between both times (t = -3.129, P = 0.005). Nurses who participated in the capsules improved their documentation of pain from baseline (59.3%) to T-2 (80.8%; chi = 12.993, P nurses increased their nonpharmacological interventions from baseline (16.7%) to T-3 (31.9%; chi = 8.623, P = 0.003). Finally, we obtained significant differences on pain documentation between the group of nurses who attended at least 1 capsule and the group of nurses who did not attend any capsule at both times (T-2 and T-3; chi = 20.424, P nurses' knowledge of pain management and some of the practices over time. We believe that an intervention tailored to nurses

Survey of licensee control room habitability practices

International Nuclear Information System (INIS)

Boland, J.F.; Brookshire, R.L.; Danielson, W.F.; Driscoll, J.W.; Graham, E.D.; McConnell, R.J.; Thompson, V.N.

1985-04-01

This document presents the results of a survey of Licensee control-room-habitability practices. The survey is part of a comprehensive program plan instituted in August 1983 by the NRC to respond to ongoing questions from the Advisory Committee on Reactor Safeguards (ACRS). The emphasis of this survey was to determine by field review the control-room habitability practices at three different plants, one of which is still under construction and scheduled to receive an operating license in 1986. The other two plants are currently operating, having received operating licenses in the mid-1970's and early 1980's. The major finding of this survey is that despite the fact that the latest control-room-habitability systems have become larger and more complex than earlier systems surveyed, the latest systems do not appear to be functionally superior. The major recommendation of this report is to consolidate into a single NRC document, based upon a comprehensive systems engineering approach, the pertinent criteria for control-room-habitability design

Cortisol at the emergency room rape visit as a predictor of PTSD and depression symptoms over time.

Science.gov (United States)

Walsh, Kate; Nugent, Nicole R; Kotte, Amelia; Amstadter, Ananda B; Wang, Sheila; Guille, Constance; Acierno, Ron; Kilpatrick, Dean G; Resnick, Heidi S

2013-11-01

Dysregulation of the hypothalamic-pituitary-adrenal axis, typically reflected by alterations in cortisol responsivity, has been associated with exposure to traumatic events and the development of stress-related disorders such as posttraumatic stress disorder (PTSD) and depression. Serum cortisol was measured at the time of a post sexual assault medical exam among a sample of 323 female victims of recent sexual assault. Analyses were conducted among 235 participants who provided data regarding history of previous assault as well as PTSD and depression symptoms during at least one of the three follow-ups. Growth curve models suggested that prior history of assault and serum cortisol were positively associated with the intercept and negatively associated with the slope of PTSD and depression symptoms after controlling for covariates. Prior history of assault and serum cortisol also interacted to predict the intercept and slope of PTSD and depression symptoms such that women with a prior history of assault and lower ER cortisol had higher initial symptoms that decreased at a slower rate relative to women without a prior history and those with higher ER cortisol. Prior history of assault was associated with diminished acute cortisol responsivity at the emergency room visit. Prior assault history and cortisol both independently and interactively predicted PTSD and depression symptoms at first follow-up and over the course a 6-month follow-up. Copyright © 2013 Elsevier Ltd. All rights reserved.

Comparative study on cases of vertigo and dizziness in the emergency room and otorhinolaryngological clinic

International Nuclear Information System (INIS)

Tsujimoto, Toshiya; Kawashima, Kayoko; Hashimoto, Seiko; Imai, Takao

2011-01-01

We recently studied the characteristics of vertigo and dizziness in 197 patients who first visited the emergency room (ER group) and in 288 patients who first visited the otorhinolaryngological clinic of Minoh City Hospital (ENT group) between January 1 and December 31 of 2009. The ER group can be regarded as representing the hyperacute phase and the ENT group as representing the acute to chronic phase. These two groups were completely distinct. We also subdivided these groups into the high risk subgroup (H subgroup) for cases with the underlying diseases of diabetes mellitus, hypertension, cerebrovascular disease and hyperlipidemia, and the normal subgroup (N subgroup).Comparison of the two groups showed that, in the ER group, a significantly larger numbers of patients had symptoms of peripheral vestibular origin except for benign paroxysmal positional vertigo (BPPV) and Meniere's disease, and a significantly larger number of patients had symptoms of unknown origin in the ENT group. Half of this group may be accounted for by patients with symptoms of peripheral vestibular origin except for BPPV and Meniere's disease in the ER group. In 8 out of 158 patients of the ER group and 1 out of 122 patients of the ENT group, cerebral lesions were not found on CT images but were found with MRI. Careful investigation is necessary in the patients with normal CT findings. Central vestibular lesions were found in 7 out of 197 patients (3.5%) of the ER group and 5 out of 288 patients (1.7%) of the ENT group. The incidence of central lesions tended to be higher in the ER group than in the ENT group. There was no significant difference in the incidence of central lesion among the H and N subgroups of both groups. Careful investigation of the central vestibular lesion is also necessary in the N subgroup. (author)

Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department.

Science.gov (United States)

Moore, Gaye; Hepworth, Graham; Weiland, Tracey; Manias, Elizabeth; Gerdtz, Marie Frances; Kelaher, Margaret; Dunt, David

2012-02-01

To prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department. A prospective cohort analysis utilised one month of data from a Principal Referral Hospital in Melbourne, Australia. All visits involving people classified as homeless were included, excluding those who died. Homelessness was defined as living on the streets, in crisis accommodation, in boarding houses or residing in unstable housing. Rates of re-presentation, defined as the total number of visits to the same emergency department within 28 days of discharge from hospital, were measured. Performance of the risk screening tool was assessed by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios. Over the study period (April 1, 2009 to April 30, 2009), 3298 presentations from 2888 individuals were recorded. The homeless population accounted for 10% (n=327) of all visits and 7% (n=211) of all patients. A total of 90 (43%) homeless people re-presented to the emergency department. The predictive model included nine variables and achieved 98% (CI, 0.92-0.99) sensitivity and 66% (CI, 0.57-0.74) specificity. The positive predictive value was 68% and the negative predictive value was 98%. The positive likelihood ratio 2.9 (CI, 2.2-3.7) and the negative likelihood ratio was 0.03 (CI, 0.01-0.13). The high emergency department re-presentation rate for people who were homeless identifies unresolved psychosocial health needs. The emergency department remains a vital access point for homeless people, particularly after hours. The risk screening tool is key to identify medical and social aspects of a homeless patient's presentation to assist early identification and referral. Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

GOTHIC Simulation of APR1400 Auxiliary Charging Pump room heat up

Energy Technology Data Exchange (ETDEWEB)

Ha, Hui-Un; Heo, Sun [KHNP, Daejeon (Korea, Republic of)

2014-10-15

As a part of the Advanced Power Reactor 1400 (APR1400) U. S. Nuclear Regulatory Commission Design Certification (NRC DC) project, we have been investigating Auxiliary Charging Pump (ACP) room heat up. With reference to the design specification of the ACP room, we determined input information and developed a GOTHIC model of the APR1400 ACP room. This calculation model is described herein, and representative results from the calculation are presented as well. The results of the present paper are used to determine the integrity of ACP operating in the accident. APR 1400 GOTHIC model was developed for ACP room heat up calculation. Calculation results confirm that door opening is cooling the room properly. It is found that the difference due to the surface option of heat conductors is insignificant. Based on this result, further studies should be performed to confirm integrity of ACP.

Design process and philosophy of TVA's latest advance control room complex

International Nuclear Information System (INIS)

Owens, G.R.; Masters, D.W.

1979-01-01

TVA's latest nuclear power plant control room design includes a greater emphasis on human factors as compared to their earlier plant designs. This emphasis has resulted in changes in the overall design philosophy and design process. This paper discusses some of the prominent design features of both the control room and the surrounding control room complex. In addition, it also presents some of the important activities involved in the process of developing the advanced control room design

Differences in Presentation, Management and Outcomes in Women and Men Presenting to an Emergency Department With Possible Cardiac Chest Pain.

Science.gov (United States)

Ruane, Lorcan; H Greenslade, Jaimi; Parsonage, William; Hawkins, Tracey; Hammett, Christopher; Lam, Carolyn Sp; Knowlman, Thomas; Doig, Shaela; Cullen, Louise

2017-12-01

Research suggests that female patients with acute coronary syndrome (ACS) experience delays in emergency department (ED) management and are less likely to receive guideline-based treatments and referrals for follow-up testing. Women are often found to have poorer clinical outcomes in comparison to men. This study aimed to assess current sex differences in the presentation, management and outcomes of patients with undifferentiated chest pain presenting to a tertiary ED. Data were analysed from two prospective studies conducted at a single Australian site between 2007 and 2014. Eligible patients were those of 18 years of age or older presenting with at least 5 minutes of chest pain or other symptoms for which the treating physician planned to investigate for possible ACS. Presenting symptoms, ED time measures, follow-up testing and outcomes, including 30-day ACS and mortality, were measured and compared between male and female patients. Of 2349 (60% men) patients presenting with chest pain, 153 men and 51 women were diagnosed with ACS within 30days . Presenting symptoms were similar in men and women with confirmed ACS. Time from symptom onset to ED presentation, time spent in the ED and total time in hospital were similar between the sexes. Male and female patients had similar rates of follow-up provocative testing. After adjustment for clinical factors, the odds of undergoing angiography were 1.8 (95% CI: 1.36-2.40) times higher for men than women. Of those undergoing coronary angiography within 30 days, a smaller proportion of women, compared to men, received revascularisation. Within 30 days, three (0.2%) male and one (0.1%) female patient died. Minimal sex differences were observed in the contemporary emergency management of patients presenting with suspected ACS. Thirty-day outcomes were similarly low in men and women despite lower rates of coronary angiography and revascularisation in women. Further research is required to replicate these results in different

Flooding and emergency room visits for gastrointestinal illness in Massachusetts: a case-crossover study.

Directory of Open Access Journals (Sweden)

Timothy J Wade

Full Text Available INTRODUCTION: Floods and other severe weather events are anticipated to increase as a result of global climate change. Floods can lead to outbreaks of gastroenteritis and other infectious diseases due to disruption of sewage and water infrastructure and impacts on sanitation and hygiene. Floods have also been indirectly associated with outbreaks through population displacement and crowding. METHODS: We conducted a case-crossover study to investigate the association between flooding and emergency room visits for gastrointestinal illness (ER-GI in Massachusetts for the years 2003 through 2007. We obtained ER-GI visits from the State of Massachusetts and records of floods from the National Oceanic and Atmospheric Association's Storm Events Database. ER-GI visits were considered exposed if a flood occurred in the town of residence within three hazard periods of the visit: 0-4 days; 5-9 days; and 10-14 days. A time-stratified bi-directional design was used for control selection, matching on day of the week with two weeks lead or lag time from the ER-GI visit. Fixed effect logistic regression models were used to estimate the risk of ER-GI visits following the flood. RESULTS AND CONCLUSIONS: A total of 270,457 ER-GI visits and 129 floods occurred in Massachusetts over the study period. Across all counties, flooding was associated with an increased risk for ER-GI in the 0-4 day period after flooding (Odds Ratio: 1.08; 95% Confidence Interval: 1.03-1.12; but not the 5-9 days (Odds Ratio: 0.995; 95% Confidence Interval: 0.955-1.04 or the 10-14 days after (Odds Ratio: 0.966, 95% Confidence Interval: 0.927-1.01. Similar results were observed for different definitions of ER-GI. The effect differed across counties, suggesting local differences in the risk and impact of flooding. Statewide, across the study period, an estimated 7% of ER-GI visits in the 0-4 days after a flood event were attributable to flooding.

The Active Listening Room Simulator: Part 2

OpenAIRE

Naqvi, Amber; Rumsey, Francis

2001-01-01

This paper presents the results of computer simulation of active reflectors in a reference listening room which are used to create artificial reflections in a two speaker, stereo listening configuration. This formulates the second phase of experiments in the active listening room project involving the analysis of computer modeling results and loudspeaker selection based on free field response. The aim of this project is to create a truly variable listening condition in a reference listening r...

An electronic logbook for the HEP control room

International Nuclear Information System (INIS)

Roediger, G.; Pomatto, P.; Kyriakopulos, J.; Panacek, S.; Canal, P.; Kubarovsky, A.

2001-01-01

The Control Room Logbook (CRL) is designed to improve and replace the paper logbooks traditionally used in the HEP accelerator control room. Its features benefit the on-line coordinator, the shift operators, and the remote observers. The author explains some of the most attractive features for each of these roles. The features include the ability to configure the logbook for the specific needs of a collaboration, a large variety of entry types an operator can add by simply clicking and dragging, and a flexible web interface for the remote observer to keep up with control room activities. The entries and saved as UTF-8 based XML files, which allowed us to give the data structure and meaning such that it can easily be parsed in the present and far into the future. The XML tag data is also indexed in a relational database, making queries on dates, keywords, entry type and other criteria feasible and fast. The CRL is used in the D0 control room. This presentation also discusses our experience with deployment, platform independence and other interesting issues that arose with the installation and use of logbook

An Electronic Logbook for the HEP Control Room

International Nuclear Information System (INIS)

Gary Roediger

2001-01-01

The Control Room Logbook (CRL) is designed to improve and replace the paper logbooks traditionally used in the HEP accelerator control room. Its features benefit the on-line coordinator, the shift operators, and the remote observers. This paper explains some of the most attractive features for each of these roles. The features include the ability to configure the logbook for the specific needs of a collaboration, a large variety of entry types an operator can add by simply clicking and dragging, and a flexible web interface for the remote observer to keep up with control room activities. The entries are saved as UTF-8 based XML files, which allowed us to give the data structure and meaning such that it can easily be parsed in the present and far into the future. The XML tag data is also indexed in a relational database, making queries on dates, keywords, entry type and other criteria feasible and fast. The CRL is used in the D0 control room. This presentation also discusses our experience with deployment, platform independence and other interesting issues that arose with the installation and use of the logbook

Disparities in access to emergency general surgery care in the United States.

Science.gov (United States)

Khubchandani, Jasmine A; Shen, Connie; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

2018-02-01

As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. Copyright © 2017 Elsevier Inc. All rights reserved.

Near-term improvements for nuclear power plant control room annunciator systems

International Nuclear Information System (INIS)

Rankin, W.L.; Duvernoy, E.G.; Ames, K.R.; Morgenstern, M.H.; Eckenrode, R.J.

1983-04-01

This report sets forth a basic design philosophy with its associated functional criteria and design principles for present-day, hard-wired annunciator systems in the control rooms of nuclear power plants. It also presents a variety of annunciator design features that are either necessary for or useful to the implementation of the design philosophy. The information contained in this report is synthesized from an extensive literature review, from inspection and analysis of control room annunciator systems in the nuclear industry and in related industries, and from discussions with a variety of individuals who are knowledgeable about annunciator systems, nuclear plant control rooms, or both. This information should help licensees and license applicants in improving their hard-wired, control room annunciator systems as outlined by NUREG-0700

Low frequency sound reproduction in irregular rooms using CABS (Control Acoustic Bass System)

DEFF Research Database (Denmark)

Celestinos, Adrian; Nielsen, Sofus Birkedal

2011-01-01

of an irregular room model using the FDTD (Finite Difference Time Domain) method has been presented. CABS has been simulated in the irregular room model. Measurements of CABS in a real irregular room have been performed. The performance of CABS was affected by the irregular shape of the room due to the corner...

Clinical spectrum of rhabdomyolysis presented to pediatric emergency department

Science.gov (United States)

2013-01-01

Background Rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes. The aim of the work is to analyze the clinical spectrum and to evaluate the prevalence of various etiologies in children, who present to the emergency department (ED) with rhabdomyolysis. Methods During a 6-year study period, we retrospectively analyzed the medical charts of patients, aged 18 years or younger, with a definite diagnosis of rhabdomyolysis and serum creatinine phosphokinase (CK) levels greater than 1000IU/L. We analyzed the clinical spectrum and evaluated the potential risk factors of acute renal failure (ARF). Results Thirty-seven patients (mean age = 10.2 ± 5.5 years), including 26 males and 11 females, were enrolled in the study. Two of the most common presented symptoms in these 37 patients were muscle pain and muscle weakness (83.8% and 73%, respectively). Dark urine was reported in only 5.4% of the patients. The leading cause of rhabdomyolysis in the 0- to 9-year age group was presumed infection, and the leading cause in the 10- to 18-year age group was trauma and exercise. The incidence of ARF associated with rhabdomyolysis was 8.1 % and no child needed for renal replacement therapy (RRT). We did not identify any reliable predictors of ARF or need for RRT. Conclusions The classic triad of symptoms of rhabdomyolysis includes myalgia, weakness and dark urine are not always presented in children. The cause of rhabdomyolysis in younger age is different from that of teenager group. However, the prognosis of rhabdomyolysis was good with appropriate management. PMID:24004920

Future control room design (modernization of control room systems)

International Nuclear Information System (INIS)

Reischl, Ludwig; Freitag, Timo; Dergel, Rene

2009-01-01

In the frame of lifetime extension for nuclear power plants the modernization of the complete safety and operational control technology will be digitalized. It is also recommended to modernize the operator facilities, monitoring systems in the control room, the back-up shut-down center and the local control stations. The authors summarize the reasons for the modernization recommendations and discuss possible solutions for display-oriented control rooms. A concept for control room backfitting includes generic requirements, requirements of the local authorities, ergonomic principles information content and information density, and the design process. The backfitting strategy should include a cooperation with the operational personnel, The quality assurance and training via simulator needs sufficient timing during the implementation of the backfitting.

Involuntary psychiatric attendances at an Australasian emergency department: A comparison of police and health-care worker initiated presentations.

Science.gov (United States)

Llewellin, Peter; Arendts, Glenn; Weeden, Jacqueline; Pethebridge, Andrew

2011-10-01

To identify any significant differences in the population of patients brought in to a hospital ED under involuntary mental health orders, based on whether the orders are initiated by police or health professionals. A retrospective analysis of consecutive presentations to a tertiary hospital ED with a co-located psychiatric emergency care centre over a 12 month period, with univariate and multivariate statistical comparisons. Two hundred and eighty-two patients (making 378 ED presentations) met the case definition and were analysed. Compared with patients on medical orders, patients on police orders had significantly more presentations related to violence, longer stays in ED and lower rates of admission to an inpatient bed, but were no more likely to require restraint or security intervention within the ED. Patients on police and medical orders differ considerably, but the impact of these differences on ED workload is small. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Computational model of gamma irradiation room at ININ

Science.gov (United States)

Rodríguez-Romo, Suemi; Patlan-Cardoso, Fernando; Ibáñez-Orozco, Oscar; Vergara Martínez, Francisco Javier

2018-03-01

In this paper, we present a model of the gamma irradiation room at the National Institute of Nuclear Research (ININ is its acronym in Spanish) in Mexico to improve the use of physics in dosimetry for human protection. We deal with air-filled ionization chambers and scientific computing made in house and framed in both the GEANT4 scheme and our analytical approach to characterize the irradiation room. This room is the only secondary dosimetry facility in Mexico. Our aim is to optimize its experimental designs, facilities, and industrial applications of physical radiation. The computational results provided by our model are supported by all the known experimental data regarding the performance of the ININ gamma irradiation room and allow us to predict the values of the main variables related to this fully enclosed space to within an acceptable margin of error.

Control room inleakage testing using tracer gases at Zion Generating station

International Nuclear Information System (INIS)

Lagus, P.L.; Brown, J.H.; Dubois, L.J.; Fleming, K.M.

1993-01-01

In order to assess the amount of air inleakage into the Control Room Envelope at Zion Generating Station (ZGS), a series of tracer gas tests using sulfur hexafluoride (SF 6 ) were performed on the Control Room ventilation system (PV system) and the Computer Room/Miscellaneous Area ventilation system (OV system) during February, 1991. Two redundant trains, denoted A and B comprise the PV system. Inleakage was measured for each train. An OV supply duct passes through the Control Room Envelope. Leakage from this duct into the Control Room would constitute air leakage into the Control room Envelope and hence any potential leakage had to be quantified. Each test attempted to measure the contribution (if any) of a particular section of PV return duct or OV supply duct to the total air inleakage into the Control Room. This paper reviews the tracer gas tests. Described here are the control room inleakage testing, HVAC equipment room duct inleakage, purge plenum inleakage, OV duct leakage into the control room envelope, vestibule PV return inleakage, TSC duct inleakage, and cable spreading room inleakage. Conclusions from the testing are presented. 5 refs., 4 figs., 7 tabs

Assessing inhalation injury in the emergency room

Directory of Open Access Journals (Sweden)

Tanizaki S

2015-07-01

Full Text Available Shinsuke Tanizaki Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan Abstract: Respiratory tract injuries caused by inhalation of smoke or chemical products are related to significant morbidity and mortality. While many strategies have been built up to manage cutaneous burn injuries, few logical diagnostic strategies for patients with inhalation injuries exist and almost all treatment is supportive. The goals of initial management are to ensure that the airway allows adequate oxygenation and ventilation and to avoid ventilator-induced lung injury and substances that may complicate subsequent care. Intubation should be considered if any of the following signs exist: respiratory distress, stridor, hypoventilation, use of accessory respiratory muscles, blistering or edema of the oropharynx, or deep burns to the face or neck. Any patients suspected to have inhalation injuries should receive a high concentration of supplemental oxygen to quickly reverse hypoxia and to displace carbon monoxide from protein binding sites. Management of carbon monoxide and cyanide exposure in smoke inhalation patients remains controversial. Absolute indications for hyperbaric oxygen therapy do not exist because there is a low correlation between carboxyhemoglobin levels and the severity of the clinical state. A cyanide antidote should be administered when cyanide poisoning is clinically suspected. Although an ideal approach for respiratory support of patients with inhalation injuries do not exist, it is important that they are supported using techniques that do not further exacerbate respiratory failure. A well-organized strategy for patients with inhalation injury is critical to reduce morbidity and mortality. Keywords: inhalation injury, burn, carbon monoxide poisoning, cyanide poisoning

Evaporation Controlled Emission in Ventilated Rooms

DEFF Research Database (Denmark)

Topp, Claus; Nielsen, Peter V.; Heiselberg, Per

-scale ventilated room when the emission is fully or partly evaporation controlled. The objective of the present research work has been to investigate the change of emission rates from small-scale experiments to full-scale ventilated rooms and to investigate the influence of the local air velocity field near......Emission of volatile organic compounds (VOCs) from materials is traditionally determined from tests carried out in small-scale test chambers. However, a difference in scale may lead to a difference in the measured emission rate in a small-scale test chamber and the actual emission rate in a full...

Controlling the clean room atmosphere

International Nuclear Information System (INIS)

Meeks, R.F.

1979-01-01

Several types of clean rooms are commonly in use. They include the conventional clean room, the horizontal laminar flow clean room, the vertical laminar flow clean room and a fourth type that incorporates ideas from the previous types and is known as a clean air bench or hood. These clean rooms are briefly described. The origin of contamination and methods for controlling the contamination are discussed

Multidisciplinary collaboration for meeting radiation emergencies

International Nuclear Information System (INIS)

Jankowski, C.B.

1986-01-01

Radiation emergencies preparedness depend on the participation of many kinds of professionals in a concerted effort to meet whatever unforeseen situation may arise. This is true even for an injury involving only a single individual, the most common kind of radiation emergency. Each local hospital supporting a nuclear power facility performs at least one medical drill annually to review its ability to manage radiation casualties. Admitting even one injured and contaminated plant employee to the emergency room requires the involvement of many hospital departments, including the nursing, medical, security, housekeeping, radiology, clinical laboratories, and administration groups. The triage of several injured victims to regional hospitals would demand even more personnel and coordination of their efforts. In an extreme situation, the need for health care personnel could be enormous. Planning for large-scale radiation emergencies should involve physicians, but there must also be advice from and coordination with nurses, health physicists, emergency management specialists, emergency medical technicians, and state and local police and fire officials

Preparedness of Operation Teams' Non-technical Skills in a Main Control Room of Nuclear Power Plants to Manage Emergency Situations

International Nuclear Information System (INIS)

Yim, Ho Bin; Kim, Ar Ryum; Seong, Poong Hyun

2012-01-01

Human reliability is one of the important determinants for the system safety. Nuclear Energy Agency reported that approximately half of events reported by foreign nuclear industry were related with inappropriate human actions. The human error problems can be viewed in two ways: the person approach and the system approach. Other terms to represent each approach are active failures and latent conditions. Active failures are unsafe acts committed by people who are in direct contact with systems whereas latent conditions are the inevitable 'resident pathogens' within the system. To identify what kinds of non-technical skills were needed to cope with emergency conditions, a method to evaluate preparedness of task management in emergency conditions based on monitoring patterns was presented. Five characteristics were suggested to evaluate emergency task management and communication: latent mistake resistibility, latent violation resistibility, thoroughness, communication, and assertiveness. Case study was done by analyzing emergency training of 9 different real operation teams in the reference plant. The result showed that the 9 teams had their own emergency task management skills which resulted in good and bad performances

The influence of the directivity of musical instruments in a room

DEFF Research Database (Denmark)

Otondo, Felipe; Rindel, Jens Holger

2004-01-01

Measurements of the directivity of musical instruments are presented as part of the study of the influence of their representation in room acoustic simulations and auralizations. Pairs of measured and averaged directivities have been used both for room simulation comparisons and as a basis...... for listening experiments with auralizations. Room simulation results show a clear influence of the changes in the representation directivity on the distribution of acoustical parameters in the room. The results of the listening experiments with auralizations show that some changes produced by directivity...

Emerging souvenirs-clinical presentation of the returning traveller with imported arbovirus infections in Europe.

Science.gov (United States)

Eckerle, I; Briciu, V T; Ergönül, Ö; Lupşe, M; Papa, A; Radulescu, A; Tsiodras, S; Tsitou, C; Drosten, C; Nussenblatt, V R; Reusken, C B; Sigfrid, L A; Beeching, N J

2018-03-01

Arboviruses are an emerging group of viruses that are causing increasing health concerns globally, including in Europe. Clinical presentation usually consists of a nonspecific febrile illness that may be accompanied by rash, arthralgia and arthritis, with or without neurological or haemorrhagic syndromes. The range of differential diagnoses of other infectious and noninfectious aetiologies is broad, presenting a challenge for physicians. While knowledge of the geographical distribution of pathogens and the current epidemiological situation, incubation periods, exposure risk factors and vaccination history can help guide the diagnostic approach, the nonspecific and variable clinical presentation can delay final diagnosis. This narrative review aims to summarize the main clinical and laboratory-based findings of the three most common imported arboviruses in Europe. Evidence is extracted from published literature and clinical expertise of European arbovirus experts. We present three cases that highlight similarities and differences between some of the most common travel-related arboviruses imported to Europe. These include a patient with chikungunya virus infection presenting in Greece, a case of dengue fever in Turkey and a travel-related case of Zika virus infection in Romania. Early diagnosis of travel-imported cases is important to reduce the risk of localized outbreaks of tropical arboviruses such as dengue and chikungunya and the risk of local transmission from body fluids or vertical transmission. Given the global relevance of arboviruses and the continuous risk of (re)emerging arbovirus events, clinicians should be aware of the clinical syndromes of arbovirus fevers and the potential pitfalls in diagnosis. Copyright © 2018. Published by Elsevier Ltd.

The German emergency and disaster medicine and management system—history and present

Directory of Open Access Journals (Sweden)

Norman Hecker

2018-04-01

Full Text Available As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach. Keywords: Emergency medical systems, Disaster medicine, Public health, Germany

Emergency medical service systems in Japan : Past, present, and future

OpenAIRE

Tanigawa, Koichi; Tanaka, Keiichi

2006-01-01

Emergency medical services are provided by the fire defense headquarter of the local government in Japan. We have a one-tiered EMS system. The ambulance is staffed by three crews trained in rescue, stabilization, transportation, and advanced care of traumatic and medical emergencies. There are three levels of care provided by ambulance personnel including a basic-level ambulance crew (First Aid Class one, FAC-1), a second level (Standard First Aid Class, SFAC), and the highest level (Emergenc...

Criteria of choosing building structures for rooftop boiler rooms

Directory of Open Access Journals (Sweden)

Plotnikov Artyom

2018-01-01

Full Text Available The paper investigates parameters of noise and vibration distribution in the territory of residential area depending on the structural materials and power of independent heat supply systems. Rooftop boiler rooms are decentralized heat supply systems in buildings. Today, residential areas are strongly affected by noise and vibrations. Adverse effects are isolated by buildings materials, protective shields and floating floors. Rooftop boiler rooms located in Tyumen city were investigated within this research. Structures of rooftop boiler rooms were analyzed. Acoustic analysis results and the parameters of equivalent continuous sound level are presented. An option for improvement of rooftop boiler rooms structures is suggested. Comparison of capital investments in construction and installation activities is carried out. Conclusion on capital investments required for noise protection is made.

The incidence of injury presentations to emergency departments: what we don't know can hurt us.

LENUS (Irish Health Repository)

Meaney, S

2012-01-01

The incidence of injury presentations to emergency departments in the Republic of Ireland has not been established. Data were collected relating to all injuries that presented on every eighth day in July-December 2005 to the three hospitals in Cork City. In total, 2,967 injury presentations were recorded. The total, male and female age-adjusted rate of injury presentations was 11,322, 13,933 and 8,550 per 100,000, respectively. The peak male rate was among 15-29 year-olds (26,735 per 100,000), 2.5 times the female rate in the same age range (10,719 per 100,000). The peak female rate was among over 85 year-olds (18,543 per 100,000). Place of injury, activity at time of injury and underlying substance\\/object causing injury were unspecified for 44%, 46% and 43% of recorded injuries. Improving the recording of injury data needs to be prioritised in Irish emergency departments ideally in conjunction with the development of a national injury surveillance system.

Control room lay-out

International Nuclear Information System (INIS)

Toma, Violeta

2004-01-01

TRIUMF (Tri-University Meson Facility) is Canada's national laboratory for particle and nuclear physics. There are 6 accelerators and 3 Control Rooms at TRIUMF. The main control room serves the big cyclotron, the 500 MeV, and the adjacent experiment. The 42 MeV and two 32 MeV ones are production dedicated. These cyclotrons belong to a private company but are operated by TRIUMF staff from ATG (Applied Technology Group) Control Room. The last is ISAC (Isotope Acceleration and Separation) Control Room, from which the LINAC is controlled. Research areas cover theoretical (2 subjects), pure (5 subjects) and applied (8 subjects) physics. In the early '70s, as the 500 MeV was being completed, the first Control Room was built in the main accelerator building. The recent topics covered by this paper are proton and pion therapy, what are the operator's duties?, the CP42, TR30 and TR13 cyclotron control rooms, the ISAC control systems including control room modification. Due to the nature of an operator's job, the Control Room layout is pretty important. This is true for any work environment, but when working shifts it becomes essential. Lots of time and effort, not to mention money, were spent to figure out the optimum configuration. It seems to me that the key factor in the control room layout is versatility, and this is because it has to keep happy a group of people with different inclinations, which have a tendency to become quite moody after the second night shift. No matter what, there will still be unhappy people, but we are trying our best. (Y. Tanaka)