Velloso,Isabela Silva Cancio; Araújo,Meiriele Tavares; Nogueira,Jéssica Dias; Alves,Marília
The aim of the present study was to discuss the way visibility constitutes a power device in the everyday practice of the Mobile Emergency Care Service in Belo Horizonte, Minas Gerais, Brazil. A qualitative case study was developed and data were collected through semi-structured interviews with 31 workers of the service (five physicians, 11 nurses, seven nursing assistants and eight ambulance drivers) and submitted to discourse analysis. The analysis of power relations in the service allowed ...
Ortiga, Angela Maria Blatt; Lacerda, Josimari Telino de; Natal, Sonia; Calvo, Maria Cristina Marino
This case study evaluated the Mobile Emergency Care Service (SAMU) in Santa Catarina State, Brazil, in 2013/2014. The theoretical log frame and evaluation matrix were validated by expert consensus workshops. Two dimensions were proposed: emergency care management and emergency care, analyzed with 22 indicators. Data collection used interviews, direct observation in the eight regional SAMU dispatches, and a questionnaire sent to the coordinators of the municipal SAMU. The analysis and value judgment according to separate dimensions, sub-dimensions, and indicators allowed identifying strengths and weaknesses amenable to intervention. No regional dispatch performed well in both dimensions; all were classified as "fair" in emergency care and "bad" in emergency management. An important strength was agile communication with callers for help, standardization, and external support for care. The mechanisms for internal and external linkage and communication need to be effectively implemented. The quality of advanced support units requires improvement.
Holler, Christine Puck; Wichmann, Sine; Nielsen, Søren Loumann
In Copenhagen, Denmark, patients in need of prehospital emergency assistance dial 112 and may then receive evaluation and treatment by physicians (from the Mobile Emergency Care Unit (MECU)). ST-elevation myocardial infarction (STEMI) is a severe condition leaving only a limited time frame to del...... diagnosis on the scene and, furthermore, to compare these on-scene diagnoses with the primary discharge diagnoses from hospital....
O'Dwyer, Gisele; Machado, Cristiani Vieira; Alves, Renan Paes; Salvador, Fernanda Gonçalves
Mobile prehospital care is a key component of emergency care. The aim of this study was to analyze the implementation of the State of Rio de Janeiro's Mobile Emergency Medical Service (SAMU, acronym in Portuguese). The methodology employed included document analysis, visits to six SAMU emergency call centers, and semistructured interviews conducted with 12 local and state emergency care coordinators. The study's conceptual framework was based on Giddens' theory of structuration. Intergovernmental conflicts were observed between the state and municipal governments, and between municipal governments. Despite the shortage of hospital beds, the SAMUs in periphery regions were better integrated with the emergency care network than the metropolitan SAMUs. The steering committees were not very active and weaknesses were observed relating to the limited role played by the state government in funding, management, and monitoring. It was concluded that the SAMU implementation process in the state was marked by political tensions and management and coordination weaknesses. As a result, serious drawbacks remain in the coordination of the SAMU with the other health services and the regionalization of emergency care in the state.
Sikka, Neal; Carlin, Katrina N; Pines, Jesse; Pirri, Michael; Strauss, Ryan; Rahimi, Faisil
There are a significant number of emergency department (ED) visits for lacerations each year. When individuals experience skin, soft tissue, or laceration symptoms, the decision to go to the ED is not always easy on the basis of the level of severity. For such cases, it may be feasible to use a mobile phone camera to submit images of their wound to a remote medical provider who can review and help guide their care choice decisions. The authors aimed to assess patient attitudes toward the use of mobile phone technology for laceration management. Patients presenting to an urban ED for initial care and follow-up visits for lacerations were prospectively enrolled. A total of 194 patients were enrolled over 8 months. Enrolled patients answered a series of questions about their injury and a survey on attitudes about the acceptability of making management decisions using mobile phone images only. A majority of those surveyed agreed that it was acceptable to send a mobile phone picture to a physician for a recommendation and diagnosis. Patients also reported few concerns regarding privacy and security and believe that this technology could be cost effective and convenient. In this study, the majority of patients had favorable opinions of using mobile phones for laceration care. Mobile phone camera images (a) may provide a useful modality for assessment of some acute wound care needs and (b) may decrease ED visits for a high-volume complaint such as acute wounds.
Bouri, Nidhi; Ravi, Sanjana
Personal health records (PHRs), in contrast to electronic health records (EHRs) or electronic medical records (EMRs), are health records in which data are accessible to patients and not just providers. In recent years, many systems have enabled PHRs to be available in a mobile format. Mobile PHRs (mPHRs) allow patients to access health information via the Internet or telecommunication devices, such as mobile phones, personal digital assistants, and tablet computers. mPHRs have the potential to help patients and providers identify medical conditions and prescriptions from numerous locations, which may minimize medical errors and identify improvements to health behaviors during emergencies, when patients present to a new provider, or EHRs are not accessible. Despite their benefits, numerous challenges inhibit the adoption and further development of mPHRs, including integration into overall health technology infrastructure and legal and security concerns. This paper identifies the benefits of mPHRs during emergencies and the remaining challenges impeding full adoption and use, and provides recommendations to federal agencies to enhance support and use of mPHRs.
Holler, Christine Puck; Wichmann, Sine; Nielsen, Søren Loumann
In Copenhagen, Denmark, patients in need of prehospital emergency assistance dial 112 and may then receive evaluation and treatment by physicians (from the Mobile Emergency Care Unit (MECU)). ST-elevation myocardial infarction (STEMI) is a severe condition leaving only a limited time frame...... to deliver optimal care in the form of percutaneous transluminal coronary angioplasty. In theory, all patients with chest pain could have STEMI. The aim of this study was to study which of the patients suspected of having acute cardiac disease based on the 112 calls and met by the MECU were given a cardiac...
Rodrigo Assis Neves Dantas
Full Text Available OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K and Content Validity Index (CVI, considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.
Li, Chun-Ta; Lee, Cheng-Chi; Weng, Chi-Yao
Recent advances in medical treatment and emergency applications, the need of integrating wireless body area network (WBAN) with cloud computing can be motivated by providing useful and real time information about patients' health state to the doctors and emergency staffs. WBAN is a set of body sensors carried by the patient to collect and transmit numerous health items to medical clouds via wireless and public communication channels. Therefore, a cloud-assisted WBAN facilitates response in case of emergency which can save patients' lives. Since the patient's data is sensitive and private, it is important to provide strong security and protection on the patient's medical data over public and insecure communication channels. In this paper, we address the challenge of participant authentication in mobile emergency medical care systems for patients supervision and propose a secure cloud-assisted architecture for accessing and monitoring health items collected by WBAN. For ensuring a high level of security and providing a mutual authentication property, chaotic maps based authentication and key agreement mechanisms are designed according to the concept of Diffie-Hellman key exchange, which depends on the CMBDLP and CMBDHP problems. Security and performance analyses show how the proposed system guaranteed the patient privacy and the system confidentiality of sensitive medical data while preserving the low computation property in medical treatment and remote medical monitoring.
RAJGURU P. V. DR. DESHMUKH S. D
Mobile agent technology has been promoted as an emerging technology that makes it much easier to design, implement, and maintain distributed systems, introduction to basic concepts of mobile agents like agent mobility, agent types and places and agent communication. Then benefits of the usage of mobile agents are summarized and illustrated by selected applications. The next section lists requirements and desirable properties for mobile agent languages and systems. We study the main features, ...
Lindekaer, A.L.; Nielsen, S.L.; Pedersen, Ulf Gøttrup
INTRODUCTION: We conducted a quality assurance project of The Mobile Emergency Care Unit (MECU) in the Capital Region of Denmark when dispatched to febrile convulsions. The study focuses on prehospital treatment, comparison between prehospital and in-hospital diagnoses and parents' perceptions...... of their child's febrile convulsions and their satisfaction with the MECU. MATERIAL AND METHODS: The period of investigation was from March 1st 2004 to March 31st 2005. Children with a diagnosis of febrile convulsions or relevant differential diagnoses were eligible for inclusion. Children were excluded...... should still be dispatched primarily to febrile convulsions Udgivelsesdato: 2008/11/24...
Emergency care services are the focus of a series of toolkits developed by the NHS National electronic Library for Health to provide resources for emergency care leads and others involved in modernising emergency care, writes Steven Black.
Edgcombe, Hilary; Paton, Chris; English, Mike
In this paper, we discuss the role of mobile technology in developing training tools for health workers, with particular reference to low-income countries (LICs). The global and technological context is outlined, followed by a summary of approaches to using and evaluating mobile technology for learning in healthcare. Finally, recommendations are made for those developing and using such tools, based on current literature and the authors' involvement in the field.
Holler, Christine Puck; Wichmann, Sine; Nielsen, Søren Loumann;
to deliver optimal care in the form of percutaneous transluminal coronary angioplasty. In theory, all patients with chest pain could have STEMI. The aim of this study was to study which of the patients suspected of having acute cardiac disease based on the 112 calls and met by the MECU were given a cardiac...
Graham, Jennifer E; Heatley, J Jill
Raptors may present with a variety of conditions, such as trauma, debilitation, and disease, that necessitate emergency care. Emergency treatment should prioritize stabilization of the patient. Diagnostic testing should be delayed until feasible based on patient status. This article reviews emergency medicine in raptors, including appropriate handling and restraint, hospitalization, triage and patient assessment, sample collection, supportive care, and common emergency presentations.
Mikkelsen, Søren; Wolsing-Hansen, Jonathan; Nybo, Mads
Point-of Care analysis is increasingly being applied in the prehospital scene. Arterial blood gas analysis is one of many new initiatives adding to the diagnostic tools of the prehospital physician. In this paper we present a study on the feasibility of the Radiometer ABL-90 in a ground...
Istepanian, Robert; Laxminarayan, Swamy; Pattichis, Constantinos S.
M-health can be defined as the "emerging mobile communications and network technologies for healthcare systems.' This book paves the path toward understanding the future of m-health technologies and services and also introducing the impact of mobility on existing e-health and commercial telemedical systems. M-Health: Emerging Mobile Health Systems presents a new and forward-looking source of information that explores the present and future trends in the applications of current and emerging wireless communication and network technologies for different healthcare scenaria.
Lee, Ren-Guey; Chen, Kuei-Chien; Hsiao, Chun-Chieh; Tseng, Chwan-Lu
Hypertension and arrhythmia are chronic diseases, which can be effectively prevented and controlled only if the physiological parameters of the patient are constantly monitored, along with the full support of the health education and professional medical care. In this paper, a role-based intelligent mobile care system with alert mechanism in chronic care environment is proposed and implemented. The roles in our system include patients, physicians, nurses, and healthcare providers. Each of the roles represents a person that uses a mobile device such as a mobile phone to communicate with the server setup in the care center such that he or she can go around without restrictions. For commercial mobile phones with Bluetooth communication capability attached to chronic patients, we have developed physiological signal recognition algorithms that were implemented and built-in in the mobile phone without affecting its original communication functions. It is thus possible to integrate several front-end mobile care devices with Bluetooth communication capability to extract patients' various physiological parameters [such as blood pressure, pulse, saturation of haemoglobin (SpO2), and electrocardiogram (ECG)], to monitor multiple physiological signals without space limit, and to upload important or abnormal physiological information to healthcare center for storage and analysis or transmit the information to physicians and healthcare providers for further processing. Thus, the physiological signal extraction devices only have to deal with signal extraction and wireless transmission. Since they do not have to do signal processing, their form factor can be further reduced to reach the goal of microminiaturization and power saving. An alert management mechanism has been included in back-end healthcare center to initiate various strategies for automatic emergency alerts after receiving emergency messages or after automatically recognizing emergency messages. Within the time
Dijk, M.; Orsato, R.J.; Kemp, R.P.M.
In this paper, we analyse the emergence of a trajectory of electric mobility. We describe developments in electric vehicles before and after 2005. The central thesis of the paper is that electric mobility has crossed a critical threshold and is benefiting from various developments whose influence
Dijk, M.; Orsato, R.J.; Kemp, R.P.M.
In this paper, we analyse the emergence of a trajectory of electric mobility. We describe developments in electric vehicles before and after 2005. The central thesis of the paper is that electric mobility has crossed a critical threshold and is benefiting from various developments whose influence ca
The use of mobile phones in care delivery has the potential to improve the way in which care is delivered. When implemented effectively, mobile technologies can empower patients and enhance communication between patients and their health-care providers. When barriers are recognised and addressed, mobile technologies can change working lives, facilitating rapid access to information and supporting efficiency in practice.
This book presents a state-of-the-art overview of the available and emerging mobile technologies and explores how these technologies can serve as support tools in enhancing user participation in health care and promoting well-being in the daily lives of individuals, thereby reducing the burden of chronic disease on the health care system. The analysis is supported by presentation of a variety of case studies on the ways in which mobile technologies can be used to increase connectivity with health care providers and relevant others in order to promote healthy lifestyles and improve service provision. Detailed information is also provided on a sample project in which a set of tools has been used by teens at risk of obesity to record their sociopsychological environment and everyday health routines. Specifically, it is evaluated whether video diaries, created using a mobile platform and shared in real time via a social network, assist subjects in confronting obesity as a chronic disease. The book will be of inte...
Steinhubl, Steven R; Muse, Evan D; Topol, Eric J
The surge in computing power and mobile connectivity have fashioned a foundation for mobile health (mHealth) technologies that can transform the mode and quality of clinical research and health care on a global scale. Unimpeded by geographical boundaries, smartphone-linked wearable sensors, point-of-need diagnostic devices, and medical-grade imaging, all built around real-time data streams and supported by automated clinical decision-support tools, will enable care and enhance our understanding of physiological variability. However, the path to mHealth incorporation into clinical care is fraught with challenges. We currently lack high-quality evidence that supports the adoption of many new technologies and have financial, regulatory, and security hurdles to overcome. Fortunately, sweeping efforts are under way to establish the true capabilities and value of the evolving mHealth field.
This article points out the limits of top-down strategies in China rooted in the construction of large-scale transportation facilities, primarily road networks. It helps to identify emerging trends that show a shift from a "hardware" approach, which focuses mainly on heavy in- frastructure investments, to a "software" approach, which rather relies on improving travel conditions. Based on the description of three existing mobility services that won awards in the 2010 "Better Mobility, Better Life" Prize for Innovative Urban Mobility Solutions, this article assesses these bottom-up, multi-participation strategies, and the effects of these "soft strategies" on improving travel conditions, reducing car dependency, building communities, etc. Finally, it concludes that these soft measures can contribute to the building of a harmonious society and low-carbon cities, and should receive more attention and support.
Full Text Available The mobile phone is a modern-day invention, which has managed to reach many parts of the world enabling telecommunications across areas where it was not possible before. Although these devices have proved to be life saving in certain circumstances (e.g., after accidents and helped improve the quality of life in some sectors, concerns continue to be raised about potential adverse health impacts associated with their use. These range from cancer and cognitive deficiencies to subjective effects, such as a feeling of warmth around the ear used, headache and fatigue. We provide an overview of the concerns raised and summarise what is known about them. We conducted a literature search in Pubmed/Medline to identify published papers on health effects of mobile phones, and an intensive search on the Internet to collect data on the global use of mobile phones. In the year 2000, there were an estimated 500 million mobile phone users worldwide. Today, there are about 3.3 billion users. The use of mobile phones among young children and adolescents is also increasing. Health-risk research has mainly focused on adults and on a single outcome, brain tumours. No significant relationship has been established between mobile phone use and the incidence or growth of brain tumours. Other research indicates emerging concerns, including hearing problems and self-reported health symptoms, such as tiredness, stress, headache, anxiety, concentration difficulties and sleep disturbances, but results remain inconclusive. Currently, there is little epidemiological evidence indicating that the use of mobile phones causes adverse health effects.
Taylor, Barbara S; Garduño, L Sergio; Reyes, Emily V; Valiño, Raziel; Rojas, Rita; Donastorg, Yeycy; Brudney, Karen; Hirsch, Jennifer
The interaction between geographic mobility and risk for human immunodeficiency virus infection is well recognized, but what happens to those same individuals, once infected, as they transition to living with the infection? Does mobility affect their transition into medical care? If so, do mobile and nonmobile populations achieve similar success with antiretroviral treatment? The definition of mobility has changed over the centuries to encompass a complex phenotype including permanent migration, frequent travel, circular migration, and travel to and from treatment centers. The heterogeneity of these definitions leads to discordant findings. Investigations show that mobility has an impact on infection risk, but fewer data exist on the impact of geographic mobility on medical care and treatment outcomes. This review will examine existing data regarding the impact of geographic mobility on access to and maintenance in medical care and on adherence to antiretroviral therapy for those living with human immunodeficiency virus infection. It will also expand the concept of mobility to include data on the impact of the distance from residence to clinic on medical care and treatment adherence. Our conclusions are that the existing literature is limited by varying definitions of mobility and the inherent oversimplification necessary to apply a "mobility measure" in a statistical analysis. The impact of mobility on antiretroviral treatment outcomes deserves further exploration to both define the phenomenon and target interventions to these at-risk populations.
emergency care, emergency nursing care, and a 'general' section for any other area related to ..... The expectation and requirement to deliver safe and high- .... prospective comparison between advanced life support and basic life support.
Yoo, Y.; Tussyadiah, Iis; Fesenmaier, D.R.
While experiencing space and time at a destination, tourists interact with people and artifacts to create meaning and sense of their experiences. Narratives are the ways in which they communicate, recall and enact the lived experiences of travel. This study deconstructs elements of tourists' narr...... involve interactions and imply different devices and infrastructures. Based on the concept of emergent distributed narratives, this study provides a scenario for future mobile 2.0 service developments. © 2008 IEEE.......While experiencing space and time at a destination, tourists interact with people and artifacts to create meaning and sense of their experiences. Narratives are the ways in which they communicate, recall and enact the lived experiences of travel. This study deconstructs elements of tourists...
Cuidado integral e atenção às urgências: o serviço de atendimento móvel de urgência do estado do Rio de Janeiro Integral care and attention to emergency: the mobile emergency care service in the state of Rio de Janeiro
Full Text Available O inadequado atendimento às urgências é motivo de insatisfação da população e de aumento de morbidade e mortalidade. Para responder ao problema, o Estado implantou o Serviço de Atendimento Móvel de Urgência (SAMU, o primeiro componente da Política Nacional de Urgências que propõe o atendimento integral às urgências. Com o objetivo de analisar a prática de integralidade no SAMU, analisamos a regulação nos SAMU do Estado do Rio de Janeiro. A metodologia baseou-se na análise da conduta estratégica (Giddens, 1984 relacionando as estratégias de ação dos agentes com as dimensões estruturais. A categorização da análise do resultado destacou: o SAMU bem sucedido, com práticas de integralidade no seu componente individual e de acesso aos serviços; sua função de observatório de rede, que indicou restrição no acesso à atenção básica e ao hospital; a insuficiência de recursos e o uso inadequado de ambulâncias; e demandas não reconhecidas, em que casos foram recusados. O campo confirmou a potência do SAMU como observatório de saúde. Entretanto, a mobilização de recursos autoritativos e alocativos mostrou-se insuficiente para um sistema integrado de atenção às urgências.Emergency inadequate care is a matter of dissatisfaction for the population and increases morbidity and mortality. The SAMU (Mobile Emergency Care Service was the first component of the National Emergency Policy to be deployed; this public policy proposes integral care of emergencies. In order to examine the practices of integral care at SAMU we analyzed its regulation in the state of Rio de Janeiro. The methodology was based on the strategic conduct analysis (Giddens, 1984, relating the agents and their strategies with the structural dimensions. The categorization of the analysis highlighted: the successful SAMU, with integral care practices in their individual component and access to services; its function as observatory of the network of
Ishibashi, Kenichi; Morishima, Naoto; Kanbara, Masayuki; Sunahara, Hideki; Imanishi, Masami
Interaction between emergency medical technicians (EMTs) and doctors is essential in emergency medical care. Doctors require diverse information related to a patient to provide efficient aid. In 2005, we started the Ikoma119 project and have developed a ubiquitous communication platform for emergency medical care called Mobile ER. Our platform, which is based on wireless internet technology, has such desirable properties as low-cost, location-independent service, and ease of service introduction. We provide an overview of our platform and describe the services that we have developed. We also discuss the remaining issues to realize our platform's actual operation.
Roberta Juliane Tono de Oliveira
Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.
Conger, Dylan; Finkelstein, Marni J.
Foster children face many obstacles to academic achievement. In addition to low educational achievement, they may have high rates of school mobility and experience long delays when transferring schools. Sources of these transfers and delays include numerous residential movements and lack of coordination between child welfare and school…
do Nascimento, Keyla Cristiane; Gomes, Antônio Marcos Tosoli; Erdmann, Alacoque Lorenzini
This qualitative study was performed based on the Social Representations Theory, using a structured approach. The objective was to analyze the social representations of intensive care for professionals who work in mobile intensive care units, given the determination of the central nucleus and the peripheral system. This study included the participation of 73 health care professionals from an Emergency Mobile Care Service. Data collection was performed through free association with the inducing term care for people in a life threatening situation, and analyzed using EVOC software. It is observed that a nucleus is structured in knowledge and responsibility, while contrasting elements present lexicons such as agility, care, stress, and humanization. The representational structure revealed by participants in this study refer particularly to the functionality of intensive care, distinguishing itself by the challenges and encouragements provided to anyone working in this area.
Jones, Deborah J; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin
Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach.
O'Connell, Timothy W; Patlas, Michael N
Mobile devices, wireless networks and software have significantly evolved since the late 1990s and are now available with sufficient computing power, speed and complexity to allow real-time interpretation of radiology studies. Emergency radiology (ER)'s time-sensitive nature would seem to be an excellent match for study interpretation using mobile devices, allowing the radiologist to read studies anywhere, at any time. While suitable for use by the radiologist outside of the hospital, or clinicians and surgeons at the bedside or in the operating room, these devices do have limitations, and regulatory approval for in-hospital diagnostic use is limited. In the ER setting, we suggest that the best use of mobile devices is to be available to consult directly with patients about their imaging findings and to the clinical team during rounds and at handover. This will bring the radiologist to the clinician and patient, helping us to better understand the patient's presentation, educate both the physician and patient and increase the visibility and value of the radiologist as a member of the clinical care team.
As mobile computing technologies have been more powerful and inclusive in people's daily life, the issue of mobile assisted language learning (MALL) has also been widely explored in CALL research. Many researches on MALL consider the emerging mobile technologies have considerable potentials for the effective language learning. This review study…
Palsson, S.E. [Icelandic Radiation Protection Inst. (Finland)
The report is intended for persons involved in radiological emergency response management. An introduction is given to the technical basis of the mobile Internet and ongoing development summarised. Examples are given describing how mobile Internet technology has been used to improve monitoring media coverage of incidents and events, and a test is described where web based information was selectively processed and made available to WAP enabled mobile phones. The report concludes with recommendations stressing the need for following mobile Internet developments and taking them into account when designing web applications for radiological response management. Doing so can make web based material accessible to mobile devices at minimal additional cost. (au)
Palsson, S.E. [Icelandic Radiation Protection Inst. (Finland)
The report is intended for persons involved in radiological emergency response management. An introduction is given to the technical basis of the mobile Internet and ongoing development summarised. Examples are given describing how mobile Internet technology has been used to improve monitoring media coverage of incidents and events, and a test is described where web based information was selectively processed and made available to WAP enabled mobile phones. The report concludes with recommendations stressing the need for following mobile Internet developments and taking them into account when designing web applications for radiological response management. Doing so can make web based material accessible to mobile devices at minimal additional cost. (au)
Ownership, knowledge, patient care cost and use of mobile cell phones by family ... care delivery with regards to mobile phone technology should be explored. ... A survey of 250 Family Medicine residents in training centres in Nigeria was ...
Riley, Jennifer; Barron, Heather
Wildlife patients often present as emergencies. For veterinarians who do not typically treat wildlife, it is important to be able to stabilize and determine the underlying cause of the animal's signs. This article discusses initial assessment, stabilization, and treatment of common emergency presentations in wild birds, reptiles, and mammals.
Federal Laboratory Consortium — The NIOSH Mobile Emergency Medical Service (EMS) Work Environment Laboratory is a 2005 Wheeled Coach Type III ambulance mounted on a Ford E-450 cut-away van chassis....
Amanda Priscila de Santana Cabral
Full Text Available Conhecer a epidemiologia dos acidentes de transportes terrestres é fundamental para definir políticas de prevenção desse agravo e das mortes por ele causados. Objetivou-se caracterizar o perfil epidemiológico das vítimas do trânsito e a distribuição dos atendimentos por acidentes de transporte a partir de técnica de análise espacial. Estudo descritivo, utilizou como fonte de dados o banco de atendimentos do Serviço de Atendimento Móvel de Urgência do município de Olinda, Pernambuco, entre julho de 2006 a junho de 2007. A distribuição geográfica das ocorrências foi analisada por meio do Índice de Moran. Pedestres, ocupantes de motocicleta e ciclistas concentraram 78% dos atendimentos; houve predomínio do sexo masculino (79% e da faixa etária 20-39 anos (65%. Os finais de semana concentraram a maioria dos atendimentos (56,1%; χ² = 123,7; p Understanding the occurrence of land transportation accidents and describing the victims is fundamental for the definition of prevention and control policies regarding these events and the deaths they cause. The aim of the present study was to characterize the epidemiological profile of land transportation victims and the distribution of emergency care for land transportation accidents using spatial analysis. A descriptive study was carried out using the Mobile Emergency Care Service database of the city of Olinda (Pernambuco, Brazil for occurrences between July 2006 and June 2007. The geographic distribution was analyzed using the Moran Index. Pedestrians, motorcyclists and bicyclists concentrated 78% of the emergency care; there was a predominance of male victims (79% and victims between 20 and 39 years of age (65%. A greater concentration of occurrences was found on weekends (56%; χ² = 123.7; p < 0.001. Between Monday and Thursday, 52% of occurrences were concentrated between 6 am and 5:59 pm; on weekends, 57% of the occurrences were concentrated between 6 pm and 5:59 am. Motorcycles
Sonnenwald, Diane H.; Söderholm, Hanna Maurin; Welch, Gregory F.;
reported the technology would require additional training, changes to existing financial models used in emergency health care, and increased access to physicians. Conclusions. Teaching collaboration skills and strategies to physicians and paramedics could benefit their collaboration today, and increase...
Matsuda, Naoyuki; Takatani, Yudai; Higashi, Tomoko; Inaba, Masato; Ejima, Tadashi
In the emergency and critical care medicine, infection is easy to merge to various basic conditions and diseases. In the social structure aging in critical care, the immune weakness was revealed as the result of severe infection and septic shock in the reduced function of neutrophils and lymphocytes. In the life-saving emergency care, cardiovascular diseases, diabetes, chronic renal failure and lever dysfunction are often observed, and the underlying diseases have the foundation of biological invasion after a first inflammatory attack of surgery, trauma, burn, and systemic injury. It will be placed into a susceptible situation such as artificial respiratory management. In this review, we discussed severe infection in emergency and critical care. It is necessary to pay attention to the drug resistance bacterias in own critical care setting by trends.
.... Emergency care is appropriate when services are needed immediately because of an injury or sudden illness... participant or caregiver, or both, understand when and how to get access to emergency services and that no... PACE participant who is out of the PACE service area, and who believes their illness or injury is...
Choi, YoungSoo; Park, JongWon; Kim, TaeWon; Jeong, KyungMin [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)
Severe accidents at nuclear power plant have led to significant consequences to the people, the environment or the facility. Therefore, the appropriate response is required for the mitigation of the accidents. In the past, most of responses were performed by human beings, but it was dangerous and risky. In this paper, we proposed unmanned mobile system for the monitoring of nuclear accident in order to response effectively. For the integrity of reactor cooling and containment building, reactor cooling pipe and hydrogen distribution monitoring with unmanned ground vehicle was designed. And, for the safety of workers, radiation distribution monitoring with unmanned aerial vehicle was designed. Unmanned mobile monitoring system was proposed to respond nuclear accidents effectively. Concept of reinforcing the integrity of RCS and containment building, and radiation distribution monitoring were described. RCS flow measuring, hydrogen distribution measuring and radiation monitoring deployed at unmanned vehicle were proposed. These systems could be a method for the preparedness of effective response of nuclear accidents.
Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai
Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.
McCarley, T D; Yates, W R
Mobile outreach psychiatric services have become a popular model of providing care to the mentally ill. A mobile program has been instituted in Tulsa, Oklahoma, to provide care to homeless mentally ill in Tulsa County and to assist with emergency crisis intervention. The SPMI (Severely and Persistently Mentally III) have been a challenge for both medical and psychiatric providers, and MOCS (Mobile Outreach Crisis Services) was developed to address these problems. This article describes MOCS, briefly reviews recent literature, and discusses ways this program can benefit primary care physicians.
Full Text Available With the proliferation of mobile technologies in China, the Chinese mobile medical applications market is growing rapidly. This may be particularly useful for Chinese rural populations who have limited access to quality medical care where mobile technologies can reach across geographic and socioeconomic boundaries and potentially increase access to care and improve health outcomes.
Full Text Available Traffic-related pedestrian injuries are a growing public health threat worldwide. The global economic burden of motor vehicle collisions and pedestrian injuries totals $500 billion. In 2004, there were 4,641 pedestrian deaths and over 70,000 injuries in the United States. Injury patterns vary depending on the age, gender and socioeconomic status of the individual. Children, older adults, and those of lower socioeconomic status are most affected. The burden of injury upon the individual, families and society is frequently overwhelming. Although pedestrian injuries and deaths are relatively on the decline in the United States, this is not universally true throughout the world. It requires particular attention by emergency medicine physicians, public health experts and policy makers.
John Hagel III
Full Text Available The signs are around us. We are on the cusp of a shift to a new common sense model that will re-shape many facets of our life, including how we identify ourselves, participate with others, connect with others, mobilize resources and learn. This paper will focus on only one facet of this new common sense model – emerging approaches for mobilizing resources.
Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique
Introduction: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore...... decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay...... was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Conclusion: Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching...
Latifi, R; Weinstein, R S; Porter, J M; Ziemba, M; Judkins, D; Ridings, D; Nassi, R; Valenzuela, T; Holcomb, M; Leyva, F
The use of telemedicine is long-standing, but only in recent years has it been applied to the specialities of trauma, emergency care, and surgery. Despite being relatively new, the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modern care of trauma and surgical patients. This paper will address the current applications of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application. The University Medical Center and the Arizona Telemedicine Program (ATP) in Tucson, Arizona have two functional teletrauma and emergency telemedicine programs and one ad-hoc program, the mobile telemedicine program. The Southern Arizona Telemedicine and Telepresence (SATT) program is an inter-hospital telemedicine program, while the Tucson ER-link is a link between prehospital and emergency room system, and both are built upon a successful existing award winning ATP and the technical infrastructure of the city of Tucson. These two programs represent examples of integrated and collaborative community approaches to solving the lack of trauma and emergency care issue in the region. These networks will not only be used by trauma, but also by all other medical disciplines, and as such have become an example of innovation and dedication to trauma care. The first case of trauma managed over the telemedicine trauma program or "teletrauma" was that of an 18-month-old girl who was the only survival of a car crash with three fatalities. The success of this case and the pilot project of SATT that ensued led to the development of a regional teletrauma program serving close to 1.5 million people. The telepresence of the trauma surgeon, through teletrauma, has infused confidence among local doctors and communities and is being used to identify knowledge gaps of rural health care providers and the needs for instituting new outreach educational programs.
Abelsson, Anna; Lindwall, Lillemor
Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation. To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care. The study had a qualitative approach. Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis. Ethical considerations: The study followed the ethical principles in accordance with the Declaration of Helsinki. The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient. It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human. Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.
McMillan, Colleen; Lee, Joseph; Milligan, James; Hillier, Loretta M; Bauman, Craig
Despite the high health risks associated with severe mobility impairments, individuals with physical disabilities are less likely to receive the same level of primary care as able-bodied persons. This study explores family physicians' perspectives on primary care for individuals with mobility impairments to identify and better understand the challenges that prevent equitable service delivery to this group of patients. Semi-structured interviews were conducted in the autumn of 2012 with a purposeful sample of 20 family physicians practising in Southwestern Ontario to gather their perspectives of the personal and professional barriers to healthcare delivery for individuals with mobility impairments, including perceptions of challenges, contributing reasons and possible improvements. A thematic analysis was conducted on the transcripts generated from the interviews to identify perceptions of existing barriers and gaps in care, needs and existing opportunities for improving primary care for this patient population. Eight themes emerged from the interviews that contributed to understanding the perceived challenges of providing care to patients with mobility impairments: transportation barriers, knowledge gaps and practice constraints resulting in episodic care rather than preventive care, incongruence between perceived and actual accessibility to care, emergency departments used as centres for primary care, inattention to mobility issues among specialist and community services, lack of easily accessible practice tools, low patient volumes impact decision-making regarding building decreased motivation to expand clinical capacity due to low patient volume, and lastly, remuneration issues. Despite this patient population presenting with high healthcare needs and significant barriers and care gaps in primary care, low prevalence rates negatively impact the acquisition of necessary equipment and knowledge required to optimally care for these patients in typical primary care
Apply first aid to treat cuts and scrapes and prevent infection. To care for a bleeding cut, put pressure on it until the bleeding has stopped. Created: 8/10/2006 by Emergency Communications System. Date Released: 11/16/2007.
Discussion: Comparison of results in each country separately and cumulatively demonstrated a statistically significant improvement in participant’s knowledge after completing a Global Emergency Care Skills course. This improvement mirrors the qualitative improvement in psychomotor skills, knowledge and attitudes seen in candidates who participated in the course.
This paper uses empirical material gathered with young adults in New Zealand to examine a potential sustainability transition-in-practice. It draws from two frameworks; the actor-centred Energy Cultures Framework to explore mobility behaviours, and the multi-level perspective (MLP) to situate behaviour change within the socio-technical transitions literature. The MLP has traditionally been used to analyse historical transitions (e.g. from the horse and cart to the motor vehicle), but in this paper, it is used to explore an on-going change trend; the emergent mobilities of young adults who appear to be aspiring for different types of mobility. A series of mobility trends are described, which emerged from a programme of qualitative interviews (n = 51). The material culture, norms and practices that constitute these trends are articulated. These are then considered through the lens of the MLP. The evidence points to emergent trends of multimodality that, if leveraged upon and supported, could contribute to a systemic sustainability transition.
The secure messaging space is alive with new innovations that are moving the industry forward. Key in this space is the push toward moving secure messaging to the cloud and pushing it out to mobile devices. Among the examples are solutions that allow physicians to receive encrypted email on mobile devices, as well as ones that allow doctors to securely text-message each other to coordinate care. However, the security issues around these emerging technologies in this very active space must be further explored.
Massey, Tammara; Gao, Tia
During mass casualty incidents, a large number of patients need to be triaged accurately in order to save the maximum number of lives. Recently portable health systems have been developed that can gather patient's vital signs and wireless transmit this information to a central location for analysis. This research introduces a methodology to improve triage in mass casualty incidents by combining statistical optimization techniques with mobile health systems to manage resources using evidence based data. We combine data collected during a field test with data of patient's vital signs to simulate how mobile health systems can optimize resources in emergency response situations.
... 42 Public Health 2 2010-10-01 2010-10-01 false Emergency and urgent care services. 405.440 Section... Emergency and urgent care services. (a) A physician or practitioner who has opted-out of Medicare under this subpart need not enter into a private contract to furnish emergency care services or urgent care...
Dexheimer, Judith W; Borycki, Elizabeth M
Electronic health records are increasingly used in regional health authorities, healthcare systems, hospitals, and clinics throughout North America. The emergency department provides care for urgent and critically ill patients. Over the past several years, emergency departments have become more computerized. Tablet computers and Smartphones are increasingly common in daily use. As part of the computerization trend, we have seen the introduction of handheld computers, tablets, and Smartphones into practice as a way of providing health professionals (e.g. physicians, nurses) with access to patient information and decision support in the emergency department. In this article, we present a scoping review and outline the current state of the research using mobile devices in the emergency departments. Our findings suggest that there is very little research evidence that supports the use of these mobile devices, and more research is needed to better understand and optimize the use of mobile devices. Given the prevalence of handheld devices, it is inevitable that more decision support, charting, and other activities will be performed on these devices. These developments have the potential to improve the quality and timeliness of care but should be thoroughly evaluated.
Full Text Available Emergency Medicine as a specialty has only recently been introduced to Ghana. This article reviews the overall health and medical care systems as well as the evolution and the current state of emergency care in Ghana and the progress made in establishing Emergency Medicine (EM as a specialty along the Anglo-American model of emergency care. The article also describes the improvements implemented in emergency patient care, and emergency medicine management systems. Although there are challenges to overcome, much optimism remains about the future of this new specialty in Ghana and its ability to transform the face of emergency care.
Starnini, Michele; Baronchelli, Andrea
Multi-agent models often describe populations segregated either in the physical space, i.e. subdivided in metapopulations, or in the ecology of opinions, i.e. partitioned in echo chambers. Here we show how the interplay between homophily and social influence controls the emergence of both kinds of segregation in a simple model of mobile agents, endowed with a continuous opinion variable. In the model, physical proximity determines a progressive convergence of opinions but differing opinions result in agents moving away from each others. This feedback between mobility and social dynamics determines to the onset of a stable dynamical metapopulation scenario where physically separated groups of like-minded individuals interact with each other through the exchange of agents. The further introduction of confirmation bias in social interactions, defined as the tendency of an individual to favor opinions that match his own, leads to the emergence of echo chambers where different opinions can coexist also within the ...
dos Santos, Maria Claudia; Bernardes, Andrea; Gabriel, Carmen Silvia; Evora, Yolanda Dora Martinez; Rocha, Fernanda Ludmilla Rossi
This study aims to characterize the communication process among nursing assistants who work in vehicles of the basic life support of the mobile emergency service, in the coordination of this service, and in the unified medical regulation service in a city of the state of São Paulo, Brazil. This descriptive and qualitative research used the thematic content analysis for data analysis. Semi-structured interviews were used for the data collection, which was held in January, 2010. Results show diffculties in communication with both the medical regulation service and the coordination. Among the most highlighted aspects are failures during the radio transmission, lack of qualified radio operators, difficult access to the coordination and lack of supervision by nurses. However, it was possible to detect solutions that aim to improve the communication ana consequently, the service offered by the mobile emergency service.
Mary E W Dankbaar
Full Text Available Each year over 1.5 million health care professionals attend emergency care courses. Despite high stakes for patients and extensive resources involved, little evidence exists on the quality of assessment. The aim of this study was to evaluate the validity and reliability of commonly used formats in assessing emergency care skills.Residents were assessed at the end of a 2-week emergency course; a subgroup was videotaped. Psychometric analyses were conducted to assess the validity and inter-rater reliability of the assessment instrument, which included a checklist, a 9-item competency scale and a global performance scale.A group of 144 residents and 12 raters participated in the study; 22 residents were videotaped and re-assessed by 8 raters. The checklists showed limited validity and poor inter-rater reliability for the dimensions "correct" and "timely" (ICC = .30 and.39 resp.. The competency scale had good construct validity, consisting of a clinical and a communication subscale. The internal consistency of the (subscales was high (α = .93/.91/.86. The inter-rater reliability was moderate for the clinical competency subscale (.49 and the global performance scale (.50, but poor for the communication subscale (.27. A generalizability study showed that for a reliable assessment 5-13 raters are needed when using checklists, and four when using the clinical competency scale or the global performance scale.This study shows poor validity and reliability for assessing emergency skills with checklists but good validity and moderate reliability with clinical competency or global performance scales. Involving more raters can improve the reliability substantially. Recommendations are made to improve this high stakes skill assessment.
Kayongo, M; Esquiche, E; Luna, M R; Frias, G; Vega-Centeno, L; Bailey, P
With support from the Averting Maternal Death and Disability (AMDD) Program, CARE began the FEMME Project in 2000 to increase access and utilization of emergency obstetric care (EmOC) services for the approximately 48,000 pregnant women in the northern provinces of Ayacucho. The project targeted 5 facilities with a comprehensive package of interventions designed to improve capacity to provide quality EmOC services and to promote a human rights approach in health care. Key program activities included improvements in infrastructure, human resources capacity development, development of service standards and protocols, quality improvement activities, and promoting a rights-based approach to health. By the end of the project, northern Ayacucho had 6 functioning EmOC facilities: 3 comprehensive (including a non-FEMME project facility) and 3 basic. This exceeds the UN minimum recommendation of 5 EmOC facilities per 500,000 population. Other changes in the UN process indicators indicate an increase in quality and utilization of EmOC services. Met need for EmOC increased significantly from 30% in 2000 to a high of 84% in 2004. Case fatality rates declined and the number of maternal deaths in the entire region declined. CARE's work in Ayacucho made an impact on policies and programs related to EmOC throughout the region. Within CARE, project experiences have supported maternal health programs particularly in the Latin American/Caribbean region.
... reasonable expenses for emergency medical care, including hospitalization, of ASWs who suffer illness or... date on which the expense was incurred. (f) Cost of emergency medical care including hospitalization... 32 National Defense 6 2010-07-01 2010-07-01 false Expenses for emergency medical care. 1656.20...
Bin Cheng; Ruofei Shi; Dingyuan Du; Ping Hu; Jun Feng; Guangbin Huang; Anning Cai
In the 21st century,natural disasters and emergencies occur frequently worldwide,which leads to the loss of hundreds of thousands of lives as well as the direct and indirect economic losses.China has a vast territory frequently struck by natural disasters.However,the reality is not optimistic.Poor organization and management during the rescue actions,the lack of large-scale,systematic medical rescue equipment were all great barriers to the outcomes.Mobile hospitals are expected to provide better health care.We were inspired by the concept of mobile hospital.Chongqing Emergency Medical Center,has set up trauma care system since 1988,in which prehospital care,intensive care,and in-hospital treatment is fully integrated.As a major advantage,such a system provided assurance of"golden hour" rescue treatment.Providing mobile intensive care and prehospital surgical service for severe trauma patients could reduce mortality significantly.Based on the civilian experiences in Chongqing Emergency Medical Center,the mobile emergency (surgical) hospital was developed.
Full Text Available Rivaroxaban is an oral, direct Factor Xa inhibitor, approved for the prevention and treatment of several thromboembolic disorders. Rivaroxaban does not require routine coagulation monitoring and has a short half-life. However, confirmation of rivaroxaban levels may be required in circumstances such as life-threatening bleeding or perioperative management. Here, we explore the management strategies in patients receiving rivaroxaban who have a bleeding emergency or require emergency surgery. Rivaroxaban plasma concentrations can be assessed quantitatively using anti-Factor Xa chromogenic assays, or qualitatively using prothrombin time assays (using rivaroxaban-sensitive reagents. In patients receiving long-term rivaroxaban therapy who require elective surgery, discontinuation of rivaroxaban 20–30 hours beforehand is normally sufficient to minimize bleeding risk. For emergency surgery, we advise against prophylactic use of hemostatic blood products, even with high rivaroxaban concentrations. Temporary rivaroxaban discontinuation is recommended if minor bleeding occurs; for severe bleeding, rivaroxaban withdrawal may be necessary, along with compression or appropriate surgical treatment. Supportive measures such as blood product administration might be beneficial. Life-threatening bleeding demands comprehensive hemostasis management, including potential use of agents such as prothrombin complex concentrate. Patients taking rivaroxaban who require emergency care for bleeding or surgery can be managed using established protocols and individualized assessment.
Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique
barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. Methods: A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced...... obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district. Elizabeth Echoka1,&, Anselimo Makokha2, Dominique Dubourg3, Yeri Kombe1, Lillian Nyandieka1, Jens Byskov4 Results: Findings indicate that pregnant women experienced delays in making...
BACKGROUND: The volume and duration of stay of the critically ill in the emergency department (ED) is increasing and is affected by factors including case-mix, overcrowding, lack of available and staffed intensive care beds and an ageing population. The purpose of this study was to describe the clinical activity associated with these high-acuity patients and to quantify resource utilization by this patient group. METHODS: The study was a retrospective review of ED notes from all patients referred directly to the intensive care team over a 6-month period from April to September 2004. We applied a workload measurement tool, Therapeutic Intervention Scoring System (TISS)-28, which has been validated as a surrogate marker of nursing resource input in the intensive care setting. A nurse is considered capable of delivering nursing activities equal to 46 TISS-28 points in each 8-h shift. RESULTS: The median score from our 69 patients was 19 points per patient. Applying TISS-28 methodology, we estimated that 3 h 13 min nursing time would be spent on a single critically ill ED patient, with a TISS score of 19. This is an indicator of the high levels of personnel resources required for these patients in the ED. ED-validated models to quantify nursing and medical staff resources used across the spectrum of ED care is needed, so that staffing resources can be planned and allocated to match service demands.
Armano, Giuliano; Javarone, Marco Alberto
Innovation is a key ingredient for the evolution of several systems, including social and biological ones. Focused investigations and lateral thinking may lead to innovation, as well as serendipity and other random discovery processes. Some individuals are talented at proposing innovation (say innovators), while others at deeply exploring proposed novelties, at getting further insights on a theory, or at developing products, services, and so on (say developers). This separation in terms of innovators and developers raises an issue of paramount importance: under which conditions a system is able to maintain innovators? According to a simple model, this work investigates the evolutionary dynamics that characterize the emergence of innovation. In particular, we consider a population of innovators and developers, in which agents form small groups whose composition is crucial for their payoff. The latter depends on the heterogeneity of the formed groups, on the amount of innovators they include, and on an award-factor that represents the policy of the system for promoting innovation. Under the hypothesis that a "mobility" effect may support the emergence of innovation, we compare the equilibria reached by our population in different cases. Results confirm the beneficial role of "mobility", and the emergence of further interesting phenomena.
Glickman, Seth W; Kit Delgado, M; Hirshon, Jon Mark; Hollander, Judd E; Iwashyna, Theodore J; Jacobs, Alice K; Kilaru, Austin S; Lorch, Scott A; Mutter, Ryan L; Myers, Sage R; Owens, Pamela L; Phelan, Michael P; Pines, Jesse M; Seymour, Christopher W; Ewen Wang, N; Branas, Charles C
The demands on emergency services have grown relentlessly, and the Institute of Medicine (IOM) has asserted the need for "regionalized, coordinated, and accountable emergency care systems throughout the country." There are large gaps in the evidence base needed to fix the problem of how emergency care is organized and delivered, and science is urgently needed to define and measure success in the emerging network of emergency care. In 2010, Academic Emergency Medicine convened a consensus conference entitled "Beyond Regionalization: Integrated Networks of Emergency Care." This article is a product of the conference breakout session on "Defining and Measuring Successful Networks"; it explores the concept of integrated emergency care delivery and prioritizes a research agenda for how to best define and measure successful networks of emergency care. The authors discuss five key areas: 1) the fundamental metrics that are needed to measure networks across time-sensitive and non-time-sensitive conditions; 2) how networks can be scalable and nimble and can be creative in terms of best practices; 3) the potential unintended consequences of networks of emergency care; 4) the development of large-scale, yet feasible, network data systems; and 5) the linkage of data systems across the disease course. These knowledge gaps must be filled to improve the quality and efficiency of emergency care and to fulfill the IOM's vision of regionalized, coordinated, and accountable emergency care systems. 2010 by the Society for Academic Emergency Medicine.
A revolution is underway in the computing world that is causing a fundamental paradigm shift in device capabilities and form-factor, with a move from well-established legacy desktop/laptop computers to mobile devices in varying sizes and shapes. Amongst all the tasks these devices must support, graphics has emerged as the 'killer app' for providing a fluid user interface and high-fidelity game rendering, effectively making the graphics processor (GPU) one of the key components in (present and future) mobile systems. By utilizing the GPU as a general-purpose parallel processor, this dissertation explores the GPU computing design space from an applications standpoint, in the mobile context, by focusing on key challenges presented by these devices---limited compute, memory bandwidth, and stringent power consumption requirements---while improving the overall application efficiency of the increasingly important speech recognition workload for mobile user interaction. We broadly partition trends in GPU computing into four major categories. We analyze hardware and programming model limitations in current-generation GPUs and detail an alternate programming style called Persistent Threads, identify four use case patterns, and propose minimal modifications that would be required for extending native support. We show how by manually extracting data locality and altering the speech recognition pipeline, we are able to achieve significant savings in memory bandwidth while simultaneously reducing the compute burden on GPU-like parallel processors. As we foresee GPU computing to evolve from its current 'co-processor' model into an independent 'applications processor' that is capable of executing complex work independently, we create an alternate application framework that enables the GPU to handle all control-flow dependencies autonomously at run-time while minimizing host involvement to just issuing commands, that facilitates an efficient application implementation. Finally, as
Starnini, Michele; Frasca, Mattia; Baronchelli, Andrea
Multi-agent models often describe populations segregated either in the physical space, i.e. subdivided in metapopulations, or in the ecology of opinions, i.e. partitioned in echo chambers. Here we show how both kinds of segregation can emerge from the interplay between homophily and social influence in a simple model of mobile agents endowed with a continuous opinion variable. In the model, physical proximity determines a progressive convergence of opinions but differing opinions result in agents moving away from each others. This feedback between mobility and social dynamics determines the onset of a stable dynamical metapopulation scenario where physically separated groups of like-minded individuals interact with each other through the exchange of agents. The further introduction of confirmation bias in social interactions, defined as the tendency of an individual to favor opinions that match his own, leads to the emergence of echo chambers where different opinions coexist also within the same group. We believe that the model may be of interest to researchers investigating the origin of segregation in the offline and online world.
Darlene R. House; Philip Cheptinga; Rusyniak, Daniel E.
Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge....
Lund, Stine; Nielsen, Birgitte B; Hemed, Maryam
measure was four or more antenatal care visits during pregnancy. Secondary outcome measures were tetanus vaccination, preventive treatment for malaria, gestational age at last antenatal care visit, and antepartum referral. RESULTS: The mobile phone intervention was associated with an increase in antenatal...
The mobile palliative care and support team nurse works in different departments within the hospital. The clinical situation of a patient enables the team to identify in what ways she is declining and thereby participate in the care management in order to favour the patient's return home.
Harkins, Judith; Tucker, Paula E.; Williams, Norman; Sauro, Jeff
In the United States, a nationwide Commercial Mobile Alert Service (CMAS) is being planned to alert cellular mobile device subscribers to emergencies occurring near the location of the mobile device. The plan specifies a unique audio attention signal as well as a unique vibration attention signal (for mobile devices set to vibrate) to identify…
Smits, M.; Francissen, O.; Weerts, M.; Janssen, K.; Grunsven, P. van; Giesen, P.
OBJECTIVE: To examine patient and care characteristics of emergency ambulance call-outs and to determine how many of them were, in retrospect, effectively providing primary care. DESIGN: Retrospective cross-sectional study. METHOD: We charted patient and care characteristics of 598 emergency
Ohio State Dept. of Education, Columbus. Trade and Industrial Education Service.
This textbook for emergency medical personnel should be useful to fire departments, private ambulance companies, industrial emergency and rescue units, police departments, and nurses. The 30 illustrated chapters cover topics such as: (1) Emergency Medical Service Vehicles, (2) Safe Driving Practices, (3) Anatomy and Physiology, (4) Closed Chest…
Full Text Available Effective and efficient public service delivery like healthcare services are very important in today's society, especially in the rural areas. People in rural areas are expected to have access to public facilities at all times. However, these services are not always available when they are needed. This paper discusses the problems faced by rural areas of Mafikeng in South Africa (SA when public and basic healthcare facilities like medical ambulance transports are needed during emergency situation. The challenges ranges from poor communication, poor road network and unstructured address to non-arrival of ambulances leading loss of lives that are preventable. This paper designed and implemented a system prototype using mobile application technologies to offer cost-effective services to patients during emergencies. It is intended to reduce long queues in hospitals and long waiting periods for an ambulance via location-based services. By using this application, lives in the rural areas can be made easier and loss of lives prevented by providing timely response from the appropriate healthcare providers during emergencies.
Lao, Ka Man
Purpose - The prevalence of mobile phones, especially the development of smartphones, has attracted numerous companies to exploit the potential in mobile marketing. One notable mobile marketing tool that is progressively gaining interest is the mobile coupon. The aim of this study is to build a conceptual model to explain consumers’ attitude and intention to redeem mobile coupon in the emergence of smartphones. Design/methodology/approach – This study is based on an online survey questionn...
Japan is far behind Western nations in emergency care, such as the United States where paramedics are placed under the M-ICU system and France in which the SAMU system is in force. This paper is an attempt to introduce developments in the delivery of emergency care in the Japanese rural setting and the present state of emergency care delivered at our hospitals, while checking them against national policy.
Mota, Larissa Larie; Andrade, Selma Regina de
To systematize, with professionals from the Mobile Emergency Care Service of Santa Catarina municipality, the main issues for the development of an educational tool of attention to the emergency room, dedicated to the school-age population. Qualitative study, conducted through meetings in the focus group format, with 19 professionals who develop their activities in the city Emergency Mobile Emergency Service. Data were categorized and analyzed using thematic analysis technique. The contents discussed at the meetings were grouped into four thematic categories: The Mobile Emergency Service and the school: education and health promotion for children; As the Mobile Emergency Care Service works: What is important to know ?; Something's wrong, what now? and; We are nearly finished, give your opinion. The specific issues arising from the meetings contributed to the production of an educational tool on the activities of the Mobile Emergency Service, which may be used by the School Health Program to promote health education in the care area to the emergency room with the population schoolchildren. Sistematizar, junto aos profissionais do Serviço de Atendimento Móvel de Urgência de um município catarinense, os principais temas para a elaboração de um instrumento educativo sobre atenção às urgências, dedicado à população em idade escolar. Estudo qualitativo, realizado por meio de encontros no formato de grupo focal, com 19 profissionais que desenvolvem suas atividades no Serviço de Atendimento Móvel de Urgência municipal. Os dados foram categorizados e analisados com a técnica de análise temática. Os conteúdos debatidos nos encontros foram agrupados em quatro categorias temáticas: O Serviço de Atendimento Móvel de Urgência e a escola: educação e promoção da saúde para as crianças; Como o Serviço de Atendimento Móvel de Urgência funciona: o que é importante saber?; Tem algo errado, e agora? e; Estamos quase concluindo, dê sua opinião. Os
Joshipura, Manjul; Hyder, Adnan A; Rehmani, Riffat
One of the striking deficiencies in the current health delivery structure is lack of focus on emergency care in primary health systems, which are ill-equipped to offer appropriate care in emergency situations resulting in a high burden of preventable deaths and disability. Emergency medical systems (EMS) encompass a much wider spectrum from recognition of the emergency, access to the system, provision of pre-hospital care, through definitive hospital care. The burden of death and disability resulting from lack of appropriate emergency care is very high in low- and middle-income countries. In South Asia, health services in general, and emergency care in particular, have failed to attract priority, investments and efforts for a variety of reasons. It has to be emphasized that integrating EMS with other health system components improves health care for the entire community, including children, the elderly, and other vulnerable groups with special needs. Out-of-facility care is an integral component of the health care system in South Asia. EMS focuses on out-of-facility care and also supports efforts to implement cost-effective community health care. There is a possibility of integration of other health services and programmes with an innovative, cost-effective EMS in the region.
Bayne, C Gresham; Boling, Peter A
Medicare reimbursement for home visits average around $100 without ancillaries, so making 10 home visits to prevent even a single $1,000 ambulance ride is cost-neutral for Medicare. Home medical care is only an added cost if it fails to offset acute care use. The government's demographic and financial pressure suggests a need to press ahead with the enhanced mobile care model, so the explosion in point-of-care devices should continue. The main challenge is to decide which ones provide dispositive value to patients.
van Lieshout, E.J.
The Mobile Intensive Care Unit (MICU) is a combination of i) a team of critical care nurse, physician and ambulance driver, ii) a MICU-trolley (i.e. equipped with cardiovascular monitor, mechanical ventilator, syringe pumps etc. indispensable for safe transport and iii) an Intensive Care ambulance.
van Lieshout, E.J.
The Mobile Intensive Care Unit (MICU) is a combination of i) a team of critical care nurse, physician and ambulance driver, ii) a MICU-trolley (i.e. equipped with cardiovascular monitor, mechanical ventilator, syringe pumps etc. indispensable for safe transport and iii) an Intensive Care ambulance.
Darlene R. House
Full Text Available Objective. Mobile phones have been successfully used for Emergency Department (ED patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge.Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up.Results. Of 788 families, 704 (89.3% had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases.Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.
House, Darlene R; Cheptinga, Philip; Rusyniak, Daniel E
Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.
M. van Veen (Mirjam)
textabstractIn the first part of the thesis performance of the Manchester Triage System in paediatric emergency care was evaluated. In chapter 1 we reviewed the literature to evaluate realibility and validity of triage systems in paediatric emergency care. The Manchester Triage System was used to tr
In this thesis, the primary aim was to gain insight into management of obstetric emergencies occurring in primary midwifery care in the Netherlands. Secondly, we aimed to develop preventative strategies and tools to optimise care in case of an obstetric emergency. From 2008-2010, a unique dataset of
Gelrud, Joan; Burroughs, Helen; Koterwas, Joanne
Emergency department overcrowding is a nationally recognized barrier to patient safety. Other obstacles to efficiency and adequate care in emergency rooms include lengthy patient waits and side-tracked ambulances. This article explores one community hospital's approach to significantly decreasing emergency visit turnaround times while increasing patient satisfaction.
de Jesus, Fábio Santos; Paim, Daniel de Macedo; Brito, Juliana de Oliveira; Barros, Idiel de Araujo; Nogueira, Thiago Barbosa; Martinez, Bruno Prata; Pires, Thiago Queiroz
Objective To evaluate the variation in mobility during hospitalization in an intensive care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion criteria included patients admitted with an independence score of ≥ 4 for both bed-chair transfer and locomotion, with the score based on the Functional Independence Measure. Patients with cardiac arrest and/or those who died during hospitalization were excluded. To measure the loss of mobility, the value obtained at discharge was calculated and subtracted from the value obtained on admission, which was then divided by the admission score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility during hospitalization was 14.3% (p < 0.001). Loss of mobility was greater in patients hospitalized for more than 48 hours in the intensive care unit (p < 0.02) and in patients who used vasopressor drugs (p = 0.041). However, the comparison between subjects aged 60 years or older and those younger than 60 years indicated no significant differences in the loss of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3 score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit. This loss was greater in patients who were hospitalized for more than 48 hours and in those who used vasopressors; however, the causal and prognostic factors associated with this decline need to be elucidated. PMID:27410406
Nydahl, P; Dubb, R; Filipovic, S; Hermes, C; Jüttner, F; Kaltwasser, A; Klarmann, S; Mende, H; Nessizius, S; Rottensteiner, C
Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters.
Jeong, Il-Woong; Choi, Jin; Cho, Kyusung; Seo, Yong-Ho; Yang, Hyun Seung
Detecting emergency situation is very important to a surveillance system for people like elderly live alone. A vision-based emergency response system with a paramedic mobile robot is presented in this paper. The proposed system is consisted of a vision-based emergency detection system and a mobile robot as a paramedic. A vision-based emergency detection system detects emergency by tracking people and detecting their actions from image sequences acquired by single surveillance camera. In order to recognize human actions, interest regions are segmented from the background using blob extraction method and tracked continuously using generic model. Then a MHI (Motion History Image) for a tracked person is constructed by silhouette information of region blobs and model actions. Emergency situation is finally detected by applying these information to neural network. When an emergency is detected, a mobile robot can help to diagnose the status of the person in the situation. To send the mobile robot to the proper position, we implement mobile robot navigation algorithm based on the distance between the person and a mobile robot. We validate our system by showing emergency detection rate and emergency response demonstration using the mobile robot.
Full Text Available Abstract The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3–12 lead ECG, SPO2, NIBP, IBP, Temp and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available or through Plain Old Telephony Systems (POTS where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three
Kyriacou, E; Pavlopoulos, S; Berler, A; Neophytou, M; Bourka, A; Georgoulas, A; Anagnostaki, A; Karayiannis, D; Schizas, C; Pattichis, C; Andreou, A; Koutsouris, D
The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a
Goldstein, Judah; McVey, Jennifer; Ackroyd-Stolarz, Stacy
Caring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step.
De La Harpe, Retha
Data quality of paper health records remain problematic and little is known about mobile health data quality. A semiotic data quality framework is used as an analytical lens to identify the quality of data in care health service provision in resource-restricted communities. A mobile application was developed using a co-design approach. The results of the empirical study indicate data quality problems on the syntactic, semantic, pragmatic and social semiotic levels. The social aspect of data quality is an important contributor of quality associated problems. It is important to consider this human involvement in the capturing and using of data for the value of care data to be fully utilized. With better quality data a better care service can be provided and ultimately resulting in better quality life.
Over the last decade, Roma populations in Europe have been the object of strict securitarian policies. The Rome case is particularly interesting due to the continued shift from securitarian to humanitarian discourses and actions led by local institutions. The specific health care system implemented in the legal and illegal Roma camps was one of the tools used. The ethnographic fieldwork behind this article involved following the daily activities of a mobile medical unit dedicated to Roma camps in Rome and monitoring a health care project led by a nongovernmental organization. This analysis focuses on one particular dimension of precarious forms of Roma citizenship that the health care policies have developed to address Roma issues: the international mobility dynamics relating to health issues, which drive subjects into a forced integration of multiple, incomplete, and fragmentary medical approaches.
Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel
AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how patie...
Shin, D J; Athamanolap, P; Chen, L; Hardick, J; Lewis, M; Hsieh, Y H; Rothman, R E; Gaydos, C A; Wang, T H
Management of curable sexually-transmitted infections (STI) such as Chlamydia can be revolutionized by highly sensitive nucleic acid testing that is deployable at the point-of-care (POC). Here we report the development of a mobile nucleic acid amplification testing (mobiNAAT) platform utilizing a mobile phone and droplet magnetofluidics to deliver NAAT in a portable and accessible format. By using magnetic particles as a mobile substrate for nucleic acid capture and transport, fluid handling is reduced to particle translocation on a simple magnetofluidic cartridge assembled with reagents for nucleic acid purification and amplification. A mobile phone user interface operating in tandem with a portable Bluetooth-enabled cartridge-processing unit facilitates process integration. We tested 30 potentially Chlamydia trachomatis (CT)-infected patients in a hospital emergency department and confirmed that mobiNAAT showed 100% concordance with laboratory-based NAAT. Concurrent evaluation by a nontechnical study coordinator who received brief training via an embedded mobile app module demonstrated ease of use and reproducibility of the platform. This work demonstrates the potential of mobile nucleic acid testing in bridging the diagnostic gap between centralized laboratories and hospital emergency departments.
Engestrom, Yrjo; Nummijoki, Jaana; Sannino, Annalisa
This article presents a process of collective formation of a new concept of mobility between home care workers and their elderly clients, who are at risk of losing physical mobility and functional capacity. A new tool called mobility agreement was introduced to facilitate the inclusion of regular mobility exercises in home care visits and in the…
B. S. Santos
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
Harkins, Judith; Tucker, Paula E; Williams, Norman; Sauro, Jeff
In the United States, a nationwide Commercial Mobile Alert Service (CMAS) is being planned to alert cellular mobile device subscribers to emergencies occurring near the location of the mobile device. The plan specifies a unique audio attention signal as well as a unique vibration attention signal (for mobile devices set to vibrate) to identify that the incoming message pertains to an emergency. Ratings of vibration signals of varying lengths and patterns were obtained from 44 deaf users of mobile devices for the perceived effectiveness of the signal in getting their attention in an emergency situation. Longer signals received higher ratings than shorter ones, and three signals with temporal on-off patterns were rated significantly better than a constant vibration. The U.S. government's recommended vibration signal for the CMAS, an important feature for access to emergency alerts by deaf persons, is supported by the results of the study.
Guise, Jeanne-Marie; Lowe, Nancy K; Deering, Shad; Lewis, Patricia O; O'Haire, Christen; Irwin, Lori K; Blaser, Molly; Wood, Laurie S; Kanki, Barbara G
Evidence from other high-risk industries has demonstrated that teamwork skills can be taught and effective teamwork may improve safety. Increasingly, health care providers, hospital administrators, and quality and safety professionals are considering simulation as a strategy to improve quality and patient safety. A mobile obstetric emergency simulation and team training program was created to bring simulation technology and teamwork training used routinely in other high reliability fields directly to health care institutions. A mobile unit constituted a practical approach, given the expense of simulation equipment, the time required for staff to develop educational materials and simulation scenarios, and the need to have a standardized program to promote consistent evaluation across sites. Between 2007 and 2009, in situ simulation of obstetric emergencies and teamwork training was tested with more than 150 health care professionals in labor and delivery units across four rural and two community hospitals in Oregon. HOW DO ORGANIZATIONS DETERMINE WHICH TYPE OF SIMULATION IS BEST FOR THEM? Because simulation technologies are relatively costly to start and maintain, it can be challenging for hospitals and health care professionals to determine which format (send staff to a simulation center, develop in-house simulation program, develop a consortium of hospitals that run a simulation program, or use a mobile simulation program) is best for them. In situ simulation is an effective way to develop new skills, to maintain infrequently used clinical skills even among experienced clinical teams, and to uncover and address latent safety threats in the clinical setting.
Savatmongkorngul, Sorravit; Yuksen, Chaiyaporn; Suwattanasilp, Chanakarn; Sawanyawisuth, Kittisak; Sittichanbuncha, Yuwares
This study aims to evaluate the mobile emergency severity index (ESI) tool in terms of validity compared with the original ESI triage. The original ESI and mobile ESI were used with patients at the Department of Emergency Medicine, Ramathibodi Hospital, Thailand. Eligible patients were evaluated by sixth-year medical students/emergency physicians using either the original or mobile ESI. The ESI results for each patient were compared with the standard ESI. Concordance and kappa statistics were calculated for pairs of the evaluators. There were 486 patients enrolled in the study; 235 patients (48.4%) were assessed using the mobile ESI, and 251 patients (51.6%) were in the original ESI group. The baseline characteristics of patients in both groups were mostly comparable except for the ED visit time. The percentages of concordance and kappa statistics in the original ESI group were lower than in the mobile group in all three comparisons (medical students vs gold standard, emergency physicians vs gold standard, and medical students vs emergency physicians). The highest kappa in the original ESI group is 0.69, comparing emergency physicians vs gold standard, while the lowest kappa in the application group is 0.84 comparing the medical students vs gold standard. Both medical students and emergency physicians are more confident with the mobile ESI application triage. In conclusion, the mobile ESI has better inter-rater reliability, and is more user-friendly than the original paper form.
Vollaard, Hans; van de Bovenkamp, Hester M.; Vrangbæk, Karsten
involvement in healthcare policy over the last twenty years. Based on interviews and document and literature analysis we show that the scope of EU involvement has widened from public health and access to care, to quality of care. In this paper we concentrate on the latter. Focusing on the recent EU......Despite the fact that Member States and many citizens of the EU like to keep healthcare a foremost national competence and the EU treaties state that Member States remain primarily responsible for the organization and delivery of health care services, the European Union (EU) has expanded its...... and desirability of the EU's involvement is clearly needed, also considering the differences in quality of care policies between and within EU Member States. Both arguments in favour and against further EU involvement are discussed in this paper...
Sterns, J B
Access to capital will become more difficult. Capital access is dependent on ability to repay debt, which, in turn, is dependent on internally generated cash flows. Under any health care reform proposal, revenue inflows will be slowed. The use of corporate finance techniques to limit financial risk and lower cost will be a permanent response to fundamental changes to the health care system. These changes will result in greater balance sheet management, centralized capital allocation, and alternative sources of capital.
Patrícia Fátima Levandovski; Maria Alice Dias da Silva Lima; Aline Marques Acosta
To analyze patient satisfaction with nursing care received at a hospital emergency service. Methodology. This is a quantitative, descriptive, cross-sectional study. The sample was composed by 250 patients over 18 years old who used an emergency service in the south region of Brazil. Data were collected using an identification form and the Patient Satisfaction Instrument. Results. Results point to a good level of satisfaction of patients with the nursing care received, with the greatest mean f...
Turakhia, Mintu P; Kaiser, Daniel W
Atrial fibrillation (AF) is a multifaceted and highly variable disease that is often difficult to manage within the traditional health-care model. The conventional model of regular or pre-scheduled appointments with physicians or allied health professionals is poorly suited to the unpredictable and often urgent clinical needs of patients with AF. Mobile health (mHealth) has the potential to dramatically transform the delivery and quality of AF care. In this brief review, we summarize the current limitations and evidence gaps in treating patients with AF. We then describe the current mHealth landscape, changes in telehealth coverage and reimbursement, and recent technological advances of smartphones, mobile applications, and connected wearable devices. We also describe important barriers and challenges, such as clinical management of large volumes of data, application of predictive analytics/machine learning, and the need for high-quality randomized clinical trials.
Koufi, Vassiliki; Malamateniou, Flora; Vassilacopoulos, George
The drive to achieve excellence in healthcare delivery while containing costs, underlies the need for a new generation of applications which facilitate the realization of a patient-centric care model. Under this emerging care model healthcare delivery can be integrated across the continuum of services, from prevention to follow up, and care can be coordinated across all settings. With care moving out into the community, health systems require real-time information to deliver coordinated care to patients. The integration of leading-edge technologies, such as mobile technology, with Personal Health Records (PHRs) can meet this requirement by making comprehensive and unified health information available to authorized users at any point of care or decision making through familiar environments such as Google's Android. This paper presents a framework that provides ubiquitous access to patients' PHRs via Android-enabled mobile devices. Where possible health information access and management is performed in a transparent way, thus enabling healthcare professionals to devote more time on practicing medicine and patients to manage their own health with the least possible intervention. This depends heavily on the context, which is collected by both Android-specific core system services and special purpose software agents with the latter being also responsible for preserving PHR data privacy.
Cooper, Simon; O'Carroll, Judith; Jenkin, Annie; Badger, Beryl
...) mixed methods clinical case study in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multiprofessional emergency care practitioners (ECPs...
M. van Veen (Mirjam); H.A. Moll (Henriëtte)
textabstractBackground. Triage in paediatric emergency care is an important tool to prioritize seriously ill children. Triage can also be used to identify patients who do not need urgent care and who can safely wait. The aim of this review was to provide an overview of the literature on reliability
Wiegers, T.A.; Borst, J. de
Objective: to gain more insight in the perceptions and experiences of care providers and clients with the organisation of emergency transfer in maternity care, with regard to transportation, responsibilities and communication between caregivers. Background: in the Netherlands a woman with an
Hume, P A; Chalmers, D J; Wilson, B D
OBJECTIVE: To examine trampoline related injuries resulting in emergency department attendance. METHODS: Cases were identified by searching free text descriptions of the circumstances of injury contained in the records of the emergency department of a large city hospital. RESULTS: 114 cases were identified for a 12 month period, giving an incidence rate of 108 per 100,000 population per year (95% confidence interval = 89 to 129) compared with 9.3 hospital admissions per 100,000 population per year (95% confidence interval = 8.3 to 10.4) for a corresponding period reported in earlier research from New Zealand. This suggested that for every one hospital admission there are approximately 12 emergency department attendances. Of the cases, 95% were aged less than 20 years. As for the earlier research, falls from the trampoline to the surrounding surface were the commonest cause of injury. In the present study, sprains and strains were the commonest type of injury (40%), and the body site most frequently involved was the lower limb (46%). CONCLUSIONS: The findings support the conclusion from earlier research that although existing trampoline standards address many of the issues relating to trampoline safety, the need remains for measures to reduce the impact of falls from the trampoline to the ground surface and to prohibit the use of trampolines as unsupervised "play equipment". PMID:9015596
Full Text Available In the 21st century, natural disasters and emergencies occur frequently worldwide, which leads to the loss of hundreds of thousands of lives as well as the direct and indirect economic losses. China has a vast territory frequently struck by natural disasters. However, the reality is not optimistic. Poor organization and management during the rescue actions, the lack of large-scale, systematic medical rescue equipment were all great barriers to the outcomes. Mobile hospitals are expected to provide better health care. We were inspired by the concept of mobile hospital. Chongqing Emergency Medical Center, has set up trauma care system since 1988, in which prehospital care, intensive care, and in-hospital treatment is fully integrated. As a major advantage, such a system provided assurance of “golden hour” rescue treatment. Providing mobile intensive care and prehospital surgical service for severe trauma patients could reduce mortality significantly. Based on the civilian experiences in Chongqing Emergency Medical Center, the mobile emergency (surgical hospital was developed.
Carmen Lúcia Mottin Duro
Full Text Available This study aimed to assess nurses’ perception regarding the risk classification in emergency care units. It is a descriptive study that used a qualitative approach and that was conducted with 55 nurses from emergency care units in the south of Brazil. Data were collected between July and October, 2011, through open questions, answered in writing. The data collected were submitted to the thematic analysis technique. Results indicate that the risk classification contributes to the organization of the service flow provided to patients, intervening in severe cases and preventing sequelae. Difficulties were described, such as: inadequate physical installations, overcrowding, disagreement in the definition of priorities among doctors and nurses and lack of articulation between the emergency care network and basic health care. It is highlighted the need to improve the physical structure, the quantity of human resources and the implementation of public policies to overcome these challenges.
Charles Street, part of the Emergency Preparedness team at KSC, uses a phone on the specially equipped emergency response vehicle. The vehicle, nicknamed '''The Brute,''' serves as a mobile command center for emergency preparedness staff and other support personnel when needed. It features a conference room, computer work stations, mobile telephones and a fax machine. It also can generate power with its onboard generator. Besides being ready to respond in case of emergencies during launches, the vehicle must be ready to help address fires, security threats, chemical spills, terrorist attaches, weather damage or other critical situations that might face KSC or Cape Canaveral Air Force Station.
Spang, Lisa; Holmqvist, Kajsa
Emergency care takes place in a complex work environment that is characterized by critically ill patients, short hospital stays, and a wide variety of different healthcare professionals. Studies of occupational therapists' (OTs) experiences of working within emergency care have shown that they often experience difficulties in explaining the essence of occupational therapy and have to justify their approaches. Much effort has been made in Sweden to help OTs dispel the notion that occupational therapy is difficult to explain, and the aim of this study was to describe how Swedish OTs perceive their work in emergency care. A qualitative descriptive approach was taken, and 14 interviews were conducted with OTs working in emergency care. Qualitative content analysis was used to analyse the data. The overall theme that emerged was "Feeling established through deliberate occupation-based work". The underlying categories showed different strategies used by the OTs to provide occupational therapy in an emergency care context. Deliberate strategies were used to demonstrate the effectiveness of occupational therapy and its approaches to patients and other health care professionals, and this resulted in the OTs feeling both established and needed. Unlike the OTs in previous studies, the Swedish OTs experienced no difficulties in explaining occupational therapy and could make convincing arguments for their interventions. Parallel to their clinical work, the OTs worked with on-going development to find ways to improve their approaches. In summary, these Swedish OTs seem to have been provided with a professional language and the knowledge required to establish themselves in an emergency care setting.
Wilson, Kumanan; Atkinson, Katherine M; Westeinde, Jacqueline
Mobile technology and applications (apps) have disrupted several industries including healthcare. The advantage of apps, being personally focused and permitting bidirectional communication, make them well suited to address many immunization challenges. As of April 25, 2015 searching the Android app store with the words 'immunize app' and 'immunization app' in Canada yielded 225 apps. On the Apple App Store a similar search produced 98 results. These include apps that provide immunization related information, permit vaccine tracking both for individuals and for animals, assist with the creation of customized schedules and identification of vaccine clinics and serve as sources of education. The diverse functionality of mobile apps creates the potential for transformation of immunization practice both at a personal level and a system level. For individuals, mobile apps offer the opportunity for better record keeping, assistance with the logistics of vaccination, and novel ways of communicating with and receiving information from public health officials. For the system, mobile apps offer the potential to improve the quality of information residing in immunization information systems and program evaluation, facilitate harmonization of immunization information between individuals, health care providers and public health as well as reduce vaccine hesitancy. As mobile technology continues to rapidly evolve there will emerge new ways in which apps can enhance immunization practice.
Laker, Lauren F; Torabi, Elham; France, Daniel J; Froehle, Craig M; Goldlust, Eric J; Hoot, Nathan R; Kasaie, Parastu; Lyons, Michael S; Barg-Walkow, Laura H; Ward, Michael J; Wears, Robert L
In 2017, Academic Emergency Medicine convened a consensus conference entitled, "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes." This manuscript, a product of the breakout session on "understanding complex interactions through systems modeling," explores the role that computer simulation modeling can and should play in research and development of emergency care delivery systems. This manuscript discusses areas central to the use of computer simulation modeling in emergency care research. The four central approaches to computer simulation modeling are described (Monte Carlo Simulation, System Dynamics modeling, Discrete-Event Simulation, and Agent Based Simulation), along with problems amenable to their use and relevant examples to emergency care. Also discussed is an introduction to available software modeling platforms and how to explore their use for research, along with a research agenda for computer simulation modeling. Through this manuscript, our goal is to enhance adoption of computer simulation, a set of methods which hold great promise in addressing emergency care organization and design challenges. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Luc Malemo Kalisya
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.
Duke, Trevor; Cheema, Baljit
Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little.
Remick, Katherine; Gross, Toni; Adelgais, Kathleen; Shah, Manish I; Leonard, Julie C; Gausche-Hill, Marianne
Citing numerous pediatric-specific deficiencies within Emergency Medical Services (EMS) systems, the Institute of Medicine (IOM) recommended that EMS systems appoint a pediatric emergency care coordinator (PECC) to provide oversight of EMS activities related to care of children, to promote the integration of pediatric elements into day-to-day services as well as local and/or regional disaster planning, and to promote pediatric education across all levels of EMS providers. A systematic review of the literature was undertaken to describe the evidence for pediatric coordination across the emergency care continuum. The search strategy was developed by the investigators in consultation with a medical librarian and conducted in OVID, Medline, PubMed, Embase, Web of Science, and CINAHL databases from January 1, 1983 to January 1, 2016. All research articles that measured a patient-related or system-related outcome associated with pediatric coordination in the setting of emergency care, trauma, or disaster were included. Opinion articles, commentaries, and letters to the editors were excluded. Three investigators independently screened citations in a hierarchical manner and abstracted data. Of 149 identified titles, nine were included in the systematic review. The nine articles included one interventional study, five surveys, and three consensus documents. All articles favored the presence of pediatric coordination. The interventional study demonstrated improved documentation, clinical management, and staff awareness of high priority pediatric areas. The current literature supports the identification of pediatric coordination to facilitate the optimal care of children within EMS systems. In order for EMS systems to provide high quality care to children, pediatric components must be integrated into all aspects of care including day-to-day operations, policies, protocols, available equipment and medications, quality improvement efforts, and disaster planning. This systematic
Huang, Xinyuan; Matricardi, Paolo Maria
Strategies to improve patients' adherence to treatment are essential to reduce the great health and economic burden of allergic rhinitis and asthma. Mobile phone applications (apps) for a better management of allergic diseases are growing in number, but their usefulness for doctors and patients is still debated. Controlled trials have investigated the feasibility, cost-effectiveness, security, and perspectives of the use of tele-medicine in the self-management of asthma. These studies focused on different tools or devices, such as SMS, telephone calls, automatic voice response system, mobile applications, speech recognition system, or cloud-computing systems. While some trials concluded that m-Health can improve asthma control and the patient's quality of life, others did not show any advantage in relation to usual care. The only controlled study on allergic rhinitis showed an improvement of adherence to treatment among tele-monitored patients compared to those managed with usual care. Most studies have also highlighted a few shortcomings and limitations of tele-medicine, mainly concerning security and cost-efficiency. The use of smartphones and apps for a personalized asthma and allergy care needs to be further evaluated and optimized before conclusions on its usefulness can be drawn.
Cooper, Simon; Porter, Jo; Endacott, Ruth
This paper follows previous publications on generic qualitative approaches, qualitative designs and action research in emergency care by this group of authors. Contemporary views on mixed methods approaches are considered, with a particular focus on the design choice and the amalgamation of qualitative and quantitative data emphasising the timing of data collection for each approach, their relative 'weight' and how they will be mixed. Mixed methods studies in emergency care are reviewed before the variety of methodological approaches and best practice considerations are presented. The use of mixed methods in clinical studies is increasing, aiming to answer questions such as 'how many' and 'why' in the same study, and as such are an important and useful approach to many key questions in emergency care.
Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David
The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.
Full Text Available Ann L Bossen,1 Heejung Kim,2,3 Kristine N Williams,1 Andreanna E Steinhoff,2 Molly Strieker1 1University of Iowa College of Nursing, Iowa City, IA, USA; 2University of Kansas School of Nursing, Kansas City, KS, USA; 3Yonsei University College of Nursing, Seoul, Republic of Korea Abstract: Demographic aging of the world population contributes to an increase in the number of persons diagnosed with dementia (PWD, with corresponding increases in health care expenditures. In addition, fewer family members are available to care for these individuals. Most care for PWD occurs in the home, and family members caring for PWD frequently suffer negative outcomes related to the stress and burden of observing their loved one's progressive memory and functional decline. Decreases in cognition and self-care also necessitate that the caregiver takes on new roles and responsibilities in care provision. Smart technologies are being developed to support family caregivers of PWD in a variety of ways, including provision of information and support resources online, wayfinding technology to support independent mobility of the PWD, monitoring systems to alert caregivers to changes in the PWD and their environment, navigation devices to track PWD experiencing wandering, and telemedicine and e-health services linking caregivers and PWD with health care providers. This paper will review current uses of these advancing technologies to support care of PWD. Challenges unique to widespread acceptance of technology will be addressed and future directions explored. Keywords: technology, dementia care, caregiver support
Innes, Kelli; Crawford, Kimberley; Jones, Tamsin; Blight, Renee; Trenham, Catherine; Williams, Allison; Griffiths, D; Morphet, Julia
In response to increasing demands some emergency departments have introduced transdisciplinary care coordination teams. Such teams comprise staff from multiple disciplines who are trained to perform roles outside their usual scope of practice. This study aimed to critically evaluate the patient, carer and ED staff perceptions of the transdisciplinary model of care in an emergency department in a Melbourne metropolitan hospital. The evaluation of the transdisciplinary team involved interviews with patients and carers who have received the transdisciplinary team services, and focus groups with emergency nursing and transdisciplinary team staff. Analysis of the data revealed that the transdisciplinary model provided an essential service, where staff members were capable of delivering care across all disciplines. The ability to perform comprehensive patient assessments ensured safe discharge, with follow-up services in place. The existence of this team was seen to free up time for the emergency nursing staff, enabling them to see other patients, and improving department efficiency while providing quality care and increasing staff satisfaction. This study identified several important factors which contributed to the success of the transdisciplinary team, which was well integrated into the larger emergency department team. Copyright © 2016 Elsevier Ltd. All rights reserved.
Sabater González, Mikel; Calvo Carrasco, Daniel
Fowl are birds belonging to one of the 2 biological orders, the game fowl or land fowl (Galliformes) and the waterfowl (Anseriformes). Studies of anatomic and molecular similarities suggest these two groups are close evolutionary relatives. Multiple fowl species have a long history of domestication. Fowl are considered food-producing animals in most countries and clinicians should follow legislation regarding reportable diseases and antibiotic use, even if they are pets. This article reviews aspects of emergency care for most commonly kept fowl, including triage, patient assessment, diagnostic procedures, supportive care, short-term hospitalization, and common emergency presentations.
Full Text Available Paul Y Takahashi,1 Anupam Chandra,1 Frederick North,1 Jennifer L Pecina,2 Benjavan Upatising,3 Gregory J Hanson11Mayo Clinic Division of Primary Care Internal Medicine, 2Mayo Clinic Department of Family Medicine, Rochester, MN, USA; 3Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USAAbstract: Recent changes and consolidations in health care systems have resulted in an increase in new health care delivery models. Telemedicine holds great promise as one of these models. There is a great potential for new patient evaluation and treatment models in emergency care (EC, especially when patients are miles away from a medical team. Evaluations can be performed in a patient's home, a nursing care facility, and in hospitals that focus on advanced subspecialty care. Due to rapid developments in this area, current care models are constantly being evaluated and modified. This review article outlines current telemedicine models for EC and summarizes their potential benefits to patients and the health care system. The review examines the role that the telephone, a fundamental tool of telemedicine, plays in these new models. The review also examines evidence of improved health care outcomes by highlighting the role of telemedicine in reducing hospitalizations. The patient is the primary focus; as a result, this review also examined patient experiences and satisfaction levels regarding telemedicine health care teams. The authors support these technological advances and their potential for information transfer. Health care providers need to continue developing these models by making use of increasing amounts of information. One of the main implementation barriers of these new models in the US and other countries is the issue of payment and reimbursement. Despite this, advancements in EC telemedicine continue.Keywords: telemedicine, emergency care, geriatric, patient evaluation models
This article presents a discussion of emerging non-medical roles in emergency care against the current policy context and the issues of role substitution and interprofessional working. Non-medical roles in emergency care have grown internationally in response to an increasing demand for emergency care services and to address the growing importance of the quality healthcare agenda. The blurring of role boundaries between professional groups has become more common. Data sources. Searches were made of three electronic databases; CINAHL, Medline and EMBASE. The literature relating to interprofessional healthcare roles, and new roles in emergency care was searched from 1980 to 2010 and underpinned the discussion. A theoretical framework that has emerged from the literature is that task, role substitution and interprofessional working lie on a spectrum and evolving non-medical roles can be plotted on the spectrum, usually starting at one end of the spectrum under task substitution and then potentially moving in time towards true interprofessional working. There is still a great deal of progress to be made until non-medical roles in emergency care can truly be encompassed under the umbrella of interprofessional working and that a more robust critical mass of evidence is required to substantiate the theory that interprofessional working within teams contributes to effective, cost-effective care and better patient outcomes. It is essential to understand the underlying motivation, policy context and key drivers for the development of new nursing and non-medical roles. This allows services to be established successfully, by understanding and addressing the key predicable barriers to implementation and change. © 2011 Blackwell Publishing Ltd.
Jensen, Jens F.
The paper describes and evaluates a recent project in Aalborg, Denmark, dealing with the communication of cultural heritage and industrial culture to young people via their own preferred media platform: mobile phones. The communication was based on the new cultural genre: Alternative Reality Games......, a method that - so to speak - writes the player into the story and history, and a method that because of the narrative form is especially well-suited to support coherences and coherent stories....
AJRH Managing Editor
secondary or tertiary health care facilities, enabling the strategic ... and experienced staff, equipment and consumables to carry out the ... CEmOC in Ibarapa Local Government Area in. Southwest ... reviewing 998 maternal deaths and 1451 near-miss cases in ... who then presented as dire emergencies in hospital after.
Erika Phindile Chowa
Discussion: Swaziland ECs were predominantly contiguous and running at overcapacity, with high patient volumes and limited resources. The limited access to technology and specialists are major challenges. We believe that these data support greater resource allocation by the Swaziland government to the emergency care sector.
Full Text Available SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011 with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%. 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%, breast (13.6% and prostate (10.5%; 70.7% were in advanced stages (IV, 47.1%; 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.
Qualidade de Vida no Trabalho em uma Central de Regulação Médica de um Serviço de Atendimento Móvel de Urgência (SAMU [(Quality of Life at Work in a Medical Regulation Centre in a Mobile Emergency Care Service (SAMU
Vanessa Luciana Lima Melo de Avelar
Full Text Available Este artigo descreve e analisa os profissionais de uma central de regulação médica de um Serviço de Atendimento Móvel de Urgência (SAMU quanto a variáveis de qualidade de vida no trabalho. Trata-se de uma pesquisa descritiva, de caráter quantitativo e qualitativo, baseada nos referenciais teóricos de Walton (1973 e Hackman e Oldham (1975. De um modo geral, os resultados apontam para um nível satisfatório de qualidade de vida no trabalho, com maior destaque aos aspectos “possibilidade de crescimento”, “potencial motivacional da tarefa” e “relevância social” em poder ajudar, tanto na forma direta quanto indireta, às pessoas que demandam atendimento. Apesar dos resultados favoráveis, a fala dos sujeitos sinaliza para a necessidade de melhorias quanto aos aspectos de infra-estrutura, adequação de escalas e jornadas de trabalho com a realidade do município e volume de atendimentos, bem como a interlocução do SAMU com os serviços hospitalares e pré-hospitalares fixos, além da conscientização da população. Percebeu-se que a retaguarda da supervisão na resolução destes problemas e uma busca constante pela melhoria da qualidade de vida no trabalho podem contribuir para a manutenção dos profissionais em seus postos de trabalho. --- Quality of Life at Work in a Medical Regulation Centre in a Mobile Emergency Care Service (SAMU --- Abstract --- This article describes and analyzes the quality of work life of professionals of a central medical regulation of a Mobile Emergency Care Service (SAMU. This is a descriptive, quantitative and qualitative research, based on theoretical references of Walton (1973 and Hackman and Oldham (1975. Overall, the results point to a satisfactory level of quality of work life, with emphasis on aspects of “growth opportunity”, “motivational potential of the task” and “social relevance” to help, either as direct as indirectly, people who require care. Despite the favorable
Full Text Available If it is the case that mobile devices, with their specific social and technological structures and attendant cultural practices, have become an integral part of everyday life, then the educational field has to react. But how and who? Fact is that mobile devices have reached and become fully integrated in everyday life, worldwide and across social milieus. This development is «ubiquitous» (e.g. Haythornthwaite, 2008, Beale 2007, Nyiri 2002 and is accompanied by an increase in individualisation enabled and necessitated by a variety of mobile devices characterised by media convergence. Education must ask questions about the impact of these irreversible trends on the personal development of young people and about its role in mediating them as well as about their impact on individual agency of young people in the context of emerging socio-cultural structures (see Stald 2007.
The recent numerical expansion of the middle classes in Brazil, Russia, India, China and South Africa (BRICS) has (re)opened the debate on their positioning in the broader political and social development processes within each of these countries, and the emergence of global Southern perspectives on
Ibrar Rafique; Umbreen Akhtar; Umar Farooq; Mussadiq Khan; Junaid Ahmad Bhatti
Objective: To assess the emergency care outcomes of acute chemical poisoning cases in tertiary care settings in Rawalpindi, Pakistan. Methods: The data were extracted from an injury surveillance study conducted in the emergency departments (ED) of three tertiary care hospitals of Rawalpindi city from July 2007 to June 2008. The World Health Organization standard reporting questionnaire (one page) was used for recording information. Associations of patients' characteristics with ED care outcomes, i.e., admitted vs. discharged were assessed using logistic regression models. Results: Of 62 530 injury cases reported, chemical poisoning was identified in 434 (0.7%) cases. The most frequent patient characteristics were poisoning at home (61.9%), male gender (58.6%), involving self-harm (46.0%), and youth aged 20–29 years (43.3%). Over two-thirds of acute poisoning cases (69.0%) were admitted. Acute poisoning cases were more likely to be admitted if they were youth aged 10–19 years [odds ratio (OR)=4.41], when the poisoning occurred at home (OR=21.84), and was related to self-harm (OR=18.73) or assault (OR=7.56). Conclusions: Findings suggest that controlling access of poisonous substances in youth and at homes might reduce related ED care burden. Safety promotion agencies and emergency physicians can use these findings to develop safety messages.
Ameh, Charles A; Bishop, Sophie; Kongnyuy, Eugene; Grady, Kate; Van den Broek, Nynke
To assess the availability of, and challenges to the provision of emergency obstetric care in order to raise awareness and assist policy-makers and development partners in making appropriate decisions to help pregnant women in Iraq. Descriptive and exploratory study based on self-administered questionnaires, an in-depth interview and a Focus Group Discussion. The setting was 19 major hospitals in 8 out of the 18 Governorates and the participants were 31 Iraqi doctors and 1 midwife. The outcome measures were availability of emergency obstetric care (EOC) in hospitals and challenges to the provision of EOC. Only 26.3% (5/19) of hospitals had been able to provide all the 8 signal functions of comprehensive emergency obstetric care in the previous 3 months. All the 19 hospitals provided parenteral antibiotics and uterine evacuation, 94.7% (18/19) were able to provide parenteral oxytocics and perform manual removal of retained placenta, magnesium sulphate for eclampsia was available in 47.4% (9/19) of hospitals, 42.1% (8/19) provided assisted vaginal delivery, 26.5% (5/19) provided blood transfusion and 89.5% (17/19) offered Caesarean section. The identified challenges for health care providers include difficulties travelling to work due to frequent checkpoints and insecurity, high level of insecurity for patients referred or admitted to hospitals, inadequate staffing due mainly to external migration and premature deaths as a result of the war, lack of drugs, supplies and equipment (including blood for transfusion), and falling standards of training and regulation. Most women and their families do not currently have access to comprehensive emergency obstetric care. Health care providers recommend reconstruction and strengthening of all components of the Iraqi health system which may only be achieved if security returns to the country.
Walker, Judi; Cullen, Marianne; Chambers, Helen; Mitchell, Eleanor; Steers, Nicole; Khalil, Hanan
Measuring the prevalence of wounds within health care systems is a challenging and complex undertaking. This is often compounded by the clinicians' training, the availability of the required data to collect, incomplete documentation and lack of reporting of this type of data across the various health care settings. To date, there is little published data on wound prevalence across regions or states. This study aims to identify the number and types of wounds treated in the Gippsland area using the Mobile Wound Care (MWC™) program. The MWC program has enabled clinicians in Gippsland to collect data on wounds managed by district nurses from four health services. The main outcomes measured were patient characteristics, wound characteristics and treatment characteristics of wounds in Gippsland. These data create several clinical and research opportunities. The identification of predominant wound aetiologies in Gippsland provides a basis on which to determine a regional wound prospective and the impact of the regional epidemiology. Training that incorporates best practice guidelines can be tailored to the most prevalent wound types. Clinical pathways that encompass the Australian and New Zealand clinical practice guidelines for the management of venous leg ulcers can be introduced and the clinical and economical outcomes can be quantitatively measured. The MWC allows healing times (days) to be benchmarked both regionally and against established literature, for example, venous leg ulcers.
Karthikeyan, N; Sukanesh, R
A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the
Jitendra N. Bajpai
Full Text Available The convergence of the ongoing innovations to make vehicles driverless, carbon free and accessible on ‘as needed’ basis, is evolving fast. A review of available information suggests that these technologies have substantial potential to generate positive externalities by improving road safety, lowering of fuel consumption and emissions in vehicles, and providing mobility options for vulnerable population including young, old and persons with disability. However, given the limited commercialization it is difficult to discern the nature of impact these technologies will have in reducing the two negative travel externalities, road congestion and low density expansion of cities. Gradual mainstreaming of these technologies will offer opportunities for further research in understanding the behavioral responses of their end users, and the risks that these technologies may pose to manufacturers, consumers, and stakeholders.
Y. van Ierland (Yvette)
markdownabstract__Abstract__ Children constitute a substantial part of the workload of physicians in primary care and hospital emergency care. In the Netherlands, about 70% of the 3.9 million inhabitants less than 20 years of age had one or more contacts with their general practitioner (GP) in 2011
dos Santos, José Luis Guedes; Pestanab, Aline Lima; Higashi, Giovana Dorneles Callegaro; de Oliveira, Roberta Juliane Tono; Cassetari, Sônia da Silva Reis; Erdmann, Alacoque Lorenzini
The purpose of this study was to understand the meanings attributed to the organizational context and the role of nurses in care management at emergency care units.This study was based on qualitative research and the Grounded Theory methodological framework. Data were collected from September 2011 to June 2012 by means of semi-structured interviews with 20 participants from two emergency care units (UPA) in southern Brazil, divided into three sample groups. The context is marked by constraints that hinder communication and interaction between professionals and the search of assistance by patients with demands that are not resolved at other levels of care. This scenario highlights the performance of nurses in the managerial dimension of their work, who assume the responsibility for managing care and coordinating professional actions in favour of improved care practices.
Emergency medical assistance is immediate, the current medical support that is provided hurted person to avoid any possible harmful consequences for his life and health. Emergency medical aid is part of the health care system that is rarely thought, but is still expected to be available always and continuously in case of need. Emergency medical assistance should always be available throughout the territory where people live, because there is no adequate replacement. Emergency Medical Services and emergency medical transportation services are health care that is provided in terms of all persons in the state of medical urgency. In urgent or emergency conditions, health care can be provided on the site of injuries and disease or health institution. Cases of medical urgency are ranked by degrees. The first and most difficult level of medical urgency indicate all urgent pathological conditions, diseases, injuries and poisoning, which occur in the workplace and public places. To expect medical team of emergency medical assistance at the scene intervened medical urgency, it is necessary to make call it. Call the phone number refers to the 94. Call sent to this number to receive orderly dispatcher. Dispatchers are employees who perform their work in the dispatching center. They appear in the phone number 94, made the assessment and screening calls, worry about the degree of urgency, and the absorption team, which team is the nearest place of the event. After received calls they send expert medical teams to the place of accident. In the dispatching center work always doctor and medical technician. Emergency medical care cases is a great professional and educational challenge and imposes a constant need in education of doctors and the whole emergency medical teams. Education of all employees in the state of emergency care is required continualy and for students too to receive new knowledge in the field of medical urgency by various professional purposes.
Bigna, Jean J; Noubiap, Jean J; Plottel, Claudia S; Kouanfack, Charles; Koulla-Shiro, Sinata
Mobile health (mhealth) has emerged as a powerful resource in the medical armamentarium against human immunodeficiency virus (HIV) infection. We sought to determine among adult caregivers of HIV-exposed/infected children; the extent of mobile phone ownership, the ability to communicate in Cameroon's national official languages (NOL), and the refusal to receive such reminders. We conducted a pre-trial analysis of potentials participants of the MORE CARE trial. MORE CARE took place from January through March 2013 in three geographic locations in Cameroon. We included caregivers aged 18 years or older. Written communication was assessed by the ability to read and understand information presented in the consent form. Verbal communication was assessed during a two-way conversation and in a discussion about HIV infection. A question about mobile phone ownership and another about refusal to receive reminders via mobile phone were phrased to allow "Yes" or "No" as the only possible reply. A p mobile phone reminders. By region, 39.5% in rural, 6.3% in semi-urban, and 7.5% in urban setting had at least one obstacle, with significant differences between the rural and urban settings (pmobile phone calls 96% (p = 0.054). The ability to communicate in NOL orally was 89.7% and 84.4% in writing (p = 0.052). Mobile phone ownership (pmobile phone. These impediments were higher in a rural setting as compared to urban or semi-urban areas.
Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn
. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency...... influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care.Trial registration: Clinicaltrials.gov identifier: NCT01209663....
Baldwin, Lynne P; Low, Phuay Hui; Picton, Claire; Young, Terry
Using a case study as an example, this paper illustrates the current model of care in Accident and Emergency (A & E); in particular, the 'cells' in which data/information is stored and how explicit and accessible it is (or is not) to healthcare professionals. It is a model of care which may be summed up as static information/dynamic clinicians. This paper then describes how mobile devices may be used to track patients through an A&E department. From there, a model of care is proposed that has at its core the notion of dynamic information/static clinicians which takes into account the potential and likelihood of such mobile technology being used to support healthcare professionals in the future. It is argued, however, that such 'disruptive technologies' are merely tools at our disposal and that it is human activity which must be foremost when considering how we might work differently ('better') in treating and/or dealing with patients.
Lv, Ziyu; Wu, Guowei; Yao, Lin; Chen, Zhikui
This paper describes a mobile health monitoring system called iCare for the elderly. We use wireless body sensors and smart phones to monitor the wellbeing of the elderly. It can offer remote monitoring for the elderly anytime anywhere and provide tailored services for each person based on their personal health condition. When detecting an emergency, the smart phone will automatically alert pre-assigned people who could be the old people's family and friends, and call the ambulance of the emergency centre. It also acts as the personal health information system and the medical guidance which offers one communication platform and the medical knowledge database so that the family and friends of the served people can cooperate with doctors to take care of him/her. The system also features some unique functions that cater to the living demands of the elderly, including regular reminder, quick alarm, medical guidance, etc. iCare is not only a real-time health monitoring system for the elderly, but also a living ass...
Atkinson, Paul; Bowra, Justin; Lambert, Mike; Lamprecht, Hein; Noble, Vicki; Jarman, Bob
To meet a critical and growing need for a standardized approach to emergency point of care ultrasound (PoCUS) worldwide, emergency physicians must be trained to deliver and teach this skill in an accepted and reliable format. Currently, there is no globally recognized, standard PoCUS curriculum that defines the accepted applications, as well as standards for training and practice of PoCUS by specialists and trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine (IFEM) convened a sub-committee of international experts in PoCUS to outline a curriculum for training of specialists in emergency PoCUS. This curriculum document represents the consensus of recommendations by this sub-committee. The curriculum is designed to provide a framework for PoCUS education in emergency medicine. The focus is on the processes required to select core and enhanced applications, as well as the key elements required for the delivery of PoCUS training from introduction through to continuing professional development and skill maintenance. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance PoCUS education in emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems but in particular for developing nations or for nations seeking to develop PoCUS training programs within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational environment, resources and goals of educational programs.
Benoit, J; Berdah, L; Carlier-Gonod, A; Guillou, T; Kouche, C; Patte, M; Schneider, M; Talcone, S; Chappuy, H
Children suffer most from today's increasing precariousness. In France, access to care is available for all children through various structures and existing measures. The support for foreign children is overseen by specific legislation often unfamiliar to caregivers. Pediatric emergencies, their location, organization, actors, and patient flow are a particular environment that is not always suitable to communication and may lead to situations of abuse. Communication should not be forgotten because of the urgency of the situation. The place of the child in the dialogue is often forgotten. Considering the triangular relationship, listening to the child and involving the parents in care are the basis for a good therapeutic alliance. Privacy and medical confidentiality in pediatric emergencies are governed by law. However, changes in treatments and medical practices along with the variety of actors involved imply both individual and collective limitations, to the detriment of medical confidentiality. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
In this audio podcast, lead author and Preventing Chronic Diseaseâs 2013 Student Research Contest Winner, Mehul D. Patel, talks about his article on stroke care and emergency medical services. Created: 9/5/2013 by Preventing Chronic Disease (PCD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 9/5/2013.
Sarika Chaturvedi; Bharat Randive
Background: The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its "service guarantee" of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Me...
Hopkins, Ramona O; Mitchell, Lorie; Thomsen, George E; Schafer, Michele; Link, Maggie; Brown, Samuel M
Immobility in the intensive care unit (ICU) is associated with neuromuscular weakness, post-intensive care syndrome, functional limitations, and high costs. Early mobility-based rehabilitation in the ICU is feasible and safe. Mobility-based rehabilitation varied widely across 5 ICUs in 1 health care system, suggesting a need for continuous training and evaluation to maintain a strong mobility-based rehabilitation program. Early mobility-based rehabilitation shortens ICU and hospital stays, reduces delirium, and increases muscle strength and the ability to ambulate. Long-term effects include increased ability for self-care, faster return to independent functioning, improved physical function, and reduced hospital readmission and death. Factors that influence early mobility-based rehabilitation include having an interdisciplinary team; strong unit leadership; access to physical, occupational, and respiratory therapists; a culture focused on patient safety and quality improvement; a champion of early mobility; and a focus on measuring performance and outcomes.
Pesik, N; Keim, M E; Iserson, K V
The threat of domestic and international terrorism involving weapons of mass destruction-terrorism (WMD-T) has become an increasing public health concern for US citizens. WMD-T events may have a major effect on many societal sectors but particularly on the health care delivery system. Anticipated medical problems might include the need for large quantities of medical equipment and supplies, as well as capable and unaffected health care providers. In the setting of WMD-T, triage may bear little resemblance to the standard approach to civilian triage. To address these issues to the maximum benefit of our patients, we must first develop collective forethought and a broad-based consensus that these decisions must reach beyond the hospital emergency department. Critical decisions like these should not be made on an individual case-by-case basis. Physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply. It is for this reason that emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision making before an acute bioterrorist event.
Putzer, Gavin J; Park, Yangil
The smartphone has emerged as an important technological device to assist physicians with medical decision making, clinical tasks, and other computing functions. A smartphone is a device that combines mobile telecommunication with Internet accessibility as well as word processing. Moreover, smartphones have additional features such as applications pertinent to clinical medicine and practice management. The purpose of this study was to investigate the innovation factors that affect a physician's decision to adopt an emerging mobile technological device such as a smartphone. The study sample consisted of 103 physicians from community hospitals and academic medical centers in the southeastern United States. Innovation factors are elements that affect an individual's attitude toward using and adopting an emerging technology. In our model, the innovation characteristics of compatibility, job relevance, the internal environment, observability, personal experience, and the external environment were all significant predictors of attitude toward using a smartphone. These influential innovation factors presumably are salient predictors of a physician's attitude toward using a smartphone to assist with clinical tasks. Health information technology devices such as smartphones offer promise as a means to improve clinical efficiency, medical quality, and care coordination and possibly reduce healthcare costs. PMID:22737094
Putzer, Gavin J; Park, Yangil
The smartphone has emerged as an important technological device to assist physicians with medical decision making, clinical tasks, and other computing functions. A smartphone is a device that combines mobile telecommunication with Internet accessibility as well as word processing. Moreover, smartphones have additional features such as applications pertinent to clinical medicine and practice management. The purpose of this study was to investigate the innovation factors that affect a physician's decision to adopt an emerging mobile technological device such as a smartphone. The study sample consisted of 103 physicians from community hospitals and academic medical centers in the southeastern United States. Innovation factors are elements that affect an individual's attitude toward using and adopting an emerging technology. In our model, the innovation characteristics of compatibility, job relevance, the internal environment, observability, personal experience, and the external environment were all significant predictors of attitude toward using a smartphone. These influential innovation factors presumably are salient predictors of a physician's attitude toward using a smartphone to assist with clinical tasks. Health information technology devices such as smartphones offer promise as a means to improve clinical efficiency, medical quality, and care coordination and possibly reduce healthcare costs.
Paxton, A; Bailey, P; Lobis, S; Fry, D
This paper examines the availability of basic and comprehensive emergency obstetric care (EmOC), interventions used to treat direct obstetric complications. Determining what interventions are provided in health facilities is the first priority in analyzing a country's capabilities to treat obstetric emergencies. There are eight key interventions, six constitute basic EmOC and all eight comprehensive EmOC. Based on data from 24 needs assessments, the following global patterns emerge: comprehensive EmOC facilities are usually available to meet the recommended minimum number for the size of the population, basic EmOC facilities are consistently not available in sufficient numbers, both in countries with high and moderate levels of maternal mortality, and the majority of facilities offering maternity services provide only some interventions indicating an unrealized potential. Upgrading maternities, health centers and hospitals to at least basic EmOC status would be a major contributing step towards maternal mortality reduction in resource-poor countries.
Abar, Beau; Hong, Steven; Aaserude, Eric; Holub, Ashley; DeRienzo, Vincent
The prevalence of depression among patients in the emergency department (ED) is significantly higher than in the general population, making the ED a potentially important forum for the identification of depression and intervention. Concomitant to the identification of depression is the issue of patient access to appropriate care. This study sought to establish prevalence estimates of potential barriers to care among ED patients and relate these barriers with symptoms of depression. Two medical students conducted brief surveys on all ED patients ≥ 18 years on demographics, perceived access to care, and depression. A total of 636 participants were enrolled. The percentage of participants with mild or greater depression was 42%. The majority of patients reported experiencing some barriers to care, with the most prominent being difficulty finding transportation, work responsibilities, and the feeling that the doctor is not responsive to their concerns. Higher depression scores were bivariately associated with higher overall barriers to care mean scores (r = 0.44; p patients' concerns, embarrassment about a potential illness, and confusion trying to schedule an appointment. Across all barriers analyzed, there was a greater incidence of depression associated with a greater perception of barriers. These barriers may be used as potential targets for intervention to increase access to health care resources. Copyright © 2016 Elsevier Inc. All rights reserved.
Maria da Graça Oliveira Crossetti
Full Text Available The objective of this study was to analyze the structural elements of critical thinking (CT of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.
Tripp, Nadia; Hainey, Kirsten; Liu, Anthony; Poulton, Alison; Peek, Michael; Kim, Jinman; Nanan, Ralph
Mobile technology in the form of the smartphone is widely used, particularly in pregnancy and they are an increasing and influential source of information. To describe the diverse nature of pregnancy related applications (apps) for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision. The 2 smartphone platforms, Apple and Android, were searched for pregnancy related apps and reviewed for their purpose and popularity. iTunes and Google Play returned 1059 and 497 pregnancy related apps respectively. Forty percent of the apps were informative, 13% interactive, 19% had features of a medical tool and 11% were social media apps. By far the most popular apps, calculated as the number of reviews multiplied by average reviewer rating, were those with interactive features. The popularity of pregnancy-related apps could indicate a shift towards patient empowerment within maternity care provision. The traditional model of 'shared maternity care' needs to accommodate electronic devices into its functioning. Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone. This combined with the fact that smartphones are widely used by many women of childbearing age, has the potential to modify maternity care and experiences of pregnancy. Therefore it is important that healthcare professionals and policy-makers are more aware of these new developments, which are likely to influence healthcare and alter health-seeking behaviour. In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Full Text Available Introduction: The improvement of technology has increased noise levels in hospital Wards to higher than international standard levels (35-45 dB. Higher noise levels than the maximum level result in patient’s instability and dissatisfaction. Moreover, it will have serious negative effects on the staff’s health and the quality of their services. The purpose of this survey is to analyze the level of noise in intensive care units and emergency wards of the Imam Reza Teaching Hospital, Mashhad. Procedure: This research was carried out in November 2009 during morning shifts between 7:30 to 12:00. Noise levels were measured 10 times at 30-minute intervals in the nursing stations of 10 wards of the emergency, the intensive care units, and the Nephrology and Kidney Transplant Departments of Imam Reza University Hospital, Mashhad. The noise level in the nursing stations was tested for both the maximum level (Lmax and the equalizing level (Leq. The research was based on the comparison of equalizing levels (Leq because maximum levels were unstable. Results: In our survey the average level (Leq in all wards was much higher than the standard level. The maximum level (Lmax in most wards was 85-86 dB and just in one measurement in the Internal ICU reached 94 dB. The average level of Leq in all wards was 60.2 dB. In emergency units, it was 62.2 dB, but it was not time related. The highest average level (Leq was measured at 11:30 AM and the peak was measured in the Nephrology nursing station. Conclusion: The average levels of noise in intensive care units and also emergency wards were more than the standard levels and as it is known these wards have vital roles in treatment procedures, so more attention is needed in this area.
Serviço de Atendimento Móvel de Urgência: análise da política brasileira Servicio de Atención Móvil de Urgencia: análisis de la política brasileña Mobile Emergency Care Service: analysis of Brazilian policy
Cristiani Vieira Machado
partir de 2003. En los primeros años de implantación predominaron servicios de cobertura municipal; en 2008, los de cobertura regional se tornaron más relevantes. La cobertura estimada alcanzó 53,9% de la población en 2009, residente en 20,5% de los municipios brasileños. La implantación varió entre los Estados y hubo menos ambulancias de soporte avanzado de lo recomendado, tanto en el conjunto del país como en varios estados. CONCLUSIONES: El SAMU fue adoptado en 2003, con la elaboración de normas federales. La implantación de la política comprende desafíos como realización de inversiones adecuadas, inserción del servicio en una red articulada de atención de urgencia, conformación de sistemas de informaciones apropiados, capacitación de los profesionales. El enfrentamiento de tales desafíos permitirá que el SAMU se configure como una estrategia estructurada de la atención a la salud en el Sistema Único de Salud.OBJECTIVE: To analyze the configuration of mobile emergency health care policy in Brazil. METHODOLOGICAL PROCEDURES: The study was based on public policy analysis. Bibliographic and document review, analysis of official data and interviews with federal administrators related to formulation and implementation of the Mobile Emergency Care Service (SAMU in Brazil in the 2000s were performed. ANALYSIS OF RESULTS: Priority was given to SAMU at the federal level since 2003. During the first years of implementation, municipal level services predominated; in 2008, services with regional scope became more significant. Estimated coverage reached 53.9% of the population in 2009, in 20.5% of Brazilian municipalities. Implementation varied between States, and there were less advanced support ambulances than recommended, both nationally and in several States. CONCLUSIONS: SAMU was adopted nationwide since 2003 upon development of federal norms. Implementation of the policy involves challenges, including adequate investment, integration of the service into
Panaousis, Emmanouil A; Millar, Grant P; Politis, Christos; 10.5121/ijwmn.2010.2205
The nature of Mobile Ad hoc NETworks (MANETs) makes them suitable to be utilized in the context of an extreme emergency for all involved rescue teams. We use the term emergency MANETs (eMANETs) in order to describe next generation IP-based networks, which are deployed in emergency cases such as forest fires and terrorist attacks. The main goal within the realm of eMANETs is to provide emergency workers with intelligent devices such as smart phones and PDAs. This technology allows communication "islets" to be established between the members of the same or different emergency teams (policemen, firemen, paramedics). In this article, we discuss an adaptive and secure routing protocol developed for the purposes of eMANETs. We evaluate the performance of the protocol by comparing it with other widely used routing protocols for MANETs. We finally show that the overhead introduced due to security considerations is affordable to support secure ad-hoc communications among lightweight devices.
Parmar, Parveen; Arii, Maya; Kayden, Stephanie
As Hurricane Katrina demonstrated in 2005, US health response systems for disasters-typically designed to handle only short-term mass-casualty events-are inadequately prepared for disasters that result in large-scale population displacements. Similarly, after the 2011 Great East Japan Earthquake, Japan found that many of its disaster shelters failed to meet international standards for long-term provision of basic needs and health care for the vulnerable populations that sought refuge in the shelters. Hospital disaster plans had not been tested and turned out to be inadequate, and emergency communication equipment did not function. We make policy recommendations that aim to improve US responses to mass-displacement disasters based on Japan's 2011 experience. First, response systems must provide for the extended care of large populations of chronically ill and vulnerable people. Second, policies should ensure that shelters meet or exceed international standards for the provision of food, water, sanitation, and privacy. Third, hospital disaster plans should include redundant communication systems and sufficient emergency provisions for both staff and patients. Finally, there must be routine drills for responses to mass-displacement disasters so that areas needing improvement can be uncovered before an emergency occurs.
Wesolowski, Amy; Qureshi, Taimur; Boni, Maciej F; Sundsøy, Pål Roe; Johansson, Michael A; Rasheed, Syed Basit; Engø-Monsen, Kenth; Buckee, Caroline O
The recent emergence of dengue viruses into new susceptible human populations throughout Asia and the Middle East, driven in part by human travel on both local and global scales, represents a significant global health risk, particularly in areas with changing climatic suitability for the mosquito vector. In Pakistan, dengue has been endemic for decades in the southern port city of Karachi, but large epidemics in the northeast have emerged only since 2011. Pakistan is therefore representative of many countries on the verge of countrywide endemic dengue transmission, where prevention, surveillance, and preparedness are key priorities in previously dengue-free regions. We analyze spatially explicit dengue case data from a large outbreak in Pakistan in 2013 and compare the dynamics of the epidemic to an epidemiological model of dengue virus transmission based on climate and mobility data from ∼40 million mobile phone subscribers. We find that mobile phone-based mobility estimates predict the geographic spread and timing of epidemics in both recently epidemic and emerging locations. We combine transmission suitability maps with estimates of seasonal dengue virus importation to generate fine-scale dynamic risk maps with direct application to dengue containment and epidemic preparedness.
Ozturk, Selcuk; Kayaalp, Mehmet; McDonald, Clement J
Interpreting patient's medication history from long textual data can be unwieldy especially in emergency care. We developed a real-time software application that converts one-year-long patient prescription history data into a visually appealing and information-rich timeline chart. The chart can be digested by healthcare providers quickly; hence, it could be an invaluable clinical tool when the rapid response time is crucial as in stroke or severe trauma cases. Furthermore, the visual clarity of the displayed information may help providers minimize medication errors. The tool has been deployed at the emergency department of a trauma center. Due to its popularity, we developed another version of this tool. It provides more granular drug dispensation information, which clinical pharmacists find very useful in their routine medication-reconciliation efforts.
Sabbatini, Amber K; Merck, Lisa H; Froemming, Adam T; Vaughan, William; Brown, Michael D; Hess, Erik P; Applegate, Kimberly E; Comfere, Nneka I
Patient-centered emergency diagnostic imaging relies on efficient communication and multispecialty care coordination to ensure optimal imaging utilization. The construct of the emergency diagnostic imaging care coordination cycle with three main phases (pretest, test, and posttest) provides a useful framework to evaluate care coordination in patient-centered emergency diagnostic imaging. This article summarizes findings reached during the patient-centered outcomes session of the 2015 Academic Emergency Medicine consensus conference "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The primary objective was to develop a research agenda focused on 1) defining component parts of the emergency diagnostic imaging care coordination process, 2) identifying gaps in communication that affect emergency diagnostic imaging, and 3) defining optimal methods of communication and multidisciplinary care coordination that ensure patient-centered emergency diagnostic imaging. Prioritized research questions provided the framework to define a research agenda for multidisciplinary care coordination in emergency diagnostic imaging.
Levine, Adam C.; Regan H Marsh; Nelson, Sara W.; Tyer-Viola, Lynda; Burke, Thomas F
Background Global health experts identify emergency obstetric care (EmOC) as the most important intervention to improve maternal survival in low- and middle-income countries. In Zambia, 1 in 27 women will die of maternal causes, yet the level of availability of EmOC is not known at the provincial level. Aims Our goal was to develop a tool to measure the availability of EmOC in rural Zambia in order to estimate pregnant women?s access to this life-saving intervention. Methods We created an ins...
Levine, Adam C; Marsh, Regan H.; Nelson, Sara W.; Tyer-Viola, Lynda; Burke, Thomas F.
Background Global health experts identify emergency obstetric care (EmOC) as the most important intervention to improve maternal survival in low- and middle-income countries. In Zambia, 1 in 27 women will die of maternal causes, yet the level of availability of EmOC is not known at the provincial level. Aims Our goal was to develop a tool to measure the availability of EmOC in rural Zambia in order to estimate pregnant women’s access to this life-saving intervention. Methods We created an ins...
Juliana C.F. Romanzeira
Full Text Available OBJECTIVE: To assess the quality of neonatal transport performed by the Mobile Emergency Medical Services (Serviço de Atendimento Móvel de Urgência [SAMU].METHODS: This was a cross-sectional before-and-after observational study. The study was carried out from March to August of 2013 using a validated instrument, the Transport Risk Index of Physiologic Stability (TRIPS, to assess the characteristics of the newborn, medical and mechanical complications (equipment and ambulance, and stability of newborns before and after transport. Tests were conducted with 95% confidence level. Numerical variables are represented by measures of central tendency and dispersion. Categorical variables were compared by Fisher's exact test. In the comparison of variables between the groups, the Student's t-test was used for variables with normal distribution, Fisher exact test, when appropriate, and the Mann-Whitney test, for non-normal distribution.RESULTS: 33 newborns were transported from low-risk units to neonatal intensive care units. Male gender (57.6% and full-term gestational age (63.6% were more prevalent. Birth weight < 2,500 g was found in 39.4% of newborns. Respiratory failure accounted for 42.4% of the requests. The mean transport time was 58 minutes without medical or mechanical complications. The TRIPS score worsened in 15% of neonates; in this group of infants, the mean initial temperature of 36.46 ± 0.19 decreased significantly to 36.08 ± 0.22 (p = 0.041.CONCLUSION: The transport performed by the SAMU was adequate for most newborns. The oscillation in body temperature was the only significant variable for the alteration in the TRIPS score.
Romanzeira, Juliana C F; Sarinho, Silvia W
To assess the quality of neonatal transport performed by the Mobile Emergency Medical Services (Serviço de Atendimento Móvel de Urgência [SAMU]). This was a cross-sectional before-and-after observational study. The study was carried out from March to August of 2013 using a validated instrument, the Transport Risk Index of Physiologic Stability (TRIPS), to assess the characteristics of the newborn, medical and mechanical complications (equipment and ambulance), and stability of newborns before and after transport. Tests were conducted with 95% confidence level. Numerical variables are represented by measures of central tendency and dispersion. Categorical variables were compared by Fisher's exact test. In the comparison of variables between the groups, the Student's t-test was used for variables with normal distribution, Fisher exact test, when appropriate, and the Mann-Whitney test, for non-normal distribution. 33 newborns were transported from low-risk units to neonatal intensive care units. Male gender (57.6%) and full-term gestational age (63.6%) were more prevalent. Birth weighttransport time was 58 minutes without medical or mechanical complications. The TRIPS score worsened in 15% of neonates; in this group of infants, the mean initial temperature of 36.46±0.19 decreased significantly to 36.08±0.22 (p=0.041). The transport performed by the SAMU was adequate for most newborns. The oscillation in body temperature was the only significant variable for the alteration in the TRIPS score. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
McCarthy, Jennifer L; Clingenpeel, Joel M; Perkins, Amy M; Eason, Margaret K
The aim of this study was to investigate the hypothesis that a significant percentage of urgent care center to pediatric ED transfers can be discharged home without emergency department (ED) resource utilization. A retrospective chart review was completed for a 6-month period on all patients transferred from urgent care centers. A data collection tool focusing on demographics, diagnoses, reason for transfer, ED resource utilization, ED disposition, and 72-hour ED return was used. Each encounter was classified as "urgent" or "nonurgent" based on resource utilization criteria. Descriptive statistics were reported for demographics, encounter data, and 72-hour ED return stratified by nonurgent versus urgent classification. Two-sample t, χ, and Fisher exact tests were used to assess differences in characteristics between the nonurgent and urgent groups. One hundred nine patients met inclusion criteria. Of these, 93 (85%) were discharged from the ED. Twenty nine (27%) of the transferred patients were discharged without ED resource utilization. Seventy-two-hour return was noted for only 1 patient who was again discharged at the subsequent encounter. A large proportion of patients transferred from urgent care centers were directly discharged from the ED without any ED resource utilization. Eliminating or reducing such transfers has the potential to limit the amount of nonurgent ED visits, thus producing cost savings and better patient care.
Miró, O; Antonio, M T; Jiménez, S; De Dios, A; Sánchez, M; Borrás, A; Millá, J
The objective of this study was to assess the influence of overcrowding on health care quality provided by emergency departments (ED). The study was carried out in an urban, university tertiary care hospital. All patients seen at the internal medicine unit (IMU) of the ED who returned during the following 72 hours, and those who died in the ED rooms were included in the study. During a consecutive period of 2 years (104 weeks), we prospectively quantified the number of weekly visits, revisits and deaths. We calculated revisit and mortality rates (in respect of percentage of all visited patients) for each week. Correlation between the number of weekly visits, and revisit and mortality rates was assessed using a simple linear regression model. We consigned 81,301 visits, 1137 revisits and 648 deaths; mean (+/- SD) number of weekly visits, revisits and deaths were 782 (68), 10.93 (3.97) and 6.23 (3.04) respectively; weekly revisit rate was 1.40% (0.48%) and weekly mortality rate was 0.79% (0.36%). We observed a significant, positive correlation between mortality rates and weekly number of visits (p = 0.01). Although a similar trend was also found for revisit rates, such an increase did not reach statistical significance (p = 0.06). It is concluded that since revisit and mortality rates constitute good health care quality markers, present data demonstrate that ED overcrowding implies a decrease in the health care quality provided by it.
Kameda, Toru; Taniguchi, Nobuyuki
Point-of-care abdominal ultrasound (US), which is performed by clinicians at bedside, is increasingly being used to evaluate clinical manifestations, to facilitate accurate diagnoses, and to assist procedures in emergency and critical care. Methods for the assessment of acute abdominal pain with point-of-care US must be developed according to accumulated evidence in each abdominal region. To detect hemoperitoneum, the methodology of a focused assessment with sonography for a trauma examination may also be an option in non-trauma patients. For the assessment of systemic hypoperfusion and renal dysfunction, point-of-care renal Doppler US may be an option. Utilization of point-of-care US is also considered in order to detect abdominal and pelvic lesions. It is particularly useful for the detection of gallstones and the diagnosis of acute cholecystitis. Point-of-case US is justified as the initial imaging modality for the diagnosis of ureterolithiasis and the assessment of pyelonephritis. It can be used with great accuracy to detect the presence of abdominal aortic aneurysm in symptomatic patients. It may also be useful for the diagnoses of digestive tract diseases such as appendicitis, small bowel obstruction, and gastrointestinal perforation. Additionally, point-of-care US can be a modality for assisting procedures. Paracentesis under US guidance has been shown to improve patient care. US appears to be a potential modality to verify the placement of the gastric tube. The estimation of the amount of urine with bladder US can lead to an increased success rate in small children. US-guided catheterization with transrectal pressure appears to be useful in some male patients in whom standard urethral catheterization is difficult. Although a greater accumulation of evidences is needed in some fields, point-of-care abdominal US is a promising modality to improve patient care in emergency and critical care settings.
Fujita, Hideo; Uchimura, Yuji; Waki, Kayo; Omae, Koji; Takeuchi, Ichiro; Ohe, Kazuhiko
To improve emergency services for accurate diagnosis of cardiac emergency, we developed a low-cost new mobile electrocardiography system "Cloud Cardiology®" based upon cloud computing for prehospital diagnosis. This comprises a compact 12-lead ECG unit equipped with Bluetooth and Android Smartphone with an application for transmission. Cloud server enables us to share ECG simultaneously inside and outside the hospital. We evaluated the clinical effectiveness by conducting a clinical trial with historical comparison to evaluate this system in a rapid response car in the real emergency service settings. We found that this system has an ability to shorten the onset to balloon time of patients with acute myocardial infarction, resulting in better clinical outcome. Here we propose that cloud-computing based simultaneous data sharing could be powerful solution for emergency service for cardiology, along with its significant clinical outcome.
Emmanouil A. Panaousis
Full Text Available The nature of Mobile Ad hoc NETworks (MANETs makes them suitable to be utilized in the context of anextreme emergency for all involved rescue teams. We use the term emergency MANETs (eMANETs inorder to describe next generation IP-based networks, which are deployed in emergency cases such asforest fires and terrorist attacks. The main goal within the realm of eMANETs is to provide emergencyworkers with intelligent devices such as smart phones and PDAs. This technology allows communication”islets” to be established between the members of the same or different emergency teams (policemen,firemen, paramedics. In this article, we discuss an adaptive and secure routing protocol developed forthe purposes of eMANETs. We evaluate the performance of the protocol by comparing it with otherwidely used routing protocols for MANETs. We finally show that the overhead introduced due to securityconsiderations is affordable to support secure ad-hoc communications among lightweight devices.
Jun, H.B.; Sim, K.B. [Chungang University, Seoul (Korea, Republic of)
In this paper, we propose a behavior learning algorithm of the collective autonomous mobile robots based on the reinforcement learning and conditional evolution. The cooperative behavior is a high level phenomenon observed in the society of social animals and, recently the emergence of cooperative behavior in collective autonomous mobile robots becomes an interesting field in artificial life. In our system each robot with simple behavior strategies can adapt to its environment by means of the reinforcement learning. The internal reinforcement signal for the reinforcement learning is generated by fuzzy interference engine, and dynamic recurrent neural networks are used as an action generation module. We propose conditional evolution for the emergence of cooperative behavior. The evolutionary conditions are spatio-temporal limitations to the occurrence of genetic operations. We show the validity of the proposed learning and evolutionary algorithm through several computer simulations. (author). 22 refs., 9 figs.
Vester-Andersen, M; Waldau, T; Wetterslev, J;
BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care...... no statistically significant effect on 30-day mortality after emergency abdominal surgery, nor any effect on secondary outcomes. The trial was stopped prematurely owing to slow recruitment and a much lower than expected mortality rate among the enrolled patients. REGISTRATION NUMBER: NCT01209663 (http://www.clinicaltrials.gov)....
Ameh, Charles; Adegoke, Adetoro; Hofman, Jan; Ismail, Fouzia M; Ahmed, Fatuma M; van den Broek, Nynke
To provide and evaluate in-service training in "Life Saving Skills - Emergency Obstetric and Newborn Care" in order to improve the availability of emergency obstetric care (EmOC) in Somaliland. In total, 222 healthcare providers (HCPs) were trained between January 2007 and December 2009. A before-after study was conducted using quantitative and qualitative methods to evaluate trainee reaction and change in knowledge, skills, and behavior, in addition to functionality of healthcare facilities, during and immediately after training, and at 3 and 6 months post-training. The HCPs reacted positively to the training, with a significant improvement in 50% of knowledge and 100% of skills modules assessed. The HCPs reported improved confidence in providing EmOC. Basic and comprehensive EmOC healthcare facilities provided 100% of expected signal functions-compared with 43% and 56%, respectively, at baseline-with trained midwives performing skills usually performed by medical doctors. Lack of drugs, supplies, medical equipment, and supportive policy were identified as barriers that could contribute to nonuse of new skills and knowledge acquired. The training impacted positively on the availability and quality of EmOC and resulted in "up-skilling" of midwives. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Gillespie, Amaya M; Obregon, Rafael; El Asawi, Rania; Richey, Catherine; Manoncourt, Erma; Joshi, Kshiitij; Naqvi, Savita; Pouye, Ade; Safi, Naqibullah; Chitnis, Ketan; Quereshi, Sabeeha
Following the World Health Organization (WHO) declaration of a Public Health Emergency of International Concern regarding the Ebola outbreak in West Africa in July 2014, UNICEF was asked to co-lead, in coordination with WHO and the ministries of health of affected countries, the communication and social mobilization component-which UNICEF refers to as communication for development (C4D)-of the Ebola response. For the first time in an emergency setting, C4D was formally incorporated into each country's national response, alongside more typical components such as supplies and logistics, surveillance, and clinical care. This article describes the lessons learned about social mobilization and community engagement in the emergency response to the Ebola outbreak, with a particular focus on UNICEF's C4D work in Guinea, Liberia, and Sierra Leone. The lessons emerged through an assessment conducted by UNICEF using 4 methods: a literature review of key documents, meeting reports, and other articles; structured discussions conducted in June 2015 and October 2015 with UNICEF and civil society experts; an electronic survey, launched in October and November 2015, with staff from government, the UN, or any partner organization who worked on Ebola (N = 53); and key informant interviews (N = 5). After triangulating the findings from all data sources, we distilled lessons under 7 major domains: (1) strategy and decentralization: develop a comprehensive C4D strategy with communities at the center and decentralized programming to facilitate flexibility and adaptation to the local context; (2) coordination: establish C4D leadership with the necessary authority to coordinate between partners and enforce use of standard operating procedures as a central coordination and quality assurance tool; (3) entering and engaging communities: invest in key communication channels (such as radio) and trusted local community members; (4) messaging: adapt messages and strategies continually as patterns
Lallemand, E; Drouet, N; Faudemay, C; Lacroute, J M; Menthonnex, P
The increased incidence of antenatal distress calls to the SAMU (emergency medical squad) by pediatric obstetricians in maternity departments (6 times in 5 years) poses the problem of recognizing their indications. Based on case reports of 128 newborns who profited from antenatal assistance, the authors attempt to define the indications. The elimination of student physicians in training for anesthesiology-intensive care, additional participants during SAMU transportation of patients, makes it even more necessary to define these indications accurately so that a single language of communication and procedure may be instituted for all who are involved in this effort.
Schneider, Tali; Panzera, Anthony Dominic; Martinasek, Mary; McDermott, Robert; Couluris, Marisa; Lindenberger, James; Bryant, Carol
This study assessed physicians' receptivity to using mobile technology as a strategy in patient care for adolescents with asthma. Understanding physicians' perceived barriers and benefits of integrating mobile technology in adolescents' asthma care and self-management is an initial step in enhancing overall patient and disease outcomes. We conducted in-depth interviews with second- and third-year pediatric residents and attending physicians who oversee pediatric residents in training (N = 27) at an academic medical center in the southeastern United States. We identified both benefits from and barriers to broader use of mobile technologies for improving asthma outcomes in adolescents. Resident physicians demonstrated greater readiness for integrating these technologies than did attending physicians. Prior to adoption of mobile technologies in the care of adolescent asthma patients, barriers to implementation should be understood. Prior to widespread adoption, such systems will need to be evaluated against traditional care for demonstration of patient outcomes that improve on the current situation.
Leigh, Bailah; Mwale, Theresa Gloria; Lazaro, Dorothy; Lunguzi, Juliana
To assess the availability, accessibility, utilization, and quality of emergency obstetric care (EmOC) services in Malawi. A complete enumeration was made of all hospitals and a 25% random sample of all health centers, in all districts of Malawi. Enumerators (nurses and midwives) collected data by reviewing facility registers and records, observations, and interviews with health workers to determine extent of utilization of services. In-depth interviews and focus group discussions were also held with key informants to identify barriers to utilization of services and explore participants' perceptions of quality of care. Almost twice the minimum number of recommended comprehensive EmOC facilities exist (1.8 facilities per 500,000 population), but only 2% of the recommended number of basic EmOC facilities. Met need was only 18.5%; cesarean delivery rate was less than 3%. The case fatality rate was 3.4% indicating poor quality of care, attributable partly to absence of skilled birth attendants and motivated staff, and the frequent shortage of drugs and medical supplies. Malawi needs to improve the provision of quality EmOC services by implementing evidence-based strategies for the reduction of maternal mortality. Consequently, the Malawi Road Map for accelerating improvement was developed through multidonor and multisector collaboration with the Reproductive Health Unit of the Ministry of Health. This Road Map is now being implemented in all districts of Malawi.
Full Text Available Background: The volume of health information necessary to provide competent health care today has become overwhelming. Mobile computing devices are fast becoming an essential clinical tool for accessing health information at the point-of-care of patients.Objectives: This study explored and described how registered nurses experienced accessing information at the point-of-care via mobile computing devices (MCDs.Method: A qualitative, exploratory, descriptive and contextual design was used. Ten in–depth interviews were conducted with purposively sampled registered nurses employed by a state hospital in the Nelson Mandela Bay Municipality (NMBM. Interviews were recorded, transcribed verbatim and analysed using Tesch’s data analysis technique. Ethical principles were adhered to throughout the study. Guba’s model of trustworthiness was used to confirm integrity of the study.Results: Four themes emerged which revealed that the registered nurses benefited from the training they received by enabling them to develop, and improve, their computer literacy levels. Emphasis was placed on the benefits that the accessed information had for educational purposes for patients and the public, for colleagues and students. Furthermore the ability to access information at the point-of-care was considered by registered nurses as valuable to improve patient care because of the wide range of accurate and readily accessible information available via the mobile computing device.Conclusion: The registered nurses in this study felt that being able to access information at the point-of-care increased their confidence and facilitated the provision of quality care because it assisted them in being accurate and sure of what they were doing.
Romano, Marco; Onorati, Teresa; Aedo, Ignacio; Diaz, Paloma
When an emergency occurs, citizens can be a helpful support for the operation centers involved in the response activities. As witnesses to a crisis, they initially can share updated and detailed information about what is going on. Moreover, thanks to the current technological evolution people are able to quickly and easily gather rich information and transmit it through different communication channels. Indeed, modern mobile devices embed several sensors such as GPS receivers, Wi-Fi, accelerometers or cameras that can transform users into well-equipped human sensors. For these reasons, emergency organizations and small and medium enterprises have demonstrated a growing interest in developing smart applications for reporting any exceptional circumstances. In this paper, we present a practical study about this kind of applications for identifying both limitations and common features. Based on a study of relevant existent contributions in this area and our personal direct experience in developing and evaluating emergency management solutions, our aim is to propose several findings about how to design effective and efficient mobile emergency notification applications. For this purpose we have exploited the basic sensors of modern mobile devices and the users' aptitude for using them. The evaluation consists of a practical and a theoretical part. In the practical part, we have simulated a traffic accident as closely as possible to a real scenario, with a victim lying on the ground near a car in the middle of a street. For the theoretical part, we have interviewed some emergency experts for collecting their opinions about the utility of the proposed solution. Results from this evaluation phase confirm the positive impact that EN application have for both operators' and citizens' perspective. Moreover, we collected several findings useful for future design challenges in the same area, as shown in the final redesign of the proposed application.
Full Text Available When an emergency occurs, citizens can be a helpful support for the operation centers involved in the response activities. As witnesses to a crisis, they initially can share updated and detailed information about what is going on. Moreover, thanks to the current technological evolution people are able to quickly and easily gather rich information and transmit it through different communication channels. Indeed, modern mobile devices embed several sensors such as GPS receivers, Wi-Fi, accelerometers or cameras that can transform users into well-equipped human sensors. For these reasons, emergency organizations and small and medium enterprises have demonstrated a growing interest in developing smart applications for reporting any exceptional circumstances. In this paper, we present a practical study about this kind of applications for identifying both limitations and common features. Based on a study of relevant existent contributions in this area and our personal direct experience in developing and evaluating emergency management solutions, our aim is to propose several findings about how to design effective and efficient mobile emergency notification applications. For this purpose we have exploited the basic sensors of modern mobile devices and the users’ aptitude for using them. The evaluation consists of a practical and a theoretical part. In the practical part, we have simulated a traffic accident as closely as possible to a real scenario, with a victim lying on the ground near a car in the middle of a street. For the theoretical part, we have interviewed some emergency experts for collecting their opinions about the utility of the proposed solution. Results from this evaluation phase confirm the positive impact that EN application have for both operators’ and citizens’ perspective. Moreover, we collected several findings useful for future design challenges in the same area, as shown in the final redesign of the proposed application.
Lee A Wallis
Full Text Available Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back.The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care.In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be
Wallis, Lee A; Fleming, Julian; Hasselberg, Marie; Laflamme, Lucie; Lundin, Johan
Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back. The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care. In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be integrated into routine
Schwartze, Jonas; Wolf, Klaus-Hendrik; Von Bargen, Tobias; Rochon, Maike; Wagner, Markus; Bannenberg, Uwe; Drews, Markus; Fischer, Thomas; Hellwig, Torben; Hofmann, Stefan; Höft-Budde, Petra; Jäger, Ralf; Lorenz, Stefan; Naumann, Ruth; Plischke, Maik; Reytarowski, Jörg; Richter, Constanze; Steinbrügge, Christina; Ziegenspeck, Anja; Von Ingelheim, Julius; Haux, Reinhold
German medical care is going to suffer from a decreasing number of general practitioners due to demographic change. We study if ambulatory care in rural areas can be complementary ensured by a mobile care unit. A medical care van - the "rolling medical practice" (RMP) - has been constructed based on care scenarios created for rural communities in northern Germany. Performance and acceptance of the RMP is evaluated by constant monitoring of anonymized medical documentation and questionnaires. The RMP is visiting six villages on two days a week in a three-week interval. It is constructed from a standard van with a custom box body fully equipped for general care needs. Actually treated care cases meet expectations and are acute as well as chronicle symptoms. Case numbers range from 6 to 50 visits in 5 month. We showed that almost full ranged mobile medical care, as supplement to general medical supply is possible.
Beauvais, Audrey; Frost, Lenore
Predicted work-related injuries for nurses and home healthcare workers are on the rise given the many risk factors in the home environment and the escalating demands for home healthcare workers in the United States. Fortunately, safe patient handling and mobility programs can dramatically decrease injuries. Despite strides being made to promote safe patient handling and mobility programs in acute care, more can be done to establish such initiatives in the home care setting.
Hennes, H J; Reinhardt, T; Otto, S; Dick, W
Quality assurance has become an important issue in emergency medicine. At present, no prospective studies are available that quantify the efficacy of interventions performed by emergency doctors. The development and implementation of a rapid, yet simple scoring system, allowing preclinical assessment of all emergency medicine patients, is required. Once the scoring system is implemented, evaluation of the prehospital intervention, based upon objective parameters, is possible. METHODS. The Mainz Emergency Evaluation Score (MEES) is based on seven parameters: level of consciousness, heart rate, heart rhythm, arterial blood pressure, respiratory rate, partial arterial oxygen saturation and pain. A coded value is assigned to each parameter, with the normal physiological condition securing a score of 4, while a life-threatening condition receives a value of 1. For the parameter of pain there is no life-threatening condition, so the lowest value allowed is 2 (Table 2). Addition of the respective values from the seven parameters yields the MEES value, which objectively reflects the patients' condition (minimum = 8, maximum = 28). Comparing the MEES value before (MEES1) and after the intervention (MEES2) allows an objective evaluation of the efficacy of the preclinical care (delta-MEES = MEES2-MEES1). A difference of > or = +2 is considered an improvement, +1, +/- 0, -1 are rated as unchanged and rank sum test (Wilcoxon) and the correlation coefficient (Kendall-Tau). RESULTS. In 356 patients the condition of 187 (52%) patients improved during the preclinical treatment; the condition of 156 (44%) patients did not change. In 13 patients (3%) the condition became worse (Table 5, Fig. 2). Allocation to 16 diagnosis groups revealed that the improvement in the patient's condition depended on the underlying disease (Table 3); the disease-specific parameter improved in all cases (Table 7). CONCLUSIONS. With the MEES score one can assess the patient's prehospital condition and
Söderholm, Hanna M.; Sonnenwald, Diane H.; Cairns, Bruce
Emergency trauma is a major health problem worldwide. To evaluate the potential of emerging 3D telepresence technology for facilitating paramedic - physician collaboration while providing emergency medical trauma care we conducted a between-subjects post-test experimental lab study. During...... proxy condition also reported higher levels of self-efficacy. These results indicate 3D telepresence technology has potential to improve paramedics' performance of complex emergency medical tasks and improve emergency trauma health care when designed appropriately. © 2007 ACM....
Carrillo-García, C; Martínez-Roche, M E; Vivo-Molina, M C; Quiñonero-Méndez, F; Gómez-Sánchez, R; Celdrán-Gil, F
The objective was to analyze the phenomenon of work satisfaction of doctors of the Mobile Emergency Team and the Emergency Coordinator Office 061 of the Region of Murcia. A observational, analytical and cross-sectional study of development carried out with the medical staff of the Casualty and Emergency Operations Department 061 of the Region of Murcia. Data collection was carried out in December 2013 and January 2014. NTP 394 was used. Work satisfaction: general satisfaction scale. nonparametric tests for 2 samples or k samples depending on type of comparison. A participation rate of 88.2% was obtained, in relation to the general job satisfaction, the average of the participants was 69.55 (SD = 14.4). Of the 15 items that make up the questionnaire, « work colleagues » is the factor with which doctors are more satisfied with, indicating that up to an 87%, show a positive assessment on this point. Being the second aspect most respondents valued their « job stability » with a percentage of positive ratings of 76.7%. The main findings clearly demonstrate the importance of inter-professional relations and human potential as the cornerstone in the exercise of the activity of healthcare professionals. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.
Kotris, Ivan; Drenjančević, Domagoj; Talapko, Jasminka; Bukovski, Suzana
Aim To identify and investigate a difference between microorganisms present on intensive care unit (ICU) health care workers' (HCW, doctors, nurses or medical technicians) and medical students' mobile phones as well as to investigate a difference between the frequency and the way of cleaning mobile phones. Methods Fifty swabs were collected from HCWs who work in the ICU (University Hospital Centre Osijek) and 60 swabs from medical students (School of Medicine, University of Osijek). Microorganisms were identified according to standard microbiological methods and biochemical tests to the genus/species level. Results Out of 110 processed mobile phones, mobile phones microorganisms were not detected on 25 (22.7%), 15 (25%) students' and 10 (20%) HCW's mobile phones. No statistically significant difference was found between the number of isolated bacteria between the HCW' and students' mobile phones (p>0.05). Statistically significant difference was found between both HCW and students and frequency of cleaning their mobile phones (pmobile phones between HCWs and students (pmobile phones at least once a week, 35 (52.0%), and most medical students several times per year, 20 (33.3%). HCW clean their mobile phones with alcohol disinfectant in 26 (40.0%) and medical students with dry cloth in 20 (33.3%) cases.
Mobile phones are becoming increasingly important in everyday life and now in healthcare. There has been a steady growth of information and communication technologies in health communication and technology is used progressively in telemedicine, wireless monitoring of health outcomes in disease and in the delivery of health interventions. Mobile phones are becoming an important method of encouraging better nurse-patient communication and will undoubtedly increase in application over coming years. This article presents recent developments and applications of mobile technology for health promotion and patient-monitoring in chronic disease.
Baquedano, Irasema Romero; dos Santos, Manoel Antônio; Martins, Tatiane Aparecida; Zanetti, Maria Lúcia
This study examines the self-care ability of type 2 diabetes mellitus patients and relates it to sociodemographic and clinical variables. The study included 251 patients who were cared for by an emergency service in Mexico, in 2007. Data were obtained through structured interviews held at participants' households, through a form, a questionnaire and the Self-Care Ability Scale. Descriptive and correlation statistics were used for data analysis. The results show that 83 (33.5%) individuals displayed good self-care ability and 168 (66.5%) individuals displayed regular ability. A directly proportional correlation was found between self-care ability and schooling (r=0.124; preligion (rs=-0.435; p<0.05) and duration of disease evolution (r=-0.667; p<0.05). The conclusion is that most of the individuals with type 2 diabetes mellitus displayed regular ability for self-care. Self-care ability is related to multiple variables that should be taken into account by health professionals when suggesting educational programs.
Petrakis, Beth Ann; Gifford, Allen L.; Rao, Sowmya R.; Houston, Thomas K.; Asch, Steven M.; O’Toole, Thomas P.
Objectives. We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows. Methods. We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated costs and savings of large-scale implementation. Results. Participants were satisfied with the text-messaging intervention, had very few technical difficulties, and were interested in continuing. Patient-cancelled visits and no-shows trended downward from 53 to 37 and from 31 to 25, respectively. Participants also experienced a statistically significant reduction in emergency department visits, from 15 to 5 (difference of 10; 95% confidence interval [CI] = 2.2, 17.8; P = .01), and a borderline significant reduction in hospitalizations, from 3 to 0 (difference of 3; 95% CI = −0.4, 6.4; P = .08). Conclusions. Text message reminders are a feasible means of reaching homeless veterans, and users consider it acceptable and useful. Implementation may reduce missed visits and emergency department use, and thus produce substantial cost savings. PMID:25100425
Pradhan, Debasis; Bhattacharyya, Prithwis
We report a case of "can ventilate but can't intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don't struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.
Schneeberger, Caroline; Mathai, Matthews
Task shifting-moving tasks to healthcare workers with a shorter training-for emergency obstetric care (EmOC) can potentially improve access to lifesaving interventions and thereby contribute to reducing maternal and neonatal morbidity and mortality. The present paper reviews studies on task shifting for the provision of EmOC. Most studies were performed in Sub-Saharan Africa and South Asia and focused primarily on task shifting for the performance of cesarean deliveries. Cesarean delivery rates increased following EmOC training without significant increase in adverse outcomes. The paper discusses the advantages and disadvantages of task shifting in EmOC and the role of this approach in improving maternal and newborn health in the short and long term.
Yao, Tianming; Rong, Jingjing; Liang, Ming; Sun, Jingyang; Xuan, Fengqi; Zhao, Lijun; Wang, Xiaozeng; Li, Fei; Wang, Geng; Han, Yaling
.... In this research, we aimed to study the possibility of performing emergency surgical intervention in mobile minimally invasive interventional shelter for splenic injury in the case of natural disasters...
Ali, Moazzam; Ahmed, Khawaja Masuood; Kuroiwa, Chushi
This paper describes an approach to maternal mortality reduction in Pakistan that uses UN emergency obstetric care (EmOC) process indicators to examine if public health care centres in Pakistan's Punjab province comply with minimum recommendations for basic and comprehensive services. In a cross sectional study in September 2003, through random sampling at area and health-facility levels from 30% of districts in Punjab province (n = 11/34 districts), all public health facilities providing EmOC were included (n = 120). Facility data were used for analysis. No district in Punjab met the minimum standards laid down by the UN for providing EmOC services. The number of facilities providing basic and comprehensive EmOC services fell far short of recommended levels. Only 4.7% of women with complications attended hospitals. Caesarean section was carried out in only 0.4% of births. The case fatality rate was hard to accurately calculate due to poor record keeping and data quality. The study may be taken as a baseline for developing and improving the standards of services in Punjab province. It is vital to upgrade existing basic EmOC facilities and to ensure that staff skills be improved, facilities be better equipped in critical areas, and record keeping be improved. Hence to reduce maternal mortality, facilities for EmOC must exist, be accessible, offer quality services, and be utilized by patients with complications.
Emergency obstetric care (EmOC), like any health intervention, requires resources, and resources are almost always limited. This forces decision makers to take into account the costs (and effectiveness) of EmOC provision and compare them with the costs (and effectiveness) of other health interventions. This is not inordinately complicated, but it does require paying attention to the fact that EmOC services require different types of inputs and are produced in facilities that also provide other health care services. This paper discusses the basic concepts underlying the costing of EmOC services, and the essential issues one must take into account while assessing the cost-effectiveness of EmOC interventions. A definition of EmOC provision cost is offered and then explained by progressively refining a simple measure of expenditures on all that is used to provide EmOC services. Thereupon the process of collecting cost data and calculating costs is outlined using a simple spreadsheet format, and issues related to the analysis of costs and cost-effectiveness are discussed.
Islam, Mohammad Tajul; Haque, Yasmin Ali; Waxman, Rachel; Bhuiyan, Abdul Bayes
The Women's Right to Life and Health project aimed to reduce maternal morbidity and mortality in Bangladesh through provision of comprehensive emergency obstetric care (EmOC) in the country's district and sub-district hospitals. Human resources development was one of the project's major activities. This paper describes the project in 2000-2004 and lessons learned. Project documents, the training database, reports and training protocols were reviewed. Medical officers, nurses, facility managers and laboratory technicians received training in the country's eight medical college hospitals, using nationally accepted curricula. A 17-week competency-based training course for teams of medical officers and nurses was introduced in 2003. At baseline in 1999, only three sub-district hospitals were providing comprehensive EmOC and 33 basic EmOC, mostly due to lack of trained staff and necessary equipment. In 2004, 105 of the 120 sub-district hospitals had become functional for EmOC, 70 with comprehensive EmOC and 35 with basic EmOC, while 53 of 59 of the district hospitals were providing comprehensive EmOC compared to 35 in 1999. The scaling up of competency-based training, innovative incentives to retain trained staff, evidence-based protocols to standardise practice and improve quality of care and the continuing involvement of key stakeholders, especially trainers, will all be needed to reach training targets in future.
Caracterização das vítimas de ferimentos por arma de fogo, atendidas pelo Serviço de Atendimento Móvel de Urgência em Campo Grande-MS Characterization of victims injured by firearms assisted by the Mobile Emergency Care Service in Campo Grande-MS
the Mobile Emergency Care Service (SAMU - Serviço de Atendimento Móvel de Urgência in the municipality of Campo Grande, state of Mato Grosso do Sul (MS, in the period from April 2005 to April 2007 - the first two years of operation since the implementation of the service in the capital of the state. A descriptive, retrospective and longitudinal study was carried out, based on a documental analysis of the information system of the SAMU of Campo Grande. In the study, 233 events were described. The results showed 213 male victims aged between 20 and 24 years. The head and neck were the most injured parts of the body and the South region of the city was the one that concentrated most events. It follows that violence caused by firearms in Campo Grande, MS, affects the economically active population and comes from regions characterized by poverty and social inequality. This justifies the implementation of a free service like SAMU, which has had an important impact on the community's health.
Stahnisch, Frank W
A critical analysis of the historical involvement of neurology and neurosurgery in military emergency care services enables us to better contextualize and appreciate the development of modern neurology at large. Wartime neurosurgery and civil brain science during the German Nazi period tightly coalesced in examining the specific injury types, which military neurosurgeons such as Wilhelm Toennis, Klaus Joachim Zuelch, and Georg Merrem encountered and treated based on their neurophysiological understanding gained from earlier peacetime research. Collaborative associations with Dr. Toennis in particular proved to be highly beneficial to other military neurologists and neurosurgeons during World War II and beyond. This article also discusses the prewar developments and considers the fate of German neurosurgeons and military neurologists after the war. The envisaged dynamic concepts of fast action, reaction, and recycling, which contemporary physicians had intensively studied in the preceding scientific experiments in their neurophysiological laboratories, had already been introduced into neurological surgery during the interwar period. In retrospect, World War II emergency rescue units greatly strengthened military operations through an active process of 'recycling' indispensable army personnel. Neurosurgical emergency chains thereby introduced another decisive step in the modernization of warfare, in that they increased the momentum of military mobility in the field. Notwithstanding the violence of warfare and the often inhumane ways in which such knowledge in the field of emergency neurology was gained, the protagonists among the group of experts in military neurology and neurosurgery strongly contributed to the postwar clinical neuroscience community in Germany. In differing political pretexts, this became visible in both East Germany and West Germany after the war, while the specific military and political conditions under which this knowledge of emergency medicine
Kofi Marfo Osei
Conclusion: Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME centre, our inventory assessment indicated a need to develop better implementation strategies for infection control policies, to collaborate with other departments on coordination of patient care, and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and ‘ready-to-hand’. Consequently, key factors in determining readiness to provide quality emergency care include supply-chain, healthcare financing, functionality of systems, and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development.
Pistiner, Michael; Mattey, Beth
Anaphylaxis is a life-threatening emergency. In the school setting, school nurses prepare plans to prevent an emergency, educating staff and students on life-threatening allergies. A critical component of any emergency plan is a plan of care in the event of accidental ingestion or exposure to an antigen to prevent the sequelae of untreated anaphylaxis. A universal anaphylaxis emergency care plan developed by the American Academy of Pediatrics and reviewed by NASN offers an opportunity for schools, family, and health care providers to use one standard plan and avoid confusion. The plan and benefits of use are described in this article.
Olsen, Ø E; Ndeki, S; Norheim, O F
Our objective was to determine the availability and quality of obstetric care to improve resource allocation in northern Tanzania. We surveyed all facilities providing delivery services (n=129) in six districts in northern Tanzania using the UN Guidelines for monitoring emergency obstetric care (EmOC). The three last questions in this audit outline are examined: Are the right women (those with obstetric complications) using emergency obstetric care facilities (Met Need)? Are sufficient quantities of critical services being provided (cesarean section rate (CSR))? Is the quality of the services adequate (case fatality rate (CFR))? Complications are calculated using Plan 3 of the UN Guidelines to assess the value of routine data for EmOC indicator monitoring. Nearly 60% of the expected complicated deliveries in the study population were conducted at EmOC qualified health facilities. 81.2% of the expected complicated deliveries are conducted in any facility (including facilities not qualifying as EmOC facilities). There is an inadequate level of critical services provided (CSR 4.6). Voluntary agencies provide most of these services in rural settings. All indicators show large variations with the setting (urban/rural location, level and ownership of facilities). Finally, there is large variation in the CFR with only one facility meeting the minimum accepted level. Utilization and quality of critical obstetric services at lower levels and in rural districts must be improved. The potential for improving the resource allocation within lower levels of the health care system is discussed. Given the small number of qualified facilities yet relatively high Met Need, we argue that it is neither the mothers' ignorance nor their lack of ability to get to a facility that is the main barrier to receiving quality care when needed, but rather the lack of quality care at the facility. Little can be concluded using the CFR to describe the quality of services provided.
Sholom, S; McKeever, S W S
In this article, optically stimulated luminescence (OSL) data are presented from integrated circuits (ICs) extracted from mobile phones. The purpose is to evaluate the potential of using OSL from components in personal electronic devices such as smart phones as a means of emergency dosimetry in the event of a large-scale radiological incident. ICs were extracted from five different makes and models of mobile phone. Sample preparation procedures are described, and OSL from the IC samples following irradiation using a (90)Sr/(90)Y source is presented. Repeatability, sensitivity, dose responses, minimum measureable doses, stability and fading data were examined and are described. A protocol for measuring absorbed dose is presented, and it was concluded that OSL from these components is a viable method for assessing dose in the days following a radiological incident.
Dewei JIA; Yubo DUAN; Jing LIU
Mobile electronic devices such as MP3, mobile phones, and wearable or implanted medical devices have already or will soon become a necessity in peoples' lives.However, the further development of these devices is restricted not only by the inconvenient charging process of the power module, but also by the soaring prices of fossil fuel and its downstream chain of electricity manipulation.In view of the huge amount of solar energy fueling the world biochemically and thermally, a carry-on electricity harvester embedded in portable devices is emerging as a most noteworthy research area and engineering practice for a cost efficient solution. Such a parasitic problem is intrinsic in the next generation portable devices. This paper is dedicated to presenting an overview of the photovoltaic strategy in the chain as a reference for researchers and practitioners committed to solving the problem.
Kim, J C; Kim, D Y; Jung, S M; Lee, M H; Kim, K S; Lee, C K; Nah, J Y; Lee, S H; Kim, J H; Choi, W J; Yoo, S K
So far we have developed Emergency Telemedicine System (ETS) which is a robust system using heterogeneous networks. In disaster areas, however, ETS cannot be used if the primary network channel is disabled due to damages on the network infrastructures. Thus we designed network management software for disaster communication network by combination of Mobile Ad hoc Network (MANET) and Wireless LAN (WLAN). This software maintains routes to a Backbone Gateway Node in dynamic network topologies. In this paper, we introduce the proposed disaster communication network with management software, and evaluate its performance using ETS between Medical Center and simulated disaster areas. We also present the results of network performance analysis which identifies the possibility of actual Telemedicine Service in disaster areas via MANET and mobile network (e.g. HSDPA, WiBro).
Wac, Katarzyna; Bults, Richard; Konstantas, Dimitri; Halteren, van Aart; Jones, Val; Widya, Ing; Herzog, Rainer
Health care is one of the most prominent areas for the application of wireless technologies. New services and applications are today under research and development targeting different areas of health care, from high risk and chronic patients’ remote monitoring to mobility tools for the medical perso
Brown, Jeremy; Grudzen, Corita; Kyriacou, Demetrios N; Obermeyer, Ziad; Quest, Tammie; Rivera, Donna; Stone, Susan; Wright, Jason; Shelburne, Nonniekaye
To identify research priorities and appropriate resources and to establish the infrastructure required to address the emergency care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, emergency medicine, and palliative care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the emergency care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative care in the emergency department setting.
Wälivaara, Britt-Marie; Andersson, Staffan; Axelsson, Karin
The trend for health care and nursing care turns from hospital to health care and nursing care at home. Studies have shown that health care professionals have no access to patient records in home and nursing home settings. Technological development creates opportunities for a host of mobile technology solutions. The aim of this study was to describe the reasoning among general practitioners (GPs) about the use of mobile distance-spanning technology (MDST) in care at home and in nursing homes. Seventeen GPs were divided in five groups for a group interview. The interviews were tape-recorded and transcribed verbatim. The qualitative content analysis resulted in four areas about the MDST, MDST has an impact on GPs' work, the nurses' profession, and the patient and the family, with nine adherent categories. The findings were interpreted and formulated in the theme: MDST should be used with caution. The results show quite a few expressions about the MDST as useful and valuable in health care at home and in nursing home settings; however, in every category, there were text that we interpreted as caution when using the MDST. The MDST cannot be used in all situations and cannot replace human meetings in health care and nursing care at home and in nursing homes. The MDST should primarily be a tool for the profession, and understanding the professions' reasoning about technology use in health care at home and in nursing home settings must be the base for implementing MDST.
YANG Jie; AN Jian-ping; LIU Heng
For the research of mobile Ad hoc network (MANET), hardware in the loop simulation (HILS) is introduced to improve simulation fidelity. The architectures and frameworks of HILS system are discussed. Based on HILS and QualNet network simulator, two kinds of simulation frameworks for MANET multicast emergency communicati on network are proposed. By running simulation under this configuration and doing experiments with on-demand multicast routing protocol (ODMRP), unicast and multicast functions of this protocol are tested. Research results indicate that HILS method can effectively reduce the difficulty of system modeling and improve precision of simulation, and can further accelerate transition from design to system deployment.
Full Text Available Abstract Objectives Pre-hospital care (PH in Brazil is currently in the phase of implementation and expansion, and there are few studies on the impacts of this public health service. The purpose of this study is to assess the quality of care and severity of trauma among the population served, using trauma scores, attendance response times, and mortality rates. This work compares two pre-hospital systems: the Mobile Emergency Care Service, or SAMU 192, and the Fire Brigade Group, or CB. Method Descriptive study evaluating all patients transported by both systems in Catanduva, SP, admitted to a single hospital. Results 850 patients were included, most of whom were men (67.5%; the mean age was 38.5 ± 18.5 years. Regarding the use of PH systems, most patients were transported by SAMU (62.1%. The trauma mechanisms involved motorcycle accidents in 32.7% of cases, transferred predominantly by SAMU, followed by falls (25.8%. Regarding the response time, CB showed the lowest rates. In relation to patient outcome, only 15.5% required hospitalization. The average score on the Glasgow Coma Scale was 14.7 ± 1.3; average RTS was 7.7 ± 0.7; ISS 3.8 ± 5.9; and average TRISS 97.6 ± 9.3. The data analysis showed no statistical differences in mortality between the groups studied (SAMU - 1.5%; CB - 2.5%. The trauma scores showed a higher severity of trauma among the fatal victims. Conclusion Trauma victims are predominantly young and male; the trauma mechanism that accounted for the majority of PH cases was motorcycle accidents; CB responded more quickly than SAMU; and there was no statistical difference between the services of SAMU and CB in terms of severity of the trauma and mortality rates.
Ohio State Dept. of Education, Columbus. Div. of Vocational Education.
This student manual, the sixth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains three sections covering the following course content: control of bleeding, caring for wounds and bandaging various body parts, and caring for shock victims. Each section contains objectives, an introduction,…
Ohio State Dept. of Education, Columbus. Div. of Vocational Education.
This student manual, the sixth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains three sections covering the following course content: control of bleeding, caring for wounds and bandaging various body parts, and caring for shock victims. Each section contains objectives, an introduction,…
Lang, N; Hansmann, M; Niesen, M
A mobile unit for reanimation of the newborn is reported to be used alternatively in the deliveryroom or in the surgical tract. The following adventages are achieved: a large working plate easily accessible from three sides, a complete and variable instrumentation, an efficent warmth supply and the possibility for easy cleaning and desinfection.
Loermans, M.; Jong, J.D. de
Background: Provisional plans of the European Union aim for increasing the right for patients to travel abroad for healthcare. Desired and expected impact of this future ruling is to achieve enhanced patient mobility and to realize effective cooperation and better sharing capacities between
Roh, Sang-Young; Yeom, Hye-A; Lee, Myung-Ah; Hwang, In Young
to describe the levels of mobility in older cancer patients receiving palliative care in Korea, and to examine the associations of their mobility with lifestyle factors (sleep disturbance, physical activity) and physical symptoms (pain, fatigue). In this cross-sectional descriptive study, 91 older cancer patients receiving palliative care were interviewed using a semi-structured survey questionnaire. Mobility was measured using the 6MWT. Physical activity behavior was measured using the classification of the ACSM. Sleep disturbance was assessed using the frequency sub-category of the SHQ. Both pain and fatigue were measured using a VAS. The mean 6MWT distance was 220.38 m. Participants in their 60 s, 70 s, and 80 s walked, on average, 260.93 m, 205.31 m, and 157.05 m, respectively. Approximately 73% of the participants engaged in regular physical activity. Those engaged in regular physical activity were significantly more mobile than those who were not (t = 2.44; p = .017). Higher levels of mobility were correlated with lower levels of sleep disturbance (r = -.37), fatigue (r = -.23), and pain (r = -.27). Significant predictors for mobility included levels of sleep disturbance, medication status, age, number of family members and monthly income, accounting for 34.7% of the variance in mobility. Korean cancer patients have relatively low levels of mobility. Cancer patients aged over 80 years are a vulnerable group at risk for impaired mobility. Older palliative care patients are more active than one might expect. Levels of mobility are inversely associated with pain, fatigue, and sleep-related symptoms. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
Aim Emergency dental care is a vital service that new graduates should be prepared to offer. There are few published data relating to emergency dental care education. To assess this, and to gain a profile of accident and emergency departments (A&E) in dental schools, an online survey was sent to all of the dental schools in the Republic of Ireland and the UK. Setting The survey addressed the school's A&E curriculum, teaching methods, undergraduate exposure and departmental details. Results Th...
Levine, Adam C; Marsh, Regan H; Nelson, Sara W; Tyer-Viola, Lynda; Burke, Thomas F
Global health experts identify emergency obstetric care (EmOC) as the most important intervention to improve maternal survival in low- and middle-income countries. In Zambia, 1 in 27 women will die of maternal causes, yet the level of availability of EmOC is not known at the provincial level. Our goal was to develop a tool to measure the availability of EmOC in rural Zambia in order to estimate pregnant women's access to this life-saving intervention. We created an instrument for determining the availability of EmOC based on the supplies and medicines in stock at health facilities as well as the skill level of health workers. We then surveyed a random sample of 35 health centres in the Central Province of Zambia using our novel instrument. We graded health centres based on their ability to provide the six basic functions of EmOC: administering parenteral antibiotics, administering parenteral oxytocics, administering parenteral anticonvulsants, performing manual removal of the placenta, removing retained products of conception and performing assisted vaginal delivery. Of the 29 health centres providing delivery care, 65% (19) were graded as level 1 or 2, 28% (8) as level 3 or 4 and 7% (2) as level 5. No health centre received a grade of level 6. The availability of EmOC in the Central Province of Zambia is extremely limited; the majority of health centres provide only one or two basic functions of EmOC, and no health centres perform all six functions. Our grading system allows for inter- and intra-country comparisons by providing a systematic process for monitoring access to EmOC in rural, low-income countries similar to Zambia.
Lwin, May Oo; Yung, Chee Fu; Yap, Peiling; Jayasundar, Karthikayen; Sheldenkar, Anita; Subasinghe, Kosala; Foo, Schubert; Jayasinghe, Udeepa Gayantha; Xu, Huarong; Chai, Siaw Ching; Kurlye, Ashwin; Chen, Jie; Ang, Brenda Sze Peng
Singapore is a hotspot for emerging infectious diseases and faces a constant risk of pandemic outbreaks as a major travel and health hub for Southeast Asia. With an increasing penetration of smart phone usage in this region, Singapore’s pandemic preparedness framework can be strengthened by applying a mobile-based approach to health surveillance and control, and improving upon existing ideas by addressing gaps, such as a lack of health communication. FluMob is a digitally integrated syndromic surveillance system designed to assist health authorities in obtaining real-time epidemiological and surveillance data from health-care workers (HCWs) within Singapore, by allowing them to report influenza incidence using smartphones. The system, integrating a fully responsive web-based interface and a mobile interface, is made available to HCW using various types of mobile devices and web browsers. Real-time data generated from FluMob will be complementary to current health-care- and laboratory-based systems. This paper describes the development of FluMob, as well as challenges faced in the creation of the system. PMID:28367433
Lwin, May Oo; Yung, Chee Fu; Yap, Peiling; Jayasundar, Karthikayen; Sheldenkar, Anita; Subasinghe, Kosala; Foo, Schubert; Jayasinghe, Udeepa Gayantha; Xu, Huarong; Chai, Siaw Ching; Kurlye, Ashwin; Chen, Jie; Ang, Brenda Sze Peng
Singapore is a hotspot for emerging infectious diseases and faces a constant risk of pandemic outbreaks as a major travel and health hub for Southeast Asia. With an increasing penetration of smart phone usage in this region, Singapore's pandemic preparedness framework can be strengthened by applying a mobile-based approach to health surveillance and control, and improving upon existing ideas by addressing gaps, such as a lack of health communication. FluMob is a digitally integrated syndromic surveillance system designed to assist health authorities in obtaining real-time epidemiological and surveillance data from health-care workers (HCWs) within Singapore, by allowing them to report influenza incidence using smartphones. The system, integrating a fully responsive web-based interface and a mobile interface, is made available to HCW using various types of mobile devices and web browsers. Real-time data generated from FluMob will be complementary to current health-care- and laboratory-based systems. This paper describes the development of FluMob, as well as challenges faced in the creation of the system.
Full Text Available Margot Green1, Vince Marzano1, I Anne Leditschke2,3, Imogen Mitchell2,3, Bernie Bissett1,4,5 1Physiotherapy Department, Canberra Hospital, Canberra, ACT, Australia; 2Intensive Care Unit, Canberra Hospital, Canberra, ACT, Australia; 3School of Medicine, Australian National University, Canberra, ACT, Australia; 4Discipline of Physiotherapy, University of Canberra, Canberra, ACT, Australia; 5School of Medicine, University of Queensland, Brisbane, QLD, Australia Objectives: To describe our experience and the practical tools we have developed to facilitate early mobilization in the intensive care unit (ICU as a multidisciplinary team.Background: Despite the evidence supporting early mobilization for improving outcomes for ICU patients, recent international point-prevalence studies reveal that few patients are mobilized in the ICU. Existing guidelines rarely address the practical issues faced by multidisciplinary ICU teams attempting to translate evidence into practice. We present a comprehensive strategy for safe mobilization utilized in our ICU, incorporating the combined skills of medical, nursing, and physiotherapy staff to achieve safe outcomes and establish a culture which prioritizes this intervention.Methods: A raft of tools and strategies are described to facilitate mobilization in ICU by the multidisciplinary team. Patients without safe unsupported sitting balance and without ≥3/5 (Oxford scale strength in the lower limbs commence phase 1 mobilization, including training of sitting balance and use of the tilt table. Phase 2 mobilization involves supported or active weight-bearing, incorporating gait harnesses if necessary. The Plan B mnemonic guides safe multidisciplinary mobilization of invasively ventilated patients and emphasizes the importance of a clearly articulated plan in delivering this valuable treatment as a team.Discussion: These tools have been used over the past 5 years in a tertiary ICU with a very low incidence of
Piot, Elise; Leheup, Benoît F; Losson, Séverine; Gédor, Lorène; Domina, Lucie; Béhem, Chantal; Amanzouggarene, Malika
Interventions of mobile palliative care teams in nursing homes have been the subject special consideration, however very little data are available on this subject. To determine the proportion of patients followed and consultations conducted in nursing homes for the dependent elderly by a mobile palliative care team, to describe the patients followed and to analyze the various aspects of this intervention. Retrospective study on the interventions carried out by a mobile palliative care team in nursing homes between January 1st and December 31st, 2012. The interventions in nursing homes targeted, 7.2% of the followed patients and represented 8.7% of the total activity of the mobile team. Intervention requests were made primarily by the family physician. The followed patients were mostly women (63%), with a mean age of 84 years, presenting non-cancerous diseases (78.2%), and had an average of 4.4 consultations. Half of the patients died during follow-up. Three quarters of the patients presented pain, neuro-psychological symptoms and verbal communication disorders. Four out of ten patients met with the occupational therapist and one of ten, the psychologist. The activity of mobile palliative care teams remains marginal, although steadily (on the rise. The collected data illustrate the specificity of geriatric palliative care, while certain characteristics inherent to nursing homes require establishing appropriate therapy proposals. Although quantitatively limited, the activity of mobile palliative care teams in nursing homes appears important as these interventions are likely meet the needs of both patients and staff in addition to enabling patients in palliative care to remain at their current place of residence.
John, M E; Samson-Akpan, P E; Etowa, J B; Akpabio, I I; John, E E
To evaluate the effectiveness of mobile phones in enhancing self-care, adjustment and engagement in non-disclosed youth living with HIV. Youth aged 15-24 years represent 42% of new HIV infections globally. Youth who are aware of their HIV status generally do not disclose it or utilize HIV-related facilities because of fear of stigma. They rely on the Internet for health maintenance information and access formal care only when immune-compromised and in crisis. This study shows how non-disclosed youth living with HIV can be reached and engaged for self-management and adjustment through mobile phone. One-group pre-test/post-test experimental design was used. Mobile phones were used to give information, motivation and counselling to 19 purposively recruited non-disclosed youth with HIV in Calabar, South-South Nigeria. Psychological adjustment scale, modified self-care capacity scale and patient activation measure were used to collect data. Data were analysed using PASW 18.0. Scores on self-care capacity, psychological adjustment and engagement increased significantly at post-test. HIV-related visits to health facilities did not improve significantly even at 6 months. Participants still preferred to consult healthcare providers for counselling through mobile phone. Mobile phone-based interventions are low cost, convenient, ensure privacy and are suitable for youth. Such remote health counselling enhances self-management and positive living. Mobile phones enhance self-care, psychological adjustment and engagement in non-disclosed youth living with HIV, and can be used to increase care coverage. Findings underline the importance of policies to increase access by locating, counselling and engaging HIV-infected youth in care. © 2016 International Council of Nurses.
SUN Tie-shan; LI Guo-ping; LU Ming-hua
This paper is a preliminary and illustrative case study of Beijing's emerging mobile communication industri-al (MCI) cluster, which helps understand the cluster by qualitative analysis and description. Beijing's MCI cluster is emerg-ing as far as the competence of the industry and its spatial concentration are concerned, although it is not the type of thecluster described by PORTER due to the low competence of indigenous firms. The formation of the cluster can be ex-plained by means of the factor and demand conditions of Beijing. However, it is mostly determined by the multinationalsthat promote the growth of the industry and the formation of the cluster, and by the government that also plays a key rolein many ways. As a matter of fact, the interaction between the multinationals and the local government is the key to under-standing the formation of the cluster. Allinall, Beijing's emerging MCI cluster is a value-chain, geographicallyconcentrat-ed but non-localized cluster, which is highly dominated by the multinationals and the local government. Its special character-istics bear some policy implications as to the change of the roles of the local government and the localization of multination-als, etc.
Full Text Available Background: The National Rural Health Mission of India advocates public private partnerships (PPPs to meet its "service guarantee" of Emergency obstetric care (EmOC provision. The Janani Suraksha Yojana (JSY has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Methods: A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. Results: The PPP scheme for EmOC is restricted to deliveries by Caesarean section. The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. Conclusion: The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs.
Chaturvedi, Sarika; Randive, Bharat
The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its "service guarantee" of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. The PPP scheme for EmOC is restricted to deliveries by Caesarean section.The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs.
Tsegaye, Ademe; Somigliana, Edgardo; Alemayehu, Tadesse; Calia, Federico; Maroli, Massimo; Barban, Paola; Manenti, Fabio; Putoto, Giovanni; Accorsi, Sandro
To evaluate the functionality of an ambulance service dedicated to emergency obstetric care (EmOC) that referred pregnant women to health centers for delivery assistance or to a hospital for the management of obstetric complications. A retrospective study investigated an ambulance referral system for EmOC in a rural area of Ethiopia between July 1 and December 31, 2013. The service was available 24h a day and was free of charge. Women requesting referral were transported to nearby health centers. Assistance was provided locally for uncomplicated deliveries. Women with obstetric complications were referred from health centers to a hospital. A total of 528 ambulance referrals were recorded. The majority of patients (314 [59.5%]) were transported from villages to health centers. The remaining individuals were brought to a hospital, having been referred from health centers (179 [33.9%]) or were referred directly from villages owing to hospital proximity (35 [6.6%]). Of the 179 patients referred to the hospital from health centers, 84 (46.9%) were diagnosed with major direct obstetric complications. No maternal deaths were recorded among patients using the ambulance service. The cost of the ambulance service was US$ 18.47 per referred patient. An ambulance service dedicated to EmOC that interconnected health centers and a hospital facilitated referrals and better utilized local resources. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Aso, Mayumi; Kato, Kyoichi; Yasuda, Mitsuyoshi; Takahashi, Toshiyuki; Say, Syogo; Fujimura, Kazumasa; Kuroki, Kazunori; Nakazawa, Yasuo
A hand hygiene behavior questionnaire and environmental survey were conducted regarding the mobile X-ray system used in the emergency room. As a result, among a total of 22 radiological technologists at this hospital who replied to the questionnaire, 18 wore disposable gloves when performing X-ray imaging using the mobile system. Among those 18, 11 were found to touch computed radiology (CR) consoles and HIS/RIS terminals while still wearing the gloves, thus creating the potential for spreading pathogens to other medical equipment and systems. According to the results of an environmental survey of the emergency imaging preparation room, the highest levels of bacteria were detected on CR consoles and HIS/RIS terminals. A possible reason for this is that these locations are not wiped down and cleaned as a part of routine cleaning and disinfection protocols, thus demonstrating the importance of cleaning and disinfection. Hand hygiene by medical personnel and appropriate cleaning and disinfecting of the working environment are important for preventing the spread of nosocomial infections. Radiological technologists are also required to take effective measures against infections in consideration of the high frequency of contact with both infected patients and patients susceptible to infections.
Lackner, C K; Bielmeier, S; Burghofer, K
A change is emerging in the hospital landscape due to health political measures, which in consequence also influences the prehospital medical care in emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data from Bavarian emergency medical services. In 2006 there were 14,261 traffic accidents in Bavaria where an emergency doctor attended the scene. The patients were primarily cared for by land-based rescue services and air rescue services were only used in 19.1% of the cases. Of the patients involved in a traffic accident 47.6% were transported to a primary health care hospital. A prehospital interval of more than 60 min occurred in 20% of the missions. Of the patients 96.2% were transported to tertiary or maximum care hospital by air rescue services but emergency facilities were, however restricted to daylight hours. There was a further limitation due to the routine duty hours in hospitals as only 36.7% of accidents occurred during this time intervall. An increase of admission post trauma in maximum care clinics occurred from 2002 until 2006 while simultaneously the prehospital period was extended. In order to assure sufficient trauma care for seriously injured persons a continuous 24 h availability of emergency trauma facilities is necessary. For this purpose it is necessary to establish regional trauma networks between receiving hospitals as well as air rescue services at night time. Furthermore, a cost-efficient compensation of the structural, personnel and logistic expenses for the treatment of the severely injured has to be assured.
Bone, Dianna; Persson, Mikael; Ribbe, Tommy; Dale, Susanne
Scintigraphic tomography (SPECT) with a gamma camera is an established tool for the diagnosis of disturbances in perfusion of the myocardium. The technique has been shown to be useful in the management of patients with acute myocardial infarction. However, SPECT is not widely used for seriously ill patients due to the need to transport the patient to the gamma camera system. In order to make tomography available by the bedside, a form of limited view angle tomography, Ectomography, has been implemented on a mobile gamma camera system. Projection data are acquired by rotating a slant hole collimator in front of the stationary detector and therefore, the head gantry is simple and easily transported. The mobile system is completely self-contained providing acquisition, reconstruction and bedside display. System sensitivity can be increased by using a segmented collimator, making it possible to present reconstructed sections for diagnosis less than 10 min after the start of acquisition. At present, reconstruction is performed with 2D filtered back projection. A comparative study of patients with suspected coronary artery disease has shown that Ectomography and SPECT yield similar diagnostic information. In an experimental study, in which a coronary artery was occluded, it has been possible to use Ectomography to define myocardial area at risk and final infarct size. Myocardial imaging has been performed in the intensive care unit and a pilot study has demonstrated that brain scans can also be performed. Bedside tomographic scintigraphy has been shown to be feasible and studies can be performed without moving the patient. The method should provide, therefore, an alternative to SPECT in intensive care and the emergency room.
Bone, Dianna E-mail: email@example.com; Persson, Mikael; Ribbe, Tommy; Dale, Susanne
Scintigraphic tomography (SPECT) with a gamma camera is an established tool for the diagnosis of disturbances in perfusion of the myocardium. The technique has been shown to be useful in the management of patients with acute myocardial infarction. However, SPECT is not widely used for seriously ill patients due to the need to transport the patient to the gamma camera system. In order to make tomography available by the bedside, a form of limited view angle tomography, Ectomography, has been implemented on a mobile gamma camera system. Projection data are acquired by rotating a slant hole collimator in front of the stationary detector and therefore, the head gantry is simple and easily transported. The mobile system is completely self-contained providing acquisition, reconstruction and bedside display. System sensitivity can be increased by using a segmented collimator, making it possible to present reconstructed sections for diagnosis less than 10 min after the start of acquisition. At present, reconstruction is performed with 2D filtered back projection. A comparative study of patients with suspected coronary artery disease has shown that Ectomography and SPECT yield similar diagnostic information. In an experimental study, in which a coronary artery was occluded, it has been possible to use Ectomography to define myocardial area at risk and final infarct size. Myocardial imaging has been performed in the intensive care unit and a pilot study has demonstrated that brain scans can also be performed. Bedside tomographic scintigraphy has been shown to be feasible and studies can be performed without moving the patient. The method should provide, therefore, an alternative to SPECT in intensive care and the emergency room.
Martin, C. Andrew
This paper presents the findings of a qualitative study designed to describe the experience of HIV medication adherence using a mobile phone application. For the purpose of this qualitative study, nine semi-structured focus group discussions were conducted over a three-month period at an AIDS service organization in Central Texas. The data were…
Schmid, Achim; Cacace, Mirella; Götze, Ralf; Rothgang, Heinz
In this article, we will further the explanation of the state's changing role in health care systems belonging to the Organisation for Economic Cooperation and Development (OECD). We build on our analysis of twenty-three OECD countries, which reveals broad trends regarding governments' role in financing, service provision, and regulation. In particular, we identified increasing similarities between the three system types we delineate as National Health Service (NHS), social health insurance, and private health insurance systems. We argue that the specific health care system type is an essential contributor to these changes. We highlight that health care systems tend to feature specific, type-related deficiencies, which cannot be solved by routine mechanisms. As a consequence, non-system-specific elements and innovative policies are implemented, which leads to the emergence of "hybrid" systems and indicates a trend toward convergence, or increasing similarities. We elaborate this hypothesis in two steps. First, we describe system-specific deficits of each health care system type and provide an overview of major adaptive responses to these deficits. The adaptive responses can be considered as non-system-specific interventions that broaden the portfolio of regulatory policies. Second, we examine diagnosis-related groups (DRGs) as a common approach for financing hospitals efficiently, which are nevertheless shaped by type-specific deficiencies and reform requirements. In the United States' private insurance system, DRGs are mainly used as a means of hierarchical cost control, while their implementation in the English NHS system is to increase productivity of hospital services. In the German social health insurance system, DRGs support competition as a means to control self-regulated providers. Thus, DRGs contribute to the hybridization of health care systems because they tend to strengthen coordination mechanisms that were less developed in the existing health care
Bronwyn A Myers
Full Text Available The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering emergency obstetric care (EmOC and population distribution were modelled for a district in eastern Indonesia. As an index of remoteness, the proportion of the population more than two hours estimated travel time from EmOC was calculated. For the best case scenario (transport by ambulance in the dry season, modelling estimated more than 10,000 fertile aged women were more than two hours from EmOC. Maternal mortality ratios were positively correlated with the remoteness index, however there was considerable variation around this relationship. In a companion study, ethnographic research in a subdistrict with relatively good access to health care and high maternal mortality identified factors influencing access to EmOC, including some that had not been incorporated into the travel time model. Ethnographic research provided information about actual travel involved in requesting and reaching EmOC. Modeled travel time could be improved by incorporating time to deliver request for care. Further integration of social and spatial methods and the development of more dynamic travel time models are needed to develop programs and policies to address these multiple factors to improve maternal health outcomes.
Future directions of the AFEM Out-of-Hospital Emergency Care Workgroup include creating an online Toolkit. This will serve as a repository of template documents to guide implementation and development of clinical care, education, transportation, public access, policy and governance.
Graf Bernhard M
Full Text Available Abstract Background During the last stage of life, palliative care patients often experience episodes of respiratory distress, bleeding, pain or seizures. In such situations, caregivers may call emergency medical services leading to unwanted hospital admissions. The study aims to show the influence of our palliative care team to reducing emergency calls by cancer patients or their relatives during the last six month of life. Methods Fifty relatives of deceased patients who had been attended by our palliative care team were randomly selected. Data was obtained retrospectively during a structured interview. In addition to demographic data, the number of emergency calls made during the final six months of the patient's life, the reason for the call and the mental compound score (MCS-12 of the caregivers was registered. Results Forty-six relatives agreed to the interview. Emergency calls were placed for 18 patients (39% during the final six months of their lives. There were a total of 23 emergency calls. In 16 cases (70% the patient was admitted to the hospital. Twenty-one (91% of the calls were made before patients had been enrolled to receive palliative care from the team, and two (9% were made afterwards. The mean mental compound score of the caregivers at the time of the interview was 41 (range 28–57. There was a lack of correlation between MCS-12 and number of emergency calls. Conclusion Emergency calls were more likely to occur if the patients were not being attended by our palliative care team. Because of the lack of correlation between MCS-12 and the number of emergency calls, the MCS-12 cannot indicate that acutely stressful situations triggered the calls. However, we conclude that special palliative care programs can reduce psychosocial strain in family caregivers. Therefore, the number of emergency calls may be reduced and this fact allows more palliative patients to die at home.
Pediatric information seeking behaviour, information needs, and information preferences of health care professionals in general emergency departments: Results from the Translating Emergency Knowledge for Kids (TREKK) Needs Assessment.
Scott, Shannon D; Albrecht, Lauren; Given, Lisa M; Hartling, Lisa; Johnson, David W; Jabbour, Mona; Klassen, Terry P
The majority of children requiring emergency care are treated in general emergency departments (EDs) with variable levels of pediatric care expertise. The goal of the Translating Emergency Knowledge for Kids (TREKK) initiative is to implement the latest research in pediatric emergency medicine in general EDs to reduce clinical variation.
Boyd, Jennifer B; McGrath, Mary H; Maa, John
As total health care expenditures are expected to constitute an increasing portion of the US gross domestic product during the coming years, the US health care system is anticipating a historic spike in the need for care. Outsourcing medical and surgical care to other nations has expanded rapidly, and several ethical, legal, and financial considerations require careful evaluation. Ultimately, the balance between cost savings, quality, and patient satisfaction will be the key determinant in the future of medical outsourcing.
Dubb, Rolf; Nydahl, Peter; Hermes, Carsten; Schwabbauer, Norbert; Toonstra, Amy; Parker, Ann M; Kaltwasser, Arnold; Needham, Dale M
Early mobilization of patients in the intensive care unit (ICU) is safe, feasible, and beneficial. However, implementation of early mobility as part of routine clinical care can be challenging. The objective of this review is to identify barriers to early mobilization and discuss strategies to overcome such barriers. Based on a literature search, we synthesize data from 40 studies reporting 28 unique barriers to early mobility, of which 14 (50%) were patient-related, 5 (18%) structural, 5 (18%) ICU cultural, and 4 (14%) process-related barriers. These barriers varied across ICUs and within disciplines, depending on the ICU patient population, setting, attitude, and ICU culture. To overcome the identified barriers, over 70 strategies were reported and are synthesized in this review, including: implementation of safety guidelines; use of mobility protocols; interprofessional training, education, and rounds; and involvement of physician champions. Systematic efforts to change ICU culture to prioritize early mobilization using an interprofessional approach and multiple targeted strategies are important components of successfully implementing early mobility in clinical practice.
Full Text Available Catherine H Yu,1,2 Giuliana Guarna,1 Pamela Tsao,3 Jude R Jesuthasan,1 Adrian NC Lau,3,4 Ferhan S Siddiqi,1 Julie Anne Gilmour,3 Danyal Ladha,1 Henry Halapy,5 Andrew Advani1–3 1Li Ka Shing Knowledge Institute, St Michael’s Hospital, 2Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, University of Toronto, 3Department of Medicine, Faculty of Medicine, University of Toronto, 4Division of Endocrinology, Department of Medicine, University Health Network, 5Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada Purpose: For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases.Methods: The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years with chronic medical conditions including addictions, were included.Results: A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated.Conclusion: While the majority of
Velmahos George C
Full Text Available Abstract The era of the acute care surgeon has arrived and this "new" specialty will be expected to provide trauma care, emergency surgery, and surgical critical care to a variety of patients arriving at their institution. With the exception of practicing bariatric surgeons, many general surgeons have limited experience caring for obese patients. Obese patients manifest unique physiology and pathophysiology, which can influence a surgeon's decision-making process. Following trauma, obese patients sustain different injuries than lean patients and have worse outcomes. Emergency surgery diseases may be difficult to diagnose in the obese patient and obesity is associated with increased complications in the postoperative patient. Caring for an obese patient in the surgical ICU presents a distinctive challenge and may require alterations in care. The following review should act as an overview of the pathophysiology of obesity and how obesity modifies the care of trauma, emergency surgery, and surgical critical care patients.
Giovanni, Mazza G; Shenvi, Rohit; Battles, Marcie; Orthner, Helmuth F
The eMonitor is a component of the ePatient system; a prototype system used by emergency medical services (EMS) personnel in the field to record and transmits electronic patient care report (ePCR) information interactively. The eMonitor component allows each Mobile Data Terminal (MDT) on an unreliable Cisco MobileIP wireless network to securely send and received XML messages used to update patient information to and from the MDT before, during and after the transport of a patient.
de Britto, Felipe A; Martins, Tatiana B; Landsberg, Gustavo A P
To assess impact of a mobile health solution in the nursing care plan compliance of a home care service. A retrospective cohort study was performed with 3,036 patients. Compliance rates before and after the implementation were compared. After the implementation of a mobile health aplication, compliance with the nursing care plan increased from 53% to 94%. The system reduced IT spending, increased the nursing team efficiency and prevented planned hiring. The use of a mobile health solution with geolocating feature by a nursing home care team increased compliance to the care plan.
Anthony, David R
Despite the global health community's historical focus on providing basic, cost-effective primary health care delivered at the community level, recent trends in the developing world show increasing demand for the implementation of emergency care infrastructures, such as prehospital care systems and emergency departments, as well as specialised training programmes. However, the question remains whether, in a setting of limited global health care resources, it is logical to divert these already-sparse resources into the development of emergency care frameworks. The existing literature overwhelmingly supports the idea that emergency care systems, both community-based and within medical institutions, improve important outcomes, including significant morbidity and mortality. Crucial to the success of any public health or policy intervention, emergency care systems also seem to be strongly desired at the community and governmental levels. Integrating emergency care into existing health care systems will ideally rely on modest, low-cost steps to augment current models of primary health care delivery, focusing on adapting the lessons learned in the developed world to the unique needs and local variability of the rest of the globe.
Bika, O H; Edozien, L C
Emergency obstetric care in the UK has been systematically developed over the years to high quality standards. More recently, advances have been made in the organisation and delivery of care for women presenting with acute gynaecological problems, but a lot remains to be done, and emergency gynaecology has a lot to learn from the evolution of its sister special interest area: acute obstetric care. This paper highlights areas such as consultant presence, risk management, patient flow pathways, out-of-hours care, clinical guidelines and protocols, education and training and facilities, where lessons from obstetrics are transferrable to emergency gynaecology.
JIANG Guan-yu; SHEN Wei-feng; GAN Jian-xin
The three links theory applied in trauma emergency care system refers to an integrated system with the three important components of trauma emergency care system, viz. prehospital trauma services, hospital trauma services and critical care services. The development of the trauma emergency care system should be guided by the three links theory so as to set up a practical and highly efficient system: a prompt operating and monitoring transportation system, a smooth and real-time information system, a rational and sustainable system of regulations and contingency plans, and a system for cultivating all-round trauma physicians.
Antonia S Stang
Full Text Available OBJECTIVE: To systematically review the literature regarding the prevalence, preventability, severity and types of adverse events (AE in the Emergency Department (ED. METHODS: We systematically searched major bibliographic databases, relevant journals and conference proceedings, and completed reference reviews of primary articles. Observational studies (cohort and case-control, quasi-experimental (e.g. before/after studies and randomized controlled trials, were considered for inclusion if they examined a broad demographic group reflecting a significant proportion of ED patients and described the proportion of AE. Studies conducted outside of the ED setting, those examining only a subpopulation of patients (e.g. a specific entrance complaint or receiving a specific intervention, or examining only adverse drug events, were excluded. Two independent reviewers assessed study eligibility, completed data extraction, and assessed study quality with the Newcastle Ottawa Scale. RESULTS: Our search identified 11,624 citations. Ten articles, representing eight observational studies, were included. Methodological quality was low to moderate with weaknesses in study group comparability, follow-up, and outcome ascertainment and reporting. There was substantial variation in the proportion of patients with AE related to ED care, ranging from 0.16% (n = 9308 to 6.0% (n = 399. Similarly, the reported preventability of AE ranged from 36% (n = 250 to 71% (n = 24. The most common types of events were related to management (3 studies, diagnosis (2 studies and medication (2 studies. CONCLUSIONS: The variability in findings and lack of high quality studies on AE in the high risk ED setting highlights the need for research in this area. Further studies with rigorous, standardized outcome assessment and reporting are required.
Thomas E. Terndrup
Full Text Available Introduction: Elders who utilize the emergency department (ED may have little prospectiveknowledge of appropriate expectations during an ED encounter. Improving elder orientation toED expectations is important for satisfaction and health education. The purpose of this study wasto evaluate a multi-media education intervention as a method for informing independently livingelders about ED care. The program delivered messages categorically as, the number of tests,providers, decisions and disposition decision making.Methods: Interventional trial of representative elders over 59 years of age comparing pre andpost multimedia program exposure. A brief (0.3 hour video that chronicled the key events after ahypothetical 911 call for chest pain was shown. The video used a clinical narrator, 15 ED healthcare providers, and 2 professional actors for the patient and spouse. Pre- and post-video testsresults were obtained with audience response technology (ART assessed learning using a 4point Likert scale.Results: Valid data from 142 participants were analyzed pre to post rankings (Wilcoxon signedranktests. The following four learning objectives showed significant improvements: number oftests expected [median differences on a 4-point Likert scale with 95% confidence intervals: 0.50(0.00, 1.00]; number of providers expected 1.0 (1.00, 1.50; communications 1.0 (1.00, 1.50;and pre-hospital medical treatment 0.50 (0.00, 1.00. Elders (96% judged the intervention asimproving their ability to cope with an ED encounter.Conclusion: A short video with graphic side-bar information is an effective educational strategy toimprove elder understanding of expectations during a hypothetical ED encounter following calling911.
Serviço de Atendimento Móvel de Urgência (SAMU: análise da demanda e sua distribuição espacial em uma cidade do Nordeste brasileiro Mobile Emergency Care Service (SAMU: analysis of demand and its space distribution in a city of the Brazilian northeast
Amanda Priscila de Santana Cabral
Full Text Available O município de Olinda, Pernambuco, criou instrumento para armazenamento de dados dos formulários das ocorrências do Serviço de Atendimento Móvel de Urgência (SAMU-192 e de forma pioneira georreferencia os atendimentos realizados. Objetiva-se descrever o perfil epidemiológico das ocorrências atendidas no município, de fevereiro (implantação do serviço a junho de 2006, com ênfase na distribuição espacial das ocorrências mais relevantes. Foram utilizados dados secundários do banco de dados SAMU-192, considerando a freqüência das seguintes variáveis: sexo, faixa etária, tipo de ocorrências, dias da semana, tipo de causas clínicas, tipo de causas externas, tipo de acidentes de transportes e veículos envolvidos. Tendo por base as freqüências dos tipos de causas clínicas/externas, identificaram-se aquelas de maior magnitude para mapeamento e identificação dos aglomerados espaciais com o emprego de estimador de intensidade Kernel. Das 1956 ocorrências, 1114 foram por causas clínicas e 645 por causas externas; finais de semana acumularam 46,0% dos atendimentos; 55,1% das ocorrências por causas clínicas foram em mulheres, enquanto 72,1% das causas externas em homens. A média etária para as causas clínicas foi de 47 anos e 34 anos para causas externas. Destacaram-se as doenças do aparelho circulatório (23,1% das causas clínicas e acidentes de transporte (52,7% das causas externas; desses 61,1% motivados por atropelamentos e 33,6% com motocicletas envolvidas. A análise espacial reforça a necessidade da integração entre a Secretaria de Saúde e órgãos afins para a implantação de medidas preventivas, e o perfil epidemiológico apresentou informações capazes de auxiliar na organização do serviço e na compreensão do perfil de morbidade.The city of Olinda (Pernambuco, Brazil created a tool for storing data from the Emergency Mobile Healthcare Service forms (SAMU-192 which is a pioneer in providing
Bhat, Anup; Chakravarthy, Kalyana; Rao, Bhamini K
The rehabilitation needs of the patients in neurological Intensive Care Units (ICUs) vary from that of a medical ICU patient. Early mobilization is known to improve the various neurological outcomes in patients admitted to neurological ICUs, although little is known about the practice pattern among physiotherapists. The mobilization practice pattern may vary significantly than that of developed countries due to the reasons of differences in training of professionals, availability of equipment, and financial assistance by health insurance. To study the current mobilization practices by the physiotherapists in neurological ICUs of India. A cross-sectional survey was conducted with a content validated questionnaire about the mobilization practices. Online questionnaire was distributed to physiotherapists working in neurological ICUs of India. Descriptive statistics were used. Out of 185 e-mails sent, 82 physiotherapists completed the survey (survey response rate = 44%). Eighty participants (97.6%) mentioned that the patients received some form of mobilization during the day. The majority of the physiotherapists (58.5%), "always" provided bed mobility exercises to their patients when it was found appropriate for the patients. Many physiotherapists (41.5%) used tilt table "sometimes" to introduce orthostatism for their patients. Mobilization in various forms is being practiced in the neurological ICUs of India. However, fewer mobilization sessions are conducted on weekends and night hours in Indian Neurological ICUs.
Full Text Available Context: The rehabilitation needs of the patients in neurological Intensive Care Units (ICUs vary from that of a medical ICU patient. Early mobilization is known to improve the various neurological outcomes in patients admitted to neurological ICUs, although little is known about the practice pattern among physiotherapists. The mobilization practice pattern may vary significantly than that of developed countries due to the reasons of differences in training of professionals, availability of equipment, and financial assistance by health insurance. Aim of the Study: To study the current mobilization practices by the physiotherapists in neurological ICUs of India. Subjects and Methods: A cross-sectional survey was conducted with a content validated questionnaire about the mobilization practices. Online questionnaire was distributed to physiotherapists working in neurological ICUs of India. Descriptive statistics were used. Results: Out of 185 e-mails sent, 82 physiotherapists completed the survey (survey response rate = 44%. Eighty participants (97.6% mentioned that the patients received some form of mobilization during the day. The majority of the physiotherapists (58.5%, “always” provided bed mobility exercises to their patients when it was found appropriate for the patients. Many physiotherapists (41.5% used tilt table “sometimes” to introduce orthostatism for their patients. Conclusion: Mobilization in various forms is being practiced in the neurological ICUs of India. However, fewer mobilization sessions are conducted on weekends and night hours in Indian Neurological ICUs.
Chan, Steven Richard; Torous, John; Hinton, Ladson; Yellowlees, Peter
Mobile telemental health is defined as the use of mobile phones and other wireless devices as applied to psychiatric and mental health practice. Applications of such include treatment monitoring and adherence, health promotion, ecological momentary assessment, and decision support systems. Advantages of mobile telemental health are underscored by its interactivity, just-in-time interventions, and low resource requirements and portability. Challenges in realizing this potential of mobile telemental health include the low penetration rates of health applications on mobile devices in part due to health literacy, the delay in current published research in evaluating newer technologies, and outdated research methodologies. Despite such challenges, one immediate opportunity for mobile telemental health is utilizing mobile devices as videoconferencing mediums for psychotherapy and psychosocial interventions enhanced by novel sensor based monitoring and behavior-prediction algorithms. This paper provides an overview of mobile telemental health and its current trends, as well as future opportunities as applied to patient care in both academic research and commercial ventures.
Steven Richard Chan
Full Text Available Mobile telemental health is defined as the use of mobile phones and other wireless devices as applied to psychiatric and mental health practice. Applications of such include treatment monitoring and adherence, health promotion, ecological momentary assessment, and decision support systems. Advantages of mobile telemental health are underscored by its interactivity, just-in-time interventions, and low resource requirements and portability. Challenges in realizing this potential of mobile telemental health include the low penetration rates of health applications on mobile devices in part due to health literacy, the delay in current published research in evaluating newer technologies, and outdated research methodologies. Despite such challenges, one immediate opportunity for mobile telemental health is utilizing mobile devices as videoconferencing mediums for psychotherapy and psychosocial interventions enhanced by novel sensor based monitoring and behavior-prediction algorithms. This paper provides an overview of mobile telemental health and its current trends, as well as future opportunities as applied to patient care in both academic research and commercial ventures.
Moss, Cheryle; Nelson, Katherine; Connor, Margaret; Wensley, Cynthia; McKinlay, Eileen; Boulton, Amohia
To understand how people who present on multiple occasions to the emergency department experience their health professionals' moral comportment (ethic of care and duty of care); and to understand the consequences of this for 'people who present on multiple occasions' ongoing choices in care. People (n = 34) with chronic illness who had multiple presentations were interviewed about the role that emergency departments played within their lives and health-illness journey. Unprompted, all participants shared views about the appropriateness or inappropriateness of the care they received from the health professionals in the emergency departments they had attended. These responses raised the imperative for specific analysis of the data regarding the need for and experience of an ethic of care. Qualitative description of interview data (stage 3 of a multimethod study). The methods included further analysis of existing interviews, exploration of relevant literature, use of Tronto's ethic of care as a theoretical framework for analysis, thematic analysis of people who present on multiple occasions' texts and explication of health professionals' moral positions in relation to present on multiple occasions' experiences. Four moral comportment positions attributed by the people who present on multiple occasions to the health professionals in emergency department were identified: 'sustained and enmeshed ethic and duty of care', 'consistent duty of care', 'interrupted or mixed duty and ethic of care', and 'care in breach of both the ethic and duty of care'. People who present on multiple occasions are an important group of consumers who attend the emergency department. Tronto's phases/moral elements in an ethic of care are useful as a framework for coding qualitative texts. Investigation into the bases, outcomes and contextual circumstances that stimulate the different modes of moral comportment is needed. Findings carry implications for emergency department care of people who
Jakab, Andrei; Kulkas, Antti; Salpavaara, Timo; Kauppinen, Pasi; Verho, Jarmo; Heikkilä, Hannu; Jäntti, Ville
Background Although clinical applications such as emergency medicine and prehospital care could benefit from a fast-mounting electroencephalography (EEG) recording system, the lack of specifically designed equipment restricts the use of EEG in these environments. Methods This paper describes the design and testing of a six-channel emergency EEG (emEEG) system with a rapid preparation time intended for use in emergency medicine and prehospital care. The novel system comprises a quick-applicati...
Entsieh, Angela Afua; Emmelin, Maria; Pettersson, Karen Odberg
The diffusion of mobile phones in low- and middle-income countries has taken place faster than any other infrastructural development. Mobile Midwife, a mobile application implemented in Ghana in 2010, sends timely messages in local languages to registered expectant mothers and new parents. The field of mobile health (mHealth) is severely underresearched, yet it can be an alternative for improving health systems and the ways in which health services are delivered. Our goal was to investigate the role that Mobile Midwife technology has played in the lives of pregnant and nursing mothers in Awutu Senya District, Ghana. A total of three focus group discussions and 19 individual interviews were conducted. Discussions and interviews were recorded, transcribed verbatim from the local language to English, and analyzed by means of qualitative content analysis at the manifest and latent levels. The main findings show that while oscillating between modern and traditional practices, women gradually gained trust in Mobile Midwife's counselling and attempted to balance between myths and reality regarding nutrition in pregnancy. In addition, their decisions to seek essential obstetric care were enhanced by Mobile Midwife's advice. Women also felt strengthened in their understanding of the importance of seeking professional care during pregnancy and childbirth as well as recognizing signs of ill health in the newborn. The findings indicate that Mobile Midwife could be an excellent tool in working towards the improvement of maternal health. Mobile Midwife will hopefully contribute to the stepwise achievement of the Sustainable Development Goals extended from the Millennium Development Goals, which expire at the end of 2015. There is a need for strong political will from key stakeholders, to embark in the field of mHealth as a complementary means to strengthen health systems.
Angela Afua Entsieh
Full Text Available Background: The diffusion of mobile phones in low- and middle-income countries has taken place faster than any other infrastructural development. Mobile Midwife, a mobile application implemented in Ghana in 2010, sends timely messages in local languages to registered expectant mothers and new parents. The field of mobile health (mHealth is severely underresearched, yet it can be an alternative for improving health systems and the ways in which health services are delivered. Objective: Our goal was to investigate the role that Mobile Midwife technology has played in the lives of pregnant and nursing mothers in Awutu Senya District, Ghana. Design: A total of three focus group discussions and 19 individual interviews were conducted. Discussions and interviews were recorded, transcribed verbatim from the local language to English, and analyzed by means of qualitative content analysis at the manifest and latent levels. Results: The main findings show that while oscillating between modern and traditional practices, women gradually gained trust in Mobile Midwife's counselling and attempted to balance between myths and reality regarding nutrition in pregnancy. In addition, their decisions to seek essential obstetric care were enhanced by Mobile Midwife's advice. Women also felt strengthened in their understanding of the importance of seeking professional care during pregnancy and childbirth as well as recognizing signs of ill health in the newborn. Conclusions: The findings indicate that Mobile Midwife could be an excellent tool in working towards the improvement of maternal health. Mobile Midwife will hopefully contribute to the stepwise achievement of the Sustainable Development Goals extended from the Millennium Development Goals, which expire at the end of 2015. There is a need for strong political will from key stakeholders, to embark in the field of mHealth as a complementary means to strengthen health systems.
Full Text Available Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time. Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral. Conclusion. Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.
Full Text Available Background: Appropriate and timely care seeking reduces mortality for childhood illnesses including pneumonia. Despite over 90 000 Lady Health Workers (LHWs deployed in Pakistan, whose tasks included management of pneumonia, only 16% of care takers sought care from them for respiratory infections. As part of a community case management trial for childhood pneumonia, community mobilization interventions were implemented to improve care seeking from LHWs in Haripur district, Pakistan. The objective of the study was to increase the number of children receiving treatment for pneumonia and severe pneumonia by Lady Health Workers (LHWs through community mobilization approaches for prompt recognition and care seeking in 2 to 59 month–old children. Methods: To assess pneumonia care seeking practices, pre and post– intervention household surveys were conducted in 28 target Union Councils. Formative research to improve existing LHW training materials, job aids and other materials was carried out. Advocacy events were organized, LHWs and male health promoters were trained in community mobilization, non–functional women and male health committees were revitalized and LHWs and male health promoters conducted community awareness sessions. Results: The community mobilization interventions were implemented from April 2008 – December 2009. Project and LHW program staff organized 113 sensitization meetings for opinion leaders, which were attended by 2262 males and 3288 females. The 511 trained LHWs organized 6132 community awareness sessions attended by 50 056 women and 511 male promoters conducted 523 sessions attended by 7845 males. In one year period, the number of LHWs treating pneumonia increased from 11 in April 2008 to 505 in March 2009. The care seeking from LHWs for suspected pneumonia increased from 0.7% in pre–intervention survey to 49.2% in post–intervention survey. Conclusion: The increase in care seeking from LHWs benefited the community
Cherrington, Andrea L.; Agne, April A; Lampkin, Yolanda; Birl, Annie; Shelton, Tanya C.; Guzman,Alfredo; Willig, James H.
Community Health Worker (CHW) interventions can help improve diabetes self-management and health outcomes. There is limited evidence on how to effectively integrate CHW programs with primary care efforts. Mobile health technology (mHealth) can connect CHWs to members of the healthcare team and enhance care. We tested a model for the integration of a CHW delivered mHealth intervention to improve diabetes self-management. Seventy-two African American patients with diabetes were followed using t...
OBJECTIVE: In the Netherlands, an increasing number of emergency departments (EDs) and general practitioner cooperatives collaborate by creating one Emergency-Care-Access-Point (ECAP). This has resulted in fewer patients at ECAP EDs. The objective of this study was to explore differences in patient characteristics, presented complaints and ED discharge diagnoses between EDs with an ECAP and EDs without an ECAP. METHODS: A retrospective observational study was performed with 1800 consecutive p...
During the past decade, health care delivery has undergone enormous changes. The nationwide growth in managed care organizations and the changing methods of provider reimbursement are restructuring the entire health care system. Diversification and integration strategies have blurred historical separations between the activities of hospitals, nursing homes, physicians, and other providers. Services are being offered in and shifting to less costly settings, such as ambulatory clinics, work sites, and homes. Many factors have contributed to the increasing trend of health care delivery outside hospitals. This presentation will provide insight to the management and surveillance of infection prevention in these health care settings.
Brekke, Kurt R; Levaggi, Rosella; Siciliani, Luigi; Straume, Odd Rune
We study the effects of cross-border patient mobility on health care quality and welfare when income varies across and within regions. We use a Salop model with a high-, middle-, and low-income region. In each region, a policy maker chooses health care quality to maximise the utility of its residents when health care costs are financed by general income taxation. In equilibrium, regions with higher income offer better quality, which creates an incentive for patient mobility from lower- to higher-income regions. Assuming a prospective payment scheme based on DRG-pricing, we find that lower non-monetary (administrative) mobility costs have (i) no effect on quality or welfare in the high-income region; (ii) a negative effect on quality but a positive effect on welfare for the middle-income region; and (iii) ambiguous effects on quality and welfare for the low-income region. Lower monetary mobility costs (copayments) might reduce welfare in both the middle- and low-income region. Thus, health policies that stimulate cross-border patient mobility can be counterproductive when regions differ in income. Copyright Â© 2016 Elsevier B.V. All rights reserved.
Veloso, Isabela Silva Cancio; Araujo, Meiriele Tavares; Alves, Marília
The work of Mobile Emergency Medical Service (SAMU) involves the participation of several professionals that meet the demands of different levels of complexity in a huge geographic territory, with planning different of services with exclusively fixed structures. The aim of this study was to analyze the configuration of practices of power in the daily work of professionals of the SAMU. It was a qualitative case study which had been set in the SAMU of Belo Horizonte, Minas Gerais, Brazil. The sample was composed by 31 workers and data were collected using semi-structured interview and than submitted to discourse analysis. In the context of struggles and power relations in SAMU, stands out 'the power of zero vacancy' and the 'uniform bodies and images of power in the SAMU'. It was possible to observe that power in SAMU is present as social practice, with its centrality moving according to lived situations and to interests in question.
Full Text Available Background: Due to lack of training in emergency care, basic emergency care in India is still in its infancy. We designed All India Institute of Medical Sciences basic emergency care course (AIIMS BECC to address the issue. Aim: To improve the knowledge and skill of healthcare workers and laypersons in basic emergency care and to identify impact of the course. Materials and Methods: Prospective study conducted over a period of 4 years. The target groups were medical and nonmedical personnel. Provider AIIMS BECC is of 1 day duration including lectures on cardio-pulmonary resuscitation, choking, and special scenarios. Course was disseminated via lectures, audio-visual aids, and mannequin training. For analysis, the participants were categorized on the basis of their education and profession. A pre- and a post-course evaluation were done and individual scores were given out of 20 and compared among all the groups and P value was calculated. Results: A total of 1283 subjects were trained. 99.81% became providers and 2.0% were trained as instructors. There was a significant improvement in knowledge among all the participants irrespective of their education level including medicos/nonmedicos. However, participants who had higher education (graduates and postgraduates and/or belonged to medical field had better knowledge gain as compared to those who had low level of education (≤12th standard and were nonmedicos. Conclusion: BECC is an excellent community initiative to improve knowledge and skill of healthcare and laypersons in providing basic emergency care.
Full Text Available Abstract Background Emergency Medical Care is an important component of health care system. Unfortunately it is however, ignored in many low income countries. We assessed the availability and quality of facility-based emergency medical care in the government health care system at district level in a low income country – Pakistan. Methods We did a quantitative pilot study of a convenience sample of 22 rural and 20 urban health facilities in 2 districts – Faisalabad and Peshawar – in Pakistan. The study consisted of three separate cross-sectional assessments of selected community leaders, health care providers, and health care facilities. Three data collection instruments were created with input from existing models for facility assessment such as those used by the Joint Commission of Accreditation of Hospitals and the National Center for Health Statistics in USA and the Medical Research Council in Pakistan. Results The majority of respondents 43/44(98%, in community survey were not satisfied with the emergency care provided. Most participants 36/44(82% mentioned that they will not call an ambulance in health related emergency because it does not function properly in the government system. The expenses on emergency care for the last experience were reported to be less than 5,000 Pakistani Rupees (equivalent to US$ 83 for 19/29(66% respondents. Most health care providers 43/44(98% were of the opinion that their facilities were inadequately equipped to treat emergencies. The majority of facilities 31/42(74% had no budget allocated for emergency care. A review of medications and equipment available showed that many critical supplies needed in an emergency were not found in these facilities. Conclusion Assessment of emergency care should be part of health systems analysis in Pakistan. Multiple deficiencies in emergency care at the district level in Pakistan were noted in our study. Priority should be given to make emergency care responsive to
Pears, Katherine C.; Kim, Hyoun K.; Buchanan, Rohanna; Fisher, Philip A.
Few prospective studies have examined school mobility in children in foster care. This study described the school moves of 86 such children and 55 community comparison children (primarily Caucasian), living in a medium-sized metropolitan area in the Pacific Northwest who were approximately 3 to 6 years old at the study start. Additionally, the…
Chen, Hung-Ming; Liou, Yong-Zan
In a mobile health management system, mobile devices act as the application hosting devices for personal health records (PHRs) and the healthcare servers construct to exchange and analyze PHRs. One of the most popular PHR standards is continuity of care record (CCR). The CCR is expressed in XML formats. However, parsing is an expensive operation that can degrade XML processing performance. Hence, the objective of this study was to identify different operational and performance characteristics for those CCR parsing models including the XML DOM parser, the SAX parser, the PULL parser, and the JSON parser with regard to JSON data converted from XML-based CCR. Thus, developers can make sensible choices for their target PHR applications to parse CCRs when using mobile devices or servers with different system resources. Furthermore, the simulation experiments of four case studies are conducted to compare the parsing performance on Android mobile devices and the server with large quantities of CCR data.
Jensen, Tina Blegind; Agger Nielsen, Jeppe
Empirical evidence from a case study of the diffusion and adoption of mobile technology in a highly structured home care setting in Denmark shows how an organizational field vision of an efficient mobile technology was created and became transformed through diverse translation mechanisms...... the organizing vision for mobile technology in practice. Our findings show that an integration of the translation perspective not only furthers our understanding of the malleability of the organizing vision but also shows how actions at multiple levels interact to enable technology adoption and eventually...... institutionalization. Our study contributes to the increasing research on diffusion and adoption of mobile technologies within healthcare by challenging dominant single level analysis and factor-orientated approaches....
Mikkelsen, Søren; Lossius, Hans Morten; Toft, Palle
public health planning, we describe the workload of a prehospital anaesthesiologist-manned mobile emergency care unit (MECU) and the total population it services in terms of factors associated with mortality. PARTICIPANTS: The study is a register-based study investigating all missions carried out......OBJECTIVE: When planning and dimensioning an emergency medical system, knowledge of the population serviced is vital. The amount of literature concerning the prehospital population is sparse. In order to add to the current body of literature regarding prehospital treatment, thus aiding future....... PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures were number of missions and number of patient contacts. Secondary patient variables were mortality and association between mortality and age, sex, comorbidity, prior admission to hospital and response time. RESULTS: The MECU completed 41 513...
Since the development of percutaneous tracheostomy, the number of tracheostomy patients on hospital wards has increased. Problems associated with adequate tracheostomy care on the wards are well documented, particularly the management of tracheostomy-related emergencies. A survey was conducted among non-consultant hospital doctors (NCHDs) starting their Critical Care Medicine training rotation in a university affiliated teaching hospital to determine their basic knowledge and skills in dealing with tracheostomy emergencies. Trainees who had received specific tracheostomy training or who had previous experience of dealing with tracheostomy emergencies were more confident in dealing with such emergencies compared to trainees without such training or experience. Only a minority of trainees were aware of local hospital guidelines regarding tracheostomy care. Our results highlight the importance of increased awareness of tracheostomy emergencies and the importance of specific training for Anaesthesia and Critical Care Medicine trainees.
Hulya Sirzai; Beril Dogu; Selamet Demir; Figen Yilmaz; Banu Kuran
The aim of the study was to investigate the functional performance in children with spina biifda, using the Pediatric Evaluation of Disability Inventory (PEDI) to look into capacity of twen-ty-eight children with spina biifda with lesions at different levels in different dimensions of self-care, mobility and social function. Mean age of the patients was 3.5 ± 2.3 (1-10) years. In the muscle test carried out, 13 patients (44.8%) had no movements including pelvic elevation in lower extremity muscles and they were at level 5. Sixteen patients (54%) were non-ambulatory according to the Hoofer ambulation classiifcation. Raw and scale scores in the self-care, mobil-ity and social function domains both in the functional skill scale and in the caregiver scale were found to be lower compared to the data of the normal population. A statistically significant correlation was observed in the self-care values of the Functional Skills Scales and the Caregiver Assistance Scale measurements, which was positive for age and negative for Functional Ambu-lation Scale and muscle test (P< 0.05). A positive relation was found between the Functional Skills Scales-mobility area and age while a negative relation was observed between Functional Ambulation Scale and muscle test (P < 0.005). A negative relation was also found between Care-giver Assistance Scale-mobility and Functional Ambulation Scale and muscle test (P < 0.005). In our study, the functional performance of the children was found to be low. Low-level lesions, encouraging muscular strength and independence in mobility are all very important factors for functional independence.
Yang, Fangyu; Ji, Meihua; Ding, Shu; Wu, Ying; Chang, Polun; Lin, Chiawei; Yang, Xin
Delirium is a common complication among patients in ICU settings. Although it has been repeatedly confirmed that Confusion Assessment Model for Intensive Care Unit (CAM-ICU), one of the most commonly used ICU delirium assessment tool, is highly accurate in validation studies, it's sensitivity and specificity is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium and to test its reliability and validity both by research nurses and among ICU bedside nurses. The app was programmed with Java and installed on a mobile device with Android system. After completion of reliability and validity testing, the app will be integrated into the existing Hospital Information System in order to automatically retrieve essential information for risk factor identification and formulation of care plan accordingly to prevent or manage ICU delirium.
Jaekel, Camilla; Paar, Cheryl; Schiltz, Jenifer; Peterson, Rose
Injuries sustained from illicit drug use or alcohol intoxication are common in emergency departments. Ongoing assessments of psychosocial issues in trauma patients are imperative, even after the patient leaves the specialized area of the emergency department. Oftentimes, bedside nurses are ill prepared to identify the subtle clues of deeper psychosocial issues in complex patients such as trauma patients. This article focuses on the rationale for the development of a patient care standard to guide the bedside staff nurse in the care of the trauma patient. An example of a multiple trauma diagnosis-related patient care standard is presented.
Whether mHealth improves maternal and newborn health outcomes remains uncertain as the response is perhaps not true or false but lies somewhere in between when considering unintended harmful consequences. Fuzzy logic, a mathematical approach to computing, extends the traditional binary “true or false” (one or zero) to exemplify this notion of partial truths that lies between completely true and false. The commentary explores health, socio-ecological and environmental consequences–positive, neutral or negative. Of particular significance is the negative influence of mHealth on maternal care-behaviors, which can increase stress reactivity and vulnerability to stress-induced illness across the lifespan of the child and establish pathways for intergenerational transmission of behaviors. A mHealth “fingerprinting” approach is essential to monitor psychosocial, economic, cultural, environmental and physical impact of mHealth intervention and make evidence-informed decision(s) about use of mHealth in maternal and newborn care.
Full Text Available Whether mHealth improves maternal and newborn health outcomes remains uncertain as the response is perhaps not true or false but lies somewhere in between when considering unintended harmful consequences. Fuzzy logic, a mathematical approach to computing, extends the traditional binary “true or false” (one or zero to exemplify this notion of partial truths that lies between completely true and false. The commentary explores health, socio-ecological and environmental consequences–positive, neutral or negative. Of particular significance is the negative influence of mHealth on maternal care-behaviors, which can increase stress reactivity and vulnerability to stress-induced illness across the lifespan of the child and establish pathways for intergenerational transmission of behaviors. A mHealth “fingerprinting” approach is essential to monitor psychosocial, economic, cultural, environmental and physical impact of mHealth intervention and make evidence-informed decision(s about use of mHealth in maternal and newborn care.
Roca, Carlos P; Helbing, Dirk
Human wellbeing in modern societies relies on social cohesion, which can be characterized by high levels of cooperation and a large number of social ties. Both features, however, are frequently challenged by individual self-interest. In fact, the stability of social and economic systems can suddenly break down as the recent financial crisis and outbreaks of civil wars illustrate. To understand the conditions for the emergence and robustness of social cohesion, we simulate the creation of public goods among mobile agents, assuming that behavioral changes are determined by individual satisfaction. Specifically, we study a generalized win-stay-lose-shift learning model, which is only based on previous experience and rules out greenbeard effects that would allow individuals to guess future gains. The most noteworthy aspect of this model is that it promotes cooperation in social dilemma situations despite very low information requirements and without assuming imitation, a shadow of the future, reputation effects, signaling, or punishment. We find that moderate greediness favors social cohesion by a coevolution between cooperation and spatial organization, additionally showing that those cooperation-enforcing levels of greediness can be evolutionarily selected. However, a maladaptive trend of increasing greediness, although enhancing individuals' returns in the beginning, eventually causes cooperation and social relationships to fall apart. Our model is, therefore, expected to shed light on the long-standing problem of the emergence and stability of cooperative behavior.
Full Text Available Ware G Kuschner, Sunayana Reddy, Nidhi Mehrotra, Harman S PaintalDivision of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USAAbstract: Primary care providers should be aware of two new developments in nicotine addiction and smoking cessation: 1 the emergence of a novel nicotine delivery system known as the electronic (e- cigarette; and 2 new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as “thirdhand smoke”. The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS. The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room
Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.
Carpenter, Christopher R; Bromley, Marilyn; Caterino, Jeffrey M; Chun, Audrey; Gerson, Lowell W; Greenspan, Jason; Hwang, Ula; John, David P; Lyons, William L; Platts-Mills, Timothy F; Mortensen, Betty; Ragsdale, Luna; Rosenberg, Mark; Wilber, Scott
In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Pines, Jesse M
Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players.
Nolte, Christian Hans
This work reports on factors contributing to pre- and intrahospital delay in the emergency management of acute stroke patients. Further, data on level of knowledge on stroke risk factors, stroke signs and appropriate behaviour is reported.
Full Text Available Pastoral care takes different forms in responding to people’s needs in their context. Accordingly, over the centuries it has evolved in response to emerging needs. Historical developments in pastoral care are well-documented. However, pastoral care in Africa has a short and unsystematically documented history. Scholarly discussions on pastoral care concerning the continent tend to be considered under African theological frameworks. Notwithstanding the already existing weaknesses in African theological discussion, pastoral care in Africa has remained fragmented with diverse and seemingly knee-jerk approaches in guiding individuals who provide pastoral care. In view of this, this article firstly aims to provide a broad overview and initiate a discussion on the current challenges in pastoral care in Africa. Secondly, it aims to reveal some gaps worth pursuing by scholars in the discipline. Thirdly, it sheds some light on approaches employed by pastoral practitioners in pastoral ministry practice. In doing so, this article opens the lid on some perspectives adopted in ministry work on the frontlines, that is, providing pastoral care to people in their communities – particularly church communities. This article first outlines the problem to be addressed followed by an overview of pastoral care in Africa. It then proceeds to address potential research opportunities within the discipline. Finally, it highlights some emerging approaches in providing pastoral care in the communities. This article does not focus on one particular pastoral care issue, but gives an overview of the situation relative to pastoral care in Africa and the emerging responses.
simple movements of people, goods, and information from A to B. The ‘mobilities turn’ has made it its hallmark to explore the ‘more than’ effects of a world increasingly on the move. This new title in the Routledge Series ‘Critical Concepts in Built Environment’ creates a state-of-the-art reference work......The world is on the move. This is a widespread understanding by many inhabitants of contemporary society across the Globe. But what does it actually mean? During over one decade the ‘mobilities turn’ within the social sciences have provided a new set of insights into the repercussions of mobilities...... to social networks, personal identities, and our relationship to the built environment. The omnipresence of mobilities within everyday life, high politics, technology, and tourism (to mention but a few) all point to a key insight harnessed by the ‘mobilities turn’. Namely that mobilities is much more than...
Harcourt, Debra; McDonald, Clancy; Cartlidge-Gann, Leonie; Burke, John
Objective Frequent attendance by people to an emergency department (ED) is a global concern. A collaborative partnership between an ED and the primary and community healthcare sectors has the potential to improve care for the person who frequently attends the ED. The aims of the Working Together to Connect Care program are to decrease the number of presentations by providing focused community support and to integrate all healthcare services with the goal of achieving positive, patient-centred and directed outcomes.Methods A retrospective analysis of ED data for 2014 and 2015 was used to ascertain the characteristics of the potential program cohort. The definition used to identify a 'frequent attendee' was more than four presentations to an ED in 1 month. This analysis was used to develop the processes now known as the Working Together to Connect Care program. This program includes participant identification by applying the definition, flagging of potential participants in the ED IT system, case review and referral to community services by ED staff, case conferencing facilitated within the ED and individualised, patient centred case management provided by government and non-government community services.Results Two months after the date of commencement of the Working Together to Connect Care program there are 31 active participants in the program: 10 are on the Mental Health pathway, and one is on the No Consent pathway. On average there are three people recruited to the program every week. The establishment of a new program for supporting frequent attendees of an ED has had its challenges. Identifying systems that support people in their community has been an early positive outcome of this project.Conclusion It is expected that data regarding the number of ED presentations, potential fiscal savings and client outcomes will be available in 2017.What is known about the topic? Frequent attendance at EDs is a global issue and although the number of 'super users' is
Cancer care in the United States is being transformed by a number of medical and economic trends, including rising drug costs, increasing availability of targeted therapies and oral oncolytic agents, healthcare reform legislation, changing reimbursement practices, a growing emphasis on comparative effectiveness research (CER), the emerging role of accountable care organizations (ACOs), and the increased role of personalization of cancer care. To examine the attitudes of health plan payers and pharmacy benefit managers (PBMs) toward recent changes in cancer care, current cost-management strategies, and anticipated changes in oncology practice during the next 5 years. An online survey with approximately 200 questions was conducted by Reimbursement Intelligence in 2011. The survey was completed by 24 medical directors and 31 pharmacy directors from US national and regional health plans and 8 PBMs. All respondents are part of a proprietary panel of managed care decision makers and are members of the Pharmacy and Therapeutics Committees of their respective plans, which together manage more than 150 million lives. Survey respondents received an honorarium for completing the survey. The survey included quantitative and qualitative questions about recent developments in oncology management, such as the impact on their plans or PBMs of healthcare reform, quality improvement initiatives, changes in reimbursement and financial incentives, use of targeted and oral oncolytics, and personalized medicine. Respondents were treated as 1 group, because there were no evident differences in responses between medical and pharmacy directors or PBMs. Overall, survey respondents expressed interest in monitoring and controlling the costs of cancer therapy, and they anticipated increased use of specialty pharmacy for oncology drugs. When clinical outcomes are similar for oral oncolytics and injectable treatments, 93% prefer the oral agents, which are covered under the specialty tier by 59
Leroy, J E; Bensouda, C; Durand, E; Greffet, A; Scemama, A; Carli, P; Danchin, N; Sauval, P
More and more elderly people are hospitalised with myocardial infarction. Little is known on their pre-hospital management. In 2001 and 2002, 105 patients aged 80 years or more with suspected ST elevation infarction were managed by the mobile intensive care unit system of the SAMU de Paris-Necker. Diagnosis of infarction was confirmed in 92 (88%). Over 60% of the patients were women. Median time delay from symptom onset to call to the emergency service was 127 minutes, longer in nonagenarians (175 vs 101 minutes). Prehospital use of aspirin was 81% and 39% received an intravenous bolus of heparin. A reperfusion strategy was decided in only 30% (primary PCI: 23/26). One-month mortality was 21% and was related to older age, time when the call to the Samu was made, and absence of current smoking. Overall, the prehospital management of very elderly patients with suspected ST elevation infarction appears far from optimal.
Wolf, Lisa A; Delao, Altair M; Perhats, Cydne
Workplace violence has been recognized as a violent crime that requires targeted responses from employers, law enforcement, and the community. According to data from the Bureau of Labor Statistics, the most common source of nonfatal injuries and illnesses requiring days away from work in the health care and social assistance industry was assault on the health care worker. What is not well understood are the precursors and sequelae of violence perpetrated against emergency nurses and other health care workers by patients and visitors. The purpose of this study was to better understand the experience of emergency nurses who have been physically or verbally assaulted while providing patient care in US emergency departments. The study was conducted using a qualitative descriptive exploratory design. The sample consisted of 46 written narratives submitted by e-mail by emergency nurses describing the experience of violence while providing care at work. Narrative analysis and constant comparison were used to identify emerging themes in the narratives. "Environmental," "personal," and "cue recognition" were identified as the themes. Overall, nurses believed that violence was endemic to their workplace and that both limited recognition of cues indicating a high-risk person or environment and a culture of acceptance of violence were barriers to mitigation. These findings are consistent with the extant literature but with an added contribution of clearly identifying an underlying cultural acceptance of violence in the emergency department, as well as a distinct lack of cue recognition, in this sample of emergency nurses. Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.
Wichaidit, Wit; Alam, Mahbub-Ul; Halder, Amal K.; Unicomb, Leanne; Hamer, Davidson H.; Ram, Pavani K.
Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate,...
Walker, Anne F.
ACCESSIBILITY OF HOSPITAL EMERGENCY SERVICES HAS BEEN an issue of increasing concern and was recently brought into public focus in Ontario by the tragic death of Joshua Fleuelling, whose ambulance was redirected from the nearest hospital. As will be reviewed, the limited case law has identified a legal duty for physicians and hospitals to provide treatment to people in need of emergency care, a duty that should be considered when formulating hospital policies. The impact of this duty of care ...
Chun-Chuan Shih; Hsun-Hua Lee; Ta-Liang Chen; Chin-Chuan Tsai; Hsin-Long Lane; Wen-Ta Chiu; Chien-Chang Liao
Background. Little research exists on acupuncture treatment's effect on patients with traumatic brain injury (TBI). Methods. Using Taiwan's National Health Insurance Research Database, we conducted a cohort study to compare the use of emergency care and hospitalization in TBI patients with and without acupuncture treatment in the first year after TBI. The adjusted relative risks (RRs) and 95% confidence intervals (CIs) of high use of emergency care and hospitalization associated with acupunct...
Boyle Malcolm J
Full Text Available Abstract Background The Valsalva Manoeuvre (VM is a primary measure for terminating haemodynamically stable supraventricular tachycardia (SVT in the emergency care setting. The clinical use and termination success of the VM in the prehospital setting has not been investigated to date. The objective of this study was to determine Melbourne Mobile Intensive Care Ambulance (MICA Paramedic knowledge of the VM, and to compare this understanding with an evidence-based model of VM performance. Methods A cross-sectional study in the form of a face-to-face interview was used to determine Melbourne MICA Paramedic understanding of VM instruction between January and February, 2008. The results were then compared with an evidence-based model of VM performance to ascertain compliance with the three criteria of position, pressure and duration. Ethics approval was granted. Results There were 28 participants (60.9% who elected a form of supine posturing, some 23 participants (50% selected the syringe method of pressure generation, with 16 participants (34.8% selecting the "as long as you can" option for duration. On comparison, one out of 46 MICA Paramedics correctly identified the three evidence-based criteria. Conclusions The formal education of Melbourne's MICA Paramedics would benefit from the introduction of an evidence based model of VM performance, which would impact positively on patient care and may improve reversion success in the prehospital setting. The results of this study also demonstrate that an opportunity exists to promote the evidence-based VM criteria across the primary emergency care field.
Wilkin, Holley A; Tannebaum, Michael A; Cohen, Elizabeth L; Leslie, Travie; Williams, Nora; Haley, Leon L
Access to continuous care through a primary care provider is associated with improved health outcomes, but many communities rely on emergency departments (EDs) for both emergent and non-emergent health problems. This article describes one portion of a community-based participatory research project and investigates the type of education that might be needed as part of a larger intervention to encourage use of a local primary care clinic. In this article we examine how people who live in a low-income urban community and the healthcare workers who serve them conceptualize 'emergency medical condition'. We conducted forum and focus group discussions with 52 community members and individual interviews with 32 healthcare workers. Our findings indicate that while community members share a common general definition of what constitutes a medical emergency, they also desire better guidelines for how to assess health problems as requiring emergency versus primary care. Pain, uncertainty and anxiety tend to influence their choice to use EDs rather than availability of primary care. Implications for increasing primary care use are discussed.
To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care.
Schmidt, Catherine T; Ward, Rachel E; Suri, Pradeep; Kurlinski, Laura; Anderson, Dennis E; Kiely, Dan K; Bean, Jonathan F
Mobility problems are common among older adults. Symptomatic lumbar spinal stenosis (SLSS) is a major contributor to mobility limitations among older primary care patients. In comparison with older primary care patients with mobility problems but without SLSS, it is unclear how mobility problems differ in older primary care patients with SLSS. The purpose of this study was to compare health characteristics, neuromuscular attributes, and mobility status in a sample of older primary care patients with and without SLSS who were at risk for mobility decline. We hypothesized that patients with SLSS will manifest poorer health and greater severity of neuromuscular impairments and mobility limitations. This is a secondary analysis of the Boston Rehabilitative Study of the Elderly (Boston RISE). Fifty community-dwelling primary care patients aged 65 years or older at risk for mobility decline met inclusion criteria. SLSS was determined on the basis of computerized tomography (CT) scan and self-reported symptoms characteristic of neurogenic claudication. Outcome measures included health characteristics, neuromuscular attributes (trunk endurance, limb strength, limb speed, limb strength asymmetry, ankle range of motion [ROM], knee ROM, kyphosis, sensory loss), and mobility (Late-Life Function and Disability Instrument: basic and advanced lower extremity function subscales, 400-meter walk test, habitual gait speed, and Short Physical Performance Battery score). Health characteristics were collected at a baseline assessment. Neuromuscular attributes and mobility status were measured at the annual visit closest to conducting the CT scan. Five participants met criteria for having SLSS. Differences are reported in medians and interquartile ranges. Participants with SLSS reported more global pain, a greater number of comorbid conditions [SLSS: 7.0 (2.0) vs no-SLSS: 4.0 (2.0), P size and therefore inability to detect potential differences across additional measures of neuromuscular
Olthuis, G.J.; Prins, C.; Smits, M.J.A.; Pas, H. van de; Bierens, J.; Baart, A.
STUDY OBJECTIVE: A key to improving the quality of emergency care is improvement of the contact between patient and emergency department (ED) staff. We investigate what patients actually experience during their ED visit to better understand the patterns of relationships among patients and health
Söderholm, Hanna M.; Sonnenwald, Diane H.; Manning, James E.
We conducted an experiment with a posttest, between-subjects design to evaluate the potential of emerging 3D telepresence technology to support collaboration in emergency health care. 3D telepresence technology has the potential to provide richer visual information than do current 2D video confer......&T Published online 14 August 2008 in Wiley InterScience....
Belvis Esclapes, V M; Merenciano Cortina, F; Torrus Tendero, P; Mira Llinares, A
Urological emergencies, except those occurring in children, seen in a General Hospital were studied for one year. The retrospective study, both descriptive and comparative, conducted has allowed to know that there had been 3,244 emergencies (4.2% of total cases) though the urologist acted only in 1,410 (43.4%). A predominance of males (76.10%) in their sixth and seventh decade (33% of total) was seen. Presentation increased slightly (2%) above average during the summer months. 80.9% came to the Emergency Ward of their own accord and 70% were discharged soon after assistance. Nephritic colic (19.08%), haematuria (14.04%) and U.T.I. (13.83%) were the most common causes for presentation. A total of 284 patients (20.14%) required hospitalization. 96.6% were given medical and/or instrumental treatment, versus 3.4% (49) who underwent surgery basically due to testicular disease (34.69%), sepsis (24.50%), traumatic injury of male genitalia (20.3%), etc. The most frequent conditions were analyzed by age, sex, and seasonal distribution. Also, an analysis was made on the concept of "Urological Emergency" to evaluate incidence and types in our environment.
Harris, M S
A number of myths have prevented the development of a formal health care marketing strategy for the 100 million-plus racial and ethnic group members in the United States, despite their relatively greater need for health services. This market continues to grow in numbers, resources, and influence as the majority market level off. Marketers must look to minorities for new business, but traditional health care marketers have a long way to go before they are in a position to truly maximize this opportunity.
Rodin, Alexander; Shachak, Aviv; Miller, Aaron; Akopyan, Vladimir; Semenova, Nataliya
Mobile phone screens can facilitate stimulation to various components of the visual system and many mobile apps are accepted as a means of providing clinical assessments for the oculo-visual system. Although many of these apps are intended for use in clinical settings, there is a growing number of apps in eye care developed for self-tests and eye exercises for lay people. These and other features, however, have not yet been well described. Our objective was to identify, describe, and categorize mobile apps related to eye care that are available to users in the Canadian iTunes market. We conducted an extensive search of the Apple iTunes Store for apps related to eye care. We used the terms "eye," "eye care," "vision," and "eye test" and included apps that are targeted at both lay people and medical professionals. We excluded apps whose primary function is not related to eye care. Eligible apps were categorized by primary purpose, based on how they were described by their developers in the iTunes Store. Our search yielded 10,657 apps, of which 427 met our inclusion criteria. After removing duplicates, 355 unique apps were subject to further review. We assigned the eligible apps to three distinct categories: 39/355 apps (11.0%) were intended for use by medical professionals, 236 apps (66.5%, 236/355) were intended for use by lay people, and 80 apps (22.5%, 80/355) were intended for marketing eye care and eye-care products. We identified 9 subcategories of apps based on the descriptions of their primary functions. Apps for medical professionals fell into three subcategories: clinical calculators (n=6), clinical diagnostic tools (n=18), and education and networking apps for professionals (n=15). Apps for lay people fell into four subcategories: self-testing (n=153), eye exercises (n=30), patient tools and low vision aids (n=35), and apps for patient education (n=18). Mixed-use apps (n=80) were placed into two subcategories: marketing of individual practitioners or eye-care
Simpson, Catherine E; Sahetya, Sarina K; Bradsher, Robert W; Scholten, Eric L; Bain, William; Siddique, Shazia M; Hager, David N
An important, but not well characterized, population receiving intermediate care is that of medical patients admitted directly from the emergency department. To characterize emergency medical patients and their outcomes when admitted to an intermediate care unit with clearly defined admission guidelines. Demographic data, admitting diagnoses, illness severity, comorbid conditions, lengths of stay, and hospital mortality were characterized for all emergency medical patients admitted directly to an intermediate care unit from July through December 2012. A total of 317 unique patients were admitted (mean age, 54 [SD, 16] years). Most patients were admitted with respiratory (26.5%) or cardiac (17.0%) syndromes. The mean (SD) Acute Physiology and Chronic Health Evaluation score version II, Simplified Acute Physiology Score version II, and Charlson Comorbidity Index were 15.6 (6.5), 20.7 (11.8), and 2.7 (2.3), respectively. Severity of illness and length of stay were significantly different for patients who required intensive care within 24 hours of admission (n = 16) or later (n = 25), patients who continued with inter mediate care for more than 24 hours (n = 247), and patients who were downgraded or discharged in less than 24 hours (n = 29). Overall hospital mortality was 4.4% (14 deaths). Emergency medical patients with moderate severity of illness and comorbidity can be admitted to an intermediate level of care with relatively infrequent transfer to intensive care and relatively low mortality. ©2016 American Association of Critical-Care Nurses.
Santos, Y; Porto, F; Marques, L; Tomaz, A; Toledo, R; Lucena, N
Ergonomics is the study of a workplace and the worker. Its aim is to better adapt the workplace to man by preserving the body for short and long term work. This helps to adjust and improve functionality, thus preserving the body for short and long term work. It was through the observation of SAMU's (Mobile Emergency Unit) professional's helpers that the interest to evaluate these individuals arose. In addition, the aim of this research is to investigate the work ability of health professionals that work for SAMU/JP. The population was composed of 97 health professionals who currently work for SAMU/JP. A sociodemographic questionnaire was used as data collection instrument and it was validated by the index of the Work Ability (WAI). The research took place in 2010, in the headquarters of SAMU, in the city of João Pessoa, state of Paraíba - Brazil. The data analysis was carried out by simple descriptive statistics followed by comparison of the results with the pertinent literature. The quantity of daily sleeping hours, the levels of satisfaction in the job and the number of diagnosed diseases were among the most worrying factors. In spite of this, the health professionals obtained a work ability average considered to be "good".
Hilts, Linda; Howard, Michelle; Price, David; Risdon, Cathy; Agarwal, Gina; Childs, Anne
Approaches to improving the quality of health care recognize the need for systems and cultures that facilitate optimal care. Interpersonal relationships and dynamics are a key factor in transforming a system to one that can achieve quality. The Quality in Family Practice (QIFP) program encompasses clinical and practice management using a comprehensive tool of family practice indicators. The objective of this study was to explore and describe the views of staff regarding changes in the clinical practice environment at two affiliated academic primary care clinics (comprising one Family Health Team, FHT) who participated in QIFP. An FHT in Hamilton, Canada, worked through the quality tool in 2008/2009. A qualitative exploratory case study approach was employed to examine staff perceptions of the process of participating. Semi-structured interviews were conducted in early 2010 with 43 FHT staff with representation from physicians, nurses, allied health professionals, support staff and managers. Interviews were audio-taped and transcribed verbatim. A modified template approach was used for coding, with a complexity theory perspective of analysis. Themes included importance of leadership, changes to practice environment, changes to communication, an increased understanding of team roles and relationships, strengthened teamwork, flattening of hierarchy through empowerment, changes in clinical care and clinical impacts, challenges and rewards and sustainability. The program resulted in perceived changes to relationships, teamwork and morale. Addressing issues of leadership, role clarity, empowerment, flattening of hierarchy and teamwork may go a long way in establishing and maintaining a quality culture.
Megan J. Schlichte
Full Text Available Recalcitrant dermatitis, such as that of the hands, face, or genitals, may be due to allergic contact dermatitis (ACD from ingredients in seemingly innocuous personal care products. Rising rates of allergy have been noted due to the preservative methylisothiazolinone (MI. This preservative is commonly found in skin and hair care products, especially wipes. This study evaluated the use of MI in products specifically marketed for babies and children and examined the associated marketing terms of such products. Ingredients of skin care products specifically marketed for babies and children were surveyed at two major retailers. Of 152 products surveyed, 30 products contained MI. Categories of products surveyed included facial or body wipes, antibacterial hand wipes, hair products, soaps, bubble baths, moisturizers, and sunscreens. Facial or body wipes and hair products were the categories with the greatest number of MI-containing products. MI-containing products were manufactured by a number of popular brands. Of note, products marketed as “gentle,” “sensitive,” “organic,” or “hypoallergenic” often contained MI, thus emphasizing the importance of consumer scrutiny of product choices. These findings reinforce the importance of educating parents and providing consumer decision-making advice regarding common skin care products, in order to help prevent ACD in children.
Haynes, Sarah; Kim, Katherine K
There is global concern about healthcare cost, quality, and access as the prevalence of complex and chronic diseases, such as heart disease, continues to grow. Care for patients with complex chronic disease involves diverse practitioners and multiple transitions between medical centers, physician practices, clinics, community resources, and patient homes. There are few systems that provide the flexibility to manage these varied and complex interactions. Participatory and user-centered design methodology was applied to the first stage of building a mobile platform for care coordination for complex, chronic heart disease. Key informant interviews with patients, caregivers, clinicians, and care coordinators were conducted. Thematic analysis led to identification of priority user functions including shared care plan, medication management, symptom management, nutrition, physical activity, appointments, personal monitoring devices, and integration of data and workflow. Meaningful stakeholder engagement contributes to a person-centered system that enhances health and efficiency.
Quero, J M; Tarrida, C L; Santana, J J; Ermolov, V; Jantunen, I; Laine, H; Eichholz, J
This paper presents the MIMOSA architecture and development platform to create Ambient Intelligence applications. MIMOSA achieves this objective by developing a personal mobile-device centric architecture and open technology platform where microsystem technology is the key enabling technology for their realization due to its low-cost, low power consumption, and small size. This paper focuses the demonstration activities carried out in the field of health care. MIMOSA project is a European level initiative involving 15 enterprises and research institutions and universities.
Iglesias, M L; Lafuente, A
The aim of this article is to provide professionals in the hospital emergency departments with sufficient tools to face, according to the organisation and possibilities of each hospital, the admission of patients in the final days of life. It is primordial to provide a professional, technical and human environment based on concepts, attitudes and skills that make it possible to deal with the demands of comfort and the emotional and psycho-social requirements generated by these situations.
Fattore, Giovanni; Petrarca, Giuseppina; Torbica, Aleksandra
Patient flows across the regions of the Italian National Health Service can shed light on patient mobility, including cross-border flows within the European Union. We used 2009 data on 11,531 NHS admissions for aortic valve replacement operations to measure the extent of inter-regional patient mobility and to determine whether resident and non-resident patients differ. We also investigated whether public and private hospitals behave differently in terms of attracting patients. For this major cardio-surgical intervention, patient mobility in Italy is substantial (13.6% of total admissions). Such mobility mainly involves patients moving from southern to northern regions, which often requires several hundred kilometers of travel and a transfer of financial resources from poorer to richer regions. Patients admitted in the regions where they reside are older than those admitted outside their regions (69.2 versus 65.6, p<0.0001), and stay in hospital approximately 0.7 days longer (14.7 versus 14.0, p=0.017). Compared to public hospitals, private hospitals are more likely to admit non-resident patients (OR between 2.1 and 4.4). The extent and direction of patients' mobility raise equity concerns, as receiving care in locations that are distant from home requires substantial financial and relational resources.
Huseth-Zosel, Andrea L; Sanders, Gregory; O'Connor, Melissa; Fuller-Iglesias, Heather; Langley, Linda
The current study examined rural-urban differences in health care provider (HCP) perceptions, attitudes, and practices related to driving safety/cessation-related anticipatory guidance provision to older adults. A cross-sectional survey was conducted with HCPs in several north central states. Exploratory factor analysis was used to examine dimensions of HCP perceptions and attitudes related to mobility counseling. Binary logistic regression analyses were conducted to determine if HCP rurality was significantly predictive of HPC provision of mobility counseling by age. Rural HCPs were less likely than urban HCPs to provide mobility counseling to their patients aged 75 or older. Rural HCPs were less likely to refer patients to a driving fitness evaluation resource if they had questions related to driving issues, and were less likely to perceive there were adequate resources to help with driving issues. Rural-urban differences in HCP mobility counseling provision may contribute to potential health disparities between urban and rural patients. Both rural and urban HCPs need training about older driver issues, so they may educate their patients about driving safety/cessation. Future research should examine the association between rural-urban differences in HCP mobility counseling provision and rural older adult overrepresentation in motor vehicle injuries and fatalities statistics.
Selim, Heba Sayed
Full Text Available Aim: This study aimed at investigating the microbial contamination of mobile phones in a hospital setting. Methods: Swab samples were collected from 40 mobile phones of patients and health care workers at the Alexandria University Students’ Hospital. They were tested for their bacterial contamination at the microbiology laboratory of the High Institute of Public Health. Quantification of bacteria was performed using both surface spread and pour plate methods. Isolated bacterial agents were identified using standard microbiological methods. Methicillin-resistant was identified by disk diffusion method described by Bauer and Kirby. Isolated Gram-negative bacilli were tested for being extended spectrum beta lactamase producers using the double disk diffusion method according to the Clinical and Laboratory Standards Institute recommendations.Results: All of the tested mobile phones (100% were contaminated with either single or mixed bacterial agents. The most prevalent bacterial contaminants were methicillin-resistant and coagulase-negative staphylococci representing 53% and 50%, respectively. The mean bacterial count was 357 CFU/ml, while the median was 13 CFU/ml using the pour plate method. The corresponding figures were 2,192 and 1,720 organisms/phone using the surface spread method. Conclusions: Mobile phones usage in hospital settings poses a risk of transmission of a variety of bacterial agents including multidrug-resistant pathogens as methicillin-resistant . The surface spread method is an easy and useful tool for detection and estimation of bacterial contamination of mobile phones.
O'gara, Paula E; Fairhurst, Wendy
Therapeutic, patient-centred communication as well as being desirable in its own right may also have the potential to improve satisfaction, health outcomes and change health behaviours in Emergency Care. This paper, the second of two, identifies from a substantive literature review five specific communication strategies that, when employed in an Emergency Care consultation, could significantly enhance its therapeutic potential. The five strategies: questioning, listening and noticing, communicating empathy, establishing and incorporating the patient's cares and concerns and concluding the consultation have been derived from the purposeful selection and analysis of communication research between 1990 and 2002.
Mobile devices allow clinicians to access electronic clinical systems away from traditional base locations. They have contributed to increased productivity and efficiency, and clinical staff also cite benefits to patient care. A selection of NHS trusts have participated in a national pilot to explore the benefits and drawbacks of this technology. Clinical engagement with frontline staff is essential to ensure the staff feel valued, listened to, and fully involved to ensure any change to existing practice is successful. Moreover, the training needs of the workforce require careful consideration. The provision of information technology (IT) support services is fundamental to ensure that staff receive the necessary assistance with any functionality issues they may experience with mobile devices to minimise the effect on clinical practice. Variability in internet connectivity may present as a challenge to clinical staff, and the benefits of complimentary offline working solutions should be considered. Barriers to the successful use of mobile devices should be reported as this may have a negative clinical effect on the safe delivery of patient care. Clinical staff need to be mindful of their obligations in relation to information governance, and should appreciate that the same consideration needs to be given to both paper and electronic records.
Full Text Available ABSTRACT Objetive: to characterize the care services performed through risk rating by the Manchester Triage System, identifying demographics (age, gender, main flowcharts, discriminators and outcomes in pediatric emergency Method: cross-sectional quantitative study. Data on risk classification were obtained through a search of computerized registration data from medical records of patients treated in the pediatric emergency within one year. Descriptive statistics with absolute and relative frequencies was used for the analysis. Results: 10,921 visits were conducted in the pediatric emergency, mostly male (54.4%, aged between 29 days and two years (44.5%. There was a prevalence of the urgent risk category (43.6%. The main flowchart used in the care was worried parents (22.4% and the most prevalent discriminator was recent event (15.3%. The hospitalization outcome occurred in 10.4% of care performed in the pediatric emergency, however 61.8% of care needed to stay under observation and / or being under the health team care in the pediatric emergency. Conclusion: worried parents was the main flowchart used and recent events the most prevalent discriminator, comprising the hospitalization outcomes and permanency in observation in the pediatric emergency before discharge from the hospital.
Harmsen, Annelieke Maria Karien; Geeraedts, Leo Maria George; Giannakopoulos, Georgios Fredericus; Terra, Maartje; Christiaans, Herman Martinus Timotheus; Mokkink, Lidwine Brigitta; Bloemers, Frank Willem
In The Netherlands, standard prehospital trauma care is provided by emergency medical services and can be supplemented with advanced trauma care by Mobile Medical Teams. Due to observed over and undertriage in the dispatch of the Mobile Medical Team for major trauma patients, the accuracy of the dispatch criteria has been disputed. In order to obtain recommendations to invigorate the dispatch criteria, this study aimed at reaching consensus in expert opinion on the question; which acute trauma patient is in need of care by a Mobile Medical Team? In this paper we describe the protocol of the DENIM study (a Delphi-procedure on the identification of prehospital trauma patients in need of care by Mobile Medical Teams). A national three round digital Delphi study will be conducted to reach consensus. Literature was explored for relevant topics. After agreement on the themes of interest, the steering committee will construct questions for the first round. In total, 120 panellists with the following backgrounds; Mobile Medical Team physicians and nurses, trauma surgeons, ambulance nurses, emergency medical operators will be invited to participate. Group opinion will be fed back between each round that follows, allowing the panellists to revise their previous opinions and so, converge towards group consensus. Successful prehospital treatment of trauma patients greatly depends on the autonomous decisions made by the different professionals along the chain of prehospital trauma care. Trauma patients in need of care by the Mobile Medical Team need to be identified by those professionals in order to invigorate deployment criteria and improve trauma care. The Delphi technique is used because it allows for group consensus to be reached in a systematic and anonymous fashion amongst experts in the field of trauma care. The anonymous nature of the Delphi allows all experts to state their opinion whilst eliminating the bias of dominant and/or hierarchical individuals on group
Magomedova, S A; Edinarova, I E
The analysis is presented relating the organization of emergency medical care in the Republic of Dagestan. The analysis of official statistic data revealed that from 2005 and until the present time there is a sustained increase of resourcing to this form of service by the population both in the republic in general and in urban areas. The increase of appealability among urban population is significantly higher than in the republic. This characteristic trait can be explained by the fact that the rural areas of the Republic continue to significantly log behind in the provision with main types of medical services. According the official statistic data, in 2005 the difference in appealability between urban and rural areas consisted 133, in 2006 ? 128, in 2007 ? 115, in 2008 ? 102 per 1000 of population. In the structure of emergency calls from rural and urban population the cases of sudden diseases. The portion of emergency calls by chronic patients has a clear tendency to decrease both among rural and urban population. The mentioned trends need the adjustment of organization of emergency medical care in rural areas, including intensive development of material technical and manpower of rural substations of emergency medical care. It is timely to consider the issue of development in the Republic of Dagestan the twenty-four-hour integrated consultative control board of emergency medical care to advice by phone the medical emergency teams, the personnel of district hospitals and feldsher obsteritian stations and general practitioners.
Full Text Available Abstract Background The Homeland Security Act (HSA of 2002 provided for the designation of a critical infrastructure protection program. This ultimately led to the designation of emergency services as a targeted critical infrastructure. In the context of an evolving crisis in hospital-based emergency care, the extent to which federal funding has addressed disaster preparedness will be examined. Discussion After 9/11, federal plans, procedures and benchmarks were mandated to assure a unified, comprehensive disaster response, ranging from local to federal activation of resources. Nevertheless, insufficient federal funding has contributed to a long-standing counter-trend which has eroded emergency medical care. The causes are complex and multifactorial, but they have converged to present a severely overburdened system that regularly exceeds emergency capacity and capabilities. This constant acute overcrowding, felt in communities all across the country, indicates a nation at risk. Federal funding has not sufficiently prioritized the improvements necessary for an emergency care infrastructure that is critical for an all hazards response to disaster and terrorist emergencies. Summary Currently, the nation is unable to meet presidential preparedness mandates for emergency and disaster care. Federal funding strategies must therefore be re-prioritized and targeted in a way that reasonably and consistently follows need.
A number of new capital sources have been developed and used by health care institutions unable to finance high-tech projects with equity or conventional tax-exempt debt instruments; these include REITs, MLPs, per-use rentals, venture capital, and banks as brokers. However, there are no magic capital acquisition solutions. Institutions with good credit will continue to find a number of doors open to them; poorer credit risks will have fewer options, and those available will carry greater risk, allow for less provider control over projects, and limit potential return on investment to some extent. It is essential to examine carefully the drawbacks inherent in each type of alternative financing source. Venture capital in particular requires specific analysis because of the wide variety of possible arrangements that exist. If you cannot find either traditional or alternative sources of funding for a proposed project, you should reexamine the project and its underlying utilization projections and reimbursement assumptions.
S B Gangadhar
Full Text Available The number of day-care surgeries is increasing every day. The boundaries of day-care surgeries are being redefined on a continual basis. Multi-dimensional benefits to the patient, hospital and national economy are the driving forces behind the changing scenario on the horizon of day surgery. The literature search included Google, medlinx, pubmed and medline. We have attempted to look at the controversies in patient selection with comorbidities, pre-operative assessment and an acceptable ASA grade of patients. An attempt is also made to look at suitable surgical procedures, a pathway of introducing procedures, which are still complex and specialist procedures in challenging environment. The techniques of general anaesthesia, central neuraxial blocks, regional nerve blocks with indwelling catheters and monitoring techniques are deliberated upon. Finally the most important post-operative issues of discharge criteria, including recovery after spinal anaesthetic, oral fluid intake, voiding and travel after day surgery, are considered.
Liechty Edward A
Full Text Available Abstract Background Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. Methods/Design We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis and 28-day neonatal mortality. Discussion In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant
Franco, Yvonne E; De Lorenzo, Robert A; Salyer, Steven W
During the Second Iraq War (Operation Iraqi Freedom), high-intensity, low-utilization medical and surgical services, such as neurosurgical care, were consolidated into a centralized location within the combat zone. This arrangement necessitated intra-theater air medical evacuation of critically ill or injured patients from outlying combat support hospitals (CSH) to another combat zone facility having the needed services. A case series is presented of intratheater transfer of neurosurgical patients in Iraq during 2005-06. Ninety-eight patients are included in the series, with typical transfer distances of 40 miles (approximately 20-25 minutes of flight time). All patients were transported with a CSH nurse in addition to the standard Army EMT-B flight medic. Seventy-six percent of cases were battle injury, 17% were non-battle injuries, and the balance were classified as non-injury mechanisms. Seventy-six percent of cases were head injuries, with the balance involving burns, stroke, and other injuries. At 30 days, 12% of the patients had died, and 9% remained hospitalized in a critical care setting. None of the patients died during evacuation. Intratheater and interfacility transfer of critical care patients in the combat theater often involves severely head-injured and other neurosurgical cases. Current Army staffing for helicopter transport in these case requires a nurse or other advanced personnel to supplement the standard EMT-B flight medic. Copyright © 2012 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
Gribble Karleen D
Full Text Available Abstract Emergency management organisations recognise the vulnerability of infants in emergencies, even in developed countries. However, thus far, those who care for infants have not been provided with detailed information on what emergency preparedness entails. Emergency management authorities should provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants. Those who care for formula fed infants should be provided with detailed information on the supplies necessary for an emergency preparedness kit and with information on how to prepare formula feeds in an emergency. An emergency preparedness kit for exclusively breastfed infants should include 100 nappies and 200 nappy wipes. The contents of an emergency preparedness for formula fed infants will vary depending upon whether ready-to-use liquid infant formula or powdered infant formula is used. If ready-to-use liquid infant formula is used, an emergency kit should include: 56 serves of ready-to-use liquid infant formula, 84 L water, storage container, metal knife, small bowl, 56 feeding bottles and teats/cups, 56 zip-lock plastic bags, 220 paper towels, detergent, 120 antiseptic wipes, 100 nappies and 200 nappy wipes. If powdered infant formula is used, an emergency preparedness kit should include: two 900 g tins powdered infant formula, 170 L drinking water, storage container, large cooking pot with lid, kettle, gas stove, box of matches/lighter, 14 kg liquid petroleum gas, measuring container, metal knife, metal tongs, feeding cup, 300 large sheets paper towel, detergent, 100 nappies and 200 nappy wipes. Great care with regards hygiene should be taken in the preparation of formula feeds. Child protection organisations should ensure that foster carers responsible for infants have the resources necessary to formula feed in the
van der Wath, Annatjie; van Wyk, Neltjie; Janse van Rensburg, Elsie
To report a study of emergency nurses' experiences of caring for survivors of intimate partner violence. Emergency nurses have the opportunity to intervene during the period following exposure to intimate partner violence when survivors are most receptive for interventions. The confrontation with the trauma of intimate partner violence can, however, affect emergency nurses' ability to engage empathetically with survivors, which is fundamental to all interventions. The research was guided by the philosophical foundations of phenomenology as founded by Husserl. A descriptive phenomenological inquiry grounded in Husserlian philosophy was used. The phenomenological reductions were applied throughout data collection and analysis. During 2010, concrete descriptions were obtained from interviewing 11 nurses working in emergency units of two public hospitals in an urban setting in South Africa. To arrive at a description of the essence, the data were analysed by searching for the meaning given to the experience of caring for survivors of intimate partner violence. Emergency nurses in South Africa are often witnesses of the emotional and physical effects of intimate partner violence. Exposure to the vulnerability and suffering of survivors elicits sympathy and emotional distress. Emergency nurses are left with the emotional impact and disruptive and recurrent memories. Exploring the tacit internal experiences related to caring for survivors of intimate partner violence revealed emergency nurses' vulnerability to the effects of secondary traumatic stress. The findings generated an opportunity to develop guidelines through which to support and empower emergency nurses. © 2013 Blackwell Publishing Ltd.
Wang, Hsin-Hsiao S; Wiener, John S; Ross, Sherry S; Routh, Jonathan C
Individuals with spina bifida are typically followed closely as outpatients by multidisciplinary teams. However, emergent care of these patients is not well defined. We describe patterns of emergent care in patients with spina bifida and healthy controls. We reviewed Nationwide Emergency Department Sample data from 2006 to 2010. Subjects without spina bifida (controls) were selected from the sample using stratified random sampling and matched to each case by age, gender and treatment year at a 1:4 ratio. Missing emergency department charges were estimated by multiple imputation. Statistical analyses were performed to compare patterns of care among emergency department visits and charges. A total of 226,709 patients with spina bifida and 888,774 controls were identified. Mean age was 28.2 years, with 34.6% of patients being younger than 21. Patients with spina bifida were more likely than controls to have public insurance (63.7% vs 35.4%, p spina bifida seen emergently (OR 8.7, p spina bifida cases vs controls ($2,102 vs $1,650, p spina bifida presenting emergently are more likely to have urological or neurosurgical problems, to undergo urological or neurosurgical procedures, to be admitted from the emergency department and to incur higher associated charges. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Fernández-Sola, Cayetano; Cortés, María Mar Díaz; Hernández-Padilla, José Manuel; Torres, Cayetano José Aranda; Terrón, José María Muñoz; Granero-Molina, José
Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure. The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses. A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study. Participants and research context: This research was conducted in Spain in 2013-2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out. Ethical considerations: The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain). The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department. Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity. Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.
Full Text Available Background: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. Objectives: To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. Study Design: This is a cross-sectional descriptive study. Setting and Participants: The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. Statistical Analysis: Data was tabulated and analyzed using SPSS 12. Results: Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9% or related to economics (30.7%. A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems
Khan, Zulfia; Mehnaz, Saira; Khalique, Najam; Ansari, Mohd Athar; Siddiqui, Abdul Razzaque
Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA) is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. This is a cross-sectional descriptive study. The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs) already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. Data was tabulated and analyzed using SPSS 12. Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9%) or related to economics (30.7%). A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems. Barriers to utilization of available services leads to hazardous perinatal practices in urban slums.
Bassett, Rick; Adams, Kelly McCutcheon; Danesh, Valerie; Groat, Patricia M; Haugen, Angie; Kiewel, Angi; Small, Cora; Van-Leuven, Mark; Venus, Sam; Ely, E Wesley
Sedation management, delirium monitoring, and mobility programs have been addressed in evidence-based critical care guidelines and care bundles, yet implementation in the ICU remains variable. As critically ill patients occupy higher percentages of hospital beds in the United States and beyond, it is increasingly important to determine mechanisms to deliver better care. The Institute for Healthcare Improvement's Rethinking Critical Care (IHI-RCC) program was established to reduce harm of critically ill patients by decreasing sedation, increasing monitoring and management of delirium, and increasing patient mobility. Case studies of a convenience sample of five participating hospitals/health systems chosen in advance of the determination of their clinical outcomes are presented in terms of how they got started and process improvements in sedation management, delirium management, and mobility. The IHI-RCC program involved one live case study and five iterations of an in-person seminar in a 33-month period (March 2011-November 2013) that emphasized interdisciplinary teamwork and culture change. Qualitative descriptions of the changes tested at each of the five case study sites demonstrate improvements in teamwork, processes, and reliability of daily work. Improvement in ICU length of stay and length of stay on the ventilator between the pre- and postimplementation periods varied from slight to substantial. Changing critical care practices requires an interdisciplinary approach addressing cultural, psychological, and practical issues. The key lessons of the IHI-RCC program are as follows: the importance of testing changes on a small scale, feeding back data regularly and providing sufficient education, and building will through seeing the work in action.
Coffey, M. Justin; Coffey, C. Edward
The growth of new technologies in health care is exponential, and the impact of such rapid technological innovation on health care delivery is substantial. This review describes two emerging technologies—mobile applications and wearable technologies—and uses a virtual case report to illustrate the impact of currently available technologies on the health care experience of a patient with neuropsychiatric illness. PMID:27489452
Coffey, M Justin; Coffey, C Edward
The growth of new technologies in health care is exponential, and the impact of such rapid technological innovation on health care delivery is substantial. This review describes two emerging technologies-mobile applications and wearable technologies-and uses a virtual case report to illustrate the impact of currently available technologies on the health care experience of a patient with neuropsychiatric illness.
Agger Nielsen, Jeppe; Mathiassen, Lars
Background: Mobile technologies have emerged as important tools that health care personnel can use to gain easy access to client data anywhere. This is particularly useful for nurses and care workers in home health care as they provide services to clients in many different settings. Although...... a growing body of evidence supports the use of mobile technologies, the diverse implications of mobile health have yet to be fully documented. Objective: Our objective was to examine a large-scale government-sponsored mobile health implementation program in the Danish home care sector and to understand how......-sponsored program, mobile technology proved to have considerable interpretive flexibility with variation in perceived nature of technology, technology strategy, and technology use between agencies. What was first seen as a very promising innovation across the Danish home care sector subsequently became the topic...
Ohio State Dept. of Education, Columbus. Div. of Vocational Education.
This student manual, the third in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains one section covering the following topics: general anatomical terms, the body cavities and contents, the integumentary system, the skeletal system, the muscular system, the nervous system, the respiratory…
Ohio State Dept. of Education, Columbus. Div. of Vocational Education.
This student manual, the fifth in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains two sections covering the following course content; cardiopulmonary resuscitation (CPR) (including artificial ventilation, foreign body obstructions, adjunctive equipment and special techniques, artificial…
Wallace, Ian J; Garland, Theodore
Anthropologists accept that mobility is a critical dimension of human culture, one that links economy, technology, and social relations. Less often acknowledged is that mobility depends on complex and dynamic interactions between multiple levels of our biological organization, including anatomy, physiology, neurobiology, and genetics. Here, we describe a novel experimental approach to examining the biological foundations of mobility, using mice from a long-term artificial selection experiment for high levels of voluntary exercise on wheels. In this experiment, mice from selectively bred lines have evolved to run roughly three times as far per day as those from nonselected control lines. We consider three insights gleaned from this experiment as foundational principles for the study of mobility from the perspective of biological evolution. First, an evolutionary change in mobility will necessarily be associated with alterations in biological traits both directly and indirectly connected to mobility. Second, changing mobility will result in trade-offs and constraints among some of the affected traits. Third, multiple solutions exist to altering mobility, so that various combinations of adjustments to traits linked with mobility can achieve the same overall behavioral outcome. We suggest that anthropological knowledge of variation in human mobility might be improved by greater research attention to its biological dimensions.
Blood gas analysis is an integral part of the assessment of emergency department (ED) patients with acute respiratory or metabolic disease. Traditionally ABG analyses have been used, but increasingly, emergency clinicians are using venous blood gas (VBG) analyses. This has been challenged, especially by respiratory physicians, as being too inaccurate. This clinical review, using case examples, summarises the evidence supporting use of VBG to guide management decisions. Arteriovenous agreement for pH is such that values are clinically interchangeable and agreement for bicarbonate is also close. Agreement for pCO2 is poor with 95% limits of agreement of the order of 20 mm Hg (2.67 kPa); however, there is solid evidence that a venous pCO2 ≤45 mm Hg (6 kPa) reliably excludes clinically significant hypercarbia. Evidence regarding arteriovenous agreement for base excess is unclear. Given knowledge of the performance characteristics of VBG analyses, integration of the clinical findings with VBG results is often sufficient to safely guide treatment decision making.
Conclusion: Due to an absence of published literature in Sudan, much of the data have been recorded from paper records and empirical observations. Prehospital care and injury prevention in the Sudan is a recent initiative, but it is developing into a promising model with many opportunities for improvement. This momentum should be nurtured and requires a purposive, collective collaboration to draw a blueprint for a locally relevant, effective and efficient prehospital system in Sudan. It is hoped that this article will highlight and encourage further progress.
Corpman, David W
There are nearly 1 billion mobile phone subscribers in China. Health care providers, telecommunications companies, technology firms, and Chinese governmental organizations use existing mobile technology and social networks to improve patient-provider communication, promote health education and awareness, add efficiency to administrative practices, and enhance public health campaigns. This review of mobile health in China summarizes existing clinical research and public health text messaging campaigns while highlighting potential future areas of research and program implementation. Databases and search engines served as the primary means of gathering relevant resources. Included material largely consists of scientific articles and official reports that met predefined inclusion criteria. This review includes 10 reports of controlled studies that assessed the use of mobile technology in health care settings and 17 official reports of public health awareness campaigns that used text messaging. All source material was published between 2006 and 2011. The controlled studies suggested that mobile technology interventions significantly improved an array of health care outcomes. However, additional efforts are needed to refine mobile health research and better understand the applicability of mobile technology in China's health care settings. A vast potential exists for the expansion of mobile health in China, especially as costs decrease and increasingly sophisticated technology becomes more widespread.
Medhanyie, Araya Abrha; Moser, Albine; Spigt, Mark; Yebyo, Henock; Little, Alex; Dinant, GeertJan; Blanco, Roman
Feasibility assessment of mobile health (mHealth) data collection at primary health care in Ethiopia. A total of 14 health workers were recruited from 12 primary health care facilities to use smartphones, installed with customized data collection application and electronic maternal health care forms for assessing pregnant women's health for 6 months. Qualitative approaches comprising in-depth interviews and field notes were used to document the users' perception and experience in using the application and forms. All health workers had never had previous exposure to smartphones and electronic forms, but they got used to them easily. Over 6 months, all health workers completed a total of 952 patient records using the forms on smartphones. Health workers' acceptability and demand for the application and forms were high. In introducing the application, nontechnical challenges were more difficult to solve than technical challenges. Introducing an mHealth application at primary health care for routine collection of health data relevant to maternal health at a small scale was feasible. Nonetheless, implementing a system of assigning unique and consistent patient identifier, standardization of health services, and improving mobile network coverage would be prerequisites for scaled-up usage of such an application. Copyright © 2015 Elsevier Inc. All rights reserved.
Ademola P. Abidoye
Full Text Available The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel. Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hospital. With the implementation of electronic patient records and the Internet and Intranets, medical information sharing amongst relevant health-care providers was made possible. But the vital issue in this method of information sharing is security: the patient’s privacy, as well as the confidentiality and integrity of the health-care information system, should not be compromised. We examine various ways of ensuring the security and privacy of a patient’s electronic medical information in order to ensure the integrity and confidentiality of the information.
Schoenenberger, Andreas W; Exadaktylos, Aristomenis K
In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the activities of daily living, disability, poly-pharmacy, adverse drug effects, co-morbidity and atypical presentation. We also propose steps to further improve the quality of care in older ED patients by using appropriate age-centred management.
Full Text Available Background: Nowadays, disaster preparedness and responses are essential for everyone to be involved since the disaster becomes increasing. The Community Health Volunteers (CHVs in particular are the key partners required adequately prepared in emergency care during disaster event. Purpose: The study aims to examine the essential knowledge and skills of emergency care during natural disaster for CHVs. Method: The reviews published during 2000 and 2011 searching from PubMed, Science Direct, CINAHL, ProQuest Medical Library were conducted. Result: Twenty-four articles and documents related to community-based disaster preparedness programs were intensively reviewed. Based on the review, six components of knowledge and skills for emergency care in natural disaster for CHVs are required including 1 early warning, 2 disaster triage, 3 first aid, 4 search and rescue, 5 logistic and communication, and 6 team organizations. Conclusion: There was a few studies focusing on the emergency care in disaster management and some factors related to knowledge and skills were shown. It is therefore recommended that the current CHVs’ knowledge and skills should be explored in order to assist people in their community following disaster event when professional responders are not immediately available to help. Key words: Knowledge, Skill, Community health volunteers, Emergency care, Natural disaster.
Full Text Available Background. Little research exists on acupuncture treatment’s effect on patients with traumatic brain injury (TBI. Methods. Using Taiwan’s National Health Insurance Research Database, we conducted a cohort study to compare the use of emergency care and hospitalization in TBI patients with and without acupuncture treatment in the first year after TBI. The adjusted relative risks (RRs and 95% confidence intervals (CIs of high use of emergency care and hospitalization associated with acupuncture treatment were calculated in multivariate Poisson regression models with generalized estimating equation. Results. The means of medical visits of emergency care and hospitalization were lower in TBI patients with acupuncture treatment than in those without acupuncture treatment. After adjustment, acupuncture treatment was associated with decreased risk of high emergency care visits (beta = −0.0611, P=0.0452 and hospitalization (beta = −0.0989, P<0.0001. The RRs of high medical visits and expenditure for hospitalization associated with acupuncture treatment were 0.62 (95% CI = 0.50–0.76 and 0.66 (95% CI = 0.53–0.83, respectively. Conclusion. Patients with TBI who receive acupuncture treatment have reduced the use of emergency care and hospitalization in the first year after injury. The mechanisms of effects of acupuncture on TBI warrant further investigations.
Hickey, T; Dean, K; Holstein, B E
people to describe a wide range of personal health behaviors encompassing lay care, self-help, enlightened consumerism, and various preventive measures as antidotes to the impairments of old age. This paper reports some of the outcomes of an international project which reviewed geriatric self......-care in different countries and health care systems. Various influences on the evolution of interest in geriatric self-care were identified including: similarities and differences in health care systems: demographic changes; cohort differences; the emergence of professionals with specialized training in geriatric...... health care; and, the salience of biomedical models in addressing the health problems of aging. The role of professionals, especially those trained in geriatrics, is examined with an acknowledgment of the importance of a self-care strategy that is independent of professional dominance.(ABSTRACT TRUNCATED...
Full Text Available Simon Cooper1, Ruth Endacott2, Robyn Cant11School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill, Victoria, Australia; 2School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth UKAim: To review the literature on non-technical skills and assessment methods relevant to emergency care.Background: Non-technical skills (NTS include leadership, teamwork, decision making and situation awareness, all of which have an impact on healthcare outcomes. Significant concerns have been raised about the rates of adverse medical events, many of which are attributed to NTS failures.Methods: Ovid, Medline, ProQUEST, PsycINFO and specialty websites were searched for NTS measures using applicable access strategies, inclusion and exclusion criteria. Publications identified were assessed for relevance.Results: A range of non-technical skill measures relevant to emergency care was identified: leadership (n = 5, teamwork (n = 7, personality/behavior (n = 3 and situation awareness tools (n = 1. Of these, 9 have been used with emergency care populations/clinicians. All had varying degrees of reliability and validity. In the last decade there has been some development of teamwork measures specific to emergency care with a predominantly global and collective rating of broad skills.Conclusion: A variety of non-technical skill measures are available; only a few have been used in the emergency care arena. There is a need for an increase in the focused assessment of teamwork skills for a greater understanding of team performance to enhance patient safety in medical emergency care.Keywords: non-technical skills, teamwork, medical emergency, standards
Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thumé, Elaine; Thomaz, Erika Bárbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto
Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access
Nada Hassan A. A-Rahman
Full Text Available Sudan is one of the largest African countries, covering an area of 1.9 million km2—approximately one fifth of the geographic area of the United States. The population is 30 million people, the majority of whom (68% live in rural areas, as compared with the sub-Saharan African average of approximately 62%. Sudan is considered a lower-middle income country—with 47% of the population living below the poverty line and a gross domestic product (GDP of US $62 billion in 2010. In addition to excessive burden of communicable diseases such as malaria, tuberculosis, and schistosomiasis, Sudan is particularly susceptible to both natural and manmade disasters. Drought and flood are quite common due to Sudan’s proximity to and dependency on the Nile, and throughout history Sudan has also been plagued with internal conflicts and outbreaks of violence, which bring about a burden of traumatic disease and demand high quality emergency care. The purpose of this paper is to describe the state of emergency care and Emergency Medicine education, and their context within the Sudanese health care system. As is the case in most African countries, emergency care is delivered by junior staff: new graduates from medical schools and unsupervised medical officers who handle all types of case presentations. In 2001, increased mortality and morbidity among unsorted patients prompted the Ministry of Health to introduce a new triage-based emergency care system. In late 2005, twenty-one Emergency physicians delivered these new Emergency Services. In 2011, following a curriculum workshop in November 2010, the Emergency Medicine residency program was started in Khartoum. Currently there are 27 rotating registrars, the first class of whom is expected to graduate in 2015.
Palmier-Claus Jasper E
Full Text Available Abstract Background Over the past decade policy makers have emphasised the importance of healthcare technology in the management of long-term conditions. Mobile-phone based assessment may be one method of facilitating clinically- and cost-effective intervention, and increasing the autonomy and independence of service users. Recently, text-message and smartphone interfaces have been developed for the real-time assessment of symptoms in individuals with schizophrenia. Little is currently understood about patients’ perceptions of these systems, and how they might be implemented into their everyday routine and clinical care. Method 24 community based individuals with non-affective psychosis completed a randomised repeated-measure cross-over design study, where they filled in self-report questions about their symptoms via text-messages on their own phone, or via a purpose designed software application for Android smartphones, for six days. Qualitative interviews were conducted in order to explore participants’ perceptions and experiences of the devices, and thematic analysis was used to analyse the data. Results Three themes emerged from the data: i the appeal of usability and familiarity, ii acceptability, validity and integration into domestic routines, and iii perceived impact on clinical care. Although participants generally found the technology non-stigmatising and well integrated into their everyday activities, the repetitiveness of the questions was identified as a likely barrier to long-term adoption. Potential benefits to the quality of care received were seen in terms of assisting clinicians, faster and more efficient data exchange, and aiding patient-clinician communication. However, patients often failed to see the relevance of the systems to their personal situations, and emphasised the threat to the person centred element of their care. Conclusions The feedback presented in this paper suggests that patients are conscious of the
Rafman, Heidi; Lim, Siang Ngin; Quek, Swee Chye; Mahadevan, Malcolm; Lim, Chanelle; Lim, Aymeric
Delayed access to specialist care for emergency patients is associated with increased risk of morbidity and mortality, and increased patient anxiety. (1) To provide timelier access to inpatient and urgent outpatient specialist care for emergency patients. (2) To influence multiple stakeholders to modify their traditional practices and sustain changes. National University Hospital of Singapore, an academic medical centre with 997 beds in Singapore and over 34 sub-specialties. A set of six interventions was implemented to meet three goals: (1) provide timely access to urgent outpatient specialist care requested by the emergency department ED; (2) increase early inpatient discharges (in order to better match timing of emergency admissions); and (3) provide earlier defined care by inpatient specialists at the ED. An eight-step organisational change management plan was implemented to ensure all specialties complied with the changes. The goals were achieved. (1) Specialist outpatient appointments given within the timeframe requested by the ED doctor increased from 51.7% to 80.8%. (2) Early discharges increased from 11.9% to 26.6% and were sustained at 27.2%. (3) 84% of eligible patients received earlier defined specialist care at the ED. The change management achieved excellent clinician compliance rates ranging from 84% to 100%. However the median wait for admission remained unchanged. The interventions reduced the time for ED patients to access specialist outpatient and inpatient care. The systematic organisational change management approach resulted in sustained compliance.
Wastell, David; White, Sue
Existing information technology systems in much of UK social care have been designed to serve the interests of the bureaucracy rather than supporting professional practice or improving services to the public. The ill-starred Integrated Children's System in statutory children's services is typical. The Integrated Children's System is a system for form-filling, micro-managing professional practice through an enforced regime of standard processes and time scales. In this article, we argue against this dominant design. We provide several examples where technology has enabled alternative modes of support for professional work, based on socio-technical principles. One such system is Patchwork, which describes itself as a 'Facebook for Social Work'; its aim is to support multi-professional teams working with vulnerable families. © The Author(s) 2013.
Luxton, David D; Hansen, Ryan N; Stanfill, Katherine
We calculated the cost of providing stress reduction care with a mobile phone app (Breathe2Relax) in comparison with normal in-person care, the standard method for managing stress in military and civilian populations. We conducted a cost-minimization analysis. The total cost to the military healthcare system of treating 1000 patients with the app was $106,397. Treating 1000 patients with in-office care cost $68,820. Treatment using the app became less expensive than in-office treatment at approximately 1600 users. From the perspective of the civilian healthcare system, treatment using the app became less expensive than in-office treatment at approximately 1500 users. An online tool was used to obtain data about the number of app downloads and usage sessions. A total of 47,000 users had accessed the app for 10-30 min sessions in the 2.5 years since the release of the app. Assuming that all 47,000 users were military beneficiaries, the savings to the military healthcare system would be $2.7 million; if the 47,000 users were civilian, the savings to the civilian healthcare system would be $2.9 million. Because of the large number of potential users, the total societal savings resulting from self-care using the app may be considerable.
Jensen, Ole B.
In recent years, urban research has taken a ‘mobilities turn’. There has been a developing realisation that mobilities do not ‘just happen.’ Mobilities are carefully and meticulously designed, planned and staged (from above). However, they are equally importantly acted out, performed and lived...... as people are ‘staging themselves’ (from below). Staging mobilities is a dynamic process between ‘being staged’ (for example, being stopped at traffic lights) and the ‘mobile staging’ of interacting individuals (negotiating a passage on the pavement). Staging mobilities is about the fact that mobility...... asks: what are the physical, social, technical, and cultural conditions to the staging of contemporary urban mobilities? The theoretical framing in the Staging mobilities book is applied to four in-depth cases in the accompanying volume Designing mobilities.This book explore how places, sites...
Rashid, Leeda; Afzali, Edris; Donaldson, Ross; Lazar, Paul; Bundesmann, Raghnild; Rashid, Samra
Afghanistan has struggled with several decades of well-documented conflict, increasing the importance of providing emergency services to its citizens. However, little is known about the country's capacity to provide such care. Three native-speaking Afghan-American physicians performed an assessment of emergency care via combined quantitative and qualitative survey tools. Hospitals in Kabul, Afghanistan were selected based on probability proportional to size methodology, in which size was derived from prior work in the country and permission granted by the administering agency and the Ministry of Health. A written survey was given to physicians and nurses, followed by structured focus groups, and multiple days of observation per facility. A descriptive analysis was performed and data analyzed through a combination of variables in eight overarching categories relevant to emergency care. One hundred twenty-five surveys were completed from 9 hospitals. One third of respondents (32.8 %) worked full time in the emergency departments, with another 28.8 % working there at least three quarters of the time. Over 63 % of providers believed that the greatest delay for care in emergencies was in the prehospital setting. Differences were noted among the various types of facilities when looking at specific components of emergency care such as skill level of workers, frequencies of assaults in the hospitals, and other domains of service provision. Sum of squares between the different facility types were highest for areas of skill (SS = 210.3; p = .001), confidence in the system (SS = 156.5; p < .005), assault (SS = 487.6; p < .005), and feeling safe in the emergency departments (SS = 193.1, p < .005). Confidence negatively correlated to frequency of assaults (Pearson r = -.33; p < .005) but positively correlated with feeling safe (Pearson r = .51; p < .005) and reliability of equipment (Pearson r = .48; p < .005). The only correlation for access to services was prehospital care
Full Text Available Objectives: Urinary tract infection (UTI as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. Materials and Methods: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. Results: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4% emerged as the predominant pathogen causing nosocomial UTI. Conclusion: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.
Vester-Andersen, M; Lundstrøm, Lars Hyldborg; Møller, M H
operation in the standard ward, with a 30 day mortality of 14.3%, and 4.8% were admitted to the intensive care unit (ICU) after a median stay of 2 days (inter-quartile range: 1-6). When compared with 'admission to standard ward', 'admission to standard ward before ICU admission' and 'ICU admission after......BACKGROUND: Emergency major gastrointestinal (GI) surgery carries a considerable risk of mortality and postoperative complications. Effective management of complications and appropriate organization of postoperative care may improve outcome. The importance of the latter is poorly described...... in emergency GI surgical patients. We aimed to present mortality data and evaluate the postoperative care pathways used after emergency GI surgery. METHODS: A population-based cohort study with prospectively collected data from six Capital Region hospitals in Denmark. We included 2904 patients undergoing major...
This paper examines the current mobile vocabulary learning practice to discover how far mobile devices are being used to support vocabulary learning. An activity-centered perspective is undertaken, with the consideration of new practice against existing theories of learning activities including behaviorist activities, constructivist activities,…
istic and romantic emotionalism that typifies this genre. Longino, James C., et al. “A Study of World War Procurement and Industrial Mobilization...States. Harrisburg, PA: Military Service Publishing Co., 1941. CARL 355.22 J72b. Written in rough prose , this World War II era document explains the
Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public’s health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite
Lane-Fall, Meghan B; Miano, Todd A; Aysola, Jaya; Augoustides, John G T
Diversity in the physician workforce is essential to providing culturally effective care. In critical care, despite the high stakes and frequency with which cultural concerns arise, it is unknown whether physician diversity reflects that of critically ill patients. We sought to characterize demographic trends in critical care fellows, who represent the emerging intensivist workforce. We used published data to create logistic regression models comparing annual trends in the representation of women and racial/ethnic groups across critical care fellowship types. United States Accreditation Council on Graduate Medical Education-approved residency and fellowship training programs. Residents and fellows employed by Accreditation Council on Graduate Medical Education-accredited training programs from 2004 to 2014. None. From 2004 to 2014, the number of critical care fellows increased annually, up 54.1% from 1,606 in 2004-2005 to 2,475 in 2013-2014. The proportion of female critical care fellows increased from 29.5% (2004-2005) to 38.3% (2013-2014) (p workforce reflect underrepresentation of women and racial/ethnic minorities. Trends highlight increases in women and Hispanics and stable or decreasing representation of non-Hispanic underrepresented minority critical care fellows. Further research is needed to elucidate the reasons underlying persistent underrepresentation of racial and ethnic minorities in critical care fellowship programs.
Beckers, Stefan K; Timmermann, Arnd; Müller, Michael P; Angstwurm, Matthias; Walcher, Felix
Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21); problem-based learning at 29% (n = 10), e-learning at 3% (n = 1), and internship in ambulance service is mandatory at 11% (n = 4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n = 31), partially supplemented by open questions (31%, n = 11). Some faculties also perform single practical tests (43%, n = 15), objective structured clinical examination (OSCE; 29%, n = 10) or oral examinations (17%, n = 6). Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education in emergency medical care.
Wolf, Lisa A; Delao, Altair M; Perhats, Cydne; Moon, Michael D; Carman, Margaret J
Little information has been published regarding the actual practice, training, and validation of basic skills and competencies needed by the advanced practice registered nurse (APRN) in the emergency care setting. The purpose of this study was to (1) identify skills being performed by APRNs practicing in emergency care settings (2); explore types of training; and (3) describe competency validation. Additionally, we explored frequency of skill use and facilitators and barriers to performing a skill to the full extent of training and education. An exploratory mixed-methods study was performed incorporating a self-report survey and focus group interviews. The educational path to advanced practice nursing in emergency care settings is not standardized. Few programs incorporate or address the need for APRNs to receive acute care training across the life span, which is the hallmark of emergency nursing practice. Similarly, training is reported as fragmented, and validation of skills for both nurse practitioners and clinical nurse specialists can vary. APRN practice autonomy is affected by the presence of other providers (specifically physicians), institutional culture, and state boards of nursing that regulate practice. Integrated educational and orientation programs are needed that address high-acuity patients across the life span. Additionally, a more nuanced approach to assessing APRN capabilities as a combination of hard (clinical emergency) and soft (communication and organizational) skills may be an appropriate framework within which to examine the advanced practice role. Future research should continue to evaluate training, competency assessment, and outcomes for APRNs in the emergency care setting. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Full Text Available Abstract Background Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Methods Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Results Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21; problem-based learning at 29% (n = 10, e-learning at 3% (n = 1, and internship in ambulance service is mandatory at 11% (n = 4. In terms of assessment methods, multiple-choice exams (15 to 70 questions are favoured (89%, n = 31, partially supplemented by open questions (31%, n = 11. Some faculties also perform single practical tests (43%, n = 15, objective structured clinical examination (OSCE; 29%, n = 10 or oral examinations (17%, n = 6. Conclusion Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard
Chun, Seung-Man; Park, Jong-Tae
In m-healthcare service, accurate detection and notification of emergency situation are critical to chronic patients' life. Since they are usually performed by a limited number of medical staff, it is difficult to simultaneously support many patients in real-time. This article presents an architecture to support the emergency bio-data management for m-healthcare service using personalized emergency policy. The salient feature of the proposed architecture is that the decision on emergency is made using personalized emergency policy. Specifically, the structure of the detailed system components has also been designed. The emergency condition of the individual bio-data collected from wireless body area network is detected automatically using personalized emergency policy. The message flow diagram based on the personalized emergency policy is described. This enables quick emergency rescue service provided to the patient both accurately and immediately. The prototype of proposed system has been built to demonstrate the design concept.
Full Text Available In m-healthcare service, accurate detection and notification of emergency situation are critical to chronic patients' life. Since they are usually performed by a limited number of medical staff, it is difficult to simultaneously support many patients in real-time. This article presents an architecture to support the emergency bio-data management for m-healthcare service using personalized emergency policy. The salient feature of the proposed architecture is that the decision on emergency is made using personalized emergency policy. Specifically, the structure of the detailed system components has also been designed. The emergency condition of the individual bio-data collected from wireless body area network is detected automatically using personalized emergency policy. The message flow diagram based on the personalized emergency policy is described. This enables quick emergency rescue service provided to the patient both accurately and immediately. The prototype of proposed system has been built to demonstrate the design concept.
Full Text Available Abstract Background Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital. Methods From weekend admissions a group of 30 women treated for different acute obstetric conditions including five main diagnostic groups: hemorrhage, hypertensive disorders, dystocia, sepsis and anemia were purposively selected. In-depth interviews with the women were carried out at their homes within two weeks of discharge. Results Substantial difficulties in obtaining emergency obstetric care were uncovered. Health system inadequacies including lack of blood for transfusion, shortage of essential medicines especially antihypertensive drugs considerably hindered timely and adequate treatment for obstetric emergencies. Such inadequacies also inflated the treatment costs to between 5 and 18 times more than standard fees. Blood transfusion and hypertensive treatment were associated with the largest costs. Conclusion The deficiencies in the availability of life-saving interventions identified are manifestations of inadequate funding for maternal health services. Substantial increase in funding for maternal health services is therefore warranted towards effective implementation of emergency obstetric care package in The Gambia.
Kennedy, Martyn P T; Hall, Peter S; Callister, Matthew E J
Lung cancer diagnosis during emergency hospital admission has been associated with higher early secondary-care costs and lower longer-term costs than outpatient diagnoses. This retrospective cohort study analyses the secondary-care costs of 3274 consecutive patients with lung cancer. Patients diagnosed during emergency admissions incurred greater costs during the first month and had a worse prognosis compared with outpatient diagnoses. In patients who remained alive, costs after the first month were comparable between diagnostic routes. In addition to improving patient experience and outcome, strategies to increase earlier diagnosis may reduce the additional healthcare costs associated with this route to diagnosis.
Berben, Sivera A A; Meijs, Tineke H J M; van Grunsven, Pierre M; Schoonhoven, Lisette; van Achterberg, Theo
The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands. A qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA. This study identified five concepts as facilitators and barriers in pain management for trauma patients in the chain of emergency care. We described the concepts of knowledge, attitude, professional communication, organisational aspects and patient input, illustrated with quotes from the interviews and focus group sessions. Furthermore, we identified whether the themes occurred in the chain of care. Knowledge deficits, attitude problems and patient input were similar for the EMS and ED settings, despite the different positions, backgrounds and educational levels of respondents. In the chain of care a lack of professional communication and organisational feedback occurred as new themes, and were specifically related to the organisational structure of the prehospital EMS and EDs. Identified organisational aspects stressed the importance of organisational embedding of improvement of pain management. However, change of clinical practice requires a comprehensive approach focused at all five concepts. We think a shift
Walker, Anne F
Accessibility of hospital emergency services has been an issue of increasing concern and was recently brought into public focus in Ontario by the tragic death of Joshua Fleuelling, whose ambulance was redirected from the nearest hospital. As will be reviewed, the limited case law has identified a legal duty for physicians and hospitals to provide treatment to people in need of emergency care, a duty that should be considered when formulating hospital policies. The impact of this duty of care on the existing standard of medical practice will be considered.
Ibraeva, A Sh; Kausova, G K
The aim of the research was to develop recommendations for organization and improvement of emergency medical care in Shymkent (Chimkent) - a rapidly developing financial and industrial center in Southern Kazakhstan. It was found that the average annual daily load of iresuscitative teams and pediatric intensive care increased, which is associated with an increased frequency of severe cases, complications of disease of adults and children requiring intensive care therapy. Another objective measure that reflects the level of organization of Acute care of population is the specialization of rig team and timeliness arrival of the call. The highest level of the specialization of rig was observed in cardiac and critical care teams. The highest level of the indicator of average residence time teams on the call was observed in pediatric intensive care.
Duch, Patricia; Haahr Raunkjær, Camilla; Møller, Morten Hylander;
describe the prevalence and inter-hospital variation of anaesthesia care in Denmark and identify clinical predictors for choosing anaesthesia care. MATERIAL AND METHODS: This population-based cohort study included all emergency EGDs for PUB in adults during 2012-2013. About 90-day all-cause mortality after...... of the endoscopist. Some 16.7% of the patients undergoing EGD with anaesthesia care died within 90 days after the procedure, compared to 9.8% of the patients who had no anaesthesia care, adjusted OR = 1.51 (95% CI = 1.25-1.83). Comparing the two hospitals with the most frequent (98.6% of al EGDs) and least frequent...... EGD was estimated by crude and adjusted logistic regression. Clinical predictors of anaesthesia care were identified in another logistic regression model. RESULTS: Some 3.056 EGDs performed at 21 hospitals were included; 2074 (68%) received anaesthesia care and 982 (32%) were managed under supervison...
Abokwidir, Manal; Davis, Scott A; Fleischer, Alan B; Pichardo-Geisinger, Rita O
The emergency department (ED) is not the ideal setting for dermatologic care, but may be widely used, especially among disadvantaged ethnic minorities. This study was performed to characterize the role of the ED in providing dermatologic care for each racial and ethnic group in the United States. We analyzed visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1993 to 2010. Settings (office-based, outpatient department or ED), diagnoses and race/ethnicity were assessed to compare usage of the ED across groups. Usage of the ED for dermatologic conditions increased over time (p dermatologic care of black (18.3%) and Hispanic (10.5%) patients than for white patients (5.9%) and were used most in rural or small metropolitan areas. Providing better insurance, more dermatologists in rural areas and better dermatologic training for family physicians may help improve care for underserved populations and reduce inappropriate use of the ED.
Kiselev, Anton R; Gridnev, Vladimir I; Shvartz, Vladimir A; Posnenkova, Olga M; Dovgalevsky, Pavel Ya
The use of short message services and mobile phone technology for ambulatory care management is the most accessible and most inexpensive way to transition from traditional ambulatory care management to active ambulatory care management in patients with arterial hypertension (AH). The aim of this study was to compare the clinical efficacy of active ambulatory care management supported by short message services and mobile phone technology with traditional ambulatory care management in AH patients. The study included 97 hypertensive patients under active ambulatory care management and 102 patients under traditional ambulatory care management. Blood pressure levels, body mass, and smoking history of patients were analyzed in the study. The duration of study was 1 year. In the active ambulatory care management group, 36% of patients were withdrawn from the study within a year. At the end of the year, 77% of patients from the active care management group had achieved the goal blood pressure level. That was more than 5 times higher than that in the traditional ambulatory care management group (P mobile phone improves the quality of ambulatory care of hypertensive patients.
Venkatesh, Arjun K; Goodrich, Kate
The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs.
Full Text Available The hospitalisation and management of patients at the end-of-life by emergency medical services is presenting a challenge to our society as the majority of people approaching death explicitly state that they want to die at home and the transition from acute care to palliation is difficult. In addition, the escalating costs of providing care at the end-of-life in acute hospitals are unsustainable. Hospitals in general and emergency departments in particular cannot always provide the best care for patients approaching end-of-life. The main objectives of this paper are to review the existing literature in order to assess the evidence for managing patients dying in the emergency department, and to identify areas of improvement such as supporting different models of care and evaluating those models with health services research. The paper identified six main areas where there is lack of research and/or suboptimal policy implementation. These include uncertainty of treatment in the emergency department; quality of life issues, costs, ethical and social issues, interaction between ED and other health services, and strategies for out of hospital care. The paper concludes with some areas for policy development and future research.
Honda, Ayako; Randaoharison, Pierana Gabriel; Matsui, Mitsuaki
Timely access to emergency obstetric care is necessary to save the lives of women experiencing complications at delivery, and for newborn babies. Out-of-pocket costs are one of the critical factors hindering access to such services in low- and middle-income countries. This study measured out-of-pocket costs for caesarean section and neonatal care at an urban tertiary public hospital in Madagascar, assessed affordability in relation to household expenditure and investigated where families found the money to cover these costs. Data were collected for 103 women and 73 newborns at the Centre Hospitalier Universitaire de Mahajanga in the Boeny region of Madagascar between September 2007 and January 2008. Out-of-pocket costs for caesarean section were catastrophic for middle and lower socio-economic households, and treatment for neonatal complications also created a big financial burden, with geographical and other financial barriers further limiting access to hospital care. This study identified 12 possible cases where the mother required an emergency caesarean section and her newborn required emergency care, placing a double burden on the household. In an effort to make emergency obstetric and neonatal care affordable and available to all, including those living in rural areas and those of medium and lower socio-economic status, well-designed financial risk protection mechanisms and a strong commitment by the government to mobilise resources to finance the country's health system are necessary.
Watts, Jennifer; Cowden, John D; Cupertino, A Paula; Dowd, M Denise; Kennedy, Chris
Racial, ethnic and language-based disparities occur throughout the US health system. Pediatric prehospital emergency medical services are less likely to be used by Latinos. We identified perceptions of and barriers to prehospital pediatric emergency care (911) access among Spanish-speaking parents. A qualitative study involving six focus groups was conducted. Spanish-speaking parents participated with a bilingual moderator. Topics discussed included experiences, knowledge, beliefs, fears, barriers, and improvement strategies. All groups were audiotaped, transcribed, and reviewed for recurring themes. Forty-nine parents participated. Though parents believed 911 was available to all, many were uncertain how to use it, and what qualified as an emergency. Barriers included language discordance, fear of exposing immigration status, and fear of financial consequences. Parents strongly desired to learn more about 911 through classes, brochures, and media campaigns. Prehospital emergency care should be available to all children. Further quantitative studies may help solidify the identified barriers and uncover areas needing improvement within Emergency Medical Systems. Addressing barriers to 911 use in Spanish-speaking communities could improve the equity of health care delivery, while also decreasing the amount of non-emergency 911 use.
Conclusions: This pilot study describes the patient population, resource and training needs of a rural Emergency Centre in SSA. It demonstrates that acute care providers will be required to evaluate a wide variety of patient complaints, effectively utilise laboratory and radiologic testing, and perform numerous focused treatments and therapies. Specialised training programmes, such as GECC’s ECP programme, are needed to create providers able to provide high quality, lifesaving care.
Jelinek, G A; Marck, C H; Weil, J; Lane, H; Philip, J; Boughey, M; Weiland, T J
To explore the views of Australian emergency department (ED) clinicians about their skills, role and expertise in caring for people with advanced cancer. A cross-sectional electronic survey of doctors and nurses working in Australian EDs was undertaken. Comparisons were made by demographics and whether respondents had received palliative care education. The sample comprised 444 doctors (response rate 13.5%), the majority Fellows (emergency medicine specialists) of the Australasian College for Emergency Medicine, and 237 nurses, from all states, territories and regions (metropolitan and regional). A minority (n=123, 20.6%) felt that the ED was not an appropriate place for patients with advanced cancer to present for acute care, while almost two-thirds (n=397, 64.8%) found caring for such patients rewarding, particularly nurses and those who had received palliative care education; very few (n=40, 6.5%) reported feeling uncomfortable talking to the families of dying patients. A minority (n=129, 21.0%) felt that it was not appropriate for junior medical staff to assess these patients, nurses much more than doctors (42.9% vs 8.5%, p<0.001). Over half (n=338, 55.1%) felt sufficiently skilled in managing pain for people with advanced cancer, with Fellows, more experienced doctors, and those who had received palliative care education more likely to feel skilled. ED clinicians in Australia, particularly those who have received palliative care education, feel comfortable and adequately skilled in managing people with advanced cancer presenting to EDs, and most find it rewarding. The importance of palliative care education to emergency clinicians' training should be recognised. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Pourmand, Ali; Sikka, Neal
Objective: To investigate the impact of online health information (OHI) and patients’ decisions to seek emergency department (ED) care. Methods: We conducted a survey of a convenience sample of 489 ambulatory patients at an academic ED between February and September 2006. The primary measure was the prevalence of Internet use, and the secondary outcome was the impact of OHI on patients’ decision to seek ED care. Results: The study group comprised 175 (38%) males. Mean age wa...
Cruz-Oliver, Dulce M; Bernacki, Rachelle; Cooper, Zara; Grudzen, Corita; Izumi, Seiko; Lafond, Deborah; Lam, Daniel; LeBlanc, Thomas W; Tjia, Jennifer; Walter, Jennifer
There is a pressing workforce shortage and leadership scarcity in palliative care to adequately meet the demands of individuals with serious illness and their families. To address this gap, the Cambia Health Foundation launched its Sojourns Scholars Leadership Program in 2014, an initiative designed to identify, cultivate, and advance the next generation of palliative care leaders. This report intends to summarize the second cohort of Sojourns Scholars' projects and their reflection on their leadership needs. This report summarizes the second cohort of sojourns scholars' project and their reflection on leadership needs. After providing a written reflection on their own projects, the second cohort participated in a group interview (fireside chat) to elicit their perspectives on barriers and facilitators in providing palliative care, issues facing leadership in palliative care in the United States, and lessons from personal and professional growth as leaders in palliative care. They analyzed the transcript of the group interview using qualitative content analysis methodology. Three themes emerged from descriptions of the scholars' project experience: challenges in palliative care practice, leadership strategies in palliative care, and three lessons learned to be a leader were identified. Challenges included perceptions of palliative care, payment and policy, and workforce development. Educating and collaborating with other clinicians and influencing policy change are important strategies used to advance palliative care. Time management, leading team effort, and inspiring others are important skills that promote effectiveness as a leader. Emerging leaders have a unique view of conceptualizing contemporary palliative care and shaping the future. Providing comprehensive, coordinated care that is high quality, patient and family centered, and readily available depends on strong leadership in palliative care. The Cambia Scholars Program represents a unique opportunity.
Birgitta Wireklint Sundström
Full Text Available As organizational changes in the healthcare system are in progress, to enhance care quality and reduce costs, it is important to investigate how these changes affect elderly patients’ experiences and their rights to participate in the choice of healthcare. The aim of this study is to describe elderly patients’ lived experience of participating in the choice of healthcare when being offered an alternative care pathway by the emergency medical services, when the individual patient's medical needs made this choice possible. This study was carried out from the perspective of caring science, and a phenomenological approach was applied, where data were analysed for meaning. Data consist of 11 semi-structured interviews with elderly patients who chose a healthcare pathway to a community-based hospital when they were offered an alternative level of healthcare. The findings show that the essence of the phenomenon is described as “There was a ray of hope about a caring encounter and about being treated like a unique human being”. Five meaningful constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence, and a choice based on memories of suffering from care. The conclusion is that patient participation in the choice of a healthcare alternative instead of the emergency department is an opportunity of avoiding suffering from care and being objectified.
Ponce, Brent A; Brabston, Eugene W; Shin Zu; Watson, Shawna L; Baker, Dustin; Winn, Dennis; Guthrie, Barton L; Shenai, Mahesh B
Advanced features are being added to telemedicine paradigms to enhance usability and usefulness. Virtual Interactive Presence (VIP) is a technology that allows a surgeon and patient to interact in a "merged reality" space, to facilitate both verbal, visual, and manual interaction. In this clinical study, a mobile VIP iOS application was introduced into routine post-operative orthopedic and neurosurgical care. Survey responses endorse the usefulness of this tool, as it relates to The virtual interaction provides needed virtual follow-up in instances where in-person follow-up may be limited, and enhances the subjective patient experience.
Wiegersma, Janke S.; Droogh, Joep M.; Zijlstra, Jan G.; Fokkema, Janneke; Ligtenberg, Jack J. M.
Introduction: In order to minimize the additional risk of interhospital transport of critically ill patients, we started a mobile intensive care unit (MICU) with a specialized retrieval team, reaching out from our university hospital-based intensive care unit to our adherence region in March 2009. T
Wiegersma, Janke S.; Droogh, Joep M.; Zijlstra, Jan G.; Fokkema, Janneke; Ligtenberg, Jack J. M.
Introduction: In order to minimize the additional risk of interhospital transport of critically ill patients, we started a mobile intensive care unit (MICU) with a specialized retrieval team, reaching out from our university hospital-based intensive care unit to our adherence region in March 2009.
Dias, Roger Daglius; Scalabrini Neto, Augusto
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.
Popat, H; Thomas, K; Farnell, D J J
Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations.
Janke, Alexander T; Overbeek, Daniel L; Kocher, Keith E; Levy, Phillip D
Clinical research often focuses on resource-intensive causal inference, whereas the potential of predictive analytics with constantly increasing big data sources remains largely unexplored. Basic prediction, divorced from causal inference, is much easier with big data. Emergency care may benefit from this simpler application of big data. Historically, predictive analytics have played an important role in emergency care as simple heuristics for risk stratification. These tools generally follow a standard approach: parsimonious criteria, easy computability, and independent validation with distinct populations. Simplicity in a prediction tool is valuable, but technological advances make it no longer a necessity. Emergency care could benefit from clinical predictions built using data science tools with abundant potential input variables available in electronic medical records. Patients' risks could be stratified more precisely with large pools of data and lower resource requirements for comparing each clinical encounter to those that came before it, benefiting clinical decisionmaking and health systems operations. The largest value of predictive analytics comes early in the clinical encounter, in which diagnostic and prognostic uncertainty are high and resource-committing decisions need to be made. We propose an agenda for widening the application of predictive analytics in emergency care. Throughout, we express cautious optimism because there are myriad challenges related to database infrastructure, practitioner uptake, and patient acceptance. The quality of routinely compiled clinical data will remain an important limitation. Complementing big data sources with prospective data may be necessary if predictive analytics are to achieve their full potential to improve care quality in the emergency department. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Ivaninskiĭ, O I; Sharapov, I V; Sadovoĭ, M A
The most problematic spheres in the resource support of emergency medical care to rural residents are the completeness of staff of physicians in rural medical surgeries, community hospitals and departments of emergency medical care in central district hospitals. The provision of feldsher obstetrics posts with sanitary motor transport and medical equipment is yet another problematic sphere. The main troubles during provision of emergency medical care at feldsher obstetrics posts are related to surgery treatment. The organization of emergency and urgent medical care suffers of many unresolved problems related to informational program support at feldsher obstetrics posts, polyclinics of central district hospitals.
Sikder, Shegufta S; Labrique, Alain B; Ali, Hasmot; Hanif, Abu A M; Klemm, Rolf D W; Mehra, Sucheta; West, Jr, Keith P; Christian, Parul
Although safe motherhood strategies recommend that women seek timely care from health facilities for obstetric complications, few studies have described facility availability of emergency obstetric care (EmOC...
Full Text Available Abstract Background Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia. Methods We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used. Results The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital. Conclusion Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to
Gkatzidou, Voula; Hone, Kate; Sutcliffe, Lorna; Gibbs, Jo; Sadiq, Syed Tariq; Szczepura, Ala; Sonnenberg, Pam; Estcourt, Claudia
The increasing pervasiveness of mobile technologies has given potential to transform healthcare by facilitating clinical management using software applications. These technologies may provide valuable tools in sexual health care and potentially overcome existing practical and cultural barriers to routine testing for sexually transmitted infections. In order to inform the design of a mobile health application for STIs that supports self-testing and self-management by linking diagnosis with online care pathways, we aimed to identify the dimensions and range of preferences for user interface design features among young people. Nine focus group discussions were conducted (n = 49) with two age-stratified samples (16 to 18 and 19 to 24 year olds) of young people from Further Education colleges and Higher Education establishments. Discussions explored young people's views with regard to: the software interface; the presentation of information; and the ordering of interaction steps. Discussions were audio recorded and transcribed verbatim. Interview transcripts were analysed using thematic analysis. Four over-arching themes emerged: privacy and security; credibility; user journey support; and the task-technology-context fit. From these themes, 20 user interface design recommendations for mobile health applications are proposed. For participants, although privacy was a major concern, security was not perceived as a major potential barrier as participants were generally unaware of potential security threats and inherently trusted new technology. Customisation also emerged as a key design preference to increase attractiveness and acceptability. Considerable effort should be focused on designing healthcare applications from the patient's perspective to maximise acceptability. The design recommendations proposed in this paper provide a valuable point of reference for the health design community to inform development of mobile-based health interventions for the diagnosis
Gustavsson, Maria; Ekberg, Kerstin
This article reports on the findings of a planned workplace health promotion intervention, and the aim is to identify conditions that facilitated or restricted the learning to promote health at an emergency care department in a Swedish hospital. The study had a longitudinal design, with interviews before and after the intervention and follow-up…
Since the introduction of skills-based training reference frameworks for the training of nursing assistants and student nurses, certification in training in emergency procedures and care is an integral part of the initial training of future healthcare professionals. The elderly person is a great example for learning rightgestures.
Choo, Esther K; Garro, Aris C; Ranney, Megan L; Meisel, Zachary F; Morrow Guthrie, Kate
Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. This article, Part I of a two-article series, provides an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field, including observation, individual interviews, and focus groups. In Part II of this series, we will outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research.
Ranney, Megan L; Meisel, Zachary F; Choo, Esther K; Garro, Aris C; Sasson, Comilla; Morrow Guthrie, Kate
Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research.
Echoka, Elizabeth; Kombe, Yeri; Dubourg, Dominique
The knowledge on emergency obstetric care (EmOC) is limited in Kenya, where only partial data from sub-national studies exist. The EmOC process indicators have also not been integrated into routine health management information system to monitor progress in safe motherhood interventions both...... and functionality of EmOC services at district level....
Hesselink, G.J.; Berben, S.A.; Beune, T.; Schoonhoven, L.
OBJECTIVES: To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. DESIGN: A systematic review of the literature. METHODS: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health
Berben, S.A.A.; Meijs, T.H.; Grunsven, P.M. van; Schoonhoven, L.; Achterberg, T. van
INTRODUCTION: The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands. PATIENTS AND METHODS: A qualitative approach was adopted with the use of the implementation Model of Change of Clinical
Choo, Esther K.; Garro, Aris; Ranney, Megan L.; Meisel, Zachary; Guthrie, Kate Morrow
Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. This article, Part I of a two-article series, provides an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field, including observation, individual interviews, and focus groups. In Part II of this series, we will outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. PMID:26284696
Ranney, Megan L.; Meisel, Zachary; Choo, Esther K.; Garro, Aris; Sasson, Comilla; Morrow, Kathleen
Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. PMID:26284572
Tan, Kar Way; Shankararaman, Venky
It was 2:35 am on a Saturday morning. Wiki Lim, process specialist from the Process Innovation Centre (PIC) of Hippi Care Hospital (HCH), desperately doodling on her notepad for ideas to improve service delivery at HCH's Emergency Department (ED). HCH has committed to the public that its ED would meet the service quality criterion of serving 90%…
van Vugt, E.; Lanctôt, N.; Paquette, G.; Collin-Vezina, D.; Lemieux, A.
The current study examined the association between child maltreatment and trauma-related symptoms in emerging adulthood - over and above the incidence of such symptoms and conduct problems during adolescence - among a sample of female adolescents in residential care. This study used data from a long
Danielle Soares Silva
Full Text Available The objective of this study was to analyze the contributions that research has made to leadership in nursing within the context of emergency care services from 2001 to 2012. This Integrative Literature Review included studies indexed in the following databases: Latin American and Caribbean Health Sciences (LILACS, Medical Literature Analysis and Retrieval Systems Online (MEDLINE and SCOPUS. Publications were grouped into three categories: “The styles of leadership adopted by the nurses of the emergency unit”; “Leadership as a strategy to improve nursing care management”; “The development of the nurses’ leadership in emergency care services”. A large part of the publications have a poor level of evidence and is indexed in international journals, showing that there is need for investments from both national and international scientific communities. In conclusion, the most commonly used theories among the nurses are: situational and transformational. Larger investments are necessary in communication and leadership training for nurses. Descriptors: Leadership; Emergency Relief; Emergency Nursing; Nursing Administration Research; Practice Management.
Ana Maria Calil
Full Text Available INTRODUCTION: Pain is a common occurrence in trauma victims that provokes harmful effects on the body. However, there is a gap in the literature about this problem, which is still underevaluated and undertreated in Brazil, especially concerning the use of opioids. OBJECTIVES: To estimate pain intensity and the use of analgesia in traffic accident victims. MATERIALS AND METHODS: A prospective study, involving 100 accident victims (traffic accidents, who were interviewed at 2 separate posttraumatic moments, in a reference hospital of the city of São Paulo. All the medications used for these victims were recorded. All patients displayed a Glasgow Coma Scale (ECGl of 15, had stable hemodynamic parameters, and were brought directly from the scene of the accident. RESULTS: Pain of moderate and severe intensity (in 90% of cases was the most noted. After a 3-hour period, a significant number of patients with pain (48% continued without analgesia, and few opioids were used. CONCLUSION: Pain is a common event associated with trauma. It is still undertreated and underevaluated in Brazil, and the use of opioids for admittedly very severe pain is not frequently employed in the Emergency Service even in hemodynamically stable patients and with a Glasgow Coma Scale of 15.INTRODUÇÃO: A dor é um evento comum em vítimas de trauma com efeitos nocivos ao organismo, no entanto, há uma lacuna na literatura sobre essa problemática ainda sub-avaliada e sub-tratada em nosso meio, sobretudo na utilização de opióides. OBJETIVOS: Aferir a intensidade dolorosa e o uso da analgesia em vítimas de acidentes de transportes. MATERIAL E MÉTODO: Estudo prospectivo, envolvendo 100 vítimas de causas externas (acidentes de transporte, que foram entrevistadas em dois momentos distintos pós-trauma em um hospital de referência no Município de São Paulo.. Foram anotadas todas as medicações em uso para essas vítimas. Todos os pacientes tinham Escala de Coma de Gasglow
Background Bateys are impoverished areas of housing for migrant Haitian sugar cane workers in the Dominican Republic (DR). In these regions, preventative health care is almost non-existent, public service accessibility is limited, and geographic isolation prevents utilization of care even by those families with resources. Consequently, the development of a viable mobile system is vital to the delivery of acute and preventative health care in this region. Aims This study evaluated an existing ...
Grossman Michael D
Full Text Available Abstract The role of Emergency Medicine Physicians (EMP in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. Limited available data published in the literature examining the role of EMP's in trauma care will be reviewed with respect to its implications for an expanded role for EMPs in trauma care. Two training models currently in the early stages of development have been proposed to address needs for increased manpower in trauma and the critical care of trauma patients. The available information regarding these models will be reviewed along with the implications for improving the care of trauma patients in both Europe and North America.
Maria, Monica Antonio; Quadros, Fátima Alice Aguiar; Grassi, Maria de Fátima Oliveira
This study analyzes the feasibility of implementing the Nursing Care Systematization in an emergency and urgency hospital department. This is a field study, descriptive, qualitative structured according to the content analysis described by Bardin (2009). It was performed in a hospital specialized in emergency care. The sample consisted of eight practical nurses, five nurses and two assistants, all of them with experience of at least six months in the emergency room. The difficulties referred to the implementation of the NCS are: complexity in their steps; disinterest of the institution; theoretical unpreparedness of nursing, its devaluation by other professionals, inadequate sizing of employees and inadequacy of the hospital physical structure. In this context, it was note that the nurse loses representation in the health team and the application of SAE turns out to be often underestimated.
Candice Abdon Miranda
Full Text Available This exploratory study aimed at identifying nurses´ opinions on an instrument of care, based on the Systematization of Nursing Assistance to be used in the emergency room. It was carried out in a large hospital in Recife, Pernambuco, Brazil, from June to August 2009, with an accidental sample of 30 emergency nurses. The data were collected by means of a questionnaire and analyzed using descriptive statistics. Most nurses had a favorable opinion of the instrument´s contribution to the: work in the emergency room (96,6%; quality of nursing care (86,6%; action planning (97,0%; nurse´s autonomy (86,9%; and the communication and integration of the multi-professional team (83,6%. Besides that the nurses say that to use the form is viable (80, 0%. Suggestions for improvement were organizational in nature and for the addition of content.
Turvey, Carolyn L; Roberts, Lisa J
This review describes recent developments in online and mobile mental health applications, including a discussion of patient portals to support mental health care. These technologies are rapidly evolving, often before there is systematic investigation of their effectiveness. Though there are some reviews of the effectiveness of mental health mobile apps, perhaps the more significant development is innovation in technology evaluation as well as new models of interprofessional collaboration in developing behavioural health technologies. Online mental health programs have a strong evidence base. Their role in population health strategies needs further exploration, including the most effective use of limited clinical staff resources. Patient portals and personal health records serve to enhance mental health treatment also, though concerns specific to mental health must be addressed to support broader adoption of portals. Provider concerns about sharing psychiatric notes with patients hinder support for portals. Health information exchange for mental health information requires thoughtful consent management strategies so mental health patients can benefit. Finally, the broad array of health information technologies may overwhelm patients. User-friendly, well-designed, patient-centred health information technology homes may integrate these functions to promote a holistic approach to care plans and overall wellness. Such technology homes have special security needs and require providers and patients to be well informed about how best to use these technologies to support behavioural health interventions.
Silva, Antonio J.D. da, E-mail: firstname.lastname@example.org [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). Programa de Pos-Graduacao em Informatica; Santos, Joao R. dos; Pereira, Claudio M.N.A.; Carvalho, Paulo V.R., E-mail: email@example.com [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil)
Decision-making in emergency situations is characterized by its speed, pressure, and especially the uncertainty of information. Uninformed decisions or decisions based on unreliable data may lead to inappropriate actions. Although several studies that aim to combine different databases and provide full information to emergency response operation commanders can be found, only few of them are dedicated to radiological emergencies situations and even less are those that aim to provide support for the emergency first responder. We developed a system to support first responders to deal with radiological emergencies using cognitive task analysis techniques to elicit the tacitly knowledge of practitioners to grasp what information is really needed during radiological emergency response. (author)
Holt, M; Larkin, G N; LeTourneau, B; Reinhardt, U; Rippen, H E; Weatherup, T G
In Part 1 of this second annual panel discussion, six experts examine the new health care consumer. The whole concept of the patient as consumer still makes people uneasy when it's applied to health care. Whether you prefer consumer, customer, purchaser, end-user, ultimate buyer, or beneficiary, one thing's for sure: Many of us are as different from the bygone patient as an HMO is from the general practitioner who made house calls. One of the reasons for many Americans' new interest, knowledge, attitudes, and expectations about health and health care is the Internet, the second topic in this discussion. In Part 2, physician executives from the three leading physician practice management companies (PPMCs) join Jeff Goldsmith, Barbara LeTourneau, and Uwe Reinhardt for a spirited exchange about this burgeoning new industry in the American health care sector. They will tackle questions such as: Are PPMCs delivering what they promise? What will separate successful PPMCs from the rest? Can PPMCs meet Wall Street's earnings expectations and also help physicians deliver better care? When PPMCs win, who loses? And, what roles will physician executives play in PPMCs?
Ovalle, Irene; Loza, Oralia; Peralta-Torres, David; Martinez, Jacob; Hernandez, Kristen; Mata, Holly
In this commentary, six public health practitioners and researchers discuss how their participation in the El Paso HIV Community Mobilization effort has contributed to their professional development and increased their collective capacity to advocate for practice and policy improvements that contribute to health equity in general and within the context of HIV prevention. Like previous commentaries in this department that have highlighted the value of the Certified Health Education Specialist credential (http://www.nchec.org/health-education-credentialing) and the importance of gaining experience in policy advocacy, this article is relevant for public health professionals in diverse work settings. The authors hope that their experience will encourage others to participate in community mobilization efforts, and they welcome communication and collaboration with anyone interested in learning more about the HIV Community Mobilization efforts discussed in this commentary. © 2016 Society for Public Health Education.
Zhu, Egui; Lilienthal, Anneliese; Shluzas, Lauren Aquino; Masiello, Italo; Zary, Nabil
Augmented reality (AR) is increasingly used across a range of subject areas in health care education as health care settings partner to bridge the gap between knowledge and practice. As the first contact with patients, general practitioners (GPs) are important in the battle against a global health threat, the spread of antibiotic resistance. AR has potential as a practical tool for GPs to combine learning and practice in the rational use of antibiotics. This paper was driven by learning theory to develop a mobile augmented reality education (MARE) design framework. The primary goal of the framework is to guide the development of AR educational apps. This study focuses on (1) identifying suitable learning theories for guiding the design of AR education apps, (2) integrating learning outcomes and learning theories to support health care education through AR, and (3) applying the design framework in the context of improving GPs' rational use of antibiotics. The design framework was first constructed with the conceptual framework analysis method. Data were collected from multidisciplinary publications and reference materials and were analyzed with directed content analysis to identify key concepts and their relationships. Then the design framework was applied to a health care educational challenge. The proposed MARE framework consists of three hierarchical layers: the foundation, function, and outcome layers. Three learning theories-situated, experiential, and transformative learning-provide foundational support based on differing views of the relationships among learning, practice, and the environment. The function layer depends upon the learners' personal paradigms and indicates how health care learning could be achieved with MARE. The outcome layer analyzes different learning abilities, from knowledge to the practice level, to clarify learning objectives and expectations and to avoid teaching pitched at the wrong level. Suggestions for learning activities and the
Full Text Available BACKGROUND: For years, emerging infectious diseases have appeared worldwide and threatened the health of people. The emergence and spread of an infectious-disease outbreak are usually unforeseen, and have the features of suddenness and uncertainty. Timely understanding of basic information in the field, and the collection and analysis of epidemiological information, is helpful in making rapid decisions and responding to an infectious-disease emergency. Therefore, it is necessary to have an unobstructed channel and convenient tool for the collection and analysis of epidemiologic information in the field. METHODOLOGY/PRINCIPAL FINDINGS: Baseline information for each county in mainland China was collected and a database was established by geo-coding information on a digital map of county boundaries throughout the country. Google Maps was used to display geographic information and to conduct calculations related to maps, and the 3G wireless network was used to transmit information collected in the field to the server. This study established a decision support system for the response to infectious-disease emergencies based on WebGIS and mobile services (DSSRIDE. The DSSRIDE provides functions including data collection, communication and analyses in real time, epidemiological detection, the provision of customized epidemiological questionnaires and guides for handling infectious disease emergencies, and the querying of professional knowledge in the field. These functions of the DSSRIDE could be helpful for epidemiological investigations in the field and the handling of infectious-disease emergencies. CONCLUSIONS/SIGNIFICANCE: The DSSRIDE provides a geographic information platform based on the Google Maps application programming interface to display information of infectious disease emergencies, and transfers information between workers in the field and decision makers through wireless transmission based on personal computers, mobile phones and
Jerath, Angela; Parotto, Matteo; Wasowicz, Marcin; Ferguson, Niall D
Volatile anesthetic agent use in the intensive care unit, aided by technological advances, has become more accessible to critical care physicians. With increasing concern over adverse patient consequences associated with our current sedation practice, there is growing interest to find non-benzodiazepine-based alternative sedatives. Research has demonstrated that volatile-based sedation may provide superior awakening and extubation times in comparison with current intravenous sedation agents (propofol and benzodiazepines). Volatile agents may possess important end-organ protective properties mediated via cytoprotective and antiinflammatory mechanisms. However, like all sedatives, volatile agents are capable of deeply sedating patients, which can have respiratory depressant effects and reduce patient mobility. This review seeks to critically appraise current volatile use in critical care medicine including current research, technical consideration of their use, contraindications, areas of controversy, and proposed future research topics.
Full Text Available Abstract Background Oral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania. Methods Questionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations. Results Forty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%; self medication (17.6%; respondents thinking that pain would disappear with time (15.7%; and lack of money to pay for transport to the dental clinic (15.0%. Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07–1.57, P dental clinics far from home (OR = 5.31, CI = 2.09–13.54, P and being treated by traditional healer (OR = 5.31, CI = 2.25–12.49, P as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas. Conclusion Oral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended.
The mobile robotics industry is one that is certain to reach the billion-dollar level in the early 1990s. The authors' analysis finds that at least eight areas of application have the potential of exceeding the manufacturing AGVS market by the turn of the century: service and maintenance robots, medical robots, agricultural robots, military robots, office automation, electric utilities, space robots, and construction/mining. This report describes these and other applications, and reviews the mobile robotic products of 45 companies. Leading research is also assessed, and a market forecast is presented.
Fowler, H; Lacey, R; Keaney, J; Kay-Jones, C; Martlew, V; Thachil, J
Recently, the United Kingdom Haemophilia Centre Doctors Organisation published recommendations for the standard of care for assessment and treatment of patients with bleeding disorders in the emergency department (A&E). An audit was undertaken to compare the level of care to the acceptable standards in a tertiary hospital A&E, attached to a haemophilia comprehensive care centre. A&E attendances were found by cross referencing all patients with known bleeding disorders against the EDMS attendance system. Visits from the past 3 years were identified to produce sufficient data and electronic notes from these visits were then accessed, and marked against the proforma. Data were available from 45 of a total of 54 patients, who had a total of 75 emergency visits documented. In all aspects of care, the standards were not adequately met including the average length of time between booking and clinical assessment, early initiation of specific haemostatic treatment, seeking haematology advice and arrangement of follow-up. Also no specialist clotting investigations were done with only 9/11 patients admitted having their haematological diagnosis recorded. In addition, only very few patients had the severity of bleeding disorder noted and less than half their first line treatment documented. There were significant differences in the standard of care for haemophilia patients provided by the A&E department when compared with acceptable standards. Measures have been put in place and policies have been drafted to improve this situation and provide the best possible care to persons with haemophilia.
D'Ambrosio, Michael V; Bakalar, Matthew; Bennuru, Sasisekhar; Reber, Clay; Skandarajah, Arunan; Nilsson, Lina; Switz, Neil; Kamgno, Joseph; Pion, Sébastien; Boussinesq, Michel; Nutman, Thomas B; Fletcher, Daniel A
Parasitic helminths cause debilitating diseases that affect millions of people in primarily low-resource settings. Efforts to eliminate onchocerciasis and lymphatic filariasis in Central Africa through mass drug administration have been suspended because of ivermectin-associated serious adverse events, including death, in patients infected with the filarial parasite Loa loa. To safely administer ivermectin for onchocerciasis or lymphatic filariasis in regions co-endemic with L. loa, a strategy termed "test and (not) treat" has been proposed whereby those with high levels of L. loa microfilariae (>30,000/ml) that put them at risk for life-threatening serious adverse events are identified and excluded from mass drug administration. To enable this, we developed a mobile phone-based video microscope that automatically quantifies L. loa microfilariae in whole blood loaded directly into a small glass capillary from a fingerprick without the need for conventional sample preparation or staining. This point-of-care device automatically captures and analyzes videos of microfilarial motion in whole blood using motorized sample scanning and onboard motion detection, minimizing input from health care workers and providing a quantification of microfilariae per milliliter of whole blood in under 2 min. To validate performance and usability of the mobile phone microscope, we tested 33 potentially Loa-infected patients in Cameroon and confirmed that automated counts correlated with manual thick smear counts (94% specificity; 100% sensitivity). Use of this technology to exclude patients from ivermectin-based treatment at the point of care in Loa-endemic regions would allow resumption/expansion of mass drug administration programs for onchocerciasis and lymphatic filariasis in Central Africa. Copyright © 2015, American Association for the Advancement of Science.
Perfil dos atendimentos realizados por uma unidade de suporte avançado do serviço de atendimento móvel de urgência (SAMU do Rio Grande do Sul = Profile of attendances made by an advanced support unit from the mobile emergency care service (MECS of Rio Grande do Sul state, Brazil
Conclusões: Os atendimentos realizados pela Unidade de Suporte Avançado do Serviço de Atendimento Móvel de Urgência da cidade de Ijuí incluíram predominantemente homens entre 60 e 79 anos acometidos por doenças crônico-degenerativas. Os procedimentos realizados com maior frequência foram os de suporte básico de vida. Estes resultados devem direcionar a atualização dos profissionais e a organização dos serviços móveis de emergência
Ding, Mingshuang; Bell, Anthony; Rixon, Sascha; Rixon, Andrew; Addae-Bosomprah, Hansel; Simon, Jane
The objective of this review is to evaluate the effectiveness of educational communication interventions for health professionals in emergency departments. The end result is to identify the specific types of communication based educational strategies utilized by emergency department health care professionals to enhance the quality of care for patients.
Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M.; Vaal, de E.T.; Rood, Pleunie P.M.; Hoogerwerf, N.; Doggen, C.J.M.; Schoonhoven, L.
Introduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was devel
A.C. Scholten (Annemieke); S.A.A. Berben (Sivera); A.H. Westmaas (Alvin H); P.M. van Grunsven (Pierre); E.T. de Vaal; P.P.M. Rood (Pleunie); N. Hoogerwerf (N.); C.J.M. Doggen (Carine); R. van Schoonhoven (Renee)
textabstractIntroduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideli
Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M. van; Vaal, E.T. de; Hoogerwerf, N.; Doggen, C.J.; Schoonhoven, L.
INTRODUCTION: Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was deve
Kopschina, C; Stangl, R
With the emergence of a trauma network in the metropolitan area of Nuremberg, Germany, the question arose whether prehospital trauma management and emergency department management could be better integrated. A training scheme was designed for prehospital trauma care by the rescue services of the Workers' Samaritan Federation Germany (ASB), the Bavarian Red Cross, Maltese Ambulance, St. Johns Ambulance, representatives of the emergency physicians, and physicians of Rummelsberg Hospital. A detailed search of the international literature was done for all subjects regarding prehospital trauma management, and the American training systems (ITLS, PHTLS) were studied. The review was followed by a critical evaluation of the reality of on site-care, and the German and American systems were compared. A 2-day course with 6 sessions (accident place and kinetics, trauma investigation, pathologies, resuscitation, practical training, and evaluation) was developed, adapted from the Advanced Trauma Life Support (ATLS) algorithm. Special attention was given to the integration and position of the emergency physician in Germany, as well as to the defined authority of the rescue services. Conversion into practice was facilitated by teamwork. The course is free of charge to all rescue services and members of the concept group. With a qualified prehospital system that works smoothly with the ATLS concepts, improved prehospital care for trauma patients seems possible.
Markakis, Evangelos; Mavromoustakis, Constandinos X; Pallis, Evangelos
This book focuses on the challenges and solutions related to cloud and fog computing for 5G mobile networks, and presents novel approaches to the frameworks and schemes that carry out storage, communication, computation and control in the fog/cloud paradigm.
Lee, Jenny J.; Sehoole, Chika
This study examined mobility within the understudied region of southern Africa and particularly, the factors that drive and shape educational migration toward South Africa as a regional, continental, and global destination. Based on a survey administered to international students across seven South African universities, the findings revealed…
Hovgaard, Jens; Scott, Marian
In 1995 the exercise RESUME-95 (Rapid Environmental Surveying Using Mobile Equipment) took place in Finland. Groups from 8 European countries joined the exercise. The methods used were airborne gamma-ray measurements, car-borne measurements and in situ stationary measurements. The results...
Jones, R P; Conway, D H
Electromagnetic interference produced by wireless communication can affect medical devices and hospital policies exist to address this risk. During the transfer of ventilated patients, these policies may be compromised by essential communication between base and receiving hospitals. Local wireless networks (e.g. Bluetooth) may reduce the 'spaghetti syndrome' of wires and cables seen on intensive care units, but also generate electromagnetic interference. The aim of this study was to investigate these effects on displayed and actual ventilator performance. Five ventilators were tested: Drager Oxylog 2000, BREAS LTV-1000, Respironics BiPAP VISION, Puritan Bennett 7200 and 840. Electromagnetic interference was generated by three devices: Simoco 8020 radio handset, Nokia 7210 and Nokia 6230 mobile phone, Nokia 6230 communicating via Bluetooth with a Palm Tungsten T Personal Digital Assistant. We followed the American National Standard Recommended Practice for On-Site, Ad Hoc Testing (ANSI C63) for electromagnetic interference. We used a ventilator tester, to simulate healthy adult lungs and measure ventilator performance. The communication device under test was moved in towards each ventilator from a distance of 1 m in six axes. Alarms or error codes on the ventilator were recorded, as was ventilator performance. All ventilators tested, except for the Respironics VISION, showed a display error when subjected to electromagnetic interference from the Nokia phones and Simoco radio. Ventilator performance was only affected by the radio which caused the Puritan Bennett 840 to stop functioning completely. The transfer ventilators' performance were not affected by radio or mobile phone, although the mobile phone did trigger a low-power alarm. Effects on intensive care ventilators included display reset, with the ventilator restoring normal display function within 2 s, and low-power/low-pressure alarms. Bluetooth transmission had no effect on the function of all the
Full Text Available Objective: To investigate the impact of online health information (OHI and patients’ decisions to seek emergency department (ED care.Methods: We conducted a survey of a convenience sample of 489 ambulatory patients at an academic ED between February and September 2006. The primary measure was the prevalence of Internet use, and the secondary outcome was the impact of OHI on patients’ decision to seek ED care.Results: The study group comprised 175 (38% males. Mean age was 33 years old; 222 (45.4% patients were white, 189 (38.7% patients were African American, and 33 (6.7% were Hispanic. 92.6% had Internet access, and 94.5% used email; 58.7% reported that OHI was easy to locate, while 49.7% felt that it was also easy to understand. Of the subjects who had Internet access, 15.1% (1.6, 95% CI 1.3-2.0 stated that they had changed their decision to seek care in the ED.Conclusion: This study suggests that Internet access in an urban adult ED population may mirror reported Internet use among American adults. Many ED patients report that they are able to access and understand online health information, as well as use it to make decisions about seeking emergency care. [West J Emerg Med. 2011; 12(2:174-177.
Kongnyuy, Eugene J; Hofman, Jan; Mlava, Grace; Mhango, Chisale; van den Broek, Nynke
To establish a baseline for the availability, utilisation and quality of maternal and neonatal health care services for monitoring and evaluation of a maternal and neonatal morbidity/mortality reduction programme in three districts in the Central Region of Malawi. Survey of all the 73 health facilities (13 hospitals and 60 health centres) that provide maternity services in the three districts (population, 2,812,183). There were 1.6 comprehensive emergency obstetric care (CEmOC) facilities per 500,000 population and 0.8 basic emergency obstetric care (BEmOC) facilities per 125,000 population. About 23% of deliveries were conducted in emergency obstetric care (EmOC) facilities and the met need for emergency obstetric complications was 20.7%. The case fatality rate for emergency obstetric complications treated in health facilities was 2.0%. Up to 86.7% of pregnant women attended antenatal clinic at least once and only 12.0% of them attend postnatal clinic at least once. There is a shortage of qualified staff and unequal distribution with more staff in hospitals leaving health centres severely understaffed. The total number of CEmOC facilities is adequate but the distribution is unequal, leaving some rural areas with poor access to CEmOC services. There are no functional BEmOC facilities in the three districts. In order to reduce maternal mortality in Malawi and countries with similar socio-economic profile, there is a need to upgrade some health facilities to at least BEmOC level by training staff and providing equipment and supplies.
Cordasco, Kristina M; Zephyrin, Laurie C; Kessler, Chad S; Mallard, Meri; Canelo, Ismelda; Rubenstein, Lisa V; Yano, Elizabeth M
More women are using Veterans' Health Administration (VHA) Emergency Departments (EDs), yet VHA ED capacities to meet the needs of women are unknown. We assessed VHA ED resources and processes for conditions specific to, or more common in, women Veterans. Cross-sectional questionnaire of the census of VHA ED directors Resources and processes in place for gynecologic, obstetric, sexual assault and mental health care, as well as patient privacy features, stratified by ED characteristics. All 120 VHA EDs completed the questionnaire. Approximately nine out of ten EDs reported having gynecologic examination tables within their EDs, 24/7 access to specula, and Gonorrhea/Chlamydia DNA probes. All EDs reported 24/7 access to pregnancy testing. Fewer than two-fifths of EDs reported having radiologist review of pelvic ultrasound images available 24/7; one-third reported having emergent consultations from gynecologists available 24/7. Written transfer policies specific to gynecologic and obstetric emergencies were reported as available in fewer than half of EDs. Most EDs reported having emergency contraception 24/7; however, only approximately half reported having Rho(D) Immunoglobulin available 24/7. Templated triage notes and standing orders relevant to gynecologic conditions were reported as uncommon. Consistent with VHA policy, most EDs reported obtaining care for victims of sexual assault by transferring them to another institution. Most EDs reported having some access to private medical and mental health rooms. Resources and processes were found to be more available in EDs with more encounters by women, more ED staffed beds, and that were located in more complex facilities in metropolitan areas. Although most VHA EDs have resources and processes needed for delivering emergency care to women Veterans, some gaps exist. Studies in non-VA EDs are required for comparison. Creative solutions are needed to ensure that women presenting to VHA EDs receive efficient, timely, and
吴才聪; 苏怀洪; 蔡亚平; 褚天行; 汤安宁
针对应急管理中对信息共享、团队协作和移动指挥的应用需求,研究了移动应急终端间的位置共享与信息交互方法和技术框架,初步构建了移动应急位置服务网.移动应急位置服务网包括移动应急终端、无线通信网络、中心服务器、监控终端和管理终端等组成部分.定义了位置、信息与指令传输格式,以实现移动应急终端和中心服务器之间的实时通信.制定了移动应急终端组网规则,以实现位置和信息在移动应急位置服务网内的交互.研发了友邻位置与信息交互技术,重点研究了终端位置报告、终端节电、北斗终端接入、友邻位置表达、信息推送等技术.针对具体应用需求,开发了原型系统,试验表明移动应急友邻互视技术可提高事发现场应急处置团队的协作能力和应急处置效率,具有实用性.%The method and technical frame of mutual visualization and information sharing technology among mobile emergency terminals were proposed, and the location-based service network for mobile emergency management was initially developed, in order to resolve the problems such as information sharing, team cooperation, and mobile commanding in face of the emergency management in the accident or disaster field. The transfer format for location,information, and command was defined for the network communication between the terminals and the server. The terminal networking rule for mobile emergency response was established to realize the location and information sharing in the mobile emergency location-based network. The rule consisted of three kinds of networking method:networking method by the commanding center, networking method by the single emergency response department, and networking method by the distance between the applicant and other terminals. The key technologies of mutual visualization and information sharing, such as terminal location real-time reporting, terminal power
Full Text Available Out-of-hospital emergency care (OHEC should be accessible to all who require it. However, available data suggests that there are a number of barriers to such access in Africa, mainly centred around challenges in public knowledge, perception and appropriate utilisation of OHEC. Having reached consensus in 2013 on a two-tier system of African OHEC, the African Federation for Emergency Medicine (AFEM OHEC Group sought to gain further consensus on the narrower subject of access to OHEC in Africa. The objective of this paper is to report the outputs and statements arising from the AFEM OHEC access consensus meeting held in Cape Town, South Africa in April 2015. The discussion was structured around six dimensions of access to care (i.e. awareness, availability, accessibility, accommodation, affordability and acceptability and tackled both Tier-1 (community first responder and Tier-2 (formal prehospital services and Emergency Medical Services OHEC systems. In Tier-1 systems, the role of community involvement and support was emphasised, along with the importance of a first responder system acceptable to the community in which it is embedded in order to optimise access. In Tier-2 systems, the consensus group highlighted the primacy of a single toll-free emergency number, matching of Emergency Medical Services resource demand and availability through appropriate planning and the cost-free nature of Tier-2 emergency care, amongst other factors that impact accessibility. Much work is still needed in prioritising the steps and clarifying the tools and metrics that would enable the ideal of optimal access to OHEC in Africa.
Goldhaber-Fiebert, Sara N; Howard, Steven K
In this article, we address whether emergency manuals are an effective means of helping anesthesiologists and perioperative teams apply known best practices for critical events. We review the relevant history of such cognitive aids in health care, as well as examples from other high stakes industries, and describe why emergency manuals have a role in improving patient care during certain events. We propose 4 vital elements: create, familiarize, use, and integrate, necessary for the widespread, successful development, and implementation of medical emergency manuals, using the specific example of the perioperative setting. The details of each element are presented, drawing from the medical literature as well as from our combined experience of more than 30 years of observing teams of anesthesiologists managing simulated and real critical events. We emphasize the importance of training clinicians in the use of emergency manuals for education on content, format, and location. Finally, we discuss cultural readiness for change, present a system example of successful integration, and highlight the importance of further research on the implementation of emergency manuals.
Gay, Valerie; Leijdekkers, Peter
, mobile apps can offer a better holistic view of health and fitness data. Data can then be analyzed to offer better and more personalized advice and care.
Garabedian, Laura F; Ross-Degnan, Dennis; Wharam, J Frank
Mobile and smartphone (mHealth) technologies have the potential to improve diabetes care and self-management, but little is known about their effectiveness and how patients, providers, and payers currently interact with them. We conducted a systematic review and found only 20 peer-reviewed articles, published since 2010, with robust evidence about the effectiveness of mHealth interventions for diabetes. The majority of these interventions showed improvement on primary endpoints, such as HbA1c; mHealth technologies that interacted with both patients and providers were more likely to be effective. There was little evidence about persistent use by patients, use by a patient's health care provider, or long-term effectiveness. None of the studies discussed regulatory oversight of mHealth technologies or payer reimbursement for them. No robust studies evaluated the more than 1100 publicly available smartphone apps for diabetes. More research with valid study designs and longer follow-up is needed to evaluate the impact of mHealth technologies for diabetes care and self-management.
Compassionate care is a recent notion. It is based on a shared culture which focuses on promoting the rights of vulnerable people, integral to the quality of professionals' life at work. Tangible and part of day-to-day practice, it requires room to be set aside for discussion and ethical considerations, essential for ensuring the long-lasting creativity of caregivers, at the source of their mobilisation.
Tinoco-Ojanguren, Rolando; Glantz, Namino M; Martinez-Hernandez, Imelda; Ovando-Meza, Ismael
Maternal morbidity and mortality are widespread in Chiapas, Mexico's southernmost state, as in many developing regions. Globally, the utility of three approaches to addressing such problems has been debated: (a) obstetric risk screening (i.e. screening women for risk during pregnancy and channeling those at risk to preventive care); (b) emergency obstetric care (i.e. identifying complications during pregnancy or birth and providing prompt effective treatment); and (c) combined risk screening and emergency care. Unaddressed to date in peer-reviewed journals are the lay perceptions of complications and risk that precede and incite the quest for obstetric care in Mexico. High incidence of maternal mortality in Chiapas, exacerbated by the predominantly rural, highly indigenous, geographically dispersed, and economically marginalized nature of the state's southern Border Region, prompted us to conduct 45 open-ended interviews with a convenience sample of women and their close relative/s, including indigenous and non-indigenous informants in urban and rural areas of four municipalities in this region. Interviews suggest that none of the three approaches is effective in this context, and we detail reasons why each approach has fallen short. Specific obstacles identified include that (1) many women do not access adequate prenatal screening care on a regular basis; (2) emergency obstetric care in this region is severely circumscribed; and (3) lay notions of pregnancy-related risk and complications contrast with official clinical criteria, such that neither clinical nor extra-clinical prenatal monitoring encompasses the entire range of physical and social risk factors and danger signs. Findings reported here center on a rich description of the latter: lay versus clinical criteria for risk of antepartum complication.
Moore, An'Nita; Fisher, Kathleen
Healthcare information technology in US hospitals and ambulatory care centers continues to expand, and nurses are expected to effectively and efficiently utilize this technology. Researchers suggest that clinical information systems have expanded the realm of nursing to integrate technology as an element as important in nursing practice as the patient or population being served. This study sought to explore how medical surgical nurses make use of healthcare information technology in their current clinical practice and to examine the influence of healthcare information technology on nurses' clinical decision making. A total of eight medical surgical nurses participated in the study, four novice and four experienced. A conventional content analysis was utilized that allowed for a thematic interpretation of participant data. Five themes emerged: (1) healthcare information technology as a care coordination partner, (2) healthcare information technology as a change agent in the care delivery environment, (3) healthcare information technology-unable to meet all the needs, of all the people, all the time, (4) curiosity about healthcare information technology-what other bells and whistles exist, and (5) Big Brother is watching. The results of this study indicate that a new care partnership has emerged as the provision of nursing care is no longer supplied by a single practitioner but rather by a paired team, consisting of nurses and technology, working collaboratively in an interdependent relationship to achieve established goals.
Siminski, Peter; Bezzina, Andrew J; Lago, Luise P; Eagar, Kathy
Primary care presentations at emergency departments (EDs) have been the subject of much attention in recent years. This paper is a demographic analysis using administrative data from the Emergency Department Information System (EDIS) for 2005 of such presentations in New South Wales EDs and of self-reported reasons for presentation. Age and sex differences in the reasons given by patients for such presentations are analysed using data from a survey of patients conducted in a subset of EDs in 2004. The rate of "potential primary care" presentations varies greatly with age and to a lesser extent with sex. Almost half (47%) of these presentations are made by people under 25 years of age. Children aged 0-4 years account for 14% of the total. The pattern is distinctly different to the corresponding rate of ED presentations that do not fit the "potential primary care" definition. Reasons given for "potential primary care" presentations are consistent across all age groups, reflecting self-assessed urgency, access to diagnostics and self-assessed complexity. Older "primary care" patients are particularly unlikely to give reasons associated with GP affordability or availability for their presentations. Young adults' responses are consistent with the overall population, and children under the age of five seem most susceptible to availability issues.
Al-Shaqsi, Sultan; Gauld, Robin; McBride, David; Al-Kashmiri, Ammar; Al-Harthy, Abdullah
Disasters occur more frequently. Acute care providers are the first to respond to mass emergencies from the healthcare sector. The preparedness of acute care providers in New Zealand to respond to mass emergencies has not been previously studied. To assess the self-reported training and experience of New Zealand acute care providers to respond to mass emergencies and the factors associated with strong preparedness. A cross-sectional national survey of 1500 acute care providers in New Zealand carried out between 2009 and 2010. The survey assessed experience, training and self-reported preparedness. It also determined the factors associated with strong perceived preparedness. The response rate to this survey was 60.7%. Nurses had a higher response rate than doctors or paramedics. Only 29.2% of acute care providers reported responding to a previous mass emergency event. There were 53.5% of acute care providers who reported having formal training in how to deal with mass emergencies, whereas 58.1% of participants reported that they were aware of their role during a healthcare mass emergency response. The factors associated with self-reported strong preparedness to deal with mass emergencies included: being a paramedic, previous training, participation in a drill, willingness to report to work during an infection or man-made emergency, ability to triage and general awareness of the role during a mass emergency. Almost half of New Zealand acute healthcare providers have no training in dealing with mass emergency events. Training and general awareness of the role during a mass emergency response were the main factors associated with strong self-reported preparedness of acute care providers. The apparent efficacy of training allied to lack of availability means that it should be a national priority. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Jha, Ashish K; DesRoches, Catherine M; Shields, Alexandra E; Miralles, Paola D; Zheng, Jie; Rosenbaum, Sara; Campbell, Eric G
Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic health records (EHRs). Data from a national survey indicate early evidence of an emerging digital divide: U.S. hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap. These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients.
Kessler, David O; Gurwitz, Avrahom; Tsung, James W
Point-of-care ultrasound use is rapidly growing in acute-care settings such as pediatric emergency departments, and new applications are continually being explored. This is especially true in the developing world where the World Health Organization estimates that 75% of people have no access to any imaging or availability of more costly imaging technology may be limited (Essential Health Technologies Strategy 2004-2007). We report a case of intestinal roundworm infection in a 3-year-old boy and describe the ultrasound findings of Ascaris lumbricoides.
The Middle East respiratory syndrome (MERS) is a new emerging respiratory tract infection. This coronavirus infection is firstly reported from the Middle East, and it becomes threat for the global public health at present due to its existence in a remote area such as USA and Korea. The concern on the management of the patients is very important. Since most of the patients can develop severe respiratory illness and critical care management is needed, the issue on critical care for MERS is the topic to be discussed in critical medicine.
Sorensen, Bjarke Lund; Nielsen, Birgitte Bruun; Rasch, Vibeke
The aim of this field study was to analyze the main dynamics and conflicts in attending and providing good quality delivery care in a local Tanzanian rural setting. The women and their relatives did not see the problems of pregnancy and birth in isolation but in relation to multiple other problems...... perspectives and to identify a feasible strategy of action to improve access to timely and effective emergency obstetric care. There seems to be a need for a supplementary analytic model that more clearly has the health system as the central agent responsible for improving maternal health. A modified...
Quesada-González, Daniel; Merkoçi, Arben
In this review we discuss recent developments on the use of mobile phones and similar devices for biosensing applications in which diagnostics and communications are coupled. Owing to the capabilities of mobile phones (their cameras, connectivity, portability, etc.) and to advances in biosensing, the coupling of these two technologies is enabling portable and user-friendly analytical devices. Any user can now perform quick, robust and easy (bio)assays anywhere and at any time. Among the most widely reported of such devices are paper-based platforms. Herein we provide an overview of a broad range of biosensing possibilities, from optical to electrochemical measurements; explore the various reported designs for adapters; and consider future opportunities for this technology in fields such as health diagnostics, safety & security, and environment monitoring.
Full Text Available Hand-held mobile learning technology provides opportunities for clinically relevant self-instructional modules to augment traditional bedside teaching. Using this technology as a teaching tool has not been well studied. We sought to evaluate medical students’ case presentation performance and perception when viewing short, just-in-time mobile learning videos using the iPod touch prior to patient encounters.Twenty-two fourth-year medical students were randomized to receive or not to receive instruction by video, using the iPod Touch, prior to patient encounters. After seeing a patient, they presented the case to their faculty, who completed a standard data collection sheet. Students were surveyed on their perceived confidence and effectiveness after using these videos.Twenty-two students completed a total of 67 patient encounters. There was a statistically significant improvement in presentations when the videos were viewed for the first time (p = 0.032. There was no difference when the presentations were summed for the entire rotation (p = 0.671. The reliable (alpha = 0.97 survey indicated that the videos were a useful teaching tool and gave students more confidence in their presentations.Medical student patient presentations were improved with the use of mobile instructional videos following first time use, suggesting mobile learning videos may be useful in medical student education. If direct bedside teaching is unavailable, just-in-time iPod touch videos can be an alternative instructional strategy to improve first-time patient presentations by medical students.
Tews, Matthew; Brennan, Kimberly; Begaz, Tomer; Treat, Robert
Hand-held mobile learning technology provides opportunities for clinically relevant self-instructional modules to augment traditional bedside teaching. Using this technology as a teaching tool has not been well studied. We sought to evaluate medical students' case presentation performance and perception when viewing short, just-in-time mobile learning videos using the iPod touch prior to patient encounters. Twenty-two fourth-year medical students were randomized to receive or not to receive instruction by video, using the iPod Touch, prior to patient encounters. After seeing a patient, they presented the case to their faculty, who completed a standard data collection sheet. Students were surveyed on their perceived confidence and effectiveness after using these videos. Twenty-two students completed a total of 67 patient encounters. There was a statistically significant improvement in presentations when the videos were viewed for the first time (p=0.032). There was no difference when the presentations were summed for the entire rotation (p=0.671). The reliable (alpha=0.97) survey indicated that the videos were a useful teaching tool and gave students more confidence in their presentations. Medical student patient presentations were improved with the use of mobile instructional videos following first time use, suggesting mobile learning videos may be useful in medical student education. Clinical educators should consider whether, in an instance where live bedside or direct interactive teaching is unavailable, using just-in-time educational videos on a handheld device might be useful as a supplemental instructional strategy.
Heimlicher, Simon; Salamatian, Kavé
MobiHoc 2010 Conference Best Paper Award; International audience; In many practical scenarios, nodes gathering at points of interest yield sizable connected components (clusters), which sometimes comprise the majority of nodes. While recent analysis of mobile networks focused on the process governing node encounters ("contacts"), this model is not particularly suitable for gathering behavior. In this paper, we propose a model of stochastic coalescence (merge) and fragmentation (split) of clus...
Medidi, Sirisha; Golshani, Forouzan
There is an emerging interest in integrating mobile wireless communication with the Internet based on the Ipv6 technology. Many issues introduced by the mobility of users arise when such an integration is attempted. This paper addresses the problem of mobility management, i.e., that of tracking the current IP addresses of mobile terminals and sustaining active IP connections as mobiles move. The paper presents some architectural and mobility management options for integrating wireless access to the Internet. We then present performance results for Mobile IPv4, route optimization and Mobile IPv6.
Full Text Available - Home automation systems use technology to facilitate the lives of people using it, and it is especially useful for assisting the elderly and persons with special needs. These kind of systems have been a popular research subject in last few years. In this work, I present the design and development of a system that provides a life assistant service in a home environment, a smart home-based healthcare system controlled with speech recognition and mobile technology. This includes developing software with speech recognition, speech synthesis, face recognition, controls for Arduino hardware, and a smartphone application for remote controlling the system. With the developed system, elderly and persons with special needs can stay independently in their own home secure and with care facilities. This system is tailored towards the elderly and disabled, but it can also be embedded in any home and used by anybody. It provides healthcare, security, entertainment, and total local and remote control of home.
Hao, Kiyotaka; Takahashi, Jun; Ito, Kenta; Miyata, Satoshi; Sakata, Yasuhiko; Nihei, Taro; Tsuburaya, Ryuji; Shiroto, Takashi; Ito, Yoshitaka; Matsumoto, Yasuharu; Nakayama, Masaharu; Yasuda, Satoshi; Shimokawa, Hiroaki
Although emergency care of acute myocardial infarction (AMI) could theoretically be improved through improved patient delay, this notion remains to be confirmed. Additionally, the influence of large earthquakes on the emergency care of AMI cases remains to be elucidated. The Great East Japan Earthquake (March 11, 2011) has enabled us to address these issues. We analyzed the data from 2008 to 2011 (n=3,937) in the Miyagi AMI Registry Study. In-hospital mortality was significantly lower in 2011 as compared with the previous 3 years (7.3% vs. 10.5%, PEarthquake, associated with shorter elapsing time from onset to admission (120 vs. 240min, PEarthquake, patients with early admission (≤3h from onset) was significantly increased (59.1% vs. 47.0%, PJapan Earthquake compared with ordinary times by the contribution of earlier admission from onset and higher performance rate of primary PCI. (Circ J 2014; 78: 634-643).
Farias, Sílvia Maria de Carvalho; Teixeira, Olga Lúcia de Carvalho; Moreira, Walter; Oliveira, Márcia Aparecida Ferreira de; Pereira, Maria Odete
Nursing professionals working in Emergency Care suffer from the physical symptoms of stress in their everyday activity. The objective of this study was to characterize these symptoms using the Occupational Stress Indicator, a semi-structured instrument. To do this, the authors created open questions that were applied in interviews that were recorded and analyzed. The researchers listed the following physical symptoms: headache, a sensation of fatigue, leg pain, and tachycardia. According to reports form the workers, pain always resulted from emotional stress or appeared after providing emergency care, which suggests the workers find it very difficult to differentiate physical from mental stress. The investigation found that there is a need for measures to follow workers in their working activity. A manual was created, containing basic suggestions to improve the quality of life of the health team.
Goroff, Michael; Reich, Michael R
The challenge of expanding access to treatment and medicine for chronic diseases in emerging markets is both a public health imperative and a commercial opportunity. Cross-sector partnerships-involving a pharmaceutical manufacturer; a local health care provider; and other private, public, and nonprofit entities-could address this challenge. Such partnerships would provide integrated, comprehensive care and medicines for a specific chronic disease, with medicines directly supplied to the partnership at preferential prices by the manufacturer. The model discussed here requires additional specification, using real numbers and specific contexts, to assess its feasibility. Still, we believe that this model has the potential for public health and private business to cooperate in addressing the rising problem of chronic diseases in emerging markets.
Full Text Available Consumers are living longer, creating more pressure on the health system and increasing their requirement for self-care of chronic conditions. Despite rapidly-increasing numbers of mobile health applications ('apps' for consumers' self-care, there is a paucity of research into consumer engagement with electronic self-monitoring. This paper presents a qualitative exploration of how health consumers use apps for health monitoring, their perceived benefits from use of health apps, and suggestions for improvement of health apps.'Health app' was defined as any commercially-available health or fitness app with capacity for self-monitoring. English-speaking consumers aged 18 years and older using any health app for self-monitoring were recruited for interview from the metropolitan area of Perth, Australia. The semi-structured interview guide comprised questions based on the Technology Acceptance Model, Health Information Technology Acceptance Model, and the Mobile Application Rating Scale, and is the only study to do so. These models also facilitated deductive thematic analysis of interview transcripts. Implicit and explicit responses not aligned to these models were analyzed inductively.Twenty-two consumers (15 female, seven male participated, 13 of whom were aged 26-35 years. Eighteen participants reported on apps used on iPhones. Apps were used to monitor diabetes, asthma, depression, celiac disease, blood pressure, chronic migraine, pain management, menstrual cycle irregularity, and fitness. Most were used approximately weekly for several minutes per session, and prior to meeting initial milestones, with significantly decreased usage thereafter. Deductive and inductive thematic analysis reduced the data to four dominant themes: engagement in use of the app; technical functionality of the app; ease of use and design features; and management of consumers' data.The semi-structured interviews provided insight into usage, benefits and challenges of
López-Liria, Remedios; Padilla Góngora, David; Catalán Matamoros, Daniel; Arrebola López, Clara; Garrido Fernández, Pablo; Martínez Cortés, María Del Carmen; Zurita Ortega, Félix
To describe the home care provided by mobile rehabilitation-physiotherapy teams as a response to the needs of the dependent population, the characteristics of their application, and the results they have on patients and their functional independence. A descriptive, cross-sectional study from 2004 to June 2007. Community setting. Mobile rehabilitation-physiotherapy teams from Primary Care in Almeria. A total of 1093 patients were included in the programme. Data were collected on, the state of the patients' health (primary disabling process, reasons for inclusion in the treatment, initial and final functional assessment and Barthel Index); details of physiotherapy treatment, and number of sessions. Of the total sample, the mean age was 78 years and 64.2% were female. The mean waiting time for their assessment was 4 days and there was a wide variety of primary disabling processes described. There was a high percentage of symptoms of severe motor deterioration, pain and muscle weakness. Physiotherapy treatment was given in 88.6%, physiotherapy and occupational therapy in 11.1%, and orthopaedic treatment in 0.3%, of the patients. The mean number of sessions was 12.85. The variation in the Barthel Index after the final therapy was given was, 61.9% for kinesiotherapy, 10.2% combined with electrotherapy, and 14.5% for kinesiotherapy and carer education. Valuable information is provided as regards the characteristics of the geriatric and dependent population, as well as the physiotherapy help they are receiving, and also how the procedure is carried out. Copyright 2009 Elsevier España, S.L. All rights reserved.
Anderson, Kevin; Burford, Oksana; Emmerton, Lynne
Consumers are living longer, creating more pressure on the health system and increasing their requirement for self-care of chronic conditions. Despite rapidly-increasing numbers of mobile health applications ('apps') for consumers' self-care, there is a paucity of research into consumer engagement with electronic self-monitoring. This paper presents a qualitative exploration of how health consumers use apps for health monitoring, their perceived benefits from use of health apps, and suggestions for improvement of health apps. 'Health app' was defined as any commercially-available health or fitness app with capacity for self-monitoring. English-speaking consumers aged 18 years and older using any health app for self-monitoring were recruited for interview from the metropolitan area of Perth, Australia. The semi-structured interview guide comprised questions based on the Technology Acceptance Model, Health Information Technology Acceptance Model, and the Mobile Application Rating Scale, and is the only study to do so. These models also facilitated deductive thematic analysis of interview transcripts. Implicit and explicit responses not aligned to these models were analyzed inductively. Twenty-two consumers (15 female, seven male) participated, 13 of whom were aged 26-35 years. Eighteen participants reported on apps used on iPhones. Apps were used to monitor diabetes, asthma, depression, celiac disease, blood pressure, chronic migraine, pain management, menstrual cycle irregularity, and fitness. Most were used approximately weekly for several minutes per session, and prior to meeting initial milestones, with significantly decreased usage thereafter. Deductive and inductive thematic analysis reduced the data to four dominant themes: engagement in use of the app; technical functionality of the app; ease of use and design features; and management of consumers' data. The semi-structured interviews provided insight into usage, benefits and challenges of health monitoring
Sarah J Hall
Full Text Available The purpose of this study was to investigate the acute physiological stress response to an emergency alarm and mobilization during the day and at night. Sixteen healthy males aged 25 ± 4 years (mean ± SD spent four consecutive days and nights in a sleep laboratory. This research used a within-participants design with repeated measures for time, alarm condition (alarm or control, and trial (day or night. When an alarm sounded, participants were required to mobilize immediately. Saliva samples for cortisol analysis were collected 0 min, 15 min, 30 min, 45 min, 60 min, 90 min, and 120 min after mobilization, and at corresponding times in control conditions. Heart rate was measured continuously throughout the study. Heart rate was higher in the day (F20,442 = 9.140, P < 0.001 and night (F23,459 = 8.356, P < 0.001 alarm conditions compared to the respective control conditions. There was no difference in saliva cortisol between day alarm and day control conditions. Cortisol was higher (F6,183 = 2.450, P < 0.001 following the night alarm and mobilization compared to the night control condition. The magnitude of difference in cortisol between night control and night alarm conditions was greater (F6,174 = 4.071, P < 0.001 than the magnitude of difference between the day control and day alarm conditions. The augmented heart rate response to the day and night alarms supports previous observations in field settings. Variations in the cortisol responses between conditions across the day and night may relate to differences in participants′ ability to interpret the alarm when sleeping versus when awake.
Dogba, Maman; Fournier, Pierre
This paper reports on a systematic literature review exploring the importance of human resources in the quality of emergency obstetric care and thus in the reduction of maternal deaths. A systematic search of two electronic databases (ISI Web of Science and MEDLINE) was conducted, based on the following key words "quality obstetric* care" OR "pregnancy complications OR emergency obstetric* care OR maternal mortality" AND "quality health care OR quality care" AND "developing countries. Relevant papers were analysed according to three customary components of emergency obstetric care: structure, process and results. This review leads to three main conclusions: (1) staff shortages are a major obstacle to providing good quality EmOC; (2) women are often dissatisfied with the care they receive during childbirth; and (3) the technical quality of EmOC has not been adequately studied. The first two conclusions provide lessons to consider when formulating EmOC policies, while the third point is an area where more knowledge is needed.
Full Text Available Abstract Background From 2004 to 2009 there was almost a 12% rise in emergency admissions in England. This can be explained partly by an aging population and other socio-demographic characteristics, but much cannot be explained by these factors. We explored aspects of care, in addition to known demographic characteristics in general practice, that are associated with emergency admissions. Methods A cross-sectional design employing hospital admission data from 76 general practices in Northamptonshire, England for 2006–08, including demographic data, quality and outcomes framework points and GP patient survey outcomes. Results There were statistically significant associations between emergency admissions and age, gender, distance from hospital and proportion classified as white. There was also a statistically significant relationship between emergency admissions and being able to book an appointment with a preferred doctor; this relationship was stronger in less deprived communities. Conclusions Enabling patients to book with a preferred doctor, particularly those in less deprived communities could have an impact on reducing emergency admissions. It is possible that being able to consult a preferred GP gives patient’s confidence to avoid an emergency admission or it facilitates consistent clinical management that helps prevent the need for admission. However the findings only explained some of the variation.
Victoria L. Thornton
Full Text Available Introduction: Patients with sickle cell disease (SCD often seek care in emergency departments (EDs for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1 explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made for patients with SCD, and 2 report the failures of these care processes in each ED. Methods: A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization. Results: Many “high risk” failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies. Conclusion: FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease. [West J Emerg Med. 2014;15(4:446–458.
Mazzocato Pamela; Hvitfeldt Forsberg Helena; von Thiele Schwarz Ulrica
Abstract Objective Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. Methods The study was set in a Swedish university hospital ED during the initial ph...
Sonnenwald, Diane H.; Söderholm, Hanna M.; Manning, James E.
We are investigating the potential of 3D telepresence, or televideo, technology to support collaboration among geographically separated medical personnel in trauma emergency care situations. 3D telepresence technology has the potential to provide richer visual information than current 2D videocon...... and trust between the collaborating physician and paramedic show mixed results. Postinterview data help explain these results. © 2008 ASIS&T Published online 14 August 2008 in Wiley InterScience....
Danielle Soares Silva; Andrea Bernardes; Carmen Silvia Gabriel; Fernanda Ludmilla Rossi Rocha; Graziela Caldana
The objective of this study was to analyze the contributions that research has made to leadership in nursing within the context of emergency care services from 2001 to 2012. This Integrative Literature Review included studies indexed in the following databases: Latin American and Caribbean Health Sciences (LILACS), Medical Literature Analysis and Retrieval Systems Online (MEDLINE) and SCOPUS. Publications were grouped into three categories: “The styles of leadership adopted by the nurses of t...
We report the case of a 45 year-old woman who presented to the Emergency Department (ED) after an acute ankle inversion injury. After history and physical exam suggested a potential fracture, point of care (POC) ultrasound demonstrated a cortical defect of the distal fibula, consistent with fracture. Plain radiography failed to demonstrate a fracture. Later, the fracture was identified as a Weber B distal fibular fracture by stress-view radiography. This case reviews the evaluation of acute a...
Davies, Michael Glyn
During the last 10 years working intensively with families in the context of child-care legal proceedings I am struck by how their lives hinge precariously on the outcome of a professional's assessment of them. This is especially so with ‘experts’ who often act as final arbiters on a family’s viability by providing independent psychological, psychiatric or Social Work assessments. In some cases, during proceedings, a therapeutic issue often not previously known or considered viable can emerge...
Ashtekar, Shyam V; Kulkarni, Madhav B; Ashtekar, Ratna S; Sadavarte, Vaishali S
Background: Institutional birth and Emergency Obstetric Care (EmOC) are important strategies of the National Rural Health Mission (NRHM). While the Community Health Center (CHC) is expected to serve EmOC needs in NRHM, the CHCs are hamstrung due to chronic shortage of specialist doctors. Alternative strategies are therefore needed for ensuring EmOC. Objectives: This study aims to estimate the EmOC needs in a private rural hospital from case records and find some useful predictors for caesaria...
Aronsky, Dominik; Jones, Ian; Lanaghan, Kevin; Slovis, Corey M.
Efficient information management and communication within the emergency department (ED) is essential to providing timely and high-quality patient care. The ED whiteboard (census board) usually serves as an ED’s central access point for operational and patient-related information. This article describes the design, functionality, and experiences with a computerized ED whiteboard, which has the ability to display relevant operational and patient-related information in real time. Embedded functi...
Randive Bharat; Chaturvedi Sarika; Mistry Nerges
Abstract Background Contracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care (EmOC) in rural India. Methods Facility survey was conducted in all secondary and tertiary public health facilities (44) in three heterogeneous districts in Maharashtra state of India. ...
Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M
The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications. © 2015 by the Society for Academic Emergency Medicine.
Full Text Available The application of a cervical collar is a standard procedure in trauma patients in emergency medicine. It is often observed that cervical collars are applied incorrectly, resulting in reduced immobilization of the cervical spine. The objective of this study was to analyze the practical skills of trained professional rescue personnel concerning the application of cervical collars.Within emergency medical conferences, n = 104 voluntary test subjects were asked to apply a cervical collar to a training doll, wherein each step that was performed received an evaluation. Furthermore, personal and occupational data of all study participants were collected using a questionnaire.The test subjects included professional rescue personnel (80.8% and emergency physicians (12.5%. The average occupational experience of all study participants in pre-clinical emergency care was 11.1±8.9 years. Most study participants had already attended a certified training on trauma care (61% and felt "very confident" in handling a cervical collar (84%. 11% applied the cervical collar to the training doll without errors. The most common error consisted of incorrect adjustment of the size of the cervical collar (66%. No association was found between the correct application of the cervical collar and the occupational group of the test subjects (trained rescue personnel vs. emergency physicians or the participation in certified trauma courses.Despite pronounced subjective confidence regarding the application of cervical collars, this study allows the conclusion that there are general deficits in practical skills when cervical collars are applied. A critical assessment of the current training contents on the subject of trauma care must, therefore, be demanded.
Kreinest, Michael; Goller, Sarah; Rauch, Geraldine; Frank, Christian; Gliwitzky, Bernhard; Wölfl, Christoph G.; Matschke, Stefan; Münzberg, Matthias
Background/Objective The application of a cervical collar is a standard procedure in trauma patients in emergency medicine. It is often observed that cervical collars are applied incorrectly, resulting in reduced immobilization of the cervical spine. The objective of this study was to analyze the practical skills of trained professional rescue personnel concerning the application of cervical collars. Material and Methods Within emergency medical conferences, n = 104 voluntary test subjects were asked to apply a cervical collar to a training doll, wherein each step that was performed received an evaluation. Furthermore, personal and occupational data of all study participants were collected using a questionnaire. Results The test subjects included professional rescue personnel (80.8%) and emergency physicians (12.5%). The average occupational experience of all study participants in pre-clinical emergency care was 11.1±8.9 years. Most study participants had already attended a certified training on trauma care (61%) and felt "very confident" in handling a cervical collar (84%). 11% applied the cervical collar to the training doll without errors. The most common error consisted of incorrect adjustment of the size of the cervical collar (66%). No association was found between the correct application of the cervical collar and the occupational group of the test subjects (trained rescue personnel vs. emergency physicians) or the participation in certified trauma courses. Conclusion Despite pronounced subjective confidence regarding the application of cervical collars, this study allows the conclusion that there are general deficits in practical skills when cervical collars are applied. A critical assessment of the current training contents on the subject of trauma care must, therefore, be demanded. PMID:26587650
Amador, Sarah; Goodman, Claire; King, Derek; Machen, Ina; Elmore, Natasha; Mathie, Elspeth; Iliffe, Steve
Older people resident in care homes have a limited life expectancy and approximately two-thirds have limited mental capacity. Despite initiatives to reduce unplanned hospital admissions for this population, little is known about the involvement of emergency services in supporting residents in these settings. This paper reports on a longitudinal study that tracked the involvement of emergency ambulance personnel in the support of older people with dementia, resident in care homes with no on-site nursing providing personal care only. 133 residents with dementia across 6 care homes in the East of England were tracked for a year. The paper examines the frequency and reasons for emergency ambulance call-outs, outcomes and factors associated with emergency ambulance service use. 56% of residents used ambulance services. Less than half (43%) of all call-outs resulted in an unscheduled admission to hospital. In addition to trauma following a following a fall in the home, results suggest that at least a reasonable proportion of ambulance contacts are for ambulatory care sensitive conditions. An emergency ambulance is not likely to be called for older rather than younger residents or for women more than men. Length of residence does not influence use of emergency ambulance services among older people with dementia. Contact with primary care services and admission route into the care home were both significantly associated with emergency ambulance service use. The odds of using emergency ambulance services for residents admitted from a relative's home were 90% lower than the odds of using emergency ambulance services for residents admitted from their own home. Emergency service involvement with this vulnerable population merits further examination. Future research on emergency ambulance service use by older people with dementia in care homes, should account for important contextual factors, namely, presence or absence of on-site nursing, GP involvement, and access to
Gräff, I; Lenkeit, S
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.
Velloso, Isabela; Ceci, Christine; Alves, Marilia
In this paper, we make explicit the changing configurations of power relations that currently characterize the Brazilian Emergency Care System (SAMU) team in Belo Horizonte, Brazil. The SAMU is a recent innovation in Brazilian healthcare service delivery. A qualitative case study methodology was used to explore SAMU's current organizational arrangements, specifically the power relations that have developed and that demonstrate internal team struggles over space and defense of particular occupational interests. The argument advanced in this paper is that these professionals are developing their work in conditions of exposure, that is, they are always being observed by someone, and that such observational exposure provides the conditions whereby everyday emergency care practices are enacted such that practice is shaped by, as well as shapes, particular, yet recognizable power relationships. Data were collected through the observation of the SAMU's work processes and through semi-structured interviews. Research materials were analyzed using discourse analysis. In the emergency care process of work, visibility is actually embedded in the disciplinary context and can thus be analyzed as a technique applied to produce disciplined individuals through the simple mechanisms elaborated by Foucault such as hierarchical surveillance, normalizing judgment, and the examination.
Full Text Available Objectives: This study measures the association between hospital staff’s job strain (JS, mental quality of life (MQL and how they are influenced by the organization models within emergency and critical care units. Material and Methods: This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL. Results: Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employer’s efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score. Conclusions: If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented.
Bellagamba, Gauthier; Gionta, Guillaume; Senergue, Julie; Bèque, Christine; Lehucher-Michel, Marie-Pascale
This study measures the association between hospital staff's job strain (JS), mental quality of life (MQL) and how they are influenced by the organization models within emergency and critical care units. This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL. Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employer's efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score. If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
Full Text Available Aim. The aim of this retrospective study was to determine mean admission time after calls, resuscitation success rate, and determine the rate of medical emergency team (MET calls of clinics in hospital by assessing the incoming calls to MET at intensive care unit. Methods. This study was conducted by collecting emergency call forms of 147 patients. The data including age, gender, medical diagnosis, the name of the caller department, cause of call, occurrence time, call time, attending time, medical care termination time and the outcomes were extracted from the forms or patient files. Event declaration time was accepted as minute time difference between occurrence time and call time. Duration of admission was accepted as minute time difference between call times and attending time. Duration of resuscitation was accepted as minute time difference between attending time and medical care termination time. Results. Mean event declaration time was 3.3 ± 3.0 minutes. Mean duration of admission was 3.7 ± 1.6 minutes. Mean duration of resuscitation was 20.5 ± 12.7 minutes. The resuscitation of 84 patients (63.6% was successful while 48 patients (36.4% died at the end of resuscitation. It was found that the patients with a result of successful resuscitation were significantly younger and their duration of resuscitation was significantly shorter. Conclusion. We indicate that MET system is an essential part of in-hospital emergency medical care system. We suggest that a blue code call system should be established by intensive care unit members and announced to all hospital staff.
Prgomet, Mirela; Georgiou, Andrew; Westbrook, Johanna I
The substantial growth in mobile handheld technologies has heralded the opportunity to provide physicians with access to information, resources, and people at the right time and place. But is this technology delivering the benefits to workflow and patient care promised by increased mobility? The authors conducted a systematic review to examine evidence regarding the impact of mobile handheld technology on hospital physicians' work practices and patient care, focusing on quantification of the espoused virtues of mobile technologies. The authors identified thirteen studies that demonstrated the ability of personal digital assistants (PDAs) to positively impact on areas of rapid response, error prevention, and data management and accessibility. The use of PDAs demonstrates the greatest benefits in contexts where time is a critical factor and a rapid response crucial. However, the extent to which these devices improved outcomes and workflow efficiencies because of their mobility was largely absent from the literature. The paucity of evidence calls for much needed future research that asks explicit questions about the impact the mobility of devices has on work practices and outcomes.
Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L.; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael; Hastings, S. Nicole
Background Older adults in the U.S. receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization has not been adequately studied in this population. Objectives The goal of this study were to examine the relationships between health care use before and after an ED visit among older adults. Methods This retrospective cohort study examined health care use among 308 patients ≥ 65 years old discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician (PCP), specialist, ED and hospital) and risk of return ED visits. Results Older ED patients in this study had visited other types of providers frequently in the previous year (median number of primary care physician (PCP) and specialist visits = 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits 7.0 vs 4.0, p<.001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (HR 2.20, 95% CI 1.15–4.21), in models adjusted for demographics and health status. Conclusion Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. PMID:21216555
Full Text Available HIV counseling and testing may serve as an entry point for non-communicable disease screening.To determine the yield of newly-diagnosed HIV, tuberculosis (TB symptoms, diabetes and hypertension, and to assess CD4 count testing, linkage to care as well as correlates of linkage and barriers to care from a mobile testing unit.A mobile unit provided screening for HIV, TB symptoms, diabetes and hypertension in Cape Town, South Africa between March 2010 and September 2011. The yield of newly-diagnosed cases of these conditions was measured and clients were followed-up between January and November 2011 to assess linkage. Linkage to care was defined as accessing care within one, three or six months post-HIV diagnosis (dependent on CD4 count and one month post-diagnosis for other conditions. Clinical and socio-demographic correlates of linkage to care were evaluated using Poisson regression and barriers to care were determined.Of 9,806 clients screened, the yield of new diagnoses was: HIV (5.5%, TB suspects (10.1%, diabetes (0.8% and hypertension (58.1%. Linkage to care for HIV-infected clients, TB suspects, diabetics and hypertensives was: 51.3%, 56.7%, 74.1% and 50.0%. Only disclosure of HIV-positive status to family members or partners (RR=2.6, 95% CI: 1.04-6.3, p=0.04 was independently associated with linkage to HIV care. The main barrier to care reported by all groups was lack of time to access a clinic.Screening for HIV, TB symptoms and hypertension at mobile units in South Africa has a high yield but inadequate linkage. After-hours and weekend clinics may overcome a major barrier to accessing care.
Luciana Mendes Araujo Borem
Full Text Available Objective To evaluate the knowledge about diagnostic imaging methods among primary care and medical emergency physicians. Materials and Methods Study developed with 119 primary care and medical emergency physicians in Montes Claros, MG, Brazil, by means of a structured questionnaire about general knowledge and indications of imaging methods in common clinical settings. A rate of correct responses corresponding to ≥ 80% was considered as satisfactory. The Poisson regression (PR model was utilized in the data analysis. Results Among the 81 individuals who responded the questionnaire, 65% (n = 53 demonstrated to have satisfactory general knowledge and 44% (n = 36 gave correct responses regarding indications of imaging methods. Respectively, 65% (n = 53 and 51% (n = 41 of the respondents consider that radiography and computed tomography do not use ionizing radiation. The prevalence of a satisfactory general knowledge about imaging methods was associated with medical residency in the respondents' work field (PR = 4.55; IC 95%: 1.18-16.67; p-value: 0.03, while the prevalence of correct responses regarding indication of imaging methods was associated with the professional practice in primary health care (PR = 1.79; IC 95%: 1.16-2.70; p-value: 0.01. Conclusion Major deficiencies were observed as regards the knowledge about imaging methods among physicians, with better results obtained by those involved in primary health care and by residents.
Pourmand, Ali; Sikka, Neal
Objective: To investigate the impact of online health information (OHI) and patients’ decisions to seek emergency department (ED) care. Methods: We conducted a survey of a convenience sample of 489 ambulatory patients at an academic ED between February and September 2006. The primary measure was the prevalence of Internet use, and the secondary outcome was the impact of OHI on patients’ decision to seek ED care. Results: The study group comprised 175 (38%) males. Mean age was 33 years old; 222 (45.4%) patients were white, 189 (38.7%) patients were African American, and 33 (6.7%) were Hispanic. 92.6% had Internet access, and 94.5% used email; 58.7% reported that OHI was easy to locate, while 49.7% felt that it was also easy to understand. Of the subjects who had Internet access, 15.1% (1.6, 95% CI 1.3–2.0) stated that they had changed their decision to seek care in the ED. Conclusion: This study suggests that Internet access in an urban adult ED population may mirror reported Internet use among American adults. Many ED patients report that they are able to access and understand online health information, as well as use it to make decisions about seeking emergency care. PMID:21691522
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.
Hameed, S. Morad; Brenneman, Frederick D.; Ball, Chad G.; Pagliarello, Joe; Razek, Tarek; Parry, Neil; Widder, Sandy; Minor, Sam; Buczkowski, Andrzej; MacPherson, Cailan; Johner, Amanda; Jenkin, Dan; Wood, Leanne; McLoughlin, Karen; Anderson, Ian; Davey, Doug; Zabolotny, Brent; Saadia, Roger; Bracken, John; Nathens, Avery; Ahmed, Najma; Panton, Ormond; Warnock, Garth L.
Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery. The ACS model also offers enhanced opportunities for surgical education for students, residents and practicing surgeons, and it will provide avenues to strengthen clinical and academic bonds between the community and academic surgical centres. In the near future, cooperation of ACS services from community and academic hospitals across the country will lead to the formation of systems of acute surgical care whose development will be informed by rigorous data collection and research and evidence-based quality-improvement initiatives. In an era of increasing subspecialization, ACS is a strong unifying force in general surgery and a platform for collective advocacy for an important patient population. PMID:20334738
Otolorin, Emmanuel; Gomez, Patricia; Currie, Sheena; Thapa, Kusum; Dao, Blami
Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings.
Thakur, Gautam S; Helmy, Ahmed
School and College campuses face a perceived threat of violent crimes and require a realistic plan against unpredictable emergencies and disasters. Existing emergency systems (e.g., 911, campus-wide alerts) are quite useful, but provide delayed response (often tens of minutes) and do not utilize proximity or locality. There is a need to augment such systems with proximity-based systems for more immediate response to attempt to prevent and deter crime. In this paper we propose SHIELD, an on-campus emergency rescue and alert management service. It is a fully distributed infrastructure-less platform based on proximity-enabled trust and cooperation. It relies on localized responses, sent using Bluetooth and/or WiFi on the fly to achieve minimal response time and maximal availability thereby augmenting the traditional notion of emergency services. Analysis of campus crime statistics and WLAN traces surprisingly show a strong positive correlation (over 55%) between on-campus crime statistics and spatio-temporal den...
Erman-Tüysüz, A.; Havinga, Paul J.M.
In wireless sensor networks (WSNs), data dissemination is generally performed from sensor nodes to a static sink. If the data under consideration is an emergency message such as a fire alarm, it must be transmitted as fast and reliably as possible towards the sink of WSN. In such mission critical